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PubMed2006

The "Lund Concept" for the treatment of severe head trauma--physiological principles and clinical application.

The Lund Concept is an approach to the treatment of severe brain trauma that is mainly based on hypotheses originating from basic physiological principles regarding brain volume and cerebral perfusion regulation. Its main attributes have found support in experimental and clinical studies. This review explains the principles of the Lund Concept and is intended to serve as the current guide for its clinical application. The therapy has two main goals: (1) to reduce or prevent an increase in ICP (ICP-targeted goal) and (2) to improve perfusion and oxygenation around contusions (perfusion-targeted goal). The Lund therapy considers the consequences of a disrupted blood-brain barrier for development of brain oedema and the specific consequences of a rigid dura/cranium for general cerebral haemodynamics. It calls attention to the importance of improving perfusion and oxygenation of the injured areas of the brain. This is achieved by normal blood oxygenation, by maintaining normovolaemia with normal haematocrit and plasma protein concentrations, and by antagonizing vasoconstriction through reduction of catecholamine concentration in plasma and sympathetic discharge (minimizing stress and by refraining from vasoconstrictors and active cooling). The therapeutic measures mean normalization of all essential haemodynamic parameters (blood pressure, plasma oncotic pressure, plasma and erythrocyte volumes, PaO(2), PaCO(2)) the use of enteral nutrition, and avoidance of overnutrition. To date, clinical outcome studies using the Lund Concept have shown favourable results.

Blood Volume↗
PubMed2003

Positron emission tomography microdosing: a new concept with application in tracer and early clinical drug development.

The realisation that new chemical entities under development as drug candidates fail in three of four cases in clinical trials, together with increased costs and increased demands of reducing preclinical animal experiments, have promoted concepts for improvement of early screening procedures in humans. Positron emission tomography (PET) is a non-invasive imaging technology, which makes it possible to determine drug distribution and concentration in vivo in man with the drug labelled with a positron-emitting radionuclide that does not change the biochemical properties. Recently, developments in the field of rapid synthesis of organic compounds labelled with positron-emitting radionuclides have allowed a substantial number of new drug candidates to be labelled and potentially used as probes in PET studies. Together, these factors led to the logical conclusion that early PET studies, performed with very low drug doses-PET-microdosing-could be included in the drug development process as one means for selection or rejection of compounds based on performance in vivo in man. Another important option of PET, to evaluate drug interaction with a target, utilising a PET tracer specific for this target, necessitates a more rapid development of such PET methodology and validations in humans. Since only very low amounts of drugs are used in PET-microdosing studies, the safety requirements should be reduced relative to the safety requirements needed for therapeutic doses. In the following, a methodological scrutinising of the concept is presented. A complete pre-clinical package including limited toxicity assessment is proposed as a base for the regulatory framework of the PET-microdosing concept.

Animals↗
PubMed2006

A modular concept of HLA for comprehensive peptide binding prediction.

A variety of algorithms have been successful in predicting human leukocyte antigen (HLA)-peptide binding for HLA variants for which plentiful experimental binding data exist. Although predicting binding for only the most common HLA variants may provide sufficient population coverage for vaccine design, successful prediction for as many HLA variants as possible is necessary to understand the immune response in transplantation and immunotherapy. However, the high cost of obtaining peptide binding data limits the acquisition of binding data. Therefore, a prediction algorithm, which applies the binding information from well-studied HLA variants to HLA variants, for which no peptide data exist, is necessary. To this end, a modular concept of class I HLA-peptide binding prediction was developed. Accurate predictions were made for several alleles without using experimental peptide binding data specific to those alleles. We include a comparison of module-based prediction and supertype-based prediction. The modular concept increased the number of predictable alleles from 15 to 75 of HLA-A and 12 to 36 of HLA-B proteins. Under the modular concept, binding data of certain HLA alleles can make prediction possible for numerous additional alleles. We report here a ranking of HLA alleles, which have been identified to be the most informative. Modular peptide binding prediction is freely available to researchers on the web at http://www.peptidecheck.org .

Alleles↗
PubMed2006

Applying integrated urban water management concepts: a review of Australian experience.

This article explores recent Australian experiences in the application of the concept of integrated urban water management (IUWM) to land development sites through the review of 15 case studies. It discusses IUWM's emergence and comments on the success or otherwise of Australian experience in its application. The understanding of IUWM is maturing within the Australian water industry, an occurrence that has been facilitated by demonstration sites such as those reviewed. Successes include the translation of IUWM concepts into well-functioning operational urban developments, significant reductions in the impact of the urban developments on the total water cycle, and the increasing acceptance of the concept within the water and land development industries. However, there is still room for greater integration of the water supply, stormwater, and wastewater components of the urban water cycle, improved dissemination of knowledge, enhancement of skills in both public and private organisations, and monitoring the performance of systems and technologies.

Australia↗
PubMed2006

New coil concept for endoluminal MR imaging: initial results in staging of gastric carcinoma in correlation with histopathology.

Our aim was to conduct a prospective study to evaluate staging accuracy of a new coil concept for endoluminal magnetic resonance imaging (MRI) on ex vivo gastric carcinomas. Twenty-eight consecutive patients referred to surgery with a clinically proven primary gastric malignancy were included. Surgical specimens were examined with a foldable and self-expanding loop coil (8-cm diameter) at 1.5 Tesla immediately after total gastrectomy. T1- and T2-weighted and opposed-phase sequences (axial, frontal sections; 3- to 4-mm slice thickness) were acquired. Investigators blinded to any patient information analyzed signal intensity of normal gastric wall, gastric tumor, and lymph nodes. Findings were compared with histopathological staging. On surgical specimens, 2-5 gastric wall layers could be visualized. All gastric tumors (26 carcinomas, two lymphomas) were identified on endoluminal MR data (100%). Overall accuracy for T staging was 75% (18/24); sensitivity to detect serosal involvement was 80% and specificity 89%. N staging correlated in 58% (14/24) with histopathology (N+ versus N-). The endoluminal coil concept is feasible and applicable for an ex vivo setting. Endoluminal MR data provided sufficient detail for gastric wall layer differentiation, and therefore, identification of T stages in gastric carcinoma is possible. Further investigations in in vivo settings should explore the potential of our coil concept for endoluminal MR imaging.

Adenocarcinoma↗
PubMed2006

Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy.

The DaVinci Robot (Intuitive Surgical, Sunnyvale California) with its magnified 3-D vision and multi-jointed wristed instruments enabled us to perform radical prostatectomy with consideration for the pelvic anatomy. In the present paper, we review the pelvic autonomic neuroanatomy with respect to robotic prostatectomy and demonstrate the procedures and critical points of nerve-sparing robotic radical prostatectomy based on novel anatomic concepts. Microscopic and macroscopic data were acquired from 30 fresh and 25 fixed male cadavers. A video study of 205 surgeries was performed for establishing the anatomy relevant to robotic prostatectomy. From a practical standpoint, we could group the relevant neural tissue into three broad zones: (1) proximal neurovascular plate (PNP), (2) predominant neurovascular bundles (PNB), (3) accessory distal neural pathways (ANP). Autonomic ganglion cells existed widely not only in nerve components but also along the viscera. The critical areas of nerve sparing surgery were the distal end of PNP, the entire PNB, and the circumference of the apex. Interindividual differences of cell counts were evident in all sites. Based on these concepts, we established the Athermal Robotic Technique (ART) for nerve sparing prostatectomy. Surgical and oncological outcomes were not mature but feasible. These tri-zonal and ganglion cell concepts may be of benefit to new surgeons undertaking nerve-sparing robotic radical prostatectomy.

Autonomic Pathways↗
PubMed2005

Bipolar radiofrequency ablation of liver metastases during laparotomy. First clinical experiences with a new multipolar ablation concept.

BACKGROUND AND OBJECTIVE: Radiofrequency ablation (RFA) is a promising method for local treatment of liver malignancies. Currently available systems for radiofrequency ablation use monopolar current, which carries the risk of uncontrolled electrical current paths, collateral damages and limited effectiveness. To overcome this problem, we used a newly developed internally cooled bipolar application system in patients with irresectable liver metastases undergoing laparotomy. The aim of this study was to clinically evaluate the safety, feasibility and effectiveness of this new system with a novel multipolar application concept. PATIENTS AND METHODS: Patients with a maximum of five liver metastases having a maximum diameter of 5 cm underwent laparotomy and abdominal exploration to control resectability. In cases of irresectability, RFA with the newly developed bipolar application system was performed. Treatment was carried out under ultrasound guidance. Depending on tumour size, shape and location, up to three applicators were simultaneously inserted in or closely around the tumour, never exceeding a maximum probe distance of 3 cm. In the multipolar ablation concept, the current runs alternating between all possible pairs of consecutively activated electrodes with up to 15 possible electrode combinations. Post-operative follow-up was evaluated by CT or MRI controls 24-48 h after RFA and every 3 months. RESULTS: In a total of six patients (four male, two female; 61-68 years), ten metastases (1.0-5.5 cm) were treated with a total of 14 RF applications. In four metastases three probes were used, and in another four and two metastases, two and one probes were used, respectively. During a mean ablation time of 18.8 min (10-31), a mean energy of 48.8 kJ (12-116) for each metastases was applied. No procedure-related complications occurred. The patients were released from the hospital between 7 and 12 days post-intervention (median 9 days). The post-interventional control showed complete tumour ablation in all cases. CONCLUSIONS: Bipolar radiofrequency using the novel multipolar ablation concept permits a safe and effective therapy for the induction of large volumes of coagulation in the local treatment of liver metastases.

Adenocarcinoma↗
PubMed2002

[Why controlled studies may lead to misleading and unconfirmed therapeutic concepts--a critical view of evidence-based medicine].

The concept of evidence-based medicine has gathered widespread support during recent years. While this concept has clear merits in compiling and qualifying up-to-date information for clinical decisions, it should be viewed with caution as the sole valid knowledge source for clinical decision-making. The limitations of such an approach are particularly striking when reviewing two key developments in modern cardiology, fibrinolysis and acute percutaneous intervention in acute myocardial infarction. In both cases, early studies and meta-analyses showed no benefit for these therapeutic interventions over earlier treatment. Only after further refinement (mainly in dosage, time window, concomitant heparin therapy for fibrinolysis, and the introduction of stents and IIb/IIIa inhibitors for acute intervention) did these therapies become universally acknowledged. It is therefore crucial to understand that especially for physicians actively participating in the development of a clinical field clinical decisions cannot be exclusively based on published evidence. Another important problem to consider is the time gap between the emergence of new therapies and the publication and reception by the medical audience, in particular in rapidly evolving fields as cardiology. While it is clear that clinical decision-making must be backed by solid knowledge of the published evidence, in particular the specialist involved in-depth in the field may use not yet proven therapeutic concepts and measures to the patient's advantage.

Angioplasty, Balloon, Coronary↗
PubMed2006

Metabolic coronary flow regulation--current concepts.

The concept of metabolic coronary flow control provides a rationale for the close relationship of coronary flow and myocardial metabolic rate of oxygen. The concept is based on the presence of an oxygen (metabolic) sensor coupled functionally to effector mechanisms, which control vascular tone. Four modes of metabolic control models have been proposed. 1) An oxygen sensor located in the wall of coronary vessels coupling to smooth muscle tension. Endothelial prostaglandin production may support this concept. 2) An oxygen sensing mechanism located in the myocardium and changing metabolism in response to changes of local pO(2). Adenosine is a metabolite produced at an accelerated rate when the supply-to-demand relationship for oxygen falls. 3) Sensing of oxygen turnover may be achieved by carbon dioxide production and, potentially, by mitochondrial production of reactive oxygen species. 4) The red blood cell might serve as an oxygen sensor in response to changes of haemoglobin oxygenation. A potential link to vessel relaxation may be red cell ATP release. A large body of experimental evidence supports the notion that K(ATP) channels play a significant role causing smooth muscle hyper-polarization. However, additional yet unknown effector mechanisms must exist, because block of K(ATP) channels does not lead to deterioration of coronary flow control under conditions of exercise. Thus, although several lines of evidence show that metabolic flow regulation is effective during hypoxic conditions,mechanisms mediating normoxic metabolic flow control still await further clarification.

Adenosine↗
PubMed2006

Glial degeneration and reactive gliosis in alpha-synucleinopathies: the emerging concept of primary gliodegeneration.

The concept of gliodegenerative diseases has not been widely established although there is accumulating evidence that glial cells may represent a primary target of degenerative disease processes. In the central nervous system (CNS), examples that provide a "proof of concept" include at least one alpha-synucleinopathy, multiple system atrophy (MSA), but this disease is conventionally discussed under the heading of "neurodegeneration". Additional evidence in support of primary glial affection has been reported in neurodegenerative disorders such as Parkinson's disease, Alzheimer's disease and transmissible spongiform encephalopathies. Based on biochemical, genetic and transcriptomic studies it is also becoming increasingly clear that the molecular changes measured in whole tissue extracts, e.g. obtained from Parkinson's disease brain, are not based on a purely neuronal contribution. This important evidence has been missed in cell culture or laser capture work focusing on the neuronal cell population. Studies of animal and in vitro models of disease pathogenesis additionally suggest glial accountability for some CNS degenerative processes. This review provides a critical analysis of the evidence available to date in support of the concept of gliodegeneration, which we propose to represent an essential although largely disregarded component of the spectrum of classical "neurodegeneration". Examples from the spectrum of alpha-synucleinopathies are presented.

Animals↗
PubMed2002

Lung cancer during pregnancy involving the products of conception and a review of the literature.

Approximately 1 per 1,000-1,500 pregnancies is complicated by maternal malignancies. Metastatic involvement of the products of conception is a rare event. There have been 62 cases of placental and/or fetal metastatic involvement originating from maternal cancer reported since 1866. Only 14 cases of lung cancer associated with pregnancy have been documented. We report on an additional case involving the products of conception, and the management of lung cancer in pregnancy is discussed based on an extensive review of the literature. The case of a 29-year-old woman presenting during the 31(st) week of gestation with metastatic non small-cell lung cancer to the placenta, liver and bone is described. The mother was delivered by caesarean section of a healthy baby girl during her 32(nd) week of gestation. The mother's postpartum course was complicated by disseminated pulmonary and bony metastases and malignant pericardial and pleural effusions causing the patient's death within 1 month after lung cancer was diagnosed. Malignancies spreading to the products of conception are melanoma (32%), leukemia and lymphomas (15%), breast cancer (13%), lung cancer (11%), sarcoma (8%), gastric cancer (3%) and gynecologic cancers (3%), reflecting malignancies with a high incidence in women of reproductive age. All lung cancers were diagnosed with widely disseminated, inoperable neoplastic disease, including distant metastases in 46%. The mean age was 35.1 years (range, 30-45 years) and 60% of patients had a history of tobacco use. The mean survival was 7.5 months (range: 1-42 months). Placenta involvement was present in 7 out of 15 cases. Fetal involvement was reported in only one case. Because there is no evidence of a direct adverse effect of pregnancy on the course of lung cancer, we recommend delivery at a time when enough fetal maturity can be assumed and the subsequent treatment of the mother.

Adult↗
PubMed2007

Ericksonian hypnosis in tinnitus therapy: effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus-Questionnaire and Health Survey SF-36.

For the first time, the therapeutic effects on subacute and chronic tinnitus of an inpatient multimodal treatment concept based on principles of Ericksonian hypnosis (EH) were examined by standardized criteria of the Tinnitus Questionnaire (TQ) and Health Survey (SF-36) within a controlled prospective, longitudinal study. A total of 393 patients were treated within an inpatient closed-group 28-day-setting based on a resource-oriented, hypnotherapeutic concept. The severity of tinnitus was assessed by TQ at times of admission, discharge and also at a 6- and 12-month follow-up. Health-related quality of life was evaluated before and after therapy using the SF-36. After therapy, a decrease in TQ score was seen in 90.5% of the patients with subacute tinnitus and in 88,3% of those with chronic tinnitus. Assessment of the TQ score at the end of therapy revealed highly significant improvements of 15.9/14.1 points in mean. Effect sizes in the treatment groups (0.94/0.80) were superior to those in the waiting-list controls (0.14/0.23). The TQ score remained stable in the follow-up controls. Significant improvement in health-related quality of life has been observed within the treatment groups depending on initial level of tinnitus serverity I-IV according to TQ. Using a multimodal treatment concept with emphasis on resource-activating approaches of EH the annoyance of tinnitus can be significantly reduced while health-related quality of life is enhanced within a comparatively short treatment period of 28 days.

Adolescent↗
PubMed2000

Follow-up in colorectal cancer: cost-effectiveness analysis of established and novel concepts.

BACKGROUND: Follow-up programs in colorectal cancer have been under question recently due to their low efficacy. Some meta-analyses found a survival benefit and four randomized studies suggested the opposite. Therefore, this paper analyzes existing and proposed follow-up programs for costs and efficacy. METHODS: One thousand and fifty-four colorectal cancer patients intensively followed-up in Ulm (endoscopy, chest radiography, abdominal ultrasound, computed tomography (CT) pelvis) were prospectively evaluated for recurrence, salvage surgery rate, survival and costs. Costs were compared among existing and proposed international follow-up programs retrieved by a MedLine search. RESULTS: A total of 350/1,054 colorectal cancer patients (33.2%) relapsed asymptomatically, as detected by follow-up. 56/350 (local 47%, distant 53%) recurrences were resectable (16%), 21/350 patients survived (6%). The efficacy of follow-up was 21/1,054 patients (2%). Costs were, per patient, 2,220 euros (colon) or 4,851 euros (rectum). Costs in five randomized studies varied between 616 euros for minimal and 5,049 euros for intensive follow-up. Four proposed follow-up concepts include risk-adaption, which claim to reduce costs by 50-60% and range between 889 (colorectal) and 5,910 (high-risk, rectum) euros. The recommended German follow-up guideline costs 610 euros (low-risk, colorectal), 1,120 euros (high-risk, colon) or 2,252 euros (high-risk, rectum). CONCLUSION: Follow-up concepts for colorectal cancer should aim at the identification of curable patients with recurrence. Evidence-based concepts, including life quality tests, remain to be defined, but currently abdominal ultrasound, endoscopy and carcino-embryonic antigen (CEA) determination at 6-month intervals for 2 years and annual intervals for 3 years seem to identify this patient sub-group.

Carcinoembryonic Antigen↗
PubMed1999

Layered murein revisited: a fundamentally new concept of bacterial cell wall structure, biogenesis and function.

The classical concept of the architecture of microbial murein assumes cross-linked glycan chains to be arranged in horizontal layers outside of the plasma membrane. It necessitates elaborate hypotheses to explain processes such as the biosynthesis, growth and division of the bacterial cell wall and provides no explanation for transenvelope macromolecular transport. Moreover, this model is difficult to reconcile with a number of basic chemical and electron microscopical data. According to a fundamentally distinct concept which is presented here, glycan strands in the microbial wall run perpendicular to the plasma membrane, each strand being cross-linked by peptide bridges with four other strands. This arrangement allows the formation of a structured matrix pierced with ordered ionophoric channels potentially harboring either lipoprotein or teichoic (lipoteichoic) acid molecules in Gram-negative and Gram-positive bacteria, respectively. New wall structures are synthesized in toto emerging from the cytoplasmic membrane as a condensed gel-like network below the old wall without being covalently attached to it, expanding due to inherent elasticity as the old wall is lyzed. This model reflects published genetic and biochemical data and offers a simple explanation for peptidoglycan biogenesis. As the biosynthesis is terminated by enzymic cleavage of all glycan strands, murein is irreversibly released from the membrane. The murein detachment prepares the membrane for de novo assembly of both the new wall synthesis machinery and the multicomponent factory for protein, DNA and phospholipid transfer. Being assembled in parallel, both new murein and the traffic complexes grow from the membrane together. This concept eliminates the necessity for the traffic complexes to penetrate intact murein. In the process of simultaneous assembly, the expanding murein functions as a lifting platform driven by the force of turgor pressure, transporting macromolecules through the perisplasmic space.

Cell Wall↗
PubMed2001

Canalisation in human growth: a widely accepted concept reconsidered.

According to the concept of canalisation, infants and children stay within one or two growth channels, and therefore, any crossing of height centiles always warrants further evaluation. In view of evidence against this concept we re-investigated the variability of individual growth in the First Zürich Longitudinal Growth Study. The investigation is based on height measurements of 232 children (112 females, 120 males) measured at annual intervals during childhood and half-yearly during adolescence. Height data were transformed into height standard deviation scores (SDS) and canalisation defined by the width of an individual's growth channel, i.e., by the differences between maximum and minimum height SDS, in the individual series of measurements. Many subjects of the First Zürich Longitudinal Growth Study crossed numerous centiles with patterns that often seemed to show characteristic features. For approximately two thirds of the subjects, the SDS channel during the whole growth process covers more than one SDS. In childhood, between the age of two and age of minimal height velocity, only about one fourth of the subjects have an SDS channel below 0.5, indicating acceptable canalisation. During childhood, growth in boys appeared slightly more canalised than in girls (P = 0.02). Conclusion. The present investigation does not support the concept of strict canalisation of individual growth. We suggest to consider crossing of centiles a normal event in child development, though in a clinical setting crossing centiles should still be taken seriously, at least at first until a medical cause for this has been excluded.

Adolescent↗
PubMed2004

The peak bone mass concept: is it still relevant?

The peak bone mass concept implies that optimal skeletal development during childhood and adolescence will prevent fractures in late adulthood. This concept is based on the observation that areal bone density increases with growth during childhood, is highest around 20 years of age and declines thereafter. However, it is now clear that strong bones in the youngster do not necessarily lead to a fracture-free old age. In the recent bone densitometric literature, the terms bone mass and bone density are typically used synonymously. In physics, density has been defined as the mass of a body divided by its volume. In clinical practice and science, "bone density" usually has a different meaning-the degree to which a radiation beam is attenuated by a bone, as judged from a two-dimensional projection image (areal bone density). The attenuation of a radiation beam does not only depend on physical density, but also on bone size. A small bone therefore has a lower areal bone density than a larger bone, even if the physical density is the same. Consequently, a low areal bone density value can simply reflect the small size of an otherwise normal bone. At present, bone mass analysis is very useful for epidemiological studies on factors that may have an impact on bone development. There is an ongoing discussion about whether the World Health Organization (WHO) definition of osteoporosis is over-simplistic and requires upgrading to include indices representing the distribution of bone and mineral (bone strength indices). The following suggestions and recommendations outline a new concept: bone mass should not be related to age. There is now more and more evidence that bone mass should be related to bone size or muscle function. Thus analyzed, there is no such entity as a "peak bone mass". Many studies are currently under way to evaluate whether these novel approaches increase sensitivity and specificity of fracture prediction in an individual. Furthermore, the focus of many bone researchers is shifting away from bone mass to bone geometry or bone strength. Bone mass is one surrogate marker of bone strength. Widely available techniques for measurement of bone mass, such as dual-energy X-ray absorptiometry, radiogrammetry, and computed tomography, can also be used to measure variables of bone geometry such as cortical thickness, cortical area, and moment of inertia.

Adolescent↗
PubMed2003

[Manual medicine in chronic pain -- evaluation of an inpatient medical concept].

OBJECTIVE: The influence of an inpatient manual medical concept for patients suffering from chronic muscular skeletal pain syndromes on the quality of life and on target parameters of a biopsychological and social concept of pain (VAS, PDI, CES-D) was investigated. Furthermore, it was looked at the predictability of treatment outcome according to the Mainz Pain Stages. METHOD: 211 patients of the Clinic for Manual Medicine were included in the study. Selected parameters such as pain intensity (VAS), pain distribution, disability in daily life (PDI), quality of life (SF-36) and grade of depression (CES-D) were evaluated on admission, discharge and 6 weeks after treatment. The patients were divided into groups according to the Mainz Pain Stages and compared to patients on the hospital waiting list (control group). RESULTS: The patients were well distributed within the Mainz Pain Stages. It was shown that the manual therapy concept influenced different parameters dependent on the Main Pain Stages.For Stage 1 and 2 the deduction in pain intensity was greatest, while for stage 3 the reduction in disability (PDI) was the most significant outcome. CONCLUSION: The therapeutic target should depend on the chronicity of the pain syndrome. Early interdisciplinary intervention, especially after increase in pain distribution is necessary to minimize chronicity. The Mainz Pain Stages are useful for the prediction of treatment outcome but still need further investigation for this group of patients.

Activities of Daily Living↗
PubMed2003

A new concept for the etiopathogenesis of the thoracospinal deformity of idiopathic scoliosis: summary of an electronic focus group debate of the IBSE.

There is no generally accepted scientific theory for the etiology of idiopathic scoliosis, and treatment is pragmatic and unrelated to such knowledge. As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate of extant knowledge on important topics. This has been designated as an on-line Delphi discussion, and has proven very successful. The text for this EFG was written by Professor Sevastik and drawn from the extensive research carried out by himself and his co-workers. The thoracospinal concept of etiopathogenesis applies only to girls with right thoracic adolescent idiopathic scoliosis (Rcx-T-AIS-F). According to this concept, increased longitudinal growth of the left periapical ribs triggers the thoracic curve simultaneously in the three cardinal planes. The concept does not deal with factors involved in curve progression. Sevastik advocates mini-invasive operations on the ribs as a treatment for early progressive thoracic curves. Areas of controversy include whether or not there is overgrowth of the left periapical ribs in Rcx-T-AIS-F, and the question of whether there should be a clinical trial of mini-invasive operations on the ribs.

Adolescent↗

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