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Omanik P, Sesia SB, Kozlikova K, Schmidtova V, Funakova M, Haecker FM. Bracing of Pectus Carinatum in Children: Current Practices. Children (Basel) 2024; 11:470. [PMID: 38671687 PMCID: PMC11049298 DOI: 10.3390/children11040470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Although effective, compressive orthotic bracing (COB) in children with pectus carinatum is still not standardized. This study has aimed to analyze current practices amongst members of the Chest Wall International Group (CWIG). METHODS A web-based questionnaire was mailed to all CWIG members at 208 departments. It included 30 questions regarding diagnostic work-up, age for COB indication, type of COB used, daily wearing time, treatment duration, complications, and recurrence rate. RESULTS Members from 44 departments have responded (institutional response rate 21.2%). A total of 93% consider COB as the first-line treatment for PC. A conventional COB (CC) is used in 59%, and the dynamic compression system (FMF) in 41%. The overall compliance rate is >80%. A total of 67% of responders consider COB to be indicated in patients <10 years. The actual wearing time is significantly shorter than the physician-recommended time (p < 0.01). FMF patients experience a significantly faster response than CC patients (p < 0.01). No recurrence of PC has been noted in 34%; recurrence rates of 10-30% have been noted in 61%. CONCLUSIONS COB is the first-line treatment for PC with a high compliance rate. During puberty, the recurrence rate is high. Treatment standardization and follow-up until the end of puberty are recommended to enhance COB effectiveness.
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Affiliation(s)
- Pavol Omanik
- Department of Pediatric Surgery, National Institute of Children’s Diseases, 83340 Bratislava, Slovakia; (P.O.); (V.S.); (M.F.)
| | - Sergio Bruno Sesia
- Division of General Thoracic Surgery, Bern University Hospital (Inselspital), 3010 Bern, Switzerland;
| | - Katarina Kozlikova
- Institute of Medical Physics and Biophysics, Comenius University, 81372 Bratislava, Slovakia;
| | - Veronika Schmidtova
- Department of Pediatric Surgery, National Institute of Children’s Diseases, 83340 Bratislava, Slovakia; (P.O.); (V.S.); (M.F.)
| | - Miroslava Funakova
- Department of Pediatric Surgery, National Institute of Children’s Diseases, 83340 Bratislava, Slovakia; (P.O.); (V.S.); (M.F.)
| | - Frank-Martin Haecker
- Department of Pediatric Surgery, Children’s Hospital of Eastern Switzerland, 9000 St. Gallen, Switzerland
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2
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Frediani S, Zarfati A, Pardi V, Aloi I, Bertocchini A, Accinni A, Beati F, Pasanisi M, Inserra A. A new custom-made bivalve brace for pectus carinatum in children and adolescents: preliminary promising experience of 140 patients from a tertiary center. Front Pediatr 2024; 12:1321633. [PMID: 38633328 PMCID: PMC11022594 DOI: 10.3389/fped.2024.1321633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction International research suggests that poor patient compliance is the main cause of tutor failures in the context of potential novel orthopedic bivalve braces for conservative treatment of pectus carinatum. Our entire experimental study is based on the hypothesis that a rigid bivalve brace that patients can accept could solve the main problem associated with the conservative approach-poor compliance. The hypothesis was to reduce the thickness and weight of the classic bivalve brace to ensure concealment and make it sustainable enough to be worn several hours a day without compromising its therapeutic efficacy. Materials and method The research was conducted from January 2020 to December 2022 to ensure follow-up of all participants for at least 6 months. In 36 months, 140 patients with pectus carinatum were assessed and conservatively treated with the studied guardian to analyze the therapeutic efficacy of the bivalve brace and patient compliance. From the initial visit, the parents and patient were informed that this is a 2-year therapeutic course during which the bivalve brace should be worn at least 23 h a day (with 1 h of abstinence per day for routine personal hygiene practices). Compliance is the key to therapy success, and the duration of treatment depends on patient adherence. Results The exceptional effectiveness of the experimental brace was confirmed by both the questionnaire from the patients (with an average satisfaction rate of 8.9/10) and an assessment of the therapy's results by a properly selected medical committee (with a VAS scale satisfaction of 7.2/10 for symmetric forms and 7.1/10 for asymmetric ones). Conclusion In conclusion, the analyzed data confirmed the research hypotheses. First, none of the 140 patients had cardiovascular diseases directly related to their condition, confirming that pectus carinatum is a pathology of a purely aesthetic nature. Second, a cheap, lightweight, and easily obscured brace significantly improved patient compliance. Along with this, the social relevance of the aesthetic aspect today may be an important factor in motivating the study cohort to adhere to therapy. In the past, esthetics and appearance were less relevant at the social level, which may have contributed to the high abandonment and reduced compliance rates of the many studies in the literature.
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Affiliation(s)
- Simone Frediani
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Angelo Zarfati
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of Rome “Tor Vergata”, Rome, Italy
| | - Valerio Pardi
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ivan Aloi
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Arianna Bertocchini
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Accinni
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federico Beati
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Massimiliano Pasanisi
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- General and ThoracicPediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- University of Rome “Tor Vergata”, Rome, Italy
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Janssen N, Coorens NA, Franssen AJPM, Daemen JHT, Michels IL, Hulsewé KWE, Vissers YLJ, de Loos ER. Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification. J Thorac Dis 2024; 16:1687-1701. [PMID: 38505013 PMCID: PMC10944748 DOI: 10.21037/jtd-23-957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/31/2023] [Indexed: 03/21/2024]
Abstract
Background and Objective A wide variety of congenital chest wall deformities that manifest in infants, children and adolescents exists, among which are pectus excavatum and pectus carinatum. Numerous studies have been conducted over the years aiming to better understand these deformities. This report provides a brief overview of what is currently known about the epidemiology, etiopathogenesis, clinical presentation, and classification of these deformities, and highlights the gaps in knowledge. Methods A search was conducted for all the above-described domains in the PubMed and Embase databases. Key Content and Findings A total of 147 articles were included in this narrative review. Estimation of the true incidence and prevalence of pectus excavatum and carinatum is challenging due to lacking consensus on a definition of both deformities. Nowadays, several theories for the development of pectus excavatum and carinatum have been suggested which focus on intrinsic or extrinsic pathogenic factors, with the leading hypothesis focusing on overgrowth or growth disturbance of costal cartilages. Furthermore, genetic predisposition to the deformities is likely to exist. Pectus excavatum is frequently associated with cardiopulmonary symptoms, while pectus carinatum patients mostly present with cosmetic complaints. Both deformities are classified based on the shape or severity of the deformity. However, each classification system has its limitations. Conclusions Substantial progress has been made in the past few decades in understanding the development and symptomatology of pectus excavatum and carinatum. Current hypotheses on the etiology of the deformities should be confirmed by biomedical and genetic studies. For clinical purposes, the establishment of a clear definition and classification system for both deformities based on objective morphologic features is eagerly anticipated.
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Affiliation(s)
- Nicky Janssen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Nadine A Coorens
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Aimée J P M Franssen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jean H T Daemen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Iris L Michels
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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4
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Tekinbaş C, Bayraklı ZO. Overview of chest wall deformities. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S78-S88. [PMID: 38584783 PMCID: PMC10995686 DOI: 10.5606/tgkdc.dergisi.2024.25899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 04/09/2024]
Abstract
Chest wall deformities are congenital disorders characterized by abnormal development and appearance of the thoracic wall. The most common form is the pectus excavatum deformity, known as shoemaker's chest. Pectus carinatum, known as pigeon chest, is the second most common deformity. In general, most patients are asymptomatic, but cardiopulmonary problems may accompany the disease. The indication for treatment is mostly cosmetic. Treating patients before they reach adulthood increases the chance of success. Surgical treatment can be open or minimally invasive.
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Affiliation(s)
- Celal Tekinbaş
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Zeki Oğuzhan Bayraklı
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
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5
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Shahid H, Shakoor N, Bibi A, Qazi AS, Saeed RF, Nawaz A, Malik S, Mumtaz S. A Stop-gain Variant c.220C>T (p.(Gln74*)) in FLNB Segregates with Spondylocarpotarsal Synostosis Syndrome in a Consanguineous Family. Yale J Biol Med 2023; 96:383-396. [PMID: 37781000 PMCID: PMC10524816 DOI: 10.59249/utcp9818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Spondylocarpotarsal synostosis (SCT) syndrome is a very rare and severe form of skeletal dysplasia. The hallmark features of SCT are disproportionate short stature, scoliosis, fusion of carpal and tarsal bones, and clubfoot. Other common manifestations are cleft palate, conductive and sensorineural hearing loss, joint stiffness, and dental enamel hypoplasia. Homozygous variants in FLNB are known to cause SCT. This study was aimed to investigate the phenotypic and genetic basis of unique presentation of SCT syndrome segregating in a consanguineous Pakistani family. Three of the four affected siblings evaluated had severe short stature, short trunk, short neck, kyphoscoliosis, pectus carinatum, and winged scapula. The subjects had difficulty in walking and gait problems and complained of knee pain and backache. Roentgenographic examination of the eldest patient revealed gross anomalies in the axial skeleton including thoracolumbar and cervical fusion of ribs, severe kyphoscoliosis, thoracic and lumbar lordosis, coxa valga, fusion of certain carpals and tarsals, and clinodactyly. The patients had normal faces and lacked other typical features of SCT like cleft palate, conductive and sensorineural hearing loss, joint stiffness, and dental enamel hypoplasia. Whole exome sequencing (WES) of two affected siblings led to the discovery of a rare stop-gain variant c.220C>T (p.(Gln74*)) in exon 1 of the FLNB gene. The variant was homozygous and segregated with the malformation in this family. This study reports extensive phenotypic variability in SCT and expands the mutation spectrum of FLNB.
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Affiliation(s)
- Hamna Shahid
- Department of Biological Sciences, National University of Medical Sciences,
Rawalpindi, Pakistan
| | - Nazish Shakoor
- Human Genetics Program, Department of Zoology, Faculty of Biological Sciences,
Quaid-i-Azam University, Islamabad, Pakistan
| | - Anisa Bibi
- Human Genetics Program, Department of Zoology, Faculty of Biological Sciences,
Quaid-i-Azam University, Islamabad, Pakistan
| | - Asma Saleem Qazi
- Department of Biological Sciences, National University of Medical Sciences,
Rawalpindi, Pakistan
| | - Rida Fatima Saeed
- Department of Biological Sciences, National University of Medical Sciences,
Rawalpindi, Pakistan
| | - Aqeela Nawaz
- Human Genetics Program, Department of Zoology, Faculty of Biological Sciences,
Quaid-i-Azam University, Islamabad, Pakistan
| | - Sajid Malik
- Human Genetics Program, Department of Zoology, Faculty of Biological Sciences,
Quaid-i-Azam University, Islamabad, Pakistan
| | - Sara Mumtaz
- Department of Biological Sciences, National University of Medical Sciences,
Rawalpindi, Pakistan
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Janssen N, Daemen JHT, Franssen AJPM, Jansen YJL, Van Veer HGL, Hulsewé KWE, Vissers YLJ, Abramson H, de Loos ER. Modification of the Abramson procedure for minimally invasive repair of pectus carinatum: introduction of a pectus carinatum compression system. J Thorac Dis 2023; 15:4120-4129. [PMID: 37559647 PMCID: PMC10407518 DOI: 10.21037/jtd-23-642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023]
Abstract
Pectus carinatum is characterized by a protruding sternum. This deformity can be surgically corrected through the minimally invasive Abramson technique. In this procedure, a presternal metal correctional bar, secured to rib-attached stabilizers, is implanted to redress the sternum to a neutral position. To anticipate the intended position of the sternum, manual compression is applied over the sternal deformity. We describe a modified version of the Abramson procedure, encompassing a table-mounted PectusAssist™ System which generates a constant mechanical compression over the protruding sternum. The PectusAssist™ System, most importantly, eliminates the necessity of manually applying repetitive pressure on the deformity, and therefore maintains a more stable sternal position. This will ensure accuracy of the template used to bend the bar into its desired configuration. The modification we propose also simplifies presternal tunnel creation as the two bilateral retromuscular tunnels, that need to be connected presternally, are potentially better aligned due to a more stable and reduced position of the sternum. The PectusAssist™ System makes the procedure less labor intensive and reduces variability without interfering with the safety of the procedure. Therefore, we advise standard use of the PectusAssist™ System during minimally invasive repair of pectus carinatum by the Abramson procedure.
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Affiliation(s)
- Nicky Janssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jean H. T. Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Aimée J. P. M. Franssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Yanina J. L. Jansen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- BREATHE Laboratory, Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Hans G. L. Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- BREATHE Laboratory, Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Karel W. E. Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Yvonne L. J. Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Horacio Abramson
- Surgical Thoracic Service, Hospital Antonio Cetrángolo, Vicente Lopez, Buenos Aires, Argentina
| | - Erik R. de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
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7
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Daemen JHT, Haecker FM, de Loos ER. Special series: minimally invasive treatment of pectus deformities. J Thorac Dis 2023; 15:4111-4113. [PMID: 37559640 PMCID: PMC10407495 DOI: 10.21037/jtd-22-1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/08/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Jean H T Daemen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Frank-Martin Haecker
- Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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8
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Real A, Morais P, Oliveira B, Torres HR, Vilaça JL. Remote Monitoring System of Dynamic Compression Bracing to Correct Pectus Carinatum. Sensors (Basel) 2023; 23:s23094427. [PMID: 37177630 PMCID: PMC10181752 DOI: 10.3390/s23094427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
Pectus carinatum (PC) is a chest deformity caused by disproportionate growth of the costal cartilages compared with the bony thoracic skeleton, pulling the sternum forwards and leading to its protrusion. Currently, the most common non-invasive treatment is external compressive bracing, by means of an orthosis. While this treatment is widely adopted, the correct magnitude of applied compressive forces remains unknown, leading to suboptimal results. Moreover, the current orthoses are not suitable to monitor the treatment. The purpose of this study is to design a force measuring system that could be directly embedded into an existing PC orthosis without relevant modifications in its construction. For that, inspired by the currently commercially available products where a solid silicone pad is used, three concepts for silicone-based sensors, two capacitive and one magnetic type, are presented and compared. Additionally, a concept of a full pipeline to capture and store the sensor data was researched. Compression tests were conducted on a calibration machine, with forces ranging from 0 N to 300 N. Local evaluation of sensors' response in different regions was also performed. The three sensors were tested and then compared with the results of a solid silicon pad. One of the capacitive sensors presented an identical response to the solid silicon while the other two either presented poor repeatability or were too stiff, raising concerns for patient comfort. Overall, the proposed system demonstrated its potential to measure and monitor orthosis's applied forces, corroborating its potential for clinical practice.
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Affiliation(s)
- António Real
- 2Ai-School of Technology, IPCA, 4750-810 Barcelos, Portugal
- LASI-Associate Laboratory of Intelligent Systems, 4800-058 Guimaraes, Portugal
| | - Pedro Morais
- 2Ai-School of Technology, IPCA, 4750-810 Barcelos, Portugal
- LASI-Associate Laboratory of Intelligent Systems, 4800-058 Guimaraes, Portugal
| | - Bruno Oliveira
- 2Ai-School of Technology, IPCA, 4750-810 Barcelos, Portugal
- LASI-Associate Laboratory of Intelligent Systems, 4800-058 Guimaraes, Portugal
- Algoritmi Center, School of Engineering, University of Minho, 4800-058 Guimaraes, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga/Guimaraes, Portugal
| | - Helena R Torres
- 2Ai-School of Technology, IPCA, 4750-810 Barcelos, Portugal
- LASI-Associate Laboratory of Intelligent Systems, 4800-058 Guimaraes, Portugal
- Algoritmi Center, School of Engineering, University of Minho, 4800-058 Guimaraes, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4710-057 Braga/Guimaraes, Portugal
| | - João L Vilaça
- 2Ai-School of Technology, IPCA, 4750-810 Barcelos, Portugal
- LASI-Associate Laboratory of Intelligent Systems, 4800-058 Guimaraes, Portugal
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9
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Karabulut M. Increased incidence of mitral valve prolapse in children with pectus chest wall deformity. Pediatr Int 2023; 65:e15582. [PMID: 37518971 DOI: 10.1111/ped.15582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Pectus anomalies constitute 95% of chest anomalies. Pectus carinatum (PC) and excavatum (PE) are often asymptomatic in childhood. However, symptoms and signs such as chest pain, dyspnea, and mitral valve prolapse (MVP) can be seen in pectus anomalies. Demographic characteristics and accompanying cardiac signs in children with pectus deformity were investigated. METHODS In this study, the clinical findings for children with pectus deformity, and the incidence of MVP and other concomitant heart diseases detected in echocardiographic examinations were evaluated. RESULTS Eighty-two children with PE, 27 with PC, and 107 healthy children were included in this study. In the echocardiographic examination of PE, PC patients, and healthy children, MVP was detected with frequencies of 25%, 33%, and 2% respectively. CONCLUSIONS The study showed that pectus anomalies were associated with an increased incidence of MVP. All patients with pectus deformity should therefore undergo a screening echocardiogram in adolescence to assess for the presence of MVP.
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Affiliation(s)
- Muhammed Karabulut
- Department of Paediatric Cardiology, Clinical of Paediatric Health and Diseases, Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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10
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Wozniak-Mielczarek L, Osowicka M, Radtke-Lysek A, Drezek-Nojowicz M, Gilis-Malinowska N, Sabiniewicz A, Mielczarek M, Sabiniewicz R. How to Distinguish Marfan Syndrome from Marfanoid Habitus in a Physical Examination-Comparison of External Features in Patients with Marfan Syndrome and Marfanoid Habitus. Int J Environ Res Public Health 2022; 19:772. [PMID: 35055593 PMCID: PMC8775541 DOI: 10.3390/ijerph19020772] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 01/16/2023]
Abstract
Marfan Syndrome (MFS) is a systemic disorder caused by mutations in fibrillin-1. The most common cause of mortality in MFS is dissection and rupture of the aorta. Due to a highly variable and age-dependent clinical spectrum, the diagnosis of MFS still remains sophisticated. The aim of the study was to determine if there exist phenotypic features that can play the role of "red flags" in cases of MFS suspicion. The study population included 306 patients (199 children and 107 adults) who were referred to the Department of Pediatric Cardiology due to suspicion of MFS. All patients underwent complete clinical evaluation in order to confirm the diagnosis of MFS according to the modified Ghent criteria. MFS was diagnosed in 109 patients and marfanoid habitus in 168 patients. The study excluded 29 patients with other hereditary thoracic aneurysm syndromes. Comparative analysis between patients with Marfan syndrome and marfanoid habitus was performed. Symptoms with high prevalence and high positive likelihood ratio were identified (pectus carinatum, reduced elbow extension, hindfoot deformity, gothic palate, downslanting palpebral fissures, lens subluxation, myopia ≥ 3 dioptres remarkably high stature). The differentiation between patients with MFS and marfanoid body habitus is not possible by only assessing external body features; however, "red flags" could be helpful in the screening phase.
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Affiliation(s)
- Lidia Wozniak-Mielczarek
- Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Michalina Osowicka
- Department of History of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Alicja Radtke-Lysek
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.R.-L.); (N.G.-M.); (M.M.)
| | | | - Natasza Gilis-Malinowska
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.R.-L.); (N.G.-M.); (M.M.)
| | - Anna Sabiniewicz
- Students’ Scientific Circle of the Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Maksymilian Mielczarek
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.R.-L.); (N.G.-M.); (M.M.)
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdansk, 80-210 Gdansk, Poland;
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11
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Abstract
AIM This study aimed to review the literature with regard to the psychological aspects in patients with pectus excavatum (PE) and pectus carinatum (PC). METHODS The literature was reviewed by analyzing articles on PubMed using the search terms "psychology" and "pectus." RESULTS The literature search revealed 22 articles that offered a total of 2214 patients for analysis. Regarding chest wall deformities (CWD), there were 15 articles referring to PE, 4 articles on PC, and 3 pertaining to both PE and PC. Authors used various types of questionnaires and 14 studies which also included a parent questionnaire. There are 14 reports which analyzed both the preoperative and postoperative psychological status and 4 reports in which a control group was used. Treatment of CWD was shown to have consistently positive results. There is no consensus regarding the correlation between severity of CWD and psychological issues. Only 2 studies found no statistically significant results after treatment. CONCLUSIONS The literature reveals a great concern for psychosocial issues in CWD patients. Most articles describe improvement in overall quality of life (QOL) after surgery. An increase in social and physical function, body image, and self-esteem was observed in CWD patients, which is supported by parent responses.
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Affiliation(s)
- Gratiana O Alqadi
- Department of Pediatric Surgery, Chelsea Children's Hospital, 9762Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, UK.,Department of Pediatric Surgery, 87267University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, 9762Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, UK
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Wang L, Liu J, Shen S, Li Y, Feng T, Li G, Xiao H, Hu F. Comparison of Outcomes Between Anti-Nuss Operation and Modified Anti-Nuss Operation Using a Flexible Plate for Correcting Pectus Carinatum: A Retrospective Study. Front Surg 2021; 7:600755. [PMID: 33659269 PMCID: PMC7920095 DOI: 10.3389/fsurg.2020.600755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: The anti-Nuss procedure has gradually been found to have several shortcomings in clinical practice. Accordingly, our department previously designed and introduced a new steel plate. However, there is limited evidence regarding its safety and efficacy. Thus, we aim to compare the efficacy and safety of the conventional anti-Nuss operation with those of a modified anti-Nuss operation using a flexible plate. Methods: Patients with pectus carinatum who underwent surgery between January 2014 and August 2019 were consecutively enrolled in this single-center, retrospective study. In all, 53 patients underwent the modified procedure using the new steel plate (new procedure group), whereas 43 underwent the conventional anti-Nuss procedure (traditional procedure group). Outcome analysis was performed using SPSS to compare the intraoperative and postoperative short-term outcomes. Results: All patients in the new procedure group had shorter operation duration (75.23 ± 11.90 vs. 82.45 ± 9.30 min, p = 0.008), postoperative hospitalizations (3.42 ± 0.95 vs. 4.64 ± 1.53 days, p = 0.039), and plate removal surgery durations (40.60 ± 3.47 vs. 60.30 ± 9.75 min, p = 0.041) than patients in the traditional procedure group. There were no significant differences in the length of incision, postoperative Haller index, cost, postoperative surgical outcome, and incidence of complications between the two groups. Conclusion: Our data reveal that the main clinical outcomes were similar for after anti-Nuss operation and modified anti-Nuss operation. However, the modified procedure for pectus carinatum had a shorter operation duration, postoperative hospitalization, and plate removal surgery duration.
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Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Liu
- Department of Nursing, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Saie Shen
- Department of Anesthesiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao Li
- Department of Disaster and Emergency Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Guoqing Li
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibo Xiao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengqing Hu
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Skrzypczak P, Kamiński M, Pawlak K, Piwkowki C. Seasonal interest in pectus excavatum and pectus carinatum: a retrospective analysis of Google Trends data. J Thorac Dis 2021; 13:1036-1044. [PMID: 33717576 PMCID: PMC7947486 DOI: 10.21037/jtd-20-2924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Individuals affected by chest wall deformities may search for information on these conditions on the web. Google data may reflect the global interest in health-related information. Our aim was to investigate the global trends in searches associated with the topics “Pectus excavatum” and “Pectus carinatum” using Google Trends. Methods We retrieved the global data from 1st January 2004 to 31st October 2019. We analyzed the relative search volume (RSV) for countries or areas with a no-low search volume. We compared differences in interest between seasons using the Kruskal-Wallis test with the post-hoc test. Results The median RSV for the pectus excavatum was equal to 58.00 (54.00–65.00) while for pectus carinatum 28.00 (23.25–31.00). The interest in pectus excavatum decreases on average by 0.98 RSV each year, while interest in pectus carinatum increased each year by 0.87 RSV. We observed the highest interest in analyzed topics during summer and the lowest during winter. The relative difference in interest between summer and winter was equal to 21.4% for pectus excavatum and 19.2% for pectus carinatum. Pectus excavatum was the most popular topic in n=51 countries or areas, while pectus carinatum in n=7 countries or areas/regions. Conclusions Globally, interest in pectus excavatum is higher than the interest in pectus carinatum that might reflect real-world prevalence. The interest in both topics shows seasonal variation. The Internet is an essential source of information on chest wall deformities. The medical professionals should provide quality content on pectus excavatum and pectus carinatum.
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Affiliation(s)
- Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Krystian Pawlak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Cezary Piwkowki
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Buchwald J, Ligarski D, Polewczyk T. Long-term results after the modified Ravitch procedure performed in children and adolescents - a one-time procedure without the need to use additional support of the sternum. A retrospective study. Kardiochir Torakochirurgia Pol 2020; 17:173-7. [PMID: 33552179 DOI: 10.5114/kitp.2020.102336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/15/2020] [Indexed: 12/04/2022]
Abstract
Introduction Pectus excavatum is a depression of the sternum. Pectus carinatum, in contrast, is the convexity of the sternum. The mixed form is an intermediate condition. Surgical intervention is the treatment of choice. The techniques most commonly used include the Ravitch and the Nuss procedures. Aim To assess the immediate and long-term results of the original modification of the surgical treatment for anterior chest wall deformation. Material and methods The modification is based on the Ravitch procedure. The difference is that the ends of the resected cartilages are shaped like a blade in order to be inserted into the previously prepared wedge-shaped hollows located on both edges of the sternum. The result is long lasting without the need to use additional brackets. Results The follow-up examinations performed in 72 patients, including 57 boys and 15 girls, were the basis to produce long-term results. As for the type of deformity, out of 57 patients operated on due to pectus excavatum, 43 expressed satisfaction with the very good result. Similar satisfaction was reported in 7 out of 11 patients operated on due to pectus carinatum. There were 4 cases with the mixed form who had very good long-term results. Wound dehiscence was observed in 13 subjects, with one documented recurrence. Conclusions The alternative treatment we propose is a one-time procedure without the need to use additional support of the sternum. Good long-term results make the procedure suitable to be used more frequently in all types of deformities.
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Işık H, Çaylak H, Sapmaz E, Karataş O, Kavaklı K, Şengül İnan M, Gürkök S, Gözübüyük A, Genç O. Demographic characteristics of pectus deformities across Turkey. Turk Gogus Kalp Damar Cerrahisi Derg 2019; 28:322-30. [PMID: 32551163 DOI: 10.5606/tgkdc.dergisi.2020.18465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/12/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the demographic characteristics and familial inheritance of pectus deformities across Turkey. Methods Demographic characteristics of a total of 5,098 patients (5,028 males, 70 females, mean age 23.6 years; range, 1 to 56 years) with pectus excavatum and pectus carinatum admitted to our outpatient clinic between January 1996 and December 2018 were retrospectively analyzed. The distribution of the patients across the country was made according to seven regions and 81 provinces. Familial inheritance was investigated using patients" data obtained from the clinical records and telephone calls. Results Of all patients, 3,330 (65.3%) had pectus excavatum and 1,768 (34.7%) had pectus carinatum deformity with a pectus excavatum-to-pectus carinatum ratio of 1/1.9. In the Southeast Anatolia region, the rate of pectus excavatum was lower than the overall average and higher in the Marmara region (p=0.009 and p=0.037, respectively). In the Southeast Anatolia region, the rate of pectus carinatum was higher than the general average and lower in the Marmara region (p=0.001 and p=0.003, respectively). Kastamonu, Çankırı, Karabük, and Sinop were the most common provinces for pectus deformity cases. Family history was positive in 39% of pectus excavatum and 43% of pectus carinatum patients. All regions showed a similar distribution in terms of the presence of family history. Conclusion This is the first study to report the distribution of pectus deformities in Turkey and the high frequency of pectus deformities in certain regions and provinces of Turkey indicates familial inheritance.
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17
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Orrick BA, Pierce AL, Snyder CL, Alon US. Successful Brace Treatment of Pectus Carinatum in Osteogenesis Imperfecta Using the Dynamic Compression System. European J Pediatr Surg Rep 2020; 7:e117-e120. [PMID: 31908907 PMCID: PMC6938457 DOI: 10.1055/s-0039-3399557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/25/2019] [Indexed: 11/02/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder of collagen resulting in a "fragile" skeleton with increased fracture risk and other complications, dependent on the specific variant. Pectus deformities of the chest wall, while not common, can be associated with OI. The use of a pectus carinatum brace in a patient with OI poses unknown risks for fractures and adverse treatment outcomes. We successfully applied external compression bracing using the dynamic compression system to one such patient. This case illustrates the ability to treat an OI patient with pectus carinatum using a nonsurgical brace, without complications, resulting in an excellent cosmetic result.
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Affiliation(s)
- Beth A Orrick
- Department of Pediatric Surgery, Center for Pectus Excavatum and Carinatum, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Amy L Pierce
- Department of Pediatric Surgery, Center for Pectus Excavatum and Carinatum, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Charles L Snyder
- Department of Pediatric Surgery, Center for Pectus Excavatum and Carinatum, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Uri S Alon
- Bone and Mineral Disorders Clinic, Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, Missouri, United States
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18
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Razumovsky AY, Alkhasov AB, Mitupov ZB, Savelieva MS, Geodakyan OS, Demakhin AA. [Minimally Invasive Technologies in Surgery of the Chest Wall in Children]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2019; 27:687-692. [PMID: 31747162 DOI: 10.32687/0869-866x-2019-27-si1-687-692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/04/2019] [Indexed: 11/06/2022]
Abstract
Today, in our country, as well as throughout the world, there is no single approach to the tactics of managing patients with deformations of the anterior chest wall. These patients constitute a large and heterogeneous group. The team acquired great experience in treating children with pectus excavatum and pectus carinatum, as well as a unique experience in the surgical treatment of pediatric thoracic outlet syndrome and sternum clefts. Now in the world there are a lot of surgical methods used for the correction of congenital deformities of the chest wall, however, the majority of them are extremely traumatic for the patient, and the postoperative scar often presents a minor cosmetic problem than the deformation itself. In addition, almost all methods require the use of expensive technologies, the patient's long hospital stay and the use of potent drugs. As for the children with thoracic outlet syndrome and sternum clefts, these patients are extremely difficult in terms of timely diagnosis and surgical care, due to the fact that pediatric surgeons and pediatricians are very little aware of this pathology. The team of authors developed a number of techniques, based on the collaborative work of surgeons, anesthesiology and resuscitation specialists and pediatric services. They resulted in successful surgical correction of these malformations and gave patients the opportunity to lead a normal life.
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Affiliation(s)
- A Yu Razumovsky
- Filatov State Children's Hospital, 123001, Moscow, Russia.,National Medical Research Center for Children's Health, 119296, Moscow, Russia
| | - A B Alkhasov
- Filatov State Children's Hospital, 123001, Moscow, Russia.,National Medical Research Center for Children's Health, 119296, Moscow, Russia
| | - Z B Mitupov
- National Medical Research Center for Children's Health, 119296, Moscow, Russia
| | - M S Savelieva
- Children's city Clinic № 132, 119633, Moscow, Russia,
| | - O S Geodakyan
- National Medical Research Center for Children's Health, 119296, Moscow, Russia
| | - A A Demakhin
- National Medical Research Center for Children's Health, 119296, Moscow, Russia
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Abstract
Awareness of pectus carinatum has increased among the medical community over the last several decades, as innovative options for nonsurgical treatments have become more widely known. Management alternatives have shifted from open resective to minimally invasive
strategies, and finally, to reshaping the chest using both surgical and non-surgical modalities. We aim to review the evolution of the diagnosis
and treatment of pectus carinatum up to its current management.
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20
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Dekonenko C, Dorman RM, Pierce A, Orrick BA, Juang D, Aguayo P, Fraser JD, Oyetunji TA, Snyder CL, St Peter SD, Holcomb GW. Outcomes Following Dynamic Compression Bracing for Pectus Carinatum. J Laparoendosc Adv Surg Tech A 2019; 29:1223-1227. [PMID: 31241400 DOI: 10.1089/lap.2019.0171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Children with pectus carinatum (PC) are particularly vulnerable to psychosocial effects of poor body image, even though they may not experience physical symptoms. Nonoperative treatment with orthotic bracing is effective in PC correction. We describe our experience with dynamic compression bracing (DCB) for PC patients and their satisfaction with bracing. Materials and Methods: Prospective institutional data of patients undergoing DCB from July 2011 to June 2018 were reviewed and analyzed for those who entered the retainer mode after correction, defined by a correction pressure of <1 psi. A telephone survey was conducted regarding their bracing experience and satisfaction with the outcome on a scale of 1-10. Results: Of 460 PC patients, 144 reached the retainer mode. Median time to retainer mode was 5.5 months. There was no statistically significant relationship between initial correction pressure or carinatum height and time to retainer mode (P = .08 and P = .10, respectively). Fifty-seven percent were compliant with brace use, and median time to retainer mode in this subset was significantly shorter than noncompliant patients (3.5 months versus 10 months, P < .001). Fifty-three percent responded to the survey 13 months [interquartile ratios 3, 33] after the last clinic visit. The main barrier to compliance with wearing the brace was discomfort (37%), while the main motivation for compliance was appearance (58%). All endorsed bracing as worthwhile, with 94% reporting a satisfaction rating of 8 or greater for the correction outcome. Conclusion: DCB is effective in achieving correction of PC in compliant patients. Regardless of time to retainer mode, patients reported high satisfaction with bracing.
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Affiliation(s)
| | - Robert M Dorman
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Amy Pierce
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Beth A Orrick
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - David Juang
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Charles L Snyder
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - George W Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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21
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Abstract
Pectus excavatum (PE) and pectus carinatum (PC) in children are the most common congenital deformities that cause complications in the thoracic organs; however, the role of chondrocytes and cartilage canals in the pathogenesis of these conditions remains unexplored. OBJECTIVE To investigate qualitative and quantitative changes of cartilage lacunae and canals in the costal cartilages in children with PE and PC compared to those with normal chests. SUBJECT AND METHODS Costal cartilages were investigated in 10 children with normal chests (a control group), in 12 children with PE, and in 12 children with PC. Tissue fragments were fixed in 10% neutral formalin and embedded in compacted paraffin. Sections were stained with hematoxylin and eosin. Slides were examined by light microscopy. Cartilage lacunae, hyper- and hypolacunar zones, and cartilage canals were morphometrically examined, followed by statistical data analysis. RESULTS There was a significant decrease in the number of cartilage lacunae and in the frequency of hyperlacunar zones and an increase in that of hypolacunar zones in the PE and PC groups. There were no significant differences in these parameters between the PE and PC groups; however, there was a tendency to the smallest number of cartilage lacunae and canals in the PC group and that to the preponderance of empty lacunae in the PE group. Only the PC group showed also negative correlations between the proportions of empty lacunae and the age of children. CONCLUSION The pathogenesis of PE and PC in children is related to the impaired trophism of costal cartilages due to the smaller number of cartilage channels containing vessels and lacunae with chondrocytes. The development of PE and PC is associated with specific costal cartilage morphological changes that suggest that PE and PC are different manifestations of the same disease, namely connective tissue dysplasia.
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Affiliation(s)
- A V Kurkov
- Acad. A.I. Strukov Department of Pathoanatomy, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia; Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - V S Paukov
- Acad. A.I. Strukov Department of Pathoanatomy, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - A L Fayzullin
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - A B Shekhter
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
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Özkaya M, Bilgin M. Minimally invasive repair of pectus carinatum by modification of the Abramson technique. Wideochir Inne Tech Maloinwazyjne 2018; 13:383-7. [PMID: 30302152 DOI: 10.5114/wiitm.2018.75888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/11/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction The minimally invasive pectus carinatum surgery described by Abramson has been performed in many centers. We modified the “sub-muscular tunnel creation” part of the original Abramson technique. Aim To compare the operative time between the original Abramson technique and a lightly modified approach. Material and methods A retrospective review of 84 patients who underwent minimally invasive repair of pectus carinatum deformity between July 2008 and November 2017 was performed. We applied two different techniques, the original Abramson technique and the modified technique. Sixty-eight patients – 49 (72%) males and 19 (28%) females – underwent minimally invasive repair of a pectus carinatum deformity as described by Abramson (Abramson group). Sixteen patients – 13 (81%) males and 3 (19%) females – were operated on by our modified Abramson technique at our institution (Modified group). Results Eighty-four patients were included in this study: 68 patients from the Abramson group and 16 patients from the Modified group. There was no significant difference between the groups with respect to preoperative demographic features, including median age and sex. Median operative time was significantly shorter in the Modified group than the Abramson group (43 min, range: 32–54 min) in the Modified group vs. 30 min (range: 20–35 min) in the Abramson group (p < 0.001). Conclusions This article describes a modification of a surgical technique that is safely and easily used in minimally invasive correction of pectus carinatum deformities, with minimal complications, high satisfaction rates and shorter operative time.
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Wildemeersch D, D'Hondt M, Bernaerts L, Mertens P, Saldien V, Hendriks JM, Walcarius AS, Sterkens L, Hans GH. Implementation of an Enhanced Recovery Pathway for Minimally Invasive Pectus Surgery: A Population-Based Cohort Study Evaluating Short- and Long-Term Outcomes Using eHealth Technology. JMIR Perioper Med 2018; 1:e10996. [PMID: 33401363 PMCID: PMC7709887 DOI: 10.2196/10996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/20/2018] [Accepted: 08/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background Pectus excavatum and pectus carinatum are the most common chest wall deformities. Although minimally invasive correction (minimally invasive repair of pectus, MIRP) has become common practice, it remains associated with severe postoperative pain. Preoperative psychosocial factors such as anxiety and low self-esteem can increase postsurgical pain. Early detection of psychological symptoms, effective biopsychosocial perioperative management of patients, and prevention of pain chronification using an enhanced recovery pathway (ERP) may improve outcomes. However, the incidence of the latter is poorly described in adolescents undergoing MIRP. Objective The objective of our study was to evaluate the implementation of an ERP containing early recovery goals and to assess persistent postsurgical pain 3 months postoperatively in pediatric patients undergoing MIRP. The ERP consists of a Web-based platform containing psychological screening questionnaires and extensive telemonitoring for follow-up of patients at home. Methods A population-based cohort study was conducted with prospectively collected data from patients undergoing pectus surgery between June 2017 and December 2017. An ERP was initiated preoperatively; it included patient education, electronic health-based psychological screening, multimodal pre-emptive analgesia, nausea prophylaxis as well as early Foley catheter removal and respiratory exercises. After hospital discharge, patients were followed up to 10 weeks using a Web-based diary evaluating pain and sleep quality, while their rehabilitation progress was monitored via Bluetooth-connected telemonitoring devices. Results We enrolled 29 adolescents using the developed ERP. Pre-emptive multimodal analgesia pain rating scores were low at hospital admission. Optimal epidural placement, defined by T8-9 or T9-10, occurred in 90% (26/29) of the participants; thus, no motor block or Horner syndrome occurred. Mean bladder catheterization duration was 3.41 (SD 1.50) days in ERP patients. Numeric rating scale (NRS) scores for pain and the incidence of nausea were low, contributing to a fluent rehabilitation. Mean NRS scores were 2.58 (SD 1.77) on postoperative day (POD) 1, 2.48 (SD 1.66) on POD 2, and 3.14 (SD 1.98) on POD 3 in ERP-treated patients. Telemonitoring at home was feasible in adolescents after hospital discharge despite adherence difficulties. Although the pain scores at the final interview were low (0.81 [SD 1.33]), 33% (9/27) long-term follow-up ERP patients still experienced frequent disturbing thoracic pain, requiring analgesic administration, school absenteeism, and multiple doctor (re)visits. Conclusions Allocating patients to the appropriate level of care preoperatively and immediately postoperatively may improve long-term outcome variables. Internet-based technologies and feasible, objective monitoring tools can help clinicians screen surgical patients for risk factors and initiate early treatment when indicated. Future research should focus on improving risk stratification and include a psychological assessment and evaluation of the effect of perioperative care pathways in children undergoing major surgery. Trial Registration ClinicalTrials.gov NCT03100669; https://clinicaltrials.gov/ct2/show/NCT03100669 (Archived by WebCite at http://www.webcitation.org/72qLB1ADX)
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Affiliation(s)
- Davina Wildemeersch
- Department of Anesthesiology, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Pain Center, Antwerp University Hospital, Edegem, Belgium.,Laboratory for Pain Research, University of Antwerp, Wilrijk, Belgium
| | - Michiel D'Hondt
- Department of Anesthesiology, Antwerp University Hospital, Edegem, Belgium
| | - Lisa Bernaerts
- Division of Psychology, Multidisciplinary Pain Center, Antwerp University Hospital, Edegem, Belgium
| | - Pieter Mertens
- Department of Anesthesiology, Antwerp University Hospital, Edegem, Belgium
| | - Vera Saldien
- Department of Anesthesiology, Antwerp University Hospital, Edegem, Belgium
| | - Jeroen Mh Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Anne-Sophie Walcarius
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Lutgard Sterkens
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Guy H Hans
- Multidisciplinary Pain Center, Antwerp University Hospital, Edegem, Belgium.,Laboratory for Pain Research, University of Antwerp, Wilrijk, Belgium
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Szafer D, Taylor JS, Pei A, de Ruijter V, Hosseini H, Chao S, Wall J. A Simplified Method for Three-Dimensional Optical Imaging and Measurement of Patients with Chest Wall Deformities. J Laparoendosc Adv Surg Tech A 2018; 29:267-271. [PMID: 30207836 DOI: 10.1089/lap.2018.0191] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pectus excavatum and carinatum are two of the most commonly observed chest wall deformities in pediatrics. The standard diagnostic evaluation for these conditions includes either chest radiograph (CXR) or computed tomography (CT). Our research aims to develop a novel and reliable way of quantifying chest wall deformities in the clinic setting without radiation exposure. METHODS Using a handheld structured light scanner, we created three-dimensional (3D) models of patients with chest wall deformities through an IRB-approved protocol. Raters from a variety of backgrounds were then asked to take measurements based on the 3D model utilizing commercially available 3D graphical software. The standard deviation of the measurements and intraclass correlation coefficient (ICC) were then calculated to quantify inter-rater reliability. RESULTS Sixty patients with pectus excavatum (Haller index range 2.0-6.38) and pectus carinatum were enrolled and imaged in our outpatient clinic using a structured light scanner. Five patients were used to verify interuser reliability. The standard deviation of all the measurements was 2.2 mm. The ICC for absolute agreement was 0.99139, with 1.0 being perfect correlation. CONCLUSION Structured light scanners provide an alternative approach to quantifying chest wall deformities in pediatric patients without radiation exposure. Our method is highly reliable, even among users with minimal image processing or 3D modeling experience. Our protocol can potentially be used to track treatment progress in children with chest wall deformities.
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Affiliation(s)
- Dalia Szafer
- 1 Stanford University School of Medicine , Department of Surgery, Stanford, California
| | - Jordan S Taylor
- 1 Stanford University School of Medicine , Department of Surgery, Stanford, California.,2 Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital at Stanford University , Stanford, California
| | - Allison Pei
- 1 Stanford University School of Medicine , Department of Surgery, Stanford, California
| | - Vivian de Ruijter
- 1 Stanford University School of Medicine , Department of Surgery, Stanford, California
| | - Hadi Hosseini
- 1 Stanford University School of Medicine , Department of Surgery, Stanford, California
| | - Stephanie Chao
- 1 Stanford University School of Medicine , Department of Surgery, Stanford, California.,2 Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital at Stanford University , Stanford, California
| | - James Wall
- 1 Stanford University School of Medicine , Department of Surgery, Stanford, California.,2 Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital at Stanford University , Stanford, California
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Ji H, Wang J, Chen C, Zeng Q. [Automatic diagnosis of pectus carinatum for children based on the improved Haller index]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2018; 35:571-577. [PMID: 30124020 DOI: 10.7507/1001-5515.201712024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pectus carinatum (PC) is one of the most common chest wall anomalies, which is characterized by the protrusion of the anterior chest wall including the sternum and adjacent costal cartilages. Mildly patients suffer from mental problems such as self-abasement, while severely suffering patients are disturbed by significant cardiopulmonary symptoms. The traditional Haller index, which is widely used clinically to evaluate the severity of PC, is deficient in diagnosis efficiency and classification. This paper presents an improved Haller index algorithm for PC: first, the contour of the patient chest in the axial computed tomography (CT) slice where the most convex thorax presents is extracted; and then a cubic B-spline curve is employed to fit the extracted contour followed by an eclipse fitting procedure; finally, the improved Haller index and the classification index are automatically calculated based on the analytic curves. The results of CT data analysis using 22 preoperative and postoperative patient CT datasets show that the proposed diagnostic index for PC can diagnose and classify PC patients correctly, which confirms the feasibility of the evaluation index. Furthermore, digital measurement techniques can be employed to improve the diagnostic efficiency of PC, achieving one small step towards the computer-aided intelligent diagnosis and treatment for pediatric chest wall malformations.
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Affiliation(s)
- Honglei Ji
- School of Mechanical Engineering & Automation, Beihang University, Beijing 100191, P.R.China;
| | - Junchen Wang
- School of Mechanical Engineering & Automation, Beihang University, Beijing 100191, P.R.China;
| | - Chenghao Chen
- Department of Thoracic Surgery of Beijing Children's Hospital, Capital Medical University, Beijing 100045, P.R.China
| | - Qi Zeng
- Department of Thoracic Surgery of Beijing Children's Hospital, Capital Medical University, Beijing 100045,
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Wildemeersch D, Bernaerts L, D'Hondt M, Hans G. Preliminary Evaluation of a Web-Based Psychological Screening Tool in Adolescents Undergoing Minimally Invasive Pectus Surgery: Single-Center Observational Cohort Study. JMIR Ment Health 2018; 5:e45. [PMID: 29853436 PMCID: PMC6002674 DOI: 10.2196/mental.9806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/10/2018] [Accepted: 04/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Preoperative anxiety and depression are predominant risk factors for increased postoperative pain. Thoracic wall deformities in adolescents often cause low self-esteem, which contributes to psychological concerns. Several studies have suggested a relationship between preoperative mental health support and enhanced recovery after surgery. OBJECTIVE This study investigated the validity of screening questionnaires concerning psychological trait and state characteristics via a patient-specific online platform. METHODS Patients scheduled for elective pectus surgery between June 2017 and August 2017 were invited to participate in clinical interviews and online self-report questionnaires. All patients were recruited in the Anesthesiology Department, Antwerp University Hospital, Belgium. This single-center observational cohort study was performed in accordance with the ethical standards of the International Council for Harmonisation-Good Clinical Practice guidelines and the Declaration of Helsinki after obtaining study approval by the Institutional Review Board and Ethics Committee of the Antwerp University Hospital, Belgium (study identifier: 17/08/082). An online preoperative psychological inventory was performed using the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, and State-Trait Anxiety Inventory. Postoperatively, pain intensity and interference were assessed using the Multidisciplinary Pain Inventory, Coping With Pain Questionnaire, and numeric pain rating scale assessment. Patient satisfaction of the Web-based platform was evaluated. RESULTS A total of 21 adolescent patients used our Web-based psychological perioperative screening platform. Patients rated the mobile phone app, usability, and accessibility of the digital platform as good or excellent in 85% (17/20), 89% (17/19), and 95% (20/21) of the cases, respectively. A total of 89% (17/19) of the patients rated the effort of generating answers to the online questionnaires as low. The results from the completed questionnaires indicated a strong negative correlation between self-esteem and the anxiety trait (R=-0.72, P<.001) and overall anxiety characteristics (R=-0.49, P=.04). There was a positive correlation between depressive and anxiety characteristics and the anxiety trait (R=0.52, P=.03 and R=0.6, P=.02, respectively) measured by the online self-report questionnaires. Moreover, preoperative anxiety was positively correlated with postoperative pain interference (R=0.58, P=.02). Finally, there was a negative correlation between self-esteem and pain interference (R=-0.62, P=.01). Conclusions: Perioperative screening of psychological symptoms and trait characteristics with specific treatment, if necessary, could further improve postoperative pain and overall health status. Research on eHealth technology, even for psychological patient care, is rapidly increasing. TRIAL REGISTRATION ClinicalTrials.gov NCT03100669; https://clinicaltrials.gov/ct2/show/NCT03100669 (Archived by WebCite at http://www.webcitation.org/6zPvHDhU5).
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Affiliation(s)
| | | | | | - Guy Hans
- Antwerp University Hospital, Edegem, Belgium
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Narkhodzhaev NS, Turmetov IZ, Karabekov AK. [Surgical treatment of pectus carinatum in children]. Khirurgiia (Mosk) 2018:81-85. [PMID: 29798996 DOI: 10.17116/hirurgia2018581-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To improve the results of surgical treatment of pectus carinatum. MATERIAL AND METHODS The work included 47 pectus carinatum patients aged 3-15 years for the period from 2000 to 2015. All patients were divided into 2 groups depending on surgical approach: control group - 23 (48.94%) children who underwent thoracoplasty by M.M. Ravitsh procedure with the use of device for pectus carinatum repair of our design; main group - 24 (51.06%) patients where our method of thoracoplasty based on changes of deformed ribs biomechanics was used. RESULTS In control group good results were obtained in 15 (65.3%) patients, satisfactory - in 5 (21.7%) patients, recurrent deformation with all consequences was observed in 3 (13%) cases. Long-term results of surgical treatment by original method were followed-up in all 24 patients and good outcomes were obtained in 100% of children. CONCLUSION 1) Intraoperative 'spring' - effect is a provoking risk factor of recurrent chest deformation. 2) The new surgical method based on breaking the ribs bodies in 'green branch' fashion provides good results and does not require external devices to hold sternal-rib complex in corrected position.
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Affiliation(s)
- N S Narkhodzhaev
- Yasavi International Kazakh-Turkish University, Turkestan, Kazakhstan; South Kazakhstan Regional Children's Hospital, Shymkent, Kazakhstan; South Kazakhstan State Pharmaceutical Academy, Medical Faculty, Shymkent, Kazakhstan
| | - I Zh Turmetov
- Yasavi International Kazakh-Turkish University, Turkestan, Kazakhstan
| | - A K Karabekov
- South Kazakhstan State Pharmaceutical Academy, Medical Faculty, Shymkent, Kazakhstan
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Abstract
Congenital chest wall or pectus deformities including pectus excavatum (funnel chest) and pectus carinatum (pigeon chest) affect a significant proportion of the general population and up to 70% of patients with Marfan syndrome. Patients often experience significant morbidity and psychological distress, which can worsen with age. Here we discuss new techniques for both operative and non-operative treatment of pectus deformity, the importance of a welltimed intervention and special considerations in patients with Marfan syndrome.
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Shah SB, Hariharan U, Bhargava AK, Darlong LM. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature. Saudi J Anaesth 2017; 11:319-326. [PMID: 28757834 PMCID: PMC5516496 DOI: 10.4103/sja.sja_13_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors’ personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search.
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Affiliation(s)
| | - Uma Hariharan
- Department of Anaesthesia and Intensive Care, Dr. Ram Manohar Lohia Hospital and PGIMER, CHS, New Delhi, India
| | | | - Laleng M Darlong
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Abstract
AIM The purpose of this study is to describe the development of an external 3-dimensional (3D) scanner as a noninvasive method for imaging chest wall deformities. It allows objective assessment, reconstruction of the area of interest, and evaluation of the severity of the deformity by using external indexes. EXTERNAL 3D SCANNING SYSTEM The OrtenBodyOne scanner (Orten, Lyon, France) uses depth sensors to scan the entire 3D external body surface of a patient. The depth sensors combine structured light with two classic computer vision techniques: depth from focus and depth from stereo. The data acquired are processed and analyzed using the Orten-Clinic software. MATERIALS AND METHODS To investigate the performance of the device, a preliminary prospective study (January 2015-March 2016) was carried out in patients attending our hospital chest wall deformities unit. In total, 100 patients (children and young adults) with pectus excavatum or pectus carinatum, treated by surgery or non-operative methods were included. In patients undergoing non-operative treatment, external 3D scanning was performed monthly until complete correction was achieved. In surgically treated patients, scanning was done before and after surgical correction. In 42 patients, computed tomography (CT) was additionally performed and correlations between the Haller index calculated by CT and the external Haller index using external scanning were investigated using a Student's test (r = 0.83). CONCLUSION External scanning is an effective, objective, radiation-free means to diagnose and follow-up patients with chest wall deformities. Externally measured indexes can be used to evaluate the severity of these conditions and the treatment outcomes.
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Affiliation(s)
- Ana Lain
- Department of Pediatric Surgery, University Hospital of Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Laura Garcia
- Department of Pediatric Surgery, University Hospital of Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Carlos Gine
- Department of Pediatric Surgery, University Hospital of Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Olivier Tiffet
- Department of Adults General Surgery and Thoracic Surgery, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Manuel Lopez
- Department of Pediatric Surgery, University Hospital of Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
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Katrancioglu O, Akkas Y, Karadayi S, Sahin E, Kaptanoğlu M. Is the Abramson technique effective in pectus carinatum repair? Asian J Surg 2018; 41:73-6. [PMID: 27825548 DOI: 10.1016/j.asjsur.2016.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The minimally invasive pectus carinatum (PC) surgery described by Abramson has been performed in many centers. We have been using this technique since 2011. This article describes our experience with PC correction. METHODS Between 2011 and 2016, 32 patients at our institution underwent minimally invasive repair of a PC deformity. All patients presented with cosmetic complaints. The deformity involved the lower sternum (all had chondrogladiolar type PC), and three patients had asymmetrical deformities. All operations followed the principles defined by Abramson. RESULTS Satisfactory esthetic results were achieved in our patients. The hospital stay averaged 5.3 days (range 4-7 days). The most common early complication was pneumothorax, and the most common late complication was wire suture breakage. CONCLUSION The Abramson technique is an effective, minimally invasive procedure for PC with shorter operating and hospitalization times and low morbidity rates.
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Abstract
BACKGROUND Pectus bar removal is the final stage of the procedure for minimally invasive repair of pectus excavatum. Based on our experience with one of the largest scale data, we would like to address the important issues in pectus bar removal, such as appropriate duration of bar maintenance, techniques for bar removal, and strategies to avoid complications. METHODS Between September 1999 and August 2015, we operated on 2,553 patients with pectus excavatum and carinatum using pectus bars for a minimally invasive approach. Among them, 1,821 patients (71.3%) underwent pectus bar removal as a final stage of pectus deformity repair, and their data were analyzed retrospectively to identify the outcomes and adverse effects of the pectus bar removal procedure. The mean age of the patients was 9.13 years (range, 16 months to 44 years) and the male to female ratio was 3.55. The study is approved by the Institutional Review Board (IRB), the ethical committee of Seoul St. Mary's Hospital. The IRB has exempted the informed consent from every patient in this study due to this is a retrospective chart review without revealing any patients' personal data. RESULTS Our technique involved straightening of the bar in a supine position. The overall mean duration of pectus bar maintenance was 2.57 years (range, 4 months to 14 years). The mean duration was 2.02 years (range, 4 months to 7 years) for children under 12 years, 2.99 years (range, 7 months to 9 years) for teenagers aged 12-20 years, and 3.53 years (range, 3 months to 14 years) for adults over 20 years. Forty-eight patients (2.6%) underwent bar removal more than 5 years after bar insertion and 58 patients (3.2%) underwent bar removal earlier than initially planned. The most common adverse reaction after bar removal was wound seroma including infection (43 patients, 2.36%). Recurrence after bar removal occurred in nine patients (0.49%), and seven of these required redo repair (0.38%). CONCLUSIONS Pectus bar removal is a safe and straightforward procedure with a low rate of complication.
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Affiliation(s)
- Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
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Abstract
Major advancements have been made in the surgical repair of congential chest wall deformities. This review highlights selected readings of the experience in correction of pectus excavatum and pectus carinatum. In particular, it summarizes the current standard of care and outcomes of new and modified procedures for patients with chest wall deformities.
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Affiliation(s)
- Anna Lakoma
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Eugene S Kim
- Department of Surgery, Baylor College of Medicine, Houston, Texas..
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Calloway EH, Chhotani AN, Lee YZ, Phillips JD. Three-dimensional computed tomography for evaluation and management of children with complex chest wall anomalies: useful information or just pretty pictures? J Pediatr Surg 2011; 46:640-647. [PMID: 21496531 PMCID: PMC3838878 DOI: 10.1016/j.jpedsurg.2010.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 09/27/2010] [Accepted: 10/14/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Shaded surface display (SSD) technology, with 3-dimensional computed tomography reconstruction, has been reported in a few small series of patients with congenital or acquired chest wall deformities. Shaded surface display images are visually attractive and educational, but many institutions are hesitant to use these secondary to cost and image data storage concerns. This study was designed to assess the true value of SSD to the patient, family, and operating surgeon, in the evaluation and management of these children. METHODS After institutional review board approval, we performed a retrospective review of records of 82 patients with chest wall deformities, evaluated with SSD, from 2002 to 2009. Shaded surface display usefulness, when compared to routine 2-dimensional computed tomography, was graded on a strict numerical scale from 0 (added no value besides education for the patient/family) to 3 (critical for surgical planning and patient management). RESULTS There were 56 males and 26 females. Median age was 15.3 years (range, 0.6-41.1 years). Deformities included 56 pectus excavatum, 19 pectus carinatum, and 8 other/mixed deformities. Six patients also had acquired asphyxiating thoracic dystrophy (AATD). Eleven (13%) had previous chest wall reconstructive surgery. In 25 (30%) patients, SSD was useful or critical. Findings underappreciated on 2-dimensional images included sternal abnormalities (29), rib abnormalities (28), and heterotopic calcifications (7). Shaded surface display changed or influenced operation choice (4), clarified bone vs soft tissue (3), helped clarify AATD (3), and aided in rib graft evaluation (2). Point biserial correlation coefficient analysis (R(pb)) displayed significance for SSD usefulness in patients with previous chest repair surgery (R(pb) = 0.48, P ≤ .001), AATD (R(pb) = 0.34, P = .001), pectus carinatum (R(pb) = 0.27, P = .008), and females (R(pb) = 0.19, P = .044). CONCLUSIONS Shaded surface display, when used to evaluate children and young adults with congenital or acquired chest wall deformities, provides useful or critical information for surgical planning and patient management in almost one third of patients, especially in those requiring a second operation, with acquired asphyxiating thoracic dystrophy, pectus carinatum, and females.
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Affiliation(s)
- E. Hollin Calloway
- Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ali N. Chhotani
- Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yueh Z. Lee
- Department of Radiology, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Duncan Phillips
- Department of Surgery, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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