Ravitch Surgery or Dynamic Compression Bracing for Pectus Carinatum: A Retrospective Cohort Study

BACKGROUND

Pectus carinatum is a pediatric condition that can be treated by dynamic compression system (DCS) bracing or surgery. Several publications on DCS bracing or surgery are available; however, they do not compare both treatments.

METHODS

Over a 10-year period, 738 patients with pectus carinatum were treated at the Amsterdam Pectus Center (Amsterdam, The Netherlands). This study describes this 10-year experience and the results of both treatments.

RESULTS

Of the 631 patients who underwent DCS bracing treatment, 553 finished treatment, and 78 patients are still under treatment. A total of 73.8% (n = 408) of these patients finished treatment successfully, 13.6% (n = 75) experienced treatment failure, and 12.7% (n = 70) were lost to follow-up. The success rate decreased with an increasing pressure of initial compression (84.2%-67.3%). Marfan syndrome and Poland syndrome were associated with unfavorable results. Ravitch surgery was performed in 105 patients, with a success rate of 92.4%. Complications occurred in 32.4% of patients, and 6.7% of patients had complications for which surgery was needed. No relationship was found between osteotomy or sternal fixation and outcomes or complications. The Abramson procedure was performed in 2 patients.

CONCLUSIONS

DCS bracing should be the treatment of choice in patients with pectus carinatum because of its noninvasiveness, good results, and lower complication rate compared with surgery. Besides pressure of initial correction, motivation is an important factor influencing outcomes, and compliance remains a major challenge in treating pectus carinatum using DCS bracing. Bracing patients before their growth spurt should be discouraged. Patients with a higher pressure of initial compression (>8.0-8.5 psi) and Marfan syndrome or Poland syndrome have poorer outcomes. In those patients, surgery may be considered.

Prevalence of Hand Malformations in Patients With Moebius Syndrome and Their Management

BACKGROUND

Moebius syndrome is a disorder characterized by facial and abducens nerve paralysis. Patients can present a wide range of upper extremity malformations. Literature focused on orthopedic manifestations of Moebius syndrome shows variability in the prevalence and clinical presentation of upper extremity anomalies. The aim of this work is to evaluate the prevalence of upper extremity malformations in patients with Moebius syndrome, clarify its various clinical presentations, and present treatment strategies for their management.

METHODS

This is a retrospective, cross-sectional study including patients with Moebius syndrome and upper extremity malformations between 2012 and 2019. Data include demographic characteristics, Moebius syndrome subtype, type of malformation, affected extremity, and surgical procedures underwent. Quantitative data were recorded as mean (standard deviation [SD]), and qualitative data were expressed in terms of totals and percentages. Statistical association between Moebius syndrome subtype and development of upper extremity anomalies was evaluated using binary logistic regression.

RESULTS

Twenty-five out of 153 patients (16.3%) presented upper extremity malformations (48% male). Mean age of presentation was 9.08 ± 9.43 years. Sixty-eight percent of the malformations were unilateral. The most common presentations included Poland syndrome and simple syndactyly with 8 cases each (32%), followed by 5 cases of brachysyndactyly (20%), 3 cases of amniotic band syndrome (12%), and 1 case of cleft hand (4%). No statistical association was found between Moebius syndrome subtype and odds ratio for development of upper extremity anomalies. Thirteen patients (52%) underwent reconstructive procedures.

CONCLUSION

Poland syndrome and syndactyly are the most common anomalies in patients with Moebius syndrome. Patients may present with a wide range of hand malformations, each patient should be carefully evaluated in order to determine whether surgical treatment is needed and to optimize rehabilitation protocols.

Levels of 137Cs in game and soil in Opole Anomaly, Poland in 2012-2020

Once deposited, radiocesium remains in the environment for a long time, and constantly enters the food chain. Over time, game species tend to accumulate ¹³⁷Cs by two orders of magnitude more than farm animals. This occurs especially in places heavily contaminated, thus meat products made out of local game should be treated with caution. One of such areas, known as the Opole Anomaly, is located in South-Western Poland and represents one of most ¹³⁷Cs contaminated regions across Europe after the Chernobyl accident. The aim of the study was to find out the ¹³⁷Cs activity in soil and local game, the value of the soil-to-game aggregated transfer factor and to assess the effective dose of the ionising radiation (E_eff) received by consumers of local game meat in years 2012-2019. We examined meat of three common game species: red deer, roe deer and wild boar for ¹³⁷Cs activity. ¹³⁷Cs activity in meat samples ranged from 0.14 to 592 Bq kg^-1. The aggregated transfer factor (T_ag) in game ranged from 0.006 to 0.01 m² kg^-1 f.w. for wild boar, 0.005-0.008 m² kg^-1 f.w. for roe deer, and 0.003-0.004 m² kg^-1 f.w. for red deer. The effective dose received by people who regularly consume local game meat ranged from less than 14.2 µSv y^-1 to 134 µSv y^-1, depending on the amount of differently contaminated game meat consumed annually. Even those for whom game is the only source of meat, consumption of wild boar along with local mushrooms and bilberries will, since 2012, not exceed the regulation limit of ¹³⁷Cs at the level of 1 mSv y^-1. By the best of our knowledge this is the first study regarding ¹³⁷Cs activity in game and risk assessment from the most contaminated "post-Chernobyl" area in Poland.

Deep Inferior Epigastric Perforator Flap for Successful Simultaneous Breast and Chest Wall Reconstruction in a Poland Anomaly Patient

Breast reconstruction in female Poland anomaly remains a surgical challenge with variable chest wall deformity and nipple position. Pedicled latissimus dorsi myocutaneous flap with implant reconstruction may have several drawbacks and complications. Free deep inferior epigastric flap (DIEP) flap is a reliable option for postmastectomy breast reconstruction, but rarely reported in Poland anomaly. We presented a 52-year-old Poland anomaly patient who underwent successful reconstruction for breast and chest wall deformity using DIEP flap. Preoperative ultrasound Doppler study for internal mammary vessels is recommended for microsurgical anastomosis. Care should be taken with regard to the flap inset and the location of the nipple areolar complex.

Poland sequence with dextrocardia: which comes first?

We report on two cases of Poland sequence (defect of the pectoralis major and hand on the same side) with dextrocardia, and review the literature on such patients. In all 16 reported cases, the Poland defect was on the left side, and associated with a rib defect, whereas most cases of Poland sequence involve the right side, and few have a rib defect. The dextrocardia appeared to be a dextroposition, and was not associated with other cardiac defects, whereas isolated dextrocardias (without situs inversus) frequently are. These observations suggest that the dextrocardia associated with Poland sequence is usually secondary to it.

Possibly new multiple congenital anomaly syndrome: cranio-fronto-nasal dysplasia with Poland anomaly

We present a possibly new multiple congenital anomaly syndrome of craniosynostosis, Poland anomaly, cranio-fronto-nasal "dysplasia," and genital and breast anomalies. A similar pattern of anomalies was observed in two previous cases from the literature; however, some peculiar findings suggest that these cases might represent a new multiple congenital anomaly syndrome.

Congenital disorders of the hand and upper extremity

This article summarizes normal formation and growth of the upper limb as a basis for understanding malformation. Shoulder anomalies, including Sprengel's undescended scapula, clavicle pseudarthrosis, cleidocraniodystostosis, and Poland's syndrome, are presented. Classification and examples of limb malformations are discussed as well as neuromuscular disorders, such as obstetric brachial plexopathy, cerebral palsy, and arthrogryposis. The author hopes that this article provides a basic understanding of the evaluation necessary for appropriate counseling and referrals for treatment of the child with hand and upper extremity congenital deformities.

A variant of Poland's syndrome

A case of Poland's syndrome--the association of congenital thoracic abnormalities with ipsilateral syndactyly--in a newborn infant is described. The infant demonstrated unusual manifestations of the syndrome: there was extension of the liver through the chest, and there was absence of a whole arm rather than hypoplasia and syndactyly. The authors describe the investigation and treatment of this infant, and they discuss the diversity of findings in Poland's syndrome.

[Poland-Moebius syndrome. Description of a new case]

A new case of Poland-Moebius syndrome in a male is report and developmental field and developmental field defect is debate.

[Symbrachydactyly--a roentgenographic and clinical study of 126 cases]

One hundred and twenty-six cases of symbrachydactyly were analyzed roentgenographically and clinically. This curious anomaly of the hand is sporadic and of unknown etiology. It is predominantly one-sided, either isolated or combined with ipsilateral pectoral muscle defect (fifty-one cases). On X-ray pictures, the skeletal abnormalities of the hands ranged from mild involvement featured with hypoplastic or aplastic middle phalanges to the most severe involvement in which all the phalanges were missing, providing a continuous spectrum. Even in the mildly affected hands hypoplasia involves all the phalanges and metacarpals, most severely in the middle phanges followed by distal, proximal phalanges and metacarpals in turn. The forearms and arms are less affected than the hands. The tendency is observed in the severely affected hands. In the most severely affected hand all the digits are missing, but there exist several finger-buds which carry often nail rudiments. Synostosis is seen in the remaining hypoplastic metacarpals often and in carpals infrequently. Although remarkable shortening and curving forearm bones are observed often, the humeral involvement remains mild. Abnormalities of muscles and tendons are frequently observed in the hand and forearm. The anomaly is classified roentgenographically into three types: Type I (brachydactyly type) which is featured with fingers having three or two phalanges (fifty-four hands), Type II (partial ectrodactyly type) in which one to four digits have only one phalanx or none(thirty-nine hands), and Type III(total ectrodactyly type) in which all the digits have only one phalanx or none (thirty-five hands). The symbrachydactyly seems to be caused by a extensive defect in an undifferentiated mesenchyme of the arm bud at about developmental stage 16, which may later cause a failure of separation of skeletal and muscular tissues of the hand and forearm or an arrest in their development.