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At least 739 records · Page 41Linked to original sources
PubMed1999

Anterior chest wall: frequency of anatomic variations in children.

PURPOSE: To evaluate the frequency of anterior chest wall variations in children. MATERIALS AND METHODS: The computed tomographic (CT) images of 200 consecutive infants and children (114 boys and 86 girls; mean age, 10.5 years; age range, 3 months to 19 years) who underwent chest CT during a 20-month period were evaluated for chest wall variations. Children who had undergone chest wall surgery or were suspected of having a chest wall abnormality were excluded. The frequency of chest wall anomalies was compared with age and sex (Fisher exact test). RESULTS: The CT scans of 65 children (33%) depicted one or more variations in the anterior chest wall: titled sternum (n = 29), prominent convexity of anterior rib or costal cartilage (n = 19), prominent asymmetric costal cartilage (n = 20), well-defined paracostal subcutaneous nodule (n = 4), mild pectus excavatum (n = 4), or mild pectus carinatum (n = 4). The frequency of these findings did not vary significantly with age (P = .96) or sex (P = .36). CONCLUSION: Variations in the anterior chest wall are common, occurring in one-third of children, and should be considered normal. These asymptomatic variations should not be considered alarming when palpated at physical examination.

Adolescent↗
PubMed1989

[Surgery in pectus excavatum without fixation aids].

Analysis of 40-year experience with operations for pectus excavatum over the period from 1950-1988 is presented. In a series of 177 children ten different surgical approaches were used in succession. Since 1975 operations were performed exclusively by the method according to Ravitch and Welch which does not apply any fixation splints. The procedure is substantiated by the pathologico-anatomical and metabolic causes of the origin and development of inborn deformities of the chest. The operation consists of several exact procedures on the muscles, cartilages, and sternum, which have to be carried out consistently. The important parts of the surgical procedure are described. Since 1975 the method was used in 28 children, with very good and good results in 92.8%.

Child↗
PubMed2006

Combined severe pectus excavatum correction and aortic root replacement in Marfan's syndrome.

A 23-year-old man with Marfan's syndrome was admitted for repair of annulo-aortic ectasia and severe pectus excavatum. A submammary skin incision approach followed by bilateral subperichondrial resection of abnormal costal cartilages was performed. The left intercostal muscles and perichondrial sheaths were divided 2 inches lateral to the sternum in a parasternal fashion to place the retractor. The aortic root was replaced with a 23-mm St. Jude's composite graft (St. Jude Medical, Inc, St. Paul, MN). Chest wall reconstruction was completed with a high sternal osteotomy and support of the sternum was made with Gortex strips (W.L. Gore & Associates, Inc, Flagstaff, AZ). The patient made an uneventful recovery.

Adult↗
PubMed2000

Is the grass greener? Early results of the Nuss procedure.

BACKGROUND/PURPOSE: Minimal access surgery (MIS, Nuss Procedure) is gaining acceptance rapidly as the preferred method for pectus excavatum repair. This shift in operative management has followed a single institution's evaluation of the procedure. This report describes an additional experience with the Nuss procedure. METHODS: Twenty-one patients with pectus excavatum underwent repair by the Nuss Procedure. The patients ranged in age from 5 to 15 years (average, 8.2 years). There were 19 boys and 2 girls. RESULTS: In 1 patient (age 5 years) the MIS procedure was aborted because of persistence of chest wall asymmetry. The other 20 patients had completion of their procedure without intraoperative complication. The operating times ranged from 45 to 90 minutes; however, there was an additional anesthetic set-up time (average, 45 minutes). All cases utilized a single support bar (11 to 17 inches). Patients underwent extubation in the operating room and were admitted to a ward bed with an epidural catheter in place for pain control and received intravenous analgesia. The hospital stay ranged from 4 to 11 days and averaged 4.9 days. Early postoperative complications included ileus (n = 1), bilateral pleural effusion (n = 2), atelectasis (n = 1), fungal dermatitis (n = 1), pneumothorax (n = 1), and flipped pectus bar (n = 2). Delayed complications included flipped pectus bar (n = 2), marked pectus carinatum requiring bar removal (n = 1), mild carinatum (n = 1), mild bar deviation (n = 1), progressive chest wall asymmetry (n = 3) with 1 requiring bar removal and open pectus repair, pleural effusion (n = 1), and chronic persistent pain requiring bar removal (n = 1). The length of follow-up is 3 to 20 months with an average of 12.3 months. CONCLUSIONS: The Nuss Procedure is quick, minimally invasive, and a technically easy method to learn; however, our data indicate there is a significant learning curve. Although previous reports suggest that few complications occur, we believe further assessment of patient selection regarding age, presence of connective tissue disorder, and severe chest wall asymmetry are still needed. Long-term follow-up also will be required to assure both health professionals and the public that this is the procedure of choice for patients with pectus excavatum.

Adolescent↗
PubMed1994

[Surgical treatment of thoracic wall malformations].

Anterior chest wall deformities in children are the expression of some congenital malformation such as Poland's syndrome and pectus excavatum. The surgical treatment of these malformations affecting children is aimed at correcting large wall defects and stabilizing the chest wall, assuring at the same time chest harmonious growth and postoperative functional assessment. We present the results of the treatment of 2 cases of Poland's syndrome, 20 cases of pectus excavatum and 2 cases of pectus carinatum, with a follow-up of 6 months--9 years.

Cartilage↗
PubMedDate not supplied

Pectus excavatum complicating breast cancer surgery.

Breast cancer surgery in the presence of previous reconstruction for pectus excavatum has not been reported. Such a case is described where simultaneous chest wall resection was undertaken because of fibrous tissue distortion mimicking malignant infiltration. Furthermore, postoperative adhesions necessitated opening the pleural lining during rib resection. This resulted in recurrent pleural effusion from axillary lymphatic leakage that required thoracocentesis. Breast surgery in these circumstances has to be performed with care.

Breast Neoplasms↗
PubMed1997

Surgery of chest wall deformities.

OBJECTIVE: To evaluate the medium-term results of 77 surgical corrections in patients with chest wall deformities, 53 (68.8%) with pectus excavatum and 24 with pectus carinatum, operated upon from 1985 to 1994. METHODS: The mean age of the patients was 14.7 years (4-39 years) and 77% were younger than 15 years of age. There were 59 male (76.7%) and 18 female patients. Only four had a family history of the malformation. Seven patients (9.1%) presented with asthma-like symptoms, and 13 (16.9%) referred dyspnea and tiredness for small efforts. The remainder (74.2%) were asymptomatic, but most were psychologically disturbed by the deformity and postural abnormality. Two patients had other skeletal abnormalities. The modified surgical technique used in all cases consisted of subperichondrial resection of the abnormal costal cartilages, transverse and longitudinal osteotomies of the sternum and internal stabilization with a steel rod which was generally removed between 6 and 12 months postoperatively. RESULTS: There was neither early nor late mortality. One patient had a pneumothorax which required chest tube drainage. The mean admission time was 10.5 days (8-14 days). Follow-up was complete, and 90% of the patients had increased effort tolerance. Five of the seven patients (72%) with 'asthmatic' symptoms showed a decrease in the frequency of the crises. Two patients had recurrence of the depression by 3 and 8 months, respectively. The remaining 75 patients (97.3%) were satisfied with the cosmetic result of the surgery. CONCLUSIONS: Surgical treatment of chest wall deformities using this technique leads to good cosmetic, orthopedic and psychological results. We believe that the operations should be performed at any age in patients who have at least a moderate deformity.

Adolescent↗
PubMed2003

Postpericardiotomy syndrome after minimally invasive pectus excavatum repair unresponsive to nonsteroidal anti-inflammatory treatment.

A 14-year-old boy developed postpericardiotomy syndrome after an otherwise uneventful minimally invasive pectus excavatum repair. Dyspnoea, chest pain, and pericardial effusion progressed despite nonsteroidal anti-inflammatory treatment. The symptoms rapidly resolved with intravenous methylprednisolone, and pericardiocentesis was thus avoided. This is the first report of postpericardiotomy syndrome after the Nuss procedure treated with systemic steroids.

Adolescent↗
PubMed1990

[Effects of surgical correction on pulmonary function in pectus excavatum cases].

Preoperative and postoperative pulmonary function were compared by spirometry in one hundred and eleven cases, from 1980 to 1989, with pectus excavatum deformity. The patients consisted of 85 males and 26 females, aged 5-41 years. In the preoperative examination, mean values for % vital capacity (%VC), % 1 sec. timed vital capacity (FEV1.0%), % residual volume (%RV), % maximal voluntary ventilation (%MVV) were within normal limits. %VC had a tendency to decrease with increase in the degree of depression of the anterior chest wall. Postoperatively, %VC was significantly dropped, although no significant change was seen in FEV1.0%, %RV and %MVV. Seven of 10 cases with low %VC and four of 6 cases with low %VC and %RV preoperatively demonstrated improvement in %VC and %RV after sternal elevation surgery.

Adolescent↗
PubMed1990

[Anesthesia for pectus excavatum].

The incidence of arrhythmia, postoperative complication and pulmonary oxygenation (PaO2) were studied in 48 patients with pectus excavatum scheduled for the Ravitch operation under halothane-nitrous oxide-oxygen (GOF) and enflurane-nitrous oxide-oxygen (GOE) anesthesia. Preoperative abnormalities of ECG were observed in 36 of 18 cases. Main abnormalities were incomplete right bundle branch block, left atrium enlargement, and sinus arrhythmia. Ventricular arrhythmia was observed in 4 of 12 cases during GOF anesthesia, whereas no arrhythmia was observed during GOE anesthesia. In postoperative chest X-ray, pulmonary atelectasis (60%), pleural effusion (48%), and pneumothorax (8%) were observed. The results suggest that GOE is more advantageous for pectus excavatum operation than GOF. Postoperative pulmonary surveillance is important for pectus excavatum operation.

Adolescent↗
PubMed2005

The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum.

PURPOSE: This report describes the authors' experience using a vacuum to pull the abnormal chest wall outward in patients with pectus excavatum. METHODS: A suction cup was used to create a vacuum at the chest wall. A patient-activated hand pump was used to reduce pressure up to 15% below atmospheric pressure. The device was used by 60 patients (56 males, 4 females), aged 6.1 to 34.9 years (median, 14.8 years), for a minimum of 30 minutes, twice a day, up to 5 hours per day (median, 90 minutes). Patient progress was documented using photography, radiography, and plaster casts of the defect. In 14 children this method was used during the Nuss procedure to enlarge the retrosternal space for safer passage of the introducer. RESULTS: Follow-up occurred between 2 and 18 months (median, 10 months). Computed tomographic scans showed that the device lifted the sternum and ribs within 1 to 2 minutes; this was confirmed thoracoscopically during the Nuss procedure. The suction cup enlarged the retrosternal space for safer passage of the introducer. Initially, the sternum sank back after few minutes. After 1 month, an elevation of 1 cm was noted in 85% of the patients. After 5 months, the sternum was lifted to a normal level in 12 patients (20%) when evaluated immediately after using the suction cup. All patients exhibited moderate subcutaneous hematoma, although the skin was not injured. One patient suffered from transient paresthesis in the right arm and leg. Two patients experienced orthostatic disturbances during the first application of the suction cup. There were no other complications. DISCUSSION: In patients with pectus excavatum, application of a vacuum effectively pulled the depressed anterior chest wall forward. The initial results proved dramatic, although it is not yet known how much time is required for long-term correction. CONCLUSIONS: This vacuum method holds promise as a valuable adjunct treatment in both surgical and nonsurgical correction of pectus excavatum.

Adolescent↗
PubMed1991

[Clinical classification and surgical correction of pectus excavatum].

We described the experience in clinical classification and surgical correction of 320 cases of pectus excavatum (1984-1990). The patients age ranged from 2 to 14 years. According to the configuration, the deformity was divided into types: extensive type (7.5%); common type (74.3%); localized type (12.5%); mixed type or irregular (5.6%). We found such as four characteristic signs shoulder anteversion, kyphosis, chest excavation and abdominal bulge. Rotation of sternum, costal margin eversion, chest asymmetry and flat chest were also encountered. All these made the correction very difficult. A reverse "V" shape osteotomy of the sternum and ribs was with internal fixation. Small hand saw, special periosteum elevator and related internal fixation device were designed for the operation. In severe cases, satisfactory result was obtained by the technique combined with other surgical procedure.

Adolescent↗
PubMed2004

Chest wall anomalies: pectus excavatum and pectus carinatum.

Pectus excavatum, the concave depression of the breast bone, comprises most chest wall anomalies. The Nuss procedure, a minimally invasive procedure to correct pectus excavatum, has revolutionized the management of this disease over the past decade. The results and complications of this procedure are discussed. The surgical management of the less common pectus carinatum or "pigeon breast" also is reviewed.

Adolescent↗
PubMed1995

The orthopaedic manifestations of prune-belly (Eagle-Barrett) syndrome.

Forty children were managed for prune-belly syndrome between 1979 and 1989, and twenty-five of them had musculoskeletal abnormalities. The musculoskeletal abnormalities were primary in twenty-two children, secondary to renal osteodystrophy in one, and both primary and secondary to renal osteodystrophy in two. Thirteen children had marked abnormality of the hip, and congenital dislocation was typically resistant to conventional treatment. Scoliosis was seen in seven patients. Pectus excavatum (a chest-wall deformity) was seen in eleven patients, including five of the six who had an idiopathic-like curve. Although prune-belly syndrome is uncommon, the diagnosis necessitates a thorough orthopaedic evaluation because of the high prevalence of associated musculoskeletal abnormalities.

Child↗
PubMed2000

Turnover procedure.

Sternal turnover can be considered an orthotopic bone transplantation in reverse position. It yields immediate stability of the chest and good cosmetic results. Procedures using "pedicled plastrons" (rectal muscles, internal mammary arteries) have been reported; a large series of 300 cases, however, shows satisfying results with free grafts. Technetium-99m isotope studies yielded visualization of the plastron 1 year after sternal turnover. After redo-operations, histopathologic studies gave nearly normal sternal bone marrow findings.

Bone Transplantation↗
PubMed1989

Chest wall deformities in children.

Pectus excavatum and pectus carinatum deformities are not uncommon. Pectus excavatum is associated with definite demonstrable adverse physiologic effects. The psychologic impact of these deformities on the patient can be truly devastating. The clinician must realize the impact and importance of the advice given to patients and their families. Although correction of these deformities is a major surgical undertaking, it is well tolerated, safe, and usually produces a satisfactory result.

Angiocardiography↗
PubMed1989

Evolving management of pectus excavatum based on a single institutional experience of 664 patients.

Most pediatricians and family physicians believe that children with pectus excavatum require surgery only for cosmetic indications and then only in teenagers. We believe pectus excavatum should be repaired in childhood (1) to relieve structural compression of the chest and allow normal growth of the thorax; (2) to prevent pulmonary and cardiac dysfunction in teenagers and adults; and (3) to obviate the cosmetic impact that may cause a child to avoid sports and gymnastics. Preoperative CT scans now help select those children who need repair to prevent progressive deformities. Pulmonary function studies during vigorous exercise can document respiratory dysfunction in teenagers. These features are reversible if repair is completed before the pubertal growth spurt. The ideal age for repair is 4 to 6 years, which permits enough emotional maturity for a positive hospital experience and avoids later psychological effects. Repair at an earlier age has no operative advantages. Our operative technique consists of the removal of three to four overgrown costal cartilages, repositioning of the sternum with a transverse osteotomy, and internal support using the child's lowest normal ribs, avoiding any prosthetic support. To prevent recurrence in teenagers, we add a temporary bar beneath the sternum to prevent depression of the sternum from the weight of the chest-wall muscle mass. Six hundred sixty-four patients have been followed for 1 to 40 years; 95% have excellent long-term results and only 5% have mild to moderate recurrences. Our current techniques of patient selection and surgery will be presented.

Adolescent↗
PubMed1994

Repair of pectus deformities with sternal support.

During the past 25 years, 252 children underwent repair of pectus deformities. There were 195 male and 57 female patients, of whom 227 had pectus excavatum and 25 had pectus carinatum. Of the 252 patients, 113 underwent repair at between 2 and 5 years of age. Exercise limitation was reported by 51%, and 32% had frequent respiratory infections or asthma. Repair was performed through a transverse incision with subperiosteal resection of the lower four or five costal cartilages, from sternum to costochondral junction bilaterally. A transverse wedge osteotomy was made through the anterior table of the sternum, with fracture but no displacement of the posterior table. For children younger than 5 years (n = 108), the periosteal sheath of the fifth rib from each side was sewn together behind the sternal tip. For older patients (n = 136), a thin steel strut was used for sternal support for 6 months. There were no deaths within the first year. Complications included seroma (16), atelectasis (12), pneumothorax (three), and recurrent chest depression (three). More than 98% of patients had improvements in exercise tolerance, endurance, respiratory symptoms, and cosmetic appearance; these improvements were considered excellent results. Operation at an early age with routine use of substernal support with minimal preoperative and postoperative testing has provided excellent results at a low cost.

Adolescent↗