Funnel Chest
Surgical Procedures, Minimally Invasive
Adolescent Psychology
Psychological Tests
Chest Tubes
Publication Bias
Repair of pectus excavatum deformities: 30 years of experience with 375 patients. (1/94)
OBJECTIVE: To review the surgical experience with pectus excavatum chest deformities at UCLA Medical Center during a 30-year period. BACKGROUND: Pectus excavatum is a relatively common malformation that is often symptomatic; however, children's physicians often do not refer patients for surgical correction. METHODS: Hospital records from 375 patients who underwent repair of pectus excavatum deformities between 1969 and 1999 were reviewed. Decrease in stamina and endurance during exercise was reported by 67%; 32% had frequent respiratory infections, 8% had chest pain, and 7% had asthma. The mean pectus severity score (width of chest divided by distance between posterior surface of sternum and anterior surface of spine) was 4.65 (normal chest = 2.56). All patients had marked cardiac deviation into the left chest. Repair was performed with subperiosteal resection of the abnormal cartilages, transverse wedge osteotomy of the anterior sternum, and internal support with a steel strut for 6 months. Repair was performed on 177 children before age 11 years; 38 adults with severe symptoms underwent repair. RESULTS: The mean hospital stay was 3.1 days. With a mean follow-up of 12.6 years, all patients with preoperative respiratory symptoms, exercise limitation, and chest pain experienced improvement. Vital capacity increased 11% (mean) within 9 months in 35 patients evaluated. There were no deaths. Complications included hypertrophic scar formation (35), atelectasis (12), pleural effusion (13), recurrent sternal depression (5), and pericarditis (3). More than 97% had a very good or excellent result. CONCLUSION: Pectus excavatum deformities can be repaired with a low rate of complications, a short hospital stay, and excellent long-term physiologic and cosmetic results. (+info)Surgical correction of pectus excavatum using a retrosternal bar. (2/94)
Pectus excavatum is a progressive congenital deformity for which surgical correction is an established procedure. The method of correction using a stainless steel retrosternal bar to maintain the sternum elevated is, in our experience, the most successful procedure. Successful surgical correction usually requires resection of all deformed costal cartilages with transverse osteotomy of the anterior table of the sternum and internal fixation using a bar anterior to the rib cage but behind the sternum. In the last 13 years 118 patients with this deformity have been evaluated and 72 patients have been surgically corrected by the described procedure. Of these 72 patients, 65 (90 percent) have had excellent or good cosmetic and functional results. The best results were obtained when the child was operated on between the ages of 6 and 10 years, the poorest results in those operated on under the age of 3 or over the age of 20. For a satisfactory result the bar must be left in for at least six months; the best results were obtained in those patients in whom the bar was left in for at least one year. No serious complications have followed the use of this technique. (+info)Pulmonary function changes following surgical correction for pectus excavatum. (3/94)
OBJECTIVE: To assess whether and to what extent pulmonary function returns to normal after surgical correction for pectus excavatum. METHODS: Twenty-seven patients who could be examined in person at the outpatient department of our hospital were included in this study. Of these patients, 24 were boys and 3 were girls, with age ranging from 3 to 16 years (mean: 8.67 years). The mean age at surgery was 4 years and mean years at follow-up was 6.8. Pulmonary function measurements included inspiratory vital capacity (IVC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV/TLC ratio, maximal voluntary ventilation (MVV), forced ventilatory capacity (FVC), forced expiratory volume in one second (FEV1), maximal mid-expiratory flow (MMEF), maximal expiratory flow at 75% vital capacity (V75), maximal expiratory flow at 50% vital capacity (V50), maximal expiratory flow at 25% vital capacity (V25) and breathing reserve ratio (BR). RESULTS: TLC, FRC, MVV, MMEF, V75 and V50 were not different from normal values. IVC, FVC, FEV1 and V25 were significantly decreased compared with normal values. RV and RV/TLC were high in 87.5% cases. CONCLUSIONS: Preoperative symptoms improved substantially after operation. Little airway obstruction was observed postoperatively, suggesting that patients with pectus excavatum should have surgery as early in life as possible, preferably by age 3. (+info)Modified sternal elevation for children with pectus excavatum. (4/94)
OBJECTIVE: To describe our experience in the treatment of pectus excavatum (PE) using a modified sternal elevation procedure. METHODS: From Oct. 1986 to Dec. 1997, 171 patients with PE were admitted to the Department of Pediatric Surgery of the First Hospital of West China University of Medical Sciences. All patients were diagnosed through a history and physical examination. Cardiopulmonary function was assessed by M-mode echocardiography and instrument of pulmonary function in 40 patients before and 4.2 years after surgery which was performed between 1989 and 1994. We performed the following three procedures in the sternal elevation: (1) forming the metal strut in a "arch" shape, (2) suturing the perichondrium into a "pipe" shape, and (3) encouraging patients to do chest expansion exercise after operation. All patients were followed up for 1 to 12 years. RESULTS: The normal contour of the costal cage was enlarged in all but one patient. Exercise tolerance was improved, and cardiac function recovered to the same level as in healthy children, while pulmonary function recovered very slowly after surgery. CONCLUSION: The normal appearance of chest wall can be recovered and normal cardiopulmonary function can be restored by the modified sternal elevation procedure in children with PE. (+info)Repair of pectus excavatum and carinatum deformities in 116 adults. (5/94)
OBJECTIVE: To determine the feasibility of surgically correcting pectus excavatum and carinatum deformities in adult patients. SUMMARY BACKGROUND DATA: Although pectus chest deformities are common, many patients progress to adulthood without surgical repair and experience increasing symptoms. There are sparse published data regarding repair of pectus deformities in adults. METHODS: Since 1987, 116 patients over the age of 18 years with pectus excavatum (n = 104) or carinatum (n = 12) deformities underwent correction using a highly modified Ravitch repair, with a temporary internal support bar. The ages ranged from 19 to 53 years (mean 30.1). Eighty-six patients sought repair after reviewing information regarding pectus deformities available on the Internet. Each patient experienced dyspnea with mild exertion and decreased endurance; 84 had chest pain with activity; 75 had palpitations and/or tachycardia. Seven patients underwent repair for symptomatic recurrent deformities. The mean severity score (chest width divided by distance from sternum to spine) was 4.8. The sternal bar was removed from 101 patients 6 months after the repair without complications. RESULTS: Each of the patients with reduced endurance or dyspnea with mild exercise experienced marked improvement within 6 months. Chest discomfort was reduced in 82 of the 84 patients. Complications included pleural effusion (n = 7), pneumothorax (n = 2), pericarditis (n = 2), dislodged sternal bar (n = 3), and mildly hypertrophic scar (n = 12). Mean hospitalization was 2.9 days; mean blood loss was 122 mL. Pain was mild and of short duration (intravenous analgesics were used a mean of 2.1 days). There were no deaths. With a mean follow-up of 4.3 years, 109 of 113 respondents had a very good or excellent result. CONCLUSIONS: Although technically more difficult than in children, pectus deformities may be repaired in adults with low morbidity, short hospital stay, and very good physiologic and cosmetic results. (+info)Complete congenital sternal cleft associated with pectus excavatum. (6/94)
We report herein a rare case of complete congenital sternal cleft (absent sternum) and anterior pericardial defect in association with pectus excavatum. In neonates with absent sternum, the sternal bars can be easily approximated by simple suture, due to the flexibility of the cartilaginous thorax. There is also little danger of cardiac compression when the repair is performed early in life. If reconstruction is delayed, the increased rigidity of the chest wall and the physiologic accommodation of the thoracic organs to the circumference of the chest render simple approximation impossible, without serious compromise of the heart and lungs. Our patient was a 13-year-old girl, whose case was particularly unusual because of the association of sternal cleft with pectus excavatum. After surgical correction of the pectus excavatum, we were able to construct a sternum by incising the lateral border of each sternal bar, thereby creating flaps that we sutured together at midline. The sternal bars were then approximated by loops of nonabsorbable suture around their circumference. The patient had an uncomplicated course, and at the 12-month follow-up visit, her sternal appearance was normal. (+info)Surgical treatment for pectus excavatum. (7/94)
The aim of this study was to compare clinical outcomes in pectus excavatum patients undergoing a Ravitch operation with those undergoing a Nuss procedure. Retrospective study was conducted on one hundred and twenty three patients who underwent Ravitch operation (n=16) and Nuss procedure (n=107) between 1995 and 2002. Mean age of the patients was 7.9+/-6.2 yr. In the Ravitch group, operation time was 196.9+/-61.0 min, and required 10.2+/-2.6 chondral bone resections. Average hospital stay time was 15.9 days. In the Nuss group, operation time was 67.2+/-33.1 min, and bar removal was required two years after the bar insertion. The length of hospital stay was averagely 8.0 days, and postoperative reoperations were performed in five patients due to bar displacements, while early bar removal was required in one patient. The patient interviews for operation results were conducted and revealed that 92.3% of the patients in the Ravitch group showed good to excellent, while 93.3% of Nuss bar removed patients replied good to excellent. Though Nuss procedure has many advantages, it also has some disadvantages. So, the method of the operation should be selected according to the characteristics of the patient. (+info)A late complication of pectus excavatum repair. (8/94)
We report a late complication of pectus excavatum repair which highlights the importance of a chest X-ray in evaluating chest pain in patients who have had previous chest surgery. It also raises the question of whether or not implanted wires should be electively removed following bony union. (+info)Pectus Excavatum, commonly referred to as "Funnel Chest," is a congenital deformity of the chest wall where the sternum (breastbone) and rib cartilages grow inward, creating a sunken or caved-in appearance of the chest. This condition can vary in severity, from mild to severe, and may affect one's appearance, breathing, and overall health. In some cases, surgical intervention might be required to correct the deformity and improve related symptoms.
Minimally invasive surgical procedures are a type of surgery that is performed with the assistance of specialized equipment and techniques to minimize trauma to the patient's body. This approach aims to reduce blood loss, pain, and recovery time as compared to traditional open surgeries. The most common minimally invasive surgical procedure is laparoscopy, which involves making small incisions (usually 0.5-1 cm) in the abdomen or chest and inserting a thin tube with a camera (laparoscope) to visualize the internal organs.
The surgeon then uses long, slender instruments inserted through separate incisions to perform the necessary surgical procedures, such as cutting, coagulation, or suturing. Other types of minimally invasive surgical procedures include arthroscopy (for joint surgery), thoracoscopy (for chest surgery), and hysteroscopy (for uterine surgery). The benefits of minimally invasive surgical procedures include reduced postoperative pain, shorter hospital stays, quicker return to normal activities, and improved cosmetic results. However, not all surgeries can be performed using minimally invasive techniques, and the suitability of a particular procedure depends on various factors, including the patient's overall health, the nature and extent of the surgical problem, and the surgeon's expertise.
Adolescent psychology is a branch of psychology that focuses on the study of adolescents, their behavior, thoughts, and emotions. This field examines the cognitive, social, and emotional development of adolescents, as well as any challenges or mental health issues they may face during this stage of life. It also involves the application of psychological theories and principles to promote positive adolescent development and address adolescent mental health concerns. Adolescent psychologists work in various settings, including schools, clinics, hospitals, and private practices, providing assessment, diagnosis, treatment, and counseling services to adolescents and their families.
Psychological tests are standardized procedures or measures used to assess various aspects of an individual's cognitive functioning, personality traits, emotional status, and behavior. These tests are designed to be reliable and valid tools for evaluating specific psychological constructs such as intelligence, memory, attention, achievement, aptitude, interests, and values. They can be in the form of questionnaires, interviews, observational scales, or performance-based tasks. The results obtained from these tests help mental health professionals make informed decisions about diagnosis, treatment planning, and educational or vocational guidance for their clients. It is important to note that psychological tests should only be administered, scored, and interpreted by trained and qualified professionals to ensure accurate and meaningful results.
Chest pain is a discomfort or pain that you feel in the chest area. The pain can be sharp, dull, burning, crushing, heaviness, or tightness. It may be accompanied by other symptoms such as shortness of breath, sweating, nausea, dizziness, or pain that radiates to the arm, neck, jaw, or back.
Chest pain can have many possible causes, including heart-related conditions such as angina or a heart attack, lung conditions such as pneumonia or pleurisy, gastrointestinal problems such as acid reflux or gastritis, musculoskeletal issues such as costochondritis or muscle strain, and anxiety or panic attacks.
It is important to seek immediate medical attention if you experience chest pain that is severe, persistent, or accompanied by other concerning symptoms, as it may be a sign of a serious medical condition. A healthcare professional can evaluate your symptoms, perform tests, and provide appropriate treatment.
Chest tubes are medical devices that are inserted into the chest cavity to drain fluid, air, or blood. They are typically used to treat conditions such as pneumothorax (collapsed lung), hemothorax (blood in the chest cavity), pleural effusion (excess fluid in the chest cavity), and chylothorax (milky fluid in the chest cavity).
Chest tubes are usually inserted between the ribs and directed into the chest cavity, allowing for drainage of the affected area. The tubes are connected to a collection system that creates negative pressure, which helps to remove the air or fluid from the chest cavity.
The size and number of chest tubes used may vary depending on the severity and location of the condition being treated. Chest tubes are typically removed once the underlying condition has been resolved and the drainage has decreased to a minimal amount.
Publication bias refers to the tendency of researchers, editors, and pharmaceutical companies to handle and publish research results in a way that depends on the nature and direction of the study findings. This type of bias is particularly common in clinical trials related to medical interventions or treatments.
In publication bias, studies with positive or "statistically significant" results are more likely to be published and disseminated than those with negative or null results. This can occur for various reasons, such as the reluctance of researchers and sponsors to report negative findings, or the preference of journal editors to publish positive and novel results that are more likely to attract readers and citations.
Publication bias can lead to a distorted view of the scientific evidence, as it may overemphasize the benefits and underestimate the risks or limitations of medical interventions. This can have serious consequences for clinical decision-making, patient care, and public health policies. Therefore, it is essential to minimize publication bias by encouraging and facilitating the registration, reporting, and dissemination of all research results, regardless of their outcome.
Thoracic radiography is a type of diagnostic imaging that involves using X-rays to produce images of the chest, including the lungs, heart, bronchi, great vessels, and the bones of the spine and chest wall. It is a commonly used tool in the diagnosis and management of various respiratory, cardiovascular, and thoracic disorders such as pneumonia, lung cancer, heart failure, and rib fractures.
During the procedure, the patient is positioned between an X-ray machine and a cassette containing a film or digital detector. The X-ray beam is directed at the chest, and the resulting image is captured on the film or detector. The images produced can help identify any abnormalities in the structure or function of the organs within the chest.
Thoracic radiography may be performed as a routine screening test for certain conditions, such as lung cancer, or it may be ordered when a patient presents with symptoms suggestive of a respiratory or cardiovascular disorder. It is a safe and non-invasive procedure that can provide valuable information to help guide clinical decision making and improve patient outcomes.
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