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Chest wall deformities
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Robert E. Kelly, Marcelo Martinez-Ferro, Horacio Abramson
Pectus excavatum is the most common chest wall deformity in infants, children, and adolescents. Its incidence is estimated at 1 in 400 live births and has a male to female ratio of 4 : 1. The etiology of pectus excavatum is unknown. It has a genetic predisposition with patients having a family history of chest wall deformities in 35–40% of cases. Excavatum patients may have a family history of a carinate or protrusion deformity. The pectus excavatum depression is created by two components: Sternum and costal cartilages, with different morphology in different patients. The pectus excavatum depression may be symmetric or asymmetric. In the asymmetric deformities, the more acute and severe depression is more commonly on the right side. The rarest configuration of pectus excavatum is a combination of ipsilateral depression and a contralateral carinate protrusion. In some series, 90% of cases are noted within the first year of life, but in others the lesion is noted more commonly after the onset of the pubertal growth spurt. The great majority of carinate deformity is noted after the pubertal growth spurt.
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
All of the options provided are possible causes of pectus excavatum. The imaging features described are consistent with underlying diagnosis of Marfan syndrome, which is a connective tissue disorder. Skeletal features in this condition include posterior vertebral body scalloping due to dural ectasia, scoliosis, spondylolisthesis, acetabular protrusion and arachnodactyly. Cardiac complications in this condition include aortic root dilatation, mitral valve regurgitation and aortic dissection. Cardiac disease is the cause of death in 90% of patients. Homocystinuria is rare. Patients can have Marfanoid features, and mortality in these patients is also mostly due to cardiovascular complications. Screening for this condition is performed in the neonate with the heel-prick test. Patients often have developmental delay.
Hybrid Approach to Repair of Acquired Thoracic Dystrophy in an Adult Patient after Failed Childhood Ravitch Procedure
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Repair of recurrent pectus excavatum with or without ATD is a complex operation that often involves significant perioperative risk of morbidity and mortality. Patients undergoing surgical repair of recurrent pectus excavatum, regardless of the technique, have considerable amount of postoperative pain and require long periods of recovery before becoming fully functional. Careful patient selection is important in ensuring successful outcomes after surgery.
Non-Neural (S-100 Negative) Bronchial Granular Cell Tumor Causing Acute Respiratory Failure
Published in Fetal and Pediatric Pathology, 2020
Stephanie Y Chen, Arhanti Sadanand, Patrick A Dillon, Mai He, Louis P Dehner, David S Leonard
A previously healthy 9-year-old female with a history of pectus excavatum presented to a local hospital with shortness of breath and nausea. Chest radiograph demonstrated right middle/lower lobe opacification, thought to be pneumonia, and she was placed on an oral antibiotic. However, she continued to have an increasing oxygen requirement despite antibiotics, and a chest computed tomography (CT) demonstrated a 3.7 cm endobronchial lesion within the right upper bronchus with rightward tracheal deviation (Figure 1). She developed respiratory failure, requiring intubation within two days of presentation and was transferred to our institution. Direct laryngoscopy and bronchoscopy revealed an obstructing endobronchial mass arising from the right upper lobe bronchus, occluding the middle and inferior lobar bronchi. Debulking cleared the middle and lower lobe bronchi allowing extubation on postoperative day one to high-flow nasal cannula and eventual weaning to room air.
REVIEW OF THE INTERNATIONAL LITERATURE
Published in American Journal of Clinical Hypnosis, 2018
The authors present a study on the uses of self-hypnosis training to help patients with severe postoperative pain. All patients in this study had been diagnosed with pectus excavatum, which is a rare condition affecting one in 300 to 500 people overall, albeit with a higher incidence rate in males. Patients with pectus excavatum have a malformation of their chest and rib area that causes their chest to develop a “caved-in” appearance. This malformation of the chest area can be corrected with a surgery known as the Nuss procedure, although this procedure is sometimes associated with severe postoperative pain. The authors trained 24 adolescents, who were about to undergo the Nuss procedure, in self-hypnosis training for analgesia to see if the patients might cope better with their pain than a control group which did not receive training in self-hypnosis. The patients who received training in self-hypnosis reported lower mean and maximum pain intensity scores. These patients also used less morphine equivalents per hour over time compared to the patients who did not receive training in self-hypnosis. The authors also reported that the patients who received self-hypnosis training had shorter overall lengths of stay in the hospital compared with the patients in the control group.
Bone-cartilage proportion in deformed ribs of male pectus excavatum patients
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Tomohisa Nagasao, Niyazi Aizezi, Masahiko Noguchi, Tadaaki Morotomi, Hiroo Kudo, Tetsukuni Kogure
The studies of Park and Nakaoka appear similar to the present study. However, their studies were conducted to clarify the etiological cause of pectus excavatum; we conducted the present study seeking to perform surgery more effectively. Thus, the present study is different from previous anthropometric studies in terms of purpose. This characteristic aspect of the present study is reflected by having set a marking point at the most ventral point (PP). No previous study defined this point as a marking point.