RESUMEN
OBJECTIVE: Pectus excavatum repair with the Nuss procedure can be successfully performed in adults. After removing the pectus bars, the anterior chest wall may regress to some degree. The purpose of this study was to clarify the amount of improvement and regression of the chest wall after bar removal. METHODS: In 45 adult patients who underwent the Nuss procedure, the sternovertebral distance (SVD) on lateral chest X-ray was measured (A) before the Nuss procedure, (B) before bar removal, and (C) after bar removal. The average SVD was compared, and the difference between A and C suggesting final sternal elevation and B and C suggesting regression was calculated. The correlation between the duration of bar in situ and the amount of regression was analyzed. RESULTS: The average period of bar in situ was 34.9 ± 5.0 (range 23-45) months. The average SVD-A, SVD-B, and SVD-C values were 58.9 ± 20.0, 89.3 ± 19.1, and 81.6 ± 20.1 mm, respectively, with significant differences among them. Final sternal elevation was 22.7 ± 17.4 mm, and average regression was 7.6 ± 8.6 mm. The correlation coefficient between the duration of bar in situ and the amount of regression was 0.119, suggesting no clear correlation. CONCLUSIONS: In spite of some degree of chest wall regression after bar removal, the Nuss procedure was effective for adult patients with pectus excavatum. The period of bar in situ and chest wall regression had little correlation.
Asunto(s)
Tórax en Embudo , Pared Torácica , Adulto , Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Humanos , Estudios Retrospectivos , Esternón , Pared Torácica/diagnóstico por imagen , Pared Torácica/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: For the evaluation of the chest wall deformity, we adopted a non-invasive 3D body scanning system. The objective of this study is to evaluate surgical effect on the whole thorax using 3D scanning technique before and after Nuss procedure. METHODS: We performed 3D body scanning using Structure Sensor (Occipital Inc, USA) in 11 symmetric patients (average age 13 ± 3.2) under general anesthesia before and after Nuss procedure. Using the scanned data, the improved chest wall was analyzed using 3D-Rugle (Medic Engineering, Japan) imaging software. Preoperative and postoperative 3D data were super-imposed and a thoracic elevating distance in the line of the axial and sagittal section through the deepest point was calculated. Pre- and postoperative external sternal angle (ESA) were calculated from the scanned data. RESULTS: Mean thoracic elevation distance at the deepest point was 38.6 ± 6.1 mm and it was 28.4 ± 5.1 mm and 19.4 ± 4.9 mm at 4 cm and 8 cm cranial side, respectively. Average ESA improved from 3.9 ± 1.6 degrees to 15.0 ± 1.1 degrees after the operation. CONCLUSION: Chest depression was effectively elevated 39 mm at the deepest point after Nuss procedure. An indirect elevation effect by pectus bars was found on the wide area of the anterior chest.
Asunto(s)
Tórax en Embudo/diagnóstico , Imagenología Tridimensional/métodos , Pared Torácica/diagnóstico por imagen , Toracoplastia/métodos , Imagen de Cuerpo Entero/métodos , Adolescente , Adulto , Niño , Tórax en Embudo/cirugía , Humanos , Masculino , Periodo PosoperatorioRESUMEN
For the Nuss procedure in adult patients with pectus excavatum, sufficient sternal elevation is difficult due to the rigid chest wall. To solve the problem, we present a novel rib osteotomy procedure. From the skin incisions on the lateral chest which are the common approach for the Nuss procedure, a surgical drill is used to incise bilateral anterior half of the rib cortex after installing the pectus bars. Osteotomy is done on the ribs next to the points where the bars penetrate the intercostal muscle. After making rib osteotomy, the ribs bend spontaneously like greenstick fracture. Elevation of the stiff anterior chest wall can be achieved by this procedure. Rib osteotomy is also beneficial for pain relief due to the reduction of the strain to the ribs. It could be expected that regression after bar removal is avoided.
Asunto(s)
Tórax en Embudo , Pared Torácica , Adulto , Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos , Osteotomía , Costillas/diagnóstico por imagen , Costillas/cirugía , Esternón , Resultado del TratamientoRESUMEN
The correction of severe asymmetric pectus excavatum is still challenging, especially for adults with a rigid thorax. For the repair of asymmetric cases, we introduce our surgical techniques added to the Nuss procedure. Chondrotomy of the depressed and deformed costal cartilage to elevate the depressed side was performed in a 42-year-old female patient. The depressed chest wall was directly elevated using pectus bars. Her sternal rotation angle improved from 27° to 15° after bar removal. In a 26-year-old male patient, oblique sternotomy and chondrotomy were performed. The sternal rotation angle improved from 26° to 9° postoperatively. These techniques were effective for correcting severe asymmetric pectus excavatum in adults.
Asunto(s)
Cartílago Costal/cirugía , Tórax en Embudo/cirugía , Esternón/cirugía , Procedimientos Quirúrgicos Torácicos/métodos , Pared Torácica/cirugía , Adulto , Cartílago Costal/patología , Femenino , Tórax en Embudo/patología , Humanos , Masculino , Índice de Severidad de la Enfermedad , Esternotomía/métodos , Esternón/patología , Pared Torácica/patologíaRESUMEN
BACKGROUND/PURPOSE: To show the changes of the thorax after bar removal in young children with pectus excavatum in long-term postoperative follow-up. METHODS: A total of 173 patients who underwent Nuss procedure under the age of 10â¯years from January 2005 to December 2013 and underwent bar removal were retrospectively reviewed. Then, Patients who were followed-up for more than 5â¯years after bar removal were selected and assessed. All patients were evaluated with the Haller index (HI) by chest computed tomography before the Nuss procedure. Follow-up after bar removal was done by two-view radiography. Radiographic HI (rHI) change was evaluated from before bar removal, to immediately after bar removal, and 3â¯years and 5â¯years after bar removal. RESULTS: Forty-two patients (35 boys, 7 girls) were followed-up for more than 5â¯years after bar removal. The average age at the Nuss procedure was 6.1⯱â¯1.3â¯years, and the average HI was 5.07⯱â¯1.54. The average age at bar removal was 8.5⯱â¯1.2â¯years. The average rHI was 2.47⯱â¯0.33 before bar removal, 2.75⯱â¯0.50 immediately after bar removal, 3.24⯱â¯0.64 at 3â¯years after bar removal, and 3.46⯱â¯0.91 at 5â¯years after bar removal. The rHI value increased significantly between all periods. CONCLUSIONS: The Nuss procedure for young children may have the risk of recurrence during growth after bar removal. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Tórax en Embudo , Niño , Femenino , Estudios de Seguimiento , Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Humanos , Masculino , Periodo Posoperatorio , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: The aim of this study was to clarify the relationship between the length of the round ligament and the presence of a patent processus vaginalis (PV) based on the hypothesis that a short round ligament is the cause of ovarian inguinal hernia in female infants. METHODS: Between April 2011 and March 2017, 132 girls underwent laparoscopic surgery for inguinal hernia. Before surgery, the presence of ovarian prolapse was diagnosed. We observed the internal inguinal ring laparoscopically and examined the diameter of the PV orifice as well as the round ligament length. Medical records and video records were reviewed to evaluate PV patency and round ligament length. RESULTS: Seventeen of the 132 cases had an ovarian inguinal hernia; all of them were infants. In all infants, with or without a prolapsed ovary, the round ligament was short, causing the ovary and fallopian tube to be close to the hernia orifice over the pelvic brim. In girls aged over 12 months, the round ligament lengths on the hernia side, contralateral open PV side, and contralateral closed PV side were 33.0 ± 9.3, 36.8 ± 7.5, and 41.4 ± 8.5 mm, respectively. The round ligament length in open PV was significantly shorter than in the closed PV, but the difference was smaller in older patients. CONCLUSION: The round ligament, which is the female gubernaculum in the fetus, was shorter in the open PV than in the closed PV in younger girls. The short round ligament results in the ovarian prolapsed hernia.
Asunto(s)
Pesos y Medidas Corporales/métodos , Hernia Inguinal/cirugía , Conducto Inguinal/anatomía & histología , Laparoscopía/métodos , Prolapso de Órgano Pélvico/diagnóstico , Ligamentos Redondos/anatomía & histología , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Hernia Inguinal/complicaciones , Humanos , Lactante , Ovario/cirugía , Prolapso de Órgano Pélvico/complicacionesRESUMEN
PURPOSE: The aim of this study was to show the difference between the pulmonary function of children with mild or severe types of pectus excavatum (PE) and post-operative changes in their predicted vital capacity (%VC) following Nuss procedure. PATIENTS AND METHODS: One hundred and twenty-four of the 208 children who underwent Nuss procedure for PE between January 2007 and March 2016 were deemed eligible for this study and evaluated retrospectively. A spirometry was performed on these children on four occasions: before operation; pre-bar removal; and 1 month and 1 year after bar removal. Ninety-seven of the children who were more than 7 years of age were divided using the Haller Index (HI) into a mild group (n = 54) and a severe group (n = 43) and compared. The children were also divided into three groups based on their age and their %VC was compared at each follow-up occasion. RESULTS: The severe group showed a significantly lower %VC and peak expiratory flow rate than the mild group. %VC change after bar removal showed significantly lower in group aged 11 or over. 43 of the children had spirometry data recorded 1 year after bar removal which, compared with 1 month after bar removal, showed a significant higher %VC in groups aged of 10 or under. CONCLUSION: Nuss procedure in children aged of 10 or under proved to be an advantage in the post-operative pulmonary function.
Asunto(s)
Tórax en Embudo/fisiopatología , Tórax en Embudo/cirugía , Pulmón/fisiopatología , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Masculino , Periodo Posoperatorio , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Espirometría , Resultado del Tratamiento , Capacidad VitalRESUMEN
OBJECTIVES: Patients with pectus excavatum (PE) after prior sternotomy for cardiac surgery present unique challenges for repair of PE. Open repairs have been recommended because of concerns about sternal adhesions and cardiac injury. We report a multi-institutional experience with repair utilizing substernal Nuss bars in this patient population. METHODS: Surgeons from the Chest Wall International Group were queried for experience and retrospective data on PE repair using sub-sternal Nuss bars in patients with a history of median sternotomy for cardiac surgery (November 2000 to August 2015). A descriptive analysis was performed. RESULTS: Data for 75 patients were available from 14 centres. The median age at PE repair was 9.5 years (interquartile range 10.9), and the median Haller index was 3.9 (interquartile range 1.43); 56% of the patients were men. The median time to PE repair was 6.4 years (interquartile range 7.886) after prior cardiac surgery. Twelve patients (16%) required resternotomy before support bar placement: 7 pre-emptively and 5 emergently. Sternal elevation before bar placement was used in 34 patients (45%) and thoracoscopy in 67 patients (89%). Standby with cardiopulmonary bypass was available at 9 centres (64%). Inadvertent cardiac injury occurred in 5 cases (7%) without mortality. CONCLUSIONS: Over a broad range of institutions, substernal Nuss bars were used in PE repair for patients with a history of sternotomy for cardiac surgery. Several technique modifications were reported and may have facilitated repair. Cardiac injury occurred in 7% of cases, and appropriate resources should be available in the event of complications. Prophylactic resternotomy was reported at a minority of centres.
Asunto(s)
Tórax en Embudo/cirugía , Cardiopatías/complicaciones , Prótesis e Implantes , Esternotomía , Esternón/cirugía , Pared Torácica/cirugía , Toracoplastia/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Niño , Femenino , Tórax en Embudo/complicaciones , Cardiopatías/cirugía , Humanos , Masculino , Reoperación , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Ano Imperforado/cirugía , Fundoplicación/métodos , Tórax en Embudo/cirugía , Reflujo Gastroesofágico/cirugía , Enfermedad de Hirschsprung/cirugía , Laparoscopía , Estenosis Hipertrófica del Piloro/cirugía , Niño , Colon/cirugía , Humanos , Complicaciones Intraoperatorias/epidemiología , Procedimientos Ortopédicos/métodos , Pediatría , Complicaciones Posoperatorias/epidemiología , Píloro/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Pectus excavatum involves wide range of chest wall depression. The degree of depression or asymmetry varies between young and adolescent patients. It has not been clear how the deformity progresses as patients grow. To elucidate the change of asymmetric deformity, preoperative computed tomography (CT) scan was evaluated according to different age groups. METHODS: Preoperative CT scans of 154 patients with pectus excavatum were collected and analyzed using Haller's CT index, asymmetric index and sternal rotation angle. Patients were divided into 5 age groups as follows; group 1: 4-6 y (n=53), group 2: 7-9 y (n=25), group 3: 10-12 y (n=25), group 4: 13-15 y (n=23), group 5: 16-23 y (n=28). The degree of asymmetric chest wall deformity was expressed using sternal rotation angle as follows; symmetrical (-5º to +5º), left-mild (-5º to -15º), right-mild (+5º to +15º), right-moderate (+15º to +25º) and right-severe (over +25º). RESULTS: As the age of patients increased, asymmetric index increased from 1.025±0.065 in group 1 to 1.124±0.111 in group 5 and sternal rotation angle also increased from 6.11±8.61 in group 1 to 15.41±11.98 in group 5. In these two parameters, significant difference was seen between group 1 and 4, group 2 and 4, group 1 and 5 and group 2 and 5. However, average CT index revealed no significant difference in any age groups. In group 1, 83% of patients were classified in symmetrical or left- and right-mild. The incidence of right-moderate plus right-severe was 17% in group 1, 20% in group 2, 40% in group 3, 52.1% in group 4 and 50% in group 5. CONCLUSIONS: The degree of chest depression did not show any change in all age groups. Asymmetric deformity on the right side progressed around the age of 10 to 12. Half of patients over the age of 13 showed moderate or severe asymmetry. These results were suggestive to consider the optimum age for the correction of pectus excavatum.
Asunto(s)
Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Tomografía Computarizada por Rayos X , Adolescente , Análisis de Varianza , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Pared Torácica/anomalías , Pared Torácica/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The etiology of pectus excavatum (PE) has not been clarified. In 1944, Sweet (Sweet RH. Pectus excavatum. Ann Surg 1944;119:922-934) mentioned about the possibility of the overgrowth of costal cartilage being involved. However, no additional report that supports his hypothesis is available. In this study, we investigated whether the overgrowth of costal cartilage was an actual cause of PE through measurement of the costal cartilage length in PE patients and healthy controls. MATERIALS AND METHODS: We investigated the length of the fifth and sixth costal cartilages and ribs in PE patients from reconstructed images of 3-dimensional computed tomography. To examine the relative costal cartilage length, we calculated the C/R ratio, defined as the quotient of the costal cartilage length divided by the adjacent rib length, and compared it between PE patients and healthy controls. RESULTS: In PE patients, the C/R ratios were not larger than in healthy controls at any level. At the left sixth, the C/R ratio was significantly smaller in patients than in the healthy control group. DISCUSSION: The results revealed that, in PE patients, relative costal cartilage lengths were not longer than in healthy controls. We conclude that the overgrowth of costal cartilage is not the etiology of PE.
Asunto(s)
Enfermedades de los Cartílagos/complicaciones , Tórax en Embudo/etiología , Adolescente , Adulto , Enfermedades de los Cartílagos/diagnóstico por imagen , Enfermedades de los Cartílagos/patología , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Femenino , Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/patología , Humanos , Hipertrofia/patología , Masculino , Costillas/diagnóstico por imagen , Costillas/patología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: For laparoscopic surgery in pediatric patients, the initial trocar insertion is usually made employing open laparotomy to avoid injury to the viscera. It is safe but somewhat time-consuming for establishing a pneumoperitoneum, and requires additional sutures for anchoring or preventing air leakage. We devised a new initial trocar insertion technique employing an umbilical center incision to shorten the surgical duration and improve the esthetic appearance. PATIENTS AND METHODS: Four hundred and thirty-one pediatric patients were indicated for this umbilical center insertion method (UCM) at 2 pediatric surgical departments. Patients suspected of having umbilical lesions (except for umbilical hernia) or extensive bowel adhesions were excluded. RESULTS: There was no complication associated with UCM. In almost all patients, a pneumoperitoneum was established within 1 minute. The wound was completely within the umbilical ring, and very satisfactory esthetically. DISCUSSION: We consider UCM to be a safe and easy procedure, and acceptable method of initial trocar insertion for pediatric laparoscopic surgery.
Asunto(s)
Laparoscopía/instrumentación , Laparoscopía/métodos , Instrumentos Quirúrgicos , Ombligo/cirugía , Adolescente , Apendicectomía/instrumentación , Apendicectomía/métodos , Niño , Preescolar , Femenino , Gastrostomía/efectos adversos , Gastrostomía/instrumentación , Gastrostomía/métodos , Humanos , Lactante , Recién Nacido , Laparoscopía/efectos adversos , Masculino , Neumoperitoneo Artificial/efectos adversos , Neumoperitoneo Artificial/instrumentación , Neumoperitoneo Artificial/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: The cause of pectus excavatum has been hypothesized to be overgrowth of the costal cartilage. According to this theory, the length of costal cartilages must be longer in the side of deep depression in asymmetric patients. To challenge this hypothesis, we measured the lengths of ribs and costal cartilages and investigated lateral differences. SUBJECTS AND METHODS: Twenty-four adolescent and adult patients with asymmetric pectus excavatum (14-30 years of age) with no history of surgery were investigated in this study. The fifth and sixth ribs and costal cartilages were individually traced to measure their full lengths on 3-dimensional computed tomographic (CT) images. As an index of asymmetry, sternal rotation angle was measured in the chest CT images. Patients with a 21 degrees or greater angle of sternal twist were designated as an asymmetric group and those with an angle of smaller than 20 degrees as a symmetric group. Lateral differences in the fifth and sixth costal and costal cartilage lengths were compared between the groups. RESULTS: On comparison of the costal and costal cartilage lengths in the asymmetric group, the right fifth ribs and costal cartilages were significantly shorter than the left (P = .02 and .03, respectively), and right sixth ribs were also significantly shorter than the left (P = .004), but right sixth costal cartilages were not (P = .31). In the symmetric group, the lengths of the left and right fifth ribs and costal cartilages were showing no significant difference (P = .20 and P = .80, respectively), and those of the sixth ribs and costal cartilage were also showing no significant difference (P = .97 and P = .64, respectively). DISCUSSION: The ribs and costal cartilages on the right side with severer depression were significantly shorter or not different than those on the contralateral side. Based on these findings, the theory of costal cartilage overgrowth is contradictory. The etiology of asymmetric chest deformity should be reevaluated.
Asunto(s)
Enfermedades de los Cartílagos/complicaciones , Cartílago Articular/fisiopatología , Tórax en Embudo/etiología , Costillas/fisiopatología , Pared Torácica/fisiopatología , Adolescente , Adulto , Enfermedades de los Cartílagos/diagnóstico por imagen , Enfermedades de los Cartílagos/fisiopatología , Cartílago Articular/diagnóstico por imagen , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Tórax en Embudo/diagnóstico por imagen , Humanos , Masculino , Pronóstico , Radiografía , Costillas/diagnóstico por imagen , Pared Torácica/diagnóstico por imagen , Adulto JovenRESUMEN
A full-term newborn male infant presented with dyspnea and cleft lip and palate. He was thought to have esophageal atresia with tracheoesophageal fistula. He underwent bronchoscopy before operation that showed a laryngotracheoesophageal cleft (LTEC) type III. The left main bronchus originated from the lower esophagus. His diagnosis was communicating bronchopulmonary foregut malformation (CBPFM) type IA associated with LTEC type III. Enhanced chest computed tomographic scan showed the left pulmonary artery originated from the descending aorta. Staged operations were indicated. At first, reconstruction of the left pulmonary artery was done at 3 months of age. Then at 6 months of age, operations for LTEC (tracheoplasty and esophagostomy) and CBPFM left bronchoplasty were performed. Reconstruction of esophagus was performed at age of 1 year. He is now 3 years old and doing well with a mild degree of bronchomalacia. This is the first report of total reconstruction of CBPFM type IA associated with LTEC.
Asunto(s)
Anomalías Múltiples/cirugía , Bronquios/anomalías , Esófago/anomalías , Laringe/anomalías , Arteria Pulmonar/anomalías , Tráquea/anomalías , Anomalías Múltiples/diagnóstico , Aorta Torácica/anomalías , Bronquios/cirugía , Broncomalacia/etiología , Broncoscopía , Labio Leporino , Fisura del Paladar , Diagnóstico Diferencial , Atresia Esofágica/diagnóstico , Esófago/cirugía , Gastrostomía , Humanos , Recién Nacido , Yeyunostomía , Laringe/cirugía , Pulmón/anomalías , Pulmón/cirugía , Masculino , Arteria Pulmonar/cirugía , Atelectasia Pulmonar/etiología , Estómago/anomalías , Toracotomía , Tráquea/cirugía , Fístula Traqueoesofágica/congénito , Fístula Traqueoesofágica/cirugía , TraqueostomíaRESUMEN
BACKGROUND/PURPOSE: Meconium obstruction of prematurity (MO) often occurs in extremely low-birth weight (ELBW) infants, and its treatment is quite a challenge for neonatologists. We attempted to establish a method of primary treatment for MO of prematurity in ELBW infants. METHODS: An iopamidol enema with 50 cm H(2)O static pressure was performed as the primary treatment. This procedure is safe and effective and we recommend this as the first treatment for MO in ELBW infants. RESULTS: The procedure was performed 50 times in 23 infants and no complications occurred. Out of 23 patients, 20 (88%) improved, but the other 3 did not. In the failure group, the procedure was performed on a significantly later date and the mortality rate was higher (12.5 vs. 67%). CONCLUSIONS: This procedure is safe and effective. We recommend this as the first treatment for MO in ELBW infants.
Asunto(s)
Medios de Contraste/uso terapéutico , Enema/métodos , Enfermedades del Prematuro/terapia , Obstrucción Intestinal/terapia , Yopamidol/uso terapéutico , Femenino , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Recien Nacido Prematuro , Obstrucción Intestinal/etiología , Masculino , Meconio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Objective assessment of the chest in patients with pectus excavatum after the Nuss procedure has not been published. This study evaluated the results of the Nuss procedure using computed tomographic (CT) index (CTi). METHODS: We have performed the Nuss procedure in 382 patients since 1998, and 150 patients who underwent bar removal were included in this study. Computed tomographic scans were obtained before the Nuss procedure and after bar removal, and then preoperative CTi (pre-CTi) and postoperative CTi (post-CTi) were calculated. Computed tomographic scans of 62 age-matched patients without chest deformity were collected as controls. Patients were divided at 10 years of age into the younger and older groups, and groups with mild and severe deformity were defined using a pre-CTi value of 5 as border. These CT indices were compared and statistically analyzed. RESULTS: Mean pre-CTi in all cases was 5.97 +/- 3.31 and improved to 3.08 +/- 0.64. Postoperative CTi was not significantly different from that of the control (2.47 +/- 0.32, P = .17). In the group with mild depression, pre-CTi was 4.15 +/- 0.62, and post-CTi was 2.88 +/- 0.50. Preoperative CTi in the group with severe deformity (7.44 +/- 3.82) improved to 3.25 +/- 0.69. Postoperative CTi values between the severe and mild groups were not significantly different (P = .75). Computed tomographic index of the young group improved from 6.20 +/- 3.58 to 2.93 +/- 0.49 and in older group from 5.50 +/- 2.64 to 3.40 +/- 0.79. These 2 post-CTi values were not significantly different (P = .73). CONCLUSION: Postoperative CT scan could provide objective evaluation of sternal elevation. Mean CTi after the Nuss procedure was statically equivalent to that of the control cohort. Good sternal elevation can be achieved with the Nuss procedure regardless of the severity of chest depression or age.
Asunto(s)
Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/cirugía , Procedimientos Quirúrgicos Torácicos/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Factores de Edad , Estudios de Casos y Controles , Niño , Preescolar , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
An 8-year-old girl presented with abdominal tumor that was discovered incidentally. At surgery, the tumor originated from the retroperitoneal sympathetic trunk; and the histologic diagnosis was ganglioneuroblastoma, nodular (GNBn), unfavorable histology on Shimada's classification, International Neuroblastoma Staging System (INSS) stage 1. This patient was found positive for neuroblastoma (NB) by mass screening at 6 months old. There was no tumor detected, and tumor markers decreased to normal range by 18 months of age. We examined her previous computed tomographic films retrospectively and noticed a mass in the same region indicating that the tumor had been there for 8 years without treatment. This is the first report of infantile mass screening-positive NB appearing after long-term follow-up with unfavorable histology. And the follow-up interval was the longest ever reported. This case is suggestive of considering the natural history and treatment strategies for infantile NBs, and the relationship between infantile NB and ganglioneuroblastoma, nodular. It is important to follow mass screening-positive cases of NB over the long term if wait-and-see policy is adopted.
Asunto(s)
Biomarcadores de Tumor/sangre , Ganglioneuroblastoma/diagnóstico , Neoplasias Retroperitoneales/diagnóstico , Biopsia con Aguja , Niño , Femenino , Estudios de Seguimiento , Ganglioneuroblastoma/patología , Ganglioneuroblastoma/cirugía , Humanos , Inmunohistoquímica , Laparotomía/métodos , Imagen por Resonancia Magnética , Tamizaje Masivo , Observación , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Medición de Riesgo , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The Nuss procedure is a new, minimally invasive technique for the repair of pectus excavatum. We describe our experience with this operation, in a relatively large series in a single institution, and introduce our technical modification for stabilizing the pectus bar. In 107 patients (75 male and 32 female) with pectus excavatum who underwent the Nuss procedure, age at operation ranged from 3 to 23 years old (mean: 7.5+/-4.1) and Haller's CT index ranged from 33 to 2.6 (mean: 6.1+/-3.5). To stabilize the pectus bars, we tied the rib and both edges of the bars with surgical steel wire, 0.8 mm in diameter, using a Duchenne needle to guide the wire behind the rib. Average operating time with this technique (n=100) was 48+/-20 min. The stability of pectus bars after the operation was assessed by lateral chest X-ray films. The position of the center of the pectus bars, facing the sternum at right angles, was classified as excellent. A minimal bar displacement of less than 45 degrees was classified as incomplete. The position of the bars that had rotated 90 degrees was classified as poor. The post-operative course was uneventful in all cases except for three patients who showed wound infection, hemothorax or pneumothorax, independently. Two patients required wire removal due to skin irritation as a late complication. Five patients underwent re-operations due to bar displacement. Among them, only two cases were included in the group of wire fixation. Only five teen-aged patients required a lateral stabilizing bar. Lateral chest X-ray films of 100 patients showed that the position of the pectus bar was excellent in 86 cases, incomplete in 12 cases and poor in two cases. In 70 patients aged less than 10 years, the position in 91% was excellent and in 9% was incomplete. In 30 patients aged 10 years and older, 14 required two pectus bars and the results were excellent in all cases. The other 16 patients with a single bar showed excellent results in eight (50%) cases, incomplete in six (37.5%) and poor in two (12.5%). The wire-fixation technique was safe, effective and time efficient to perform in young cases. Teen-aged patients, however, were at high risk of bar displacement. Therefore, the use of two bars and lateral stabilizing bars are recommended for these high-risk patients.