RESUMEN
INTRODUCTION: Minimally invasive repair of pectus carinatum (MIRPC) has been performed using the Abramson technique in which the bar that compresses the sternum is fixed with steel wires on the ribs. A 14-year-old patient underwent to a MIRPC using a sandwich technique in which two metallic bars fixed with bridges were implanted below the sternum under thoracoscopic vision, and another bar in a subcutaneous tunnel was implanted above. This technique has the potential to avoid specific problems related to the original technique like loosening of support for correction (broken wire), avoidance of induction of pectus excavatum or subcutaneous tissue adhesion.
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Pectus Carinatum , Humanos , Pectus Carinatum/cirugía , Adolescente , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Toracoscopía/métodos , Toracoscopía/instrumentación , Esternón/cirugía , Esternón/anomalías , Hilos Ortopédicos , Resultado del TratamientoRESUMEN
Background: Deformities of the anterior thoracic wall are called pectus: pectus excavatum and pectus carinatum. Pectusexcavatum is characterised by dorsal deviation of the caudal region of the sternum while pectus carinatum consists ofprotrusion of the sternum and/or adjacent cartilage. Both defects may remain symptom-free, but respiratory and cardiacabnormalities have been reported. Another deformity observed in dogs is the swimming dog syndrome, which consists ofthe lateral opening of the thoracic and pelvic limbs, associated with the pedalling movement. These disorders are frequentlyreported in medical practice, are considered rare among canines. This report aims to describe a case of pectus excavatumassociated with the swimming dog syndrome (Case 1) and another case of pectus carinatum (Case 2).Cases: Case 1. An approximately 45-day-old male American Pitbull canine had difficulty standing. Physical examinationrevealed hyperextension of the thoracic and pelvic limb joints and flattening of the thorax. After radiographic examination, pectus excavatum and the swimming dog syndrome were confirmed. The conservative treatment with splinting andhydrotherapy was chosen. At the 3-month follow-up, slight improvement in the limbs and irregular and unsatisfactorygrowth of the thorax leading to episodes of dyspnoea were observed. Case 2. A female Pug, approximately 2 months old,had a thorax deformity. Physical examination revealed thorax protrusion, confirmed on radiography as pectus carinatum.Conservative therapy was provided using compressive bandage. One month later, the tutor reported improvement in thecondition and absence of respiratory changes.Discussion: Pectus deformities has low incidence, and cases to pectus carinatum, there is a sexual predisposition, that is,males are more predisposed, differing from Case 2, a female dog. In the cases of pectus excavatum, no genetic alterationwas directly related to its occurrence...(AU)
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Animales , Masculino , Perros , Pectus Carinatum/patología , Pectus Carinatum/veterinaria , Tórax en Embudo/patología , Tórax en Embudo/veterinaria , Pared Torácica/anomalías , Disnea/veterinaria , Radiografía Torácica/veterinariaRESUMEN
Background: Deformities of the anterior thoracic wall are called pectus: pectus excavatum and pectus carinatum. Pectusexcavatum is characterised by dorsal deviation of the caudal region of the sternum while pectus carinatum consists ofprotrusion of the sternum and/or adjacent cartilage. Both defects may remain symptom-free, but respiratory and cardiacabnormalities have been reported. Another deformity observed in dogs is the swimming dog syndrome, which consists ofthe lateral opening of the thoracic and pelvic limbs, associated with the pedalling movement. These disorders are frequentlyreported in medical practice, are considered rare among canines. This report aims to describe a case of pectus excavatumassociated with the swimming dog syndrome (Case 1) and another case of pectus carinatum (Case 2).Cases: Case 1. An approximately 45-day-old male American Pitbull canine had difficulty standing. Physical examinationrevealed hyperextension of the thoracic and pelvic limb joints and flattening of the thorax. After radiographic examination, pectus excavatum and the swimming dog syndrome were confirmed. The conservative treatment with splinting andhydrotherapy was chosen. At the 3-month follow-up, slight improvement in the limbs and irregular and unsatisfactorygrowth of the thorax leading to episodes of dyspnoea were observed. Case 2. A female Pug, approximately 2 months old,had a thorax deformity. Physical examination revealed thorax protrusion, confirmed on radiography as pectus carinatum.Conservative therapy was provided using compressive bandage. One month later, the tutor reported improvement in thecondition and absence of respiratory changes.Discussion: Pectus deformities has low incidence, and cases to pectus carinatum, there is a sexual predisposition, that is,males are more predisposed, differing from Case 2, a female dog. In the cases of pectus excavatum, no genetic alterationwas directly related to its occurrence...
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Masculino , Animales , Perros , Pared Torácica/anomalías , Pectus Carinatum/patología , Pectus Carinatum/veterinaria , Tórax en Embudo/patología , Tórax en Embudo/veterinaria , Disnea/veterinaria , Radiografía Torácica/veterinariaRESUMEN
Background: Pectus are congenital sternal deformities considered rare in small animals, and they are divided into twotypes. Pectus excavatum causes a concave aspect in the ventral portion of the animals thorax, which is known as funnelchest, while pectus carinatum produces a convex appearance and is therefore called pigeon chest. The etiology of theseanomalies has not yet been fully elucidated, but it is assumed that there is genetic involvement. The diagnosis is basedon clinical examination and is confirmed by thoracic radiography. This report describes a case of pectus carinatum in aone-month-old domestic cat.Case: An unspayed female domestic cat, about one month old, weighing 0.1 kg, was admitted to the Veterinary Hospital ofthe Federal University of Piauí (UFPI). When her history was taken, her owner reported that he had rescued the animal theprevious day and noticed that showed difficulty breathing, so naturally worming and vaccination were not reported. Uponphysical examination, the patient showed an abdominal breathing pattern, severe dyspnea, pale mucosa, nasal discharge,apathy, poor nutritional status (body score 1), signs of apparent dehydration and a temperature of 38.5ºC. Palpation revealedincreased volume in the thoracic region. X-rays were ordered due to suspicion of diaphragmatic injury. The chest X-rayreport indicated ventral segment displacement of the 4th to the 8th sternebra, with accommodation of the cardiac silhouettein the right lateral, left lateral and dorsoventral projections, suggesting pectus carinatum. Pulmonary radiodensity wasalso augmented, with greater intensity in the right middle lobe, an alveolar pattern, radiographic signs suggestive of aninfectious process (pneumonia), and pulmonary hyperinflation. A qualitative analysis revealed cardiac silhouette whosedimensions showed no radiographic evidence of alterations at the moment of the examination. The diaphragmatic domewas intact...(AU)
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Animales , Gatos , Pectus Carinatum/diagnóstico por imagen , Pectus Carinatum/patología , Pectus Carinatum/veterinaria , Anomalías Congénitas/veterinariaRESUMEN
Background: Pectus are congenital sternal deformities considered rare in small animals, and they are divided into twotypes. Pectus excavatum causes a concave aspect in the ventral portion of the animals thorax, which is known as funnelchest, while pectus carinatum produces a convex appearance and is therefore called pigeon chest. The etiology of theseanomalies has not yet been fully elucidated, but it is assumed that there is genetic involvement. The diagnosis is basedon clinical examination and is confirmed by thoracic radiography. This report describes a case of pectus carinatum in aone-month-old domestic cat.Case: An unspayed female domestic cat, about one month old, weighing 0.1 kg, was admitted to the Veterinary Hospital ofthe Federal University of Piauí (UFPI). When her history was taken, her owner reported that he had rescued the animal theprevious day and noticed that showed difficulty breathing, so naturally worming and vaccination were not reported. Uponphysical examination, the patient showed an abdominal breathing pattern, severe dyspnea, pale mucosa, nasal discharge,apathy, poor nutritional status (body score 1), signs of apparent dehydration and a temperature of 38.5ºC. Palpation revealedincreased volume in the thoracic region. X-rays were ordered due to suspicion of diaphragmatic injury. The chest X-rayreport indicated ventral segment displacement of the 4th to the 8th sternebra, with accommodation of the cardiac silhouettein the right lateral, left lateral and dorsoventral projections, suggesting pectus carinatum. Pulmonary radiodensity wasalso augmented, with greater intensity in the right middle lobe, an alveolar pattern, radiographic signs suggestive of aninfectious process (pneumonia), and pulmonary hyperinflation. A qualitative analysis revealed cardiac silhouette whosedimensions showed no radiographic evidence of alterations at the moment of the examination. The diaphragmatic domewas intact...
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Animales , Gatos , Pectus Carinatum/diagnóstico por imagen , Pectus Carinatum/patología , Pectus Carinatum/veterinaria , Anomalías Congénitas/veterinariaRESUMEN
INTRODUCTION: Pectus excavatum (PE) and carinatum (PC) are common in Marfan syndrome (SM) and similar syndromes (SS). Patients can evolve without symptoms. In some there is depression, social adjustment disorders, pulmonary and cardiovascular symptoms in which there is controversy about their relationship with the structural damage of the thorax. OBJECTIVE: To assess the prevalence of the type of thoracic deformity in patients with MS and SS in a historical and current cohort and to analyze the clinical, pulmonary and cardiovascular impact. METHOD: Prospective study. Subjects who met the Ghent criteria and who had a complete clinical record, an echocardiogram and/or magnetic resonance imaging, computed tomography and respiratory function tests were included. RESULTS: Of a total of 338 patients with MS and SS, 112 cases with thoracic deformity were detected, the prevalence of PE and PC in SM 13.6 and 12.4, respectively, was lower in SS. There is compression and displacement of lung and right cardiac cavities by PE and the correlation between the Haller Index and the increased PASP is 44 (p = 0.009). CONCLUSIONS: The prevalence of PE and PC in SM and SS is high, which impacts on lung function and cardiovascular damage, requires corrective management of the thoracic deformity and not only implies for aesthetic purposes.
INTRODUCCIÓN: El pectus excavatum (PE) y el pectus carinatum (PC) son frecuentes en el síndrome de Marfan (SM) y en síndromes similares (SS). Los pacientes pueden evolucionar sin síntomas. En algunos hay depresión, trastornos de adaptación social, síntomas pulmonares y cardiovasculares, en los cuales hay controversia de su relación con el daño estructural del tórax. OBJETIVO: Evaluar la prevalencia del tipo de deformidad torácica en pacientes con SM y SS en una cohorte histórica y analizar el impacto clínico, pulmonar y cardiovascular. MÉTODO: Estudio prospectivo. Se incluyeron sujetos con criterios de Ghent y características específicas de cada síndrome, con expediente completo, ecocardiograma o resonancia magnética y tomografía computada, y pruebas de función respiratoria. RESULTADOS: De un total de 338 pacientes con SM y SS, se detectaron 112 casos con deformidad torácica. Prevalencia de PE y PC en SM: 13.6 y 12.4; fue menor en SS. Hay compresión y desplazamiento de pulmón y cavidades cardiacas derechas por PE. Hay correlación entre el Índice de Haller y la presión sistólica de la arteria pulmonar incrementada es de 44 (p = 0.009). CONCLUSIONES: La prevalencia de PE y PC en el SM y SS es alta, lo cual impacta en la función pulmonar y cardiovascular, en esas condiciones se requiere del manejo correctivo de la deformidad torácica y el objetivo no es estético.
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Tórax en Embudo/epidemiología , Síndrome de Marfan/complicaciones , Pectus Carinatum/epidemiología , Adolescente , Adulto , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Niño , Preescolar , Ecocardiografía/métodos , Femenino , Tórax en Embudo/complicaciones , Tórax en Embudo/etiología , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/etiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pectus Carinatum/complicaciones , Pectus Carinatum/etiología , Prevalencia , Estudios Prospectivos , Pruebas de Función Respiratoria , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: To report our experience in the treatment of pectus carinatum by using the dynamic compression system. MATERIAL AND METHODS: Retrospective study during the period from January 2005 to September 2017. Patients with typical condrogladiolar pectus carinatum and correction pressure (PC) ≤ 14 PSI (pound square inch) were included. Exclusion criteria: patients with previous thoracic surgery, mixed malformations and chondromanubrial pectus carinatum. For the treatment, the Dynamic Thoracic Compressor System (FMF) with pressure meter in PSI was used. The PC, the treatment pressure (PT), the correction time (TC) and the maintenance time (TM), recurrences and complications were analyzed. A qualitative scale was measured in three grades: where A is excellent or very good, B is regular and C is bad. RESULTS: We treated 104 patients under 18 years of age. The PT was 2.26. The average of the TC was 8.8 months. The TM was on average 8 months. 36.5% of the patients finished the treatment, 36.5% still continue in treatment and 26.9% of the patients lost the follow-up due to desertion. The qualitative assessment was positive in 95.5% of our patients, and unfavourable in 4.5%. CONCLUSION: The non-surgical treatment of pectus carinatum is efficient, non-invasive and of low morbidity. Regarding the high dropout rate, we must analyze the variables to be modified to reduce it. This treatment should be considered as the first option to correct pectus carinatum in patients with flexible thorax.
OBJETIVO: Describir nuestra experiencia en el tratamiento del pectus carinatum mediante el uso del sistema de compresión dinámico. MATERIALES Y METODOS: Estudio retrospectivo durante el período de enero de 2005 a septiembre de 2017. Se incluyeron pacientes con pectus carinatum condrogladiolar típico y presión de corrección (PC) ≤ 14 PSI (pound per square inch). Criterios de exclusión: pacientes con cirugía torácica previa, malformaciones mixtas y condromanubriales. Para el tratamiento se utilizó el sistema compresor torácico dinámico (FMF) con medidor de presión en PSI. Se analizaron la PC, la presión de tratamiento (PT), el tiempo de corrección (TC) y el tiempo de mantenimiento (TM), recidivas y complicaciones. Se realizó una escala cualitativa medida en tres grados: donde A es excelente o muy bueno, B regular y C malo. RESULTADOS: Tratamos 104 pacientes menores de 18 años. La PT fue de 2,26. El promedio del TC fue de 8,8 meses. El TM fue en promedio de 8 meses. El 36,5% de los pacientes finalizaron el tratamiento, 36,5% aún continúan en tratamiento y 26,9% de los pacientes se perdió el seguimiento por deserción del mismo. La valoración cualitativa fue positiva en el 95,5% de nuestros pacientes, y desfavorable en el 4,5%. CONCLUSION: El tratamiento no quirúrgico del pectus carinatum es eficiente, no invasivo y de baja morbilidad. Respecto a la alta tasa de deserción, debemos analizar las variables a modificar para disminuirla. Este tratamiento debe ser considerado una opción de primera elección, para corregir el pectus carinatum en pacientes con tórax flexible.
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Procedimientos Ortopédicos/métodos , Pectus Carinatum/terapia , Presión , Adolescente , Niño , Femenino , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Resumen Las deformidades de la caja torácica se pueden dividir en dos tipos, las que son productos del desarrollo anormal del pecho en el crecimiento y las congénitas que son las secundarias a una malformación estructural del pecho evidente en el nacimiento. Las malformaciones del desarrollo son las más comunes, como por ejemplo pectus excavatum o pectun carinatum. Las menos comunes son las de tipo congénito: síndrome de Poland, displasia espondilotorácica, displasia espondilocostal, síndrome de Jeune y los defectos de la costilla o el esternón. Las deformidades del pecho de tipo congénita se caracterizan por afectar la relación entre la columna vertebral, la caja torácica y los pulmones. La mayoría de estos pacientes desarrollan un disturbio respiratorio progresivo de tipo restrictivo conocido como Síndrome de Insuficiencia Torácica. Este síndrome se define como la deficiencia de la caja torácica para mantener una respiración normal y sostener el crecimiento fisiológico del pulmón. En este artículo discutiremos varias condiciones que afectan el desarrollo y función de la caja torácica.
Chest wall deformities are divided as an abnormal development during the growth or those secondary to a congenital malformation. The developmental type is the most common: pectus excavatum or pectus carinatum. The less common are the congenital types of chest wall abnormalities: Poland's syndrome, Jeune's syndrome, espondylothoracic dysplasia, espondylocostal dysplasia and defects of the ribs or sternum. The congenital type usually affects the relationship between the spine, rib cage and the lungs. Therefore, many of these patients will develop a progressive respiratory disturbance of restrictive type known as Thoracic Insufficiency Syndrome. Thoracic insufficiency syndrome is defining as a deficiency of the rib cage to maintain a normal respiration and to sustain the physiological growth of the lungs. In this article will discuss several conditions that will affect the development and function of the chest wall.
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Humanos , Osteocondrodisplasias/diagnóstico , Síndrome de Poland/diagnóstico , Tórax/anomalías , Pectus Carinatum/diagnóstico , Tórax en Embudo/diagnóstico , Osteocondrodisplasias/terapia , Síndrome de Poland/terapia , Pectus Carinatum/terapia , Tórax en Embudo/terapiaAsunto(s)
Humanos , Femenino , Adolescente , Radiografía Torácica , Pectus Carinatum/diagnóstico por imagenAsunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Recién Nacido/crecimiento & desarrollo , Recién Nacido/fisiología , Tórax/anomalías , Tórax/embriología , Tórax/crecimiento & desarrollo , Tórax en Embudo/embriología , Tórax en Embudo , Costilla Cervical/anomalías , Pectus Carinatum , Displasia Tanatofórica/patologíaRESUMEN
Background: The deformities of the anterior chest wall are universally designated as pectus deformities. Two types of deformities are known, pectus excavatum and pectus carinatum. Pectus excavatum is a dorsal ventral narrowing of the chest, also known as funnel chest, while pectus carinatum is a ventral protrusion of the sternum, also known as pigeon breast. Both are diseases seen in children and adolescents, however, they are considered rare in small animals, especially pectus carinatum. Thus, the aim of this study is to report a case of pectus carinatum in a Shih-tzu puppy dog. Case: A male canine Shih-tzu, 2 months-old, was present at the veterinary hospital. The owner reported that in the first days of life, the animal felt difficulty breathing when she took him in her lap, and still noticed abnormal increase of the thoracic region. The patient was from a litter of eight pups, without consanguinity, and the parents showed no congenital abnormality. During the interview, it was reported that the patient was eating and drinking water normally, and presented an active temperament. Moreover, he had one dose of vaccine and a dose of anthelminthic. On clinical examination, all physiological parameters were normal. However, during palpation, it was observed swelling in the ventral thoracic region. For that, we suspected pectus carinatum. Chest radiograph was ...(AU)
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Animales , Perros , Pectus Carinatum/diagnóstico , Pectus Carinatum/veterinaria , Disnea/veterinaria , Tórax/anomalías , Anomalías Congénitas/veterinariaRESUMEN
Background: The deformities of the anterior chest wall are universally designated as pectus deformities. Two types of deformities are known, pectus excavatum and pectus carinatum. Pectus excavatum is a dorsal ventral narrowing of the chest, also known as funnel chest, while pectus carinatum is a ventral protrusion of the sternum, also known as pigeon breast. Both are diseases seen in children and adolescents, however, they are considered rare in small animals, especially pectus carinatum. Thus, the aim of this study is to report a case of pectus carinatum in a Shih-tzu puppy dog. Case: A male canine Shih-tzu, 2 months-old, was present at the veterinary hospital. The owner reported that in the first days of life, the animal felt difficulty breathing when she took him in her lap, and still noticed abnormal increase of the thoracic region. The patient was from a litter of eight pups, without consanguinity, and the parents showed no congenital abnormality. During the interview, it was reported that the patient was eating and drinking water normally, and presented an active temperament. Moreover, he had one dose of vaccine and a dose of anthelminthic. On clinical examination, all physiological parameters were normal. However, during palpation, it was observed swelling in the ventral thoracic region. For that, we suspected pectus carinatum. Chest radiograph was ...