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Pectus in children

Celine Delestrain, Naziha Khen-Dunlop, Alice Hadchouel, Pierrick Cros, Héloïse Ducoin, Michael Fayon, Isabelle Gibertini, André Labbé, Géraldine Labouret, Marie-Noëlle Lebras, Guillaume Lezmi, Fouad Madhi, Guillaume Thouvenin, Caroline Thumerelle, Christophe Delacourt
BACKGROUND AND OBJECTIVES: The actual frequency of respiratory symptoms related to congenital pulmonary malformations (CPMs) remains undetermined. The goal of this study was to prospectively evaluate the respiratory symptoms occurring in infants with prenatally diagnosed CPMs, identify factors associated with the occurrence of these symptoms, and evaluate their resolution after surgery. METHODS: Infectious and noninfectious respiratory symptoms were prospectively collected in a French multicenter cohort of children with CPMs...
February 15, 2017: Pediatrics
Nadja Apelt, Joshua Schaffzin, Christina Bates, Rebeccah L Brown, Marc Mecoli, Senthilkumar Sadhasivam, Victor Garcia
BACKGROUND: Pectus excavatum repair (PEX) is among the most painful thoracic procedures performed. Continuous peripheral nerve blockade (CPNB) is known to be efficacious in optimizing pain control while limiting narcotic use in adult thoracic procedures. It was introduced in May 2015 as a bridge to oral pain control in children undergoing PEX. Consequently, the surgical site infection (SSI) rate increased from 2.7% to 27.7%. METHODS: SSI surveillance followed national guidelines...
January 6, 2017: Journal of Pediatric Surgery
François Roubertie, Sowmya Ramanan, Frederic Lavrand, Jean-Benoit Thambo
Aortic root aneurysms associated with severe pectus excavatum caused by Marfan's syndrome can be challenging to correct in children. Recent reports suggest single-stage correction of both cardiac and chest wall deformities through a median sternotomy. We report a 9-year-old girl with Marfan's syndrome, an ascending aorta aneurysm, mitral regurgitation, and pectus excavatum, who underwent David's procedure with mitral valve repair and the Nuss procedure to correct the thoracic deformity. This single-stage combined procedure was performed through a left anterolateral thoracotomy...
December 2016: Annals of Thoracic Surgery
A Durry, C Gomes Ferreira, T Tricard, P Gicquel, F Becmeur
INTRODUCTION: Pectus excavatum (PE) is the most common deformity of the anterior thoracic wall. The Nuss technique allows the thorax to be reshaped with the aid of a retrosternal metallic bar. The aim of this study is to evaluate and compare the complication rate between the original Nuss technique and a lightly modified approach. MATERIAL AND METHOD: We performed a retrospective single-center observational study based on the medical files of patients operated for PE in the Pediatric Surgery Unit between July 2004 and July 2015...
November 4, 2016: Annales de Chirurgie Plastique et Esthétique
Donald Nuss, Robert J Obermeyer, Robert E Kelly
Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. Thus far, genetic studies support an autosomal recessive heritability, which coincides with only 40% of our patients having some positive family history, but is also contradictory given a constant sex ratio of 4:1 in favor of males. This inconsistency may be explained by the effect of more than one pectus disease-associated allele. Once the deformity is noticed, it tends to progress slowly until puberty, when rapid progression is often seen...
September 2016: Annals of Cardiothoracic Surgery
Johanne Jeppesen Lomholt, Elisabeth Brammer Jacobsen, Mikael Thastum, Hans Pilegaard
BACKGROUND: The impact of correction of pectus excavatum (PE) on adolescents' health-related quality of life (HRQL) has only been investigated in prospective designs using disease-specific measures and without controls. The aim of this prospective study was to evaluate the HRQL before and after surgical correction of PE using a generic HRQL measure, and to compare the reported level of HRQL before surgery with an age-comparable control group. METHODS: Patients (n=107) and one of their parents (n=106) completed the generic HRQL measure: the Child Health Questionnaire before, 3 months, and 6 months after correction for PE...
September 2016: Annals of Cardiothoracic Surgery
Benjamin A Keller, Sandra K Kabagambe, James C Becker, Y Julia Chen, Laura F Goodman, Julianna M Clark-Wronski, Kenneth Furukawa, Rebecca A Stark, Amy L Rahm, Shinjiro Hirose, Gary W Raff
BACKGROUND: Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia. METHODS: A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n=26) or thoracic epidural analgesia (n=26) from March 2013 to January 2016 was conducted...
December 2016: Journal of Pediatric Surgery
Ryoji Tauchi, Noriaki Kawakami, Taichi Tsuji, Tetsuya Ohara, Yoshitaka Suzuki, Toshiki Saito, Ayato Nohara
PURPOSE: Pectus excavatum can negatively impact cardiac function during scoliosis surgery. Several authors reported severe hypotension associated with the prone position during scoliosis surgery in children that had both scoliosis and pectus excavatum. However, we could find no studies that evaluated the change in the thoracic factors, such as sternal tilt angle and Haller index after scoliosis surgery in patients with both scoliosis and pectus excavatum. The purpose of this study is to evaluate the change in thoracic factors after surgical treatment for scoliosis associated with pectus excavatum...
August 27, 2016: European Spine Journal
Geoff Frawley, Jacinta Frawley, Joe Crameri
BACKGROUND: Pectus excavatum (PE) is the most common congenital chest wall deformity, occurring in 1 : 1000 children with a male to female ratio of 4 : 1. Several procedures have been described to manage this deformity, including cartilage resection with sternal osteotomy (the Ravitch procedure) and a minimally invasive repair technique (the Nuss procedure). While initially described as a nonthoracoscopic technique, the current surgical approach of the Royal Childrens Hospital involves thoracoscopic assistance...
November 2016: Paediatric Anaesthesia
Stephanie Zesch, Stephanie Panzer, Wilfried Rosendahl, John W Nance, Stefan O Schönberg, Thomas Henzler
PURPOSE: The aim of this study was to systematically reinvestigate the first human mummy that was ever analyzed with X-ray imaging in 1896, using dual-source computed tomography (DSCT) in order to compare the earliest and latest imaging technologies, to estimate preservation, age at death, sex, anatomical variants, paleopathological findings, mummification, embalming and wrapping of the child mummy from ancient Egypt. Radiocarbon dating was used to determine the mummy's age and to specify the child's living period in the Egyptian chronology...
2016: European Journal of Radiology Open
Wei Ma, Jinfeng Wang, Yuping Xie
The primary etiopathology of pediatric OSAHS includes tonsil or adenoid hypertrophy. Severe OSAHS contributes to or aggravates thoracic deformity, which is rarely reported. In the current report, This children sleep snoring more than 4 years, increasing with thoracic severe depression during sleep 2 days. Clinical examination indicated tonsil and adenoid hypertrophy, and polysomnography revealed OSAHS . The symptoms of OSAHS and severe inhalation-related sternum depression disappeared rapidly after tonsillectomy...
March 2016: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Betül Kozanhan, Betül Başaran, Feride Aygın, İbrahim Akkoyun, Sadık Özmen
Laparoscopic repair has several advantages with a minimally invasive surgical option for children with Morgagni hernias; however, a number of physiological sequelae results from pneumoperitoneum and insufflation. These physiological changes may be more significant in patients with a congenital heart disease. Perioperative detailed evaluation, meticulous monitorization and cooperation with a surgical team are important in cases with patent foramen ovale for the possible risk of the paradoxical gas embolism. We present the anaesthetic management of a patient with patent foramen ovale, Down syndrome and pectus carinatus who successfully underwent laparoscopic Morgagni hernia repair...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
Asad Siddiqui, Andrew Tse, James E Paul, Peter Fitzgerald, Bernice Teh
INTRODUCTION: Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children's hospital, in patients undergoing the Nuss procedure...
2016: Local and Regional Anesthesia
C Baptista, B Bertrand, C Philandrianos, N Degardin, D Casanova
Lipofilling or fat grafting transfer is defined as a technique of filling soft tissue by autologous fat grafting. The basic principle of lipofilling is based on a harvest of adipose tissue, followed by a reinjection after treatment. Lipofilling main objective is a volume defect filling, but also improving cutaneous trophicity. Lipofilling specificities among children is mainly based on these indications. Complications of autologous fat grafting among children are the same as those in adults: we distinguish short-term complications (intraoperative and perioperative) and the medium and long-term complications...
October 2016: Annales de Chirurgie Plastique et Esthétique
Takashi Inoue, Kenichi Akashi, Masako Watanabe, Yuichi Ikeda, Shuichi Ashizuka, Takanori Motoki, Ryohei Suzuki, Nagatoshi Sagara, Noriyuki Yanagida, Sakura Sato, Motohiro Ebisawa, Shoichiro Ohta, Jyunya Ono, Kenji Izuhara, Toshio Katsunuma
BACKGROUND: There are some biomarkers for asthma diagnosis but they are often difficult in clinical use, particularly in pediatric cases. Periostin is an extracellular matrix protein, upregulated in response to IL-4 or IL-13. Serum periostin is expected to be used as a non-invasive biomarker for asthma diagnosis and management. METHODS: Twenty-eight children with asthma (BA) and 27 children without asthma (patients with pectus excavatum, etc. as control group) aged 6-16 years were included...
2016: Pediatric Allergy and Immunology
Esra Akyüz Özkan, Hashem E Khosrashahi, Halil İbrahim Serin, Bayram Metin, Mahmut Kılıç, U Aliye Geçit
OBJECTIVES: Pectus excavatum (PE) is one of the most common skeletal deformities of childhood. The study was undertaken to assess cardiac functions in children with PE. METHODS: Echocardiography was performed on 32 children with PE and 40 age-matched healthy controls. The following parameters were monitored: meridional left ventricular (LV) wall stress (WSM), arterial elastance (Ea), LV elastance at end-systole derived by single beat (Ees(sb)), LV circumferential end-systolic wall stress (ESWSc), midwall shortening fraction (SFmid), predicted midwall fiber shortening for a measured fiber stress (midwall VCFc), myocardial fiber stress (MFS), LV end-systolic dimension (LVES), LV end-diastolic dimension (LVED) and end-systolic blood pressure (Pes), LV wall thickness at end-systole (hes)...
July 2016: Interactive Cardiovascular and Thoracic Surgery
M Lučenič, M Janík, P Juhos, A Garchar
INTRODUCTION: Pectus excavatum is the most common congenital chest wall deformity. Aproximatelly 1 out of 400 to 1000 newborns are affected by this diagnosis. Surgical correction is indicated in patients that fulfil the indication criteria. The highly modified Ravitch correction (HMRR) and minimally invasive pectus excavatum repair (MIRPE) are by far the most popular methods of correction. MIRPE has been established as the method of choice amongst children. Feasibility of the minimally invasive approach in the funnel chest correction in adult population still remains controversial...
January 2016: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Katherine W Gonzalez, Obinna O Adibe, Brian G Dalton, Amita A Desai, Susan W Sharp, Shawn D St Peter
PURPOSE: The success of prospective randomized trials relies on voluntary participation, which has been perceived as a barrier for successful trials in children who rely on parental permission. We sought to identify the reasons parents decline child participation to understand potential limitations in the consent process. METHODS: A prospective observational study was conducted in 92 patients asked to participate in prospective randomized trials between 2012 and 2015...
May 2016: Pediatric Surgery International
Sebastian Udholm, Marie Maagaard, Hans Pilegaard, Vibeke Hjortdal
OBJECTIVES: To study if minimally invasive repair of pectus excavatum (PE) in adult patients would improve cardiopulmonary function at rest and during exercise as we have found previously in young and adolescent patients with PE. METHODS: Nineteen adult patients (>21 year of age) were studied at rest and during bicycle exercise before surgery and 1 year postoperatively. Lung spirometry was performed at rest. Cardiac output, heart rate and aerobic exercise capacity were measured using a photo-acoustic gas-rebreathing technique during rest and exercise...
May 2016: Interactive Cardiovascular and Thoracic Surgery
Alejandro Arevalo, Lauren Haddad, Jason Johnson, Tamekia L Jones, Vijaya Joshi
PURPOSE: Aortic root dilation is a risk factor for aneurysm and dissection. Echocardiography (echo) is the most frequently used initial screening method for the aortic root, but computed tomography (CT) is a preferred modality because of the ability to reformat the images and obtain measurements without the technical limits of echo image acquisition. There are limited data comparing the 2 modalities in measuring the aortic root. MATERIALS AND METHODS: This was a retrospective cohort study comparing echo with CT in measuring the aortic root and was conducted at a children's hospital...
May 2016: Journal of Thoracic Imaging
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