Pectus carinatum: When less is more Martinez-Ferro, M; Bellia-Munzon, G; Schewitz, I A ...
African journal of thoracic and critical care medicine,
09/2019, Letnik:
25, Številka:
3
Journal Article
Pectus carinatum : when less is more Bellia-Munzon, G.; Schewitz, I.A.; Toselli, L. ...
African journal of thoracic and critical care medicine,
09/2019, Letnik:
25, Številka:
3
Journal Article
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Odprti dostop
Awareness of pectus carinatum has increased among the medical community over the last several decades, as innovative options for nonsurgical treatments have become more widely known. Management ...alternatives have shifted from open resective to minimally invasive strategies, and finally, to reshaping the chest using both surgical and no
To report our experience in the treatment of pectus carinatum by using the dynamic compression system.
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.
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%.
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.
Recent publications report early discharge and low opioid requirements after minimally invasive pectus excavatum repair treated with bilateral intercostal nerve cryoablation. Our aim is to report our ...initial experience with this technique.
Retrospective analysis of medical records of patients undergoing bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair within our institution from September 2018 to March 2019.
A cryoprobe was applied at -70 ºC for 2 minutes each from the 3rd to the 7th intercostal nerves bilaterally under thoracoscopic control. Postoperative pain was assessed using a visual analogue scale (VAS).
Twenty-one patients were included. Ninety percent were male, the mean age being 15.2 ± 4.29 years, and the mean weight being 53.6 ± 15.33 kg. The average Haller index was 5.1 ± 2.97, and the mean repair index was 37.6 ± 13.77%. The mean number of implants introduced was 2.55 ± 0.74. The mean duration of cryoanalgesia was 39.9 ± 21.1. No patients received epidural anesthesia. Mean postoperative stay was 1.64 ± 0.73 days. Seventy-one percent of the patients required 1 dose of opioids at the most for postoperative pain control. According to the VAS, the average pain score on postoperative days 1, 3, 7, and 21 was 2.55, 2.01, 0.5, and 0.06, respectively.
Bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair leads to early discharge and good postoperative pain control in all cases. Cryoanalgesia has become our treatment of choice for pain control in the thoracoscopic repair of pectus excavatum.
Colopericardial fistula is a rare complication of colonic replacement surgery whose incidence is unknown. Therefore, we present the following case and perform a literature review.
17-year-old female ...patient of age consults for respiratory distress and precordial pain of 5 days of evolution. Background: Long gap esophageal atresia (esophagostoma and feeding gastrostomy, subsequent colonic graft). Bilateral pneumonia is initially diagnosed. It rapidly evolves to a state of sepsis. On chest x-ray, pneumopericardium is observed. Water-soluble contrasted study confirms diagnosis of colopericardial fistula. Surgical treatment is established, despite this the patient dies due to respiratory distress.
Colopericardial fistula is a very serious entity with a high mortality rate. The clinical presentation and the complementary methods of diagnostic confirmation must be known in order to carry out the appropriate treatment.
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