11/52. The management of anterior chest wall deformity in patients presenting for breast augmentation.Anterior chest wall asymmetry is sometimes encountered in patients presenting for consideration of breast augmentation. The chest wall asymmetry or deficiency may be significant enough to consider reconstruction at the same time as breast augmentation in a small number of cases. Customized and prefabricated chest wall implants have been used in a variety of conditions including poland syndrome, pectus excavatum, and sunken anterior chest. Careful moulage preparation and on-table implant modification are needed to "seat" these implants on the skeletal chest wall under the pectoralis major muscle. The chest wall implant provides a base for the subsequent breast prostheses and fills up a bony deficit that cannot be camouflaged by the breast prostheses alone.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/52. Complete congenital sternal cleft associated with pectus excavatum.We report herein a rare case of complete congenital sternal cleft (absent sternum) and anterior pericardial defect in association with pectus excavatum. In neonates with absent sternum, the sternal bars can be easily approximated by simple suture, due to the flexibility of the cartilaginous thorax. There is also little danger of cardiac compression when the repair is performed early in life. If reconstruction is delayed, the increased rigidity of the chest wall and the physiologic accommodation of the thoracic organs to the circumference of the chest render simple approximation impossible, without serious compromise of the heart and lungs. Our patient was a 13-year-old girl, whose case was particularly unusual because of the association of sternal cleft with pectus excavatum. After surgical correction of the pectus excavatum, we were able to construct a sternum by incising the lateral border of each sternal bar, thereby creating flaps that we sutured together at midline. The sternal bars were then approximated by loops of nonabsorbable suture around their circumference. The patient had an uncomplicated course, and at the 12-month follow-up visit, her sternal appearance was normal.- - - - - - - - - - ranking = 0.2keywords = chest (Clic here for more details about this article) |
13/52. Pectus excavatum complicating breast cancer surgery.breast cancer surgery in the presence of previous reconstruction for pectus excavatum has not been reported. Such a case is described where simultaneous chest wall resection was undertaken because of fibrous tissue distortion mimicking malignant infiltration. Furthermore, postoperative adhesions necessitated opening the pleural lining during rib resection. This resulted in recurrent pleural effusion from axillary lymphatic leakage that required thoracocentesis. breast surgery in these circumstances has to be performed with care.- - - - - - - - - - ranking = 0.1keywords = chest (Clic here for more details about this article) |
14/52. Minimally-invasive endoscopic correction of funnel chest deformity via an umbilical incision.Congenital funnel chest deformities (pectus excavatum) are a well known condition that may require surgical correction if repercussions on the respiratory and cardiac dynamics are caused by the compression on the mediastinal structures and by the reduction of the respiratory volume. However, the aesthetic defect may have serious psychological implications and-even if no respiratory impairment is caused-may nevertheless indicate aesthetic correction by implanting a custom-made prosthesis. Alloplastic correction traditionally results in long, visible scars. Since the presternal area is prone to hypertrophic scarring, this type of scar may be a disturbing complication of the intervention. Endoscopically-assisted minimally-invasive implantation of customized implants via an umbilical incision to introduce a customized single-unit silicone implant can avoid unsightly scarring and allows safe hemostasis in the dissection pocket, minimizing well-known side effects and patient morbidity.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
15/52. A repair of funnel chest without sternal dissection in aortic root replacement.A 46-year-old man with marfan syndrome was admitted for repair of annuloaortic etasia and funnel chest. Before median sternotomy, seven transverse skin incisions were made for resection of deformed ribs. The convex portions at the costochondral junctions of the right 4 approximately 7th and left 5 approximately 7th ribs were removed. Thereafter, the conventional median sternotomy was safely performed. Aortic root was replaced. After weaning from the cardiopulmonary bypass, the redundant distal end of the sternum was resected, fractured sites of the concave sternum were straightened and secured with wire fixation, and the split sternum was sutured with wires in an ordinary fashion.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
16/52. postpericardiotomy syndrome after minimally invasive pectus excavatum repair unresponsive to nonsteroidal anti-inflammatory treatment.A 14-year-old boy developed postpericardiotomy syndrome after an otherwise uneventful minimally invasive pectus excavatum repair. Dyspnoea, chest pain, and pericardial effusion progressed despite nonsteroidal anti-inflammatory treatment. The symptoms rapidly resolved with intravenous methylprednisolone, and pericardiocentesis was thus avoided. This is the first report of postpericardiotomy syndrome after the Nuss procedure treated with systemic steroids.- - - - - - - - - - ranking = 0.10008585542731keywords = chest, pain (Clic here for more details about this article) |
17/52. A late complication of pectus excavatum repair.We report a late complication of pectus excavatum repair which highlights the importance of a chest X-ray in evaluating chest pain in patients who have had previous chest surgery. It also raises the question of whether or not implanted wires should be electively removed following bony union.- - - - - - - - - - ranking = 0.30008585542731keywords = chest, pain (Clic here for more details about this article) |
18/52. Prevention of pectus excavatum for children with spinal muscular atrophy type 1.To demonstrate the elimination of pectus excavatum and promotion of more normal lung growth and chest wall development by the use of high-span positive inspiratory pressure plus positive end-expiratory pressure (PIP PEEP), patients with spinal muscular atrophy type 1 with paradoxical breathing were placed on high-span PIP PEEP when sleeping from the point of diagnosis of spinal muscular atrophy. Although the appearance of pectus excavatum is ubiquitous in untreated infants with spinal muscular atrophy type 1, after institution of high-span PIP PEEP, pectus resolves and lungs and chest walls grow more normally. High-span PIP PEEP is indicated for all infants diagnosed with spinal muscular atrophy who demonstrate paradoxical breathing for the purpose of promoting more normal lung and chest development.- - - - - - - - - - ranking = 0.3keywords = chest (Clic here for more details about this article) |
19/52. Severe hypotension in the prone position in a child with neurofibromatosis, scoliosis and pectus excavatum presenting for posterior spinal fusion.A 34-mo-old boy with neurofibromatosis, scoliosis, and pectus excavatum developed severe hypotension when positioned prone. A magnetic resonance image study revealed neurofibromas encircling the great vessels. During the next anesthetic the patient was placed in the prone position on transverse bolsters and hypotension ensued again. A transesophageal echocardiogram (TEE) revealed compression of the right ventricle by the sternum. When the child was turned supine, the blood pressure returned to baseline. The patient was returned to the prone position, this time with bolsters placed longitudinally, without problem. This case supports a cardiac evaluation, possible intraoperative TEE, and avoidance of sternal pressure in patients with chest wall deformities requiring prone positioning. IMPLICATIONS: A child with neurofibromatosis, scoliosis, and a chest wall deformity presenting for spinal fusion developed severe hypotension while prone. This was due to compression of the heart by the sternum, not compression of the great vessels by neurofibromas. Sternal pressure in prone patients with chest wall deformities should be avoided. Unique management included the use of transesophageal echocardiography to determine the cause of the hypotension.- - - - - - - - - - ranking = 0.3keywords = chest (Clic here for more details about this article) |
20/52. Cardiorespiratory outcome after corrective surgery for pectus excavatum: a case study.PURPOSE: The purpose of this case study was to examine the effect of pectus excavatum before and after surgical correction on ventilatory and cardiorespiratory responses to submaximal and maximal exercise. methods: The patient was a 30-yr-old longshoreman who had mild pectus excavatum since infancy that became worse during his adolescent growth years. The deformity persisted into adulthood with increasing symptoms. Although he had a history of habitual aerobic exercise, the patient experienced frequent episodes of pain in the lower anterior chest, breathlessness, and reduced stamina when performing activities of daily living. He performed pulmonary function tests, submaximal and maximal incremental exercise testing, before and 6 months after corrective surgery. RESULTS: Six months after corrective surgery, the patient demonstrated increases in FEV1 (13.0%), maximum voluntary ventilation (MVV, 32.3%), maximum power output (max, 15.5%), [OV0312]O2max (7.9%), metabolic threshold ([OV0312]O2theta, 30.8%), oxygen-pulse ([OV0312]O2/fc, 14.0%), and maximal tidal volume (VTmax, 11.7%). On submaximal testing, we found that the time constant for oxygen uptake kinetics was 46.8 s for the on-transit and 46.5 s for the off-transit before surgery and 33.6 s for the on-transit and 30.3 s for the off-transit six months after surgery. CONCLUSIONS: The information derived from this case study supports the opinion that corrective surgery for pectus excavatum may alleviate the impaired ventilatory and cardiorespiratory performance seen preoperatively.- - - - - - - - - - ranking = 0.10008585542731keywords = chest, pain (Clic here for more details about this article) |
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