Search

Background: We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. Methods: Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. Results: The mean age of the patients was 24.35±13.20 years (range, 14–57 years), and all patients were male. The percentage of excellent aesthetic results, as rated by the patients, was 37.5%, and the percentage of good results was 56.25%. The preoperative and postoperative Haller Index values were 2.01±0.19 (range, 1.60–2.31), and 2.22±0.19 (range, 1.87–2.50), respectively (p-value=0.01), and the median hospital stay was 7.09±2.91 days (range, 5–15 days). Only one patient experienced postoperative complications. Conclusion: Minimally invasive repair is effective for the treatment of pectus carinatum, even in adult patients.

Hypoventilation can present as the primary manifestation or as a part of the clinical spectrum in a variety of diseases. It often goes unrecognized by clinicians and health care providers, especially if the presentation is subacute. If untreated, it is associated with increased morbidity and mortality. Some of the consequences of hypoventilation (e.g., cor pulmonale and pulmonary hypertension) may be irreversible. It becomes imperative that conditions commonly associated with hypoventilation (e.g., obesity hypoventilation syndrome, muscular dystrophy, and rigid chest wall diseases) be carefully evaluated and appropriate treatment implemented to prevent these complications. The ability to ventilate patients without invasive procedures is now available. These noninvasive therapies can be successfully implemented and are tolerated well by patients. The noninvasive positive pressure ventilation not only improves nocturnal hypoventilation during sleep but may improve muscle strength during the daytime. This review provides an overview of the treatment of hypoventilation in various diseases with emphasis on noninvasive positive pressure therapy. Treatment needs to be individualized to a given patient and the primary pathology. Success is impacted by the experience of the respiratory team caring for the patient.

Objective: In 1998, Dr Donald Nuss proposed minimally invasive repair of pectus excavatum (MIRPE) which did not require the osteochondrous parts of the anterior chest wall to be resected. The paper aims at presenting the authors’ own 6 years of experience in funnel chest repair with MIRPE technique. Also, many technical problems of this method are discussed. Materials and methods: Between 1999 and 2005, 461 patients (99 female and 362 male, aged 3—31 years, mean age 15.2 years) with pectus excavatum were operated with the Nuss technique. All patients were operated-on according to the original operativeprotocolproposed byDonaldNuss. With growingexperience, own modifications were introduced. Insertion of two bars was done in 17.4%, transverse sternotomy in adolescents with rigid anterior chest wall in 7.8%, limited excision of the rib cartilages in 5.9%, and parasternal fixation of the bar to prevent it from rotating in 59.7% of patients. Results: There were no deaths. Intraoperative complications were noted in 19 (4.1%) patients and postoperative ones were observed in 43 (9.3%) patients. The operative time ranged from 25 to 130 min (52 min on average). In 192 (41.6%) patients, an epidural block was used. The hospital stay ranged from 4 to 12 days with the mean of 5.3 days. A redo procedure for the bar rotation was necessary in 13 (2.8%) patients. The support bar has been removed in 260 (56.4%) patients so far. In all the patients, an adequate contour of the anterior chest wall has been maintained. Conclusions: MIRPE proposed by Nuss has all the features of a minimally invasive procedure and is straightforward. Better clinical results are achievable in patients under 12 years of age with a symmetric deformity. In older patients (over 15 years of age) with a rigid chest or with an asymmetric deformity, additional procedures are required to achieve a comprehensive correction of the deformity. Recent results and forward clinical observations may give proof to establish MIRPE as a method of choice in funnel chest correction.

Pneumothorax frequently requires drainage, and many thoracic surgeons continue to use the traditional rigid chest tubes. Traditional tube thoracostomy using a large-bore tube is an essential technique for thoracic surgeons, but it is associated with significant pain at the time of insertion and during continued drainage. We have found a new small-bore, flexible thoracostomy method using a modified central venous catheter that is simple, less painful, and safe.

A new method for funnel chest correction using AO implants and instruments is described. The method appears to offer certain advantages particularly in the more rigid chest wall of aldolescents and adults.

Krueger et al. 's hypothesis that the response of the lungs to acceleration is a) similar to that of a fluid b) having the same mean density, was discussed considering separately the physical basis of a) and b). The validity of a) is sustained by the fact that lungs (which by themselves have some finite rigidity) are enclosed by the far more rigid chest wall; in this condition “shear” supporting forces may be negligible as they are in fluids. The part b) of the hypothesis is theoretically untenable and was substituted with the assumption that the density of any horizontal layer of lung is related with the corresponding recoil, (or the local transpulmonary pressure, P) in the same fashion as it is in whole lungs. If the lung density increases with vertical distance (h) from the top of the lung, the P-h relationships become curvilinear, convex towards the pressure axis. The experimental P-h curves are too different from each other to allow conclusions; apart from its validity the scheme presented has the merit of relating pressure, expansion and density of the lung with height coherently with the assumptions used. These concern the physical properties of the chest wall and the pleural boundary as well as those of the lung.

Drainage of the pleura and mediastinum after cardiac surgery is routinely achieved with rigid, wide-bore plastic drains.1 Although these drains are effective, they are also painful, particularly during removal,2 and they may cause damage to bypass grafts, impair ventilation, and cause cardiac arrhythmias.3 Flexible fluted silicone drains may be just as effective.4 Because of the fluted design, smaller sizes can be used without any reduction in the effective drainage capacity. The small size and flexibility may cause less pain, interfere less with the heart and surrounding structures, and result in fewer drain site infections. To investigate these potential benefits and to establish the efficacy of these drains, we designed a prospective, randomized trial that compared the two types of drain.