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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The author presents three decades of experience in the management of anterior chest wall deformities. During this period more than 800 operations were performed on patients with pectus excavatum and carinatum. In this series, there was no death and serious complications were rare. The author believes that the principles on which surgical treatment of pectus excavatum should be based are as follows: (1) bilateral removal of the "culprit" costal cartilages, (2) adequate mobilization of the sternum and correction of the sternal positional deformity by transverse osteotomy, (3) stabilizing the corrected position of the sternum with a substernal "hammock" support. Using this technique the author developed new surgical techniques for the correction of different varieties of chest wall deformities: Pectus excavatum, asymmetric pectus excavatum, pectus carinatum with xiphoid angulation, horizontal pectus excavatum, asymmetric pectus carinatum, chondrosternal prominence with chondrogladiolar depression, and recurrent pectus excavatum. The present method applied for correction of pectus excavatum utilizes the above principles and a substernal Marlex mesh support with bilateral muscle coverage. For carinatum repair, the author routinely uses positional correction of the sternum and sternal shortening. Patients who have significant pectus deformities should undergo surgical repair, preferably between one and eight years of age.
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PMID:Surgical correction of pectus excavatum and carinatum. 1059 12

Congenital chest wall deformities include five types: pectus excavatum (funnel chest), pectus carinatum (pigeon breast), Poland's syndrome, defects of sternal fusion, and miscellaneous dysplasias and skeletal disorders. Of these five types, two, pectus excavatum and Poland's syndrome, are defects of the skeletal chest wall. These two specific anomalies comprise the vast majority of congenital defects of the chest wall and, as depression deformities, are readily amenable to surgical correction.
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PMID:Reconstruction of congenital chest wall deformities using solid silicone onlay prostheses. 1080 38

Pectus excavatum (PE) is a congenital condition in which the sternum is displaced posteriorly with associated changes in the adjacent costal cartilages. The aetiology of PE is uncertain although various underlying abnormalities of the diaphragm have been implicated. There is sparse information regarding the use of fast MRI in evaluating the deformity. Our aims were to use fast MRI to evaluate static and respiratory-related dynamic chest wall characteristics, the extent of cardiac displacement and diaphragmatic excursion in patients. FLASH and TurboFLASH MR sequences in axial and coronal planes were performed on the thoraces of six young patients with PE and six individually matched healthy controls during full inspiratory and full expiratory breath-holds. The Pectus Index was derived from chest wall measurements using axial images. The distances of the left and right cardiac borders from the midline were measured using axial images, and excursion of the dome of each hemidiaphragm was measured using coronal images. The degree of sternal depression worsened substantially in expiration. Anterior chest wall movement was similar in the two groups. Patients had significantly flatter chests than the controls. There was a trend towards leftward cardiac displacement in the patients (maximum distance between left heart border and midline during full expiration 99.5 mm in patients and 91.8 mm in controls). The right diaphragmatic dome excursion was greater than the left in the controls (53.6 mm and 47.4 mm, respectively), but this was not seen in the patients (50.2 mm and 50.4 mm, respectively). It is concluded that fast MRI is very informative in evaluating skeletal abnormalities, chest wall motion, and cardiac and diaphragmatic changes seen in PE.
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PMID:Breath-hold MRI in evaluating patients with pectus excavatum. 1151 94

Forty-seven children with funnel chest (FC) who underwent sternal elevation and 210 normal children were examined to determine the indications for surgical treatment using the vertebral index (VI) and frontosagittal index (FSI). In normal children VI gradually increased and FSI gradually decreased with age. Both indices changed significantly at 3 years of age. Although the VI of FC patients decreased significantly from 33.8 +/- 7.6 (n=40) to 24.4 +/- 3.9 (n=38) postoperatively (P < 0.0001), it was significantly larger than that of normal children over 3 years of age (20.2 +/- 2.2, n=150) (P < 0.0001), and although the FSI of FC patients increased significantly from 22.0 +/- 7.0 (n=40) to 34.5 +/- 6.5 (n=38) postoperatively (P < 0.0001), it was significantly smaller than that of normal children over 3 years of age (41.1 +/- 4.0, n=150) (P < 0.0001). Since many patients had a thin and flat chest despite excellent correction, their postoperative indices were not normal. There was a correlation between VI and FSI in normal children and a high degree of correlation between VI and FSI both before and after operation in FC patients. We conclude that a VI of more than 27 and/or a FSI of less than 29 are indications for surgical treatment based on the mean VI + 3SD and FSI - 3SD of normal children over 3 years of age. These values are almost equal to the mean VI - SD and FSI + SD of patients with physical, cosmetic, and/or psychological disturbances. However, it is not necessary to measure both indices simultaneously. Postoperative VI and FSI did not always reflect the degree of chest-wall depression in FC patients because of their flat chests.
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PMID:Indications for surgical treatment of funnel chest by chest radiograph. 1172 46

Pectus excavatum, the concave depression of the breast bone, comprises most chest wall anomalies. The Nuss procedure, a minimally invasive procedure to correct pectus excavatum, has revolutionized the management of this disease over the past decade. The results and complications of this procedure are discussed. The surgical management of the less common pectus carinatum or "pigeon breast" also is reviewed.
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PMID:Chest wall anomalies: pectus excavatum and pectus carinatum. 1562 87

Pectus excavatum (PE) is a congenital sternal depression. The two most popular methods of correction are the highly modified Ravitch repair (HMRR) and the Nuss procedure. Presented here is a case of PE surgical correction in a 17.5-year-old male, beginning with the Nuss technique and converting to the HMRR during surgery, due to unsatisfying results. The procedure inadvertently culminated in perforation of the heart and lungs by the inserted pectus bar, with aggravation of the damage by resuscitation efforts. This article analyzes the chain of events leading to the patient's death and reviews the literature on the subject.
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PMID:Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature. 1809 73

Pectus excavatum is a depression of the sternum and costal cartilages which may present at birth, or more commonly during the teenage growth spurt. Symptoms of lack of endurance, shortness of breath with exercise, or chest pain are frequent. Although pectus excavatum may be a component of some uncommon syndromes, patients usually are healthy. Evaluation should include careful anatomic description with photographs, radiography to demonstrate the depth of the depression, extent of cardiac compression, or displacement, measurement of pulmonary function, and echocardiography to look for mitral valve prolapse (in 15%) or diminished right ventricular volume. Indications for surgical treatment include two or more of the following: a severe, symptomatic deformity; progression of deformity; paradoxical respiratory chest wall motion; computer tomography scan with a pectus index greater than 3.25; cardiac compression/displacement and/or pulmonary compression; pulmonary function studies showing restrictive disease; mitral valve prolapse, bundle branch block, or other cardiac pathology secondary to compression of the heart; or failed previous repair(s). The developmental factors, genetics, and physiologic abnormalities associated with the condition are reviewed.
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PMID:Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. 1858 24

Pre-operative diagnosis of chest-wall deformity is important for successful surgical correction and post-operative evaluation of funnel chest patients. However, conventional indices that define the severity of deformity have several limitations; manually calculated and cannot supply information about asymmetry. We developed four indices that can represent both the depression and the asymmetry of the chest-wall, and can automatically be extracted by computerized image processing technique. Three indices, including eccentricity index (EI), flatness index (FI), and circularity index (CI), were suggested to represent the depression of the chest-wall, and one index, rotation index (RI), to represent the asymmetry of the chest-wall. To verify the feasibility of new indices, several synthetic images and real CT images were used to analyze the performance of new indices and the statistical relationship with conventional Haller index. The experimental results showed possible application of suggested indices to the diagnosis of funnel chest patient. Suggested indices showed clear trends of change with the severity of chest-wall deformation in regards to both the depression and the asymmetry. Results of statistical analysis showed high correlation between new indices and HI, showing possibility of replacing HI.
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PMID:Development of automatized new indices for radiological assessment of chest-wall deformity and its quantitative evaluation. 1861 70

There is a large and diverse group of congenital abnormalities of the thorax that manifest as deformities and/or defects of the anterior chest wall and, depending on the severity and concomitant anomalies, may have cardiopulmonary implications. Pectus excavatum, the most common anterior chest deformity, is characterized by sternal depression with corresponding leftward displacement and rotation of the heart. Pectus carinatum, the second most common, exhibits a variety of chest wall protrusions and very diverse clinical manifestations. The cause of these conditions is thought to be abnormal elongation of the costal cartilages. Collagen, as a major structural component of rib cartilage, is implicated by genetic and histologic analysis. Poland syndrome is a unique unilateral chest/hand deficiency that may include rib defects, pectoral muscle deficit, and syndactyly. Cleft sternum is a rare congenital defect resulting from nonfusion of the sternal halves, which leaves the heart unprotected and requires early surgical intervention.
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PMID:Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. 1963 63

Pectus excavatum (PE) is a posterior depression of the sternum and adjacent costal cartilages and is frequently seen by primary care providers. PE accounts for >90% of congenital chest wall deformities. Patients with PE are often dismissed by physicians as having an inconsequential problem; however, it can be more than a cosmetic deformity. Severe cases can cause cardiopulmonary impairment and physiologic limitations. Evidence continues to present that these physiologic impairments may worsen as the patient ages. Data reports improved cardiopulmonary function after repair and marked improvement in psychosocial function. More recent consensus by both the pediatric and thoracic surgical communities validates surgical repair of the significant PE and contradicts arguments that repair is primarily cosmetic. We performed a review of the current literature and treatment recommendations for patients with PE deformities.
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PMID:Current management of pectus excavatum: a review and update of therapy and treatment recommendations. 2020 34


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