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Sonaglioni A, Nicolosi GL, Trevisan R, Lombardo M, Grasso E, Gensini GF, Ambrosio G. The influence of pectus excavatum on cardiac kinetics and function in otherwise healthy individuals: A systematic review. Int J Cardiol 2023; 381:135-144. [PMID: 37003372 DOI: 10.1016/j.ijcard.2023.03.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/28/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND A number of anterior chest wall deformities, most notably pectus excavatum (PE), may have a detrimental effect on cardiac motion and function. Interpretation of transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE) results may be hampered by the possible influence of PE on cardiac kinetics. METHODS A comprehensive search of all articles assessing cardiac function in PE individuals was carried out. Inclusion criteria were: 1) individuals aged >10 years; 2) studies providing objective assessment of chest deformity (Haller index). Studies that measured myocardial strain parameters in PE patients were also included. RESULTS The search (EMBASE and Medline) yielded a total of 392 studies, 36 (9.2%) of which removed as duplicates; a further 339 did not meet inclusion criteria. The full-texts of 17 studies were then analyzed. All studies concordantly reported impaired right ventricular volumes and function. With respect to left ventricle (LV), TTE studies uniformly demonstrated a significant impairment in conventional echoDoppler indices in PE individuals, whereas STE studies provided conflicting results. Importantly, LV functional alterations promptly reverted upon surgical correction of chest defect. In subjects with PE of mild-to-moderate severity, we observed that degree of anterior chest wall deformity, as noninvasively assessed by modified Haller index (MHI), was strongly associated with myocardial strain magnitude, in heterogenous cohorts of otherwise healthy PE individuals. CONCLUSIONS Clinicians should be aware that in PE individuals, TTE and STE results may not always be indicative of intrinsic myocardial dysfunction, but may be, at least in part, influenced by artifactual and/or external chest shape determinants.
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Affiliation(s)
| | | | | | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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Incidence of chest wall deformity in 15,862 students in the province of Sivas, Türkiye. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:116-122. [PMID: 36926155 PMCID: PMC10012986 DOI: 10.5606/tgkdc.dergisi.2023.23325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/16/2022] [Indexed: 03/18/2023]
Abstract
Background This study aims to investigate the prevalence of chest deformity in middle- and high-school students in Sivas province of Turkey, to identify the risk factors associated with the psychological and physical disorders caused by the deformity, and to facilitate early diagnosis and treatment guidance by increasing awareness of this problem. Methods Between October 2011 and May 2012, a total of 15,862 students (8,508 males, 7,354 females; mean age: 15.9±1.3 years; range, 12 to 19 years) from public schools were included. A number of schools were randomly selected for study, and the students were screened by physical examination. A study protocol was developed in which patients with deformities were questioned about family history and symptoms. Results Chest wall deformity was detected in a total of 250 students (1.6%). The prevalence rates of pectus carinatum and pectus excavatum in the children were 0.7% and 0.6%, respectively. The overall prevalence of chest wall deformity was 1.6%. Conclusion Chest wall deformity is more common in boys and pectus carinatum is the most common deformity type. Chest wall deformity is more common in the 15-16 age group and female sex is a risk factor for psychological discomfort.
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Chen T, Chen C, Zeng Q, Zhang Y, Jiao J, Zhang X, Zhang N, Yu J. Use of caliper-based external measurement of body surface in assessing the severity of pectus excavatum. Front Pediatr 2022; 10:1015026. [PMID: 36186654 PMCID: PMC9521316 DOI: 10.3389/fped.2022.1015026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Objective assessment of the severity of pectus excavatum (PE) mainly depends on internal imaging examination, which poses radiation exposure risks and high financial costs. Our study explores the feasibility of caliper-based external measurements of the body surface to assess PE severity. MATERIALS AND METHODS Patients with PE aged 4-18 years who underwent both internal imaging examinations and external measurements were chosen for the study. Overall, 176 patients underwent surgery and 21 underwent regular observation. The Haller index (HI) and correction index (CI) were used to derive the external measurement indices, HI-caliper and CI-caliper. Receiver-operator characteristic analysis provided the optimal cut-off values and compared the diagnostic values of HI-caliper and CI-caliper. Spearman's correlation coefficient and Cohen's kappa coefficient were used to analyze the correlation and consistency between HI-caliper or CI-caliper and HI-CT or CI-CT, respectively. Also, a paired samples t-test was used to compare the differences of HI-caliper or CI-caliper before and after surgery. RESULTS HI-caliper and CI-caliper measurements had strong correlations with HI-CT and CI-CT results (rs = 0.70, p < 0.001; rs = 0.69, p < 0.001), respectively. The optimal cut-off values of HI-caliper and CI-caliper were 1.83 (sensitivity = 0.841, specificity = 0.905) and 12% (sensitivity = 0.881, specificity = 0.857), exhibiting comparable diagnostic values with HI-CT and CI-CT. HI-caliper > 1.83 or CI-caliper > 12% had medium intensity consistency with HI-CT ≥ 3.25 or CI-CT ≥ 28% (k = 0.545, 95% confidence interval: 0.374-0.716, p < 0.001). The HI-caliper and CI-caliper values were significantly different before and after surgery. CONCLUSION Caliper-based external measurement is a feasible method to screen patients who require surgical intervention and for monitoring the progression of PE severity.
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Affiliation(s)
- Tian Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jinghua Jiao
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xu Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Na Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Yu
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Oleksak F, Spakova B, Durdikova A, Durdik P, Kralova T, Igaz M, Molnar M, Gura M, Murgas D. Correlation of anthropometric index and cardiopulmonary exercise testing in children with pectus excavatum. Respir Physiol Neurobiol 2021; 296:103790. [PMID: 34560293 DOI: 10.1016/j.resp.2021.103790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/09/2021] [Accepted: 09/19/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is a method used to evaluate functional impairment of patients with various diseases. OBJECTIVE The objective was to use CPET to estimate the usability of anthropometric index (AI) in patients with pectus excavatum (PE) as a marker of functional impairment caused by chest deformity. METHODS The study included 32 paediatric patients (28 males) with PE. Patients underwent CPET using a breath-by-breath exhaled gas analysis method and continuous monitoring of cardiac parameters. RESULTS In both groups, two (overall four) patients met criteria for cardiogenic limitation (low VO2 and low O2Pulse). Mean VO2/WR was below two standard deviations (2SD) in patients with less severe PE; other observed parameters were within normal limits (Z-score ± 2 SD). The AI had no observed correlation with peak ventilation, VO2peak and peak workload. CONCLUSION The obtained CPET data do not correlate well with the severity of chest deformity expressed with AI. There were similar physical activity limitations in both examined groups of patients and they did not depend on the severity of the deformity.
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Affiliation(s)
- F Oleksak
- Clinic for Children and Adolescents, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia.
| | - B Spakova
- Clinic of Pediatric Surgery, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
| | - A Durdikova
- Clinic for Children and Adolescents, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
| | - P Durdik
- Clinic for Children and Adolescents, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
| | - T Kralova
- Clinic for Children and Adolescents, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
| | - M Igaz
- Clinic for Children and Adolescents, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
| | - M Molnar
- Clinic of Pediatric Surgery, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
| | - M Gura
- Clinic of Pediatric Surgery, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
| | - D Murgas
- Clinic of Pediatric Surgery, University Hospital in Martin, Jessenius Medical Faculty in Martin, Commenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovakia
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Ito Y, Suzuki H, Sasahara Y, Mitsukawa N, Yoshino I. Can surgical repair for pectus excavatum contribute to lung growth? Interact Cardiovasc Thorac Surg 2021; 33:928-934. [PMID: 34423359 DOI: 10.1093/icvts/ivab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigates whether the surgical correction of chest deformity is associated with the growth of the lung parenchyma after surgery for pectus excavatum. METHODS Ten patients with pectus excavatum who were treated by the Nuss procedure were examined. The preoperative and postoperative computed tomography (2.5 ± 1.2 years after surgery) scans were performed, and the Haller index, lung volume and lung density were analyzed using a three-dimensional image analysis system (SYNAPSE VINCENT, Fujifilm, Japan). The radiological lung weight was calculated as follows: lung volume (ml) × lung density (g/ml). RESULTS The average age of the 10 patients (men 8; women 2) was 13.8 years (range: 6-26 years). The Haller index was significantly improved from the preoperative value of 5.18 ± 2.20 to the postoperative value of 3.68 ± 1.38 (P = 0.0025). Both the lung volume and weight had significantly increased by 107.1 ± 19.6% and 121.6 ± 11.3%, respectively, after surgery. CONCLUSIONS A significant increase in the weight of the lung after surgical correction suggests that the growth of the lung parenchyma is associated with the correction of chest deformity in younger patients with pectus excavatum.
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Affiliation(s)
- Yuki Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshitaro Sasahara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Alaca N, Alaca I, Yüksel M. Physiotherapy in addition to vacuum bell therapy in patients with pectus excavatum. Interact Cardiovasc Thorac Surg 2020; 31:650-656. [PMID: 32960955 DOI: 10.1093/icvts/ivaa161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Vacuum bell and exercise therapy are non-invasive treatments for pectus excavatum (PE). The purpose of this study was to determine the effects of the physiotherapy programme applied in addition to vacuum bell treatment in patients with PE. METHODS The study included 26 male patients with PE aged 11-18 years. Patients were randomly divided into 2 groups: group 1 received only vacuum bell treatment; group 2 had vacuum bell therapy and physiotherapy. Patient demographic and disease-related characteristics, type of sternal depression, perception of their deformity, postural evaluations, treatment satisfaction and quality of life were evaluated before and 12 weeks after treatment. RESULTS From external chest circumference measurements related to PE, sternal depression and anthropometric index values showed improvement in both groups (P < 0.05), but better results were observed in group 2 than in group 1 (P < 0.05). Modified percent depth and scores from the T3 region (distance between the most prominent point of the sternum and the spinous process of the vertebra at the same level) showed improvement only in group 2 (P < 0.01), whereas severity of PE, the patient's perception of his deformity and parental physiological quality-of-life scores improved in both groups (P < 0.05). Posture, satisfaction with treatment and the patients' physiological quality-of-life scores were significantly better in group 2 (P < 0.05). CONCLUSIONS Due to the additional improvements and greater satisfaction in the group receiving physiotherapy, we think that a proper rehabilitation programme should be applied simultaneously with the vacuum bell treatment in patients with PE. CLINICAL TRIAL REGISTRATION: CLINICALTRIALS.GOV NCT04167865.
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Affiliation(s)
- Nuray Alaca
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ihsan Alaca
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.,Chest Wall Deformities and Pectus Association, Istanbul, Turkey
| | - Mustafa Yüksel
- Chest Wall Deformities and Pectus Association, Istanbul, Turkey
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Scalabre A, Maniouloux F, Vermersch S, Patoir A, Haddad E, Lopez M, Varlet F, Tiffet O. Utility of radiation-free imaging for initial evaluation of pectus excavatum. Interact Cardiovasc Thorac Surg 2019; 29:503-509. [DOI: 10.1093/icvts/ivz145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The OrtenBodyOne scanner is a radiation-free, 3-dimensional imaging system recently developed for evaluation of the severity of pectus excavatum (PE). The goal of this study was to evaluate the utility of this new imaging system compared with that of computed tomography (CT) for the evaluation of the severity of PE.
METHODS
Patients treated for PE from April 2015 to January 2017 with available CT and OrtenBodyOne data were included. Correlations between indexes calculated from CT and from OrtenBodyOne were determined by applying the non-parametric Spearman correlation procedure with a Bonferroni correction to adjust for multiple comparisons.
RESULTS
Forty men (90.9%) and 4 women (9.1%), 20 with symmetrical (45.5%) and 24 with asymmetrical PE (54.5%), were included. The median age was 16.1 years (range 4.3–63.5 years). The following measures and indexes acquired using OrtenBodyOne and CT were significantly correlated: pectus depth (r = 0.84; P = 0.002), anthropometric index (r = 0.81; P = 0.002) and asymmetry index (r = 0.67; P = 0.002). The correlation between the CT Haller index and the external Haller index was only significant for symmetrical PE (r = 0.57; P = 0.008).
CONCLUSIONS
The OrtenBodyOne imaging system can be used to evaluate the severity of symmetrical PE using the external Haller index. Asymmetry and anthropometric indexes are more reliable for the evaluation of asymmetrical PE. Measures can be repeated throughout treatment while avoiding unnecessary irradiation.
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Affiliation(s)
- Aurélien Scalabre
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - Floriane Maniouloux
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - Sophie Vermersch
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - Arnaud Patoir
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - Elie Haddad
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - Manuel Lopez
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - François Varlet
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - Olivier Tiffet
- Chest Wall Deformities Unit, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint Etienne Cedex 2, France
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Computer-Aided Design and Manufacturing Technology for Identification of Optimal Nuss Procedure and Fabrication of Patient-Specific Nuss Bar for Minimally Invasive Surgery of Pectus Excavatum. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app9010042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Nuss procedure is one of the most widely used operation techniques for pectus excavatum (PE) patients. It attains the normal shape of the chest wall by lifting the patient’s chest wall with the Nuss bar. However, the Nuss bar is for the most part bent by a hand bender according to the patient’s chest wall, and this procedure causes various problems such as the failure of the operation and a decreased satisfaction of the surgeon and patient about the operation. To solve this problem, we proposed a method for deriving the optimal operation result by designing patient-specific Nuss bars through computer-aided design (CAD) and computer-aided manufacturing (CAM), and by performing auto bending based on the design. In other words, a three-dimensional chest wall model was generated using the computed tomography (CT) image of a pectus excavatum patient, and an operation scenario was selected considering the Nuss bar insertion point and the post-operative chest wall shape. Then, a design drawing of the Nuss bar that could produce the optimal operation result was derived from the operation scenario. Furthermore, after a computerized numerical control (CNC) bending machine for the Nuss bar bending was constructed, the Nuss bar prototype was manufactured based on the derived design drawing of the Nuss bar. The Nuss bar designed and manufactured with the proposed method has been found to improve the Haller index (HI) of the pectus excavatum patient by approximately 37% (3.14 before to 1.98 after operation). Moreover, the machining error in the manufacturing was within ±5% compared to the design drawing. The method proposed and verified in this study is expected to reduce the failure rate of the Nuss procedure and significantly improve the satisfaction of the surgeon and patient about the operation.
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Abstract
Pectus excavatum is the most common chest wall deformity in children. The central portion of the chest is displaced posteriorly relative to the remainder of the anterior chest wall. Quantification of defect severity can be performed with multiple imaging modalities or external thoracic measures, but is most commonly quantified by the Haller Index (HI) or Pectus Correction Index (PCI). These two measures provide a measure of the chest based on cross sectional imaging, most commonly CT scans, allowing for standard comparison and definitions of pectus defects. The purpose of this article is to describe the creation, calculation, and limitations of the methods quantifying pectus defects.
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Affiliation(s)
- Joseph A Sujka
- Thomas Holder and Keith Aschraft Endowed Chair, The Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, United States
| | - Shawn D St Peter
- Thomas Holder and Keith Aschraft Endowed Chair, The Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, United States.
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A New modified anthropometric haller index obtained without radiological exposure. Int J Cardiovasc Imaging 2018; 34:1505-1509. [DOI: 10.1007/s10554-018-1366-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
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Kim H, Kim J. Evaluation of the anatomical parameters for normal tissue sparing in the prone position radiotherapy with small sized left breasts. Oncotarget 2018; 7:72211-72218. [PMID: 27756882 PMCID: PMC5342155 DOI: 10.18632/oncotarget.12662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/07/2016] [Indexed: 11/25/2022] Open
Abstract
Prone position radiotherapy for a small (< 750 cm3) breast is controversial because of the variable benefits for the irradiated heart volume. The objective anatomical parameters related with chest wall shape that can determine the heart dose sparing patients in the prone position. Twenty-one patients underwent CT-simulation in supine and prone position. Dose volume parameters were compared and the objective indexes such as the Haller index, anthropometric index, mid-sternum thickness, and central lung distance (CLD) were evaluated the relationship between the shape of the chest wall and irradiated normal tissue volume in prone position. The median breast volume was 440.10 cm3 (range, 151.5–727.41 cm3). There was no difference of breast target volume between supine and prone position (p = 0.178). The Haller index under 2.5 (p = 0.046), an anthropometric index over 0.05 (p = 0.007), and the CLD over 2 (p = 0.023) conferred a greater heart sparing effect in the prone position. In conclusions, the objective anatomical parameters related chest wall shape predict the decrease in irradiated heart volume in the prone position. Therefore, it is possible to screen for patients with a reduced heart volume irradiation among those with small breasts before applying prone position radiotherapy.
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Affiliation(s)
- Hyunjung Kim
- Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Korea.,Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jinyoung Kim
- Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Korea
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Ewert F, Syed J, Wagner S, Besendoerfer M, Carbon RT, Schulz-Drost S. Does an external chest wall measurement correlate with a CT-based measurement in patients with chest wall deformities? J Pediatr Surg 2017; 52:1583-1590. [PMID: 28499711 DOI: 10.1016/j.jpedsurg.2017.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/28/2017] [Accepted: 04/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Measurements in chest wall deformities are typically conducted using a thorax caliper or a CT scan of the chest wall. This paper focuses on the possible correlation between these two methods to validate the reliability of the thorax caliper, minimize radiation exposure, and limit the usage of expensive imaging techniques. METHODS We evaluated 95 consecutive patients (77 pectus excavatum (PE), 17 pectus carinatum (PC), 1 mixed deformity) who received surgical correction of the anterior chest wall. The results of the external chest wall measurements and the CT-based measurements were statistically compared. RESULTS A significant correlation between the two measurements was observed in PE and PC at the highest point of the deformation. The strongest correlation was noted in PE. We also noted a correlation between the transverse diameter of the external measurement and the inner thoracic diameter of the CT scan but not for the sagittal diameters in the upper parts of the sternum. CONCLUSIONS Thorax caliper measurements are suitable for determining the sagittal thoracic diameter at the maximum level of the deformity and the transverse diameter with an accuracy comparable to that of CT measurements. Since these values key, the thorax caliper is reliable for monitoring and documenting chest wall malformations. LEVEL OF EVIDENCE Study of diagnostic test. Testing previously developed diagnostic criteria in a consecutive series of patients and a universally "gold" standard-Level I.
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Affiliation(s)
- Franziska Ewert
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
| | - Julia Syed
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
| | - Sonja Wagner
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
| | | | - Roman T Carbon
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
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Snyder CW, Farach SM, Litz CN, Danielson PD, Chandler NM. The modified percent depth: Another step toward quantifying severity of pectus excavatum without cross-sectional imaging. J Pediatr Surg 2017; 52:1098-1101. [PMID: 28189448 DOI: 10.1016/j.jpedsurg.2017.01.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/16/2017] [Accepted: 01/21/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Current approaches to quantifying the severity of pectus excavatum require internal measurements based on cross-sectional imaging. This study evaluated the modified percent depth (MPD), a novel index of severity that can be obtained with external measurements, potentially avoiding the need for cross-sectional imaging. METHODS Patients undergoing surgical repair of pectus excavatum (pectus group), and those undergoing cross-sectional imaging for unrelated reasons (control group), between 2010 and 2016 were included. The MPD of the deformity was calculated using external (i.e. skin surface to skin surface) measurements from the radiographic images. The same external measurements were taken using chest calipers on a subset of these patients in the outpatient clinic. The optimal threshold for MPD that defined severe pectus deformity was derived from receiver-operator characteristic (ROC) analysis. Sensitivity and specificity of the MPD was compared with that of the Haller Index (HI) and Correction Index (CI). RESULTS There were 92 children (49 pectus, 43 controls) included. The median MPD was 20.2% and 4.2% for pectus and control patients, respectively (p<0.0001). An MPD cutoff of 10% optimally discriminated between severe pectus patients and controls by ROC analysis. An MPD of >10% had 98% sensitivity and 98% specificity for severe pectus deformity. Sensitivity and specificity were respectively 93% and 93% for HI >3.25, and 100% and 79% for CI >10. CONCLUSION An MPD >10% performs slightly better than the HI and CI in distinguishing patients with severe pectus deformities. This novel measurement approach offers distinct advantages over existing indices, in that it does not require cross-sectional imaging and can be done using chest calipers in the office setting. Further studies with larger sample size are needed to verify reproducibility of the technique. LEVEL OF EVIDENCE Level II, Study of Diagnostic Test.
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Affiliation(s)
- Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; 6th Medical Group, MacDill Air Force Base, Tampa, Florida; Division of Acute Care Surgery, Tampa General Hospital, University of South Florida, Tampa, Florida.
| | - Sandra M Farach
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Cristen N Litz
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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Abstract
The correction of deep pectus excavatum, with the Nuss procedure, frequently require a series of maneuvers that is inherently dangerous. Herein we describe 10 technical modifications to prevent potential complications. These modified techniques have certain advantages and according to the authors, with these maneuvers the risk of pericardial sac, cardiac injury, bar displacement and complications during the removal of the bar could be markedly reduced.
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Affiliation(s)
| | - Miguel Lia Tedde
- Hospital das Clinicas, University of São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
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15
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Rebeis EB, Campos JRMD, Moreira LFP, Pastorino AC, Pêgo-Fernandes PM, Jatene FB. Variation of the Anthropometric Index for pectus excavatum relative to age, race, and sex. Clinics (Sao Paulo) 2013; 68:1215-9. [PMID: 24141837 PMCID: PMC3782722 DOI: 10.6061/clinics/2013(09)07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/22/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. METHODS Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). RESULTS Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11-40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old. CONCLUSION In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent.
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Affiliation(s)
- Eduardo Baldassari Rebeis
- Instituto do Coração, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São PauloSP, Brazil
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16
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Horimoto Y, Osuda Y, Takada C, Yoshida S, Miwa M, Tsugawa S, Kozuka N. Reliability of Two Protocols for Measuring Chest Wall Dimensions in the Transverse Plane in Individuals with Severe Motor and Intellectual Disabilities. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yoshitaka Horimoto
- Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences
| | | | | | - Susumu Yoshida
- Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences
| | - Makoto Miwa
- Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences
| | | | - Naoki Kozuka
- Department of Physical Therapy, School of Health Sciences Sapporo Medical University
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17
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Khanna G, Jaju A, Don S, Keys T, Hildebolt CF. Comparison of Haller index values calculated with chest radiographs versus CT for pectus excavatum evaluation. Pediatr Radiol 2010; 40:1763-7. [PMID: 20473605 DOI: 10.1007/s00247-010-1681-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/15/2010] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pectus excavatum is a common chest wall anomaly in children. Pre-operative imaging for pectus excavatum is performed with CT, which is used to calculate the Haller index to determine the severity of pectus excavatum. OBJECTIVE To determine the correlation between Haller index values calculated with two-view chest radiographs and those calculated with CT and to determine, with CT as the reference standard, the diagnostic performance of radiographic Haller index for identifying cases that meet imaging criteria for surgical correction of pectus excavatum. MATERIALS AND METHODS For the period 2001-2009, our radiology information system was searched to identify all children who had undergone CT for Haller index calculation. Children who had also undergone two-view chest radiography (CXR) within 6 months of the CT were included in this retrospective study. Two radiologists independently calculated CT Haller index and radiographic Haller index. Data distributions were tested for normality with the Shapiro-Wilk W test. The associations between CT Haller index and radiographic Haller index were determined with the Spearman coefficient of rank correlation. Differences between CT Haller index and radiographic Haller index were tested with the Wilcoxon signed rank test. Haller index values were dichotomized into positive (>3.2) and negative (≤3.2) cases. Using CT as the reference standard, the sensitivity, specificity, and accuracy of radiographic Haller index in identifying children who meet imaging criteria for surgery were calculated. RESULTS CT and CXR for evaluation of pectus excavatum were available for 32 children (25 male; median age 14.5 years). With CT, the median Haller indices for observers 1 and 2 were 3.4 and 3.5 and with CXR 3.5 and 3.5. There were statistically significant correlations between the radiographic Haller index and CT Haller index estimated by the two observers [Spearman correlation coefficient (95% confidence interval) for observer 1 = 0.71 (0.48-0.85, P < 0.01) and for observer 2 = 0.77 (0.52-0.88, P < 0.01)]. A statistically significant correlation was found between the radiographic Haller index calculated by the two observers [Spearman correlation coefficient = 0.98 (0.95-0.99, P < 0.01)]. Using CT Haller index as the reference standard, radiographic Haller index had a sensitivity of 0.95 (0.75-0.99), specificity of 0.75 (0.43-0.94), and accuracy of 0.88 (0.72-0.95) for observer 1, and a sensitivity of 0.95 (0.75-0.99), specificity of 0.67 (0.35-0.90), and accuracy of 0.84 (0.68-0.93) for observer 2. CONCLUSION Radiographic Haller index correlates strongly with CT Haller index, has good interobserver correlation, and has a high diagnostic accuracy for pre-operative evaluation of pectus excavatum. We suggest that a CT of the chest is not required for pre-operative evaluation of pectus excavatum, and a two-view chest radiograph is sufficient for preoperative imaging of pectus excavatum.
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Affiliation(s)
- Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110, USA.
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18
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Wolter TP, Lorenz S, Neuhann-Lorenz C. Aesthetic breast augmentation and thoracic deformities. Aesthetic Plast Surg 2010; 34:612-6. [PMID: 20419300 DOI: 10.1007/s00266-010-9520-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
To ensure the best results from aesthetic breast augmentation, preoperative evaluation and adequate patient information are essential. However, assessment of the underlying thoracic shape often is neglected. Patients with obvious deformities are aware of the problematic reconstruction, whereas patients with mild or moderate deformities often are not aware of their condition and fail to see that standard breast augmentation will lead to unsatisfying results. The authors reviewed their charts for patients with breast augmentation and mild to moderate thoracic deformities, then compiled the therapeutic possibilities and the outcome. Of the 548 patients who underwent breast augmentation, 7.1% (n = 39) exhibited low- or midgrade thoracic wall deformities. Almost none of the patients were aware of their deformity. The patients were augmented with silicone-filled, textured round implants. Placement and volume were adapted to the anatomic situation. A reoperation was not performed in any case, and both patient and physician satisfaction was high. The percentage of patients with thoracic deformity in this group was high compared with an overall incidence of less than 2%. This emphasizes the need for cautious physical examination and preoperative documentation. By individualized surgical planning and diligent implant selection, optimal results and patient satisfaction can be achieved.
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Glinkowski W, Sitnik R, Witkowski M, Kocoń H, Bolewicki P, Górecki A. Method of pectus excavatum measurement based on structured light technique. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:044041. [PMID: 19725752 DOI: 10.1117/1.3210782] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We present an automatic method for assessment of pectus excavatum severity based on an optical 3-D markerless shape measurement. A four-directional measurement system based on a structured light projection method is built to capture the shape of the body surface of the patients. The system setup is described and typical measurement parameters are given. The automated data analysis path is explained. Their main steps are: normalization of trunk model orientation, cutting the model into slices, analysis of each slice shape, selecting the proper slice for the assessment of pectus excavatum of the patient, and calculating its shape parameter. We develop a new shape parameter (I(3ds)) that shows high correlation with the computed tomography (CT) Haller index widely used for assessment of pectus excavatum. Clinical results and the evaluation of developed indexes are presented.
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Affiliation(s)
- Wojciech Glinkowski
- Medical University of Warsaw, Department of Orthopaedics and Traumatology of Locomotor System, Center of Excellence TeleOrto, ul. Lindleya 4, 02-005 Warsaw, Poland
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20
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Camargo OPD, Leme LEG. Revisão de artigos de ortopedia e medicina esportiva publicados em periódicos brasileiros. ACTA ORTOPEDICA BRASILEIRA 2009. [DOI: 10.1590/s1413-78522009000600006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O objetivo desta revisão é apresentar os artigos com especial interesse nas áreas de Ortopedia e Medicina Esportiva publicados em periódicos nacionais qualificados pelo ISI, fora da área de publicação específica em Ortopedia em dois anos. Neste período foram localizados 38 artigos publicados em diversas revistas nacionais com distintos desenhos de pesquisa. Torna-se evidente uma maior divulgação das publicações em Ortopedia e Medicina Esportiva em periódicos gerais, viabilizando ao especialista maior fonte de referências e pesquisas.
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