Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents＇ psychological and behavior. This study aimed to investigate the psychological characteristics and factors that a...Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents＇ psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients＇ age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery. Methods The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables. Results There was a significant difference in the relapse rate for funnel chest in the different age groups （X2=11.883, P=-O.008）. There was a higher relapse rate in patients of 〈10 or 〉-19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups （F=12.538, P=-0.0001）, the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E （introversion/extraversion） in the different age groups （F=10.06, P=0.0001）. There was also a significance in the funnel chest index before surgery in the different psychological scales （P〈0.01）, with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly corr展开更多
Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum...Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum surgery-sternal elevation （Ravitch operation） and sternal turnover. The effect of the operation on patients＇ heart and heart function remains unclear. This study aimed to understand the changes of electrocardiogram and cardiac function after Nuss procedure. Methods From 2008 January to 2013 July, thoracoscopic Nuss operation was performed in 217 patients with pectus excavatum. All the patients underwent the preoperative, postoperative detection of ECG and cardiac function in 3 months to 1 year after operation. Results After 3 months to 1 year follow-up, arrhythmias persisted in 46 out of 135 patients with preoperative symptoms （P 〈 0.05）; Stroke volume and cardiac output significantly increased （P 〈 0.05）; And cardiac parameters greatly improved （P 〈 0.05）. Conclusions Minimally invasive repair of pectus excavatum deformity can correct the chest malformation, alleviate arrhythmia, and improve cardiac function.展开更多
Background/Purpose: The minimally invasive Nuss procedure is emerging as the p referred technique for repair of pectus excavatum. Original methods of pectus ba r placement have been modified to improve safety and effi...Background/Purpose: The minimally invasive Nuss procedure is emerging as the p referred technique for repair of pectus excavatum. Original methods of pectus ba r placement have been modified to improve safety and efficacy and avoid cardioth oracic complications. The currently reported modifications to facilitate retrost ernal pectus bar placement include routine use of right thoracoscopy or a subxip hoid incision. The purpose of this article is to describe additional modificatio ns of the Nuss procedure to improve safety and efficacy. Methods: A retrospectiv e analysis was performed on 51 patients who have had a thoracoscopic-assisted N uss procedure at The Children’s Hospital, Denver, Colo, between 1999 and 2002. Technical modifications included patient positioning, routine use of left thorac oscopy, and an Endo-kittner. Results: Fifty-one patients have successfully und ergone the Nuss procedure using the new modifications. Surgical time ranged from 45 to 120 minutes. There have been no intraoperative or postoperative bleeding complications. There have been 2 large pneumothoraces requiring needle thoracent eses in the operating room before extubati’on. No chest tubes were required pos toperatively. Subjectively, all patients have been satisfied with their surgical correction. Average length of hospital stay was 4 to 6 days. Conclusions: By us ing left chest thoracoscopy and Endo-kittner dissectors, the risk of cardiothor acic injury can be eliminated. Moreover, other methods to ensure safe substernal dissection are unnecessary.展开更多
A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department.With o...A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department.With organ function supportive treatment,the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib,which damaged the heart repeatedly and induced the consequent acute cardiac tamponade.After operation,the patient was successfully managed and discharged.Follow-ups till three years indicated a good recovery.展开更多
Background:Pectus excavatum is the most common congenital chest wall deformity,with a high incidence in live births.This study aimed to evaluate the measured factors on CT images related to the number of pectus bars f...Background:Pectus excavatum is the most common congenital chest wall deformity,with a high incidence in live births.This study aimed to evaluate the measured factors on CT images related to the number of pectus bars for surgical correction.Methods:A total of 497 patients who had undergone minimally invasive repair between April 2007 and July 2011 were classified into single-bar(n=358)and doublebar(n=139)insertion groups.We measured eight distinct distances and one angle on CT scans to reflect quantitative assessment.Univariate analysis and multivariate logistic regression analysis were performed to detect statistically significant association between radiologic measurements and the pectus bars required.Results:After adjusting for age and gender,the transverse distance(T),the transverse distance of the depression area(A),the inclined distance of the depression area(B),the AP distance of the depression area(C),the depression angle(G),and the eccentric distance of deformity(E)were significantly correlated with double-bar insertion.The regression model showed that age(,P<0.0001),gender(P<0.0001),depression angle(G)(P<0.0001),direction of the depression(DD)(P<O.OOO1)and depression depth(D)(P<0.0001)were significantly associated with doublebar insertion.Conclusion:CT scan provides useful factors which can be of assistance in predicting the number of pectus bars for the surgical correction of pectus excavatum.展开更多
Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has b...Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs)-in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal. The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson’s equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100%of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expiratory flow (FEF25%-75%). Preoperatively, FVC and FEV 1 medians were lower than the normal by 13%, whereas the FEF 25%-75%median was lower than normal by 20%(all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean postbar removal improvement than the younger patients. An older patient with a preoperative FEF25-75 score of 80%of normal would be predicted by these data to have a postoperative FEF25-75 of 97%, indicating almost complete normalization for this function. These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.展开更多
文摘Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents＇ psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients＇ age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery. Methods The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables. Results There was a significant difference in the relapse rate for funnel chest in the different age groups （X2=11.883, P=-O.008）. There was a higher relapse rate in patients of 〈10 or 〉-19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups （F=12.538, P=-0.0001）, the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E （introversion/extraversion） in the different age groups （F=10.06, P=0.0001）. There was also a significance in the funnel chest index before surgery in the different psychological scales （P〈0.01）, with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly corr
基金supported by National Science & Technology Pillar Program during the 12th Fiveyear Plan Period(No.SQ2011SF12C03081)
文摘Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum surgery-sternal elevation （Ravitch operation） and sternal turnover. The effect of the operation on patients＇ heart and heart function remains unclear. This study aimed to understand the changes of electrocardiogram and cardiac function after Nuss procedure. Methods From 2008 January to 2013 July, thoracoscopic Nuss operation was performed in 217 patients with pectus excavatum. All the patients underwent the preoperative, postoperative detection of ECG and cardiac function in 3 months to 1 year after operation. Results After 3 months to 1 year follow-up, arrhythmias persisted in 46 out of 135 patients with preoperative symptoms （P 〈 0.05）; Stroke volume and cardiac output significantly increased （P 〈 0.05）; And cardiac parameters greatly improved （P 〈 0.05）. Conclusions Minimally invasive repair of pectus excavatum deformity can correct the chest malformation, alleviate arrhythmia, and improve cardiac function.
文摘Background/Purpose: The minimally invasive Nuss procedure is emerging as the p referred technique for repair of pectus excavatum. Original methods of pectus ba r placement have been modified to improve safety and efficacy and avoid cardioth oracic complications. The currently reported modifications to facilitate retrost ernal pectus bar placement include routine use of right thoracoscopy or a subxip hoid incision. The purpose of this article is to describe additional modificatio ns of the Nuss procedure to improve safety and efficacy. Methods: A retrospectiv e analysis was performed on 51 patients who have had a thoracoscopic-assisted N uss procedure at The Children’s Hospital, Denver, Colo, between 1999 and 2002. Technical modifications included patient positioning, routine use of left thorac oscopy, and an Endo-kittner. Results: Fifty-one patients have successfully und ergone the Nuss procedure using the new modifications. Surgical time ranged from 45 to 120 minutes. There have been no intraoperative or postoperative bleeding complications. There have been 2 large pneumothoraces requiring needle thoracent eses in the operating room before extubati’on. No chest tubes were required pos toperatively. Subjectively, all patients have been satisfied with their surgical correction. Average length of hospital stay was 4 to 6 days. Conclusions: By us ing left chest thoracoscopy and Endo-kittner dissectors, the risk of cardiothor acic injury can be eliminated. Moreover, other methods to ensure safe substernal dissection are unnecessary.
文摘A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department.With organ function supportive treatment,the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib,which damaged the heart repeatedly and induced the consequent acute cardiac tamponade.After operation,the patient was successfully managed and discharged.Follow-ups till three years indicated a good recovery.
基金supported by a grant from the Research Foundation of Korea University(K1220231)
文摘Background:Pectus excavatum is the most common congenital chest wall deformity,with a high incidence in live births.This study aimed to evaluate the measured factors on CT images related to the number of pectus bars for surgical correction.Methods:A total of 497 patients who had undergone minimally invasive repair between April 2007 and July 2011 were classified into single-bar(n=358)and doublebar(n=139)insertion groups.We measured eight distinct distances and one angle on CT scans to reflect quantitative assessment.Univariate analysis and multivariate logistic regression analysis were performed to detect statistically significant association between radiologic measurements and the pectus bars required.Results:After adjusting for age and gender,the transverse distance(T),the transverse distance of the depression area(A),the inclined distance of the depression area(B),the AP distance of the depression area(C),the depression angle(G),and the eccentric distance of deformity(E)were significantly correlated with double-bar insertion.The regression model showed that age(,P<0.0001),gender(P<0.0001),depression angle(G)(P<0.0001),direction of the depression(DD)(P<O.OOO1)and depression depth(D)(P<0.0001)were significantly associated with doublebar insertion.Conclusion:CT scan provides useful factors which can be of assistance in predicting the number of pectus bars for the surgical correction of pectus excavatum.
文摘Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs)-in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal. The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson’s equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100%of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expiratory flow (FEF25%-75%). Preoperatively, FVC and FEV 1 medians were lower than the normal by 13%, whereas the FEF 25%-75%median was lower than normal by 20%(all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean postbar removal improvement than the younger patients. An older patient with a preoperative FEF25-75 score of 80%of normal would be predicted by these data to have a postoperative FEF25-75 of 97%, indicating almost complete normalization for this function. These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.
