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1.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1248724

ABSTRACT

El síndrome de Poland constituye una malformacion que asocia diversos grados de anomalia toracica y a nivel del miembro superior, con una incidencia de 1 cada 30000 nacidos vivos. Esta patologia geenra ausencia de la glandula mamaria y del musculo pectroral mayor como malformacion mas frecuente. Lo cual produce una asimetria a nivel de torax con perdida de la armonia la cual lleva a una alteracion tanto fisica como psicologica a nivel de la paciente. Por esto es necesario resolver esta patologia con la menor morbilidad posible. El planteo de generar la menor morbilidad nos llevo a realizar una tecnica por abordaje unico sub axilar, a traves del cual se diseca el musculo dorsal ancho y se transpone de forma anterior, obteniendo una sola incision, la cual se mantiene oculta debajo del miembro superior adducido. Produciendo menor tiempo operatorio, menor tiempo de internacion, disminuyendo el número de incsiones y logrando una adecuada fijacion anterior del musculo dorsal ancho.


Poland's syndrome is a malformation associated with varying degrees of thoracic and upper limb abnormality, with an incidence of 1 in 30,000 live births. This pathology generates the absence of the mammary gland and the major pectoral muscle as the most frequent malformation. Which produces an asymmetry at the chest level with loss of harmony which leads to both physical and psychological alteration at the level of the patient. For this reason, it is necessary to resolve this pathology with the least possible morbidity. The proposal to generate the least morbidity led us to perform a single sub axillary approach technique, through which the latissimus dorsi muscle is dissected and transposed anteriorly, obtaining a single incision, which is kept hidden under the upper limb adduced. Producing less operative time, shorter hospitalization time, reducing the number of incisions and achieving an adequate anterior fixation of the latissimus dorsi muscle.


A síndrome de Poland é uma malformação associada a vários graus de anomalia torácica e de membros superiores, com uma incidência de 1 em 30.000 nascidos vivos. Essa patologia gera a ausência da glândula mamária e do músculo pectoral principal como a malformação mais frequente. O que produz uma assimetria ao nível do peito com perda de harmonia que conduz a alterações físicas e psicológicas ao nível do paciente. Por isso, é necessário resolver essa patologia com a menor morbidade possível. A proposta de gerar o mínimo de morbidade nos levou a realizar uma única técnica de abordagem subaxilar, por meio da qual o músculo grande dorsal é dissecado e transposto anteriormente, obtendo-se uma única incisão, que é mantida escondida sob o membro superior. aduzido. Produzindo menos tempo operatório, menor tempo de internação, reduzindo o número de incisões e conseguindo uma fixação anterior adequada do músculo grande dorsal.


Subject(s)
Humans , Female , Adult , Poland Syndrome/surgery , Mammaplasty/methods , Follow-Up Studies , Treatment Outcome , Reconstructive Surgical Procedures/methods , Thoracic Wall/abnormalities , Thoracic Wall/surgery
2.
Rev. colomb. cir ; 36(1): 66-73, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1150519

ABSTRACT

Introducción. El manejo quirúrgico de las lesiones de la pared costal con resección y reconstrucción con material protésico ha venido en aumento, debido al avance en las técnicas quirúrgicas y en la experiencia del cirujano, así como en la innovación y las características de los materiales protésicos, que permiten realizar resecciones amplias de la pared garantizando una mayor estabilidad esquelética, una menor alteración de la mecánica respiratoria y mejores los resultados estéticos. Métodos. Se presenta la experiencia en la clínica CardioVID, Medellín, Colombia, entre los años 2015 y 2019, mediante una revisión retrospectiva de 8 casos sometidos a resección de lesiones benignas de la pared torácica y reconstrucción con material protésico. Resultados. Se encontró una adecuada evolución de los pacientes, con un buen resultado estético y funcional, con adecuado control de la enfermedad, sin reportes de complicaciones ni de recidiva en el seguimiento. Discusión. Una técnica adecuada permite la reconstrucción de estos defectos con complicaciones mínimas y bajas tasas de extracción de prótesis, finalizando con excelentes resultados funcionales y cosméticos. Con nuestra experiencia podemos concluir que la elección adecuada de los pacientes candidatos a manejo quirúrgico, una buena técnica quirúrgica y un personal con experiencia son cruciales para lograr buenos resultados en cuanto a función pulmonar y estética. Además de lograr una sobrevida bajo los parámetros establecidos posterior a lograr una resección R0


Introduction. Surgical management of chest wall lesions with resection and reconstruction with prosthetic material has been increasing, due to advances in surgical techniques and surgeon's experience, as well as innovation and characteristics of prosthetic materials. They allow wide resections of the wall, guaranteeing greater skeletal stability, less alteration of respiratory mechanics, and better aesthetic results.Methods. The experience in the CardioVID clinic, Medellín, Colombia, between the years 2015 and 2019, is presented through a retrospective review of eight cases that underwent resection of benign lesions of the chest wall and reconstruction with prosthetic material.Results. An adequate evolution of the patients was found, with a good aesthetic and functional result, with adequate control of the disease, without reports of complications or recurrence in follow-up.Discussion. An adequate technique allows the reconstruction of these defects with minimal complications and low prosthesis extraction rates, ending with excellent functional and cosmetic results. With our experience, we can conclude that the proper choice of patients who are good candidates for surgical management, a good surgical technique, and an experienced staff are crucial to achieve good results in terms of lung function and aesthetics results, in addition to obtain survival under the established parameters after achieving an R0 resection


Subject(s)
Humans , Thoracic Wall , Prostheses and Implants , Thoracic Surgery , Neoplasms
3.
Article in Portuguese | LILACS | ID: biblio-1359749

ABSTRACT

RESUMO: O Tumor de Células Gigantes é uma neoplasia osteolítica benigna, porém agressiva, ricamente vascularizada e com numerosas células gigantes com atividade osteoclástica. Ocorre mais frequentemente nas epífises de ossos longos e raramente acomete as costelas (cerca de 1% dos casos). A apresentação deste tumor em porção anterolateral de arco costal é extremamente rara em comparação com a região posterior. O presente relato descreve o caso de uma paciente que apresentava uma tumoração dolorosa em parede torácica anterolateral esquerda, de crescimento insidioso. Exames de imagem revelaram uma lesão insuflativa em 10º arco costal esquerdo (4,2 x 3,5 cm), com áreas de calcificação interior. A paciente foi submetida a tratamento cirúrgico, com ressecção ampla do tumor, englobando 9º, 10º e 11º arcos costais e uma porção do diafragma. O diagnóstico definitivo de tumor de células gigantes se deu pela imunohistoquímica da peça cirúrgica. Este relato permite fornecer bases para o estudo das possibilidades terapêuticas desta patologia em localizações atípicas, reforçando que a exérese em bloco com margens amplas destes tumores promove uma menor chance de recidiva local. (AU)


ABSTRACT: Giant Cell Tumor is a benign but aggressive osteolytic neoplasm, richly vascularized and with numerous giant cells with osteoclastic activity. It often occurs in long bone epiphyses and rarely affects the ribs (about 1% of cases). The presentation of this tumor in the anterolateral portion of the costal arch is extremely rare compared to the posterior region. The present report describes the case of a patient who had a painful tumor on the left anterolateral chest wall, of insidious growth. Imaging exams revealed an insufflating lesion in the 10th left costal arch (4.2 x 3.5 cm), with areas of interior calcification. The patient underwent surgical treatment, with wide resection of the tumor, comprising 9th, 10th and 11th ribs and a portion of the diaphragm. The definitive diagnosis of giant cell tumor was made by immunohistochemistry of the surgical specimen. This report provides a basis for studying the therapeutic possibilities of this pathology in atypical locations, reinforcing that the block excision with wide margins of these tumors promotes a lower chance of local recurrence. (AU)


Subject(s)
Humans , Female , Adult , Ribs/pathology , Thoracic Surgery , Bone Neoplasms , Giant Cells , Thoracic Wall/surgery , Giant Cell Tumors
4.
Neumol. pediátr. (En línea) ; 16(3): 103-109, 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1344091

ABSTRACT

Conocer la estructura del sistema respiratorio es fundamental para comprender cómo realiza sus funciones, desde la principal, el intercambio gaseoso, hasta otras funciones no respiratorias tales como el equilibrio ácido-base, fonación, defensa pulmonar, metabolismo pulmonar y procesamiento de materiales bioactivos. El objetivo de esta revisión es describir los conocimientos actuales de la anatomía del aparato respiratorio y mencionar sus funciones tanto respiratorias como no respiratorias.


Knowing the structure of the respiratory system is essential to understand how it performs its various functions, from the main, gas exchange, to its non-respiratory functions such as acid-base balance, phonation, lung defense, pulmonary metabolism, and the handling of bioactive materials. The main objective of this review is to describe the updated knowledge of the respiratory system's anatomy and to mention its various respiratory and non-respiratory functions.


Subject(s)
Humans , Child , Respiratory Physiological Phenomena , Pediatrics , Phonation/physiology , Pulmonary Gas Exchange/physiology , Thoracic Wall/physiology , Lung/physiology
5.
Neumol. pediátr. (En línea) ; 15(3): 411-413, sept. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1127614

ABSTRACT

Lung abscess is a rare entity in pediatric age, but it generates significant morbidity. Even less frequent is the presence of this with spontaneous drainage to the skin, generating an abscess in the chest wall, reason for consultation, of the present clinical case. Subsequently, the presence of lung abscess with extension to the chest wall without pleural involvement was documented by imaging studies, an extremely rare and unusual entity, with only one case described in the world literature within our reach and in an adult patient.


El absceso pulmonar es una entidad infrecuente en la edad pediátrica, pero que genera una morbilidad importante. Aún menos frecuente es la presencia de este con drenaje espontáneo a piel, generando un absceso en pared torácica, motivo de consulta, del presente caso clínico. Posteriormente y por estudios imagenológicos se documentó la presencia de absceso pulmonar con extensión a pared torácica sin afectación pleural, una entidad extremadamente rara e inusual, con un solo caso descrito en la literatura mundial a nuestro alcance y en un paciente adulto.


Subject(s)
Humans , Male , Child, Preschool , Fistula/complications , Fistula/diagnostic imaging , Lung Abscess/complications , Lung Abscess/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Drainage , Thoracic Wall
6.
Autops. Case Rep ; 10(2): e2020151, Apr.-June 2020. graf
Article in English | LILACS | ID: biblio-1131818

ABSTRACT

The authors describe a rare unilateral muscle variation in the thoracic wall combining the pectoralis quartus and chondro-epitrochlearis muscles. A routine dissection was performed in the upper right limb of a male adult cadaver with approximately 35-50 years of age, embalmed in formalin 10%. An accessory muscle, the pectoralis quartus, was identified and was associated with a tendon that was inserted in the medial humeral epicondyle, characteristic of the chondro-epitrochlearis muscle tendon. Such variations have significant clinical relevance to orthopedics, mastology, neural and vascular surgery, and other specialties, for surgical approaches in both the axillary and brachial regions.


Subject(s)
Humans , Male , Adult , Thoracic Wall/anatomy & histology , Muscles/anatomy & histology , Muscles/abnormalities , Autopsy , Tendons , Dissection , Anatomic Variation
7.
Arq. ciências saúde UNIPAR ; 24(1): 21-26, jan-abr. 2020.
Article in Portuguese | LILACS | ID: biblio-1095820

ABSTRACT

Mulheres submetidas à cirurgia de mastectomia podem apresentar algumas complicações, dentre elas, alterações respiratórias e prejuízo funcional. O objetivo deste estudo foi avaliar a cinemática da parede torácica e a capacidade funcional no pós-operatório de pacientes mastectomizadas sem tratamento neoadjuvante e adjuvante associados. Foram avaliadas 4 mulheres no grupo mastectomia (GM) e 4 mulheres no grupo controle (GC). Todas as participantes foram submetidas aos procedimentos de avaliação antropométrica, função pulmonar, força muscular respiratória, cinemática da parede torácica e capacidade funcional. O GM também foi submetido à avaliação de inspeção e palpação torácica. Os dados foram analisados por meio de estatística descritiva. Foi observado que o GM apresentou menor variação de volume corrente da parede torácica, com delta de variação de 22,03% a menos que o GC, sendo a maior redução de volume corrente evidenciada no compartimento de caixa torácica pulmonar, com redução de 41,57% em relação ao GC. O GM não apresentou alterações de função pulmonar, força muscular respiratória e capacidade funcional, apresentando valores de normalidade nessas avaliações. Portanto, mulheres submetidas ao procedimento cirúrgico de mastectomia, sem tratamento neoadjuvante e adjuvante associados, não apresentaram comprometimento da função pulmonar, da força muscular respiratória e da capacidade funcional, contudo foi verificado redução do volume pulmonar na região do procedimento cirúrgico.


Women submitted to a mastectomy surgery may present some complications, among them, respiratory changes and functional impairment. The purpose of this study was to evaluate the chest wall kinematics and functional capacity in the postoperative period of mastectomized patients without associated adjuvant and neoadjuvant treatment. A total of four (4) women in the mastectomy group (MG) and four (4) in the control group (CG) were evaluated. All participants were submitted to the procedures of anthropometric evaluation, pulmonary function, respiratory muscle strength, chest wall kinematics and functional capacity. Patients in MG were also submitted to an inspection and palpation evaluation of the chest and breasts. Database was analyzed using descriptive statistics. It was observed that the MG presented a smaller variation of tidal volume of the chest wall, with a variation delta of 22.03% less than CG, with the largest reduction in tidal volume evidenced in the pulmonary chest cavity compartment, with a reduction of 41.57% when compared to CG. The MG did not present alterations of pulmonary function, respiratory muscle strength and functional capacity, presenting values of normality in these evaluations. Therefore, women submitted to the surgical procedure of mastectomy without associated neoadjuvant and adjuvant treatment did not present any impairment of pulmonary function, respiratory muscle strength and functional capacity. However, a reduction could be observed in the pulmonary volume in the region of the surgical procedure.


Subject(s)
Humans , Female , Middle Aged , Aged , Postoperative Period , Respiratory Function Tests , Women/psychology , Functional Residual Capacity , Mastectomy/rehabilitation , Surgical Procedures, Operative/rehabilitation , Biomechanical Phenomena , Respiratory Muscles/surgery , Breast Neoplasms/surgery , Tidal Volume , Thoracic Wall/surgery , Muscle Strength , Rib Cage/surgery
8.
Einstein (Säo Paulo) ; 18: eMD5223, 2020. graf
Article in English | LILACS | ID: biblio-1056059

ABSTRACT

ABSTRACT Computed tomography with multiple detectors and the advancement of processors improved rendered images and three-dimensional reconstructions in clinical practice. Traditional axial slices form non-intuitive images because they are seen in only one plane. The three-dimensional reconstructions can show structures details and diseases with complex anatomy in different perspectives. Cinematic rendering is a newly three-dimensional reconstruction technique, already approved for clinical use, which can produce realistic images from traditional computed tomography data. The algorithm used is based on light trajectory methods and the global lighting model, which simulate thousands of images from all possible directions. Thus, the technique shapes the physical propagation of light and generates a realistic three-dimensional image with depth, shadows and more anatomic details. It is a multidimensional rendering acquired through complex lighting effects. The aim of this article was to show the advance of three-dimensional technology with the cinematic rendering in images exams of the thoracic wall.


RESUMO A tomografia computadorizada com os múltiplos detectores e o avanço dos processadores melhoraram as imagens renderizadas e as reconstruções tridimensionais na prática clínica. Os cortes axiais tradicionais formam imagens não intuitivas, pois são vistas em apenas um plano. Já as reconstruções tridimensionais podem exibir detalhes anatômicos em diferentes perspectivas das estruturas e de doenças com anatomia complexa. A renderização cinematográfica é uma técnica de reconstrução tridimensional recentemente introduzida, já aprovada para uso clínico, que pode produzir imagens realistas a partir de dados tradicionais da tomografia computadorizada. O algoritmo usado é baseado em métodos de trajetória da luz e no modelo de iluminação global, os quais simulam milhares de imagens de todas as direções possíveis. Assim, a técnica molda a propagação física da luz e gera uma imagem tridimensional realista, com profundidade, sombras e mais detalhes da alteração anatômica. É uma renderização multidimensional adquirida por efeitos de iluminação complexos. O objetivo deste artigo foi mostrar o avanço da tecnologia tridimensional com a renderização cinematográfica nos dos exames de imagens da parede torácica.


Subject(s)
Humans , Male , Adult , Thoracic Neoplasms/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Sarcoma, Synovial/diagnostic imaging , Imaging, Three-Dimensional/methods , Thoracic Wall/diagnostic imaging , Algorithms , Tomography, X-Ray Computed/methods , Sarcoma, Synovial/secondary , Middle Aged
9.
Autops. Case Rep ; 10(3): e2020166, 2020. graf
Article in English | LILACS | ID: biblio-1131826

ABSTRACT

The chest wall chondrosarcoma (CWC) is a rare slowly growing primary tumor of the chest wall with an incidence of <0.5 per million person-years. We present the case of a giant CWC that caused a mass effect on the mediastinum, heart, and lung. Large tumors with thoracic structures compression may be life threatening, and its resection and subsequent chest wall reconstruction represent a significant multidisciplinary surgical challenge. In this case, despite the large tumor dimensions, the preoperative planning—sparing key reconstructive options without compromising the tumor resection—allowed a complete en bloc tumor excision of a grade III chondrosarcoma with negative histologic margins. Successful reconstruction of the large full-thickness chest wall defect, with a latissimus dorsi muscle flap and methyl methacrylate incorporated into a polypropylene mesh in a sandwich fashion, was accomplished. Patient recovery was uneventful with good functional and aesthetic outcomes, and no evidence of recurrence at 1.5 years follow-up. This case report illustrates the main clinical, radiological, and histologic features of a CWC while discussing the surgical goals and highlighting the principles for chest wall reconstruction following extensive resection of a large and rare entity.


Subject(s)
Humans , Male , Middle Aged , Bone Neoplasms/surgery , Chondrosarcoma/surgery , Reconstructive Surgical Procedures , Thoracic Wall/pathology , Heart , Lung , Mediastinum
10.
Chinese Journal of Traumatology ; (6): 125-138, 2020.
Article in English | WPRIM | ID: wpr-827837

ABSTRACT

Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.


Subject(s)
Flail Chest , Therapeutics , Hemothorax , Therapeutics , Humans , Lung Injury , Therapeutics , Pain Management , Pneumothorax , Therapeutics , Rib Fractures , Therapeutics , Thoracic Injuries , Therapeutics , Thoracic Wall , Wounds and Injuries , Wounds, Nonpenetrating , Therapeutics
11.
Rev. argent. cir. plást ; 25(2): 77-79, apr-jun.2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1152235

ABSTRACT

Entre los tumores malignos de la pared torácica, los sarcomas representan menos del 1% de los casos. A pesar de ser infrecuentes, es importante resaltar el manejo multidisciplinario de estos tipos de tumores ya que se caracterizan por ser de gran tamaño y afectar una amplia superficie torácica y por consiguiente de los tejidos blandos anexos a los mismos. De ahí la real importancia de la participación de cirujanos plásticos, torácicos y oncólogos en el tratamiento de estos tumores. La confección del colgajo dorsal en cirugías de sarcomas de la pared torácica ha permitido completar el tratamiento resectivo de dichos tumores. Presentamos el caso de un paciente varón de 64 años, con un sarcoma de la parrilla costal, quien fue sometido a resección amplia de la lesión que comprometia a la 7ma, 8va y 9na costillas, reconstrucción inmediata con próstesis de titanio y malla de polipropileno y cobertura del defecto con confección de colgajo del dorsal ancho. A 5 meses de seguimiento, sin evidencia de actividad de la enfermedad


Among malignant tumors of the chest wall, sarcomas account for less than 1% of cases. Despite being infrequent, it is important to highlight the multidisciplinary management of these types of tumors since they are characterized by being large and affecting a wide chest area and therefore the soft tissues attached to them. Hence the real importance of the participation of pásticos, thoracic and oncologos surgeons in the treatment of these tumors.The confection of the dorsal flap in surgeries of sarcomas of the thoracic wall has allowed to complete the treatment of these tumors. We present the case of a 64-year-old male patient with a sarcoma of the rib cage, who underwent extensive resection of the lesion involving the 7th, 8th and 9th ribs, immediate reconstruction with titanium prosthesis and mesh. polypropylene and coverage of the defect with flap made of the latissimus dorsi. At 5 months of follow-up, without evidence of disease activity.


Subject(s)
Humans , Male , Middle Aged , Prostheses and Implants , Surgical Flaps/surgery , Surgical Mesh , Reconstructive Surgical Procedures , Thoracic Wall/surgery , Interdisciplinary Communication , Therapy, Soft Tissue
12.
Rev. argent. cir. plást ; 25(2): 80-83, apr-jun.2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1152244

ABSTRACT

El propósito de la presentación de este caso es demostrar nuestra experiencia en el Servicio de Cirugía Plástica y Reconstructiva de resolver casos complejos de defectos de pared torácica con colgajos locales y a distancia y valorizar su uso en reconstrucciones complejas. En los últimos años trabajamos coordinadamente con el Servicio de Mastologia de nuestro hospital y este caso fue resuelto también en conjunto con el Servicio de Cirugía Torácica.


The purpose of the presentation of this case is to demonstrate our experience in the service of plastic and reconstructive surgery to solve complex an distance cases of thoracic wall defects and value their use in complex reconstructions. In recent years we worked in coordination with the hospital's mastology service and this case was also resolved in conjunction with the thoracic surgery service


Subject(s)
Humans , Female , Adult , Patient Care Team , Quality of Life , Surgical Flaps , Breast Neoplasms/surgery , Reconstructive Surgical Procedures/methods , Thoracic Wall/surgery
13.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 225-233, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013295

ABSTRACT

ABSTRACT Objective: To evaluate the chest wall shape in patients with adolescent idiopathic scoliosis (AIS) in comparison to healthy subjects and the association between the chest wall shape with the spine deformity and lung function in patients with AIS. Methods: This cross-sectional study enrolled 30 AIS patients and 20 healthy subjects aged 11-18 years old. The Cobb angle evaluation was performed in AIS patients. The chest wall shape was assessed by the photogrammetry method, using the Postural Assessment Software (PAS). We created thoracic markers shaped as angles (A) and distances (D), as follows: A2 (right acromion/xiphoid/left acromion), A4L (angle formed between the outer point of the smallest waist circumference and its upper and lower edges on the left side), A7 (angle formed by the intersection of the tangent segments of the upper and lower scapulae angles), D1R/D1L [distance between the xiphoid process and the last false rib on the right (R) and left (L) sides], and D3 (distance between xiphoid process and anterior superior iliac spine). Results: The thoracic markers A2 and A7 were significantly higher, while the A4L and D1R/D1L were significantly reduced in the AIS group compared to the control. Moderate correlations were found between: A2 and the main and proximal thoracic Cobb angles (r=0.50, r=0.47, respectively); D1R/D1L and the main thoracic Cobb angle (r=- 0.40); and the forced expiratory volume in the first second (FEV1) and D3R (r=0.47). Conclusions: The photogrammetry method was able to detect chest wall changes in AIS patients, besides presenting correlation between Cobb angles and lung function.


RESUMO Objetivo: Avaliar o formato da caixa torácica em pacientes com escoliose idiopática do adolescente (EIA), comparando-os com indivíduos saudáveis e analisar a associação do formato da caixa torácica com a deformidade da coluna vertebral e função pulmonar em pacientes com EIA. Métodos: Estudo transversal que avaliou 30 pacientes com EIA e 20 indivíduos saudáveis com idade entre 11 e 18 anos. O ângulo de Cobb foi avaliado em pacientes com EIA. O formato da caixa torácica foi analisado pelo método da fotogrametria, utilizando o Software para Avaliação Postural (SAPO). Foram criados marcadores torácicos descritos como ângulos (A)e distâncias (D): A2 (acrômio direito/processo xifoide/acrômio esquerdo), A4E (ângulo formado entre o ponto externo da menor circunferência da cintura e suas bordas superior e inferior do lado esquerdo), A7 (ângulo formado pela interseção das retas tangentes aos ângulos superior e inferior das escápulas), D1D/D1E [distância entre o processo xifoide e a última costela falsa nos lados direito (D) e esquerdo (E)] e D3 (distância entre o processo xifoide e a espinha ilíaca anterossuperior). Resultados: Os marcadores torácicos A2 e A7 foram significativamente maiores, enquanto o A4E e o D1D/D1E foram significativamente menores no grupo EIA em relação ao controle. Foram encontradas correlações moderadas entre: A2 e os ângulos de Cobb torácico principal e proximal (r=0,50 e r=0,47, respectivamente); D1D/D1E e o ângulo de Cobb torácico principal (r=-0,40); e o volume expiratório forçado no primeiro segundo (VEF1) e D3D (r=0,47). Conclusões: O método da fotogrametria detectou alterações na caixa torácica de pacientes com EIA, além de apresentar correlações significativas entre os ângulos de Cobb e a função pulmonar.


Subject(s)
Humans , Male , Female , Child , Adolescent , Scapula , Thoracic Vertebrae , Photogrammetry/methods , Respiratory Function Tests/methods , Scoliosis/diagnosis , Scoliosis/physiopathology , Scoliosis/pathology , Brazil , Anthropometry/methods , Cross-Sectional Studies , Reproducibility of Results , Thoracic Wall/physiopathology , Thoracic Wall/pathology
14.
Autops. Case Rep ; 9(2): e20180780, Abr.-Jun. 2019. ilus
Article in English | LILACS | ID: biblio-994674

ABSTRACT

Hydatidosis is a frequent infestation in large endemic areas, caused by helminths. Primary localization within the muscle or bone tissues is rare. We report the case of a 52-year-old woman with a cystic lesion located in the right pectoralis minor muscle, who was initially diagnosed with cystic lymphangioma by imaging examination. She was submitted for surgical treatment; in block resection of the tumor along with the involved muscle was performed. The histopathological diagnosis was of hydatid cyst. The contribution of the ancillary lab tests is analyzed for a precise preoperative diagnostic approach. This case well illustrates that the most likely is not always what it appears to be. Facing of a cystic lesion in the lungs, liver or muscle, clinicians should always think on hydatid disease, particularly in endemic areas.


Subject(s)
Humans , Female , Middle Aged , Lymphangioma, Cystic/diagnosis , Thoracic Wall/pathology , Muscular Diseases/diagnosis , Diagnosis, Differential , Echinococcosis/diagnosis
15.
Rev. bras. anestesiol ; 69(1): 87-90, Jan.-Feb. 2019. graf
Article in English | LILACS | ID: biblio-977421

ABSTRACT

Abstract Thoracic trauma with rib fractures is a challenging condition due to the severe associated pain. Uncontrolled pain impairs breathing and an adequate pain control is necessary to provide comfort and to avoid further complications. Serratus Anterior Plane block is a procedure safe and easy to accomplish. The authors describe a case of thoracic trauma with rib fractures and respiratory compromise. Pain control was only achieved after performing a Serratus Anterior Plane block. The technique was done as described in the medical literature with placement of a catheter. Pain relief was achieved with a low concentration infusion of local anesthetic.


Resumo O trauma torácico com fraturas de costelas é uma condição desafiadora devido à dor intensa associada. O não controle da dor prejudica a respiração enquanto, o seu controle adequado é necessário para proporcionar conforto e evitar maiores complicações. O bloqueio do plano serrátil anterior é um procedimento seguro e fácil de fazer. Descrevemos um caso de trauma torácico com fraturas de costelas e comprometimento respiratório. O controle da dor só foi obtido após o bloqueio do plano serrátil anterior. A técnica foi aplicada conforme descrito na literatura médica, com a colocação de um cateter. O alívio da dor foi obtido com uma infusão de anestésico local em baixa concentração.


Subject(s)
Humans , Male , Adult , Pain/etiology , Rib Fractures/complications , Pain Management/methods , Fractures, Multiple/complications , Analgesia/methods , Nerve Block/methods , Thoracic Wall
16.
J. bras. pneumol ; 45(3): e20180058, 2019. tab, graf
Article in English | LILACS | ID: biblio-990114

ABSTRACT

ABSTRACT Objective: To investigate the effects of manual chest compression (MCC) on the expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) airway clearance maneuver applied in patients on mechanical ventilation. The flow bias, which influences pulmonary secretion removal, is evaluated by the ratio and difference between the peak expiratory flow (PEF) and the peak inspiratory flow (PIF). Methods: This was a crossover randomized study involving 10 patients. The PEEP-ZEEP maneuver was applied at four time points, one without MCC and the other three with MCC, which were performed by three different respiratory therapists. Respiratory mechanics data were obtained with a specific monitor. Results: The PEEP-ZEEP maneuver without MCC was enough to exceed the threshold that is considered necessary to move secretion toward the glottis (PEF − PIF difference > 33 L/min): a mean PEF − PIF difference of 49.1 ± 9.4 L/min was achieved. The mean PEF/PIF ratio achieved was 3.3 ± 0.7. Using MCC with PEEP-ZEEP increased the mean PEF − PIF difference by 6.7 ± 3.4 L/min. We found a moderate correlation between respiratory therapist hand grip strength and the flow bias generated with MCC. No adverse hemodynamic or respiratory effects were found. Conclusions: The PEEP-ZEEP maneuver, without MCC, resulted in an expiratory flow bias superior to that necessary to facilitate pulmonary secretion removal. Combining MCC with the PEEP-ZEEP maneuver increased the expiratory flow bias, which increases the potential of the maneuver to remove secretions.


RESUMO Objetivo: Avaliar os efeitos da compressão torácica manual (CTM) sobre o flow bias expiratório durante a manobra positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) para a remoção de secreção em pacientes sob ventilação mecânica invasiva. O flow bias, que influencia na remoção de secreção pulmonar, foi avaliado pela razão e diferença entre pico de fluxo expiratório (PFE) e pico de fluxo inspiratório (PFI). Métodos: Estudo cruzado e randomizado no qual participaram 10 pacientes. A manobra PEEP-ZEEP foi aplicada em quatro momentos, sendo um sem CTM e os outros três em associação com a CTM, que foram aplicadas por três fisioterapeutas distintos. Um monitor específico foi utilizado para o registro dos dados de mecânica respiratória. Resultados: A manobra PEEP-ZEEP sem a CTM foi suficiente para ultrapassar o limiar do flow bias expiratório (diferença PFE − PFI > 33 l/min), considerado necessário para deslocar a secreção em direção à glote; a média da diferença PFE − PFI encontrada foi de 49,1 ± 9,4 l/min. A média da razão PFE/PFI alcançada foi de 3,3 ± 0,7. A associação da CTM à PEEP-ZEEP aumentou a média da diferença PFE − PFI em 6,7 ± 3,4 l/min. Foi observada correlação moderada entre a força de preensão manual dos fisioterapeutas e o flow bias gerado durante a CTM. Não foram encontradas alterações hemodinâmicas ou respiratórias adversas ao longo do estudo. Conclusões: A manobra PEEP-ZEEP sem a CTM resultou em um flow bias expiratório superior ao considerado efetivo para auxiliar na remoção de secreção pulmonar. A associação com a CTM aumentou o flow bias expiratório, o que aumenta o potencial da manobra para remover secreções.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Respiration, Artificial/methods , Positive-Pressure Respiration/methods , Pulmonary Ventilation/physiology , Thoracic Wall/physiopathology , Lung/physiology , Reference Values , Respiration, Artificial/adverse effects , Time Factors , Linear Models , Respiratory Mechanics/physiology , Analysis of Variance , Treatment Outcome , Cross-Over Studies , Bodily Secretions , Arterial Pressure/physiology
17.
Kosin Medical Journal ; : 152-160, 2019.
Article in English | WPRIM | ID: wpr-786386

ABSTRACT

In the case of isolated sternal fractures, conservative treatment with analgesics is common, but pain can persist for more than 10 weeks, which can significantly interfere with daily life. Ultrasound-guided paravertebral nerve block is reported to be a successful means of pain control in patients with chest wall injury or rib fracture.A 70-year-old female patient presented with anterior chest pain that had persisted for 2 weeks despite conservative treatment. Sagittal reconstruction chest computed tomography and sternum lateral oblique x-ray revealed an isolated sternal fracture. An ultrasound-guided bilateral paravertebral nerve block was performed for pain control. After performing the procedure twice at a 1-week interval, the patient reported complete pain alleviation, and no other problems were observed over the 3-month follow-up period.Ultrasound-guided bilateral paravertebral nerve block can help patients with isolated sternal fractures to manage pain and return to normal activities sooner than with oral analgesics.


Subject(s)
Aged , Analgesics , Chest Pain , Female , Follow-Up Studies , Humans , Nerve Block , Pain Management , Rib Fractures , Sternum , Thoracic Wall , Thorax , Ultrasonography
18.
Journal of Liver Cancer ; : 136-142, 2019.
Article in English | WPRIM | ID: wpr-765716

ABSTRACT

Proton beam therapy (PBT) is one of the advances in radiotherapy techniques, which enables dose escalation with lower probability of radiation-induced liver or gastrointestinal injuries. However, the chest wall proximal to the tumor can be affected by high dose irradiation. Here, we report on a 58-year-old male patient who presented with huge hepatocellular carcinoma, received treatment with transarterial chemoembolization and PBT, and developed severe chest wall pain due to radiation-induced myositis. The patient's symptoms were controlled by oral steroids.


Subject(s)
Carcinoma, Hepatocellular , Humans , Liver , Male , Middle Aged , Myositis , Proton Therapy , Protons , Radiotherapy , Steroids , Thoracic Wall
19.
Article in English | WPRIM | ID: wpr-761774

ABSTRACT

Human sparganosis is a food-borne zoonosis mainly caused by the plerocercoid belonging to the genus Spirometra. The most common clinical sign of sparganosis is a subcutaneous mass in the trunk including abdominal or chest wall. The mass may be mistaken for a malignant tumor, thereby causing difficulty in terms of diagnosis and treatment. A 66-year-old woman visited our clinic for the removal of a lipoma-like mass. It was movable, hard, and painless. We identified 2 white mass, measuring 0.2×4 cm and 0.2×1 cm. Pathologic findings indicated the white mass was a sparganum. She recalled having eaten a raw frog approximately 60 years before. A 35-year-old who lived North Korea was also presented to our clinic with an asymptomatic nodule on her abdomen. Intraoperatively, we found sparganum approximately 24 cm size. Subcutaneous masses are associated with clinical signs of inflammation or they may mimic a soft tissue neoplasm. While the incidence rate of sparganosis has decreased with economic development and advancements in sanitation, surgeons still encounter patients with sparganosis in the clinical setting. Therefore, a careful history is required in order to diagnose sparganosis.


Subject(s)
Abdomen , Adult , Aged , Democratic People's Republic of Korea , Diagnosis , Economic Development , Female , Humans , Incidence , Inflammation , Lipoma , Sanitation , Soft Tissue Neoplasms , Sparganosis , Sparganum , Spirometra , Subcutaneous Tissue , Surgeons , Thoracic Wall
20.
Article in English | WPRIM | ID: wpr-763517

ABSTRACT

Primary leiomyoma of the chest wall is extremely rare. A 13-month-old boy presented to outpatient clinic of the department of pediatrics with a soft, movable, and palpable mass in the right supraclavicular area. Neck computed tomography revealed a 2.5-cm-sized soft tissue mass in the right anterior supraclavicular area. The mass was completely resected, and histopathological examination showed a localized primary leiomyoma with cystic change. The patient was followed up and has been disease-free for more than 11 months since surgery. To the best of our knowledge, 13 cases of leiomyoma of the chest wall have been reported to date, but this is the second case of primary leiomyoma of the chest wall in a pediatric patient. This report describes the clinical course of this case and presents a review of relevant literature.


Subject(s)
Ambulatory Care Facilities , Humans , Infant , Leiomyoma , Male , Neck , Pediatrics , Smooth Muscle Tumor , Thoracic Wall , Thorax
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