ABSTRACT
PURPOSE: Pectus carinatum is a thoracic deformity, which causes severe psychological problems for affected patients but almost no physical limitations. Invasive procedures are difficult to justify for this reason. We present a conservative therapy which leads to complete resolution in most cases when performed properly. METHODS: Between January 2008 and December 2012, 69 patients from 4 to 17 years with pectus carinatum were treated with a custom-fitted brace. Patients were stratified in children, adolescents, and adults. RESULTS: Mean therapy time was 7 months. Mean time of daily brace wearing was 12 to 15 hours. The results were evaluated by pictures taken before and after the therapy and from a patient interview. Standardized lateral views revealed a mean correction angle of 10 degrees in the children's group and 5 degrees in the adolescent group. In the adolescent group, 82% of patients judged the result as "excellent" or "good." In this large group with 56 patients, those who reported the result "unchanged" had a mean daily brace wearing time of 8.73 hours, those who judged the result as "good" 14.53 hours, and those who judged the result as "excellent" 18.36 hours. CONCLUSION: Our results show that pectus carinatum is efficiently treated with a customized brace therapy within 7 to 12 months. Best correction can be achieved in children and young adolescents. Daily brace-wearing time should be above 14 hours, ideally 24 hours. Duration of the treatment should be around 1 year. Treatment results correlate directly with the cooperation of the patients.
Subject(s)
Braces , Patient Compliance , Pectus Carinatum/therapy , Adolescent , Braces/adverse effects , Child , Child, Preschool , Female , Humans , Male , Patient Satisfaction , Recurrence , Self-Assessment , Time Factors , Treatment OutcomeABSTRACT
The first enantioselective total syntheses of indole alkaloids of the condylocarpine type are reported. (+)-Condylocarpine, (+)-isocondylocarpine, and (+)-tubotaiwine were prepared in high enantiomeric purity (er > 99:1) from (1S,5R)-hexahydro-1,5-methano-1H-azocino[4,3-b]indole-12-one 7b by way of five or six isolated intermediates.
