ABSTRACT
Pectus excavatum, the most common congenital deformity of the chest wall, has esthetic, psychological and social repercussions as well as a slight impact on pulmonary function. Treatment is surgical and is carried out for esthetic purposes in most cases. The most commonly applied surgical technique is based on the one originally described by Ravitch: sub-perichondrial, bilateral chondrectomy and sternal osteotomy. In 1997, however. Nuss described a minimally invasive approach to correction by means of a support bar. Our objective was to perform minimally invasive correction of pectus excavatum using a substernal extrapleural approach guided by video-assisted thoracoscopy. We treated three patients over 15 years of age without surgical complications. In all three cases, the minimally invasive technique corrected the pectus excavatum with excellent esthetic results. Both the path of insertion and duration were shorter with the described approach than with traditional surgery. Video images facilitated extrapleural insertion of the bar and minimized complications.
Subject(s)
Funnel Chest/surgery , Minimally Invasive Surgical Procedures , Thoracic Surgery, Video-Assisted , Adolescent , Esthetics , Female , Funnel Chest/diagnostic imaging , Humans , Male , Patient Satisfaction , Radiography, ThoracicABSTRACT
El pectus excavatum es la deformación congénita más frecuente de la pared torácica con repercusiones estéticas, psicológicas, sociales y escasamente funcionales. Su tratamiento es quirúrgico y en la mayoría de los casos la indicación es estética. La técnica quirúrgica más utilizada está basada en la descripción original de Ravitch: condrectomías subpericóndricas bilaterales y osteotomías esternales. Sin embargo, Nuss describió en 1997 una técnica de corrección mínimamente invasiva con una barra-soporte. Nuestro objetivo fue realizar la corrección mínimamente invasiva del pectus con un abordaje extrapleural subesternal guiados por videotoracoscopia. Intervinimos a tres pacientes de 16 y 17 años sin complicaciones intraoperatorias. En ambos casos la cirugía mínimamente invasiva resultó ser una técnica útil en la corrección del pectus excavatum, con un excelente resultado estético, mínima vía de abordaje y tiempo quirúrgico reducido en comparación con la técnica clásica. La visión por videotoracoscopia facilita la inserción extrapleural de la barra y minimiza las complicaciones (AU)
Subject(s)
Adolescent , Male , Female , Humans , Minimally Invasive Surgical Procedures , Thoracic Surgery, Video-Assisted , Radiography, Thoracic , Patient Satisfaction , Esthetics , Funnel ChestABSTRACT
Most radiological signs are of low specificity for predicting malignancy in patients with a solitary pulmonary nodule (SPN), making clinical management difficult. Only certain calcification patterns in SPN or the absence of growth over a period two years assures that the nodule is benign. The clinical and radiological characteristics of 31 patients with SPN were studied. Twenty-two were cases bronchopulmonary carcinoma and 9 were pulmonary tuberculoma. Accuracy in the prediction of malignancy was assessed using Bayes' theorem, which is based on degrees of likelihood of various radiological and clinical characteristics. Patients with carcinoma (mean age 65 +/- 9 years) were significantly older than those with tuberculoma (38 +/- 19 years) (p < 0.05). The proportion of smokers was significantly higher among patients with carcinoma (91%) than those with tuberculoma (44%) (p < 0.05). In 50% of the patients with SPN due to bronchopulmonary carcinoma (11 patients), the nodule was in the upper right lobe; in 55% of those with tuberculomas (5 patients) the nodule was found in the upper left lobe. There were no significant differences in the characteristics of the computerized tomography images for the two groups. Mean likelihood of malignancy for patients with carcinoma, by Bayes' theorem, was 83.7%, a rate that was significantly higher than that of tuberculoma patients (46%) (p < 0.05). The application of Bayes' probability theorem for a set of clinical and radiological characteristics can orient the physician as to whether an SPN is likely to be malignant or not, thereby providing guidance on the advisability of performing invasive diagnostic procedures to determine etiology.
