RESUMO
BACKGROUND: Although effective, compressive orthotic bracing (COB) in children with pectus carinatum is still not standardized. This study has aimed to analyze current practices amongst members of the Chest Wall International Group (CWIG). METHODS: A web-based questionnaire was mailed to all CWIG members at 208 departments. It included 30 questions regarding diagnostic work-up, age for COB indication, type of COB used, daily wearing time, treatment duration, complications, and recurrence rate. RESULTS: Members from 44 departments have responded (institutional response rate 21.2%). A total of 93% consider COB as the first-line treatment for PC. A conventional COB (CC) is used in 59%, and the dynamic compression system (FMF) in 41%. The overall compliance rate is >80%. A total of 67% of responders consider COB to be indicated in patients <10 years. The actual wearing time is significantly shorter than the physician-recommended time (p < 0.01). FMF patients experience a significantly faster response than CC patients (p < 0.01). No recurrence of PC has been noted in 34%; recurrence rates of 10-30% have been noted in 61%. CONCLUSIONS: COB is the first-line treatment for PC with a high compliance rate. During puberty, the recurrence rate is high. Treatment standardization and follow-up until the end of puberty are recommended to enhance COB effectiveness.
RESUMO
PURPOSE: We have started to assess the severity of pectus excavatum by means of anthropometric methods prior to CT examination since 2012. The aim of the study was to establish a significance of anthropometry as first-line diagnostic method. Afterwards, we analyzed statistical significance of differences in selected anthropometric indicators before and after surgical intervention. The analysis was also focused on the data from CT scans. METHODS: The followed group represented 27 patients, including 6 girls and 21 boys aged 7-18 years (mean age 15.59 years). Evaluation of anthropometric measurements was realized by somatometry, and other metrical measurements were calculated from thoracic CT scans of patients. All measurements were managed with the approval of the Ethics Committee. RESULTS: The significant differences were found in sagittal diameter and thoracic index in 64.0 % of the patients. Data analyzed from CT showed that flat chest prevailed in both gender (100 %). The largest group represented asymmetric type of pectus excavatum (40.74 %). The superiority of the asymmetric type to the right was confirmed. The values of the Haller index were in range 2.00-5.17 (mean value 3.64). 81.5 % of patients met criterion for surgical correction. Most patients with pectus excavatum had a milder form of deformation. CONCLUSIONS: Anthropometry provides feasible and non-invasive method of pectus deformities evaluation. Based on the study results, anthropometry should be performed prior to CT examination in order to select patients for surgical treatment. Anthropometric measurements are helpful in accurate documentation of growth, longitudinal observation of the patient, and can support decision concerning the type of surgery.
