scholarly journals A retrospective study on the impact of bar flipping on the recurrence of pectus excavatum after the Nuss procedure

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu-Jiun Fan ◽  
Po-Cheng Lo ◽  
Yuan-Yu Hsu ◽  
I-Shiang Tzeng ◽  
Bo-Chun Wei ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pectus Excavatum ◽  
Slope Angle ◽  
Chest Radiographs ◽  
The Other ◽  
Nuss Procedure ◽  
Patient Groups ◽  
Lateral Chest ◽  
The Impact ◽  
Improvement Index

Abstract Background The Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping. Methods This retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI × 100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests. Results In this study, 359 adult and adolescent patients with an average age of 23.9 ± 7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n = 131), α = 11–20° (n = 154), α = 21–30° (n = 51), and α > 30° (n = 23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p < 0.001). Conclusions The α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

scholarly journals A Retrospective Study on the Impact of Bar Flipping on the Recurrence of Pectus Excavatum after the Nuss Procedure

2021 ◽  
Author(s):  
Yu-Jiun Fan ◽  
Po-Cheng Lo ◽  
Yuan-Yu Hsu ◽  
I-Shiang Tzeng ◽  
Bo-Chun Wei ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pectus Excavatum ◽  
Slope Angle ◽  
Chest Radiographs ◽  
The Other ◽  
Nuss Procedure ◽  
Patient Groups ◽  
Lateral Chest ◽  
The Impact ◽  
Improvement Index

Abstract BackgroundThe Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping.MethodsThis retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI×100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests.ResultsIn this study, 359 adult and adolescent patients with an average age of 23.9±7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n=131), α = 11-20° (n=154), α = 21-30° (n=51), and α > 30° (n=23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p<0.001).ConclusionsThe α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

scholarly journals Modified Nuss operation using introducer-bar complex for pectus excavatum in adults: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lei Wang ◽  
Juan Liu ◽  
Yao Li ◽  
Tienan Feng ◽  
Beibei Cao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Blood Loss ◽  
Pectus Excavatum ◽  
Operation Time ◽  
Nuss Procedure ◽  
Plate Removal ◽  
Traditional Procedure ◽  
Group Outcomes ◽  
Significant Difference ◽  
Clinical Benefits

Abstract Background Shortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue. Methods Patients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes. Results All patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30 ± 10.49 min, p < 0.001), and less blood loss during operation (6.25 ± 4.88 vs. 10.90 ± 5.75 ml, p = 0.003) than patients in the traditional procedure group. There was no significant difference in the length of incision, postoperative Haller index, cost, number of steel bars, postoperative surgical outcome and incidence of complications between the two groups. Conclusion Through the main clinical outcome were similar, our results shown that modified procedure may have the shorter operation time, postoperative hospital stay, and operation time for plate removal and less blood loss, which may bring potential clinical benefits to patients.

The complex Impact of Five Years of Stress Related to Life-Threatening Events on Pregnancy Outcomes: A Preliminary Retrospective Study

2015 ◽  
Vol 30 (2) ◽  
pp. 317-321 ◽  
Author(s):  
M. Keren ◽  
N. Keren ◽  
A. Eden ◽  
S. Tsangen ◽  
A. Weizman ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
The Other ◽  
Late Period ◽  
Intermediate Period ◽  
Membrane Rupture ◽  
Middle Period ◽  
Life Threatening ◽  
The Impact

AbstractObjective:To study the impact of chronic, life-threatening stressors in the form of daily missile attacks, for five consecutive years, on pregnancy outcomes.Method:Charts of deliveries from two neighboring towns in the south of Israel, covering the years 2000 and 2003–2008, were reviewed retrospectively. One city had been exposed to missile attacks, while the other was not. For each year, 100 charts were chosen at random.Results:Significant association was found between exposure to stress and frequency of pregnancy complications (P = 0.047) and premature membrane rupture (P = 0.029). A more detailed analysis, based on dividing the stressful years into three distinct periods: early (2003–2004), intermediate (2005–2006) and late (2007–2008), revealed that preterm deliveries were significantly more frequent (P = 0.044) during the intermediate period, as was premature membrane rupture during the late period (P = 0.014).Conclusion:Exposure to chronic life-threatening stress resulted in more pregnancy complications and in particular more premature membrane ruptures. The impact was most significant during the middle period of the 5-year-exposure to the stressor. Hence it seems that factors of duration and habituation may play a role in the impact of chronic, life-threatening stressors on pregnancy.

scholarly journals Radiological changes after Nuss operation for pectus excavatum

Medicina ◽  
2009 ◽  
Vol 45 (9) ◽  
pp. 699 ◽  
Author(s):  
Artūras Kilda ◽  
Saulius Lukoševičius ◽  
Vidmantas Barauskas ◽  
Živilė Jankauskaitė ◽  
Algidas Basevičius
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
First Year ◽  
Nuss Procedure ◽  
Funnel Chest ◽  
Haller Index ◽  
Wall Deformation ◽  
Lateral Chest ◽  
Radiological Changes ◽  
The Mean

The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure. Materials and methods. Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated. Results. A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81±6.96 mm; 1 month after operation, 97.84±17.08 mm; 6 months, 110.55±13.85 mm; and 12 months, 113.6±14.61 mm. After removal of the bar, the distance was 105±11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1–6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3±12.86 mm, P=0.012). Conclusions. The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index.

The effect of minimally invasive pectus excavatum repair on thoracic scoliosis

2020 ◽  
Author(s):  
Mehlika İşcan ◽  
Burcu Kılıç ◽  
Akif Turna ◽  
Mehmet Kamil Kaynak
Keyword(s):  
Cobb Angle ◽  
Torsion Angle ◽  
Pectus Excavatum ◽  
The Body ◽  
Spinal Curvature ◽  
Nuss Procedure ◽  
Thoracic Scoliosis ◽  
Computed Tomography Images ◽  
Male Patients ◽  
The Impact

Abstract OBJECTIVES The Nuss technique comprises the placement of an intrathoracic bar behind the sternum. However, besides improving the body posture through the correction of the pectus excavatum (PE), this procedure may cause or worsen thoracic scoliosis as a result of the considerable stress loaded on the chest wall and the thorax. Our goal was to investigate the impact of the Nuss procedure on the thoracic spinal curvature in patients with PE. METHODS A total of 100 patients with PE who underwent the Nuss procedure were included in the study and evaluated retrospectively. The Haller index (HI), asymmetry index and sternal torsion angle were calculated from thoracic computed tomography images before the operation. To evaluate the scoliosis in the T2–T8 thoracic vertebrae, Cobb angles were calculated on a plain chest X-ray before the Nuss operation and after the removal of the bar. Cobb angles were classified as normal (5°), scoliotic posture (5°–10°) and scoliosis (&gt;10°). All angles before and after the Nuss operation were compared. The patients were followed up for a mean of 41 months. Substernal bars were removed after a mean of 33 months. RESULTS The mean age of the patients was 19.6 ± 6.7 years. The Cobb angle was statistically significantly increased in all patients (P = 0.01), male patients (P = 0.01) and children (P = 0.046) but not in adults (P = 0.11) and female patients (P = 0.54). The Cobb angle was increased in patients with severe (HI ≥ 3.5) but not in patients with moderate (3.2 &lt; HI &lt; 3.5) or mild (2.0 &lt; HI &lt; 3.2) PE deformity. CONCLUSIONS The present study shows that the Cobb angle indicates that the severity of thoracic scoliosis increases following the Nuss procedure, particularly in male patients, in patients with mild and moderate sternal torsion angle and in those with a high preoperative HI. This alteration might be due to correctional forces and torque applied by the bar. Patients undergoing the Nuss procedure for the correction of PE should be followed up strictly for timely diagnosis and management of the scoliosis.

scholarly journals Thoracoscopy Assisted Minimally Surgery (NUSS procedure) for Pectus Excavatum vs. Novel Modified NUSS procedure - A Single-Center Retrospective Study

2018 ◽  
Vol 21 (5) ◽  
pp. E404-E408
Author(s):  
Lifei Meng ◽  
Mingsong Wang
Keyword(s):  
Retrospective Study ◽  
Blood Loss ◽  
Pectus Excavatum ◽  
Operation Time ◽  
Nuss Procedure ◽  
School Of Medicine ◽  
Hospitalization Time ◽  
Group A ◽  
Reducing Costs ◽  
Group B

Objective: The purpose of this article is to evaluate the efficacy of thoracoscopy assisted minimally surgery (NUSS procedure) for pectus excavatum and novel modified NUSS procedure by comparing the data of patients of pectus excavatum who had undergone novel modified NUSS Procedure or NUSS procedure. Methods: A retrospective study was performed, involving 132 cases of patients with pectus excavatum collected from Shanghai Jiaotong University School of Medicine Xinhua Hospital cardio-thoracic surgery between Jan. 2009 and Jan. 2012. The 132 patients were strictly divided into two groups: Group A included 76 cases that underwent a novel modified NUSS procedure; Group B included 56 cases that underwent NUSS procedure. Compared data included gender, age, operative time, blood loss, postoperative hospital staying and clinical variables and demographic were compared with univariable analysis. Results: No statistically significant correlations were observed in the two groups, such as age (12.67±4.793 years vs. 12.20± 6.423 years), sex, and other clinical data (P > 0.05). In Group A, postoperative hospitalization time (3.95±0.487 days vs. 6.07±1.412 days), operation time (46.28±12.218 minutes vs. 72.23±24.270 minutes), and blood loss (7.37±4.863 ml vs. 16.93±14.002 ml) were significantly better than those in Group B (P < 0.05), shortening hospitalization time, reducing costs, meaning statistically significant differences. There was no recurrence in Group A and Group B after operation. Conclusion: The study demonstrated that novel modified NUSS procedure is less invasive, having rapid recovery, shortening the time of hospital stay, and reducing hospital cost. Thus, it is safe, worth promoting, and is widely being used.

scholarly journals Modified Nuss Operation Using Introducer-Bar Complex for Pectus Excavatum in Adults: A Retrospective Study

2020 ◽  
Author(s):  
Lei Wang ◽  
Juan Liu ◽  
Yao Li ◽  
Tienan Feng ◽  
Beibei Cao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Blood Loss ◽  
Pectus Excavatum ◽  
Operation Time ◽  
Nuss Procedure ◽  
Plate Removal ◽  
Traditional Procedure ◽  
Group Outcomes ◽  
Significant Difference ◽  
Clinical Benefits

Abstract BackgroundShortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue.MethodsPatients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes.ResultsAll patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30±10.49 min, p < 0.001), and less blood loss during operation (6.25 ± 4.88 vs. 10.90±5.75ml, p = 0.003) than patients in the traditional procedure group. There was no significant difference in the length of incision, postoperative Haller index, cost, number of steel bars, postoperative surgical outcome and incidence of complications between the two groups.ConclusionThrough the main clinical outcome were similar, our data reveals modified procedure has shorter operation time, postoperative hospital stay, operation time for plate removal and less blood loss, which will bring potential clinical benefits to patients.

scholarly journals Robson Classification System Applied to Induction of Labor

2018 ◽  
Vol 40 (09) ◽  
pp. 513-517 ◽  
Author(s):  
Sara Vargas ◽  
Susana Rego ◽  
Nuno Clode
Keyword(s):  
Retrospective Study ◽  
Classification System ◽  
Foley Catheter ◽  
Tertiary Hospital ◽  
Induction Of Labor ◽  
The Other ◽  
Robson Classification ◽  
Group 5 ◽  
Group 2 ◽  
The Impact

Objective Induction of labor (IL) is a common obstetric procedure, but it is questionable whether or not it results in higher cesarean section (CS) rates. The present study aims to evaluate the impact of IL in the overall CS rates and to analyze these rates according to the method of IL employed and to the Robson group in which it was applied. Methods We have conducted a retrospective study including pregnant women whose labor was induced at a tertiary hospital in 2015 and 2016. All women were classified according to the Robson Classification System (RCS). The CS rates were analyzed and compared regarding the method of IL employed. Results A total of 1,166 cases were included. The CS rate after IL was 20.9%, which represented 23.1% of the total of CSs performed in 2015 and 2016. The highest CS rates were recorded in RCS groups 5 (65.2%) and 8 (32.3%). Group 2 was the highest contributor to the overall CS rate, since it represented 56.7% of the population. The intravaginal prostaglandins method was the most used (77%). Transcervical Foley catheter was the preferred method in group 5 and intravaginal prostaglandins in all the other groups. The CS rate was higher when transcervical Foley catheter was used (34.1%). Conclusion Transcervical Foley catheter induction was associated with a higher rate of CS, probably because it was the preferred method used in group 5.

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