Two sexually intact male Bengal cats, one a 4-month-old weighing 2.8 kg and the other, a 3-month-old weighing 2.0 kg, were presented to the University of Missouri-Columbia Veterinary Teaching Hospital for evaluation of respiratory distress. On initial presentation, both cats were dyspneic, exercise intolerant, and had marked concave deformation of the caudal sternum. Surgical correction of pectus excavatum was performed using a cylindrical external splint and U-shaped xternal splint. Post-operative thoracic radiography revealed that there was decreased concavity of the sternum and increased thoracic height at the level of the caudal sternebrae in both cats.
Animals ; Cat Diseases/*surgery ; Cats ; Funnel Chest/surgery/*veterinary ; Lung Diseases/etiology/veterinary ; Male ; Treatment Outcome

OBJECTIVETo improve sternal elevation for pectus excavatum to be more simple, less injured and less recurrent.

METHODSWe modified procedures for the sternal elevation for pectus excavatum by dispersal of the shortened fibrous bundle connection with central tendon of the diaphragm, correction of the reverse angle of sternocostales joins, transverse cuneiform anterior osteotomy of sternum and reconnection of oblique resected costal cartilage.

RESULTSSince March 1997, 8 children (4 - 10-year-old) with the pectus excavatum have been treated by this modified sternal elevation, 4 of them who suffer from quick heart pulse improved their heart rate immediately during the operation, all patients have less bleeding and good cosmetic appearance without any complications. There were satisfactory results without recurrence after 6 months to 1 year follow-up.

CONCLUSIONThe modified sternal elevation for pectus excavatum is safe, effective and reliable method.

Child ; Child, Preschool ; Female ; Follow-Up Studies ; Funnel Chest ; surgery ; Humans ; Male ; Sternum ; surgery

Although the incidence of descending necrotizing mediastinitis(DNM) is low, this is a serious disease because it"s mortality have been reported to be as high as 40~50%. Currently, many authors have emphasized aggressive surgical approaches rather than medical treatment alone. We report good results in 2 DNM patients treated by less invasive approach with video-assisted thoracoscopic surgery. Less invasive methods with video-assisted thoracoscopic surgery can reduce hospital stay and morbidity if effective drainage can be achieved in selected DNM patients.
Drainage ; Funnel Chest ; Humans ; Incidence ; Length of Stay ; Marfan Syndrome ; Mediastinitis* ; Mortality ; Thoracic Surgery, Video-Assisted*

BACKGROUND: Nuss procedure used in pectus excavatum repair is preferred, because of its excellent effect from the cosmetic point of view and improved pulmonary function, but it cause severe pain due to thoracic expansion after the operation. This study was designed to evaluate effective fentanyl dose using an intravenous patient-controlled analgesia (IV-PCA) pump for pain control following pectus excavatum repair in pediatric patients. METHODS: Sixty patients undergoing elective thoracic surgery were randomly assigned to received fentanyl 0.5microgram/kg/hr (Group I, n = 20), 0.7microgram/kg/hr (Group II, n = 20), and 1.0microgram/kg/hr (Group III, n = 20) via an IV-PCA pump (basal, 1 ml/h; bolus, 0.5 ml; lock out interval, 30 min) after operation. A blind observer evaluated each patient using the Children's Hospital of Eastern Ontario pain scale (CHEOPS) and the faces scale (FS). Incidences of side effects and pain control satisfaction were assessed at postoperative 48 hrs. RESULTS: There were no significant differences in CHEOPS or FS score between the groups the postoperative 48 hrs period. CHEOPS and FS scores at 4 and 8 hrs in groups II and III were significantly lower than in group I (P<0.05), but all groups showed lower CHEOPS and FS scores during the first postoperative 48 hrs. Satisfaction of pain control assessment by mothers was significantly higher in groups II and III than in group I (P<0.05). CHEOPS and FS scores were highly correlated with each other (P<0.001). CONCLUSIONS: We conclude that infusion of fentanyl at 0.5microgram/kg/hr using an IV-PCA pump is effective for pain control of 5 years of age or older after Nuss procedure.
Analgesia, Patient-Controlled* ; Fentanyl* ; Funnel Chest* ; Humans ; Incidence ; Mothers ; Ontario ; Thoracic Surgery

We at Keimyung University Dongsan Medical Center experienced simultaneous repair of pectus excavatum and secundum atrial septal defect. We used resection deformed perichondrium, raising sternum at right angle to secure good operative field for open heart surgery. Mechanical ventilation was applied which could be weaned on postoperative 2 hours. The hospital course was uneventful without any other sequale. The patient was discharged on postoperative day 6.
Funnel Chest* ; Heart Septal Defects, Atrial* ; Humans ; Respiration, Artificial ; Sternum ; Thoracic Surgery

Pectus excavatum is the common congenital chest wall deformity in children, and Nuss procedure is the conventional surgical treatment for this disease. Nuss procedure is superior to Ravitch correction for it is less harmful in terms of the surgical technique. However, Nuss procedure is associated with severe postoperative pain, thus adequate postoperative analgesia is important. In this review, factors that influence the postoperative pain after Nuss procedure, the pain managements, the related complications and the side effects of drugs are discussed.
Analgesia ; methods ; Child ; Child, Preschool ; Funnel Chest ; surgery ; Humans ; Pain, Postoperative ; etiology ; therapy

Echocardiography, Three-Dimensional ; Funnel Chest/surgery* ; Humans ; Ventricular Dysfunction, Right/diagnostic imaging* ; Ventricular Function, Right

BACKGROUND: Funnel chest is one of the most common anomaly of chest wall, which is manifested by depression of sternum and costal cartilage. Popular operative methods were Ravitch operation and Wada operation. MATERIAL AND METHOD: From 1983 to 1996, 21 cases of funnel chest were corrected surgically in the department of thoracic surgery, National Medical Center. Investigated age and sex distribution, combined anomaly,clinical symptom, degree of correction and complication, postoperative satisfaction. We used 2 different surgical methods, one was Wada & its variants(17 cases), the other was Ravitch and it variants(4 cases). Most of operative indications were cosmetic problems. RESULT: The pre-operative Welch index was 4.188, but this index decreased to 3.46 after the operations.(p=0.046) The degree of correction was higher in Wada & it variant operation than the modified Ravitch operation.(p=0.54) Their results were satisfactory in 20 patients, while unsatisfactory in 1 patient because of a k-wire fracture. There was no recurrence of chest wall depression or postoperative death during the OPD follow up period. CONCLUSION: We recommend Wada operation in symmetric and small degree of depressive chest wall deformity in preand post school age.
Cartilage ; Congenital Abnormalities ; Depression ; Follow-Up Studies ; Funnel Chest* ; Humans ; Postoperative Complications ; Recurrence ; Sex Distribution ; Sternum ; Thoracic Surgery ; Thoracic Wall

The aim of this study was to compare clinical outcomes in pectus excavatum patients undergoing a Ravitch operation with those undergoing a Nuss procedure. Retrospective study was conducted on one hundred and twenty three patients who underwent Ravitch operation (n=16) and Nuss procedure (n=107) between 1995 and 2002. Mean age of the patients was 7.9 +/- 6.2 yr. In the Ravitch group, operation time was 196.9 +/- 61.0 min, and required 10.2 +/- 2.6 chondral bone resections. Average hospital stay time was 15.9 days. In the Nuss group, operation time was 67.2 +/- 33.1 min, and bar removal was required two years after the bar insertion. The length of hospital stay was averagely 8.0 days, and postoperative reoperations were performed in five patients due to bar displacements, while early bar removal was required in one patient. The patient interviews for operation results were conducted and revealed that 92.3% of the patients in the Ravitch group showed good to excellent, while 93.3% of Nuss bar removed patients replied good to excellent. Though Nuss procedure has many advantages, it also has some disadvantages. So, the method of the operation should be selected according to the characteristics of the patient.
Adolescent ; Child ; Female ; Funnel Chest/*surgery ; Human ; Male ; Patient Satisfaction ; Postoperative Complications ; Retrospective Studies ; Surgical Procedures, Operative

The presense of pectus excavatum in Marfan's syndrome may complicate cardiac operation by making midline sternotomy technically more difficult and limiting the operative exposure of the heart. We operated on a 33 year old male patient with Marfan's syndrome and severe pectus excavatum who had severe mitral regurgitation and moderate aortic regurgitation with 52mm aortic root dilation. The operative field was adequately exposed through a midline sternal incision with two sternal retactors. The patient underwent Bentall operation and mitral valve replacement. The repair of pectus excavatum was performed after completion of CPB and the administration of protamin. Permanent internal stabilization achieved by overlapping of the ends of lower ribs and reinforced with sternal closure wire.
Adult ; Aortic Valve Insufficiency ; Funnel Chest* ; Heart* ; Humans ; Male ; Marfan Syndrome* ; Mitral Valve ; Mitral Valve Insufficiency ; Ribs ; Sternotomy ; Thoracic Surgery*