Estamos propondo um índice antropométrico para pectus excavatum correlacionando-o ao índice de Haller e ao índice vertebral inferior. Estudamos 20 pacientes com deformidade e 30 indivíduos normais. Os pacientes portadores do defeito torácico foram submetidos à correção cirúrgica. A correlação entre os índices foi alta, a acurácia semelhante e houve diferença significante entre o pré e pós-operatório estabelecida pelos índices. / We are proposing an anthropometric index for pectus excavatum correlating it to Haller's index and to the lower vertebral index. We have studied 20 patients with deformity and 30 normal patients. Patients carrying thoracic defect were submitted to surgical correction. The correlation between the indexes was high, the accuracy was similar and there was significant difference between the pre and post-operative established by the indexes.

Pectus excavatum (PEX) é uma depressão esternal em relação às cartilagens costais. Problemas psicológicos e intolerância ao exercício são alterações clínicas freqüentemente detectadas. A correão cirúrgica do PEX ganhou um novo momento desde a introdução da nova técnica minimamente invasivade Nuss. O objetivo deste estudo é comparar os resultados das técnicas operatórias de Robicsek (convencional) e minimamente invasiva (Nuss). Dois grupos de pacientes foram estudados em nosso Serviço: a) 40 pacientes com tórax normal; 40 pacientes com PEX. Esse último grupo foi operado pela técnica de Robicsek (20 pacientes) ou de Nuss (20 pacientes). Ambas as técnicas conseguiram resultados pós-operatórios satisfatórios, mas o índice de Haller e medidas clínicas sugerem que resultados são diferentes. Nuss pode obter melhor forma torácica / Pectus excavatum (PEX) is a depression of the sternum in relation to the costal cartilages. Psychological disorders and exercise intolerance are current clinical abnormalities detectables. Surgical correction of PEX has gained a new momentum since the introduction of the new minimally invasive repair by Nuss. The present study aims to compare the results of Robicsek (conventional) versus Nuss (minimally invasive) technique. Two groups of patients were studied at our Service: a) 40 patients with normal thoracic box configuration; b) 40 patients with PEX. The latter were operated according to the Robicsek (20 pacients) or Nuss technique (20 patients). Both techniques manage to successful postoperative results, but Haller index and clinical measures suggest that results are significant differents. Nuss technique may obtain the best thoracic shape

Estamos propondo um índice antropométrico para pectus excavatum correlacionando-o ao índice de Haller e ao índice vertebral inferior. Estudamos 20 pacientes com deformidade e 30 indivíduos normais. Os pacientes portadores do defeito torácico foram submetidos à correção cirúrgica. A correlação entre os índices foi alta, a acurácia semelhante e houve diferença significante entre o pré e pós-operatório estabelecida pelos índices. / We are proposing an anthropometric index for pectus excavatum correlating it to Haller's index and to the lower vertebral index. We have studied 20 patients with deformity and 30 normal patients. Patients carrying thoracic defect were submitted to surgical correction. The correlation between the indexes was high, the accuracy was similar and there was significant difference between the pre and post-operative established by the indexes.

Pectus excavatum (PEX) é uma depressão esternal em relação às cartilagens costais. Problemas psicológicos e intolerância ao exercício são alterações clínicas freqüentemente detectadas. A correão cirúrgica do PEX ganhou um novo momento desde a introdução da nova técnica minimamente invasivade Nuss. O objetivo deste estudo é comparar os resultados das técnicas operatórias de Robicsek (convencional) e minimamente invasiva (Nuss). Dois grupos de pacientes foram estudados em nosso Serviço: a) 40 pacientes com tórax normal; 40 pacientes com PEX. Esse último grupo foi operado pela técnica de Robicsek (20 pacientes) ou de Nuss (20 pacientes). Ambas as técnicas conseguiram resultados pós-operatórios satisfatórios, mas o índice de Haller e medidas clínicas sugerem que resultados são diferentes. Nuss pode obter melhor forma torácica / Pectus excavatum (PEX) is a depression of the sternum in relation to the costal cartilages. Psychological disorders and exercise intolerance are current clinical abnormalities detectables. Surgical correction of PEX has gained a new momentum since the introduction of the new minimally invasive repair by Nuss. The present study aims to compare the results of Robicsek (conventional) versus Nuss (minimally invasive) technique. Two groups of patients were studied at our Service: a) 40 patients with normal thoracic box configuration; b) 40 patients with PEX. The latter were operated according to the Robicsek (20 pacients) or Nuss technique (20 patients). Both techniques manage to successful postoperative results, but Haller index and clinical measures suggest that results are significant differents. Nuss technique may obtain the best thoracic shape

Background: Pectus excavatum is the most common deformation of the chest, affecting mainly boys. The etiology is unclear. Objective: The aim of this study is to characterize the patients with pectus excavatum and clarify changes of posture after surgical correction by Nuss. Method: 19 patients (17.3 ± 1.9 years) with pectus excavatum chest deformity were tested a day before and 6 months after surgical correction of the chest according to Nuss. Testing included: clinical examination of range of motion in the shoulder and hip joint, range of motion of the spine Thomayer test, Shober and Stibor distances, as well as paraclinic test mCTSIB on Balance Master ® System and the questionnaire method by means of Pectus Excavatum Evaluation Questionnaire. Statistical significance was determined at 0.05. Results and Discussion: The results show that the correction of the chest has a significant influence on the evaluation of and satisfaction with appearance, increases range of motion of shoulder joints and spine, and positively affects postural stability and balance. Conclusion: A simple and non-invasive tests have shown that the effect of correction of the chest is not just a cosmetic nature and can be an incentive to continue to study this issue.

Pectus excavatum é a deformidade congênita na parede torácica anterior mais comum e seu tratamento é essencialmente cirúrgico. Tratamentos cirúrgicos e repouso prolongado no leito levam a alterações metabólicas, músculoesqueléticas, cardiovasculares e respiratórias, que podem prolongar o tempo necessário para a recuperação funcional dos pacientes no pós-operatório, aumentar o tempo de internação e os custos em saúde. A reabilitação precoce após cirurgias, com a realização de exercícios físicos e respiratórios, reduzir estes efeitos adversos, garante melhor recuperação pós-operatória, com aumento da independência dos pacientes, maior bem-estar psicológico e melhores resultados funcionais. O objetivo deste estudo foi avaliar se os pacientes submetidos a reabilitação precoce após correção cirúrgica de Pectus excavatum pela técnica de Nuss apresentam melhor capacidade funcional de exercício e função pulmonar no dia da alta hospitalar quando comparados com os pacientes submetidos a cuidados convencionais. Os Candidatos a correção cirúrgica foram alocados aleatoriamente em 2 grupos: o grupo reabilitação precoce (GRP), que iniciou a intervenção logo após a cirurgia e o grupo de cuidados convencionais (GC), que recebeu os cuidados de rotina da instituição. O teste de função pulmonar por meio da espirometria simples e a avaliação da capacidade funcional de exercício pelo teste de caminhada de seis minutos (TC6), foram realizados antes da cirurgia (pré-operatório) e no dia da alta hospitalar (pós-operatório). Quarenta pacientes foram analisados, 20 em cada grupo. No teste de função pulmonar, todos os pacientes apresentaram redução significativa dos valores de CVF, VEF1 e PFE no pós-operatório, sem diferença entre os grupos. Todos os pacientes apresentaram redução significativa da distância percorrida no TC6 pós-operatório comparada com a distância percorrida no pré-operatório (p < 0,005). Houve diferença estatisticamente significante entre o GRP e GC na avaliação pós-operatória (506.26 ± 66.54 vs 431.11 ± 75.61, p=0.02), e a diferença entre as distâncias percorridas no pré-operatório e no dia da alta hospitalar foi significativamente menor no GRP em comparação com o GC (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). Concluímos que os pacientes submetidos a reabilitação precoce após técnica de Nuss apresentam melhor capacidade funcional de exercício no dia da alta hospitalar em comparação com os pacientes do grupo convencional, sem diferença da função pulmonar entre os grupos / Pectus excavatum is the most common congenital chest wall deformity and its treatment is essentially surgical. Surgical treatments and postoperative bed rest lead to metabolic, musculoskeletal, cardiovascular and respiratory alterations, with the possibility of prolonging the time required for postoperative patient recovery, increasing hospitalization time and health expenditure. Early rehabilitation after surgeries, which involves physical and breathing exercises, reduces these adverse effects and ensure better postoperative recovery, with increased independence of patients, greater psychological well-being and better functional outcomes. The objective of this study was to assess whether patients undergoing early rehabilitation after Pectus excavatum repair using the Nuss procedure have better functional exercise capacity and lung function on hospital discharge day compared with patients undergoing conventional care. Patients were randomly allocated into two groups: the early rehabilitation group (ERG) which started rehabilitation after surgery and the group of conventional care (CG) which received routine care of the institution. The lung function was assessed by simple spirometry and the functional exercise capacity by the 6-minute walk test (6MWT) were performed before surgery (preoperative) and in hospital discharge day (postoperative). Forty patients were evaluated, 20 in each group. All patients presented a significant reduction in FVC, FEV1 and PEF in the postoperative lung function test and there was no statistically significant difference between groups. All patients showed significant reduction in postoperative distance walked in 6MWT compared with the preoperative distance (p < 0.005). There was statistically significant different in functional exercise capacity between the ERG and CG in the postoperative evaluation (506.26 ± 66.54 vs 431.11 ± 75.61, p=0.02) and the difference between distance walked in the preoperative and postoperative period was significantly lower in the ERC compared to the CG (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). We conclude that patients undergoing early rehabilitation after Nuss procedure presented better postoperative functional exercise capacity in hospital discharge day compared to patients in the conventional group, with no difference in lung function between groups

Pectus excavatum é a deformidade congênita na parede torácica anterior mais comum e seu tratamento é essencialmente cirúrgico. Tratamentos cirúrgicos e repouso prolongado no leito levam a alterações metabólicas, músculoesqueléticas, cardiovasculares e respiratórias, que podem prolongar o tempo necessário para a recuperação funcional dos pacientes no pós-operatório, aumentar o tempo de internação e os custos em saúde. A reabilitação precoce após cirurgias, com a realização de exercícios físicos e respiratórios, reduzir estes efeitos adversos, garante melhor recuperação pós-operatória, com aumento da independência dos pacientes, maior bem-estar psicológico e melhores resultados funcionais. O objetivo deste estudo foi avaliar se os pacientes submetidos a reabilitação precoce após correção cirúrgica de Pectus excavatum pela técnica de Nuss apresentam melhor capacidade funcional de exercício e função pulmonar no dia da alta hospitalar quando comparados com os pacientes submetidos a cuidados convencionais. Os Candidatos a correção cirúrgica foram alocados aleatoriamente em 2 grupos: o grupo reabilitação precoce (GRP), que iniciou a intervenção logo após a cirurgia e o grupo de cuidados convencionais (GC), que recebeu os cuidados de rotina da instituição. O teste de função pulmonar por meio da espirometria simples e a avaliação da capacidade funcional de exercício pelo teste de caminhada de seis minutos (TC6), foram realizados antes da cirurgia (pré-operatório) e no dia da alta hospitalar (pós-operatório). Quarenta pacientes foram analisados, 20 em cada grupo. No teste de função pulmonar, todos os pacientes apresentaram redução significativa dos valores de CVF, VEF1 e PFE no pós-operatório, sem diferença entre os grupos. Todos os pacientes apresentaram redução significativa da distância percorrida no TC6 pós-operatório comparada com a distância percorrida no pré-operatório (p < 0,005). Houve diferença estatisticamente significante entre o GRP e GC na avaliação pós-operatória (506.26 ± 66.54 vs 431.11 ± 75.61, p=0.02), e a diferença entre as distâncias percorridas no pré-operatório e no dia da alta hospitalar foi significativamente menor no GRP em comparação com o GC (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). Concluímos que os pacientes submetidos a reabilitação precoce após técnica de Nuss apresentam melhor capacidade funcional de exercício no dia da alta hospitalar em comparação com os pacientes do grupo convencional, sem diferença da função pulmonar entre os grupos / Pectus excavatum is the most common congenital chest wall deformity and its treatment is essentially surgical. Surgical treatments and postoperative bed rest lead to metabolic, musculoskeletal, cardiovascular and respiratory alterations, with the possibility of prolonging the time required for postoperative patient recovery, increasing hospitalization time and health expenditure. Early rehabilitation after surgeries, which involves physical and breathing exercises, reduces these adverse effects and ensure better postoperative recovery, with increased independence of patients, greater psychological well-being and better functional outcomes. The objective of this study was to assess whether patients undergoing early rehabilitation after Pectus excavatum repair using the Nuss procedure have better functional exercise capacity and lung function on hospital discharge day compared with patients undergoing conventional care. Patients were randomly allocated into two groups: the early rehabilitation group (ERG) which started rehabilitation after surgery and the group of conventional care (CG) which received routine care of the institution. The lung function was assessed by simple spirometry and the functional exercise capacity by the 6-minute walk test (6MWT) were performed before surgery (preoperative) and in hospital discharge day (postoperative). Forty patients were evaluated, 20 in each group. All patients presented a significant reduction in FVC, FEV1 and PEF in the postoperative lung function test and there was no statistically significant difference between groups. All patients showed significant reduction in postoperative distance walked in 6MWT compared with the preoperative distance (p < 0.005). There was statistically significant different in functional exercise capacity between the ERG and CG in the postoperative evaluation (506.26 ± 66.54 vs 431.11 ± 75.61, p=0.02) and the difference between distance walked in the preoperative and postoperative period was significantly lower in the ERC compared to the CG (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). We conclude that patients undergoing early rehabilitation after Nuss procedure presented better postoperative functional exercise capacity in hospital discharge day compared to patients in the conventional group, with no difference in lung function between groups

<p>Cilj: Proveriti da li je moguće promeniti način CT verifikacije Hallerovog indeksa u okviru preoperativne pripreme pacijenata sa deformitetom grudnog ko&scaron;a po tipu pectus excavatum-a, uz utvrđivanje fiziolo&scaron;kog opsega vrednosti indeksa, njegove zavisnosti od uzrasta i pola, kao i respiratorne faze u kojoj se CT pregled izvodi. Utvrditi značaj vrednosti indeksa korekcije, indeksa asimetrije i indeksa torzije sternuma. Proveriti i mogućnost smanjivanja efektivne doze jonizujućeg zračenja kod primene CT tehnike jednog skena (single slice). Materijal i metod rada: Ispitivanje se sastojalo iz prospektivne studije koja je obuhvatila 30 pacijenata sa pektus ekskavatumom uz CT snimanje (single slice) u respiratornim fazama: ekspirijum i inspirijum. Na dobijenim snimcima su izračunati pored Halerovog indeksa i indeksi asimetrije, korekcije i sternalne torzije. Prema dobijenim rezultatima merenja i izračunavanja, dono&scaron;ena je odluka o načinu terapijskog tretmana. U retrospektivnoj studiji, urađena je analiza 100 CT pregleda grudnog ko&scaron;a kod dece gde nije verifikovan pectus excavatum, uz kalibriranje vrednosti indeksa u odnosu na uzrast i pol pacijenata. Retrospektivno istraživanje je obuhvatilo i analizu dodatnih 30 CT pregleda grudnog ko&scaron;a pacijenata sa deformitetom grudnog ko&scaron;a po tipu pectus excavatum-a, koji su dijagnostikovani i/ili operisani. Kod svih operisanih pacijenata je primenjenja Nusova operativna tehnika. U ovoj grupi pacijenata je izračunata srednja vrednost efektivne doze jonizujućeg zračenja, a dobijene vrednosti su potom komparirane sa efektivnim dozama koje su dobijene niskodoznim CT pregledima grudnog ko&scaron;a uz primenu novog protokola (&quot;single-slice&quot; tehnika u respiratornim fazama inspirijuma i ekspirijuma). Rezultati: Fiziolo&scaron;ki opseg vrednosti Haller-ovog indeksa u populaciji zdravih pacijenata se kretao od 1,47 do 3,17 i u proseku je iznosio 2,23&plusmn;0,32 (znatna pozitivna korelacija uzrasta i vrednosti HI). Na osnovu rezultata Man-Vitnijevog testa nije postojala polna razlika u posmatranoj grupi. Haller-ov indeks u grupi dijagnostikovane/operisane dece je u proseku iznosio 3,39 i kretao se u intervalu od 2,23 do 5,72 (korelacija između uzrasta ovih pacijenata i Haller-ovog indeksa je bila neznatna i negativna). Utvrđena je zavisnost veličine Haller-ovog indeksa od respiratorne faze u kojoj se CT pregled izvodi. Tako su prosečne vrednosti Haller-ovog indeksa u inspirijumu dece sa dijagnostikovanim deformitetom iznosile 2,69&plusmn;0,76. Kod dece ove grupe u ekspirijumu vrednosti Haller-ovog indeksa su iznosile 3,49&plusmn;1,19. U inspirijumu su samo 3/32 (9%) ispitanika imali vrednost HI preko 3,25 (granična vrednost za operativni tretman), dok ih je u ekspirijumu bilo znatno vi&scaron;e 13/32 (41%), &scaron;to je statistički značajna razlika (&chi;2=6,250; df =1; p=0,012). &quot;Single-slice&quot; tehnika CT pregleda u inspirijumu i ekspirijumu 20-25 puta smanjuje efektivnu dozu jonizujućeg zračenja. Zaključak: Vrednost Haller-ovog indeksa raste sa uzrastom deteta, dok nije utvrđena zavisnost Haller-ovog indeksa od pola. Moguće je promeniti načini CT verifikacije Haller-ovog indeksa u preoperativnoj pripremi za Nuss-ovu operaciju primenom &quot;single-slice&quot; tehnike u ekspiratornoj fazi. Osim Hallerovog indeksa, korisno je određivati i indeks korekcije, indeks asimetrije i indeks sternalne rotacije. Predlaže se protokol standardne preoperativne pripreme i lečenja pacijenata dečjeg uzrasta sa deformitetom grudnog ko&scaron;a po tipu pektus ekskavatuma, sa ciljem njegove primene u svakodnevnom radu u institucijama koje se bave ovim problemom, a u cilju pobolj&scaron;anja kvaliteta dijagnostikovanja i krajnjeg ishoda lečenja.</p> / <p>Aim: The aim of this study was to verify whether it is possible to change the way of CT verification of Haller index (HI), as part of preoperative preparation for patients with pectus excavatum, with the determination of the physiological range of the index value, its dependence on the age and sex, as well as the respiratory phase during which the scan is performed. Also, the aim was to determine the significance of correction, asymmetry and sternal torsion indices values. Evaluate the possibility of reduction the effective dose of ionizing radiation using a single slice CT scan technique. Materials and methods: The study consisted of prospective study that included evaluation of CT scans (single slice technique) of 30 patients with pectus excavatum in both respiratory phases: expirium and inspirium. Haller index and indices of asymmetry, correction and sternal torsion were measured. The decision for the treatment was made according to the results of measurements and calculations of these indices. In retrospective study, 100 CT scans of the chest in children without the deformity (pectus excavatum) were analyzed, and the index value was calibrated depending on the age and gender. The retrospective study also included the analysis of another 30 CT scans in patients who were operated or diagnosed with pectus excavatum. Nuss procedure was used in all operated patients. In this group of patients the median value of effective dose of ionizing radiation was calculated, and the values were compared with the effective dose obtained using low-dose CT examinations applied in the new protocol (single-slice technique in inspiratory and expiratory respiratory phases). Results: The physiological range of Haller index value in healthy patients was from 1.47 to 3.17 and average value was 2.23&plusmn;0.32 (significant positive correlation between age and the value of HI). Results of Mann- Whitney test did not demonstrate any difference between gender in the observed group. In the group of patients who were operated/diagnosed with pectus excavatum the average value of Haller index was 3.39 within the range of 2.23 to 5.72 (correlation between the age of these patients and Haller index was negative, but not significant). The dependence of the Haller index value and certain respiratory phase during which the CT scan was performed also was determined. Thus, the average value of Haller index in inspirium in children with diagnosed deformity was up to 2.69&plusmn;0.76. In the same group of patients the value of Haller index in expirium was up to 3.49&plusmn;1.19. Only 3/32 (9%) patients had HI value over 3.25 (a boundary value for surgical treatment) during inspirium, while 13/32 (41%) patients had it in expirium, this data showed statistically significant difference (&chi;2=6.250; df=1; p=0.012). Single-slice CT technique during the inspiratory and expiratory phase reduces 20-25 times the effective dose of ionizing radiation. Conclusion: The value of Haller index increases with the age, but its dependence on the gender was not determined. It is possible to change the way of CT verification of Haller index in preoperative preparation for the Nuss operation using the &quot;single-slice&quot; technique in exspiratory phase. In addition to Haller index it is useful to determine correction index, the index of asymmetry and the index of sternal rotation as well. This protocol is proposed for standard preoperative preparation and treatment of pediatric population with pectus excavatum with the aim of its application in daily work in institutions that deal with this problem, but also to improve the quality of diagnosis and treatment outcomes.</p>

Objective: The goal of the thesis "Monitoring of the Respiratory Functions in patients after the Rib Cage Surgery according to Nuss" was to confront the present knowledge about respiratory functions and the strength of respiratory muscles of patients with inherited pectoral deformity pectus excavatum, to compare it with my own measuring and to find out about their development after the surgical correction according to Nuss. Methodology: There were 15 patients being monitored (13 men and 3 women), who underwent spirometric and bodypletysmographic examination and the occlusal mouth pressures were determined before the surgery. The same pulmonary function tests were run in the course of 4 to 10 months (7.1 months on average) on all the patients, the control determination of mouth pressures is available for 13 of them. Results: In the entry tests, compared to adequate values the patients in this file had increased residual lung capacities (RV 142%, p=0.001; ITGV 116.2%, p=0.004; RV%TLC 133.8%, p=0.002; ITGV% 116.1%, p=0.001) at the expense of statistically lower vital lung capacity (VC 81.9%, p=0.0004) and inspiratory reserve capacity (IC 84.2%, p=0.0003), while the total lung capacity remained unaltered (TLC 99.7%, p=0.877). The obstructive parameters of these patients were significantly altered (FEV1 95.7%,...