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

Submitted by Carvalho Dias João Paulo (joao.dias@famerp.br) on 2018-04-10T17:56:49Z No. of bitstreams: 1 fernandadcbraojosbraga_tese.pdf: 7246857 bytes, checksum: 371a625b93c8304fbef8864abf3dbdc8 (MD5) / Made available in DSpace on 2018-04-10T17:56:49Z (GMT). No. of bitstreams: 1 fernandadcbraojosbraga_tese.pdf: 7246857 bytes, checksum: 371a625b93c8304fbef8864abf3dbdc8 (MD5) Previous issue date: 2016-11-01 / Background - Closing defects of the anterior body wall consists of a large group of congenital anomalies characterized by herniation of one or more viscera to the amniotic cavity by a ventral hole, with an incidence of one in 2,000 live births. Malformations included in this group are gastroschisis, omphalocele, ectopia cordis and Pentalogy of Cantrell, limb-body wall complex and bladder/cloacal extrophy. The common origin of the body closing failures, except omphalocele, is based on an unifying embryological hypothesis, in which the defects are the consequences of a failure in the process of fusion between the two lateral body folds. To understand this mechanism is necessary a comprehension of the formation of folds of the body wall. Objectives - To characterize the body wall closure defects in fetuses by MRI and to evaluate the MRI contribution as a method complementary to ultrasonography in indication of surgical method. Patients and Methods - This is a longitudinal/ prospective study comprinsing 31 pregnant women with fetuses diagnosed with anterior body wall closure defects distributed in: Group 1 (G1) - pregnant women in medical care at the Base Hospital ( HB / FAMERP ) in the period from January 2009 to July 2014; Group 2 (G2 ) - pregnant women in medical care at the HB / FAMERP from September 2014 to December 2015. Gastroschisis, omphalocele, ectopia cordis, Pentalogy Cantrell, limb-body wall complex, and bladder exstrophy were included among these defects. Results - The evaluation of fetal MRI allowed the anatomic - morphological characterization of the conceptus and of the anterior body wall defect regarding to its location, extent and herniated contents and detection of birth defects associated with the diagnosis of anterior body wall defect. Conclusion - The understanding of embryonic development as a dynamic process is essential in characterizing the closure defects of the anterior body wall on MRI, reflecting the accuracy of diagnosis and, consequently, the course of pregnancy and planning of surgical treatment. In addition, the excellent spatial resolution of MRI and spontaneous contrast of structures help in detecting other associated malformations and complications of the evolution of body closure defects. Thus, MRI contributes to the preparation of family and multidisciplinary hospital staff. / Introdução - Os defeitos de fechamento da parede corporal anterior consistem em um grupo amplo de anomalias congênitas, caracterizados por herniação de uma ou mais vísceras para a cavidade amniótica por um orifício ventral, com incidência de um em cada 2.000 nascidos vivos. As malformações incluídas neste grupo são gastrosquise, onfalocele, ectopia cordis, pentalogia de Cantrell, complexo membro parede e extrofias de bexiga e cloaca. A origem comum das falhas de fechamento corporal, com exceção da Onfalocele, se baseia em uma hipótese embriológica unificadora, na qual os defeitos são consequências de uma falha no processo de fusão entre as duas pregas laterais. Para entender este mecanismo é necessária a compreensão da formação das pregas da parede corporal anterior. Objetivos: Caracterizar os defeitos de fechamento de parede corporal anterior em fetos por ressonância magnética, visando avaliar a contribuição da RM como método complementar à ultrassonografia e na indicação do método cirúrgico. Casuística e Métodos - Trata-se de um estudo transversal / prospectivo longitudinal constituído por 31 gestantes entre 18 e 36 semanas e 1 dia com fetos diagnosticados com defeitos de fechamento da parede corporal anterior distribuídos em: Grupo 1 (G1) - gestantes atendidas no Hospital de Base (HB/FAMERP) da Faculdade de Medicina de São José do Rio Preto no período de janeiro de 2009 a julho de 2014; Grupo 2 (G2) - gestantes atendidas no HB/FAMERP de setembro de 2014 a dezembro de 2015. Incluem-se entre os referidos defeitos gastrosquise, onfalocele, ectopia cordis e pentalogia de Cantrell, complexo membro-parede, além de extrofia de bexiga. Resultados - A avaliação dos fetos por RM permitiu a caracterização anátomo - morfológica do concepto e do defeito de parede corporal anterior, com relação à sua localização, extensão e conteúdo herniado e a detecção de defeitos congênitos associados ao diagnóstico de defeito de fechamento da parede corporal anterior. Conclusão - A compreensão do desenvolvimento embrionário como um processo dinâmico é essencial na caracterização dos defeitos de fechamento da parede corporal anterior na RM, refletindo na precisão do diagnóstico e, consequentemente, na condução clínica da gestação e no planejamento do tratamento cirúrgico. Além disso a excelente resolução espacial da RM e o contraste espontâneo do conteúdo das alças intestinais auxiliam na detecção de outras malformações associadas e complicações da evolução dos defeitos de fechamento corporal anterior. Desta forma, a RM contribui para a preparação da família e da equipe hospitalar multidisciplinar.

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

La fusion d’images TDM de phase artérielles et veineuses est cruciale afin d’assurer une meilleure planification chirurgicale. Cependant, le recalage non-rigide d’images abdominales est encore un challenge à cause de la respiration qui fait glisser les viscères abdominaux le long de la paroi abdominale, créant ainsi un champ de déformation discontinu. L’objectif de cette thèse est de fournir un outil de recalage précis pour les images TDM multi-phases de l’abdomen.Comme la zone de glissement dans l’abdomen est difficile à segmenter, nous avons d’abord implémenté deux outils de segmentation interactifs permettant une délinéation en 10 minutes de la paroi abdominale et du diaphragme. Pour intégrer ces zones de glissement comme a priori, nous réalisons le recalage sur de nouvelles images dans lesquelles la paroi abdominale et les viscères thoraciques ont été enlevés. Les évaluations sur des données de patient ont montré que notre approche fournit une précision d’environ 1 mm. / The fusion of arterial and venous phase CT images of the entire abdominal viscera is critical for a better diagnosis, surgi-cal planning and treatment, since these two phase images contain complementary information. However, non-rigid regis-tration of abdominal images is still a big challenge due to the breathing motion, which causes sliding motion between the abdominal viscera and the abdo-thoracic wall. The purpose of this thesis is to provide an accurate registration method for abdominal viscera between venous and arterial phase CT images.In order to remove the sliding motion effect, we decide to separate the image into big motion and less motion regions, and perform the registration on new images where abdo-thoracic wall and thoracic viscera are removed. The segmentation of these sliding interfaces is completed with our fast interactive tools within 10 minitues. Two state-of-the-art non-rigid registration algorithms are then applied on these new images and compared to registration obtained with original images. The evaluation using four abdominal organs (liver, kidney, spleen) and several vessel bifurcations shows that our approach provides a much higher accuracy within 1 mm.

No description available.

<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>

Dans ce travail, le concept d'approche mini-invasive est décrit dans sa globalité. Pour les chirurgiens pédiatres le concept a été analysé de manière systématique en répondant aux problématiques cliniques des patients dans tous les champs d'application. La somme de ce travail a le tour de force de répondre à toutes les grandes questions qui ont été posées lors des premiers temps de la coelioscopie pédiatrique, mais aussi de répondre, pour les plus récents, à des interrogations concernant les perspectives. Cette Thèse a donc pour objectif de développer l'évolution de la vidéochirurgie chez l'enfant et de mettre en valeur certaines applications que nous avons travaillées dans les différents domaines de la coelioscopie pédiatrique : tout d'abord dans la tolérance et la sécurité de la vidéochirurgie; puis ses applications en Chirurgie Digestive et Thoracique, en Rétropéritonéoscopie, en Oncologie et en Urologie ; mais aussi ses applications dans des techniques avancées de chirurgie néonatale ainsi que l'introduction de techniques encore moins invasives comme la chirurgie assistée par aimant ou des techniques non opératoires utilisées dans le traitement de certaines malformations de la paroi thoracique, en démontrant leurs bénéfices et leur efficacité / In this work, the concept of minimal invasive approach is described in its entirety. For pediatric surgeons, the concept was analyzed systematically meeting the clinical problems of patients in all fields of application. The result of this work is to answer all the big questions that were asked during the early days of the pediatric laparoscopy but also to respond to the latest questions about the perspectives. The goal of this thesis is to describe the evolution of laparoscopy in pediatric, and to report some applications. We have worked in several fields such as: Tolerance and safety of laparoscopy in advanced neonatal surgery, and its applications in Digestive Surgery, Thoracic, Retroperitoneoscopy, Oncology and Urology. This also introduces the use of less invasive techniques, such as magnet-assisted surgery of non-operative techniques in the correction on chest wall deformities, demonstrating their efficacity and efficiency

Pacientes portadores de doença pulmonar obstrutiva crônica (DPOC) podem apresentar assincronia toracoabdominal (ATA). Existem diversos métodos de estimativa da ATA, porém, não há um consenso sobre qual é o mais adequado. O objetivo deste estudo foi comparar dois métodos de estimativa da assincronia toracoabdominal e avaliar a ineficiência ventilatória em pacientes DPOC no repouso e durante o exercício. Foram avaliados 22 pacientes com DPOC (VEF1 40,2±10,5% predito) e 13 indivíduos controle (GC) pareados por idade, gênero e índice de massa corpórea. A cinemática toracoabdominal foi avaliada utilizando pletismografia optoeletrônica no repouso e durante o exercício leve e moderado (70% da carga máxima) no ciclo ergômetro. A ATA foi calculada entre a caixa torácica superior (CTS) e inferior (CTI) e o abdome (ABD) utilizando os métodos de ângulo de fase (AF) e relação de fase (RF). A ineficiência ventilatória foi calculada em cada compartimento como a diferença entre o volume máximo (VM) e o volume calculado (VC) de acordo com o ciclo respiratório (determinado pela soma de volume dos três compartimentos) dividida pelo volume máximo (VM-VC)/VM. Os pacientes com DPOC foram classificados como assíncronos (grupo AT) ou não assíncronos (grupo NA) utilizando como referência os valores do GC. Foi utilizado o teste qui-quadrado ou de Fisher para avaliar a discriminação de pacientes entre os métodos e o ANOVA de dois fatores para comparações entre os grupos. O nível de significância foi ajustado para 5%. O método AF determinou maior número de pacientes com ATA quando comparado com RF no repouso (respectivamente, 15 vs. 7) e no exercício leve (11 vs. 3) e moderado (14 vs. 8). Os valores de assincronia no grupo AT entre CTS-CTI e CTI-ABD foram maiores no repouso (AF: 35,7±45,4° e -42,2±42,5° e RF: 61,8±29,1° e -66,9±27,4°, respectivamente) e no exercício leve (AF: 53,3±35,6° e -55,8±40,4°; RF: 106,1±40,3° e - 124,8±17,2°) e moderado (AF: 61,6±55,1° e -75,9±44,8°; RF: 85,9±23,6° e -81,8±42,2°) quando comparados com os grupos NA (p < 0,05) e GC (p < 0,05). Na análise entre CTSABD não houve diferença entre os grupos. Observou-se que o grupo AT apresentou menor contribuição e maior ineficiência ventilatória da CTI em todos os momentos de avaliação e, durante o exercício moderado, menor volume corrente quando comparado com os grupos NA e GC. Os nossos resultados sugerem que o ângulo de fase apresenta maior detecção de ATA nos pacientes com DPOC. A presença de assincronia parece ocorrer principalmente na caixa torácica inferior e associada com menor contribuição e maior ineficiência ventilatória deste compartimento / Chronic obstructive pulmonary disease (COPD) patients can present thoracoabdominal asynchrony (TAA). There are several TAA estimation techniques, however, there is no consensus about which is the most appropriate. The aim of this study was to compare two thoracoabdominal asynchrony quantification techniques and to assess chest wall ventilatory inefficiency in COPD patients at rest and during exercise. We evaluated 22 COPD patients (FEV1 40,2±10,5% predicted) and 13 healthy controls (CG) matched by age, gender and body mass index. Thoracoabdominal kinematics was assessed via optoelectronic plethysmography at rest and during mild and moderate exercise (70 % maximum workload) in a cycle ergometer. TAA was calculated among upper (URC) and lower ribcage (LRC) and abdomen (ABD) by using the phase angle (PA) and phase relation (PR) approaches. Ventilatory Inefficiency was estimated in each compartment as the difference between the maximal volume (VM) and the volume (VC) calculated according to respiratory timing (sum of volume in the 3 compartments) divided by the maximal volume (VM-VC)/VM. COPD patients were classified as asynchronous (AT group) or not (NA group) by using as reference the values on the controls. Chi-square or Fisher\'s exact test was used for assessing the patients differentiation between the two TAA quantification approaches and two-way ANOVA was used to compare respiratory parameters among groups (CG, AT and NA). Statistical significance was set at 5% level. PA approach determined more patients as asynchronous when compared to RF at rest (respectively, 15 vs. 7) and during mild (11 vs. 3) and moderate (14 vs. 8) exercise. Asynchrony values in AT group among URC-LRC and LRC-ABD were greater at rest (respectively, 35.7±45.4° and -42.2±42.5° with PA and 61.8±29.1° and -66.9±27.4° with PR) and during mild (PA: 53.3±35.6° and -55.8±40.4°; PR: 106.1±40.3° and -124.8±17.2°) and moderate exercise (PA: 61.6±55.1° and - 75.9±44.8°; PR: 85.9±23.6° and -81.8±42.2°) when compared to NA (p < 0.05) and CG (p < 0.05). Analysis among URC-ABD presented no difference between groups. It was observed that AT group presented a smaller LRC contribution and greater ventilatory inefficiency during all assessing moments and, during moderate exercise, had a lower tidal volume when compared to NA and CG. Our results suggest that phase angle approach presents larger TAA detection in COPD patients. This asynchrony seems to occur mainly in the lower ribcage and be associated with decreased contribution and increased ventilatory inefficiency of this compartment