Search

The study objectives were to describe the compounded complication rate of minimally invasive repair of pectus excavatum, identify predisposing risk factors, and evaluate the optimal timing of correction. Minimally invasive repair of pectus excavatum is the standard treatment for pectus excavatum and consists of 2 invasive procedures, for example, correction with bar insertion followed by bar removal after 2 to 3 years. A retrospective cohort study identifying children, adolescents, and adults of both genders corrected for pectus excavatum with minimally invasive repair of pectus excavatum between 2001 and 2022. Information on complications related to bar insertion and removal procedures for each individual patient was compiled into a compounded complication rate. Complication severities were categorized according to the Clavien-Dindo classification. A total of 2013 patients were corrected by minimally invasive repair of pectus excavatum with a median age (interquartile range) for correction of 16.6 (5) years. Overall compounded complication rate occurred at a frequency of 16.4%, of which 9.3% required invasive reinterventions (Clavien-Dindo classification ≥IIIa). The complication rate related to bar insertion was 2.6-fold higher compared with bar removal (11.8% vs 4.5%, respectively). Multivariable analysis revealed age (adjusted odds ratio, 1.05; P <.001), precorrection Haller Index (adjusted odds ratio, 1.10; P <.033), and early-phase institutional experience (adjusted odds ratio, 1.59; P <.002) as independent predisposing risk factors. The optimal age of correction was 12 years, and the compounded complication rate correlated exponentially with age with a doubling time of 7.2 years. Complications increased 2.2-fold when the Haller index increased to 5 or more units. Minimally invasive repair of pectus excavatum is associated with a high compounded complication rate that increases exponentially with age and high Haller Index. Consequently, we recommend repair during late childhood and early adolescence, and emphasize the importance of informing patients and relatives about the significant risks of adult correction as well as the need of 2 consecutive procedures taking the complication profile into account before planning surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

The presence of pectus excavatum in patients undergoing open heart surgery is rare, and no consensus has been reached regarding the surgical approach. Thus, this paper describes a single-stage procedure for correction of pectus excavatum with the modified Nuss procedure ad modum Pilegaard in 4 patients undergoing open heart surgery. Three of 4 patients successfully underwent the single-stage procedure. At follow-up after bar removal, all patients had no complications related to the Nuss bar, and all had excellent cosmetic results. [ABSTRACT FROM AUTHOR]

• Surgical stabilization of flail chest lead to fast weaning from mechanical ventilation. • Plates can be used for stabilization of sterno-costal dehiscence. • Cartilage reconstruction of a CT scan can reveal the true severity of the trauma. Flail chest is diagnosed clinically by the presence of paradox movement of a segment of the thoracic wall during spontaneous breathing. Radiographic finding confirming a clinical flail chest are fractures of three or more consecutive ribs or costal cartilages in two or more places. Surgical stabilization is associated with a reduced length of hospital stay, time with mechanical ventilation and risk of respiratory complications. A trauma patient had a Computed Tomography (CT) scan showing multiple costa fractures, sternal fracture, manubrium fracture, sternal displacement and dehiscence of the sternal-costal attachment. The severity of the trauma was visualized after performing a cartilage reconstruction of the trauma CT scan. The patient underwent surgery, using fixation plates to stabilize the thoracic cage, and was then weaned quickly from mechanical ventilation. This case indicates, that if a patient has a severe flail chest recognized clinically, but not radiologically, a reconstruction of cartilage can reveal the true severity of the trauma. Indeed, the patient in this case experienced a positive outcome from surgery. However, such a procedure demands correct timing and experience in surgical stabilization of the thoracic wall. Furthermore, the injury required accurate planning with the involved personal before surgery. Surgical stabilization of advanced flail chest with concomitant sternal fracture, seems to be a safe procedure, that might reduce the need of mechanical ventilation and the length of stay at the Intensive Care Unit (ICU). Furthermore, cartilage reconstruction of the trauma CT scan can potentially identify a severe flail chest, that might be missed on regular 3D bone reconstruction. [ABSTRACT FROM AUTHOR]

Highlights • Mycotic aneurysms of the pulmonary arteries are very rare with high mortality. • Risk groups are IV drug users and patients with congenital heart disorders. • Symptoms are often non-specific and may cause a diagnostic delay. • When hemoptysis is present, the suspicion of a pulmonary aneurysm should be raised. • For rapidly progressing proximal aneurysms, a midline approach is recommended. Abstract Introduction Mycotic aneurysms of the pulmonary arteries are very rare and have high mortality. Risk groups are intravenous drug users and patients with congenital heart disorders. The surgical approach varies due to a limited number of reported cases. Presentation of case We present a case of a mycotic aneurysm of the right pulmonary artery in a 56-year old man presenting with recurrent pneumonias, weight loss and hemoptysis. Discussion There is often a diagnostic delay because of non-specific symptoms mimicking more common disorders. Treatment strategies include conservative management, surgery and endovascular treatment. Conclusion This report demonstrates a rare case of aneurysm of the pulmonary artery presenting with hemoptysis. For rapidly progressing proximal aneurysms of the pulmonary arteries, the midline surgical approach is recommended. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is associated with impaired skeletal muscle function and degeneration of the skeletal muscles. However, the mechanisms underlying the degeneration are not well described in human skeletal muscle. Here we show that skeletal muscle of T2DM patients exhibit degenerative remodeling of the extracellular matrix that is associated with a selective increase of a subpopulation of fibro-adipogenic progenitors (FAPs) marked by expression of THY1 (CD90)—the FAPCD90+. We identify platelet-derived growth factor (PDGF) as a key FAP regulator, as it promotes proliferation and collagen production at the expense of adipogenesis. FAPsCD90+ display a PDGF-mimetic phenotype, with high proliferative activity, clonogenicity, and production of extracellular matrix. FAPCD90+ proliferation was reduced by in vitro treatment with metformin. Furthermore, metformin treatment reduced FAP content in T2DM patients. These data identify a PDGF-driven conversion of a subpopulation of FAPs as a key event in the fibrosis development in T2DM muscle. [Display omitted] • Type 2 diabetes is associated with fibro-fatty degeneration of skeletal muscle • CD34+ FAPs represent a unique cell population responsible for fibro-fatty infiltration • CD90+ FAPs display enhanced cell division and collagen production mediated by PDGF • The FAPsCD90+ accumulate in skeletal muscle of type 2 diabetic patients Pathological tissue transformation, including fibro-fatty organ degeneration, is a hallmark of type 2 diabetes. Farup et al. demonstrate that degeneration of skeletal muscle in individuals with type 2 diabetes is associated with the accumulation of a subset of fibro-adipogenic progenitors, expressing CD90, endowed with enhanced progenitor potential and collagen production. [ABSTRACT FROM AUTHOR]