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Introduction: The current clinical staging of pleural mesothelioma (PM) is often discordant with the pathologic staging. This study aimed to identify clinical and radiological features that could help predict unresectability in PM. Methods: Twenty-two descriptive radiologic features were retrospectively evaluated on preoperative computed tomography (CT) and/or positron emission tomography/CT (PET/CT) performed in patients with presumably resectable PM who underwent surgery. Measurements of maximum and sum pleural thickness at three levels of the thorax (upper, middle, and lower) were taken and stratified based on the cutpoints provided by the International Association for the Study of Lung Cancer (IASLC). Clinical and radiological features, including clinical-stage, were compared between resectable and unresectable tumors by univariate analysis and logistic regression modeling. Results: Of 133 patients, 69/133 (52%) had resectable and 64/133 (48%) had unresectable PM. Asbestos exposure (p = 0.005), neoadjuvant treatment (p = 0.001), clinical T-stage (p < 0.0001), all pleural thickness measurements (p < 0.05), pleural thickness pattern (p < 0.0001) and degree (p = 0.033), lung invasion (p = 0.004), extrapleural space obliteration (p < 0.0001), extension to subphrenic space (p = 0.0004), and two combination variables representing extensive diaphragmatic contact and/or chest wall involvement (p = 0.002) and mediastinal invasion (p < 0.0001) were significant predictors at univariate analysis. At multivariable analysis, all models achieved a strong diagnostic performance (area under the curve (AUC) > 0.8). The two best-performing models were one that included the upper-level maximum pleural thickness, extrapleural space obliteration, and mediastinal infiltration (AUC = 0.876), and another that integrated clinical variables and radiological assessment through the clinical T-stage (AUC = 0.879). Conclusion: Selected clinical and radiologic features, including pleural thickness measurements, appear to be strong predictors of unresectability in PM. Clinical relevance statement: A more accurate prediction of unresectability in the preoperative assessment of patients with pleural mesothelioma may avoid unnecessary surgery and prompt initiation of nonsurgical treatments. Key Points: About half of pleural mesothelioma patients are reported to receive an incorrect disease stage preoperatively. Eleven features identified as predictors of unresectability were included in strongly performing predictive models. More accurate preoperative staging will help clinicians and patients choose the most appropriate treatments. [ABSTRACT FROM AUTHOR]

Introduction: We report a case of advanced triple-negative breast cancer (TNBC) with special clinical manifestations, in which a durable remission was achieved after short-term administration of toripalimab combined with chemotherapy. The progress, advantages, and unique experience of chemoimmunotherapy in TNBC were examined. Case Presentation: A patient with TNBC with local recurrence 2 years following surgery, with inoperable large chest wall lesions and positive PD-L1 as the main manifestations, was treated with toripalimab plus paclitaxel (albumin-bound) for 5 months and achieved a partial remission. Twenty-five months after the discontinuation of treatment, the chest wall lesions exhibited a slow but continuous decline, until they achieved a nearly complete remission; however, the patient eventually died from cancer progression. Conclusion: Typically, chest wall recurrence in TNBC has a poor prognosis; however, recurrence was rapidly controlled, sustained remission was achieved after immunotherapy combined with chemotherapy, and the curative effect continued after drug withdrawal, which is a rare occurrence. Thus, the tailing effect of immune checkpoint inhibitors was confirmed in the treatment of TNBC. Introduction: We report a case of advanced triple-negative breast cancer (TNBC) with special clinical manifestations, in which a durable remission was achieved after short-term administration of toripalimab combined with chemotherapy. The progress, advantages, and unique experience of chemoimmunotherapy in TNBC were examined. Case Presentation: A patient with TNBC with local recurrence 2 years following surgery, with inoperable large chest wall lesions and positive PD-L1 as the main manifestations, was treated with toripalimab plus paclitaxel (albumin-bound) for 5 months and achieved a partial remission. Twenty-five months after the discontinuation of treatment, the chest wall lesions exhibited a slow but continuous decline, until they achieved a nearly complete remission; however, the patient eventually died from cancer progression. Conclusion: Typically, chest wall recurrence in TNBC has a poor prognosis; however, recurrence was rapidly controlled, sustained remission was achieved after immunotherapy combined with chemotherapy, and the curative effect continued after drug withdrawal, which is a rare occurrence. Thus, the tailing effect of immune checkpoint inhibitors was confirmed in the treatment of TNBC. Introduction: We report a case of advanced triple-negative breast cancer (TNBC) with special clinical manifestations, in which a durable remission was achieved after short-term administration of toripalimab combined with chemotherapy. The progress, advantages, and unique experience of chemoimmunotherapy in TNBC were examined. Case Presentation: A patient with TNBC with local recurrence 2 years following surgery, with inoperable large chest wall lesions and positive PD-L1 as the main manifestations, was treated with toripalimab plus paclitaxel (albumin-bound) for 5 months and achieved a partial remission. Twenty-five months after the discontinuation of treatment, the chest wall lesions exhibited a slow but continuous decline, until they achieved a nearly complete remission; however, the patient eventually died from cancer progression. Conclusion: Typically, chest wall recurrence in TNBC has a poor prognosis; however, recurrence was rapidly controlled, sustained remission was achieved after immunotherapy combined with chemotherapy, and the curative effect continued after drug withdrawal, which is a rare occurrence. Thus, the tailing effect of immune checkpoint inhibitors was confirmed in the treatment of TNBC. [ABSTRACT FROM AUTHOR]

Introduction: Mondor's Disease (MD) is a thrombophlebitis of the anterolateral chest wall, with only about 400 cases reported worldwide, predominantly in women. We report a case of MD with sudden onset of pain, edema, and asymmetry in the left breast, evolving over two weeks. Objectives: To present a case of breast MD identified in an outpatient primary care center in Bogotá, Colombia, as a contribution to broaden the understanding of this disease, raise awareness among healthcare teams about the importance of early identification and appropriate treatment, and contribute to the characterization of MD in the country. Findings: Physical examination revealed edema in the outer quadrants of the left breast associated with a visible longitudinal lesion in the upper outer quadrant (UOQ), tender to palpation. Ultrasound evidence confirmed superficial venous thrombosis. Interventions: A breast ultrasound was performed, showing vascular dilation in the UOQ of the left breast. A breast specialist evaluation was conducted to confirm the diagnosis of MD. Medical management included anti-inflammatory drugs and local heat application, resulting in favorable evolution. Conclusions: MD is an unusual condition in primary care settings, requiring greater awareness among healthcare teams for improved early identification.

Pectus excavatum, the most frequent malformation of the chest wall, has been related to cardiac compression and exercise intolerance. Cardiac outcomes after minimally invasive repair of pectus excavatum with retrosternal implants, particularly after removal (> 2 years postoperative) are generally unknown. We evaluated stress echocardiography outcomes before repair and after bar removal. This study comprised a retrospective cohort of patients with diagnosis of isolated pectus excavatum who underwent stress echocardiography before minimally invasive repair with retrosternal implants, and after bar removal. The diastolic function was evaluated by means of the trans tricuspid flow and tissue doppler imaging. The compression of the atrioventricular groove was assessed using the trans tricuspid gradient and the tricuspid area. We included 43 patients, with a mean age of 15.7 ± 4.0 years (91% male). After bar removal, 83% of patients referred improvement of exercise capacity. Furthermore, we found a significant improvement in right ventricular filling patterns, including a better E/A ratio profile during exercise (p = 0.001), lower filling pressures both at rest (p < 0.0001) and during exercise (p = 0.031), and lower rates of resting paradoxical septal motion [70% vs. 20%, p = 0.0007]. The trans tricuspid mean gradient during exercise was significantly lower after bar removal (p < 0.0001). In this study involving patients with minimally invasive repair of pectus excavatum, we demonstrated a beneficial impact of such intervention after bar removal, with significant improvements related to the right ventricular function, as well as signs of relief of cardiac compression. [ABSTRACT FROM AUTHOR]

Thoracic hernias encompass the protrusion of thoracic contents through the thorax or intra‐abdominal tissue into the thorax. They can be classified as diaphragmatic hernias – either congenital or acquired; pulmonary hernias – involving tissue protrusion through cervical fascia or intercostal spaces; and mediastinal hernias – including cardiac, intrapericardial and hiatal hernias. Prompt identification and classification of thoracic hernias rely on diagnostic imaging, primarily through computed tomography and magnetic resonance, to identify associated complications. This article comprehensively reviews thoracic hernias and their key imaging features. [ABSTRACT FROM AUTHOR]

Background The postural abnormality, forward shoulder posture (FSP), is the most common cause of respiratory impairment in older individuals with chronic obstructive pulmonary disease (COPD). A recent study found that performing pectoral stretching and scapular strengthening exercises for eight weeks could reduce FSP in healthy participants. We aimed to determine the effects of pectoral stretching and scapular stabilizer strengthening exercises on FSP, chest wall mobility, respiratory muscle strength, and pulmonary function in male patients with COPD. Methods This study was randomized clinical trial. Forty male COPD patients with FSP aged 60–90 years were included and randomly allocated to control (n=20) and exercise (n=20) groups. Following completion of the scapulothoracic exercises (three days/week, for eight weeks), respiratory functions were assessed by measuring the magnitude of FSP, chest mobility, respiratory muscle strength, and pulmonary functions. Results FSP and thoracic kyphosis angle significantly decreased compared to controls (p Conclusions The eight-week combined pectoral muscles self-stretching and serratus anterior and lower trapezius strengthening exercises could be an effective treatment and/or prevention strategy for FSP reduction, leading to improved respiratory function in male COPD patients.

The aim of this systematic review was to investigate the effectiveness of physiotherapy interventions on chest mobility in obstructive lung diseases. Searches were performed in PEDro, Pubmed and Cochrane Central Register of Controlled Trials databases without language restrictions between 2010 and 25th December 2020. Randomized controlled trials (RCTs) investigating physiotherapy interventions on chest wall mobility were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. The assessment of risk of bias was conducted using the PEDro scale for RCTs. The articles were excluded if they have less than 5 out of 10 score. Five studies included had good to excellent quality. A total of 139 patients were included in all RCTs. Intervention duration ranged from a single session to 12 weeks and the intervention schedules varied, consisting of 1–24 sessions, lasting 5–45 min per sessions. Three studies used respiratory muscle stretching and releasing techniques, one study combined respiratory muscle stretching with aerobic training, and one study planned diaphragmatic breathing. Four studies assessed chest wall mobility with optoelectronic plethysmography, whereas one study used measuring tape. The result of this first systematic review that investigates the effects of physiotherapy interventions on chest wall mobility in obstructive lung diseases suggests that more and better quality RCTs with objective measurement tools are required. [ABSTRACT FROM AUTHOR]

Background The postural abnormality, forward shoulder posture (FSP), is the most common cause of respiratory impairment in older individuals with chronic obstructive pulmonary disease (COPD). A recent study found that performing pectoral stretching and scapular strengthening exercises for eight weeks could reduce FSP in healthy participants. We aimed to determine the effects of pectoral stretching and scapular stabilizer strengthening exercises on FSP, chest wall mobility, respiratory muscle strength, and pulmonary function in male patients with COPD. Methods This study was randomized clinical trial. Forty male COPD patients with FSP aged 60–90 years were included and randomly allocated to control (n=20) and exercise (n=20) groups. Following completion of the scapulothoracic exercises (three days/week, for eight weeks), respiratory functions were assessed by measuring the magnitude of FSP, chest mobility, respiratory muscle strength, and pulmonary functions. Results FSP and thoracic kyphosis angle significantly decreased compared to controls (p

N/a.

Chest wall tumors are relatively uncommon, representing 1 to 2% of all neoplasms, and approximately 5% of thoracic neoplasms. Sarcomas are rare tumors with heterogeneous presentation. They are divided into two large groups: bone and soft tissue tumors. Occurrence in the chest wall is rare, representing 8% of all sarcomas. The treatment of choice is resection with wide margins and, when invasion of deep structures occurs, thoracotomy is indicated. The reconstruction of the bone framework is carried out with synthetic materials, providing stability, and is followed by the reconstruction of soft tissues with muscular, musculocutaneous, or random local flaps. Primary malignant tumors of the chest wall account for less than 1% of all neoplasms and include a wide variety of bone and soft tissue lesions. Chondrosarcomas represent 20% of primary tumors of the chest wall, with 80% originating in the ribs and 20% in the sternum.

Background: Anatomical variations and, in particular, arterial variations constitute an important chapter in the learning of Clinical Anatomy. Purpose: The purpose of this report is to describe a rare bilateral anatomical variation in the internal thoracic artery (ITA) in a 60-year-old corpse and to depict its extreme clinical importance in coronary artery bypass surgery. Methods: The rare bilateral aberrant branches of the internal thoracic artery and their course in the thorax were incidentally discovered during routine anatomy dissection of the thorax at the Faculty of Medicine and Medical Sciences of the University of Balamand. The findings were thoroughly documented using digital photography, and the dissection followed the instructions from the “16th Edition of Grant’s Dissector”. Results: In the observed case, the left aberrant branch of ITA descends laterally and gives medial and lateral anterior intercostal branches at the first six intercostal spaces. Conversely, the right aberrant artery, which branches from the ITA, descends laterally and gives medial and lateral branches to every intercostal space in the first five intercostal spaces. Conclusion: This report emphasizes that any unexpected variations in the lateral aberrant branches of the internal thoracic artery may complicate the surgical procedure. Bilateral aberrant lateral branches of the internal thoracic artery constitute rare anatomical variations of the internal thoracic artery and have been rarely reported in the literature. Such a course for aberrant lateral branches in the thorax poses possible lethal complications during several procedures involving the thorax, including basic coronary artery bypass graft, thoracocentesis and intercostal paracentesis and breast reconstruction.

Anterior chest wall involvement is frequently seen in adult patients with spondyloarthropathy and often related to advanced axial disease and rarely reported in pediatric patients. In addition, anterior chest wall involvement is frequently encountered in patients with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Despite treatments of these conditions were similar, differentiation of these two diseases might be challenging due to the overlapping features. Also, several rheumatic diseases, including spondyloarthropathy, could be seen in association with familial Mediterranean fever (FMF). Additionally, treatment of cases with concomitant FMF and spondyloarthropathy might be challenging due to the different biological drug needs of the diseases. Herein, we presented a case of sternoclavicular arthritis in a pediatric FMF patient for the first time and emphasize on the challenges in differentiating SAPHO from spondyloarthropathy and difficulties in treatment. [ABSTRACT FROM AUTHOR]

Background: Anatomical variations and, in particular, arterial variations constitute an important chapter in the learning of Clinical Anatomy. Purpose: The purpose of this report is to describe a rare bilateral anatomical variation in the internal thoracic artery (ITA) in a 60-year-old corpse and to depict its extreme clinical importance in coronary artery bypass surgery. Methods: The rare bilateral aberrant branches of the internal thoracic artery and their course in the thorax were incidentally discovered during routine anatomy dissection of the thorax at the Faculty of Medicine and Medical Sciences of the University of Balamand. The findings were thoroughly documented using digital photography, and the dissection followed the instructions from the "16th Edition of Grant's Dissector". Results: In the observed case, the left aberrant branch of ITA descends laterally and gives medial and lateral anterior intercostal branches at the first six intercostal spaces. Conversely, the right aberrant artery, which branches from the ITA, descends laterally and gives medial and lateral branches to every intercostal space in the first five intercostal spaces. Conclusion: This report emphasizes that any unexpected variations in the lateral aberrant branches of the internal thoracic artery may complicate the surgical procedure. Bilateral aberrant lateral branches of the internal thoracic artery constitute rare anatomical variations of the internal thoracic artery and have been rarely reported in the literature. Such a course for aberrant lateral branches in the thorax poses possible lethal complications during several procedures involving the thorax, including basic coronary artery bypass graft, thoracocentesis and intercostal paracentesis and breast reconstruction. [ABSTRACT FROM AUTHOR]

Abstract Transdiaphragmatic intercostal hernia is a rare disease. It is usually caused by trauma and is rarely caused by coughing. Although a few cases of intercostal hernia induced by coughing have been reported, our case of a non traumatic acquired acute transdiaphragmatic intercostal and abdominal hernia induced by coughing is very rare. A 77-year-old woman presented with sudden-onset left lower chest pain after an episode of violent coughing. She had risk factors for intercostal hernia, including obesity, chronic obstructive pulmonary disease, oral steroid use, and diabetes mellitus. Computed tomography showed herniation of the lung and intra-abdominal organs into the thoracic and abdominal wall through a ruptured diaphragm, as well as the intercostal and abdominal muscles. Surgery was completed with interrupted sutures to close the defects after the reduction of the herniated organs. Our experience suggests that careful examinations, including the assessment of risk factors and computed tomography imaging, were essential for establishing an accurate diagnosis, and that the repair of a ruptured diaphragm with simple interrupted sutures without any prosthetic materials seems to be feasible in selected patients with a transdiaphragmatic intercostal hernia.

Abstract Dynamic chest radiography (DCR) is a real-time sequential high-resolution digital X-ray imaging system of the thorax in motion over the respiratory cycle, utilising pulsed image exposure and a larger field of view than fluoroscopy coupled with a low radiation dose, where post-acquisition image processing by computer algorithm automatically characterises the motion of thoracic structures. We conducted a systematic review of the literature and found 29 relevant publications describing its use in humans including the assessment of diaphragm and chest wall motion, measurement of pulmonary ventilation and perfusion, and the assessment of airway narrowing. Work is ongoing in several other areas including assessment of diaphragmatic paralysis. We assess the findings, methodology and limitations of DCR, and we discuss the current and future roles of this promising medical imaging technology. Critical relevance statement Dynamic chest radiography provides a wealth of clinical information, but further research is required to identify its clinical niche. Graphical abstract

Coccidioidomycosis is an infection caused by soil-dwelling fungi, Coccidioides, that are endemic to the southwestern United States, northern Mexico, and scattered areas of Latin America. It typically presents with pulmonary manifestations that resemble symptoms of bronchitis, pneumonia, and the flu. Extrapulmonary manifestations that involve the skin, lymph nodes, bones, and joints have also been well described, but disseminated coccidioidomycosis initially presenting as chest wall infection without pulmonary symptoms is not. In this article, we present a case of a 33-year-old man who presented with chest wall swelling and eventually diagnosed with chest wall abscesses due to disseminated coccidioidomycosis. We propose that consideration of disseminated coccidioidomycosis in nonresolving swelling, mass, lesions, or abscess especially in endemic areas for coccidioidomycosis and in travelers to the endemic area may prevent the progression and further complications of coccidioidomycosis.

Thoracic surgery is often associated with severe postoperative pain levels. Even though these are less pronounced in thoracoscopic approaches, mechanical irritation, compression or injury of intercostal nerves and placement of chest tubes can cause pain levels, which must be treated. An adequate pain therapy in thoracic surgery is essential as insufficient inspiration due to inadequate analgesia may result in postoperative complications. Epidural anesthesia was considered the gold standard in thoracotomy for a long time. For video-assisted thoracoscopy, however, it is sometimes no longer recommended due to its benefit-risk ratio. Alternative thoracic blocks are the paravertebral block, the erector spinae plane block and the serratus anterior block, for which research has found heterogeneous results. This article summarizes the current recommendations for perioperative management of thoracoscopic surgery and gives an overview of the PROSPECT recommendations as well as the current Association of the Scientific Medical Societies in Germany (AWMF) guidelines for perioperative and postoperative pain therapy. In particular, individual regional anesthesia techniques and their current evidence are reviewed. [ABSTRACT FROM AUTHOR]

Objectives: To develop a predictive model using conventional ultrasound combined with CEUS to identify thoracic wall recurrence after mastectomy. Methods: A total of 162 women with pathologically confirmed thoracic wall lesions (benign 79, malignant 83; median size 1.9 cm, ranging 0.3–8.0 cm) underwent a mastectomy and were checked by both conventional ultrasound and CEUS and were retrospectively included. Logistic regression models of B-mode ultrasound (US) and color Doppler flow imaging (CDFI) with or without CEUS were established to assess the thoracic wall recurrence after mastectomy. The established models were validated by bootstrap resampling. The models were evaluated using calibration curve. The clinical benefit of models were assessed using decision curve analysis. Results: The area under the receiver characteristic was 0.823 (95% CI: 0.76, 0.88) for model using US alone, 0.898 (95% CI: 0.84, 0.94) for model using US combined with CDFI, and 0.959 (95% CI: 0.92, 0.98) for model using US combined with both CDFI and CEUS. The diagnostic performance of the US combined with CDFI was significantly higher than that of the US alone (0.823 vs 0.898, p = 0.002) but significantly lower than that of the US combined with both CDFI and CEUS (0.959 vs 0.898, p < 0.001). Moreover, the unnecessary biopsy rate of the US combined with both CDFI and CEUS was significantly lower than that of the US combined with CDFI (p = 0.037). Conclusions: Compared to B-mode ultrasound and CDFI, CEUS improves the diagnostic performance to evaluate thoracic wall recurrence after mastectomy. Key Points: • CUES is an effective supplementary method for US in the diagnosis of thoracic wall recurrence after mastectomy. • CEUS combined with both US and CDFI can significantly improve the accuracy of diagnosis of thoracic wall recurrence after mastectomy. • CEUS combined with both US and CDFI can reduce the rate of unnecessary biopsy of thoracic wall lesions after mastectomy. [ABSTRACT FROM AUTHOR]

Background: Traumatic Spinal Cord Injury (TSCI) is one of the catastrophic events, the rate of which has been growing compared to the past decades. Complications caused by TSCI have a wide spectrum and can range from complete paralysis to numbness of the limbs. Additional to the injury severity and disability of the patient, the recovery rate depends on the treatment strategies. Despite extensive efforts and research in this field, there are still few treatment options for TSCI patients. Controversial results have been reported, however, spinal cord decompression is the only certainty for the treatment of these patients. In the present study, patients with thoracic and lumbar fractures were undergone decompression, less and more than 24 hours, and the recovery rate (RR) was compared after 6 months. Methods: In this study, patients with lumbar and thoracic fractures who were referred to the neurosurgery department of Ahvaz Golestan Hospital during May 2019 to December 2021 were included. Decompression was performed at the fracture level as a total and at the upper and lower levels of the fracture as a partial decompression. To evaluate fine motor movements, picking up a small object with toes and following a rectangular path were used. Also, the gross motor movements, upper and lower proximal and distal muscle forces were measured. Results: 160 patients including 133 men (83.1%) and 16.9% women (27) with 36±12 years mean age were included. The most fracture location was lumbar (53.1%), followed by the thoracic (43.1%) and fractures in both regions (3.8%). The most injured vertebras were L1 (27.5%) and T12 (18.8%). Six months later, 61.9% of patients had a good score for removing a small object with toe, of which 67.5% belonged to patients with

Pectus excavatum(PE) is a congenital chest deformity characterized by deep depression in the sternum. Autologous fat transplantation has been used for aesthetic purposes, mainly on the face, and has recently gained relevance in thoracic and breast surgeries. The present study aims to present a case of mild PE associated with hypomastia. A 24-year-old female patient attended the consultation for breast augmentation due to hypomastia, but the clinical examination also revealed an associated mild PE that the patient did not notice. Surgical planning included breast augmentation and autologous fat transfer. A 260ml silicone breast implant was used, and 250ml of fat was injected in the sternal region and the lower medial contour of the breasts. There were no complications during the 12-month follow-up period. The combination of augmentation mammoplasty and fat transplantation in treating PE deformity proved to be a minimally invasive, good, safe option with high patient satisfaction.

Objective: Lung cancer remains the leading cause of cancer deaths worldwide. The surgical approach to locally advanced non-small cell lung cancer (NSCLC) goes beyond the classical approach and requires a multidisciplinary approach both preoperatively and postoperatively. In addition to the tumor size, the location of T3 tumors affects the extent of the surgery. Materials and Methods: Patients who underwent lung resection for cancer between March 2019 and October 2022 were retrospectively reviewed. Patients who underwent chest wall resection were evaluated in terms of age, gender, pathology, type of operation, survival, recurrence, complications, receipt of preoperative chemotherapy, tumor node metastasis (TNM) stage, whether or not mediastinoscopy was performed, STAS (The spread through air spaces) positivity, visceral pleural invasion, parietal pleural invasion, lymphovascular invasion, perineural invasion, and alveolar/bronchial wall invasion. Results: Thoracic wall resection was performed in nine patients with locally advanced NSCLC. The use of prolene mesh was required in eight patients. All patients complained of pain in the thoracic wall in the preoperative period. Postoperative pathology results showed STAS positivity in four patients; alveolar/bronchial wall invasion in four; and visceral, parietal, pleural, and lymphovascular invasion in seven. The mean survival of the patients was 24.20 months (0.63–39). No patient developed recurrence during the follow-up period. Conclusion: Chest wall resection and reconstruction for lung cancer is a surgical treatment method that should be performed without violating respiratory physiology and by using a small amount/number of synthetic materials.

Fascial plane blocks are useful for multimodal analgesia after cardiac surgery since they can provide effective analgesia without the serious risks associated with conventional techniques such as neuraxial hematoma and pneumothorax. This narrative review covers blocks performed at the parasternal intercostal, interpectoral, pectoserratus, serratus anterior, erector spinae, and retrolaminar planes, which are targets for fascial plane blocks in cardiac surgery. Brief anatomical considerations, mechanisms, and currently available evidence are reviewed. Additionally, recent evidence on fascial plane blocks for subcutaneous-implantable cardioverter-defibrillator implantation are also reviewed.

Dynamic musculoskeletal ultrasound is an important diagnostic tool that allows the practitioner to observe soft tissue structures over a range of motion and identify pathology not diagnosed on other modalities. Familiarity with this modality allows health care practitioners to appropriately refer patients for this type of examination. This article will review several indications for dynamic ultrasound imaging, including slipping rib, muscle hernia, snapping hip, and peroneal tendon pathology. The examination technique and expected findings for common pathology in each location are discussed. [ABSTRACT FROM AUTHOR]

Transdiaphragmatic intercostal hernia is a rare disease. It is usually caused by trauma and is rarely caused by coughing. Although a few cases of intercostal hernia induced by coughing have been reported, our case of a non traumatic acquired acute transdiaphragmatic intercostal and abdominal hernia induced by coughing is very rare. A 77-year-old woman presented with sudden-onset left lower chest pain after an episode of violent coughing. She had risk factors for intercostal hernia, including obesity, chronic obstructive pulmonary disease, oral steroid use, and diabetes mellitus. Computed tomography showed herniation of the lung and intra-abdominal organs into the thoracic and abdominal wall through a ruptured diaphragm, as well as the intercostal and abdominal muscles. Surgery was completed with interrupted sutures to close the defects after the reduction of the herniated organs. Our experience suggests that careful examinations, including the assessment of risk factors and computed tomography imaging, were essential for establishing an accurate diagnosis, and that the repair of a ruptured diaphragm with simple interrupted sutures without any prosthetic materials seems to be feasible in selected patients with a transdiaphragmatic intercostal hernia. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative bleeding is one of the main causes of complications in cardiovascular surgery, which highlights the importance of ensuring adequate intraoperative hemostasis, providing a better patient outcome. This study aimed to improve the prevention of postoperative bleeding in the Cardiovascular Surgery Department of the Hospital Estadual Mário Covas (Santo André, Brazil) using an adapted version of the Papworth Haemostasis Checklist to assess the impact of this standardization on bleeding rate, postoperative complications, reoperation, and mortality. Methods: This is a non-randomized controlled clinical trial, whose non-probabilistic sample consisted of patients undergoing cardiac surgery in the abovementioned service within a two-year interval. The Papworth Haemostasis Checklist was adapted to the Brazilian laboratory parameters and the questions were translated into Portuguese. This checklist was used before the surgeon started the chest wall closure. Patients were followed up until 30 days after surgery. A P-value < 0.05 was considered statistically relevant. Results: This study included 200 patients. After the checklist, a reduction in 24-hour drain output, postoperative complications, and reoperation was observed, although statistical significance was not reached. Finally, there was a significant reduction in the number of deaths (8 vs. 2; P=0.05). Conclusion: The use of the adapted checklist in our hospital proved to be an effective intervention to improve the prevention of postoperative bleeding, with a direct impact in the number of deaths in the study period. The reduction in deaths was possible thanks to the reduction in the bleeding rate, postoperative complications, and reoperations for bleeding. [ABSTRACT FROM AUTHOR]

Dynamic chest radiography (DCR) is a real-time sequential high-resolution digital X-ray imaging system of the thorax in motion over the respiratory cycle, utilising pulsed image exposure and a larger field of view than fluoroscopy coupled with a low radiation dose, where post-acquisition image processing by computer algorithm automatically characterises the motion of thoracic structures. We conducted a systematic review of the literature and found 29 relevant publications describing its use in humans including the assessment of diaphragm and chest wall motion, measurement of pulmonary ventilation and perfusion, and the assessment of airway narrowing. Work is ongoing in several other areas including assessment of diaphragmatic paralysis. We assess the findings, methodology and limitations of DCR, and we discuss the current and future roles of this promising medical imaging technology. Critical relevance statement Dynamic chest radiography provides a wealth of clinical information, but further research is required to identify its clinical niche. Key points: Dynamic chest radiography (DCR) captures high-resolution moving images of the thorax. The ionising radiation dose of DCR is low. DCR can image the diaphragm, chest wall, ventilation and perfusion. Most papers on DCR are small, with heterogeneity in study design or outcome. Large, multicentre studies with similar outcomes and healthy controls are desirable. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Postoperative bleeding is one of the main causes of complications in cardiovascular surgery, which highlights the importance of ensuring adequate intraoperative hemostasis, providing a better patient outcome. This study aimed to improve the prevention of postoperative bleeding in the Cardiovascular Surgery Department of the Hospital Estadual Mário Covas (Santo André, Brazil) using an adapted version of the Papworth Haemostasis Checklist to assess the impact of this standardization on bleeding rate, postoperative complications, reoperation, and mortality. Methods: This is a non-randomized controlled clinical trial, whose non-probabilistic sample consisted of patients undergoing cardiac surgery in the abovementioned service within a two-year interval. The Papworth Haemostasis Checklist was adapted to the Brazilian laboratory parameters and the questions were translated into Portuguese. This checklist was used before the surgeon started the chest wall closure. Patients were followed up until 30 days after surgery. A P-value < 0.05 was considered statistically relevant. Results: This study included 200 patients. After the checklist, a reduction in 24-hour drain output, postoperative complications, and reoperation was observed, although statistical significance was not reached. Finally, there was a significant reduction in the number of deaths (8 vs. 2; P=0.05). Conclusion: The use of the adapted checklist in our hospital proved to be an effective intervention to improve the prevention of postoperative bleeding, with a direct impact in the number of deaths in the study period. The reduction in deaths was possible thanks to the reduction in the bleeding rate, postoperative complications, and reoperations for bleeding.

Background: Traumatic Spinal Cord Injury (TSCI) is one of the catastrophic events, the rate of which has been growing compared to the past decades. Complications caused by TSCI have a wide spectrum and can range from complete paralysis to numbness of the limbs. Additional to the injury severity and disability of the patient, the recovery rate depends on the treatment strategies. Despite extensive efforts and research in this field, there are still few treatment options for TSCI patients. Controversial results have been reported, however, spinal cord decompression is the only certainty for the treatment of these patients. In the present study, patients with thoracic and lumbar fractures were undergone decompression, less and more than 24 hours, and the recovery rate (RR) was compared after 6 months. Methods: In this study, patients with lumbar and thoracic fractures who were referred to the neurosurgery department of Ahvaz Golestan Hospital during May 2019 to December 2021 were included. Decompression was performed at the fracture level as a total and at the upper and lower levels of the fracture as a partial decompression. To evaluate fine motor movements, picking up a small object with toes and following a rectangular path were used. Also, the gross motor movements, upper and lower proximal and distal muscle forces were measured. Results: 160 patients including 133 men (83.1%) and 16.9% women (27) with 36±12 years mean age were included. The most fracture location was lumbar (53.1%), followed by the thoracic (43.1%) and fractures in both regions (3.8%). The most injured vertebras were L1 (27.5%) and T12 (18.8%). Six months later, 61.9% of patients had a good score for removing a small object with toe, of which 67.5% belonged to patients with<24 hours surgery (P=0.01). Also, RR for ability to follow a rectangle (P=0.017) and lower limit gross motor were significantly better in patients with<24 surgery (P=0.02). However, no significant difference was found between the two groups for improved sensations (P<0.05). Conclusion: This study showed that decompression<24 hours in TSCI is associated with a significant improvement in lower fine movements. [ABSTRACT FROM AUTHOR]

Objectives: The breathing phase for the determination of thoracic indices in patients with pectus excavatum is not standardized. The aim of this study was to identify the best period for reliable assessments of morphologic indices by dynamic observations of the chest wall using real-time MRI. Methods: In this prospective study, patients with pectus excavatum underwent morphologic evaluation by real-time MRI at 3 T between January 2020 and June 2021. The Haller index (HI), correction index (CI), modified asymmetry index (AI), and modified eccentricity index (EI) were determined during free, quiet, and forced breathing respectively. Breathing-related differences in the thoracic indices were analyzed with the Wilcoxon signed-rank test. Motion of the anterior chest wall was analyzed as well. Results: A total of 56 patients (11 females and 45 males, median age 15.4 years, interquartile range 14.3–16.9) were included. In quiet expiration, the median HI in the cohort equaled 5.7 (4.5–7.2). The median absolute differences (Δ) in the thoracic indices between peak inspiration and peak expiration were ΔHI = 1.1 (0.7–1.6, p <.001), ΔCI = 4.8% (1.3–7.5%, p <.001), ΔAI = 3.0% (1.0–5.0%, p <.001), and ΔEI = 8.0% (3.0–14.0%, p <.05). The indices varied significantly during different inspiratory phases, but not during expiration (p >.05 each). Furthermore, the dynamic evaluation revealed three distinctive movement patterns of the funnel chest. Conclusions: Real-time MRI reveals patterns of chest wall motion and indicate that thoracic indices of pectus excavatum should be assessed in the end-expiratory phase of quiet expiration. Key Points: • The thoracic indices in patients with pectus excavatum depend on the breathing phase. • Quiet expiration represents the best breathing phase for determining thoracic indices. • Real-time MRI can identify different chest wall motion patterns in pectus excavatum. [ABSTRACT FROM AUTHOR]

Novel fascial plane blocks may allow early tracheal extubation and discharge from the intensive care unit (ICU). The present study primarily aimed to determine whether fascial plane blocks, in comparison with intravenous analgesia alone, significantly shortened tracheal extubation times in patients undergoing cardiac surgery. The secondary objectives were to compare each block's performance with that of intravenous analgesia alone in terms of the individual tracheal extubation time and length of ICU stay. Retrospective observational study. Single-center study. Patients who underwent cardiac surgery between 2018 and 2019 were identified from a prospective clinical registry. After obtaining ethics approval, the clinical and electronic records of patients undergoing cardiac surgery in 2018 were analyzed. Data of patients receiving fascial plane blocks (erector spinae plane [ESP], pectoral plane I and II [PECs], and serratus anterior plane [SAP] blocks) with intravenous analgesia were compared with those of patients receiving only intravenous analgesia. A propensity score (PS) model was used to control for differences in the baseline characteristics. Adjusted p < 0. 05 was considered statistically significant. Of the 589 patients screened, 532 met the inclusion criteria; 404 received a fascial plane block. After PS matching, weighted linear regression revealed that by receiving a block, the predicted extubation time difference was 9.29 hours (b coefficient; 95% CI: -11.98, -6.60; p = 0. 022). Similar results were obtained using PS weighting, with a reduction of 7.82 hours (b coefficient; 95% CI: -11.89, -3.75; p < 0. 001) in favor of the block. In the fascial-plane-block group, ESP block achieved the best performance. The length of ICU stay decreased by 1.1 days (b coefficient; 95% CI: -1.43, -0.79; p = 0. 0001) in the block group. No complications were reported. Fascial plane block is associated with reduced extubation times and lengths of ICU stay. ESP block achieved the best performance, followed by PECs and SAP blocks. After PS matching, only ESP block reduced the extubation time. [ABSTRACT FROM AUTHOR]

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Ultrasound-guided injection is useful for managing thoracic spine and chest wall pain. With ultrasound, pain physicians perform the injection with real-time viewing of major structures, such as the pleura, vasculature, and nerves. Therefore, the ultrasound-guided injection procedure not only prevents procedure-related adverse events but also increases the accuracy of the procedure. Here, ultrasound-guided interventions that could be applied for thoracic spine and chest wall pain were described. We presented ultrasound-guided thoracic facet joint and costotransverse joint injections and thoracic paravertebral, intercostal nerve, erector spinae plane, and pectoralis and serratus plane blocks. The indication, anatomy, Sonoanatomy, and technique for each procedure were also described. We believe that our article is helpful for clinicians to conduct ultrasound-guided injections for controlling thoracic spine and chest wall pain precisely and safely.

In children and young adults, tumors in the chest and thoracic wall exhibit a wide variety of types, making it challenging to differentiate between benign and malignant cases before invasive histopathological examination.To evaluate the utility of apparent diffusion coefficient (ADC) for discriminating malignant thoracic masses in children and young adults.This retrospective study included chest magnetic resonance imaging (MRI) scans in patients aged <30 years. Patients' age and sex, tumor location (mediastinum or thoracic wall), tumor size, MR characteristics including necrosis or hemorrhage, and ADC values were assessed.Malignant masses were found in older patients (mean age = 18.0 ± 8.1 vs. 10.6, ± 9.1 years; P = 0.008), had lower mean ADC values (0.765 ± 0.298 vs. 2.051 ± 0.855 × 10−3 mm2/s; P < 0.001), and showed more internal hemorrhage (6/12 vs. 17/86; P = 0.031) compared to benign masses. Univariate and multivariate regression analyses also showed significant differences in age, tumor size, and ADC values. In the diagnostic performance analysis, age (area under the receiver operating characteristic curve [AUC] = 0.723, 95% confidence interval [CI] = 0.624–0.809; P = 0.004) and ADC mean value (AUC = 0.941, 95% CI = 0.874–0.978, P < 0.001) were significant. The optimal cutoff values were 13 years for age (sensitivity = 83.3%, specificity = 61.6%) and an ADC mean of 1.196 × 10−3 mm²/s (sensitivity = 100%, specificity = 86.1%) for discriminating malignant from benign thoracic masses.When evaluating thoracic masses in children and young adults, older age and lower ADC values help identify malignancy. [ABSTRACT FROM AUTHOR]

Haemophilia is an inherited X-linked bleeding disorder characterised by a deficiency or absence of clotting factor VIII (haemophilia A) or IX (haemophilia B), which can cause musculoskeletal bleeding. The standard treatment for haemophilia is with factor concentrates to replace the missing or deficient clotting factor. However, there is a risk that the immune system develops antibodies against the exogenous factor, known as inhibitors. Managing patients with haemophilia and inhibitors who develop bleeding in unusual sites can be challenging for the treating physician. Here, we present a rare case of patient with severe haemophilia A who was diagnosed with inhibitors after developing bleeding in the left posterior chest wall (extra pleural haematoma). The patient was successfully managed with activated prothrombin complex concentrate (aPCC) (FEIBA: FVIII inhibitor bypassing activity; Baxter AG), and the pain and swelling gradually resolved over three weeks. This case emphasises the importance of clinical suspicion of inhibitor formation in a patient already diagnosed with haemophilia A presenting with unusual bleeding that does not respond to standard treatment.

BackgroundChest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis.MethodsPre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al., N Engl J Med 371:1577-87, 2014) were retrospectively reviewed. Two clinicians blinded to clinical details using the Ralph scoring system performed separate readings. An independent reader reviewed discrepant results for quality assessment and cavity presence. Cavitation presence was plotted against time to positivity (TTP) of sputum liquid cultures (MGIT 960). The Wilcoxon rank sum test was performed to calculate the difference in average TTP for these groups. The average lung field affected was compared to log 10 TTP by linear regression. Baseline markers of disease severity and patient characteristics were added in univariable regression analysis against radiological severity and a multivariable regression model was created to explore their relationship.ResultsFor 1354 participants, the median TTP was 117 h (4.88 days), being 26 h longer (95% CI 16-30, p

Background and purposeChest wall toxicity is observed after stereotactic body radiation therapy (SBRT) for peripherally located lung tumors. We utilize machine learning algorithms to identify toxicity predictors to develop dose-volume constraints.Materials and methodsTwenty-five patient, tumor, and dosimetric features were recorded for 197 consecutive patients with Stage I NSCLC treated with SBRT, 11 of whom (5.6%) developed CTCAEv4 grade ≥2 chest wall pain. Decision tree modeling was used to determine chest wall syndrome (CWS) thresholds for individual features. Significant features were determined using independent multivariate methods. These methods incorporate out-of-bag estimation using Random forests (RF) and bootstrapping (100 iterations) using decision trees.ResultsUnivariate analysis identified rib dose to 1 cc

Fascial plane blocks are useful for multimodal analgesia after cardiac surgery since they can provide effective analgesia without the serious risks associated with conventional techniques such as neuraxial hematoma and pneumothorax. This narrative review covers blocks performed at the parasternal intercostal, interpectoral, pectoserratus, serratus anterior, erector spinae, and retrolaminar planes, which are targets for fascial plane blocks in cardiac surgery. Brief anatomical considerations, mechanisms, and currently available evidence are reviewed. Additionally, recent evidence on fascial plane blocks for subcutaneous-implantable cardioverter-defibrillator implantation are also reviewed. [ABSTRACT FROM AUTHOR]

Background: Most patients with chest wall deformities have a negative body image, which affects their self-esteem and quality of life (QoL)., Objectives: The aim of this study was to evaluate changes in patients' QoL after minimally invasive repair of pectus excavatum (MIRPE)., Material and Methods: A prospective, single-center study was conducted between 2019 and 2023. We included 20 pediatric patients at a median age of 15 years and 9 months who underwent MIRPE. Two QoL questionnaires were used: the KIDSCREEN-52 and the EQ-5D-Y. The data were statistically analyzed with the Wilcoxon and Mann-Whitney tests. All patients and their parents were asked to complete questionnaires preoperatively and 12 months after surgical treatment., Results: All patients were followed up during the 12-month study period. The study group was comprised of 65% male patients. The median Haller index was 5.0 standard deviation (SD) = 1.58). The assessment of general health condition was higher among the boys (with postoperative improvement), though this finding was not statistically significant. Routine daily activities were easier for all patients after MIRPE (p = 0.048). The patients showed improved physical activity (p = 0.038) and psychological wellbeing (p = 0.013) after elevation of the anterior chest wall. There was no impact on relations with parents, free time or school environment, but we found better patient contact with peers in the postoperative period. A high correlation was confirmed between the parents' and the patients' responses in each questionnaire., Conclusions: Chest wall deformities can have a strong impact on the patient's wellbeing, which is a very important part of psychological development in adolescents. Our study showed that improved QoL should be always considered as an indication for surgical treatment of chest wall deformities in children.

Mondor disease (MD) is a benign inflammatory disorder of the veins over the thoracoabdominal wall. Although the disease has been described for a century, very few descriptions in literature are available. This is due to a lack of awareness among treating physicians about the disease entity as well as the self-limiting course of the disease. Patients usually present with a painful lesion in the lateral thoracic wall or as a palpable cord in the late resolving stages. The disease usually resolves with non-steroidal anti-inflammatory drugs and supportive therapy. Few patients with symptomatic tender cords require surgical excision or release. Recent studies have noted association with breast cancer, and an increase in incidence was noted in the COVID-19 pandemic. We report a woman in her 40s who presented with a band in her right lateral chest wall for 6 months and was diagnosed with MD. She underwent an excision and is currently symptom free., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Introduction: Chest radiotherapy has been utilized to treat intra-thoracic and mediastinal tumors. Chest wall irradiation (C-XRT) survivors frequently develop valvular disease, including aortic stenosis, which eventually requires valve replacement. Previous trials have shown worse outcomes with surgical aortic valve replacement. However, transcatheter aortic valve replacement (TAVR) outcomes-related data in patients with C-XRT is limited., Methods: The national inpatient sample (NIS) database was queried from 2016 to 2020 to identify adult hospitalizations with TAVR, which were dichotomized based on a history of C-XRT using ICD-10-CM codes. Propensity score matching was performed to derive age, sex, hospital characteristics, and co-morbidities matched controls without a history of C-XRT. The outcomes studied were inpatient mortality and complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression were used to analyze the outcomes., Results: Of 296,670 patients who underwent TAVR between 2016 and 2020, 515 had a history of C-XRT. Upon propensity score matching in patients undergoing TAVR, Patients with a history of C-XRT showed significantly lower adjusted odds of in-hospital mortality (adjusted odd ratio [aOR] 0.04, 95 % CI [0.003-0.57], p = 0.017), lower mean LOS by 1.6 days (-1.88 to -1.26 days, p < 0.001) and reduced mean THC (-$74,720, [-$88,784 to -$60,655], p < 0.001). Additionally, patients with C-XRT had significantly lower adjusted odds of inpatient complications, mainly acute myocardial infarction, cerebrovascular events, acute respiratory failure, acute kidney injury, need for vasopressors and cardiopulmonary resuscitation, whereas similar odds of complications, including a requirement of intubation, mechanical ventilation, hemodialysis, and cardiogenic shock., Conclusion: Our analysis showed reduced adjusted odds of in-hospital mortality, length of stay, total hospital charges, and inpatient complications in patients undergoing TAVR with a history of C-XRT. TAVR appears to be a safe and viable alternative in this population subgroup., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

The authors performed rigid reconstruction using the sandwich technique for full-thickness chest wall defects by using two layers of acellular dermal matrix and bone cement. We assessed six patients who underwent chest wall reconstruction. Reconstruction was performed by sandwiching bone cement between two layers of acellular dermal matrix. In all patients, there was no defect of the overlying soft tissue, and primary closure was performed for external wounds. The average follow-up period was 4 years (range, 2–8 years). No major complications were noted. The sandwich technique can serve as an efficient and safe option for chest wall reconstruction.

Bilateral pectoralis major myocutaneous (PMMC) flaps are commonly used to reconstruct large chest wall defects. We report a case of large chest wall defect reconstruction using bilateral PMMC flaps augmented with axillary V-Y advancement rotation flaps for additional flap advancement. A 74-year-old male patient was operated on for recurrent glottic squamous cell carcinoma. Excision of the tumor resulted in a 10×10 cm defect in the anterior chest wall. Bilateral PMMC flaps were raised to cover the chest wall defect. For further flap advancement, V-Y rotation advancement flaps from both axillae were added to allow complete closure. All flaps survived completely, and postoperative shoulder abduction was not limited (100° on the right side and 92° on the left). Age-related skin redundancy in the axillae enabled the use of V-Y rotation advancement flaps without limitation of shoulder motion. Bilateral PMMC advancement flaps and the additional use of V-Y rotation advancement flaps from both axillae may be a useful reconstructive option for very large chest wall defects in older patients.

Introduction: Low-grade fibromyxoid sarcoma (LGFMS) is a rare special subtype of fibrosarcoma, it is more common in the trunk and proximal limbs. First described by Evans in 1987, this tumor is also named Evans tumor. Diagnosis of LGFMS may be quite challenging, either due to the low suspicion rate of the tumor or low specificity of its morphological pattern and immunohistochemical profile, a phenomenon that is magnified when tumor location is less usual, such as in the chest wall. The present article presents a challenging case of LGFMS of the chest wall. Case report: Female, 58-year-old patient was referred to the oncology referral clinic with a breast tumor. Diagnostic investigation included imaging tests (breast US and chest CT scan) and core needle biopsy. CT scan revealed the epicenter of the tumor in the left anterior thoracic wall. Biopsy to evaluate the histologic type of tumor was carried out and the result was inconclusive. Therefore, surgical excision of the tumor was performed. Histopathology and immunohistochemistry studies of the surgical specimen confirmed the diagnosis of LGFMS of the chest wall. Currently, after 36 months of the surgical excision, the patient is still doing well and continues under clinical follow-up. Conclusion: Although the diagnosis of LGFMS of the chest wall is challenging, it should be done correctly, since these cases require a long and thorough clinical follow-up.

Background The postural abnormality, forward shoulder posture (FSP), is the most common cause of respiratory impairment in older individuals with chronic obstructive pulmonary disease (COPD). A recent study found that performing pectoral stretching and scapular strengthening exercises for eight weeks could reduce FSP in healthy participants. We aimed to determine the effects of pectoral stretching and scapular stabilizer strengthening exercises on FSP, chest wall mobility, respiratory muscle strength, and pulmonary function in male patients with COPD. Methods This study was randomized clinical trial. Forty male COPD patients with FSP aged 60–90 years were included and randomly allocated to control (n=20) and exercise (n=20) groups. Following completion of the scapulothoracic exercises (three days/week, for eight weeks), respiratory functions were assessed by measuring the magnitude of FSP, chest mobility, respiratory muscle strength, and pulmonary functions. Results FSP and thoracic kyphosis angle significantly decreased compared to controls (p Conclusions The eight-week combined pectoral muscles self-stretching and serratus anterior and lower trapezius strengthening exercises could be an effective treatment and/or prevention strategy for FSP reduction, leading to improved respiratory function in male COPD patients.

Granulosa cell tumor (GCT) is a rare tumor that originates from neural/Schwann cells. GCTs can occur at any age and at any site in the body. The most common site is the tongue, followed by the mammary gland, upper respiratory tract (throat and bronchus), and gastrointestinal tract (esophagus, large intestine and perianal area, stomach, small intestine, and bile duct). Malignant GCTs account for less than 1%-2% of all GCTs. Fewer than five GCTs in the thoracic wall have been reported, almost all of these benign. Here, we report a new case of malignant GCT of the thoracic wall, with rib invasion and pleural metastasis, in an Asian male. Microscopic examination revealed round, granular cells with eosinophilic cytoplasm and without prominent atypia. Despite these findings the disease showed rapid clinical progression. In summary, the tumor, although histologically 'benign', was clinically 'malignant'. [ABSTRACT FROM AUTHOR]

Rheumatoid nodules are the most common extra-articular presentations of rheumatoid arthritis. Although rheumatoid nodules can develop anywhere in the body, they develop most commonly in the subcutaneous region, where they are easily exposed to repetitive trauma or pressure. However, an infrascapular presentation has not yet been reported. We report a case of giant bilateral rheumatoid nodules that developed in the infrascapular area, complicating its distinction from elastofibroma dorsi on radiological examination.

ABSTRACT Objective: This study aims the treatment results of broad pectus excavatum after a long-term follow-up and skeletal maturity. Methods: Eighty-four children and adolescents with broad-type pectus excavatum were selected for evaluation after treatment with a dynamic orthosis that applies compression to the lower rib projections and prescription of exercises. The broad pectus excavatum was defined as a deformity that the depressed area was greater and covered the area above and below the nipple line. All patients were evaluated for more than 1 year after the end of treatment and skeletal maturity. Post-treatment results were categorized as mild, moderate and severe. Statistic correlations between results and deformity flexibility, deformity severity, and adherence to treatment were assessed. Results: The mean age at the beginning of treatment was 13.3 years, and the follow-up duration was 25.7 months after suspension of orthosis use. Forty-eight percent of patients showed good results. With regular use of orthoses and performance of exercises, this rate increased to 70% (p < 0,001). Mild cases showed more success than severe cases (p = 0,007). Initial flexibility didn’t influence the results (p = 0,63). Conclusion: Treatment of broad pectus excavatum with orthoses and exercises led to good definitive results in most resilient patients, especially in those with mild deformities. Level of Evidence V, Expert Opinion.