Home
 
Pectus Excavatum (Funnel Chest) Surgery PDF Print E-mail
Written by Ko Chung Sen   
Wednesday, 26 May 2010 07:41

     

Pectus excavatum (‘funnel chest’ or ‘sunken chest’), is characterized by a depressed sternum.  It is a congenital deformity.  The condition tends to progress with age and worsens during puberty.

     Pectus excavatum is well tolerated in infancy. However, older children may present with chest pain, palpitations, syncope from transient arrhythmia and mitral valve prolapse.

Why Repair A Funnel Chest?

In the past, it was thought that pectus excavatum was repaired merely for cosmetic reasons. However, evidences have shown that there are real impairments of the cardiac and pulmonary functions with reduced life expectancy in cases with significant deformities. Compression and displacement of the heart may cause chest pain with exercise, palpitations and arrhythmia (in 16% of cases), mitral valve prolapse (17%). The lung complications include mild to severe restricted breathing, obstructive airway and increased incidence of pneumonia and asthma. The spirometry is usually 10% to 20% below the expected average for the population and the mean total lung capacity is only 79% of predicted. Lastly, the distorted self image had led to depression and even suicide.

     After repair, these patients have shown normal ventilation scan and consistent decrease in heart rate at a given workload. Their cardiac index improved by 38% (stroke volume) and they can reach exercise target heart rate without becoming symptomatic. The average cardiovascular function increased by greater than one half SD (standard deviation) following the surgical repair of pectus excavatum. There was also marked improvement in the psychosocial well being.  

     Nowadays, an operation is considered if a patient presented with a history of progressive worsening of pectus excavatum, symptoms of exercise intolerance, chest pain, and shortness of breath and clinical evaluations showed cardiac and pulmonary compromise.

Repair

1. Ravitch Operation – Open resection of costal cartilages

 2.   Nuss Procedure (MIRPE - Minimally Invasive Repair of Pectus Excavatum)

     Previously, the condition was treated with the Open Technique (Ravitch procedure, 1949) which was a difficult, complex open and invasive surgery. This procedure involved making a large, transverse sub-mammary chest incision, raising the pectoralis muscle flaps. resecting the costal cartilages and breaking the sternum. The Open Technique operations can take up to six hours with significant blood loss. The patients have to stay in hospital for a considerable length of time and the post-operative pain is significant. One of the major drawback is the fact that the patient is left with a large, unsightly scar in place of the deformity.

     The new Nuss procedure is a minimally invasive surgical approach that inserts a stainless steel bar into the chest cavity through two small incisions of less than 2.5cm to mould and remodel the anterior chest wall. There is no cutting of bones or resection of costal cartilages. It works like the dental braces for mal-aligned teeth. The operation was developed by Professor Donald Nuss in 1986 and reported in 1998. It has since replaced the open technique with excellent results. The bar is left in place for two to three years (longer in adult). The main concern for the operation is a small risk of displacement or infection.

     One bar is usually sufficient except for those patients with long deformity where two bars are needed. The best time for someone to undergo the operation would be between the ages of eight and ten before puberty. It can be done in patients as young as two if the deformity is very severe. The bones in older patients are less malleable. Since this procedure available now is minimally invasive and much easier, more people are prepared to undergo the operation. The recovery is much faster that patients can be start competitive sports again in three months time. The patients should avoid bending or twisting the chest in the first four weeks.

Possible side effects are rare except pain & discomfort in first few weeks.  Others include: metal sensitivity or allergic reactions, surgical trauma to nerve, heart, lungs, bones and tissues, skin irritation, infection, pneumothorax, inadequate remodeling and recurrence after removal

 

 

Last Updated on Saturday, 05 June 2010 14:32
 
Sputum Testing for Pulmonary Tuberculosis PDF Print E-mail
Written by Leong Oon Keong   
Wednesday, 26 May 2010 07:38

     Pulmonary tuberculosis or simply TB is caused by a bacteria named Mycobacterium tuberculosis.  These acid fact bacilli (AFB) maybe present in the sputum of persons with active disease.

     Sputum direct smear and staining (with the Ziehl Neelsen stain) for AFB can be spot or collected in the morning on awakening.  Three morning sputum samples (not saliva) are usually requested by the doctor.  If the sputum is smear positive the person is confirmed to have pulmonary tuberculosis.  However, the absence of a positive smear result does not exclude active TB disease.

     If the sputum direct smears are negative but the person is still suspected to have active TB, a sputum culture for AFB using special culture media (Lowenstein Jensen) is requested.  About 35% of sputum smear negative cases will be culture positive.  Species identification and antibiotic sensitivity testing are conducted when there is suspicion of multi-drug resistant TB, atypical mycobacteria infection or when treatment failure occurs.

     In instances when a person has a non productive cough, the sputum specimen can be obtained through induction with nebulised hypertonic saline.  Other tests for TB infection include the Mantoux skin test and a new blood test called the Quantiferron TB Gold test. 

     Latent tuberculosis occurs when a person is infected with the bacteria but does not have active disease and hence no symptoms.   About 10% of latent TB cases develop active disease at some point in life.  They need to be watchful for disease activation.

 

 
PCS four years stronger PDF Print E-mail
Written by Leong Oon Keong   
Wednesday, 05 May 2010 01:44

     The Perak Chest Society founded on 29th September 2006 is four years old.  We wish to thank the volunteers who have worked tirelessly throughout these years,  We have successfully carried out many projects together (listed on page 4).

     Our main event this year will be the Perak Lung Health Day.  It will be held on Saturday 30th and Sunday 31st October in Ipoh Parade.  Dato Dr. Mah Hang Soon will be officiating this event.  The following diseases will be highlighted: asthma, COPD, lung cancer, obstructive sleep apnea and the ills of smoking.  There will be free lung function testing,  asthma computer games for children and abnormal lung sounds to listen, etc. Please mark your calendar and bring along your friends to this fun filled event.  We shall purchase portable equipment and use recyclable material to construct our exhibition booths.  In future, we can transport these exhibits to Taiping, Kampar, Teluk Intan and Sitiawan to promote lung health in these towns.

    We have nebulisers, peak flow meters, pulse oximeters for loan to members without charge.  It is rather unfortunate that we have one member who has yet to return a nebuliser which he had borrowed a long time ago.

     We have recently applied to the Inland Revenue Department for tax exemption status for our Society.  We are also planning to conduct Home Pulmonary Rehabilitation Workshops for our members.  We need more volunteers to help run our programmes and we hope you can support us.  Please visit our website for details.  Thank you.

 

 
STOP for Obstructive Sleep Apnea PDF Print E-mail
Written by Leong Oon Keong   
Wednesday, 05 May 2010 01:50

     Obstructive sleep apnea (OSA) is a disease.  It increases the risks of hypertension, heart attacks, strokes and motor vehicle accidents.  Dr. Chung of the University of Toronto has devised and validated a simple screening questionnaire for  obstructive sleep apnea. 

     The STOP test consists of four questions.

S    Do you snore loudly?

T    Do you often feel tired, fatiqued or sleepy during daytime?

O    Has anyone observed you stop breathing during sleep?

P    Do you have or are you being treated for high blood pressure?

     If you answer 2 or more YES you are at high risk for OSA.  All persons suspected of having OSA should undergo a sleep study conducted either at home or in hospital.  Persons diagnosed to have moderate or severe OSA should undergo CPAP therapy.   CPAP therapy is the treatment of choice for OSA.  All overweight and obese patients are advised to lose weight.  Surgery  is recommended when CPAP therapy fails. 

    OSA is an important cause of morbidity and mortality.  It is frequently overlooked.  It must be differentiated from habitual snoring which is only a nuisance to the spouse.       Remember OSA kills!!!

 

 
FDA Warning on use of LABA PDF Print E-mail
Written by Leong Oon Keong   
Saturday, 20 February 2010 01:26
  • Long-Acting Beta Agonists (LABAs: e.g. salmeterol, formoterol) do not relieve sudden-onset asthma symptoms. Patients should always have a rescue inhaler, such as a salbutamol inhaler, to treat sudden onset asthma symptoms.
  • LABAs must never be taken alone for the treatment of asthma.
  • Patients who need a LABA plus an asthma controller medication that is not available as a combination product should work with their healthcare professionals to ensure that each individual medication is taken correctly.
  • Patients should read the Medication Guide for LABAs.
  • Patients should talk with their healthcare professional to learn the warning signs of worsening asthma.
  • Patients should discuss any questions they have about the use of LABAs with their healthcare professional.
Last Updated on Saturday, 20 February 2010 01:34
 
 
world copd day 2007 012.jpg

Latest JEvents

No events
August 2010
S M T W T F S
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31 1 2 3 4
September 2010
S M T W T F S
29 30 31 1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30 1 2
October 2010
S M T W T F S
26 27 28 29 30 1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
31 1 2 3 4 5 6

Polls

Are You Prepared for the Flu Pandemic?
 

Who's Online

We have 2 guests online