Statistics

 array:23 [
  "pii" => "S1807593222029933"
  "issn" => "18075932"
  "doi" => "10.1590/S1807-59322006000200018"
  "estado" => "S300"
  "fechaPublicacion" => "2006-04-01"
  "aid" => "2993"
  "copyright" => "CLINICS"
  "copyrightAnyo" => "2006"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
  "subdocumento" => "cor"
  "cita" => "Clinics. 2006;61:185-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1807593222029921"
    "issn" => "18075932"
    "doi" => "10.1590/S1807-59322006000200017"
    "estado" => "S300"
    "fechaPublicacion" => "2006-04-01"
    "aid" => "2992"
    "copyright" => "CLINICS"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
    "subdocumento" => "cor"
    "cita" => "Clinics. 2006;61:183-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">LETTER TO THE EDITOR</span>"
      "titulo" => "IS THERE ANY SCIENTIFIC EVIDENCE FOR THE PREVENTION OF PREECLAMPSIA WITH LOW-DOSE ASPIRIN&#63; META-ANALYSIS VERSUS RANDOMIZED CONTROLLED TRIAL TO ANSWER THIS QUESTION&#46;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "183"
          "paginaFinal" => "184"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Rodrigo Ruano, Rosana S&#46; Fontes, Marcelo Zugaib"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Rodrigo"
              "apellidos" => "Ruano"
            ]
            1 => array:2 [
              "nombre" => "Rosana S&#46;"
              "apellidos" => "Fontes"
            ]
            2 => array:2 [
              "nombre" => "Marcelo"
              "apellidos" => "Zugaib"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029921?idApp=UINPBA00004N"
    "url" => "/18075932/0000006100000002/v1_202212060939/S1807593222029921/v1_202212060939/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">TECHNICAL NOTE</span>"
    "titulo" => "TECHNICAL MODIFICATION OF THE NUSS OPERATION FOR THE CORRECTION OF PECTUS EXCAVATUM"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "185"
        "paginaFinal" => "186"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Jos&#233; Ribas Milanez de Campos, Marcelo Heleno Fonseca, Eduardo de Campos Werebe, Manuel Carlos Prieto Velhote, F&#225;bio Biscegli Jatene"
        "autores" => array:5 [
          0 => array:3 [
            "nombre" => "Jos&#233; Ribas Milanez"
            "apellidos" => "de Campos"
            "email" => array:1 [
              0 => "jribas@usp.br"
            ]
          ]
          1 => array:2 [
            "nombre" => "Marcelo Heleno"
            "apellidos" => "Fonseca"
          ]
          2 => array:2 [
            "nombre" => "Eduardo"
            "apellidos" => "de Campos Werebe"
          ]
          3 => array:2 [
            "nombre" => "Manuel Carlos Prieto"
            "apellidos" => "Velhote"
          ]
          4 => array:2 [
            "nombre" => "F&#225;bio Biscegli"
            "apellidos" => "Jatene"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Thoracic Surgery Service&#44; Hospital das Cl&#237;nicas&#44; Faculty of Medicine&#44; University of S&#227;o Paulo"
            "identificador" => "aff1"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:6 [
        "identificador" => "fig2"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 500
            "Ancho" => 993
            "Tamanyo" => 33847
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para10" class="elsevierStylePara elsevierViewall">Pectus excavatum is a deformity of the thoracic wall present in less than 1&#37; of the population&#46; Treatment is essentially surgical because of the size of the deformity&#46; The most employed surgical options are the technique proposed by Ravitch<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> and its variations and the technique proposed by Nuss&#46;<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a> The first one is considered the conventional technique&#44; while the Nuss procedure is minimally invasive and is currently receiving wide acceptance&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">The goal of this report is to propose 2 technical modifications to the Nuss operation regarding the position in which the patient is placed on the surgery table and the site of introduction of the optical trocar&#46;</p><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">DESCRIPTION OF THE PROPOSED TECHNIQUE</span><p id="para30" class="elsevierStylePara elsevierViewall">The patient is placed in the supine position&#44; under general anesthesia and orotracheal intubation&#46; The patient lies on a 12 cm-high cushion that extends from the head to the waist and is placed longitudinally on the surgical table&#44; parallel to the median line &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>&#41;&#46; The patient&#39;s arms are stretched along the body and fixed to the surgical table&#46; The optical trocar &#40;5 mm and 30&#176;&#41; is inserted 2 intercostal spaces cranially with respect to the space where the metal bar will be introduced at the median axillary line&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para40" class="elsevierStylePara elsevierViewall">Otherwise&#44; the operative technique remains as originally described by Nuss&#46;<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a></p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">COMMENTS</span><p id="para50" class="elsevierStylePara elsevierViewall">In the technique originally described by Nuss&#44; the arms of the patient are kept abducted at 90&#176; in relation to the body&#44; and the the optical trocar is introduced 2 intercostal spaces caudal to the introduction point for the metal bar &#40;<a class="elsevierStyleCrossRef" href="#fig2">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p id="para60" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="celist10"><li class="elsevierStyleListItem" id="celistitem10"><span class="elsevierStyleLabel">1&#46;</span><p id="para70" class="elsevierStylePara elsevierViewall">Increased safety regarding the introduction of the trocar&#59; this is because this procedure is carried out at a higher level in the pleural cavity&#44; thus reducing the risk of a diaphragmatic lesion&#46;</p></li><li class="elsevierStyleListItem" id="celistitem20"><span class="elsevierStyleLabel">2&#46;</span><p id="para80" class="elsevierStylePara elsevierViewall">Easier handling of the optical device&#59; this enables better visualization of the bar inserter during dissection of the anterior mediastinum&#46;</p></li><li class="elsevierStyleListItem" id="celistitem30"><span class="elsevierStyleLabel">3&#46;</span><p id="para90" class="elsevierStylePara elsevierViewall">Optimization of the resources offered by the 30&#176; optical device&#44; with better visualization due to the possibility of complete rotation&#59; this enables working laterally or under the bar inserter&#46;</p></li><li class="elsevierStyleListItem" id="celistitem40"><span class="elsevierStyleLabel">4&#46;</span><p id="para100" class="elsevierStylePara elsevierViewall">Better visibility of the pleural cavity&#44; of the sites to be handled&#44; and of the dissected tunnel near the posterior wall of the sternum&#59; thus&#44; the pectus excavatum deformity does not obstruct optical image&#46;</p></li><li class="elsevierStyleListItem" id="celistitem50"><span class="elsevierStyleLabel">5&#46;</span><p id="para110" class="elsevierStylePara elsevierViewall">Easier identification of the intrathoracic vessels&#44; such as the internal thoracic arteries&#44; and a better view of the left pleural cavity in cases in which this cavity is open&#46;</p></li><li class="elsevierStyleListItem" id="celistitem60"><span class="elsevierStyleLabel">6&#46;</span><p id="para120" class="elsevierStylePara elsevierViewall">Easier passing of the fixation wires of the metal bar in the right hemithorax to avoid its displacement&#46;</p></li><li class="elsevierStyleListItem" id="celistitem70"><span class="elsevierStyleLabel">7&#46;</span><p id="para130" class="elsevierStylePara elsevierViewall">Better positioning of a thoracic drain&#44; if necessary in case of aerial fistulae&#44; using the trocar orifice&#59; this position is closer to the apex of the thoracic cavity&#46;</p></li><li class="elsevierStyleListItem" id="celistitem80"><span class="elsevierStyleLabel">8&#46;</span><p id="para140" class="elsevierStylePara elsevierViewall">An aesthetically more acceptable result&#59; the small scar&#44; which is approximately 5 mm&#44; is covered by the patient&#39;s arms due to its location closer to the axillary cavity&#46; 9&#46; Last&#44; but not least&#44; minimization of the possibility of a brachial plexus lesion&#59; this is due to the placement of the arms of the patient along his&#47;her body&#46;</p></li></ul></p><p id="para150" class="elsevierStylePara elsevierViewall">We have employed these two technical modifications in 6 patients who underwent surgery in our Thoracic Surgery Department over the last 4 months&#44; and we have observed the efficacy and the benefits of this technique&#46; We thus consider it important to share this information because we are convinced that it can contribute to better performance of this surgery&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "DESCRIPTION OF THE PROPOSED TECHNIQUE"
        ]
        1 => array:2 [
          "identificador" => "cesec20"
          "titulo" => "COMMENTS"
        ]
        2 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:6 [
        "identificador" => "fig1"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 396
            "Ancho" => 994
            "Tamanyo" => 31728
          ]
        ]
      ]
      1 => array:6 [
        "identificador" => "fig2"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 500
            "Ancho" => 993
            "Tamanyo" => 33847
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:2 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The operative treatment of pectus excavatum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              MM Ravitch \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00000658-194904000-00002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1949"
                        "volumen" => "129"
                        "paginaInicial" => "429"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17859324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A 10-year review of a minimally invasive technique for the correction of pectus excavatum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              D Nuss \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RE Kelly \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              DP Croitoru \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              ME Katz \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0022-3468(98)90314-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Surg"
                        "fecha" => "1998"
                        "volumen" => "33"
                        "paginaInicial" => "545"
                        "paginaFinal" => "552"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9574749"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18075932/0000006100000002/v1_202212060939/S1807593222029933/v1_202212060939/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006100000002/v1_202212060939/S1807593222029933/v1_202212060939/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029933?idApp=UINPBA00004N"
]