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Biomedical subjects

Andre Hebra

Publications and source records attributed to Andre Hebra.

5 recordsLinked to original sources
PubMed2006

Minimally invasive repair of pectus excavatum in adult patients.

Since 1996, the technique for minimally invasive repair of pectus excavatum (MIRPE) has gained increasing acceptance among pediatric patients. However, the feasibility of the operation and outcomes have not yet been evaluated in adult patients. This study was a retrospective analysis of the author's experience combined with a survey of members of the American Pediatric Surgical Association in treating adult patients with MIRPE. Thirty adults (age range, 18-32 years; mean, 23 years; 75% men) with severe pectus excavatum (chest index > 3.2) were treated with MIRPE. The main indication for surgery was cosmetic (80%). One 32-year-old female patient underwent simultaneous MIRPE and breast augmentation. In 60 per cent of cases, the operative time was 1 to 2 hours. Thoracic epidural was successfully used for postoperative pain management in 90 per cent of patients. Two pectus bars were necessary in 16 per cent of cases, and bilateral stabilizers were used in 53 per cent of patients. Complications included seroma (10%), bar displacement (6%), pneumothorax requiring tube thoracostomy (6%), superficial wound infection (3%), and stabilizer bar fracture (3%). Two patients required conversion to modified Ravitch repair. Patient satisfaction was rated as excellent (50%), good (36%), and fair (14%). Less than 50 per cent of patients achieved 100 per cent correction of their deformity. MIRPE can be used safely for repair of pectus excavatum in adult patients. The complication rate appears to be similar to previously reported series of pediatric patients. Although adult patients may have residual asymmetry of the chest postrepair, overall satisfaction with the repair was very good or excellent in 86 per cent of patients.

Adolescent↗
PubMed2003

Serum amylase and lipase alone are not cost-effective screening methods for pediatric pancreatic trauma.

BACKGROUND: Injury to the pancreas is rare in pediatric trauma. Identification of pancreatic injury relies on clinical, radiographic, and laboratory data. Serum screening for pancreatic injury frequently is used but has not proven to correlate well with pancreatic injury. This study investigated utility and cost effectiveness of serum assessment of amylase and lipase. METHODS: A retrospective study of 1,821 pediatric trauma patients over 64 months was conducted. A total of 293 (16%) of these patients suffered trauma to the torso 195 (11%) of whom had confirmed intraabdominal injury. Eight pancreatic injuries (4% of abdominal injuries) were identified; 5 underwent surgery for pancreatic ductal injury. One patient not operated on had a pseudocyst that required late drainage. RESULTS: Serum amylase or lipase levels (AMY/LIP) were measured in 507 (28%) patients. A total of 116 (23%) had elevated AMY/LIP levels. Six of 8 with proven pancreatic injury underwent AMY/LIP testing; 5 had elevated values. Forty-eight percent of patients with elevated AMY/LIP levels had no evidence of intraabdominal injury. Seventy-four of 116 (64%) with elevated AMY/LIP levels underwent abdominal and pelvic computed tomography (CT) scanning, yet 38 (51%) of these had completely normal scans. Many patients with elevated AMY/LIP levels (cost, $6 per test) underwent screening CT scans (cost, $592 per test) based on AMY/LIP alone. No patient with elevated AMY/LIP levels but without clinical suspicion was proven to have pancreatic injury. Cost data are presented. CONCLUSIONS: Serum amylase and lipase determinations may support clinical suspicion in the diagnosis of pediatric pancreatic trauma but are not reliable or cost effective as screening tools. Costs incurred from routine serum amylase and lipase or from imaging tests subsequent to elevated serum values may be significant and unjustified.

Abdominal Injuries↗
PubMed2002

Comparison of minimally invasive and modified Ravitch pectus excavatum repair.

BACKGROUND/PURPOSE: Minimally invasive repair of pectus excavatum (MIRPE) has gained wide acceptance during the last 4 years. This study compares, retrospectively, the experience at 2 large hospitals, 1 using MIRPE and the other a modified Ravitch repair (MRR). METHODS: From 1996 to 2000, 68 PE patients underwent MIRPE at one hospital, and 139 underwent MRR at another hospital. Ages ranged from 5 to 19 years (mean, 12) for MIRPE, and 3 to 51 years (mean, 17.3) for MRR. The mean pectus severity index was 4.2 for MIRPE and 4.9 for MRR (normal, 2.5). RESULTS: There were no deaths after MIRPE or MRR. Complications included 6 reoperations for MIRPE and none for MRR. There were 8 rehospitalizations for MIRPE and none for MRR. Ninety percent of MIRPE complications occurred in the first 25 cases. The mean blood loss was under 90 mL for both MIRPE and MRR. Mean operating time was 75 minutes for MIRPE and 212 minutes for MRR. Ninety-six percent of MIRPE patients and no MRR patients had epidurals. Intravenous analgesics averaged 5 days for MIRPE and 1.7 days for MRR. Mean hospitalization was 6.5 days for MIRPE and 2.9 days for MRR. Mean time before return to work or school was 18 days for MIRPE and 12 days for MRR. The sternal bar was removed from 107 of 139 MRR patients (mean time, 19 minutes) and 18 of 68 MIRPE patients (mean time, 25 minutes). CONCLUSIONS: Both MIRPE and MRR provide excellent clinical results. MRR has a longer operating time but decreased hospital stay, complication rate, and use of pain medications. Attention to technical operative details and surgeon's experience are essential for optimal results using both techniques.

Adolescent↗