Neonatal and Pediatric Medicine
Open Access

Breast cancer; Carcinogenesis; Pregnancy; Pregnancyassociated breast cancer; Molecular mechanisms

Introduction

Funnel chest (drilled chest) is a congenital malformation of the ventral chest wall, also called “funnel chest”. It is characterized by abnormal growth of the sternum and costal cartilage, with thoracic prolapse and ventro-dorsal constriction, presenting in depression [1].

This malformation has been reported in humans, dogs, cats, lambs, calves, rabbits, and other species. In dogs, the incidence of funnel chest is 0.33%, with a higher prevalence in brachycephalic breeds such as French Bulldogs, English Bulldogs, Pekingese, Pugs, Maltese, Shih Tzu, and American Bully, which is likely associated with a high genetic component of be brought [2]. In these breeds, other malformations such as swimmer dog syndrome and airway disorders such as nasal constriction, tracheal hypoplasia, and soft palate hyperplasia (brachycephalic airway syndrome) are sometimes commonly diagnosed as funnel chest. Its etiology is not well defined and is believed to be a genetic predisposition with a genetic component. Several studies suggest shortening of the diaphragmatic tendon, congenital deficiency of the craniophrenic muscle, and osteogenesis/abnormal cartilage formation. However, phenotypes and different states can also be associated with it. B. Abnormal intrauterine pressure and negative elevation of intrathoracic pressure due to changes in the upper airway (eg, airway obstruction due to soft palate hyperplasia) [3].

The clinical manifestations of funnel chest vary and are related to pulmonary changes due to contraction of the thoracic cavity or to pulmonary atelectasis due to heart compression (cardiac compression puts pressure on the lungs causing lung tissue to lose volume). Occasionally, patients may present with recurrent pneumonia leading to chronic respiratory disease. Cardiovascular changes can be observed in association with cardiac deflection and compression, systolic or diastolic dysfunction, or other congenital cardiac alterations. The main clinical signs observed are dyspnea, tachypnea, hyperventilation, pallor or cyanosis of mucous membranes, intolerance to manipulation or exercise, apathy, anorexia, vomiting or burping, coughing, heart murmurs and arrhythmias. Depending on the severity of the cardiopulmonary symptoms, this condition can result in high mortality in affected dogs [4].

Diagnosis of funnel chest is made by physical examination, visualization, and palpation of a depression formed in the sternum and confirmed by complementary tests such as chest x-ray, computed tomography, or magnetic resonance imaging. An evaluation of funnel chest can be performed by measuring the anterior sagittal and vertebral indices and the normal chest indices on chest radiographs in no brachycephalic dogs, brachycephalic dogs, and cats. Based on these indicators, funnel chest can be classified as mild, moderate, or severe radiographs in brachycephalic newborn puppies with a normal chest and varying degrees of funnel chest [5].

Paper box splint on chest

The UNESP Veterinary Hospital, Botucatu, Brazil. At birth, puppies were diagnosed with cleft palate (secondary cleft palate, with hard and soft palates, shallow depth), were unable to receive colostrum, and were fed a commercial breast milk replacer (Support Milk Dog®) via an oral gastric tube. was given only (using urethral tube No. 06) with a volume of 3 ml / 100 g weight, every 3 hours he at a temperature of 37 ° C. Newborns were separated from their mothers and littermates on the day of birth, placed in plastic boxes with blankets, and heated in thermal bags [6].

As for maternal information, this is a 12 month old primiparous bitch, fed Commercial Super Her Premium Her formula, vaccinated, no history of gestational illness and dewormed. I was. No medication was taken during pregnancy. Pregnancy was reported to result from inbred mating between siblings of the same litter. The bitch underwent an elective caesarean section at approximately 62 days of gestation and produced 10 pups. Gestational age estimates were determined by measuring fetal diameter with maternal ultrasound [7].

Both parietal (cephalic) diameters and thoracic diameters o changes were seen in the other newborns. On physical examination, the patient had dyspnea, substernal contraction during inspiration, cyanosis during manipulation, HR 255 bpm, FR 30 mpm, body temperature 36.8 °C, blood glucose 151 mg/dL, weak sucking reflex and breast seeking, strong vestibular. A stretch reflex was exhibited. , weighed 318 g, was normally hydrated, and had no changes in cardiopulmonary auscultation. On evaluation of the thoracic cavity, caudal-lateral deepening and ventrodorsal narrowing of the sternum were observed [8].

Discussion

The occurrence of malformations in dogs can be attributed to prenatal factors, genetic causes that may be hereditary, or teratogens during pregnancy such as toxins, radiation, chemicals, infections, mechanical influences or drugs. There were no reports of maternal exposure to teratogens in the anamnesis and medical histories of the described cases. However, in case 1, the kennel had a history of diagnosis of funnel chest in a litter of bitches from the same family. Therefore, malformations in French bulldog puppies may be related to genetic factors in the kennel breed lineage.In humans and animals, approximately 40% of people with funnel chests were affected by malformations. I have a family of first degree relatives. In addition, dogs have the highest incidence of malformations, approximately 84.4% are known to be observed in purebred puppies, and brachycephalic breeds have a 44% prevalence of overt funnel-chested puppies. known to have a high tendency related to the genetic component of these breeds [9].

A major effect of consanguinity (or inbreeding) is loss of genetic diversity and increased homozygosity, which can lead to expression of deleterious genes. A consequence of the reproductive process at this level of familial relationships is that both carry the genes associated with the malformations, and upon mating, these replicas are more likely to be passed on to offspring, and littermates with these malformations. The genetic defect can be inherited from one or both parents, and this is common in purebred puppies, as thoracothorax has a high prevalence in brachycephalic breeds. , the cause of malformations in American Bully puppies may also be related to genetic factors. The overt clinical signs in the pups in this report were substernal contractions (contractions of the abdomen just below the sternum) during inspiration. Newborns and children’s chests are more flexible than adults, so they may show dimples. Chest contraction indicates that the patient is having dyspnea (requires high intrathoracic pressure during inspiration to expand the lungs), and substernal type is associated with a mild to moderate degree of dyspnea. increase. Especially in brachycephalic dogs, it is important to include funnel chest as a differential diagnosis in neonatal puppies with dyspnea and substernal depression. Because funnel chest is often underdiagnosed, pneumonia that does not respond well to treatment warrants further investigation. Leukocytosis with left deviation associated with neutropenia and mild absolute lymphocytosis were observed on hemocytometry in case 1. This change, coupled with the possibility of secondary bacterial infections, may be related to pneumonia in this puppy. Should be interpreted using the reference parameter of the patient’s age (in weeks). Antibiotic therapy with ceftriaxone, a broad-spectrum beta-lactam drug considered safe in neonatal dogs, was introduced. Cephalosporins and penicillins are commonly recommended for the treatment of neonatal infections. The class of antibiotics used.

Both types are effective when it comes to choosing which splint to use, but we found that puppies with severe breathlessness benefited more from boxes than from PVC tubes in routine neonatal care. In the case of the thorax, lateral compression is greater, which may be uncomfortable for some animals. It is recommended that you test the controls as your pup is more comfortable and observe no worsening crying, agitation or shortness of breath. The length of stay with the rail is also variable. With our care routine, complete breast remodeling is observed in as little as 2-8 days. To remove the splint, the chest should be examined daily and the splint should be removed to observe lack of depth in the sternum area and improvement in breathing patterns [10].

As it is a hereditary malformation, animals diagnosed with funnel chest are not recommended for reproductive use and spaying/neutering is recommended even in the absence of clinical symptoms. This information is emphasized to case tutors and aims to avoid parental continuity in the reproductive process by recommending castration or neutering of these animals and those with a history of funnel chest in littermates.

Congenital malformations are diagnosed more frequently in newborn dogs. It is important that the veterinarian has knowledge of the clinical or surgical approach to malformations, indicates the best corrective actions, and explains the tutor or breeder’s ability to manage/treat each defect. As precautions, attention should be paid to parent selection, avoidance of inbreeding and animals with a history of genetic problems or defects, and maternal exposure to teratogens during pregnancy. Antenatal care is essential to prevent birth defects and reduce mortality in newborn puppies.

Conclusions

Treatment with orthodontic splints (PVC tubes and boxes) is effective in the conservative treatment of funnel chest in neonatal pups, resulting in chest remodeling and improved breathing patterns. , may require revision surgery. Each case should be evaluated individually. In the case presented, funnel chest is likely related to genetic factors linked to racial predisposition. It should be treated as early as possible to prevent clinical manifestations and improve neonatal survival.

1. Angelica VG, Tracy AM (2018) Screening for spontaneous preterm birth and resultant therapies to reduce neonatal morbidity and mortality: A review. Semin Fetal Neonatal Med 23: 126-132.

Indexted at, Google Scholar, Crossref

2. Joice SM, Tricia SF, Raquel CGL, Veronica CV, Danielle SDM (2021) Premature birth: topics in physiology and pharmacological characteristics. Rev Assoc Med Bras 67: 150-155.

Indexted at, Google Scholar, Crossref

3. Wen LL, Chang WH, Wang HW (2021) Risk factors associated with preterm premature rupture of membranes (PPROM). Taiwan J Obstet Gynecol 60: 805-806.

Indexted at, Google Scholar, Crossref

4. Goligher, Ewan C (2012) Ventilator-Induced Diaphragm Dysfunction. Anesthesiology 117: 463–464.

Indexed at, Google Scholar, Crossref


5. Stein H (2013) Electrical Activity of the Diaphragm [Edi] Values and Edi Catheter Placement in Non-Ventilated Preterm Neonates. Am. J. Perinatol. 33:707–711.

Indexed at, Google Scholar, Cross Ref

6. Chiew Yeong Shiong (2013) Effects of Neurally Adjusted Ventilatory Assist [NAVA] Levels in Non-Invasive Ventilated Patients: Titrating NAVA Levels with Electric Diaphragmatic Activity and Tidal Volume Matching. BioMedical Engineering OnLine 2:12-61.

Indexed at, Google Scholar, Cross Ref

7. Beck Jennifer (2009) Patient-Ventilator Interaction during Neurally Adjusted Ventilatory Assist in Low Birth Weight Infants. Pediatric Research 65:663–668.

Indexed at, Google Scholar, Cross Ref

8. Stein, Howard (2012) Synchronized Mechanical Ventilation Using Electrical Activity of the Diaphragm in Neonates. Clinics in Perinatology 39:525–542.

Indexed at, Google Scholar, Cross Ref

9. Kallio Merja (2012) Electrical Activity of the Diaphragm during Neurally Adjusted Ventilatory Assist in Pediatric Patients. Pediatric Pulmonology.50: 925–931.

Indexed at, Google Scholar, Crossref

10. Rahmani A (2012) Neurally Adjusted Ventilatory Assist in the Neonatal Period: Applications and Limitations. Journal of Neonatal-Perinatal Medicine5: 205–212.

Google Scholar, Crossref