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Tang XE, Lu T, Zhou YC, Zhan MJ, Chen W, Peng Z, Liu JH, Gui YF, Deng ZH, Fan F. Adult age estimation from the sternum using maximum intensity projection images of CT and data mining in a Chinese population. Int J Legal Med 2024; 138:961-970. [PMID: 38240839 DOI: 10.1007/s00414-024-03161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/08/2024] [Indexed: 04/11/2024]
Abstract
This study aimed to explore and develop data mining models for adult age estimation based on CT reconstruction images from the sternum. Maximum intensity projection (MIP) images of chest CT were retrospectively collected from a modern Chinese population, and data from 2700 patients (1349 males and 1351 females) aged 20 to 70 years were obtained. A staging technique within four indicators was applied. Several data mining models were established, and mean absolute error (MAE) was the primary comparison parameter. The intraobserver and interobserver agreement levels were good. Within internal validation, the optimal data mining model obtained the lowest MAE of 9.08 in males and 10.41 in females. For the external validation (N = 200), MAEs were 7.09 in males and 7.15 in females. In conclusion, the accuracy of our model for adult age estimation was among similar studies. MIP images of the sternum could be a potential age indicator. However, it should be combined with other indicators since the accuracy level is still unsatisfactory.
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Affiliation(s)
- Xian-E Tang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ting Lu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yu-Chi Zhou
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Meng-Jun Zhan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wang Chen
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhao Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jun-Hong Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yu-Fan Gui
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhen-Hua Deng
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Fei Fan
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
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Chraibi O, Rajaallah A, Lamris MA, Aitlhaj N, El Kassimi CE, Rafai M. Rare case of chondrosarcoma of the manubrium sterni: Management challenges and insights (a surgical case report). Int J Surg Case Rep 2024; 117:109443. [PMID: 38458018 PMCID: PMC10937845 DOI: 10.1016/j.ijscr.2024.109443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Chondrosarcoma of the manubrium sterni is an exceedingly rare localization of chondrosarcoma. Its treatment poses a significant therapeutic challenge due to the tumor's proximity to the mediastinal organs and the clavicles. This challenge is magnified when the inner ends need to be resected due to tumor contact with the sternoclavicular joints and, more critically, during the reconstruction of the thoracic wall. CASE PRESENTATION We present the case of a 71-year-old female with a 45x42x51 mm chondrosarcoma of the manubrium sterni, extending to both sternoclavicular joints. The diagnosis was confirmed cytologically and histologically after an ultrasound-guided biopsy. A surgical strategy involving en bloc resection of the manubrium sterni, the internal ends of both clavicles, and the first two ribs, followed by sternal reconstruction using a synthetic manubrial plate and titanium costal staples without clavicular bridging, was indicated and executed. CLINICAL DISCUSSION This case outlines the surgical considerations and techniques adopted for this complex procedure, emphasizing the operative planning and interdisciplinary collaboration required for a successful outcome. CONCLUSION At 18 months post-surgery, the patient demonstrated favorable clinical and radiological progress, indicating a positive response to the treatment strategy employed.
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Affiliation(s)
- Omar Chraibi
- 32 pavilion of CHU Ibn Rochd of Casablanca, Morocco
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3
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Pongruengkiat W, Pitaksinagorn W, Yurasakpong L, Taradolpisut N, Kruepunga N, Chaiyamoon A, Suwannakhan A. Anatomical study and meta-analysis of the episternal ossicles. Surg Radiol Anat 2024; 46:195-202. [PMID: 38194161 DOI: 10.1007/s00276-023-03280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
Episternal ossicles (EO) are accessory bones located superior and posterior to the manubrium, representing an anatomical variation in the thoracic region. This study aimed to investigate the prevalence and developmental aspects of EO in global populations. The prevalence of EO in pediatric populations was assessed using the "Pediatric-CT-SEG" open-access data set obtained from The Cancer Imaging Archive, revealing a single incidence of EO among 233 subjects, occurring in a 14-year-old patient. A meta-analysis was conducted using data from 16 studies (from 14 publications) through three electronic databases (Google Scholar, PubMed, and Journal Storage) encompassing 7997 subjects. An overall EO prevalence was 2.1% (95% CI 1.1-3.0%, I2 = 93.75%). Subgroup analyses by continent and diagnostic methods were carried out. Asia exhibited the highest prevalence of EO at 3.8% (95% CI 0.3-7.5%, I2 = 96.83%), and X-ray yielded the highest prevalence of 0.7% (95% CI 0.5-8.9%, I2 = 0.00%) compared with other modalities. The small-study effect was indicated by asymmetric funnel plots (Egger's z = 4.78, p < 0.01; Begg's z = 2.30, p = 0.02). Understanding the prevalence and developmental aspects of EO is crucial for clinical practitioners' awareness of this anatomical variation.
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Affiliation(s)
| | - Warisa Pitaksinagorn
- Mahidol University International College, Mahidol University, Nakhon Pathom, Thailand
| | - Laphatrada Yurasakpong
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Napawan Taradolpisut
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Nutmethee Kruepunga
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
- Department of Anatomy, Faculty of Medicine, Kasetsart University, Bangkok, Thailand
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand.
- In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand.
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Aranda JL, Gomez MT, Fuentes M, Rivas C, Forcada C, Jimenez MF. Sternal resection and reconstruction: a review. J Thorac Dis 2024; 16:708-721. [PMID: 38410553 PMCID: PMC10894421 DOI: 10.21037/jtd-23-450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/28/2024]
Abstract
Sternal resection and reconstruction is a rare but sometimes challenging procedure due to its profound anatomical and functional implications. For these reasons, an adequate preoperative evaluation is crucial in each patient, especially when we are faced with malignant lesions that sometimes require extensive radical resections, thus demanding an integrated reconstructive strategy that allows stabilizing the chest wall, protecting the underlying mediastinum and minimize resulting deformity. The large number of available reconstruction techniques and the lack of quality studies for their analysis mean that sternal reconstruction depends to a great extent on the consensus of experts or, more frequently, on the simple preference of each surgical team. This article aims to provide an overview of sternal resection and reconstruction. Indications for partial versus total or subtotal sternectomy are suggested and their surgical and oncological outcomes are presented. The use of rigid or semi-rigid prostheses is an ongoing debate, although recent functional data advise reserving rigid reconstructions for extensive defects. Sternectomy for primary tumors or local tumor involvement has a good prognosis with an overall survival of 5 and 10 years: 67% and 58%, respectively, provided that a radical resection with free surgical margins is performed. Breast cancer is the most common secondary sternal tumor, and surgery can offer 5-year overall survival ranging from 20% to 50% provided an R0 resection is achieved, although radical surgery does not appear to decrease rates. of recurrence. Metastases of origin other than the breast give the worst results (less than 40% at 36 months and 0% at 5 years) and although the data available on these cases are limited, the radicality of the resection does not seem to modify the survival or recurrence rates, so a conservative approach is probably more appropriate.
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Affiliation(s)
- Jose L Aranda
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - María T Gomez
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Marta Fuentes
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Cristina Rivas
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Clara Forcada
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
| | - Marcelo F Jimenez
- Thoracic Surgery Unit, Salamanca University Hospital, Salamanca, Spain
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Wu L, Nagasao T, Hosokawa A, Miyanagai T. Presence of manubrium- sternum joint does not assure sufficient elevation of sternum in Nuss procedure for pectus excavatum patients. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-023-02001-x. [PMID: 38231367 DOI: 10.1007/s11748-023-02001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND The manubrium and body of the sternum are connected by the manubrium-sternum joint (MSJ). In performing the Nuss procedure for pectus excavatum patients, the body of the sternum is elevated as the operator flips correction bars upside down. Theoretically, the presence of the MSJ should allow elevation of the sternum body. However, does the MSJ secure sufficient elevation of the sternum? This study aims to elucidate this clinical question. METHODS Seventy-four adult pectus excavatum patients with moderate to serious deformity (with Haller Index being equal to or greater than 5) were included in the study. The MSJ was open in all patients. For 29 patients, the sternum was elevated by only bar flipping (Non-Separation Group); for 45 patients, the sternum was horizontally separated after bar flipping (Separation Group). Whether or not additional elevation for Separation Group patients results from the division was observed, and the degree of the additional elevation was evaluated. Furthermore, 74 patients subjectively evaluated postoperative pain and gave scores with a Visual Analog Scale ranging from 0 (no pain) to 10 (intolerable pain). The VAS scores were compared between the two groups. RESULTS In the Separation Group, the sternums of all patients achieved additional elevation from sternum separation. The pain scores were lower for the Separation Group than for the Non-Separation Group. CONCLUSION Even when the MSJ is present, horizontal separation enhances the elevation of the sternum. Furthermore, horizontal separation of the sternum reduces postoperative pain.
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Affiliation(s)
- LinXuan Wu
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan
| | - Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan.
| | - Atsushi Hosokawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan
| | - Tomoki Miyanagai
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Ikenobe 1750-1, Kida County, Miki-Cho, Kagawa Prefecture, Japan
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6
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Hanzelyová K, Babiak F, Bajaj J, Janík M, Straka U. The utility of sternum in creating a biological profile: A review and future directions. Soud Lek 2024; 69:6-9. [PMID: 38697832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This review delves into the forensic utility of the sternum in creating a biological profile, focusing on sex, stature, and age estimation. Emphasizing the sternum's significance in challenging scenarios, the study supports the combined length of the manubrium and sternal body as a crucial indicator in sex and stature estimation. However, it highlights the need for caution in applying findings across diverse populations and questions the reliability of Hyrtl's law. Age estimation, primarily based on morphological changes and ossification ages, is explored, with one study showing promise but requiring further validation. While acknowledging the sternum's advantages, the review underscores potential limitations and the absence of specific studies on ancestry estimation, leaving this aspect open for future research. In conclusion, the review provides a comprehensive overview of the sternum's forensic applications, urging continued research to enhance accuracy and applicability.
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Aldakheel DA. Classification of thoracic spine fractures: the four-column theory. Int Orthop 2023; 47:2907-2915. [PMID: 36943457 PMCID: PMC10673741 DOI: 10.1007/s00264-023-05778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics. METHODS This is a narrative review of the literature. RESULTS The classification is based on the relationship between movement and common forces acting on the spine. A mechanistic concept is incorporated into the classification, which considers both movements and the application of forces, leading to pathomorphological characteristics. A hierarchical ranking determines the severity of fractures within the thoracic spine, and treatment recommendations are presented in each category. The fourth column of the spine is incorporated into the classification through direct and indirect mechanisms. CONCLUSIONS The proposed classification accommodates several advantages, such as simplicity and practicality, that make this classification helpful in daily practice. The dynamic relationship between movement and force provides a better understanding of the fracture mechanism. Finally, incorporating the fourth column will strengthen the indication for surgical management. To the best of our knowledge, this classification is the first classification developed uniquely for the thoracic spine fractures and will help to address a critical gap in the literature.
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Affiliation(s)
- Dakheel A Aldakheel
- Colleg of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- Department of Orthopaedic Surgery, King Fahd Hospital of the University, Khobar, Saudi Arabia.
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Ohno T, Suenaga H, Yamawaki-Ogata A, Kanie K, Kato R, Uto K, Ebara M, Ito H, Narita Y, Usui A, Mutsuga M. Development of novel waxy bone haemostatic agents composed of biodegradable polymers with osteogenic-enhancing peptides in rabbit models. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad170. [PMID: 37930044 PMCID: PMC10639036 DOI: 10.1093/icvts/ivad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The use of bone wax (BW) is controversial for sternal haemostasis because it increases the risk of wound infection and inhibits bone healing. We developed new waxy bone haemostatic agents made from biodegradable polymers containing peptides and evaluated them using rabbit models. METHODS We designed 2 types of waxy bone haemostatic agents: peptide wax (PW) and non-peptide wax (NPW), which used poly(ε-caprolactone)-based biodegradable polymers with or without an osteogenesis-enhancing peptide, respectively. Rabbits were randomly divided into 4 groups based on treatment with BW, NPW, PW or no treatment. In a tibial defect model, the bleeding amount was measured and bone healing was evaluated by micro-computed tomography over 16 weeks. Bone healing in a median sternotomy model was assessed for 2 weeks using X-ray, micro-computed tomography, histological examination and flexural strength testing. RESULTS The textures of PW and NPW (n = 12 each) were similar to that of BW and achieved a comparable degree of haemostasis. The crevice area of the sternal fracture line in the BW group was significantly larger than that in other groups (n = 10 each). The PW group demonstrated the strongest sternal flexural strength (n = 10), with complete tibial healing at 16 weeks. No groups exhibited wound infection, including osteomyelitis. CONCLUSIONS Waxy biodegradable haemostatic agents showed satisfactory results in haemostasis and bone healing in rabbit models and may be an effective alternative to BW.
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Affiliation(s)
- Tsukasa Ohno
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Hiroto Suenaga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Aika Yamawaki-Ogata
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Kei Kanie
- Department of Basic Medicinal Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Tokai National Higher Education and Research System, Nagoya, Japan
- Department of Biotechnology and Chemistry, Kindai University, Higashi-Hiroshima, Japan
| | - Ryuji Kato
- Department of Basic Medicinal Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Tokai National Higher Education and Research System, Nagoya, Japan
- Division of Micro-Nano Mechatronics, Institute of Nano-Life-Systems, Institutes of Innovation for Future Society, Nagoya University, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Koichiro Uto
- Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science (NIMS), Tsukuba, Japan
| | - Mitsuhiro Ebara
- Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science (NIMS), Tsukuba, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
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Eldaabossi S, Al-Ghoneimy Y, Antar A, Lotfy E, Aljawad H, Abish YG, Helyl M, Oraby H, Soliman H, Abdullatif B, Nour SO, Lotfi A. Partial sternectomy with reconstruction of a giant cell tumor of the sternum, a case report, Saudi, Arabia. J Cardiothorac Surg 2023; 18:296. [PMID: 37848912 PMCID: PMC10580503 DOI: 10.1186/s13019-023-02404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/30/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Giant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor that rarely affects the sternum. CASE PRESENTATION We report a case of giant cell tumor of the sternum in a 28-year-old Saudi with painful swelling at the lower part of the sternum. Subtotal sternectomy and reconstruction with a neosternum using two layers of proline mesh, a methyl methacrylate prosthesis, and bilateral pectoralis muscle advancement flaps were performed. CONCLUSIONS Giant cell tumor of the sternum is a rare diagnosis. Surgical resection with negative margins is the ideal management. To avoid defects or instability of the chest wall, reconstruction of the chest wall with neosternum should be considered.
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Affiliation(s)
- Safwat Eldaabossi
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia.
- Department of Chest Diseases, Al-Azhar Faculty of Medicine, Cairo, Egypt.
| | | | - Ahmad Antar
- Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Elsaid Lotfy
- Radiology Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Hameed Aljawad
- Pathology and Laboratory Medicine, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Yasser G Abish
- Pathology and Laboratory Medicine, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
- Al-Azhar Faculty of Medicine, Cairo, Egypt
| | | | | | - Hesham Soliman
- Anesthesia Department, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
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Hernández-Zamora RE, Sotelo-Carbajal J, Martínez-Maya G, García-Ledezma A, Román-Matus A, Torres-Salazar QL. Sternal dehiscence, a reconstructive challenge. Case report. Int J Surg Case Rep 2023; 111:108926. [PMID: 37804680 PMCID: PMC10569974 DOI: 10.1016/j.ijscr.2023.108926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Sternotomy is the main surgical procedure used to access the heart and great vessels. Among its most important complications is post-sternotomy dehiscence with an incidence of 10 %; the main risk factors for its occurrence are diabetes mellitus, obesity or chronic obstructive pulmonary disease. CASE PRESENTATION We present a clinical case of a 74-year-old male patient with sternal dehiscence secondary to sternotomy for myocardial revascularisation. CLINICAL DISCUSSION AND CONCLUSIONS Surgical dehiscence of sternotomy presents remarkable complexity and poses a significant challenge to the medical team. The therapeutic approach focuses on addressing the infection, removing the necrotic tissue and then covering the area with highly vascularised tissue. Surgical alternatives include the possibility of using a unilateral pectoralis muscle flap, an option that provides adequate sternal stability and leads to satisfactory functional and cosmetic results.
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Affiliation(s)
| | - Jorge Sotelo-Carbajal
- Hospital General Regional No.1 Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
| | - Gabriela Martínez-Maya
- Hospital General Regional No.1 "Vicente Guerrero" del Instituto Mexicano del Seguro Social, Acapulco de Juárez, Guerrero, Mexico
| | - Arnold García-Ledezma
- Hospital General Regional No.1 Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
| | - Alexis Román-Matus
- Hospital Regional "Dr. Manuel Cárdenas de la Vega" del Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, Culiacán, Mexico
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11
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Kuatrakul A, Vachirawongsakorn V. Forensic age-at-death estimation using the sternal junction in Thai adults: an autopsy study. Anat Cell Biol 2023; 56:367-373. [PMID: 37190771 PMCID: PMC10520865 DOI: 10.5115/acb.23.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
One of the main parameters in the analysis of skeletal remains in forensic anthropological cases is the estimation of age. This study aimed to investigate the correlation between age and the fusion status of the sternal junction. This crosssectional study was carried out on 184 sterna from 94 females and 90 males obtained from known-age cadavers in the Thai population. By direct observation, the fusion stage of the manubrio-sternal and sterno-xiphoidal junctions was studied and divided into unfused and fused joints. The results showed that a large proportion of the sterna remain unfused throughout adulthood, with fusion observed in both young and old cadavers. Insignificant differences in the rate of fusion, the sexes and ages were observed. None of the sterna under 30 years of age in females and 32 years of age in males showed fusion of the manubrio-sternal and sterno-xiphoidal junctions. Based on the variability of the sternal fusions observed in this study, we highlighted a very limited role of the sternum alone in the estimation of age in the Thai population.
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Affiliation(s)
- Adisuan Kuatrakul
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Forensic Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Vijarn Vachirawongsakorn
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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Al Ani A, Abdelmonem K, Forsat K, Alqaderi N, Teir H. Primary sternal osteomyelitis: A case report. Int J Surg Case Rep 2023; 110:108654. [PMID: 37591189 PMCID: PMC10457543 DOI: 10.1016/j.ijscr.2023.108654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Primary sternal osteomyelitis is a rare condition that is frequently caused by Staphylococcus aureus. It is often confused with other cardiac and pulmonary conditions. Early antimicrobial treatment and surgical debridement is the cornerstone of treatment. CASE PRESENTATION A 51-year-old male adult came to the emergency room (ER) with a 2-week history of chest pain, fever, and malaise. His past medical history was unremarkable. Examination revealed a tender anterior chest wall swelling. White Blood Cells (WBCs) (21.6 × 104)/mm3) and C-reactive protein (CRP) (294.10 mg/L) were elevated. Pus from the swelling and blood samples were sent for culture and sensitivity. Electrocardiogram (ECG) was normal and a computed tomography (CT) scan of the chest showed a large dense anterior chest wall abscess extending deep in the chest and to both axillae which caused bony erosion of the sternum. Incision and drainage of the abscess were performed, followed by surgical debridement of the wound. Cultures along the course showed both Staphylococcus aureus and Enterococcus. The patient improved gradually and 2 months after his initial presentation, he became free of symptoms, and CT has shown complete resolution. DISCUSSION Osteomyelitis usually happens after an external bacterium seeds the bone where it begins to grow and thrive, leading to the destruction and pus accumulation under the periosteum. For the treatment, identifying the causative agent is critical in giving intravenous (IV) antibiotic. Thereafter, incision and drainage of an abscess can be performed, similar to what was done with the patient mentioned. Radiography, specifically a CT scan, is crucial as it clearly reveals bony margins and can differentiate between a sequestrum and an involucrum. It also identifies cortical erosion, intraosseous gases and periosteal reactions. CONCLUSION Sternal osteomyelitis can have a nonspecific clinical presentation. Laboratory investigations and radiological findings are crucial for a prompt diagnosis. To prevent the progression of the disease and complications, early intervention is vital to ensure a good prognosis.
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Affiliation(s)
- Amer Al Ani
- College of Medicine, Ajman university, Ajman, United Arab Emirates.
| | | | - Kowthar Forsat
- College of Medicine, Ajman university, Ajman, United Arab Emirates
| | - Nour Alqaderi
- College of Medicine, Ajman university, Ajman, United Arab Emirates
| | - Hajar Teir
- College of Medicine, Ajman university, Ajman, United Arab Emirates
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Papalexis N, Peta G, Vara G, Spinnato P, Errani C, Martella C, Miceli M, Facchini G. Palliative Arterial Embolization for Metastases of the Sternum. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03459-1. [PMID: 37188897 DOI: 10.1007/s00270-023-03459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND To investigate the safety and efficacy of palliative arterial embolization for metastases of the sternum. MATERIALS AND METHODS This study included 10 consecutive patients (5 M, 5 F; mean age 58.1; range 37-70) with metastases of the sternum from different primary tumors, treated with palliative arterial embolization using NBCA-Lipiodol between January 2007 and June 2022. Four patients received a second embolization at the same site, for a total of 14 embolizations. Data on technical and clinical success, as well as changes in tumor size, were collected. All embolization-related complications were evaluated according to the CIRSE classification system for complications. RESULTS Post-embolization angiography showed occlusion of more than 90% of the pathological feeding vessels in all procedures. Pain score and analgesic drug consumption were reduced by 50% in all 10 patients (100%, p < 0.05). The mean duration of pain relief was 9.5 months (range 8 to 12 months, p < 0.05). Metastatic tumor size was reduced from a mean of 71.5 cm3 (range 41.6 to 90.3 cm3) pre-embolization to a mean of 67.9 cm3 (range 38.5 to 86.1 cm3) at the 12-month follow-up (p < 0.05). None of the patients experienced embolization-related complications. CONCLUSION Arterial embolization is safe and effective as a palliative treatment for patients with metastases of the sternum who did not benefit from radiation therapy or experienced recurrence in symptoms.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Vara
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Martella
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Jalil RA, Abdallah FA. Multiple local recurrences of primary sternal chondrosarcoma: tumor manipulation or self-seeding. J Cardiothorac Surg 2023; 18:114. [PMID: 37031192 PMCID: PMC10082493 DOI: 10.1186/s13019-023-02213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/02/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Primary sternal chondrosarcoma, although rare, is the most common malignant tumor of the sternum. The gold standard treatment is complete surgical excision, which frequently causes the instability of the thorax necessitating future reconstruction. Local recurrence is common increasing the risk of distant metastasis. CASE PRESENTATION A 60-year-old male patient was diagnosed with primary sternum chondrosarcoma and underwent surgical excision with negative resection margins. Later, he was found to have two local recurrences at 11 months and 37 months post initial excision. The two recurrences were surgically removed followed by local adjuvant radiation. CONCLUSION The seeding theories have been reported more frequently with relation to diagnostic biopsy procedures, tumor manipulation and self-seeding tumors. The patient developed two local recurrences despite total resection with negative margins, without concerns regarding seeding in distant metastasis.
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Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Farah A Abdallah
- Department of Research, King Hussein Cancer Center, Queen Rania Al Abdullah Street, Amman, 11941, Jordan.
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Torimitsu S, Nishida Y, Yajima D, Inokuchi G, Makino Y, Motomura A, Chiba F, Yamaguchi R, Hoshioka Y, Iwase H. Statistical analysis of biomechanical properties and size of the sternum and its fracture risk in a Japanese sample. Leg Med (Tokyo) 2023; 62:102242. [PMID: 36924618 DOI: 10.1016/j.legalmed.2023.102242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/07/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Sternal fractures can have life-threatening complications. To understand chest injury mechanisms, sufficient data regarding the mechanical properties and structure of the sternum are required. The aim of this study was to examine the mechanical properties and size of the sternum in a Japanese forensic sample. MATERIALS AND METHODS Sterna were obtained from 120 Japanese dead bodies of known age and sex. The sample thickness (ST) and the sample width (SW) were measured using a computed tomographic image. Three-point-bending tests were conducted using a three-point-bending apparatus to assess the fracture load (FL) of the sample. Then, the flexural strength (FS) was calculated and the natural logarithm of FL (ln FL) and FS (ln FS) were also calculated. RESULTS The values of ST, ln FL, and ln FS for male samples were significantly greater than those for female samples. Both ln FL and ln FS had significant negative correlations with age regardless of sex; the Pearson product-moment correlation coefficients were larger for female samples than for male samples. Although age was significantly negatively correlated with SW in female samples, there was no significant correlation between age and SW in male samples. No significant correlations were found between age and ST regardless of sex. CONCLUSION This is the first study to present quantitative data on the biomechanical properties of the sternum. Because of the smaller sternal strength of elderly women, it is especially important for them to avoid the risk of sternal fractures.
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Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yoshifumi Nishida
- Department of Mechanical Engineering, Tokyo Institute of Technology, 2-12-1, O-okayama, Meguro-ku, Tokyo 152-8552, Japan.
| | - Daisuke Yajima
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan.
| | - Go Inokuchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Ayumi Motomura
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Yumi Hoshioka
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Näslund E, Lindberg LG, Strandberg G, Apelthun C, Franzén S, Frithiof R. Oxygen saturation in intraosseous sternal blood measured by CO-oximetry and evaluated non-invasively during hypovolaemia and hypoxia - a porcine experimental study. J Clin Monit Comput 2023; 37:847-856. [PMID: 36786963 PMCID: PMC10175432 DOI: 10.1007/s10877-023-00980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE This study intended to determine, and non-invasively evaluate, sternal intraosseous oxygen saturation (SsO2) and study its variation during provoked hypoxia or hypovolaemia. Furthermore, the relation between SsO2 and arterial (SaO2) or mixed venous oxygen saturation (SvO2) was investigated. METHODS Sixteen anaesthetised male pigs underwent exsanguination to a mean arterial pressure of 50 mmHg. After resuscitation and stabilisation, hypoxia was induced with hypoxic gas mixtures (air/N2). Repeated blood samples from sternal intraosseous cannulation were compared to arterial and pulmonary artery blood samples. Reflection spectrophotometry measurements by a non-invasive sternal probe were performed continuously. RESULTS At baseline SaO2 was 97.0% (IQR 0.2), SsO2 73.2% (IQR 19.6) and SvO2 52.3% (IQR 12.4). During hypovolaemia, SsO2 and SvO2 decreased to 58.9% (IQR 16.9) and 38.1% (IQR 12.5), respectively, p < 0.05 for both, whereas SaO2 remained unaltered (p = 0.44). During hypoxia all saturations decreased; SaO2 71.5% (IQR 5.2), SsO2 39.0% (IQR 6.9) and SvO2 22.6% (IQR 11.4) (p < 0.01), respectively. For hypovolaemia, the sternal probe red/infrared absorption ratio (SQV) increased significantly from baseline (indicating a reduction in oxygen saturation) + 5.1% (IQR 7.4), p < 0.001 and for hypoxia + 19.9% (IQR 14.8), p = 0.001, respectively. CONCLUSION Sternal blood has an oxygen saturation suggesting a mixture of venous and arterial blood. Changes in SsO2 relate well with changes in SvO2 during hypovolaemia or hypoxia. Further studies on the feasibility of using non-invasive measurement of changes in SsO2 to estimate changes in SvO2 are warranted.
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Affiliation(s)
- Erik Näslund
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden. .,Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden. .,Department of Anaesthesia, Gävle Hospital, 801 87, Gävle, Sweden.
| | - Lars-Göran Lindberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Gunnar Strandberg
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Catharina Apelthun
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Stephanie Franzén
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
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Nagasao T, Aizezi N, Tamai M, Kogure T, Morotomi T. Separation of the seventh costal-sternal junction-A new technique to improve outcomes for the Nuss procedure for pectus excavatum. J Plast Reconstr Aesthet Surg 2023; 76:4-9. [PMID: 36513003 DOI: 10.1016/j.bjps.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/31/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the standard Nuss procedure for pectus excavatum, the costal arch is often elevated together with the sternum, resulting in unevenness of the lower part of the thorax. This complication is commonly called rib flaring. This paper presents a technique to avoid rib flaring and evaluates its effectiveness. MATERIALS AND METHODS In our technique, a part of the seventh costal cartilage is removed, disconnecting the costal arch from the sternum. The effectiveness of this technique was evaluated in a retrospective clinical study of 63 pectus excavatum patients who were randomly collected and were divided into two groups. One group-defined as the Standard Group-includes 27 patients (29.8 ± 6.5SD y/o) on whom standard Nuss procedure was conducted; the other group-defined as the Separation Group-includes 36 patients (31.8 ± 6.1SD y/o) on whom the cartilage removal was conducted in addition to the standard Nuss procedure. The degree of postoperative costal-arch elevation was defined as ECA (Elevation of Costal Arch) and was compared between the two groups. RESULTS ECA was significantly greater for the Standard Group (10.2 ± 3.3SD mm) than for the Separation Group (-1.1 ± 3.42SDmm). CONCLUSION Postoperative protrusion of the costal arch is prevented by the separation of the seventh costal cartilage from the sternum. Our original technique is a useful option for the treatment of pectus excavatum.
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Affiliation(s)
- Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, Medical/Graduate School of KAGAWA University, Kagawa, Japan.
| | - Niyazi Aizezi
- Department of Plastic and Reconstructive Surgery, Medical/Graduate School of KAGAWA University, Kagawa, Japan
| | - Motoki Tamai
- Department of Plastic and Reconstructive Surgery, Medical/Graduate School of KAGAWA University, Kagawa, Japan
| | - Tetsukuni Kogure
- Department of Plastic and Reconstructive Surgery, Medical/Graduate School of KAGAWA University, Kagawa, Japan
| | - Tadaaki Morotomi
- Department of Plastic and Reconstructive Surgery, Medical/Graduate School of KINDAI University, Osaka, Japan
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Partido Navadijo M, Alemán Aguilera I. Utility of the sternal synostosis for age-at-death estimation in a Mediterranean population. Forensic Sci Med Pathol 2022; 18:423-428. [PMID: 35881222 DOI: 10.1007/s12024-022-00506-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/14/2022]
Abstract
Age estimation is essential for the identification of skeletal remains in Forensic Anthropology. Numerous studies have been performed on diverse regions of the skeleton, including the synostosis of the sternal segments. In this sense, the fusion of the different sternal segments was assessed to analyze whether it had a correlation with age-at-death in a Mediterranean population. A total of 189 sternums which belonged to individuals between the ages of 20 and 98 from both sexes (56.6% males; 43.4% females), from the San José's Cemetery of Granada Contemporary Collection (Spain), were selected. Scores ranging from 1 to 3 were assigned in accordance with the degree of manubrio-sternal fusion and sterno-xyphoidal fusion. Cohen's kappa coefficient for intra- and inter-observer error was performed and then chi-square test was run to analyze any correlation between the stage of synostosis and the skeletal age. Only the sterno-xyphoidal fusion, which starts between 30 and 39 years old, provided a predictable result, as the manubrium and the sternal body usually remain without fusion. This study demonstrates a direct correlation between fusion of the xyphoid process and chronological age.
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Affiliation(s)
- Manuel Partido Navadijo
- Laboratory of Anthropology, Dept. of Legal Medicine, Toxicology and Physical Anthropology, University of Granada, Avda. de la Investigación, 11, 18016, Granada, Spain.
| | - Inmaculada Alemán Aguilera
- Laboratory of Anthropology, Dept. of Legal Medicine, Toxicology and Physical Anthropology, University of Granada, Avda. de la Investigación, 11, 18016, Granada, Spain
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Morgan B, Prakash K, Mayberry JC, Brickley MB. Thoracic trauma: Clinical and paleopathological perspectives. Int J Paleopathol 2022; 39:50-63. [PMID: 36219928 DOI: 10.1016/j.ijpp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Although trauma is one of the most significant areas of study in paleopathology, most studies focus on fractures of single anatomical elements. Paleopathological research on regional trauma, such as of the thorax, is rare. This paper explores the causes, complications, and consequences of adult thoracic trauma using clinical data in order to inform paleopathological research. MATERIALS AND METHODS Trends in paleopathological thoracic trauma literature were assessed by evaluating publications from Bioarchaeology International, International Journal of Osteoarchaeology, International Journal of Paleopathology, and American Journal of Biological Anthropology. Clinical publications on thoracic trauma throughout time were also assessed through a PubMed search, and modern prevalence data was found through trauma databases such as the National Trauma Databank. RESULTS Consideration of thoracic trauma involving concomitant injuries is a recent trend in clinical literature and patient care, but paleopathological research on thoracic trauma has been limited. Since thoracic fractures tend to occur in conjunction with other injuries, assessing them together is critical to the interpretation of trauma in the past. CONCLUSIONS Clinical research into thoracic fractures and concomitant injuries provides valuable data for paleopathological research. Evaluating the likelihood and consequences of concomitant injury in skeletal remains provides a more robust understanding of trauma in the past and its impact on past lifeways. SIGNIFICANCE This paper provides a review of current clinical and paleopathological literature on thoracic trauma and demonstrates the importance of moving beyond the analysis of fractures or trauma of single anatomical elements. LIMITATIONS Thoracic bones are often taphonomically altered and differentially preserved leading to difficulty in identifying and interpreting fractures. SUGGESTIONS FOR FURTHER RESEARCH Practical application of the data presented here to archaeological samples will help to advance paleopathological understandings of thoracic trauma.
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Affiliation(s)
- Brianne Morgan
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
| | - Karanvir Prakash
- Virginia Commonwealth University, Department of Orthopedic Surgery, Richmond, VA, USA.
| | - John C Mayberry
- University of Washington, Department of Surgery, Seattle, WA 98195, USA.
| | - Megan B Brickley
- McMaster University, Department of Anthropology, Hamilton, Ontario L8S 4L9, Canada.
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Zhu H, Zhai M, Li X, Xu H. The "Hand as Foot" teaching method in the anatomy of sternum. Asian J Surg 2022; 45:2874-2875. [PMID: 35798603 DOI: 10.1016/j.asjsur.2022.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Hui Zhu
- Department of Cardiovascular Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, PR China.
| | - Miaobo Zhai
- Department of Cardiovascular Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, PR China.
| | - Xinxi Li
- Department of Cardiovascular Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, PR China.
| | - Huipu Xu
- Department of Cardiovascular Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, PR China.
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21
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HAJE DAVIDEPODESTÁ, TEIXEIRA KELSENDEOLIVEIRA, SILVA NETO MOACIR, VOLPON JOSÉBATISTA, MENDLOVITZ PAULOSERGIO, VASCONCELOS PAULODOLABELA. STERNUM TOMOGRAPHIC EVALUATION IN PECTUS PATIENTS: ANALYSIS OF SAGITAL PARAMETERS. Acta Ortop Bras 2022; 30:e250612. [PMID: 36451784 PMCID: PMC9670782 DOI: 10.1590/1413-785220223005e250612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/13/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the sagittal tomographic reformatting of the sternum using unpublished radiographic parameters (indexes and angles), comparing them between the different types of pectus, and controls. METHODS 44 patients with pectus deformities and controls underwent chest CT for analysis. The types of pectus were classified into: inferior pectus carinatum (IPC), superior (SPC) and lateral (LPC), and broad (BPE) and localized pectus excavatum (LPE). The following tomographic parameters were created and measured: (1) spine-manubrium-sternum index (SMS); (2) column-sternum index (CSI); (3) manubrium-sternal angle (MSA); (4) inferior manubrium angle (IMA); and (5) inferior sternum angle (ISA). Statistical analysis was performed between the pectus and control groups, and between the different types of pectus. RESULTS There was a significant difference between: a) pectus excavatum and pectus carinatum when analyzing the SMS, CSI, MSA and ISA indexes. b) LPE and control group for SMS and ISA. c) LPC and LPE, and LPC and BPE for SMS; d) BPE and LPC for CSI; e) IPC and LPE, and IPC and BPE for ISA; f) SPC and LPE, and SPC and BPE for IMA. CONCLUSION The radiographic indexes and angles created provided differentiation parameters between patients with different types of pectus, and between these and controls. Level of Evidence II, Prognostic Studies.
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Affiliation(s)
- DAVI DE PODESTÁ HAJE
- Centro Clínico Orthopectus, Brasília, DF, Brazil.,Hospital de Base do Distrito Federal, Secretaria de Estado da Saúde do Distrito Federal, Brasília, DF, Brazil
| | - KELSEN DE OLIVEIRA TEIXEIRA
- Hospital de Base do Distrito Federal, Secretaria de Estado da Saúde do Distrito Federal, Brasília, DF, Brazil
| | | | - JOSÉ BATISTA VOLPON
- Universidade de São Paulo, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
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22
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Geraedts TCM, Daemen JHT, Vissers YLJ, Hulsewé KWE, Van Veer HGL, Abramson H, de Loos ER. Minimally invasive repair of pectus carinatum by the Abramson method: A systematic review. J Pediatr Surg 2022; 57:325-332. [PMID: 34969524 DOI: 10.1016/j.jpedsurg.2021.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this review is to provide an overview of the outcomes after minimally invasive pectus cartinatum repair (MIRPC) by the Abramson method to determine its effectiveness. METHODS The PubMed and Embase databases were systematically searched. Data concerning subjective postoperative esthetic outcomes after initial surgery and bar removal were extracted. In addition, data on recurrence, complications, operative times, blood loss, post-operative pain, length of hospital stay, planned time to bar removal and reasons for early bar removal were extracted. The postoperative esthetic result, was selected as primary outcome since the primary indication for repair in pectus carinatum is of cosmetic nature. RESULTS Six cohort studies were included based on eligibility criteria, enrolling a total of 396 patients. Qualitative synthesis showed excellent to satisfactory esthetic results in nearly all patients after correctional bar placement (99.5%, n = 183/184). A high satisfaction rate of 91.0% (n = 190/209) was found in patients after bar removal. Recurrence rates were low with an incidence of 3.0% (n = 5/168). The cumulative postoperative complication rate was 26.5% (n = 105/396), of whom 25% required surgical re-intervention. There were no cases of mortality. CONCLUSIONS Minimally invasive repair of pectus carinatum through the Abramson method is effective and safe. Its efficacy is demonstrated by the excellent to satisfactory esthetic results in 99.5% and 91.0% of patients after respectively correctional bar placement and implant removal. Future studies should aim to compare different treatment options for pectus carinatum in order to elucidate the approach of choice for different patient groups.
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Affiliation(s)
- Tessa C M Geraedts
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands; Faculty of Health, Medicine and Life Sciences (FHML), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Hans G L Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; BREATHE Laboratory, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Horacio Abramson
- Surgical Thoracic Service, Hospital Antonio Cetrángolo, Vicente Lopez, Buenos Aires, Argentina
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands.
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Sebro R, De la Garza-Ramos C. Machine learning for the prediction of osteopenia/osteoporosis using the CT attenuation of multiple osseous sites from chest CT. Eur J Radiol 2022; 155:110474. [PMID: 35988394 DOI: 10.1016/j.ejrad.2022.110474] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To use machine learning and the CT attenuation of all bones visible on chest CT scans to predict osteopenia/osteoporosis. METHOD We retrospectively evaluated 364 patients with CT scans of the chest, and Dual-energy X-ray absorptiometry (DXA) scans within 6 months of each other. Studies were performed between 01/01/2015 and 08/01/2021. Volumetric segmentation of the ribs, thoracic vertebrae, sternum, and clavicle was performed using 3D Slicer to obtain the mean CT attenuation of each bone. The study sample was randomly split into training/validation (80 %, n = 291 patients) and test (20 %, n = 73 patients) datasets. Univariate analyses were used to identify the optimal CT attenuation thresholds to diagnose osteopenia/osteoporosis. We used penalized multivariable logistic regression models including Least Absolute Shrinkage and Selection Operator (LASSO), Elastic Net, and Ridge regression, and Support Vector Machines (SVM) with radial basis functions (RBF) to predict osteopenia/osteoporosis and compared these results to the CT attenuation threshold at T12. RESULTS There were positive correlations between the CT attenuation between all bones (r > 0.6, P < 0.001 for all). There were positive correlations between CT attenuation of the bones and the L1-L4 BMD T-score, total hip T-score, and femoral neck T-scores (r > 0.4, P < 0.001 for all). A CT attenuation threshold of 170.2 Hounsfield units (HU) at T12 had an AUC of 0.702, while a threshold of 192.1 HU at T4 had an AUC of 0.757. The SVM with RBF had the highest AUC (AUC = 0.864) and was better than the LASSO (P = 0.011), Elastic Net (P = 0.011), Ridge regression (P = 0.011) but was not better than using the CT attenuation at T12 (P = 0.060). CONCLUSIONS The CT attenuation of the ribs, thoracic vertebra, sternum, and clavicle can be used individually and collectively to predict BMD and to predict osteopenia/osteoporosis.
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Affiliation(s)
- Ronnie Sebro
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, United States; Center for Augmented Intelligence, Mayo Clinic, Jacksonville, FL 32224, United States.
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24
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Jeamamornrat V, Monum T, Keereewan W, Mahakkanukrauh P. Stature estimation using the sternum in a Thai population. Anat Cell Biol 2022; 55:170-178. [PMID: 35773219 PMCID: PMC9256492 DOI: 10.5115/acb.22.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
Stature estimation is an important process of biological profile analysis for the identification of skeletal remains. In forensic practice, non-long bones might be needed for estimating stature, in case long bones were not recovered or well preserved. This study developed the stature estimation model from dry sterna in a Thai population. The combined length of manubrium and mesosternum (CMM) was the best single stature estimation indicator for males and combined sex samples, whereas the sternal area (SA) was the best stature estimation indicator for females in our study. The best multiple regression analysis models of our study were stature equal 122.685+0.182 (CMM)+0.592 (intercostal length between the third and fourth ribs [ICL34]) with a standard error of estimation (SEE) of 6.134 cm for males, stature equal 130.676+0.005 (SA) with SEE of 5.370 cm for females, and stature equal 79.412+0.342 (CMM)+0.506 (corpus sterni width at first sternebra [CSWS1])+0.794 (ICL34) with SEE of 6.222 cm for unknown sex samples. The results indicated that a sternum can be used for estimating the stature of skeletal remains in a Thai population. However, these models might not be suitable for other populations, especially, in case the suspected stature is over the stature range in our study.
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Affiliation(s)
- Verapat Jeamamornrat
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tawachai Monum
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Waratchaya Keereewan
- Master of Science Program in Forensic Science, Graduate School, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Osteology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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25
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Minervini F, van Veelen NM, Van de Wall BJM, Beeres FJP, Michelitsch C; Sternal Fracture Classification Observer Group. Validation of the modified AO sternum classification system. Eur J Orthop Surg Traumatol 2022. [PMID: 35704065 DOI: 10.1007/s00590-022-03302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The Arbeitsgemeinschaft für Osteosynthesefragen (AO) foundation along with the Orthopaedic. Trauma Association (OTA) introduced a new classification for sternal fractures in 2018 aiming to provide greater uniformity and clinical utility for the surgical community. A previous validation study identified some critical issues such as the differentiation between type A and B fractures and localization of the fracture either in the manubrium or in the body. Due to the moderate agreement in inter- and intra-observer variability, some modifications were proposed in order to improve the performance of the classification. The aim of this study was to re-assess the inter- and intra-observer variability after adding modifications to the classification. Our hypothesis was that a significative improvement of inter- and intra-observer variability could be achieved. MATERIAL AND METHODS Twenty computed tomography (CT) scans of patients with sternal fractures were analyzed by six. Junior and six senior surgeons independently. Two assessments were performed with an interval of 6 weeks. The kappa (K) value was calculated in order to assess inter- and intra-observer variability. RESULTS The overall mean kappa value for inter-observer variability improved from 0.364 to 0.468 (p < 0.001). Inter-observer variability mean for location was 0.573 (SD 0.221) and for type was 0.441 (SD: 0.181). Intra-observer variability showed a mean of 0.703 (SD: 0.153) with a statistic significant improvement when compared to the previous study (mean 0.414, SD: 0.256, p < 0.001). CONCLUSIONS By modifying the AO/OTA classification of sternal fractures, the inter- and intra-observer variability improved and now shows moderate to substantial agreement.
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26
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Panayiotou A, De La Hoz Polo M, Tang V, Haque S. Spectrum of anatomical variants, normal findings and pathology in and around the paediatric sternum. Pediatr Radiol 2022; 52:1175-1186. [PMID: 35142891 DOI: 10.1007/s00247-021-05268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/18/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
Abnormalities of the sternum and adjacent structures are an uncommon presentation in the paediatric population and can have a variety of benign and malignant causes, including normal and developmental variants of the chest wall. Although there is overlap with adults, many sternal abnormalities are unique to the paediatric population. Following clinical examination, radiography is usually the first type of imaging used; however, it is limited and often ultrasound and cross-sectional imaging are needed for further assessment. An understanding of the normal anatomy is important; however, this can be challenging due to the varied appearances of age-related changes of the sternum. The purpose of this article is to familiarize the general paediatric radiologist with the expected anatomy and imaging findings of the developing sternum, anatomical variants and pathology of the sternum and adjacent structures encountered in this group of patients.
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Affiliation(s)
- Andreas Panayiotou
- Department of Radiology, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | | | - Vivian Tang
- Department of Radiology, Royal Manchester Children's Hospital, Manchester, UK
| | - Saira Haque
- Department of Radiology, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
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Szűcs D, Fejes V, Kozma Z, Poór VS, Sipos K. Sternal aspirate sampling of Bacillariophyceae (diatoms) and Cyanobacteria in suspected drowning cases. J Forensic Leg Med 2021; 85:102298. [PMID: 34896890 DOI: 10.1016/j.jflm.2021.102298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022]
Abstract
A diagnosis of drowning is not always possible based on the traditional autopsy findings. The most widely used ancillary methods are based on the detection of diatoms and other waterborne organisms in the organs of the systemic circulation by light microscope or polymerase chain reaction (PCR). One of the greatest concerns is sample contamination. Bone marrow is a favourable source because the compact bone protects the sample from water ingress in the case of advanced decay. In our pilot study, we aimed to adopt sternal bone marrow aspiration - which is a widely used technique in haematology - for postmortem sampling. Control experiments of non-drowning victims showed that cleaning the skin over the sternum can prevent external contamination. Sternal aspirate samples were taken from seven suspected drowning victims along with lung, spleen, and femoral bone marrow samples. All specimens were examined for the presence of diatoms by light microscope and Cyanobacteria-specific DNA by PCR. We were able to obtain bone marrow aspirates from all cases without complications. In four of the sternal samples both diatoms and cyanobacterial DNA were detected, while one additional sternum sample was tested positive with PCR, but no diatom shells were detectable. Sternal bone marrow aspiration is simple and quick, which can be performed at the beginning of an autopsy, minimizing the chance of contamination. We have shown that this sampling method can be adopted for postmortem diatom testing. This minimally invasive technique might be used in virtual autopsy (postmortem computed tomography, PMCT) settings without opening body cavities.
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Cui X, Li RG, Ma DT. A safe area for sternal puncture in children: an MSCT study based on sternal development. Surg Radiol Anat 2021; 44:105-115. [PMID: 34748048 PMCID: PMC8573577 DOI: 10.1007/s00276-021-02850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/11/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Multislice spiral CT (MSCT) was used to investigate the anatomical characteristics of sternal development, and to provide anatomical basis for sternal puncture in children. METHODS We retrospectively analyzed the thoracic MSCT data of 600 children who received thoracic MSCT from January to June 2020 with their age ranging from 1 month to 19 years. The distribution of sternal ossification centers and adjacent tissues and organs was observed. Subcutaneous soft tissue thickness and the distance between the skin and the posterior margin of the sternum were measured in the central areas of sternal manubrium and mesosternum (segments I and II), and the correlation between the two was calculated using linear correlation. RESULTS A total of 600 patients were enrolled, the mean age was 9.87 years and the standard deviation was 8.28 years. The sternal manubrium and ossification centers at the I and II segments of the mesosternum were visible in all cases (100%). There was no ossification in segment III of the mesosternum in 15 cases (2.5%), including 12 cases (80%) adjacent to the posterior pericardium and 7 cases (46.7%) of lung tissue. There were 274 cases (45.7%) of segment IV without ossification, including 204 cases (74.5%) of adjacent pericardium and 95 cases (32.8%) of lung tissue. The xiphoid process was not ossified in 258 cases (43%), including 190 cases (73.6%) adjacent to the pericardium and 97 cases (37.6%) adjacent to the lung tissue. Correspondingly, the thickness of subcutaneous soft tissue of the sternal manubrium and the central region of the I and II segments of the mesosternum had a low positive correlation with age (P < 0.001), the distance between the skin and the posterior margin of the sternum showed a moderate positive correlation with age (P < 0.001), and the distance between the skin and the posterior margin of the sternum showed a high positive correlation with the thickness of subcutaneous soft tissue (P < 0.001). CONCLUSIONS Nonossification of the sternal ossification center usually occurs below segment III of the mesosternum and is usually adjacent to heart and lung tissue. Pediatric sternal puncture should be performed at the sternal manubrium and the mesosternum of segments I and II. However, attention should be paid to the space between multiple ossification centers. The thickness of subcutaneous soft tissue is a critical factor that determines the depth of the puncture.
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Affiliation(s)
- Xue Cui
- Department of Radiology, Tai'an City Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong Province, 271000, People's Republic of China
| | - Rui-Guang Li
- Department of Radiology, Tai'an City Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong Province, 271000, People's Republic of China
| | - De-Ting Ma
- Department of Radiology, Tai'an City Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong Province, 271000, People's Republic of China.
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Enginoev S, Rad AA, Ekimov S, Kondrat'ev D, Magomedov G, Amirhanov A, Tsaroev B, Ziankou A, Motreva A, Chernov I, Tarasov D, Kadyraliev B, Sá MPBO. Risk Factors for Deep Sternal Wound Infection after Off-Pump Coronary Artery Bypass Grafting: a Case-Control Study. Braz J Cardiovasc Surg 2021; 37:13-19. [PMID: 34673508 PMCID: PMC8973134 DOI: 10.21470/1678-9741-2020-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction The objective of this study was to identify risk factors for deep sternal
wound infection (DSWI) after off-pump coronary artery bypass (OPCAB)
grafting surgery. Methods A total of 8,442 patients undergoing OPCAB from April 1, 2009 to December 31,
2018 were retrospectively analyzed. A total of 956 were eventually enrolled
on this study based on our exclusion criteria. All subjects were divided
into two groups: group 1 (n=63) - DSWI; group 2 (n=893) - without DSWI.
Patients were excluded if they had one of the following: acute coronary
syndrome, conversion to OPCAB grafting surgery, redo procedure, concomitant
cardiac surgery procedures. Results The prevalence of body mass index (BMI) ≥40 kg/m2 (7.9%
vs. 1.9%, respectively; P=0.01), lower
extremity atherosclerotic artery disease (23.8% vs. 7.2%,
respectively; P=0.001) and use of bilateral internal
thoracic artery (19.5% vs. 2.5%, respectively;
P=0.008) was significantly higher in patients with
DSWI. The incidence of morbidities, including reoperation for bleeding
(26.4% vs. 2.1%, respectively;
P<0.001), stroke (4.8% vs. 0.8%,
respectively; P=0.02), acute renal failure (7.9%
vs. 0.8%, respectively; P=0.001),
delirium (7.9% vs. 1.7%, respectively;
P=0.008) and blood transfusion (30.6% vs.
9.8%, respectively; P<0.001) was significantly higher in
patients with DSWI. Conclusions A BMI of >40 kg/m2, lower extremity artery disease, use of
bilateral internal thoracic artery (BITA) graft, postoperative stroke,
sepsis, reoperation due to postoperative complications and blood product
requirement significantly increased the risk of sternal infection after
OPCAB.
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Affiliation(s)
- Soslan Enginoev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia.,Astrakhan State Medical University, Astrakhan, Russia
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Sergey Ekimov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Dmitry Kondrat'ev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Gasan Magomedov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Alan Amirhanov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Bashir Tsaroev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Alexander Ziankou
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Anna Motreva
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Igor Chernov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Dmitry Tarasov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | | | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil
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30
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Alonso Sánchez J, Gallego Herrero C, García Prieto J, Cruz-Conde MC, Casado Pérez C, Rasero Ponferrada M, Coca Robinot D. Self-limiting sternal tumors of childhood (SELSTOC): A diagnostic challenge. Radiologia (Engl Ed) 2021; 63:400-5. [PMID: 34625195 DOI: 10.1016/j.rxeng.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Self-limiting sternal tumors of childhood (SELSTOC) are rapidly growing sternal lesions that tend to resolve spontaneously. Patients have no history of infection, trauma, or neoplasms, and the most likely etiologyis an aseptic inflammatory reaction of unknown origin. The differential diagnosis includes a wide spectrum of lesions such as tumors, infections, malformations, or anatomic variants. MATERIAL AND METHODS We analyzed all cases of sternal masses in pediatric patients seen between 2012 and 2019; five of these had findings compatible with SELSTOC. We retrospectively recorded patients' race, sex, age, clinical presentation, laboratory findings, imaging tests, treatment, and follow-up. RESULTS We present five cases of rapidly growing sternal lesions whose clinical and radiological features are compatible with SELSTOC. In the absence of alarming symptoms and laboratory markers, watchful waiting could be an appropriate therapeutic approach. However, patients with some findings such as fever, elevated acute phase reactants, and/or comorbidities could require therapeutic interventions such as antibiotics or percutaneous drainage. In our series, depending on the clinical presentation and the patient's comorbidities, different therapeutic approaches were adopted (a conservative approach in two patients, antibiotics in three patients, and percutaneous drainage in one patient). In all cases, the sternal lesion was absent at discharge and/or at later follow-up visits. CONCLUSION Radiologists and pediatricians must be aware of this entity and the different diagnostic and therapeutic approaches to rapidly growing sternal lesions in pediatricpatients because recognizing SELSTOC can avoid unnecessary diagnostic tests and/or disproportionate therapeutic strategies.
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Roesler MK, Schmeisser MJ, Schumann S. Interclavicularis anticus digastricus muscle in a female body donor: a case report. Surg Radiol Anat 2021; 44:93-97. [PMID: 34626203 PMCID: PMC8758645 DOI: 10.1007/s00276-021-02848-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
Background and objectives Muscular variations of the ventral thoracic wall are generally common and of great clinical interest. Materials and methods An unusual muscular variation of the ventral thoracic wall was observed and dissected in a West-European female body donor. Results An interclavicularis anticus digastricus muscle was observed and studied. It originated from the manubrium sterni and inserted bilaterally to the clavicles. Both muscle bellies were interconnected by a tendon on the ventral surface of the manubrium sterni. The muscle was innervated by branches of the lateral pectoral nerve. Conclusions The interclavicularis anticus digastricus muscle is a muscular variation of the ventral thoracic wall of unknown prevalence. This variation might be of clinical interest in orthopaedics and thoracic surgery. It is also a vulnerable structure during infraclavicular insertion of a subclavian vein catheter or fractures of the clavicle.
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Affiliation(s)
- M K Roesler
- Institute for Microscopic Anatomy and Neurobiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - M J Schmeisser
- Institute for Microscopic Anatomy and Neurobiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Focus Program Translational Neurosciences (FTN), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - S Schumann
- Institute for Microscopic Anatomy and Neurobiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
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Choi CW, Park YK, Shin HK, Lim JW, Her K. Sternal Resection and Reconstruction for Solitary Plasmacytoma of the Sternum: Case Report. J Chest Surg 2021; 54:400-403. [PMID: 33234766 PMCID: PMC8548202 DOI: 10.5090/jcs.20.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 11/21/2022] Open
Abstract
A 63-year-old patient was admitted with a sternal fracture and mass. On evaluation, most of the body of the sternum had been destroyed by a tumor. Radical resection of the sternum was performed and part of the major pectoral muscles adherent to the sternal tumor was also resected. The chest wall defect was reconstructed with mesh, bone cement, and a titanium rib plate system. Reconstruction with this method seemed to be an appropriate procedure to prevent instability of the chest wall.
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Affiliation(s)
- Chang Woo Choi
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - You Kyeong Park
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hwa Kyun Shin
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Woong Lim
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Keun Her
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Abstract
BACKGROUND The origin of powered avian flight was a locomotor innovation that expanded the ecological potential of maniraptoran dinosaurs, leading to remarkable variation in modern birds (Neornithes). The avian sternum is the anchor for the major flight muscles and, despite varying widely in morphology, has not been extensively studied from evolutionary or functional perspectives. We quantify sternal variation across a broad phylogenetic scope of birds using 3D geometric morphometrics methods. Using this comprehensive dataset, we apply phylogenetically informed regression approaches to test hypotheses of sternum size allometry and the correlation of sternal shape with both size and locomotory capabilities, including flightlessness and the highly varying flight and swimming styles of Neornithes. RESULTS We find evidence for isometry of sternal size relative to body mass and document significant allometry of sternal shape alongside important correlations with locomotory capability, reflecting the effects of both body shape and musculoskeletal variation. Among these, we show that a large sternum with a deep or cranially projected sternal keel is necessary for powered flight in modern birds, that deeper sternal keels are correlated with slower but stronger flight, robust caudal sternal borders are associated with faster flapping styles, and that narrower sterna are associated with running abilities. Correlations between shape and locomotion are significant but show weak explanatory power, indicating that although sternal shape is broadly associated with locomotory ecology, other unexplored factors are also important. CONCLUSIONS These results display the ecological importance of the avian sternum for flight and locomotion by providing a novel understanding of sternum form and function in Neornithes. Our study lays the groundwork for estimating the locomotory abilities of paravian dinosaurs, the ancestors to Neornithes, by highlighting the importance of this critical element for avian flight, and will be useful for future work on the origin of flight along the dinosaur-bird lineage.
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Affiliation(s)
- Talia M Lowi-Merri
- Department of Ecology and Evolutionary Biology, University of Toronto, 25 Willcocks Street, Toronto, ON, M5S 3B2, Canada.
- Department of Natural History, Royal Ontario Museum, 100 Queen's Park, Toronto, ON, M5S 2C6, Canada.
| | - Roger B J Benson
- Department of Earth Sciences, University of Oxford, South Parks Road, Oxford, OX1 3AN, UK
| | - Santiago Claramunt
- Department of Ecology and Evolutionary Biology, University of Toronto, 25 Willcocks Street, Toronto, ON, M5S 3B2, Canada
- Department of Natural History, Royal Ontario Museum, 100 Queen's Park, Toronto, ON, M5S 2C6, Canada
| | - David C Evans
- Department of Ecology and Evolutionary Biology, University of Toronto, 25 Willcocks Street, Toronto, ON, M5S 3B2, Canada
- Department of Natural History, Royal Ontario Museum, 100 Queen's Park, Toronto, ON, M5S 2C6, Canada
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Abelaira Filho A, Avanci LE, Almeida TF, Witchtendahl R, Leal JCF. Patients Submitted to Myocardial Revascularization with the Use of Bilateral Internal Thoracic Arteries: Diabetics vs. Non-Diabetics. Braz J Cardiovasc Surg 2021; 36:500-505. [PMID: 33656831 PMCID: PMC8522316 DOI: 10.21470/1678-9741-2020-0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The primary objective of this study is to evaluate in-hospital mortality and mortality within 30 days from discharge. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up. METHODS This is a retrospective review of the medical records of 152 patients undergoing elective CABG with the use of BITA and cardiopulmonary bypass (CPB). These patients were divided into two groups, diabetics and non-diabetics. Patients with acute myocardial infarction and concomitant valvular disease were not included in the sample. RESULTS Preoperative characteristics did not show significant differences between the groups, which allowed a comparative analysis. The variables electrocardiography time and aortic clamping time were higher in the diabetic group, with a significant statistical difference (P<0.0001). In-hospital mortality occurred in three patients, and there was no mortality up to 30 days in both groups. There was no significant difference in the primary end point between groups (P=0.56). Deep sternal wound infection was present in only one patient and showed no significant difference in the secondary outcome between groups (P=0.40). CONCLUSION We did not observe a higher mortality and occurrence of deep sternal wound infection with the use of BITA in diabetic patients compared to non-diabetics, even with greater CPB and aortic clamping times in diabetics.
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Affiliation(s)
- Achilles Abelaira Filho
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Luis Ernesto Avanci
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Thiago Faria Almeida
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Rodolfo Witchtendahl
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - João Carlos Ferreira Leal
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
- Department of Cardiovascular Surgery, Faculdade Estadual de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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Wattamwar K, Levin TL. Delayed sternal ossification in congenital heart disease: incidence using computed tomography. Pediatr Radiol 2021; 51:1676-1681. [PMID: 33740086 DOI: 10.1007/s00247-021-05026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/15/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While congenital heart disease (CHD) is known to be associated with sternal abnormalities, its association with absent sternal ossification is less well known. The literature is sparse and based on radiographs. OBJECTIVE To quantify delayed sternal ossification in CHD using computed tomography (CT). MATERIALS AND METHODS An imaging database search identified children with complex CHD and controls younger than 3 years of age who underwent chest CT from 2010 to 2019. Records were reviewed for demographics, CHD type and other pertinent history. Images were reviewed for manubrial or sternal segment ossification. Controls consisted of children undergoing chest CT for noncardiac reasons. Statistical analyses were conducted using a significance threshold of 0.05. RESULTS Fifty-nine children had complex CHD (mean age: 9.4 months); 36 (61.0%) had cyanotic CHD. There were 189 controls (mean age: 17.9 months). Delayed sternal ossification was present in 7 children (11.9%) in the study group; 6 had cyanotic heart disease (85.7%). Patterns of ossification included manubrium only; manubrium and first sternal segment; first and second sternal segments; and manubrium, first segment and hypoplastic second segment. Three controls (1.6%) had sternal ossification delay, all with manubrial ossification only. Delayed sternal ossification was more prevalent in the study group than in the controls (P=0.002). Compared to the controls, a higher incidence of delayed sternal ossification was seen in children with cyanotic CHD (P<0.001) but not acyanotic CHD (P=0.37). CONCLUSION Delayed sternal ossification occurs in children with CHD, particularly cyanotic forms, and requires no additional work-up.
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Affiliation(s)
- Kapil Wattamwar
- Department of Radiology, Montefiore Medical Center, 111 E. 210th St., Bronx, NY, 10467, USA.
| | - Terry L Levin
- Department of Radiology, Montefiore Medical Center, 111 E. 210th St., Bronx, NY, 10467, USA
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Shedge R, Kanchan T, Kumar Garg P, Gupta Dixit S, Warrier V, Krishan K. Age estimation from sternebral fusion in an Indian population - A computed tomographic evaluation. Leg Med (Tokyo) 2021; 53:101951. [PMID: 34339983 DOI: 10.1016/j.legalmed.2021.101951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Forensic age estimation is a crucial aspect of the human identification process. Sternebral fusion is one of the skeletal indicators of age that has not been thoroughly researched for the purpose of age estimation. The present study was conducted with the aim of assessing the utility of each of the sternebral fusion in age estimation, and to ascertain if these fusion stages can help in identifying whether an individual has attained the medicolegally significant ages of 16 and 18 years. Thoracic CT images of 148 study participants (74 females, 74 males) were analysed to evaluate the fusion of sternebrae 1-2, sternebrae 2-3, and sternebrae 3-4. The fusion scores for these were found to be statistically significant (P < 0.001) with sternebrae 1-2 fusion showing the highest coefficient of correlation at R = 0.900. Linear regression models were generated using each of the sternebral fusions separately and together for estimation of age. The standard error of estimate for the regression models ranged from 1.51 to 2.86 years. Box and Whisker plots were constructed to see the fusion score wise age distribution of the study population, and it was observed that sternebral fusion has the ability to indicate whether an individual has attained the age of 16 and 18 years. Our study concludes that sternebral fusion can act as an accurate method of forensic age estimation of juveniles and young adults.
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Affiliation(s)
- Rutwik Shedge
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Varsha Warrier
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh 160014, India.
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Vatzia K, Fanariotis M, Makridis KG, Vlychou M, Fezoulidis IV, Vassiou K. Frequency of sternal variations and anomalies in living individuals evaluated by MDCT. Eur J Radiol 2021; 142:109828. [PMID: 34280594 DOI: 10.1016/j.ejrad.2021.109828] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this retrospective study was to present the frequency and MDCT appearances of sternal variations and anomalies, as well as to highlight their clinical significance. METHODS This retrospective study was carried out on 1150 patients, who underwent chest MDCT. Axial planes, multiplanar and curved-planar reconstructed images were studied. Age and sex distribution of the variations was evaluated. RESULTS Anatomical variations of the sternum were found in 74.1%. The most frequent variation was the double-ended xiphoid process (36.9%), followed by the single xiphoidal foramen (25.8%) and the sternal sclerotic band (12.8%). Other variations observed were: sternal notch (10.1%), xiphoidal ligament calcification (8.3%), sternal foramen (4.9%), complete manubriosternal fusion (4.1%) and sternoxiphoidal fusion (4.1%), triple-ended xiphoid process (3.7%), sternal cleft (1.5%), whereas the rest of the variations including sternoxiphoidal junction pseudoforamen, suprasternal bone, pseudocleft, suprasternal tubercle and absence of xiphoid process were in less than 1%. In our subjects, sternal and xiphoidal foramina were adjacent to: the pericardium (37.14%), the diaphragm (22.9%), the mediastinal fat (17.1%), the liver (11.4%), the lung (8.5%) and to the stomach (2.9%). CONCLUSIONS Sternal variations are frequent, asymptomatic, detected incidentally at cross-sectional imaging and may be confused with pathologic conditions. Radiologists should be familiar with these variations in order to discriminate them from pathologies and avoid complications during interventional procedures. ADVANCES IN KNOWLEDGE This study presents thoroughly the sternal variations' MDCT appearance, detected in a Greek population, correlates them with age and gender and discuss their clinical significance in detail.
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Affiliation(s)
- Konstantina Vatzia
- Faculty of Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece.
| | - Michail Fanariotis
- Department of Radiology, Sykehuset Telemark HF, Ulefossvegen 55, 3710 Skien, Telemark, Norway
| | | | - Marianna Vlychou
- Department of Radiology, University Hospital of Larissa, Biopolis, 41110 Larissa, Greece
| | - Ioannis V Fezoulidis
- Department of Radiology, University Hospital of Larissa, Biopolis, 41110 Larissa, Greece
| | - Katerina Vassiou
- Department of Anatomy, Faculty of Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece
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Lin TT, Hsu HH, Lee SC, Peng YJ, Ko KH. Dynamic magnetic resonance imaging features of cavernous hemangioma in the manubrium: A case report. World J Clin Cases 2021; 9:4262-4267. [PMID: 34141789 PMCID: PMC8173419 DOI: 10.12998/wjcc.v9.i17.4262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osseous hemangiomas, especially those located in the manubrium, are rare benign tumors. In a review of the literature, only three case reports of sternal hemangioma were found. A precise diagnosis is difficult because of their nonspecific findings on computed tomography (CT)/magnetic resonance imaging (MRI).
CASE SUMMARY An 88-year-old woman was suffering from a progressively enlarging mass in the manubrium. Chest CT images showed an osteolytic and expansile lesion with cortical destruction. Vascular malformation was suspected after CT-guided biopsy. On the dynamic MRI scans, the mass showed a bright signal on the T2-weighted image, peripheral nodular enhancement on the early-phase images and progressive centripetal fill-in on the delayed-phase images. Cavernous hemangioma was suspected preoperatively based on the MRI features and finally confirmed by histopathologic analysis.
CONCLUSION This uncommon case demonstrates the possible characteristic features of manubrium cavernous hemangioma on dynamic MRI scans; knowledge about these features may prevent patients from developing catastrophic complications, such as rupture or internal hemorrhage, caused by biopsy or surgery.
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Affiliation(s)
- Tsung-Tai Lin
- Department of Radiology, National Defense Medical Center, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, National Defense Medical Center, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Shih-Chun Lee
- Department of Thoracic Surgery, National Defense Medical Center, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Kai-Hsiung Ko
- Department of Radiology, National Defense Medical Center, Tri-Service General Hospital, Taipei 114, Taiwan
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Dergel M, Balik M, Pacovsky J, Vobornik M, Mandak J, Laco J. Solitary metastasis of clear cell renal cell carcinoma in sternum diagnosed unexpectedly during cardiac surgery - A rare but potentially fatal trap. Urol Case Rep 2021; 38:101730. [PMID: 34136359 PMCID: PMC8181793 DOI: 10.1016/j.eucr.2021.101730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022] Open
Abstract
We present a very rare case of fatal complication during the cardiac surgery caused by unrecognized solitary metastasis of clear cell renal cell carcinoma in the sternum.
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Affiliation(s)
- Martin Dergel
- Department of Cardiac Surgery, Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Michal Balik
- Department of Urology, Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Jaroslav Pacovsky
- Department of Urology, Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Martin Vobornik
- Department of Cardiac Surgery, Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Jiri Mandak
- Department of Cardiac Surgery, Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
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Imaduddin M, Ayyanar P, Sultania M, Muduly D, Sable MN, Naik S, Mohanty S, Kar M. Primary malignant giant cell tumor of the sternum. Autops Case Rep 2021; 11:e2021281. [PMID: 34249788 PMCID: PMC8214899 DOI: 10.4322/acr.2021.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Primary malignant giant cell tumor (PMGCT) is a diagnosis based on the presence of a high-grade sarcomatous component along with a typical benign giant cell tumor (GCT). We report the first case of PMGCT of the sternum in a 28-year-old male with painless swelling over the manubrium sterni. The differential diagnoses of PMGCT and giant cell-rich osteosarcoma were considered. Surgical resection was performed, and the reconstruction was done with a neosternum using polymethyl methacrylate and prolene mesh. At 30 months follow-up, the patient is disease-free.
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Affiliation(s)
- Mohammed Imaduddin
- All India Institute of Medical Sciences, Department of Surgical Oncology, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Pavithra Ayyanar
- All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Mahesh Sultania
- All India Institute of Medical Sciences, Department of Surgical Oncology, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Dillip Muduly
- All India Institute of Medical Sciences, Department of Surgical Oncology, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Mukund Namdev Sable
- All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Suprava Naik
- All India Institute of Medical Sciences, Department of Radiodiagnosis, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Sambit Mohanty
- Prolife Diagnostics, Department of Pathology, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Madhabananda Kar
- All India Institute of Medical Sciences, Department of Surgical Oncology, Sijua, Patrapada, Bhubaneswar, Odisha, India
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Chaudhry IUH, Cheema A, Aqeel C, Al Shaer A, Alradei FG, Alquraish F, Tawfeeq M. Modified surgical reconstruction technique for a rare isolated congenital sternal cleft: In a six -year-old child. Ann Med Surg (Lond) 2021; 65:102280. [PMID: 33981421 PMCID: PMC8082199 DOI: 10.1016/j.amsu.2021.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/21/2022] Open
Abstract
We report the modified surgical reconstruction technique for correction for a large isolated congenital sternal cleft in 6 years old girl using a methyl methacrylate marlex mesh sandwich plate (MMS). The patient was referred to our tertiary care institution with a sizeable anterior chest wall bony defect. There was a large bulging under the skin due to protrusion of mediastinal viscera and visible cardiac pulsations with breathing. A chest x-ray and computed tomographic scan (CT) of the thorax was done to evaluate the bony defect. We reconstructed the sternal bony defect by our innovative technique using methyl methacrylate. The patient was discharged after three days for further follow up in outpatient. One year follow up patient is doing well with excellent results. Our technique is simple, cost-effective, and provides a perfect cosmetic effect for children's sternal large defects. INTRODUCTION Sternal clefts are rare congenital malformations that result from the defective embryologic fusion of paired mesodermal bands in the midline. This rare anomaly incidence is 1:100,000 cases per live births, which constitute 1% of all congenital chest wall deformities. The first Case of the sternal cleft was reported in 1740. The hereditary sternal gap is rare, and hence sporadic cases have been reported in the medical literature. Ravitch described that the first surgical correction was reported by Lannelongue et al., in 1988., But Burton published the first successful repair in 19474. An isolated sternal cleft is a rare entity and is classified into two categories' complete and incomplete sternal gap. Early repair is recommended; otherwise, surgical correction is challenging in children as the hypo plastic sternal edges cannot be approximated primarily, and this requires prosthetic, autologous grafts or some kind of parasternal chondroplasties. CASE PRESENTATION Since birth, a six-year-old girl was referred to our tertiary care center with a large central chest wall defect. She was a full-term normal delivery with no other congenital malformations. The defect was noticed at birth and became more evident as she grew up. In addition to cosmetic concern on coughing, there was bulging under the skin and visible cardiac pulsation. On examination, there was a large gap (7cm) in the midline of the chest with sternal adages well apart, moving independently. DISCUSSION The sternal cleft is a congenital anomaly with less than 0.15% and is more common in the female gender. Isolated sternal cleft without any other associated abnormalities is very rare. It has been reported as a part of defined syndromes like PENTALOGY OF CANTRELL, VACTREL, DANDY WALKER, and PHASE (Posterior fossa brain malformation, hemangioma, arterial lesions, cardiac abnormalities, and eye abnormality).6 Embryo logically sternum originate from the somatic layer of lateral mesodermal plates as bilateral bands. They fuse in the midline by the 10th week to constitute a cartilaginous framework of manubrium, sternum, and xiphoid process. Failure of this fusion can lead to a partial or complete sternal cleft.7 Etiology of this disease is unknown; however, it has been linked with riboflavin or methyl-cobalamin deficiency, high alcohol intake during pregnancy. CONCLUSION in conclusion, our improvised reconstruction technique for large sternal cleft in children has several advantages. There is no need to do extensive chordotomies or using bone grafts. Less complicated procedure Provides more rigid frame for protection of thoracic structures and better chest wall stability. Hospital stay is minimal and is very cost-effective. The child's future growth is not affected as ribs and costal cartilages are left intact in this technique. There is no chance of displacement or excursion of the MMS plate. In female patients, this provides better cosmoses as there is no need to mobilize the pectoralis significant muscles flaps for coverage. The geometry of the rib cage is well preserved.
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Affiliation(s)
- Ikram ul Haq Chaudhry
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Ahsan Cheema
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Chaudhry Aqeel
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Ahmed Al Shaer
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Fahad G. Alradei
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Fatima Alquraish
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Mansour Tawfeeq
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
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Huber T, Haug C. Morphological changes during the post-embryonic ontogeny of mesothelan spiders and aspects of character evolution in early spiders. Dev Genes Evol 2021; 231:47-56. [PMID: 33866412 PMCID: PMC8213562 DOI: 10.1007/s00427-021-00675-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/31/2021] [Indexed: 11/30/2022]
Abstract
Most morphological studies focus on adult specimens, or if developmental studies are pursued, especially in Euarthropoda, they focus on embryonic development. Araneae (spiders) is one of these groups, in consequence with understudied post-embryonic development. Here we present aspects of the post-embryonic stages of different species of Mesothelae, sister group to the remaining spiders (when fossil species are not taken into account). We used different imaging methods and measured different external morphological structures to detect possible ontogenetic changes. One structure exhibiting post-embryonic changes is the chelicera. Here the significant change occurs between the last immature stage and the adult, yet only in males. For the spinnerets, we could not detect ontogenetic changes, but instead a high variability in length and width, probably due to their lack of pivot joints between the elements. The strongest morphological change during ontogeny occurred on the sternum, which begins with a rather roundish shape in the first stage and changes to being fairly elongate in shape in the last immature stages and the adult. This specific sternum shape only occurs in adults of mesothelan spiders, while opisthothelan spiders have a broader sternum also in the adult. We discuss our results in an evolutionary context, also taking into account recent finds of fossil spiders.
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Affiliation(s)
- Thomas Huber
- LMU Munich, Biocenter, Großhaderner Str. 2, 82152, Planegg-Martinsried, Germany
| | - Carolin Haug
- LMU Munich, Biocenter, Großhaderner Str. 2, 82152, Planegg-Martinsried, Germany. .,GeoBio-Center of the LMU Munich, Richard-Wagner-Str. 10, 80333, München, Germany.
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Lin CW, Ho TY, Yeh CW, Chen HT, Chiang IP, Fong YC. Innovative chest wall reconstruction with a locking plate and cement spacer after radical resection of chondrosarcoma in the sternum: A case report. World J Clin Cases 2021; 9:2302-2311. [PMID: 33869607 PMCID: PMC8026833 DOI: 10.12998/wjcc.v9.i10.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chondrosarcoma, a cartilage matrix producing tumor, is the second most commonly observed primary bone tumor after osteosarcoma, accounting for 15% of all chest wall malignancies. We herein report the case of a patient with chondrosarcoma of the sternum and our management of the chest wall defects that presented following radical tumor resection.
CASE SUMMARY A 31-year-old patient presented to our hospital with dull pain and a protruding mass overlying the chest for 3 mo. The presence of nocturnal pain and mass size progression was reported, as were overhead arm elevation-related limitations. Computed tomography showed a focal osteoblastic mass in the sternum with bony exostosis and adjacent soft tissue calcification. Positron emission tomography-computed tomography revealed hypermetabolic activity with a mass located over the upper sternum. Magnetic resonance imaging showed a focal ill-defined bony mass of the sternum with cortical destruction and periosteal reaction. Preoperative biopsy showed a consistent result with chondrosarcoma with immunohistochemical positivity for S100 and focal positivity for IDH-1. The grade II chondrosarcoma diagnosis was confirmed by postoperative pathology. The patient underwent radical tumor resection and chest wall reconstruction with a locking plate and cement spacer. The patient was discharged 1 wk after surgery without any complications. At the 1-year follow-up, there was no local recurrence on imaging. The functional scores, including Constant Score, Nottingham Clavicle Score, and Oxford Shoulder Score, showed the absence of pain in the performance of daily activities or substantial functional disabilities.
CONCLUSION The diagnosis of chondrosarcoma must be considered when chest wall tumors are encountered. The surgical reconstructive materials, with a locking plate and cement spacer, used in our study are cost-effective and readily-available for the sternum defect.
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Affiliation(s)
- Chung-Wei Lin
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan
| | - Chen-Wei Yeh
- Department of Education, China Medical University Hospital, China Medical University, Taichung City 40447, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung City 40402, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan
| | - I-Ping Chiang
- Department of Pathology, China Medical University Hospital, China Medical University, Taichung 40454, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung City 40402, Taiwan
- Department of Orthopedic Surgery, China Medical University Beigang Hospital, Yunlin County 65152, Taiwan
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Pagotto VPF, Gallafrio ST, Carneiro IC, Gemperli R, Jatene FB. Treatment and Chest Reconstruction for Mediastinitis Following Sternotomy for Cardiac Surgery at the Heart Institute of the University of São Paulo Medical School. Braz J Cardiovasc Surg 2021; 36:565-570. [PMID: 33577255 PMCID: PMC8522307 DOI: 10.21470/1678-9741-2020-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of São Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.
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Affiliation(s)
| | | | - Igor Castro Carneiro
- Plastic Surgery Division, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Rolf Gemperli
- Plastic Surgery Division, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Cardiothoracic Surgery Department, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Tiwari S, Singh A, Bhandari P, Ghatak D, Agarwal H. Complex open sternal fracture with impingement of the pericardium. Trop Doct 2020; 51:425-427. [PMID: 33356920 DOI: 10.1177/0049475520981264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of sternal fracture ranges from 3 to 8%. In more than half, they are associated with other organ trauma such as blunt cardiac injuries, rib, scapular or vertebral fractures. Hence, the presence of sternal fracture is considered a marker for significant transmission of energy. The management of isolated sternal fractures is usually non-operative with surgery reserved for displaced fractures or in cases of respiratory insufficiency. However, management may become challenging when they are associated with other significant trauma. We discuss a case of sternal fracture complicated by the presence of blunt cardiac injury, open pneumothorax, rib fractures, anterior flail chest and empyema.
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Affiliation(s)
- Sandeep Tiwari
- Professor, Department of Trauma Surgery, KGMU, Lucknow, India
| | - Anita Singh
- Assistant Professor, Department of Trauma Surgery, KGMU, Lucknow, India
| | - Paras Bhandari
- Senior Resident, Department of Trauma Surgery KGMU, Lucknow, India
| | - Debmoy Ghatak
- Junior Resident, Department of General Surgery KGMU, Lucknow, India
| | - Harshit Agarwal
- Trauma Surgeon, Department of Trauma Surgery KGMU, Lucknow, India
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Tsuge I, Saito S, Sakamoto A, Matsuda S. Anterior chest wall reconstruction after resection of a sternal tumor with a single mandibular plate and Gore-Tex® sheet. Asian J Surg 2020; 44:563-565. [PMID: 33341335 DOI: 10.1016/j.asjsur.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Saito
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Razafimanjato NNM, Rabezanahary E, Ratsimarisolo N, Ravoatrarilandy M, Rajaonera TA, Ahmad A, Rakotovao HJL. New reduction technique simplified for surgical stabilisation of isolated manubriosternal dislocation: A case report and literature review. Afr J Thorac Crit Care Med 2020; 26. [PMID: 34240033 DOI: 10.7196/AJTCCM.2020.v26i4.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 11/17/2022] Open
Abstract
Manubriosternal joint (MSJ) dislocation is often poorly tolerated, with pain, and both static and dynamic dysfunction in breathing. This
injury is rare, and treatment includes both surgical and non-surgical interventions. Moreover, the treatment needs to be personalised to
a specific case. We present a case of a 19-year-old Comorian man who had chest pains that were exacerbated by movements after falling
from a tree. Careful physical examination revealed that the man had a ‘stair step’-looking deformity located at the anterior chest wall at the
level of the MSJ. A computed tomography scan confirmed the diagnosis of manubriosternal disruption. The patient underwent a surgical
intervention under general anaesthesia and had an uneventful recovery.
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Christian AB, Grigorian A, Nahmias J, Duong WQ, Lekawa M, Joe V, Dolich M, Schubl SD. Comparison of surgical fixation and non-operative management in patients with traumatic sternum fracture. Eur J Trauma Emerg Surg 2020. [PMID: 33078258 DOI: 10.1007/s00068-020-01527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/09/2020] [Indexed: 11/12/2022]
Abstract
Purpose The incidence of sternal fractures in blunt trauma patients lies between 3 and 7%. The role, timing and indications for surgical management are not well delineated and remain controversial for patients undergoing surgical stabilization of sternum fracture (SSSF). We sought to identify the national rate of SSSF in patients with a sternum fracture hypothesizing patients undergoing SSSF will have a decreased rate of mortality and complications. Methods The Trauma Quality Improvement Program (2015–2016) was queried for patients with sternum fracture. Propensity scores were calculated to match patients undergoing SSSF to patients managed non-operatively in a 1:2 ratio using demographic data. Results From 9460 patients with a sternum fracture, 114 (1.2%) underwent SSSF. After propensity-matching, 112 SSSF patients were compared to 224 patients undergoing non-operative management (NOM). There were no differences in matched characteristics (all p > 0.05). Compared to patients undergoing NOM, patients undergoing SSSF had an increased median length of stay (LOS) (16 vs. 7 days, p < 0.001), ICU LOS (9.5 vs. 5.5 days, p = 0.016) and ventilator days (8 vs. 5, p = 0.035). The SSSF group had a similar rate of ARDS (2.7% vs. 2.2%, p = 0.80), pneumonia (1.8% vs. 0.9%, p = 0.48) and unplanned intubation (8.9% vs. 5.8%, p = 0.29) but a lower mortality rate (2.7% vs. 11.2%, p = 0.008). Conclusion Just over 1% of patients with sternum fracture underwent SSSF in a national analysis. Patients undergoing SSSF had an increased LOS and similar rate of all measured pulmonary complications, however a lower mortality rate compared to patients managed non-operatively.
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Ahmed K, Nady MA. Sternal reconstruction using locking compression plates (LCP): our experience in Egypt, a case series. J Cardiothorac Surg 2020; 15:224. [PMID: 32825827 PMCID: PMC7441539 DOI: 10.1186/s13019-020-01266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Sternal fractures are rare accounting for about 3–8% of traumatic chest. There are many lines of treatments for sternal fractures which can be classified as conservative or surgical. Surgical techniques include wire fixation and sternal plating. There are no standardization of indications for each line of management. We explore if sternal reconstruction using locking titanium plates and self-tapping screws provide the patient with the best chance of proper sternal healing avoiding chronic pain and its complications and allow the patient early mobilization and rapid restoring of his normal life at its maximum. Methods Our inclusion criteria are patients of both gender from 20 to 60 years of age presented with traumatic sternal fracture at any site or pathological fracture due to metastatic or primary tumors infiltrating the sternum. High Associated Injury Scale scores were excluded. Exclusion criteria also included patients younger than 20 years or older than 60 years. Primary outcome is post-operative pain score and is measured using numerical pain scale ranging from zero to 10 where zero means there is no pain at all and ten is the worst imaginable pain ever. Results Sternal reconstruction using titanium plates has proven to be an efficient method of stabilization with tremendous immediate relief of pain showed by the differences between pre-operative and post-operative pain scale scores in our patients (n = 5) with Median scores being 7 and 1.5 with range being from 7 to 9 and 1 to 3 respectively (p-value = .039). Operative time range between 150 min and 90 min with median of 120 min. Extubation of patients was smooth with no events with median time of extubation being 120 min. From our experience, there were no observed wound complications except at the third patient who suffered a small wound hematoma that was resolved by gentle compressing only and needed no further intervention. Conclusion We recommend adopting sternal reconstruction using titanium plating systems more readily encouraging even larger clinical trials on the way to a clear guidelines. Plating systems show promising results with least pain, better stability, less complications and rapid, smooth recovery. Trial registration NCT04092374
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Affiliation(s)
- Kareem Ahmed
- Cardiothoracic Surgery Department, Assiut University Heart Hospital, Assiut, Egypt.
| | - Mohamed Alaa Nady
- Cardiothoracic Surgery, Assiut University Heart Hospital, Assiut, Egypt
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Yoon YC, Lee J, Jeong JY. Radical resection and reconstruction of the sternum for metastasis of hepatocellular carcinoma. J Cardiothorac Surg 2020; 15:202. [PMID: 32727544 PMCID: PMC7392652 DOI: 10.1186/s13019-020-01247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
Metastatic hepatocellular carcinoma of the sternum is rare and a few cases of surgical resection have been reported. Anterior chest wall reconstruction after radical resection of the sternum and ribs aims to protect the heart and lung from external damage and herniation and restore physiologic stability of the chest wall during respiration. A variety of reconstruction techniques using various materials have been reported, but so far there are no definitive guidelines for the reconstruction of chest wall defects. Recently, we encountered a rare case of metastatic cancer of the sternum from hepatocellular carcinoma in which radical resection of the sternum and ribs, and anterior chest wall reconstruction with acellular dermal matrix and titanium plates were performed.
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Affiliation(s)
- Young Chul Yoon
- Department of General Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea.
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