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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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Fuente-Lucas G, Planells-Alduvin MC, Tallón-Guerola P, Alcalá-Minagorre P. Self limiting sternal tumors of childhood in a 7 months old infant. An Pediatr (Barc) 2024; 100:e3-e5. [PMID: 38580592 DOI: 10.1016/j.anpede.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 04/07/2024] Open
Affiliation(s)
- Gonzalo Fuente-Lucas
- Servicio de Pediatría, Hospital General Univesitario de Alicante, Alicante, Spain.
| | | | - Paloma Tallón-Guerola
- Servicio de Radiología Pediátrica, Hospital General Universitario de Alicant, Alicante, Spain
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Mandava A, Kandem S, Juluri R, Reddy AK, Koppula V. Primary Osteosarcoma of the Sternum with Lung Metastases. Radiol Imaging Cancer 2024; 6:e230199. [PMID: 38391309 PMCID: PMC10988336 DOI: 10.1148/rycan.230199] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Anitha Mandava
- From the Departments of Radiodiagnosis (A.M., R.J., A.K.R., V.K.) and
Medical Oncology (S.K.), Basavatarakam Indo American Cancer Hospital &
Research Institute, Road No. 10, Banjara Hills, Hyderabad, Telangana 500034,
India
| | - Sanath Kandem
- From the Departments of Radiodiagnosis (A.M., R.J., A.K.R., V.K.) and
Medical Oncology (S.K.), Basavatarakam Indo American Cancer Hospital &
Research Institute, Road No. 10, Banjara Hills, Hyderabad, Telangana 500034,
India
| | - Rakesh Juluri
- From the Departments of Radiodiagnosis (A.M., R.J., A.K.R., V.K.) and
Medical Oncology (S.K.), Basavatarakam Indo American Cancer Hospital &
Research Institute, Road No. 10, Banjara Hills, Hyderabad, Telangana 500034,
India
| | - Arvind K. Reddy
- From the Departments of Radiodiagnosis (A.M., R.J., A.K.R., V.K.) and
Medical Oncology (S.K.), Basavatarakam Indo American Cancer Hospital &
Research Institute, Road No. 10, Banjara Hills, Hyderabad, Telangana 500034,
India
| | - Veeraiah Koppula
- From the Departments of Radiodiagnosis (A.M., R.J., A.K.R., V.K.) and
Medical Oncology (S.K.), Basavatarakam Indo American Cancer Hospital &
Research Institute, Road No. 10, Banjara Hills, Hyderabad, Telangana 500034,
India
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Cauley RP, Slatnick BL, Truche P, Barron S, Kang C, Morris D, Chu L. Development of a risk score to predict occurrence of deep sternal dehiscence requiring operative debridement. J Thorac Cardiovasc Surg 2024; 167:757-764.e8. [PMID: 35618530 DOI: 10.1016/j.jtcvs.2022.04.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Severe deep sternal wound (DSW) complications after cardiac surgery are a source of cost, morbidity, and mortality. Our objective was to develop and validate a clinical risk score for predicting risk of DSW requiring operative bone debridement, the most severe form of sternal dehiscence. METHODS A retrospective review was conducted of patients who underwent open cardiac surgery at a single institution between October 2007 and March 2019. Primary outcome was DSW requiring sternal bone debridement. Potential risk factors were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and significant covariates were included in a logistic regression prediction model. Interval validation was performed using 10-fold cross-validation. A novel sternal wound dehiscence risk score was derived from the relative parameterization estimates. RESULTS One hundred thirty-four of 8403 patients (1.6%) were identified as having a DSW. Female sex (odds ratio [OR], 2.75; 95% CI, 2.58-2.93), body mass index (OR, 1.0946; 95% CI, 1.09-1.09), percent glycated hemoglobin (OR, 1.31; 95% CI, 1.28-1.33), peripheral vascular disease (OR, 2.38; 95% CI, 2.2005-2.5752), smoking (OR, 1.66; 95% CI, 1.53-1.79) and elevated creatinine level (OR, 1.20; 95% CI, 1.18-1.22) were independent predictors of DSW. Patients were categorized as minimal risk (0%-1%), low risk (2%-3%), intermediate risk (4%-7%), and high risk (9%-64.0%) on the basis of risk score. CONCLUSIONS This risk stratification model for DSW requiring operative debridement might provide individualized estimates of risk, and guide counseling and potential risk mitigation strategies.
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Affiliation(s)
- Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
| | - Brianna L Slatnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass
| | - Sivana Barron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Christine Kang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Donald Morris
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Louis Chu
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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Shirke MM, Dominic C, Debnath P, Sunny J, Haq M, Nawaz H, Harky A. Computed Tomography Scanning for Sternal Wound Infections: A Systematic Review. Ulster Med J 2024; 92:139-147. [PMID: 38292500 PMCID: PMC10824137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Sternal wound infection (SWI) has always been a significant risk in patients who undergo sternotomies as part of their cardiac surgical procedures. Computed tomography (CT) imaging is often used to diagnose and assess sternal wound infections. Its purpose includes identifying and locating infection and any sternal dehiscence. Methods A systematic literature review across PubMed, Embase, and Ovid was performed according to PRISMA guidelines to identify relevant articles that discussed the utility of CT scanning for SWI, common features identified, patient outcomes and sensitivity/specificity (Figure 1). Results 25 papers were included. 100% (n=25) of the papers were published in peer-reviewed journals. CT scans in SWIs can be seen as a beneficial aid in diagnosing as well as determining the components of infection. Commonalities were identified such as fluid collection in the mediastinum, free gas, pleural effusions, and sternal dehiscence which point towards the presence of sternal wound infection. Conclusion CT scanning is a novel and emerging methodology for imaging in SWI and post-sternotomy complications, hence increased research is required to expand the literature on this area as well as the creation of guidelines and cut-offs or signs for radiology professionals to identify and determine the extent of infection.
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Affiliation(s)
| | | | | | - Jesvin Sunny
- Department of Medicine, University of Central Lancashire, Preston, UK
| | - Mawiyah Haq
- Faculty of Medicine, St. George’s University of London, London, UK
| | - Hamza Nawaz
- Barts and the London School of Medicine, QMUL
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
- Department of Integrative Biology, Faculty of Life Science, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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Young A, Goga U, Aktuerk D, Aziz Z, Cross S, Balan A. A radiologist's guide to median sternotomy. Clin Radiol 2024; 79:33-40. [PMID: 38008662 DOI: 10.1016/j.crad.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 11/28/2023]
Abstract
Median sternotomy is widely recognised as the primary incision technique in cardiac surgery. This surgical procedure involves dividing the sternum to gain access to the heart and lungs, making it invaluable in correcting congenital heart defects. Furthermore, it is frequently employed in adult patients, particularly during coronary artery bypass graft (CABG) procedures. In this imaging review, we present a comprehensive overview of the pre-procedural assessment and various post-sternotomy complications encountered within our clinical experience at a tertiary cardiothoracic centre. The focus of this review is to outline the imaging features associated with mediastinal adhesions and establish the minimal safe distance between the sternum and common mediastinal structures when considering re-sternotomy. By providing visual examples, we aim to facilitate a better understanding of these key concepts. Moreover, we delve into a detailed discussion of a spectrum of postoperative complications that may arise following median sternotomy including those related to metalwork (sternal wire fracture), bone (sternal dehiscence, non-union and osteomyelitis), and soft tissue (abscess, haematoma).
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Affiliation(s)
- A Young
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - U Goga
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - D Aktuerk
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Z Aziz
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - S Cross
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - A Balan
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Jia E, Morgenstern M, Barron S, Chen A, Garvey SR, Park JB, Rahmani B, Adebagbo OD, Nwokedi J, Chu L, Cauley RP. Sternal bone anatomy on preoperative imaging as an independent predictor of deep sternal dehiscence following median sternotomy. J Plast Reconstr Aesthet Surg 2024; 88:306-309. [PMID: 38039720 DOI: 10.1016/j.bjps.2023.11.033] [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: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
Complications following median sternotomy are associated with morbidity, mortality, and major healthcare costs. With plastic surgeons being increasingly consulted to close complex sternotomy wounds, a more accurate risk stratification tool for this comorbid patient population is warranted. This study examines the association of preoperative radiologic sternal measurements and deep sternal dehiscence, comparing this with other known clinical risk factors. A decreased manubrium sternal thickness relative to body weight (<0.13 mm/kg) and an absolute inferior sternal width ≤13.8 mm had a significant association with the development of deep sternal dehiscence, even with adjustment for known clinical risk factors. With such measurements assisting in further risk stratification, the opportunity to improve risk assessment holds value for plastic and reconstructive surgeons who are consulted to close extensive sternotomy wounds.
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Affiliation(s)
- Emmeline Jia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Monica Morgenstern
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Sivana Barron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Amy Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shannon R Garvey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - John B Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Benjamin Rahmani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Oluwaseun D Adebagbo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Josephine Nwokedi
- Division of General Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Louis Chu
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Xie WP, Chen XH, Zhou SJ, Chen Q, Cao H. Sternal Pin Used to Close Sternum in Infants after Cardiac Surgery. Thorac Cardiovasc Surg 2024; 72:77-83. [PMID: 37230479 DOI: 10.1055/s-0043-1768967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE A retrospective study was conducted to explore the efficacy of bioabsorbable poly-L-lactic acid sternal pins in sternal closure in infants after cardiac surgery. METHODS A total of 170 infantile patients who underwent cardiac surgery were divided into the steel wire group (group A), the PDS cord group (group B), and the steel wire + sternal pin group (group C). The occurrence of the thoracic deformity was evaluated by vertebral index (VI), frontosagittal index (FSI), and Haller index (HI) values; the stability of the sternum was evaluated by detecting sternal dehiscence and displacement. RESULTS By comparing the absolute values of the differences in VI, FSI, and HI in the three groups, it was found that the difference values of VI and HI in group C were significantly lower than those in group B (p = 0.028 and 0.005). For the highest deformation index, the deformation rate of infants in group C before discharge and during the 1-year follow-up was lower than that in group A and group B (p = 0.009 and 0.002, respectively). The incidence of sternal displacement in group C was also significantly lower than that in groups A and B (p = 0.009 and 0.009). During the 1-year follow-up, there was no sternal dehiscence, and the sternum healed completely in the three groups. CONCLUSION The use of "steel wire + sternal pin" for sternal closure in infants after cardiac surgery can reduce the occurrence of sternal deformity, reduce anterior and posterior displacement of the sternum, and improve sternal stability.
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Affiliation(s)
- Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Fernández AM, Ruiz E, Cantador B, González FJ, Baamonde C, Álvarez A. Case Report of Complex Chest Wall Repair for Sternal Dehiscence After Bilateral Lung Transplantation. Transplant Proc 2023; 55:2307-2308. [PMID: 37798166 DOI: 10.1016/j.transproceed.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND We report a case of a complex chest wall reconstruction because of sternal dehiscence, requiring different surgical procedures for its complete resolution. CASE REPORT A 54-year-old man patient with Langerhans cell histiocytosis and chronic obstructive pulmonary disease underwent bilateral sequential lung transplantation through a clamshell incision, using nitinol thermo-reactive clips for sternal closure. One year later, he consulted because of chest pain, fever, and purulent secretions. Physical examination and chest X-ray revealed a right pulmonary hernia due to post-clamshell wound dehiscence. Chest wall repair was performed, placing an expanded-polytetrafluoroethylene synthetic mesh, and the sternum was realigned and fixated with titanium plates and screws. However, in the immediate postoperative period, there was a large amount of serous drainage through the surgical wound, needing negative pressure therapy. Unfortunately, the wound became necrotic with exposure to the osteosynthesis material. In addition, a chest computed tomography scan showed fluid accumulation in the anterior chest wall. Therefore, two-stage revision surgery was indicated: first, the removal of the previous prosthesis and, the definite one, the use of a pedicled latissimus dorsi myocutaneous flap to provide effective coverage of the wound. CONCLUSION Sternal dehiscence is not an uncommon complication after clamshell incision in patients undergoing bilateral sequential lung transplantation, and it is associated with significant morbidity. In the presence of chest wall instability, surgical repair is mandatory.
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Affiliation(s)
- Alba María Fernández
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Eloísa Ruiz
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Benito Cantador
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Francisco Javier González
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Carlos Baamonde
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Antonio Álvarez
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain.
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Razzouk J, Kricfalusi M, Case T, Petersen G, Small E, Sajdak G, Nguyen K, Kagabo W, Ramos O, Danisa O, Cheng W. Surface anatomical landmarks for spine surgery: A CT-based study of the sternal notch and sternal angle in 1,035 patients. J Clin Neurosci 2023; 118:46-51. [PMID: 37866208 DOI: 10.1016/j.jocn.2023.08.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Understanding the location of surface anatomical landmarks in relation to the cervical and thoracic spine is important for a wide array of clinical applications. The objective of this study was to investigate the influence of patient demographic and anthropometric characteristics on the locations of the sternal notch and sternal angle in relation to the spine using computed tomography (CT) of a large cohort of young adult patients without spinal pathology. METHODS Vertebral levels corresponding to the sternal notch and sternal angle were analyzed using CT of 1,035 patients. Influences of patient height, weight, body mass index (BMI), sex, and ethnicity were assessed. RESULTS 567 male and 468 female patients were included in this study. Mean patient height, weight, BMI, and age were 1.68 ± 0.11 m, 81.94 ± 24.39 kg, 27.79 ± 7.9 kg/m2, and 25.9 ± 5.9 years. Of the 1,035 patients, 495 were Hispanic or Latino, 321 were Caucasian, 130 were African American, 68 were Asian, 5 were identified as "other," and 16 did not have racial or ethnic data available. The location of the sternal notch in relation to the thoracic spine demonstrated a bimodal distribution pattern clustered at the T2 and T3 vertebral bodies. The location of the sternal angle in relation to the thoracic spine demonstrated a bimodal distribution pattern clustered at the T4 and T5 vertebral bodies. Moderate, negative correlations were observed between patient weight and location of the sternal notch (r = -0.447; p <.001) and sternal angle (r = -0.499; p <.001), respectively. Zero significant correlations were observed between patient height and location of the sternal notch (r = -0.045; p =.377) or sternal angle (r = -0.080; p =.229). A weak, negative correlation was observed between patient BMI and location of the sternal notch (r = -0.378; p <.001). A moderate, negative correlation was observed between patient BMI and location of the sternal angle (r = -0.445; p <.001). The locations of the sternal landmarks did not differ based on patient sex, race or ethnicity. CONCLUSIONS The location of the sternal notch most frequently corresponds to the T2 or T3 vertebral body, while the sternal angle is most frequently located at the T4 or T5 vertebral body. Increased patient weight is associated with relatively cephalad sternal landmarks. Patient height, sex, and ethnicity are not associated with either sternal landmark.
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Affiliation(s)
- Jacob Razzouk
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | - Trevor Case
- California University of Science and Medicine, Colton, CA, USA
| | | | - Easton Small
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Grant Sajdak
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kai Nguyen
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Whitney Kagabo
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Omar Ramos
- Department of Orthopaedic Surgery, Twin Cities Spine Center, Minneapolis, MN, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA, USA.
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Abdellaoui S, Scalabre A, Piolat C, Lavrand F, Lachkar AA, Lehn A, Klipfel C, Henry B, Soldea V, Hameury F, Becmeur F. Pectus Arcuatum: A Pectus Unlike Any Other. J Pediatr Surg 2023; 58:1679-1685. [PMID: 37045714 DOI: 10.1016/j.jpedsurg.2023.03.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/28/2023] [Accepted: 03/19/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Pectus arcuatum is often mistaken for a type of pectus carinatum. However, pectus arcuatum is a unique clinical form of pectus caused by premature obliteration of the sternal sutures (manubrial sternum, four sternebrae and xiphoïd process), whereas pectus carinatum is due to abnormal growth of the costal cartilage. In order to better describe pectus arcuatum, we analysed the files of patients with pectus arcuatum followed in our centers. METHODS Multicenter retrospective study of young patients' files diagnosed with pectus arcuatum. RESULTS The clinical diagnosis of pectus arcuatum was made in 34 patients with a mean age at diagnosis of 10.3 years (4-23 years). A chest profile X-ray or a CT scan was performed in 16 patients (47%) and confirmed the diagnosis of PA by the presence of a sternal fusion. It was complete in 12 patients. A malformation was associated in 35% of cases (Noonan syndrome 33%, scoliosis 25% or cardiopathy 16%). 11 patients (32%) had a family history of skeletal malformation. Orthopedic treatment was initiated in 3 patients without any success. 11 patients underwent surgical correction, which was completed in 7 of them. CONCLUSION The diagnosis of pectus arcuatum is based on clinical experience and if necessary, on a profile chest X-ray showing the fusion of the sternal pieces. It implies the search for any associated malformations (musculoskeletal, cardiac, syndromic). Bracing treatment is useless for pectus arcuatum. Corrective surgery, based on a sternotomy associated with a partial chondro-costal resection, can be performed at the end of growth. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sarah Abdellaoui
- Department of Pediatric Surgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, Bron, France.
| | - Aurélien Scalabre
- Department of Pediatric Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Christian Piolat
- Department of Pediatric Surgery, Hôpital Couple-Enfant, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Frédéric Lavrand
- Department of Pediatric Surgery, Groupe Hospitalier Pellegrin, Hôpital D'enfants, Bordeaux, France
| | - Amane-Allah Lachkar
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Anne Lehn
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clémence Klipfel
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Brice Henry
- Department of Pediatric Surgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Valentin Soldea
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Hameury
- Department of Pediatric Surgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - François Becmeur
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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12
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Tuncer K, Kose M, Ogul H. Spontaneous stairlike fracture of sternum in multiple myeloma. Joint Bone Spine 2023; 90:105553. [PMID: 36842759 DOI: 10.1016/j.jbspin.2023.105553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Affiliation(s)
- Kutsi Tuncer
- Department of Orthopedic Surgery, Medical Faculty, Altinbas University, Istanbul, Turkey
| | - Mehmet Kose
- Department of Orthopedic Surgery, Medical Faculty, Altinbas University, Istanbul, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Duzce University, Duzce, Turkey.
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13
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Jen A, Kochkodan-Self J, Mandell JC. A Retrospective Analysis of Sternal Lesions Detected on Breast MRI in Patients Without History of Cancer. J Breast Imaging 2023; 5:48-55. [PMID: 38416958 DOI: 10.1093/jbi/wbac078] [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: 05/31/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the imaging characteristics and stability over time of sternal lesions identified on breast MRI in patients without history of cancer. METHODS An IRB-approved retrospective analysis of all breast MRIs performed at our institution from September 1, 2017 to December 1, 2021 that included one of several key words related to the sternum. Studies with history of non-dermatologic malignancy including breast cancer, absence of a true sternal lesion, or presence of symptoms during the examination were excluded. Imaging was reviewed for size, distribution, signal characteristics, and presence of contrast enhancement, perilesional edema, periosteal edema, or intralesional fat. Available comparison imaging, clinical history, and follow-up recommendations were reviewed. Descriptive statistics were used to summarize lesion data. RESULTS Of 60 lesions included from 60 patients, 40 lesions with more than two years of comparison imaging were either stable or decreased in size and none demonstrated change in signal characteristics. The majority of these presumed benign lesions demonstrated hypointense signal on T1-weighted sequences (21/40, 52.5%), hyperintense signal on fluid-sensitive sequences (33/40, 82.5%), contrast enhancement (32/40, 80.0%), and absence of clear intralesional fat (29/40, 72.5%). One patient who did not have comparison imaging was diagnosed with malignancy (multiple myeloma) eight months following their MRI. This lesion demonstrated uniquely diffuse and heterogeneous enhancement but did not undergo biopsy. CONCLUSION Sternal lesions in women without history of non-dermatologic malignancy have a very low likelihood of malignancy. Common imaging characteristics of the presumed benign lesions can inform imaging recommendations when incidental sternal lesions are discovered.
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Affiliation(s)
- Aaron Jen
- Brigham and Women's Hospital and Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Jeanne Kochkodan-Self
- Brigham and Women's Hospital and Harvard Medical School, Department of Radiology, Boston, MA, USA
| | - Jacob C Mandell
- Brigham and Women's Hospital and Harvard Medical School, Department of Radiology, Boston, MA, USA
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14
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Del Rey de Cabo C, López Herrero R, Fernández Collantes A, Cocho Crespo S. Displaced sternal fracture and right internal thoracic artery injury induced by blunt chest trauma from cow kick. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:613-614. [PMID: 36220730 DOI: 10.1016/j.redare.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 06/16/2023]
Affiliation(s)
- C Del Rey de Cabo
- Servicio de Anestesiología y Reanimación, Hospital Virgen de la Concha, Zamora, Spain.
| | - R López Herrero
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Fernández Collantes
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - S Cocho Crespo
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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15
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Affiliation(s)
- Sakiko Honda
- Department of Cardiology, Matsushita Memorial Hospital, Japan
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16
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Yavaş HG, Ufuk F, Akçay A, Öztürk G. The effect of skeletal muscle area and attenuation in patients with sternum fracture due to blunt chest trauma. Eur Rev Med Pharmacol Sci 2022; 26:1170-1177. [PMID: 35253173 DOI: 10.26355/eurrev_202202_28109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aims to retrospectively investigate the imaging features of patients with sternum fracture (SF) and concomitant organ injuries. We also aimed to evaluate the potential prognostic effect of skeletal muscle area (TMA) and muscle attenuation (MuA) values. PATIENTS AND METHODS Computed tomography (CT) images of patients with SF were re-evaluated by two observers (Observer-1 and 2). Observer-3 has measured TMA and MuA values. Observer-1 has repeated the measurements blindly to the first measurement results to evaluate the inter-observer agreement. The length of hospital stay, death, hemiplegia, or quadriplegia were investigated from the archives. Mann-Whitney U-test or Student's t-test was used to investigate the relationship between linear variables. The intraclass correlation coefficient (ICC) score was used to evaluate the interobserver agreement. Logistic regression analysis was used to estimate the relative effect of variables by calculating unadjusted odds ratios (ORs) for categorical outcomes. RESULTS Sixty-five patients had SF and 53 patients had SF and concomitant organ injuries. The most common injuries accompanying SF were rib fracture (73.58%) and lung contusion (60.38%). Manubrium fracture was the most common fracture location (52.3%), and 18 patients (27.7%) had displaced SF. Eight patients (15.1%) were discharged with plegia and five (9.4%) died. Hemothorax, displaced SF and decreased MuA were predictors of prolonged hospital stay, and the presence of cardiac contusion, displaced SF, hemothorax, and vertebra body fracture were independent factors for death. CONCLUSIONS The presence of a displaced SF and decreased MuA value are important prognostic factors in patients with SF.
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Affiliation(s)
- H G Yavaş
- Department of Radiology, Kırşehir Education and Research Hospital, Kırşehir, Turkey.
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17
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Lu J, Tse WT, Law KM, Leung TY. Prenatal diagnosis of ascending aortic aneurysm associated with sternal cleft. Ultrasound Obstet Gynecol 2022; 59:267-268. [PMID: 33998075 DOI: 10.1002/uog.23687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/21/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- J Lu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - W T Tse
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - K M Law
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
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18
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Iwaiwi B, Hamdi Shaqqura B, Sabbah A, Abu Akar FE. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6563851. [PMID: 35381072 PMCID: PMC9297509 DOI: 10.1093/icvts/ivac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/20/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022] Open
Abstract
Pectus carinatum may rarely be associated with kyphosis. However, the correlation between both conditions is not well reported. Therefore, there are no reports for combined correction of both deformities in the same patient. Moreover, studies estimating the kyphosis prevalence in patients with pectus carinatum are lacking. To our knowledge, this is the first paper to present such a case. We report an 18-year-old boy with both pectus carinatum and kyphosis that were surgically corrected in a combined procedure. The indication of surgery is cosmetic, and the postoperative recovery included pneumothorax but was otherwise uneventful and satisfactory.
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Affiliation(s)
- Bashaer Iwaiwi
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Bisanne Hamdi Shaqqura
- Department of Cardiothoracic Surgery, Al-Makassed Charitable Society Hospital, East Jerusalem, Palestine
| | - Alaeddin Sabbah
- Department of Orthopedic Surgery, Al-Makassed Charitable Society Hospital, East Jerusalem, Palestine
| | - Firas Emad Abu Akar
- Department of Cardiothoracic Surgery, Al-Makassed Charitable Society Hospital, East Jerusalem, Palestine
- Corresponding author. Department of Cardiothoracic Surgery, Makassed Charitable Society Hospital, 28 Raba’a Adaweieh street, Mount of olives, East Jerusalem 90917, P.O Box 49442. Palestinian Territories. Tel: +972522200688; e-mail: (F.A. Akar)
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19
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Cajiao K, Florez H, Peris P. Sternal Stress Fractures: An Unusual Cause of Chest Pain in Patients With Osteoporosis. J Clin Rheumatol 2022; 28:e286-e288. [PMID: 33337804 DOI: 10.1097/rhu.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Katherine Cajiao
- From the Rheumatology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
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20
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Abstract
One of the most severe forms of blunt chest trauma is multiple floating rib fractures. Incidence of this event is up to 20% of all chest injuries. Mortality rate is about 40%. Modern surgical approach involves new technologies for rib osteosynthesis and chest stabilization. These procedures can reduce mortality by 8-10%. One of the possible options for chest stabilization in victims with anterior floating fractures, including sternal fractures, is insertion of a chest plate according to the principle of Nuss procedure. The last technique is used for correction of pectus excavatum. We report our first experience of Nuss procedure in a patient with multiple trauma, floating rib fractures and sternal fracture. Surgical intervention is described in detail. The authors emphasize an important role of thoracoscopy in a patient with chest trauma. Several modern trends in surgery for chest trauma are discussed: active surgical approach for multiple floating rib fractures, combination of surgical and resuscitation methods for chest stabilization, minimized surgical trauma by using of high-tech and endoscopic surgery.
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Affiliation(s)
- A S Benyan
- Seredavin Samara Regional Clinical Hospital, Samara, Russia
- Samara State Medical University, Samara, Russia
| | - P V Ryzhov
- Samara State Medical University, Samara, Russia
| | - M A Medvedchikov-Ardiya
- Seredavin Samara Regional Clinical Hospital, Samara, Russia
- Samara State Medical University, Samara, Russia
| | - M P Airapetova
- Seredavin Samara Regional Clinical Hospital, Samara, Russia
| | - A Yu Borkovsky
- Seredavin Samara Regional Clinical Hospital, Samara, Russia
- Samara State Medical University, Samara, Russia
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21
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Kalbouneh H, Mubarak N, Daradkeh S, Ashour O, Alkhatib AM, Suboh L, Nofal A, Mahafzah W, Alsalem M. Estimation of sex based on metrics of the sternum in a contemporary Jordanian population: A computed tomographic study. Medicine (Baltimore) 2021; 100:e28169. [PMID: 34889290 PMCID: PMC8663886 DOI: 10.1097/md.0000000000028169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023] Open
Abstract
There is a paucity of osteometric standards for sex estimation from unknown skeletal remains in Jordan and the sexual dimorphism of the sternum has not yet been investigated. The aim of this study was to evaluate the sexual dimorphism in sternal measurements using 3D multidetector computed tomography (MDCT), and to assess their reliability for sex estimation in a Jordanian population. A total of 600 MDCT scans (300 males and 300 females) were used and a total of 8 sternal measurements were studied (manubrium length, sternal body length, combined length of manubrium and body, corpus sterni width at 1st and 3rd sternebrae, sternal index and area). Sexual dimorphism was evaluated by means of discriminant function analyses. Significant sexual dimorphism was found mainly in middle-aged and older adults. Including all subjects, multivariate, and stepwise functions gave an overall accuracy of 83.0% and 84.0%, respectively. Additionally, multivariate and stepwise analyses were conducted separately for each age group. The accuracy of sex estimation in multivariate analysis (all variables) varied from 63.2% in the young, and 83.7% in the middle adults to 84.9% for older adults. In stepwise analysis, the highest accuracy rates were provided by only sternal area in young adults (81.6%), and sternal area combined with sternal body length in middle-aged and older adults (84.2% and 85.3%, respectively). The best sex discriminator using univariate analysis (single variable) was sternal area followed by sternal body length (84.0% and 80.8% respectively). Notably, univariate analyses for most variables gave relatively higher classification accuracies in females but were poor at predicting males in the sample (sex bias ranged between -6.4% and -20%). Our data suggest that dimorphism in the human sternum increases with advancing age and separate discriminant functions are needed for each age group in Jordanians. In addition, multivariate and stepwise analyses using sternum gave higher classification accuracies with comparatively lower sex biases compared to univariate analyses.
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Affiliation(s)
- Heba Kalbouneh
- Department of Anatomy, School of Medicine, The University of Jordan, Amman, Jordan
| | - Nidaa Mubarak
- Radiology Department, Jordan University Hospital, Amman, Jordan
| | - Salah Daradkeh
- Department of Orthopaedics, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Omar Ashour
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Lojayn Suboh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Amani Nofal
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Waleed Mahafzah
- Radiology Department, Jordan University Hospital, Amman, Jordan
| | - Mohammad Alsalem
- Department of Anatomy, School of Medicine, The University of Jordan, Amman, Jordan
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22
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Ho CWG, Tan BK, Ong BH, Nakao M, Lim CH. Customized Two-Dimensional Computed Tomography-Guided Preoperative Pectus Bar Shaping. Ann Plast Surg 2021; 87:676-680. [PMID: 34176895 DOI: 10.1097/sap.0000000000002892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Successful minimally invasive repair of pectus excavatum relies on a pectus bar that closely conforms to the desired shape of the sternum and ribs to produce optimal elevation and remodeling. However, the present method of empirical intraoperative bar shaping is tedious and risks trauma to surrounding structures. To overcome this, we devised a technique using a life-sized computed tomography (CT) printout of the patient's chest wall to guide preoperative bar bending. METHODS A 5-cm-wide polymethylmethacrylate block placed on the sternum as the patient underwent chest CT was used as a marker to guide scaling of an axial screenshot of the patient's chest to life-size. This life-size image was printed and the planned correction of the patient's chest wall was traced onto it. The pectus bar was bent according to this template. Patient demographics, Haller index, surgical indications, operative technique, complications, aesthetic and functional improvements, and overall satisfaction were assessed. RESULTS Thirty patients (4 women) underwent primary minimally invasive repair of pectus excavatum with a single pectus bar shaped preoperatively over an 8-year period. The average age and Haller index was 20.6 years and 5.4, respectively. The mean operative time was 66.4 minutes. Satisfactory sternal elevation was attained with a single attempt at bar insertion in all cases. Two patients had pneumothoraxes that resolved without intervention. The mean follow-up period was 50.1 months. There were no cases of bar migration or recurrence of deformity after bar removal. On a 5-point Likert scale, all patients indicated an improvement in aesthetic appearance (4.6), and patients with physical symptoms (10) reported an improvement in function (4.4). The overall satisfaction score was 4.7. CONCLUSIONS This technique of CT-guided preoperative pectus bar shaping is straightforward, eliminates the need for intraoperative revisions to bar shape, and achieves effective correction of the pectus excavatum deformity. All patients were satisfied with the aesthetic, functional, and overall outcomes.
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Affiliation(s)
- Christopher Wei Guang Ho
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital
| | - Bien-Keem Tan
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital
| | - Boon Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre
| | | | - Chong-Hee Lim
- Department of Cardiothoracic Surgery, National Heart Centre
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Ngoc Thach P, Tran Ban H, Anh Dung HV, Minh Chieu V, Viet Tanh NT, Truong Nhan V, Thanh Tri T, Tra My TT, Tan Lien Bang M, Minh Duc N. A case report of surgical repair of cleft sternum in a child. Clin Ter 2021; 172:495-499. [PMID: 34821337 DOI: 10.7417/ct.2021.2363] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Sternal cleft is a rare congenital chest wall defect, occurring in only 1 in 100,000 live births, and very few cases have been described in the literature. Surgery is indicated to protect the heart and major vessels. This study provides a clinical case presentation and literature review of sternal cleft. METHODS This is a review of a case presenting with chest wall defects. The patient underwent a primary cleft closure at Children's Hospital No. 2. All perioperative data were collected and presented. CASE PRESENTATION A healthy 3-year-old girl was admitted to Children's Hospital No. 2 with an abnormal chest shape, observed by her mother. An inverted "U"-shaped defect of the sternum was visible, and the extent of the defect could be observed by chest X-ray and spiral computed tomography (CT) imaging of the chest. After the diagnosis was confirmed, the patient was prepared for primary closure surgery. We achieved primary closure, the patient discontinued oxygen 5 days after surgery, and the patient was discharged 14 days after surgery. CONCLUSION Chest wall malformations can present with various phenotypes, although congenital sternal cleft is a rare anomaly. This defect is often asymptomatic. Depending on the size of the defect, a sternal cleft may be treated or monitored. The optimal treatment during early life is surgical repair to achieve primary closure.
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Affiliation(s)
- P Ngoc Thach
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - H Tran Ban
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
- Department of Pediatric Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh city, Ho Chi Minh City, Vietnam
| | - H V Anh Dung
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - V Minh Chieu
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - N T Viet Tanh
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - V Truong Nhan
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - T Thanh Tri
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - T T Tra My
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - M Tan Lien Bang
- Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam
| | - N Minh Duc
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
- Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
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24
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Klei DS, Öner FC, Leenen LPH, van Wessem KJP. Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review. Eur J Trauma Emerg Surg 2021; 47:991-1001. [PMID: 33006034 PMCID: PMC8322016 DOI: 10.1007/s00068-020-01505-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Combined sternal and spinal fractures are rare traumatic injuries with significant risk of spinal and thoracic wall instability. Controversy remains with regard to treatment strategies and the biomechanical need for sternal fixation to achieve spinal healing. The present study aimed to assess outcomes of sternovertebral fracture treatment. METHODS A systematic review of literature on the treatment of traumatic sternovertebral fractures was conducted. Original studies published after 1990, reporting sternal and spinal healing or stability were included. Studies not reporting treatment outcomes were excluded. RESULTS Six studies were included in this review, with a total study population of 98 patients: 2 case series, 3 case reports, and 1 retrospective cohort study. 10 per cent of sternal fractures showed displacement. Most spinal fractures were located in the thoracic spine and were AOSpine type A (51%), type B (35%), or type C (14%). 14 per cent of sternal fractures and 49% of spinal fractures were surgically treated. Sternal treatment failure occurred in 5% of patients and biomechanical spinal failure in 8%. There were no differences in treatment failure between conservative and operative treatment. CONCLUSION Literature on traumatic sternovertebral fracture treatment is sparse. Findings indicate that in most patients, sternal fixation is not required to achieve sternal and spinal stability. However, results of the current review should be cautiously interpreted, since most included studies were of poor quality.
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Affiliation(s)
- Dorine S Klei
- Department of Trauma Surgery, Medical Centre Utrecht, University, Suite G04.232, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - F Cumhur Öner
- Orthopaedic Surgery, Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, Medical Centre Utrecht, University, Suite G04.232, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Karlijn J P van Wessem
- Department of Trauma Surgery, Medical Centre Utrecht, University, Suite G04.232, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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Abstract
Osteoarticular tuberculosis of flat bones of the chest wall such as sternum, scapula and rib is extremely rare in children. Because of its atypical clinical presentation mimicking malignant bone tumours, diagnosis remains a challenge. Histological and microbiological diagnosis remains confirmatory. Antitubercular therapy is the cornerstone in management.
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Affiliation(s)
- Muthuvel Balasubramaniyan
- Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Verma
- Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumeet Rajendra Dhawan
- Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Can C, Gündoğan C, Kömek H. Is 68Ga-Prostate-Specific Membrane Antigen PET/CT Superior than 18F-FDG PET/CT for Evaluation of Metastatic Osteosarcoma? Clin Nucl Med 2021; 46:e233-e235. [PMID: 33031232 DOI: 10.1097/rlu.0000000000003320] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We present the case of a 75-year-old man with osteosarcoma of the sternum in whom 68Ga-prostate-specific membrane antigen (PSMA) PET/CT showed high radiotracer activity in the primary tumor and metastatic lesions than 18F-FDG PET/CT. The present case shows that 68Ga-PSMA PET/CT is very useful for staging of osteosarcoma due to in vivo expression of PSMA. 68Ga-PSMA PET/CT can have potential effects on prognosis and in response assessment following treatment in osteosarcoma. The use of PSMA-targeted radioligand treatments may be beneficial especially in metastatic chemorefractory osteosarcoma.
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Affiliation(s)
- Canan Can
- From the Department of Nuclear Medicine, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
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Ryo T, Ishiguro F, Takenaka H, Ashida S, Yokoyama Y, Shigemitsu K. [Nail Penetrating Injury of the Sternum]. Kyobu Geka 2021; 74:206-208. [PMID: 33831874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 48-year-old male was transported to the emergency room with a dirty rusty nail stuck in his chest. Three-dimensional computed tomography (3D-CT) scan revealed that the nail had penetrated the sternum and its tip was close to the left innominate vein. Emergency surgery was performed to avoid severe infections and major vascular injury. The nail was easily removed. We cleansed and debrided the wound which remained open to prevent infection, and was closed on post-operative day 3.
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Affiliation(s)
- Taiki Ryo
- Department of Thoracic Surgery, Ogaki Municipal Hospital, Ogaki, Japan
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Li NP, Wingfield MA, Mills MK, Beckett BR, Hansford BG. Percutaneous image-guided sternal biopsy: a cross-institutional retrospective review of diagnostic yield and safety in 50 cases. Skeletal Radiol 2021; 50:495-504. [PMID: 32815039 DOI: 10.1007/s00256-020-03587-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Image-guided sternal biopsy may be technically daunting given the immediately subjacent critical structures. There is a paucity of literature describing technique, safety, and efficacy. This study aims to quantify the diagnostic yield and safety of image-guided sternal biopsies. Secondary aims include (1) describing the preferred approach/technique and (2) identifying imaging features and disease entities associated with higher and lower diagnostic yields. MATERIALS AND METHODS A retrospective review of 50 image-guided sternal biopsies performed at two quaternary care centers from 2000 to 2019 was performed. Recorded lesion-related variables included as follows: location, density, extraosseous extension, and size. Recorded variables from electronic medical records included as follows: patient demographics, histologic or microbiological diagnosis, and complications. Recorded technique-related variables included as follows: needle obliquity, type, and gauge; biopsy core number and length; and modality. RESULTS Of the 50 biopsies, 88.0% resulted in a definitive histologic diagnosis. Six biopsies were non-diagnostic. The majority of biopsies were performed under computed tomography (88.0%), followed by ultrasound (12.0%). Tumor was the most common biopsy indication (90.0%), followed by infection (10.0%). Of the diagnostic biopsies indicated for tumor, 88.9% were malignant. Seventy-four percent of the lesions were predominantly lytic. Fifty percent of lesions had extraosseous extension. Lesion locations were as follows: manubrium (48.0%), sternal body (48.0%), and sternomanubrial joint (4.0%). No minor or major, acute, or delayed procedure-related complications were encountered. CONCLUSION Image-guided sternal biopsy is an efficacious and safe method of obtaining a definitive histologic diagnosis regardless of lesion-specific features or location.
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Affiliation(s)
- Ningcheng Peter Li
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Molly A Wingfield
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA
| | - Brooke R Beckett
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Barry G Hansford
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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Sinha R, Knod J, Dukleska K, Mello D. Primary Sternal Cleft Repair in First Week of Life. World J Pediatr Congenit Heart Surg 2021; 12:671-673. [PMID: 33591229 DOI: 10.1177/2150135120975767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a full-term neonate with a postnatal diagnosis of a sternal cleft. Cardiac evaluation was otherwise remarkable for a patent ductus arteriosus and patent foramen ovale. Computed tomography scan confirmed the absence of a sternum except for a small inferior portion, including the xyphoid process. The patient underwent primary repair at five days of age through a midline incision where an absence of pericardium anteriorly was noted. She was extubated successfully the next day and discharged home on postoperative day 3. On follow-up examination, her sternum has been healing well without any clinical concerns. We advocate early repair of such defects in order to allow primary closure in a tension-free manner.
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Affiliation(s)
- Raina Sinha
- Division of Cardiac Surgery, 20425Connecticut Children's, Hartford, CT, USA
| | - Jennifer Knod
- Division of General Surgery, 20425Connecticut Children's, Hartford, CT, USA
| | - Katerina Dukleska
- Division of General Surgery, 20425Connecticut Children's, Hartford, CT, USA
| | - Dennis Mello
- Division of Cardiac Surgery, 20425Connecticut Children's, Hartford, CT, USA
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Abstract
ABSTRACT Sternal fractures have often been associated with high-impact thoracic trauma. In children, this is not always the case. X-ray and even computed tomography can miss subtle sternal fractures. Point-of-care ultrasound has been shown to be more sensitive and specific for detecting subtle sternal fractures as compared with plain X-ray. The following 2 cases describe sternal fractures that were missed by traditional imaging modalities, including a fracture missed by chest computed tomography. They also highlight other potential causative mechanisms for sternal fractures in children, including hyperflexion injuries and low-mechanism motor vehicle accidents.
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Affiliation(s)
- Paul Adeeb Khalil
- From the Denver Health Medical Center, University of Colorado, Aurora, CO
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Abstract
Pectus excavatum (PE) is one of the most common chest wall defects. Accurate assessment of PE deformities is critical for effective surgical intervention. Index-based evaluations have become the standard for objectively estimating PE, however, these indexes cannot represent the whole information of chest CT images and may associated with significant error due to the individual differences. To overcome these limitations, this paper developed a computer-aided diagnosis (CAD) system based on the convolutional neural network (CNN) to automatically learn discriminative features and classify PE images. We also adopted block-wise fine-tuning methods based on the transfer learning strategy to reduce the potential risk of overfitting caused by limited data and experimentally explored the best fine-tuning degree. Our method achieved a high level of classification accuracy with 94.76% for PE diagnosis. Furthermore, we proposed a majority rule-based voting method to provide a comprehensively diagnostic results for each patient, which integrated the classification results of the whole thorax. The promising results support the feasibility of our proposed CNN-based CAD system for automatic PE diagnosis, which paves a way for comprehensive assessments of PE in clinics.
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Affiliation(s)
- Lixuan Lai
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Siqi Cai
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Luyu Huang
- Division of Thoracic Surgery, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Haiyu Zhou
- Division of Thoracic Surgery, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- School of Medicine, South China University of Technology, Guangzhou, 510640, China.
| | - Longhan Xie
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, 510640, China.
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Cardenas-de la Garza JA, Esquivel-Valerio JA, Arvizu-Rivera RI, Colunga-Pedraza PR, Galarza-Delgado DA. Flushing out a plasmacytoma in a patient with POEMS and AESOP syndromes. Lancet 2020; 396:e21. [PMID: 32861309 DOI: 10.1016/s0140-6736(20)31756-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/16/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - Jorge A Esquivel-Valerio
- Department of Rheumatology, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico.
| | - Rosa I Arvizu-Rivera
- Department of Rheumatology, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico
| | - Perla R Colunga-Pedraza
- Haematology Division, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico
| | - Dionicio A Galarza-Delgado
- Department of Rheumatology, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico
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Jang SJ, Cha YK, Kim JS, Do HH, Bak SH, Kwack WG. Computed tomographic findings of chest injuries following cardiopulmonary resuscitation: More complications for prolonged chest compressions? Medicine (Baltimore) 2020; 99:e21685. [PMID: 32872040 PMCID: PMC7437829 DOI: 10.1097/md.0000000000021685] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chest injuries are common and inevitable complications of chest compressions during cardiopulmonary resuscitation (CPR). This study aimed to investigate lung parenchymal and thoracic skeletal injuries after CPR by using computed tomography (CT) and to analyze the correlation between the duration of CPR and related complications.We examined 43 non-traumatic cardiac arrest patients who were successfully resuscitated after CPR and had chest CT scans within 24 hours of CPR. Lung parenchymal injuries were assessed by quantifying the lung contusion score (LCS) on the CT images, and each skeletal injury was investigated by classifying the location and the distribution. Other CPR-related chest injuries were also described, such as pleural effusion/hemothorax, pneumothorax, and retrosternal hematoma. Statistical analysis was conducted to determine whether the duration of CPR was correlated with each complication.Lung contusions were found in all of the patients (mean LCS: 22, range: 5-47). The distribution of lung contusions were predominantly in the bilateral dependent portions of the lungs (41 patients). All of the rib fractures occurred in the anterior arc (43 patients), and the sternal fractures occurred predominantly in the mid-sternal body (31 patients). In patients younger than 70 years old, the number of rib fractures significantly increased among those who underwent CPR for more than 25 minutes compared to those who received CPR for less than 25 minutes (median 4.5 vs 9; mean 8.3 vs 5.6 per person, respectively; P = .035). The risk of sternal fracture tended to be higher for patients who received CPR for more than 10 minutes compared to those who received CPR for less than 10 minutes (odds ratio: 3.60; 95% confidence interval: 0.86-15.06; P = .079). However, there was no statistically significant correlation between the duration of CPR and LCS or other CPR-related chest injuries.The duration of CPR was associated with the number of rib fractures and the occurrence of sternal fractures, but it did not affect the extent of CPR-related lung contusions or other CPR-related chest injuries. All of the rib fractures occurred in the anterior arc, while the sternal fractures occurred predominantly in the mid-sternal body. However, since this study was conducted in a single institution, the number of patients included was relatively small, thus limiting the statistical analysis.
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Affiliation(s)
- Seo Jin Jang
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine
| | - Yoon Ki Cha
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine
| | - Han Ho Do
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang
| | - So Hyeon Bak
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon
| | - Won Gun Kwack
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, South Korea
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Inoue S, Yoshida T, Nishino T, Goto M, Furukita Y, Yamamoto Y, Fujiwara S, Minato T, Sumitomo H, Yuasa Y, Takizawa H, Tangoku A. The sterno-tracheal distance is an important factor of anastomotic leakage of retrosternal gastric tube reconstruction after esophagectomy. Esophagus 2020; 17:264-269. [PMID: 31776810 DOI: 10.1007/s10388-019-00705-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/20/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009. METHODS A total of 221 patients who underwent a subtotal esophagectomy with gastric tube reconstruction during January 2004-April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared. RESULTS The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route reconstruction. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in the RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2 to 11.1% in the RS route (p = 0.037). CONCLUSION The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD < 13 mm.
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Affiliation(s)
- Seiya Inoue
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Takahiro Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takeshi Nishino
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masakazu Goto
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yoshihito Furukita
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yota Yamamoto
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Satoshi Fujiwara
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takuya Minato
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hiroyuki Sumitomo
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yasuhiro Yuasa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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Liu Y, Cheng J, Xu J, Yu J, Zhao L, Zhao K, Chen B. Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis. Clin Anat 2020; 33:605-609. [PMID: 31444881 DOI: 10.1002/ca.23461] [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: 05/08/2019] [Revised: 07/28/2019] [Accepted: 08/17/2019] [Indexed: 02/05/2023]
Abstract
It is generally accepted that primary spontaneous pneumothorax (PSP) is found mostly in tall, thin young males. However, the precise etiology of PSP is unclear. We compared some thoracic structural angles of PSPs and controls in young males to determine the predominant factor. CT data of 43 male PSPs (age 21.88 ± 5.30) and 30 controls (age 21.47 ± 5.47) were collected. The angle of thoracic vertebrae slope (∠α), sternal slope angle (∠β), and tracheal-sternal stem angle (∠γ) were measured in the sagittal position. Carina angle (∠δ) was measured in the coronal position. After a propensity score match (PSM) of age and smoking history, the angles were comparatively evaluated. There were significant differences in all four angles between two unmatched groups, while only in three (∠β, ∠γ, and ∠δ) after PSM was performed. The correlation between ∠β and PSP was most significant, and R2 was 0.456. The prediction accuracy of ∠β was 81.3%, OR was 1.386, 95% confidence interval was (1.095-1.754). The sternal slope angles in PSPs are greater than controls indicate the sternal slope angle is associates with the development of PSP and it could be a thoracic structural index to predict the risk of PSP occurrence. Clin. Anat. 33:605-609, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Yong Liu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahang Xu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junjie Yu
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Zhao
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Zhao
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baojun Chen
- Department of thoracic surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
The Sternum is a human bone located in the anterior area of the thoracic cage. It is present in most of the axial cuts provided from the Magnetic Resonance Imaging (MRI) acquisitions, used in the medical field. Detecting the Sternum is relevant as it contains rigid key-points for 3D model reconstructions, assisting in the planning and evaluation of several surgical procedures, and for atlas development by segmenting structures in anatomical proximity. In the absence of applicable approaches for this specific problem, this paper focuses on two distinct automated methods for Sternum segmentation in MRI. The first, relies on K-Means (Clustering) to perform the segmentation, while the second encompasses the closed Minimum Path over the elliptical transformation of Gradient images. A dataset of 14 annotated acquisitions was used for evaluation. The results favored the Gradient approach over Clustering.
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Gorospe L, Casado JL, Serrano-Villar S, de la Puente-Bujidos C, Pérez-Elías MJ, Vivancos-Gallego MJ. Atraumatic Incomplete Sternal Fracture Incidentally Detected in a Human Immunodeficiency Virus Patient at Lung Cancer Screening With Low-Dose Thoracic CT. J Clin Rheumatol 2019; 25:e132. [PMID: 31764500 DOI: 10.1097/rhu.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aydin Y, Ogul H, Eroglu A. Primary Sternal Osteomyelitis due to Coagulase-Negative Staphylococci. Rev Clin Esp 2019; 221:62-63. [PMID: 33998480 DOI: 10.1016/j.rceng.2019.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/13/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Y Aydin
- Departamenta de Cirugía Torácica, Universidad de Ataturk, Facultad de Medicina, Erzurum, Turquía.
| | - H Ogul
- Departamento de Radiología, Universidad de Ataturk, Facultad de Medicina, Erzurum, Turkey
| | - A Eroglu
- Departamenta de Cirugía Torácica, Universidad de Ataturk, Facultad de Medicina, Erzurum, Turquía
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Crehuet Gramatyka D, Gutiérrez San Román C, Fonseca Martín R, Barrios Fontoba J, López Andreu J, Esteban Ricós MJ, Miró Rubio I, Costa Roig A, Del Peral Samaniego M, Vila Carbó JJ. [Anatomical relations in innominate artery compression syndrome: retrospective case-control study]. Cir Pediatr 2019; 32:165-171. [PMID: 31626399] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the anatomical relations between brachiocephalic trunk (BT), trachea, spine and sternum in patients with Innominate Artery Compressing Syndrome (IACS) and control patients. METHODS Retrospective case-control study of patients diagnosed with IACS in our center, in whom vascular computerized tomography (CT) was performed. The CT were compared with those of control patients free of obstructive respiratory pathology, without congenital heart disease and free of deforming thoracic mass, in whom CT was performed due to other reason. Each case was paired with three controls per case, in similar age groups. The significance value was set as p<0,05. RESULTS Nine cases were included (7 boys and 2 girls) with their 27 respective controls (20 boys and 7 girls). The BT origin position with respect to the trachea, thought as a clock face, was 01:30 (00:30- 03:00) in cases and 01:30 (00:30-02:30) in controls. No differences were observed (p=0.72). The relation between anteroposterior/transversal tracheal diameters was 0.44 (0.184-0.6) in cases, 0.885 (0.64-1.16) in controls. The sternum-trachea/sternum-vertebra relation was 0.685 (0.6-0.76) in cases, 0.67 (0.49-0.79) in controls. No differences were observed (p=0.75). The angle of thoracic kyphosis was 29º (9º-34º) in cases, 24º (4º-33º) in controls. There were no statistically significant differences (p=0.45). CONCLUSIONS We found no differences between the two groups in the BT origin in relation to the trachea. In all cases, the origin was on the left side of the body. Therefore, we question the premise that IACS is due to a more left origin of BT.
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Affiliation(s)
| | | | | | | | | | | | - I Miró Rubio
- Hospital Universitario y Politécnico La Fe. Valencia
| | - A Costa Roig
- Hospital Universitario y Politécnico La Fe. Valencia
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Salerno S, Zerbo S, Vinci A, Lanzarone A, Baldino G, Procaccianti P, Lo Re G, Argo A. Role of post mortem computed tomography in diagnosis of upper cervical fractures in child due to road accident: A case report and literature review. Med Leg J 2019; 87:151-155. [PMID: 31295056 DOI: 10.1177/0025817219848285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sergio Salerno
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Stefania Zerbo
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Alessia Vinci
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Antonietta Lanzarone
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Gennaro Baldino
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Paolo Procaccianti
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
| | - Giuseppe Lo Re
- Department of Diagnostic Radiology, Policlinico University of Palermo, Palermo, Italy
| | - Antonina Argo
- Section of Legal Medicine, Department of Health Promotion, University of Palermo, Palermo, Italy
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Bedalov A, Bašić Ž, Marelja I, Dolić K, Bukarica K, Missoni S, Šlaus M, Primorac D, Andjelinović Š, Kružić I. Sex estimation of the sternum by automatic image processing of multi-slice computed tomography images in a Croatian population sample: a retrospective study. Croat Med J 2019; 60:237-245. [PMID: 31187951 PMCID: PMC6563181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/27/2019] [Indexed: 10/13/2023] Open
Abstract
AIM To determine the sexual dimorphism of the sternum with standard measurements in a contemporary Croatian population sample using multi-slice computed tomography (MSCT) and to compare the data obtained by an automatic with those obtained by a manual approach. METHODS Five sternal measurements were obtained from MSCT images of 73 men and 55 women and three sternal indices were calculated. Custom image analysis software was developed for automatic segmentation and calculation of sternal measurements. Measurements of sexual dimorphism were automatically calculated and compared with manual measurements. RESULTS All of the sternal measurements exhibited significant differences between men and women. The discrepancies between manual and automatic measurements ranged from 2.8% to 3.6% of the mean average values obtained with the automatic approach. The most accurate single-variable discriminant function was sternal body length (82.8%), the most accurate index was sternal area (89.1%), and the discriminant function using three variables was manubrium width, sternal body length, and sternal body width (90.6%). CONCLUSION Sternal measurements are a reliable sex indicator and can be used in forensic casework. Computer-aided measurement methods can accelerate sex estimation and improve its precision and accuracy.
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Morf S. [CME: Significance of Thoracic Sonography in Thoracic Trauma]. Praxis (Bern 1994) 2018; 107:1243-1248. [PMID: 30424691 DOI: 10.1024/1661-8157/a003135] [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] [Indexed: 06/09/2023]
Abstract
CME: Significance of Thoracic Sonography in Thoracic Trauma Abstract. Trauma patients should be treated according to international guidelines. Depending on the severity of the trauma, an immediate threat to life must be ruled out and sonography is part of the complementation of diagnostics. The EFAST investigation includes the exclusion of fluid in the thorax, the exclusion of pneumothorax and the exclusion of fluid in the pericardium. Thorax ultrasound is becoming increasingly important in the evaluation of the outcome in thoracic trauma patients as well as in the control of the initiated therapy.
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Affiliation(s)
- Susanne Morf
- 1 Institut für klinische Notfallmedizin, Spital Limmattal
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Kalayci S, Akbulut A, Koca G, Yigit H, Korkmaz M. Barrier effect of sternum to right ventricle dilatation appearing like letter phi "φ" on MPI. J Nucl Cardiol 2018; 25:1433-1435. [PMID: 28975578 DOI: 10.1007/s12350-017-1075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Suleyman Kalayci
- Department of Nuclear Medicine, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
- Department of Cardiology, Zonguldak Ataturk Government Hospital, Zonguldak, Turkey
| | - Aylin Akbulut
- Department of Nuclear Medicine, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Gokhan Koca
- Department of Nuclear Medicine, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hasan Yigit
- Department of Radiology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meliha Korkmaz
- Department of Nuclear Medicine, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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What Is Your Diagnosis? J Avian Med Surg 2018; 32:158-63. [PMID: 29905109 DOI: 10.1647/2017-272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schulz-Drost S, Krinner S, Langenbach A, Merschin D, Grupp S, Hennig FF, Ekkernkamp A, Mauerer A. The Operative Management of Flail Chest Injuries with Concomitant Sternal Fracture. Chirurgia (Bucur) 2018; 112:573-593. [PMID: 29088557 DOI: 10.21614/chirurgia.112.5.573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/23/2022]
Abstract
Background: Flail Chest Injuries (FCI) are one of the most severe thoracic injuries. Moreover, an additional sternal fracture (SF) even worsens the outcome, such as the duration of mechanical ventilation, therefore an surgical fixation of the fractures could be considered in certain cases to improve the weaning from the ventilator. This paper aims to emphasize on the management of different types of SF in FCI. Methods: All surgically treated cases (2012-2016) that showed the combination of FCI and SF have been evaluated for their clinical details, the morphology of the fractures and the technical aspects of the surgical procedure in a retrospective investigation. Results: All of the SF (n=15) had been fixed by locked plate osteosynthesis through a median approach in a supine position. Three main regions of the sternum showed the need for different fixation strategies: the upper manubrium, central and lower corpus sterni. Concomitant rib fractures were addressed either through the same approach or through additional limited incisions. Conclusions: Combinations of SF and FCI are high risc injuries with high demand on surgical skills. They can be properly fixed with a locking plate osteosynthesis through a combination of limited incisions employing different types of plates depending on the type of SF.
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Demetrian AD, Olteanu M, Mîndrilă I, Macovei A, Râmboiu DS, Enache ME, Bălă VS, Demetrian C, Popescu M, Streba CT. Long disease-free survival following total sternal resection and reconstruction of the sternum with acrylic cement for unique massive sternal metastasis after operated breast cancer. Rom J Morphol Embryol 2018; 59:1225-1232. [PMID: 30845305 DOI: pmid/30845305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unique sternal metastasis is an uncommon finding in the follow-up of operated breast cancer. We present a case of massive sternal metastasis occurred few years after radical resection of a right mammary cancer, that we solved by total sternal resection and reconstruction of sternum with acrylic cement and Vicryl mesh. The patient is disease-free five years after the operation.
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Affiliation(s)
- Alin Dragoş Demetrian
- Department of Extreme Conditions Medicine, University of Medicine and Pharmacy of Craiova, Romania;
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Ewert F, Syed J, Wagner S, Besendoerfer M, Carbon RT, Schulz-Drost S. Does an external chest wall measurement correlate with a CT-based measurement in patients with chest wall deformities? J Pediatr Surg 2017; 52:1583-1590. [PMID: 28499711 DOI: 10.1016/j.jpedsurg.2017.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/28/2017] [Accepted: 04/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Measurements in chest wall deformities are typically conducted using a thorax caliper or a CT scan of the chest wall. This paper focuses on the possible correlation between these two methods to validate the reliability of the thorax caliper, minimize radiation exposure, and limit the usage of expensive imaging techniques. METHODS We evaluated 95 consecutive patients (77 pectus excavatum (PE), 17 pectus carinatum (PC), 1 mixed deformity) who received surgical correction of the anterior chest wall. The results of the external chest wall measurements and the CT-based measurements were statistically compared. RESULTS A significant correlation between the two measurements was observed in PE and PC at the highest point of the deformation. The strongest correlation was noted in PE. We also noted a correlation between the transverse diameter of the external measurement and the inner thoracic diameter of the CT scan but not for the sagittal diameters in the upper parts of the sternum. CONCLUSIONS Thorax caliper measurements are suitable for determining the sagittal thoracic diameter at the maximum level of the deformity and the transverse diameter with an accuracy comparable to that of CT measurements. Since these values key, the thorax caliper is reliable for monitoring and documenting chest wall malformations. LEVEL OF EVIDENCE Study of diagnostic test. Testing previously developed diagnostic criteria in a consecutive series of patients and a universally "gold" standard-Level I.
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Affiliation(s)
- Franziska Ewert
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
| | - Julia Syed
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
| | - Sonja Wagner
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
| | | | - Roman T Carbon
- Department of Pediatric Surgery, University Hospital Erlangen, Germany.
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Erraoui M, Amine B, Tahiri L, El Binoune I, Bahha J, Hajjaj-Hassouni N. Noncontiguous multi-tiered spinal tuberculosis associated with sternal localization: a case report. J Med Case Rep 2017; 11:181. [PMID: 28676098 PMCID: PMC5497373 DOI: 10.1186/s13256-017-1323-2] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/15/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare. CASE PRESENTATION We report a case of multi-tiered tuberculous spondylodiscitis with sternal localization in an immunocompetent 41-year-old Arab woman who had inflammatory bilateral sciatica L5 and S1 and a history of low back pain caused by a trauma. Radiography, computed tomography, and a vertebral biopsy were useful for diagnosis. She reacted well to anti-bacillary treatment despite the occurrence of multiple paravertebral and subcutaneous abscesses. The medullar magnetic resonance imaging control performed at 4 months, 12 months, and 1 year after the end of treatment showed a favorable evolution. CONCLUSIONS To avoid the delay of diagnosis, especially in our endemic context, tuberculosis must be evoked usually. This will improve the prognosis of our patients.
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Affiliation(s)
- Mariam Erraoui
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Bouchra Amine
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Latifa Tahiri
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Imane El Binoune
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Jihane Bahha
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
| | - Najia Hajjaj-Hassouni
- Faculty of Medicine and Pharmacy, LIRPOS, URAC 30, Rheumatology, Mohammed V University, Rabat, Sale Morocco
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Snarr BS, Liu MY, Zuckerberg JC, Falkensammer CB, Nadaraj S, Burstein D, Ho D, Gardner MA, Butto A, Ewing SG, Pandian NG, Banerjee A. The Parasternal Short-Axis View Improves Diagnostic Accuracy for Inferior Sinus Venosus Type of Atrial Septal Defects by Transthoracic Echocardiography. J Am Soc Echocardiogr 2017; 30:209-215. [PMID: 28139440 PMCID: PMC5837475 DOI: 10.1016/j.echo.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sinus venosus defects (SVD) of the inferior vena cava (IVC) type, or inferior SVDs, are an uncommon form of atrial communication located outside the confines of the fossa ovalis and involve override of the IVC. Despite numerous studies describing the anatomical and echocardiographic features of the inferior SVD, distinguishing this defect from a large secundum atrial septal defect (ASD) by echocardiography is often challenging. Accurate diagnosis of an inferior SVD and correct differentiation from a secundum ASD is essential for appropriate presurgical planning. Absence of the posterior rim in the parasternal short-axis views may serve as a useful clue in diagnosing inferior SVDs. We sought to determine the utility of using the presence or absence of a posterior atrial rim in the parasternal short-axis view to help distinguish an inferior SVD from a secundum ASD. This sign may help clinch the diagnosis when subcostal imaging is suboptimal. METHODS We retrospectively reviewed transthoracic echocardiograms from 15 patients with a known surgical diagnosis of an inferior SVD between 2004 and 2015. The presence or absence of a posterior rim in the parasternal short-axis view was determined by two primary investigators. The posterior rim was also evaluated in 14 patients with a secundum ASD repair as controls. Echocardiograms were then reviewed blindly by attending-level echocardiographers and cardiology fellows in training. Diagnostic accuracy was assessed both with and without the use of the posterior rim criterion. Statistical analysis was used to determine the effect of using the rim criterion on inferior SVD diagnosis. We also reviewed all surgically diagnosed secundum ASDs that were incorrectly diagnosed as inferior SVD by preoperative imaging and determined whether use of the posterior rim criterion would have resulted in the correct diagnosis. RESULTS The posterior rim was absent in all 15 patients with a surgical diagnosis of inferior SVD and present in all 14 patients with a secundum ASD. For all observers, there was a statistically significant increase in diagnostic accuracy of inferior SVDs with the use of the rim criterion (P < .0001). We noted that secundum ASDs with inferior extension also have persistent posterior rims. The rim criterion correctly classified all large secundum ASDs with inferior extension that were previously misdiagnosed by echocardiogram preoperatively. CONCLUSIONS Absence of the posterior rim ("bald" posterior wall) is a consistent finding in patients with an inferior SVD and distinguishes an inferior SVD from a large secundum ASD with inferior extension. Parasternal short-axis evaluation of the posterior atrial rim is a helpful tool for all levels of physician training in improving diagnostic accuracy for detecting inferior SVDs and in distinguishing them from secundum ASDs.
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Affiliation(s)
- Brian S Snarr
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Y Liu
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy C Zuckerberg
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine B Falkensammer
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sumekala Nadaraj
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Danielle Burstein
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah Ho
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monique A Gardner
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arene Butto
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stanford G Ewing
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Natesa G Pandian
- Division of Cardiology, Hoag Hospital, Newport Beach, California
| | - Anirban Banerjee
- Division of Cardiology, the Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Affiliation(s)
- Penny Fang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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