-
Journal of Radiation Research Oct 2021Stereotactic Ablative Radiotherapy (SABR) remains one of the preferred treatment techniques for early-stage cancer. It can be extended to more treatment locales...
Stereotactic Ablative Radiotherapy (SABR) remains one of the preferred treatment techniques for early-stage cancer. It can be extended to more treatment locales involving the sternum, scapula and spine. This work investigates SABR checks using Alanine and nanoDot dosimeter for three treatment sites, including sternum, spine and scapula. Alanine and nanoDot dosimeters' performances were verified using a 6 MV photon beam before SABR pretreatment verifications. Each dosimeter was placed inside customized designed inserts into a Rod Phantom (in-house phantom) made of Perspex that mimics the human body for a SABR check. Electron Paramagnetic Resonance (EPR) spectrometer, Bruker EleXsys E500 (9.5 GHz) and Microstar (Landauer Inc.) Reader was employed to acquire the irradiated alanine and nanoDot dosimeters' signal, respectively. Both dosimeters treatment sites are expressed as mean ± standard deviation (SD) of the measured and Eclipse calculated dose Alanine (19.59 ± 0.24, 17.98 ± 0.15, 17.95 ± 0.18) and nanoDot (19.70 ± 0.43, 17.05 ± 0.08, 17.95 ± 0.98) for spine, scapula and sternum, respectively. The percentage difference between alanine and nanoDot dosimeters was within 2% for sternum and scapula but 2.4% for spine cases. These results demonstrate Alanine and nanoDot dosimeters' potential usefulness for SABR pretreatment quality assurance (QA).
PubMed: 34668563
DOI: 10.1093/jrr/rrab056 -
Journal of Thoracic Disease Sep 2023Sternal closure after median sternotomy traditionally uses a stainless steel wire cerclage. Sternal wires are placed through or around the sternum, and the wire ends are...
Sternal closure after median sternotomy traditionally uses a stainless steel wire cerclage. Sternal wires are placed through or around the sternum, and the wire ends are twisted together to bring the sternum back together. Complications of this technique include sternal instability, dehiscence, non-union, and increased pain. Compared to traditional wire cerclage, the Figure 8 FlatWire Sternal Closure System has been demonstrated to be stronger and significantly reduce sternal cut-through and postoperative pain. There was no significant difference in hospital length of stay or mean hospitalization cost. Operative time was slightly longer in the FlatWire group, but this difference has been attributed to the learning curve of mastering the FlatWire technique. This article and supplemental video will demonstrate the technique of FlatWire Sternal Closure System. Briefly, the FlatWire is placed around the sternum, and the FlatWire end is fed through the security box. Once all of the wires are placed, the Figure 8 tensioning device is used to tighten each wire through the security box to the appropriate tensile force. Next, the FlatWires are rotated 90 degrees to hold the sternal position temporarily. Once sternal approximation is achieved, each FlatWire is twisted 120 degrees, and any excess length of the FlatWire is clipped.
PubMed: 37868890
DOI: 10.21037/jtd-23-110 -
The Annals of Thoracic Surgery Jul 2021Reconstruction of the anterior chest wall defect after sternectomy is a challenge for cardiothoracic surgeons. In 2010, the Padua group published the first case of...
BACKGROUND
Reconstruction of the anterior chest wall defect after sternectomy is a challenge for cardiothoracic surgeons. In 2010, the Padua group published the first case of cadaveric sternum transplantation after sternectomy. This multicenter study reports the clinical indications and early and long-term results of sternal chondral allograft transplantation.
METHODS
This is a retrospective multicenter study from 7 academic centers. We collected demographic data, surgical indications, technical details, and early postoperative results. The complications, long-term stability, and tolerance of the allografts were also analyzed.
RESULTS
Between January 2008 and December 2019, 58 patients underwent sternectomy followed by reconstruction using cadaveric-cryopreserved sternochondral allografts. Thirty-two patients were male, median age 63.5 years (interquartile range, 50-72 years). Indications for sternectomy were secondary sternal tumors (n = 13), primary sternal tumors (n = 15), and nonneoplastic disease (n = 30). Thirty patients underwent total sternectomy, 16 lower-body sternectomy, and 12 upper-body manubrium resection. The 30-day mortality was 5%; overall morbidity was 31%. Six early reoperations were necessary because of bleeding (n = 1), titanium plate dislocation (n = 1), and resuture of the skin in the lower part of the incision (n = 4). Overall, 5-year survival was 74%. In all the survived patients, the reconstructions were stable and free from mechanical or infective complications.
CONCLUSIONS
The main indications for sternal allograft implantation were complex poststernotomy dehiscence followed by primary or secondary tumor involvement of the sternum. The collected results demonstrate that sternochondral allograft transplantation is a safe and effective method in reconstructing the anterior chest wall after sternectomy. Further studies to demonstrate the integration of the bone grafts into the patients' sternal wall will be made.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Allografts; Bone Diseases; Bone Neoplasms; Bone Transplantation; Cadaver; Child; Child, Preschool; Comorbidity; Female; Humans; Male; Middle Aged; Plastic Surgery Procedures; Retrospective Studies; Sternum; Tissue Donors; Transplantation, Homologous; Young Adult
PubMed: 33080234
DOI: 10.1016/j.athoracsur.2020.08.032 -
Asian Journal of Surgery Jul 2024
Topics: Humans; Osteomyelitis; Sternum; Ribs; Male; Female; Middle Aged
PubMed: 38458863
DOI: 10.1016/j.asjsur.2024.02.139 -
Journal of Cardiothoracic Surgery Dec 2023Hemopericardium is a serious complication that can occur after cardiac surgery. While most post-operative causes are due to inflammation and bleeding, patients with...
BACKGROUND
Hemopericardium is a serious complication that can occur after cardiac surgery. While most post-operative causes are due to inflammation and bleeding, patients with broken sternal wires and an unstable sternum may develop hemopericardium from penetrating trauma.
CASE PRESENTATION
We present the case of a 62-year-old male who underwent triple coronary bypass surgery and presented five months later with sudden anterior chest wall pain. Chest computed tomography revealed hemopericardium with an associated broken sternal wire that had penetrated into the pericardial space. The patient underwent a redo-sternotomy which revealed a 3.5 cm bleeding, jagged right ventricular laceration that correlated to the imaging findings of a fractured sternal wire projecting in the pericardial space. The laceration was repaired using interrupted 4 - 0 polypropylene sutures in horizontal mattress fashion between strips of bovine pericardium. The patient's recovery was uneventful and he was discharged on post-operative day four without complications.
CONCLUSION
Patients with broken sternal wires and an unstable sternum require careful evaluation and management as these may have potentially life-threatening complications if left untreated.
Topics: Humans; Male; Middle Aged; Bone Wires; Cardiac Surgical Procedures; Lacerations; Pericardial Effusion; Sternotomy; Sternum; Thoracic Injuries
PubMed: 38071382
DOI: 10.1186/s13019-023-02452-6 -
Journal of Applied Clinical Medical... Oct 2021The goal of this study was to investigate how the choice of the region of interest (ROI) affects the registration results of surface imaging for daily positioning of...
PURPOSE
The goal of this study was to investigate how the choice of the region of interest (ROI) affects the registration results of surface imaging for daily positioning of breast cancer patients.
METHODS
The AlignRT system (VisionRT, London) and the XVI Cone beam CT (CBCT; Elekta, Stockholm) installed on two Versa HD linacs (Elekta) were used in this study, which included 28 patients (160 fractions). In the clinical workflow, patients were prepositioned with AlignRT and then shifted in 6 degrees of freedom (DOF) according to the CBCT. A new reference capture was taken immediately afterward. Retrospectively, the surface capture resulting from prepositioning was registered to the latest reference capture. By varying the ROI used for registration, the surface-based results were optimized in terms of minimizing the deviation to the clinically applied CBCT shifts. Two sets of ROIs were used: one obtained by applying a variable margin to the breast surface, another by combining ROIs of anatomical structures, including the sternum and contralateral breast.
RESULTS
Registration results showed significant differences from one ROI to another. Generally, the results improved with increasing ROI size, especially for rotational DOFs. ROIs, including the axilla or supraclavicular lymph drainage region, did not yield an improved registration result. On the other hand, an ROI comprising the breast surface, sternum, and a belt caudal to the breasts decreased the average magnitude of the translational and rotational deviations by 6.6% and 30.8% (p < 0.01), respectively, compared to the breast surface only results.
CONCLUSION
The influence of the ROI choice on surface imaging registration results was analyzed and the surface-based shifts were compared to clinically applied CBCT shifts. An optimal ROI for the treatment of breast cancer patients, consisting of the breast surface, sternum, and a belt, was identified.
Topics: Breast Neoplasms; Cone-Beam Computed Tomography; Female; Humans; Radiotherapy Planning, Computer-Assisted; Retrospective Studies
PubMed: 34543500
DOI: 10.1002/acm2.13410 -
Radiologia 2021Self-limiting sternal tumors of childhood (SELSTOC) are rapidly growing sternal lesions that tend to resolve spontaneously. Patients have no history of infection,...
INTRODUCTION
Self-limiting sternal tumors of childhood (SELSTOC) are rapidly growing sternal lesions that tend to resolve spontaneously. Patients have no history of infection, trauma, or neoplasms, and the most likely etiologyis an aseptic inflammatory reaction of unknown origin. The differential diagnosis includes a wide spectrum of lesions such as tumors, infections, malformations, or anatomic variants.
MATERIAL AND METHODS
We analyzed all cases of sternal masses in pediatric patients seen between 2012 and 2019; five of these had findings compatible with SELSTOC. We retrospectively recorded patients' race, sex, age, clinical presentation, laboratory findings, imaging tests, treatment, and follow-up.
RESULTS
We present five cases of rapidly growing sternal lesions whose clinical and radiological features are compatible with SELSTOC. In the absence of alarming symptoms and laboratory markers, watchful waiting could be an appropriate therapeutic approach. However, patients with some findings such as fever, elevated acute phase reactants, and/or comorbidities could require therapeutic interventions such as antibiotics or percutaneous drainage. In our series, depending on the clinical presentation and the patient's comorbidities, different therapeutic approaches were adopted (a conservative approach in two patients, antibiotics in three patients, and percutaneous drainage in one patient). In all cases, the sternal lesion was absent at discharge and/or at later follow-up visits.
CONCLUSION
Radiologists and pediatricians must be aware of this entity and the different diagnostic and therapeutic approaches to rapidly growing sternal lesions in pediatricpatients because recognizing SELSTOC can avoid unnecessary diagnostic tests and/or disproportionate therapeutic strategies.
Topics: Bone Neoplasms; Child; Drainage; Humans; Retrospective Studies; Sternum; Thoracic Neoplasms
PubMed: 34625195
DOI: 10.1016/j.rxeng.2020.04.008 -
Frontiers in Cell and Developmental... 2021Adult erythropoiesis is a highly controlled sequential differentiation of hematopoietic stem cells (HSCs) to mature red blood cells in the bone marrow (BM). The bones...
Adult erythropoiesis is a highly controlled sequential differentiation of hematopoietic stem cells (HSCs) to mature red blood cells in the bone marrow (BM). The bones which contain BM are diverse in their structure, embryonic origin, and mode of ossification. This has created substantial heterogeneity in HSCs function in BM of different bones, however, it is not known if this heterogeneity influences erythropoiesis in different bones and different regions of the same bone. In this study, we examined steady state BM erythroid progenitors and precursors from different bones - the femur, tibia, pelvis, sternum, vertebrae, radius, humerus, frontal, parietal bone, and compared all to the femur. Trabecular and cortical regions of the femur were also compared for differences in erythropoiesis. In addition, mouse spleen was studied to determine at which age erythropoietic support by the spleen was lost postnatally. We report that total erythroid cells, and erythroid precursors in the femur are comparable to tibia, pelvis, humerus and sternum, but are significantly reduced in the vertebrae, radius, frontal, and parietal bones. Erythroid progenitors and multipotential progenitor numbers are comparable in all the bones except for reduced number in the parietal bone. In the femur, the epiphysis and metaphysis have significantly reduced number of erythroid precursors and progenitors, multipotential progenitors and myeloid progenitors compared to the diaphysis region. These results show that analysis of erythroid precursors from diaphysis region of the femur is representative of tibia, pelvis, humerus and sternum and have significant implications on the interpretation of the steady-state erythropoiesis finding from adult BM. Postnatal spleen supports erythroid precursors until 6 weeks of age which coincides with reduced number of red pulp macrophages. The residual erythroid progenitor support reaches the adult level by 3 months of age. In conclusion, our findings provide insights to the differences in erythropoiesis between different bones, between trabecular and cortical regions of the femur, and developmental changes in postnatal spleen erythropoiesis.
PubMed: 34055777
DOI: 10.3389/fcell.2021.646646 -
Surgical and Radiologic Anatomy : SRA Jan 2022Multislice spiral CT (MSCT) was used to investigate the anatomical characteristics of sternal development, and to provide anatomical basis for sternal puncture in...
PURPOSE
Multislice spiral CT (MSCT) was used to investigate the anatomical characteristics of sternal development, and to provide anatomical basis for sternal puncture in children.
METHODS
We retrospectively analyzed the thoracic MSCT data of 600 children who received thoracic MSCT from January to June 2020 with their age ranging from 1 month to 19 years. The distribution of sternal ossification centers and adjacent tissues and organs was observed. Subcutaneous soft tissue thickness and the distance between the skin and the posterior margin of the sternum were measured in the central areas of sternal manubrium and mesosternum (segments I and II), and the correlation between the two was calculated using linear correlation.
RESULTS
A total of 600 patients were enrolled, the mean age was 9.87 years and the standard deviation was 8.28 years. The sternal manubrium and ossification centers at the I and II segments of the mesosternum were visible in all cases (100%). There was no ossification in segment III of the mesosternum in 15 cases (2.5%), including 12 cases (80%) adjacent to the posterior pericardium and 7 cases (46.7%) of lung tissue. There were 274 cases (45.7%) of segment IV without ossification, including 204 cases (74.5%) of adjacent pericardium and 95 cases (32.8%) of lung tissue. The xiphoid process was not ossified in 258 cases (43%), including 190 cases (73.6%) adjacent to the pericardium and 97 cases (37.6%) adjacent to the lung tissue. Correspondingly, the thickness of subcutaneous soft tissue of the sternal manubrium and the central region of the I and II segments of the mesosternum had a low positive correlation with age (P < 0.001), the distance between the skin and the posterior margin of the sternum showed a moderate positive correlation with age (P < 0.001), and the distance between the skin and the posterior margin of the sternum showed a high positive correlation with the thickness of subcutaneous soft tissue (P < 0.001).
CONCLUSIONS
Nonossification of the sternal ossification center usually occurs below segment III of the mesosternum and is usually adjacent to heart and lung tissue. Pediatric sternal puncture should be performed at the sternal manubrium and the mesosternum of segments I and II. However, attention should be paid to the space between multiple ossification centers. The thickness of subcutaneous soft tissue is a critical factor that determines the depth of the puncture.
Topics: Child; Humans; Pericardium; Punctures; Retrospective Studies; Sternum; Tomography, Spiral Computed
PubMed: 34748048
DOI: 10.1007/s00276-021-02850-2 -
Diagnostics (Basel, Switzerland) Apr 2024Bone metastasis has been reported in up to 70% of patients with advanced breast cancer. A total of 55.76% of skeletal metastases in women were derived from breast...
Bone metastasis has been reported in up to 70% of patients with advanced breast cancer. A total of 55.76% of skeletal metastases in women were derived from breast cancer. However, patients with bone metastasis from an occult primary breast cancer are a rare subset of patients. Here, we present the case of a 38-year-old woman who had sternum pain for 4 months. A whole-body PET-CT scan revealed that the FDG uptake of both the sternum and internal mammary node was significantly increased. The final diagnosis of occult breast cancer was established by immunohistochemical (IHC) staining, which is of great significance for identifying the origin of a metastatic tumor despite no visualized lesions of mammary glands.
PubMed: 38611678
DOI: 10.3390/diagnostics14070765