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Journal of Cardiothoracic Surgery Jun 2024First rib tumors are extremely rare. Its compression of neurovascularity can easily lead to severe complications such as thoracic outlet syndrome, so early surgical... (Review)
Review
BACKGROUND
First rib tumors are extremely rare. Its compression of neurovascularity can easily lead to severe complications such as thoracic outlet syndrome, so early surgical resection is crucial. However, there is no standardized approach to surgery.
CASE PRESENTATION
A previously healthy 18-year-old Chinese male undergoes a chest computed tomography (CT) scan that incidentally reveals a raised calcified mass on the right first rib, which is most likely an osteochondroma when combined with magnetic resonance imaging (MRI). We achieved excellent results with resection and thoracic reconstruction by adopting an inverse L-shaped incision in the anterior chest and a longitudinal split of the sternum.
CONCLUSIONS
Our practice provides great reference for the surgical management of first rib tumors.
Topics: Humans; Male; Ribs; Osteochondroma; Adolescent; Bone Neoplasms; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Manubrium
PubMed: 38915107
DOI: 10.1186/s13019-024-02902-9 -
Revista Brasileira de Ortopedia Jun 2024To investigate the epidemiology of injury types among jiu-jitsu practitioners, as well as the incidence regarding different skill and experience levels, through the...
To investigate the epidemiology of injury types among jiu-jitsu practitioners, as well as the incidence regarding different skill and experience levels, through the question: "What are the characteristics and prevalence of musculoskeletal injuries in Jiu-Jitsu practitioners?". Since the beginning of the study, in August 2020, we conducted a search on the MEDLINE, LILACS, and SciELO electronic databases. We included cross-sectional studies published between 2018 and 2023 on the epidemiology of the types of injuries among jiu-jitsu practitioners that compared their incidence regarding different levels of ability and experience. Two independent researchers performed the data extraction and assessed the risk of bias. Seven studies were included. The common outcomes involved 2,847 jiu-jitsu practitioners. A high prevalence in the knee joint and chest and rib areas was reported. Considering the difference in experience level among the practitioners, we could observe that most of the individuals included were beginners. Among the age groups observed, male practitioners older than 30 years of age were the ones who presented the highest rate of musculoskeletal injury, especially during training sessions. There is a high prevalence of musculoskeletal injuries among jiu-jitsu practitioners. The most affected anatomical segments are the knee joint, the chest, and the rib region, followed by the shoulder joint. The related factors change according to certain variables, being more common during training in male individuals over 30 years of age and beginners in the sport.
PubMed: 38911890
DOI: 10.1055/s-0044-1785662 -
Frontiers in Pediatrics 2024Traffic accidents, particularly blunt impacts, cause serious injuries in children. We aimed to assess inflammatory and injury responses in infant rabbits subjected to...
BACKGROUND
Traffic accidents, particularly blunt impacts, cause serious injuries in children. We aimed to assess inflammatory and injury responses in infant rabbits subjected to acute lung injury resulting from blunt impact, with the goal of identifying potential circulatory injury markers.
METHODS
Forty 4-week-old infant rabbits were subjected to a right chest impact using a Hopkinson bar with 2,600 g. Computed tomography was employed to assess injury severity. Pathological changes were observed using hematoxylin and eosin staining in the control, 0, 24, and 72 h groups, post-injury. Immunohistochemistry was used to examine surfactant protein A (SP-A) changes in right lung tissues and upper main bronchi. Serum levels of interleukin-6 (IL-6), IL-8, and SP-A were measured using ELISA within 24 h post-injury in the control, 0 h, and 24 h groups.
RESULTS
Following blunt injury, significant increases were observed in blood white blood cell count ( = 101.556, < 0.01) and neutrophil percentage ( = 104.228, < 0.01), which gradually decreased after 24 and 72 h. The lung wet/dry weight ratio indicated significant edema ( = 79.677, < 0.01), corroborated by hematoxylin and eosin staining showing edema, exudation, and marked granulocyte infiltration in the control, 0 h, 24 h and 72 h groups. SP-A levels decreased rapidly at 0 h, and recovered between 24 and 72 h in the right lung tissues ( = 6.7, < 0.05), left lung ( = 15.825, < 0.05) and upper main bronchi ( = 59.552, < 0.01). The ELISA results showed increasing trends for the control and 0 h groups, while decreasing trends were observed in 24 h group for IL-6 ( = 58.328, < 0.01) and IL-8 ( = 41.802, < 0.01). Conversely, SP-A exhibited a decreasing trend in the control and 0 h groups but increased in the serum of 24 h group ( = 52.629, < 0.01).
DISCUSSION
In cases of direct chest trauma in infant rabbits, particularly mild injuries without rib fractures. SP-A levels correlated with pathological changes across all groups and may serve as biomarkers for pediatric blunt lung impact.
PubMed: 38910959
DOI: 10.3389/fped.2024.1354531 -
Ugeskrift For Laeger Jun 2024Slipping rib syndrome (SRS) is a possibly lesser known but not rare condition associated with severe pain in the lower part of the thorax and/or upper abdomen. SRS is... (Review)
Review
Slipping rib syndrome (SRS) is a possibly lesser known but not rare condition associated with severe pain in the lower part of the thorax and/or upper abdomen. SRS is caused by an anatomical variant where typical costa 9 collides with costa 8 resulting in neuralgic pain. Surgery with reconstruction of the rib curvature has few recurrences. The diagnosis and treatment of SRS patients are presented, but our primary aim is to raise awareness about a painful and largely overlooked condition as a differential diagnosis in patients with unexplained chronic pain in the lower thorax.
Topics: Humans; Ribs; Syndrome; Chest Pain; Diagnosis, Differential; Tomography, X-Ray Computed
PubMed: 38903030
DOI: 10.61409/V09230577 -
International Journal of Surgery Case... Jul 2024Giant cell tumors of bone (GCTB) are infrequent tumors that usually impact the epiphyses of long bones and uncommonly manifest in the ribs. Herein, we report a case of...
INTRODUCTION AND IMPORTANCE
Giant cell tumors of bone (GCTB) are infrequent tumors that usually impact the epiphyses of long bones and uncommonly manifest in the ribs. Herein, we report a case of asymptomatic GCTB directly invading the lung tissue.
CASE PRESENTATION
A 36-year-old man was referred to our emergency department with only left chest pain. Computed tomography revealed a large heterogeneous solid cystic mass in the left lung apex and amorphous calcification and distraction in the posterior part of the left fourth rib. Histological examination also exhibited that the GCTB originated from the rib. The patient underwent an en-bloc resection with no recurrence in his one-year follow-up.
CLINICAL DISCUSSION
GCTB is characterized by osteoclast-like multinucleated giant cells and can exhibit aggressive local behavior. GCTB in the rib is rare, mainly found in the posterior arc. Radiographic features include lytic lesions with bone remodeling, often seen eccentrically in long bone epiphyses. Aggressive tumors may show cortical destruction and soft tissue extension. Surgery is often recommended for GCTB management, aiming for complete resection with sufficient surgical margins.
CONCLUSION
The absence of well-defined diagnostic criteria hinders the accurate diagnosis of GCTB, making a comprehensive assessment through radiological and histological examinations crucial. Upon physical examination, GCTB should be considered in the differential diagnosis for mediastinal lesions, regardless of their size. Furthermore, surgical removal can be taken into account as the primary treatment strategy for tumors that originate from the posterior arc of the ribs, such as GCTB.
PubMed: 38896991
DOI: 10.1016/j.ijscr.2024.109896 -
Journal of Clinical Medicine Jun 2024Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury...
Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, = 0.0007), fewer concomitant injuries (5 vs. 7, = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy.
PubMed: 38893026
DOI: 10.3390/jcm13113315 -
International Journal of Molecular... May 2024Derived from axial structures, Sonic Hedgehog (Shh) is secreted into the paraxial mesoderm, where it plays crucial roles in sclerotome induction and myotome...
Derived from axial structures, Sonic Hedgehog (Shh) is secreted into the paraxial mesoderm, where it plays crucial roles in sclerotome induction and myotome differentiation. Through conditional loss-of-function in quail embryos, we investigate the timing and impact of Shh activity during early formation of sclerotome-derived vertebrae and ribs, and of lateral mesoderm-derived sternum. To this end, Hedgehog interacting protein (Hhip) was electroporated at various times between days 2 and 5. While the vertebral body and rib primordium showed consistent size reduction, rib expansion into the somatopleura remained unaffected, and the sternal bud developed normally. Additionally, we compared these effects with those of locally inhibiting BMP activity. Transfection of Noggin in the lateral mesoderm hindered sternal bud formation. Unlike Hhip, BMP inhibition via Noggin or Smad6 induced myogenic differentiation of the lateral dermomyotome lip, while impeding the growth of the myotome/rib complex into the somatic mesoderm, thus affirming the role of the lateral dermomyotome epithelium in rib guidance. Overall, these findings underscore the continuous requirement for opposing gradients of Shh and BMP activity in the morphogenesis of proximal and distal flank skeletal structures, respectively. Future research should address the implications of these early interactions to the later morphogenesis and function of the musculo-skeletal system and of possible associated malformations.
Topics: Animals; Hedgehog Proteins; Ribs; Spine; Gene Expression Regulation, Developmental; Mesoderm; Quail; Somites; Bone Morphogenetic Proteins; Carrier Proteins
PubMed: 38891790
DOI: 10.3390/ijms25115602 -
Annals of Surgery Open : Perspectives... Mar 2024
PubMed: 38883955
DOI: 10.1097/AS9.0000000000000377 -
Annals of Surgery Open : Perspectives... Mar 2024
PubMed: 38883939
DOI: 10.1097/AS9.0000000000000389 -
Factors associated with incomplete resection for large, locally invasive non-small cell lung cancer.Journal of Thoracic Disease May 2024Large, node-negative but locally invasive non-small cell lung cancer (NSCLC) is associated with increased perioperative risk but improved survival if a complete...
BACKGROUND
Large, node-negative but locally invasive non-small cell lung cancer (NSCLC) is associated with increased perioperative risk but improved survival if a complete resection is obtained. Factors associated with positive margins in this population are not well-studied.
METHODS
We performed a retrospective cohort study using National Cancer Database (NCDB) for adult patients with >5 cm, clinically node-negative NSCLC with evidence of invasion of nearby structures [2006-2015]. Patients were classified as having major structure involvement (azygous vein, pulmonary artery/vein, vena cava, carina/trachea, esophagus, recurrent laryngeal/vagus nerve, heart, aorta, vertebrae) or chest wall invasion (rib pleura, chest wall, diaphragm). Our primary outcome was to evaluate factors associated with incomplete resection (microscopic: R1, macroscopic: R2). Kaplan-Meier analysis and cox multivariable regression models were used to evaluate overall survival (OS), 90-day mortality, and factors associated with positive margins.
RESULTS
Among 2,368 patients identified, the median follow-up was 33.8 months [interquartile range (IQR), 12.6-66.5 months]. Most patients were white (86.9%) with squamous cell histology (47.3%). Major structures were involved in 26.4% of patients and chest wall invasion was seen in 73.6%. Four hundred and seventy-eight patients (20.2%) had an incomplete resection. Multivariable analysis revealed that black race [hazard ratio (HR) 1.568, 95% confidence interval (CI): 1.109-2.218] and major structure involvement (HR 1.412, 95% CI: 1.091-1.827) was associated with increased risk of incomplete resection and surgery at an academic hospitals (HR 0.773, 95% CI: 0.607-0.984), adenocarcinoma histology (HR 0.672, 95% CI: 0.514-0.878), and neoadjuvant chemotherapy (HR 0.431, 95% CI: 0.316-0.587) were associated with decreased risk of incomplete resection. The 5-year OS was 43.7% in the entire cohort and 28.8% in patients with positive margins and 47.5% in patients with an R0 resection. Positive margin was also associated with a significantly higher 90-day mortality rate (9.9% versus 6.7%).
CONCLUSIONS
For patients with large, node-negative NSCLC invading nearby structures, R0 resection portends better survival. Treatment at academic centers, adenocarcinoma histology, and receipt of neoadjuvant chemotherapy are associated with R0 resection in this high-risk cohort.
PubMed: 38883676
DOI: 10.21037/jtd-23-989