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Soudni Lekarstvi 2024This review delves into the forensic utility of the sternum in creating a biological profile, focusing on sex, stature, and age estimation. Emphasizing the sternum's... (Review)
Review
This review delves into the forensic utility of the sternum in creating a biological profile, focusing on sex, stature, and age estimation. Emphasizing the sternum's significance in challenging scenarios, the study supports the combined length of the manubrium and sternal body as a crucial indicator in sex and stature estimation. However, it highlights the need for caution in applying findings across diverse populations and questions the reliability of Hyrtl's law. Age estimation, primarily based on morphological changes and ossification ages, is explored, with one study showing promise but requiring further validation. While acknowledging the sternum's advantages, the review underscores potential limitations and the absence of specific studies on ancestry estimation, leaving this aspect open for future research. In conclusion, the review provides a comprehensive overview of the sternum's forensic applications, urging continued research to enhance accuracy and applicability.
Topics: Sternum; Humans; Forensic Anthropology; Age Determination by Skeleton; Male; Body Height; Sex Determination by Skeleton; Female
PubMed: 38697832
DOI: No ID Found -
Klinicka Onkologie : Casopis Ceske a... 2024Uveal melanoma is a rare cancer, in which metastases occur in approximately one half of cases. In metastatic disease, the prognosis is unfavorable and the median of...
BACKGROUND
Uveal melanoma is a rare cancer, in which metastases occur in approximately one half of cases. In metastatic disease, the prognosis is unfavorable and the median of survival does not exceed 6 months. Effective treatment options were very limited up to date. Tebentafusp is a bispecific fusion protein, which as the first drug proved efficacy in uveal melanoma.
CASE
The patient was referred for suspected uveal melanoma of the left eye. She was treated for Hodgkin's disease in the past. Primarily, the tumor was treated by radiosurgery with radiotherapy of a small lesion of the vertebral body. However, later the patient had to undergo bulbus enucleation with confirmation of a large tumor category pT4b. PET/CT revealed metastases of the bones and the liver; simultaneously, haplotype A*02: 01 was confirmed. The patient underwent radiotherapy of the sternum and later, after confirmation of payment from the health insurance company, she started treatment with tebentafusp. The first three doses were administered during admission to the hospital, with a need to treat cytokine release syndrome by corticosteroids. Later, the administration was performed in an out-patient regimen, without complications, except for a transient elevation of transaminases. The first CT restaging confirmed stable disease; however, the second restaging confirmed a new osteolytic lesion in the processus of Th11. Because of progression, the treatment with tebentafusp was withdrawn after 6 months. Unfortunately, the lesion could not be treated by radiotherapy. Two months later, the patient was urgently admitted to the hospital because of right-sided hemiplegia; MRI revealed bleeding metastatic lesion in the brain stem.
CONCLUSION
In this case report, we present the case of the first patient treated with this drug in the Czech Republic.
Topics: Humans; Melanoma; Uveal Neoplasms; Female; Czech Republic; Antineoplastic Agents; Bone Neoplasms; Liver Neoplasms; Recombinant Fusion Proteins
PubMed: 38697822
DOI: 10.48095/ccko2024134 -
Frontiers in Cellular and Infection... 2024Diagnosing poses challenges, and it's unclear if its rare isolation is due to infrequent occurrence or its fastidious nutritional requirements.
INTRODUCTION
Diagnosing poses challenges, and it's unclear if its rare isolation is due to infrequent occurrence or its fastidious nutritional requirements.
METHODS
This study analyzes the complete genome sequence of , obtained directly from the pus of a sternum infection in a lung transplant patient using metagenomic sequencing.
RESULTS
Genome analysis revealed limited therapeutic options for the infection, primarily susceptibility to tetracyclines. Three classes of mobile genetic elements were identified: two new insertion sequences, a new prophage (phiUMCG-1), and a species-specific variant of a mycoplasma integrative and conjugative element (MICE). Additionally, a Type I Restriction-Modification system was identified, featuring 5'-terminally truncated pseudogenes with overlapping repeats, indicating the potential for forming alternative variants through recombination.
CONCLUSION
This study represents the first-ever acquisition of a complete circularized bacterial genome directly from a patient sample obtained from invasive infection of a primary sterile site using culture-independent, PCR-free clinical metagenomics.
Topics: Humans; Metagenomics; Genome, Bacterial; High-Throughput Nucleotide Sequencing; Mycoplasma; Mycoplasma Infections; Whole Genome Sequencing; Lung Transplantation; Prophages; Interspersed Repetitive Sequences; Anti-Bacterial Agents
PubMed: 38694516
DOI: 10.3389/fcimb.2024.1368923 -
Journal of Plastic, Reconstructive &... Jun 2024Pectus arcuatum, also known as horns of steer anomaly or Currarino-Silverman Syndrome, is a distinct chest wall anomaly characterized by severe manubriosternal...
BACKGROUND
Pectus arcuatum, also known as horns of steer anomaly or Currarino-Silverman Syndrome, is a distinct chest wall anomaly characterized by severe manubriosternal angulation, a shortened sternum, and mild pectus excavatum. The anomaly is typically repaired using open techniques, employing orthopedic fixation devices. Here, we report the results of a minimally invasive hybrid procedure to repair pectus arcuatum.
METHODS
The procedure combines a standard Nuss procedure to correct the depressed sternum with a short upper chest (in boys) or inter-mammary (in girls) incision for bilateral subperichondrial resection of the upper costal cartilages, osteotomy, and correction of the manubrial angulation. The medical records of all patients who underwent the procedure over the last 10 years were reviewed.
RESULTS
Five patients, 3 boys and 2 girls, aged 14 to 17 years, underwent the procedure. Three patients had their pectus bars removed 3-4 years after repair. Follow-up after correction ranged from 6 months to 7 years. Good correction resulted in all patients achieving recovery without complications and recurrence. To date, all patients have been satisfied with their results.
CONCLUSIONS
The minimally invasive hybrid procedure adequately corrects pectus arcuatum with minimal scarring and high satisfaction.
Topics: Humans; Male; Female; Adolescent; Minimally Invasive Surgical Procedures; Funnel Chest; Osteotomy; Sternum; Treatment Outcome; Thoracic Wall; Retrospective Studies; Follow-Up Studies
PubMed: 38691947
DOI: 10.1016/j.bjps.2024.04.043 -
Multimedia Manual of Cardiothoracic... May 2024Bone metastasis is the most common form of distant metastasis encountered within the breast cancer population. Surgical resection of bone metastases is a curative...
Bone metastasis is the most common form of distant metastasis encountered within the breast cancer population. Surgical resection of bone metastases is a curative treatment option in patients who present with an isolated solitary lesion and no other associated disease. This decision is typically made following a multidisciplinary discussion. Patients can also be put forward for surgical excision of bone metastases following inadequate response to chemotherapy or radiotherapy. With tumours located in the manubrium of the sternum, surgery serves not only to resect the bone metastasis but to provide suitable chest wall reconstruction. The goal of this approach is to maintain the structural and bony stability of the chest wall as well as that of associated structures, e.g. rib insertion or articulation of the shoulder girdle. A widely utilized approach involves excising the area of metastasis within the manubrium followed by implanting a bone cement prosthesis. Titanium plates are used to fix the bone prosthesis to the sternal body inferiorly and to the remainder of the manubrium superiorly. We present a step-by-step video tutorial for performing a lower hemi-manubriectomy in a patient with triple-negative breast cancer. Our goal is to describe the fundamental principles and surgical techniques used to perform this procedure followed by the postoperative outcomes.
Topics: Humans; Female; Bone Neoplasms; Manubrium; Triple Negative Breast Neoplasms; Middle Aged
PubMed: 38690721
DOI: 10.1510/mmcts.2024.005 -
Journal of Cardiothoracic Surgery Apr 2024There are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized,...
BACKGROUND
There are various reconstructive methods after total sternectomy. Reproducibility is scarce due to overall small patient numbers. Therefore we present a standardized, interdisciplinary approach for thoracic and plastic surgery.
METHODS
Four patients underwent interdisciplinary chest wall reconstruction with STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flap in our center.
RESULTS
All patients reported chest wall stability after reconstruction. They reported good quality of life, no dyspnea, prolonged pain or impairment in lung function from rigid reconstruction. FEV1/FVC was overall better after surgery. Secondary wound healing was not impaired and there was no implant defect in follow up.
CONCLUSIONS
We recommend an interdisciplinary surgical approach in chest wall reconstruction after total sternectomy. The combination of rigid reconstruction with titanium bars and a myocutaneous vastus lateralis muscle free flap renders excellent results in patient satisfaction and is objectifiable via spirometry.
Topics: Humans; Thoracic Wall; Plastic Surgery Procedures; Male; Sternum; Middle Aged; Aged; Female; Quality of Life; Myocutaneous Flap
PubMed: 38689350
DOI: 10.1186/s13019-024-02743-6 -
Annali Italiani Di Chirurgia 2024Primary chest wall tumors account for 5% of all thoracic neoplasms and 1% of all primary tumors. Chondrosarcoma is a rare solid tumor, with an annual incidence of <0.5...
INTRODUCTION
Primary chest wall tumors account for 5% of all thoracic neoplasms and 1% of all primary tumors. Chondrosarcoma is a rare solid tumor, with an annual incidence of <0.5 per million people per year. It predominantly occurs in the pelvis and femur, occasionally occurs in flat bones such as the sternum and ribs, and rarely invades lung tissue. Chest wall chondrosarcomas represent only 5-15% of all chondrosarcomas. Radical surgery often leads to a large range of chest wall defects, especially when the range exceeds 6 cm × 6 cm and involves the sternum, spine, or multiple consecutive ribs. The reconstruction of the chest wall bone should be considered to restore the integrity and stability of the chest, prevent chest wall softening and abnormal breathing, and ensure the stability of respiratory circulation. Chest wall reconstruction can help restore thoracic hardness and integrity, prevent lung hernia and abnormal breathing, while also ensuring a positive aesthetic outcome. The chest wall reconstruction includes reconstruction of the pleura, bony structures, and soft tissues.
CASE REPORT
In our case of an adult male, after the resection of the third and fourth anterior rib chondrosarcoma, the common anatomical plate was shaped and fixed to the stump of the third rib with screws to ensure the stability of the thorax while retaining the mobility of the thorax. After applying hernia mesh pruning, the chest wall defect was stitched to complete the pleural reconstruction of the defect area. This procedure can effectively maintain the stability of the pleural cavity, provide more effective support for the chest wall soft tissue, and promote the recovery of upper limb function and lung function.
CONCLUSION
The radical surgery of giant chest wall chondrosarcoma often leads to a large range of chest wall defects. Chest wall reconstruction needs to be carried out at the same time to restore the integrity and stability of the chest wall, to avoid chest wall softening and abnormal breathing, and to ensure the stability of respiratory circulation. Using the "sandwich" method for chest wall reconstruction, in which an anatomical plate is combined with hernia mesh and muscle soft tissue, and during which pleura, bony structure, and soft tissues are reconstructed, can provide more effective support for chest wall soft tissue, effectively prevent postoperative muscle tissue collapse, avoid postoperative abnormal breathing, and promote the recovery of postoperative upper limb function and lung function. It is a very effective method for chest wall reconstruction.
Topics: Humans; Chondrosarcoma; Thoracic Wall; Male; Thoracic Neoplasms; Bone Neoplasms; Ribs; Plastic Surgery Procedures; Middle Aged
PubMed: 38684505
DOI: 10.62713/aic.3148 -
Journal of Global Infectious Diseases 2024Extra pulmonary tuberculosis is on the rise worldwide, and younger patients, are females. And people from Asia and Africa are at high risk. Sternoclavicular TB is...
Extra pulmonary tuberculosis is on the rise worldwide, and younger patients, are females. And people from Asia and Africa are at high risk. Sternoclavicular TB is extremely rare, even in countries that have a high prevalence of TB. It can be in the absence of pulmonary TB. It has a varied clinical presentation. Painless chest wall swelling can be the presenting symptom of sternoclavicular diagnosis. Ultrasonography and high-resolution computed tomography can identify the nature of the lesion and the extent of bone involvement. Aspiration from the swelling or histopathology examination is mandatory for diagnosis. Caseous necrosis is diagnostic of TB. Detection of acid-fast bacilli in smears or tissue or molecular methods is required for definitive diagnosis. A high degree of clinical suspicion is required for early diagnosis. The treatment of thoracic TB is the subject of controversy. Anti-tubercular drugs are the mainstay of treatment. Surgical intervention is basically for flattening cold abscesses and removing infected tissue, including affected bones and cartilage.
PubMed: 38680750
DOI: 10.4103/jgid.jgid_64_23 -
Iranian Journal of Medical Sciences Apr 2024Extensive chest wall defects occur in 28% of all sternal resection cases and are a major challenge in thoracic surgery. These cases are generally considered "critical...
Extensive chest wall defects occur in 28% of all sternal resection cases and are a major challenge in thoracic surgery. These cases are generally considered "critical defects" requiring primary or secondary reconstruction using various types of flaps, mesh repairs, bone autografts, or endoprosthesis. The past decade witnessed rapid advances in the application of personalized endoprostheses in thoracic surgery. Surgeons began to use carbon or titanium grafts for personalized sternum replacement. The main advantages of these implants are superior cosmetic effect, biocompatibility, and low risk of infection. Herein, we present a case of a 55-year-old patient with an indication for extended sternum resection due to metastatic thyroid cancer. The patient underwent extended sternum resection, followed by the implantation of a personalized microporous titanium sternum equipped with graspers for atraumatic rib fixation.
Topics: Humans; Middle Aged; Titanium; Sternum; Prostheses and Implants; Male; Plastic Surgery Procedures; Thyroid Neoplasms
PubMed: 38680226
DOI: 10.30476/ijms.2023.97060.2873 -
Scientific Reports Apr 2024Despite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical... (Meta-Analysis)
Meta-Analysis
Despite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical practice. The value of topical vancomycin and gentamicin for sternal wound infections (SWI) prophylaxis was further questioned by recent studies including randomized controlled trials (RCTs). The aim of this systematic review and meta-analysis was to comprehensively assess the safety and effectiveness of RAD to reduce the risk of SWI.We screened multiple databases for RCTs assessing the effectiveness of RAD (vancomycin, gentamicin) in SWI prophylaxis. Random effects meta-analysis was performed. The primary endpoint was any SWI; other wound complications were also analysed. Odds Ratios served as the primary statistical analyses. Trial sequential analysis (TSA) was performed.Thirteen RCTs (N = 7,719 patients) were included. The odds of any SWI were significantly reduced by over 50% with any RAD: OR (95%CIs): 0.49 (0.35-0.68); p < 0.001 and consistently reduced in vancomycin (0.34 [0.18-0.64]; p < 0.001) and gentamicin (0.58 [0.39-0.86]; p = 0.007) groups (p = 0.15). Similarly, RAD reduced the odds of SWI in diabetic and non-diabetic patients (0.46 [0.32-0.65]; p < 0.001 and 0.60 [0.44-0.83]; p = 0.002 respectively). Cumulative Z-curve passed the TSA-adjusted boundary for SWIs suggesting adequate power has been met and no further trials are needed. RAD significantly reduced deep (0.60 [0.43-0.83]; p = 0.003) and superficial SWIs (0.54 [0.32-0.91]; p = 0.02). No differences were seen in mediastinitis and mortality, however, limited number of studies assessed these endpoints. There was no evidence of systemic toxicity, sternal dehiscence and resistant strains emergence. Both vancomycin and gentamicin reduced the odds of cultures outside their respective serum concentrations' activity: vancomycin against gram-negative strains: 0.20 (0.01-4.18) and gentamicin against gram-positive strains: 0.42 (0.28-0.62); P < 0.001. Regional antibiotic delivery is safe and effectively reduces the risk of SWI in cardiac surgery patients.
Topics: Humans; Surgical Wound Infection; Randomized Controlled Trials as Topic; Anti-Bacterial Agents; Antibiotic Prophylaxis; Vancomycin; Gentamicins; Sternum; Cardiac Surgical Procedures
PubMed: 38678140
DOI: 10.1038/s41598-024-60242-z