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Clinical Transplantation and Research Jun 2024Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and...
Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.
PubMed: 38725186
DOI: 10.4285/ctr.24.0011 -
Annals of Cardiac Anaesthesia Jan 2024
Topics: Humans; Surgical Wound Infection; Sternum; Surgeons; Sternotomy
PubMed: 38722113
DOI: 10.4103/aca.aca_202_23 -
Health Science Reports May 2024Given the extensive impact of road traffic accidents (RTAs) consequences and their potential ramifications on the health of both current and future generations, this...
BACKGROUND
Given the extensive impact of road traffic accidents (RTAs) consequences and their potential ramifications on the health of both current and future generations, this study examines the social and demographic factors that influence RTA-related mortality among women of reproductive age.
METHODS
The study population consisted of cases retrieved from the database of the Legal Medicine Organization, encompassing all women aged 15-49 who succumbed to road accidents between 2011 and 2021.
RESULTS
The mean age of women in the reproductive age group from East Azerbaijan province between 2011 and 2021 was 33.67 years, with a standard deviation of 9.18. RTAs on main roads accounted for the majority of incidents (395 cases, 50.8%), with 93.7% (728 cases) attributed to road traffic. In 54.4% of these cases, the affected organ was the head and neck, and the primary cause of death in 52.1% was head trauma. Across all age groups, injuries to the neck and head were the most common, followed by injuries to the abdomen, chest, back, and sternum.
CONCLUSION
The higher incidence of road accidents in the 25-29 age group highlights the need for targeted interventions to address risky behaviors, inexperience, and peer influences in this demographic. Our observation of passengers experiencing the highest mortality rate emphasizes the vulnerability of road users, particularly pedestrians, in traffic accidents. Pedestrian violations in the 17-30 age group further emphasize the importance of education and awareness campaigns aimed at reducing risky behavior.
PubMed: 38715725
DOI: 10.1002/hsr2.2058 -
Cureus Apr 2024Although rare, primary chondrosarcoma is the most frequent malignant tumor of the sternum. It commonly manifests as a painful, expanding mass arising from the...
Although rare, primary chondrosarcoma is the most frequent malignant tumor of the sternum. It commonly manifests as a painful, expanding mass arising from the costochondrosternal junction. Since it is resistant to radiotherapy and chemotherapy, surgical resection with reconstruction is the preferred treatment. A 50-year-old male presented with swelling over the left fourth sternocostal joint, gradually increasing in size. Imaging and clinical assessment suggested an infiltrative neoplasm, and surgical resection was indicated. The patient underwent a partial sternectomy, including a resection of the xiphoid process and costal cartilages two to seven and a partial resection of the manubrium. Postoperative pathohistological analysis specified the change as a low-grade chondrosarcoma in the pT1 stage. Chest wall reconstruction involved three pectus bars fixated around the ribs and the placement of a synthetic polypropylene mesh. The patient required postoperative rehospitalization due to partial skin layer wound dehiscence, serous drainage, and fever. Empirical antibiotic therapy was initiated, and the patient underwent a median superior laparotomy with partial omentoplasty of the sternal region, preserving the mesh and pectus bars. A culture analysis revealed methicillin-resistant , and postoperative antibiotic therapy was adapted to the antibiogram. Subsequently, all parameters of inflammation decreased, and wound healing followed. A one-year follow-up CT scan showed no disease recurrence. This case highlights the intricate surgical management that contributed to the successful treatment of sternal chondrosarcoma. Sternal wound infection, a severe postoperative complication with a high mortality rate, requires prompt identification, precise revision with culture-directed antibiotics, and effort to preserve the prosthetic material.
PubMed: 38707077
DOI: 10.7759/cureus.57594 -
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 -
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