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Texas Heart Institute Journal Aug 2015Primary chondromyxoid fibroma is a benign bone tumor. Its localization in the sternum is quite rare; we found only 6 relevant reports. We report our diagnosis and... (Review)
Review
Primary chondromyxoid fibroma is a benign bone tumor. Its localization in the sternum is quite rare; we found only 6 relevant reports. We report our diagnosis and treatment of a chondromyxoid fibroma in the sternum of a 63-year-old woman. The patient underwent subtotal sternectomy and chest-wall reconstruction with use of a titanium rib bridge system and Prolene mesh. The patient's clinical course was uneventful, and she had no local recurrence 41 months postoperatively. Our review herein of the 6 previous cases reveals that our patient is the oldest thus far to have been diagnosed with a sternal chondromyxoid fibroma.
Topics: Biopsy; Bone Neoplasms; Female; Fibroma; Humans; Middle Aged; Plastic Surgery Procedures; Sternotomy; Sternum; Thoracic Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26413029
DOI: 10.14503/THIJ-14-4381 -
The Journal of Thoracic and... Oct 2016
Review
Topics: Humans; Practice Guidelines as Topic; Sternotomy; Sternum; Surgical Wound Infection
PubMed: 27555340
DOI: 10.1016/j.jtcvs.2016.01.060 -
Folia Morphologica 2017The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical... (Review)
Review
BACKGROUND
The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations.
MATERIALS AND METHODS
We review relevant literature, and we present data obtai-ned from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation.
RESULTS
The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects.
CONCLUSIONS
The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively.
Topics: Female; Humans; Male; Middle Aged; Sternum
PubMed: 28150272
DOI: 10.5603/FM.a2017.0006 -
Interactive Cardiovascular and Thoracic... Apr 2021A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration... (Review)
Review
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether >238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and >23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.
Topics: Administration, Topical; Anti-Infective Agents; Cardiac Surgical Procedures; Gentamicins; Humans; Meta-Analysis as Topic; Sternotomy; Sternum; Surgical Wound Infection; Treatment Outcome; Vancomycin
PubMed: 33346346
DOI: 10.1093/icvts/ivaa292 -
The Journal of Thoracic and... Mar 2018
Topics: Aortic Valve; Minimally Invasive Surgical Procedures; Sternum; Thoracotomy
PubMed: 29129422
DOI: 10.1016/j.jtcvs.2017.10.005 -
Yonsei Medical Journal Dec 2023Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal...
PURPOSE
Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal complication rate, the clamshell incision is considered a procedure that requires improvement. In this study, we aimed to investigate the outcomes of transverse sternotomy with clamshell incision in comparison to sternum-sparing bilateral anterolateral thoracotomy (BAT).
MATERIALS AND METHODS
In total, 134 bilateral sequential lung transplants were performed from May 2013 to June 2022. The clamshell incision was used between May 2013 and December 2017, and the BAT was introduced in January 2018. Thirty-four patients underwent clamshell surgery, and 100 patients underwent BAT. We retrospectively compared patient characteristics and perioperative and postoperative outcomes between the two groups.
RESULTS
The clamshell group required an operation time of 745.18±101.76 min, which was significantly longer than that of the BAT group at 669.90±134.09 min (=0.003). The mechanical ventilation period after surgery was 17.26±16.04 days in the clamshell group, significantly longer than the 11.35±12.42 days in the BAT group (=0.028). Intensive care unit stay was also significantly longer in the clamshell group (21.54±15.23 days vs. 15.03±14.28 days; =0.033). In-hospital mortality rates were 26.5% in the clamshell group and 22.0% in the BAT group.
CONCLUSION
Less-invasive lung transplantation via sternum-sparing BAT is a safe procedure with low morbidity and favorable outcomes. Preventing sternal instability enables more stable breathing after surgery, earlier weaning from mechanical ventilation, and faster recovery to routine activities.
Topics: Humans; Retrospective Studies; Lung Transplantation; Sternum; Thoracotomy; Operative Time
PubMed: 37992745
DOI: 10.3349/ymj.2023.0104 -
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 -
Multimedia Manual of Cardiothoracic... Nov 2023On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed...
On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed sternal closure. One notable source of postoperative bleeding is the sternum, either due to medullar bleeding or bone margin oozing, which may be difficult to control. Furthermore, in cases with right ventricular failure or dilatation needing an open-chest strategy, sternal margins might erode and injure the right ventricular anterior wall. We propose a simple but effective sternal protection technique during open-chest management and further delayed chest closure. Using leftover tubing from the cardiopulmonary bypass circuit or a mediastinal 32 Fr drain, both sternal margins are covered and secured with sutures. Moreover, in case of profuse bleeding, a thrombin-derived haemostatic agent can be applied between the bone marrow and the tube for an additional level of haemostasis. The sternal wound is isolated with a latex membrane and covered with transparent sterile adhesive sheets to achieve vacuum sealing.
Topics: Humans; Surgical Wound Infection; Sternum; Heart Failure; Reoperation
PubMed: 37922119
DOI: 10.1510/mmcts.2023.058 -
Diagnostic and Interventional Radiology... 2014We aimed to evaluate the postnatal development and the maturation of the sternum and sternal variations using multidetector computed tomography (MDCT). Additionally, we...
PURPOSE
We aimed to evaluate the postnatal development and the maturation of the sternum and sternal variations using multidetector computed tomography (MDCT). Additionally, we aimed to examine the roles of gender and age in sternal development.
MATERIALS AND METHODS
Two hundred and fifty patients who underwent thorax MDCT examinations were evaluated for sternal development and variations. Coronal curved planar reconstruction and maximum intensity projection images were used to better assess the ossification centers in the manubrium and the body of the sternum. Multiplanar images were used to accurately measure the thickness and the sagittal dimension of the manubrium, the sagittal dimension of the body, and the total sagittal dimension of the sternum in the sagittal plane.
RESULTS
No significant differences in the manubrium measurements were observed between the genders. The thickness and sagittal dimension of the manubrium, sagittal dimension of the body, and total sagittal dimension of the sternum in the sagittal plane were significantly different between the age groups. We evaluated the ossification centers; shape and developmental variations in the manubrium and body; direction, calcification, and termination of the xiphoid process; developmental variations in the xiphoid process; and manubriosternal and sternoxiphoidal fusion. Significant variations were observed from person to person.
CONCLUSION
The anatomy and the developmental properties of the sternum should be well understood in cases of potential chest and sternum injuries and in several surgical procedures. Therefore, knowledge of the development and the maturation of the sternum, and sternal variations and anomalies is important. We suggest that the postnatal development and the morphogenesis of the sternum can be adequately assessed using MDCT.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Multidetector Computed Tomography; Osteogenesis; Sternum; Young Adult
PubMed: 24100061
DOI: 10.5152/dir.2013.13121 -
Canadian Respiratory Journal 2012A greater structural expansion of the rib cage in females compared with males has been described in cystic fibrosis (CF) patients; however, conflicting data exist as to...
BACKGROUND
A greater structural expansion of the rib cage in females compared with males has been described in cystic fibrosis (CF) patients; however, conflicting data exist as to whether an elongation of the bony ribs and sternum contributes to this expansion.
OBJECTIVES
To compare height-adjusted anthropometric measures and sternum length between a group of normal subjects and a group of CF patients of both sexes.
METHODS
Anthropometric measurements including body weight, height, upper and lower limb lengths, biacromial distance and pelvic width were measured in the standing position in 30 CF patients (13 males) and 28 normal subjects (14 males). Body surface measurements of anterior-posterior and lateral diameters of the rib cage at functional residual capacity, and sternum length were also obtained.
RESULTS
Compared with normal subjects, CF patients had lower body weight, shorter standing height and shorter height-adjusted upper and lower limb lengths. Rib cage diameters were greater in CF patients than in normal subjects of either sex, but height-adjusted sternum length was not different.
CONCLUSION
Significant differences in bodily proportions were found between normal subjects and CF patients, suggesting a differential growth pattern for the trunk and limbs. However, increased rib cage dimensions with lung hyperinflation and airway obstruction was not associated with an elongation of the sternum.
Topics: Adult; Anthropometry; Body Height; Body Weight; Case-Control Studies; Cystic Fibrosis; Female; Functional Residual Capacity; Humans; Male; Ribs; Sternum; Thoracic Wall
PubMed: 22679612
DOI: 10.1155/2012/408518