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A rare case of focal primary amyloidosis is presented with CT and MR correlation. Imaging findings demonstrate an expansile, mixed sclerotic and lytic lesion in the sternum, with MR signal characteristics similar to those previously described for diffuse primary amyloidosis and hemodialysis-related amyloidosis.
We describe a case of chondrosarcoma of the sternum requiring wide full thickness chest wall excision thereby creating a difficult defect for reconstruction. A mesh was used for support and two extended deep inferior epigastric artery fasciocutaneous flaps were mobilised medially into the defect.
The skeletal changes of severe hyperparathyroidism, known as osteitis fibrosa cystica, are now rarely encountered, because hyperparathyroidism is currently being diagnosed and treated at an early stage. Herein, a case of brown tumor of the sternum is reported; our report adds histologic data on this type of tumor to the literature.
Closure of the median sternotomy incision using stainless steel wires passed through the tip of a sternum-perforating awl is a common procedure. Digital injury can result should the awl shaft suddenly snap during sternal penetration. Sheathing the shaft with a plastic guard will prevent injury when this occurs.
A modification of the Kocher clamp used for wire closure of the sternum is described. With the clamp applied securely to the individual strands, the wire can be readily twisted; the shorter length of the clamp allows the surgeon a much firmer grip on the wire and saves considerable time during closure.
Stenting the sternum may be essential to keep the sternal edges apart and optimize the hemodynamics in some patients, after cardiac operations. We have devised an effective stent that can be prepared very quickly from the equipment available in the operating room.
Chondrocytes from the presumptive calcification region of 20 day old embryonic chick sternum were found to synthesize a 70 Kd Type X procollagen precursor in addition to the previously described 59 Kd Type X collagen molecules. The 70 Kd molecules exhibited an additional cyanogen bromide peptide, contained a disulfide-bonded domain, and were converted into the 59 Kd moieties during pulse-chase experiments. The conversion of the 70 Kd to the 59 Kd Type X collagen was prevented upon microtubular transport inhibition with colchicine and resulted in tissue accumulation of the 70 Kd Type X procollagen.
Desmoplastic fibroma of bone is very rare. This is only the second case reported in the sternum and the first reported with CT findings.
Stress fracture of the sternum is a rare condition which presents as acute anterior chest pain after repetitive upper-body exercise. Two case reports are presented and it is postulated that this is an often underdiagnosed condition which should be considered in the differential diagnosis of acute chest pain in the athlete. Awareness of the injury together with meticulous clinical examination supported by good quality radiographs or isotope bone scan may lead to an increase in the diagnosis of this injury.
Primary malignant sternal tumours are very rare. The most common malignant sternal tumour is a chondrosarcoma. Until now, controversies in the management of malignant sternal tumours were mainly caused by limited clinical experience. However, treatment of malignant sternal tumours should not differ from that of chest wall malignancies. In this paper a 74-year-old man with a kyphoscoliosis and an osteosarcoma of the sternum is described who received combined treatment modalities, consisting of surgical resection and reconstruction with a myocutaneous flap, followed by external beam radiotherapy. This treatment strategy is discussed.
OBJECTIVE: Using the Ley prosthesis, a 0.5mm thick titanium alloy plate for stabilising the sternum, is a new method in the treatment of mediastinitis after open-heart surgery. We report a retrospective analysis of our experience with this device. METHODS: One hundred consecutive cases of post-operative mediastinitis in the period 1992-1997 were reviewed. The primary procedure at reoperation for infection was as follows: 52 patients were treated with the Ley prosthesis and 48 patients underwent other conventional procedures. The choice of the surgical technique depended on the attending surgeon. The prosthesis was used more frequently in patients with sternal dehiscence (P<0.001) but otherwise patients' characteristics were similar in the two groups. As a control population for outcome data, 100 uninfected patients were matched with regard to operative procedure, age, sex and date of surgery. RESULTS: The median hospital stay was 48.5 days in the mediastinitis group vs. 14 days in the control group. The all-cause 90-day mortality in the mediastinitis group was 18% vs. 5% in the control group. The 52 patients treated with the Ley prosthesis had a median length of stay in the cardiac surgery ward for 29 days vs. 41.5 days in the mediastinitis group not treated with the prosthesis (P=0.013). However, when the total length of stay including hospitals outside the cardiac surgery ward was taken into account, the prosthesis did not reduce the length of stay. Only 8/52 patients treated with the prosthesis required further surgery vs. 23/48 patients who were not primarily treated with the prosthesis (P<0.001). The Ley prosthesis had no impact on mortality. CONCLUSION: The Ley prosthesis is a valuable adjunct to the treatment of mediastinitis after open-heart surgery. A shorter stay at the cardiac surgery ward and a reduced need for further surgical procedures were observed when using this prosthesis.
Recurrence after complete excision of non-invasive thymoma is infrequent. We report a case of recurrent thymoma in the sternum in a 76-year-old man 13 years after complete surgical resection of stage I thymoma.
Resection of the sternum can be performed safely and offers the best choice for cure for a primary sternal malignancy. Survival after resection is dependent on the histology and grade of the tumor.
Cultured chondrocytes derived from the caudal and cephalic ends of embryonic chick sterna have been compared with each other and with whole sternum, by using a panel of 21 lectins to probe the distribution of oligosaccharides in glycoconjugates of cells and matrix at various times of culture or development. On culture in collagen gels, the cells changed their morphology with time, degrading glycan in the surrounding culture medium and depositing new matrix, the glycan content of which reflected the site of origin of the cells, indicating that the glycan phenotype of both cells and matrix ('glycotype') was predetermined and persistent. Sterna of embryonic chicks showed unexpected complexity in their distribution pattern of glycan, containing at least six distinct regions. Major regional temporal differences were evident among saccharides terminating in alpha-N-acetyl galactosamine and beta-galactose, while changes in glycans terminating in fucose, sialic acid and alpha-mannose were somewhat less marked. Subsets of complex N-glycans changed little.
BACKGROUND: Internal thoracic arterial grafts (ITA) in coronary artery bypass surgery provide excellent long-term patency results. Due to the elevated incidence of sternal infections following pedicled ITA harvesting, blood supply to the sternum has gained the focus of attention. This study sought to evaluate real time parameters of sternal microcirculation prior and immediately after harvesting of the ITA by a novel laser Doppler flowmetry and remission spectroscopy system (Oxygen-To-See (O2C), LEA Medizintechnik, Giessen). METHODS: 21 patients (16 males, age 63 + 4 years, mean NYHA 2.3 +/- 0.3) scheduled for coronary artery bypass grafting (CABG) were enrolled into the study. After median sternotomy, the probe was placed sequentially pre- and retrosternally for measurements of tissue oxygen saturation (sO2), hemoglobin concentration (rHb), superficial (2 mm) und deep (8 mm) blood flow. Measurements were performed and analyzed before and after surgical harvesting of the ITA with a pedicle. RESULTS: Baseline pre- and retrosternal tissue oxygen saturation (sO2) were 90 +/- 3 % and 87 + 4 %, respectively (n. s.). After left ITA harvesting, presternal sO2 remained unchanged (90 + 4 %, n. s.), whereas retrosternal sO2 decreased significantly (54 + 4 %, p < 0.001). Simultaneously, retrosternal post-capillary venous filling (rHb) increased significantly after ITA harvesting (86 +/- 2 vs. 93 + 2, p < 0.05), whereas presternal rHb remained unchanged. Retrosternal superficial and deep blood flow also decreased significantly (75 +/- 5 vs. 41 +/- 4, and 94 +/- 5 vs. 52 +/- 6) in contrast to comparable presternal blood flow before and after ITA harvesting. There were neither superficial nor deep sternal wound infections occurred in the studied patient population. CONCLUSIONS: The pedicled harvesting of ITA leads to a significant decrease of microcirculatory blood flow, retrosternal tissue oxygen saturation, and an increase in post-capillary venous filling. Parameters of microcirculation in the presternal area after ITA harvesting remained unchanged compared to baseline values. Hence, the incidence of sternal infections after ITA harvesting in coronary surgery may well be explained by a significant decrease of sternal blood supply in the retrosternal area. Further prospective randomized studies are needed to elucidate the potential role of skeletonized ITA preparation in sternal microcirculation.
PURPOSE: Lesions of the thoracic skeleton can sometimes be a problem in radiological diagnosis. Aim of the study was to investigate the value of ultrasound in the diagnosis of thoracic trauma in clinical practice. METHOD: Patients with thoracic trauma and suspected rib or sternal fracture were entered in the study. The results of the thoracic x-ray including a special target film and thoracic sonography were compared. RESULTS: 103 patients took part in the study (32 women, 71 men, average age 54.3 years). In x-ray the diagnosis of rib fracture was certain in 27 patients (30%). In US 56 patients (58%) had definitive signs of rib fracture. Because of multiple fractures in the same patients the total number of radiologically found rib fractures was 49, whereas 101 fractures could be detected by sonography. Also minimal pleural effusions could be found in 31 patients (32%) sonographically, only 18 of them were seen in x-ray. Larger effusions in six patients (6%) with serial rib fractures and haematothorax could all be diagnosed in x-ray and also US. The seven patients with suspected sternum fracture showed clear fracture signs in x-ray as well as US. CONCLUSIONS: Rib fractures could be found about twice as often US than x-ray. There was no difference in the diagnosis of sternal fracture. Detection of fluids (local haematoma and pleural effusion) is better via US than by x-ray. Therapeutical consequences may follow a quick bed-side diagnosis by US in a patient who needs intensive care. Other aspects after detection of a rib fracture US apart from thoracic contusion are psychological effects for the patients (usually they can cope better with their pain), the importance in the interpretation of the duration of incapacity to work and the additional information provided by expert opinions.
A case report is presented of a stress fracture of the sternum in a golf player occurring some weeks after modifying training habits. An ultrasound screening test was used successfully and the diagnosis confirmed with a positive technetium bone scan. The patient had explorative surgery elsewhere. This case is compared to another case described in 1987 by Keating in a wrestler.
The x-ray findings of the sternum of 120 patients are analyzed. The difficulties to prove fractures, metastasis, inflammation, and degenerative alterations are shown, and the differential diagnosis is discussed. The exclusion of pathological findings is valuable only after diagnostic with different projections and sagittal and transversal tomography.