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[Isolated tuberculosis of the sternum].

Isolated tuberculous foci of the sternum are rare. In a period of 26 years (1955 to 1981) we have treated ten sternal lesions surgically in our clinic. Eight of these were tuberculous. The clinical material (three females, five males) is described, including diagnostic and therapeutic details. The frequency, localisation, clinical features, diagnosis, treatment, prognosis and differential diagnosis of specific sternal infections are discussed and the relevant literature is reviewed.

Adult↗

[Congenital bifid sternum (author's transl)].

The authors give a short description of the frequency and types of the rare deformities of the sternum. Following a detailed presentation of the various methods of treatment, three of their own observations, one of them an ectopia cordis, are given as case-reports. Two of these patients have already been observed over a long period.

Abnormalities, Multiple↗

A comparison between sternum and rib in osteomyocutaneous reconstruction of major mandibular defects.

Following major mandibular resection for intraoral malignancy, 6 patients underwent reconstruction using rib and 22 patients underwent reconstruction using the outer table of the sternum; the pectoralis major muscle was used as the vascular carrier for both bone and skin in all patients. Five of the 6 patients in the rib group encountered major complications. In the sternal group, loss of bone occurred in only 2 of 22 patients. Those aspects of technique considered important to the outcome are detailed. Results are discussed in terms of bone survival, intraoral features including denture placement, and the patient's appearance. The sternal transfer has consistently shown itself to be superior to rib, in terms of both early morbidity and later functional and aesthetic results. It is our present method of choice for reconstruction following major intraoral resection.

Bone Transplantation↗

Paget's disease of the sternum simulating an ectopic adenoma on parathyroid scintigraphy.

The authors present the case of a patient with recurrent hyperparathyroidism who was shown on thallium-technetium subtraction scintigraphy, ultrasound, and magnetic resonance imaging to have recurrent parathyroid tissue in the right side of the neck. The thallium scan also showed intense uptake centrally in the chest, mimicking an intrathoracic adenoma. This was subsequently shown on plain films and a radionuclide bone scan to be due to Paget's disease of the sternum. This case illustrates the value of a combined imaging strategy in preventing an unnecessary thoracotomy after a false-positive nuclear medicine scan.

Adenoma↗

Brown tumor of the sternum: a potential source of false-positive Tl-201 and Tc-99m subtraction imaging in the mediastinum.

Tl-201 and Tc-99m subtraction imaging is a well-established technique for detecting parathyroid adenomas. We report a case of a brown tumor of the upper sternum mimicking an ectopic mediastinal parathyroid adenoma on Tl-201 and Tc-99m subtraction imaging in a patient with hyperparathyroidism. This brown tumor showed Tl-201 uptake but not Tc-99m uptake and thus did not subtract out in this scan.

Adenoma↗

External fixation of the sternum for thoracic trauma.

A flail chest with a manubriosternal separation in a man with multiple injuries was treated with an external fixator applied to the sternum and the manubrium. Pain and ventilatory function were improved, permitting immediate postoperative extubation and prompt patient mobilization. The external fixator was removed after fracture union at 2 months. One year after injury, the patient's pulmonary function was normal. External fixation is an alternative to other methods of sternal fracture stabilization.

Abdominal Injuries↗

A fracture of the sternum in a child.

Fractures of the sternum are seldom seen due to its anatomical structure and supporting structures. The incidence of sternal lesions in children is extremely rare, and the scarcity of published accounts warrants reporting this case, which was treated successfully without surgery.

Adolescent↗

Penetration of ceforanide and cefamandole into the right atrial appendage, pericardial fluid, sternum, and intercostal muscle of patients undergoing open heart surgery.

Doses of 30 mg of ceforanide or cefamandole per kg were administered intravenously to 26 patients just before their chests were opened for coronary artery bypass or cardiac valve replacement surgery. Samples of right atrial appendage, pericardial fluid, plasma, aortic wall, intercostal muscle, and sternum were obtained at different times after the antibiotic was injected, and these samples were assayed for cephalosporin concentration. For ceforanide the pre-bypass plasma half-life was 2.5 h, and the atrial appendage half-life was 2.1 h; for cefamandole the pre-bypass plasma half-life was 0.75 h and the atrial appendage half-life was 0.72 h. At 3 h the concentrations of ceforanide and cefamandole in atrial appendages were 28.0 and 5.0 micrograms/g, respectively. Ceforanide achieved higher and more sustained concentrations in other tissues than cefamandole. Considering the minimal inhibitory concentrations of these drugs for staphylococci, cefamandole and ceforanide should provide adequate protection against infection by these organisms for the duration of the surgical procedure.

Cardiac Surgical Procedures↗

Osteomyelitis of the sternum caused by Apophysomyces elegans.

Apophysomyces elegans, a member of the family Mucoraceae, was found to infect the chest wall and sternum of an immunocompetent man following minor trauma. As in previous cases, amphotericin B therapy alone was inadequate. Extensive surgical debridement was required in order to eradicate the infection.

Aged↗

Malignant fibrous histiocytoma of sternum: an unusual cause of pyrexia of undetermined origin.

Malignant fibrous histiocytoma of the bone is a very rare tumour mainly affecting long bones, and the most common presenting symptom is local pain. A case of malignant fibrous histiocytoma presenting with pyrexia of undetermined origin and arising in the sternum, a localization not previously described, is reported. The patient died with septic shock after multi-drug chemotherapy including high dose methotrexate treatment with citrovorum factor rescue.

Adult↗

Successful surgical repair of congenital total cleft sternum with partial ectopia cordis.

Total bifid sternum with or without ectopia cordis is a rare congenital anomaly which is treated successfully in a limited number of cases. Several methods of correction have been described using tissue grafts (cartilage, bone), inert artificial prostheses (acrylic plaques, marlex mesh), and techniques to approximate the sternal bands by relaxation of costal cartilages. In our case the method described by Verska was used to approximate the bifid sternal bands. The successful result in our patient proves the efficiency of this technique.

Congenital Abnormalities↗

Aneurysmal bone cyst of the sternum: a case report of successful treatment with radiotherapy.

An unusual case of a lytic, expanding lesion of the manubrium with histological diagnosis of aneurysmal bone cyst in a 13-year-old girl is presented. After a recurrence following primary surgery, the patient was treated successfully by external beam radiotherapy. A total dose of 25.2 Gy was delivered using conventional fractionation (1.8 Gy day(-1)) to the whole sternum. She remains recurrence- and symptom-free 46 months after the end of the treatment. This is the sixth patient with primary aneurysmal bone cyst in the sternal region, the first paediatric patient for this location, and the first case of its kind treated exclusively by radiotherapy ever reported in the literature. The histopathological, radiological and clinical findings of the patient are presented, relevant literature is reviewed, and radiotherapeutic management of such lesions is discussed.

Adolescent↗

[Clinical morphology of the sternum].

The length, width and thickness of the sternum were measured in 74 adult specimens with the aim of optimizing the dimensions of staples used after sternotomy. This article describes the experimental procedure and presents the results. Sex differences were confined mainly to the length, with males measuring 16.5 cm, and females 15 cm. Width and thickness maxima (7.4 cm and 1.7 cm, respectively) are measured at the proximal and distal ends of the manubrium, while the width and thickness of the corpus (2.7-3.5 cm and 1.0-1.4 cm, respectively) show relatively minor differences.

Aged↗

Establishment of a whole-chick sternum model that recapitulates normal cartilage development.

A serum-free organ culture model for chondrocyte maturation, using the Avian sternum, was developed. Day-14 chick embryo sterna were placed in organ culture in the presence of defined medium. The optimal medium for chondrocyte terminal differentiation contained specific concentrations of dexamethasone, insulin, thyroid hormone and ascorbic acid. Three parameters, including sternal growth, cell diameter and type X collagen production, were analyzed as indicators of chondrocyte terminal differentiation. These parameters were analyzed in cephalic, middle and caudal regions of the organ-cultured chick sterna and compared to sterna grown in ovo. This study demonstrates that the organ-cultured tissue maintains normal morphological characteristics and terminal differentiation in the cephalic region only, similar to in ovo development, while maintaining normal cell-matrix relationships.

Animals↗

Insufficiency fracture of the sternum caused by osteopenia: plain film findings in seven patients.

Sternal insufficiency fractures, whether nonbuckling (displaced or nondisplaced) or buckling, are rare and have been described in elderly osteopenic patients with accentuated kyphosis of the thoracic spine. We retrospectively analyzed the radiographs and clinical records in seven osteopenic patients with sternal insufficiency fractures and correlated the type of insufficiency fracture with the presence and degree of dorsal kyphosis, as well as the presence of chest pain, soft-tissue mass, and osteolysis. We found that displaced or nondisplaced nonbuckling fractures (five patients) may be associated with chest pain localized to the sternum (three patients), and may be present with (three patients) or without (two patients) associated thoracic kyphosis. This type of insufficiency fracture also may be accompanied by a soft-tissue mass and osteolysis (three patients), findings simulating pathologic fractures. All buckling insufficiency fractures (two patients) were associated with thoracic kyphosis and were asymptomatic. Our findings suggest that sternal insufficiency fractures may occur with or without exaggerated dorsal kyphosis. The fractures are an uncommon complication of osteopenia and may resemble pathologic fractures when osteolysis and soft-tissue swelling are present.

Adult↗

A case of congenital bifid sternum.

A case of bifid sternum is reported, which illustrates that it is sometimes not possible to repair the sternal defect either by approximation of the sternal bars or by a large autogenous cartilage graft from the ninth, tenth and eleventh ribs. In such cases, the only alternative is to take a graft from the mother.

Female↗