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A sternum fracture resulting from indirect insignificant trauma is described in a 12-year-old boy. Similarities between this case and aseptic osteochondronecrosis are revealed. Conservative treatment results in a quick recovery.
Pseudomonas osteochondritis of the chest wall and sternum has rarely been reported, but when present it has been extremely difficult to eradicate. Multiple operations to debride the involved areas and use of antibiotics have often been inadequate to control this resistant infection. This report describes our experience with three patients who had the late development of Pseudomonas osteochondritis of the chest wall. The infection occurred following crush trauma, sternotomy for congenital heart disease, and mastectomy and amputation of the upper extremity for carcinoma of the breast. Antibiotic therapy alone and with limited operations was unsuccessful in controlling the infection in all three instances. Eventually, each patient required extensive regional surgical removal of involved bone and cartilage. Complete healing followed. Our experience favors the early wide removal of bony and cartilaginous tissues in the involved region with preoperative and postoperative coverage by appropriate antibiotics. Operative management is detailed.
Resection of large portions of the thoracic wall, during the treatment of neoplasms of that area, results in defects which are difficult to reconstruct. Synthetic nets have been used with different results, mainly because of problems of rejection and infection. We successfully used a silicone implant for the treatment of a case of chondrosarcoma of the sternum and ribs.
Cleft sternum is a rare malformation, either superior, inferior or total, which is frequently associated with supraumbilical raphé. Such a case is reported. Sometimes cavernous hemangiomata are noted. It occurs subsequent to disturbances of abdominal wall midline fusion. The etiology is unknown. The recurrence risk is probably nil, but one familial case must be taken into consideration.
The most of the arterial vascularisation of the adult sternum is on the dependence of the internal thoracic arteries. The best results of the aorto-coronary by-pass starting from this arteries are however subjected to more infectious complications. The study of this arterial supply, in "surgical" conditions, after sternotomy and ablation of one or two internal thoracic arteries show this devascularization. The residual arterial supply is only constituted by thin branches coming from intercostal arteries.
Methods of treatment of suppurative mediastinitis in cardiosurgical operations applied at the clinic are analysed. These methods are: debridment with closure of the sternum with irrigation of the substernal space, debridment with bandage of open wound and healing per secundam, debridment with bandage of open wound and its closure by myocutaneous layers. It has been concluded that these infections are very complex etiopathogenetically because of which it is very important to know all relevant risk factors aiming to prevent development of this complication in cardiosurgical operations. Its early recognition is necessary.
In a 14-year-old adolescent, primary acute osteomyelitis in a rare localization, the sternum, was associated with anterior mediastinitis. Antibiotic therapy and partial sternectomy together with emptying the mediastinal abscess was successful. Therapeutic management of such cases is presented in a review of the literature.
The authors report on a rare case of pulsating tumor of the sternum. En bloc resection was carried out with removal of the sternal manubrium and body, tracts of the I-II-III rib with the intercostal muscles and part of the left pectoralis major. Reconstruction of the thoracic wall was performed with a marlex MMA sandwich prosthesis. From a histological viewpoint, the carcinoma was well differentiated and compatible with thyroid primitivity. Non complementary antiblastic therapies were provided as all the examinations carried out were negative and the intervention was radical. The patient had been followed-up with serial controls and three complete stagings at one, three and five years after intervention (CT, echography and function tests of the thyroid, bone scintigraphy). At follow-up of more than six years the patient is doing well and is event free. The authors believe, even with the help of reports from the literature that, in sternal metastases from thyroid carcinomas, especially when single and large, surgical therapy is required.
A case report presents fracture of sternum during the resuscitation and in continuity iatrogenic hematoma and afterwards abscessus of mediastinum, and empyema the both of pleura cavities. Fracture of thorax wall is rather often event, but in the most, it has not adverse effects. This case refers to 68 years old patient, who had one of the most serious complications: abscessus of mediastinum, empyema of left and right pleura cavities with perforation outside the anterior wall of thorax. He was treated in General Hospital Biała Podlaska, Department of Surgery with good results and was extracted home as well-being patient after 35 days spent in hospital the second hospitalisation.
Tubercular involvement of the sternum, leading to osteomyelitis, is a rarely described entity even in countries where tuberculosis is endemic. Presentation in pediatric age group is even more uncommon. We describe a 12 year old girl who presented with a mass over the manubruim sterni and fever. CT chest demonstrated a soft tissue mass in the anterior mediastinum, eroding the cortex of the manubrium. Tubercular etiology was suggested by presence of epithelioid granulomas and acid fast bacilli in the Ziehl-Neelsen staining of the aspirate from the lesion. The patient responded well to antitubercular treatment.
Successful surgical repair of pectus excavatum deformities has so far only been reported in very young animals. This case report describes an alternative technique for repairing pectus excavatum in a young cat. The cat had shown moderate deformity with slight respiratory impairment when young and had experienced clinical problems with age. A sternum realignment technique involving a pin associated with an external splint was used. This alternative technique was a safe and efficient procedure in the five-month-old cat.
We report a case of giant cell tumor of the manubrium with radiological evidence of aggressiveness. Few cases of giant cell tumor of the sternum have been published. Extensive surgery offers the best hopes of recovery. Cytogenetic studies evidenced several clonal abnormalities including a 17q isochromosome. The TP53 suppressor gene is located at 17q13.1. Whether loss of one of the TP53 alleles may have contributed to the aggressive behavior of our patient's tumor is discussed.
To investigate the temporal and topographic changes in the expression of various collagens during the process of endochondral bone formation, qualitative and quantitative analysis of the collagens synthesized by organ cultures from the separated presumptive calcification and permanent cartilaginous regions of embryonic chick sternum at various stages of development was performed. Special emphasis was placed on the study of Type X collagen, a recently described species that may play a role in tissue calcification. We found that Type X collagen is biosynthesized exclusively by cartilage from the zone of presumptive calcification and that its biosynthetic expression is acquired at stage 43 (day 17) of sternal development. Quantitative analysis indicated that Type X was the biosynthetic product which showed the most dramatic changes increasing markedly with increased sternal age. While no Type X collagen could be detected at stage 40, it represented about 12% of the total collagen synthesized at stage 43, further increasing to 45% at stage 46 of sternal development. The increase in Type X collagen in the presumptive calcification region was accompanied by a relative decrease in the proportion of 1 alpha, 2 alpha, 3 alpha, alpha 1(II), and Type IX collagens. In contrast, the permanent hyaline cartilage did not display detectable synthesis of Type X collagen at any sternal age. The strict topographic distribution and the temporal expression of Type X collagen biosynthesis coincident with the development of sternal calcification, confirm the notion that this collagen may play an important role in the extracellular matrix remodeling associated with the initiation and progression of tissue calcification.
Proteoglycan Lt (PG-Lt), isolated from 17-day-old chicken embryo sterna, appeared to differ from its counterpart from tibia and femur (Noro, A., Kimata, K., Oike, Y., Shinomura, T., Maeda, N., Yano, S., Takahashi, N., and Suzuki, S. (1983) J. Biol. Chem. 258, 9323-9331). The intact disulfide-bonded molecule of approximately 300 kDa was separable into three chains of 115, 84, and 68 kDa on reduction, the molecular masses being relative to those of collagen standards on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). This is in contrast to tibial cartilage PG-Lt, from which there was no observed release of a 68-kDa chain (100 kDa relative to globular protein standards) after reduction. The 115-kDa chain of sternum PG-Lt consists of a core 68-kDa polypeptide to which the chondroitin sulfate chains are attached. The ratio of 4-sulfated to 6-sulfated disaccharides released after either chondroitinase ABC or AC digestion is 3:1. Identity of PG-Lt with type IX collagen was indicated by their similar elution profiles on DEAE-Trisacryl and by the presence in both proteins of co-migrating 84- and 68-kDa bands on SDS-PAGE. This identity was confirmed by immunoblotting PG-Lt after SDS-PAGE, with affinity-purified polyclonal antibodies specific for a triple helical domain (HMW) of type IX collagen. The nonreduced high molecular mass material and all three bands of the reduced PG-Lt were immunoreactive, giving immunostaining patterns similar to autoradiographs from the [14C]glycine-labeled protein.
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