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At least 109 records · Page 6Linked to original sources
PubMed1990

[The diagnosis and treatment of primary malignant tumors of the sternum].

Results of examination and treatment of 24 patients with primary neoplasms of the sternum including chondrosarcoma (18 cases), solitary plasmacytoma (5) and osteogenic sarcoma (1) were analysed. The diagnosis was based mainly on X-ray procedures and was further improved by computed tomography which allowed to precisely evaluate the extent of intrathoracic mass and its relation to adjacent mediastinal structures. Surgery was the main procedure used for the treatment of primary tumors of the sternum. Sixteen patients were operated on, and not a single case showed involvement of the mediastinum. Closure of defect was the major difficulty involved in the surgical treatment. Adequate resection of the sternum followed by autoplasty yielded good results.

Adult↗
PubMed1990

[Aspergillus osteomyelitis of the sternum after thoracoplasty].

The case of a 69-year-old man with osteomyelitis of the sternum caused by Aspergillus is reported. The patient had undergone a thoracoplasty eighteen months before for left empyema. At operation, the lower fourth of the sternum with some bilateral costal cartilages was resected, and the resultant dead space was covered with a rectus abdominis muscle flap. The diagnosis as Aspergillus osteomyelitis of the sternum was confirmed by culture of resected material. The cause of sternal osteomyelitis was assumed to be direct spread from an infection of costal cartilages left at thoracoplasty. He was discharged on the 31st postoperative day after complete wound healing.

Aged↗
PubMed1989

The integrated approach to suppurative mediastinitis: rewiring the sternum over transposed omentum.

Acute mediastinitis after cardiopulmonary procedures remains a devastating complication and a challenge to the reconstructive surgeon. A review of the literature and our own experience confirm the need for early aggressive drainage followed by timely reconstruction. In carefully selected patients, the sternum may be reclosed, provided that omental tissue has been transposed into the defect between the myocardium and the posterior cortex of the sternum. The technique is outlined and the results are analyzed and compared with three additional patient subgroups: (1) sternal wounds rewired over drains, (2) sternal wounds rewired with drains and irrigation catheters, and (3) wounds closed by sternal excision and muscle-flap transposition. To date, nine omental transfers have been performed with complete success. Mediastinal drainage routinely ceases after 3 to 5 days, and hospitalization has averaged 10 to 14 days. Early open debridement allows establishment of drainage and permits close evaluation of the character of the bony sternum. Muscle flaps may then be used in those patients with multiply fractured or frankly necrotic sternal tissue, while sternal closure over omental flaps may be used in all other patients. Adherence to this protocol has allowed for bacteriologic control of the wound, minimal morbidity, and no mortality.

Acute Disease↗
PubMed1987

Computed tomography of the sternum.

The author presents his experience with computed tomography (CT) in the diagnosis of sternal anomalies. The normal anatomy of the sternum and the peristernal soft tissues are described. The embryology, pertinent to the understanding of congenital sternal anomalies, is reviewed. The technique used to image the sternum is briefly explained. Variants of the sternum, traumatic changes, iatrogenic alterations, inflammation, and neoplastic lesions are illustrated. It is concluded that CT offers definite advantages in the evaluation of presumed sternal pathology and should be the examination of choice in the appropriate clinical setting.

Bone Neoplasms↗
PubMed1984

[Sternum-splitting approach for ossification of the posterior longitudinal ligament in the cervico-thoracic junction].

In this paper the author reported an operative approach for ossification of the posterior longitudinal ligament (OPLL) of the lower cervical and upper thoracic vertebrae. There are two types of surgery for OPLL, namely, posterior and anterior approaches. As a rule, we utilize an anterior approach for OPLL. Recently we performed a modified sternum-splitting approach in surgery for OPLL in the cervico-thoracic junction. In the original trans-sternal approach introduced by Cauchoix, the sternum is split from the suprasternal notch to the xiphoid process. We cut the manubrium only. However, a satisfactory exposure of the cervico-thoracic vertebrae down to the third thoracic level was obtained. After reaching the anterior surface of the cervico-thoracic vertebrae, the central portion of the vertebral body and the ossified lesion between the lower one third of the C7 vertebral body and the upper one third of the Th3 vertebral body were removed with an air-drill under an operating microscope. The longitudinal bone defect of the vertebral bodies was filled with a bone graft obtained from the iliac bone. Removal of the ossified lesion in the cervico-thoracic junction can be performed safely by utilizing the modified sternum-splitting approach. This approach can be applied also to endarterectomies at the origins of the vertebral arteries and the right subclavian artery.

Cervical Vertebrae↗
PubMed1977

Sternum length and intermammillary distance in normal newborns.

Short sternum and widely spaced nipples are recognized clinical findings in Edwards' and Patau's syndromes and in Noonan's, Turner's and renal hypoplasia syndromes, respectively. Sternum length, intermammillary distance, length of trunk and thoracic circumference were measured in 307 consecutive live newborns. Intermammillary distance was found to have the highest partial regression coefficient over sternum length. It seems therefore advisable to consider both parameters in the phenotypic description of syndromes where an abnormal variation of one of them is suspected.

Anthropometry↗
PubMed1996

The osteology of the African elephant (Loxodonta africana): vertebral column, ribs and sternum.

The vertebral column, sternum and ribs of the African elephant were studied and illustrated. In the cervical series, the vertebrae are characterized by very short (compressed) vertebral bodies and short spinous processes. There are 20-21 thoracic vertebrae that carry ribs, and three lumbar vertebrae. The neural arches of the five sacral vertebrae fuse with each other as well as with the wings of the ilium, while the intervertebral discs do not ossify and the vertebral bodies remain separate. There are 19-21 caudal vertebrae. In the latter, the neural arches of only the first five to six vertebrae fuse dorsally, the vertebral foramens of the other vertebrae as well as the vertebral canal remain open dorsally. The body of the first rib is greatly expanded while that of the last three to four ribs are reduced. The cartilages of the first six ribs articulate with the sternum, the last five to six ribs do not bear costal cartilages and are not attached to the costal arch. The sternum consists of five sternabrae that form three approximately equal, but separate, segments. The first segment is formed by the first sternabra, the second segment is formed by the second to fourth sternabrae and the last segment is formed by the fifth sternabra. The first and second sternabrae articulate with each other by means of a synovial joint, the second to fourth sternabrae are fused to each other and the fourth and fifth sternabrae are loosely attached to each other by connective tissue.

Animals↗
PubMed1996

[Cortical fracture of the sternum in a child: an infrequent case].

We report the case of a six-year-old girl who suffer an isolated sternal fracture due to hyperflexion of the thorax (while she was playing on a jumping-bed). On clinical examination, only slight tenderness and pain with compression of sternum was found. Chest X-ray demonstrated a fracture of the body of the sternum without other findings. The patient was admitted, observed during 12 hours with ECG monitoring and discharged because no cardiac or pulmonary pathology appeared. We present this case because fracture of the sternum in a child is rare, especially if road-traffic accident with seat belt injury is not implicated as a cause.

Child↗
PubMed1988

Effective technique of sternum closure in high-risk patients.

A successful technique of closing the sternum in a selected group of poor-risk patients involves the combination of a mattress suture and a fixative single-wire suture, both of 0 stainless-steel monofilament. Our technique was used on 100 high-risk patients and compared with double control groups, one consisting of 200 normal-risk patients and the second of 100 high-risk patients. We found that the incidence of wound infections was reduced to 1% with our new technique compared with 3% and 1% in the control groups (the high- and normal-risk groups, respectively). There was neither dehiscence nor mediastinitis in the study group, compared with 1% and 0.5% incidences of these complications in the controls. Also, there was no mortality in the combined-closure group compared with mortality of 0.5% and 1% in the control groups. We believe that this closure effectively strengthens the complex of bone and wire, improving the stability of the chest by giving a correct axis to the sternum. It is also cost-effective and easy to perform and does not prolong operation time.

Aged↗
PubMed1994

Rigid internal fixation of the sternum in postoperative mediastinitis.

OBJECTIVE: The current standard treatment of mediastinitis following median sternotomy is radical sternal débridement and obliteration of anterior mediastinal dead space with muscle or omental flaps. This report describes and reviews our experiences with a new technique of sternal salvage based on osseous quantitative bacteriologic assessment and rigid fixation in patients with postoperative mediastinitis. DESIGN: A retrospective review of 29 patients treated with sternal rigid internal fixation. SETTING: Two tertiary care academic medical centers in Chicago, Ill, and Ann Arbor, Mich. PATIENTS: Patients with postoperative mediastinitis following median sternotomy who underwent rigid internal fixation of retained sternum. INTERVENTION: Following débridement, quantitative bacteriologic assessment and sternal vascularity were assessed. Sternal segments with good vascularity and in bacteriologic balance were anatomically reduced and rigidly fixed to each other with titanium miniplates in 24 patients with postoperative mediastinitis. Five of the 29 patients, at high risk for mediastinitis, underwent rigid internal fixation immediately after their cardiac procedure. MAIN OUTCOME MEASURES: Resolution of infection, wounds remaining closed, and stable sternums. RESULTS: Bony union was obtained in 27 (93%) of 29 patients. The postoperative hospital stay ranged from 5 to 84 days, with a mean stay of 17 days and a median stay of 7 days. Length of stay was directly related to pulmonary function, which correlated with preoperative intubation status. CONCLUSIONS: Radical sternal débridement may not be necessary in all patients with postoperative mediastinitis following median sternotomy. Sternal salvage can safely and reliably be performed with a combination of clinical assessment of vascularity and osseous quantitative bacteriologic assessment. Anatomic reduction of the viable sternal segments is possible even in severely osteoporotic bone.

Adolescent↗
PubMed2000

A sequential developmental field defect of the vertebrae, ribs, and sternum, in a young woman of the 12th century AD.

Changes in the vertebral column are often noted in skeletal material. Descriptions of these anomalies are often lacking, and their developmental origins are not often discussed. The skeleton of a young woman from the medieval cemetery of Tirup, in Denmark, has multiple defects of the axial skeleton, including extra thoracic and lumbar vertebrae, border shifting, extra ribs, block vertebra, and deformed sternum. This case study is particularly interesting because of the number and diversity of anomalies seen; the rarity of these defects, even in living populations; and her survival to adult age. Careful analysis of the bones and use of the morphogenetic method of determining development stages has led to the conclusion that the initial defect probably occurred very early in development, during blastogenesis, with the initial development of at least two extra somitomeres in the paraxial mesoderm. These extra elements in turn led to problems in union and differentiation, and later chondrification and ossification of the vertebra. The malformations of the vertebrae also induced changes in the ribs and sternum. The initial error of segmentation is identified as a developmental field defect, and the cascade of anomalies seen is a developmental sequence caused by the initial field defect. The genetic and environmental causes of developmental field defects are reviewed.

Adult↗
PubMed1999

Heterotopic sternum transplant in rats: A new model of a vascularized bone marrow transplantation.

We introduced the heterotopic vascularized sternum transplant as a more simple and pure alternative to allogeneic hind limb transplantation for the study of bone marrow transplantation. We report the clinical and histopathological manifestations after transplantation of syngeneic and allogeneic sternal grafts with and without immunosuppression with FK-506. Syngeneic grafts maintained normal histology, whereas allografts showed rejection, which was prevented by FK-506. FK-506-treated allografts developed chimerism that was present throughout the observation period. Transplantation of the sternum may be a valuable model to study vascularized bone marrow transplantation and its effects on repopulation of bone marrow of the host, chimerism, and tolerance.

Animals↗
PubMed1975

Scanning electron micrographs of cancellous bone from the human sternum.

Thick sections from the manubrium and the first and second sternabrae were polished and the marrow removed. Low magnification scanning electron micrographs show that the cancellous bone near the medial plane is lightly constructed, is not markedly anisotropic and does not vary greatly from place to place. In the lateral parts of the sternabrae the trabeculae are somewhat thicker and the spaces between them are larger. Measurements on the polished surface lead to numerical values of a number of parameters characteristic of the surface patterns, such as the relative surface occupied by bone, the mean widths of the trabecular sections, the mean path lengths through the bone or marrow, and a number representing the departure from isotropy of the pattern. Parameters characteristic of the three-dimensional trabecular structure can be deduced, viz., the relative volume of bone, the area of the interface between bone and marrow and the mean thickness of the trabeculae. The sternum is compared with other bones which have been investigated by the same methods. There is little resemblance to the rib or to the proximal femur. The cancellous bone in the sternum and in the lumbar vertebral body are similar in appearance but the former has slighter trabeculae and larger marrow spaces.

Adult↗
PubMed2005

Prenatal ultrasonography and neonatal imaging of complete cleft sternum: a case report.

The prenatal diagnosis of a complete cleft sternum was established in a fetus of a twin pregnancy at 22 weeks' gestation. We present the prenatal imaging and correlation with postnatal magnetic resonance imaging and high-resolution ultrasonography. Thinned and depressed midline anterior chest wall transmitting the cardiac pulsation was the clue to the diagnosis, and the defective sternum could be identified on close sonographic observation. Successful surgical correction was undertaken at 2 months of age. There were no major associated abnormalities such as ectopia cordis or midline abdominal wall defects.

Adult↗
PubMed2002

A case report of recurrent epithelial ovarian cancer metastatic to the sternum, diaphragm, costae, and bowel managed by aggressive secondary cytoreductive surgery without postoperative chemotherapy.

BACKGROUND: Ovarian epithelial cancer typically presents in advanced stage and has been traditionally managed by a combination of cytoreductive surgery followed by adjuvant systematic chemotherapy. The management of recurrent ovarian cancer has been individualized: surgical resection of intraabdominal and/or pelvic disease has been performed when technically feasible and usually followed with chemotherapy. CASE: This case describes aggressive surgical management of recurrent ovarian cancer metastatic to the lower ribs, sternum, and diaphragm. A clear cell, Stage IIIA ovarian cancer was successfully resected in a 73-year-old female. The patient had total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy followed by six cycles of adjuvant chemotherapy, consisting of cyclophospamide and carboplatinum. A period of 8 years elapsed before recurrent disease was detected; there were two separate metastatic sites. A secondary cytoreductive surgery without further chemotherapy has been the mainstay of treatment. A combination of exploratory laparotomy and en bloc resection revealed the metastatic deposits, a 5-cm mass involving the diaphragm, the lower aspect of the manubrium sternum, and four right lower ribs. The second deposit was identified in the left paracolic gutter invading the sigmoid colon. CONCLUSION: At 47 months of follow-up, the patient is alive and without any evidence of measurable disease by exam and confirmed by CT scans of chest, abdomen, and pelvis. To our knowledge, this is one of the few reported cases managed successfully by surgical approach and is recommended in selected patients with metastatic ovarian cancer.

Aged↗
PubMed1993

Chondromyxoid fibroma of the sternum. Case report.

We report the second case of chondromyxoid fibroma (CMF) of the sternum, documented in the literature. In this case, only histology of the biopsy was useful in diagnosing CMF before definitive surgery. A wide subtotal resection of the sternum and reconstruction with a Gore-Tex soft tissue patch was performed.

Adult↗
PubMed1998

Anatomic bases of aorto-coronary bypasses: the internal thoracic artery and blood supply of the sternum.

The internal thoracic a. is much used in cardiac surgery because of its anatomic position, but its mobilisation may lead to devascularisation of the sternum. The aim of this study was to establish a precise systematisation of the vascularisation of the sternum by means of dissections and radiography after injection of contrast medium in 15 subjects. It is based on the internal thoracic a. and its collaterals, which form multiple anastomoses. This anatomic basis provides an understanding of the problems of the devascularisation (partial and temporary) and the infections that may occur following the use of one or both internal thoracic aa. during coronary bypass operations. However, it should always be regarded as the graft of choice, given the longevity of these bypasses.

Angiography↗
PubMed1983

[Morphometric studies of x-rays of the sternum].

Sex determination of a sufficient certainty is possible using measurements (length and breadth) obtained by X-rays of the human sternum. Body height may be determined by X-rays of the human sternum if a wide dispersion is given. The given relations and formulae are valid only when measuring the sterna of adults.

Adult↗