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At least 19 recordsLinked to original sources

PubMed1991

Thoracoplasty with marlex mesh following total resection of sternum: a case of chondrosarcoma of sternum.

Removal of the whole sternum for malignant tumor results in a large defect, causing a severe deformity and possible paradoxial movement of the chest wall. Many of thoracoplasty cases after total sternectomy require considerably complicated invasion. Recently, we performed on a patient with chondrosarcoma of the sternum total resection of the sternum including bilateral costal cartilage followed by thoracic reconstruction with polyethylene hard mesh (heavy Marlex mesh). In the present paper, we make a report of the case of thoracoplasty reliable to perform which has produced immediate chest wall stability without postoperative thoracic deformation. Postoperative CT confirmed that the mesh is well infiltrated with fibrous granulation tissue which connected chest muscle. Impairment of respiratory function after the operation is not observed.

Bone Neoplasms↗

PubMed1977

[Regularities and differences in the structure of the circulatory bed of the sternum].

The investigation has been carried out in 95 preparations of the anterior chest wall of corpses of humans of either sex aged from newborns to 90. It has been established that the blood supply of all the layers of sternum is brought about by the anterior and medial branches of the internal sternum artery forming subperiosteal plexuses on its anterior and posterior surfaces. The posterior plexus is better developed. Its loops are of less size and denser per a square surface unit. Three types of blood supply of the manubrium sterni posterior surface have been distinguished (right-side, balanced and left-side types) as well as two variations of blood supply of the sternum body (in the first variant two sternal branches approach the sternum at the level of every intercostal space, in the second variant--only one does). The outflow of the venous blood from the sternum is brought about into the anterior and posterior venous subperiosteal plexuses and then via one of the three anatomical variations into the internal thoracic veins. The subperiosteal network of the sternum in newborns and infants is of segmentary character and is formed in relation with developing ossification nuclei. With age, in the process of fusion of the ossification nuclei the subperiosteal network looses its segmentary character and acquires a common total character.

Adolescent↗

PubMedDate not supplied

Eosinophilic granuloma of sternum. Report of one case.

A rare case of solitary eosinophilic granuloma of the sternum in a 5-year-old boy is reported. He presented anterior chest pain and a nodular, somewhat tender mass over the sternum. Chest x-ray, tomography, CT scanning of the sternum and total body Gallium scanning revealed an isolated lytic lesion 5 cm below the sternal angle. An excisional biopsy of the mass showed the typical histologic appearance of eosinophilic granuloma. An isolated eosinophilic granuloma of sternum is rarely reported in the English literature. The differential diagnosis of sternal tumors and a review of eosinophilic granuloma of sternum is discussed.

Child, Preschool↗

PubMed1990

Case report 593: Hemangioma of sternum.

A 38-year-old woman presented with an expansile lesion of the sternum. Plain film tomograms and computed tomography showed an expansile lesion of the sternum. Bone scanning revealed increased uptake in the sternum. The neoplasm was surgically excised and proved to be a hemangioma (Fig. 4a) and 4b). The rarity of this neoplasm in the sternum was stressed. An extensive search of the literature failed to reveal a single previous report of a sternal hemangioma. A differential list of other primary benign and malignant sternal tumors was presented.

Adult↗

PubMed1991

Resternotomy in patients with valved conduits adherent to the sternum.

Twenty-two patients with valved conduits adherent to the sternum underwent resternotomy. Mean age was 10 +/- 6 years, and mean conduit age was 4 +/- 4 years. Diagnoses were D-transposition (7), truncus arteriosus (7), univentricular heart (6), Taussig-Bing anomaly (1), and corrected transposition (1). The majority of patients (68%) had reoperation for outgrown or degenerated conduits. In 17 patients, the sternum was opened with a chisel. Two of these patients sustained conduit neointimal collapse from manipulation, and 3 had conduit tear requiring immediate cardiopulmonary bypass through the femoral vessels. In the last 5 patients, the sternum was opened above and below the conduit, and the inner table was chiseled and left attached to the conduit avoiding injury and undue conduit manipulation. Cardiopulmonary bypass and operation were carried out uneventfully. We believe that the recent technique described provides a safe alternative approach to valved conduits adherent to the sternum.

Adolescent↗

PubMedDate not supplied

Photon-deficient finding in sternum on bone scintigraphy in patients with malignant disease.

The sternum is known as a common site of bone metastasis in a variety of neoplasms. Sternal metastasis is usually visualized as hot spot on bone scintigraphy. However, photon deficiency in the sternum on bone scintigraphy is reported in few cases with malignancy. We undertook a retrospective analysis to clarify the clinical significance of photon deficiency in the sternum in 12 patients with malignancy. Twelve patients (five breast cancer, two multiple myeloma, one lung cancer, one renal cell cancer, one hepatocellular carcinoma, one malignant lymphoma, and one thyroid cancer) showing cold sternal metastasis on bone scintigraphy were identified among 9,430 patients in whom bone scintigraphy was performed. Except for two cases with pathologically confirmed sternal metastasis, all patients showed lytic change in the sternum on tomography or CT scan. Six cases of solitary sternal metastasis showed partial effect of systemic therapy (chemotherapy, humoral therapy, and radiation therapy) and surgical treatment. It is necessary to keep in mind that this type of lesion may occur as a manifestation of metastatic disease.

Adult↗

PubMed1991

Cranio-caudal movement of the sternum on induction of anaesthesia.

The cranio-caudal movement of the sternum was studied by the technique of video magnification during induction of anaesthesia with thiopentone 2-4 mg kg-1 i.v. in 20 patients. Anaesthesia produced no consistent change in end-expiratory position of the sternum; there was a range of movement from 3.1 mm cephalad to 5.4 mm caudad. There was a significant relationship between movement and degree of obesity of the patient (P less than 0.01), with the sternum tending to caudal movement in the obese patient.

Anesthesia, Intravenous↗

PubMed1992

Comparative structure and morphology of the goat sternum in West African dwarf and Danish Landrace breeds.

The structure and morphology of the sternum from 33 West African dwarf (WAD) and sixteen Danish Landrace breed goats were studied radiographically. In young kids of the Danish Landrace breed (DL), the number of sternal elements (Sternebrae) was six or seven with the fifth or the last but one being double in some animals due to bilateral bodies. All the sternal elements in the WAD breed appeared to have each a single locus of ossification and the number of sternal elements varied between 5, 6 or 7 at birth. In those goats with 5 or 6 sternal segments, bilateral indentations were observed on the left and right side on either the last or the last two segments. These indentations were considered to indicate a prenatal cranial coalescence of the last segments leading to the reduced number of sternebra. The structure and morphology of the sternum in neonatal kids for the two breeds appears to be basically different. 8 sternal and 5 asternal ribs were observed in animals of both breeds. The cartilaginous attachments of the ribs on the sternal segments were variable. A floating rib was also observed in one of the WAD goats. The comparative structure and morphology of other ruminant sternum is also discussed.

Animals↗

PubMed1991

Spontaneous fibro-osseous proliferative lesions in the sternums and femurs of B6C3F1 mice.

Bone morphology associated with fibro-osseous proliferation in the femurs and sternums of 98 female B6C3F1 mice were compared morphologically and quantitatively to femurs and sternums from 100 male B6C3F1 and 79 CF1 mice (48 female and 31 male). In addition, sternal samples from five B6C3F1 mice per sex were collected and processed for electron microscopy. Fibro-osseous proliferation was present in female B6C3F1 mice, but not male B6C3F1 or female CF1 mice. In female B6C3F1 mice at 32 weeks of age, the marrow spaces in the region of the proximal and distal epiphyseal plate were lined by large osteoblasts and had large vascularized centers. At 58 weeks, metaphyseal fibrovascular proliferative areas containing multinucleated cells and new cancellous bone delineating the lesion were seen. At 84 weeks, fibro-osseous tissue occupied the outer third of the sternal marrow cavity and by 110 weeks, more than two thirds of the marrow cavity. Fibro-osseous proliferation was present in 100 and 94% of the examined sternums and femurs, respectively, of female B6C3F1 mice at 110 weeks of age, but not in male B6C3F1 or female CF1 mice. Ultrastructural examination of the sternal changes at 110 weeks showed numerous osteoblasts, irregular bony spicules, and fibrocyte-like cells. By morphometry, the normal marrow cavity in B6C3F1 females occupied 35% of a longitudinal section of the whole sternebra compared with 70% and 75% of the whole sternebra in B6C3F1 males and CF1 female, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗

PubMed1976

Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.

Mediastinal sepsis following open heart surgery is a significant cause of death. Open drainage of the mediastinumalone was employed originally in management of this problem. More recently, debridement, drainage, and reclosure have been used. Various irrigation solutions, such as antibiotics and Betadine, have been advocated to control severe mediastinal sepsis. Three principles of management in patients unresponsiveness to the above techniques have proved successful in two patients with life-threatening mediastinal sepsis: (1) radical, complete excision of the sternum and adjacent costal cartilages; (2) transposition of the greater omentum on a vascular pedicle to the mediastinum; and (3) primary closure with full-thickness rotational skin flaps. The radical excision of the sternum removes residual foci of sepsis in cartilage and sternal bone marrow. The transposition of the omentum provides a highly vascular, rapidly granulating covering for the contaminated great vessels and hase been successfully to prevent recurrence of suture line bleeding of an exposed ascending aortic anastomosis site. Primary closure of the wound with full-thickness skin flaps provides a suprisingly satisfactory covering for the heart. Preoperative and postoperative measurements of ventilatory mechanics have shown relatively small ventilatory impairment after the alteration of the thoracic cage imposed by excision of the sternum. Two patients have returned to active lives. A treatment failure probably due to incomplete adherence to these guidelines also is presented.

Adult↗

PubMed1992

[Emergency diagnosis of sternum fracture with ultrasound].

Fractures of the sternum often are not discernable on X-rays. The standard lateral X-ray of the sternum may allow the diagnosis. The aim of this study was to find out whether sternal fractures can be visualized by ultrasound. The flat, plane and broad bone provides an ideal rest for a linear scanner; the one used in our study had 5 MHz. We show that sternal fractures can easily be diagnosed by means of ultrasound, and because of an interruption of the cortical reflex, possibly better than on radiographs. We also wanted to show whether sonography, which is in widespread use for the diagnosis of blunt abdominal trauma, can also be used in an emergency situation of blunt thoracic injury (e.g. seat belt injury). In 16 cases of fractures of the sternum already diagnosed by X-ray, an examiner unacquainted with the X-ray results was able to locate and diagnose all fractures by ultrasound within 1 min.

Accidents, Traffic↗

PubMed1992

Position of heart in relation to sternum and nipple line at various ages.

Frontal X-ray pictures of 210 healthy children from birth to twelve years of age with radio-opaque markers at sternal ends and both nipples were reviewed. The position of centre of cardiac silhouette was correlated with sternal areas and internipple line. The heart was found to descend with age, its centre lying beneath mid-sternum during first six months of life and beneath lower sternum after infancy (p less than 0.001). The position did not vary with age in relation to internipple line (p greater than 0.05). In 77.6% of all children, it was below the internipple line and in 22.4% above or at the internipple line. Because of the erratic relationship of cardiac centre with internipple line, the latter should not be considered a landmark for cardiac position. External cardiac massage should be applied in relation to sternum and at different locations according to the age. Sites for optimal compression have been suggested. No sexual dimorphism was observed.

Anthropometry↗

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↗

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↗

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↗

PubMed1991

The healing sternum: a comparison of osseous healing with wire versus rigid fixation.

Although median sternotomy is used for most cardiac procedures, postoperative dehiscence remains a serious and persistent problem. This investigation was designed to assess new bone formation and sternal healing across the linear osteotomy of the sternum and to determine if rigid fixation would enhance bony healing and thus decrease unfavorable sequelae. To test this hypothesis, 14 skeletally mature baboons (Papio anubis) underwent standard median sternotomy; seven sternotomies were closed with interrupted 24-gauge cerclage wires, and seven, with thin Vitallium compression miniplates and transverse lag screws. The sterna from each group were harvested en bloc at 4 and 8 weeks, radiographed, processed, and serially sectioned and stained for histomorphometry to assess the quantity of new bone across the linear osteotomy. Clinical stability was superior with the plated and lag screw group at 4 weeks; however, by 8 weeks, no clinical difference between treatments was apparent. Histomorphometric analysis indicated that the linear osteotomy gap treated with plates and screws was less than the gap associated with the wire group. Rigid fixation of the sternum resulted in earlier union with primary osseous healing, suggesting greater inherent stability. these factors may decrease adverse sequelae for this procedure.

Animals↗

PubMed1992

Prenatal ultrasonographic findings associated with wide clefting of the upper two thirds of the fetal sternum.

Complete or partial absence or clefting of the fetal sternum is uncommon. A teenage primiparous patient at 34 weeks' gestation with severe preeclampsia was delivered of an infant with wide clefting of the upper two thirds of the sternum. The infant had no respiratory or cardiac symptoms. There were no other congenital abnormalities. Corrective neonatal surgery was performed at 1 month of age. Retrospective analysis of the ultrasonographic examination performed at 34 weeks revealed evidence of this fetal sternal defect.

Adolescent↗