Titanium transverse plate fixation: a new solution for old sternal problems.

OBJECTIVE: To evaluate our initial results with the titanium transverse plate fixation system of the sternum in four patients. METHODS: Two patients with late dehiscence and persistent instability of the sternum after cardiac surgery were treated with refixation by titanium transverse plates and screws. Two patients were treated with the same refixation method after pre-treatment with debridement, antibiotic therapy and vacuum-assisted closure therapy for extensive mediastinitis. RESULTS: All four patients healed without complications. The mean postoperative length of stay was 17,3 days (range 7-44). The instability and/or pain disappeared in all patients. The postoperative imaging showed good positioning of the osteosynthesis material. There was no re-infection in patients with mediastinitis. CONCLUSIONS: The titanium transverse plate fixation system is a very promising adjunct to the armamentarium of the cardio-thoracic surgeon for treatment of sternal problems, including dehiscence and fractures, even when mediastinitis is involved. It offers more stability compared to simple rewiring, without the need for extensive retrosternal dissection.

The prognosis of patients operated on for gastric cancer in relation to the percentage of lymph nodes invaded by tumour.

INTRODUCTION: In evaluating the type of gastrectomy and lymphadenectomy for gastric cancer, adequate prognosis has been dependant on the retrieval of at least 15 lymph nodes. We propose an alternative method in which the prognostic value is evaluated, according to whether or not more than 20% of the retrieved lymph nodes are invaded by tumour. MATERIALS & METHODS: Sixty-five patients (36 men, 29 women) with a median age of 69 years (mean age 68.9 +/-12.1 years) were evaluated, who were operated upon between 1985 and 1999 for gastric cancer by gastrectomy with either D1 or D2 lymphadenectomy. RESULTS: The average number of retrieved lymph nodes was 10.4 +/- 8.6. In 51 patients (78.5%) less than 15 and in 14 patients (21.5%) 15 or more lymph nodes were retrieved, according to the TNM guidelines. In our study, there is a statistically significant difference in prognosis between patients with less than 20% and those with more than 20% of the retrieved lymph nodes invaded by tumour, irrespective of the total number of lymph nodes resected. CONCLUSION: Gastric cancer patients in whom less than 20% of the retrieved lymph nodes are invaded, have a significantly better prognosis compared with patients in whom 20% or more of the lymph nodes retrieved are invaded by tumour, irrespective of the total number of retrieved lymph nodes.