Clinical Application of Thoracoscopic Resection of Anterior Mediastinal Tumors under the Xiphoid Process.

Objective: To explore the feasibility and advantages of thoracoscopic resection of anterior mediastinal tumors through subxiphoid and lateral thoracic approaches. Method: 74 patients with anterior mediastinal tumors hospitalized in our hospital from January 2019 to January 2022 were retrospectively analyzed. They were divided into the lateral chest group (31 cases) and the infraxiphoid group (43 cases) according to different operation methods. The tumor size, operation time, intraoperative bleeding, postoperative pain score, postoperative complications, postoperative drainage tube removal time, and hospital stay were compared between the two groups. Result: The intraoperative bleeding and postoperative pain scores in the subxiphoid group were better than those in the lateral chest group. There was no significant difference in operation time and postoperative complications between the two groups. Conclusion: Compared with the lateral thoracic approach, the thoracoscopic subxiphoid approach can be more safe and effective in resectioning anterior mediastinal tumors.

Modified subcostal arch xiphoid thoracoscopic expanded thymectomy for thymic carcinoma: a case report and review of literature.

Thymic neoplasms are a relatively uncommon tumor, with the anterior mediastinum being the most common. Median sternotomy is the procedure of choice for the treatment of thymomas. With the advent of thoracoscopy, an increasing number of countries are adopting the right thoracic approach for the treatment of thymomas, but there are still no clear surgical standards or modalities to treat thymic carcinoma. We propose a modified subxiphoid subcostal arch thoracoscopic enlarged thymectomy to treat thymic carcinoma based on various reviews. We have also reviewed the relevant literature on the subject of evidence-based medicine. The evaluation of CD70 in combination with CD5 and CD117 or preferentially expressed antigen in melanoma in combination with CD5 and CD117 may help to diagnose thymic squamous cell carcinoma (TSCC) more accurately. The modified thoracoscopic expanded thymic resection under the costal arch of the xiphoid process is not only suitable for TSCC but also for thymic cyst, thymoma, locally invasive thymoma, and thymic carcinoma.

Heterotopic Ossification of the Xiphoid Process after Abdominal Surgery for Traumatic Hemoperitoneum.

Heterotopic ossification of the xiphoid process is extremely rare, with only three cases previously reported. However, the surgical pathology for postoperative elongation of the xiphoid process after abdominal surgery has not yet been reported. We report a case of the postoperative elongation of the xiphoid process, 8 years after abdominal surgery for traumatic hemoperitoneum in a 53-year-old man. The patient underwent surgical excision of the elongated mass of the xiphoid process. Histopathology revealed multiple exostoses. Heterotopic ossification can occur after surgical trauma to soft or bone tissue. Surgical excision with primary closure is the treatment of choice for symptomatic heterotopic ossification.

Abnormal chondrocyte apoptosis in the cartilage growth plate is influenced by genetic background and deletion of CHOP in a targeted mouse model of pseudoachondroplasia.

Pseudoachondroplasia (PSACH) is an autosomal dominant skeletal dysplasia caused by mutations in cartilage oligomeric matrix protein (COMP) and characterised by short limbed dwarfism and early onset osteoarthritis. Mouse models of PSACH show variable retention of mutant COMP in the ER of chondrocytes, however, in each case a different stress pathway is activated and the underlying disease mechanisms remain largely unknown. T585M COMP mutant mice are a model of moderate PSACH and demonstrate a mild ER stress response. Although mutant COMP is not retained in significant quantities within the ER of chondrocytes, both BiP and the pro-apoptotic ER stress-related transcription factor CHOP are mildly elevated, whilst bcl-2 levels are decreased, resulting in increased and spatially dysregulated chondrocyte apoptosis. To determine whether the abnormal chondrocyte apoptosis observed in the growth plate of mutant mice is CHOP-mediated, we bred T585M COMP mutant mice with CHOP-null mice to homozygosity, and analysed the resulting phenotype. Although abnormal apoptosis was alleviated in the resting zone following CHOP deletion, the mutant growth plates were generally more disorganised. Furthermore, the bone lengths of COMP mutant CHOP null mice were significantly shorter at 9 weeks of age when compared to the COMP mutant mice, including a significant difference in the skull length. Overall, these data demonstrate that CHOP-mediated apoptosis is an early event in the pathobiology of PSACH and suggest that the lack of CHOP, in conjunction with a COMP mutation, may lead to aggravation of the skeletal phenotype via a potentially synergistic effect on endochondral ossification.

Estimation of age from human sternum: an autopsy study on a sample from South India.

Age estimation is one of the main parameters in the evaluation of skeletal remains in forensic anthropology casework. The present investigation is an attempt to study the fusion of manubrium and xiphoid process with mesosternum in 118 sterna (67 males and 51 females) of known age obtained during autopsy in South Indian population. The male samples were aged between 25 and 74 years and the females between 20 and 80 years. The fusion is studied to derive standards for the estimation of age from sternum. The results indicate that, with advancing age, the proportion of sternum with fusion of manubrio-mesosternal and mesosterno-xiphisternal junctions increases in males and females. A larger proportion of sterna showed fusion of mesosterno-xiphisternal junction than manubrio-mesosternal junction in different age groups. Fusion of manubrio-mesosternal and mesosterno-xiphisternal junctions was proportionately commoner in males than females. None of the sterna aged below 30 years showed fusion of mesosterno-xiphisternal junction. Nonfusion of mesosterno-xiphisternal junction was reported till the age of 48 years in males and 46 years in females. Manubrio-mesosternal junction was observed to be very variable with regard to fusion status as the joint remained unfused even in the elderly ages. Based on the variability of the fusion of manubrio-mesosternal and mesosterno-xiphisternal junctions observed in the study, it can be concluded that the sternum alone is not reliable for estimation of age in South Indian population.

Endogenous regeneration of critical-size chondral defects in immunocompromised rat xiphoid cartilage using decellularized human bone matrix scaffolds.

Clinical efforts to repair cartilage defects delivering cells or engineered cartilage implants into the lesions have met with limited success. This study used a critical-size chondral defect model in immunocompromised rat xiphoid cartilage to test whether endogenous chondrogenesis could be achieved using human bone matrix scaffolds to deliver human cartilage particles and/or a variant isoform of fibroblast growth factor-2 (FGF2-variant). Seventy-two male athymic RNU rats were enrolled in this study with eight rats per experimental group. Decellularized and demineralized human bone matrix scaffolds loaded with human articular cartilage particles or heat-inactivated cartilage particles were combined with different doses of the FGF2-variant. Scaffolds were implanted into 3-mm-diameter critical-size defects prepared using a biopsy punch through the center of the xiphoid. The samples were evaluated 28 days postsurgery using X-ray, equilibrium partitioning of ionic contrast microcomputed tomography, and safranin O-stained histological sagittal sections. Scaffolds containing cartilage particles plus the FGF2-variant induced dose-dependent increases in the formation of neocartilage (p<0.05), which was distributed homogeneously throughout the defects in comparison to scaffolds containing only the FGF2-variant. These effects were less pronounced when scaffolds with heat-inactivated cartilage particles were used. These results demonstrate that endogenous repair of chondral defects can be achieved in the absence of exogenous cells or bone marrow, suggesting that a similar approach may be successful for treating chondral lesions clinically.

A new animal model for assessing cartilage repair and regeneration at a nonarticular site.

The aim of this study was to establish a critical-sized nonjoint chondral defect animal model and to evaluate its feasibility for testing cartilage regeneration strategies. Dermal biopsy punches 1-4 mm in diameter were used to create cylindrical full-thickness defects in the center of athymic rat xiphoids. The 3 and 4 mm defects remained unhealed 35 days postsurgery, with a large area in the center that had low proteoglycan content based on contrast-enhanced microCT (EPIC-microCT), radiographic, and histological analyses. In a second step, tissue-engineered cartilage was synthesized by culturing primary bovine articular chondrocytes on poly-L-lactic acid (PLA) scaffolds in a perfusion-shear bioreactor for 28 days. These chondrocyte/PLA constructs or primary bovine chondrocytes were implanted into 3-mm-diameter defects. Empty defects and defects implanted with empty PLA scaffolds were used as controls. Xiphoids were harvested 28 days after surgery and examined with faxitron, microCT, and histology using hematoxylin and eosin and safranin-O staining. Both chondrocyte/PLA constructs and chondrocytes alone formed neocartilage. The results indicate that a 3 mm cylindrical defect in a rat xiphoid is an economic, feasible, and reproductive model to evaluate the potential of various constructs for nonjoint cartilage repair.

Atherosclerosis in relation to fat penniculus (obesity) between xiphoid and umbilicus.

BACKGROUND: It has been shown that possible influence of body weight is more evident for coronary than aortic atherosclerosis; and more in men than women. Coronary heart disease due to obesity in males becomes significant when body mass index (BMI) exceeds 30 (30% overweight) and does not affect the life expectancy particularly in women. This study was conducted to asses the relation of thickness of fat penniculus (obesity) between xiphoid and umbilicus to different atherosclerotic lesions; and to collect basic data about age and sex distribution of this relation METHODS: It was prospective descriptive study and conducted at mortuary of King Edward Medical University, and Department of Pathology, Allama Iqbal Medical College. Lahore. A total of 130 human autopsies were carried out in one-and-a-half year of study duration. The ages of the deceased ranged between 8 and 85 years. Heart aorta and its major branches were included in this study. In addition, fat penniculus between xiphoid and umbilicus was measured and atherosclerosis lesions were categorised and correlated with this parameter. Haematoxylin and Eosin, and different special stains were done in Pathology Department of Allama Lqbal Medical College, Lahore to asses to severity of atherosclerosis lesions. RESULTS: The fatty streaks were present in predominantly more cases with Fat Penniculus < 20 mm than in asses with Fat Penniculus < 10 mm and < 30 mm. The fibrolipid plaques, complicated and calcified lesions were present in a dominant number of cases with Fat Penniculus < 30 mm on percentage basis. CONCLUSION: Raised lesions were seen more frequently in cases with Fat Penniculus 20 mm to < 30 mm than in cases with Fat Penniculus < 10 mm and < 20 mm thickness.

Osteochondroma developing from the xyphoid appendix into an abdominal wall scar from a previous laparotomy.

We describe herein the case of a 45-year-old man who developed an osteochondroma from the xyphoid appendix into an abdominal wall scar from a laparotomy performed 4 years previously. To our knowledge, rare cases of osteochondroma of the xyphoid bone have been documented in the literature. As shown by the tumor's rapid development during a period of only 4 years, osteochondromas arise from, or grow well under, inflammatory and cicatricial conditions. Periosteal contusion causing growth-plate cartilage migration and enchondral ossification seems to be the first presentation of osteochondroma.

Metástasis xifoidea de cáncer de duodeno / Xiphoid metastasis from duodenal cancer

El cáncer duodenal es una neoplasia con baja prevalencia en la población general. Cuando produce metástasis, éstas se localizan habitualmente en ganglios, hígado y pulmones. Las metástasis óseas de cáncer duodenal son muy infrecuentes y la localización xifoidea es extraordinaria. Presentamos el caso de un paciente que 5 años después de ser intervenido de una neoplasia duodenal desarrolló una metástasis xifoidea. Debatimos la utilidad de la tomografía por emisión de positrones y las opciones terapéuticas (AU)

Duodenal cancer has a low prevalence in the general population. Metastases from this neoplasm usually affect the lymph nodes, liver or lung. Bone metastases from duodenal cancer are highly infrequent and xiphoid localization is exceptional. We present the case of a patient who, 5 years after undergoing surgery for duodenal adenocarcinoma, developed xiphoid metastasis. We discuss the utility of positron emission tomography in the diagnosis of this entity and the therapeutic options (AU)

Xiphoidectomy.

Complex surgical procedures in the upper abdomen required ear exposure. To improve exposure xiphoidectomy is indicated; however, in the past there was an extensive time commitment and unpredictable bleeding. We describe a rapid and bloodless approach to xiphoidectomy, utilizing a self-retaining retractor, controlled osteotomy, and complete removal to the xiphisternal junction. The xiphoid bone is dissected with high-voltage electrosurgery, denatured, and resected completely. Bleeding points are easily controlled with electrocoagulation. This procedure allows optimal exposure to the most superior aspect of the abdominal cavity.

Heterotopic bone formation: presentation of an experimental rat model and a clinical case.

Heterotopic bone formation (HBF), an ill-defined phenomenon, refers to the formation of bone in tissue that normally does not ossify. Two existing theories to explain HBF are that two cellular entities, one from the bone and the other from the muscle or fascia (two cell types) are involved, and that stem cell responds to a factor induced by trauma (one cell + factor). In our report, the HBF in a patient's vertical abdominal wound was possibly due to IEL, a stem cell, which is stimulated by a factor from xiphoid when it is traumatized by surgical incision. After 28 days' culture rat tissue specimens from the xiphoid, upper gastrointestinal tract, pubis and bladder exhibited macroscopic mineralization with cellular infiltration, a paradigm of 2-dimensional BF. Characteristically, pubis + bladder, xiphoid + ileum and xiphoid + duodenum showed 2-dimensional BF by as early as 5 days. Thus, it appears that both theories of HBF may be valid.

AG-041R, a novel indoline-2-one derivative, induces systemic cartilage hyperplasia in rats.

AG-041R (3R-1-(2,2-diethoxyethyl)-3-((4 methylphenyl)aminocarbonylmethyl)-3-((4-methylphenyl) ureido)-indoline-2-one) is a novel small compound synthesized as a cholecystokinin-2 (CCK(2))/gastrin receptor antagonist. In the course of the development of this compound, we discovered unexpectedly that oral administration of a high dose for 4 weeks markedly induced systemic cartilage hyperplasia. This change was histologically observed in the auricles, the trachea, the marginal region of the femoral condyle, the xiphoid process and intervertebral disks in rats. Daily intraarticular injections of AG-041R into rat knee joints for 3 weeks also caused cartilage hyperplasia in the marginal region of the femoral condyle, but no hyperplasia was observed in any other cartilage. We have confirmed that chondrogenic activity of AG-041R is an intrinsic property of the compound, and is not due to its CCK(2)/gastrin receptor antagonistic actions. These results indicate that AG-041R is a novel stimulator of chondrogenesis, and can be expected to be a potent therapeutic agent for cartilage disorders.

Xiphodynia masking acute myocardial infarction: a diagnostic cul-de-sac.

A 52-year-old hypertensive woman is described in whom a clinically evident diagnosis of xiphodynia, the painful xiphoid process, complicated the diagnosis of impending myocardial infarction. The authors suggest that xiphodynia be considered a second-line assumption after more dangerous conditions have been thoroughly ruled out.