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1.
Ann Plast Surg ; 90(2): 151-155, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36688858

RESUMO

INTRODUCTION: Chondrosarcoma (CS) is most common primary osseous tumor of the chest wall. The aim of this study was to report results from surgical procedures and evaluate clinical factors predicting survival of patients with chest wall CSs treated in a single tertiary sarcoma center. MATERIALS AND METHODS: Fifty patients with primary CS located in the ribs and sternum were included. Details of the clinical data and oncological outcomes, including local recurrence (LR) and disease-specific survival (DSS), were collected. RESULTS: The tumor was primarily originated in the sternum in 6 patients (12.5%) and in ribs 2 to 11 in the remaining patients. Specimens were histologically graded 1 in 13 patients (26%), 2 in 28 (56%), 3 in 8 (16%), and 1 (2%) as mesenchymal grade 3 CS. R0 margins were obtained in all cases. Reconstruction was warranted in 47 (94%) cases. Local recurrence developed in 3 (6%) patients, and the median time to LR was 17 (range, 16-68) months. Eight (16%) patients developed metastasis. Increasing tumor volume was a statistically significant factor for reduction of DSS. CONCLUSIONS: Chondrosarcoma of the chest wall can be treated effectively with clear margins, resulting in lower LR rate and higher DSS than CS of the extremities and pelvis. Metastasis of the chest wall mostly occurs in high-grade tumors, and the locations of the metastases differ greatly from those observed in CS of the extremities and pelvis. Metastases are commonly extrapulmonary, indicating the need for postoperative follow-up with multiple imaging modalities to monitor recurrence and metastases.


Assuntos
Neoplasias Ósseas , Condrossarcoma , Sarcoma , Parede Torácica , Humanos , Parede Torácica/cirurgia , Condrossarcoma/patologia , Condrossarcoma/cirurgia , Sarcoma/cirurgia , Esterno , Costelas , Neoplasias Ósseas/cirurgia , Estudos Retrospectivos , Recidiva Local de Neoplasia/patologia
3.
Food Res Int ; 163: 112251, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36596162

RESUMO

The aim of this research was to investigate how the electrical conductivity of short ribs affected Pulsed Electric Field (PEF) process parameters and the ability of PEF to enhance their quality and reduce sous vide (SV) processing time. Short ribs with different range of electrical conductivity (3-6, 6-9, and 9-12 mS/cm) values were treated using input voltage of 10 kV, pulse width of 20 µs, pulse frequency of 50 Hz and pulse number, of either 1600 (low intensity PEF/LPEF) or 5200 (high intensity PEF/HPEF), followed by SV processing at 60 °C for either 24 or 36 h. The quality parameters assessed were cooking loss (%), Texture Profile Analysis (TPA) parameters, and Commission Internationale d'Eclairage (CIE) L*a*b* colour parameters. There was a variation in electrical conductivity of short ribs according to the position of the bone in the short rib, which demonstrated good congruence with the distribution of fat and connective tissue. SV processing with or without PEF pre-treatment did not have a significant effect (p > 0.05) on cooking loss or CIE L*a*b* colour parameters. Short ribs with a medium conductivity (6-9 mS/cm) had a significantly lower hardness after high intensity PEF followed by SV for 24 h, whilst short ribs with an average conductivity of 3-6 and 9-12 mS/cm required longer SV time (up to 36 h) and had a significantly lower hardness compared to non PEF pre-treated samples. TPA values of short ribs treated with the same PEF intensity and SV processing parameters were comparable regardless of the short ribs initial electrical conductivity, which indicates that PEF treatment could ameliorate the biological electrochemical variability inherent to short ribs and PEF could be the potential tool to decrease their SV processing time and enhance their tenderness.


Assuntos
Culinária , Carne , Animais , Bovinos , Carne/análise , Eletricidade , Condutividade Elétrica , Costelas
4.
J Plast Reconstr Aesthet Surg ; 76: 4-9, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36513003

RESUMO

BACKGROUND: In the standard Nuss procedure for pectus excavatum, the costal arch is often elevated together with the sternum, resulting in unevenness of the lower part of the thorax. This complication is commonly called rib flaring. This paper presents a technique to avoid rib flaring and evaluates its effectiveness. MATERIALS AND METHODS: In our technique, a part of the seventh costal cartilage is removed, disconnecting the costal arch from the sternum. The effectiveness of this technique was evaluated in a retrospective clinical study of 63 pectus excavatum patients who were randomly collected and were divided into two groups. One group-defined as the Standard Group-includes 27 patients (29.8 ± 6.5SD y/o) on whom standard Nuss procedure was conducted; the other group-defined as the Separation Group-includes 36 patients (31.8 ± 6.1SD y/o) on whom the cartilage removal was conducted in addition to the standard Nuss procedure. The degree of postoperative costal-arch elevation was defined as ECA (Elevation of Costal Arch) and was compared between the two groups. RESULTS: ECA was significantly greater for the Standard Group (10.2 ± 3.3SD mm) than for the Separation Group (-1.1 ± 3.42SDmm). CONCLUSION: Postoperative protrusion of the costal arch is prevented by the separation of the seventh costal cartilage from the sternum. Our original technique is a useful option for the treatment of pectus excavatum.


Assuntos
Cartilagem Costal , Tórax em Funil , Humanos , Tórax em Funil/cirurgia , Estudos Retrospectivos , Costelas/cirurgia , Esterno/cirurgia , Resultado do Tratamento
5.
Curr Biol ; 33(1): 197-205.e2, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36563692

RESUMO

Evolutionary transitions are frequently associated with novel anatomical structures,1 but the origins of the structures themselves are often poorly known. We use developmental, genetic, and paleontological data to demonstrate that the therian sternum was assembled from pre-existing elements. Imaging of the perinatal mouse reveals two paired sternal elements, both composed primarily of cells with lateral plate mesoderm origin. Location, articulations, and development identify them as homologs of the interclavicle and the sternal bands of synapsid outgroups. The interclavicle, not previously recognized in therians,2 articulates with the clavicle and differs from the sternal bands in both embryonic HOX expression and pattern of skeletal maturation. The sternal bands articulate with the ribs in two styles, most clearly differentiated by their association with sternebrae. Evolutionary trait mapping indicates that the interclavicle and sternal bands were independent elements throughout most of synapsid history. The differentiation of rib articulation styles and the subdivision of the sternal bands into sternebrae were key innovations likely associated with transitions in locomotor and respiratory mechanics.3,4 Fusion of the interclavicle and the anterior sternal bands to form a presternum anterior to the first sternebra was a historically recent innovation unique to therians. Subsequent disassembly of the radically reduced sternum of mysticete cetaceans was element specific, reflecting the constraints that conserved developmental programs exert on composite structures.


Assuntos
Evolução Biológica , Esterno , Animais , Camundongos , Mamíferos , Mesoderma , Costelas , Cetáceos
6.
Vet Surg ; 51(1): 62-67, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34486743

RESUMO

OBJECTIVE: To evaluate the short and long-term outcomes of foals treated surgically for fractured ribs and variables that may affect outcome. STUDY DESIGN: Retrospective. ANIMALS: Seventy-three equine neonates with surgically repaired fractured ribs. METHODS: Medical records were reviewed to include sex, breed, the side of thorax affected, number of ribs fractured, co-morbidities directly associated with rib fracture, and surgical technique used. Short-term outcome was defined as survival to discharge. Long-term outcome was whether or not they started a race. Race records of maternal siblings were obtained for comparison. RESULTS: Seventy-three neonates underwent surgery for fractured ribs. Fifty-seven neonates (78%) survived to discharge from the hospital. Rib fractures were more commonly observed in colts and in the left hemithorax (61% and 57%, respectively). Sex, side affected, number of ribs fractured, co-morbidities, number of ribs repaired, and surgical technique did not affect the short- or long-term outcomes. Thirty-five of 57 (61%) foals treated surgically for rib fractures that survived to discharge started a race compared to 173 of 257 (67%) of maternal siblings that raced. CONCLUSIONS: Short- and long-term outcome were not affected by co-morbidities, surgical technique, or number of fractured ribs. CLINICAL SIGNIFICANCE: Neonates with surgically repaired fractured ribs had a good prognosis for survival and and those that survived had a similar chances of starting a race compared to maternal siblings.


Assuntos
Doenças dos Cavalos , Fraturas das Costelas , Animais , Doenças dos Cavalos/cirurgia , Cavalos , Masculino , Estudos Retrospectivos , Fraturas das Costelas/cirurgia , Fraturas das Costelas/veterinária , Costelas
7.
Kyobu Geka ; 75(13): 1071-1073, 2022 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-36539220

RESUMO

BACKGROUND: Aggressive surgical treatment for renal cell carcinoma (RCC) bone metastasis has shown good results. METHODS: Since January 1995, four patients underwent surgery at our institution for rib metastasis of operated RCCs. Of these patients, three were male and one was female. The patients had a mean age of 67.5 years. Except one patient who presented with rib metastasis at the time of diagnosis of RCC, the average period of metastasis to the ribs after RCC surgery was 24.3 months. All patients underwent resection of metastasized tumors involving the ribs, with or without chest wall involvement. The clinical features of the surgical treatment for RCC bone metastasis were retrospectively analyzed. RESULTS: The mean time to tumor recurrence was 22.3 months postmetastasectomy. All patients developed other bone metastases and underwent multidisciplinary therapy. After metastasectomy, the four patients survived for 19~93 months. CONCLUSION: Surgical treatment for patients with rib metastases of RCC may contribute in prolonging survival.


Assuntos
Neoplasias Ósseas , Carcinoma de Células Renais , Neoplasias Renais , Humanos , Masculino , Feminino , Idoso , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/secundário , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Estudos Retrospectivos , Recidiva Local de Neoplasia , Neoplasias Ósseas/cirurgia , Costelas/cirurgia
8.
J Cardiothorac Surg ; 17(1): 329, 2022 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-36539826

RESUMO

BACKGROUND: Surgical resection is the most effective curative management of benign rib tumors and carries an excellent prognosis. Due to complex anatomy and narrow field, higher rib resection is technically demanding and requires extensive dissection. CASE PRESENTATION: We report a case of second rib tumor resection performed transthoracic under Da Vinci robot assistance. A 32-year-old male complained about increasing pain in the left anterior chest wall. After 3D reconstruction of CT, it showed a well-circumscribed fusiform lesion with a multi-component structure. Measured 17 × 6 × 4 cm and extended into the chest cavity to the depth below the pectoralis minor muscle. The patient underwent robotic-assisted trans-thoracic second rib resection. At four weeks of outpatient follow-up, the patient reported no pain and uncomplicated wound healing. CONCLUSION: This minimally invasive approach offers optimal visualization and tissue manipulation while dramatically decreasing the possibility of collateral damage, hence ensuring fast function recovery. To the best of our knowledge, these kinds of procedures are rarely reported in detail.


Assuntos
Neoplasias , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Torácicos , Masculino , Humanos , Adulto , Procedimentos Cirúrgicos Robóticos/métodos , Prognóstico , Costelas/cirurgia
9.
Hell J Nucl Med ; 25(3): 315-316, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36507887

RESUMO

A 45-year-old man had right chest and back pain for 15+ days without any cause, each lasting 3-10 minutes, and sometimes it could radiate to the right shoulder. Chest computed tomography (CT) scan showed bony destruction in the dorsal segment of the 4th rib on the right. Metastatic disease was suspected and for this reason, fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT was performed. The images demonstrated increased 18F-FDG activity in the dorsal segment of the 4th rib on the right with osteolytic bony destruction. Postsurgical pathological examination showed aneosinophilic abscess (EA).


Assuntos
Neoplasias Ósseas , Fluordesoxiglucose F18 , Masculino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos , Abscesso/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Neoplasias Ósseas/secundário , Costelas/diagnóstico por imagem
10.
BMJ Case Rep ; 15(11)2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36414336

RESUMO

Gorham-Stout disease (GSD) is thought to be due to uncontrolled proliferation of vascular and lymphatic structures within bone tissue causing destruction and osteolysis of bone. We present a patient in her mid-40s who reported chronic shoulder pain, a pleural effusion and irregular periods. Investigations showed osteolysis of her ribs, pleural effusions, an ovarian mass and a raised carbohydrate antigen 125 (Ca-125). She was subsequently diagnosed with GSD, and referred to gynaecology-oncology in consideration of potential ovarian malignancy. GSD is a diagnosis of exclusion that requires a high degree of clinical suspicion, as well as multiple investigations to achieve diagnosis. Clinicians rely on a small number of case reports to provide guidance for this. Therefore, this report provides an overview of a rare pathology, considers the differentials of a raised Ca-125 and describes how a pleural effusion, which links them both, alarmed us regarding an incidental finding of an ovarian cyst.


Assuntos
Osteólise Essencial , Osteólise , Neoplasias Ovarianas , Derrame Pleural , Feminino , Humanos , Osteólise Essencial/diagnóstico , Osteólise Essencial/patologia , Diagnóstico Diferencial , Osteólise/diagnóstico , Costelas/patologia , Derrame Pleural/etiologia , Derrame Pleural/diagnóstico , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico
11.
Ann Plast Surg ; 89(6): e69-e80, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416709

RESUMO

OBJECTIVE: Autologous costal cartilage is used extensively in reconstructive surgery because of its stability, durability, and biocompatibility. The current preoperative evaluation of costal cartilage often only consists of a physical examination. Several studies have highlighted the benefits of preoperative imaging as a tool to ensure optimal graft harvest. This systematic review aims to synthesize the current evidence and establish the efficacy of the various imaging modalities for the assessment of costal cartilage. REVIEW METHODS: The data sources were explored using a search strategy based on the terms ("costal cartilage" OR "ribs" AND "imaging*") combined with Boolean operators. The primary outcome measures were the ability to measure the dimensions of costal cartilages and to detect the presence of calcifications. RESULTS: A total of 28 publications were included in the final review, with 12 case series, 7 case control studies, and 9 cohort studies. Twenty-two studies used computed tomography (CT); 4 studies used x-ray and 2 studies used ultrasonography, whereas no studies used magnetic resonance imaging. Meta-analysis of the data from these studies was not deemed possible. CONCLUSIONS: Our findings suggest that CT is the modality with the strongest evidence base that provides the greatest degree of information. The major benefits of CT are its ability to provide 3-dimensional image reconstruction for surgical planning, ability to detect synchondroses, and assess cartilage quality. Where radiation exposure is less preferable, x-ray and ultrasound (US) may play an important role. X-ray appears to be particularly useful when the main concern is the presence of calcification. The limited studies available indicate that US can provide useful and accurate information on cartilage quality and morphology. Further studies are warranted in exploring the use of US in preoperative planning, particularly in the pediatric population.


Assuntos
Cartilagem Costal , Criança , Humanos , Cartilagem Costal/diagnóstico por imagem , Cartilagem Costal/transplante , Costelas , Tomografia Computadorizada por Raios X/métodos , Imageamento Tridimensional , Cartilagem/diagnóstico por imagem
13.
J Cancer Res Ther ; 18(6): 1807-1808, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412449

RESUMO

Osteochondromas are usually osseous outgrowths arising from the metaphyseal region of cortical bone. Moreover, osteochondroma can also arise from flat bones and the spine. However, their origin in the ribs is extremely rare and always near the costochondral junction. We present a 26-year-old male who presented with chief complaints of difficulty in walking for 2 weeks subsequently diagnosed with osteochondroma based on the presence of a cartilage cap on Magnetic resonance imaging.


Assuntos
Neoplasias Ósseas , Osteocondroma , Masculino , Humanos , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/diagnóstico por imagem , Osteocondroma/diagnóstico , Osteocondroma/diagnóstico por imagem , Costelas/diagnóstico por imagem , Costelas/patologia , Paraparesia , Imageamento por Ressonância Magnética
14.
Homo ; 73(1): 69-76, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36353975

RESUMO

Sex determination is one of the first biological attribute to be assessed when unidentified remains surface. In material of forensic interest, being able to use every skeletal element available for identification purposes is of paramount importance. The osteometric method from the sternal rib end has been found to generate accurate sex estimates, but as various studies have proved, all osteometric methods should be population-specific, as one equation does not fit all. The aim of this study is to assess sexual dimorphism in a contemporary Greek population sample of 68 males and 43 females, with the use of discriminant function analysis. The superior-inferior height (SIH) and anterior-posterior breadth (APB) from the third to fifth sternal rib ends of both sides were taken from 3D models created with the use of a hand-held 3D scanner. The results demonstrated that SIH is more sexually dimorphic than APB (alpha value of .05) while the application of Iscan's (1985) formula on the contemporary Greek sample, provided results of low accuracy, ranging from 48.6-52.4%. The cross-validated discriminant functions equations for the current sample, produced results ranging between 74.0-82.9% indicating that population-specific formulas produce results of higher accuracy, that are vital in cases of forensic interest.


Assuntos
Determinação do Sexo pelo Esqueleto , Masculino , Feminino , Humanos , Determinação do Sexo pelo Esqueleto/métodos , Antropologia Forense/métodos , Grécia , Esterno/anatomia & histologia , Costelas/anatomia & histologia , Análise Discriminante
15.
Sci Justice ; 62(5): 484-493, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36336441

RESUMO

Forensic anthropologists may not always be able to differentiate heat-induced fractures from fractures with other aetiologies, namely sharp force traumas, with clear nefarious impact on medico-legal conclusions. The objective of this study was to experimentally investigate if blade chemical traces are transferred to defleshed bone tissue and if they remain there after a burning event. This was accomplished by prompting sharp force traumas in 20 macerated fresh pig ribs with five different instruments, namely a stainless steel knife, an artisanal knife and a ceramic kitchen knife, a small axe and a large axe. Another pig rib was used as control, not being subjected to any trauma. All instruments were probed by X-ray fluorescence (XRF) to establish the composition of each blade. Bone samples, both pre-burned and post-burned (at 500 °C, 700 °C, 900 °C and 1100 °C), were then probed by XRF. All sharp force instruments left detectable chemical traces on pre-burned bone, although not in all samples. Furthermore, traces were still detected after experimental burning in most cases. Potentially, XRF can provide relevant information about the aetiology of fractures in burned and unburned bones, although the effect of soft tissues and diagenesis must still be investigated.


Assuntos
Queimaduras , Suínos , Animais , Raios X , Fluorescência , Costelas , Medicina Legal
16.
Int J Mol Sci ; 23(21)2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36362086

RESUMO

RUNX proteins, such as RUNX2, regulate the proliferation and differentiation of chondrocytes and osteoblasts. Haploinsufficiency of RUNX2 causes cleidocranial dysplasia, but a detailed analysis of Runx2+/- mice has not been reported. Furthermore, CBFB is required for the stability and DNA binding of RUNX family proteins. CBFB has two isoforms, and CBFB2 plays a major role in skeletal development. The calvaria, femurs, vertebrae and ribs in Cbfb2-/- mice were analyzed after birth, and compared with those in Runx2+/- mice. Calvarial development was impaired in Runx2+/- mice but mildly delayed in Cbfb2-/- mice. In femurs, the cortical bone but not trabecular bone was reduced in Cbfb2-/- mice, whereas both the trabecular and cortical bone were reduced in Runx2+/- mice. The trabecular bone in vertebrae increased in Cbfb2-/- mice but not in Runx2+/- mice. Rib development was impaired in Cbfb2-/- mice but not in Runx2+/- mice. These differences were likely caused by differences in the indispensability of CBFB and RUNX2, the balance of bone formation and resorption, or the number and maturation stage of osteoblasts. Thus, different amounts of CBFB and RUNX2 were required among the bone tissues for proper bone development and maintenance.


Assuntos
Subunidade alfa 1 de Fator de Ligação ao Core , Osteoblastos , Animais , Camundongos , Diferenciação Celular/genética , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Subunidades alfa de Fatores de Ligação ao Core/metabolismo , Osteoblastos/metabolismo , Osteogênese/genética , Costelas/metabolismo , Crânio/metabolismo , Coluna Vertebral/metabolismo
17.
Zhongguo Gu Shang ; 35(10): 979-83, 2022 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-36280417

RESUMO

OBJECTIVE: This paper is aimed at investigating the efficacy of combining internal fixation using prefabricated rib-locking titanium plate with ultrasound-guided thoracic paravertebral nerve blockade in treating multiple rib fractures among the elderly. METHODS: Retrospective analysis of 221 elderly patients with multiple rib fractures treated from February 2016 to November 2020. According to whether surgery was performed, they were divided into the plate-blockage combination group (surgical group, 102 cases) and conservative treatment group (non-surgical group, 119 cases). The surgical group consisted of 58 males and 44 females aged from 60 to 85 years old, with an average of (67.2±3.6 ) years old, who suffered from 3 to 12 rib fractures with an average of (5.3±2.1) fractures. The non-surgical group consisted of 66 males and 53 females aged from 60 to 84 years old with an average of (66.8±3.2) years old, who suffered from 2 to 11 rib fractures with an average of(6.1±2.3) fractures. The clinical data, efficacies observed, and complications associated with both groups were compared and analyzed. RESULTS: There was no significant difference in preoperative clinical data between two groups (P>0.05), and all patients were discharged smoothly. Pulmonary infection (P=0.028), atelectasis (P=0.032), respiratory failure (P=0.026), time to get out of bed (P=0.040), time to fracture healing (P=0.035), length of hospital stay in the operation group (P=0.043), visual analogue scale (VAS) at 3 days (P=0.028), 5 days(P=0.032), and 7 days(P=0.019), maximal voluntary ventilation (MVV) at 3 months after surgery (P=0.042), forced expiratory volume in one second (FEV1)(P=0.035), and maximal voluntary ventilation at 6 months, the maximal voluntary ventilation(MVV)(P=0.021) and forced FEV1(P=0.026) were all significantly better than those in non-surgical treatment group. CONCLUSION: For elderly patients with severe multiple rib fractures, the proposed plate-blockade combination can timely and effectively relieve pain, restore thoracic stability, shorten hospital stay, and reduce the incidence of complications such as pulmonary infections and acute respiratory distress syndrome(ARDS) compared with non-surgical treatments. Prefabricated rib-locking titanium plates have proved to demonstrate high clinical efficacy in treating multiple rib fractures among the elderly.


Assuntos
Bloqueio Nervoso , Fraturas das Costelas , Masculino , Feminino , Humanos , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fraturas das Costelas/cirurgia , Fraturas das Costelas/etiologia , Titânio , Estudos Retrospectivos , Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Costelas
18.
J Pak Med Assoc ; 72(9): 1865-1867, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36280995

RESUMO

We report a case of a middle age male who presented to our tertiary care university hospital with the complaints of nasal obstruction and decrease hearing. The CT scan of head and neck exhibited a mass in nasopharynx and enlarged bilateral cervical lymph nodes. Biopsy from nasopharynx confirmed the lesion as poorly differentiated non-keratinizing squamous cell carcinoma and staged as cT2N2M0. He received neoadjuvant chemotherapy. Subsequently, he underwent chemo radiation therapy. He represented with left chest wall pain. Imaging confirmed isolated lesion on left sided 6th rib. Rib lesion was resected followed by radiation therapy to surgical bed and systemic treatment. The patient remained disease free for 4.5 years. Later, his disease relapsed, and he died of systemic disease progression. To the best of the author's knowledge, only few cases have been reported with isolated rib metastasis from nasopharyngeal carcinoma and this is the first case in which metastasectomy was considered.


Assuntos
Metastasectomia , Neoplasias Nasofaríngeas , Pessoa de Meia-Idade , Masculino , Humanos , Carcinoma Nasofaríngeo , Pescoço , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/patologia , Costelas/diagnóstico por imagem , Costelas/patologia
19.
J Plast Reconstr Aesthet Surg ; 75(12): 4354-4360, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36253301

RESUMO

BACKGROUND: In microvascular breast reconstruction, internal mammary vessel (IMV) exposure has been performed. The preservation of intercostal nerve (ICN) is effective for preserving sensibility and decreasing postoperative pain. In nipple reconstruction, cartilage grafting is performed to provide additional support and projection. We considered that ICN preservation and costal cartilage banking could be performed simultaneously. This method was described as the "partial rib-sparing procedure." The purpose of this study was to introduce this procedure. METHODS: Surgical technique of this procedure was as follows. The second intercostal space was used. The width of the trimmed cartilage was kept within the superior half of the third costal cartilage. Soft tissue within 5 mm of the inferior border of the second rib edge was preserved to save the second ICN. The length of IMVs in the partial rib-sparing procedure and that in the total rib-sparing procedure was compared. RESULTS: The number of patients in the partial rib-sparing and total rib-sparing groups was 137 procedures and 57 procedures, respectively. The length of IMVs was significantly longer in the partial rib-sparing procedure (median 20.5 mm vs. 17.6 mm, P < 0.001). In the partial rib-sparing group, no patient complained of prolonged local pain, and chest wall contour abnormalities were absent in all cases. CONCLUSIONS: The partial rib-sparing procedure is superior, especially for patients with narrow intercostal spaces and/or patients who decide to undergo nipple reconstruction with costal cartilage. This procedure could be performed to preserve the soft tissues around the ICN and decrease the postoperative pain.


Assuntos
Neoplasias da Mama , Mamoplastia , Artéria Torácica Interna , Humanos , Feminino , Nervos Intercostais/cirurgia , Artéria Torácica Interna/cirurgia , Mamilos/cirurgia , Microcirurgia/métodos , Anastomose Cirúrgica/métodos , Mamoplastia/métodos , Costelas/cirurgia , Costelas/irrigação sanguínea , Dor Pós-Operatória/cirurgia , Neoplasias da Mama/cirurgia
20.
J Cardiothorac Surg ; 17(1): 265, 2022 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-36217204

RESUMO

BACKGROUND: Resection of lung cancer with chest wall involvement is an invasive procedure. CASE PRESENTATION: We report a case of pulmonary adenocarcinoma with chest wall involvement that was resected through video-assisted thoracoscopic segmentectomy and combined en bloc resection of the chest wall (2nd to 4th ribs). Surgical stress was decreased by reducing the extent of lung parenchymal resection and applying a video-assisted technique with an additional posterior paravertebral incision. CONCLUSION: A thoracoscopic surgical approach involving incisions in areas requiring resection of the proximal, lateral, and posterior sides of the involved ribs can be applied to tumors invading the chest wall.


Assuntos
Neoplasias Pulmonares , Parede Torácica , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Costelas/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Parede Torácica/patologia , Parede Torácica/cirurgia
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