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2.
PLoS One ; 16(10): e0256027, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618825

RESUMO

BACKGROUND: Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury-respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. METHODS: This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. RESULTS: There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18-0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04-0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61-9.45), physiotherapy OR 2.17 (95% CI 1.52-3.11), ICU doctor OR 6.13 (95% CI 3.94-9.55), ICU liaison OR 55.75 (95% CI 17.48-177.75), pain team OR 8.15 (95% CI 5.52 --12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64-3.94) and regional analgesia OR 8.8 (95% CI 3.39-22.79), incentive spirometry OR 8.3 (95% CI 4.49-15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43-39.2) in the intervention group compared to the control group in the post- period. CONCLUSION: The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. TRIAL REGISTRATION: ANZCTR: ACTRN12618001548224, approved 17/09/2018.


Assuntos
Cuidados Críticos/métodos , Pacotes de Assistência ao Paciente/métodos , Traumatismos Torácicos/terapia , Ferimentos não Penetrantes/terapia , Idoso , Idoso de 80 Anos ou mais , Analgesia , Feminino , Humanos , Masculino , Oxigênio/administração & dosagem , Manejo da Dor , Modalidades de Fisioterapia , Terapia Respiratória , Costelas/lesões , Esterno/lesões , Resultado do Tratamento
3.
Pan Afr Med J ; 39: 233, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34659606

RESUMO

Sternal agenesis as well as ectopia cordis are extremely rare congenital malformations. We here report a single case treated in the Department of Paediatric Surgery in Benin. The study involved a 3-year-old girl with congenital sternal agenesis associated with ectopia cordis; firstly, she underwent controlled healing. Then thoracoplasty was performed with favourable outcome. Long-term results are good. Now, she is 13 years old, is attending school and has a satisfactory clinical condition. This is one of the few cases reported in the literature. Optimal therapeutic management has been keeping the patient alive in West Africa.


Assuntos
Ectopia Cordis/cirurgia , Esterno/cirurgia , Benin , Pré-Escolar , Feminino , Seguimentos , Humanos , Esterno/anormalidades , Resultado do Tratamento
4.
Khirurgiia (Mosk) ; (9): 34-39, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480453

RESUMO

OBJECTIVE: To analyze the incidence of cardiac surgeries and postoperative sternal osteomyelitis/sternomediastinitis, as well as treatment outcomes in these patients. MATERIAL AND METHODS: We summarized 171 patients with postoperative sternal osteomyelitis and sternomediastinitis. RESULTS: Organization of the Khabarovsk center for cardiovascular surgery in the Far Eastern Federal District was followed by 7.9- and 24.9-fold increase of the number of cardiac surgeries and CABG in 2005-2019, respectively. As a result, the number of patients with sternal osteomyelitis and sternomediastinitis after cardiac surgery increased from 0.50±0.10 to 1.59±0.17 cases per 100.000 (t=3.01; p<0.01). CPB and aortic clamping time (t=3.97; p<0.01), as well as surgery time (t=2.4; p<0.05) were significant risk factors of early postoperative complications. Two-stage surgical treatment of postoperative sternal osteomyelitis and sternomediastinitis (removal of ligatures and foreign bodies, sternal curettage with removal of sequesters at the first stage; resection of sternum with chest wall repair at the second stage) reduced hospital-stay from 31.9±13.4 to 29.2±10.8 days.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Osteomielite , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia
5.
J Card Surg ; 36(12): 4509-4518, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34570388

RESUMO

OBJECTIVES: To compare outcomes after the development of early (≤30 days) versus delayed (>30 days) deep sternal wound infection (DSWI) after cardiac surgery. METHODS: Between 2005 and 2016, 64 patients were treated surgically for DSWI following cardiac surgery. Thirty-three developed early DSWI, while 31 developed late DSWI. The mean follow-up was 34.1 ± 32.3 months. RESULTS: Survival for the entire cohort at 1, 3, and 5 years was 93.9%, 85.1%, and 80.8%, respectively. DSWI diagnosed early and attempted medical management was strongly associated with overall mortality (hazard ratio [HR], 25.0 and 9.9; 95% confidence intervals [CIs], 1.18-52.8 and 1.28-76.5; p-value .04 and .04, respectively). Survival was 88.1%, 77.0%, 70.6% and 100%, 94.0% and 94.0% at 1, 3, and 5 years in the early and late DSWI groups, respectively (log-rank = 0.074). Those diagnosed early were more likely to have a positive wound culture (odds ratio [OR], 0.06; 95% CI, 0.01-0.69; p = .024) and diagnosed late were more likely to be female (OR, 8.75; 95% CI, 2.0-38.4; p = .004) and require an urgent DSWI procedure (OR, 9.25; 95% CI, 1.86-45.9; p = .007). Both early diagnosis of DSWI and initial attempted medial management were strongly associated with mortality (HR, 7.48; 95% CI, 1.38-40.4; p = .019 and HR, 7.76; 95% CI, 1.67-35.9; p = .009, respectively). CONCLUSIONS: Early aggressive surgical therapy for DSWI after cardiac surgery results in excellent outcomes. Those diagnosed with DSWI early and who have failed initial medical management have increased mortality.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Infecção da Ferida Cirúrgica , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Esterno/cirurgia
6.
J Cardiothorac Surg ; 16(1): 280, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583717

RESUMO

BACKGROUND: The Abramson technique for the correction of pectus carinatum (PC) is commonly performed worldwide. However, the postoperative complications of this technique related to bar fixation, including wire breakage and bar displacement, are relatively high. In this study, a new minimally invasive technique for correction of PC is described, in which the pectus bar is secured by bilateral selected ribs, and for which no special fixation to the rib is needed. METHODS: The procedure was performed by placing the pectus bar subcutaneously over the sternum with both ends of the bar passing through the intercostal space of the selected rib at the anterior axillary line. The protruding sternum was depressed by the bar positioned in this 2 intra- and 2 extra-thorax manners. Between October 2011 and September 2019, 42 patients with PC underwent this procedure. RESULTS: Satisfactory cosmetic results were obtained in all the patients. The mean operation time was 87.14 min, and the mean postoperative stay was 4.05 days. Wound infection occurred in 3 patients, 2 were cured by antibiotics, and 1 received bar removal 4 months after the initial operation due to the exposure of the implant resulting from uncontrolled infection. Mild pneumothorax was found in 3 patients and cured by conservative treatment. One patient suffered from hydropneumothorax, which was treated with chest drainage. The bars were removed at a mean duration of 24.4 months since primary repair in 20 patients without recurrence. CONCLUSIONS: This new technique for minimally invasive correction of PC deformity is a safe and feasible procedure yielding good results and minimal complications.


Assuntos
Tórax em Funil , Pectus Carinatum , Parede Torácica , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Pectus Carinatum/cirurgia , Esterno/cirurgia , Resultado do Tratamento
7.
J Int Med Res ; 49(9): 3000605211041265, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34551599

RESUMO

OBJECTIVE: To compare the sternal fixation effect of a polyetheretherketone (PEEK) cable product and stainless steel wire after median sternotomy. METHODS: A multicentre retrospective clinical trial was conducted in patients that underwent median sternotomy for a range of surgical reasons. The sternum was fixed using PEEK sternal cables in the experimental group and stainless steel wires in the control group. The general patient state, product manoeuvrability, bone and wound healing state and blood test results were evaluated at seven visits during the preoperative, surgical and follow-up periods. RESULTS: A total of 108 patients (54 in each group) were included in the analysis at the final 180-day follow-up. The sternum was successfully closed using PEEK cables or steel wires in all patients and all healed well. No pathological changes were found on the X-ray imaging. Computed tomography imaging confirmed ideal fracture healing. No significant difference was found between the experimental group and the control group in outcomes. CONCLUSION: PEEK cables are easy to implant and show desirable effectiveness in sternal fixation without any observed side-effects.


Assuntos
Aço Inoxidável , Esternotomia , Benzofenonas , Fios Ortopédicos , Humanos , Polímeros , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Esterno/cirurgia
8.
J Coll Physicians Surg Pak ; 31(9): 1069-1074, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34500523

RESUMO

OBJECTIVE: To determine the efficacy of a sternal wire system in secondary sternal dehiscence after repeat closure of the sternum, following surgical revision after open heart surgery. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Zonguldak Bülent Ecevit University, Zonguldak, Turkey; and Turkey Yuksek Ihtisas Training and Research Hospital, Turkey, from January 2015 to May 2019. METHODOLOGY: Patients, who underwent open heart surgery with median sternotomy, were included in this retrospective study. The patients were divided into two groups, according to the sternal closure material. The time of the sternal reconstruction surgery, because of sternal dehiscence, fracture, broken sternal wire(s) or cable(s) after the first revision surgery, was noted for each patient. RESULTS: A total of 389 patients were identified. Group 1 included 72 (50%) patients whose sternums were closed with a sternal cable system; and Group 2 included 72 (50%) patients whose sternums were closed with conventional steel wires after propensity matching. The duration of cardiopulmonary bypass, number of intra-aortic balloon pumps used, and number of extracorporeal membrane oxygenators used were significantly higher in Group 1 (p = 0.007, p = 0.034, and p = 0.028, respectively). The number of emergency operations was significantly higher in Group 2 (p = 0.021). There was no significant difference in terms of secondary sternal dehiscence between the groups (p = 0.366). CONCLUSION: Application of the sternal wire system in revisional open heart surgery is not more effective than conventional steel wire at preventing secondary sternal dehiscence. Key Words: Sternal dehiscence, Sternal cable, Sternal wire, Open heart surgery, Postoperative revision.


Assuntos
Esterno , Deiscência da Ferida Operatória , Fios Ortopédicos , Estudos de Casos e Controles , Humanos , Reoperação , Estudos Retrospectivos , Esternotomia/efeitos adversos , Esterno/cirurgia , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/prevenção & controle , Deiscência da Ferida Operatória/cirurgia
9.
J Card Surg ; 36(11): 4083-4089, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34473370

RESUMO

OBJECTIVE: The optimal management of deep sternal wound infection (DWSI) remains controversial. Our objective was to evaluate outcomes of patients with DSWI managed with transposition of laparoscopically harvested omentum (LHO). METHODS: Between 2000 and 2020, a total of 38,623 adult patients who underwent full median sternotomy for cardiac surgery were analyzed retrospectively at our institution. DSWI occurred in 455 (1.2%), of whom 364 (93.2%) were managed with pectoralis myocutaneous flap (PMF) and 33 (7.2%) with LHO. Univariate and multivariate analysis models were used to determine predictors of cumulative late mortality and adjusted survival curves were generated. RESULTS: Among patients who received LHO, average age was 65.7 ± 9.7 years and a larger proportion of patients were male. A majority of patients (88%) had coronary bypass surgery, with bilateral internal mammary arteries use in only 21.2%. Mean length of stay (LOS) was 58.90 days and early hospital mortality occurred in 4 patients (12.1%). Patients who received LHO compared to only PMF had larger body mass index and had more heart failure. Furthermore, the hospital LOS was also significantly prolonged in the LHO group (58.9 vs. 27.4 days, p = .002), with a slightly higher in-hospital mortality (12.1% vs. 3.3%, p = .03). Late survival for LHO patients at 5 and 10 years was 71.9% and 44.8%, respectively. CONCLUSION: Use of LHO is a safe and viable alternative to traditional myocutaneous flaps to manage complex DSWI. Early and late survival were favorable in this high-risk population.


Assuntos
Omento , Infecção da Ferida Cirúrgica , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Omento/cirurgia , Estudos Retrospectivos , Fatores de Risco , Esternotomia , Esterno/cirurgia
10.
Anat Histol Embryol ; 50(6): 985-995, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34569090

RESUMO

The axial skeleton of orange rumped agouti, Dasyprocta leporina, was studied for better understanding of its locomotor behaviour. The bones from eight adult agoutis of both sexes were observed for their anatomical features and functional significance. The vertebral formula was found to be C7 T12 L7 S5 Cy5-6 . The well-developed occipital crest, caudally oriented prominent axis spine and well-developed transverse processes from C3 -C7 indicated a highly flexible neck with greater sagittal mobility. Articular facets were horizontal in anterior series while oblique in the posterior series, which enabled them to perform both lateral and sagittal movements during locomotion. The caudally directed thoracic spines, T12 as anticlinal vertebra and prominent mamillary process in the posterior series were suggestive of strong dorso-ventral flexion/extension and rotation. The robust lumbar vertebrae, well-developed transverse processes with cranio-ventral extension, were the feature for powerful sagittal/dorsoventral movement. The presence of spinous processes and well-developed transverse processes in all caudal vertebrae was an indication of a highly movable tail. The ribs were 13 pairs with first seven as sternal and six as asternal. They were laterally compressed in the anterior series as a cursorial adaptation. A strong muscular attachment to vertebrae provides this rodent speed, agility, dexterity and strength suitable for survival in food chain.


Assuntos
Citrus sinensis , Dasyproctidae , Animais , Vértebras Lombares , Costelas , Esterno
11.
Plast Reconstr Surg ; 148(2): 429-437, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398095

RESUMO

BACKGROUND: Sternal wound infection and dehiscence following cardiac surgery remain difficult clinical problems with high morbidity. Older classification systems regarding timing to reconstruction do not take into account recent improvements in critical care, wound vacuum-assisted closure use, or next-generation antibiotic therapies, which may prolong time to reconstruction. METHODS: Records of patients undergoing sternal wound reconstruction performed by the senior author (J.A.A.) from 1996 to 2018 at a high-volume cardiac surgery center were reviewed. Indications included sternal wound infection or dehiscence. All patients underwent single-stage removal of hardware, débridement, and flap closure. Patients were divided into two groups based on timing of wound closure after cardiac surgery: less than 30 days or greater than or equal to 30 days. RESULTS: Of the 505 patients identified during the study period, 330 had sufficient data for analysis. Mean time to sternal wound surgery was 15.7 days in the early group compared to 64.4 days (p < 0.01) beyond 30 days. Postdébridement cultures were positive in 72 percent versus 62.5 percent of patients (p = 0.11), whereas rates of postoperative infection were significantly higher in the delayed group: 1.9 percent versus 9.5 percent (p < 0.01). Partial wound dehiscence rates were also higher after 30 days (1.9 percent versus 11.3 percent; p < 0.01), whereas total length of stay was decreased. Use of wound vacuum-assisted closure was significantly associated with reconstruction beyond 30 days (p < 0.01). CONCLUSIONS: Although performing sternal wound reconstruction more than 30 days after initial cardiac surgery was associated with a shorter overall hospital length of stay and higher extubation rates in the operating room, these patients also had elevated postoperative infection and wound complication rates. The authors thus recommend not delaying definitive surgical reconstruction when possible. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Desbridamento/métodos , Desbridamento/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Esterno/cirurgia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos , Cicatrização
12.
Medicine (Baltimore) ; 100(33): e26998, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414985

RESUMO

BACKGROUND: Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical therapy modality to improve the sternocleidomastoid (SCM) muscle thickness, the ratio of the SCM muscle thickness on the affected side to that on the non-affected side (A/N ratio), and head rotation in infant under 3 months of age diagnosed with CMT. METHODS AND ANALYSIS: A single-blind, randomized clinical trial was conducted. Participants were assigned in one of the 3 study groups through randomization. The treatment was performed 3 times a week for 30 minutes until the head tilt was ≤5 degrees. Group 1 was treated by handling for active or active-assist movement, group 2 was treated with passive stretching, and group 3 was treated with thermotherapy. For general characteristics, a χ2 test and 1-way analysis of variance were used. Intragroup differences were analyzed using a paired t test, and intergroup differences were analyzed using an age-adjusted analysis of covariance. RESULTS: After the intervention, there was no significant difference between groups in terms of SCM thickness on the affected side and A/N ratio (P > .05). Degree of head rotation on the affected side showed significant differences between groups (P < .05), with Group 2 showing significantly better results than group 1 and group 3 (P < .05, both). CONCLUSION: Passive stretching treatment was more effective than other treatments of this study for improvement in degree of head rotation in CMT infants under 3 months of age. TRIAL REGISTRATION: The trial is registered at the Institutional Review Board of Sahmyook University (IRB number, 2-7001793-AB-N-012019103HR) and the Clinical Research Information Service (CRiS; registry number, KCT0004862).


Assuntos
Músculos/fisiopatologia , Modalidades de Fisioterapia/normas , Esterno/fisiopatologia , Torcicolo/congênito , Pesos e Medidas/normas , Humanos , Lactente , Modalidades de Fisioterapia/estatística & dados numéricos , Método Simples-Cego , Torcicolo/complicações , Torcicolo/terapia , Pesos e Medidas/instrumentação
13.
J Hosp Infect ; 116: 47-52, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34332004

RESUMO

BACKGROUND: Although diabetes is a recognized risk factor for postoperative infections, the seminal Portland Diabetic Project studies in cardiac surgery demonstrated intravenous insulin infusions following open-cardiac surgery achieved near normal glycaemia and decreased deep sternal wound infection to similar rates to those without diabetes. AIM: We sought to examine a contemporary cohort of patients undergoing coronary artery bypass graft surgery (CABGS) to evaluate the relationship between diabetes, hyperglycaemia and risk of surgical site infection (SSI) in current-era models of care. METHODS: Consecutive patients who underwent CABGS between 2016 and 2018 were identified through a state-wide data repository for healthcare-associated infections. Clinical characteristics and records of postoperative SSIs were obtained from individual chart review. Type 2 diabetes (T2D), perioperative glycaemia and other clinical characteristics were analysed in relation to the development of SSI. FINDINGS: Of the 953 patients evaluated, 11% developed SSIs a median eight days post CABGS, with few cases of deep SSIs (<1%). T2D was evident in 41% and more prevalent in those who developed SSIs (51%). On multivariate analysis T2D was not significantly associated with development of SSI (odds ratio (OR) 1.35; P=0.174) but body mass index (BMI) remained a significant risk factor (OR 1.07, P<0.001). In patients with T2D, perioperative glycaemia was not significantly associated with SSI. CONCLUSION: In a specialist cardiac surgery centre using perioperative intravenous insulin infusions and antibiotic prophylaxis, deep SSIs were uncommon; however, approximately one in 10 patients developed superficial SSIs. T2D was not independently associated with SSI yet BMI was independently associated with SSI post CABGS.


Assuntos
Diabetes Mellitus Tipo 2 , Infecção da Ferida Cirúrgica , Antibioticoprofilaxia , Ponte de Artéria Coronária/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Humanos , Estudos Retrospectivos , Fatores de Risco , Esterno , Infecção da Ferida Cirúrgica/epidemiologia
14.
Anticancer Res ; 41(8): 4039-4043, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34281871

RESUMO

BACKGROUND: Metastases of meningiomas are infrequent and the site of extracranial metastasis such as the bone is extremely rare. CASE REPORT: A 75-year-old male had a history of five sessions of surgery and gamma-knife treatment for brain meningioma over a period of 29 years. He visited our hospital because he noticed a swelling in his anterior chest 2 years and 6 months after the final treatment. After an open biopsy, histopathological analysis revealed the mass to be a metastatic grade II meningioma. We resected the tumor along with the sternum, ribs, pleura, and pericardium. The patient had recurrences in the thoracic cavity and pericardium postoperatively and received radiation therapy. He also had metastasis in the abdominal cavity, which spread rapidly. CONCLUSION: We report on a rare instance of metastasis to the sternum in a case of atypical meningioma, showing rapid growth and invasion after long-term treatment.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Meníngeas/patologia , Meningioma/patologia , Esterno/patologia , Neoplasias Ósseas/diagnóstico por imagem , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Esterno/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
J Forensic Sci ; 66(6): 2299-2306, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34250595

RESUMO

The current standard technique for cardiopulmonary resuscitation (CPR), initially described in the early 1960s, has quickly become the expected response for all persons found without a pulse or respiration. Despite the potentially lifesaving properties of external cardiac massage, the mainstay of resuscitation, it consists of repeated blunt force trauma to the chest, which can lead to extensive traumatic skeletal and nonskeletal injuries. Numerous autopsy-based studies have documented the incidence and patterns of rib and sternal fractures associated with attempted CPR, but there is relatively little data on the incidence and severity of nonskeletal CPR-related injuries. We reviewed reports from 1878 autopsies performed between September 2017 and December 2019 (inclusive), for documentation of CPR-related injuries. Among these cases, there were 93 cases with resuscitation-related nonskeletal injuries. The most common type of injury identified were visceral contusions, documented in 57.0% of cases. These contusions predominantly involved the heart, lungs, neck soft tissue, and surrounding structures. Resuscitation-related lacerations were seen in 17.2% of the cases, most predominantly involving the pericardium, heart, and liver. Statistical analysis of the data demonstrated that lacerations were more likely to be seen in females and with associated sternal fractures. Additionally, hemothoraces were present in 34.4% of cases and hemopericardium was seen in 8.6% of cases. This study provides additional documentation of the range, severity, and incidence of various types of resuscitation-related visceral injuries to better assist autopsy pathologists in distinguishing these injuries from other antecedent traumatic injuries.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Contusões/etiologia , Lacerações/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Criança , Pré-Escolar , Contusões/patologia , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/patologia , Hemotórax/etiologia , Hemotórax/patologia , Humanos , Lactente , Lacerações/patologia , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Lesões do Pescoço/patologia , Derrame Pericárdico/etiologia , Derrame Pericárdico/patologia , Estudos Retrospectivos , Fatores Sexuais , Esterno , Vísceras/lesões , Vísceras/patologia , Adulto Jovem
16.
Eur J Radiol ; 142: 109828, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34280594

RESUMO

PURPOSE: The aim of this retrospective study was to present the frequency and MDCT appearances of sternal variations and anomalies, as well as to highlight their clinical significance. METHODS: This retrospective study was carried out on 1150 patients, who underwent chest MDCT. Axial planes, multiplanar and curved-planar reconstructed images were studied. Age and sex distribution of the variations was evaluated. RESULTS: Anatomical variations of the sternum were found in 74.1%. The most frequent variation was the double-ended xiphoid process (36.9%), followed by the single xiphoidal foramen (25.8%) and the sternal sclerotic band (12.8%). Other variations observed were: sternal notch (10.1%), xiphoidal ligament calcification (8.3%), sternal foramen (4.9%), complete manubriosternal fusion (4.1%) and sternoxiphoidal fusion (4.1%), triple-ended xiphoid process (3.7%), sternal cleft (1.5%), whereas the rest of the variations including sternoxiphoidal junction pseudoforamen, suprasternal bone, pseudocleft, suprasternal tubercle and absence of xiphoid process were in less than 1%. In our subjects, sternal and xiphoidal foramina were adjacent to: the pericardium (37.14%), the diaphragm (22.9%), the mediastinal fat (17.1%), the liver (11.4%), the lung (8.5%) and to the stomach (2.9%). CONCLUSIONS: Sternal variations are frequent, asymptomatic, detected incidentally at cross-sectional imaging and may be confused with pathologic conditions. Radiologists should be familiar with these variations in order to discriminate them from pathologies and avoid complications during interventional procedures. ADVANCES IN KNOWLEDGE: This study presents thoroughly the sternal variations' MDCT appearance, detected in a Greek population, correlates them with age and gender and discuss their clinical significance in detail.


Assuntos
Anormalidades Musculoesqueléticas , Esterno , Humanos , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Anormalidades Musculoesqueléticas/epidemiologia , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Processo Xifoide
17.
J Card Surg ; 36(10): 3881-3883, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34145631

RESUMO

In this case report, we describe how to recycle the left internal thoracic artery (LITA) when misused but not damaged. Eight years after a left anterior small thoracotomy followed by left anterior descending (LAD) stenting for STEMI in first postoperative day, a 67-years-old woman had an NSTEMI with angiographic evidence of intrastent re-stenosis with a perfectly patent LITA, harvested only from the fourth to the sixth intercostal space. During redo surgery, LITA was harvested as a pedicle from the anastomosis to the fourth intercostal space and primarily from the first to the fourth intercostal space. Special attention was paid at the level of the fourth intercostal space where the vessel was stuck to the sternum: a 15-blade was used being scissors or cautery too dangerous. At the end of harvesting, the LITA was full-length available for a new coronary anastomosis on LAD, distal to the previous one.


Assuntos
Artéria Torácica Interna , Idoso , Feminino , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/cirurgia , Esterno/cirurgia , Toracotomia
18.
Poult Sci ; 100(7): 101112, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34116350

RESUMO

As the largest single bone, avian sterna are very different from those of mammals in terms of morphology and functions. Moreover, years of artificial selection in poultry led to incomplete sternal ossification at slaughter age, which may cause diseases, sternal injury, and restriction to breast muscle growth. However, in living birds, studies have rarely described the ossification pattern and underlying mechanisms of the sterna. Here, we examined the pattern (timeline, ossification centers, ossification directions, weekly changes of different parts, quantified differences in ossification degree among sexes and parts) and developmental changes (histological structure, gene expression) of postnatal duck sternal ossification. Direct observation and alcian blue and alizarin red staining of whole sterna samples revealed that, duck sterna mainly ossified during 5 to 9 wk old with five ossification centers. These centers and their ossification directions were different from and more complex than the previously studied birds. The weekly changes of sterna and the quantitative analysis of ossification-related traits showed that ossifications in the three parts of duck sterna (sternum body, keel, posterolateral processes) were mutually independent in space and time, meanwhile, the male duck sterna were more late-maturing than the female. The results of hematoxylin-eosin, alcian blue, and toluidine blue stainings and the expression levels of COL2A1, COL10A1, COL1A2, and CTSK together supported that, duck sternal ossification was highly similar to typical endochondral ossification. Furthermore, continuously high expression of MMP13 and SPARC and their significant (P < 0.05) co-expression with COL2A1, COL10A1, COL1A2, and CTSK suggested the importance of MMP13 and SPARC in duck sternal ossification. Taken together, our results may be helpful for the understanding of avian sternal ossification and the improvement of the performance and welfare of poultry from a new perspective.


Assuntos
Patos , Osteogênese , Animais , Galinhas , Feminino , Expressão Gênica , Masculino , Esterno
19.
West J Emerg Med ; 22(3): 690-695, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-34125048

RESUMO

INTRODUCTION: The intraosseous (IO) route is one of the primary means of vascular access in critically ill and injured patients. The most common sites used are the proximal humerus, proximal tibia, and sternum. Sternal IO placement remains an often-overlooked option in emergency and prehospital medicine. Due to the conflicts in Afghanistan and Iraq the use of sternal IOs have increased. METHODS: The authors conducted a limited review, searching PubMed and Google Scholar databases for "sternal IO," "sternal intraosseous," and "intraosseous" without specific date limitations. A total of 47 articles were included in this review. RESULTS: Sternal IOs are currently FDA approved for ages 12 and older. Sternal IO access offers several anatomical, pharmacokinetic, hemodynamic, and logistical advantages over peripheral intravenous and other IO points of access. Sternal IO use carries many of the same risks and limitations as the humeral and tibial sites. Sternal IO gravity flow rates are sufficient for transfusing blood and resuscitation. In addition, studies demonstrated they are safe during active CPR. CONCLUSION: The sternal IO route remains underutilized in civilian settings. When considering IO vascular access in adults or older children, medical providers should consider the sternum as the recommended IO access, particularly if the user is a novice with IO devices, increased flow rates are required, the patient has extremity trauma, or administration of a lipid soluble drug is anticipated.


Assuntos
Estado Terminal/terapia , Serviços Médicos de Emergência/métodos , Infusões Intraósseas , Esterno , Humanos , Infusões Intraósseas/instrumentação , Infusões Intraósseas/métodos , Medição de Risco
20.
J Card Surg ; 36(9): 3085-3091, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34133049

RESUMO

BACKGROUND: Sternal complications are common following transverse thoracosternotomy in patients undergoing bilateral lung transplantation. We present a single-institution experience using a next generation rigid fixation system for primary sternal closure following transverse sternotomy for bilateral lung transplantation. METHODS: Retrospective review was performed on all patients who had bilateral sequential lung transplants utilizing a transverse thoracosternotomy from 2016 to 2020. Demographics, baseline characteristics, peri-operative data, and outcomes were collected, reviewed and summarized. Two groups of patients were identified: wire cerclage (Group A), combination plate-and-band rigid fixation (Group B). The primary outcome was sternal complications, which were divided into mechanical and non-mechanical. RESULTS: Twenty-two patients met inclusion criteria. Three patients (13.6%) were in Group A, nineteen patients (86.4%) in Group B. Two patients in each Group A (66.6%) and Group B (10.5%) experienced a sternal complication. Sternal complications included sternal dehiscence (2), sternal malunion (1), and surgical site infection (1). One patient with plate-and-band fixation (5.2%) had a mechanical sternal complication. Three patients required reoperation secondary to sternal complication. CONCLUSIONS: The utilization of a combination plate-and-band rigid fixation system for primary closure is safe and may be an effective method to reduce sternal complications following transverse thoracosternotomy for lung transplantation.


Assuntos
Transplante de Pulmão , Deiscência da Ferida Operatória , Placas Ósseas , Fios Ortopédicos , Humanos , Estudos Retrospectivos , Esternotomia , Esterno/cirurgia , Deiscência da Ferida Operatória/cirurgia
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