Search Results (15)

Background: Tracheoesophageal shunt insufficiency (TESI) is a common and potentially life-threatening complication after laryn(-gopharyn)gectomy (L(P)E). We investigated whether TESI could be the result of a specific shunt location. Methods: A monocentric, retrospective cohort analysis of 171 consecutively treated L(P)E patients was performed. Patients with a secondary prosthesis instillation and patients with insufficient postoperative imaging were excluded. Disease related data as well as location of primary voice prosthesis were assessed. Results: The cohort was divided into 62 TESI-positive and 109 TESI-negative individuals. The mean time from surgery to TESI was 32 months. No differences were observed in gender, age, tumor localization, T/R/M-status. Surgery without adjuvant therapy was more often performed in TESI-negative individuals when compared with their positive counterparts. However, Cox regression including T/N status, therapy and categorized distance of the tracheoesophageal shunt to the manubrium (≤1.5 cm vs. >1.5 cm) revealed that a distance of ≤1.5 cm was associated with a 2.1-fold increased risk of TESI, while all other parameters did not influence the event-free survival. Conclusions: Primary shunt positioning ≤1.5 cm to the ridge of the manubrium is associated with an increased risk of TESI. In these individuals secondary shunt operation resulting in a position >1.5 cm distant to the manubrium should be recommended. Full article

For patients eligible to undergo breast-conserving surgery (BCS) after neoadjuvant chemotherapy, accurate preoperative localisation of tumours is vital to ensure adequate tumour resection that can reduce recurrence probability effectively. For this reason, we have developed a 3D-printed personalised breast surgery guide (BSG) assisted with supine magnetic resonance imaging (MRI) and image 3D reconstruction technology, capable of mapping the tumour area identified on MRI onto the breast directly using dual positioning based on the manubrium and nipple. In addition, the BSG allows the colour dye to be injected into the breast to mark the tumour region to be removed, yielding more accurate intraoperative resection and satisfactory cosmetic outcomes. The device has been applied to 14 patients from January 2018 to July 2023, with two positive margins revealed by the intraoperative biopsy. This study showed that the BSG-based method could facilitate precise tumour resection of BCS by accurately localising tumour extent and margin, promoting the clinical efficacy in patients with breast cancer as well as simplifying the surgical process. Full article

Tracheal hypoplasia is a major concern in brachycephalic dogs, but there is no consensus for the trachea in brachycephalic cats. We aimed to compare tracheal length and diameter between normo- and brachycephalic cats using computed tomography (CT) image measurements and evaluate their usefulness in tracheostomy planning. A total of 15 normocephalic and 14 brachycephalic cats were included in the study. Tracheas of normocephalic cats were significantly longer compared with brachycephalic cats. No difference was detected in tracheal diameter between normocephalic and brachycephalic cats. Both groups had a lateral diameter significantly larger than the dorsoventral diameter at the level of the cranial end of the manubrium sterni and at the level of the second rib. Normocephalic and brachycephalic cats’ tracheas have the same dorsoventral flattening at the level of the cranial end of the manubrium sterni and at the level of the second rib. The location between the 4th and 5th cervical vertebrae seems the best place to perform a tracheostomy in cats due to its round shape and easily accessible anatomical location. No sign of tracheal hypoplasia in brachycephalic cats was detected. Finally, 7 mm appears to be an adequate diameter for the tracheal tubes used to perform feline tracheostomies. Full article

We aimed to overview the most recent data on sternal metastases from a multidisciplinary approach (diagnosis strategies, outcome, and histological reports). This narrative review based on a PubMed search (between January 2020 and 22 July 2023) using key words such as “sternal”, “manubrium”, and “metastasis” within the title and/or abstract only included original papers that specifically addressed secondary sternal spreading of cancer in adults, for a total of 48 original articles (14 studies and 34 single case reports). A prior unpublished case in point is also introduced (percutaneous incisional biopsy was used to address a 10 cm sternal tumour upon first admission on an apparently healthy male). The studies (n = 14) may be classified into one of three groups: studies addressing the incidence of bone metastases (including sternum) amid different primary cancers, such as prostate cancer (N = 122 with bone metastases, 83% of them with chest wall metastases), head and neck cancers (N = 3620, 0.8% with bone metastases, and 10.34% of this subgroup with sternum involvement); and glioblastoma (N = 92 with bone metastases, 37% of them with non-vertebral metastases, including the sternum); assessment cohorts, including breast cancer (N = 410; accuracy and sensitivity of PET/CT vs. bone scintigraphy is superior with concern to sternum spreading) and bone metastases of unknown origin (N = 83, including a subgroup with sternum metastases; some features of PET/CT help the differentiation with multiple myeloma); and cohorts with various therapeutic approaches, such as palliative arterial embolization (N = 10), thymic neuroendocrine neoplasia (1/5 detected with sternum metastases), survival rates for sternum metastases vs. non-sternum chest wall involvement (N = 87), oligo-metastatic (sternal) breast cancer (3 studies, N = 16 for all of them), oligo-metastatic head and neck cancer (N = 81), conformal radiotherapy (N = 24,215, including an analysis on sternum spreading), and EBRT followed by MR-HIFU (N = 6). Core data coming from the isolated case reports (N = 34) showed a female to male ratio of 1.6; the females’ ages were between 34 and 80 (mean of 57.28) and the males’ ages varied between 33 and 79 (average of 58.78) years. The originating tumour profile revealed that the most frequent types were mammary (N = 8, all females) and thyroid (N = 9, both women and men), followed by bladder (N = 3), lung (N = 2), and kidney (N = 2). There was also one case for each of the following: adenoid cystic carcinoma of the jaw, malignant melanoma, caecum MiNEN, a brain and an extracranial meningioma, tongue carcinoma, cholangiocarcinoma, osteosarcoma, and hepatocellular carcinoma. To our knowledge, this is the most complex and the largest analysis of prior published data within the time frame of our methods. These data open up new perspectives of this intricate, dynamic, and challenging domain of sternum metastases. Awareness is a mandatory factor since the patients may have a complex multidisciplinary medical and/or surgical background or they are admitted for the first time with this condition; thus, the convolute puzzle will start from this newly detected sternal lump. Abbreviations: N = number of patients; n = number of studies; PET/CT = positron emission tomography/computed tomography; EVRT = external beam radiotherapy; MR-HIFU = magnetic resonance-guided high-intensity focused ultrasound; MiNEN = mixed neuroendocrine-non-neuroendocrine tumour. Full article

The emergence of the global coronavirus pandemic in 2019 (COVID-19 disease) created a need for remote methods to detect and continuously monitor patients with infectious respiratory diseases. Many different devices, including thermometers, pulse oximeters, smartwatches, and rings, were proposed to monitor the symptoms of infected individuals at home. However, these consumer-grade devices are typically not capable of automated monitoring during both day and night. This study aims to develop a method to classify and monitor breathing patterns in real-time using tissue hemodynamic responses and a deep convolutional neural network (CNN)-based classification algorithm. Tissue hemodynamic responses at the sternal manubrium were collected in 21 healthy volunteers using a wearable near-infrared spectroscopy (NIRS) device during three different breathing conditions. We developed a deep CNN-based classification algorithm to classify and monitor breathing patterns in real time. The classification method was designed by improving and modifying the pre-activation residual network (Pre-ResNet) previously developed to classify two-dimensional (2D) images. Three different one-dimensional CNN (1D-CNN) classification models based on Pre-ResNet were developed. By using these models, we were able to obtain an average classification accuracy of 88.79% (without Stage 1 (data size reducing convolutional layer)), 90.58% (with 1 × 3 Stage 1), and 91.77% (with 1 × 5 Stage 1). Full article

Background: Rabbit models involving neck arteries are of growing importance for the development of preclinical aneurysm models. An optimal understanding of the anatomy is primordial to allow the conception of models while minimizing mortality and morbidity. The aim of this study is to give reliable anatomical landmarks to allow a standardized approach to the neck vessels. Methods: We performed a necropsy on nine specimens from ongoing experimental studies. We measured the distance between the origins of the right and left common carotid artery (rCCA/lCCA) and between the rCCA and the manubrium sterni (MS). The structures at risk were described. Results: Female New Zealand White rabbits (NZWR) weighing 3.7 ± 0.3 kg and aged 25 ± 5 weeks were included. The rCCA origin was located 9.6 ± 1.2 mm laterally and 10.1 ± 3.3 mm caudally to the MS. In all specimens, the lCCA originated from the aortic arch, together with the brachiocephalic trunk (BCT), and 6.2 ± 3.1 mm proximally to the rCCA origin. The external and internal jugular veins, trachea and laryngeal nerve were the main structures at risk. Conclusions: The data help to localize both CCAs and their origin to guide surgical approaches with the manubrium sterni as a main landmark. Special attention has to be paid to the trachea, jugular veins and laryngeal nerves. Full article

During a research of gill ectoparasites on damselfishes (Pomacentridae) and butterflyfishes (Chaetodontidae) from the Cayo Arcas reef in the Campeche Bank (Gulf of Mexico), the following monogenoids (Platyhelminthes) were found: Paraeuryhaliotrema pomacentris n. gen., n. sp. (Dactylogyridae) on beaugregory Stegastes xanthurus (Poey, 1860) (Pomacentridae) that is characterized, in part, by possessing a haptor armed with a dorsal, ventral anchor-bar complexes, seven pairs of similar hooks; two pairs of eyespots; overlapping gonads; a copulatory complex composed of a male copulatory organ (MCO) and an accessory piece; MCO tubular with a bulbous base from which arises a coiled shaft in the clockwise direction; and a dextral vaginal pore; Neohaliotrema variabilis n. sp. on bicolor damselfish Stegastes partitus (Poey, 1868) (type host), beaugregory Stegastes xanthurus (Poey, 1860) and beaugregory Stegastes leucostictus (Müller & Troschel, 1848); Neohaliotrema manubrium n. sp., Neohaliotrema aliamanubrium n. sp. and Neohaliotrema bifidum n. sp., Neohaliotrema bychowskii Zhukov, 1976 and Neohaliotrema macracanthum Zhukov, 1976 on Sergeant-major Abudefduf saxatilis (Linnaeus, 1758) (Pomacentridae); Neohaliotrema similium n. sp. on S. xanthurus; Haliotrema brevicirrus Zhukov 1976 on spotfin butterflyfish Chaetodon ocellatus Bloch 1787 (Chaetodontidae); Microcotyle multilineatus n. sp. (Microcotylidae) on brown chromis Chromis multilineata (Guichenot 1853) (Pomacentridae). The new species are described and illustrated; new illustrations and measurements of the haptoral structures, and new redescription and illustrations are provided for N. bychowskii, N. macracanthum and H. brevicirrus, respectively. The present study represents the first knowledge about ectoparasitic monogenoids of fishes in the Cayo Arcas reef from the Gulf of Mexico. Full article

The worldwide outbreak of the novel Coronavirus (COVID-19) has highlighted the need for a screening and monitoring system for infectious respiratory diseases in the acute and chronic phase. The purpose of this study was to examine the feasibility of using a wearable near-infrared spectroscopy (NIRS) sensor to collect respiratory signals and distinguish between normal and simulated pathological breathing. Twenty-one healthy adults participated in an experiment that examined five separate breathing conditions. Respiratory signals were collected with a continuous-wave NIRS sensor (PortaLite, Artinis Medical Systems) affixed over the sternal manubrium. Following a three-minute baseline, participants began five minutes of imposed difficult breathing using a respiratory trainer. After a five minute recovery period, participants began five minutes of imposed rapid and shallow breathing. The study concluded with five additional minutes of regular breathing. NIRS signals were analyzed using a machine learning model to distinguish between normal and simulated pathological breathing. Three features: breathing interval, breathing depth, and O₂Hb signal amplitude were extracted from the NIRS data and, when used together, resulted in a weighted average accuracy of 0.87. This study demonstrated that a wearable NIRS sensor can monitor respiratory patterns continuously and non-invasively and we identified three respiratory features that can distinguish between normal and simulated pathological breathing. Full article

Approximately 300 species of cnidarian jellyfish have been reported in Japanese waters. However, many specimens remain unidentified. In this study, taxonomic investigations, including morphological observations and molecular 16S phylogenetic analyses, were conducted on unknown specimens collected off Oarai, Sagami Bay, and Tosa Bay, Japan. The specimens have the following morphological characteristics: distinct peaks in jelly above the base of the manubrium, a red band on the manubrium, and cylindrical marginal bulbs, each with an abaxial ocellus that is common to the family Halimedusidae. However, the specimens can be distinguished from other Halimedusidae species by their eight radial canals, eight tentacles with numerous stalked nematocyst knobs, and eight nematocyst tracks on the exumbrella. Moreover, molecular phylogenetic analyses revealed that the Kimura two-parameter distance between the specimens and other Halimedusa species was 0.066–0.099, which is considered to represent intergeneric variability. Based on this result, we described it as a new species and established a new genus for taxonomic stabilization. We also emended the diagnostic characters of the family Halimedusidae owing to the establishment of the new genus. Halimedusidae comprises five species in four genera. This paper provides taxonomic keys for the identification of species in the family Halimedusidae. Full article

A comparative morphological study of the members of the subgenus Metallotimarcha revealed that Caucasian Timarcha hummelii is a separate species, which differs from European members of the subgenus (T. metallica, T. corinthia, T. gibba) by the internal structure of male aedeagus, namely, manubrium of the endophallus. Morphology of manubrium is described for all species of the subgenus. External characters and the shape of male aedeagus do not permit separating the members of the subgenus distinctly. Examination of both external characters and endophallus structure in the specimens from the Caucasus revealed that T. armeniaca and T. hummelii starcki are the synonyms of T. hummelii hummelii, but not separate species or subspecies. Neotypes of T. hummelii and T. armeniaca are designated. Syntypes of T. hummelii starcki are examined. The key to the species for the subgenus Metallotimarcha is compiled. Full article

Mice and rats are rodent specimens commonly used in multidisciplinary research. Specifically, vasculature imaging of rodents has been widely performed in preclinical studies using various techniques, such as computed tomography, magnetic resonance imaging, and ultrasound imaging. Photoacoustic CT (PACT) is a noninvasive, nonionizing optical imaging technique derived from photoacoustic tomography and benefits from using intrinsic endogenous contrast agents to produce three-dimensional volumetric data from images. In this study, a commercial PACT device was employed to assess the cervicothoracic vasculature of mouse and rat specimens, which has rarely been examined using PACT, under two conditions with depilation and skin incision. Various blood vessels, including the common carotid artery, internal/external jugular veins, cranial vena cava, internal thoracic vein, and mammary, were identified in the acquired PACT images. The difference between the depilated and skin-incised specimens also revealed the presence of branches from certain blood vessels and specific anatomical features such as the manubrium of the sternum. This study presents detailed PACT images observing the cervicothoracic vasculature of rodent specimens and is expected to be used as a reference for various preclinical experiments on mice and rats. Full article

The purpose of this study was to assess the sternal osteoblastic activity and perfusion in the early period after a coronary artery bypass graft (CABG) using single-photon emission computed tomography (SPECT) and three-phasic dynamic scintigraphy (3PDS) with 99mTc methylene diphosphonate (MDP). Methods: The study group consisted of 57 male patients that were 57.3 ± 6.6 years of age. Thirty-six of them were randomized into two groups: in group I (n = 18), the internal thoracic artery (ITA) was skeletonized, and in group II (n = 18), the ITA was pedicled. All the patients in groups I and II underwent an off-pump CABG using 1.7 ± 0.3 grafts, including one anastomosis of the ITA to the left anterior descending coronary artery. The control group III (n = 21) consisted of patients that underwent mitral valve repair surgery, in whom the sternotomy without the ITA harvesting was performed. The 3PDS and SPECT of the thorax with 99mTc MDP were performed 2 weeks after surgery. Results: The sternal phosphates uptake in group I was approximately twice as high as in group II and approximately 1.5 times higher than in group III (p < 0.05). The MDP uptake asymmetry after the ITA skeletonization was the same as in the group with both intact ITAs. In contrast, after the pedicled ITA harvesting, the osteoblastic activity of the ipsilateral side of the sternum was lower than in the contralateral one. There was no statistically significant difference in scintillation count in the xiphoid process between groups I and II (p > 0.05); however, we observed a significant difference in the manubrium and body (p < 0.05). Conclusion: The main factor that improved the sternal perfusion after a CABG was the preservation of branches supplying the sternum using the skeletonization technique of ITA harvesting. Full article

Background: The radiotherapy (RT) volumes in anaplastic (ATC) and differentiated thyroid carcinoma (DTC) are controversial. Methods: We retrospectively examined the patterns of failure after postoperative intensity-modulated RT for ATC and DTC. Computed tomography images were rigidly registered with the original RT plans. Recurrences were considered in-field if more than 95% of the recurrence volume received 95% of the prescribed dose, out-of-field if less than 20% received 95% of the dose, and marginal otherwise. Results: Of 30 DTC patients, 4 developed regional recurrence: 1 being in-field (level III), and 3 being out-of-field (all level II). Of 5 ATC patients, all 5 recurred at 7 sites: 2 recurrences being local, and 5 being regional [2 marginal (intramuscular to the digastric and sternocleidomastoid), 3 out-of-field (retropharyngeal, soft tissues near the manubrium, and lateral to the sternocleidomastoid)]. Conclusions: In DTC, locoregional recurrence is unusual after RT. Out-of-field DTC recurrences infrequently occurred in level II. Enlarged treatment volumes to level II must be balanced against a potentially greater risk of toxicity. Full article

Isolated sternal involvement in tuberculosis is rare. Very few case reports are available in literature even from the countries where tuberculosis is endemic. We are reporting a case of 32-year-old female who presented to us with a pus discharging sinus over manubrium sterni with no other systemic features of tuberculosis. Sinus tract was excised and biopsy confirmed tuberculosis. Patient received antitubercular therapy for 9 months. Full article

Introduction: The aim of the study is to analyze diagnostic yield of the new surgical technique — the Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) in preoperative staging of Non-Small-Cell Lung Cancer (NSCLC). Material and methods: Operative technique included 5–8 cm collar incision in the neck, elevation of the sternal manubrium with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves and dissection of all mediastinal nodal stations except of the pulmonary ligament nodes (station 9). Results: 698 patients (577 men, 121 women), of mean age 62.8 (41–79) were operated on from 1.1.2004 to 31.1.2010, including 501 squamous-cell carcinomas, 144 adenocarcinomas, 25 large cell carcinomas and 28 others. Mean operative time was 128 min. (45 to 330 min.) and 106.5 min. in the last 100 patients. 30-day mortality was 0.7% (unrelated causes) and morbidity 6.6%. The mean number of dissected nodes during TEMLA was 37.9 (15 to 85). Metastatic N2 and N3 nodes were found in 152/698 (21.8%) and 26/698 patients (3.7%), respectively. Subsequent thoracotomy was performed in 445/ 513 patients (86.7%) after negative result of TEMLA. During thoracotomy, omitted N2 was found in 7/445 (1.6%) patients. Sensitivity of TEMLA in discovery of N2–3 nodes was 96.2%, specificity was 100%, accuracy was 99,0%, Negative Predictive Value (NPV) was 98.7% and Positive Predictive Value (PPV) was 100%. Conclusions: TEMLA is a new minimally invasive surgical procedure providing unique possibility to perform very extensive, bilateral mediastinal lymphadenectomy with very high diagnostic yield in staging of NSCLC. Full article