Anterior Chest Research Articles

Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique

This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic neck dissection (END) through anterior chest wall approach (ACWA) without creation of any neck incisions. Resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). From January 2020 to August 2020, 6 patients with a biopsy proven head and neck carcinoma underwent resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). The selective neck dissection was successfully performed endoscopically in all cases with no conversion to open approach and with good visualization of the major neurovascular structures. The operative time for the END ranged from 120 to 170minutes, with 10-50mL estimated blood loss. No significant perioperative complications were encountered. The mean total number of cervical LN retrieved was 13.67 + 2.42, and the mean LNR was .01 + .13. All patients were discharged in the third postoperative day, and they were satisfied with the cosmetic outcome. Selective total END through ACWA is technically feasible and safe with satisfactory cosmetic results. The absence of neck scars and magnification of the important neurovascular structures are the most obvious advantages of this innovative technique. It may be a valid alternative to conventional surgery when performed in selected patients. However, further research with longer follow up is needed to clarify the oncological safety and the real benefits of END in head and neck cancer patients.

P039 INTERCOSTAL HERNIA FOLLOWING DIEP RECONSTRUCTION: A CASE PRESENTATION

Abstract Aim Intercostal lung herniation is a rare clinical condition defined as the protrusion of lung parenchyma beyond the anatomic boundaries of the thoracic wall. Acquired lung hernias are typically occur secondary to trauma or are associated with severe pulmonary disease. We present a case of lung herniation following DIEP breast reconstruction which is the first reported case to date. Material and Methods 40-year-old woman with a history of bilateral mastectomy for breast cancer and subsequent delayed, bilateral DIEP breast reconstruction. She returned to the emergency department four days after her reconstruction with chest pain, shortness of breath and swelling of her chest. CT angiography of her chest demonstrated a focal protrusion of her right lung into her anterior chest wall (Figure 1). Thoracic surgery was consulted for repair which was achieved with a patch technique using Allomax dermal matrix. Results We describe the first reported intercostal lung hernia following DIEP breast reconstruction reported in scientific literature. Our patient had no history of trauma, thoracic surgery or pulmonary disease which are considered the greatest risk factors for acquired intercostal lung herniation. Much like abdominal wall hernias, protrusion of tissue through a small defect places tissue at risk for ischemia. Early recognition is thus essential to avoid tissue loss. Conclusions Intercostal lung hernia is an uncommon clinical entity that has not previously been described as a complication of DIEP breast reconstruction. Its development is associated with significant morbidity including flap loss in this case. Early recognition of this rare complication is essential to avoid more severe sequelae of tissue ischemia.

Premature Deaths Due to Silicosis in Turkey, 2006-2017: A Twelve-Year Longitudinal Study.

Background Deaths due to epidemics of silicosis still continue to be reported both in developing and developed countries, and silica exposure from different sectors remains an important occupational health concern.Aims To identify characteristics of silicosis cases by focusing on a developing country and evaluate the frequency of and factors related to premature deaths and also reveal preventable causes of premature deaths in silicosis.Study Design Retrospective cohort.Methods We reviewed the records of 9769 patients who were diagnosed with occupational diseases in İstanbul Occupational Diseases Hospital between 2006 and 2017. According to International Classification of Diseases (ICD)-10 codes, 1473 silicosis cases were detected. The sociodemographic characteristics, job characteristics, comorbidities, serological, functional, and radiological data, and follow-up time were obtained from the medical records. Mortality data were gathered from The National Death Notification System of Ministry of Health.ResultsThe study examined 9769 cases diagnosed with an occupational disease, and 15.0% (n = 1473) of them were diagnosed with silicosis. The median age of silicosis patients was 40.0 years, and 26.9% of them were child labor when they started to work in dusty industries. Child labor was mostly seen among dental technicians (57.7%), denim sandblasters (46.4%), and miners (37.0%). In the follow-up period, 26.3% of Teflon sandblasters, 11.1% of coal miners, 8.6% of denim sandblasters had died before their average life expectancy, and the years of loss of life was 26.0 ± 11.6 years all over the group. Premature death was associated with occupation [hazard ratio (Teflon sandblasting): 3.93, CI: 1.43-10.78; hazard ratio (marble production): 4.4, CI: 1.02-19.21]; large opacities in posterior anterior chest X-ray [hazard ratio: 2.14, CI: 1.18-3.86]; tuberculosis [hazard ratio: 2.60, CI: 1.42-4.76]; and reduction in forced vital capacity (forced vital capacity% ≤80) during diagnosis [hazard ratio: 4.43, CI: 2.22-8.83].Conclusion: More than a quarter of silicosis cases are those who start working in dusty industries at an early age. Factors associated with premature death in patients with silicosis are patient occupation, large opacities on chest X-ray, tuberculosis, and pulmonary function loss at diagnosis.

Dorsal Push and Abdominal Binding Improve Respiratory Compliance and Driving Pressure in Proned Coronavirus Disease 2019 Acute Respiratory Distress Syndrome.

OBJECTIVES:We describe seven proned patients with coronavirus disease 2019-related acute respiratory distress syndrome in whom a paradoxical decrease in driving pressure reversibly occurred during passive, volume-controlled ventilation when compressing the lower back by a sustained “dorsal push.” We offer a potential explanation for these unexpected observations and suggest the possible importance of eliciting this response for lung-protective ventilation of similar patients.DESIGN/SETTING:Case series at a single teaching hospital affiliated with the University of Minnesota. Measurements were recorded from continuously monitored airway pressure and flow data.PATIENTS:Nonconsecutive and nonrandomized sample of coronavirus disease 2019 acute respiratory distress syndrome patients who were already prone and paralyzed for optimized lung protective clinical management while inhaling pure oxygen.INTERVENTIONS:Sustained, firm manual pressure applied over the lower back in all patients, followed by abdominal binding in a subset of these.MEASUREMENTS AND MAIN RESULTS:Respiratory system driving pressure declined and respiratory system compliance improved in seven patients with the dorsal push maneuver. In a subset of four of these, abdominal binding sustained those improvements over >3 hours.CONCLUSIONS:Sustained compressive force applied to the dorsum of the passive and prone patient with severe respiratory failure due to coronavirus disease pneumonia may elicit a paradoxical response characterized by improved compliance and for a given tidal volume, lower plateau, and driving pressures. Such findings, which suggest end-tidal overinflation within the aerated part of the diseased lung despite the already compressed anterior chest wall of prone positioning, complement and extend those observations recently described for the supine position in coronavirus disease 2019 acute respiratory distress syndrome.

Lung Ultrasound versus Pulmonary Auscultation in Detecting Pulmonary Congestion in the Critically Ill

BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound (LUS) as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. AIM: The aim of this study was to compare LUS versus pulmonary auscultation for detecting pulmonary edema in critically ill patients. PATIENTS AND METHODS: Sixty-one patients were included in this study, all included patients underwent clinical examination, chest auscultation of anterior and lateral (axillary) chest wall and back in each hemithorax in supine position was done, followed by LUS using Bedside LUS in Emergency (BLUE) protocol. LUS score was recorded; abnormal auscultation was defined as the presence of rales or wheezes. Laboratory tests were done on admission such as pro-BNP, renal function, and blood gases. Pro-BNP was used as diagnostic tool for volume overload and was correlated with LUS and stethoscope for detecting pulmonary edema. Pneumonia was excluded with normal total leukocyte counts, C-reactive protein, and absence of fever. RESULTS: This study included 61 patients with diagnosis of pulmonary edema, all data were recorded on admission and showed that there was statistically significant good positive correlation between LUS and Pro-BNP (p < 0.05), and Pearson correlation between LUS and Pro-BNP among the studied patients is statistically significant at the 0.01 level (two-tailed). Furthermore, we found that both LUS and Pro-BNP were statistically significant higher among patients with rales (p < 0.05) only 36 (59%) patients were positive as pulmonary edema with pulmonary auscultation (presence of rales) and 25 (41%) patients were negative for pulmonary edema (NO RALES) while they were positive for pulmonary edema with LUS (high LUS score)and pro-BNP. CONCLUSION: Pulmonary auscultation has poor sensitivity for pulmonary congestion while LUS had statistically significant higher sensitivity for pulmonary edema.

Abstract 16758: Unexplained Recurrent St-elevation Myocardial Infarction Complicated By Diffuse Alveolar Hemorrhage In Undiagnosed Granulomatosis With Polyangiitis

Case Presentation: A 53-year-old man with a history of well-controlled hypertension and dyslipidemia presented with chest pain due to anterior STEMI for which a proximal LAD stent was placed. A week later, he presented with recurrent chest pain and ST elevation in the anterior chest leads. Coronary angiography showed in-stent thrombosis with heavy thrombus burden extending through the LAD. Manual thrombectomy with a second stent placement was done. He was discharged on triple therapy (aspirin, clopidogrel, and rivaroxaban), later, he presented to our medical facility with a 1-week history of hemoptysis. His clinical condition deteriorated requiring intubation. Laboratory work-up revealed elevated renal functions, proteinuria, and significant hematuria. CXR showed diffuse patchy opacities while CT chest was consistent with diffuse alveolar hemorrhage (Figure 1). Further work-up revealed elevated anti-proteinase 3 (c-ANCA) and low C4. Based on microscopic hematuria, renal impairment, and a positive c-ANCA, a diagnosis of granulomatosis with polyangiitis (GPA) was made. Induction with methylprednisolone, cyclophosphamide, and rituximab was initiated. His condition gradually improved, he was extubated successfully with marked improvement of renal functions. He was discharged on clopidogrel and scheduled for follow-up. Discussion: Few case reports have described STEMI as the initial presentation of GPA, likely attributed to vasculitis and accelerated atherosclerosis from systemic inflammation. Our patient had well-controlled cardiovascular risk factors and renal involvement with hematuria and elevated creatinine at the time of STEMI diagnosis, together with intermittent joint pains, suggesting ongoing systemic vasculitis. Clinicians should have a high index of suspicion for the possibility of non-atherosclerotic coronary stenosis as in cases of coronary vasculitis for early detection and management of a potentially reversible condition.

Effect of a ‘Spine Offloading’ Chair Design on Seated Height and Posture

: A prototype chair with anterior chest and arm supports has been designed to reduce compressive spine loads. The purpose of this study was to compare the effects of this offloading design on seated height compared to a control configuration of the same chair. 20 males sat on each configuration for 1 hour. Seated height, perceived pain, spine angles, seat pressure, and participants’ experiences were measured. Spine height loss was significantly reduced in the offloading (-0.75 ± 3.79mm) compared to the control configuration (-6.16 ± 4.27mm, p < 0.001), and participants sat significantly more anterior on the seat pan in the offloading (20.56 ± 1.67cm) compared to control configuration (18.03 ± 1.92cm, p < 0.001). There were no differences in spine angles or perceived back and gluteal pain between configurations. This design appears to be a promising approach to protecting the back during sitting when engaging in forward leaning tasks where the offloading effect of a backrest may be minimized. Practitioner Summary: A prototype chair with anterior chest and arm supports designed to offload the spine was shown to significantly reduce seated height loss during 1-hour of sitting compared to a control configuration. While participants perceived the offloading design to be more supportive, no differences in perceived pain or posture were found.

Unusual presentation of lung carcinoma as nasal tip metastasis: A review of literature

Lung carcinoma is the most common type of carcinoma seen in males and 4 most common in females. Skin metastasis from lung carcinoma is frequent with an incidence of 1%-12%, with most common site being the anterior chest wall. Skin metastasis from lung carcinoma to the tip of nose is very rare with only 12 cases being reported in literature(Table 1). It can be confused with other benign and malignant conditions, such as infection, lymphoma, hemangioma, rhinophyma, sarcoidosis, tuberculosis and carcinomas, making its diagnosis difficult. Less than 20 cases of cutaneous nasal tip metastasis are reported in literature out of which 12 are from malignancies of lung. Sometimes it can appear earlier than the primary lesion and thus delays the diagnosis of primary lesion. = In this case report, we report a case of nasal tip cutaneous metastasis from squamous cell carcinoma of lung.

P065 A case of fibrodysplasia ossificans progressiva in Kenya

Abstract Background Fibrodysplasia Ossificans Progressiva (FOP) is an extremely rare and disabling disorder affecting 1 in 2 million individuals worldwide. It is caused by mutations in bone morphogenetic protein which leads to extra-skeletal ossification of soft tissues in a characteristic cranio-caudal pattern. Hallux valgus, episodic flares and progressive functional disability are characteristic features. The cause of death is often cardio-respiratory failure following thoracic insufficiency. The objective of our case study is to describe a rare but interesting case of fibrodysplasia ossificans progressiva (FOP) in an African setting. Methods This was a retrospective case review Results Two-year-old boy presented with painful firm masses of bony consistency over the axilla, neck, occiput and the forehead for seven months. He developed progressive inability to lift the arms, flex his neck and had a characteristic stiff posture while walking. The masses had a waxing and waning nature lasting about 4–5 days but with no complete resolution. He was previously treated with antibiotics for lymphadenitis which was diagnosed by biopsy of the neck mass at a different health facility. On examinationhe had bony masses on the posterior aspect of the neck tender on palpation and attached to the underlying subcutaneous tissue. Similar masses were found on his anterior and posterior chest wall measuring 1 cm by 1 cm anteriorly and larger masses- measuring 5 cm by 5 cm posteriorly. He had bilateral hallux valgus and both elbows held in fixed flexion. His fingers had varying degrees of fixed flexion. The lower limbs were unaffected. Laboratory evaluation within normal ranges. extensive dystrophic soft tissue calcification around both elbows outlining the joint capsules. dystrophic soft tissue calcification in the bilateral axillae extensive “sheet like” soft tissue dystrophic calcifications overlying the posterior elements of the vertebral column separate from the vertebrae. Histology showed muscle replacement by hyaline cartilage and bone with intervening fibromyxoid stroma. Discussion &amp; Conclusions This case is meant to raise awareness of this rare disease across Africa. The misdiagnosis of FOP approaches 90% of cases worldwide. Definitive genetic testing of FOP is now available and can now confirm a diagnosis before the appearance of heterotopic ossifications. Clinical suspicion of FOP early in life on the basis of malformed great toes can lead to early clinical diagnosis. Current management focuses on early diagnosis, avoidance of trauma and optimization of function. A short course of oral steroids is beneficial in prevention of flares.

O001. Juvenile-onset spondyloarthritis: a study of 54 cases in Senegal

Abstract Background Juvenile onset spondyloarthritis (JoSpA), also known as enthesitis-related arthritis (ERA), accounts for approximately 10-20% of all juvenile idiopathic arthritis (JIA) and affects four times more boys than girls. It’s characterized by frequent arthritis of the lower limbs and strongly associated with presence of HLA-B27. In sub-Saharan Africa, SpA is considered as a rare disease where the frequency of HLA-B27 is &amp;lt; 1% in the population. However, an interesting exception is found in the Fula ethnic group of Gambia, where the prevalence of HLA-B27 was estimated at 6% to 7.8%. This ethnic group is also present in Senegal Aims: To determine the epidemiological, clinical, Para clinical, therapeutic and disease course aspects of JoSpA in Senegal. Methods A retrospective observational study, was conducted in rheumatology department of Aristide Le Dantec Hospital, between January 2012 and December 2020. Two hundred and fifteen JIA cases were collated, 54 were JoSpA fulfilling the ILAR classification criteria of ERA, with age of onset of symptoms ≤ 16 years. Exclusion criteria were: psoriasis or history of psoriasis, presence of rheumatoid factor and presence of systemic arthritis. Disease activity was assessed by activity indexes (BASDAI and ASDAS), functional impact by BASFI, and Quality of Life by Nottingham Health Profile (NHP). Results A total of 54 patients (29 males and 25 females with a sex ratio M/F of 1.16) were included in the study. The mean age at onset of symptoms was 12.4 years, mean age at diagnosis was 23.2 years. 34 (63%) patients were of Fula ethnicity. The inaugural symptomatology was exclusively peripheral in 33 cases (61.1%), axial and peripheral in 23 cases (42.6%). At the time of diagnosis, arthritis was located in the lower limbs in 92.1% of cases, where knee involvement was predominant in 30 (55.6%) cases, followed by hip involvement in 17 (31.5%) cases. Axial involvement was present in 46 cases (85.2%), dominated by sacroiliac pain/ buttock pain in 73.9%, followed by low back pain in 52.1%. Entheseal involvement was present in 30 cases, dominated by Achilles enthesitis and plantar fasciitis in 83.3%. Involvement of the anterior chest wall was found in 12 patients. Uveitis was present in 3 patients. Biological inflammatory syndrome was found in 55.5% of cases, with a mean CRP level of 17.1mg/l. Search for HLA-B27 was carried out in 34 patients, 25 were HLA-B27 positive (73.5%). Among HLA-B27 positive patients, 21 (84%) were of Fula ethnicity. On radiography, sacroiliitis was present in 29 patients, and 8 had coxitis. On admission, the mean BASDAI and ASDAS-CRP were 4.66/10 and 2.98 respectively, mean BASFI was 4.36/10. NHP showed impairment of all items, especially the concepts of energy, pain, sleep and physical mobility. Treatment was based on: NSAIDs (42 patients, 79.6%), methotrexate (30 patients, 55.5%), sulfasalazine (8 patients, 14.8%), oral steroids (15 patients, 27.7%), intra-articular joint steroid injections (6 patients), hip replacement surgery (2 patients), and functional rehabilitation (5 patients). The evolution was favorable, after 6 months of treatment, mean BASDAI and BASFI were 2.47/10 and 2.19/10 respectively. Conclusion In our study, JoSpA affects both girls and boys. The prevalence of HLA-B27 was 73.5% of cases, especially in the Fula ethnic group. The disease is considered as a source of significant functional impact and impairment of quality of life. The treatment was based mainly on conventional treatment. Evolution was globally favorable after treatment. Further epidemiological studies are needed to obtain reliable prevalence rates and to better understand our findings.

Lumbar Skin Lesion in a Term Infant.

Lumbar Skin Lesion in a Term Infant.

Migratory foreign body in the chest

A 12 years old male child presented to our institution 3 days after he sustained a penetrating injury to his left antero-lateral chest by a sewing needle. At presentation, he was stable except having a localized chest pain at the site of the needle. The pertinent finding was on the chest examination in which there was a pinpointed entry wound at the left 4th intercostal space antero-laterally with a localized tenderness. Chest x-ray revealed a radio opaque foreign body. After obtaining chest ultrasound which localized and marked the needle in the anterior chest wall, local exploration of the chest wall was done over the marked area but foreign body was not found. Hence, thoracic cavity was entered through antero-medial thoracotomy with a finding of a sewing needle in the anterior mediastinum with its tip embedded in the pericardium. Needle was removed without any sequel and patient was discharged improved on the second post-operative day.

Post-COVID-19 mucormycosis presenting as chest wall cellulitis with mediastinitis

A 27-year-old man with no known comorbidities presented to our institute with a 7-day history of pain and redness over the right side of the anterior chest wall, fever, and shortness of breath. 2 weeks before the start of symptoms, he was diagnosed with mild COVID-19 and took over-the-counter methylprednisolone 16 mg twice a day for 2 weeks. At presentation, he had tachypnoea (respiratory rate 30 breaths per min [reference range 12–16 per min]), with a blood oxygen saturation of 80% on room air.

The Utility of the Omentum Flap for Complex Intrathoracic Problems.

Introduction: Omentum flap is a viable reconstructive option for complex chest wall and mediastinal reconstruction. The impact of vasoconstrictors and the laminar pattern of blood flow associated with left ventricular assist devices (LVADs) on the outcomes of reconstructions has not been thoroughly evaluated. Methods: A retrospective review of all patients who underwent chest wall or mediastinal reconstruction using pedicled omentum flaps between 2003 and 2019. Results: Forty patients (60% males) underwent chest wall or mediastinal reconstruction using a pedicled omentum flap at a mean age of 58 years. The median follow-up was 24.3 months. The most common indication was the reconstruction of anterior chest wall/sternal defects (n = 16), followed by coverage of repaired bronchopleural fistula (n = 6), osteoradionecrosis of the anterolateral chest wall (n = 5), reconstruction of anterior/lateral chest wall following oncologic resections (n = 5), coverage of replaced infected LVAD (n = 4), and coverage of exposed/replaced aortic root vascular grafts (n = 4). Vasoconstrictors were used in 26 patients (65%). Eight flaps had partial necrosis, and none of the flaps had complete necrosis. There was no difference in flap complication rates in patients who received vasoconstrictors during the case compared to those who did not (P = 1.0). Thirteen (33%) flaps were skin grafted at a median of 13 days with 100% skin graft viability. Abdominal incisional hernia developed in 8 patients. In patients with LVADs, the omentum remained viable during the follow-up period. Conclusion: The ability of the omentum to easily reach various regions in the chest and the low failure rate make this flap a reliable reconstructive method.

Myocardial strain analysis in infants with pectus excavatum: A subtle method to detect myocardial impairment?

Myocardial strain analysis in infants with pectus excavatum: A subtle method to detect myocardial impairment?

An Uncommon Cause of Hematemesis in a Patient With End-stage Renal Disease

Question: A 45-year-old man presented with an acute onset of large volume hematemesis associated with worsening facial and neck swelling for the past 6 months. He has a significant past medical history of end-stage renal disease secondary to congenital dysplastic kidneys and has been on hemodialysis for the past 30 years. He has no history of chronic liver disease. Clinical examination revealed diffuse facial and neck edema. Dilated superficial veins were also seen on his upper anterior chest wall. A pulsatile left brachiocephalic arteriovenous fistula was present. The patient was intubated and urgent esophagogastroduodenoscopy was performed. The following bleeding lesion was visualized 25 cm from the incisors (Figure A). What is the diagnosis? Look on page 405 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The patient was suspected to have downhill esophageal varices. The bleeding varix located 25 cm from the incisors was band ligated with successful hemostasis (Figure B). A computed tomographic venography of the thorax was performed, which revealed an occluded right brachiocephalic to superior vena cava stent (white arrow) and a prominent azygos vein (red arrow) (Figure C). The patient underwent a percutaneous central venogram and balloon angioplasty of the occluded right brachiocephalic and superior vena cava stent (Figure D). After the procedure, the patient’s facial and neck swelling diminished rapidly and there were no further episodes of bleeding. Downhill varices, or otherwise known as proximal esophageal varices are most commonly due to superior vena cava obstruction secondary to various etiologies such as malignancy, mediastinal fibrosis, and central venous catheter placement.1Ostler P.J. Clarke D.P. Watkinson A.F. Gaze M.N. Superior vena cava obstruction: a modern management strategy.Clin Oncol (R Coll Radiol). 1997; 9: 83-89Abstract Full Text PDF PubMed Google Scholar Although malignancy is the most common etiology of superior vena cava obstruction, bleeding downhill varices tend to occur more in patients with benign etiologies, such as central venous catheter placement.2Loudin M. Anderson S. Schlansky B. Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review.BMC Gastroenterol. 2016 24; 16: 134Crossref PubMed Scopus (13) Google Scholar This phenomenon may be due to increased venous return and pressure secondary to the underlying arteriovenous access for hemodialysis. The underlying superior vena cava obstruction leads to diversion of venous return through the azygos vein, which in turns causes engorgement of the veins draining the proximal to middle aspect of the esophagus, and causing the development of downhill varices.3Marini T.J. Chughtai K. Nuffer Z. et al.Blood finds a way: pictorial review of thoracic collateral vessels.Insights Imaging. 2019; 10: 63Crossref PubMed Scopus (3) Google Scholar During acute bleeding, endoscopic therapies such as variceal band ligation can be used for hemostasis. However, the mainstay of treatment is to treat and relieve the underlying superior vena cava obstruction. Clinicians should have a high index of suspicion for downhill varices if a patient with end-stage renal disease on hemodialysis presents with upper gastrointestinal bleeding, especially if the patient has a history of central venous catheter placement.

先天性前胸部皮下皮様瘻孔 ―自験例2例の報告，および既報告50例の検討―

先天性前胸部皮下皮様瘻孔 ―自験例2例の報告，および既報告50例の検討―

Bilateral sternalis muscle in a Sudanese cadaver.

Introduction and importanceSternalis/rectus sterni is a rare muscle found in the anterior chest wall, it occurs in 35% of humans. The early detection of its presence is critical in regular mammogram screening in order to avoid possible differential diagnostic dilemma.Case presentationWe report here a case of the sternalis muscle observed bilaterally, it was found during routine dissection session of an elderly male cadaver in the dissection room, Faculty of Medicine, University of Khartoum.Clinical discussion and conclusionSternalis muscle is a familiar entity to anatomists, but can pose a diagnostic and surgical dilemma to some clinicians. Presence of the muscle can be confusing in regular mammogram screening and CT and MRI should be utilized to clear the dilemma, and further evidence needs to be explored and studied.

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Resting ECG measurements can identify abnormalities in children with catecholaminergic polymorphic ventricular tachycardia

Abstract Background Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a rare inherited disease characterized by exercise- or emotionally-triggered life-threatening ventricular arrhythmias. The resting ECG is considered to be normal and diagnosis has depended on exercise testing that is difficult acutely post-arrest or in young children. Purpose To identify resting ECG abnormalities in children with CPVT through assessment of measurement matrix parameters compared to a cohort of normal children. Methods A discovery cohort of 65 CPVT patients from the Electrophysiology program were identified. After excluding those on antiarrhythmics or in an arrhythmia at the time of their baseline ECG, 31 cases were matched 3:1 by age and sex with 93 healthy controls. Each individual had baseline ECG parameters and 180 machine-derived ECG amplitudes and durations (measurement matrix) measured. Statistical differences between ECG measures were assessed using Student's T-Test adjusted with a False Detection Rate of 1%. Significant measures were processed in a machine-learning algorithm to derive a Tree Model to differentiate individuals with and without CPVT. Results No significant differences were detected between CPVT patients who had and did not have a cardiac arrest. Comparing the CPVT and control cohorts, significant repolarization differences were seen in the amplitudes of lateral (I, negative aVR, V5, V6) and anterior leads (V2, V3, V4) at the J-point, ST midpoint, ST endpoint, and T-wave. Specifically, individuals with CPVT had significantly lower mean amplitudes in all aforementioned leads except aVR where the mean amplitudes were higher. These data were then used to create a Tree Model of the discovery cohort displayed in Figure 1 with a resulting R2 of 0.74, sensitivity of 0.81, and specificity of 0.98. Conclusions Baseline differences in repolarization are detectable in the left and anterior chest leads using machine-derived measurements of baseline ECGs in patients with CPVT, which may guide clinical suspicion when evaluating the resting ECG. These results warrant further analysis including testing of the Tree Model with a validation cohort. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Scholar Award from the Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada to Trainee Dr. Taraneh TofighiCanadian Institute for Health Research Figure 1. CPVT Tree Model