Intrapericardial migration of dislodged sternal struts as late complication of open pectus excavatum repairs

<p>Abstract</p> <p>We present a case of sternal steel strut dislodgement and migration in a patient undergoing Ravitch repair for pectus excavatum (PE) 37 years ago. Broken struts perforated the right ventricle and right ventricular outflow tract (RVOT) and additionally migrated into the left upper lobar bronchus.</p> <p>Dislodged sternal struts represent rare complications after surgical repair of patients suffering from pectus excavatum. Reviewing the literature, only five cases of intrapericardial migration of dislodged sternal struts or wires have been reported so far.</p> <p>In our case, the first strut was removed from the airways through a left antero-lateral thoracotomy. Using cardiopulmonary bypass, a second strut was removed via ventriculotomy. These life-threatening sequelae underscore the importance of postoperative follow-up and early removal of osteosynthetic materials used in open PE repair. Accurate preoperative localization of migrated materials and availability of CPB support are crucial for successful surgical removal.</p> <p>Introduction</p> <p>The migration of dislodged sternal steel struts or wires into the pericardium and cardiac cavities is a rare but life-threatening complication of open pectus excavatum (PE) repair <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>. Removal of these materials poses a challenge for cardiothoracic surgeons. Herein, the authors report a case of migration of dislodged steel struts through the right ventricle and right ventricular outflow tract (RVOT) into the left upper lobar bronchus in a patient who underwent Ravitch repair 37 years ago.</p

The effects of fruit smoothies on enamel erosion

Objectives: This prospective, randomised in vitro study was to investigate the pH and titratable acidity of fruit smoothie drinks and to assess the effect of these drinks on enamel erosion. Method: Fifty enamel slabs were divided into five groups which were allocated to the sample solutions groups: Innocent® smoothie strawberries and bananas (SB), Innocent® smoothie mangoes and passion fruit (MP) and Diet Coke. Distilled deionised water (DD) was used as negative control and citric acid 0.3 % as positive control. All the slabs were subjected to a 21-day pH cycling regime involving 2 min of immersions, five times a day with appropriate remineralization periods in between. Measurement of surface loss was assessed using profilometry. Independent sample t tests were used to compare mean. Results: The titratable acidity for both test smoothies were 3.5-4 times more than that needed to neutralise Diet Coke and citric acid 0.3 %. The pH of SB, MP smoothie and Diet Coke was found to be 3.73, 3.59 and 2.95, respectively. MP smoothie caused the greatest amount of surface loss followed by Diet Coke. Both smoothies were found to cause significant surface loss. MP smoothie resulted in significantly higher surface loss compared with MB smoothie and citric acid 3 %. Conclusion: The smoothies tested were acidic and had high titratable acidity. They produced a significant erosion of enamel in vitro. The results of this study suggest that there should be increased awareness of the erosive effects of smoothies especially as their consumption seems to be on the increase

Clinical practice: Swallowing problems in cerebral palsy

Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2–2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain. Children with CP can have swallowing problems with severe drooling as one of the consequences. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Early attention should be given to dysphagia and excessive drooling and their substantial contribution to the burden of a child with CP and his/her family. This review displays the important functional and anatomical issues related to swallowing problems in children with CP based on relevant literature and expert opinion. Furthermore, based on our experience, we describe a plan for approach of investigation and treatment of swallowing problems in cerebral palsy

Multi-level analysis of spatio-temporal features in non-mass enhancing breast tumors

Diagnostically challenging breast tumors and Non-Mass-Enhancing (NME) lesions are often characterized by spatial and temporal heterogeneity, thus difficult to detect and classify. Differently from mass enhancing tumors they have an atypical temporal enhancement behavior that does not enable a straight-forward lesion classification into benign or malignant. The poorly de fined margins do not support a concise shape description thus impacting morphological characterizations. A multi-level analysis strategy capturing the features of Non-Mass-Like-Enhancing (NMLEs) is shown to be superior to other methods relying only on morphological and kinetic information. In addition to this, the NMLE features such as NMLE distribution types and NMLE enhancement pattern, can be employed in radiomics analysis to make robust models in the early prediction of the response to neo-adjuvant chemotherapy in breast cancer. Therefore, this could predict treatment response early in therapy to identify women who do not benefit from cytotoxic therapy