A multi-institutional analysis of sternoclavicular joint coverage following osteomyelitis

BACKGROUND: Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. METHODS: A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed. RESULTS: Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/m2. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed twostaged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P\u3e0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/m2 vs. 32.9±9.1 kg/m2; P CONCLUSIONS: Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay

Perspectives on the Treatment of Malignant Pleural Mesothelioma

Malignant mesothelioma is an aggressive tumor arising from the serosal outer linings of the lungs (pleurae), heart, abdomen, and testes. Treatment trials have focused on malignant pleural mesothelioma, which accounts for 90% of cases, is often diagnosed at an advanced stage, and invariably leads to death. Malignant pleural mesothelioma has proved to be a formidable challenge for clinicians and scientists, with the 5-year survival rate continuing to languish at 5 to 10%.1 By far the most important risk factor for the development of malignant mesothelioma is asbestos exposure, although other risk factors, including related minerals, are beginning to emerge.2 The United States and other Western countries are seeing a gentle decline in cases of malignant mesothelioma as a result of transforming work practices. In the United States, age-adjusted mortality has been reduced from almost 14 deaths per 1 million persons in 2000 to 11 deaths per 1 million in 2015.3 Britain (England, Scotland, and Wales) has one of the highest death rates in the world at 77 deaths per 1 million (from 2017 to 2019), although this rate is also in decline.4 However, regional successes in prevention through eliminating clinically significant exposure to asbestos have not been matched by the development of new treatments.In this review, we reflect on the limited effect of the few positive phase 3 randomized, controlled studies, as well as recent trials examining the benefit of immunotherapy. We speculate about how rapid advances in our understanding of the genetics and biology of malignant pleural mesothelioma could translate into more effective therapies.</div