Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a v...Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a vital role in protecting the thoracic organs, supporting the respiratory system, and maintaining the shape of the chest. Therefore, any defect or deformity of the chest wall can have significant functional and aesthetic consequences for the patient. The authors present a case report at Kenyatta National Hospital (KNH) of a dyspneic 47-year-old male patient with a right anterolateral chest wall defect post-pneumonectomy previously complicated by bronchopleural fistula. Past attempts at the chest wall reconstruction had utilized the ipsilateral latissimus dorsi muscle, pectoralis major muscle, and the omental pedicled flaps with limited success. A chimeric anterolateral thigh (ALT) perforator-free flap with vastus lateralis (VL) muscle was used to obliterate the post-pneumonectomy intrathoracic dead space and to provide a cutaneous paddle. This case report aims to show the versatility of the ALT flap for chest wall reconstruction to prevent the post-pneumonectomy syndrome associated with tracheal deviation, inspiratory stridor, and exertional dyspnea. In conclusion, chest wall reconstruction with obliteration of intrathoracic dead space post-pneumonectomy is challenging and needs careful planning and execution.展开更多
端粒长度和结构的稳定与肿瘤及衰老的发生密切相关,端粒维持机制是细胞增殖的必要条件,端粒维持机制的激活是肿瘤细胞演化过程中的一个重要环节。这种端粒维持机制可能是通过重新激活端粒酶,使细胞快速增殖。在端粒酶失活或不足的情况下...端粒长度和结构的稳定与肿瘤及衰老的发生密切相关,端粒维持机制是细胞增殖的必要条件,端粒维持机制的激活是肿瘤细胞演化过程中的一个重要环节。这种端粒维持机制可能是通过重新激活端粒酶,使细胞快速增殖。在端粒酶失活或不足的情况下,也存在着一种或多种维持和增加端粒长度的机制,统称为端粒延长替代机制(Alterative lengthening of telomere,ALT)。其特点包括:具有不均一的端粒长度,存在与ALT相关的PML小体(APBs)以及同源重组增加。ALT细胞内存在的ALT相关蛋白及异常活跃的同源重组为ALT机制的激活和维持提供了可能。文章综述了ALT的特征性表型、与端粒酶的相关性及其可能的发生机制。对ALT机制的深入研究将有利于阐明衰老与肿瘤之间的辩证关系。展开更多
文摘Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a vital role in protecting the thoracic organs, supporting the respiratory system, and maintaining the shape of the chest. Therefore, any defect or deformity of the chest wall can have significant functional and aesthetic consequences for the patient. The authors present a case report at Kenyatta National Hospital (KNH) of a dyspneic 47-year-old male patient with a right anterolateral chest wall defect post-pneumonectomy previously complicated by bronchopleural fistula. Past attempts at the chest wall reconstruction had utilized the ipsilateral latissimus dorsi muscle, pectoralis major muscle, and the omental pedicled flaps with limited success. A chimeric anterolateral thigh (ALT) perforator-free flap with vastus lateralis (VL) muscle was used to obliterate the post-pneumonectomy intrathoracic dead space and to provide a cutaneous paddle. This case report aims to show the versatility of the ALT flap for chest wall reconstruction to prevent the post-pneumonectomy syndrome associated with tracheal deviation, inspiratory stridor, and exertional dyspnea. In conclusion, chest wall reconstruction with obliteration of intrathoracic dead space post-pneumonectomy is challenging and needs careful planning and execution.
文摘端粒长度和结构的稳定与肿瘤及衰老的发生密切相关,端粒维持机制是细胞增殖的必要条件,端粒维持机制的激活是肿瘤细胞演化过程中的一个重要环节。这种端粒维持机制可能是通过重新激活端粒酶,使细胞快速增殖。在端粒酶失活或不足的情况下,也存在着一种或多种维持和增加端粒长度的机制,统称为端粒延长替代机制(Alterative lengthening of telomere,ALT)。其特点包括:具有不均一的端粒长度,存在与ALT相关的PML小体(APBs)以及同源重组增加。ALT细胞内存在的ALT相关蛋白及异常活跃的同源重组为ALT机制的激活和维持提供了可能。文章综述了ALT的特征性表型、与端粒酶的相关性及其可能的发生机制。对ALT机制的深入研究将有利于阐明衰老与肿瘤之间的辩证关系。
