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At least 199 records · Page 11Linked to original sources
PubMed1999

Aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer.

A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.

Aortic Valve↗
PubMed2005

Inframanubrial parathyroid glands in patients with primary hyperparathyroidism: alternatives to sternotomy.

Deep inframanubrial parathyroid tumors have traditionally been excised through a median sternotomy. With the advent of minimally invasive surgical access, we chose to examine the treatment options and outcomes of patients with inframanubrial mediastinal parathyroid tumors. Patients with primary hyperparathyroidism seen at a university medical center over a 12-year period were retrospectively reviewed. The utility of localization studies, methods of treatment, complications, and outcomes were examined in patients with a parathyroid tumor located in the mediastinum inferior to the manubrium. Patients with parathyroid adenomas located at the thoracic inlet were excluded. Sixteen patients with inframanubrial mediastinal tumors were treated during the study period. Altogether, 81% of the patients had undergone at least one prior neck exploration for primary hyperparathyroidism. Preoperative calcium and parathyroid hormone levels were 12.4 +/- 0.36 mg/dl and 273 +/- 70 pg/ml, respectively. Localization studies identified mediastinal parathyroid adenomas in the following locations: anterior mediastinum (n = 8), middle mediastinum (n = 7), posterior mediastinum (n = 1). Mediastinal computed tomography and technetium-sestamibi scans demonstrated the best sensitivity, 92% and 85%, respectively. Seven patients underwent successful excision of the mediastinal adenoma by transcervical mediastinal exploration with the Cooper retractor. The other patients underwent angiographic ablation (n = 4), anterior mediastinotomy (n = 3), video-assisted thoracoscopy (VATS) (n = 1), and VATS plus thoracotomy (n = 1). The mean hospital stay for the study group was 2.9 +/- 0.7 days. The complication rate was 25%. All patients were normocalcemic after a mean follow-up of 15 +/- 7 months. Most inframanubrial mediastinal parathyroid tumors can be successfully managed without median sternotomy.

Adenoma↗
PubMed1998

The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis.

OBJECTIVE: The purpose of this retrospective study was to examine the value of whole-body nuclear medicine imaging and to evaluate the typical scintigraphic pattern of sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO). In this entity the correct diagnosis is frequently missed because of uncharacteristic changes in other imaging modalities. MATERIALS AND METHODS: Forty-nine patients (age range 15-65 years old, mean age 36 years) with sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO) were examined with whole-body scintigraphy and conventional radiography. RESULTS: Forty-three of 49 patients with SCCH/PAO showed a characteristic "bullhead"-like high tracer uptake of the sternocostoclavicular region with the manubrium sterni representing the upper skull and the inflamed sternoclavicular joints corresponding to the horns (= bullhead sign). Scintigraphy revealed additional skeletal manifestations (spondylitis, sacroiliitis, osteitis) in 33 of 49 patients with SCCH and/or PAO. CONCLUSIONS: Bone scintigraphy is the imaging modality of choice for the diagnosis of skeletal involvement in PAO. Nuclear medicine reveals unexpected locations and shows the typical pattern of focal hot spots of the spine, sacroiliac joints and/or appendicular skeleton in the large majority of cases in combination with a bullhead-like tracer uptake of the sternocostoclavicular region. The bullhead sign is the typical and highly specific scintigraphic manifestation of SCCH and PAO in radionuclide bone scans and helps to avoid unnecessary biopsies.

Adolescent↗
PubMed1998

Tracheal ring-graft reinforcement in lieu of tracheostomy for tracheomalacia.

Three children with tracheomalacia had tracheal reinforcement with free three-quarter circumference ring grafts of autologous cartilage taken from the costal margin. A low cervical manubrium-splitting approach gave excellent access to the anterior mediastinum and the intrathoracic trachea in two children. The first child, a neonate with oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF), had 11 grafts to support the whole of the trachea from the cricoid to the carina and never required a tracheostomy. For the first 5 years she had frequent pneumonic episodes and on one occasion bilateral pneumothoraces. These episodes and radiographic lung hyperinflation, attributed to distal bronchomalacia, have reduced spontaneously in frequency and severity. At 9 years of age she has a well-supported trachea with palpable cartilage rings in the cervical segment. The trachea has grown to approximately 75% of expected normal size for her age. Another child with tracheomalacia related to innominate-artery compression and who presented with 'dying episodes' was completely relieved and resumed a normal life without a tracheostomy following insertion of four grafts to the intrathoracic trachea. He remains well and symptom-free 8 months postoperatively. A third child had cartilage-graft reinforcement of the lower cervical trachea, including the tracheostomy site, to achieve tracheostomy closure at 16 months of age. Five years later he continues to have a well-supported trachea showing acceptable growth. However, he has ongoing evidence of tracheo-bronchomalacia presenting as expiratory wheezing, lung hyperinflation, and pneumonic episodes that are diminishing spontaneously with growth. Our experience, limited to three children, recommends primary tracheal reinforcement with autologous free costal-cartilage grafts for tracheomalacia in the neonate and young infant. This procedure and the anterior mediastinal approach are well-tolerated, providing instant tracheal support, removing the need for a tracheostomy, and allowing the child's rapid return to the family. Long-term follow-up, presently 9 and 5 years in two children originally presenting with OA and TOF, indicates adequate tracheal growth and an aesthetically acceptable appearance. It is relevant to prognosis that relief of the life-threatening tracheal component exposed the full extent of the bronchial cartilaginous weakness, which has significantly detracted from the quality of life for these two children with OA and TOF-related tracheomalacia.

Cartilage↗
PubMedDate not supplied

[The "bull horn sign"--scintigraphic pattern in sternocostoclavicular hyperostosis and pustular arthro-osteitis].

27 patients with sternocostoclavicular hyperostosis (SCC) and/or pustulotic arthroosteitis (PAO) were examined with whole body scintigraphy, conventional radiography, and other imaging modalities, such as CT, MRI. 25 of 27 patients with SCCH showed a characteristic high bullhorn-like uptake of the sternocostoclavicular region with the manubrium sterni representing the skull and the inflamed sternocostoclavicular joints corresponding to the horns (= bullhorn-sign). Scintigraphy revealed additional skeletal manifestations (spondylitis, sacroilitis, osteitis, periostitis) in 19 of the 27 patients with SCCH and/ or PAO. In combination with PPP or psoriasis pustulosa, the typical scintigraphic bullhorn pattern enables the diagnosis of PAO (19 patients) with high confidence. Patients with SCCH but without skin disease at the time of presentation (8 of 27 patients) may develop PPP later and, therefore, it is justified to classify them as incomplete PAO with high risk to develop other skeletal manifestations later in the course of the disease.

Adult↗
PubMed2004

Short-term evaluation of over-under myringoplasty technique.

Over-under tympanoplasty is a technique aimed at eliminating the disadvantages of the two classical techniques of overlay and underlay myringoplasty, which are employed in repairing the tympanic membrane. In this retrospective study, a total of 104 patients underwent myringoplasty, which was performed by means of the underlay technique in 46 patients and over-under technique in 58 patients. The mean follow-up period was 11 months. In the first group of patients, the underlay technique was performed; the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the second group, the over-under technique was performed; the grafted membrane was placed under the remaining drum and over the malleus. The rate of success in the first group of 46 patients was 91.5%, and that of atelectasis was 19.5%. The rate of success in the second group of 58 patients was 94.9% and 12%, respectively. Lateralization of the graft was not observed in either of the groups. In the patients operated on by means of the underlay technique, the air-bone gap decreased by 16.55 dB this rate was 16.96 dB in those operated on by the over-under technique. The authors consider over-under tympanoplasty to be superior to the other two classical methods not only because of its effectiveness, but also because of the results achieved by this technique.

Adolescent↗
PubMed2004

sine oculis in basal Metazoa.

We report the recovery of homologs of Six1/2/sine oculis (so), a homeodomain-containing member of the Six-gene family, from a diverse set of basal Metazoa, including representatives of the poriferan classes Demospongia, Calcarea and Hexactinellida, the cnidarian classes Hydrozoa, Scyphozoa and Anthozoa, as well as a ctenophore. so sequences were also recovered from a platyhelminth, an echiurid and two bivalve molluscs, members of the super-phyletic group Lophotrochozoa. In the case of the platyhelminth, multiple distinct so sequences were recovered, as well as a member of the related group Six4/5/D-Six4. Extended sequences of the so gene were recovered from the demosponge, Haliclona sp., and the scyphozoan Aurelia aurita via PCR, and 3' RACE. The affinities of all recovered sequences were assessed using a parsimony analysis based on both nucleic and amino acid sequence and using successive character weighting. Our results indicate that so is highly conserved across the animal kingdom. Preliminary expression data for Aurelia reveal that transcripts of the so homolog are present in the manubrium as well as in the rhopalia, which contain the statocyst and eyes, in the free-swimming ephyra and juvenile stages of these jellyfish.

Amino Acid Sequence↗
PubMed1998

A toxin homology domain in an astacin-like metalloproteinase of the jellyfish Podocoryne carnea with a dual role in digestion and development.

Metalloproteinases of the astacin family such as tolloid play major roles in animal morphogenesis. Cnidarians are thought to be evolutionary simple organisms and, therefore, a metalloproteinase from the marine hydrozoan Podocoryne carnea was analysed to evaluate the role of this conserved gene familiy at the base of animal evolution. Surprisingly, the proteinase domain of Podocornyne PMP1 is more similar to human meprin than to HMP1 from another hydrozoan, the freshwater polyp Hydra vulgaris. However, PMP1 and HMP1 both contain a small C-terminal domain with six cysteines that distinguishes them from other astacin-like molecules. Similar domains have been described only recently from sea anemone toxins specific for potassium channels. This toxin homology (Tox1) domain is clearly distinct from epidermal growth factor (EGF)-like domains or other cysteine-rich modules and terminates with the characteristic pattern CXXXCXXC with three out of six cysteines in the last eight residues of the protein. PMP1 is transiently expressed at various sites of morphogenetic activity during medusa bud development. In the adult medusa, however, expression is concentrated to the manubrium, the feeding organ, where the PMP1 gene is highly induced upon feeding. These disparate expression patterns suggest a dual role of PMP1 comparable to tolloid in development and, like astacin in the crayfish, also for food digestion. The Tox1 domain of PMP1 could serve as a toxin to keep the pray paralysed after ingestion, but as a sequence module such Tox1 domains with six cysteines are neither restricted to cnidarians nor to toxins.

Amino Acid Sequence↗
PubMed2005

Solitary eosinophilic granuloma of the sternum.

We report a rare case of eosinophilic granuloma of the sternum in a 25-year-old woman, who presented with anterior chest pain and a tender mass over the sternum. Total-body bone scintigraphy and computed tomography scanning of the thorax revealed an isolated lytic lesion of the manubrium. An open biopsy showed the typical histologic appearance of an eosinophilic granuloma. Surgical curettage of the solitary lesion was performed, and the sternal defect was filled with a bone replacement material. At the 2-year follow-up, no local recurrence was found, and the patient was in good health.

Adult↗
PubMed2005

Inflammatory sternal metastasis heralding lung cancer: two cases.

Bone pain due to bone metastases is a frequent presenting symptom of lung cancer. However, sternal metastases are unusual. We report two patients with inflammatory sternal metastases mimicking osteitis and indicating lung cancer. Chest computed tomography scan showed lytic lesion of the sternal manubrium invading anterior soft tissue. Diagnosis relied on histological examination of sternal biopsy and negative bacteriologic cultures. Local radiotherapy resulted in resolution of local signs.

Adenocarcinoma↗
PubMed1990

Platysma musculocutaneous flap for reconstruction of trachea in esophageal cancer.

In 2 patients with advanced cervical esophageal cancer invading the trachea, total laryngoesophagectomy with resection of the posterior portion of the trachea and lymph node dissection of the bilateral neck and superior mediastinum was carried out. The partial defect in the trachea was repaired with a platysma musculocutaneous flap. A permanent tracheostoma, composed of the tracheal remnant anteriorly and the platysma musculocutaneous flap posteriorly, was made just over the manubrium sterni.

Aged↗
PubMed1991

Early postoperative sternal approximation after ITA harvesting: computed tomographic evaluation.

Between November 1989 and February 1990, 66 randomized sternotomized patients underwent aortocoronary bypass and were subjected to a sternal scanner in the early postoperative period. Each examination included a manubrial and a sternal body print. At each level, we studied the occurrence of spacing or misalignment of the sternal layers. The 66 patients were subdivided into four groups according to the type of conduit harvested (single left internal thoracic artery or saphenous vein) and the type of material used for the sternal closure (steel wires or nylon yarns). In all cases, adequate early sternal approximation, which is represented by a good alignment as well as by an excellent contact of the sternal layers, was infrequently demonstrated. Moreover, the two abnormalities most often observed were manubrial spacing and sternal body misalignment. The sternal closure technique and internal thoracic artery harvesting had no significant effect on the sternal approximation. To minimize manubrial spacing and sternal body misalignment, we propose that the surgeon should apply three threads through the manubrium, withdraw the shoulder roll beforehand, elevate both of the patient's shoulders, and maintain the two xyphoid layers in the same plane and in fairly close contact during the tightening of the wires.

Aged↗
PubMed1994

Prevention and management of strictures after hypopharyngocolostomy or esophagocolostomy.

The records of 14 patients who underwent surgical revision for anastomotic strictures after hypopharyngocolostomy or esophagocolostomy were reviewed. The esophageal reconstruction was originally performed for esophageal strictures or resections after corrosive injury in 13 patients and for achalasia in 1. The esophageal substitutes used consisted of right ileocolon in 12 patients and left colon in 2. Routes of colon positioning were substernal in 13 patients and subcutaneous in 1. One-half of all strictures were located at the hypopharynx and the other half at the cervical esophagus. Causes of the strictures were anastomotic leakage in 5 patients, progressive caustic scarring in 4, graft ischemia in 3, combined caustic and tuberculous scar in 1, and technical error in 1. The interval from esophageal reconstruction to the revision was 1 month to 15 years with a median of 7 months. Surgical approaches included cervical incision only in 9 patients, cervical incision plus sternotomy in 3, and cervical incision plus partial resection of sternal manubrium in 2. Revisional procedures consisted of excision of scar with reanastomosis in 12 patients, skin graft in 1, and free jejunal graft in 1. After revision, all but 1 patient had excellent results. On the basis of these experiences we conclude that most strictures after pharyngocolostomy or esophagocolostomy can be surgically corrected after excision of the scar and mobilization of the esophageal substitute through a cervical incision only or a cervical incision plus sternotomy.

Adult↗
PubMed1995

Free latissimus dorsi flap for chest wall repair after complete resection of infected sternum.

BACKGROUND: Radical debridement, followed by muscle flap cover, has significantly reduced morbidity and mortality of infected sternotomy wounds. The pectoralis major, rectus abdominis, and greater omentum flaps are most commonly used, whereas the latissimus dorsi muscle is rarely employed. METHODS: In 7 patients with persistent infection and necrosis of the sternum, radical and extensive debridement including the sternum, costochondral arches, manubrium and sternoclavicular joints was performed. A free latissimus dorsi flap was used for soft tissue reconstruction without additional stabilization of the chest wall. RESULTS: All flaps survived without revision of the anastomosis. In the follow-up period (22 months to 5 years) no recurrent infection was observed. Three patients died during the study period (3 to 24 months after operation) due to causes not related to sternum operation. No additional weakness, pain, or restricted movements of the shoulders due to missing sternum was observed. CONCLUSIONS: Our findings suggest that the use of free latissimus dorsi flap after complete sternectomy for infection has several advantages: it provides abundant tissue to allow radical and extensive debridement, obliterates completely the dead space, and helps to control infection. Even without additional chest wall reconstruction it gives enough stability to allow pain-free normal daily activities.

Aged↗
PubMed1990

Abnormalities of the bony thorax causing tracheobronchial compression.

A number of intrathoracic and extrathoracic causes of airway obstruction have been well documented in the literature. At times, tracheal compression may be caused by abnormalities of the bony thorax whose previously unrecognized significance can result in unexpected difficulties when extubation is attempted following a routine intubation. Alternatively, patients may develop progressive distress secondary to their skeletal abnormalities. We report on cases illustrating anomalies of the manubrium, sternum and spine which have caused significant, occasionally life-threatening, tracheal and bronchial narrowing including pectus excavatum and scoliosis. A protocol is presented detailing the appropriate methods of diagnosis and treatment of these types of deformities.

Adolescent↗
PubMed1986

Prediction of subclavian vein location using plain chest radiography.

The relationship between the right subclavian vein and the thoracic inlet below the clavicle was studied by Venography in 72 patients. The area of the thoracic inlet below the clavicle was defined as a radiolucent area surrounded superiorly by the lower border of the clavicle, inferiorly by the inner margin of the first rib and medially by the lateral margin of the manubrium (CRM area). In 10 patients, the subclavian vein was situated below the axis of the clavicle, and the CRM area was large enough to extend near the top of the first rib arch. In 62 patients, the subclavian vein extended above the axis of the clavicle and the CRM area was small or invisible. The existence of a large thoracic inlet below the clavicle (large CRM area which extends near the top of the first rib arch) may be a useful indicator for predicting the low location of the subclavian vein, and may be used to predict or explain venipuncture failure using the standard infraclavicular approach.

Adult↗
PubMed1983

Middle-ear mechanics in the CF-bat Rhinolophus ferrumequinum.

The acoustic vibrations of the eardrum at the umbo and of the stapes have been measured in the greater horseshoe bat. The displacement amplitude response of the eardrum shows a second-order low-pass characteristic, typical of a lumped mass and stiffness system with a resonance frequency of about 55 kHz. The effective mass was calculated to be about 8 micrograms, and the specific stiffness 40 X 10(6) dyne/cm3, which is one hundred times greater than guinea pig. The measured level ratio appears to be greater (3X - 5X) than the geometric ratio (2X) probably due to flexing of the manubrium. The umbo-stapes phase lag exceeds 1 cycle at high frequencies, suggesting a system of at least four reactances. This is not consistent with the relatively slight change in lever ratio with frequency. One possibility for reconciling the two results is that the distributed mass and stiffness of the ossicles act as a transmission line for transverse vibrations. There is no evidence for a sharply peaked middle-ear response (although it is more sharply tuned than some species), nor for resonant absorption by the cochlea in the region of 83 kHz - the 'constant' frequency of this bat. The eardrum shows theoretically optimal matching to the air at 55 kHz and is reasonably efficient from 15 kHz to at least 110 kHz.

Acoustic Stimulation↗
PubMed1989

Middle ear and cochlear receptors in the subterranean mole-rat, Spalax ehrenbergi.

The eardrum and the auditory ossicles of the middle ear, and the population of cochlear receptors in subterranean mole-rats of Spalax ehrenbergi complex were qualitatively and quantitatively analyzed. The area of the eardrum was 10.2 (S.D. = 0.9) mm2, that of the stapedial footplate 0.6 (S.D. = 0.07) mm2, the malleus: incus lever ratio was 1.25:1. The malleus is simply built, not attached to the tympanic ring. The incus is large; its long process is almost parallel to the manubrium of the malleus. The short process of the incus is provided with a peculiar bony cap, a structure thus far undescribed in mammalian auditory ossicles. Firmness of mutual connection of the ossicles may vary among different forms of Spalax. The size and form of the stapes are characterized by a large variability as well. The length of the basilar membrane was 12.6 (S.D. = 0.7) mm. The mean density of inner hair cells amounted to 93.3 that of outer hair cells to 386.4 cells per mm of the basilar membrane length. In general, the density increased from the base towards the apex. On average there were 415 outer, 100 inner hair cells in the organ of Corti; the ratio being constant along the basal 65% of the length and decreasing in the apical part of the organ of Corti. The radial width of the triad of outer hair cells increased and remained constant along the apical half of the Corti organ. Based on available findings of comparative and functional morphology, most of the studied features may be considered correlates of low-frequency tuning of the hearing organ in mole-rats.

Animals↗