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At least 253 records · Page 14Linked to original sources
PubMed1999

Internal fixation of the sternum in median sternotomy dehiscence.

Sternal dehiscence may be defined as separation of the bony sternum and manubrium following median sternotomy. It may occur at any time postoperatively and has various etiologies. Restoration of sternal integrity in sternal dehiscence is a challenging problem, particularly when associated with deep-seated infection. This report reviews a single-stage technique that virtually eliminates the infected sternotomy wound and provides anatomic reduction and stabilization of the sternum. Complete debridement of infected and/or nonviable soft tissue, bone, and cartilage is followed by pulse irrigation. Parallel stainless steel mandibular reconstruction plates are then placed on each side of the remaining sternum and wired together. One or more transmanubrial compression plates may be added. Bilateral pectoralis major musculocutaneous flap advancement and primary skin closure is performed over two to three closed suction drains. From January of 1994 to July of 1996, this technique was used by the same surgeon in 26 male and 4 female patients aged 43 to 78 years (mean = 61). Indications for the operation were sternal dehiscence with infection (osteomyelitis and/or mediastinitis) in 14 patients and sternal dehiscence without infection in 16 patients. All patients survived to discharge with mean time on the ventilator, intensive care unit length of stay, and postoperative length of stay of 0.7, 2, and 8 days, respectively. Choice and duration of antibiotics were based on culture results and operative findings. Subsequent hardware removal was necessary in one patient for hardware loosening and three patients for late periplate infection. A closed wound was eventually achieved in all 30 patients, and sternal stability was restored in 29 patients. In the management of sternal dehiscence, the described technique of internal fixation can provide anatomic sternal reduction and stabilization, elimination of infection, and wound closure in a single-stage operation. Successful outcomes were achieved despite the presence of severe infection.

Adult↗
PubMed2002

Preoperative magnetic resonance imaging screening for a surgical decision regarding the approach for anterior spine fusion at the cervicothoracic junction.

STUDY DESIGN: In a study investigating the correlation between a set of designed criteria and judgments of surgical experience, 100 cervical magnetic resonance images from different patients were used. OBJECTIVES: To demonstrate reliable and reproducible anatomic measurements that can aid spine surgeons in selecting surgical approaches for anterior spine fusion in the cervicothoracic region. SUMMARY OF BACKGROUND DATA: Surgical approaches to the cervicothoracic junction vary among surgeons. Whereas sternotomy provides maximum exposure, less extensive approaches are preferred to minimize surgical trauma, provided surgical goals are not compromised. No quantitative criteria currently exist to determine before surgery the least invasive surgical approach for sufficiently exposing pertinent anatomy. METHODS: Thirteen geometric variables designed to be clinically practical and to expose important anatomic relations were used to evaluate 100 sagittal scout cervical magnetic resonance image sequences. An experienced spine surgeon independently rated each image for the most appropriate surgical approach to the C5-T2 region. The ratings were tested for interrater reliability using a second spine surgeon. After testing for interrater and intrarater reliability, the geometric measurements were correlated with the surgeon's selected surgical approaches for each intervertebral segment (P < 0.05). RESULTS: Instrument manubrial thoracic distances, reflecting standardized heights of intervertebral discs above or below the superior tip of the manubrium, were the most reliable, reproducible, and correlative with the choice of surgical approach. All the measurements but one, the instrument manubrial thoracic distance for T1/T2, demonstrated interrater and intrarater reliability, with an interclass correlation of at least 0.70. The primary surgeon-investigator indicated the anterior approach with sternotomy (n = 3) or the transverse cervical approach (n = 97) for the C7/T1 exposure, and the anterior approach with sternotomy (n = 43) or the transverse cervical approach (n = 57) for the T1/T2 exposure. The interrater questionnaire reliability results indicated statistical agreement between the primary surgeon-investigator and the second cervical spine surgeon at all vertebral segments evaluated. Instrument manubrial thoracic distances showed the strongest significant correlation with the surgical approach, demonstrating a statistical power of 1. For the C7/T1 exposure, the instrument manubrial thoracic distance for C7/T1 was 1.9 +/- 2 cm (95% confidence interval [CI] = 1.41 to 2.22) for the transverse cervical approach, and -3.3 +/- 1.3 cm (95% CI = -4.79 to -1.75)] for the anterior approach with sternotomy. The instrument manubrial thoracic distance measurements for C5/C6, C6/C7, and T1/T2 also showed nonoverlapping 95% confidence intervals for the transverse cervical versus the anterior approach with sternotomy for the C7/T1 exposure. For the T1/T2 exposure, all four instrument manubrial thoracic distance measurements again showed statistically significant differences between approaches, with nonoverlapping 95% confidence intervals and a statistical power of 1. In addition, the measurements elaborating the anterior-to-posterior distance of the thoracic outlet and the measurements of the angle between the planes of the intervertebral disc and the sternum also showed statistically significant differences between approaches for the T1/T2 segment, with a statistical power of at least 0.9. CONCLUSIONS: Strong correlations exist between objective measurements and the choice of surgical approach for anterior spine fusion. Among investigated anatomic relations, the instrument manubrial thoracic distance correlated most reliably with the surgeons' choice of the anterior approach. Such objective measurements represent tools that cervical spine surgeons can use to determine the surgical approach.

Cervical Vertebrae↗
PubMed2003

Lateralization of the tympanic membrane as a complication of canal wall down tympanoplasty: a report of four cases.

OBJECTIVE: To describe the pathophysiology and treatment of the lateralized tympanic membrane that occurs after canal wall down tympanoplasty. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral hospital. PATIENTS: Four patients in whom lateralization of the tympanic membrane developed as a complication of canal wall down tympanoplasty. RESULTS: The patients had undergone middle ear surgery 20 to 34 years before their first visit to the authors. A Bondy operation with soft-wall reconstruction of the ear canal had been performed in three patients and a modified radical mastoidectomy in one patient. They all had severe conductive hearing loss. Common findings were anterior canal sulcus blunting, good tubal function, normal middle ear mucosa, and mobile stapes. At revision surgery, the lateralized tympanic membrane was removed, and the temporalis fascia was grafted medial to the malleus manubrium. The exposed bony surface in the ear canal was covered with a split-thickness skin graft, and the ear canal and the mastoid cavity were tightly packed to secure the graft. All the patients regained good hearing after the revision. Although deterioration of the anterior tympanic ring was presumed to be the primary cause of the graft lateralization, the lack of a posterior bony ear canal might have facilitated this condition. CONCLUSION: Lateralization of the tympanic membrane can occur even in an ear with a radicalized mastoid cavity, especially when the anterior tympanic ring is torn and the posterior ear canal is reconstructed with soft tissue.

Bone Conduction↗
PubMed2004

Investigation into the possible cause of subjective decreased sensory perception in the nipple-areola complex of women with macromastia.

Patients with macromastia often comment on a lack of sensation in their nipple-areola complex. A study was designed to investigate the cause of this decreased sensation. Two hypotheses were proposed. First, the decreased sensation could result from neuropraxia of the sensory nerve fibers secondary to traction caused by the heavy breast parenchyma. The second hypothesis proposed that tissue expansion of the nipple and areola by the voluminous breast parenchyma caused a decrease in nerve fibers per surface area and hence decreased sensory perception. Sixty-one patients were assessed in the study. All patients underwent surgery in which histological biopsy of either the areola alone (31 reduction mammaplasty patients) or the nipple and areola (30 mastectomy patients) was possible. Before surgery, each nipple-areola complex was tested with Weinstein Enhanced Sensory Test monofilaments as a quantitative test of tactile sensation. Breast cup size, ptosis, and weight of tissue excised were recorded to allow general assessment of the breast size. The nipple and areola biopsy specimens were assessed using immunohistochemistry (S-100 polyclonal antibody, Dako Z311) to measure nerve fiber count per unit area. Statistical analysis was undertaken to find any association among sensitivity, breast cup size, ptosis, weight of tissue resected, and nerve fiber density in the nipple and areola biopsy specimens. Sensitivity at the areola decreased with increasing breast cup size (r = 0.47, p < 0.001) and ptosis (r = 0.42, p = 0.002 for increasing distance between inframammary crease and nipple; r = 0.49, p < 0.001 for increasing manubrium to nipple distance). There was a weak correlation between nerve fiber density at the areola and breast cup size (r = -0.22, p = 0.1). Sensitivity at the nipple was higher than at the areola. Nerve fiber density count at the nipple was higher than at the areola, but there was no statistically significant correlation between nipple sensitivity and breast cup size, ptosis, or weight of tissue resected. The results suggest that the areola and nipple are different in their neuroanatomy. The areola is a thin, pliable structure that is predisposed to stretch as the breast enlarges and therefore experience a decrease in nerve fiber density. The nipple is a compact structure that is less likely to stretch with breast enlargement. In the nipple, neither sensory perception nor nerve fiber density varied with size or breast ptosis. The perceived lack of sensation in the nipple-areola complex is multifactorial. This study shows that neither traction injury to the sensory nerves nor decreased nerve density alone can explain the subjective numbness reported by patients with macromastia. Psychological factors, such as dissatisfaction with body form or interpretation of lack of sensation in the areola as also affecting the nipple, may influence the patient's assessment of the nipple-areola sensitivity.

Adolescent↗
PubMed2006

Age-related normal variants of sternal uptake on bone scintigraphy.

PURPOSE: The purpose of this study was to describe the variable age-related normal appearance of the sternal area on bone scintigraphy. METHODS: We studied 334 patients (158 males and 176 females) aged 15 days to 85 years, mean age 32.5 +/- 19.9 years, who did not have symptoms associated with the sternum and chest wall or a history of malignancy. All patients underwent whole-body bone scan 3 hours after intravenous injection of Tc-99m MDP. RESULTS: In patients younger than 10 years, sternal uptake was equal to nearby ribs with homogeneous uptake and poorly defined outlines. In older patients, the sternum showed markedly greater uptake than nearby ribs and the borders became well defined. Different patterns of sternal uptake were noted: 1) increased uptake in the manubrium; 2) hot spots in the angle of Louis, body and xiphoid; 3) a photopenic area just above the xiphoid process; 4) heterogeneous sternal body uptake; and 5) hyperactivity along the sternal body borders. Of these variants, the angle of Louis hot spot was the most common finding (63.5%). A linear pattern of hot spots in the sternal body was seen most frequently between 10 and 30 years old and corresponded to 3 transverse ridges of bone, representing the sites of union. Increased tracer uptake only at the medial end of the clavicle in the SC joints was seen in 42.13% of patients younger than 30 years. CONCLUSION: This study showed age-related normal variants of sternal uptake on bone scanning in asymptomatic patients. Understanding these variants may be helpful in differentiating normal and abnormal patterns of uptake in the sternum on radionuclide bone imaging.

Adolescent↗
PubMed2003

Asymptomatic enlargement of the medial clavicle: report of five cases.

Five middle-aged women presented with unexplained chronic swelling at the medial clavicle. None of the patients recalled a history of trauma and none experienced pain or other symptoms associated with the swelling. In all cases, suspicion of tumor prompted referral to an orthopedic oncologist; two cases were biopsied before referral. Radiological studies demonstrated degenerative changes confined to the medial clavicle in three cases, exophytic overgrowth of the medial clavicle and adjacent manubrium in one case, and bilateral degenerative changes on both sides of the joint in one case. Prolonged follow-up supported the diagnosis of a benign, likely degenerative condition. These cases demonstrate the tendency for a variety of degenerative changes to manifest clinically as swelling at the medial clavicle. Inherent properties of the clavicle may predispose the medial clavicle to such changes. Recognition of this entity may prevent unnecessary testing or surgical biopsy of patients with this condition in the future. A thorough differential diagnosis of swelling at the medial clavicle is also presented.

Adult↗
PubMed2003

Treatment of posterior epiphyseal disruption of the medial clavicle with a modified Balser plate.

BACKGROUND: Acute posterior dislocation of the sternoclavicular joint is a rare but dangerous injury that is often difficult to diagnose. Because of late closure of the medial clavicular epiphysis, epiphyseal disruption must be taken into consideration in patients up to 25 years of age with an apparent diagnosis of posterior sternoclavicular dislocation. We developed a novel method of treating epiphyseal disruptions with a modified Balser plate. METHODS: This method was used in a 19-year-old patient with a posterior epiphyseal disruption of the left medial clavicle. After molding of the plate, the hook was introduced into the manubrium sterni and the plate was fixed on the clavicle with screws. RESULTS: The new method could be applied safely and achieved a good functional result without any external immobilization. The postoperative course was uneventful. CONCLUSION: Fixation of the posterior epiphyseal disruption of the medial clavicle with a modified Balser plate is feasible and may be an alternative to traditional methods.

Adult↗
PubMed1995

Karyotypic evolution in a granulocytic sarcoma developing in a myeloproliferative disorder with a novel (3;4) translocation.

A 59-year-old man presented with a granulocytic sarcoma arising in the manubrium, and splenomegaly. The blood count showed 1.2 x 10(9)/l eosinophils and a marrow aspirate was hypercellular with eosinophilia. Cytogenetic analysis of the marrow revealed a novel t(3;4) (p13;q12) and analysis of cells aspirated from the granulocytic sarcoma showed the same abnormality and an additional trisomy 8. Intensive chemotherapy and local radiotherapy led to resolution of the chest mass but persistence of the chromosome translocation in the marrow.

Chromosomes, Human, Pair 3↗
PubMed1993

Coincidental occurrence of primary hyperparathyroidism and cancer-associated hypercalcaemia in a middle-aged man.

Primary hyperparathyroidism (PHPT) is found not uncommonly in patients with cancer. In this report, however, we describe a patient where both humoral hypercalcaemia of malignancy and PHPT were present coincidentally. A 47-year-old man was found to have PHPT due to parathyroid hyperplasia. Serum parathyroid hormone (PTH) levels, which were elevated before parathyroidectomy, were undetectable post-operatively; however, hypercalcaemia persisted. Nephrogenous cyclic adenosine monophosphate was elevated along with this undetectable PTH, indicative of the presence of a PTH-like factor in the serum. This was confirmed by the finding of an elevated level of PTH-related protein (PTHrP) in plasma (9.1 pmol/l, normal < 2.6 pmol/l). Secondary carcinoma was identified in a lesion in the region of the manubrium sternii. This stained positively for PTHrP by immunocytochemistry and PTHrP messenger RNA was detected by in-situ hybridization. This case illustrates the value of sensitive PTH assays in distinguishing PHPT from other causes of hypercalcaemia and also shows the importance of considering primary hyperparathyroidism in the differential diagnosis of the patient with cancer and hypercalcaemia.

Bone Neoplasms↗
PubMed1991

Long-term use of central venous catheters in paediatric oncology treatment.

During a 26-month period, 158 central venous catheters were inserted in 114 children (median age: 4.5 years) with malignant diseases. Polyurethane catheters were used, inserted either using a cut-down procedure or percutaneously in the external or internal jugular vein. All catheters were tunnelled from the point of insertion to the midpoint of the manubrium or upper sternum. The catheter tip reached the superior caval vein or the right atrium in 94% of the cases. The catheters were used for all infusions, including total parenteral nutrition, and for blood sampling. The median catheter duration was 104 days (range 5-835 days). Sixty-eight (43%) of the catheters were removed as they were no longer needed, and 31 (20%) were removed due to local infection or septicaemia. During a total of 23,486 catheter days (64.4 years), 110 episodes of septicaemia occurred. This represents one episode per 214 catheter days. In 43 of the 110 episodes of septicaemia, blood cultures showed growth of bacteria of the kind usually found in the gastrointestinal and respiratory tracts. All septicaemias were treated with intravenous broad-spectrum antibiotics and in 21 cases the catheters were removed due to septicaemia. Thirty-four (22%) catheters were removed accidentally. There were two cases of subclavian vein thrombosis.

Adolescent↗
PubMed1977

Surgical repair of a large incomplete cleft sternum.

Congenital deformities of the chest are not uncommon, are frequently symptomatic, and are readily correctable. This applies particularly to malfusion of the manubrium and upper sternum, which results in a bony deficiency together with divarication of the sternomastoid muscles and the sternoclavicular joints. Such defects of the sternum are best corrected as soon after birth as possible. Two patients are reported who had such a defect, and the technique for a satisfactory repair is described.

Humans↗
PubMed1988

A technique for concurrent repair of pectus excavatum and intracardiac defects.

Pectus excavatum deformity may present problems when median sternotomy is required for repair of intracardiac defects. We have used a partial median sternotomy extending from the manubrium to the level of the second intercostal space with extension into that space. The perichondral sheaths are disconnected from the sternum on the right side after removing the deformed costal cartilages. Exposure is thus provided for the cardiac procedure. Following this, the upper sternal fragments are sutured together and the repair is completed in a manner similar to the Ravitch technique.

Funnel Chest↗
PubMedDate not supplied

Microfilum lutjani N. G. N. Sp. (Protozoa Microsporida), a gill parasite of the golden African snapper Lutjanus fulgens (Valenciennes, 1830) (Teleost Lutjanidae): developmental cycle and ultrastructure.

Microfilum lutjani n. g., n. sp. (Microsporida) was found on the gill filaments of Lutjanus fulgens (Teleost) inhabiting the coasts of Senegal. This microsporidium forms xenomas distinguished by the microvilli covering the plasma membrane. At all stages of development individuals have isolated nuclei and are in direct contact with the host cytoplasm. Merogony is binary and sporogony is tetrasporoblastic. The spore (4.75 x 2.60 microns) is characterized by a manubrium inserted on a laterally offset anchoring disc and extending into a very short, noncoiled polar filament (no longer than 500 nm) in the form of a hook. This type of polar filament has not been described previously in the Microsporida.

Animals↗
PubMed2005

How we do it: the anterior thoraco-cervical approach to tumours of the thoracic inlet.

KEYPOINTS: Tumours that arise in the thoracic inlet and superior mediastinum may be benign or malignant and present the surgeon with a difficult problem of access. The standard approach to the thoracic inlet from below offers limited exposure to the vascular and neural structures superior to the tumours. The anterior thoraco-cervical approach to the root of the neck and superior mediastinum combines the anterior cervical approach with a limited upper median sternotomy. If further access is required to achieve surgical clearance a full sternotomy split can be performed. The approach offers excellent exposure and helps to facilitate complete resection of benign and malignant tumours, which would otherwise be deemed inoperable or difficult to resect completely through other standard approaches. In contrast to previously described anterior transcervical thoracic approaches which required resection of part of the clavicle or manubrium as well as thoracotomy with increased morbidity, the anterior thoraco-cervical approach is associated with little morbidity and the postoperative stay is short.

Chylothorax↗
PubMed2004

Response of the cat eardrum to static pressures: mobile versus immobile malleus.

A phase-shift shadow moiré interferometer was used to measure the shape of the cat eardrum with a normal mobile malleus and with an immobile malleus as it was cyclically loaded with static middle-ear pressures up to +/-2.2 kPa. The shape was monitored throughout the loading and unloading phases, and three complete cycles were observed. The mobile-manubrium measurements were made in five ears. In three ears, the malleus was then immobilized with a drop of glue placed on the head of the malleus. Eardrum displacements were calculated by subtracting shape images pixel by pixel. The measurements are presented in the form of gray-level full-field shape and displacement images, of displacement profiles, and of pressure-displacement curves for selected points. Displacement patterns with a mobile malleus show that pars-tensa displacements are larger than manubrial displacements, with the maximum pars-tensa displacement occurring in the posterior region in all cats except one. Displacements vary from cycle to cycle and display hysteresis. For both the mobile-malleus and immobile-malleus cases, the eardrum response is nonlinear. The response is asymmetric, with lateral displacements being larger than medial displacements. With a mobile malleus, manubrial displacements exhibit more pronounced asymmetry than do pars-tensa displacements.

Algorithms↗
PubMed1977

Training and electrocardiographic abnormalities in the elderly.

Electrocardiograms (CM5 lead, where one lead is attached in the V5 position and one at the manubrium sterni, with the neutral lead on the back of the neck) have been recorded from 14 men and 25 women aged 60 to 75 years, at rest, during progressive bicycle ergometer exercise to 75 to 85 per cent maximum oxygen intake, and during the subsequent recovery phase. Earlier studies showing a high frequency of ischaemic electrocardiographic abnormalities in women are confirmed; it is suggested that this may reflect a high work load per unit mass of myocardium. Training induces an elevation of the ST segment at rest and during recovery, with a reduction in ST depression during work at a given heart rate, the exercise changes being related to the intensity and frequency of training selected by the subject. Possible explanations of the response to regular exercise include not only the development of the collateral circulation, but also a lessening of the hyperkalaemia of effort and a reduction in the work load per unit mass of myocardium secondary to hypertrophy or a change in the average dimensions of the heart.

Aged↗
PubMed1979

Multiple regions of absent bone mineral and marrow function in a patient with chronic renal failure.

99mTc-methylene diphosphonate bone mineral and 99mTc-sulfur colloid bone marrow studies were performed on a patient with chronic renal failure. Multiple regions of absent deposition of both radiotracers were noted, involving the right ilium, multiple ribs, and the manubrium. Radiographs of these bones were normal. The findings suggest absent regional perfusion of the involved bones.

Adult↗
PubMed1986

Sternocostoclavicular hyperostosis: a review and report of 11 cases.

Sternocostoclavicular hyperostosis is a benign ossifying diathesis of unknown etiology characterized by hyperostosis and soft-tissue ossification between the clavicles, anterior portion of the upper ribs, and manubrium, with variable hyperostosis or ankylosis in the spine and sacroiliac joints. Our cumulative experience with 11 cases is reported, with emphasis on radiographic features of the condition. Scintigraphic results in five patients and computed tomographic findings in one patient are presented. A review of the literature and our own material indicates that sternocostoclavicular hyperostosis may be more common than has been previously recognized.

Adult↗