Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Manubrium”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed1995

The anterior cervical approach to the cervicothoracic junction.

To reach the upper thoracic vertebrae, a number of extensive approaches have been proposed combining thoracotomy, sternotomy, or clavicle resection with anterior dissection into the superior mediastinum. We present a simple anterior cervical approach for patients with disease limited to one vertebral level, in which midline ventral decompression is the goal of surgery. Regardless of the anterior approach used, the caudal extent of exposure is limited to T3 by the great vessels of the mediastinum, whereas the angle of the approach to the cervicothoracic junction is dictated by the manubrium. In the anterior cervical approach, lateral exposure to the uncovertebral joints is easily achieved. Five patients are reviewed in whom this anterior cervical approach was used at the first or second thoracic level. Decompression and instrumentation resulting in neurological improvement and axial stability were achieved in all five patients. The surgical anatomy of the cervicothoracic junction is reviewed with attention to the recurrent laryngeal nerves and the thoracic duct as they relate to the side of approach chosen.

Adult↗
PubMed2006

Unique features of herniated discs at the cervicothoracic junction: clinical presentation, imaging, operative management, and outcome after anterior decompressive operation in 10 patients.

OBJECTIVE: Disc herniations at the C7-T1 level are unusual (4% of all herniated cervical discs) and are often incorrectly diagnosed because of unusual neurological findings and suboptimal imaging studies. Furthermore, the anterior approach may be problematic because the manubrium and slope of the vertebral bodies away from the surgeon obscures the end plates. The recurrent laryngeal nerve and the thoracic duct may be injured by respective right- or left-sided approaches. A posterior approach to this level has, therefore, been advocated, but results of C7-T1 herniations treated anteriorly have not been specifically addressed in the literature. We, therefore, reviewed our experience in the operative management of patients undergoing single level anterior cervical discectomy and fusion at the C7-T1 interspace for the 10 years ending June 2004 with regard to clinical presentation, imaging, problems of operative exposure, and neurological outcome. METHODS: Of 268 patients with single level anterior cervical discectomy and fusions (ACDFs), 10 (3.7%) had C7-T1 disc herniations. We retrospectively reviewed the medical records, operative reports, and imaging studies of these 10 patients. RESULTS: All patients presented with C8 motor deficit without myelopathy. The operation was carried out through an anterior approach with a skin incision 3 cm above the clavicle. Visualization of the C7-T1 disc space was achieved in all without difficulty. Eight of 10 patients are neurologically intact. CONCLUSION: The C7-T1 disc herniates laterally because of the absence of Luschka joints at this level. Central herniation with myelopathy is rare. An anterior approach was easily accomplished in all patients. Recovery of motor function was related to duration and severity of preoperative deficit.

Adult↗
PubMed1992

Nine-lead Holter monitoring using a lead-switching technique for the detection of ischemic ST changes.

We devised a technique to record a greater number of leads (a 9-lead monitor) by connecting a lead-switching adaptor to a commercially available 3-channel Holter recorder (9-lead DCG). Anodes were attached from positions V1 to V6 (CM1 to CM6), and to high lateral (HL), low lateral (LL) and low back (LB). A cathode was attached to the manubrium of the sternum. The CM5 lead was continuously recorded on channel 1. The device is able to switch continuously every 20 sec among leads CM6, LB, HL and LL on channel 2, and among leads CM1, CM4, CM2, and CM3 on channel 3. Electrocardiograms were simultaneously recorded with both the 9-lead DCG and the conventional 12-lead ECG systems during treadmill testing in 67 patients with coronary artery disease. In addition, 6 patients with acute myocardial infarction were studied with the 9-DCG to test ST elevation. The sensitivity and specificity of leads CM2 to CM6, HL, LL, and LB in detecting ST depressions that occurred in each corresponding lead of the 12-lead ECG lead were very high (p < 0.0001). The LB lead in particular was noteworthy for its markedly high specificity (94%) and sensitivity (83%) in detecting ST depressions occurring in leads II and aVF. Our lead-switching technique is useful when an increase in the number of leads is required in the DCG method. The LB lead, an anode on the low back, may be specific to detect inferior myocardial ischemia.

Adult↗
PubMed2005

Mediastinal tracheostomy: unilateral resection of the anterior chest wall.

Since the first reliable mediastinal tracheostomy described by Grillo et al. in 1966, many new techniques have been described in order to reduce the number of complications. We here report the case of a 55-year-old man who was referred for surgery with post-radiochemotherapy recurrence of a double neoplasm of the pharyngolarynx extending to the proximal trachea and the medial part of the oesophagus. Through a median sternotomy, a pharyngolaryngoesophagectomy was performed with an extended tracheal resection. The reconstruction of the upper digestive tract was performed with a gastric pull-up. The mediastinal tracheostomy was performed with a pectoralis major muscular flap through a right unilateral resection of the manubrium, the right clavicular head and the right first and second costal cartilages. Historically, the mediastinal tracheostomy was performed through a large bilateral resection of the anterior chest wall, in order to prevent the tension on the tracheocutaneous sutures. Nowadays, with the possibility of various pedicled flaps, bilateral resection no longer seems to be necessary. This unilateral resection leads to a reduction in post-operative sequelae.

Esophagus↗
PubMed2005

Blood sampling from the cranial vena cava in the Norway rat (Rattus norvegicus).

This paper describes blood sampling from the cranial vena cava (CVC) in the Norway rat. In order to limit stress, the blood sampling should be done under short-term inhalation anaesthesia, for example, an oxygen/isoflurane mixture. The injection site is just cranial to the first rib, 0.3-0.8 cm lateral to the manubrium when the animal is in dorsal recumbency. The needle, attached to a syringe, is inserted at 30 degrees in the direction of the opposite femoral head. After penetration of the skin, negative pressure is developed in the syringe and the insertion of the needle is continued for another 0.2-1 cm in the given direction until blood begins to flow. The amount of blood sampled ranges from 0.8 to 2.5 mL depending on the body weight of the patient. A trial on 50 rats aged 5-24 months included 25 rats sampled once, eight rats sampled twice with an interval of seven days, 11 rats sampled twice with an interval of three weeks and four rats sampled four times with intervals of four weeks--a total of 87 blood samplings. The serious complications quoted in association with blood sampling from the CVC in other experimental animals (vascular lacerations, heart puncture, serious haemorrhage, tracheal and throat trauma) were not observed in our study. There were only four blood samplings (4.5%) with mild haemorrhage from the injection site, due to erroneous sampling from the jugular vein.

Anesthesia, Inhalation↗
PubMed2005

Irradiation with standard tangential breast fields in patients treated with conservative surgery and sentinel node biopsy: using a three-dimensional tool to evaluate the first level coverage of the axillary nodes.

Recent data show that axillary coverage can be obtained, but only through a selective CT-based treatment planning, as standard tangential fields are inadequate to deliver therapeutic doses. Currently, the replacement of axillary dissection with new techniques, such as sentinel node (SN) biopsy, makes it necessary to re-address the question about the real role of axillary irradiation, complicated by the differences in the anatomy of dissected and undissected axillary regions. The purpose of this paper is the dosimetric analysis of first axillary level coverage in standard irradiation of 15 breast-cancer patients treated with quadrantectomy and SN biopsy (negative finding). During surgery a clip on the site of the SN was positioned, marking the caudal margin of first axillary level. After the breast treatment plan was completed, the first axillary level was contoured on CT scans, from the site of the surgical clip up to the sternal manubrium, for coverage analysis with dose-volume histograms (DVHs) and three-dimensional isodose visualization. The maximum dose mean ranged from 5% to 80% of the prescribed dose (mean value 48.7%). The mean total dose received by the volume of interest was lower than 40 Gy in all but one patient. No patient had total irradiation of first nodal level; only one patient had 35% of the volume enclosed in the 100% isodose. Our analysis lead to the conclusion that therapeutic doses are not really delivered to first level axillary level nodes by a standard tangential field technique, and that specific treatment planning and beam arrangement are required when adequate coverage is necessary.

Axilla↗
PubMed2004

Aneurysmal bone cyst of the sternum: a case report of successful treatment with radiotherapy.

An unusual case of a lytic, expanding lesion of the manubrium with histological diagnosis of aneurysmal bone cyst in a 13-year-old girl is presented. After a recurrence following primary surgery, the patient was treated successfully by external beam radiotherapy. A total dose of 25.2 Gy was delivered using conventional fractionation (1.8 Gy day(-1)) to the whole sternum. She remains recurrence- and symptom-free 46 months after the end of the treatment. This is the sixth patient with primary aneurysmal bone cyst in the sternal region, the first paediatric patient for this location, and the first case of its kind treated exclusively by radiotherapy ever reported in the literature. The histopathological, radiological and clinical findings of the patient are presented, relevant literature is reviewed, and radiotherapeutic management of such lesions is discussed.

Adolescent↗
PubMed1985

Recognition of malleus handle fracture in the differential diagnosis of otologic trauma.

We have had the opportunity to care for four patients who experienced barotrauma or implosive trauma to their ears. The differential diagnosis in these cases included ossicular injuries as well as possible perilymph fistulae. In each of these cases there was a small conductive hearing loss which fluctuated and a high compliance tympanogram. Careful otoscopy with the aid of pneumomassage revealed an isolated malleus handle (manubrium) fracture. Exploration of one ear was performed to rule out perilymph fistula and the diagnosis of malleus handle fracture was confirmed. Recognition of this injury preoperatively in these three other patients made exploration unnecessary. While injuries to the ossicular chain have been well-described in the literature, isolated malleus handle fracture has not been previously reported.

Acoustic Impedance Tests↗
PubMed1990

A surgical approach to the cervicothoracic spine.

We describe a method for approaching the lower cervical and upper thoracic spine, the brachial plexus and related vessels. The method involves the elevation of the medial corner of the manubrium, the sternoclavicular joint, and the medial half of the clavicle on a pedicle of the sternomastoid muscle. We have used this exposure in 17 cases with few complications and good results. Its successful performance requires high standards of anaesthesia, surgical technique and postoperative care.

Adult↗
PubMed1997

Can (99m)technetium methylene diphosphonate bone scans objectively document costochondritis?

STUDY OBJECTIVES: To determine whether bone imaging with 99mTc methylene diphosphonate is a specific method of making the diagnosis of costochondritis in patients with chest pain who rule out for myocardial infarction. DESIGN: Nonblinded prospective controlled study in 20 patients and 10 control subjects. SETTING: Inpatient medical service of a tertiary teaching hospital. PATIENTS: Two hundred consenting patients admitted to the hospital with chest pain and suspected myocardial infarction were examined. Those in whom acute myocardial infarction was ruled out were evaluated for the clinical signs of costochondritis, ie, tenderness over one or more costochondral junctions. Twenty patients who met the clinical criterion gave informed consent and were subjected to bone imaging. Ten control subjects with cancer who did not have clinical signs of costochondritis underwent bone imaging to rule out metastatic disease (normal in all cases). INTERVENTIONS: Bone imaging with I.V. 99mTc methylene diphosphonate. MEASUREMENTS: Bone scans of the investigative patients and the control subjects were read by two independent nuclear medicine specialists. RESULTS: Sixteen of the 20 patients with clinically diagnosed costochondritis showed increased technetium uptake at all costochondral junctions bilaterally; six of them also had increased uptake elsewhere on the chest wall (sternum, manubrium, or first rib). All 10 of the control patients likewise showed increased technetium uptake at all costochondral junctions bilaterally. CONCLUSIONS: Bone imaging with 99mTc methylene diphosphonate is not a specific method of making the diagnosis of costochondritis.

Bone Neoplasms↗
PubMed1999

Effect of lung volume reduction surgery on bony thorax configuration in severe COPD.

STUDY OBJECTIVES: Hyperinflation in patients with severe COPD is associated with an increased anteroposterior (AP) rib cage diameter. We sought to determine whether bilateral lung volume reduction surgery (LVRS) affects bony thorax configuration. DESIGN: Prospective of clinical data collection before and after LVRS. SETTING: Tertiary-care university medical center. PATIENTS: We measured multiple AP and transverse thoracic diameters, by using plain chest roentgenograms (CXRs) in 25 patients (11 men, 14 women), and thoracic CT scans in 14 patients (7 men, 7 women), preoperatively and 3 months postoperatively. A subgroup of 7 patients (reference data) also had CXR thoracic diameter measurements made, using films obtained previously within a year of their presurgical evaluation. Another subgroup of 10 patients had CT scan measurements also made 12 months postoperatively. MEASUREMENTS AND RESULTS: CXR dimensions were taken at the level of the manubrium sterni (M) and thoracic T7 and T11 levels. CT dimensions were taken at T4, T6, T8, and T10 levels. At each level, left (L), midsagittal (C), and right (R) AP and maximal transverse diameters were measured. The sum of the three AP diameters (Total) was used for calculations. Patients also underwent tests such as spirometry, lung volumes, diffusing capacity of the lung for carbon monoxide, 6-min walk distance (6MWD), and transdiaphragmatic pressures during maximum static inspiratory efforts (Pdimax sniff) measured before and 3 months after LVRS. Patients were (mean +/- SD) 58+/-8 years old, with severe COPD and hyperinflation (FEV1, 0.68+/-0.23 L; FVC, 2.56+/-7.3 L; and total lung capacity [TLC], 143+/-22% predicted). After LVRS, AP diameters were reduced at thoracic level T7 (from 24.2+/-2.0 cm to 23.3+/-2.2 cm, p = 0.0002), and transverse diameters were reduced at T7 (from 26.8+/-1.9 cm to 26.4+/-1.7 cm, p = 0.001) and T11 (from 29.9+/-2.2 cm to 29.5+/-2.2 cm, p = 0.03), as measured using the CXR. In contrast, thoracic diameters were similar in subjects with CXRs before LVRS and within 1 year before evaluation. CT-measured AP diameters were significantly reduced 3 months after LVRS at T6, (from 48.8+/-6.0 cm to 46.7+/-5.4 cm, p = 0.02), T8 (from 54.2+/-7.0 cm to 52.3+/-6.5 cm, p = 0.004), and T10 (from 53.8+/-7.5 cm to 51.2+/-8.0 cm, p = 0.001), but not at T4. These AP diameter reductions directly correlated with the postoperative reductions in TLC and residual volume, and also with the increases in Pdimax sniff and 6MWD after LVRS. The reduction in AP diameters at thoracic levels T8 and T10 seen 3 months after LVRS remained stable at 12-month follow-up, whereas those measured at T6 lost statistical significance. CT-measured transverse diameters were unchanged at all levels after LVRS. CONCLUSIONS: We conclude that LVRS decreases mid-to-lower AP rib cage diameter as assessed by CXR and thoracic CT. Although transverse diameters were reduced on CXR, the magnitude was small and was not confirmed with CT. After LVRS, AP diameter reductions are most likely the result of reduction in lung volume, and they are associated with improvements in diaphragm strength and exercise endurance.

Female↗
PubMed1989

Differences in acoustic and dynamic characteristics of spontaneous cough in pulmonary diseases.

The aim of this study was to determine whether the flow dynamics and sound spectra of spontaneous cough show characteristic differences in asthma, acute and chronic bronchitis, TBCS and FPD. During the cough, the air flow from the mouth and the sound from the sternal manubrium were simultaneously recorded. The cough sounds were analyzed spectrographically. Peak expiratory flow during cough was significantly lower in asthma than in TBCS, acute bronchitis or FPD. Duration of the first cough sound was longer in asthma than in FPD, TBCS or chronic bronchitis. The number of additional cough sounds was smaller in asthma than in the other conditions. The highest frequency components of cough sound were lower in asthma than in chronic bronchitis or TBCS. The results indicate that pulmonary diseases differ with respect to acoustic and dynamic characteristics of spontaneous cough. This finding may prove useful in the diagnosis of cough.

Acoustics↗
PubMed1991

[Clinical morphology of the sternum].

The length, width and thickness of the sternum were measured in 74 adult specimens with the aim of optimizing the dimensions of staples used after sternotomy. This article describes the experimental procedure and presents the results. Sex differences were confined mainly to the length, with males measuring 16.5 cm, and females 15 cm. Width and thickness maxima (7.4 cm and 1.7 cm, respectively) are measured at the proximal and distal ends of the manubrium, while the width and thickness of the corpus (2.7-3.5 cm and 1.0-1.4 cm, respectively) show relatively minor differences.

Aged↗
PubMed2001

Mini-sternotomy for the treatment of aortic valve lesions.

OBJECTIVE: To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment. METHODS: We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity. Their ages ranged from 32 to 76 years, and 18 were males and 12 were females. We used negative pressure in a venous 1/4-inch cannula, and the patients were maintained in Trendelemburg's position. Twenty-seven patients received bioprostheses with diameters ranging from 23 to 29mm. Three patients underwent only removal of the calcifications of the aortic valve leaflets and aortic commissurotomy. RESULTS: The mean duration of anoxic cardiac arrest was 63.11min. Access was considered good in all patients. One death was due to pulmonary and renal problems not related to the incision. All patients had a better recovery in the intensive care unit, got out of bed sooner, coughed more easily, and performed prophylactic physiotherapeutic maneuvers for respiratory problems more easily and with less pain in the incision. Early ambulation was more easily carried out by all patients. CONCLUSION: Mini-sternotomy proved to be better than the conventional sternotomy because it provided more comfort for the patients in the early postoperative period, with less pain and greater desire for early ambulation and all its inherent advantages.

Adult↗
PubMedDate not supplied

Dual-chamber pacemaker implantation via the cephalic vein in healthy equids.

The purpose of the present study was to develop a feasible and safe technique for dual-chamber pacemaker implantation in healthy horses. Implantation was performed in a standing, tranquilized horse and in ponies. Atrial and ventricular leads were transvenously inserted through the cephalic vein, and a subcutaneous pacemaker pocket was created between the lateral pectoral groove and the manubrium sterni in 6 equids. Positioning of each lead was guided by echocardiography and by measuring the electrical characteristics of the lead. The implantation procedure lasted about 4 hours in each animal and was well tolerated. In all animals, dual-chamber pacemaker function was obtained, and these results remained good throughout the follow-up period. At the time of implantation, atrial and ventricular sensing were between 2.1 and 7.2 mV and 7.8 and 16.8 mV, respectively, and atrial and ventricular pacing thresholds at 0.5 millisecond varied from 0.5 to 0.7 V and from 0.3 to 1.0 V, respectively. Six months after the implantation, sensing values varied from 2 to 10 mV for the atrial lead and from 2 to 16 mV for the ventricular lead, while pacing thresholds at 0.5 millisecond varied from less than 0.5 to 2.5 V for the right atrium and from less than 0.5 to 5.0 V for the right ventricle. Atrial lead dislodgment occurred in 2 animals, requiring insertion of a new lead. Ventricular lead dislodgment was not observed.

Animals↗
PubMed2004

Biomechanical analysis of reconstructions for sternoclavicular joint instability.

BACKGROUND: A variety of reconstructive methods have been described for the treatment of sternoclavicular joint instability, yet none have been analyzed in the laboratory, to our knowledge. The purpose of the present study was to evaluate three different reconstruction techniques with use of a cadaveric model: (1) intramedullary ligament reconstruction, (2) subclavius tendon reconstruction, and (3) reconstruction with use of a semitendinosus graft placed in a figure-of-eight fashion through drill-holes in the clavicle and manubrium. METHODS: Thirty-six fresh cadaveric specimens were mounted supine on a materials testing machine in a custom testing fixture and were subjected to anterior and posterior subfailure translation to determine stiffness in the intact state after preloading. One of the three reconstruction methods was performed, and the specimens were subjected to anterior or posterior translation to failure. Changes in stiffness compared with the intact state were analyzed statistically. RESULTS: In the anterior direction, the stiffness of the semitendinosus figure-of-eight reconstruction was significantly greater than that of the intramedullary ligament reconstruction but was not significantly different from that of the subclavius tendon reconstruction. The peak load to failure (as defined by translation equal to the anteroposterior diameter of the medial head of the clavicle) was 230.3 +/- 146.1 N for the semitendinosus figure-of-eight reconstruction, 84.6 +/- 45.7 N for the intramedullary ligament reconstruction, and 75.6 +/- 19.0 N for the subclavius tendon reconstruction. In the posterior direction, the stiffness of the semitendinosus figure-of-eight reconstruction was significantly greater than those of both of the other reconstructions. The peak load to failure was 241.4 +/- 49.7 N for the semitendinosus figure-of-eight reconstruction, 85.0 +/- 22.8 N for the intramedullary ligament reconstruction, and 51.5 +/- 28.9 N for the subclavius tendon reconstruction. CONCLUSIONS: The figure-of-eight semitendinosus reconstruction for sternoclavicular joint instability has initial biomechanical properties that are superior to those of the intramedullary ligament reconstruction and subclavius tendon reconstruction techniques. CLINICAL RELEVANCE: While it is difficult to extrapolate in vitro data to the clinical situation, the figure-of-eight semitendinosus technique has superior initial biomechanical properties and may produce improved clinical outcomes in the surgical treatment of sternoclavicular joint instability.

Analysis of Variance↗
PubMed1992

CT evidence for the "osseous pinch" mechanism of traumatic aortic injury.

OBJECTIVE: Our prior experiments suggested that traumatic laceration of the aorta induced by rapid deceleration results from pinching of the aorta between the spine and the anterior bony complex (manubrium, clavicle, and first rib). This study examines that hypothesis with in vivo CT data. MATERIALS AND METHODS: In 22 patients with angiographically and surgically proved lacerations of the proximal descending aorta, chest CT scans were obtained before (18) or after (four) surgical repair. The point of impact of the anterior bony complex with the anterior surface of the thoracic spine during compression of the thorax was predicted by simulated rotation of the first rib based on calculations made from the CT scans. RESULTS: In all 22 patients, the projected site of impact of the anterior bony complex with the spine corresponded to the actual injured aortic segment as determined with angiography. CONCLUSION: Our data further support the proposed "osseous pinch" mechanism of injury to explain traumatic tears of the aorta.

Aorta, Thoracic↗
PubMed2005

Muscle organization of the cubozoan jellyfish Tripedalia cystophora Conant 1897.

The musculature of the cubomedusa Tripedalia cystophora was investigated using immunohistochemical staining with an anti-actin antibody and histochemical staining with fluorescent phalloidin. The subumbrella is lined with a sheet of circular, striated muscle that is interrupted at the perradii, and by the nerve ring. The sheet is continuous with circular, striated muscle of the velarium, which turns radially on each face of the four velarial frenula. Perradial strips of smooth muscle run radially from just above the level of the rhopalia into the manubrium and lips. The strips give off perpendicular offshoots that run a short distance in parallel with the circular swim muscle. Musculature of the tentacles and pedalia is longitudinal and limited to the oral side of the pedalia. The pedalial muscle connects with bundles of smooth muscle that runs circularly from the tentacle base well into the subumbrella. The arrangement of striated muscle in the frenula suggests that these structures may function in directional nozzle formation of the velarium during turning. In addition, the perpendicular branching of the radial strips and the circular extensions of pedalial muscle may function in hinge formation to aid bending of the pedalia and tentacles into the subumbrella during feeding and protective responses.

Animals↗