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At least 343 records · Page 19Linked to original sources
PubMed1990

[Auto-transplantation of small intestine, an emergency salvage procedure after failure of esophagoplasty].

The colon or stomach is generally used for extended oesophagoplasty. These pediculated plasties may be complicated by necrosis or stenosis and require total or partial resection at a later stage. We report such an outcome in this case report: failure of left coloplasty, partial failure of right coloplasty and stomach then rendered unusable. The cervico-thoracic oesophagus was reconstructed using a free revascularised small bowel transplant, re-establishing the continuity between the cervical oesophagus and the retrosternal right colon. This case presents several particularities: semi-emergency salvage procedure, use of a saphenous vein graft to revascularise the intestinal artery using the lingual artery as nutrient artery, venous drainage of the transplant via the intrathoracic left brachiocephalic vein, necessity for resection of the left half of the manubrium sterni and the head of the left clavicle.

Colon↗
PubMed1990

Subxiphoid pericardiotomy versus echocardiography: a prospective evaluation of the diagnosis of occult penetrating cardiac injury.

Diagnostic subxiphoid pericardiotomy (SP) is presently advocated for the diagnosis of occult cardiac injuries in patients with stable vital signs with juxta-cardiac-penetrating chest wounds. This approach, however, results in a reported 80% negative pericardial exploration rate. To investigate the reliability of bedside two-dimension echocardiography (2-D echo) in predicting cardiac injury as compared to SP, a prospective study was undertaken of patients with stable vital signs who were admitted with penetrating chest wounds that were located within the space bounded by the manubrium, nipples, and subcostal line. Initial evaluation of the patients with bedside 2-D echo was found to have a 96% accuracy, 97% specificity, and 90% sensitivity in predicting cardiac injury. The only false-negative findings were in a patient who consented to SP 18 hours after bedside 2-D echo was performed. The reliability of bedside 2-D echo compared to SP was not significantly different according to the kappa measure of reliability. These data suggest that bedside 2-D echo is an expeditious and reliable method to diagnose occult cardiac injuries during the initial assessment of a patient with stable vital signs who had penetrating chest trauma. This approach may allow for the selective use of SP on patients with positive bedside 2-D echo and could eliminate unnecessary surgical procedures.

Echocardiography↗
PubMed1989

Evaluation of pentamorphone in humans: a new potent opiate.

We evaluated the analgesic properties of 14-beta-n-pentylaminomorphinone (pentamorphone), a new morphinan derivative, in 23 male volunteers divided into 6 groups who were given either placebo (1 per group) or 0.015, 0.03, 0.06, 0.12, 0.24, 0.48 microgram.kg-1 pentamorphone intravenously. Analgesia was evaluated by the maximal tolerance to a spring-loaded rod on the tibia and manubrium. Analgesic assessments and arterial blood samples were taken prior to and at set time intervals following drug administration. Pentamorphone produced a linear increase in pain tolerance with increasing dose as well as a dose-dependent depression of ventilation. Pentamorphone had no effect on blood pressure or heart rate in the doses used. Plasma histamine levels at 5 minutes were not elevated with any of the dosages. Pentamorphone appears to be an analgesic with clinically tolerable side effects in the range 0.12 to 0.24 microgram.kg-1 that merits further evaluation under clinical conditions.

Analgesics↗
PubMed1989

[Modified Ravitch operation in the treatment of patients with funnel chest].

The characteristic traits of funnel chest have been presented and the clinical results of surgical treatment in 13 patients by the modified Ravitch method have been discussed. Nine results were excellent and four results were good. A marked improvement of general physical function of the patients due to the increase of respiratory system efficiency and a good cosmetic effect were found. The modification of the operation consists in additional longitudinal osteotomy of the sternum, suturing of the manubrium to the sternum shaft, non-suturing of the rib cartilages after resection, filling of the through-like groove in the reposited sternum with the fragments of the resected rib cartilages, and immobilization of the fragments of the longitudinally osteotomized sternum that are inserted crosswise with several (usually three) Kirschner wires, based on the thorax.

Adolescent↗
PubMed1989

[Structure of the middle ear in infants].

In section specimens of 20 infants aged 2 months to one year the morphology of the middle ear was studied in comparison with 20 adult cases aged 20-50 years. The differences were in size and shape of the tympanic cavity, eustachian tube, mastoid and middle ear ossicles. The comparison of dimensions of auditory ossicles in the infants and in adults shows that the length of malleus increases 11.9%, the length of manubrium mallei--11.5%, crus longum incudis--10.2%, the incus length--7.6%, incus width--8.2%, stapes length--4.5%, length of stapes basis--5.3%, width of stapes basis--7.5%. These data may be useful in pediatric otolaryngology.

Adult↗
PubMed1989

[Intervertebral spondylodesis of mid- an lower-cervical vertebrae using blood-supplied transplants].

The anatomical prerequisites, grounds and methods of anterior osteoplastic spondylosyndesis after traumas of the cervical part of the spinal column are described. Layer transplants from the manubrium sterni on the feeding pedicle--the breast portion of the muscle were used. The evolution of blood supplied transplants in 20 patients (out of 25 patients operated upon) was followed. The skeletal extension and plaster immobilization were used as means of additional stabilization of the spinal column. High resistance of the blood supplied transplants to microbe aggression was noted.

Adult↗
PubMed1989

[Evolution of the functional axes of the middle ear in mammals].

In 44 mammalian species, the auditory ossicles have been studied in situ in the tympanic cavity and in vestibular orientation. After the lateral semicircular canal's direction and dimensions have been put in common, measurements have been undertaken leading to a comparison of 4 phylogenic stages. Thus we have observed a rotation of the stapes, of the incus and of the malleus head, a receding of the manubrium of the malleus ending in an inversion of the bone's concavity, an extension of the supposed unfolded chain, a parallelization of the malleolus handle and of the lower incudal apophysis, a slope of the functional axes towards the back, a diminution of the distance between the two lever arms due to a receding of the anterior arm and a diminution of the ratio between these lever arms. These varied changes are linked to the occipital rotation and to the receding of the jaws following humanization.

Anatomy, Comparative↗
PubMed1979

Problems in resection of chest wall sarcomas.

To illustrate the problems of reconstruction in major chest wall resection, five patients with a variety of soft tissue tumors of the chest wall, located at different sites, are presented. Patients, who underwent a lateral or posterolateral chest wall resection required removal of two to five ribs sequentially as well as the adjacent soft tissue. Those who underwent an anterior chest wall resection required resection of the manubrium or the body of sternum as well as of adjacent costal cartilages. To prevent instability of the chest, herniation, and to minimize flailing, the chest defect was bridged with the use of Marlex mesh. Whenever possible, the omentum was brought into the chest cavity to increase the vascularity of the reconstruction. Since, in most instances, the tumors involved the skin because of previous damage from radiation therapy, extensive skin coverage was planned well in advance of resection. Pedicle skin flaps or rotation flaps were used to cover the skin defect. Ventilatory support by volume respirator, was required for three to four days. In all patients, the chest wall was completeley stable after three to six weeks.

Adolescent↗
PubMed1988

Anatomic and radiologic observations of the clavicle of adult dogs.

In an anatomic and radiologic study of the clavicle of 50 adult dogs of 10 breeds, the clavicle had ossified in 96% of the dogs. The clavicles studied had various shapes, and each clavicle was attached to the caudomedial part of the clavicular intersection of the brachiocephalic muscle, to the mastoid part of the cleidocephalic muscle, and to 4 radiating bands of connective tissue fasciculi. One band was attached to the caudal border of the scapula and fascia deep to the latissimus dorsi muscle, 1 was attached to the manubrium of the sternum, and 1 each was attached to the epimysia of the superficial pectoral and sternocephalic muscles. We concluded that, during movements of the thoracic limb, the clavicle and the 4 fasciculated connective tissue bands associated with it stabilize the position of the brachiocephalic muscle with relation to the crest of the greater tubercle of the humerus. Also, the fasciculated band attached to the caudal border of the scapula provides protection for nerves from the brachial plexus and axillary blood vessels that supply the thoracic limb.

Animals↗
PubMedDate not supplied

Synthetic prostheses in repair of chest wall defects after exeresis of malignancies.

Five cases of chest wall repair with synthetic prostheses following thoracectomy for malignant tumours are reported. Two patients were submitted to partial sternal resection (manubrium); in the first case Marlex mesh alone and in the second a composite graft with Methyl-methacrylate were used. The remaining cases underwent extended thoracectomy and reconstructive procedure based upon Marlex prosthetic replacement and myoplasty. No postoperative complications were observed and satisfactory stabilization of the chest wall with good cosmetic results were obtained.

Bone Neoplasms↗
PubMed1979

[Hearing results following tympanoplasty (author's transl)].

Tympanoplasty can produce a stable hearing improvement in many patients with chronically inflamed ears. In our series of patients, severe damage to the inner ear following surgery occurred in 3% patients and was associated with a hearing loss of greater than 15 dB. Complete hearing loss occurred in 0.2% of the patients reviewed. In patients with an intact ossicular chain, simple myringoplasty is associated with the best results. Loss of the stapedial arches affects the postoperative air-bone gap most significantly, while loss of the manubrium mallei or the creation of a radical mastoid cavity are additional negative factors. Extent or localization of ossicular fixation has no direct influence on hearing results when appropriate ossicular reconstruction is performed.

Cochlear Implants↗
PubMed1985

Esophageal duplication cyst containing a foreign body.

About 10% to 15% of all duplication cysts in the alimentary tract are esophageal. Esophageal duplication cysts are intimately attached to the alimentary tract, are lined by mucous membrane and have smooth muscle. This paper describes a 2-year-old child who presented with symptoms of progressive respiratory distress. A diagnosis of esophageal duplication cyst was made. At surgery a low cervical incision was made and the sternal manubrium split, thereby providing adequate exposure. The cyst was then removed. The most useful investigations were chest roentgenography and barium esophagography. Computerized tomography showed a small, round foreign body in the middle of the cyst that was subsequently found to be a bingo chip. Communication between the cyst and the esophagus was not obvious at the time of surgery and had not been demonstrated by barium esophagography. When complete excision of the cyst is not possible because of inflammatory reaction all the mucosa must be removed to prevent recurrence. Careful postoperative respiratory support and broad-spectrum antibiotic therapy are recommended.

Child, Preschool↗
PubMed1985

[Postnatal development of the sound-transporting apparatus in the middle ear of rabbits].

The middle ear apparatus realized a multiplicatory function during the transfer of the vibrational energy, depending on the area ratio of pars tensa of tympanic membrane and of stapes footplate as well as the lever ratio of long arms of manubrium and of incus. These structures exhibit a size increase during the postnatal development, but the sequel on the multiplicatory function in rabbits is unknown. The middle ear structures of 46 rabbits, 1 to 30 d old, were prepared and measured. The area of pars tensa and the levers of malleus and incus increase with age. After the 10th d of life, no statistical significant growth were measurable. But the calculated multiplicatory factor of single animals indicate the end of the development at the 15th postnatal d. In contrast, the cochlear function attains the adult values not till the 26th d of life. It is 10 d longer than the middle ear growth.

Aging↗
PubMed1985

[Mediastinal tracheotomy in cervicofacial oncologic surgery. Contribution of the pectoralis major myocutaneous flap].

Four cases of anterior mediastinal tracheostomy with myocutaneous Pectoralis Major flap are described. Resection of the manubrium, clavicular heads and the cartilages of the first and second ribs is necessary. The use of myocutaneous Pectoralis Major flap give good functional results. No infection or hemorrhage of mediastinal great vessels occurred. The indications of Anterior mediastinal tracheostomy are discussed. Stomal and peristomal recurrences following laryngectomy for carcinoma represents the indication of choice. Stomal recurrences are difficult to treat and the prognostic is poor. Prevention of the stomal recurrences is discussed.

Aged↗
PubMed1985

Intravenous methylprednisolone pulse therapy in ankylosing spondylitis.

For several years the medical treatment of active ankylosing spondylitis (AS) has been NSAID because gold, penicillamine, antimalarials and steroids have been without efficacy. In 1981, Mintz et al reported that methylprednisolone pulse therapy (MPPT) had an excellent effect in patients with AS. Seven patients with active AS and insufficient efficacy of NSAID for three months were treated with one gram methylprednisolone daily given intravenously for three successive days. Mobility and pain were recorded before, during, and after treatment. Significant pain relief and improvement of mobility of the spine for at least six weeks were clearly demonstrated (p less than 0.05). Finger to floor distance and chin manubrium distance improved significantly for at least six months (p less than 0.05). We conclude that intravenous MPPT is a useful treatment in patients with active AS when NSAID is insufficient.

Adult↗
PubMed1985

[Tragal perichondrium and cartilage in tympanoplasty. A report on 2500 operations by an established ENT physician].

The operations were almost always performed under local anaesthesia. The procedure, which is bloodless and painless, is described in detail. The material is taken via an endaural incision and causes little trauma. Tragal perichondrium, which can be reinforced by adherent cartilage, is suitable for apposition to manubrium and to the anterior tympanic sulcus due to inherent properties such as bradytrophia, natural concavity and the absence of contraction or swelling. Autologous cartilage was usually used for interpositions. The results were satisfactory with respect to healing and function. There were 3.25% perforations, and 6.7% (n = 283) in subtotal tympanic membrane defects. In cholesteatoma operations the recurrence was only 5%; this may be due to the prevalence of small cholesteatomas and the almost constant use of an open technique. A socially acceptable hearing level (less than or equal to 35 dB) was obtained in 62.7% in the short term.

Adolescent↗
PubMed1985

[Trans-cleido-manubrial approach to the upper thoracic spine (T1-T2)].

Authors describe their own experience of Sundaresan anterior approach and exposure of the upper thoracic vertebrae (T1-T2) including resection of the internal third of the clavicle and manubrium sterni. They point out technical details of that surgical approach and its indications.

Humans↗
PubMed1985

[Comparison of 2 molded autograft technics on intact ossicular chains].

Two techniques using molded autografts on intact ossicular chains were compared in 159 patients: some patients received molded autografts alone while in the others it was reinforced by a second fragment of temporal aponeurosis inserted behind the manubrium of the malleus. Fixation of these two grafts prevented ascension of the graft into the canal. Results obtained showed slight superiority for the double graft over the single one.

Adolescent↗