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At least 361 records · Page 20Linked to original sources
PubMed1984

[Sternum-splitting approach for ossification of the posterior longitudinal ligament in the cervico-thoracic junction].

In this paper the author reported an operative approach for ossification of the posterior longitudinal ligament (OPLL) of the lower cervical and upper thoracic vertebrae. There are two types of surgery for OPLL, namely, posterior and anterior approaches. As a rule, we utilize an anterior approach for OPLL. Recently we performed a modified sternum-splitting approach in surgery for OPLL in the cervico-thoracic junction. In the original trans-sternal approach introduced by Cauchoix, the sternum is split from the suprasternal notch to the xiphoid process. We cut the manubrium only. However, a satisfactory exposure of the cervico-thoracic vertebrae down to the third thoracic level was obtained. After reaching the anterior surface of the cervico-thoracic vertebrae, the central portion of the vertebral body and the ossified lesion between the lower one third of the C7 vertebral body and the upper one third of the Th3 vertebral body were removed with an air-drill under an operating microscope. The longitudinal bone defect of the vertebral bodies was filled with a bone graft obtained from the iliac bone. Removal of the ossified lesion in the cervico-thoracic junction can be performed safely by utilizing the modified sternum-splitting approach. This approach can be applied also to endarterectomies at the origins of the vertebral arteries and the right subclavian artery.

Cervical Vertebrae↗
PubMed1984

[Roentgenologic observation of the course following sternotomy].

The course of healing after medial sternotomy can be controlled by means of tomography of the sternum. If healing progresses in a normal way, restitution can be seen in the region of the corpus sterni after about 20 days, whereas restitution in the area of the manubrium sterni is evident after 8 weeks only. Osseous absorption is a leading x-ray sign of disturbed restitution, the other leading sign being persistence of dehiscence of the sternum following sternotomy.

Humans↗
PubMed1983

Pulmonary capillary blood volume during immersion in water at different temperatures.

Pulmonary capillary blood volume (Qc) was determined for 7 subjects in the standing posture and immersed up to the sternal manubrium at three water temperatures: 34 degrees C +/- 0.5 degrees C, thermally neutral bath; 25 degrees C +/- 0.5 degrees C, cold bath; and 40 degrees C +/- 0.5 degrees C, hot bath. The Qc was calculated from the lung transfer factor DLco measured while breathing two gas mixtures (21.1% O2 and 90.0% O2) during breath holding. Control experiments in a dry air environment show that Qc values for standing posture decrease compared to the sitting values, owing to a redistribution of the intrathoracic blood volume to lower body parts as a result of gravity. Immersion at 34 degrees C in an upright position produces a significant increase in Qc (P less than 0.01). This is a result of the hydrostatic counterpressure: blood shifts from the periphery to the intrathoracic regions. Immersion at 25 degrees C increases Qc compared to the values obtained at 34 degrees C, but the difference is not significant. The contribution of vasoconstriction to blood volume shift in cold water is probably less important than that of hydrostatic counterpressure. During immersion at 40 degrees C, the rise in Qc is very significant (P less than 0.05). This may be explained by an increase in cardiac output and central blood volume when skin temperature is raised at 40 degrees C.

Adult↗
PubMed1984

Partial median sternotomy: anterior approach to the upper thoracic esophagus.

Based upon experience with cervicothoracic esophageal carcinomas in which resection of the manubrium, adjacent clavicles, and ribs has facilitated exposure of the tumor, it has been found that a partial upper sternal split (without resection) provides access to the upper thoracic esophagus to the level of the carina. With a knowledge of the anatomic relationships of the esophagus in this area, this direct anterior approach has been used for both benign and selected malignant diseases involving the upper thoracic esophagus. A partial median sternotomy has been used in 11 patients with the following esophageal pathology: upper- and/or middle-third malignancy (six), benign upper-third stricture (three), perforation of upper-third esophagogastric anastomotic stricture (one), and cricopharyngeal achalasia in association with a chronic cervical compression fracture that prevented extension of the neck (one). The following operations were performed: blunt esophagectomy with cervical esophagogastric anastomosis (six), segmental esophageal resection with primary anastomosis (three), drainage of perforation (one), and extended cervical esophagomyotomy (one). A chylothorax developed in one patient with carcinoma, the only major postoperative complication in this group. Transient hoarseness occurred in two patients. Careful evaluation of the patient with upper thoracic esophageal pathology, focusing on the type, extent, and location of the abnormality relative to the level of the carina, as well as the habitus of the patient, often indicates that a partial sternotomy can be utilized to facilitate the operation.

Adult↗
PubMed1983

[Clinical characteristics of metastases of thyroid cancer to the lungs].

Metastases were detected in 120 out of 598 cancer patients (20.2%). 96 patients underwent a close clinical examination. Symptoms produced by mediastinal and lung metastases were the first clinical manifestations of the disease in 23% of cases, whereas in 38.5%, both metastases and primary tumor were detected simultaneously. Metastatic cancer of lung and mediastinum was mostly symptom-free. Metastases most frequently occurred in lungs, less frequently in mediastinal lymph nodes and rarely in the pleura. Lung metastases usually disseminated in foci. Spherical metastases and foci of shadowed lung tissue were less frequent. In cases of thyroid cancer disseminated into mediastinum, all groups of lymph nodes were involved. If slightly enlarged, regional lymph nodes located behind manubrium sterni were most difficult to detect.

Adult↗
PubMed1982

[Cicatricial stenosis in the crico-tracheal region. A new surgical approach].

Nearly a half of laryngo-tracheal cicatrical stenoses following long-term intubation are found at the level of the cricoid cartilage. Early and correctly-performed tracheotomy can prevent this complication in almost all cases. The best results of surgical treatment can be expected after transverse partial resection of cricoid and upper trachea or after Réthi's laminotomy. In 14 patients after cricotomy a bone graft from the manubrium sterni was inserted, to separate permanently the free borders of the divided cricoid cartilage. Operative technics and the results of treatment are presented.

Adolescent↗
PubMed1982

[The posterior manubrial ligament].

The posterior manubrial ligament is part of the suspensory ligamentous system of the ossicles, and extends backwards from the posterosuperior spine of the tympanic notch to the postero-internal portion of the manubrium just below the neck of the malleus. It lies in relation to structures in the posterosuperior region of the tympanic barrier to downwards extension of epitympanic recess lesions during chronic otitis.

Ear, Middle↗
PubMed1982

[Treatment of ankylosing spondylitis with slow-release diclofenac sodium in a single daily dose].

The efficacy and tolerability of slow-release diclofenac sodium were investigated in 40 patients with ankylosing spondylitis. The patients received one coated tablet of 100 mg daily in the morning for 21 days in addition to standard physiotherapy. The efficacy of the trial treatment was evaluated by measuring the chin-to-manubrium sterni and fingertips-to-floor distances, Schober's sign, and chest expansion. Every morning and evening the severity of pain and the degree of spinal stiffness were recorded by the patients on visual analogue scales. A significant improvement of the symptoms was found in 35 of the patients as compared to the initial findings. The slow-release formulation of diclofenac Na was very well tolerated. The necessity of balneophysical therapy in ankylosing spondylitis is emphasized, which in most cases will only be possible in combination with adequate drug therapy.

Adult↗
PubMed1981

Posterior dislocation of the clavicle causing fatal tracheoesophageal fistula.

A 24-year-old man severely injured in a motor vehicle accident was found to have, on the right side, a pneumothorax, extrapleural hematoma, acromioclavicular dislocation and fracture of the first three ribs and of the transverse processes of C7 and T1. Through a right thoracotomy, transection of the right main stem bronchus and a laceration of the left main stem bronchus were discovered. These were repaired. Twenty days after admission, posterior dislocation of the clavicle at the sternum was noted. A diagnosis of tracheoesophageal fistula was made on the 32nd day but the symptoms had been sternoclavicular and acromioclavicular dislocations. At autopsy the medial end of the clavicle was found to be torn from its articular discand and locked behind the manubrium. The fistula was behind the posterior capsule between the carina and esophagus. The authors conclude that continued pressure from the displaced clavicle may have led to delayed necrosis of the esophagus and that reduction of the dislocated clavicle might have saved the patient's life.

Acromioclavicular Joint↗
PubMed1980

Peristomal recurrence: pathophysiology, prevention, treatment.

Postlaryngectomy peristomal recurrence is the most devastating late complication of laryngeal carcinoma. Its development is most closely associated with emergency tracheotomy done prior to definitive treatment of the primary tumor and with subglottic tumor involvement. The pathophysiologic mechanism of the development of peristomal recurrence is by tumor seeding of the tracheotomy site, by metastatic spread to the pretracheal and paratracheal nodes (especially from the subglottis), and by direct extension of tumor through the thyroid cartilage, cricoid cartilage, or cricothyroid membrane. The best treatment is the prevention of peristomal recurrence. Intubation followed by partial laser excision of the primary tumor can be used to avoid tracheotomy in some cases. Patients showing subglottic involvement by tumor should undergo either postoperative irradiation of the stoma or prophylactic recurrent laryngeal lymphatic and superior mediastinal dissection by removal of the manubrium sterni and sternoclavicular joints. When peristomal recurrence develops, radiation alone offers the least chance of success. Induction chemotherapy should be considered when the condition of the patient allows this. This must be coupled with full course irradiation or mediastinal dissection in operable patients. Mediastinal dissection should be done only by those experienced with the technique and should be accompanied by appropriate postoperative support.

Aged↗
PubMed1995

Malleus vibration modelled as rigid body motion.

Malleus motion is classically regarded as a rotation about a fixed axis whose location is determined by the anatomy and suspension of the middle ear ossicles. In a previous paper (1) we have shown that the mode of vibration is complex and varies with frequency. To define the malleus motion in detail, its vibration was measured interferometrically at a large number of points (about 20) on the manubrium in anesthetized cat. The viewing direction was kept fixed. A pure tone stimulus was used and the frequency was changed from 100 Hz to 25 kHz. Assuming that the malleus moves as a rigid body the observed motion can be decomposed into three components; one translational component along the direction of viewing (z axis) and two rotational components characterized by rotation vector components in the plane perpendicular to the translational component. These motion components were calculated from the experimental data. Our results show that the direction of the malleus rotation axis is changing within each cycle. Results from different animals show large interanimal variations.

Animals↗
PubMedDate not supplied

[Salvage esophagoplasty using free jejunal transplant after repeated failure of other esophagoplasties. 25 cases].

Salvage oesophagoplasty using a free jejunal transplant is the ultimate reconstruction possible after repeated failures using the classic procedures of oesophagoplasty. The free jejunal transplant appears to be the best choice. Twenty-five free jejunal transplants were performed by the same surgeon for such reconstructions including 13 cases involving benign lesions and 12 cases of cancer. There were no post-operative death and none of the transplantations was a complete failure although three cases of stenosis and fistulization occurred. Several recommendations can be made: save the existing digestive tract, redissect the residual digestive plasty and pull it up. The residual digestive flap can be examined by opacification or endoscopically in order to evaluate its length. An arteriography of the pediculated plasty gives information on its vascularization. A free jejunal graft can safely cover 25 to 30 cm. When possible, residual plasties should be positioned subcutaneously. The reconstruction of the cervico-thoracic oesophagus usually requires a vascular bypass with a saphene graft. In difficult cases, it may be necessary to remove a part of the sternal manubrium and the head of the clavicular bone in order to avoid compressing the jejunal graft. When the length of the reconstruction is greater than 30 cm, a long jejunal transplant with two pedicules (1 pedicule revascularized from the cervical vessels and the other pedicule from the internal thoracic vessels) is needed. An alternative technique would be a free antebrachial flap (six cases operated with two post-operative deaths at 6 weeks and two fistulas).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Contribution to the study of the development and ossification of human sternum.

We have studied the development of sternum in man. Complete microscopic series of sections through thorax of human embryos and fetuses from the second and third months of gestation served as the research material. Preparations were stained by Alcian blue and Mayer's haematoxyline, counterstained by eosine. We also had a set of macroscopic preparations of sterna and adjacent parts of ribs from fetuses of the fifth and sixth months of gestation. These specimens were stained by Alcian blue and by Alizarine and subsequently cleared by glycerine method. We have found that sternum develops by a fusion of sternal bars. Sternal bars develop from anterior bent parts of ribs, lying one over another like tiles. The newly formed sternum has different proportions in comparison to its definitive state. In all the cases its manubrium is wider and bigger, its xiphoid process is longer, in almost all the cases doubled or at least bifurcated. The sternocostal junctions are provided with interzones with the exception of the first rib. Its primordium continues into sternum without any border. Clavicle is connected with sternal anlage without any visible border and this interzone quickly develops as the primordia of the sternoclavicular articulation and the disc. In the medial part, there is a cartilaginous model which ossifies very early--as the first bone of the body. In young embryos from the end of the second month of gestation the clavicle and sternum show very different structures. Ossification of the sternum begins in the fifth month by developing a large number of very small centers of ossification which are not yet detectable by X-ray or CT.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1994

Incus interposition and ossiculoplasty with hydroxyapatite prostheses.

This article traces the evolution of transplant material in ossicular reconstruction of the middle ear. The first transplant consisted of the body and short process of the homograft incus. It was repositioned or wedged between the stapes head and the manubrium of the malleus. Further modification consisted of the sculpture of prostheses from homograft incudes; these were known as the notched incus with short or long process. By means of a notch in the short process, they were locked in place. The final phase is the use of hydroxyapatite as a biocompatible material from which similar prostheses may be precisely manufactured. These hydroxyapatite prostheses, known as the incus and incus-stapes replacement prosthesis, appear to be well tolerated and to produce excellent hearing results.

Biocompatible Materials↗
PubMed1994

[A case of traumatic intrapulmonary foreign body].

A case of 60-year-old man with traumatic intrapulmonary foreign body that was not inhaled, but through the chest wall was described. In July 1992 a grass cutter was working in a forestry with a circular saw when he was struck into the right lung. He had a sharp pain in the anterior chest. No abnormality was seen in front of his neck and the chest wall. The next month he developed a cough with bloody sputum. The chest X-ray showed a metallic foreign body at the right side of manubrium. Computed tomogram showed a steel wire fragment lodging beside the innominate artery and vein and in the right lung. Median sternotomy was performed and a foreign body was successfully removed with partial resection of upper lobe.

Foreign Bodies↗
PubMed1993

Autoradiographic studies on 3H-fucose incorporation into manubria and its translocation to antheridial space during spermatogenesis in Chara vulgaris L.

The internal space of antheridium in Chara vulgaris L. is filled with the PAS-positive polysaccharide mucilage. It is produced and secreted by non-generative, polyploidal cells--manubria. Autoradiographic studies with the use of 3H-fucose have shown that this precursor is incorporated into polysaccharidial compounds at the manubrium surface. The dynamics of this process is different in proliferative phase than after symplasmic isolation of antheridium. The translocation of mucilage into antheridial space is very intensive, especially at the older developmental stages of antheridium. The data obtained after 12-hour postincubation indicated secondary metabolic changes of mucilage. The decrease in total radioactivity per investigated section is most intensive by the end of spermatogenesis. These facts seem to confirm the assumption about nutritive role of mucilage filling Chara antheridium during the process of spermatogenesis.

Autoradiography↗
PubMed1993

The management of advanced subglottic carcinoma with stomal invasion: a case report.

Primary subglottic carcinoma is rare. The initial stage is usually asymptomatic and the carcinoma is advanced when the symptoms are in evidence. Because the trachea and thyroid gland adjoin to the subglottic area, the tumor invades them along with the superior mediastinum and lung by the way of paratracheal lymph drainage. To resuscitate a severe airway obstruction, an emergency tracheotomy is required, which, however, results in a higher frequency of stomal recurrence later. We treated a case with advanced subglottic carcinoma and performed extended radical neck dissection with the resection of total larynx, thyroid gland, and involved trachea with peristomal skin en bloc. In order to completely remove the paratracheal and superior mediastinal lymph nodes, the sternal manubrium and its adjoining clavicles and ribs were cut off. This was necessary to optimize the field of vision, and to prevent injury to the great vessels and pleura. Because of its availability, its thickness, and its skin paddle, the pectoralis major myocutaneous flap was formed to the skin defect and to protect the great vessels. Postoperative stoma was at the sternal level and did not compress the great vessels. Parathyroid gland, after chopping, was reimplanted into muscle tissue to prevent hypocalcemia. No more postoperative radiotherapy or chemotherapy was necessary because the lymph nodes were spared. There were no postoperative complications and the patient was discharged 2 weeks later. No recurrence occurred in the 28 months follow-up period.

Glottis↗
PubMed1977

[Regularities and differences in the structure of the circulatory bed of the sternum].

The investigation has been carried out in 95 preparations of the anterior chest wall of corpses of humans of either sex aged from newborns to 90. It has been established that the blood supply of all the layers of sternum is brought about by the anterior and medial branches of the internal sternum artery forming subperiosteal plexuses on its anterior and posterior surfaces. The posterior plexus is better developed. Its loops are of less size and denser per a square surface unit. Three types of blood supply of the manubrium sterni posterior surface have been distinguished (right-side, balanced and left-side types) as well as two variations of blood supply of the sternum body (in the first variant two sternal branches approach the sternum at the level of every intercostal space, in the second variant--only one does). The outflow of the venous blood from the sternum is brought about into the anterior and posterior venous subperiosteal plexuses and then via one of the three anatomical variations into the internal thoracic veins. The subperiosteal network of the sternum in newborns and infants is of segmentary character and is formed in relation with developing ossification nuclei. With age, in the process of fusion of the ossification nuclei the subperiosteal network looses its segmentary character and acquires a common total character.

Adolescent↗