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At least 739 records · Page 41Linked to original sources
PubMed1990

A modification of the supraclavicular approach to the central circulation.

Traditional anterior or posterior triangle approaches to the central circulation may be at times unsuccessful in the patient whose anatomy makes cannulation difficult. We used a supraclavicular approach to cannulation of the central circulation in 100 patients for intraoperative monitoring or insertion of renal dialysis catheters. We have had only two failures, both in patients for dialysis catheter placement, and no complications. Review of the literature reveals a similar history of success with variations of this approach. The supraclavicular approach is an easy cannulation technique for the inexperienced physician and a useful alternative to traditional approaches for the experienced physician.

Catheterization, Central Venous↗
PubMed1990

Sternoclavicular septic arthritis due to haemophilus influenzae.

We have reported a case of septic sternoclavicular arthritis illustrating a rare complication of infection with a relatively common pathogen, Haemophilus influenze. Early identification of the infecting organism and appropriate antibiotic therapy are essential to prevent further morbidity from the complications of this unusual pyoarthritis.

Arthritis, Infectious↗
PubMed1992

Efficacy of the supraclavicular route for temporary hemodialysis access.

The percutaneous supraclavicular approach for temporary central venous hemodialysis access was successfully used in 27 of 34 cases (79%) without significant complications and was found to be a durable technique acceptable to every patient. The supraclavicular site was used from 3 to 156 days (mean, 40 days). The average catheter life was 25 days, and 13 guidewire catheter changes among eight patients were required for catheter limb thrombosis or suspected infection. Preventable kinks resulting from technical error occurred in two catheters (5%), necessitating guidewire replacement in one. A total of 41 catheters were used, and infection was documented in one (2%). Catheters were intentionally removed in 21 patients and were removed for proved infection (1) or suspected infection (5) in the remaining six patients. No new clinical evidence of central venous stenosis or thrombosis, such as arm swelling, prominent cutaneous collateral veins, or increased venous pressure at dialysis, was observed. We suggest the supraclavicular approach as the primary route for temporary central venous hemodialysis access. Continued follow-up is necessary to substantiate the initial favorable experience with the supraclavicular technique.

Adult↗
PubMed1993

Pustulotic arthro-osteitis: a cause of atypical chest pain and a new arthritic syndrome.

We have described a 38-year-old white American woman who had a 7-year history of pain in the left anterior chest, neck, right wrist, and buttocks. The pain fluctuated in severity and appeared to coincide with worsening of her skin condition, palmoplantar pustulosis (PPP). She manifested the typical skeletal features of an arthritic condition referred to as pustulotic arthro-osteitis, which is frequently associated with the characteristic rash of PPP. This is an infrequently described disorder in the United States, possibly reflecting lack of familiarity or confusion with related disorders.

Adult↗
PubMed2004

Blastomycosis of long bones.

The presentation of blastomycosis clinically and radiographically is nonspecific and often mistaken for a neoplasm. Delay in diagnosis is common. Patients with osseous blastomycosis present with pain and swelling. Radiographs usually show an eccentric lucency in the distal ends of long bones. These patients frequently are referred for a neoplastic workup and a diagnosis is made only after biopsy. We review the cases of five patients diagnosed with a bone tumor who had blastomycosis osteomyelitis. The time to diagnosis from original symptoms was 4.7 months (range, 3-8 months). The average age of the patients was 45.6 years (range, 20-59 years). A Musculoskeletal Tumor Society functional assessment was done. Early radiographs of the current patients ranged from normal to showing faint osteopenia in the involved location. As the disease progressed, the area of lucency appeared with either diffuse or well-marginated borders. Treatment included surgical debridement with antifungals. The mean functional score was 93.3%. All patients are disease-free. Blastomycosis, similar to tuberculosis, often is mistaken for a neoplasm. Blastomycosis osteomyelitis can be treated with excellent results. The key is diagnosis and including endemic fungal infections in the differential diagnosis of bone tumors. In addition, every potential neoplasm should include cultures of specimens obtained at biopsy.

Adult↗
PubMed2005

Pediatric shoulder trauma.

Pediatric shoulder trauma is relatively uncommon. Injuries requiring surgical intervention are even rarer. However, it is important for the practicing orthopaedic surgeon to differentiate nonoperative injuries from the urgent and potentially operative injuries. Missing such an injury in the pediatric population could be potentially life threatening or lead to long-term disability. Posterior sternoclavicular dislocations should be differentiated from medial clavicular physeal injuries and promptly reduced. Open fractures or neurovascular threatening fractures should be attended to immediately. Severely displaced proximal physeal humerus fractures in the older child often have a better long-term outcome after anatomic reduction. Finally, although glenohumeral dislocations, once reduced, are not life threatening or limb threatening, they do have a very high incidence of recurrence in adolescent patients. This should be kept in mind when formulating the treatment plan. If these overall treatment recommendations and plans are adhered to, the majority of pediatric shoulder trauma will result in a good outcome.

Adolescent↗
PubMed2006

The segmental pectoralis major free flap: anatomical features of its vascular pedicle.

BACKGROUND: The pectoralis major muscle may be suited for free transplantation of a segment of the muscle. We investigated the length and diameter of its vascular pedicle to determine its feasibility. METHODS: The length of the pedicle, its arterial diameter, and its entry point into the muscle were determined in 17 cadaveric flaps. RESULTS: The pedicle length up to the medial border of the pectoralis minor muscle averaged 6.6 cm. The mean external arterial diameter was 1.8 mm, and the venous diameter was consistently larger. The vascular pedicle consistently entered the muscle lateral to the midpoint of, and a mean of, 8.8 cm caudal to the clavicular line. CONCLUSION: The vascular length and diameter are sufficient for microvascular anastomosis. Although an anatomic landmark for the cranial border of the flap could not be defined, the sternocostal part of the pectoralis major muscle may potentially be used as a segmental free flap.

Anastomosis, Surgical↗
PubMed1982

Function of the subclavius muscle in a nonhuman primate, the spider monkey (Ateles).

Within the primate order, the morphology of the subclavius muscle is known to be unique among the prehensile-tailed South American monkeys. 3 spider monkeys, Ateles, were monitored electromyographically to determine the recruitment of this muscle during various locomotor and postural activities. Rather than indicating a static stabilizing function, which has typically been inferred from classical anatomical studies, results from this study suggest that the subclavius performs more as a dynamic element in movements of the pectoral girdle during brachiation, vertical climbing, pronograde quadrupedalism and leaping. Complementary activity patterns were also identified between the subclavius and the caudal fibers of the trapezius indicating that the subclavius is used when the animal must depress, or resist cranial displacement, of the protracted shoulder girdle, while the caudal trapezius is recruited when the girdle is retracted on the chest wall.

Animals↗
PubMed1979

Pustulosis palmoplantaris and its relation to chronic recurrent multifocal osteomyelitis.

In previous study we found that clavicular lesions in chronic recurrent multifocal osteomyelitis (CRMO) in young patients was associated with palmoplantar pustulosis (PPP). In this work the relationship between sternoclavicular lesions and PPP was studied in a group of adult patients. The sternoclavicular region of 52 patients with PPP and 25 control persons was examined by tomography. Among the PPP patients there were inflammatory lesions in the sternal synchondroses in 3 patients. There were no such lesions in the controls. In this unselected population of adult patients there was thus no definite association between PPP and sterno-clavicular lesions. In young patients on the other hand, CRMO with clavicular lesions may be another, probably noninfectious, cause of PPP.

Adult↗