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PubMedDate not supplied

Predictive criteria for length of nasogastric tube insertion for tube feeding.

This study was aimed at identifying non-invasive techniques and criteria for predicting the proper length for insertion of a nasogastric tube for tube feeding so that the tube tip would be located in the fundus or body for the stomach. A review of literature and existing practices revealed unsubstantiated and discrepant methods currently in use and justified the need for this research. The study involved relating several external body measurements to a measurement from the tip of the nose to the lower esophageal sphincter, via the esophagus, in 99 adult cadavers and 5 normal adult volunteers. A variety of analyses including stepwise multiple regression, were used and are presented. A formula is presented and is stated to provide a 91% confidence level of tube tip placement in the stomach between 1 and 10 cm. This is compared to a confidence level of 72% using the traditional nose to ear to xiphoid measurement. The formula is ( (NEX-50cm) /2)) + 50cm where NEX is the distance from the tip of the nose to the earlobe to the xiphoid. Two methods for simple mechanical clinical application are described.

Adolescent↗
PubMed1992

Subxiphoid pericardiotomy in the diagnosis and management of large pericardial effusions associated with malignancy.

To determine the safety, diagnostic value, and clinical outcome of patients with malignancy undergoing subxiphoid pericardiotomy for large pericardial effusions, we prospectively studied 25 consecutive patients with malignancy and new, large pericardial effusions diagnosed by echocardiography. Twenty-two of the 25 operations were done under local anesthesia, and no patient died at surgery. Pericardial fluid cytology revealed malignant cells in 11 patients (44 percent), while tumor was seen in only five (45 percent) of these 11 patients on pathologic examination. The remaining 14 patients showed no evidence of pericardial invasion with tumor. Evidence of intrathoracic disease by CT or MRI scanning, tamponade, a sanguineous pericardial fluid character, and an elevated serum and pericardial fluid lactate dehydrogenase level all were suggestive of malignant invasion of the pericardium. All 25 patients were followed at least 12 months postoperatively. Effusions recurred in three patients (12 percent), and one patient required reoperation. Overall mortality was 72 percent with a 91 percent (10 of 11) mortality for those with malignant effusions and a 57 percent (8 of 14) mortality for those with nonmalignant effusions. Diagnostically, subxiphoid pericardiotomy has little advantage over examination of pericardial fluid alone in this group of patients. Therapeutically, however, it is a low morbidity procedure which is safe and effective in treating patients with malignancy and large pericardial effusions.

Cardiac Tamponade↗
PubMed1975

Sutureless epicardial pacemaker lead: a satisfactory preliminary experience.

The first pacemaker systems used the epicardial electrode. The transvenous endocardial electrode rapidly supplanted the epicardial electrode since it could be positioned with less morbidity and mortality and was associated with a lower incidence of wire breakage. The long term complication rate of the transvenous electrode had not been inconsequential. The sutureless epicardial electrode combines the greater reliability of the epicardial lead system with the ease of insertion and low morbidity of the endocardial lead system. We have used this electrode in 33 patients. The electrode was positioned using the subxiphoid approach and local anesthesia in most patients. There have been few complications and none that resulted in long term morbidity. There have been no deaths related either to the operative approach or to the pacing system. There has been no instance of lead failure during the follow-up period.

Aged↗
PubMed2003

Compositional changes of the xiphoid process and costal cartilage with aging.

To elucidate compositional changes of the cartilage with aging, the authors investigated age-related changes of element contents in the xiphoid process and costal cartilage by inductively coupled plasma-atomic emission spectrometry. After the ordinary dissection by medical students was finished, the xiphoid processes and bilateral the fourth costal cartilages were resected and element contents were determined. The subjects consisted of 17 men and 9 women, ranging in age from 52 to 96 yr. No significant correlations were found between age and the content of elements, such as Ca, P, S, Mg, Na, Zn, Fe, and Si in the xiphoid process and costal cartilage, except for S in the costal cartilage, in which an extremely significant correlation was found. With regard to the relationships among element contents, the common finding that there were significant direct correlations both between Ca and P contents and between Ca and Mg contents, whereas there were significant inverse correlations both between Ca and S contents and between P and S contents obtained in the xiphoid process and costal cartilage.

Aged↗
PubMed2004

The limiting factors for the transxiphoid approach in congenital cardiac surgery.

OBJECTIVE: Minimally invasive cardiac surgery is currently being performed for a wide variety of cardiothoracic procedures. Since August 1998, the transxiphoid approach using a direct cannulation to the ascending aorta has been selected for the closure of atrial septal defects (ASD) and ventricular septal defects (VSD) in our institution. However, this approach cannot be performed for all patients because of the small "xiphoid window." We analyzed the factors limiting this approach to determine the best factor predicting risk. METHODS: Of 26 patients who had an ASD or a VSD, 14 underwent complete repair using a transxiphoid approach. Preoperative data collected for all patients included the relationship between the right ventricular outflow tract and the lower sternum (the RVSA) in the cineangiograph. Multiple logistic regression analysis was used to investigate which of the factors best predicted whether the transxiphoid approach should be adopted. RESULTS: The factors best predicting this approach were the combination of RVSA and body surface area (BSA) (odds ratios of 2.982 [P = .018] and 0.925 [P = .046], respectively). With the logistic model used in a prospective study of 6 consecutive patients, we were completely successful in predicting whether the transxiphoid approach could be performed. CONCLUSION: The combination of RVSA and BSA was the limiting factor for using the transxiphoid approach in congenital cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1983

Computed tomography of the normal sternum.

The normal CT anatomy of the sternum was studied in 35 patients. In addition to the normal appearance of the sternum, normal variants that may mimic disease were often noted. In the manubrium, part of the posterior cortical margin was unsharp and irregular in 34 of 35 patients. Part of the anterior cortical margin was indistinct in 20 of the 35 patients. Angulation of the CT gantry to a position more nearly perpendicular to the manubrium improved the definition of the cortical margins. The body of the sternum was ovoid to rectangular and usually had sharp cortical margins. Sections through the manubriosternal joint and xyphoid often demonstrated irregular mottled calcifications and indistinct margins again simulating bony lesions. The rib insertions, sternal clavicular joints, and adjacent soft-tissue appearance also were evaluated.

Adolescent↗
PubMed2000

Lack of a phenotype in transgenic mice aberrantly expressing COL2A1 mRNA because of highly selective post-transcriptional down-regulation.

We reported previously that a 1.9-kb 5'-fragment from the human COL1A1 gene drove transcription of a promoterless human COL2A1 gene in tissues of transgenic mice that normally express the COL1A1 but not the COL2A1 gene. In the present study, we have established that the aberrant transcription of the COL2A1 gene did not produce any gross or microscopic phenotype, because the transcripts were not efficiently translated in cells that do not normally express the COL2A1 gene. In two lines of transgenic mice, the mRNA levels from the transgene were 30% to 45% of the mRNA for the proalpha1(I) chain of type I procollagen, the most abundant mRNA in the same tissues. Analysis of collagens extracted from skin of the transgenic mice indicated that triple-helical type II collagen, with the normal pattern of cyanogen bromide peptides, was synthesized from the transgene. However, the level of type II collagen in skin was less than 2% of the level of type I collagen. Hybridization in situ indicated the presence of mRNA for both COL2A1 and COL1A1 in the same cells. Immunofluorescence staining for type II collagen, however, was negative in the same tissues. The results, therefore, indicated that many mesenchymal cells in the transgenic mice had high steady-state levels of the homologous mRNAs for type I and type II procollagen, but only the mRNAs for type I procollagen were efficiently translated.

Animals↗
PubMed1976

The angle of obesity: a simple measurement for body typing.

Measurements of the angle at the xiphisternal notch was taken in 143 school children between the ages of six and fifteen years, the average being eight. The children were graded as thin (T), normal with a tendency to be thin (NT), normal (N), normal tending to be fat (NF), and fat (F). This trading was by visual assessment. The average angle was found to be 90 degrees. Those with lesser than the average angle tended to be thin and those with greater than the average angle tended to be fat. The smaller angled were considered to have a larger thorax and smaller abdomen and vice versa for the larger angled children. The significance of these findings to various diseases is discussed and the significance of measuring this angle.

Adolescent↗
PubMed1999

Xyphoid MIDCAB: report of the technique and experience with a less invasive MIDCAB procedure.

BACKGROUND: Coronary bypass surgery on the beating heart has been in existence since the inception of coronary revascularization. The advent and evolution of the heart-lung machine and cardioplegia have greatly advanced and expanded the realm of bypass surgery, allowing surgeons to perform precise coronary anastomoses in a still field of the arrested heart. The minimally invasive direct coronary artery bypass (MIDCAB) has been used primarily for grafting the left internal mammary artery (LIMA) to left anterior descending artery (LAD) and is gaining acceptance as a less invasive option. Dr. Frederico Benetti in Argentina championed the resurgence of beating heart surgery in 1985, and pioneered the left anterior thoracotomy MIDCAB procedure, which he has further refined to a xiphoid approach. The xiphoid incision is a simpler, less painful approach than that through a left anterior thoracotomy. METHODS: An incision is made through the xiphoid and, if necessary, into the tip of the sternum allowing the left side of the chest to be elevated. The distal LIMA is identified and dissected proximally to about the third interspace to give enough distance for a tensionless anastomosis. The pericardium is opened and the heart positioned to expose the LAD. Local stabilization for the LAD is obtained and the LIMA-to-LAD anastomosis is performed. RESULTS: The xiphoid MIDCAB approach was used for LIMA-to-LAD anastomosis in ten patients ranging in age from 52 to 86 years (mean age 73 years). Three patients underwent angioplasty of additionally obstructed vessels (so-called hybrid procedures) following initial MIDCAB. Despite high preoperative-risk profiles and Parsonnet scores, there were no deaths. However, two of the three hybrid patients had major complications resulting in a prolonged hospital stay. CONCLUSIONS: Initial clinical experience with xiphoid MIDCAB proves it is a feasible alternative to intercostal MIDCAB with the possible advantages of reduced pain and chest wall complications. Further investigation into this surgical approach is warranted.

Aged↗