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At least 955 records · Page 53Linked to original sources
PubMed1999

Low risk of locoregional recurrence of primary breast carcinoma after treatment with a modification of the Halsted radical mastectomy and selective use of radiotherapy.

BACKGROUND: The purpose of the current study was to evaluate the locoregional recurrence rate after treatment of patients with operable breast carcinoma with a modification of the Halsted radical mastectomy and the selective use of radiotherapy and to identify risk factors for locoregional recurrence. METHODS: Between 1979-1987, 691 consecutive patients underwent mastectomy after a negative biopsy of the axillary apical lymph nodes. The median age of the patients was 59 years (range, 26-89 years). The clinical tumor size was < 2 cm in 72 patients, 2-5 cm in 387 patients, and >5 cm in 169 patients; 16 patients had a T4 tumor. Surgery was comprised of a modification of the Halsted radical mastectomy, including at least part of the pectoralis major muscle and the entire pectoralis minor muscle, in 573 patients; 303 patients had positive axillary lymph nodes. Adjuvant radiotherapy to the chest wall and regional lymph nodes was given to 74 patients, whereas an additional 414 patients underwent irradiation to the internal mammary and medial supraclavicular lymph nodes. The median follow-up was 91 months. RESULTS: The actuarial overall survival rate was 82% at 5 years and 63% at 10 years. The 10-year chest wall and regional lymph node control rates, including patients with prior distant failures, were 95% and 94%, respectively. The only two significant prognostic factors for locoregional recurrence on multivariate analysis were lymph node status and pathologic tumor size. CONCLUSIONS: Excellent locoregional control can be achieved with a modified technique of radical mastectomy in patients with negative apical biopsy and the selective use of comprehensive radiotherapy. These results may serve as a reference outcome for comparison with other locoregional treatment strategies.

Adult↗
PubMed2000

Poland's syndrome.

Poland's syndrome is characterized by hypoplasia or absence of the breast or nipple, hypoplasia of subcutaneous tissue, absence of the costosternal portion of the pectoralis major muscle, absence of the pectoralis minor muscle, and absence of costal cartilages or ribs 2, 3, and 4 or 3, 4, and 5. Clinical manifestations of Poland's syndrome are extremely variable and rarely are all the features recognized in one individual. Depending on the physician's specialty and the referral pattern, a variable incidence of the anomalous defects is recognized. Syndactyly or bony abnormalities of the forearm are seldom treated by thoracic surgeons.

Diagnosis, Differential↗
PubMed1983

Intrathoracic transposition of extrathoracic skeletal muscle.

During the past 6 years, 31 patients (20 males and 11 females) underwent 45 intrathoracic muscle transpositions of extrathoracic skeletal muscle. Eleven patients had postpneumonectomy empyema, 11 had bronchopleural fistula, four had infection of the heart and great vessels, three had reinforcement of tracheal anastomoses, and two had perforation of the gastrointestinal tract. Life-threatening infection was present in 28 patients. Ages ranged from 16 to 80 years, with a mean of 58.1. The latissimus dorsi muscle was transposed in 18 patients, pectoralis major muscle in 15, serratus anterior muscle in eight, pectoralis minor muscle in three, and rectus abdominis muscle in one. Twelve patients had multiple muscle transpositions (six concurrently and six staged). Operative mortality was 12.9% (four patients). Follow-up of the 27 operative survivors ranged from 3 to 72 months with a mean of 17.3. Twenty-four patients had no further signs or symptoms of the original infection. All had a closed chest. Long-term survivors included 73% of patients with postpneumonectomy empyema, 64% of patients with bronchopleural fistulas, and 50% of patients with infections of the heart and great vessels. We conclude that intrathoracic transposition of an extrathoracic skeletal muscle is an excellent method of treatment for persistent, life-threatening intrathoracic infection.

Adolescent↗
PubMed1988

DNA, RNA and total protein content of leg and breast muscles of White Rock chickens selected for 56-day body weight.

Pectoralis and gastrocnemius muscles from White Rock chickens divergently selected for 29 generations for high or low 56-day body weight were analyzed for DNA, RNA and protein (mg/g) content at 12 ages between hatch and 273 days of age. Dimorphism between lines was maximum at day 18 for both muscle types and then declined with age. High-line chickens generally deposited relatively more muscle tissue than those from the low line. Although nonadditive genetic variation was evident for absolute muscle weights, it was more frequent for muscle weight relative to body weight. For both muscle types, DNA unit number, as measured by DNA content (mg/g), was larger for the high line than the low immediately after hatch and smaller in the high than in the low line from day 10 to 56 after which lines were similar. RNA and protein/g muscle were similar for both lines at most ages. Between days 4 and 56, a period of rapid muscle growth, DNA unit size (protein/DNA) of both muscle types was larger in the high than in the low line. Heterosis was positive for protein, DNA unit number and size, and negative for RNA content. While weight of pectoralis muscle was similar to that of one gastrocnemius muscle on day 1, by day 273 its weight was over 3-fold greater. DNA unit number was higher in pectoralis than gastrocnemius muscle from hatch to day 4, similar on days 7 and 10 and lower for pectoralis muscle beyond day 10. RNA content was similar at all ages except 4, 7 and 10 days. DNA unit size followed the same pattern as DNA unit number; however, greater nuclei number at hatch for the high line corresponded with low DNA unit size. This pattern suggests a higher rate of cellular filling for pectoralis than gastrocnemius muscle.

Aging↗
PubMed1991

The subpectoral pocket: the preferred implant site for pediatric pacemakers.

Implantation technique for pediatric pacemaking has evolved from predominantly epicardial to predominantly endocardial. One of the potential problems with endocardial pacing in children is their very thin subcutaneous tissue, which can result in an unpleasant cosmetic result. The superficialness of the pacemaker pulse generator also may render it more susceptible to erosion and infection. A series is presented of pediatric patients who underwent implantation of a transvenous bipolar pacing system in the pediatric catheterization laboratory. The pacemaker was implanted under the pectoralis major muscle after a muscle spreading incision was made. The lead was also introduced into the subclavian vein under the pectoralis muscle. No complications resulted, and the cosmetic result was judged to be good to excellent by the parents and physicians. No infections or erosions occurred. The subpectoral pocket is recommended as the preferred site for implantation of transvenous pacemakers in pediatric patients.

Adolescent↗
PubMed2003

Effect of selection for growth rate on muscle damage during turkey breast muscle development.

Damage to the turkey pectoralis major muscle was studied in a randombred control line (RBC2), a subline (F) from the RBC2 line selected long-term for increased 16-wk BW only, and a commercial sire line (B) at 25 d of incubation and at 1, 4, 8, 16, and 20 wk posthatch. Pectoralis major muscle samples were obtained from three females and three males from each line in a manner to avoid contraction. After being fixed and sectioned, the muscle samples were stained with hematoxylin and eosin to view muscle fiber and muscle fiber bundle morphology. Beginning at 8 wk posthatch, differences in muscle fiber morphology were observed among the different lines. The RBC2 line throughout the duration of the study maintained well-organized muscle fibers and muscle fiber bundles with large capillary networks. In contrast, the growth-selected F line began to show muscle fiber degeneration at 8 wk posthatch, and limited capillary beds were observed as development proceeded. The B line had intermediate muscle morphology between the RBC2 and F lines, but by 20 wk posthatch significant muscle fiber degeneration was present with limited capillary supply. The degenerative muscle fiber changes were predominant in the growth-selected F-line, suggesting that growth selection for just BW may be associated with posthatch muscle damage.

Aging↗
PubMed1981

Contralateral effects of upper extremity proprioceptive neuromuscular facilitation patterns.

Electromyography was used to determine the presence of electrical activity in the nonexercised latissimus dorsi, infraspinatus, and pectoralis major muscles while the contralateral limb underwent the proprioceptive neuromuscular facilitation pattern of flexion, abduction, external rotation with elbow straight and extension, adduction, internal rotation with elbow straight. Activity was present in all of these muscles during both components of the pattern. There was no significant difference in activity for the pectoralis major muscle during the flexor as compared to extensor component. The infraspinatus was more active during the flexor component, while the latissimus dorsi was more active during the extensor component. These results could be used in planning a treatment program for patients who are unable to exercise one of their upper extremities and who could benefit from the contralateral effects of upper extremity proprioceptive neuromuscular facilitation patterns.

Adult↗
PubMedDate not supplied

Parenteral branched-chain amino acid treatment and avian dystrophy.

Genetically homozygous line 413 dystrophic chickens were given twice-daily intraperitoneal injections of solutions containing branched-chain amino acids (BCCA-leucine, valine, isoleucine) either alone or in combination; and their alpha-ketoacid analogs (alpha-ketoisocaproic and alpha-ketoisovaleric acids). Another trial consisted of an amino acid mixture containing BCAA. Amino acid supplementation in each case significantly prolonged righting ability measured regularly by a standardized flip-test procedure. Enhanced functional ability was not generally accompanied by a decrease in plasma creatine kinase activity. However, a measurable increase in the affected pectoralis major muscle mass and protein content (female chickens in particular) was found with BCAA therapy. Moreover, the increase in muscle bulk was attended in some cases by a reduction in the relative number of degenerating fibers quantitated microscopically. Contrariwise, the amino acid mixture caused a reduction in pectoralis muscle mass. It is concluded that parenteral BCAA therapy offers limited benefit in retarding dystrophic symptoms in the chickens.

Amino Acids↗
PubMed1999

Postmortem pH, myofibrillar fragmentation, and calpain activity in Pectoralis from electrically stimulated and muscle tensioned broiler carcasses.

Broiler carcasses were conventionally processed or were electrically stimulated (ES) and had their Pectoralis muscles tensioned during rigor mortis development (ES/MT) to evaluate the relationship between the course of postmortem muscle pH decline and myofibrillar fragmentation. Samples from Pectoralis fillets harvested at 0, 0.5, 1, 2, and 24 h postmortem were analyzed for pH, myofibrillar fragmentation index, and calpain activity. The ES/MT treatment resulted in a more rapid pH decline and less myofibrillar fragmentation at all postmortem times sampled than conventional processing. Two distinct periods of fragmentation were noted for samples from both conventionally processed and ES/MT carcasses. These results agreed with the previous studies that this ES/MT treatment accelerated the normal postmortem pH decline, inhibited calpain activity, and thereby prevented postmortem proteolysis occurring during meat aging.

Animals↗
PubMed1988

Identification of motor neurons for accessory muscles of inspiration and expiration, pectoralis, trapezius and external oblique: comparison with non-respiratory skeletal muscle.

The motor neurons for the accessory muscles of respiration, pectoralis, trapezius, external oblique, and the rectus abdominis were studied in the spinal cord. The objective was to determine if the localization and morphology of the motor neurons for these muscles bear any distinct relationship to the specialized function of these muscles, serving both as supportive skeletal muscles and as accessory respiratory muscles. In addition, it was of interest to know if the inspiratory role of the pectoralis and trapezius muscles and the expiratory role of the external oblique and rectus abdominis are related to the spatial organization of the motor neurons; this knowledge may be important in the discrimination of influences from afferent connections. The motor neurons for these muscles were retrogradely labeled with true blue and were compared with the triceps motor neurons. All neurons occurred ipsilateral and most labeling occurred in C6-7. The motor neurons for the accessory muscles were mainly confined to the ventrolateral tip of the ventral gray matter. The triceps neurons were dorsolateral to the respiratory related neurons in C6-7. Within the confines of the ventrolateral area, the majority of neurons for the pectoralis were localized medial to ventromedial, those for the trapezius were ventrolateral, and those for the external oblique were in the extreme ventrolateral to ventral sections of C7. No neurons were observed in C2 to T2 for the rectus abdominis. A second neuronal column occurred medioventrally in the ventral gray of C4-6 for the trapezius, and is distinct and separated from the C6-7 cell column.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1975

Modified radical mastectomy.

This report describes our experience with a technique of modified radical mastectomy involving incision of the lower lateral fibers of the pectoralis major muscle and detachment of the origins of the pectoralis minor muscle. These maneuvers enable sufficient retraction of these muscles to provide excellent axillary exposure while minimizing the danger of traction injury to the neurovascular structures supplying these muscles. The operation has been performed in 20 patients; statistical analysis demonstrates at least as many nodes in these specimens compared to retrospective analysis of nodes recovered from 223 radical mastectomy specimens done during the previous 5 years. The final cosmetic results are superior to those obtained with standard radical mastectomy. These results suggest that this method of modified radical mastectomy should be considered, unless the proximity of the disease to the pectoralis muscles endangers the adequacy of the surgical margins.

Breast Neoplasms↗
PubMed1989

Pectoralis minor: a unique muscle for correction of facial palsy.

The author introduced this muscle for the first time almost a decade ago, and this is the first extensive description of the intricate microanatomy of this complex but unique microneurovascular muscle unit. Advantages and disadvantages and indications and contraindications for its use in facial paralysis are presented in detail from an extensive clinical experience of almost 50 such microneurovascular transfers. Pitfalls that the reconstructive microsurgeon should beware and strengths in using this muscle for facial palsy are highlighted. The detailed operative approach is presented, with promise of undetectable scars and minimal functional loss. The strategies for how to inset this muscle unit in the new recipient site are given, along with the thought processes involved in selecting the actual sites of anchoring the muscle to reproduce a mirror image of the contralateral normal face. Finally, an exemplary clinical case demonstrating the use of the pectoralis minor muscle for both eye and lower face reanimation is presented in detail, demonstrating the dual nerve supply and the resulting independent eye and smile movements with total lack of mass action and/or synkinesis. Restorations of eye blink and of a symmetrical and coordinated smile are the frequent rewards of using this unique muscle for the correction of facial palsy.

Child↗
PubMed2005

Sonographic findings of pectoralis major tears with surgical, clinical, and magnetic resonance imaging correlation in 6 patients.

OBJECTIVE: The purpose of this research was to describe the sonographic findings of pectoralis major injuries with clinical, surgical, and magnetic resonance imaging (MRI) correlation. METHODS: Images from sonographic examinations of the pectoralis major muscle of 6 patients were retrospectively evaluated and characterized. The sonographic findings were compared with clinical, surgical, and MRI findings. RESULTS: The 6 patients were male (mean age, 30 years) with injuries sustained during weight lifting, football, and shotgun firing. Two of the 6 patients had MRI correlation; 1 had surgical correlation; 2 had both surgical and MRI correlation; and 1 had clinical follow-up. The sternal head was injured in 5 patients; 4 involved the musculotendinous junction, and 1 involved the distal tendon. The sonographic findings of muscle fiber retraction and surrounding hemorrhage allowed identification of the affected muscle. Direct impact injury causing hematoma involved the clavicular head in 1 patient. In total, 5 cases were partial-thickness pectoralis major tears, whereas complete distal tendon disruption was found in 1. CONCLUSIONS: Sonographic imaging longitudinal to the pectoralis muscle fibers showed fiber disruption, retraction, and possible hypoechoic or anechoic hematoma, most commonly involving the musculotendinous junction of the sternal head. Distal tendon assessment is important to evaluate for a full-thickness pectoralis major tear.

Adolescent↗
PubMed1981

The importance of the anterior thoracic nerves in modified radical mastectomy.

The medial anterior thoracic nerve supplies the pectoralis minor muscle and costal portion of the pectoralis major muscle. The lateral anterior thoracic nerve supplies the clavicular head and separately, three muscle groups of the sternal head. Any combination of these different muscle groups will become atrophic if the branches of the anterior thoracic nerves are injured. Muscle atrophy of the various groups of muscle bundles may not be apparent for as long as one year after the operation. These observations may be of some importance in the plastic reconstruction after modified radical mastectomy.

Atrophy↗
PubMed1983

Limited benefit to genetically dystrophic chickens from a synthetic proteinase inhibitor: Ep475.

Chickens with inherited muscular dystrophy (Line 413) were treated in two separate trials with daily intraperitoneal injections of 10% DMSO-water solutions containing the proteinase inhibitors, Ep475 and E64. Drug therapy in each case significantly prolonged the functional ability of the treated chickens. Diluent control chickens around day 35 ex ovo characteristically reached a maximum ability to right from the supine position in a standardized functional test for muscle weakness. Subsequently, the control chickens were found to decline progressively in their ability to right. Treatment with the proteinase inhibitors had no effect on the typically elevated levels of plasma creatine kinase activity. In a histological analysis of the affected pectoralis major muscle, drug treatment had no effect on the relative distribution of degenerating, and vacuolated fibers, inflammatory cells, and abnormal fiber diameters. An exception was seen in decreased necrotic fibers of chickens treated with high doses of Ep475. Moreover, both inhibitors had positive effects on two biochemical abnormalities common to the dystrophic pectoralis muscle: increase in noncollagen protein, and reduction in total calcium.

Animals↗
PubMed1996

EMG analysis of shoulder positioning in testing and strengthening the supraspinatus.

We examined the electromyographic (EMG) activity of the supraspinatus and other rotator cuff muscles, the three portions of the deltoid muscle, and the pectoralis major muscle in two previously suggested positions for isolating the supraspinatus. The position suggested by Jobe and colleagues is with the elbow extended, the shoulder in full internal rotation, and the arm in the scapular plane. Blackburn and colleagues recommended the prone position, with the elbow extended and the arm abducted to 100 degrees and externally rotated. Fine-wire EMG activity was obtained from the rotator cuff muscles and surface EMG from the other muscles in 17 subjects tested in these two positions. Both positions resulted in significant activity of the supraspinatus, but the difference between these two positions was not statistically significant. The Jobe position produced greater activation of the anterior deltoid and pectoralis major, whereas the Blackburn position caused greater activation of the posterior deltoid. Both positions produced significant activation of the middle deltoid. We conclude that either position can be used to strengthen the supraspinatus; however, neither position selectively isolates the supraspinatus during manual muscle testing.

Adult↗