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PubMedDate not supplied

Normal pulmonary geometric changes due to respiration: evaluation with inspiratory and expiratory spiral CT.

RATIONALE AND OBJECTIVES: To investigate the pattern of physiological pulmonary geometric changes in the longitudinal direction due to respiration. MATERIALS AND METHODS: Spiral CT scans of the lung were obtained in 20 normal subjects at maximal inspiration and expiration, each with a table feed time of 10 mm/sec, collimation of 10 mm, and continuous sections of 5 mm in thickness. Utilizing the pulmonary vessels or bronchi as the reference points and comparing the points of these structures shown on the CT images taken at both respiratory phases, the distance of excursion in the longitudinal direction during respiration was examined. Excursion of pulmonary structures was examined from the upper edge of the manubrium to the top of the diaphragm in three lung zones in the coronal direction. RESULTS: A significant linear correlation between the distance from the upper edge of the manubrium to the structure and the distance of its excursion was found for all three lung zones (r = 0.84, p < 0.01 for the anterior zone; r = 0.89, p < 0.01 for the middle zone; r = 0.91, p < 0.01 for the posterior zone). The mean value of displacement in posterior zone was significantly greater (p < 0.01) than that in the middle zone, which was significantly greater (p < 0.01) than that in the anterior zone at each level. CONCLUSION: We have described the normal longitudinal displacement patterns of the pulmonary structures due to respiration. These findings may be applied to the diagnosis of pulmonary diseases.

Female↗
PubMed1979

Primary Ewing's sarcoma of the sternum: a case report.

A 12 1/2-year-old female presented with Ewing's sarcoma of the manubrium sterni which extended into the anterior mediastinum. At presentation there was no evidence of metastatic disease. Her initial treatment consisted of radiation therapy and chemotherapy. The residual tumor was subsequently resected and the sternal defect was repaired with Marlex mesh. Postoperatively, she was maintained on chemotherapy consisting of BCNU, cyclophosphamide, and adriamycin. The adriamycin was discontinued after she developed sterile fibrinous pericarditis. She remains free of her disease two years after diagnosis. Although extremely rare, Ewing's does occur in the sternum and this area is amenable to wide local resection without severe functional disability.

Bone Neoplasms↗
PubMed2005

Primary tubercular osteomyelitis of the sternum.

Tubercular involvement of the sternum, leading to osteomyelitis, is a rarely described entity even in countries where tuberculosis is endemic. Presentation in pediatric age group is even more uncommon. We describe a 12 year old girl who presented with a mass over the manubruim sterni and fever. CT chest demonstrated a soft tissue mass in the anterior mediastinum, eroding the cortex of the manubrium. Tubercular etiology was suggested by presence of epithelioid granulomas and acid fast bacilli in the Ziehl-Neelsen staining of the aspirate from the lesion. The patient responded well to antitubercular treatment.

Antitubercular Agents↗
PubMed2001

[Manubriosternal dislocation caused by indirect flexion-compression trauma. A case report and review of the literature].

Manubriosternal dislocation caused by indirect flexion-compression trauma is an extremely rare condition. Two forms of manubriosternal luxation are distinguished: in type I the sternum is dislocated posterior and in type II anterior to the manubrium. Direct or indirect trauma may cause manubriosternal dislocation. Mode of injury in direct trauma is mostly a head-on collition in a motor accident resulting either in type I or type II luxation. The unusual origin of manubriosternal dislocation by indirect trauma is put down to flexion-compression injuries of the thoracic spine and results in a type II dislocation. Predisposition to manubriosternal dislocation by indirect trauma consists in rheumatoid arthritis or extreme forms of kyphosis. Outcome of many patients treated conservatively after initial reposition with adhesive tape, symptomatic pain therapy, cryotherapy and prohibition of any physical training over several weeks is subluxation or complete luxation of the manubriosternal joint. This condition may lead to chronic pain, periarticular calcification with ankylosis and progredient deformation. Lacking a controlled study for treatment of manubriosternal dislocation a standard therapeutic regime could not be established yet. In the literature only a few case-reports of patients undergoing operative therapy are published. We report a type II dislocation of the manubriosternal joint caused by indirect flexion-compression trauma. We achieved a very good long-term result using a 8-hole 1/3 tubular plate for fixation of the manubriosternal joint after reposition.

Adult↗
PubMed2003

[Chronic recurrent multifocal osteomyelitis].

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, inflammatory, skeletal disease of unknown origin, which mainly affects children and adolescents in terms of cleido-spondylo-metaphysal skeletal inflammation. Only 10% of the patients are older than 20 years. To date, only about 200 cases have been reported in the literature. In the course of the disease, the initial radiological signs are osteolysis followed by sclerosis and hyperostosis in the end stage. The histological investigations reveal chronic inflammatory infiltrates with lymphocytes and hyperostosis. Although the prognosis of CRMO, to our current understanding, is self limiting, serious complications have been reported such as pathological fractures and compression fractures of the spine. A recently recommended therapy scheme is based on the administration of azithromycin combined with calcitonin. We present the case of a 25 year old female patient who has suffered from CRMO for 1.5 years with the cervical spine and the manubrium sterni being affected. The current state of diagnosis, therapy, and prognostic outlook of this rare disease are discussed.

Adult↗
PubMed2006

Traumatic manubriosternal dislocation.

Manubriosternal dislocation is an extremely rare occurrence, especially as the result of an indirect compression injury. Manubriosternal dislocations are divided into two types: In a Type I dislocation, the body of the sternum is displaced in a dorsal direction; in Type II dislocation, the body is displaced to the ventral side of the manubrium. A manubriosternal dislocation may be caused by direct or indirect trauma. Direct injury is generally a collision injury occurring in the context of a road accident. Resulting may be in either a Type I or Type II dislocation. Indirect trauma always leads to a Type II dislocation due to a flexion-compression mechanism in the region of the spine. Rheumatic arthritis and obvious kyphosis are predisposing factors in manubriosternal dislocation due to the indirect compression injury. Non-operative treatments after reduction, e.g. correction tape or plaster bandage, symptomatic pain treatment, application of ice, and several weeks without sports, are associated with a not inconsiderable rate of subluxations or reluxations, especially due to insufficient patient compliance. These disorders can lead to chronic pain, periarticular calcification with ankylosis, and progressive deformity. It has not been possible to establish an optimal, standardized operative procedure so far because of the small number of cases. We have achieved very good, postoperative long-term outcomes after plate osteosynthesis of manubriosternal dislocations in two patients.

Accidental Falls↗
PubMed2001

The anatomy of the nervous system of the hydrozoan jellyfish, Polyorchis penicillatus, as revealed by a monoclonal antibody.

Dissociated cells from the margin and tentacles of the hydromedusa Polyorchis penicillatus were centrifuged in a Percoll gradient to remove cnidocytes. The resulting formaldehyde-fixed cells were used to inoculate mice to produce monoclonal antibodies. One of the hybridomas, which secreted antibodies against all neurons, was cloned and designated as mAb 5C6. Immunohistochemical labelling with mAb 5C6 of whole-mount preparations and paraffin sections provided a far more complete picture of the organisation of the hydromedusan nervous system than was previously available when using neuronal labelling techniques that restrict labelling to certain neuronal types. Besides confirming anatomical features described in earlier studies these techniques allowed us to discover a number of new structures and to determine connections that were only suspected. Such findings included:1. The discovery of an arch-like connection between the swimming motor neuron network at the apices of the subumbrellar muscle sheets 2. An orthogonal network connecting each pair of radial nerves in each radius 3. Continuity of a central branch of the radial nerve with the radial innervation of the manubrium 4. Details of the sensory neuronal contribution to the microanatomy of the ocelli and cnidocyte batteries 5. Presence of specialised receptor cells in the margin at the bases of tentacles 6. Neurons apparently innervating the radial muscles of the velum 7. Isolated neurons in the peduncle and gonads

Animals↗
PubMed1991

Human tympanic membrane deformation under static pressure.

The effect of static pressures in the range of plus and minus 1.6 kPa on the shape of tympanic membrane is measured using a non-contacting optical technique on a fresh human temporal bone. Full field data of the deformation are presented as well as cross-sections along two major directions. Strong asymmetry between medial and lateral movements is demonstrated. The displacement of the umbo is compared to other work. The rotation angle of the manubrium in function of pressure is calculated and also compared to other work. It is demonstrated that the rotation angels can not account for the measured movement of the umbo, which leads to the conclusion that for static high pressure levels the classical hypothesis of rotation around a fixed axis has to be abandoned. The comparison with data of TM displacement under dynamic stimuli is discussed.

Adult↗
PubMed1991

Malleus vibration mode changes with frequency.

The mode of vibration of the cat manubrium is investigated by measuring its vibration in response to sound stimulus at four locations between the umbo and the processus lateralis with a heterodyne interferometer. The determination of mode requires high precision in measurement because amplitude differences between the points are small (about 20% at low audio-frequencies). Changes in the frequency response with time have been reported in an earlier paper. The nature and magnitude of this time change is analysed in detail: over a period of 1 h the average change in amplitude is about 5% and in phase 5 degrees. The malleus vibration at some frequencies is purely translational, it is rotational at others and mixed at most frequencies. When the motion is rotational the position of the axis of rotation shifts with frequency, the shifts are so large that the axis can lie near the umbo so that amplitudes at the processus lateralis are larger than at the umbo. The classical concept of the malleus rotating around a fixed axis running from the anterior mallar to the posterior incudal ligament fits our measurements only at low frequencies.

Animals↗
PubMed1994

Modelling the malleus vibration as a rigid body motion with one rotational and one translational degree of freedom.

Vibration of a set of points distributed along the manubrium of cat was measured with a heterodyne interferometer in response to sinusoidal acoustic signals. The observed motion did not fit pure rotation of the malleus around a fixed axis coinciding with the anterior mallar and posterior incudal ligament as is classically assumed. As a first approximation a model of motion consisting of a rotational and a translational component was used. At low frequencies the rotation is mostly predominant, but the situation may be entirely reversed at mid and high frequencies. The presence of a translation besides rotation was also found at some frequencies in the motion of the human malleus.

Acoustic Stimulation↗
PubMed2005

Early sternal erosion and luetic aneurysms of thoracic aorta: report of 6 cases and analysis of cause-effect relationship.

Six patients with luetic aneurysm of the ascending aorta eroding the sternum are presented. The erosion was an early and principal presentation and the site of erosion and location and morphology of aneurysm were identical in all six patients. The erosion mainly affected the right half of the manubrium and medial end of right clavicle. The aneurysms arose from the junction of the ascending and transverse arches of the thoracic aorta and had narrow opening close to the origin of the innominate artery. The identical presentation, aetiology, angiographic location and morphology, corroborated further at surgery, suggests that syphilitic aneurysms in this location have a strong tendency to cause early sternal erosion.

Adult↗
PubMed2006

Penetration of moxifloxacin into sternal bone of patients undergoing routine cardiopulmonary bypass surgery.

This study investigated plasma and bone concentrations of moxifloxacin following a single intravenous dose of 400mg to consider its potential role in the treatment of osteomyelitis. Eight patients who underwent routine cardiopulmonary bypass surgery were enrolled in the study. Plasma and bone samples were collected 2h and 5h after the end of infusion. High performance liquid chromatography was used for the determination of moxifloxacin concentrations. Mean plasma concentrations were 3.36 microg/mL and 2.93 microg/mL at 2h and 5h after the end of infusion. The concentrations in the body and manubrium of the sternal bone were 1.65 microg/g and 1.64 microg/g at 2h and 1.4 microg/g and 1.45 microg/g at 5h, respectively. Moxifloxacin showed good penetration into bone and could be considered for the treatment of osteomyelitis.

Aged↗
PubMed2000

Pneumothorax necessitans presenting as a presternal pneumothoracocele.

A 31-year-old woman who is an intravenous drug abuser developed sternoclavicular joint infection with mediastinal and subcutaneous tissue abscesses that communicated through an erosion in the manubrium caused by osteomyelitis. Air entrapment from a subsequent apical pneumothorax formed a localized anterior "pneumothoracocele." We referred to this condition as "pneumothorax necessitans," and we suggest including it in the differential diagnosis of anterior chest wall masses.

Abscess↗
PubMed1996

Primary sternal tuberculosis treated by resection and reconstruction.

We report a case of primary mycobacterial sternal infection. An 81-year-old man with an infected parasternal sinus of non-specific pathology was treated with antibiotics for four months with only palliative effect. On hospital admission CT scan showed thickened first and second intercostal spaces and chest wall, but no bone involvement. At operation, the manubrium was found to be infected also. This was excised with the first three ribs anteriorly. Histology showed caseating granulomata. No other tuberculous foci were found in the patient.

Aged↗
PubMed1996

Changes in thoracic dimensions induced by breathing movements in fetal sheep.

The dimensions of the three major axes of the thorax (longitudinal, transverse and antero-posterior) were monitored in utero from the ultrasonic transit-time between pairs of piezo-electric transducers chronically implanted at opposite sides of the thorax in five fetal sheep at 119-122 days of gestation; tracheal and vascular catheters and diaphragmatic EMG electrodes were also implanted. To measure thoracic length, ultrasound transducers were implanted on the diaphragm and over the upper sternum and manubrium sterni. A pair was implanted on opposite sides of the chest to measure thoracic width, and another pair was implanted over the lower thoracic spine and lower sternum (antero-posterior dimension). The width of the thorax either decreased (mean 0.6 +/- 0.2 mm) or increased (mean 0.7 +/- 0.1 mm) during fetal breathing movements (FBM). The depth of the thorax (antero-posterior dimension) usually decreased (mean 0.9 +/- 0.1 mm) during FBM. The distance between the upper sternum and the diaphragm decreased by 1.0 +/- 0.1 mm (left side) and 1.6 +/- 0.3 mm (right side) during inspiratory efforts. The distance between the upper thorax and a fixed point on the lower thoracic spine decreased by a similar amount. Overall, fetal thoracic dimensions changed by 1-3%. The largest changes measured, and the most surprising, were reductions, rather than increases, in the separation between the dome of the diaphragm and the upper thorax; this suggests that, during inspiratory efforts, the upper thorax moves caudally by a greater distance than the diaphragm. FBM induce complex and variable changes in thoracic dimensions; these are likely to induce small alterations in the shape of the lungs that may act as a stimulus to lung growth.

Animals↗
PubMed1982

Unusual personal identification with characteristic features in chest roentgenograms.

This case illustrates the unexpected aspects of radiographic personal identification. A skeletonized body without the neck and head, upper extremities, and feet was discovered on a seashore. No positive results were obtained from the remains concerning either the cause of death, the manner of death, or precise identification of the body. Roentgenologic examinations of the remains revealed a marked eminence of the manubrium sterni with characteristic crossing shadows. A successful partial superimposition of the ante- and postmortem lateral chest x-ray films helped to place the personal identification as that of a fisherman, 58 years old, missing in the sea for 21 days.

Forensic Medicine↗
PubMed1994

Traumatic manubriosternal joint disruption: case report.

A manubriosternal separation was found in a 27-year-old man after a blunt chest trauma. The manubrium and body of the sternum were separated by a gap of 3 cm. Surgical reduction and fixation were performed with good results.

Adult↗