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[Use of the epimyocardial electrode by the subxyphoidal approach].
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Anterior gastric submucosal tumor.
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Perixiphoid extension of the midline incision.
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Detection of a small proteoglycan present in xiphoid cartilage regions submitted to different biomechanical forces.
1. The effect of biomechanical forces on large proteoglycans and collagen of cartilage has deserved intensive study, enhancing the importance of these molecules to support a better distribution of compressive forces especially in articular cartilage. In the present study, other extracellular matrix components, non-collagenous proteins and small proteoglycans, have been evaluated in terms of biomechanical tension. 2. Different parts of chicken xiphoid cartilage, lateral (R and L) and central (C) portions, which bear different biomechanical tensions, were analyzed. DEAE-cellulose chromatography profiles were similar for R and L portions. SDS-PAGE analyses revealed proteins of 29, 60 and 70 kDa for R and L. The 20- and 70-kDa proteins were not detected in the C portion while the 60-kDa protein was present at a high level. 3. The differences found between lateral (R and L) and central portions of the xiphoid cartilage may be related to the structure of the cartilage which bears higher tension forces than the lateral parts.
Operative correction of pectus excavatum using the right ventricle as a sternal support.
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Subxyphoid epicardial pacemakers: An alternative to the transvenous approach.
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Perixiphoid extension of the midline incision.
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The subxiphoid laparoscopic approach for resection of mediastinal parathyroid adenoma after successful localization with TC-99m-sestamibi radionuclide scan.
Primary hyperparathyroidism is caused by an ectopically located parathyroid adenoma in a small percentage of cases. Parathyroid adenomas located within the retrosternal area of the anterior mediastinum account for a large proportion of failed initial cervical explorations. Current surgical approach to these lesions is via median sternotomy, with the discomfort, hospitalization, and morbidity associated with a major thoracic operation. We report a new technique for the resection of these ectopic parathyroid adenomas after successful radiologic localization: a minimally invasive subxiphoid laparoscopic approach. The procedure was performed in a symptomatic patient with documented primary hyperparathyroidism who had failed three previous neck operations. The ectopic parathyroid adenoma was successfully resected endoscopically, with resolution of the hypercalcemia. The patient was discharged on the third postoperative day, avoiding completely the morbidity of a median sternotomy.
Successful early separation of a premature xipho-omphalopagus conjoined twins: a case report.
Premature xipho-omphalopagus conjoined twins were successfully separated at 7 days of age. The total body weight of the twins before separation was 3502 g. One twin had persistent patent ductus arteriosus and signs of cardiac failure at 4 days of age. This was managed with indomethacin. Thirty-six hours later the second twin became anuric, necessitating early emergency separation. The twins were joined from the lower sternum to the infraumbilical area. The liver was fused, but there was no major vascular connection. There were no other major anomalies. The babies stood the procedure well and were healthy at follow-up 8 months after separation.
[THE "XIPHOID APPENDIX-OCCIPITAL TUBEROSITY" RELATIONSHIP IN THE MORPHO-TYPOLOGICAL EVALUATION OF THE INDIVIDUAL].
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[Hernia of the xiphoid process].
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Heterotopic bone formation in abdominal incisions.
1. Heterotopic bone formation in abdominal scars is not as rare as the paucity of case reports in the literature would indicate. 2. Females comprised 21 percent of our patients. 3. The average age was fifty-five years. 4. The probable cause of this bone formation is injury to the xiphoid process above or the pubis below, with liberation of bone-forming cells into the wound. 5. Heterotopic bone usually remains permanently in the wound, but it can be absorbed and disappear, as was noted in one of our patients. 6. The bone should only be excised if it causes enough discomfort to warrant its removal. Careful removal should avoid recurrence. 7. In operations for intra-abdominal malignant lesions, bone formation should not be mistaken for recurrent malignant disease in the abdominal wall.
Runx1/AML1 hematopoietic transcription factor contributes to skeletal development in vivo.
The requirement of Runx2 (Cbfal/AML3), a runt homology domain transcription factor essential for bone formation and osteoblast differentiation, is well established. Although Runx2 is expressed in the developing embryo prior to ossification, yet in the absence of Runx2 initial formation of the skeleton is normal, suggesting a potential redundancy in function of Runx family members. Here we addressed expression of the hematopoietic family member Runx1 (AML1/Cbfa2) in relation to skeletal development using a LacZ knock-in mouse model (Runx1(lz/+)). The resulting fusion protein reflects Runx1 promoter activity in its native context. Our studies show that Runx1 is expressed by prechondrocytic tissue forming the cartilaginous anlagen in the embryo, resting zone chondrocytes, suture lines of the calvarium, and in periosteal and perichondral membranes of all bone. Runx1 continues to be expressed in these tissues in adult mice, but is absent in mature cartilage or mineralized bone. However, hyaline cartilage outside the bone environment (trachea, xiphoid tissues), and epithelium of many soft tissues (trachea, thyroid, lung, skin) also express Runx1. The robust expression of Runx1 in vivo in chondroblasts at sites of cartilage growth and in osteoblasts at sites of new bone formation, suggests that Runx1 expression may be related to osteochondroprogenitor cell differentiation. This observation is further supported by high expression of Runx1 in ex vivo cultures of marrow stromal cells and calvarial derived osteoblasts from Runx1(lz/+) mice. These data indicate that Runx1 may contribute to the early stages of skeletogenesis and continues to function in the progenitor cells of tissues that support bone formation in the adult.
Proteoglycans in bones of streptozotocin-induced diabetic rats.
Insulin seems to regulate the biosynthesis of proteoglycans in some tissues such as growth plate and glomeruli. The present investigation was undertaken to assess the ex vivo influence of insulin on proteoglycan metabolism in bones. Mandible and femur bones were used. Xiphoid cartilage was used as a control tissue of high glycosaminoglycan content. Diabetes was induced by 0.12 mg/g b.w. streptozotocin in male Sprague-Dawley rats, a number of which was treated with insulin (1 I.U./100 g b.w.) for 6 days. As compared with control animals, diabetic rats exhibited a decreased [35S]sulfate uptake as well as a shift to the right in Sephacryl S-500 chromatography. In addition, they showed lower density of proteoglycans in sucrose gradient and shorter glycosaminoglycan side chains in Sephadex G-200 chromatography. These changes were partly reversed by insulin.
[Vertebral and thoracic osteoarticular manifestations in palmoplantar pustulosis].
Two cases of inflammatory joint disease during attacks of aseptic palmo-plantar pustulosis are reported. Both patients had vertebral involvement: disco-vertebral erosions at several levels in one case and spondylitis and intersomatic ossification in the other. One patient also had sacroiliitis and involvement of the anterior thoracic skeleton (costoclavicular joints, costal cartilages ans xiphoid) confirmed by bone scintigraphy. The relation between this cutaneous-articular syndrome and other inflammatory joint diseases, especially ankylosing spondylitis and psoriatic arthropathy are discussed. The very unusual involvement of the anterior thoracic skeleton, the coexistence of aseptic palmo-plantar pustulosis and absence of antigens HLA B27, B13 and B17 suggest a similarity to the pustular osteoarthritis recently described by Japanese workers who grouped this condition with other spondylarthropathies.
Incisional abdominal hernia: the open mesh repair.
BACKGROUND: Mesh techniques are the methods of choice for the repair of incisional hernias since these are due to the formation of unstable scar tissue. METHODS: We review the materials and techniques used in the repair of incisional hernias. We describe in detail the operative technique performed in our clinic, the pitfalls of the repair, and the overlap behind the xiphoid and the pubic bone. RESULTS: Polypropylene is the material widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which are adjusted to the physiological requirements of the abdominal wall and permit a proper tissue integration. These meshes provide the possibility of forming a scar net instead of a stiff scar plate and therefore help to avoid former known mesh complications. CONCLUSIONS: The ideal position for the mesh is the retromuscular sublay position where the force of the abdominal pressure holds the prosthesis against the deep surface of the muscles. The lowest incidence rates of recurrence have been reported for the retromuscular sublay repair; even after long-term follow-up recurrence rates of 10% are possible. Attaining such good results requires an adequate size of the mesh with sufficient overlap of at least 5-6 cm in all directions. Open mesh repair using modern low-weight polypropylene meshes in the retromuscular sublay technique offers excellent results for the treatment of incisional hernias.