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Extended parasternal approach for aortic and tricuspid valve surgery.

We report an extended parasternal approach to aortic and tricuspid valves used in a 31-year-old man. The patient presented with a deformed sternum and severe adhesion between the sternum and right ventricular outflow tract, caused by postoperative mediastinitis, which lasted for 4 years after a radical operation for tetralogy of Fallot during his childhood. The extended parasternal approach provided a safe and excellent exposure of both aortic and tricuspid valves without postoperative chest wall instability.

A comparison of instrumentation methods to estimate thoracolumbar motion in field-based occupational studies.

The performance of an inertial measurement unit (IMU) system for directly measuring thoracolumbar trunk motion was compared to that of the Lumbar Motion Monitor (LMM). Thirty-six male participants completed a simulated material handling task with both systems deployed simultaneously. Estimates of thoracolumbar trunk motion obtained with the IMU system were processed using five common methods for estimating trunk motion characteristics. Results of measurements obtained from IMUs secured to the sternum and pelvis had smaller root-mean-square differences and mean bias estimates in comparison to r…

Allogenic sternal transplant after sternectomy for metastasis of ovarian carcinoma.

Sternal metastasis from ovarian carcinoma is extremely rare. We report a case of a young woman in whom a single metastasis at the level of the upper portion of the sternum developed. Surgical excision of the sternum was performed with replacement by a sternal allograft stabilized by titanium plates and transosseous high-tension sutures. With this simple and reproducible technique, we obtained a stable and dynamic reconstruction of the sternoclavicular joints and shoulder girdle. The use of a sternal allograft provides excellent functional and cosmetic results. The implantation technique is sim…

Sternal reconstruction for unusual chondrosarcoma: innovative technique.

The authors report a clinical case of a primary sternal chondrosarcoma, presented as a mass in the anterior mediastinum. The patient was treated with subtotal sternectomy and sternal transplantation followed by radiotherapy. Twelve months after surgery, the patient is in good clinical condition, without any sign of tumor relapse and with normal respiratory mechanics. Primary malignant tumors of the sternum are uncommon and a presentation mimicking thymoma is rare and unreported. The stermal replacement with a cryopreserved allograft sternum is an innovative technique that overcomes the problem…

Pneumatic stabilization of iatrogenic flail chest with CPAP: a case report.

Iatrogenic flail chest following resection of part of the chest wall in postoperative patients is a challenging scenario for the anesthetist. It can lead to long term morbidity and even death, if adequate management is not instituted. We describe the management of postoperative flail chest, following resection of upper two-third of the sternum along with costal cartilages for a malignant thymoma invading the sternum in an adult male with the use of continuous epidural analgesia and continuous positive airway pressure (CPAP), which provided pneumatic stabilization and an excellent recovery.

[Anomalies of the chest (author's transl)].

Presentation of the most important deformities of the thorax, with reference to personal experience and reports from the literature. Next to deformities of the rib-cage, anomalies of the sternum have a prominent place. The principal anomalies of the sternum are the funnel chest and pigeon breast. Neither carries a clear indication for operation. Numerous operative techniques make a comparison of post-op. results difficult. It seems definite that the final results are the same, whether or not the procedure calls for the use of metal prostheses. The degree of success lies between 80-90%.

Множественная классификация склерозов с использованием местного экспонента дивергенции: выбор параметров для государственной космической реконструкции.

СПРАВОЧНАЯ ИНФОРМАЦИЯ: С использованием местных дифференцирующих факторов (LDE) был сделан вывод о том, что у людей с множественным склерозом (PwMS) не обеспечивается стабильность ходьбы. Однако использование нескольких методов расчета препятствует проведению сопоставлений между различными исследованиями. Мы стремились определить, влияет ли использование различных параметров для государственной космической реконструкции при расчете LDE на классификацию PwMS. В общей сложности 55 пwMS и 23 механизма управления прошли вверх и вниз по коридору протяженностью 20 м в течение 5 минут. ЛДВ рассчитыва

Совпадение в аннотации оригинала
BACKGROUND: Using the local divergence exponent (LDE), it has been concluded that walking stability is impaired in people with multiple scle … (ML), and anteroposterior (AP) accelerations, the norm (N), and 3D data from sensors placed on the sternum and lumbar. Classification accuracy across results obtained with different parameter combinations was compared using a Quadratic Discriminant Analysis (QDA). RESULTS: The best classification accuracy, 84%, was achieved when using the LDE obtained w …

Accuracy of enhanced transcutaneous bilirubinometry according to various measurement sites.

OBJECTIVE: The goal of the study was to provide missing data on the accuracy of enhanced transcutaneous bilirubinometry in a monoracial popu … transcutaneous bilirubin was significant (coefficient of determination R2: 0.9045 forehead, 0.8808 sternum, 0.8467 abdomen). Transcutaneous measurements underestimated serum bilirubin levels significantly when total serum bilirubin values were higher than 15 mg/dL, irrespective of the site of transcutaneous measurements. The lowest mean difference betwee …

MRI findings of prolonged post-traumatic sternal pain.

OBJECTIVE: The objective of this study was to characterize the different causes of prolonged sternal pain following thoracic trauma with involvement of the sternum and to define criteria for sternal nonunion diagnosis using MRI. DESIGN AND PATIENTS: Five patients with abnormalities of the sternum were evaluated for prolonged sternal pain following thoracic trauma using MRI. MR images were evaluated by two radiologists in consensus. The patients were selected from the radiology database, which included 8 patients with post-traumatic prolonged sternal pain. RESULTS: Two patients (n = 2) reveal…

Anterior approach to the second thoracic vertebral body for surgical treatment (vertebrectomy, bone grafting, and titanium alloy plate fixation).

The surgical approach to the second thoracic vertebral body is difficult from the anterior side. A 38-year-old woman suffering from plasmacy … m the middle half of the sternocleidomastoideus along the anterior edge to the jugular notch of the sternum. After cutting the platysma, severing the sternohyoideus, splitting the sternothyroid muscle, and forming a compartment between the esophagus and vagina carotica, we extended the incision to the sternum. Without wedging the sternum, we separated tis …

Extracranial radiation doses in patients undergoing gamma knife radiosurgery.

OBJECTIVE: To determine extracranial doses in patients undergoing gamma knife radiosurgery and identify component sources of the extracranial doses using phantom measurements. METHODS: The lateral canthi, thyroid, sternum, and midpelvis region were monitored in 104 unselected patients during their gamma knife treatments using thermoluminescent dosimetry. Measured doses were normalized to integral dose, equivalent time (which is defined in relation to the activity of the cobalt-60 sources), and collimator size to correlate radiation doses with these parameters. A phantom was constructed from a…

Force distribution across the heel of the hand during simulated manual chest compression.

According to most published guidelines of cardiopulmonary resuscitation chest compression is performed on the lower half of the sternum by compressing the sternum with the heel of one hand and the other hand on top of the first. In all guidelines and during CPR training great importance is attributed to exact localisation of the so-called compression point. In a laboratory investigation we assessed the force distribution across the heel of the hand and defined the total breadth in contact with the sternum. In order to find out whether there is any difference in the force pattern with the right…

Cervical intradiscal pressure responses to end-range supine postures: a cadaveric investigation.

BACKGROUND: Cadaveric studies suggest neck postures may affect cervical intradiscal pressure (CIDP) and potentially contribute to interverte … fiberoptic pressure sensors in C4-5, C5-6, and C6-7 IVDs for supine end-range chin to neck, chin to sternum, protraction-flexion, occiput to neck, occiput to thorax, retraction-extension, and neutral traction. RESULTS: Friedman tests revealed greater CIDP in (1) chin to sternum as compared to traction at C4-5, C5-6 and C6-7 (p < .02); (2) chin to sternum …

Correlation of microbilirubin with total serum bilirubin and transcutaneous bilirubin.

Jaundice is a common condition in newborns that requires early detection. Screening for neonatal jaundice involves measuring microbilirubin … dice. Bilirubin levels were simultaneously measured using MB, TSB, and TcB at both the forehead and sternum. Statistical analysis was performed using Spearman's rank correlation coefficient and a Bland-Altman plot. The study included 212 newborns, with 876 measurements (219 datasets). The mean GA ± standard deviation (SD) was 38.31 ± 1.14 weeks, the mean …

Minimization of Surgical Site Infections in Patients With Delayed Sternal Closure After Pediatric Cardiac Surgery.

BACKGROUND: Delayed sternal closure (DSC) following pediatric cardiac surgery is commonly implemented at many centers. Infectious complications occur in 18.7% of these patients based on recent multicenter data. We aimed to describe our experience with DSC, hypothesizing that our practices surrounding the implementation and maintenance of the open sternum during DSC minimize the risk of infectious complications. METHODS: We reviewed patients less than 365 days who underwent DSC between 2012 and 2016 at our institution. Infectious complications as defined by the Society of Thoracic Surgeons Con…

Emergent non-image-guided resuscitative endovascular balloon occlusion of the aorta (REBOA) catheter placement: A cadaver-based study.

BACKGROUND: Emergent resuscitative endovascular balloon occlusion of the aorta (REBOA) insertion for critically injured patients in hemorrhagic shock is performed blindly with fluoroscopic imaging confirmation. The aim of this study was to determine a reliable method for initial REBOA catheter insertion with balloon deployment between the left subclavian artery takeoff and the celiac trunk (CT). METHODS: Human cadaver study. External surface (sternal notch, mid-sternum, xiphoid) and intravascular (left subclavian artery [LSA], and CT) landmarks were measured from standardized left and right c…

Sternal tuberculous osteomyelitis presenting as a pulsatile swelling.

Primary sternal tuberculous osteomyelitis is a rare form of tuberculous osteomyelitis. We report a case of a young adult with primary tuberculous osteomyelitis of the sternum who presented with a pulsatile anterior chest wall swelling. Computed tomography of the thorax revealed a hypodense lytic lesion in the body of the sternum that had eroded into the anterior mediastinum where it lay in close contact with the right ventricle, resulting in the clinically evident transmitted pulsations. Among the protean manifestations of tuberculosis this case illustrates a unique presentation as a pulsatile…

[A 13-year-old male with a funnel chest treated by sternal elevation].

A 13-year-old male with a funnel chest was treated by sternal elevation method. Reconstruction was performed by resection of rib cartilage, wedge osteotomy of the anterior site of the sternum, sternal elevation by placement of a titanium A-0 plate under the sternum, and fixation of the wedge osteotomy site by a titanium plate. After surgery, the chest wall deformity was improved remarkably without complication. Although the A-0 plate was removed 19 months after surgery due to a break in the plate, cosmetic and functional results are now excellent 28 months after surgery.

[Methicillin-cephem-resistant Staphylococcus aureus (MRSA) mediastinitis following open heart surgery].

Mediastinitis following cardiac surgery occurs frequently in association with high mortality and morbidity. Patient was a 6-year-old boy suffering from Sotos syndrome with secundum type of ASD. He was operated upon to repair ASD. Following the surgery, he suffered from MRSA mediastinitis and osteomyelitis of the sternum. Routine method of closed irrigation after reopening of the sternal wound was ineffective. Patient recovered following aggressive debridement repeatedly, open drainage and topical irrigation with vancomycin. This appears to be a useful method to treat MRSA mediastinitis of the …

Late-onset sternomanubrial dislocation with progressive kyphotic deformity after a thoracic burst fracture.

Fractures and dislocations of the sternum may be associated with flexion-compression injuries of the thoracic spine. Sternal injuries most commonly occur at or near the sternomanubrial joint. We present a patient with a known thoracic spine fracture who developed a subsequent late-onset, symptomatic sternomanubrial dislocation and progression of thoracic kyphosis, ultimately requiring operative fixation of both the sternum and the spine. Internal fixation of these sternal injuries should be considered in the setting of a flexion-compression thoracic spine fracture to possibly prevent a worseni…