- An unusual case of abdominal aneurysm: Inferior vena cava aneurysm - A case report. [Journal Article]
- JCJ Cardiol Cases 2019; 19(2):41-46
- Venous aneurysms are rarely reported in the literature since they are usually asymptomatic and incidentally detected due to complications such as thrombosis and pulmonary embolism. Often an inferior …
Venous aneurysms are rarely reported in the literature since they are usually asymptomatic and incidentally detected due to complications such as thrombosis and pulmonary embolism. Often an inferior vena cava (IVC) aneurysm is detected by imaging studies performed for other causes. We report a case of large Type II IVC aneurysm associated with severe pectus excavatum in an asymptomatic man detected on routine 2D echocardiography. Focal narrowing of the IVC at the level of xiphisternum detected in multi-slice computed tomography might be the possible etiology for IVC aneurysm. <Learning objective: Even though inferior vena cava aneurysms are rare, they can easily be diagnosed non-invasively by 2D echocardiography, ultrasound, and multi-slice computed tomography. The proximal obstruction of inferior vena cava by the xiphisternum as a complication of a severe form of pectus excavatum resulting in inferior vena cava aneurysm is probably a rare and possibly the only reported case in the literature.>.
- StatPearls: Anatomy, Thorax, Sternum [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- The sternum is a partially T-shaped vertical bone that forms the anterior portion of the chest wall centrally. The sternum is divided anatomically into three segments: manubrium, body, and xiphoid pr…
The sternum is a partially T-shaped vertical bone that forms the anterior portion of the chest wall centrally. The sternum is divided anatomically into three segments: manubrium, body, and xiphoid process. The sternum connects the ribs via the costal cartilages forming the anterior rib cage. The manubrium is the broad superior segment, the body is the middle portion, and the xiphoid process is a narrower distal segment forming the partial T-shape. The anatomical position and variations make the sternum an important bony structure of surgical significance. In addition to the anatomy of the sternum, clinical and forensic implications of the sternum are also topics in this article.
- Retroperitoneal lipoma; a benign condition with frightening presentation. [Journal Article]
- IJInt J Surg Case Rep 2019; 57:63-66
- CONCLUSIONS: Retroperitoneal lipomas have been reported in various age groups; namely children, middle and old age patients. Based on the characteristic radiological features of the tumor, enormous diagnostic work-up is not justified.Retroperitoneal lipoma is a very rare variant of lipoma, presents with various signs and symptoms that may be misleading. Radiologic imaging especially CT scan is the diagnostic tool of choice. Surgical resection is the main modality of management.
- [Experience with Wang procedure for treatment of pectus excavatum in young children]. [Journal Article]
- NFNan Fang Yi Ke Da Xue Xue Bao 2019 02 28; 39(2):249-252
- CONCLUSIONS: Wang procedure is a good option for treatment of pectus excavatum in young children.
- Unusual presentation of late-onset disseminated staphylococcal sepsis in a preterm infant. [Case Reports]
- BCBMJ Case Rep 2019 Mar 15; 12(3)
- An ex-30-week gestation, preterm male baby was admitted to a tertiary neonatal unit and noted to have increased ventilator requirements and diagnosed with sepsis. The baby also developed an abscess o…
An ex-30-week gestation, preterm male baby was admitted to a tertiary neonatal unit and noted to have increased ventilator requirements and diagnosed with sepsis. The baby also developed an abscess over the left elbow and over the xiphisternum along with a decrease in movement of the left hand and the right leg. Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (SA) was isolated from the blood culture. A whole body MRI showed disseminated abscess with multiple foci in the lung, left elbow and over the xiphisternum. Disseminated sepsis with multiple septic foci has not been previously reported in neonates. We would like to highlight the fact that sepsis due to PVL toxin-producing SA can cause significant morbidity and mortality in neonates. Proper screening should be done to rule out septic foci in neonates. MRI is a good non-invasive investigation to document septic foci in a neonate and rule out multiorgan involvement.
- Hematological Effects of Non-Homogenous Ionizing Radiation Exposure in a Non-Human Primate Model. [Journal Article]
- RRRadiat Res 2019; 191(5):428-438
- Detonation of a radiological or nuclear device in a major urban area will result in heterogenous radiation exposure, given to the significant shielding of the exposed population due to surrounding st…
Detonation of a radiological or nuclear device in a major urban area will result in heterogenous radiation exposure, given to the significant shielding of the exposed population due to surrounding structures. Development of biodosimetry assays for triage and treatment requires knowledge of the radiation dose-volume effect for the bone marrow (BM). This proof-of-concept study was designed to quantify BM damage in the non-human primate (NHP) after exposure to one of four radiation patterns likely to occur in a radiological/nuclear attack with varying levels of BM sparing. Rhesus macaques (11 males, 12 females; 5.30-8.50 kg) were randomized by weight to one of four arms: 1. bilateral total-body irradiation (TBI); 2. unilateral TBI; 3. bilateral upper half-body irradiation (UHBI); and 4. bilateral lower half-body irradiation (LHBI). The match-point for UHBI vs. LHBI was set at 1 cm above the iliac crest. Animals were exposed to 4 Gy of 6 MV X rays. Peripheral blood samples were drawn 14 days preirradiation and at days 1, 3, 5, 7 and 14 postirradiation. Dosimetric measurements after irradiation indicated that dose to the mid-depth xiphoid was within 6% of the prescribed dose. No high-grade fever, weight loss >10%, dehydration or respiratory distress was observed. Animals in the bilateral- and unilateral TBI arms presented with hematologic changes [e.g., absolute neutrophil count (ANC) <500/ll; platelets <50,000/ll] and clinical signs/symptoms (e.g., petechiae, ecchymosis) characteristic of the acute radiation syndrome. Animals in the bilateral UHBI arm presented with myelosuppression; however, none of the animals developed severe neutropenia or thrombocytopenia (ANC remained >500/µl; platelets >50,000/µl during 14-day follow-up). In contrast, animals in the LHBI arm (1 cm above the ilieac crest to the toes) were protected against BM toxicity with no marked changes in hematological parameters and only minor gross pathology [petechiae (1/5), splenomegaly (1/5) and mild pulmonary hemorrhage (1/5)]. The model performed as expected with respect to the dose-volume effect of total versus partial-BM irradiation, e.g., increased shielding resulted in reduced BM toxicity. Shielding of the major blood-forming organs (e.g., skull, ribs, sternum, thoracic and lumbar spine) spared animals from bone marrow toxicity. These data suggest that the biological consequences of the absorbed dose are dependent on the total volume and pattern of radiation exposure.
- Adequacy of different measurement methods in determining nasogastric tube insertion lengths: An observational study. [Journal Article]
- IJInt J Nurs Stud 2019; 92:73-78
- CONCLUSIONS: This study found distance from xiphisternum to earlobe to nose + 10 cm to provide the best estimate for the internal length of nasogastric tube required. However, even this formula could result in placement that is not optimal due to anatomical differences.
- Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery. [Journal Article]
- JCJ Cardiothorac Surg 2019 Jan 28; 14(1):25
- CONCLUSIONS: Single xiphoid transverse plate reinforcement for primary sternal closure is a feasible option for morbidly obese patients, who are otherwise at high risk of developing sternal dehiscence. Using this technique may decrease postoperative narcotics usage. Morbidly obese patients (body mass index ≥35 kg/m2) have a higher-than-normal risk of sternal dehiscence after cardiac surgery. In a pilot study, we found that those who underwent transverse sternal plating (n = 8) had no sternal dehiscence and required less postoperative analgesia than patients who underwent standard wire closure (n = 14).
- Difference between the Right and Left Phrenic Nerve Conduction Times, Latency, and Amplitude. [Journal Article]
- AMActa Med Okayama 2018; 72(6):563-566
- We studied phrenic nerve conduction times in 90 phrenic nerves of 45 normal subjects. The phrenic nerve was stimulated at the posterior border of the sternomastoid muscle in the supraclavicular fossa…
We studied phrenic nerve conduction times in 90 phrenic nerves of 45 normal subjects. The phrenic nerve was stimulated at the posterior border of the sternomastoid muscle in the supraclavicular fossa, just above the clavicle, with bipolar surface electrodes. For recording, positive and negative electrodes were placed on the xiphoid process and at the eighth intercostal bone-cartilage transition, respectively. We studied both the right and left sides to determine whether there was any difference between the two sides. The mean onset latency (± SD) of the right compound muscle action potentials (CMAPs) (5.99±0.39 msec) was significantly shorter than that of the left CMAPs (6.45±0.50 msec). The mean peak latency was significantly shorter in the right CMAPs (10.22±1.33 msec) than the left CMAPs (12.48±2.02 msec). The mean (± SD) amplitude was significantly lower in the left CMAPs (0.42±0.11 mV) than the right CMAPs (0.49±0.10 mV). The difference between the length of the nerve on the right and left sides might have affected the difference in latency between the two sides.
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- StatPearls: Anatomy, Thorax, Wall [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- The thoracic wall consists of a bony framework that is held together by twelve thoracic vertebrae posteriorly which give rise to ribs that encircle the lateral and anterior thoracic cavity. The first…
The thoracic wall consists of a bony framework that is held together by twelve thoracic vertebrae posteriorly which give rise to ribs that encircle the lateral and anterior thoracic cavity. The first nine ribs curve around the lateral thoracic wall and connect to the manubrium and sternum. Ribs 10-12 are relatively short and attach to the costal margins of the ribs just above them. Ribs 10-12, due to their short course, they do not reach the sternum. The first seven ribs are termed true ribs and attach to the manubrium and directly attach to the body of the sternum. Ribs eight to ten only attach to the inferior part of sternum via the costal cartilages. Ribs 11-12 are termed floating ribs because they do not attach directly to the sternum. Ribs eight to ten are known as false ribs because they lack direct attachment to the sternum. At the level of the spine, the ribs articulate with the costal facet of two opposing vertebrae. An articular capsule surrounds the head of each rib, and the attachment to the transverse process is made with the help of the radiate ligament. Once the ribs leave the vertebrae, they gently curve around the lateral thoracic wall and approach the anterior wall of the thoracic cavity. The vertical bone of the chest, the sternum, defines the anterior chest wall. The three separate bone segments of different size and shape that make up the sternum include 1) the thick manubrium, 2) long body of the sternum, and 3) the xiphoid process. It develops independently of the ribs. In sporadic cases, the sternum may not fully form, and the underlying heart may be exposed. The most superior portion of the sternum is the manubrium, and it is also the first to form during embryogenesis. The sternal body and xiphoid process soon follow the manubrium in development. Anatomically, the manubrium is located at the level of thoracic vertebral bodies T3 and T4. The manubrium is also the widest and thickest segment of the sternum. During a physical exam of the chest, one noticeable feature of the manubrium is the presence of the suprasternal notch. On either side of this notch, one will feel the thick attachment from the clavicles. For access to the superior mediastinum, suprasternal goiter or thymus, some thoracic surgeons will only make a midline incision in the manubrium. The sternal body is located at the level of vertebral bodies T5-T9. It covers a significant portion of the mid-chest and is very strong. To access the chest cavity, surgeons usually cut through the sternum with a mechanical saw. The xiphoid process is a thin and very small bone. Its size may vary from two to five cm, and its shape is also variable. The xiphoid may appear bifid, oval or be curved inwards/outwards. In younger individuals, the xiphoid is mostly cartilaginous but is nearly wholly ossified by age 40. By the age of 60 and over, the xiphoid is almost certainly completely calcified. To perform pericardiocentesis safely the needle has to be placed directly underneath the xiphoid because the heart is just a few fingerbreadths below.