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At least 19 recordsLinked to original sources
PubMed1992

Anatomic and clinical considerations of an internal mammary artery harvest.

In an effort to understand the perceived correlation of internal mammary artery harvesting and wound healing difficulties in the inferior margins of the sternotomy incision, we showed the cutaneous vascular perfusion in the sternal and xiphoid areas by India ink injection studies in cadavers. With these studies, we demonstrated an inherent paucity of nutrient supply to the inferior sternum and xiphoid area. The classic internal mammary artery harvest further compromises the blood supply to these areas. We believe that limiting the most inferior dissection of the internal mammary artery and not including the distal bifurcation leaves intact the lateral musculophrenic nutrient supply to the inferior sternum and xiphoid area and to the ipsilateral abdominal rectus muscle. These guidelines will help to prevent ischemic complications of this area and may aid in reconstruction. If the bifurcation is harvested, we believe that the removal of the avascular xiphoid cartilage at the time of the initial bypass procedure may eliminate this as a potential septic focus.

Abdominal Muscles↗
PubMed1977

Evaluation of teratogenic potential codeine sulfate in CF-1 mice.

The most prominent defect of codeine sulfate, 100 mg/kg sc, was delayed ossification of the supraoccipital bone, paws, xiphoid, and sternebrae as well as other sternebral defects such as checkerboard sternebrae and polysternebrae. Although these anomalies were similar to the minor defects seen in the fetuses of morphine sulfate-treated mice, the major anomalies such as exencephaly, cryptorchid testes, and rib and vertebral fusions produced by morphine were not present in the fetuses of mice challenged with codeine. Thus, codeine sulfate appears to be less teratogenic than morphine sulfate. A review of the incidences of the various defects in mice treated on a single day with codeine showed that there was a range of days on which the mouse fetus was susceptible to codeine's teratogenic effects, with the most critical days of gestation being Days 8-10. Furthermore, a comparison of the defects that occurred in those treated on both Days 8 and 9 with the defects that occurred in those treated on a single day of gestation reveals an additive or cumulative teratogenic response to codeine.

Animals↗
PubMed1992

Optimal electrode location for monitoring the ECG and breathing in neonates.

Continuous monitoring of breathing in infants is commonly performed using transthoracic impedance. This method employs skin surface electrodes measuring changes in electrical impedance and relates these changes to respiratory events. Typically, two electrodes on the infant's chest monitor both the ECG and breathing. We have attempted to identify separate electrode locations that give the best signal for breathing and ECG, and a single location that optimizes both of these signals. Thirty-seven infants were studied by placing 12 electrodes on the infant's chest and abdomen, and serially sampling pairwise combinations of electrodes. The optimal signal for breathing was obtained when electrodes spanned the diaphragm. Optimal ECG signal was seen with one electrode at the right mid-clavicle and one at the xyphoid. Clinicians should be aware of these locations in order to provide the best signal available.

Abdomen↗
PubMed1992

Diagnosis and management (by subxiphoid pericardiotomy) of large pericardial effusions causing cardiac tamponade.

To determine the clinical features, course and outcome of patients with cardiac tamponade, 57 consecutive patients with new, large pericardial effusions were prospectively studied. Twenty-five patients (44%) developed cardiac tamponade with venous hypertension and a pulsus paradoxus greater than 10 mm Hg. Electrocardiography, radiographic studies and echocardiography did not differentiate patients with and without tamponade. All 57 patients underwent thorough diagnostic evaluation followed by subxiphoid pericardial biopsy and drainage. A diagnosis was obtained in 53 patients (93%). Collagen vascular disease was significantly more frequent in the 25 patients with than in the 32 without cardiac tamponade (24 vs 3%; p less than 0.05). The frequency of malignant and uremic effusions was equal in both groups, whereas radiation-induced effusions seldom produced tamponade. At 1-year follow-up, 3 patients (12%) with tamponade had recurrent effusions, and 1 needed reoperation. This was not significantly different from the 32 patients without tamponade. Twelve-month mortality was also similar in both groups (36 vs 44%). This prospective series disclosed several unexpected findings: (1) Cardiac tamponade occurred in almost 50% of patients with new large pericardial effusions; (2) both malignancy and collagen vascular disease occurred with equal frequency as etiologies, whereas radiation-induced tamponade was unusual; (3) thorough clinical evaluation resulted in few idiopathic etiologies; and (4) subxiphoid pericardiotomy was effective for both diagnosis and therapy of tamponade.

Cardiac Tamponade↗
PubMed1992

A model for studies of the deformable rib cage.

An earlier model for the study of rib cage mechanics was modified so that rib deformity in scoliosis could be better represented. The rigid ribs of that model were replaced by five-segment deformable ribs. Literature data on cadaver rib mechanical behavior were used to assign stiffnesses to the new individual model ribs so that experimental and model rib deflections agreed. Shear and tension/compression stiffnesses had little effect on individual rib deformation, but bending stiffnesses had a major effect. Level-to-level differences in mechanical behavior could be explained almost exclusively by level to level differences in the rib shape. The model ribs were then assembled into a whole rib cage. Computer simulations of whole rib cage behaviors, both in vivo and in vitro, showed a reasonable agreement with the measured behaviors. The model was used to study rib cage mechanics in two scolioses, one with a 43 degrees and the other with a 70 degrees Cobb angle. Scoliotic rib cage deformities were quantified by parameters measuring the rib cage lateral offset, rib cage axial rotation, rib cage volume and rib distortion. Rib distortion was quantified both in best-fit and simulated computer tomography (CT) scan planes. Model rib distortion was much smaller in best-fit planes than in CT planes. The total rib cage volume changed little in the presence of the scolioses, but it became asymmetrically distributed.

Biomechanical Phenomena↗
PubMedDate not supplied

Xiphodynia: a report of three cases.

Xiphodynia is an uncommon musculoskeletal disorder that mimics a number of common abdominal and thoracic diseases. We report three cases of xiphodynia. The diagnosis is suggested when a given patient's chest or abdominal discomfort is completely or almost completely reproduced with light pressure on the xiphoid process. Local injection with an anesthetic-steroid combination is frequently curative. No more than 5 to 7 mL of solution should be injected, and results are variable when several trigger points are found on the anterior chest wall. Tack hammer deformity of the xiphoid, another cause of xiphoid pain, has been successfully treated with surgical excision.

Adult↗
PubMed1977

Subxiphoid pericardial window in patients with suspected traumatic pericardial tamponade.

The technique, indications, and results of subxiphoid pericardial window in penetrating chest wounds with suspected traumatic pericardial tamponade are reported. The classic signs of pericardial tamponade (elevated central venous pressure, muffled heart sounds, and paradoxical pulse) are unreliable in an emergency situation. Chest roentgenograms and electrocardiograms are of little diagnostic value. Pericardicentesis was either falsely positive or negative in 50% of our patients. Therefore, unexplained high central venous pressure and hypotension were considered to be pericardial tamponade until disproved by the results of a subxiphoid pericardial window. There were 4 negative and 46 positive findings of tamponade in 50 consecutive patients with suspected traumatic pericardial tamponade who underwent creation of a subxiphoid pericardial window. There were no deaths or complications from the procedures. The early use of subxiphoid pericardial window has been a major factor in reducing our mortality rate from penetrating heart wounds to 12% overall, and 8% in the past three years.

Blood Pressure↗
PubMed1977

Subxiphoid anterior mediastinal exploration.

A new surgical technique for anterior mediastinal exploration is described. The technique involves application of a Carlens mediastinoscope by means of a subxiphoid incision. The procedure provides complete exploration of the anterior mediastinal compartment and allows the surgeon to obtain a positive biopsy of the tumor or its lymph node metastases without sternotomy.

Anesthesia, General↗
PubMed1977

The subxiphoid approach in the treatment of pericardial effusion.

Subxiphoid pericardiotomy for diagnosis and treatment of pericardial effusion is a safe procedure. Not only does it appear to be safer than aspiration, but it yields more information because of its ability to obtain pericardial tissue. The recurrence rate of pericardial effusion is lower using subxiphoid pericardiotomy. For these reasons it is the technique of choice for diagnosis and treatment of nontraumatic pericardial effusion.

Drainage↗
PubMed1977

Perichondritis (Tietze's syndrome) at the xiphisternal joint: a mimic of severe disease.

Tietze's syndrome (peristernal chondritis or perichondritis) is a self-limited, painful inflammatory condition of the costochondral, sternoclavicular, manubriosternal or xiphisternal junctions. It is benign, and affects all ages, sexes and races equally. The principal manifestations are pain and, frequently, a mass most commonly at the costochondral junctions. In 1974, C.J. described the first cases to be reported at the xiphisternal junction. We describe here 24 cases at that site. These patients' presenting symptoms suggested cardiac, pulmonary, intraabdominal and other severe disease processes. Diagnosis was made on clinical grounds based on a high index of suspicion. Treatment comprised infiltration of local anesthetic to the afflicted joints with prompt, complete and prolonged relief in 21 (87.5%) of the cases, and complete temporary relief in three (12.5%). We suggest that a possible mechanism for the referral of pain is the relationship of the xiphisternal joint to a variety of structures including autonomic nerves that accompany the internal mammary arteries.

Adolescent↗
PubMed1992

Comparison of subxiphoid and traditional approaches for ICD implantation.

We compared clinical and electrophysiological data in 18 patients undergoing ICD implantation via a traditional (median sternotomy or left lateral thoracotomy) with 29 patients with a subxiphoid approach. Both groups were similar in terms of age, sex, left ventricular ejection fraction, presence of coronary artery disease, and clinical indication for the device. Fifteen patients (83%) with the traditional approach had previous cardiac surgery compared with 6 patients (21%) who had a subxiphoid approach (P < 0.001). Both groups had similar patch R wave and sensing R wave measurements. Patients with the traditional approach had a lower energy for defibrillation than patients with a subxiphoid approach (13.6 +/- 6.8 J vs 17.9 +/- 4.1 J, P < 0.05). Postoperative hospital days were fewer in the subxiphoid group compared with the traditional approaches (9.8 +/- 5.3 vs 13.7 +/- 7.5 days) but the differences did not reach statistical significance, possibly due to small numbers. The subxiphoid approach appears to be a reasonable alternative approach to the traditional approach in selected patients undergoing ICD implantation.

Defibrillators, Implantable↗
PubMed1992

Subxiphoid approach for implantable cardioverter defibrillator in patients with previous coronary bypass surgery.

From February 1988 until August 1991, 28 patients with prior coronary artery bypass grafting (CABG) received implantable cardioverter defibrillator (ICD) therapy via a subxiphoid approach. Only one patient required conversion to a median sternotomy incision. The mean defibrillation threshold was 11.9 +/- 4.4 J. The mean R wave was 8.2 +/- 3.7 mV. One perioperative death occurred due to heart failure (mortality rate 1/28 [3.50%]). No patient required reexploration for bleeding. The subxiphoid method for ICD electrode implantation is safe and reliable in patients with prior CABG surgery.

Coronary Artery Bypass↗
PubMed1992

Automatic implantable cardioverter defibrillator: surgical approaches for implantation.

Surgical approaches for implantation of the automatic cardioverter defibrillator are sternotomy, left thoracotomy, subxiphoid, and subcostal. Although any one of these may be combined with insertion of one or more of the electrodes transvenously, surgical entry into the chest is required for every noninvestigational defibrillator implantation operation. The approaches differ in exposure provided for selecting electrode sites and for handling untoward events, in amount and location of tissue that must be divided or dissected, and in average time required. The operation is an electrical one. Its purpose is to obtain reliable rhythm sensing so that defibrillation or cardioversion shocks will occur only when necessary, and to obtain low enough defibrillation thresholds for shocks of 30 joules or less to have a 10-joule defibrillation safety margin. Many of the patients have had previous cardiac operations. They usually have low or very low ejection fractions. Intraoperative electrophysiological testing with often multiple defibrillation episodes is required. The choice of approach varies with the state of the patient, the institutional experience, and the surgeon. This article describes technique, and the advantages and disadvantages of the four approaches as used by four surgeons in four different institutions.

Defibrillators, Implantable↗
PubMedDate not supplied

Predictive criteria for length of nasogastric tube insertion for tube feeding.

This study was aimed at identifying non-invasive techniques and criteria for predicting the proper length for insertion of a nasogastric tube for tube feeding so that the tube tip would be located in the fundus or body for the stomach. A review of literature and existing practices revealed unsubstantiated and discrepant methods currently in use and justified the need for this research. The study involved relating several external body measurements to a measurement from the tip of the nose to the lower esophageal sphincter, via the esophagus, in 99 adult cadavers and 5 normal adult volunteers. A variety of analyses including stepwise multiple regression, were used and are presented. A formula is presented and is stated to provide a 91% confidence level of tube tip placement in the stomach between 1 and 10 cm. This is compared to a confidence level of 72% using the traditional nose to ear to xiphoid measurement. The formula is ( (NEX-50cm) /2)) + 50cm where NEX is the distance from the tip of the nose to the earlobe to the xiphoid. Two methods for simple mechanical clinical application are described.

Adolescent↗
PubMed1992

Subxiphoid pericardiotomy in the diagnosis and management of large pericardial effusions associated with malignancy.

To determine the safety, diagnostic value, and clinical outcome of patients with malignancy undergoing subxiphoid pericardiotomy for large pericardial effusions, we prospectively studied 25 consecutive patients with malignancy and new, large pericardial effusions diagnosed by echocardiography. Twenty-two of the 25 operations were done under local anesthesia, and no patient died at surgery. Pericardial fluid cytology revealed malignant cells in 11 patients (44 percent), while tumor was seen in only five (45 percent) of these 11 patients on pathologic examination. The remaining 14 patients showed no evidence of pericardial invasion with tumor. Evidence of intrathoracic disease by CT or MRI scanning, tamponade, a sanguineous pericardial fluid character, and an elevated serum and pericardial fluid lactate dehydrogenase level all were suggestive of malignant invasion of the pericardium. All 25 patients were followed at least 12 months postoperatively. Effusions recurred in three patients (12 percent), and one patient required reoperation. Overall mortality was 72 percent with a 91 percent (10 of 11) mortality for those with malignant effusions and a 57 percent (8 of 14) mortality for those with nonmalignant effusions. Diagnostically, subxiphoid pericardiotomy has little advantage over examination of pericardial fluid alone in this group of patients. Therapeutically, however, it is a low morbidity procedure which is safe and effective in treating patients with malignancy and large pericardial effusions.

Cardiac Tamponade↗
PubMed1975

Sutureless epicardial pacemaker lead: a satisfactory preliminary experience.

The first pacemaker systems used the epicardial electrode. The transvenous endocardial electrode rapidly supplanted the epicardial electrode since it could be positioned with less morbidity and mortality and was associated with a lower incidence of wire breakage. The long term complication rate of the transvenous electrode had not been inconsequential. The sutureless epicardial electrode combines the greater reliability of the epicardial lead system with the ease of insertion and low morbidity of the endocardial lead system. We have used this electrode in 33 patients. The electrode was positioned using the subxiphoid approach and local anesthesia in most patients. There have been few complications and none that resulted in long term morbidity. There have been no deaths related either to the operative approach or to the pacing system. There has been no instance of lead failure during the follow-up period.

Aged↗
PubMed1976

The angle of obesity: a simple measurement for body typing.

Measurements of the angle at the xiphisternal notch was taken in 143 school children between the ages of six and fifteen years, the average being eight. The children were graded as thin (T), normal with a tendency to be thin (NT), normal (N), normal tending to be fat (NF), and fat (F). This trading was by visual assessment. The average angle was found to be 90 degrees. Those with lesser than the average angle tended to be thin and those with greater than the average angle tended to be fat. The smaller angled were considered to have a larger thorax and smaller abdomen and vice versa for the larger angled children. The significance of these findings to various diseases is discussed and the significance of measuring this angle.

Adolescent↗