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Yosuke Takahashi, Yasuyuki Sasaki, Yasuyuki Bito, Manabu Motoki, Takashi Murakami, Toshihiko Shibata
We herein report two cases of perigraft effusion mimicking graft infection after debranching thoracic endovascular repair for an anastomotic pseudoaneurysm of the distal ascending aorta. Both patients presented with a bulging tumor on the sternum. Enhanced computed tomography showed no endoleak, but extension of periprosthetic graft fluid to a subcutaneous sternal wound was present. We suspected a deep sternal wound infection; however, cultures of débrided tissues were negative. After drainage of the subcutaneous fluid or negative pressure wound therapy, both patients were doing well without recurrence of effusion...
October 14, 2016: Journal of Vascular Surgery
Massimiliano de Zambotti, John Trinder, Harold Javitz, Ian M Colrain, Fiona C Baker
OBJECTIVE: Insomnia disorder is a risk factor for cardiovascular (CV) pathology. It is unknown whether insomnia that develops in the context of the menopausal transition (MT) impacts the CV system. We assessed nocturnal blood pressure (BP) and heart rate (HR) profiles in women with insomnia disorder in the MT. METHODS: Twelve women meeting DSM-IV criteria for insomnia in the MT (age, mean ± SD: 50.5 ± 3.6 y) and 11 controls (age, mean ± SD: 49.0 ± 3...
October 3, 2016: Menopause: the Journal of the North American Menopause Society
Yann Philippe Charles, Amélie Marcoul, Mickaël Schaeffer, Federico Canavese, Alain Diméglio
We aimed to measure thoracic dimensions and volume in relation to growth and verify the influence of scoliosis on thoracic growth. A reference group of 294 healthy volunteers was compared with a group of 557 patients with idiopathic scoliosis ranging in age from 3 to 25 years. The optical ORTEN system for trunk surface data acquisition was used to calculate thoracic volume, perimeter, anterior-posterior and transversal diameters, T1-T12 length, and sternal length. There was no significant difference in thoracic dimensions and volume between scoliosis and reference groups in either girls or boys...
September 29, 2016: Journal of Pediatric Orthopedics. Part B
Donald Nuss, Robert J Obermeyer, Robert E Kelly
Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. Thus far, genetic studies support an autosomal recessive heritability, which coincides with only 40% of our patients having some positive family history, but is also contradictory given a constant sex ratio of 4:1 in favor of males. This inconsistency may be explained by the effect of more than one pectus disease-associated allele. Once the deformity is noticed, it tends to progress slowly until puberty, when rapid progression is often seen...
September 2016: Annals of Cardiothoracic Surgery
Donald Nuss, Robert J Obermeyer, Robert E Kelly
Repair of pectus excavatum began at the beginning of the 20(th) century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support...
September 2016: Annals of Cardiothoracic Surgery
Umberto Benedetto, Massimo Caputo, Mustafa Zakkar, Alan Davies, Ben Gibbison, Alan Bryan, Gianni D Angelini
OBJECTIVES: The radial artery (RA) is often used as a second arterial conduit in preference to the right internal thoracic artery in obese patients undergoing coronary artery bypass grafting (CABG) to minimise the risk of sternal wound complication. However, obesity has been found to promote RA vasoreactivity and early atherosclerotic degeneration, which may compromise graft patency when used in patients having CABG. Therefore, we investigated the effect of the RA as a second conduit compared with the saphenous vein (SV) on long-term survival in obese and non-obese patients undergoing first-time CABG...
October 15, 2016: European Journal of Cardio-thoracic Surgery
Kouichiro Minami, Yota Kokubo, Ichinosuke Maeda, Shingo Hibino
In chest compression for cardiopulmonary resuscitation (CPR), the lower half of the sternum is pressed according to the American Heart Association (AHA) guidelines 2010. These have been no studies which identify the exact location of the applied by individual chest compressions. We developed a rubber power-flexible capacitive sensor that could measure the actual pressure point of chest compression in real time. Here, we examined the pressure point of chest compression by ambulance crews during CPR using a mannequin...
October 14, 2016: Journal of Anesthesia
Yi-Ju Ho, Hung-Chi Chen, Shirley H L Chang, Lung-Kung Yeh, David Hui-Kang Ma
BACKGROUND: Sclerocornea, a congenital corneal pathology characterized by bilateral scleralization of the cornea, which can be found in few cases with posterior fossa malformationshemangiomas-arterial anomalies-cardiac defects-eye abnormalities-sternal cleft and supraumbilical raphe (PHACES) syndrome. Presence of vascularization in peripheral cornea and smaller diameter of recipient cornea correlate to poor outcome of penetrating keratoplasty (PKP) in sclerocornea. Here we report a method to preserve limbus during PKP for small, irregular, and scleralized cornea...
October 2016: Medicine (Baltimore)
Jiwon Sarah Park, Jennifer H Kuo, J Nilas Young, Michael S Wong
BACKGROUND: Rigid sternal fixation (RSF) has been shown to reduce sternal wound complications in high-risk patients. However, the higher initial cost continues to deter its use. This study evaluates the cost of caring for high-risk sternotomy patients who underwent RSF compared with those who underwent sternal closure with a modified wire technique (MWT). METHODS: A retrospective single institution review of high-risk patients who underwent MWT (n = 45) and RSF (n = 30) for primary sternal closure from 2006 to 2009 was conducted...
October 6, 2016: Annals of Plastic Surgery
Yu Inaba, Tsutomu Ito, Sachiko Hayashi, Yasunori Iida, Takahiko Misumi, Hideyuki Shimizu
A thoracic aortic pseudoaneurysm is a life-threatening complication following thoracic aortic surgery. We describe a surgical strategy for this pseudoaneurysm with a high risk for rupture during median sternotomy. The pseudoaneurysm was distended and widely adherent to the posterior sternum. Elective cardiopulmonary bypass and moderate hypothermia were established, and sternotomy was performed without left ventricle distention or brain ischemia. Total arch replacement was successful and the patient was discharged on post operative day (POD) 18...
2016: Annals of Vascular Diseases
Mostafa Araghi, Saeed Azizi, Nasser Vesal, Bahram Dalir-Naghade
The sedative effects of diazepam, midazolam, and xylazine after intranasal administration were evaluated in 72 (36 male and 36 female) juvenile healthy ostriches ( Struthio camelus ), weighing 50-61 kg and aged 4-5 months. The birds were randomly divided into 3 groups (n = 24), then each group was further subdivided to 4 subgroups (n = 6). For each drug, 4 different doses were chosen and the total calculated dose was equally administered into either naris of the individual bird. The appropriate dose of each drug to produce standing chemical restraint or sternal recumbency was evaluated based on the onset time, the duration of maximum effect, and the duration of sedation...
September 2016: Journal of Avian Medicine and Surgery
Jacob Zeitani, Marco Russo, Eugenio Pompeo, Gian Luigi Sergiacomi, Luigi Chiariello
BACKGROUND: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. METHODS: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2)...
October 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Chun Sung Byun, Il Hwan Park, Wan Jin Hwang, Yeiwon Lee, Hyun Min Cho
BACKGROUND: Sternal fractures are relatively rare, and caused mainly by blunt anterior chest wall trauma. In most cases, sternal fractures are treated conservatively. However, if the patient exhibits problematic symptoms such as intractable chest wall pain or bony crepitus due to sternal instability, surgical correction is indicated. But no consensus exists regarding the most appropriate surgical method. We analyzed the results of surgical fixation in cases of sternal fracture in order to identify which surgical method led to the best outcomes...
October 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Carmen Burtea, Sophie Laurent, Tuba Sanli, Deborah Fanfone, Aude Devalckeneer, Sébastien Sauvage, Marie-Claire Beckers, Sandrine Rorive, Isabelle Salmon, Luce Vander Elst, Bernard R Lauwerys, Robert N Muller
BACKGROUND: Interleukin-7 receptor alpha (IL-7Rα) represents a biomarker with potential applications in rheumatoid arthritis (RA) diagnosis and therapy. We have therefore searched by phage display potential IL-7Rα specific peptides with the primary goal being to develop in vivo molecular imaging tools. METHODS: IL-7Rα-targeted peptides were searched within a disulfide-constrained combinatorial phage displayed library of random linear heptapeptides. The apparent dissociation constant (Kd) and half maximal inhibition constant (IC50) were estimated for phage clones and synthesized peptides by ELISA...
October 12, 2016: Arthritis Research & Therapy
Cory Lee, Abraham Zavala-Garcia, Neha Teekappanavar, Catherine Lee, Olajire Idowu, Sunghoon Kim
BACKGROUND: Pectus excavatum (PE) is a chest deformity characterized by marked sternal depression. The objective of this study was to quantify the sternal curvature observed in patients diagnosed with PE using the sternal curvature angle (SCA). METHODS: A retrospective review of lateral chest X-rays of patients with PE from 2006 to 2013 was performed. The SCA was measured in a manner similar to the method of Cobb's angle is used to measure spinal curvature. SCA and Haller index were calculated from the chest X-rays for all patients...
October 8, 2016: Pediatric Surgery International
Kristen Nelson-McMillan, Christoph P Hornik, Xia He, Luca A Vricella, Jeffrey P Jacobs, Kevin D Hill, Sara K Pasquali, Diane E Alejo, Duke E Cameron, Marshall L Jacobs
BACKGROUND: Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. METHODS: Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included...
October 6, 2016: Annals of Thoracic Surgery
Shinya Miura, Nao Hamamoto, Masaki Osaki, Satoshi Nakano, Chisato Miyakoshi
BACKGROUND: The purpose of this study was to explore the prevalence, etiology, and risk factors of extubation failure (EF) in post-cardiac surgery neonates. METHODS: Neonates (30 days old or younger) who underwent cardiac surgery and were admitted to the cardiac intensive care unit between September 2010 and February 2016 were included. The prevalence and etiology of EF, defined as reintubation within 48 hours, were reviewed. Demographic, operative, and perioperative data were retrospectively collected...
October 6, 2016: Annals of Thoracic Surgery
L Ludwig, L McWhirter, S Williams, C Derry, J Stone
Functional coma - here defined as a prolonged motionless dissociative attack with absent or reduced response to external stimuli - is a relatively rare presentation. In this chapter we examine a wide range of terms used to describe states of unresponsiveness in which psychologic factors are relevant to etiology, such as depressive stupor, catatonia, nonepileptic "pseudostatus," and factitious disorders, and discuss the place of functional or psychogenic coma among these. Historically, diagnosis of functional coma has sometimes been reached after prolonged investigation and exclusion of other diagnoses...
2017: Handbook of Clinical Neurology
Ruttapon Srisonchai, Henrik Enghoff, Natdanai Likhitrakarn, Somsak Panha
Four new dragon millipede species of the genus Desmoxytes from northern Thailand are described and illustrated: D. des sp. n. from Chiang Mai Province, D. breviverpa sp. n. from Phrae Province, D. takensis sp. n. from Tak Province and      D. pinnasquali sp. n. from Phitsanulok Province. The new species were compared with type specimens of closely related species and were all found to exhibit explicit morphological differences from these. They can be distinguished from other members of Desmoxytes by the shape of the gonopods, the sternal process between male coxae 4, the pattern of spines or tubercles on the metaterga, and the shape of the paraterga...
September 22, 2016: Zootaxa
Allysson P Pinheiro, William Santana
A new species of freshwater crab, Kingsleya attenboroughi n. sp., from the Arajara district, Ceará state, Brazil, is described and illustrated. The new species differs from congeners by having a short apical plate in the first gonopod, with anteriorly directed lobes and proximally angular; proximal lobe of the apical plate with conspicuous semicircular protuberance in mesial and sternal views; marginal process protruded, projecting mesially in sternal view and subquadrate in mesial view; and field of apical spines narrow, tapering distally, with small spines concentrated proximally...
September 28, 2016: Zootaxa
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