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Sample records for sternum

  1. Computed tomography of the normal sternum

    International Nuclear Information System (INIS)

    Goodman, L.R.; Teplick, S.K.; Kay, H.

    1983-01-01

    The normal CT anatomy of the sternum was studied in 35 patients. In addition to the normal appearance of the sternum, normal variants that may mimic desease were often noted. In the manubrium, part of the posterior cortical margin was unsharp and irregular in 34 of 35 patients. Part of the anterior cortical margin was indistinct in 20 of the 35 patients. Angulation of the CT gantry to a position more nearly perpendicular to the manubrium improved the definition of the cortical margins. The body of the sternum was ovoid to rectangular and usually had sharp cortical margins. Sections through the manubriosternal joint and xyphoid often demonstrated irregular mottled calcifications and indistinct margins again simulating bony lesions. The rib insertions, sternal clavicular joints, and adjacent soft-tissue appearance also were evaluated

  2. Pictorial review: MRI of the sternum and sternoclavicular joints.

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    Aslam, M; Rajesh, A; Entwisle, J; Jeyapalan, K

    2002-07-01

    The sternum and sternoclavicular joints are difficult to evaluate with plain radiographs. The value of CT in assessing lesions of the sternum and sternoclavicular joints has been well documented, but the potential role of MRI has not been emphasized. We present the MRI techniques, normal appearances and a spectrum of abnormalities, and emphasize the role of MRI as a useful radiological investigation for the sternum and sternoclavicular joints.

  3. UPPER THORACIC SPINE FRACTURE ASSOCIATED WITH FRACTURE OF THE STERNUM

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    JOAQUÍN VALERO

    Full Text Available ABSTRACT Objectives: The objectives of this presentation are to analyze the kinematics that causes this association, describe the impact of the injury, and evaluate the treatment performed Methods: Three cases are analyzed by quantifying the displacement and angulation of the sternum, the characteristics of the spinal injury and deformity, treatment, and complications Results: The mechanism that causes the injury is flexion-distraction, the component of the vertebral body presented is type A, and the most affected region was T5. Two patients had neurological picture E. Sternum injury was caused by direct trauma Conclusion: The association of these was observed in patients who have suffered from high-energy trauma in a car accident. There was no relationship between the angulation of the sternum and its displacement to the degree of kyphosis and displacement of the thoracic spine. It is important to carry out good radiographic studies that include the sternum when there is suspicion of this relationship.

  4. Isolated Asymptomatic Short Sternum in a Healthy Young Girl

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    Francesco Turturro

    2014-01-01

    Full Text Available Congenital sternal defects are rare deformities frequently associated with other anomalies of the chest wall and other organ systems. Although pectus excavatum, pectus carinatum, and cleft sternum can present as isolated deformity, in most cases they are associated with heart and inner organs anomalies and described as symptoms of syndromes like Marfan syndrome, Noonan syndrome, Poland anomaly, and Cantrell pentalogy. In contrast, the etiology of an isolated defect is not well understood. We observed a short sternum (dysmorphic manubrium, hypoplastic body, and complete absence of the xiphoid process in a completely asymptomatic 13-year-old woman. A comprehensive instrumental exams panel was performed to exclude associated anomalies of the heart and of the other organ systems. The patient was completely asymptomatic and she did not need any medical or surgical treatment. To our knowledge, this is the first case of isolated short sternum reported in literature.

  5. Estimation of stature from sternum - Exploring the quadratic models.

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    Saraf, Ashish; Kanchan, Tanuj; Krishan, Kewal; Ateriya, Navneet; Setia, Puneet

    2018-04-14

    Identification of the dead is significant in examination of unknown, decomposed and mutilated human remains. Establishing the biological profile is the central issue in such a scenario, and stature estimation remains one of the important criteria in this regard. The present study was undertaken to estimate stature from different parts of the sternum. A sample of 100 sterna was obtained from individuals during the medicolegal autopsies. Length of the deceased and various measurements of the sternum were measured. Student's t-test was performed to find the sex differences in stature and sternal measurements included in the study. Correlation between stature and sternal measurements were analysed using Karl Pearson's correlation, and linear and quadratic regression models were derived. All the measurements were found to be significantly larger in males than females. Stature correlated best with the combined length of sternum, among males (R = 0.894), females (R = 0.859), and for the total sample (R = 0.891). The study showed that the models derived for stature estimation from combined length of sternum are likely to give the most accurate estimates of stature in forensic case work when compared to manubrium and mesosternum. Accuracy of stature estimation further increased with quadratic models derived for the mesosternum among males and combined length of sternum among males and females when compared to linear regression models. Future studies in different geographical locations and a larger sample size are proposed to confirm the study observations. Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  6. Eight calves of cervical ectopia cordis and their sternums

    International Nuclear Information System (INIS)

    Hiraga, T.; Abe, M.

    1986-01-01

    Four male and four female Holstein-Friesian calves affected with cervical ectopia cordis were examined macroscopically and their sternums were radiographed using soft X-rays. Their lifespan ranged from 3 minutes to 312 days. The heart was located within the pericardium under the muscles and skin at the ventral cervical area and its double apex was directed craniodorsally, and the base was pointed caudoventrally. The branching pattern of arteries from the aortic arch was similar to that of dog in all cases. Double cranial vena cava and double azygos vein were observed in many cases. The manubrium was very wide to enlarge the cranial thoracic aperture. The short and wide sternum consisted of 13 to 26 sternebrae, and the ossification centers of manubrium and body of sternum showed paired appearance. The thoracic portion of the thymus was absent, while the cervical portions were gathered together on the craniodorsal side of the heart. The ligaments extending from the fibrous pericardium were attached to the mandibles and parotid fasciae cranially, to the cervical fasciae laterally, and also to the first ribs or manubrium caudally and held the heart in its position. Based on these findings, the pathogenesis of this anomaly was discussed from an embryological point of view

  7. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

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    Piseth Seng

    2015-01-01

    Full Text Available Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France.

  8. An experience with a rare diagnosis of isolated tuberculosis of sternum at JNMC Hospital, Aligarh, India

    International Nuclear Information System (INIS)

    Ali, Wasif M.; Beg, Mohammad H.; Rashid, M.; Abbas, Syed N.; Zafar, U.

    2008-01-01

    Objective was to diagnose isolated tuberculosis of sternum in patients presenting with signs and symptoms suggestive of tuberculosis. A prospective study conducted at Jawaharlal Nehru Medical College, Aligrah Muslim University, Aligarh, India from July 2000 to July 2006 of 2512 patients presenting with a suspected case of tuberculosis. Cases were confirmed using different investigations along with treatment of the patients with antitubercular treatment (ATT) with further follow up for next 2 years. Nineteen patients were suffering from isolated tuberculosis of sternum. The main presenting feature was retrosternal discomfort (100%) while 14 (73.6%) patients presented with a cold abscess of sternum. All the patients were treated successfully with 12 months of ATT and followed up for 2 years for any relapse. Although tuberculosis of sternum is rare, it should be considered as an important differential diagnosis in patients presenting with chronic lesions of the sternum, particularly in endemic/developing countries. Twelve months of treatment with ATT is optimal for achieving cure without any risk of relapse. (author)

  9. Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum

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    Kambiz Sheikhy

    2017-01-01

    Full Text Available A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result.

  10. Rib and sternum fractures in the elderly and extreme elderly following motor vehicle crashes.

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    Bansal, Vishal; Conroy, Carol; Chang, David; Tominaga, Gail T; Coimbra, Raul

    2011-05-01

    As the population ages, the need to protect the elderly during motor vehicle crashes becomes increasingly critical. This study focuses on causation of elderly rib and sternum fractures in seriously injured elderly occupants involved in motor vehicle crashes. We used data from the Crash Injury Research and Engineering Network (CIREN) database (1997-2009). Study case criteria included occupant (≥ 65 years old) drivers (sitting in the left outboard position of the first row) or passengers (sitting in the first row right outboard position) who were in frontal or side impacts. To avoid selection bias, only occupants with a Maximum Abbreviated Injury Scale (MAIS) 3 (serious) or greater severity injury were included in this study. Odds ratios were used as a descriptive measure of the strength of association between variables and Chi square tests were used to determine if there was a statistically significant relationship between categorical variables. Of the 211 elderly (65-79 years old) occupants with thoracic injury, 92.0% had rib fractures and 19.6% had sternum fractures. For the 76 extreme elderly (80 years or older) with thoracic injury, 90.4% had rib fractures and 27.7% had sternum fractures. Except for greater mortality and more rib fractures caused by safety belts, there were no differences between the extreme elderly and the elderly occupants. Current safety systems may need to be redesigned to prevent rib and sternum fractures in occupants 80 years and older. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. Stabilization of Flail Chest and Fractured Sternum by Minimally Invasive Repair of Pectus Excavatum

    OpenAIRE

    Akku?, Murat; Utkusava?, Ayfer; Han?z?, Murat; Kaya, Mehmet; Bakir, Ihsan

    2015-01-01

    We report a 55-year-old male patient with a massive flail chest that required chest stabilization by minimally invasive repair of pectus excavatum (MIRPE) employing a Nuss bar. Surgical stabilization of severe flail chest and fractured sternum with Nuss bar by MIRPE is a safe and useful treatment modality in properly selected patients.

  12. Estimation of respiratory rates based on photoplethysmographic measurements at the sternum

    DEFF Research Database (Denmark)

    Chreiteh, Shadi; Belhage, Bo; Hoppe, Karsten

    2015-01-01

    rate is extracted using photoplethysmography (PPG) on the chest bone (sternum). Sternal PPG signals were acquired from 10 healthy subjects resting in a supine position. As reference signals, finger PPG, electrocardiogram (ECG), and capnography were simultaneously recorded during spontaneous and paced...... breathing. The sternal PPG signals were then compared with the reference signals in terms of Bland-Altman analysis, the power spectrum analysis and the magnitude squared coherence. The Bland-Altman analysis showed an average bias of 0.21 breaths/min between RR extracted from sternal PPG and capnography....... The respiratory power content at the sternum was 78.8 (38) % in terms of the median and (the interquartile range). The cardiac content was 19 (18.4) % within the cardiac region. The results from the magnitude squared coherence analysis was 0.97 (0.09) in the respiratory region (6 to 27 breaths/min) and 0.98 (0...

  13. Heart rhythm analysis using ECG recorded with a novel sternum based patch technology

    DEFF Research Database (Denmark)

    Saadi, Dorthe Bodholt; Fauerskov, Inge; Osmanagic, Armin

    2013-01-01

    , reliable long-term ECG recordings. The device is designed for high compliance and low patient burden. This novel patch technology is CE approved for ambulatory ECG recording of two ECG channels on the sternum. This paper describes a clinical pilot study regarding the usefulness of these ECG signals...... for heart rhythm analysis. A clinical technician with experience in ECG interpretation selected 200 noise-free 7 seconds ECG segments from 25 different patients. These 200 ECG segments were evaluated by two medical doctors according to their usefulness for heart rhythm analysis. The first doctor considered...... 98.5% of the segments useful for rhythm analysis, whereas the second doctor considered 99.5% of the segments useful for rhythm analysis. The conclusion of this pilot study indicates that two channel ECG recorded on the sternum is useful for rhythm analysis and could be used as input to diagnosis...

  14. A new sternum elevator reduces severe complications during minimally invasive repair of the pectus excavatum.

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    Takagi, Satoshi; Oyama, Takuto; Tomokazu, Nishihira; Kinoshita, Koji; Makino, Taro; Ohjimi, Hiroyuki

    2012-06-01

    Although the Nuss procedure for pectus excavatum is widely employed, a variety of complications have been reported with relatively high frequency; those that involve cardiac and pericardial injuries can be life threatening. To reduce such dangers, we present here a newly developed sternal elevator. The elevator is horseshoe shaped. Its elevator side has the same curvature as a Nuss introducer, so that interference between devices is minimal and no extra skin incision is needed for the elevator insertion. The elevator holds the sternum forward and enlarges the retrosternal space for safer passage of thoracoscopically guided introducer. The authors have used the elevator for 61 pectus excavatum cases between March 2004 and December 2009 without any major complications. The entire process of substernal tunneling was endoscopically observed, which eliminated any blunt and blind dissection, even in a significantly depressed funnel chest case. With the device, the sternum was effectively elevated again for the placement of the second plate in 30 cases. Our newly developed sternum elevator makes the Nuss procedure safer and more affordable without introducing any extra scarring.

  15. Primary Osteosarcoma of the Sternum: A case Report and Review of the Literature

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    Masoud Pezeshki Rad

    2014-10-01

    Full Text Available Osteosarcoma (osteogenic sarcoma: OS is the most common primary malignant bone tumor of long bones, whereas primary osteosarcoma of chest wall, especially in sternum, is extremely rare. We report a 57-year-old man with an immobile slow growing mass located in the middle of the sternum. The patient had no significant pain or tenderness and the past medical history was not remarkable. CT-scan showed a large densely sclerotic sternal mass and MRI revealed an extensive central signal loss within the tumor because of necrosis. We performed a CT-guided needle biopsy, but it was inconclusive. After an incisional biopsy, a high-grade osteosarcoma of the sternum was diagnosed. The patient underwent subtotal sternal resection and reconstruction using synthetic mesh and bone cement followed by chemotherapy and external beam radiotherapy. After one year of follow-up, the patient is back to normal life and is doing the daily activities without problem. By this time, focal recurrence or metastatic disease did not occur.

  16. Tuberculosis of the sternum and clavicle: imaging findings in 15 patients

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    Shah, J.; Patkar, D.; Parikh, B. [Dept. of Radiology, Nanavati Hospital, Mumbai (India); Parmar, H.; Varma, R.; Patankar, T.; Prasad, S. [Department of Radiology, King Edward VII Memorial Hospital, Mumbai (India)

    2000-08-01

    Objective. To describe the imaging findings in sterno-clavicular tubercular involvement.Design and patients. Fifteen patients with pathologically proven tuberculosis of the sternum and clavicle were retrospectively evaluated. Routine radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were used in some or all of the patients. Clinical information and imaging features were evaluated in each case.Results. Eight patients had sterno-clavicular joint (SCJ) involvement, five had isolated sternal involvement and two had isolated clavicular involvement. Seven patients were evaluated with only CT, six with only MRI and two with both. There were eight male and seven female patients, varying in age between 16 and 78 years. Fever, swelling and pain were common presenting symptoms. Two patients were HIV positive. Radiographs were positive in only eight patients. Destruction and signal intensity (SI) changes of the sternum and clavicle, destruction of the cartilage, soft tissue changes representing granulation tissue/abscess, displacement of the adjacent structures (vessels, trachea, etc.) and inflammatory changes in the adjacent structures in the form of cellulitis and myositis were common imaging features.Conclusions. All imaging methods can provide complementary information regarding sterno-clavicular tubercular involvement that is helpful for determination of the therapy. MRI is useful in determining the extent of the lesion, particularly marrow involvement and soft tissue extent. (orig.)

  17. Tuberculosis of the sternum and clavicle: imaging findings in 15 patients

    International Nuclear Information System (INIS)

    Shah, J.; Patkar, D.; Parikh, B.; Parmar, H.; Varma, R.; Patankar, T.; Prasad, S.

    2000-01-01

    Objective. To describe the imaging findings in sterno-clavicular tubercular involvement.Design and patients. Fifteen patients with pathologically proven tuberculosis of the sternum and clavicle were retrospectively evaluated. Routine radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were used in some or all of the patients. Clinical information and imaging features were evaluated in each case.Results. Eight patients had sterno-clavicular joint (SCJ) involvement, five had isolated sternal involvement and two had isolated clavicular involvement. Seven patients were evaluated with only CT, six with only MRI and two with both. There were eight male and seven female patients, varying in age between 16 and 78 years. Fever, swelling and pain were common presenting symptoms. Two patients were HIV positive. Radiographs were positive in only eight patients. Destruction and signal intensity (SI) changes of the sternum and clavicle, destruction of the cartilage, soft tissue changes representing granulation tissue/abscess, displacement of the adjacent structures (vessels, trachea, etc.) and inflammatory changes in the adjacent structures in the form of cellulitis and myositis were common imaging features.Conclusions. All imaging methods can provide complementary information regarding sterno-clavicular tubercular involvement that is helpful for determination of the therapy. MRI is useful in determining the extent of the lesion, particularly marrow involvement and soft tissue extent. (orig.)

  18. Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum.

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    Patel, Prasan; Gray, Robin R

    2014-12-28

    A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

  19. Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection

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    Spindler, Nick

    2017-06-01

    Full Text Available Introduction: Deep sternal wound infections (DSWI are a rare but devastating complication after median sternotomy. Minor perfusion in bone and soft tissue, especially after recruiting the internal mammary artery for bypass supports the development of wound infection and nonunion of the sternal bone. The aim of the study was the macroscopic and radiological presentation of the vascular system supplying the sternum, in particular the compensating blood supply routes in the event that the internal mammary artery is no longer available after use as a bypass vessel.Method: This anatomic study was carried out on the anterior chest wall of 7 specimens. The thorax plates of 7 specimens were analyzed macroscopically after microsurgical preparation. Different anatomic preparations were produced using different contrast or form-giving substances. Radiological analysis and three-dimensional reconstructions were performed to show alternative, collateral sternal vessel perfusion under estimation of the loss of the internal thoracic artery due to a bypass.Results: The length of the ITA (internal thoracic artery, measured from the beginning of the first rib to the division into the superior epigastric artery and musculophrenic artery, was an average of 16.3 cm. On average, 18.5 branches were delivered from each artery, 10 medially to the sternum supply, and the intercostal muscle. Conclusion: Our analysis gives an overview of the macroanatomic vessel system supplying the sternal bone, describing especially a common trunk deriving from the ITA and supplying multiple branches and playing an important role in building a collateral circulation of the sternum.For better evaluation, in vivo CT analysis with contrast media should be performed in patients prior to the operation and directly after the use of the double ITA to demonstrate the change in perfusion of the sternum.In the future, preconditioning of the sternum by coiling the deriving branches could become an

  20. Three dimensional images of the sternum in children with using MDCT

    International Nuclear Information System (INIS)

    Kim, Young Tong; Kim, Hyun Cheol; Bae, Won Kyung; Kim, Il Young

    2006-01-01

    We wanted to analyze the three dimensional images with using multidetector CT scanning of the sternum in children, and we wanted to compare the CT findings with the children's age. We studied the three dimensional images of the sternum of 67 children (62 were boys and 5 were girls). The age of the children was 3-15 years old (mean age:7.5). We evaluated the number of sternal bodies, the presence of the xiphoid process and the bifid shape of each sternal body. The number of sternal bodies was from three to five; 30 patients had 3 bodies, 25 patients had 4 bodies and 5 patients had 2. The number of sternal bodies was 3.4 in Group I, 3.5 in Group II and 3.9 in Group III. As the children's age increased, the number of sternal body was statistically increased. When the number of sternal bodies was three, the mean age of children was 5.4 year; when it was four or five, the mean age of children was 8.1 year. The children's age was increased as the number of sternal bodies increased. The mean age of the children with a xiphoid process was 7.0 years, and the mean age of children without a xiphoid process was 8.1. There was no statistical difference between the two groups with or without xiphoid process. Among the 67 children, 9 had the bifid shape in the 3rd portion of the sternal body, 5 had the bifid shape in 4th portion, 2 had the bifid shape in 2nd portion and 1 had the bifid shape in 5th portion. The number of sternal bodies was mostly three or four. The number of sternal bodies was related to the children's age. Three is no relationship between children's age and the presence of the xiphoid process. The bifid shapes are mostly shown in the 3rd and 4th portion of the sternal body

  1. Chronological study for solitary bone metastasis in the sternum from breast cancer with bone scintigraphy

    International Nuclear Information System (INIS)

    Miyoshi, Hidenao; Otsuka, Nobuaki; Sone, Teruki; Nagai, Kiyohisa; Tamada, Tsutomu; Mimura, Hiroaki; Yanagimoto, Shinichi; Tomomitsu, Tatsushi; Fukunaga, Masao

    1999-01-01

    Since breast cancer is frequently associated with bone metastasis, bone scintigraphies have been performed to determine pre-operative staging and to survey postoperative bone metastasis. The sternum, in particular, is a site at which is difficult to differentiate between benign bone disease and bone metastasis, because of varied uptake and wide individual variations. In this study, chronological bone images were scintigraphied in six cases with solitary sternal metastasis and three cases with benign bone disease including two fracture cases and one arthritis case. On bone scintigrams in which solitary sternal metastasis appeared, increased uptake was found in five cases, and photon deficiency was observed in one case. During follow-up scintigraphies, abnormal accumulations, such as hot spots and cold lesions, increased in the bone metastasis while abnormal uptake disappeared or was unchanged in the benign bone disease cases. On CT, four cases showed osteolytic change, and one exhibited osteosclerotic change. These findings indicate that sternal metastasis usually shows osteolytic change, even if a hot lesion is recognized on bone scintigraphy. In solitary sternal metastasis, for which early diagnosis is difficult, both an integrated diagnosis using other imaging techniques and chronological bone scintigraphy are important. (author)

  2. The Vertebral Column, Ribs, and Sternum of the African Giant Rat (Cricetomys gambianus Waterhouse)

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    Olude, Matthew Ayokunle; Mustapha, Oluwaseun Ahmed; Ogunbunmi, Temitope Kehinde; Olopade, James Olukayode

    2013-01-01

    Examined bones were obtained from eight adult African giant rats, Cricetomys gambianus Waterhouse. Animals used had an average body mass of 730.00 ± 41.91 gm and body length of 67.20 ± 0.05 cm. The vertebral formula was found to be C7, T13, L6, S4, Ca31–36. The lowest and highest points of the cervicothoracic curvature were at C5 and T2, respectively. The spinous process of the axis was the largest in the cervical group while others were sharp and pointed. The greatest diameter of the vertebral canal was at the atlas (0.8 cm) and the lowest at the caudal sacral bones (2 mm). The diameter of the vertebral foramen was the largest at C1 and the smallest at the S4; the foramina were negligibly indistinct caudal to the sacral vertebrae. There were 13 pairs of ribs. The first seven pairs were sternal, and six pairs were asternal of which the last 2-3 pairs were floating ribs. The sternum was composed of deltoid-shaped manubrium sterni, four sternebrae, and a slender processus xiphoideus. No sex-related differences were observed. The vertebral column is adapted for strong muscular attachment and actions helping the rodent suited for speed, agility, dexterity, and strength which might enable it to overpower prey and escape predation. PMID:24288518

  3. The Vertebral Column, Ribs, and Sternum of the African Giant Rat (Cricetomys gambianus Waterhouse

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    Matthew Ayokunle Olude

    2013-01-01

    Full Text Available Examined bones were obtained from eight adult African giant rats, Cricetomys gambianus Waterhouse. Animals used had an average body mass of 730.00±41.91 gm and body length of 67.20±0.05 cm. The vertebral formula was found to be C7, T13, L6, S4, Ca31–36. The lowest and highest points of the cervicothoracic curvature were at C5 and T2, respectively. The spinous process of the axis was the largest in the cervical group while others were sharp and pointed. The greatest diameter of the vertebral canal was at the atlas (0.8 cm and the lowest at the caudal sacral bones (2 mm. The diameter of the vertebral foramen was the largest at C1 and the smallest at the S4; the foramina were negligibly indistinct caudal to the sacral vertebrae. There were 13 pairs of ribs. The first seven pairs were sternal, and six pairs were asternal of which the last 2-3 pairs were floating ribs. The sternum was composed of deltoid-shaped manubrium sterni, four sternebrae, and a slender processus xiphoideus. No sex-related differences were observed. The vertebral column is adapted for strong muscular attachment and actions helping the rodent suited for speed, agility, dexterity, and strength which might enable it to overpower prey and escape predation.

  4. [A re-operative case of bentall operation and aortic arch replacement using a stent graft for a Marfan syndrome, post sternum turnover and post mitral valve replacement].

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    Sasaki, H; Aomi, S; Noji, S; Uwabe, K; Kihara, S; Kurihara, H; Koyanagi, H

    2001-09-01

    A 36-year-old male with Marfan syndrome succesfully underwent Bentall operation and aortic arch replacement using a stent graft as an elephant trunk. He had received MVR with sternum turn over 14 years previously. Median sternotomy was performed. Under circulatory arrest with rertograde cerebral perfusion we performed Bentall operation and aortic arch replacement using a stent graft. The sternum was cured well. Retractive breathing was not detected. This surgical procedure was effective for cardiovascular disease with Marfan syndrome.

  5. Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray.

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    Lederer, Wolfgang; Mair, Dieter; Rabl, Walter; Baubin, Michael

    2004-02-01

    Fractured ribs and sternum are frequent complications of thoracic compression during CPR in adults. This study was conducted to determine whether findings of plain chest radiography (CXR) correlate with post-mortem findings in patients who underwent cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest. CXR findings and autopsy results of CPR-related chest injuries comprising rib and sternum fractures were compared prospectively in 19 patients. Fractures were diagnosed in nine of 19 patients by means of radiology and in 18 of 19 patients by autopsy (rib fractures in 6/19 versus 17/19, P=0.002; sternum fractures in 5/19 versus in 9/19, P=0.227. The total number of isolated bone fractures detected by CXR was 18 (12 rib and six sternum fractures) and by autopsy 92 (83 rib and nine sternum fractures). The majority of rib fractures was located in the anterior part of the thoracic cage. Sternum fractures predominantly occurred in the lower third. Eight of 19 patients received either thrombolytic or antithrombotic treatment during CPR but no major bleeding complication associated with CPR was detected by autopsy. The findings of this study indicate that fractures associated with CPR are underreported in conventional radiographic investigations. No major bleeding complications related to CPR-associated fractures was detected.

  6. Discrete traits of the sternum and ribs: a useful contribution to identification in forensic anthropology and medicine.

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    Verna, Emeline; Piercecchi-Marti, Marie-Dominique; Chaumoitre, Kathia; Bartoli, Christophe; Leonetti, Georges; Adalian, Pascal

    2013-05-01

    During forensic anthropological investigation, biological profile is determined by age, sex, ancestry, and stature. However, several individuals may share the same profile. Observation of discrete traits can yield useful information and contribute to identification. This research establishes the frequency of discrete traits of the sternum and ribs in a modern population in southern France, using 500 computer tomography (CT) scans of individuals aged 15-60 years. Only discrete traits with a frequency lower than 10% according to the literature were considered, a total of eight traits. All scans examined were three-dimensional (3D) volume renderings from DICOM images. In our population, the frequency of all the discrete traits was lower than 5%. None were associated with sex or age, with the exception of a single trait, the end of the xiphoid process. Our findings can usefully be applied for identification purposes in forensic anthropology and medicine. © 2013 American Academy of Forensic Sciences.

  7. Lifetime accumulation of 137Cs and 40K in the ribs and sternum of an Austrian 'mountain pasture' cow

    International Nuclear Information System (INIS)

    Rabitsch, Herbert; Pichl, Elke

    2008-01-01

    The accumulation of natural and artificial radionuclides in humans and domestic animals is of interest in estimating effective doses of exposed humans and to decide whether animal products can be used for nutrition of the population. In this paper we present an investigation of the 137 Cs- and 40 K-activity levels of the ribs and sternum of a 'mountain pasture' cow, born in a highly contaminated region of Styria, Austria, at the time of the radioactive fallout following the Chernobyl accident. This is the first systematic investigation of the variation in activity levels of a contaminated animal. The International Commission on Radiological Protection (ICRP) assumes that cesium and potassium are homogenously distributed throughout the whole body of an organism. However, the presented results show that there is a non-uniform distribution of 137 Cs and 40 K in different skeletal bones and their adherent tissues of a dairy cattle. We found that activity concentrations of 137 Cs and 40 K varied up to a factor 2.5 in different components of the ribs. The minimum values of 137 Cs and 40 K in the ribs were 29.9 and 21 Bq kg -1 fresh mass for trabecular bone in the vertebral half of asternal ribs, and the maximum values 332 and 132 Bq kg -1 fresh mass for a mixed sample composed of a cartilaginous tissue layer and parts of the perichondrium, both originating from asternal costal cartilages, respectively

  8. Morphological and anatomical examinations of the dog's sternum in particular consideration of x-ray examination, CT, dissection, mazeration and histological examination

    International Nuclear Information System (INIS)

    Wilhelm, M.L.

    2000-06-01

    Material consisted of 100 sterna of dogs and 964 x-rays of dogs from the archives of the clinic for radiology. The sterna of puppies (0 to 3 months old) and juvenile dogs (3 to 18 months old) showed a typical appearance. 20 adult dogs didn't show any morphological alteration of the sternum. Exostoses were found in 31 cases, 17 dogs showed formation of osseous bridges, and 21 dogs showed arthrosis of sternocostal joints. Most frequently (34 cases) ossification of the synchondrosis xiphosternalis was found. Other alterations were distortion of the whole sternum, varying number of sternebrae, a blunt manubrium sterni, a reduced 6th sternebra, sternal dysraphism, sclerosis, subluxations, synchondral ossification, variations of the synchondrosis' width, and exostoses at the sternal ends of rib cartilage. Evaluation of x-rays from the archives made it possible to demonstrate the disposition of age groups and breeds to certain alterations. Dogs of higher age, German shepherd dogs, Spaniels and Dachshunds were most frequently afflicted by sternal exostoses and synchondral ossification. (author)

  9. Solitary Plasmacytoma of the Sternum Mimicking Bone Metastasis in a Patient with a History of Breast Cancer Evaluated by F-18-FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Treglia, Giorgio; Luca, Giovanella [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Barbara, Muoio; Carmelo, Caldarella [Catholic Univ., Rome (Italy)

    2014-06-15

    A 65-year-old woman with a history of breast cancer (stage T2N0M0 treated with left breast conservative therapy 7 years previously followed by hormone therapy) underwent fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) for restaging due to increased serum tumour markers levels (CA15-3, 37 U/ml and CEA, 8 ng/ml). The patient presented thoracic pain before performing F-18-FDG PET/CT. PET/CT demonstrated an area of increased F-18-FDG uptake corresponding to an osteolytic lesion occupying the upper sternum suspicious for bone metastasis. No other areas of abnormal F-18-FDG uptake were detected in the rest of the body. Based on this PET/CT finding, the patient performed biopsy of the sternal lesion. Histology demonstrated the presence of a sternal plasmacytoma and the patient was addressed to radiation therapy. The role of F-18-FDG PET/CT in patients with multiple myeloma is well known, whereas only some articles evaluated the usefulness of this method in patients with solitary plasmacytomas. In particular, F-18-FDG PET/CT may be useful in demonstrating the evolution of solitary plasmacytomas in multiple myeloma. In our case F-18-FDG PET/CT was useful in detecting a solitary plasmacytoma of the sternum mimicking bone metastasis in a patient with history of breast cancer, correctly addressing to further histological evaluation.

  10. Solitary Plasmacytoma of the Sternum Mimicking Bone Metastasis in a Patient with a History of Breast Cancer Evaluated by F-18-FDG PET/CT

    International Nuclear Information System (INIS)

    Treglia, Giorgio; Luca, Giovanella; Barbara, Muoio; Carmelo, Caldarella

    2014-01-01

    A 65-year-old woman with a history of breast cancer (stage T2N0M0 treated with left breast conservative therapy 7 years previously followed by hormone therapy) underwent fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT) for restaging due to increased serum tumour markers levels (CA15-3, 37 U/ml and CEA, 8 ng/ml). The patient presented thoracic pain before performing F-18-FDG PET/CT. PET/CT demonstrated an area of increased F-18-FDG uptake corresponding to an osteolytic lesion occupying the upper sternum suspicious for bone metastasis. No other areas of abnormal F-18-FDG uptake were detected in the rest of the body. Based on this PET/CT finding, the patient performed biopsy of the sternal lesion. Histology demonstrated the presence of a sternal plasmacytoma and the patient was addressed to radiation therapy. The role of F-18-FDG PET/CT in patients with multiple myeloma is well known, whereas only some articles evaluated the usefulness of this method in patients with solitary plasmacytomas. In particular, F-18-FDG PET/CT may be useful in demonstrating the evolution of solitary plasmacytomas in multiple myeloma. In our case F-18-FDG PET/CT was useful in detecting a solitary plasmacytoma of the sternum mimicking bone metastasis in a patient with history of breast cancer, correctly addressing to further histological evaluation

  11. Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasi Tashnizi

    2013-01-01

    Full Text Available Introduction: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG; but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. Materials and Methods: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. Results: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. Conclusions: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery.

  12. Mesenchymal stem cells from sternum: the type of heart disease, ischemic or valvular, does not influence the cell culture establishment and growth kinetics.

    Science.gov (United States)

    Dias, Lucinara Dadda; Casali, Karina Rabello; Ghem, Carine; da Silva, Melissa Kristocheck; Sausen, Grasiele; Palma, Patrícia Bonini; Covas, Dimas Tadeu; Kalil, Renato A K; Schaan, Beatriz D; Nardi, Nance Beyer; Markoski, Melissa Medeiros

    2017-07-25

    In an attempt to increase the therapeutic potential for myocardial regeneration, there is a quest for new cell sources and types for cell therapy protocols. The pathophysiology of heart diseases may affect cellular characteristics and therapeutic results. To study the proliferative and differentiation potential of mesenchymal stem cells (MSC), isolated from bone marrow (BM) of sternum, we made a comparative analysis between samples of patients with ischemic (IHD) or non-ischemic valvular (VHD) heart diseases. We included patients with IHD (n = 42) or VHD (n = 20), with average age of 60 years and no differences in cardiovascular risk factors. BM samples were collected (16.4 ± 6 mL) and submitted to centrifugation with Ficoll-Paque, yielding 4.5 ± 1.5 × 10 7  cells/mL. Morphology, immunophenotype and differentiation ability had proven that the cultivated sternal BM cells had MSC features. The colony forming unit-fibroblast (CFU-F) frequency was similar between groups (p = 0.510), but VHD samples showed positive correlation to plated cells vs. CFU-F number (r = 0.499, p = 0.049). The MSC culture was established in 29% of collected samples, achieved passage 9, without significant difference in expansion kinetics between groups (p > 0.05). Dyslipidemia and the use of statins was associated with culture establishment for IHD patients (p = 0.049 and p = 0.006, respectively). Together, these results show that the sternum bone can be used as a source for MSC isolation, and that ischemic or valvular diseases do not influence the cellular yield, culture establishment or in vitro growth kinetics.

  13. Lifetime accumulation of {sup 137}Cs and {sup 40}K in the ribs and sternum of an Austrian 'mountain pasture' cow

    Energy Technology Data Exchange (ETDEWEB)

    Rabitsch, Herbert [Institut fuer Materialphysik, AG Strahlenphysik, Technische Universitaet Graz, Steyrergasse 17, A-8010 Graz (Austria)], E-mail: rabitsch@tugraz.at; Pichl, Elke [Strahlenmesstechnik Graz, Steyrergasse 17, A-8010 Graz (Austria)

    2008-12-15

    The accumulation of natural and artificial radionuclides in humans and domestic animals is of interest in estimating effective doses of exposed humans and to decide whether animal products can be used for nutrition of the population. In this paper we present an investigation of the {sup 137}Cs- and {sup 40}K-activity levels of the ribs and sternum of a 'mountain pasture' cow, born in a highly contaminated region of Styria, Austria, at the time of the radioactive fallout following the Chernobyl accident. This is the first systematic investigation of the variation in activity levels of a contaminated animal. The International Commission on Radiological Protection (ICRP) assumes that cesium and potassium are homogenously distributed throughout the whole body of an organism. However, the presented results show that there is a non-uniform distribution of {sup 137}Cs and {sup 40}K in different skeletal bones and their adherent tissues of a dairy cattle. We found that activity concentrations of {sup 137}Cs and {sup 40}K varied up to a factor 2.5 in different components of the ribs. The minimum values of {sup 137}Cs and {sup 40}K in the ribs were 29.9 and 21 Bq kg{sup -1} fresh mass for trabecular bone in the vertebral half of asternal ribs, and the maximum values 332 and 132 Bq kg{sup -1} fresh mass for a mixed sample composed of a cartilaginous tissue layer and parts of the perichondrium, both originating from asternal costal cartilages, respectively.

  14. [Study of setting of ventilator volume tidal and airway pressure alarm threshold with continuous extra-sternum heart compression in cardiopulmonary resuscitation].

    Science.gov (United States)

    Luo, Jian-yu; Wang, Xiao-yuan; Cai, Tian-bin; Jiang, Wen-fang

    2013-02-01

    To investigate the setting of ventilator volume tidal (VT) and airway pressure alarm threshold during cardiopulmonary resuscitation (CPR) by continuous extra-sternum heart compression. Forty cases with respiration and cardiac arrest in the department of critical care medicine were randomly divided into low VT ventilation group and conventional VT group. Both groups were given the volume control mode. In the low VT ventilation group, VT was set on 6 - 7 ml/kg, and high pressure alarm threshold was adjusted to 60 cm H2O by the conventional 40 cm H2O during CPR. In the conventional VT group, VT and high pressure alarm threshold were set at 8 - 12 ml/kg and 40 cm H2O, respectively. Real-time actual VT, peak inspiratory pressure (PIP), and arterial blood gas test, blood lactic acid at 10 minutes and 30 minutes after CPR were observed. At 10 minutes after CPR, in the low VT ventilation group, arterial blood pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3(-), arterial oxygen saturation (SaO2) and blood lactic acid were better as compared with those in the conventional VT ventilation group (pH: 7.21±0.09 vs. 7.13±0.07, PaO2: 45.35±5.92 mm Hg vs. 40.70±4.70 mm Hg, PaCO2: 57.10±7.59 mm Hg vs. 61.60±5.47 mm Hg, HCO3(-): 18.50±3.50 mmol/L vs. 14.75±2.65 mmol/L, SaO2: 0.796±0.069 vs. 0.699±0.066, blood lactic acid: 7.07±1.60 mmol/L vs. 8.13±1.56 mmol/L, all P<0.05). The success rate of resuscitation in the low VT ventilation group was higher than that of the conventional VT ventilation group (45% vs. 15%, P<0.05), and PIP (cm H2O) of low VT ventilation group was lower than that of the conventional VT group (37.25±7.99 cm H2O vs. 42.70±7.40 cm H2O, P<0.05). In all the patients in both groups barotrauma did not occur. The strategy of low ventilator VT (6 - 7 ml/kg) with appropriate elevation of airway pressure alarm threshold was better than that of conventional ventilation setting, with no increase in

  15. Comparison of force exerted on the sternum during a sneeze versus during low-, moderate-, and high-intensity bench press resistance exercise with and without the valsalva maneuver in healthy volunteers.

    Science.gov (United States)

    Adams, Jenny; Schmid, Jack; Parker, Robert D; Coast, J Richard; Cheng, Dunlei; Killian, Aaron D; McCray, Stephanie; Strauss, Danielle; McLeroy Dejong, Sandra; Berbarie, Rafic

    2014-03-15

    Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities. After the 1 repetition maximum (1-RM) was assessed, the subject performed the bench press at the following intensities, first with controlled breathing and then with the Valsalva maneuver: 40% of 1-RM (low), 70% of 1-RM (moderate), and 1-RM (high). Next, various nasal irritants were used to induce a sneeze. The forces on the sternum were calculated according to a cylindrical model, and a 2-tailed paired t test was used to compare the mean force exerted during a sneeze with the mean force exerted during each of the 6 bench press exercises. No statistically significant difference was found between the mean force from a sneeze (41.0 kg) and the mean total force exerted during moderate-intensity bench press exercise with breathing (41.4 kg). In conclusion, current guidelines and recommendations limit patient activity after a median sternotomy. Because these patients can repeatedly withstand a sneeze, our study indicates that they can withstand the forces from more strenuous activities than are currently allowed. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Fracture of maternal sternum during spontaneous delivery.

    Science.gov (United States)

    Stubert, J; Gerber, B

    2009-12-01

    We report of a maternal sternal fracture during a spontaneous delivery in a 31-year-old primipara without a suitable trauma. The putative mechanism of fracture was strong hyperflexion of the thoracic spine and additional cervical flexion with pushing the chin to the thorax due to active management of labour. The history of the healthy woman was free of related risk factors. A possible promoting factor might be pregnancy-induced bone loss. Although there were clear symptoms, the diagnosis of the fracture was delayed by a week because nobody took account of such a possibility.

  17. Pathological fracture of the manubrium sternum of unknown aetiology

    African Journals Online (AJOL)

    Kathryn van Boom

    during which time he experienced pain over the left anterior third and ... consisted of a solitary medial meniscal tear of the right knee ... healing fracture site, and the investigations revealed no evidence of a tumour or structural abnormality.

  18. Case report: Pathological fracture of the manubrium sternum of ...

    African Journals Online (AJOL)

    An MRI showed bone marrow oedema as well as presternal and retrosternal soft tissue mass. An incision biopsy of the site and the soft tissue were performed under general anaesthesia. Additional investigations included a bone marrow biopsy from the left iliac crest, a full blood count and C-reactive protein test, all of which ...

  19. IT IS TIME THE STERNUM GETS A NEW NAME

    OpenAIRE

    Munawwar Husain; Mohd Asrarul Haque; Mohammad Mojahid Anwar; Faiz Ahmad; Jawed Ahmad Usmani; Nema Usman

    2015-01-01

    Names of objects change over a period of time. New words come up to keep in line with innovations and technology. Neologism requires that the new word entrant should be concise, phonetically strong and resemble the function to which the word may be used. Internet language is the latest invention in which the word has been so abbreviated that at times the user is frightened that its continuous usage would finally obliterate the real word. To counter that threat old-timers adopt duality in acti...

  20. Adenoid cystic carcinoma of the submandibular gland with rare metastasis to the sternum in a 52-year-old male

    Directory of Open Access Journals (Sweden)

    Abdullah Alshammari

    2016-01-01

    Full Text Available Adenoid cystic carcinoma (ACC is a rare tumor, described as being one of the most biologically destructive tumors of the head and neck. It is the most common malignancy that affects the minor salivary glands. Lung and bones are the most common regions of ACC distant metastasis. To the best of our knowledge, herein, we report the first ever case of latent isolated sternal metastasis from ACC in a 52-year-old gentleman, who was diagnosed to have ACC of the submandibular gland, excised 10 years ago.

  1. Adenoid cystic carcinoma of the submandibular gland with rare metastasis to the sternum in a 52-year-old male

    OpenAIRE

    Abdullah Alshammari; Omar Jamal Eldeib; Ahmed Jamal Eldeib; Waleed Saleh

    2016-01-01

    Adenoid cystic carcinoma (ACC) is a rare tumor, described as being one of the most biologically destructive tumors of the head and neck. It is the most common malignancy that affects the minor salivary glands. Lung and bones are the most common regions of ACC distant metastasis. To the best of our knowledge, herein, we report the first ever case of latent isolated sternal metastasis from ACC in a 52-year-old gentleman, who was diagnosed to have ACC of the submandibular gland, excised 10 years...

  2. Adenoid cystic carcinoma of the submandibular gland with rare metastasis to the sternum in a 52-year-old male.

    Science.gov (United States)

    Alshammari, Abdullah; Eldeib, Omar Jamal; Eldeib, Ahmed Jamal; Saleh, Waleed

    2016-01-01

    Adenoid cystic carcinoma (ACC) is a rare tumor, described as being one of the most biologically destructive tumors of the head and neck. It is the most common malignancy that affects the minor salivary glands. Lung and bones are the most common regions of ACC distant metastasis. To the best of our knowledge, herein, we report the first ever case of latent isolated sternal metastasis from ACC in a 52-year-old gentleman, who was diagnosed to have ACC of the submandibular gland, excised 10 years ago.

  3. A Sequential Developmental Field Defect of the Vertebrae, Ribs, and Sternum, in a Young Woman of the 12th Century AD

    DEFF Research Database (Denmark)

    Christensen, Mette Nørregaard; Usher, Bethany

    2000-01-01

    Changes in the vertebral column are often noted in skeletal material. Descriptions of these anomalies are often lacking, and their developmental origins are not often discussed. The skeleton of a young woman from the medieval cemetery of Tirup, in Denmark, has multiple defects of the axial skelet...

  4. Infant open heart surgery (image)

    Science.gov (United States)

    During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia. ... During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia.

  5. PATTERNS OF SEVEN AND COMPLICATED MALARIA IN CHILDREN

    African Journals Online (AJOL)

    GB

    2014-01-01

    Jan 1, 2014 ... appearance and irregular margin without any calcification ... lung with sternum and mediastinal plus cervical lymph node ... imaging (MRI) of the sternum (5). CT scan is .... presenting as a bleeding sternal mass. Open J.

  6. The association between pressure pain sensitivity, and answers to questionnaires estimating psychological stress level in the workplace. A feasibility study

    DEFF Research Database (Denmark)

    Ballegaard, Søren; Petersen, Pernille; Gyntelberg, Finn

    2012-01-01

    To examine the association between pressure pain sensitivity (PPS) at the sternum as a measure of persistent stress assessed by questionnaires in a working population.......To examine the association between pressure pain sensitivity (PPS) at the sternum as a measure of persistent stress assessed by questionnaires in a working population....

  7. 49 CFR 572.124 - Thorax assembly and test procedure.

    Science.gov (United States)

    2010-10-01

    ... test procedure in paragraph (c) of this section: (1) The maximum sternum displacement (compression... displacement but before reaching the minimum required 38.0 mm (1.5 in) sternum displacement limit shall not exceed 1500 N (337.2 lbf). (2) The internal hysteresis of the ribcage in each impact as determined by the...

  8. 49 CFR 572.134 - Thorax assembly and test procedure.

    Science.gov (United States)

    2010-10-01

    ...: (1) Maximum sternum displacement (compression) relative to the spine, measured with chest deflection... displacement but before reaching the minimum required 50.0 mm (1.97 in) sternum displacement limit shall not exceed 4600 N. (2) The internal hysteresis of the ribcage in each impact as determined by the plot of...

  9. Cardiovascular and neuroendocrine responses to left lateral position in non-obese young males

    DEFF Research Database (Denmark)

    Schou, M; Pump, B; Gabrielsen, A

    2001-01-01

    by magnetic resonance (n=6) to be 7.0 +/- 0.2 cm below the sternum in SUP (1/3 of anteroposterior chest diameter below the sternum) and 2.5 +/- 0.2 cm below the midsternal level in LAT. Brachial mean (auscultation) and finger mean arterial pressures (infrared photoplethysmography), cardiac output (foreign gas...

  10. July/August 2009 25 Pattern of Bone Tumours Seen at Addis A

    African Journals Online (AJOL)

    jen

    cancer morbidity and mortality, especially among young people. To measure the strength .... bones of the limbs and spine, clavicle, cranio-facial bones, pelvic bones, ribs, scapula, spine, and sternum. .... 45. 24.39. 21.95. Pathological Fracture.

  11. MRI of the Chest

    Medline Plus

    Full Text Available ... to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI ... of the chest. assess disorders of the chest bones (vertebrae, ribs and sternum) and chest wall soft ...

  12. MRI of the Chest

    Medline Plus

    Full Text Available ... sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) ... prior to your scheduled examination. Infants and young children usually require sedation or anesthesia to complete an ...

  13. MRI of the Chest

    Medline Plus

    Full Text Available ... sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) ... on the child's age, intellectual development and the type of exam. Moderate and conscious sedation can be ...

  14. Skin associated problems in working donkeys in three districts of ...

    African Journals Online (AJOL)

    span because of the rigors of their lives (Knotten belt, 2009). This study was ... and was categorized into young (15 yrs) as it takes the donkey 4 ... Attention was given to base of the tail, ear, perineum, sternum,.

  15. 49 CFR 572.18 - Thorax.

    Science.gov (United States)

    2010-10-01

    ... OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES 3-Year-Old Child § 572.18 Thorax. (a) The... attaches the top of the ribcage sternum to the thoracic spine box. (3) Adjust the dummy so that the tangent...

  16. 49 CFR 572.164 - Thorax assembly and test procedure.

    Science.gov (United States)

    2010-10-01

    ... Hybrid III Six-Year-Old Weighted Child Test Dummy § 572.164 Thorax assembly and test procedure. (a... specified in 49 CFR 572.124(c): (1) The maximum sternum displacement relative to the spine, measured with...

  17. MRI of the Chest

    Medline Plus

    Full Text Available ... heart) and myocardial infarct (scar in the heart muscle due to prior obstruction of blood flow). determine ... ribs and sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around ...

  18. Pectus excavatum

    International Nuclear Information System (INIS)

    Kim, Young Tong; Cho, Won Soo; Bae, Won Kyung; Kim, Il Young

    2002-01-01

    Pectus excavatum in which the sternum is depressed and the anterior chest wall is concave in shape, is the most common congenital deformity to affect this region of the body. Various deformities involving depression or protrusion are caused by the degree and location of the sternal depression, and associated deformities such as a tilted sternum and anterior convexity of costal cartilages may occur. The most common associated disorders are Poland syndrome, Marfan syndrome and scoliosis

  19. Pectus excavatum

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Tong; Cho, Won Soo; Bae, Won Kyung; Kim, Il Young [College of Medical, Soonchunhyang Univ., Chonan (Korea, Republic of)

    2002-06-01

    Pectus excavatum in which the sternum is depressed and the anterior chest wall is concave in shape, is the most common congenital deformity to affect this region of the body. Various deformities involving depression or protrusion are caused by the degree and location of the sternal depression, and associated deformities such as a tilted sternum and anterior convexity of costal cartilages may occur. The most common associated disorders are Poland syndrome, Marfan syndrome and scoliosis.

  20. A Prospective Comparison of Transcutaneous and Serum Bilirubin Within Brief Time Intervals.

    Science.gov (United States)

    Jones, Denise F; McRea, Abigail R; Knowles, James D; Lin, Feng-Chang; Burnette, Erin; Reller, Lara A; Lohr, Jacob A

    2017-10-01

    The American Academy of Pediatrics recommends screening newborns ≥35 weeks' gestation with total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) to detect hyperbilirubinemia. Retrospective studies show TcB measurements strongly correlate with TSB; however, few prospective trials document this relationship. Furthermore, Dräger's newest TcB instrument, JM-105, remains unstudied in the United States. We measure TcB on foreheads and sternums of newborns using JM-105 and Bilichek devices within 30 minutes of TSB measurement. We find best overall TcB/TSB correlation with JM-105 on the sternum (mean TcB-TSB difference: -0.21 ± 1.15 mg/dL). Correlations between paired measurements for TcB on the sternum using JM-105 were 0.93 for all TSB levels (n = 178), 0.82 for TSB > 10 (n = 19), 0.69 for TSB > 12 (n = 11), and 0.52 for TSB > 15 (n = 6). TcB accuracy via JM-105 on the sternum significantly differed among races ( P < .001). For 5% of paired measurements, TcB with JM-105 on the sternum underestimated TSB by ≥2 mg/dL, and for <1% by ≥3 mg/dL.

  1. Individual differences in post radiation regeneration of the bone marrow in nonuniform irradiation (experimental investigation)

    International Nuclear Information System (INIS)

    Kalandarova, M.P.

    1980-01-01

    Reparative regeneration in bone marrow of sternum and iliac bone in each of 20 dogs was studied after single and two-time total X-ray irradiation. Extreme dose rates in bodies differed 5 and 8 times. It was shown that bone marrow repair did not depend on its composition before irradiation. Dogs whose bone narrow was rich of cellular elements before irradiation had both active and sharply reduced bone marrow regeneration after single and two-time irradiation in 0.75-1.45 Gy doses (sternum). Animals with a poor total cellular composition of bone marrow of sternum before irradiation also had differences in the course of reparative processes: in some of them they were considerably pronoUnced and in others bone marrow aplasia lasted for one month. IndiVidual differences in the bone marrow (iliac bone) irradiated with 1.85-3.2 Gy doses were less marked during the reparative regeneration

  2. Immunohistochemical study of extracellular matrices and elastic fibers in a human sternoclavicular joint.

    Science.gov (United States)

    Shimada, K; Takeshige, N; Moriyama, H; Miyauchi, Y; Shimada, S; Fujimaki, E

    1997-12-01

    In this study, we clarified the distribution of elastic and oxytalan fibers in a human sternoclavicular joint (SCJ) using a color image system and in extracellular matrices using immunoperoxidase staining. Fine elastic fibers (EFs) were scattered in the fibrous layer of the sternoclavicular disk. This articular disk was composed of a collagenous bundle on the sternum side of the articular disk in the SCJ and cellular components including connective tissue on the clavicular side of the articular disk. The thickness of the disk gradually increased from the inferior to superior portion. Collagen fibers type I, III and V and other extracellular matrices (ECMs) were detected in the hypertrophic zone in the clavicular and sternum side of the SCJ and in the connective tissue of the articulatio condylar. On the cervical surface of the articular disk, cellular activity was higher than on the sternum surface.

  3. So many years ago

    African Journals Online (AJOL)

    Page 1 ... had fallen into a gravel quarry, landing with his chest on the corner of a cocopan and fracturing the ribs on both sides of his sternum. The result was a totally flail chest, with huge effort required to move very little air in and out of his lungs. Having been injured on duty, he was not a 'hospital patient' but was.

  4. 49 CFR 572.146 - Test conditions and instrumentation.

    Science.gov (United States)

    2010-10-01

    ... transducer location as shown in drawing 210-0000. A lower neck transducer as specified in drawing SA 572-S19...) Head acceleration—Class 1000 (2) Neck (i) Force—Class 1000 (ii) Moments—Class 600 (iii) Pendulum acceleration—Class 180 (iv) Rotation potentiometer response (if used)—CFC 60. (3) Thorax: (i) Rib/sternum...

  5. Long-term quasi-continuous oxygen saturation levels obtained from sternal photoplethysmography on patients with obstructive lung diseases

    DEFF Research Database (Denmark)

    Chreiteh, Shadi; Saadi, Dorthe Bodholt; Belhage, Bo

    2016-01-01

    the sternum of patients admitted to the hospital with obstructive lung diseases. Due to the lack of a gold standard reference that is suitable for long-term monitoring without interfering with the patient's activity level, we extracted reliable segments based on knowledge from the basic pulse oximeter theory...

  6. Sternal chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Nelson Perelman Rosenberg

    2003-01-01

    Full Text Available Sternal neoplasms are extremely rare. It is difficult to make prospective evaluations due to the lack of consistent reports in the literature. The authors report the case of a woman in her seventies, who presented a chondrosarcoma of the sternum, treated by them.

  7. MRI findings of prolonged post-traumatic sternal pain

    International Nuclear Information System (INIS)

    Grosse, Alexandra; Grosse, Claudia; Anderson, Suzanne; Steinbach, Lynne

    2007-01-01

    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. 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. Two patients (n = 2) revealed a sternal nonunion after sternal fracture. One patient had a sternal fracture with delayed union and minor displacement of the sternal halves. Abnormal signal intensity alterations adjacent to and within the manubrio-sternal joint were evident in 2 patients and considered due to trauma-related changes in the manubrio-sternal joint. The 3 patients who were not included in the study had no abnormalities of the sternum: 1 of them proved to have a well-healed sternal fracture and nonunion of a rib fracture, 1 had subtle Tietze's syndrome, and 1 patient revealed no pathological findings on imaging. Various factors may be responsible for prolonged sternal pain following thoracic trauma, and these can be viewed with MRI. In cases of sternal nonunion there was common fluid-like signal in the fracture interspace between the bony edges, and the bone marrow adjacent to the nonunion showed altered signal intensity. MRI identified sternal nonunion and other trauma-related abnormalities of the sternum following chest trauma. (orig.)

  8. Ventricular septal defect closure in a patient with achondroplasia.

    Science.gov (United States)

    Nakanishi, Keisuke; Kawasaki, Shiori; Amano, Atsushi

    2017-01-01

    Achondroplasia with co-morbid CHD is rare, as are reports of surgical treatment for such patients. We present the case of a 13-year-old girl with achondroplasia and ventricular septal defect. Her ventricular septal defect was surgically repaired focussing on the cardiopulmonary bypass flow, healing of the sternum, and her frail neck cartilage. The surgery and recovery were without complications.

  9. Females of the genus Podmosta (Plecoptera: Nemouridae): comparison of terminalia and a new female record in Baltic Amber.

    Science.gov (United States)

    Chen, Zhi-Teng

    2018-04-10

    Based on a specimen preserved in Baltic amber from Lithuania, a new fossil female of the nemourid genus Podmosta Ricker, 1952 is described, illustrated and compared to other described species of the genus. The new female specimen is distinguished from other Podmosta females by the "rabbit-shaped" sclerite on sternum 8.

  10. NJP Number 39 Vol 1, 2012.cdr

    African Journals Online (AJOL)

    Prof Ezechukwu

    2007-08-04

    Aug 4, 2007 ... xiphoid process (bifid sternum) with the heart ... diaphragm does not develop, and the paired ... through the resulting sternal and abdominal wall ... variants have been described by Toyoma et al. He ... (SCBU) of Aminu Kano Teaching Hospital Kano ... and include craniofacial and central nervous system.

  11. Radiology trainer. Surgical ambulance. Revision 2. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Ackermann, Ole; Barkhausen, Joerg

    2013-01-01

    The radiology trainer for surgical ambulance includes informative X-ray imaging examples for the following issues: zygoma, nasal bone, spinal cord, clavicle, shoulder, upper arms, elbow, forearms, wrist, hand, phalanx, thorax, sternum, pelvis, abdomen, hips, femur, knee, lower leg, ankle, feet.

  12. Cornelia-de Lange syndrome in an Egyptian infant with unusual ...

    African Journals Online (AJOL)

    Rabah M. Shawky

    2012-05-18

    May 18, 2012 ... Also biochemical and X-ray evidence of rickets was detected mostly due to ... Chest examination showed small chest, depressed lower sternum ... teal erosion was noted at the medial aspect of the femur, and there was an ...

  13. Diecephalic thoraco-omphalopagus conjoined twins: case report ...

    African Journals Online (AJOL)

    We present a case report of conjoined twins discovered at 17 weeks gestation on routine trans-abdominal ultrasound in a 27 year old woman. The twins were joined at the chest and upper abdomen. They shared a heart, liver, sternum and diaphragm. The patient opted for termination of the pregnancy which was performed ...

  14. Schistosomus Reflexus Causing Dystocia in a Red Sokoto Doe: A ...

    African Journals Online (AJOL)

    Dystocia was observed in a primiparous one year old Red Sokoto doe (RSD) and was relieved manually, the fetus was observed to be monstrous and gross pathological examination showed cleft sternum, scoliosis, abdominal and thoracic evisceration, absence of diaphragm, pulmonary hypoplasia, malpositioned kidney ...

  15. An Investigation of Equine Mesenchymal Stem Cell Characteristics from Different Harvest Sites: More Similar Than Not

    Directory of Open Access Journals (Sweden)

    Karla eLombana

    2015-12-01

    Full Text Available Diseases of the musculoskeletal system are a major cause of loss of use and retirement in sport horses. The use of bone marrow derived mesenchymal stem cells (BMDMSCs for healing of traumatized tissue has gained substantial favor in clinical settings and can assist healing and tissue regeneration in orthopaedic injuries. There are two common sites of harvest of BMDMSCs, the sternum and ilium. Our objective was to determine if any differences exist in BMDMSCs acquired from the sternum and the ilium. We compared the two harvest sites in their propensity to undergo multilineage differentiation, differences in cell surface markers or gene transduction efficiencies.BMDMSCs were isolated and culture-expanded from five mL aspirates of bone marrow from sternum and ilium. The cells were then plated and cultured with appropriate differentiation medium to result in multi-lineage differentiation and cell characteristics were compared between sternal and ilial samples. Cell surface antibody expression of CD11a/18, CD34, CD44 and CD90 were evaluated using flow cytometry and gene transduction efficiencies were evaluated using GFP scAAV. There were no statistically significant differences in cell characteristics between MSCs cultured from sternum and ilium under any circumstances.

  16. 49 CFR 572.195 - Thorax with arm.

    Science.gov (United States)

    2010-10-01

    ... dummy is in vertical orientation. (4) Push the dummy at the knees and at mid-sternum of the upper torso with just sufficient horizontally oriented force towards the seat back until the back of the upper torso is in contact with the seat back. (5) While maintaining the dummy's position as specified in...

  17. A Model of Locomotor-Respiratory Coupling in Quadrupeds

    Science.gov (United States)

    Giuliodori,, Mauricio J.; Lujan, Heidi L.; Briggs, Whitney S.; DiCarlo, Stephen E.

    2009-01-01

    Locomotion and respiration are not independent phenomena in running mammals because locomotion and respiration both rely on cyclic movements of the ribs, sternum, and associated musculature. Thus, constraints are imposed on locomotor and respiratory function by virtue of their linkage. Specifically, locomotion imposes mechanical constraints on…

  18. Supportive pericardial suspension for surgical airway management ...

    African Journals Online (AJOL)

    cia [3]. However, the anterior border of the left lung often crosses the midline because of hyperinflation, which interrupts the route to the sternum for aortopexy or tracheopexy in patients with right UPA. In addition, the hyperinflated lung may exacerbate the displacement and rotation of the heart to the hemithorax by compres-.

  19. Chronic psychological stress seems associated with elements of the metabolic syndrome in patients with ischaemic heart disease

    DEFF Research Database (Denmark)

    Bergmann, Natasha; Ballegaard, Søren; Krogh, Jesper

    2017-01-01

    at the sternum known to be associated to elements of the chronic stress syndrome. Elements of MS were evaluated by dual-energy X-ray absorptiometry, body weight, HOMA-IR and blood lipids. Results: Depressive symptoms were associated with a high percentage of body fat (β = 0.179, p =.001), and high level...

  20. Uncommon sites of bone infarction in a sickle cell anemia patient

    International Nuclear Information System (INIS)

    Garty, I.; Koren, A.; Katzumi, E.

    1983-01-01

    Unusual sites of bone infarction, in the skull and sternum, were observed in a patient suffering from sickle cell anemia. Asup(99m)Tc-MDP scan was performed and demonstrated foci of decreased activity in the symptomatic regions. The differentiation of bone infarction from osteomyelitis in sickle cell anemia patients is illustrated. (orig.)

  1. A simple and objective marker for stress

    DEFF Research Database (Denmark)

    Ballegaard, Soeren; Karpatschof, Benny; Trojaborg, Werner

    2009-01-01

    To examine the association between pressure pain sensitivity (PPS) at sternum and various well established physiological stress measures among opera singers during a performance as a measure for transitional stress, and resting values in out-clinic patients as a measure for persistent stress....

  2. Non-censored rib fracture data during frontal PMHS sled tests.

    Science.gov (United States)

    Kemper, Andrew R; Beeman, Stephanie M; Porta, David J; Duma, Stefan M

    2016-09-01

    The purpose of this study was to obtain non-censored rib fracture data due to three-point belt loading during dynamic frontal post-mortem human surrogate (PMHS) sled tests. The PMHS responses were then compared to matched tests performed using the Hybrid-III 50(th) percentile male ATD. Matched dynamic frontal sled tests were performed on two male PMHSs, which were approximately 50(th) percentile height and weight, and the Hybrid-III 50(th) percentile male ATD. The sled pulse was designed to match the vehicle acceleration of a standard sedan during a FMVSS-208 40 kph test. Each subject was restrained with a 4 kN load limiting, driver-side, three-point seatbelt. A 59-channel chestband, aligned at the nipple line, was used to quantify the chest contour, anterior-posterior sternum deflection, and maximum anterior-posterior chest deflection for all test subjects. The internal sternum deflection of the ATD was quantified with the sternum potentiometer. For the PMHS tests, a total of 23 single-axis strain gages were attached to the bony structures of the thorax, including the ribs, sternum, and clavicle. In order to create a non-censored data set, the time history of each strain gage was analyzed to determine the timing of each rib fracture and corresponding timing of each AIS level (AIS = 1, 2, 3, etc.) with respect to chest deflection. Peak sternum deflection for PMHS 1 and PMHS 2 were 48.7 mm (19.0%) and 36.7 mm (12.2%), respectively. The peak sternum deflection for the ATD was 20.8 mm when measured by the chest potentiometer and 34.4 mm (12.0%) when measured by the chestband. Although the measured ATD sternum deflections were found to be well below the current thoracic injury criterion (63 mm) specified for the ATD in FMVSS-208, both PMHSs sustained AIS 3+ thoracic injuries. For all subjects, the maximum chest deflection measured by the chestband occurred to the right of the sternum and was found to be 83.0 mm (36.0%) for PMHS 1, 60.6 mm (23.9%) for PMHS 2

  3. Pectus excavatum postsurgical outcome based on preoperative soft body dynamics simulation

    Science.gov (United States)

    Moreira, Antonio H. J.; Rodrigues, Pedro L.; Fonseca, Jaime; Pinho, A. C. M.; Rodrigues, Nuno F.; Correia-Pinto, Jorge; Vilaça, João L.

    2012-02-01

    Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which an abnormal formation of the rib cage gives the chest a caved-in or sunken appearance. Today, the surgical correction of this deformity is carried out in children and adults through Nuss technic, which consists in the placement of a prosthetic bar under the sternum and over the ribs. Although this technique has been shown to be safe and reliable, not all patients have achieved adequate cosmetic outcome. This often leads to psychological problems and social stress, before and after the surgical correction. This paper targets this particular problem by presenting a method to predict the patient surgical outcome based on pre-surgical imagiologic information and chest skin dynamic modulation. The proposed approach uses the patient pre-surgical thoracic CT scan and anatomical-surgical references to perform a 3D segmentation of the left ribs, right ribs, sternum and skin. The technique encompasses three steps: a) approximation of the cartilages, between the ribs and the sternum, trough b-spline interpolation; b) a volumetric mass spring model that connects two layers - inner skin layer based on the outer pleura contour and the outer surface skin; and c) displacement of the sternum according to the prosthetic bar position. A dynamic model of the skin around the chest wall region was generated, capable of simulating the effect of the movement of the prosthetic bar along the sternum. The results were compared and validated with patient postsurgical skin surface acquired with Polhemus FastSCAN system.

  4. Liver laceration related to cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Halil Beydilli

    2016-06-01

    Full Text Available Cardiopulmonary resuscitation (CPR is recognized as a medical procedure performed to maintain vital functions of a person whose cardiac and respiratory functions have stopped. Chest compression is the most essential component of CPR and it is performed on the lower half of the sternum. During CPR, many complications may occur because of chest compressions, especially chest injuries including sternum and rib fractures. Rarely tracheal injury, rupture of the stomach, or liver or spleen injury may also occur as complications.In this study, we present two cases of liver injury caused by resuscitation. With this article, we want to emphasize the importance of making correct chest compressions. Keywords: Resuscitation complications, Emergency service, Liver laceration, Autopsy

  5. A Rare Tropical Stonefly Brahmana flavomarginata (Plecoptera: Perlidae: Acroneuriinae from Vietnam

    Directory of Open Access Journals (Sweden)

    Thi Kim Thu Cao

    2013-04-01

    Full Text Available The perlid stonefly Brahmana flavomarginata Wu, originally described from China from the male adult, is described using reared male and female adults and nymphs from Vietnam. The male adult of B. flavomarginata is distinguished from its congeners by the blackish-brown body color and distinct head marking, hemitergal triangular chitin plates, and a median semicircular smooth subgenital plate (hammer on the abdominal sternum IX. The female adult has a large and round subgenital plate which extends to the posterior margin of the abdominal sternum X. The nymph can be distinguished by the relatively small compound eyes and the body covered by many long stout setae and short golden brown hair-like setae. This species is known in southwestern China (Yunnan Province and northern Vietnam (Lao Cai Province, Cao Bang Province.

  6. Congenital superior sternal cleft repair using our modified Sally technique: A case report

    Directory of Open Access Journals (Sweden)

    Tomoyuki Kuwata

    2014-12-01

    Full Text Available We report the case of an 8-month-old male neonate who underwent reconstructive surgery for a congenital superior sternal cleft to decrease the risk of commotio cordis. With regard to use of the Sally technique for the repair of a relatively wide cleft (4 × 4 cm, we were concerned about respiratory problems caused by compression following closure of the sternal halves. By closing the sternal halves imperfectly, elevation of intrapleural pressure can be avoided to some extent. By bridging the surplus resected cartilage from the lower sternum over the gap of the upper sternum, the heart is protected by more rigid material. We recommend our modified Sally technique because it is both flexible and effective for sternal cleft repair.

  7. An unusual case of thoracic ectopia cordis in a Toggenburg Goat and its three-dimensional images constructed with X-ray computed tomography.

    Science.gov (United States)

    Lai, Jyh-Mirn; Wu, Jui-Te; Yang, Wei-Cheng; Chao, Ming-Hsin; Nagahata, Hajime

    2016-05-01

    A two-day-old female Toggenburg goat with thoracic ectopia cordis (EC) was diagnosed via radiography and computed tomography. The goat was born with EC, defects of the sternum and a supra-umbilical abdominal wall, but without the presence of Cantrell's syndrome. Necropsy and histopathological findings indicated the affected kid had malformation of the heart with an enlarged left ventricle. The findings showed the heart (9 x 5 x 5 cm) stayed outside the thorax, and was covered by a semitransparent membrane. This report is the first to describe a case of thoracic EC in a goat whose sternum was not developed fully and was not connected to the ribs. It is also the first paper to describe three-dimensional images of this condition constructed from computed tomography scans.

  8. [Dynamics of the amino acid composition of the medium during cultivation of isolated organs by the directed perfusion method].

    Science.gov (United States)

    Barashkov, V A; Gitel'zon, I I; Nefedov, V P; Trubachev, I N

    1975-07-01

    The dynamics of the amino acid composition of the medium under conditions of adequate perfusion of the isolated organs of a dog (sternum, kidney and liver) was studied. It was found that after a 6-hour perfusion of the complex of organs the amount in the perfusion medium of such amino acids as histidine, lysine, alanine, considerably increased, whereas the amount of arginine, serine, aspartic acid, threonine with glutamine, isoleucine, proline, leucine and valine decreased as compared with their initial concentration. The dynamics of the amino acid medium composition during a 4-hour perfusion was studied in experiments with the isolated sternum. The concentration of alanine, lysine and histidine increased in the medium. At the same time there was seen a decrease in the concentration of serine, aspartic acid, isoleucine, tyrosine and phenyl-alanine.

  9. Study of /sup 201/Tl uptake by bone and bone marrow on /sup 201/Tl scintigraphy. With special reference to bone marrow abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Tadashige; Tanaka, Masao; Hirose, Yoshiki; Hirayama, Jiro; Handa, Kenjiro; Nakanishi, Fumiko; Yano, Kesato; Ueda, Hitoshi

    1989-04-01

    Thallium-201 (Tl-201) uptake in the bone and bone marrow was examined in a total of 93 patients with various diseases. Sternal uptake of Tl-201 was observed when patients had bone marrow abnormality especially associated with hematopoietic disease. It was associated with proliferation of immature cells and of various types of bone marrow cells, especially erythroblastic and plasma cells. Whole-body Tl-201 scanning showed a high uptake (82%) in the sternum, chest, lumbar vertebrae, and pelvis. Thallium-201 was definitively taken up by the sternum in polycythemia (5/41), hemolytic anemia (2/2), iron deficiency anemia (2/2), and multiple myeloma (2/5). For leukemia, Tl-201 uptake was slight or negative. Thallium-201 scanning proved useful in visualizing bone marrow abnormality, although careful interpretation of bone and bone marrow uptake is required. (Namekawa, K).

  10. A case report of radiation-osteomyelitis 9 years after irradiation for thymoma

    International Nuclear Information System (INIS)

    Ohkubo, Ken-ichi; Itoi, Kazumi; Yanagihara, Kazuhiro; Matsuoka, Katsunari; Kuwabara, Masayoshi

    1992-01-01

    Radiation-osteomyelitis of the sternum is rare and usually difficult to cure. A 75-year-old man, who had undergone an exploratory sternotomy for a mediastinal tumor, not resected after all, 9 years earlier and received radiation therapy successively for the histological diagnosis of malignant thymoma, was admitted to our hospital with the chief complaint of fever and pus discharge of the anterior chest wall. He also suffered from diabetes mellitus. The skin around the fistula was dark-red and atrophic due to irradiation dermatitis and the manubrium was fissured in the midline. Open drainage and two-stage operation of direct closure was tried in vain. This case was treated succesfully by resection of necrosed portion of sternum and pectoral muscle flap closure. (author)

  11. Two Cases of Sternal 'Cold' Lesions on Bone Imaging in the Metastatic Skeletal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyung Gun; Seo, Bong Kwan; Lee, Hoon Yong; Lee, Myung Chul; Choi, Sung Jae; Kim, Noe Kyeong; Koh, Chang Soon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1983-09-15

    Traditionally, a positive bone scan shows single or multiple areas of increased uptake in them metastatic skeletal disease. The occurrence of 'cold' lytic-like or photon-deficient lesions in bone imaging is probably uncommon. Photon-deficient focus or cold lesion of the sternum was demonstrated on {sup 99m}Tc-MDP bone imaging in 2 individuals with acute myeloid leukemia and primary hepatoma, respectively.

  12. Role of dominant versus non-dominant hand position during uninterrupted chest compression CPR by novice rescuers: a randomized double-blind crossover study.

    Science.gov (United States)

    Nikandish, Reza; Shahbazi, Sharbanoo; Golabi, Sedigheh; Beygi, Najimeh

    2008-02-01

    Previous research has suggested improved quality of chest compressions when the dominant hand was in contact with the sternum. However, the study was in health care professionals and during conventional chest compression-ventilation CPR. The aim of this study was to test the hypothesis, in null form, that the quality of external chest compressions (ECC) in novice rescuers during 5min of uninterrupted chest compression CPR (UCC-CPR) is independent of the hand in contact with the sternum. Confirmation of the hypothesis would allow the use of either hand by the novice rescuers during UCC-CPR. Fifty-nine first year public heath students participated in this randomised double-blind crossover study. After completion of a standard adult BLS course, they performed single rescuer adult UCC-CPR for 5 min on a recording Resusci Anne. One week later they changed the hand of contact with the sternum while performing ECC. The quality of ECC was recorded by the skill meter for the dominant and non-dominant hand during 5 min ECC. The total number of correct chest compressions in the dominant hand group (DH), mean 183+/-152, was not statistically different from the non-dominant hand group (NH), mean 152+/-135 (P=0.09). The number of ECC with inadequate depth in the DH group, mean 197+/-174 and NH group, mean 196+/-173 were comparable (P=0.1). The incidence of ECC exceeding the recommended depth in the DH group, mean 51+/-110 and NH group, mean 32+/-75 were comparable (P=0.1). Although there is a trend to increased incidence of correct chest compressions with positioning the dominant hand in contact with the sternum, it does not reach statistical significance during UCC-CPR by the novice rescuers for 5 min.

  13. MRI findings of prolonged post-traumatic sternal pain

    Energy Technology Data Exchange (ETDEWEB)

    Grosse, Alexandra; Grosse, Claudia; Anderson, Suzanne [University Hospital of Berne, Department of Diagnostic, Pediatric and Interventional Radiology, Berne (Switzerland); Steinbach, Lynne [University of California San Francisco, Department of Radiology, San Francisco, CA (United States)

    2007-05-15

    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. 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. Two patients (n = 2) revealed a sternal nonunion after sternal fracture. One patient had a sternal fracture with delayed union and minor displacement of the sternal halves. Abnormal signal intensity alterations adjacent to and within the manubrio-sternal joint were evident in 2 patients and considered due to trauma-related changes in the manubrio-sternal joint. The 3 patients who were not included in the study had no abnormalities of the sternum: 1 of them proved to have a well-healed sternal fracture and nonunion of a rib fracture, 1 had subtle Tietze's syndrome, and 1 patient revealed no pathological findings on imaging. Various factors may be responsible for prolonged sternal pain following thoracic trauma, and these can be viewed with MRI. In cases of sternal nonunion there was common fluid-like signal in the fracture interspace between the bony edges, and the bone marrow adjacent to the nonunion showed altered signal intensity. MRI identified sternal nonunion and other trauma-related abnormalities of the sternum following chest trauma. (orig.)

  14. Cine MRI of the thorax in patients with pectus excavatum

    International Nuclear Information System (INIS)

    Herrmann, K.A.; Zech, C.J.; Schoenberg, S.O.; Reiser, M.F.; Strauss, T.; Hatz, R.

    2006-01-01

    Morphologic and dynamic assessment of respiratory chest kinetics was performed in patients with pectus excavatum deformity (PE) using dynamic MRI: cine MRI. Seven consecutive patients with PE (aged 20.3 years±4.0) and ten healthy volunteers of comparable age underwent real-time cine MRI of the chest during breathing on a 1.5 T MR scanner (Magnetom Sonata, Siemens Medical Systems, Erlangen, Germany) using a standard phased array body coil and a half-Fourier single-shot turbo spin echo sequence (HASTE) for dynamic imaging. During deep inspiration and expiration, single-shot sequences were performed in one slice level over 20 s at a frequency of 1 image/s covering the entire thoracic cage in three orientations. Morphology and chest kinetics in patients with PE were analyzed and compared with normal values, and typical patterns of chest kinetics were noted. Three different types of chest morphology in PE were identified: (1) the generally flattened thoracic cage, (2) the ''tilted'' sternum, and (3) the focally deepened sternum. Three patterns of motion correspond to these morphological types: (1) elevation of the sternum and the anterior thoracic wall, (2) angulated elevation of the parasternal rib cage with persistent deepening of the sternum resembling a ''wing beat'' movement, and (3) increased diaphragmatic movements with limited chest wall dynamics. Cine MRI is an adequate radiation-free diagnostic modality for the dynamic imaging of both chest morphology and chest wall kinetics in patients with PE. The pectus severity index can easily be determined and three typical movement patterns of chest wall kinetics identified. (orig.) [de

  15. Leaded apron for use in panoramic dental radiography

    Energy Technology Data Exchange (ETDEWEB)

    Whitcher, B.L.; Gratt, B.M.; Sickles, E.A.

    1980-05-01

    The leaded aprons currently available for use during dental radiography do not protect the thyroid gland from radiation. Conventional aprons may produce artifacts when used with panoramic dental x-ray units. This study measures the dose reduction obtained with an experimental leaded apron designed for use with panoramic dental x-ray units. Skin exposures measured at the thyroid and at the sternum were reduced with the use of the apron. Films produced during the study were free from apron artifacts.

  16. Leaded apron for use in panoramic dental radiography

    International Nuclear Information System (INIS)

    Whitcher, B.L.; Gratt, B.M.; Sickles, E.A.

    1980-01-01

    The leaded aprons currently available for use during dental radiography do not protect the thyroid gland from radiation. Conventional aprons may produce artifacts when used with panoramic dental x-ray units. This study measures the dose reduction obtained with an experimental leaded apron designed for use with panoramic dental x-ray units. Skin exposures measured at the thyroid and at the sternum were reduced with the use of the apron. Films produced during the study were free from apron artifacts

  17. Sternocostoclavicular Hyperostosis: An Insufficiently Recognized Clinical Entity

    OpenAIRE

    Taro Sugase; Tetsu Akimoto; Hidenori Kanazawa; Atsushi Kotoda; Daisuke Nagata

    2017-01-01

    A 79-year-old male chronic hemodialysis patient with no history of central venous catheterization was referred to our hospital with progressive swelling of the left upper limb ipsilateral to a forearm arteriovenous fistula. Radiological assessments revealed marked hyperostosis in the ribs, sternum, and clavicles with well-developed ossification of the sternocostoclavicular ligaments. Such characteristic structural abnormalities and our failure to identify the left subclavian vein with contras...

  18. Cantrell Syndrome. Case report of an adult

    Directory of Open Access Journals (Sweden)

    João Luiz Alencar Araripe Falcão

    2000-10-01

    Full Text Available Cantrell syndrome is characterized by defects that involve the diaphragm, abdominal wall, pericardium, heart, and lower region of the sternum. It is a rare entity, usually diagnosed at birth and accompanied by high mortality due to the complexity and gravity of the anomalies. In this report, we present a 32-year-old male patient, who was diagnosed in infancy but who reached adult age asymptomatic.

  19. Form, function and fibres: a preliminary study of the Swartkrans fossil birds

    Directory of Open Access Journals (Sweden)

    V. Watson

    1991-09-01

    Full Text Available Fossil bird bones from the Swartkrans cave estimated at about one million years old have been identified to family level. Differences in humerus and sternum structure were noted. This led to an investigation into flight styles and behaviour as well as the muscle structure and function of the modern representatives of three families (Phasianidae - francolins; Columbidae - pigeons; Tytonidae - barn and grass owls in an attempt to understand why the bones in these families were so distinctive.

  20. Isolated sternal fracture - a swing-related injury in two children

    International Nuclear Information System (INIS)

    DeFriend, D.E.; Franklin, K.

    2001-01-01

    Isolated fracture of the sternum is an uncommon injury in a child. We report two cases of sternal fracture following falls from swings, which illustrate the mechanisms of injury in sternal fracture. One fracture resulted from a flexion compression injury of the thoracic spine, which has very rarely been reported in children. Sternal fracture should be considered in the differential diagnosis of acute chest pain in a child where there has been an activity involving hyperflexion force. (orig.)

  1. POEMS syndrome: unusual radiographic, scintigraphic and CT features

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, J.A.; Majos, C.; Valls, C.; Fernandez-Cabrera, L. [Department of CT and MR Imaging, Ciudad Sanitaria y Universitaria de Bellvitge, Barcelona (Spain); Narvaez, J. [Department of Rheumatology, Hospital Princeps d`Espanya, L`Hospitalet de Llobregat, Barcelona (Spain)

    1998-02-01

    POEMS syndrome is a multisystemic disorder related to a plasma cell dyscrasia. Radiologically, this syndrome is characterized by sclerotic focal bone lesions with a normal radionuclide bone scan. We report a case of POEMS syndrome with an expansile lytic lesion in the sternum showing periosteal reaction and soft tissue mass, which revealed locally increased uptake of radiotracer in bone scintigraphy. These unusual findings and the differential diagnosis are discussed. (orig.) With 3 figs., 8 refs.

  2. Is bone tenderness, as measured by manual algometry, associated with vitamin D deficiency?

    Science.gov (United States)

    Dresser, Jocelyn; MacIntyre, Mike; Chisholm, Brittney; Lawson, G E

    2014-09-01

    To explore the relationship between serum 25-hydroxycholecalciferol (25[OH]D3) and pressure-pain thresholds, as measured by algometer, in advance of a main study to determine whether PPT is a potentially cost-effective proxy measure of 25[OH]D3 status in the general population. The cross-sectional pilot study involved a convenience sample of twenty-two subjects (10 males, 12 females), aged 18 to 67 years. All subjects consented to three trials of pressure-pain threshold readings on both tibiae and the manubrium. Serum 25[OH]D3 levels were determined from blood samples drawn post-algometry. The average pressure pain thresholds were 14.92 (±6.03), 15.07(±6.07), 11.10 (±6.68) for the left and right tibia and sternum, respectively. The stability between the measurements was very high with the interclass correlation coefficient (95% CI) calculated as 0.94 (0.62-1.00), 0.9 (0.81-1.00), 0.96(0.93-1.00). The Pearson correlation coefficients were 0.03 for the left tibia, 0.17 for the right tibia and 0.20 for the sternum, J Dresser, M MacIntyre, B Chisholm, GE Lawson showing a negligible correlation for the left and right tibia, but a low positive correlation for the sternum. We did not find preliminary evidence of a strong or otherwise clinically meaningful correlation between bone tenderness and manual algometry in this pilot study. Only a weak linear relationship between PPT in the sternum and serum 25[OH]D3 concentrations was found. Replication of this study is warranted in larger and more representative study populations of interest. Discussion on a number of feasibility issues is provided to inform those future studies.

  3. An improved Virtual Torso phantom

    International Nuclear Information System (INIS)

    Kramer, Gary H; Crowley, Paul

    2000-01-01

    The virtual phantom that was previously designed by the Human Monitoring Laboratory had some limitations. It contained no sternum and the ribs extended all the way round the torso, whereas in reality the central part of the chest is covered with a mixture of cartilage (ribs) and bone (sternum). The ribs were located below the chest wall which added to the thickness of the chest wall. The lungs did not touch the inner surface of the chest wall along their length due to the differences in curvature between the ellipsoidal lungs and the ellipsoidal cylinder that defined the torso. As a result there was extra intervening tissue between the lungs and the chest wall. This was shown to have a noticeable effect on the simulation of low energy photons. The virtual phantom has been redesigned and comparison of measured and calculated counting efficiencies shows that it is a good representation of both of LLNL or JAERI at all photon energies measured. The redesigned virtual phantom agrees to within 11% of the torsos' counting efficiency over the energy range 17 - 240 keV. Before modification, the virtual phantom's counting efficiency was a of factor three lower at 17 keV and a factor of two lower at 20 keV; now it is within 5% at 17 keV and within 10% at 20 keV. This phantom can now be reliably used to simulate lung counting. The virtual phantom still contains no sternum and the ribs extend all the way round the torso, whereas in reality the central part of the chest is covered with cartilage (ribs) and bone (sternum). However, the above results indicate that this is not a major flaw in the design of the virtual phantom, as agreement between the Monte Carlo results and experimental data is good. (author)

  4. New Chinese record of the genus Spinonychiurus (Collembola, Onychiuridae), with the description of a new species

    Science.gov (United States)

    Sun, Xin; Li, Yu

    2014-01-01

    Abstract A new collembolan species is described, Spinonychiurus sinensis sp. n., which has seven chaetae in the distal row of the tibiotarsi. It is placed in the genus Spinonychiurus due to two important characters: the two subsegments on Abd. III sternum and the absence of d0 on the head. This is the first report of the genus Spinonychiurus in China. The diagnosis of Spinonychiurus is broadened and the key to the world species is provided. PMID:25317055

  5. Detection of mediastinitis after heart transplantation by gallium-67 scintigraphy

    International Nuclear Information System (INIS)

    Quirce, R.; Serano, J.; Arnal, C.; Banzo, I.; Carril, J.M.

    1991-01-01

    We report the findings of a patient with post-cardiac transplant mediastinitis detected by 67 Ga-citrate imaging. Fever and leukocytosis were the first clinical signs suggesting infection. The usual diagnostic modalities, including CT and ultrasound, failed to identify the site of infection. A 67 Ga scan showed intense abnormal uptake behind the sternum. The site of uptake was shown by necropsy to be necrotic tissue involving cardiac sutures, pulmonary arteries, and the aorta due to infection with Haemophilus aphrophilus

  6. POEMS syndrome: unusual radiographic, scintigraphic and CT features

    International Nuclear Information System (INIS)

    Narvaez, J.A.; Majos, C.; Valls, C.; Fernandez-Cabrera, L.; Narvaez, J.

    1998-01-01

    POEMS syndrome is a multisystemic disorder related to a plasma cell dyscrasia. Radiologically, this syndrome is characterized by sclerotic focal bone lesions with a normal radionuclide bone scan. We report a case of POEMS syndrome with an expansile lytic lesion in the sternum showing periosteal reaction and soft tissue mass, which revealed locally increased uptake of radiotracer in bone scintigraphy. These unusual findings and the differential diagnosis are discussed. (orig.)

  7. Association between Depression, Pressure Pain Sensitivity, Stress and Autonomous Nervous System Function in Stable Ischemic Heart Disease

    DEFF Research Database (Denmark)

    Ballegaard, Søren; Bergmann, Natasha; Karpatschof, Benny

    2016-01-01

    Background: Depression and ischemic heart disease (IHD) are associated with persistent stress and autonomic nervous system (ANS) dysfunction. The former can be measured by pressure pain sensitivity (PPS) of the sternum, and the latter by the PPS and systolic blood pressure (SBP) response to a til...... in depression, reduction in persistent stress, and restoration of ANS dysfunction was only seen in non-users, suggesting a central role of beta-adrenergic receptors in the association between these factors....

  8. A case of radiation ulcer of chest wall with osteomyelitis

    International Nuclear Information System (INIS)

    Baba, Kyoko; Shibata, Hirotatsu; Mouri, Mari; Uchinuma, Eiju

    2005-01-01

    We report a case of anterior chest skin ulcer with rib and sternum osteomyelitis following radiation therapy for post operative mammary carcinoma. Operation was performed six times including debridement with sternum and rib resection reconstruction and skin grafting. It took about one and a half years after first operation to heal the ulcer with osteomyelitis. Principle of treatment for radiation ulcer accompanied by osteomyelitis is complete resection of the damaged lesion. However, it is difficult to evaluate the exact area of the damaged lesion. Therefore it is not rare to repeat its recurrence and have trouble with its treatment. In this case, it was considered that the resected area was insufficient on the initial operation. In order to treat for radiation ulcers accompanied by osteomyelitis, enough resection of the damaged lesion in the initial operation is necessary. Ultimately, in our case, the resection of all sternum, part of the right second to fifth rib and part of left second to seventh rib was necessary. It is generally said that reconstructing bone structure is required in the case of wide defect of chest wall. Though, we did not perform reconstruction of the bone structures, there is no problem in the condition of respiratory system. The surrounding soft tissues changed to hard enough to avoid paradoxical breathing. (author)

  9. Sex estimation from sternal measurements using multidetector computed tomography.

    Science.gov (United States)

    Ekizoglu, Oguzhan; Hocaoglu, Elif; Inci, Ercan; Bilgili, Mustafa Gokhan; Solmaz, Dilek; Erdil, Irem; Can, Ismail Ozgur

    2014-12-01

    We aimed to show the utility and reliability of sternal morphometric analysis for sex estimation.Sex estimation is a very important step in forensic identification. Skeletal surveys are main methods for sex estimation studies. Morphometric analysis of sternum may provide high accuracy rated data in sex discrimination. In this study, morphometric analysis of sternum was evaluated in 1 mm chest computed tomography scans for sex estimation. Four hundred forty 3 subjects (202 female, 241 male, mean age: 44 ± 8.1 [distribution: 30-60 year old]) were included the study. Manubrium length (ML), mesosternum length (2L), Sternebra 1 (S1W), and Sternebra 3 (S3W) width were measured and also sternal index (SI) was calculated. Differences between genders were evaluated by student t-test. Predictive factors of sex were determined by discrimination analysis and receiver operating characteristic (ROC) analysis. Male sternal measurement values are significantly higher than females (P discrimination analysis, MSL has high accuracy rate with 80.2% in females and 80.9% in males. MSL also has the best sensitivity (75.9%) and specificity (87.6%) values. Accuracy rates were above 80% in 3 stepwise discrimination analysis for both sexes. Stepwise 1 (ML, MSL, S1W, S3W) has the highest accuracy rate in stepwise discrimination analysis with 86.1% in females and 83.8% in males. Our study showed that morphometric computed tomography analysis of sternum might provide important information for sex estimation.

  10. Investigation of occupational radiation exposure during interventional cardiac catheterizations performed via radial artery

    International Nuclear Information System (INIS)

    Goni, H.; Papadopoulou, D.; Yakoumakis, Em; Stratigis, N.; Benos, J.; Siriopoulou, V.; Makri, Tr; Georgiou, Ev

    2005-01-01

    The purpose of this study was to determine the thyroid, sternum and hand radiation doses of radiologists who perform angiographies and angio-plasties via the radial artery. Staff radiation dose was estimated for 21 cardiac interventional catheterizations. Thermoluminescence dosemeters (TLDs) were used to determine radiation dose for each procedure at the right and left wrist, at the sternum and the thyroid. A dose area product (DAP) meter was also attached to give a direct value in Gy cm 2 for each procedure. Staff radiation doses varied between 34 and 235 μGy per procedure at the left wrist, 28 and 172 μGy at the right wrist, 16 and 106 μGy at the level of the thyroid and 16 and 154 μGy at the level of the sternum. The DAP values varied between 25 and 167 Gy cm 2 . Radiation doses in this study are comparable to those reported in previous studies. Moreover, good correlation was found between the DAP values and the occupational dose measured with TLDs. (authors)

  11. Surgical Management of Bulky Mediastinal Metastases in Follicular Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Zainal Adwin

    2016-01-01

    Full Text Available Follicular thyroid adenoma and carcinoma are very common. Benign and malignant lesions are usually indistinguishable from cytology alone and often require confirmatory resection. The spread of follicular carcinoma is usually hematogenous and is treated with surgery and adjuvant radioactive iodine. Very rarely, metastases occur in the mediastinum. Patients usually present with severe compressive symptoms. With proper treatment and follow-up, the prognosis for these type of thyroid malignancies is excellent. In the case presented here, our patient presented to the Universiti Kebangsaan Malaysia Medical Center with a progressively enlarging anterior neck swelling. The swelling had started 10 years before his presentation. We diagnosed him with an advanced thyroid malignancy with bulky mediastinal metastases. After extensive investigations and counseling, we chose to treat the patient with tumor excision and mediastinal metastases resection. Typically, mediastinal resection involves the removal of the sternum and use of an acrylic implant to recreate the sternum. In this case, the sternum and ribs were removed with subsequent myocutaneous flap coverage for the wound defect. Our experience represents an alternative treatment option in cases where implant use is unsuitable.

  12. Sternal development in the pediatric population: evaluation using computed tomography

    International Nuclear Information System (INIS)

    Delgado, Jorge; Jaimes, Camilo; Gwal, Kriti; Jaramillo, Diego; Ho-Fung, Victor

    2014-01-01

    The normal development of the sternum using CT imaging is not known. To describe the normal development of the sternum in children on chest CT imaging. CT imaging of 300 patients (150 male, 150 female), mean age: 4.97 years (range: 0.01-9.9 years), were evaluated retrospectively. The presence and number of ossification centers in the manubrium, each individual mesosternal segment and the xiphoid were reviewed. Additionally, the vertical and horizontal fusion between ossification centers was evaluated. Differences among age and gender were calculated. Descriptive statistics, analysis of variances (ANOVA), chi-square and Fisher exact tests were performed for statistical analysis. Manubrium: A single ossification center was seen in 88% of cases and two or three ossification centers were seen in 12%. More manubrial ossification centers were correlated to a younger age (P 0.05). Xiphoid: Absence was seen in 67% of the patients. Bifid xiphoid was seen in 1% of the patients. The normal development of the different components of the sternum is a process with wide variation among children. The large variability of mesosternal ossification center types should not be confused with pathology. (orig.)

  13. Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium

    Directory of Open Access Journals (Sweden)

    Lipińska J

    2017-08-01

    Full Text Available Joanna Lipińska,1 Leszek Kutwin,1 Marcin Wawrzycki,1 Leszek Olbrzymek,2 Sławomir Jabłoński1 1Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, 2Ledo, Lodz, Poland Introduction: Resection of manubrium or body of the sternum is associated with a necessity of chest wall reconstruction. Large sternal defects require the use of different types of implants to ensure acceptable esthetic effect for the patient and chest stabilization. Aim: The purpose of this case report is to present a novel method of reconstruction of manubrium removed due to renal cancer metastasis to the sternum.Case: We present the case of a patient, who had underwent right nephrectomy for clear cell kidney cancer, diagnosed with a metastatic tumor in the sternum resulting in destruction of manubrium. The patient undergone tumor resection with primary reconstruction with an individual prosthesis. Sternal defect was filled with a personalized, computed tomography scan-based 3D-milled implant made of polyethylene.Results: Sternal reconstruction was uneventful. The patient endured surgery well, and has been under surveillance in outpatient clinic, without any respiration disorders, implant movement or local recurrence.Conclusion: Custom-designed sternal implants created by 3D technique constitute an interesting alternative for previous methods of filling defects after resection of a tumor in this location. Keywords: 3D-milled implant, thoracoplasty, reconstructive surgery, chest reconstruction, sternal metastasis, sternal implant, sternal tumor 

  14. CT saber-sheath trachea. Correlation with clinical, chest radiographic and functional findings

    International Nuclear Information System (INIS)

    Trigaux, J.P.; Hermes, G.; Dubois, P.; Beers, B. van; Delaunois, L.; Jamart, J.

    1994-01-01

    The diagnosis of saber-sheath trachea is easy at CT due to its cross-sectional imaging, but the significance of this CT sign has not been evaluated in the diagnosis of chronic obstructive pulmonary disease (COPD). Various signs of COPD were compared between a series of 20 patients with a saber-sheath trachea at CT (tracheal index ≤66%) and a group of 20 pneumologic control patients without saber-sheath trachea (tracheal index ≥70%). These signs include clinical and standard radiographic indices of COPD, sternum-spine distance and 3 functional tests of COPD: forced expiratory volume in one second, carbon monoxide diffusing lung capacity, and funtional residual capacity (FRC). A significant difference was found between the 2 groups, concerning the values of FRC and of sternum-spine distance (p -2 ). The tracheal index was significantly correlated with the FRC values and with the sternum-spine distance. No other significant difference was observed. It is concluded that saber-sheath trachea is basically a sign of hyperinflation. (orig./MG)

  15. Morphological approach of the sternal foramen: an anatomic study and a short review of the literature.

    Science.gov (United States)

    Gkantsinikoudis, N; Chaniotakis, C; Gkasdaris, G; Georgiou, N; Kapetanakis, S

    2017-01-01

    The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations. We review relevant literature, and we present data obtai-ned from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation. The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects. The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively.

  16. Studies on the distribution of hematopoietic bone marrow by bone marrow scintigraphy, 1

    International Nuclear Information System (INIS)

    Fujimori, Katsuhiko

    1976-01-01

    In 42 patients with hypoplastic anemia, 10 mCi of sup(99m)Tc sulfur colloid was injected intravenously, and scanning was performed one hour later with a Pho/Gamma III scintillation camera. Active bone marrow was usually found in the sternum, vertebrae, pelvis, and the poximal ends of humeri and femurs. These 42 cases were classified into 5 types according to distribution pattern. Type 1 (4 cases) showed complete lack of sup(99m)Tc activity in the usual marrow sites. Ferrokinetic studies indicated remarkable erythropoietic hypofunction. Type 2 (18 cases) showed island-like distribution of marrow in the pelvis or in the heads of humeri and femurs. Type 3 (6 cases) showed approximately normal uptake of sup(99m)Tc sulfur colloid in the sternum and the vertebrae, but no activity in the pelvis; or showed the apposite distribution. Marrow specimens obtained from the sternum and the pelvis showed differences in cellularity in such cases. Type 4 (8 cases) were divided into two groups, A and B. Four patients of group A showed decreased uptake of the colloid in the usual marrow sites, but expanded marrow extending into distal femous, proximal and distal tibiae and bones of the feet. These patients subsequently developed leukemia. The diagnosis was confirmed at autopsy or when leukemic features appeared during the clinical course. The remaining cases, group B, showed island-like sup(99m)Tc activity in the tibia. Until then, there had been no signs of leukemia. Type 5 (6 cases) showed normal distribution with below-normal uptake. It is concluded that the reduction of hematopoietic tissue mass is the main cause of decreased hematopoiesis in hypoplastic anemia. (J.P.N.)

  17. The Power of Flash Mob Research: Conducting a Nationwide Observational Clinical Study on Capillary Refill Time in a Single Day.

    Science.gov (United States)

    Alsma, Jelmer; van Saase, Jan L C M; Nanayakkara, Prabath W B; Schouten, W E M Ineke; Baten, Anique; Bauer, Martijn P; Holleman, Frits; Ligtenberg, Jack J M; Stassen, Patricia M; Kaasjager, Karin H A H; Haak, Harm R; Bosch, Frank H; Schuit, Stephanie C E

    2017-05-01

    Capillary refill time (CRT) is a clinical test used to evaluate the circulatory status of patients; various methods are available to assess CRT. Conventional clinical research often demands large numbers of patients, making it costly, labor-intensive, and time-consuming. We studied the interobserver agreement on CRT in a nationwide study by using a novel method of research called flash mob research (FMR). Physicians in the Netherlands were recruited by using word-of-mouth referrals, conventional media, and social media to participate in a nationwide, single-day, "nine-to-five," multicenter, cross-sectional, observational study to evaluate CRT. Patients aged ≥ 18 years presenting to the ED or who were hospitalized were eligible for inclusion. CRT was measured independently (by two investigators) at the patient's sternum and distal phalanx after application of pressure for 5 s (5s) and 15 s (15s). On October 29, 2014, a total of 458 investigators in 38 Dutch hospitals enrolled 1,734 patients. The mean CRT measured at the distal phalanx were 2.3 s (5s, SD 1.1) and 2.4 s (15s, SD 1.3). The mean CRT measured at the sternum was 2.6 s (5s, SD 1.1) and 2.7 s (15s, SD 1.1). Interobserver agreement was higher for the distal phalanx (κ value, 0.40) than for the sternum (κ value, 0.30). Interobserver agreement on CRT is, at best, moderate. CRT measured at the distal phalanx yielded higher interobserver agreement compared with sternal CRT measurements. FMR proved a valuable instrument to investigate a relatively simple clinical question in an inexpensive, quick, and reliable manner. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  18. Ectopia cordis associated with Cantrell′s pentalogy

    Directory of Open Access Journals (Sweden)

    Kumar Basant

    2008-01-01

    Full Text Available Cantrell′s pentalogy with ectopia cordis is an extremely rare and lethal congenital anomaly, with a reported incidence of 1:100000 births in developed countries. We report a neonate who presented with ectopia cordis along with cleft lower sternum, upper abdominal wall defect, ectopic umbilicus, diaphragmatic defect, and interventricular septal defect. The neonate had respiratory distress with peripheral cyanosis and died because of acidosis and electrolyte imbalance before surgical intervention could be undertaken. We discuss the case and present a brief review of literature and of embryogenesis

  19. Case report

    African Journals Online (AJOL)

    ebutamanya

    12 juin 2015 ... L'exérèse de la masse était laborieuse sur le plan profond car la lésion était très adhérente au niveau du sternum. Une partie du périoste et de l'os spongieux ont été enlevées. Cette ablation nécessitait une hémostase minutieuse car la tumeur était hypervascularisée. La tumeur était de consistance ferme, ...

  20. Extra-Gastrointestinal Stromal Tumor Presenting as an Anterior Chest Wall Mass

    Directory of Open Access Journals (Sweden)

    Junghyeon Lim

    2017-08-01

    Full Text Available A 71-year-old man was referred for an anterior chest wall mass. Chest computed tomography (CT and positron emission tomography-CT suggested a malignant tumor. Surgical biopsy through a vertical subxiphoid incision revealed an extra-gastrointestinal stromal tumor (EGIST. En bloc resection of the tumor, including partial resection of the sternum, costal cartilage, pericardium, diaphragm, and peritoneum, was performed. Pathologic evaluation revealed a negative resection margin and confirmed the tumor as an EGIST. On postoperative day 17, the patient was discharged without any complications. At the 2-week follow-up, the patient was doing well and was asymptomatic.

  1. Local dynamic stability during treadmill walking can detect children with developmental coordination disorder

    DEFF Research Database (Denmark)

    Speedtsberg, Merete Brink; Christensen, Sofie Bouschinger; Stenum, Jan

    2018-01-01

    -posterior directions were recorded with a sternum mounted accelerometer at 256Hz. Short term local dynamic stability (λs), root mean square (RMS) and relative root mean square (RMSR) were calculated from measures of orthogonal trunk accelerations. Receiver operating characteristic curve (ROC) analysis was performed...... between children with DCD and TD children in any direction. The ROC analysis of λs in separate directions and in two dimensions showed an excellent accuracy of discriminating between children with DCD and TD children. Anterior-posterior direction in combination with medio-lateral or vertical showed best...

  2. Radiological diagnosis and therapy of chest pain

    International Nuclear Information System (INIS)

    Kutzner, J.; Ernst, H.

    1980-01-01

    The causes and localization of chest pain are numerous. They can derive from infections, traumas, or tumors. Possible sites of origin are: skeletal portions, vertebral column, ribs, and sternum, as well as mediastinum and pleura. In women, occurrence tends to be cyclic and affect the mamma region. Radiological diagnosis includes radiography, nuclear techniques as well as whole body computer-tomography. Radiation therapy is indicated in cases of mediastinal tumor formation. Radiation of painful osteolytic vertebral metastases and rib destructions proves to be an efficient palliative measure. (orig.) [de

  3. Configuration and localization of the nipple-areola complex in men.

    Science.gov (United States)

    Beer, G M; Budi, S; Seifert, B; Morgenthaler, W; Infanger, M; Meyer, V E

    2001-12-01

    The causes of bilateral absence of the nipple-areola complex in men are seldom congenital, but attributable rather to destruction as a result of trauma, or after mastectomy in female-to-male transsexuals and in male breast cancer, or after the correction of extreme bilateral gynecomastia. Such a bilateral loss becomes a major reconstructive challenge with respect to the configuration and localization of a new nipple-areola complex. Because there is very little information available in the literature, we carried out a cross-sectional study on the configuration and localization of the nipple-areola complex in men.A total of 100 healthy men aged 20 to 36 years were examined under standardized conditions. The first part of the study dealt with the configuration of the nipple-areola complex (dimensions, round or oval shape). The second part concentrated on the localization of the complex on the thoracic wall with respect to anatomic landmarks and in correlation to various parameters such as weight and height of the body, circumference of the thorax, length of sternum, and position in the intercostal space. Of the 100 subjects examined, 91 had oval and seven had a round nipple-areola complex. An asymmetry between the right and the left side was found in two cases. The mean ratio of the horizontal/vertical diameter of an oval nipple-areola complex was 27:20 mm and the mean diameter for a round nipple-areola complex was 23 mm. The center of the nipple-areola complex was in the fourth intercostal space in 75 percent and in the fifth intercostal space in 23 percent of the subjects. To localize the nipple-areola complex on the thoracic wall de novo, at least two reproducible measurements proved to be necessary, composed of a horizontal line (distance from the midsternal line to the nipple = A) and a vertical line (distance from the sternal notch to the intersection of line A, = B). The closest correlation for the horizontal distance A was given by the circumference of the

  4. Endoscopic Intubation with Aid of Mechanical Ventilation via a Dedicated Nasopharyngeal Airway

    Directory of Open Access Journals (Sweden)

    Wen-Jue Soong

    2007-09-01

    Full Text Available A young child with jaw-neck-sternum immobility suffering from acute upper airway obstruction was treated with nasotracheal intubation using flexible endoscope (FE. During this difficult intubation, an inserted trimming endotracheal tube acted as a nasopharyngeal airway and simultaneous supplement with mechanical ventilation through the tube successfully resuscitated and improved the patient's ventilation and oxygenation. This management can greatly facilitate visualization of the laryngeal apparatus and translaryngeal passage of the FE. This technique can be helpful in resuscitative ventilation and difficult intubation in a critical upper airway emergency.

  5. [Plastic surgery of the thoracic wall as a method of thoracic wall reconstruction after complete surgical wound disintegration after sternotomy].

    Science.gov (United States)

    Hájek, T; Jirásek, K; Urban, M; Straka, Z

    1998-12-01

    During the period between January 1996 and July 1998 in our department 1920 patients were operated on account of heart disease from median sternotomy. In 17 patients, i.e. in 0.9% during the early postoperative period the surgical wound disintegrated incl. dehiscence of the sternum and the development of postoperative mediastinitis. In 14 of these patients the authors reconstructed the defect of the thoracic wall by their own modification of Jurkiewicz plastic operation using the pectoral muscles. One patient from this group died, in the remaining 13 patients the wound healed without deformity of the chest and without signs of instability, without restriction of movement and function.

  6. Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager.

    Science.gov (United States)

    Tocchioni, Francesca; Ghionzoli, Marco; Lo Piccolo, Roberto; Deaconu, Diana E; Facchini, Flavio; Milanez De Campos, Jose R; Messineo, Antonio

    2015-06-01

    Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Retrosternal friction-induced late disruption of the anastomotic site between Bentall's valved conduit and an aortic arch graft: report of a case.

    Science.gov (United States)

    Fukada, Johji; Morishita, Kiyofumi; Kawaharada, Nobuyoshi; Kurimoto, Yoshihiko; Muraki, Satoshi; Satsu, Takuma; Abe, Tomio

    2003-01-01

    We report a case of late mediastinal false aneurysm originating from disruption of the suture line between synthetic vascular grafts for aortic root and total aortic arch replacements. This aneurysm developed without any infection in a patient with Marfan's syndrome. To our knowledge, this event has never been reported before. The only possible cause of this disruption was that the monofilament suture was broken by continuous friction between the pointed anastomotic line and the sternum since the operation. The treatment options for this unusual event after extended synthetic graft replacement are discussed.

  8. A new species of Foza Reed & Cumberlidge, 2006 from northern Madagascar (Decapoda, Brachyura, Potamoidea, Potamonautidae, with a redescription of F. goudoti (H. Milne Edwards, 1853 comb. n., and comments on Skelosophusa prolixa Ng & Takeda, 1994

    Directory of Open Access Journals (Sweden)

    Neil Cumberlidge

    2009-08-01

    Full Text Available Foza ambohitra sp. n. is described from Ambohitra, Antsiranana Province, northern Madagascar at 421 m elevation. This species is distinguished by characters of the carapace, the male anterior thoracic sternum, and the form of the male major cheliped and first gonopod. Thelphusa goudoti H. Milne Edwards, 1853, is transferred to Foza Reed & Cumberlidge, 2006, and redescribed, and a key to the three species of this genus is provided. Comments on the rare cave crab Skelosophusa prolixa Ng & Takeda, 1994, from Antsiranana Province are also included based on newly obtained material.

  9. Our experience with the so-called pull-through technique combined with liposuction for management of gynecomastia.

    Science.gov (United States)

    Bracaglia, Roberto; Fortunato, Regina; Gentileschi, Stefano; Seccia, Antonio; Farallo, Eugenio

    2004-07-01

    Gynecomastia is a benign enlargement of male breast, common in adolescents and adults. To treat this deformity, we have been carrying out liposuction through small cutaneous incisions placed in the axilla and on the sternum. If necessary, we performed a surgical excision of glandular tissue through a periareolar incision. From 1995, we started to perform surgical excision of glandular tissue, if necessary, through the small incisions made for liposuction, thus avoiding the periareolar scars. We describe our experience with this technique, which we believe excellent for the correction of glandular and fatty glandular gynecomastia, obtaining excellent esthetic results and minimal local scarring.

  10. Case of squamous cell carcinoma developed in isotope-treated blue naevus

    Energy Technology Data Exchange (ETDEWEB)

    Nishii, Masami; Unita, Mieko; Shimizu, Masayuki (Mie Univ., Tsu (Japan). School of Medicine)

    1983-12-01

    A 29-year-old male patient underwent isotope radiation therapy for blue naevus of the right precordium and forearm every three months for two years form the age of 7 years. He developed a tumor on the irradiated site of the precordium at the age of 27 years. Histology showed chronic radiation dermatitis with squamous cell carcinoma. In spite of the removal of the tumor, he had a relapse ten months later, and underwent the extirpation of the tumor with resection of the sternum and claviculae, and with skin graft using a musculocutaneous flap.

  11. Treatment of necrotic infection on the anterior chest wall secondary to mastectomy and postoperative radiotherapy by the application of omentum and mesh skin grafting. Report of a case

    International Nuclear Information System (INIS)

    Sato, Masaaki; Tanaka, Fumihiro; Wada, Hiromi

    2002-01-01

    We report herein the case of a patient who initially underwent right radical mastectomy for breast carcinoma in 1988, followed by left breast-conserving surgery in 1997. On both occasions she was given postoperative radiation therapy of 50 Gy. Repeated dressings and the administration of antibiotics failed to heal ulcerative infected lesions that had formed on the anterior chest wall in early 1998. In 1999, the sternum and surrounding tissue were debrided and the anterior chest wall was reconstructed by omentum transposition and mesh skin grafting. The patient is currently well and alive without any evidence of recurrence of either infection or breast cancer. (author)

  12. Medicolegal aspects of atypical firearm injuries: a case report.

    Science.gov (United States)

    Gürses, Murat Serdar; Akan, Okan; Eren, Bülent; Durak, Dilek; Türkmen, Nursel; Cetin, Selçuk

    2014-01-01

    Our case was a twenty year-old man, who was injured during the military duty with G3 infantry rifle in the training area. An atypical firearm entry wound on the left side of sternum which was 4.5 cm in diameter, and was surrounded by six irregular skin burn wounds by a flash-suppressor and a 0.7 cm diameter firearm exit wound at space on the left midscapular line. Our case emphasizes that the interpretation of properties of these atypical firearm entry wounds need to be carefully assessed by physicians.

  13. [Assessment of external cardiac massage efficiency or Kouwenhoven revisited (author's transl)].

    Science.gov (United States)

    Berzin, B; Asseman, P; Rey, F; Thery, C; Scherpereel, P

    1981-01-01

    The external cardiac massage mechanism is commonly related to the ventricles compression between the vertebral block and the sternum. This over-simple explanation must be reconsidered. Following recent data, the intra thoracic pressure changes take probably a major part in it efficiency. Six patients have been studied by hemodynamic intra aortic measurements and Doppler carotidian velocimetry. Intra thoracic pressure have been recorded by an oesophageal catheter. Results are in agreement with the prominent part of the intra thoracic pressure variations. Various external cardiac methods are investigated following this monitoring. Some aspects of the classical management of the cardiac arrest have to be discussed.

  14. Two cases of Cantrell's syndrome

    International Nuclear Information System (INIS)

    Yu, Yun Jeong; Yeon, Kyung Mo

    1982-01-01

    Congenital absence of the lower sternum, defect of the abdominal wall, defects of the anterior diaphragm, pericardial defects and cardiac anomalies had been described as a syndrome by Cantrell et al. Developing mechanism of the syndrome was embryologically defined. These defects arise apparently from combined anomalies of developing of the dorsal mesoderm. The authors present two cases of Cantrell's syndrome developed in one day old and eight months old female patient in which angiocardiography was done at the Department of Radiology, Seoul National University Hospital

  15. Congenital symmastia revisited

    DEFF Research Database (Denmark)

    Sillesen, Nanna H; Hölmich, Lisbeth R; Siersen, Hans Erik

    2012-01-01

    Symmastia is defined as medial confluence of the breast. The term 'symmastia' is modified from Greek (syn meaning 'together', and mastos meaning 'breast') and was first presented by Spence et al. in 1983. Two forms of symmastia exist: an iatrogenic and a congenital version. Congenital symmastia...... is a rare condition in which web-like soft tissue traverses the sternum to connect the breasts medially. The literature on congenital symmastia is limited, few cases have been published, and knowledge about ideal treatment is still insufficient....

  16. Case report 457: Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) presenting as lesion in the sacrum

    Energy Technology Data Exchange (ETDEWEB)

    Unni, K K

    1988-03-01

    A 19-year-old women presented with a lytic lesion in the sacrum, associated with pain. Sinus histiocytosis (Rosai-Dorfman disease) was not diagnosed correctly until a biopsy specimen of an enlarged cervical lymph node showed the changes typical of sinus histiocytosis with massive lymphadenopathy. The disease was persistent in the patient and eventually involved the sternum. The patient improved with steroid therapy. The clinical, radiological and pathological aspects of this entity were discussed. It was stressed that radiologists, orthopedic surgeons and pathologists must be aware that sinus histiocytosis with massive lymphadenopathy may manifest initially as a bone 'tumor'.

  17. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

    Science.gov (United States)

    Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

    2014-01-01

    The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881

  18. Repair of pectus deformities: Experience and outcome in 317 cases

    International Nuclear Information System (INIS)

    Geric, O.; Gurkok, S.; Gozubuyuk, A.; Dakak, M.; Caytak, H.; Yucels, O.

    2006-01-01

    The most common congenital chest wall reformatories are pectus excavatum and pectus carinatum. Various techniques have been described for correction of pectus deformities. We describe our experience with surgical repair of pectus deformity (PD) in adults, including our new techniques, which uses a restorable plaque for fixation of the sternum. We reviewed the records of 317 patients who underwent surgical correction of PD between October 1997 and December 2005. All of the patients were male and the median age was 21.3 years (range 16-32 years). Of 317 patients, the type of deformity was a pectus excavatum in 230 patients and a pectus carination in 87 of the patients. Four different operative techniques were used. There were no intraoperative deaths or major perioperative morbidity. The complications rate was 17%. Overall mean hospital stay was 14.25 days. In 208 patients who underwent a mid-term outpatient follow up (mean, 8 months), there was no recurrence. Patient satisfaction was excellent in 234 patients, good in 79 patients and fair in 4 patients. The majority of patients with pectus deformity have been operated on during childhood; therefore there is limited published information about the correction of pectus cranium deformation in adults. The most important point in pectus correction is to achieve proper and long term stability of the sternum following osteotomy. Various techniques can be used for this purpose. (author)

  19. Blunt trauma of bone structures of the chest--computed tomography vs multidetector computed tomography.

    Science.gov (United States)

    Petrović, Kosta; Turkalj, Ivan; Stojanović, Sanja; Vucaj-Cirilović, Viktorija; Nikolić, Olivera; Stojiljković, Dragana

    2013-08-01

    Computerized tomography (CT), especially multidetector CT (MDCT), has had a revolutionary impact in diagnostic in traumatized patients. The aim of the study was to identify and compare the frequency of injuries to bone structures of the thorax displayed with 5-mm-thick axial CT slices and thin-slice (MDCT) examination with the use of 3D reconstructions, primarily multiplanar reformations (MPR). This prospective study included 61 patients with blunt trauma submitted to CT scan of the thorax as initial assessment. The two experienced radiologists inde pendently and separately described the findings for 5-mm-thick axial CT slices (5 mm CT) as in monoslice CT examination; MPR and other 3D reconstructions along with thin-slice axial sections which were available in modern MDCT technologies. After describing thin-slice examination in case of disagreement in the findings, the examiners redescribed thin-slice examination together which was ultimately considered as a real, true finding. No statistically significant difference in interobserver evaluation of 5 mm CT examination was recorded (p > 0.05). Evaluation of fractures of sternum with 5 mm CT and MDCT showed a statistically significant difference (p tool that can describe higher number of bone fractures of the chest in traumatized patients compared to 5 mm CT, especially in the region of sternum for which a statistical significance was obtained using MPR. Moreover, the importance of MDCT is also set by easier and more accurate determination of the level of bone injury.

  20. Gallium imaging of esophageal carcinoma: Increased sensitivity with lateral views of the thorax

    International Nuclear Information System (INIS)

    Sostre, S.; Romero, I.; Rivera, J.V.; Baez, L.; Cintron, E.

    1990-01-01

    Ga-67 imaging has not been very successful in the detection of esophageal carcinoma. In most reports, sensitivity for the primary tumor ranged from 25-61%, but imaging had been done only in anterior and posterior (A-P) projections. We performed gallium scans in 30 patients with esophageal carcinoma, adding lateral views to the routine A-P projections, to study the effect of lateral views on tumor detection. The A-P views detected only 57% of the tumors while the right lateral visualized 89%, and the left lateral detected 100%. Some lesions may be hidden by the sternum and the spine in the routine A-P views. Previous disappointments with Ga-67 imaging of esophageal carcinoma were probably due to this technical factor. Being gallium-avid, esophageal tumors deserve further studies with this agent to determine the role of Ga-67 imaging in this condition. These studies should be performed with multiple views of the thorax or, better yet, with SPECT imaging of the chest, to circumvent the problem of sternum and spine interference

  1. Co-occurrence of severe Goltz-Gorlin syndrome and pentalogy of Cantrell - Case report and review of the literature.

    Science.gov (United States)

    Smigiel, Robert; Jakubiak, Aleksandra; Lombardi, Maria Paola; Jaworski, Wojciech; Slezak, Ryszard; Patkowski, Dariusz; Hennekam, Raoul C

    2011-05-01

    Goltz-Gorlin syndrome is a highly variable disorder affecting many body parts of meso-ectodermal origin. Mutations in X-linked PORCN have been identified in almost all patients with a classical Goltz-Gorlin phenotype. The pentalogy of Cantrell is an infrequently described congenital disorder characterized by the combination of five anomalies: a midline supra-umbilical abdominal wall defect; absent or cleft lower part of the sternum; deficiency of the diaphragmatic pericardium; deficiency of the anterior diaphragm; and congenital heart anomalies. Etiology and pathogenesis are unknown. We report on an infant with findings fitting both Goltz-Gorlin syndrome (sparse hair; anophthalmia; clefting; bifid nose; irregular vermillion of both lips; asymmetrical limb malformations; caudal appendage; linear aplastic skin defects; unilateral hearing loss) and the pentalogy of Cantrell (absent lower sternum; anterior diaphragmatic hernia; ectopia cordis; omphalocele). The clinical diagnosis Goltz-Gorlin syndrome was confirmed molecularly by a point mutation in PORCN (c.727C>T). The presence of molecularly confirmed Goltz-Gorlin syndrome and pentalogy of Cantrell in a single patient has been reported twice before. The present patient confirms that the pentalogy of Cantrell can be caused in some patients by a PORCN mutation. It remains at present uncertain whether this can be explained by the type or localization of the mutation within PORCN, or whether the co-occurrence of the two entities is additionally determined by mutations or polymorphisms in other genes, environmental factors, and/or epigenetic influences. Copyright © 2011 Wiley-Liss, Inc.

  2. Wound infection after median sternotomy during the war in Croatia.

    Science.gov (United States)

    Jelić, I; Anić, D; Alfirević, I; Kalinić, S; Ugljen, R; Letica, D; Ante Korda, Z; Vucemilo, I; Bulat, C; Predrijevac, M; Corić, V; Husar, J; Jelic, M; Hulina, D; Depina, I; Dadić, D

    1996-12-01

    From 1990 to 1994 at Clinical Hospital Center, Zagreb, 1904 median sternotomies were performed for cardiac operations. Patients shared the same intensive care unit (ICU) with the wounded persons, admitted to the hospital from battlefield. Infection developed in 124 patients, an incidence of 6.51%. Methicillin resistant Staphylococcus aureus (MRSA) was isolated from 90, methicillin resistant Staphylococcus epidermidis (MRSE) from 19, and gram negative bacilli (GNB) from 56 patients, Pseudomonas aeruginosa in 2, and Clostridium pneumoniae in 1 case. Ninety-six patients (5.04%) developed superficial localized infection of subcutaneous tissues and they were treated with frequent dressing changes with antibiotic-soaked gauze in combination with systemic antibiotics. Twenty-eight patients (1.47%) developed mediastinitis and sternal dehiscence. They were treated by operative debridement followed by reclosure of the sternum with continuous antibiotic irrigation. We obtained satisfactory results with our method of closure of sternum which is a modification of Robicsek's technique. Nine of them required further operation. In seven cases we performed muscle flaps and in two omentoplasty. One hundred and twenty patients were discharged in satisfactory condition. The uncontrolled mediastinal sepsis caused death in 4 patients. Higher infection rate after median sternotomy during 1991 and 1992 could be possibly explained with the war circumstances in Croatia, and especially with MRSA strain becoming endemic in surgical ICU.

  3. Common factors method to predict the carcass composition tissue in kid goats

    Directory of Open Access Journals (Sweden)

    Helen Fernanda Barros Gomes

    2013-03-01

    Full Text Available The objective of this work was to analyze the interrelations among weights and carcass measures of the longissimus lumborum muscle thickness and area, and of sternum tissue thickness, measured directly on carcass and by ultrasound scan. Measures were taken on live animals and after slaughter to develop models of multiple linear regression, to estimate the composition of shoulder blade, from selected variables in 89 kids of both genders and five breed groups, raised in feedlot system. The variables considered relevant and not redundant on the information they carry, for the common factor analysis, were used in the carcass composition estimate development models. The presuppositions of linear regression models relative to residues were evaluated, the estimated residues were subjected to analysis of variance and the means were compared by the Student t test. Based in these results, the group of 32 initial variables could be reduced to four variables: hot carcass weight, rump perimeter, leg length and tissue height at the fourth sternum bone. The analysis of common factors was shown as an effective technique to study the interrelations among the independent variables. The measures of carcass dimension, alone, did not add any information to hot carcass weight. The carcass muscle weight can be estimated with high precision from simple models, without the need for information related to gender and breed, and they could be built based on carcass weight, which makes it easy to be applied. The fat and bones estimate models were not as accurate.

  4. Treatment of funnel chest in children

    Directory of Open Access Journals (Sweden)

    Viktor N. Stalmakhovich

    2017-10-01

    Full Text Available Background. Funnel chest has a relatively high prevalence in the Russian population. Given the high percentage of the unsatisfactory results of thoracoplasty, further research for the development of new treatment methods is needed. Aim. To improve the treatment results for funnel chest in children. Materials and methods. We analyzed the treatment results of 230 children with funnel chest after thoracoplasty. We used 2 surgical techniques: classic thoracoplasty by Nuss (114 children and its modified version by the authors (116 children. The modified technique included two-sided thoracoscopy, partial resection of the deformed rib cartilages, and endoscopic longitudinal transection of the sternal cortical plate, resulting in subcutaneous emphysema along the sternum. Results. The comparison of the 2 surgical techniques showed no significant difference in terms of duration and invasiveness of the procedure. Recurrent episodes of funnel chest were observed in children who had undergone thoracoplasty before 7 years of age, regardless of the technique used. Conclusion. This study revealed that the author’s modified thoracoplasty method was more effective in children > 14 years of age with rigid funnel chest because it allowed the surgeon to decrease the thoracic pressure on the plate and the plate itself on the ribs, facilitating the repositioning of the sternum and preventing the deformation and development of pressure sores on the ribs.

  5. Heavy metals (copper, cadmium, lead, mercury) in mute swans from Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Elvestad, K.; Karlog, O.; Clausen, B.

    1982-03-01

    During the severe winter of 1978-79, large numbers of mute swans died in coastal areas of Denmark. Of these, 2111 were collected for examination. The analyses confirm previous findings of relatively high copper levels in mute swans (mean for 178 livers was 2680 mg/kg dry weight (Dw) and for 110 kidneys 34 mg/kg Dw) (Table I, Fig. 1). The copper content was not related to sex or age (Table II). The highest liver levels of copper were found in swans from Western Jutland. Cadmium was found at the same relatively low levels as recorded for waterfowl elsewhere (mean for 178 livers was 12 mg/kg Dw, for 110 kidneys 24 mg/kg Dw) (Table I, Fig. 2). The cadmium content was not sex-related, but it increased with age (Table II). The mean mercury content (liver) was 1.4 mg/kg Dw in the 10 birds analysed (Table I). The mean lead content was 15 mg/kg Dw in the 178 livers analysed and 31 mg/kg Dw in 110 sternum (Table I and Fig. 3). The lead content was not sex-related. In sternum, but not in livers, it was related to age (Table II). One third of the swans were found lead-contaminated probably after ingestion of lead pellets. None of the swans carried high levels of both copper, cadmium, and lead (Table III).

  6. Reduced metabolic cost of locomotion in Svalbard rock ptarmigan (Lagopus muta hyperborea during winter.

    Directory of Open Access Journals (Sweden)

    John Lees

    2010-11-01

    Full Text Available The Svalbard rock ptarmigan, Lagopus muta hyperborea experiences extreme photoperiodic and climatic conditions on the Arctic archipelago of Svalbard. This species, however, is highly adapted to live in this harsh environment. One of the most striking adaptations found in these birds is the deposition, prior to onset of winter, of fat stores which may comprise up to 32% of body mass and are located primarily around the sternum and abdominal region. This fat, while crucial to the birds' survival, also presents a challenge in that the bird must maintain normal physiological function with this additional mass. In particular these stores are likely to constrain the respiratory system, as the sternum and pelvic region must be moved during ventilation and carrying this extra load may also impact upon the energetic cost of locomotion. Here we demonstrate that winter birds have a reduced cost of locomotion when compared to summer birds. A remarkable finding given that during winter these birds have almost twice the body mass of those in summer. These results suggest that Svalbard ptarmigan are able to carry the additional winter fat without incurring any energetic cost. As energy conservation is paramount to these birds, minimising the costs of moving around when resources are limited would appear to be a key adaptation crucial for their survival in the barren Arctic environment.

  7. Prospective, randomized, controlled trial of polymer cable ties versus standard wire closure of midline sternotomy.

    Science.gov (United States)

    Marasco, Silvana F; Fuller, Louise; Zimmet, Adam; McGiffin, David; Seitz, Michael; Ch'ng, Stephanie; Gangahanumaiah, Shivanand; Bailey, Michael

    2018-04-16

    Midline sternotomy remains the most common access incision for cardiac operations. Traditionally, the sternum is closed with stainless steel wires. Wires are well known to stretch and break, however, leading to pain, nonunion, and potential deep sternal wound infection. We hypothesized that biocompatible plastic cable ties would achieve a more rigid sternal fixation, reducing postoperative pain and analgesia requirements. A prospective, randomized study compared the ZIPFIX (De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with standard stainless steel wires (n = 60). Primary outcomes were pain and analgesia requirements in the early postoperative period. Secondary outcome was sternal movement, as assessed by ultrasound at the postoperative follow-up visit. Groups were well matched in demographic and operative variables. There were no significant differences between groups in postoperative pain, analgesia, or early ventilatory requirements. Patients in the ZIPFIX group had significantly more movement in the sternum and manubrium on ultrasound at 4 weeks. ZIPFIX sternal cable ties provide reliable closure but no demonstrable benefit in this study in pain or analgesic requirements relative to standard wire closure after median sternotomy. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  8. Evaluation of 6 and 10 Year-Old Child Human Body Models in Emergency Events.

    Science.gov (United States)

    Gras, Laure-Lise; Stockman, Isabelle; Brolin, Karin

    2017-01-01

    Emergency events can influence a child's kinematics prior to a car-crash, and thus its interaction with the restraint system. Numerical Human Body Models (HBMs) can help understand the behaviour of children in emergency events. The kinematic responses of two child HBMs-MADYMO 6 and 10 year-old models-were evaluated and compared with child volunteers' data during emergency events-braking and steering-with a focus on the forehead and sternum displacements. The response of the 6 year-old HBM was similar to the response of the 10 year-old HBM, however both models had a different response compared with the volunteers. The forward and lateral displacements were within the range of volunteer data up to approximately 0.3 s; but then, the HBMs head and sternum moved significantly downwards, while the volunteers experienced smaller displacement and tended to come back to their initial posture. Therefore, these HBMs, originally intended for crash simulations, are not too stiff and could be able to reproduce properly emergency events thanks, for instance, to postural control.

  9. MODIFICATION OF THE NUSS PROCEDURE-PREVENTION OF INJURIES OF THE HEART AND MAJOR BLOOD VESSELS

    Directory of Open Access Journals (Sweden)

    Mirko Žganjer

    2012-09-01

    Full Text Available Objective: The Nuss procedure is a widely accepted technique for correcting pectus excavatum. Unfortunately, fatal complications such as cardiac perforation and injury of the great blood vessels have been noticed in a few patients.We modified original Nuss technique to be simpler and lessdangerous.Methods: We modified Nuss procedure with the sternal elevation to improve sternal depression. Modified Nuss procedure was carried out by applying metal lifter raise sterum until the patient starts to raise from the operating table. The space behind sternum is now wider, and surgeryhas become safer with less probability of injuries intrathoracic organs. We compared 46 patients operated by the original Nuss method (taking into account the data from the literature on complications of the original method on a large series of patients with 54 patients operated by a modified Nuss method.Results: Before lifting the sternum depth of the deformity was between 2.9 and 6.2 cm (mean 5.4 cm, and the increase were between 1.5 and 4.0 cm (mean 2.8 cm. The difference of 2.6 cm is large enough, and the width of introducer and bars are about 3 mm for securely passed along the chest.Conclusions: A modified method of treating pectus excavatum is safer, better and with fewer complications than the original method of Nuss.

  10. Avian-like breathing mechanics in maniraptoran dinosaurs

    Science.gov (United States)

    Codd, Jonathan R; Manning, Phillip L; Norell, Mark A; Perry, Steven F

    2007-01-01

    In 1868 Thomas Huxley first proposed that dinosaurs were the direct ancestors of birds and subsequent analyses have identified a suite of ‘avian’ characteristics in theropod dinosaurs. Ossified uncinate processes are found in most species of extant birds and also occur in extinct non-avian maniraptoran dinosaurs. Their presence in these dinosaurs represents another morphological character linking them to Aves, and further supports the presence of an avian-like air-sac respiratory system in theropod dinosaurs, prior to the evolution of flight. Here we report a phylogenetic analysis of the presence of uncinate processes in Aves and non-avian maniraptoran dinosaurs indicating that these were homologous structures. Furthermore, recent work on Canada geese has demonstrated that uncinate processes are integral to the mechanics of avian ventilation, facilitating both inspiration and expiration. In extant birds, uncinate processes function to increase the mechanical advantage for movements of the ribs and sternum during respiration. Our study presents a mechanism whereby uncinate processes, in conjunction with lateral and ventral movements of the sternum and gastral basket, affected avian-like breathing mechanics in extinct non-avian maniraptoran dinosaurs. PMID:17986432

  11. Trisomy 18 Syndrome with Incomplete Cantrell Syndrome

    Directory of Open Access Journals (Sweden)

    Yi-Jen Hou

    2008-06-01

    Full Text Available The pentalogy of Cantrell was first described in 1958 by Cantrell and coworkers, who reported five cases in which they described a pentad of findings including a midline supraumbilical thoracoabdominal wall defect, a defect of the lower sternum, abnormalities of the diaphragmatic pericardium and the anterior diaphragm, and congenital cardiac anomalies. Trisomy 18 has an incidence of about 0.3 per 1000 newborns. We present a case of trisomy 18 with incomplete Cantrell syndrome. The patient presented with hypogenesis of the corpus callosum, vermian-cerebellar hypoplasia (Dandy-Walker variant, ventricular septal defect, dextrocardia, patent ductus arteriosus, a defect of the lower sternum, a midline supraumbilical abdominal wall defect with omphalocele, congenital left posterior diaphragmatic hernia (Bochdalek hernia, micrognathia, low-set and malformed ears, rocker-bottom feet, dorsiflexed hallux, hypoplastic nails, short neck, and wrist deformity. Trisomy 18 syndrome was unusually combined with the pentalogy of Cantrell. We present this case because of its rarity and high risk of mortality.

  12. Inter-operator and inter-device agreement and reliability of the SEM Scanner.

    Science.gov (United States)

    Clendenin, Marta; Jaradeh, Kindah; Shamirian, Anasheh; Rhodes, Shannon L

    2015-02-01

    The SEM Scanner is a medical device designed for use by healthcare providers as part of pressure ulcer prevention programs. The objective of this study was to evaluate the inter-rater and inter-device agreement and reliability of the SEM Scanner. Thirty-one (31) volunteers free of pressure ulcers or broken skin at the sternum, sacrum, and heels were assessed with the SEM Scanner. Each of three operators utilized each of three devices to collect readings from four anatomical sites (sternum, sacrum, left and right heels) on each subject for a total of 108 readings per subject collected over approximately 30 min. For each combination of operator-device-anatomical site, three SEM readings were collected. Inter-operator and inter-device agreement and reliability were estimated. Over the course of this study, more than 3000 SEM Scanner readings were collected. Agreement between operators was good with mean differences ranging from -0.01 to 0.11. Inter-operator and inter-device reliability exceeded 0.80 at all anatomical sites assessed. The results of this study demonstrate the high reliability and good agreement of the SEM Scanner across different operators and different devices. Given the limitations of current methods to prevent and detect pressure ulcers, the SEM Scanner shows promise as an objective, reliable tool for assessing the presence or absence of pressure-induced tissue damage such as pressure ulcers. Copyright © 2015 Bruin Biometrics, LLC. Published by Elsevier Ltd.. All rights reserved.

  13. Comparison of a Padded Patient Litter and Long Spine Board for Spinal Immobilization in Air Medical Transport.

    Science.gov (United States)

    Weber, Steven R; Rauscher, Patrick; Winsett, Rebecca P

    2015-01-01

    The long spinal board is the immobilization standard during prehospital transport. The flat surface of the board increases the pressure placed on both the thoracic kyphosis and the sacrum and increases the risk for pressure ulcers. This study compared patient stability and comfort between a padded litter system used in air medical transport and the long spine board. The study was completed at a large 350-bed Magnet Recognized nonteaching hospital. The hospital owns and operates an air medical transport service. Subjects were secured to a padded litter and a long spinal board with a cervical collar and head blocks and 3 straps. Laser pointers were used to mark neutral at points on the subject's head, sternum, and pelvis. The subject was tilted 45 degrees left and right with movement measured in inches. Comfort level was measured before and after. Paired t-tests were used to detect differences in movement. No statistical difference in movement was found between devices for the head; however, there was statistically significant greater movement on the padded litter for the sternum and pelvis. The padded litter did not immobilize as tightly as the long board although the effect of the differences was small. Copyright © 2015 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  14. A comparison of moving beam methods for the treatment of the breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chu, S S; Lee, D H; Park, C Y; Choi, B S [Yonsei University College of Medicine, Seoul (Korea, Republic of); Nam, J W [National Institute of Health, Seoul (Korea, Republic of)

    1973-12-15

    The method of tangential rotation therapy for non-operated breast cancer has been developed in Yonsei Cancer Center. This method is in principle to avoid the disorder of the lung field by radiotherapy as well as possible and to make an adequate radiation dosage according to each treated region, including breast, axilla, supra or infraclavicullar fossa, and sternum. We have various irradiation methods conducted today, but this continuous and repeated tangential rotation therapy is extraordinary superior to a traditional fixed tangential therapy. The advantages of this method are summarized as follows: 1) Simultaneous treatment with different dose is possible to the breast and the thorax including the sternum. 2) The radiation effect on the intrathoracic organs including lung and heart is almost absent. 3) It is easy to simultaneous irradiation in the large treated region. 4) The dose distribution of various types is possible by changed a rotation angle and an eccentric angle in accordance with irradiated region. 5) The irradiated fields are not overlapped and not so complicated as a fixed polytagential therapy. Therefor the continuous and repeated tangential rotation therapy is an adequate method for the non-operated breast cancer and may be sure of helping for radiation therapy.

  15. Enhanced Sternal Healing via Platelet-Rich Plasma and Biodegradable Gelatin Hydrogel.

    Science.gov (United States)

    Shibata, Masafumi; Takagi, Gen; Kudo, Mitsuhiro; Kurita, Jiro; Kawamoto, Yoko; Miyagi, Yasuo; Kanazashi, Mikimoto; Sakatani, Takashi; Naito, Zenya; Tabata, Yasuhiko; Miyamoto, Masaaki; Nitta, Takashi

    2018-05-16

    Platelet-rich plasma (PRP) contains numerous growth factors and promotes bone fracture healing. The aim of this study was to evaluate the effectiveness of the controlled release of PRP from biodegradable gelatin hydrogel for promoting healing in a rabbit ischemic sternal model. PRP was prepared from the whole blood of a Japanese white rabbit. Sixteen rabbits were randomized into four groups (each n = 4) and all underwent median sternotomy and bilateral internal thoracic artery removal. Before the sternum was closed, the following solutions were applied between the sternum incisions in three of the groups: 30 mg of gelatin hydrogel incorporating 300 μL of phosphate-buffered saline, 300 μL of a solution form of PRP, or 30 mg of gelatin hydrogel incorporating 300 μL of PRP (PRP+Gel). The fourth group acted as a control. Sternal healing was evaluated by histology and micro-computed tomography 7 days after the intervention. The PRP+Gel group showed a significantly higher proportion of fibrosis within the fracture area (an indicator of sternal healing) than the other groups and a significantly higher mean intensity of osteocalcin. These results indicate that the controlled release of PRP from locally applied gelatin hydrogel was markedly effective in enhancing sternal healing in the early postoperative period. This novel therapy could potentially help prevent complications such as deep sternal wound infection and could result in early postoperative ambulation after median sternotomy.

  16. Observation of the hypodermic fatty layer of the human torso by computed tomography method

    International Nuclear Information System (INIS)

    Matsuyama, Yoko; Inokuchi, Seiichiro; Suzuki, Masataka

    1984-01-01

    CT images were taken at 7 different longitudinal levels of the torso, and three different body types, which were defined by the Rohrer Index, were discussed. Differences between the sexes were also discussed. 1) Total cross-sectional area: In males, values showed maximum at 2 levels (mid-point of sternum, xiphoid) among 7 levels; and, for females, 2 maximal values appeared at the mid-point of the sternum level and the level of the pubic symphysis. Values at the umbilicus level were smallest in both sexes. 2) Areas of hypodermic fatty layer: Here, the values for males were maximal at the umbilicus level, next largest were found at the lower abdominal level. For females, however, the maximal values appeared at the pubic symphysis and lower abdominal levels and values for the umbilicus level followed in magnitude. 3) Hypodermic fatty layer area ratios to those of the total cross-sectional area: Values here were largest at the umbilicus level in both sexes. For males, the ratio at the lower abdominal level and at the pubic symphysis level followed in this order: For females, the order of magnitude of values was reversed between those two ratios. The most minimal ratio appeared at the level of the xiphoid in both sexes. A tendency towards higher ratios in females than in males was seen at all 7 levels for bodies of the A-type. This was seen, however, only at levels below the upper abdomen for bodies of the C-type, and at all levels, except the umbilicus and lower abdomen, for bodies of the D-type. 4) Thickness of the hypodermic fatty layer: The maximal values in this layer appeared at point F for the superior border, mid-point and xiphoid of sternum levels. For the upper abdominal level, maximal values appeared at point A, and for the umbilicus level, at point D. They were all found at point C for the lower abdominal level and at point A for the pubic symphysis level. (J.P.N.)

  17. Management of the baseline shift using a new and simple method for respiratory-gated radiation therapy: Detectability and effectiveness of a flexible monitoring system

    International Nuclear Information System (INIS)

    Tachibana, Hidenobu; Kitamura, Nozomi; Ito, Yasushi; Kawai, Daisuke; Nakajima, Masaru; Tsuda, Akihisa; Shiizuka, Hisao

    2011-01-01

    Purpose: In respiratory-gated radiation therapy, a baseline shift decreases the accuracy of target coverage and organs at risk (OAR) sparing. The effectiveness of audio-feedback and audio-visual feedback in correcting the baseline shift in the breathing pattern of the patient has been demonstrated previously. However, the baseline shift derived from the intrafraction motion of the patient's body cannot be corrected by these methods. In the present study, the authors designed and developed a simple and flexible system. Methods: The system consisted of a web camera and a computer running our in-house software. The in-house software was adapted to template matching and also to no preimage processing. The system was capable of monitoring the baseline shift in the intrafraction motion of the patient's body. Another marker box was used to monitor the baseline shift due to the flexible setups required of a marker box for gated signals. The system accuracy was evaluated by employing a respiratory motion phantom and was found to be within AAPM Task Group 142 tolerance (positional accuracy <2 mm and temporal accuracy <100 ms) for respiratory-gated radiation therapy. Additionally, the effectiveness of this flexible and independent system in gated treatment was investigated in healthy volunteers, in terms of the results from the differences in the baseline shift detectable between the marker positions, which the authors evaluated statistically. Results: The movement of the marker on the sternum [1.599 ± 0.622 mm (1 SD)] was substantially decreased as compared with the abdomen [6.547 ± 0.962 mm (1 SD)]. Additionally, in all of the volunteers, the baseline shifts for the sternum [-0.136 ± 0.868 (2 SD)] were in better agreement with the nominal baseline shifts than was the case for the abdomen [-0.722 ± 1.56 mm (2 SD)]. The baseline shifts could be accurately measured and detected using the monitoring system, which could acquire the movement of the marker on the sternum. The

  18. Abdominal Wall Desmoid Tumor in a Pregnant Woman and Cesarean Section Managment

    Directory of Open Access Journals (Sweden)

    M Mojibian

    2013-08-01

    Full Text Available Increased risk of sporadic desmoid tumor occurs in increased estrogen level (pregnancy and surgical incisions (abdominal and thorasic. The frequency of desmoid tumors in the general population is 2.4 to 4.3 cases. The case is 30 year old woman with history of previous cesarean section. In fourth month of pregnancy,ultrasonography revealed a 5×7 cm mass in lower segment of the uterus(leiomyoma. The tumor diameter was 20 cm in term gestation. The time of cesarean , incision of skin was done above the umbilicus and below the sternum and incision of uterus was done from fondus vertically down. After delivery, the mass which was separated from uterus and located in the abdominal wall was extracted. The histological investigation diagnosed a desmoid tumor.

  19. Unusual congenital pulmonary anomaly with presumed left lung hypoplasia in a young dog.

    Science.gov (United States)

    Lee, C M; Kim, J H; Kang, M H; Eom, K D; Park, H M

    2014-05-01

    A seven-month-old, entire, male miniature schnauzer dog was referred with acute vomiting, inappetence and depression primarily as a result of a gastric foreign body (pine cones). During investigations, thoracic radiographs revealed increased volume of the right lung lobes, deviated cardiomediastinal structures and elevation of the heart from the sternum. Thoracic computed tomography revealed left cranial lung lobe hypoplasia and extension of the right cranial lung parenchyma across the midline to the left hemithorax. Branches of the right pulmonary vessels and bronchi also crossed the midline and extended to the left caudal lung lobe. These findings suggested that the right and left lungs were fused. In humans this finding is consistent with horseshoe lung, which is an uncommon congenital malformation. To the authors' knowledge, this case represents the first report of such a pulmonary anomaly in a dog. © 2014 British Small Animal Veterinary Association.

  20. Tremendous bleeding complication after vacuum-assisted sternal closure

    Directory of Open Access Journals (Sweden)

    Isgro Frank

    2011-02-01

    Full Text Available Abstract Vacuum-assisted closure (VAC of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation are proved. No contraindications for the use in deep sternal wounds in cardiac surgery are described. In our case report we illustrate a scenario were a patient developed severe bleeding from the ascending aorta by penetration of wire fragments in the vessel. We conclude that all free particles in the sternum have to be removed completely before negative pressure is used.

  1. Results of open heart surgery in Jehovah's Witness patients. Single centre experience.

    Science.gov (United States)

    Juraszek, Andrzej; Kołsut, Piotr; Szymański, Jarosław; Kuriata, Jarosław; Kuśmierski, Krzysztof; Sitkowska-Rysiak, Ewa; Jasińska, Małgorzata; Kuśmierczyk, Mariusz

    2017-09-01

    Evaluation the results in patients from the religious community of Jehovah's Witness (JW) undergoing open heart surgery at our institution. Between September 2011 and March 2015, 21 patients with a religious background of the JW church underwent open heart surgery at our institution performed by the same surgical team. Mean age was 68.43 ±8.93 years. There were 13 (61.9%) female patients. Recombinant human erythropoietin was administered to every patient with a hemoglobin value open heart surgery in JW were very good, including combined procedures. The decrease of hematocrit serum levels significantly characterizing the postoperative period was highly acceptable in this series. Nevertheless, the number of sternum wound infections was a limiting factor for prompt postoperative recovery.

  2. Positioning devices for patients

    International Nuclear Information System (INIS)

    Heavens, M.

    1981-01-01

    It has been suggested that it is very important to position patients reproducibly at different stages of radiotherapy treatment planning and treatment, or similar procedures. Devices have been described for positioning a patient's upper and lower thorax. This invention provides reproducible positioning for a female patient's breasts, for example in planning treatment of and treating breast tumours. The patient is placed prone, using for example an upper thorax device. A support device is placed central to and beneath her breasts to partially displace them outwards. The device may be triangular in section with one apex contacting the chest wall at the sternum. Restraining straps may be provided to hold the breasts against the support device. Means may be provided to take a healthy breast from the path of radiation through the tumour. (author)

  3. Overview of radiological anatomy and topography

    International Nuclear Information System (INIS)

    Mohamed Ali Abdul Khader

    2004-01-01

    This chapter introduces the reader to the examination of the most common radiographs of the body that will be encountered by the x-ray operator. The discussion of the radiograph begins with a review of the anatomy and functions of the region. This is followed by a description of the normal anatomy that is imaged in the radiographs. The subjects discussed are follows - Skeleton; Axial Skeleton, Skull: functions, radiographic appearance. Vertebral Column, Thoracic Cage (Sternum and Ribs), The Chest Radiograph, Appendicular Skeleton, Shoulder Girdle and Upper Arm. Radiological Appearance of the Elbow, Radiological Appearance of the Wrist and Hand, Pelvic Girdle and Lower Limbs, Innominate (hip bones) Radiological Appearance of the Pelvis, Lower Extremities, Joints, Classification, Radiological Appearance of the Knee, Radiological Appearance of the Ankle and Foot, Systems and Cavities of the Body, Cranial Cavity, Thoracic Cavity, Abdominal Cavity, Pelvic Cavity

  4. CONTINUOUS THROMBOPROPHYLAXIS DURING SURGICAL TREATMENT OF PATIENT WITH POLYTRAUMA IN A MULTIDISCIPLINARY HOSPITAL (CASE REPORT

    Directory of Open Access Journals (Sweden)

    I. G. Belenky

    2017-01-01

    Full Text Available The paper presents  a clinical case of a staged surgical treatment according  to damage control  protocol  for a patient with multiple limb fractures, sternum  trauma as well as brain injury due to traffic accident. Following temporary external fixation during emergency treatment, 6 internal fixation procedures were performed on the patient during three surgical sessions. 4,5 months  postoperatively the authors  observed  consolidation of all fractures  with good restoration of joints function. Prophylaxis of venous thromboembolic events included low molecular heparins administration prior to the first and consequent surgical  sessions as well as oral anticoagulants during  intervals between  procedures and for extended prophylaxis. Apart from medicinal prophylaxis  the authors  utilized therapeutic exercises at all treatment stages.

  5. Traumatic thoracic injury: the role of Multidetector-row CT

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kyung Joo; Kang, Doo Kyung; Kim, Tae Hee [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2006-05-15

    The introduction of Multidetector-row CT (MDCT) has revolutionized the diagnostic strategy of multitrauma patients. The rapid acquisition of a large scanning volume with a thin slice collimation allows for motion-free images of high spatial resolution, and this enables the application of the multiplanar reformat (MPR) and 3D volume-rendering (VR) images. The MPR images more accurately demonstrate aortic rupture or dissection, diaphragmatic injuries and fracture of vertebrae, sternum and costal cartilages. Diagnosing vascular injuries can be aided by using the MIP images. Rib fracture, trachea and bronchial laceration are more easily detected by the 3D images, while airway and vascular injuries can be detected from performing virtual endoscopy. We introduce our current CT imaging protocol and we present our clinical experience with using MDCT in the assessment of patients with blunt thoracic trauma.

  6. A review of the Nearctic genus Zealeuctra Ricker (Plecoptera, Leuctridae), with the description of a new species from the Cumberland Plateau region of eastern North America.

    Science.gov (United States)

    Grubbs, Scott A; Kondratieff, Boris C; Stark, Bill P; Dewalt, R Edward

    2013-01-01

    The stonefly genus Zealeuctra (Plecoptera: Leuctridae) is endemic to the central and eastern Nearctic regions and is presently comprised of 10 species. Scanning electron microscopy (SEM) was used to examine and redescribe two important diagnostic features typically used to identify and define the adult male stage: the large, anteriorly-recurved epiproct and the medial cleft of the ninth abdominal tergite. SEM was also employed to depict the posteromedial portion of female 7(th) sternum. A new species, Z. ukayodi sp. n., is described from the Cumberland Plateau region of northeastern Alabama and Tennessee. The new species appears superficially similar to Z. talladega Grubbs, but is easily differentiated by characteristics of the male medial cleft. An updated taxonomic key to the males of Zealeuctra is provided.

  7. A review of the Nearctic genus Zealeuctra Ricker (Plecoptera, Leuctridae, with the description of a new species from the Cumberland Plateau region of eastern North America

    Directory of Open Access Journals (Sweden)

    Scott Grubbs

    2013-10-01

    Full Text Available The stonefly genus Zealeuctra (Plecoptera: Leuctridae is endemic to the central and eastern Nearctic regions and is presently comprised of 10 species. Scanning electron microscopy (SEM was used to examine and redescribe two important diagnostic features typically used to identify and define the adult male stage: the large, anteriorly-recurved epiproct and the medial cleft of the ninth abdominal tergite. SEM was also employed to depict the posteromedial portion of female 7th sternum. A new species, Z. ukayodi sp. n., is described from the Cumberland Plateau region of northeastern Alabama and Tennessee. The new species appears superficially similar to Z. talladega Grubbs, but is easily differentiated by characteristics of the male medial cleft. An updated taxonomic key to the males of Zealeuctra is provided.

  8. Clinical assessment of heart chamber size and valve motion during cardiopulmonary resuscitation by two-dimensional echocardiography.

    Science.gov (United States)

    Rich, S; Wix, H L; Shapiro, E P

    1981-09-01

    It has been generally accepted that enhanced blood flow during closed-chest CPR is generated from compression of the heart between the sternum and the spine. To visualize the heart during closed-chest massage, we performed two-dimensional echocardiography (2DE) during resuscitation efforts in four patients who had cardiac arrest. 2DE analysis showed that (1) the LV internal dimensions did not change appreciably with chest compression; (2) the mitral and aortic valves were open simultaneously during the compression phase; (3) blood flow into the right heart, as evidenced by saline bubble contrast, occurred during the relaxation phase; and (4) compression of the right ventricle and LA occurred in varying amounts in all patients. We conclude that stroke volume from the heart during CPR does not result from compression of the LV. Rather, CPR-induced improved cardiocirculatory dynamics appear to be principally the result of changes in intrathoracic pressure created by sternal compression.

  9. Extraosseous Multiple Myeloma with Retroperitoneal Manifestation: A Case Report

    International Nuclear Information System (INIS)

    Berdugo, Juan Oswaldo; Nieto, Sonia Janeth; Garzon, Julian Gonzalo

    2008-01-01

    This paper presents a case of a 57 years old man (patient of Hospital Militar Central of Bogota, Colombia) with weight loss and a mass in the right clavicle. Plain film radiography shows a lytic lesion in the sternum side of the clavicle. biopsy reports a plasmacytomas, radiotherapy was performed. Three years later lesions of similar characteristics within ribs and a focal lesion in left testicle were detected. The diagnosis was multiple myeloma, Chemotherapy and orquidectomy were performed. One year after, patient complained of diffuse abdominal pain and loss weight, contrast abdominal CT was performed. Computed tomography showed a left heterogeneous mass with irregular contours that involved the retroperitoneal space occupying its three compartments. Biopsy was performed and reported pleomorphicplasmocytic proliferation with nuclear enlargement and hyperchromic nuclei consistent with multiple myeloma with abdominal involvement.

  10. Double trisomy 48,XXX,+18 with multiple dysmorphic features.

    Science.gov (United States)

    Jiang, Zi-Yan; Wu, Xiao-Hui; Zou, Chao-Chun

    2015-02-01

    Chromosomal abnormality is a common cause of congenital anomalies, psychiatric disorders, and mental retardation. However, the double trisomy 48,XXX,+18 is a rare chromosome abnormality. Case report and literature review. A 7-hour-old girl presented to our unit because of poor response after birth. She presented with multiple dysmorphic features, including small for gestational age infant, flat nasal bridge, widely-spaced eyes, the left thumb deformities, flat facial profile, raised sternum, ventricular septal defect, the third lateral brain ventricle enlargement, and small liver. This case expands the spectrum of malformations reported in association with the double trisomy 48,XXX,+18. The literature on 16 fetuses or infants with the 48,XXX,+18 were also reviewed. These data suggested that in patients with clinical features similar to trisomy 18, especially with anomalies of the ears and/or reproductive malformations, double trisomy (48,XXX,+18) should be considered and karyotyping should be performed although it is a rare disease.

  11. APPLICATION OF LIGHT EMITTING DIODE IRRADIATION IN SURGERY AND OTHER FIELDS OF MEDICINE

    Directory of Open Access Journals (Sweden)

    Iskander Mukhamedovich Baybekov

    2017-05-01

    Full Text Available Goal. To study the experience of using Light Emitting Diode (LED in surgery and other areas of medicine. Methods and methodology. The methodological basis is the analysis of literature, synthesis of the results of experimental and clinical studies, as well as a modern interpretation of the mechanisms of action of low-intensity laser radiation and LED effects on the body. Special attention is paid to the experience of clinical and morphological studies LED of impacts at the Republican specialized center of surgery named academician V. Vahidov of the Ministry of health of the Republic of Uzbekistan. Results. Comparative features of LED and lasers, such as stimulation of reparative processes, their influence on healing of skin wounds and sternum after sternotomy, red blood cells and microcirculation are discussed. Conclusion. It has been suggested that LED is a worthy alternative to lasers. Their use is advisable in complex treatment of surgical diseases.

  12. Effects of respiration depth on human body radar cross section Using 2.4GHz continuous wave radar.

    Science.gov (United States)

    Lee, Alexander; Xiaomeng Gao; Jia Xu; Boric-Lubecke, Olga

    2017-07-01

    In this study, it was tested whether deep and shallow breathing has an effect on the cardiopulmonary radar cross-section (RCS). Continuous wave radar with quadrature architecture at 2.4GHz was used to test 2 human subjects breathing deep and shallow for 30 seconds each while seated 2 meters away from the radar. A retro-reflective marker was placed on the sternum of each subject and measured by infrared motion capture cameras to accurately track displacement of the chest. The quadrature radar outputs were processed to find the radius of the arc on the IQ plot using a circle-fitting algorithm. Results showed that the effective RCS ratio of deep to shallow breathing for subjects 1 and 2 was 6.99 and 2.24 respectively.

  13. The Effect of Daily Self-Measurement of Pressure Pain Sensitivity Followed by Acupressure on Depression and Quality of Life versus Treatment as Usual in Ischemic Heart Disease

    DEFF Research Database (Denmark)

    Bergmann, Natasha; Ballegaard, Søren; Bech, Per

    2014-01-01

    -measurement of PPS twice daily followed by acupressure as mandatory action, aiming at a reduction in PPS. Primary endpoint: change in depressive symptoms as measured by Major depression inventory (MDI). Other endpoints: changes in PPS, Well-being (WHO-5) and mental and physical QOL (SF-36). RESULTS: At 3 months PPS......BACKGROUND: Depressive symptoms and reduced quality of life (QOL) are parts of the chronic stress syndrome and predictive of adverse outcome in patients with ischemic heart disease (IHD). Chronic stress is associated with increased sensitivity for pain, which can be measured by algometry...... as Pressure Pain Sensitivity (PPS) on the sternum. AIM: To evaluate if stress focus by self-measurement of PPS, followed by stress reducing actions including acupressure, can decrease depressive symptoms and increase psychological well-being in people with stable IHD. DESIGN: Observer blinded randomized...

  14. Bilateral cervical ectopic thymic nodules with accessory thyroid tissue and an ectopic parathyroid in the neck region

    Directory of Open Access Journals (Sweden)

    Wea-Lung Lin

    2011-03-01

    Full Text Available Some remnants of thymic tissue may be deposited along the pathway of the descent of the neck during embryologic development of the thymus. Ectopic thymic tissue is usually deposited along the pathway from the mandibular angle to the manubrium of the sternum. Most reported cases of an ectopic thymus occurred in children, and cases are less common in adults. We report a 26-year-old woman, who was incidentally found to have 2 neck nodules on the posterior side of the bilateral upper pole of the thyroid gland while undergoing a subtotal thyroidectomy. The left-side neck nodule showed accessory thyroid follicles intermixed with ectopic thymic tissue, and the right-side neck nodule was ectopic parathyroid tissue together with ectopic thymic tissue.

  15. Postmortem bone marrow analysis in forensic science: study of 73 cases and review of the literature.

    Science.gov (United States)

    Tattoli, Lucia; Tsokos, Michael; Sautter, Julia; Anagnostopoulos, Joannis; Maselli, Eloisa; Ingravallo, Giuseppe; Delia, Mario; Solarino, Biagio

    2014-01-01

    In forensic sciences, bone marrow (BM) is an alternative matrix in postmortem toxicology because of its good resistance to autolysis and contaminations. Nevertheless, few studies have been focused on postmortem BM morphological changes after pathological stimuli. We examined 73 BM samples from forensic autopsies; causes of death were both natural and traumatic. BM samples were collected from the sternum by needle aspiration and biopsy; in selected cases, immunohistochemistry was performed. Few autolytic changes were found; BM cellularity decreased with increasing age and postmortem interval. Notable cell changes were detected in 45 cases (61.64%): neoplastic (n=4), and non-neoplastic BM findings (n=41), including multiorgan failure/sepsis (n=26), myelodisplastic-like conditions (n=11), and anaphylactic reactions (n=4). The results showed that BM cellularity supported circumstantial and autopsy findings, suggesting that BM samples could be a useful tool in forensic science applications. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Bentall operation, total aortic replacement and mitral valve replacement for a young adult with Marfan syndrome: a case of three-staged operation.

    Science.gov (United States)

    Inui, K; Shimazaki, Y; Watanabe, T; Kuraoka, S; Minowa, T; Miura, M; Oshikiri, S; Toyama, H

    1998-08-01

    In Marfan syndrome, the most common cardiovascular abnormalities are dilatation of the aorta and aortic valve regurgitation in adult patients. Mitral valve dysfunction is the most common cause of morbidity and mortality in infants and children with Marfan syndrome, and is not frequently operated on in adult Marfan patients who undergo surgery for diseases of the aortic root and total aorta. This report describes a successfully three-staged operation for a 24 year-old man with Marfan syndrome who underwent an emergent Bentall operation and aortic arch replacement, total aortic replacement and mitral valve replacement over 2 years. Mitral valve regurgitation was mild but increased after the second operation. The graft was tightly adhesive and invasive to the sternum. Endoscopic view was helpful to avoid graft damage at resternotomy. The postoperative course was uneventful in each operation. Microscopic examination of the mitral valve leaflets showed abnormal increase of mucopolysaccharides, and disruption and fragmentation of elastic fibers.

  17. Pain in the chest in a user of cocaine

    International Nuclear Information System (INIS)

    Wiener, M.D.; Putnam, C.E.

    1987-01-01

    A 21-year-old man presented with pleuritic substernal chest pain of one hour's duration. The pain was exacerbated in a supine position and did not radiate. Questioning revealed that he was a recreational user of cocaine and had inhaled free-based cocaine via a pipe the previous evening and as recently as two hours before admission to the hospital. Physical examination demonstrated an anxious young man with a respiratory rate of 26 breaths per minute and shallow. He was afebrile with normal heart rate and blood pressure. His sternum was tender to palpation, and auscultation revealed precordial crepitus synchronous with systole. His electrocardiogram showed sinus rhythm at a rate of 62 beats per minute. Posteroanterior and lateral roentgenograms of the chest were obtained. A diagnosis of spontaneous pneumomediastinum was made

  18. Radioimmunotherapy of small cell lung cancer xenograft mice with a 90Y anti-ROBO1 monoclonal antibody: Pathological study of effects on tumor and normal organs

    International Nuclear Information System (INIS)

    Fujiwara, K.; Koyama, K.; Kitada, T.; Takahashi, M.; Momose, T.; Suga, K.

    2015-01-01

    Full text of publication follows. ROBO1 is a membrane protein that is concerned about axon guidance. It is reported that ROBO1 contributes to tumor metastasis and angio genesis. ROBO1 is specifically expressed at high levels in small cell lung cancer (SCLC). In this study, we performed radioimmunotherapy (RIT) to SCLC models, and analyzed pathological alteration of tumor and organs. Methods: For the biodistribution study, 111 In-DOTA anti-ROBO1 IgG (about 370 kBq, 111 In anti-ROBO1) was injected into NCI-H69 xenograft mice via tail vein. To evaluate antitumor effect, RIT study was performed. 90 Y-DOTA anti-ROBO1 IgG (about 7.4 MBq, 90 Y anti-ROBO1) was injected. The experiments measured tumor volume, mouse weights and blood cell counts periodically. The tumors and organs (liver, kidney, intestine, spleen, femoral and sternum) of mice were obtained, and histopathologic analysis were carried out. Results: as a result of biodistribution study, the specific accumulation in the tumor of 111 In anti-ROBO1 was observed. Liver, kidney, spleen and lung showed comparatively high accumulation of 111 In anti-ROBO1. In the RIT study, 90 Y anti-ROBO1 significantly reduced tumor volume compared with original volume and increased median survival time to 58 days (p<0.01, versus saline, 28 days), while 90 Y anti-ROBO1 induced transient pancytopenia. Histopathologic analysis of tumors and organs further validated the therapeutic efficacy and the systemic toxicity of 90 Y anti-ROBO1. In day 7 when tumor volume reduced to 60% compared with original volume, irreversible nuclear denaturation and fibrosis were observed. The percentage of TUNEL-positive cells increased to 11.4%±5.1 in the day 7 (p<0.01, versus control, 4.14%±1.4), which showed increase of DNA fragmentation and apoptosis in the tumor tissues. Normal organs excluding spleen and sternum showed no significant injury. In day 7 post injection, spleen showed transient reduction of hematopoietic cells. Hematopoietic cells in

  19. Sternocostoclavicular Hyperostosis: An Insufficiently Recognized Clinical Entity

    Directory of Open Access Journals (Sweden)

    Taro Sugase

    2017-04-01

    Full Text Available A 79-year-old male chronic hemodialysis patient with no history of central venous catheterization was referred to our hospital with progressive swelling of the left upper limb ipsilateral to a forearm arteriovenous fistula. Radiological assessments revealed marked hyperostosis in the ribs, sternum, and clavicles with well-developed ossification of the sternocostoclavicular ligaments. Such characteristic structural abnormalities and our failure to identify the left subclavian vein with contrast material despite the abundant dilated collaterals in the left shoulder area encouraged us to diagnose our patient with sternocostoclavicular hyperostosis (SCCH complicated by central vein obstruction. The structural impact of the sternocostoclavicular region as a potential risk for inducing central vein obstruction and the diagnostic concerns of SCCH in this patient are also discussed.

  20. A diminutive perinate European Enantiornithes reveals an asynchronous ossification pattern in early birds.

    Science.gov (United States)

    Knoll, Fabien; Chiappe, Luis M; Sanchez, Sophie; Garwood, Russell J; Edwards, Nicholas P; Wogelius, Roy A; Sellers, William I; Manning, Phillip L; Ortega, Francisco; Serrano, Francisco J; Marugán-Lobón, Jesús; Cuesta, Elena; Escaso, Fernando; Sanz, Jose Luis

    2018-03-05

    Fossils of juvenile Mesozoic birds provide insight into the early evolution of avian development, however such fossils are rare. The analysis of the ossification sequence in these early-branching birds has the potential to address important questions about their comparative developmental biology and to help understand their morphological evolution and ecological differentiation. Here we report on an early juvenile enantiornithine specimen from the Early Cretaceous of Europe, which sheds new light on the osteogenesis in this most species-rich clade of Mesozoic birds. Consisting of a nearly complete skeleton, it is amongst the smallest known Mesozoic avian fossils representing post-hatching stages of development. Comparisons between this new specimen and other known early juvenile enantiornithines support a clade-wide asynchronous pattern of osteogenesis in the sternum and the vertebral column, and strongly indicate that the hatchlings of these phylogenetically basal birds varied greatly in size and tempo of skeletal maturation.

  1. Salvage lymphadenectomy of the right recurrent nerve node with tracheal involvement after definitive chemoradiation therapy for esophageal squamous cell carcinoma. Report of two cases

    International Nuclear Information System (INIS)

    Doki, Yuichiro; Yasuda, Takushi; Miyata, Hiroshi

    2007-01-01

    Thoracic esophageal cancers frequently metastasize to the right recurrent nerve nodes (RRNNs). In fact, huge RRNNs invading the trachea sometimes remain after definitive chemoradiation therapy (CRT), despite complete remission of the primary lesion. We performed salvage lymphadenectomy of a large RRNN combined with partial resection of the trachea in two patients. Using an anterior approach, we removed part of the sternum, clavicle, and the first and second costal cartilage; then, we removed the RRNNs with combined resection of the lateral quarter circumference of the trachea, the esophageal wall, and the recurrent nerve. Reconstruction was done with a musculocutaneous patch of major pectoral muscle to cover the tracheal defect. The only minor complication was venous thrombosis in one patient. Thus, combined removal of the RRNN and trachea was performed safely as a salvage operation after definitive CRT for esophageal squamous cell carcinoma. (author)

  2. Sterno-costo-clavicular hyperostosis

    International Nuclear Information System (INIS)

    Hallas, J.; Olesen, K.P.

    1988-01-01

    The clinical and radiologic findings in a case of sterno-costo-clavicular hyperostosis are reported and compared with the findings in the 23 Caucasian and about 300 Japanese cases reported in the literature. The main complaints are pain in the upper anterior chest wall and sometimes limited mobility of the shoulders. Radiologically, the clavicles, the sternum and the first ribs are grossly enlarged with complete fusion between them. As reported in previous cases, our patient had conspicuous congestion of the external jugular veins, but no other signs of compression in the thoracic inlet. There was asymptomatic compression of both subclavian veins, but none of the previously reported skin manifestations and no complaints from other parts of the locomotive system. The patient was HLA-B27 negative. (orig.)

  3. Radiographic diagnosis of hereditary chondrodysplasia in newborn lambs

    International Nuclear Information System (INIS)

    Vanek, J.A.; Walter, P.A.; Alstad, A.D.

    1989-01-01

    Normal appearing Suffolk lambs affected with hereditary chondrodysplasia (HC) and normal appearing unaffected lambs were radiographed at birth, and at 2, 4, and 8 weeks of age. In affected lambs, lesions were seen consistently in the elbows, shoulders, sternum, and spine. Similar lesions were not identified in unaffected lambs. A malformed Corriedale lamb was radiographed to compare its lesions to those seen in HC. The Corriedale lamb had islands of ossification of the anconeal process similar to those identified in lambs with signs of HC at birth. The islands of ossification seen in the Corriedale lamb were fused by 2 months of age, whereas elbow lesions seen in lambs with HC increased in severity during the same period

  4. Diagnosis and staging of breast cancer by SPECT images fused with CT images

    International Nuclear Information System (INIS)

    Li Yanjing; Zhu Qiaomei

    2007-01-01

    Objective: To evaluate the TNM staging value of 99mTc-MIBI scintimammotraphy with SPECT-CT images fusing for the diagnosis of breast cancer. Methods: 10 patients with breast cancer underwent scintimammography with 99mTc-MIBI, and SPECT images were fused with CT images. Images were compared with final diagnosis confirmed by histopathology. Results: Of the 19 breast cancer patients, one case of invasive ductal carcinoma showed false-negative. Among 18 cases of positive lesions, axillary metastases were involved in 10, supraclavicular nodes were also defined in 3, para-sternum nodes were involved in 2, 2 were missed and 1 cases without metastatic node. The axillary lymph nodes were divided into three levels with respect to their position relative to the pectoralis minor muscle by fused images. Conclusion: 99mTc-MIBI scintimammotraphy combined with SPECT-CT images fusing is of some clinical value in TNM staging of breast cancer. (authors)

  5. Protective effect of selenium against ionizing radiation-induced malformations in mice

    Energy Technology Data Exchange (ETDEWEB)

    Cekan, E.; Tribukait, B.; Vokal-Borek, H.

    A single dose of sodium selenite (0.5 mg Se/kg b.w.) was injected intraperitoneally into mice on day 9 of pregnancy, either 30 min or 2 h before 1.75 Gy whole body irradiation. Administration of selenite 2 h but not 30 min before irradiation resulted in a significant decrease in the number of malformed foetuses (p < 0.005). The decrease in foetal malformations occurred proportionally for all the major malformations observed, i.e. short or kinked tail, rib and vertebral malformations, coloboma and deformation of retina and iris. In addition, selenium pretreatment also protected against radiation-induced retardation of the sternum of the foetus.

  6. Protective effect of selenium against ionizing radiation-induced malformations in mice

    International Nuclear Information System (INIS)

    Cekan, E.; Tribukait, B.; Vokal-Borek, H.; Stockholm Univ.

    1985-01-01

    A single dose of sodium selenite (0.5 mg Se/kg b.w.) was injected intraperitoneally into mice on day 9 of pregnancy, either 30 min or 2 h before 1.75 Gy whole body irradiation. Administration of selenite 2 h but not 30 min before irradiation resulted in a significant decrease in the number of malformed foetuses (p<0.005). The decrease in foetal malformations occurred proportionally for all the major malformations observed, i.e. short or kinked tail, rib and vertebral malformations, coloboma and deformation of retina and iris. In addition, selenium pretreatment also protected against radiation-induced retardation of the sternum of the foetus. (orig.)

  7. A case report of displaced anterior junction line mimicking pneumothorax and pneumomediastinum

    International Nuclear Information System (INIS)

    Jeon, Yang Hyun; Sung, Dong Wook; Hong, Hyun Pyo; Yoon, Yup; Lee, Eil Seong

    1998-01-01

    On PA chest radiography, the anterior junction line (AJL) is seen to project from the upper right to the lower left of the upper third of the body of the sternum and represents the visceral and parietal pleura of each lung and a small quantity of mediastinal fat. In a patient with volume loss or expansion of a hemithorax, the AJL shows considerable shift and on PA chest radiography may mimic pneumothroax, the AJL shows considerable shift and on PA chest radiography may mimic pneumothorax or pneumomediastimum. In such cases, widening and hyperlucency of the retrosternal space, seen on lateral view, which represents herniated lung with a shift of AJL, may be helpful for differentiation from pneumothorax or pneumomediastinum. (author). 8 refs., 2 figs

  8. Atelocollagen sponge and recombinant basic fibroblast growth factor combination therapy for resistant wounds with deep cavities.

    Science.gov (United States)

    Nakanishi, Asako; Hakamada, Arata; Isoda, Ken-ichi; Mizutani, Hitoshi

    2005-05-01

    Recent advances in bioengineering have introduced materials that enhance wound healing. Even with such new tools, some deep ulcers surrounded by avascular tissues, including bone, tendon, and fascia, are resistant to various therapies and easily form deep cavities with loss of subcutaneous tissue. Atelocollagen sponges have been used as an artificial dermis to cover full-thickness skin defects. Topical recombinant human basic fibroblast growth factor has been introduced as a growth factor to induce fibroblast proliferation in skin ulcers. We applied these materials in combination in two patients with deep resistant wounds: one with a cavity reaching the mediastinum through a divided sternum and one with deep necrotic wounds caused by electric burns. These wounds did not respond to the topical basic fibroblast growth factor alone. In contrast, the combination therapy closed the wounds rapidly without further surgical treatment. This combination therapy is a potent treatment for resistant wounds with deep cavities.

  9. Pectus excavatum in blunt chest trauma: a case report

    Directory of Open Access Journals (Sweden)

    Liodakis Emmanouil

    2013-01-01

    Full Text Available Abstract Introduction Blunt cardiac rupture is an exceedingly rare injury. Case presentation We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. Conclusion Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

  10. Comparison of Transcutaneous Bilirubin Measurement With Total Serum Bilirubin Levels in Preterm Neonates Receiving Phototherapy.

    Science.gov (United States)

    Pendse, Amruta; Jasani, Bonny; Nanavati, Ruchi; Kabra, Nandkishor

    2017-08-15

    To compare transcutaneous bilirubin with total serum bilirubin in preterm neonates after initiation of phototherapy. Jaundice was assessed in 30 preterm neonates with transcutaneous bilirubin and total serum bilirubin before initiation of phototherapy and at 12 hr after initiation of phototherapy. A photo-occlusive patch was applied over the sternum. Transcutaneous bilirubin has a good correlation with total serum bilirubin after initiation of phototherapy. (r=0.918, Pbilirubin at 28-32 weeks of gestation (r = 0.97) was better correlated with total serum bilirubin than those at 32-37 weeks (r =0.88). The correlation was better for neonates 72 hours of age (r = 0.82). Transcutaneous bilirubin correlates significantly with total serum bilirubin at the patched sternal site after initiation of phototherapy in preterm neonates.

  11. Trigonalidae (Hymenoptera from cacao agroforestry systems in northeastern Brazil, with two new species of Trigonalys Westwood

    Directory of Open Access Journals (Sweden)

    Bernardo Santos

    2012-03-01

    Full Text Available A survey of Trigonalidae from cacao (Theobroma cacao L. agroforestry systems in southern Bahia, northeastern Brazil, is conducted. A total of 65 specimens were studied, and three species are recognized. Trigonalys melanoleuca Westwood is diagnosed and illustrated. Two new species are described and illustrated. Trigonalys erythrocephala sp. n. has most of head reddish brown; metasomal armature in sternum III conspicuous, Y-shaped; supra-antennal elevation conspicuous; hind coxa with sharp lateral angles, its dorso-mesal portion strigate; legs entirely dark brown; and fore wing lightly infuscate, darker towards anterior margin. Trigonalys gotica sp. n. with body blackish or dark brown and with pale yellow marks; mesopleuron with an oblique mark; female armature absent; frons and vertex punctate-areolate; supra-antennal elevation subtle; propodeal foramen V-shaped; and fore wing vein M arising distinctly basad to 1cu-a.

  12. Description of Alloretochus sigillatus new species with comments and new distributional records for Alloretochus peruanicus (Ephemeroptera, Caenidae, Brachycercinae).

    Science.gov (United States)

    Molineri, C

    2014-06-19

    Alloretochus sigillatus sp. nov. is described from adults of both sexes and eggs from Bolivia and Ecuador. Diagnostic characters of this species include: large body size, ratio pedicel/scape 1.75, presence of posteromedian projection on metanotum, characteristic blackish marks on abdominal terga, presence of vestiges of posterolateral projections on abdomen segments IV-VI, male subgenital plate broadly emarginated posteriorly, ratios forceps length/subbasal width 8.9, female sternum IX produced distally reaching apex of segment X, tapering distally with rounded apex, egg with 4 costae in lateral half. Additional characters for all stages and SEM photographs of eggs are provided for Alloretochus peruanicus, with new records of its presence in Argentina, Bolivia, Peru and Colombia.

  13. A prenatally diagnosed pentalogy of cantrell case with encephalocele: A rare variant

    Directory of Open Access Journals (Sweden)

    Melih Atahan Güven

    2009-06-01

    Full Text Available AIM: The aim of this study is to present a prenatally diagnosed and postnatally confirmed Pentalogy of Cantrell case also with neural tube defect. CASE: Characteristic features of Cantrell Pentalogy are omphalocele due to the defect of anterior diaphragm and lower sternum, absence of pericardium and cardiac anomaly. We are presenting here a case with encephalocele and omphalocele containing the heart with atrioventricular septal defect detected during prenatal ultrasonography. There is no consanguinity and history of drug usage or toxin exposure during pregnancy. As these malformations cause a very low chance of survival, pregnancy was terminated after an informed consent. Postmortem genetic evaluation of the fetus confirmed the prenatal findings. CONCLUSION: It is easy to diagnose omphalocele during pregnancy but if it associates with heart anomalies, Cantrell Pentalogy must be remembered. Encephalocele and other types of neural tube defects very rarely associate with this disorder and there were fewer than 20 cases reported in the literature.

  14. Comparison of fatty acid composition of subcutaneous, pericardial and epicardial adipose tissue and atrial tissue in patients with heart disease

    DEFF Research Database (Denmark)

    Eschen, Rikke Bülow; Gu, Jiwei; Andreasen, Jan Jesper

    2016-01-01

    (EPA) and docosahexaenoic acid (DHA), from three different adipose tissue compartments [epicardial (EAT), pericardial (PAT) and subcutaneous (SAT)]. Furthermore, we studied the correlation between the content of EPA and DHA in these compartments and in atrial tissue (AT). METHODS We obtained AT from......OBJECTIVES The content in adipose tissue of marine n-3 polyunsaturated fatty acids (PUFAs) is a marker of long-term fish consumption and data suggest an antiarrhythmic effect of n-3 PUFAs. We investigated the correlation between adipose tissue content of the major n-3 PUFAs, eicosapentaenoic acid...... auricles, EAT above the right ventricle, PAT, and SAT below the sternum from 50 patients undergoing cardiac surgery. Samples were frozen at -80°C and the content of n-3 PUFAs determined by gas chromatography with results given in relative weight%. RESULTS EPA and DHA were significantly correlated in EAT...

  15. Serum content of oleic acid is associated with higher platelet-, endothelial- and leukocyte-derived circulating microparticles in Norwegian normolipidemic elderly patients after an acute myocardial infarction

    DEFF Research Database (Denmark)

    Chiva-Blanch, G; Bratseth, V; Laake, K

    2016-01-01

    (EPA) and docosahexaenoic acid (DHA), from three different adipose tissue compartments [epicardial (EAT), pericardial (PAT) and subcutaneous (SAT)]. Furthermore, we studied the correlation between the content of EPA and DHA in these compartments and in atrial tissue (AT). METHODS We obtained AT from......OBJECTIVES The content in adipose tissue of marine n-3 polyunsaturated fatty acids (PUFAs) is a marker of long-term fish consumption and data suggest an antiarrhythmic effect of n-3 PUFAs. We investigated the correlation between adipose tissue content of the major n-3 PUFAs, eicosapentaenoic acid...... auricles, EAT above the right ventricle, PAT, and SAT below the sternum from 50 patients undergoing cardiac surgery. Samples were frozen at -80°C and the content of n-3 PUFAs determined by gas chromatography with results given in relative weight%. RESULTS EPA and DHA were significantly correlated in EAT...

  16. Regional Lymphotropic Therapy in Combination with Low Level Laser Therapy for Treating Multi-Drug-Resistant Tuberculosis

    Directory of Open Access Journals (Sweden)

    Oksana Dogorova

    2016-03-01

    Full Text Available With the growing incidence of Multi-Drug-Resistant Tuberculosis (MDR-TB in newly identified patients, novel multimodality treatment methods are needed, aimed at reducing the time to sputum conversion and cavity healing, which would be applicable in MDR cases. Our experimental treatment consisted of the following: 1 chemotherapy based on the drug sensitivity profile, 2 local laser irradiation therapy for 25 days, and lymphotropic administration of isoniazid (to subcutaneous tissue in alternating locations: underarm area; fifth intercostal space along the sterna border; subclavian area where the first rib meets the sternum in a daily dose of 10mg/kg 5 times a week. This treatment was significantly more effective in newly detected destructive MDR-TB versus the standard Category IV regimen for MDR-TB in terms of reduced time for sputum culture conversion and cavity healing, estimated to be 6 months after initiation of treatment.

  17. Pressure pain sensitivity: A new method of stress measurement in patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Bergmann, Natasha; Ballegaard, Søren; Holmager, Pernille

    2013-01-01

    to induce hyperalgesia.The aim of the present study was to evaluate hyperalgesia by pressure pain sensitivity (PPS) in patients with IHD, and compare PPS to questionnaires measuring depressive symptoms, reduced psychological wellbeing, and QOL as markers of stress. Design. A cross-sectional study of 361......Abstract Background. Chronic stress is prevalent in patients with ischemic heart disease (IHD) and worsens the long-term prognosis. Chronic stress is vaguely defined, but is associated with depressive symptoms, reduced psychological wellbeing, and reduced quality of life (QOL). Stress seems...... subjects with IHD. Methods. PPS was measured on the sternum, and compared to the questionnaires: Clinical stress symptoms score (CSS), Major Depression Inventory (MDI), WHO-5 Wellbeing Index, and SF-36 QOL score. Results. PPS correlated to CSS (r = 0.20, p

  18. Association between depression, pressure pain sensitivity, stress and autonomous nervous system function in stable ischemic heart disease

    DEFF Research Database (Denmark)

    Ballegaard, Søren; Bergmann, Natasha; Karpatschof, Benny

    2016-01-01

    Background: Depression and ischemic heart disease (IHD) are associated with persistent stress and autonomic nervous system (ANS) dysfunction. The former can be measured by pressure pain sensitivity (PPS) of the sternum, and the latter by the PPS and systolic blood pressure (SBP) response to a tilt...... table test (TTT). Beta-blocker treatment reduces the efferent beta-adrenergic ANS function, and thus, the physiological stress response. Objective: To test the effect of beta-blockers on changes in depression score in patients with IHD, as well as the influence on persistent stress and ANS dysfunction...... PPS score correlated in non-users, only (r = 0.69, p = 0.007). Reduction in resting PPS correlated with an increase in PPS and SBP response to TTT. Conclusions: Stress intervention in patients with IHD was anti-depres- sive in non-users, only. Similarly, the association between the reduction...

  19. Double-chambered right ventricle, ventricular septal defect, patent ductus arteriosus in a dog

    Energy Technology Data Exchange (ETDEWEB)

    Morozumi, M. [Togasaki Animal Hospital, Misato, Saitama (Japan); Kurosu, Y.; Kogure, K.; Chimura, S.; Shibata, S.; Kanemoto, I.

    1989-12-15

    A 4-month-old female mongrel puppy was presented with an anophthalmos. On physical examination, systolic murmur was heard at the 4th left intercostal space near the sternum. However the dog appeared healthy without cyanosis and had no history of exercise intolerance. The phonocardiogram revealed a pansystolic murmur and a continuous murmur on the mitral area. A systolic ejection murmur was also recorded on the pulmonic area. The electrocardiogram indicated bi-ventricular hypertrophy. Left ventricular enlargement was seen on chest radiographs. Ventricular septal defect (VSD) and patent ductus arteriosus (PDA) were diagnosed from these findings. PDA closure was performed at 2 years of age. After 2 months from the operation, the dog died during an attempted repair of the VSD. At necropsy, it was found that the double-chambered right ventricle (DCRV) was formed by an anomalous septal band. The VSD was localized on the proximal conus and was 8 mm in diameter. (author)

  20. Double-chambered right ventricle, ventricular septal defect, patent ductus arteriosus in a dog

    International Nuclear Information System (INIS)

    Morozumi, M.; Kurosu, Y.; Kogure, K.; Chimura, S.; Shibata, S.; Kanemoto, I.

    1989-01-01

    A 4-month-old female mongrel puppy was presented with an anophthalmos. On physical examination, systolic murmur was heard at the 4th left intercostal space near the sternum. However the dog appeared healthy without cyanosis and had no history of exercise intolerance. The phonocardiogram revealed a pansystolic murmur and a continuous murmur on the mitral area. A systolic ejection murmur was also recorded on the pulmonic area. The electrocardiogram indicated bi-ventricular hypertrophy. Left ventricular enlargement was seen on chest radiographs. Ventricular septal defect (VSD) and patent ductus arteriosus (PDA) were diagnosed from these findings. PDA closure was performed at 2 years of age. After 2 months from the operation, the dog died during an attempted repair of the VSD. At necropsy, it was found that the double-chambered right ventricle (DCRV) was formed by an anomalous septal band. The VSD was localized on the proximal conus and was 8 mm in diameter. (author)

  1. Esophageal Cancer with Bone Marrow Hyperplasia Mimicking Bone Metastasis: Report of a Case

    Directory of Open Access Journals (Sweden)

    Hiromi Yasuda

    2016-11-01

    Full Text Available A 63-year-old man visited the clinic with numbness in the right hand. Magnetic resonance imaging demonstrated multiple low-intensity lesions in the cervical vertebrae and sacrum, which was suspicious of cervical bone metastasis. Fluorodeoxyglucose positron emission tomography/computed tomography revealed areas of increased fluorodeoxyglucose uptake in the thoracic esophagus, sternum and sacrum. A flat, elevated esophageal cancer was identified by upper gastrointestinal endoscopy, and the macroscopic appearance indicated early-stage disease. From the cervical, thoracic and abdominal computed tomography images, there were no metastatic lesions except for the bone lesions. To confirm whether the bone lesions were metastatic, we performed bone biopsy. The histopathological diagnosis was bone marrow hyperplasia. It was crucial for treatment planning to establish whether the lesions were distant metastases. Here, we report a case of esophageal cancer with bone marrow hyperplasia mimicking bone metastasis.

  2. [Vacuum-assisted closure therapy for the treatment of sternal wound infection after cardiac surgery].

    Science.gov (United States)

    Nishimura, K; Nakamura, Y; Harada, S; Saiki, M; Marumoto, A; Kanaoka, Y; Nishimura, M

    2009-11-01

    Sternal wound infection is still one of the critical and challenging complications after cardiac surgery. Vacuum-assisted closure (VAC) therapy is a unique and simple system that helps promote wound healing. We report 3 cases with the sternal wound infection after cardiac surgery, in which VAC therapy was applied between January, 2005 and April, 2007. Two of them had good response to VAC therapy and had their wound healed after 3 and 5 weeks, respectively. However, the remaining case, in which bilateral internal thoracic artery had been taken down for coronary artery bypass grafting (CABG) and osteomyelitis of the sternum was not well controlled, did not respond to VAC therapy. Our results suggested that VAC might facilitate wound healing of the patients with sternal wound infection only after abscess was drained and opened, while it might not be useful for the patents with osteomyelitis.

  3. Subtotal parathyroidectomy for primary hyperparathyroidism. Long-term results in 292 patients

    International Nuclear Information System (INIS)

    Paloyan, E.; Lawrence, A.M.; Oslapas, R.; Shah, K.H.; Ernst, K.; Hofmann, C.

    1983-01-01

    Subtotal parathyroidectomy was performed in a consecutive series of 292 patients with primary hyperparathyroidism. We evaluated the long-term postoperative results during a period of 16 years. Patients ranged in age from 14 to 83 years and included 176 women and 116 men. Of these, 16% had a history of exposure to radiation in childhood or adolescence, while thyroid disease requiring some form of thyroidectomy coexisted in 91 (31%) of the patients. Histologic information on three or more parathyroid glands was obtained in 73% of the cases. We considered 285 patients (97.6%) cured after their first operation. The remaining seven patients (2.4%) had persistent hyperparathyroidism. However, five were cured after a sternum-splitting mediastinal exploration and one after a second neck exploration. The seventh remains hypercalcemic despite a subsequent mediastinal exploration. Temporary postoperative hypoparathyroidism occurred in 10% of our cases and permanent hypoparathyroidism in 1%. There have been no instances of recurrent hyperparathyroidism

  4. Analogue-digital conversion in order to evaluate long-term changes in uptake of isotopes in bone scintigraphy of secondary hyperparathyroidism

    International Nuclear Information System (INIS)

    Iida, Akihiko

    1994-01-01

    An analogue-digital conversion was developed, thereby allowing the incorporation of whole-body bone scintigrams, obtained by a gamma camera, into digital data via the video camera and then allowing the processing of the incorporated digital data. Using the new method, 18 hemodialysis patients, who were voluntarily selected from those who had undergone bone scintigraphy with 99m Tc-HMDP for secondary hyperparathyroidism, were examined to determine serial changes in tracer uptake. The mean duration of hemodialysis was 6. 3 years (immediately up to 25.2 years). The tracer count ratio of the central part of the skull to the lower part of the sternum correlated most well with C-PTH. The analogue-digital conversion was found to yield a slightly higher value for the above-mentioned ratio than the original data; however, there was a good correlation between the analogue-digital conversion and original data. (N.K.)

  5. Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

    Directory of Open Access Journals (Sweden)

    James Barr

    2016-01-01

    Full Text Available Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications.

  6. Fluid distribution and tissue thickness changes in 29 men during 1 week at moderate altitude (2,315 m).

    Science.gov (United States)

    Gunga, H C; Kirsch, K; Baartz, F; Steiner, H J; Wittels, P; Röcker, L

    1995-01-01

    To quantify fluid distribution at a moderate altitude (2,315 m) 29 male subjects were studied with respect to tissue thickness changes [front (forehead), sternum, tibia], changes of total body water, changes of plasma volume, total protein concentrations (TPC), colloid osmotic pressure (COP), and electrolytes. Tissue thickness at the forehead showed a significant increase from 4.14 mm to 4.41 mm 48 h after ascent to the Rudolfshuette (2,315 m) (P Rudolf-shuette in Saalfelden (744 m) COP was back to the control values. The TPC also showed an initial drop from 7.75 g.dl-1 to 7.48 g.dl-1 after 48 h at altitude and remained below the control value during the whole week (P < 0.01). It seems from our study that even with exposure to moderate altitude measurable fluid shifts to the upper part of the body occurred which were detected by our ultrasound method.

  7. Significance of the sexual openings and supplementary structures on the phylogeny of brachyuran crabs (Crustacea, Decapoda, Brachyura), with new nomina for higher-ranked podotreme taxa.

    Science.gov (United States)

    Guinot, Danièle; Tavares, Marcos; Castro, Peter

    2013-01-01

    The patterns of complexity of the male and female sexual openings in Brachyura, which have been the source of uncertainties and conflicting opinions, are documented, together with a study of the morphologies of the coxal and sternal gonopores in both sexes, penises, spermathecae, and gonopods. The vulvae, male gonopores and penises are described among selected taxa of Eubrachyura, and their function and evolution examined in the context of a wide variety of mating behaviours. The location of female and male gonopores, the condition of the penis (coxal and sternal openings and modalities of protection), and related configurations of thoracic sternites 7 and 8, which are modified by the intercalation of a wide sternal part (thoracic sternites 7 and 8) during carcinisation, show evidence of deep homology. They represent taxonomic criteria at all ranks of the family-series and may be used to test lineages. Of particular significance are the consequences of the posterior expansion of the thoracic sternum, which influences the condition, shape, and sclerotisation of the penis, and its emergence from coxal (heterotreme) to coxo-sternal, which is actually still coxal (heterotreme), in contrast to a sternal emergence (thoracotreme). The heterotreme-thoracotreme distinction results from two different trajectories of the vas deferens and its ejaculatory duct via the P5 coxa (Heterotremata) or through the thoracic sternum (Thoracotremata). Dissections of males of several families have demonstrated that this major difference not only affects the external surface (perforation of the coxa or the sternum by the ejaculatory duct) but also the internal anatomy. There is no evidence for an ejaculatory duct passing through the articular membrane between the P5 coxa and the thoracic sternum in any Brachyura, even when the sternal male gonopore is very close to the P5 coxa. Trends towards the coxo-sternal condition are exemplified by multistate characters, varying from a shallow

  8. Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments

    Energy Technology Data Exchange (ETDEWEB)

    Di Betta, Erika; Fariselli, Laura; Bergantin, Achille; Locatelli, Federica; Del Vecchio, Antonella; Broggi, Sara; Fumagalli, Maria Luisa [Department of Neurosurgery, Division of Medical Physics, Fondazione IRCCS, Istituto Neurologico C. Besta, 20133 Milano (Italy); Department of Neurosurgery, Division of Radiotherapy, Fondazione IRCCS, Istituto Neurologico C. Besta, 20133 Milano (Italy); CyberKnife Centre, Centro Diagnostico Italiano, 20147 Milano (Italy); Division of Medical Physics, Fondazione IRCCS, Istituto S. Raffaele, 20132 Milano (Italy); Department of Neurosurgery, Division of Medical Physics, Fondazione IRCCS, Istituto Neurologico C. Besta, 20133 Milano (Italy)

    2010-07-15

    Purpose: The main purpose of this work was to compare peripheral doses absorbed during stereotactic treatment of a brain lesion delivered using different devices. These data were used to estimate the risk of stochastic effects. Methods: Treatment plans were created for an anthropomorphic phantom and delivered using a LINAC with stereotactic cones and a multileaf collimator, a CyberKnife system (before and after a supplemental shielding was applied), a TomoTherapy system, and a Gamma Knife unit. For each treatment, 5 Gy were prescribed to the target. Measurements were performed with thermoluminescent dosimeters inserted roughly in the position of the thyroid, sternum, upper lung, lower lung, and gonads. Results: Mean doses ranged from of 4.1 (Gamma Knife) to 62.8 mGy (LINAC with cones) in the thyroid, from 2.3 (TomoTherapy) to 30 mGy (preshielding CyberKnife) in the sternum, from 1.7 (TomoTherapy) to 20 mGy (preshielding CyberKnife) in the upper part of the lungs, from 0.98 (Gamma Knife) to 15 mGy (preshielding CyberKnife) in the lower part of the lungs, and between 0.3 (Gamma Knife) and 10 mGy (preshielding CyberKnife) in the gonads. Conclusions: The peripheral dose absorbed in the sites of interest with a 5 Gy fraction is low. Although the risk of adverse side effects calculated for 20 Gy delivered in 5 Gy fractions is negligible, in the interest of optimum patient radioprotection, further studies are needed to determine the weight of each contributor to the peripheral dose.

  9. Bone grafting: An overview

    Directory of Open Access Journals (Sweden)

    D. O. Joshi

    2010-08-01

    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  10. Fractures from trampolines: results from a national database, 2002 to 2011.

    Science.gov (United States)

    Loder, Randall T; Schultz, William; Sabatino, Meagan

    2014-01-01

    No study specifically analyzes trampoline fracture patterns across a large population. The purpose of this study was to determine such patterns. We queried the National Electronic Injury Surveillance System database for trampoline injuries between 2002 and 2011, and the patients were analyzed by age, sex, race, anatomic location of the injury, geographical location of the injury, and disposition from the emergency department (ED). Statistical analyses were performed with SUDAAN 10 software. Estimated expenses were determined using 2010 data. There were an estimated 1,002,735 ED visits for trampoline-related injuries; 288,876 (29.0%) sustained fractures. The average age for those with fractures was 9.5 years; 92.7% were aged 16 years or younger; 51.7% were male, 95.1% occurred at home, and 9.9% were admitted. The fractures were located in the upper extremity (59.9%), lower extremity (35.7%), and axial skeleton (spine, skull/face, rib/sternum) (4.4%-spine 1.0%, skull/face 2.9%, rib/sternum 0.5%). Those in the axial skeleton were older (16.5 y) than the upper extremity (8.7 y) or lower extremity (10.0 y) (Pfractures were more frequently female (54.0%) (Pfractures were most frequently admitted (20.0%). The tibia/fibula (39.5%) and ankle (31.5%) were most common in the lower extremity; femur fractures were most frequently admitted (57.9%). Cervical (36.4%) and lumbar (24.7%) were most common locations in the spine; cervical fractures were the most frequently admitted (75.6%). The total ED expense for all trampoline injuries over this 10-year period was $1.002 billion and $408 million for fractures. Trampoline fractures most frequently involve the upper extremity followed by the lower extremity, >90% occur in children. The financial burden to society is large. Further efforts for prevention are needed.

  11. Chest wall – underappreciated structure in sonography. Part I: Examination methodology and ultrasound anatomy

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    Andrzej Smereczyński

    2017-09-01

    Full Text Available Chest wall ultrasound has been awarded little interest in the literature, with chest wall anatomy described only in limited extent. The objective of this study has been to discuss the methodology of chest wall ultrasound and the sonographic anatomy of the region to facilitate professional evaluation of this complex structure. The primarily used transducer is a 7–12 MHz linear one. A 3–5 MHz convex (curvilinear transducer may also be helpful, especially in obese and very muscular patients. Doppler and panoramic imaging options are essential. The indications for chest wall ultrasound include localized pain or lesions found or suspected on imaging with other modalities (conventional radiography, CT, MR or scintigraphy. The investigated pathological condition should be scanned in at least two planes. Sometimes, evaluation during deep breathing permits identification of pathological mobility (e.g. in rib or sternum fractures, slipping rib syndrome. Several structures, closely associated with each other, need to be considered in the evaluation of the chest wall. The skin, which forms a hyperechoic covering, requires a high frequency transducer (20–45 MHz. The subcutaneous fat is characterized by clusters of hypoechoic lobules. Chest muscles have a very complex structure, but their appearance on ultrasound does not differ from the images of muscles located in other anatomical regions. As far as cartilaginous and bony structures of the chest are concerned, the differences in the anatomy of the ribs, sternum, scapula and sternoclavicular joints have been discussed. The rich vascular network which is only fragmentarily accessible for ultrasound assessment has been briefly discussed. A comprehensive evaluation of the chest wall should include the axillary, supraclavicular, apical and parasternal lymph nodes. Their examination requires the use of elastography and contrast-enhanced ultrasound.

  12. Characterizing viscoelasticity of unhydrolyzed chicken sternal cartilage extract suspensions: Towards development of injectable therapeutics formulations.

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    Hama, Brian; Mahajan, Gautam; Kothapalli, Chandrasekhar

    2017-08-01

    Exogenous delivery of cartilage extract is being explored as a promising candidate for knee arthritis treatment as it biomimics native cartilage tissue characteristics. In this study, we report on the rheological characterization of aqueous suspensions constituted from a powdered form of unhydrolyzed chicken sternum extract. The effect of particle size (as-received vs. milled), suspension fluid (water vs. PBS), and temperature (37°C vs. 4°C), on the viscoelastic properties of the sternum extract based particulate suspensions were evaluated. Results showed that these suspensions exhibit shear-thinning characteristics as shear rate (γ̇) increases, while viscosity (η), storage (G'), and loss (G″) moduli of the suspensions increased with increasing particulate loading (ϕ: 2.5-10wt%). Reducing the as-received particle size by milling decreased G', G, and η of the suspensions and increased the influence of ϕ on these properties, possibly due to improved particle packing. Replacing water with PBS had no significant effect on the rheological properties, but temperature reduction from 37°C to 4°C increased G', G", and η of the suspensions and lowered the impact of powder loading on viscoelastic properties. The suspension's time-dependent response was typical of viscoelastic materials, characterized by an asymptotical approach to a final stress (stress relaxation) or strain (creep). Results were fit to a power-law model for creep, a general relaxation model for exponential decay in stress, Carreau-Yasuda models for flow curves, and a two-parameter Liu model to identify the maximum powder loading (ϕ m ). Among the various forces involved in particle-particle interactions within these suspensions, electrostatic forces appeared to dominate the most. Such characterization of the viscoelastic nature of these suspensions would help in formulating stable injectable cartilage extract based therapeutics for in vivo applications. Copyright © 2017 Elsevier Ltd. All

  13. Blunt trauma of bone structures of the chest: Computed tomography vs multidetector computed tomography

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    Petrović Kosta

    2013-01-01

    Full Text Available Background/Aim. Computerized tomography (CT, especially multidetector CT (MDCT, has had a revolutionary impact in diagnostic in traumatized patients. The aim of the study was to identify and compare the frequency of injuries to bone structures of the thorax displayed with 5-mm-thick axial CT slices and thin-slice (MDCT examination with the use of 3D reconstructions, primarily multiplanar reformations (MPR. Methods. This prospective study included 61 patients with blunt trauma submitted to CT scan of the thorax as initial assessment. The two experienced radiologists independently and separately described the findings for 5-mmthick axial CT slices (5 mm CT as in monoslice CT examination; MPR and other 3D reconstructions along with thin-slice axial sections which were available in modern MDCT technologies. After describing thin-slice examination in case of disagreement in the findings, the examiners redescribed thinslice examination together which was ultimately considered as a real, true finding. Results. No statistically significant difference in interobserver evaluation of 5 mm CT examination was recorded (p > 0.05. Evaluation of fractures of sternum with 5 mm CT and MDCT showed a statistically significant difference (p < 0.05 in favor of better display of injury by MDCT examination. Conclusion. MDCT is a powerful diagnostic tool that can describe higher number of bone fractures of the chest in traumatized patients compared to 5 mm CT, especially in the region of sternum for which a statistical significance was obtained using MPR. Moreover, the importance of MDCT is also set by easier and more accurate determination of the level of bone injury.

  14. Treatment Experience of Continuous Negative Pressure Drainage in the Acute Anterior Mediastinal Infection of Oropharyngeal Origined

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    Anping CHEN

    2018-04-01

    Full Text Available Background and objective Mediastinal infection is a serious infection of mediastinal connective tissue, with more complications and higher mortality. Application of broad-spectrum antibiotics and nutritional support, early sufficient drainage is the key to successful treatment. In the mode of drainage, this paper discusses the application of continuous negative pressure drainage technique to treat acute anterior mediastinal infection of severe mouth pharynx source, and the good results are summarized and shared. Methods In January to December in 2017, a total of 17 cases treated acute mediastinal infection is derived from the throat, has formed a mediastinal abscess, surgery adopts retrosternal counterpart negative pressure drainage way, namely the sternum nest and free sternum xiphoid process under the incision on the first mediastinal clearance, make breakthrough and placed drainage device, suture closed wound, continuous negative pressure drainage, negative pressure using 3 cm-5 cm water column. Results Among the 17 patients, 14 patients were relieved by continuous negative pressure drainage, and then the drainage tube was removed. In 2 cases, the infection broke into the right thoracic cavity, and the closed drainage caused the negative pressure to disappear, and the negative pressure drainage was replaced by the conventional drainage, and the drainage tube was removed after the drainage tube was clear. One patient had formed a mediastinal abscess incision drainage time later, complicated with septic shock and sepsis, resulting in the death of multiple organ failure. Conclusion The traditional treatment of severe acute mediastinal infection is sternal incision and drainage. Continuous negative pressure drainage adequate drainage of mediastinal can relieve patients' pain, effusion, and avoid the dressing out repeatedly. It is an effective method. However, there are limitations in this method, which need to be further optimized.

  15. An unusual accumulation of technetium-99m-sestamibi (99mTc-MIBI) mimicking an ectopic hyperfunctioning parathyroid tissue: usefulness of CT/SPECT technology in a single device

    International Nuclear Information System (INIS)

    Kienast, O.; Traub, T.; Dobrozemsky, G.; Dudczak, R.; Kurtaran, A.; Kletzmayr, J.; Kainberger, F.

    2002-01-01

    Full text: 99mTc-MIBI dual phase scintigraphy is a well established imaging modality in detecting hyperfunctioning parathyroid tissue. The authors report a case of 99mTc-MIBI scintigraphy showing MIBI-accumulation in projection of the upper mediastinum suspicious for hyperfunctioning parathyroid tissue. Further anatomical localization achieved by combined CT/SPECT technology revealed no mediastinal mass. A 71-year-old man with renal transplantation following chronic renal failure experienced hypercalcemia, hyperphosphatemia and elevation of serum parathyroid hormone levels. Ultrasonography of the neck revealed no enlarged parathyroid glands and further diagnostic work-up has been performed. A 99mTc-MIBI dual phase scintigraphy showed no abnormal accumulation in the typical parathyroid region but a focal activity in projection of the upper mediastinum was detected. The SPECT imaging of the neck and upper chest showed the accumulation in anterior location. This finding was interpreted as an ectopic (mediastinal) hyperfunctioning parathyroid tissue. In order to localize the focus, a CT/SPECT study with a single device system (GE Medical Systems Millennium VG gamma camera with Hawkeye) was done. This is an imaging system composed of a low current x-ray tube and a set of detectors mounted onto the camera's slip ring gantry. On registered and fused anatomical/functional images (CT/99mTc-MIBI SPECT), the increased accumulation of 99mTc-MIBI was shown to be an accumulation in the upper sternum. Further radiological examination revealed no abnormality in the sternum. This case illustrates the usefulness of the combined CT/SPECT imaging strategy with a single device in preventing unnecessary diagnostic/therapeutic interventions in patients with hyperthyroidism and abnormal 99mTc-MIBI scintigraphy. (author)

  16. The Gross Morphology and Histochemistry of Respiratory Muscles in Bottlenose Dolphins, Tursiops truncatus

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    Cotten, Pamela B.; Piscitelli, Marina A.; McLellan, William A.; Rommel, Sentiel A.; Dearolf, Jennifer L.; Pabst, D. Ann

    2011-01-01

    Most mammals possess stamina because their locomotor and respiratory (i.e., ventilatory) systems are mechanically coupled. These systems are decoupled, however, in bottlenose dolphins (Tursiops truncatus) as they swim on a breath-hold. Locomotion and ventilation are coupled only during their brief surfacing event, when they respire explosively (up to 90% of total lung volume in approximately 0.3s) (Ridgway et al., 1969). The predominantly slow-twitch fiber profile of their diaphragm (Dearolf, 2003) suggests that this muscle does not likely power their rapid ventilatory event. Based upon Bramble's (1989) biomechanical model of locomotor-respiratory coupling in galloping mammals, it was hypothesized that locomotor muscles function to power ventilation in bottlenose dolphins. It was further hypothesized that these muscles would be composed predominantly of fast-twitch fibers to facilitate the bottlenose dolphin's rapid ventilation. The gross morphology of cranio-cervical (scalenus, sternocephalicus, sternohyoid), thoracic (intercostals, transverse thoracis), and lumbo-pelvic (hypaxialis, rectus abdominis, abdominal obliques) muscles (n=7) and the fiber-type profiles (n=6) of selected muscles (scalenus, sternocephalicus, sternohyoid, rectus abdominis) of bottlenose dolphins were investigated. Physical manipulations of excised thoracic units were carried out to investigate potential actions of these muscles. Results suggest that the cranio-cervical muscles act to draw the sternum and associated ribs cranio-dorsally, which flares the ribs laterally, and increases the thoracic cavity volume required for inspiration. The lumbo-pelvic muscles act to draw the sternum and caudal ribs caudally, which decreases the volumes of the thoracic and abdominal cavities required for expiration. All muscles investigated were composed predominantly of fast-twitch fibers (range 61-88% by area) and appear histochemically poised for rapid contraction. These combined results suggest that

  17. Osteosarcoma in the anterior chest wall that developed 20 years after postoperative radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    Murata, Mariko; Shoji, Tsuyoshi; Nakayama, Ei; Bando, Toru

    2008-01-01

    Sarcomas are a rare complication of radiotherapy for breast cancer and such patients have a poor prognosis. We report resection of an osteosarcoma in the chest wall that developed 20 years after postoperative radiotherapy for breast cancer. A 57-year-old woman was referred to our department for examination and treatment of an anterior chest wall tumor in April 2007. In September 1986, she had undergone a radical mastectomy and postoperative irradiation and chemotherapy for right breast cancer. In December 2003, she underwent chemotherapy for recurrence of breast cancer which was pointed out on computed tomography involving the pleura and left superior clavicular lymph nodes. In March 2006, follow-up computed tomography of the chest demonstrated the destruction of the sternum, which was diagnosed as recurrence and she was followed with chemotherapy for breast cancer continuously thereafter. In April 2007, because of the developing sternal tumor, excisional biopsy was performed and histopathology indicated sarcoma. In May 2007, resection of the chest wall tumor with the sternum, bilateral clavicles, bilateral first and second ribs, and right partial lung (upper and middle lobe) were performed, and the chest wall defect was reconstructed with a rectus abdominis musculocutaneous free flap. Histopathologically, the tumor was osteosarcoma with margin free. Adjuvant radiotherapy to the breast plays a significant role in preventing local disease recurrence in women treated for breast cancer. However, radiotherapy can induce malignant sarcoma after a latency period of several years. The risk is extremely low for the individual patient, but this disease is aggressive and associated with a poor overall prognosis. Therefore, early detection is necessary for optimal treatment and incisional biopsy is necessary for accurate diagnosis. (author)

  18. Bone and bone marrow function of reconstructed chest wall after surgical correction of pectus excavatum

    International Nuclear Information System (INIS)

    Watanabe, Yoh; Magara, Tatsuo; Kobayashi, Hiroaki; Ichihashi, Takumi; Hikishima, Hiroshi

    1984-01-01

    Bone and Bone marrow functions of the reconstructed chest wall after surgical correction of the funnel chest deformities were evaluated by scanning method. In our series, three kinds of operative procedures were employed; strut method for adult cases, sternal turnover method with and without muscle pedicle for infant cases. Bone function was scanned by sup(99m)Tc-methylene-diphosphonate and bone marrow function was evaluated by sup(99m)Tc-sulfur-colloid. For the cases undergone each surgical procedure, bone and bone marrow scan were done at short term after surgery (within 30 days), at intermediate stage (one month to 12 months), and at long term stage (beyond one year). The results were as follows: By the evaluation at the long term stage of the cases undergoing strut method, bone as well as bone marrow scan visualized normal view of the reconstructed sternum. Regarding the cases undergone sternal turnover method without muscle pedicle, or free graft implantation of the plastron, the bone scan at the long term follow-up stage showed abnormal finding, i.e. hypo-, or defect-visualization of the inverted sternum, in 11.5% of the cases. Furthermore, bone marrow scan showed abnormality in 33.3% of the cases. On the other hand, the cases undergone sternal turnover method with muscle pedicle, in which blood supply to the plastron were preserved by the connection from superior epigastric artery to internal mammary artery, showed no abnormality as far as at the long term follow-up study neither in bone scan nor bone marrow scan. However, in the evaluation at short term after surgery, 50% of the cases undergoing bone scan showed abnormality. In addition, in this stage 85.7% of the bone marrow scan showed abnormal finding. These abnormality, however, normalized within 6 months for bone scan and 12 months for bone marrow scan, in contrast to the results of the cases undergone sternal turnover without pedicle. (J.P.N.)

  19. Reliability of sternal instability scale (SIS) for transverse sternotomy in lung transplantation (LTX).

    Science.gov (United States)

    Fuller, Louise M; El-Ansary, Doa; Button, Brenda; Bondarenko, Janet; Marasco, Silvana; Snell, Greg; Holland, Anne E

    2018-01-25

    A surgical incision for bilateral sequential lung transplantation (BSLTX) is the "clam shell" (CSI) approach via bilateral anterior thoracotomies and a transverse sternotomy to allow for sequential replacement of the lungs. This can be associated with significant post-operative pain, bony overriding or sternal instability. The sternal instability scale (SIS) is a non-invasive manual assessment tool that can be used to detect early bony non-union or instability following CSI; however, its reliability is unknown. This prospective blinded reliability study aimed to assess intra-rater and inter-rater reliability of the SIS following lung transplantation. Participants post BSLTX aged older than 18 years underwent sternal assessment utilizing the SIS. Two assessors examined the sternum using a standardized protocol at two separate time points with a test-re-test time of 48 hours. The outcome measure was SIS tool using four categories from 0 (clinically stable) to 3 (separated sternum with overriding). In total, 20 participants (75% female) with a mean age of 48 years (SD 17) and mean pain score of 3 out of 10 were included, 60% having well healed wounds and 25% reporting symptoms of sternal clicking. The most painful self-reported painful activity was coughing. The SIS demonstrated excellent reliability with a kappa = 0.91 by different assessors on the same day, and kappa = 0.83 for assessments by the same assessor on different days. The SIS is a reliable manual assessment tool for evaluation of sternal instability after CSI following BSLTX and may facilitate the timely detection and management of sternal instability.

  20. Sternal Healing after Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries: Assessment by Computed Tomography Scan

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    Yoon Cheol Shin

    2015-02-01

    Full Text Available Background: This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG surgery using bilateral internal thoracic arteries. Methods: This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA from 2006 through 2009. Postoperative computed tomography (CT angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results: Three to six months after surgery, the average total score of sternal healing was 2.07±1.52 and 68 patients (34.5% showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to 5.88±0.38 and complete healing was observed in 98.2% of patients. Conclusion: Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium.

  1. Trans-Cutaneous Bilirubinometery versus Serum Bilirubin in Neonatal Jaundice.

    Science.gov (United States)

    Mahram, Manoochehr; Oveisi, Sonia; Jaberi, Najmeh

    2015-12-01

    Hyperbilirubinemia is a common problem in neonates and causes serious complications. Thus, serial measurements of bilirubin should be done. This assessment is done through two methods of laboratory measurement in serum sample and transcutaneous bilirubinometer. This descriptive study compared transcutaneous bilirubin assessment and laboratory serum bilirubin. Bilirubin level was assessed among 256 neonates admitted to the Qods Children's Hospital in Qazvin- Iran, because of neonatal indirect jaundice, through two methods of transcutaneous bilirubinometery from two sites of forehead and sternum and laboratory measurement of bilirubin in serum. The cases were non-hemolytic icteric term neonates weighing 2500 gram or more and had not received phototherapy or other treatments. Neonates with hemolytic forms of jaundice, sepsis and suspicious to metabolic disorders were excluded. Assessments by means of KJ-8000 transcutaneous bilirubinometer from two sites of forehead and sternum and through laboratory measurement of serum bilirubin were registered and analyzed. The results of the current study showed that there was a correlation of 0.82 between serum bilirubin and transcutaneous forehead bilirubin assessment and for the used device sensitivity of 0.844; specificity of 0.842, Youden Index of 0.709 and Shortest of 0.042 for a cut-off of 12.4 in bilirubin of participants. Furthermore, Likelihood Ratio positive and negative (LR) were 5.665 and 0.164, respectively and diagnostic Odds Ratio (LR+/LR-) was 34.56. Transcutaneous bilirubinometery can be considered as a reliable tool to assess bilirubin for the screening of neonatal jaundice in term neonates.

  2. REHABILITATION IN CARDIOLOGY AND CARDIOSURGERY

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    N. V. Galtseva

    2015-01-01

    Full Text Available At the present time effectiveness of rehabilitation programs after heart surgery, myocardial infarction, and in some cases for coronary artery disease (CAD is undeniable. According to the researches, physical exercises, which underlie cardio rehabilitation of patients with CAD, reduce cardiac mortality. In the review accumulated scientific data about modern approaches to cardio rehabilitation is discussed: goals, indications, contraindications, its organization, advantages. Controlled training in patients with CAD, making a complex program of cardio rehabilitation, kinds of control during cardio training are described in details. In this review the second phase of physical rehabilitation after cardiac surgery – a stationary phase, protocols of which are subjective and often contested, is considered. More frequently physical rehabilitation after coronary artery bypass surgery is doing breathing exercises, as there is data that physical exercises, in which tangential force vector in or around the sternum appears, should be avoided for at least 3 months after surgery. On the other hand, avoiding of heaving during the first weeks after surgery leads to more pronounced atrophy of the chest muscles. But there is data, according to which, early beginning of an adapted program of cardio rehabilitation (1–2 weeks after surgery is safely, it accelerates recovery and does not increase problems with the sternum. In this review the following idea is suggested: in order to follow the stages of rehabilitation after cardiac surgery it is necessary to start it on the stationary stage, and control of load rehabilitation programs must be carried out using hemodynamic changes during exercises, energy, SF-36 questionnaire. 

  3. Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments

    International Nuclear Information System (INIS)

    Di Betta, Erika; Fariselli, Laura; Bergantin, Achille; Locatelli, Federica; Del Vecchio, Antonella; Broggi, Sara; Fumagalli, Maria Luisa

    2010-01-01

    Purpose: The main purpose of this work was to compare peripheral doses absorbed during stereotactic treatment of a brain lesion delivered using different devices. These data were used to estimate the risk of stochastic effects. Methods: Treatment plans were created for an anthropomorphic phantom and delivered using a LINAC with stereotactic cones and a multileaf collimator, a CyberKnife system (before and after a supplemental shielding was applied), a TomoTherapy system, and a Gamma Knife unit. For each treatment, 5 Gy were prescribed to the target. Measurements were performed with thermoluminescent dosimeters inserted roughly in the position of the thyroid, sternum, upper lung, lower lung, and gonads. Results: Mean doses ranged from of 4.1 (Gamma Knife) to 62.8 mGy (LINAC with cones) in the thyroid, from 2.3 (TomoTherapy) to 30 mGy (preshielding CyberKnife) in the sternum, from 1.7 (TomoTherapy) to 20 mGy (preshielding CyberKnife) in the upper part of the lungs, from 0.98 (Gamma Knife) to 15 mGy (preshielding CyberKnife) in the lower part of the lungs, and between 0.3 (Gamma Knife) and 10 mGy (preshielding CyberKnife) in the gonads. Conclusions: The peripheral dose absorbed in the sites of interest with a 5 Gy fraction is low. Although the risk of adverse side effects calculated for 20 Gy delivered in 5 Gy fractions is negligible, in the interest of optimum patient radioprotection, further studies are needed to determine the weight of each contributor to the peripheral dose.

  4. Feasibility study of entrance and exit dose measurements at the contra lateral breast with alanine/electron spin resonance dosimetry in volumetric modulated radiotherapy of breast cancer

    Science.gov (United States)

    Wagner, Daniela M.; Hüttenrauch, Petra; Anton, Mathias; von Voigts-Rhetz, Philip; Zink, Klemens; Wolff, Hendrik A.

    2017-07-01

    The Physikalisch-Technische Bundesanstalt has established a secondary standard measurement system for the dose to water, D W, based on alanine/ESR (Anton et al 2013 Phys. Med. Biol. 58 3259-82). The aim of this study was to test the established measurement system for the out-of-field measurements of inpatients with breast cancer. A set of five alanine pellets were affixed to the skin of each patient at the contra lateral breast beginning at the sternum and extending over the mammilla to the distal surface. During 28 fractions with 2.2 Gy per fraction, the accumulated dose was measured in four patients. A cone beam computer tomography (CBCT) scan was generated for setup purposes before every treatment. The reference CT dataset was registered rigidly and deformably to the CBCT dataset for 28 fractions. To take the actual alanine pellet position into account, the dose distribution was calculated for every fraction using the Acuros XB algorithm. The results of the ESR measurements were compared to the calculated doses. The maximum dose measured at the sternum was 19.9 Gy  ±  0.4 Gy, decreasing to 6.8 Gy  ±  0.2 Gy at the mammilla and 4.5 Gy  ±  0.1 Gy at the distal surface of the contra lateral breast. The absolute differences between the calculated and measured doses ranged from  -1.9 Gy to 0.9 Gy. No systematic error could be seen. It was possible to achieve a combined standard uncertainty of 1.63% for D W  =  5 Gy for the measured dose. The alanine/ESR method is feasible for in vivo measurements.

  5. [Aortopexy for tracheomalacia in infants and children].

    Science.gov (United States)

    Vinograd, I; Klin, B; Silbiger, A; Eshel, G

    2000-06-15

    During the past 12 years (1985-1998), 28 infants and children were operated on here for tracheomalacia. The diagnosis was made in all using rigid bronchoscopy. During the examination the infants breathed spontaneously, but the trachea collapsed on forced expiration. Indications for surgery were repeated cyanotic spells ("dying spells") in 22, recurrent pneumonia, and inability to extubate (in 8). In 11 there were more than 1 indications. Age at surgery was from 7 days to 3 years (average 11.7 months). All 28 children underwent bronchoscopy and guided aortopexy via a left-third intercostal approach. The ascending aorta and aortic arch (and in 6 the proximal innominate artery as well) were lifted anteriorly, using 3-5 non-absorbable sutures (5.0). The sutures were placed through the adventitia of the great vessels and then passed through the sternum. Respiratory distress was significantly improved in 21. Another 2 required external tracheal stenting with autologous rib grafts, and in 1 other an internal Palmaz stent was introduced for tracheal stability. In 4 aortopexy failed, 1 of whom had tracheobronchomalacia throughout, and another 3 had laryngomalacia which required tracheostomy to relieve the respiratory symptoms. Postoperative complications were minor: pericardial effusion in 1 and relaxation of the left diaphragm in another. 1 infant subsequently died, of unknown cause 10 days after operation, after having been extubated on the 1st postoperative day. On long-term follow-up (6 months to 12 years) 25 were found free of residual respiratory symptoms and 3 remained with a tracheostomy. Thus, infants and children with severe tracheomalacia associated with severe respiratory symptoms, can be relieved by bronchoscopic guided suspension of the aortic arch to the sternum.

  6. A cross-sectional study of pain sensitivity, disease-activity assessment, mental health, and fibromyalgia status in rheumatoid arthritis.

    Science.gov (United States)

    Joharatnam, Nalinie; McWilliams, Daniel F; Wilson, Deborah; Wheeler, Maggie; Pande, Ira; Walsh, David A

    2015-01-20

    Pain remains the most important problem for people with rheumatoid arthritis (RA). Active inflammatory disease contributes to pain, but pain due to non-inflammatory mechanisms can confound the assessment of disease activity. We hypothesize that augmented pain processing, fibromyalgic features, poorer mental health, and patient-reported 28-joint disease activity score (DAS28) components are associated in RA. In total, 50 people with stable, long-standing RA recruited from a rheumatology outpatient clinic were assessed for pain-pressure thresholds (PPTs) at three separate sites (knee, tibia, and sternum), DAS28, fibromyalgia, and mental health status. Multivariable analysis was performed to assess the association between PPT and DAS28 components, DAS28-P (the proportion of DAS28 derived from the patient-reported components of visual analogue score and tender joint count), or fibromyalgia status. More-sensitive PPTs at sites over or distant from joints were each associated with greater reported pain, higher patient-reported DAS28 components, and poorer mental health. A high proportion of participants (48%) satisfied classification criteria for fibromyalgia, and fibromyalgia classification or characteristics were each associated with more sensitive PPTs, higher patient-reported DAS28 components, and poorer mental health. Widespread sensitivity to pressure-induced pain, a high prevalence of fibromyalgic features, higher patient-reported DAS28 components, and poorer mental health are all linked in established RA. The increased sensitivity at nonjoint sites (sternum and anterior tibia), as well as over joints, indicates that central mechanisms may contribute to pain sensitivity in RA. The contribution of patient-reported components to high DAS28 should inform decisions on disease-modifying or pain-management approaches in the treatment of RA when inflammation may be well controlled.

  7. Effect of Cryoanalgesia on Post Midsternotomy Pain and Paresthesia Following CABG

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    H Hosseini

    2009-07-01

    Full Text Available Introduction: Control of post thoracotomy pain is particularly important in prevention of post operative respiratory complications. Several methods are proposed for control of postoperative pain. Cryoanalgesia by freezing of intercostal nerves is able to providing long term pain relief in post operative period which probably results in cutaneous sensory changes. Methods: This clinical trial study was done on 124 patients who underwent CABG surgery. Patients were randomly divided in two groups; control group (group I and study group (group II. In study group cryoanalgesia was applied intraoperatively on the intercostal nerves. All of the patients received appropriate analgesia on demand in postoperative period. Pain in LIMA harvesting site and sternum was measured by visual analogue pain score before discharge, one and three months following cryoanalgesia. In all of the patient’s, presence of paresthesia was evaluated. The amount of administered analgesics (narcotic, opium, indomethacin was noted daily. Data of this investigation was analyzed and evaluated using SPSS 11.5 software. Results: Pain score of sternum was higher in study group before discharge and was lower at one and three months after operation than the control group that was statistically significant (P=0.01. Pain score of LIMA region before discharge was higher, at one month post operation was equal and at three months post operative was lower than the control group (P=0.045. Use of morphine and opium was lower (P=0.017 and use of indomethacin was higher in the cryoanalgesia group that was statistically significant (P=0.001. Incidence of paresthesia was lower in the study group (P=0.001. Conclusion: It is proposed that cryoanalgesia is a safe and effective method for reduction of pain and paresthesia and need for analgesics following CABG operation.

  8. Especies nuevas de abejas de Cuba y La Española (Hymenoptera: Colletidae, Megachilidae, Apidae

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    Julio A. Genaro

    2001-12-01

    Full Text Available Se describen e ilustran cinco especies nuevas de abejas antillanas: Collectes granpiedrensis n. sp. (Cuba (Colletidae; Osmia (Diceratosmia stangei n. sp. (República Dominicana; Coelioxys (Cyrtocoelioxys alayoi n. sp. (Cuba; C. (Boreocoelioxys sannicolarensis n. sp. (Cuba (Megachilidae y Triepeolus nisibonensis n. sp. (República Dominicana (ApidaeFive new species of Antillean bees are described and illustrated: Colletes granpiedrensis n. sp. (Cuba (Colletidae is charaterized as follows: Head and mesosoma black, legs and metasoma brown. Dense brown hairs on head and mesosoma; white on frons and metasomal terga. Clypeus, frons and mesosoma with large punctures, lesser on vertex and metasoma. Malar space more wide than long. Male and female slightly similar, except in the apical margin of clypeus, supraclipeal area, and color of the pubescence on legs and sterna; Osmia (Diceratosmia stangei n. sp. (Dominican Republic (Megachilidae is charaterized as follows: Dark metallic green, metasoma black with metallic green reflections. Pubescence light; body with large, closed punctures. Female with violet reflections in tergum III and mandible tridentate; Coelioxys (Cyrtocoelioxys alayoi n. sp. (Cuba (Megachilidae is charaterized as follows: Female black, except basal area of mandibles, tegula, legs, lateral area of tergum I and sterna, reddish brown. Posterior margin of scutellum rounded. Apex of tergum VI with spine curved up. Sternum VI fringed with short, closed setae, and the apex with short spine; Coelioxys (Boreocoelioxys sannicolarensis n. sp. (Cuba (Megachilidae is charaterized as follows: Black, except antenna and tegula brown; legs and sterna reddish brown. Clypeal margin straight in profile. Gradular grooves on metasomal terga II and III distinct medially. Fovea on metasomal tergum II of male deep and short, and Triepeolus nisibonensis n. sp. (Dominican Republic (Apidae is charaterized as follows: Dorsal pubescence (short and dense on mesosoma

  9. Delayed Sternal Closure in Infant Heart Surgery-The Importance of Where and When: An Analysis of the STS Congenital Heart Surgery Database.

    Science.gov (United States)

    Nelson-McMillan, Kristen; Hornik, Christoph P; He, Xia; Vricella, Luca A; Jacobs, Jeffrey P; Hill, Kevin D; Pasquali, Sara K; Alejo, Diane E; Cameron, Duke E; Jacobs, Marshall L

    2016-11-01

    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. 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. Primary outcome was occurrence of infection complication, defined as one or more of the following: endocarditis, pneumonia, wound infection, wound dehiscence, sepsis, or mediastinitis. Multivariable regression models were fit to assess association of infection complication with: duration of SLO (days), location of DSC procedure (operating room versus elsewhere), and patient and procedural factors. Of 6,127 index operations with SLO at 100 centers, median age and weight were 8 days (IQR, 5-24) and 3.3 kg (IQR, 2.9-3.8); 66% of operations were STAT morbidity category 4 or 5. At least one infection complication occurred in 18.7%, compared with 6.6% among potentially eligible neonates and infants without SLO. Duration of SLO (median, 3 days; IQR, 2-5) was associated with an increased rate of infection complications (p < 0.001). Location of DSC procedure was operating room (16%), intensive care unit (67%), or other (17%). Location of DSC was not associated with rate of infection complications (p = 0.45). Rate of occurrence of infectious complications is high among infants with sternum left open following cardiac surgery. Longer duration of SLO is associated with increased infection complications. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Capillary refill time is an unreliable indicator of cardiovascular status in term neonates.

    Science.gov (United States)

    LeFlore, Judy L; Engle, William D

    2005-06-01

    Decisions regarding the need for volume replacement in neonates often are made in the immediate newborn period. Capillary refill time (CRT) is used as an indicator of circulatory status; however, recent data show that CRT varies considerably with age, ambient and skin temperature, anatomical site of measurement, and duration of pressure. The purpose of this study was to (1) examine the relationship between CRT and heart rate (HR) and blood pressure (BP) in term neonates, and (2) evaluate the differences among CRT values measured at 3 body sites and with varying duration of cutaneous pressure. This was a prospective, cross-sectional, correlational study. Subjects Forty-two appropriate-weight-for-gestational-age (AGA) neonates with birthweights, (M = 3407; SD = +/- 540 g), gestational ages (M = 39 weeks; SD = +/- 1 week), and sex (21 males, 21 females). Infants had no history of perinatal distress or maternal chorioamnionitis. Each neonate was studied prospectively 1 to 4 hours after birth. The infants were clothed with only a diaper and evaluated on a radiant warmer bed set to achieve an axillary temperature of 36.5 degrees to 37.0 degrees C. Capillary refill time was measured with a digital stopwatch at 3 sites: volar surface of finger (F), plantar surface of heel (H), and lower sternum (St), using brief (1- to 2-second) and extended (3- to 4-second) pressure. Heart rate was auscultated and counted for 60 seconds, and BP was measured by oscillometry. Relationships among variables were assessed by Pearson correlation coefficient, analysis of variance, and multiple regression analysis. The Bonferroni correction for multiple comparisons was applied. Capillary refill time, blood pressure, and heart rate. There was no significant site variation for CRT for either brief (2.4 +/- 0.6 to 2.9 +/- 1.0 seconds) or extended (3.8 +/- 0.8 to 4.3 +/- 0.8 seconds) pressure. However, regardless of site, CRT was greater when extended versus brief pressure was used (P correlations

  11. Gaze direction effects on perceptions of upper limb kinesthetic coordinate system axes.

    Science.gov (United States)

    Darling, W G; Hondzinski, J M; Harper, J G

    2000-12-01

    The effects of varying gaze direction on perceptions of the upper limb kinesthetic coordinate system axes and of the median plane location were studied in nine subjects with no history of neuromuscular disorders. In two experiments, six subjects aligned the unseen forearm to the trunk-fixed anterior-posterior (a/p) axis and earth-fixed vertical while gazing at different visual targets using either head or eye motion to vary gaze direction in different conditions. Effects of support of the upper limb on perceptual errors were also tested in different conditions. Absolute constant errors and variable errors associated with forearm alignment to the trunk-fixed a/p axis and earth-fixed vertical were similar for different gaze directions whether the head or eyes were moved to control gaze direction. Such errors were decreased by support of the upper limb when aligning to the vertical but not when aligning to the a/p axis. Regression analysis showed that single trial errors in individual subjects were poorly correlated with gaze direction, but showed a dependence on shoulder angles for alignment to both axes. Thus, changes in position of the head and eyes do not influence perceptions of upper limb kinesthetic coordinate system axes. However, dependence of the errors on arm configuration suggests that such perceptions are generated from sensations of shoulder and elbow joint angle information. In a third experiment, perceptions of median plane location were tested by instructing four subjects to place the unseen right index fingertip directly in front of the sternum either by motion of the straight arm at the shoulder or by elbow flexion/extension with shoulder angle varied. Gaze angles were varied to the right and left by 0.5 radians to determine effects of gaze direction on such perceptions. These tasks were also carried out with subjects blind-folded and head orientation varied to test for effects of head orientation on perceptions of median plane location. Constant

  12. Aktueller Stand der plastisch-rekonstruktiven Chirurgie aus der Sicht der Thoraxchirurgie

    Directory of Open Access Journals (Sweden)

    Rupprecht, Holger

    2012-12-01

    the transposed greater omentum and polyurethane sponges (VAC leads to a faster cleaning of the soiled thoracic cavity and accelerates the wound granulation. With this technique, even unfavourable cases could be rehabilitated.Sternal wound infections: The osteomyelitis of the sternum is a potentially life-threatening complication (mediastinitis, especially after cardiac surgery. In these cases, the vacuum therapy (VAC with polyurethane sponges have contributed to the improved prognosis. Firstly, a more rapid debridement is provoked, and second the chest wall will be stabilized more quickly, because the VAC reduces the shear forces in a dehiscence of the sternum. After reaching clean conditions, a muscle flap or the greater omentum are interposed for final wound closure.

  13. Age-related changes in thoracic skeletal geometry of elderly females.

    Science.gov (United States)

    Holcombe, Sven A; Wang, Stewart C; Grotberg, James B

    2017-05-29

    Both females and the elderly have been identified as vulnerable populations with increased injury and mortality risk in multiple crash scenarios. Particularly in frontal impacts, older females show higher risk to the chest and thorax than their younger or male counterparts. Thoracic geometry plays a role in this increase, and this study aims to quantify key parts of that geometry in a way that can directly inform human body models that incorporate the concept of person age. Computed tomography scans from 2 female subject groups aged 20-35 and 65-99 were selected from the International Center for Automotive Medicine scan database representing young and old female populations. A model of thoracic skeletal anatomy was built for each subject from independent parametric models of the spine, ribs, and sternum, along with further parametric models of those components' spatial relationships. Parameter values between the 2 groups are directly compared, and average parameter values within each group are used to generate statistically average skeletal geometry for young and old females. In addition to the anatomic measures explicitly used in the parameterization scheme, key measures of rib cage depth and spine curvature are taken from both the underlying subject pool and from the resultant representative geometries. Statistically significant differences were seen between the young and old groups' spine and rib anatomic components, with no significant differences in local sternal geometry found. Vertebral segments in older females had higher angles relative to their inferior neighbors, providing a quantification of the kyphotic curvature known to be associated with age. Ribs in older females had greater end-to-end span, greater aspect ratio, and reduced out-of-plane deviation, producing an elongated and overall flatter curvature that leads to distal rib ends extending further anteriorly in older individuals. Combined differences in spine curvature and rib geometry led to an 18

  14. Core binding factor beta (Cbfβ) controls the balance of chondrocyte proliferation and differentiation by upregulating Indian hedgehog (Ihh) expression and inhibiting parathyroid hormone-related protein receptor (PPR) expression in postnatal cartilage and bone formation.

    Science.gov (United States)

    Tian, Fei; Wu, Mengrui; Deng, Lianfu; Zhu, Guochun; Ma, Junqing; Gao, Bo; Wang, Lin; Li, Yi-Ping; Chen, Wei

    2014-07-01

    Core binding factor beta (Cbfβ) is essential for embryonic bone morphogenesis. Yet the mechanisms by which Cbfβ regulates chondrocyte proliferation and differentiation as well as postnatal cartilage and bone formation remain unclear. Hence, using paired-related homeobox transcription factor 1-Cre (Prx1-Cre) mice, mesenchymal stem cell-specific Cbfβ-deficient (Cbfβ(f/f) Prx1-Cre) mice were generated to study the role of Cbfβ in postnatal cartilage and bone development. These mutant mice survived to adulthood but exhibited severe sternum and limb malformations. Sternum ossification was largely delayed in the Cbfβ(f/f) Prx1-Cre mice and the xiphoid process was noncalcified and enlarged. In newborn and 7-day-old Cbfβ(f/f) Prx1-Cre mice, the resting zone was dramatically elongated, the proliferation zone and hypertrophic zone of the growth plates were drastically shortened and disorganized, and trabecular bone formation was reduced. Moreover, in 1-month-old Cbfβ(f/f) Prx1-Cre mice, the growth plates were severely deformed and trabecular bone was almost absent. In addition, Cbfβ deficiency impaired intramembranous bone formation both in vivo and in vitro. Interestingly, although the expression of Indian hedgehog (Ihh) was largely reduced, the expression of parathyroid hormone-related protein (PTHrP) receptor (PPR) was dramatically increased in the Cbfβ(f/f) Prx1-Cre growth plate, indicating that that Cbfβ deficiency disrupted the Ihh-PTHrP negative regulatory loop. Chromatin immunoprecipitation (ChIP) analysis and promoter luciferase assay demonstrated that the Runx/Cbfβ complex binds putative Runx-binding sites of the Ihh promoter regions, and also the Runx/Cbfβ complex directly upregulates Ihh expression at the transcriptional level. Consistently, the expressions of Ihh target genes, including CyclinD1, Ptc, and Pthlh, were downregulated in Cbfβ-deficient chondrocytes. Taken together, our study reveals not only that Cbfβ is essential for chondrocyte

  15. Small female rib cage fracture in frontal sled tests.

    Science.gov (United States)

    Shaw, Greg; Lessley, David; Ash, Joseph; Poplin, Jerry; McMurry, Tim; Sochor, Mark; Crandall, Jeff

    2017-01-02

    The 2 objectives of this study are to (1) examine the rib and sternal fractures sustained by small stature elderly females in simulated frontal crashes and (2) determine how the findings are characterized by prior knowledge and field data. A test series was conducted to evaluate the response of 5 elderly (average age 76 years) female postmortem human subjects (PMHS), similar in mass and size to a 5th percentile female, in 30 km/h frontal sled tests. The subjects were restrained on a rigid planar seat by bilateral rigid knee bolsters, pelvic blocks, and a custom force-limited 3-point shoulder and lap belt. Posttest subject injury assessment included identifying rib cage fractures by means of a radiologist read of a posttest computed tomography (CT) and an autopsy. The data from a motion capture camera system were processed to provide chest deflection, defined as the movement of the sternum relative to the spine at the level of T8.  A complementary field data investigation involved querying the NASS-CDS database over the years 1997-2012. The targeted cases involved belted front seat small female passenger vehicle occupants over 40 years old who were injured in 25 to 35 km/h delta-V frontal crashes (11 to 1 o'clock). Peak upper shoulder belt tension averaged 1,970 N (SD = 140 N) in the sled tests. For all subjects, the peak x-axis deflection was recorded at the sternum with an average of -44.5 mm or 25% of chest depth. The thoracic injury severity based on the number and distribution of rib fractures yielded 4 subjects coded as Abbreviated Injury Scale (AIS) 3 (serious) and one as AIS 5 (critical). The NASS-CDS field data investigation of small females identified 205 occupants who met the search criteria. Rib fractures were reported for 2.7% of the female occupants. The small elderly test subjects sustained a higher number of rib cage fractures than expected in what was intended to be a minimally injurious frontal crash test condition. Neither field studies nor

  16. Areal and volumetric Bone Mineral Density and risk of multiple types of fracture in older men

    Science.gov (United States)

    Chalhoub, Didier; Orwoll, Eric S.; Cawthon, Peggy M.; Ensrud, Kristine E.; Boudreau, Robert; Greenspan, Susan; Newman, Anne B.; Zmuda, Joseph; Bauer, Douglas; Cummings, Steven; Cauley, Jane A.

    2016-01-01

    Although many studies have examined the association between low bone mineral density (BMD) and fracture risk in older men, none have simultaneously studied the relationship between multiple BMD sites and risk of different types of fractures. Using data from the Osteoporotic Fractures in Men study, we evaluated the association between areal BMD (aBMD) by dual-energy X-ray absorptiometry (DXA) and volumetric BMD (vBMD) by quantitative computed tomography (QCT) measurements, and different types of fractures during an average of 9.7 years of follow up. Men answered questionnaires about fractures every 4 months (>97% completions). Fractures were confirmed by centralized review of radiographic reports; pathological fractures were excluded. Risk of fractures was assessed at the hip, spine, wrist, shoulder, rib/chest/sternum, ankle/foot/toe, arm, hand/finger, leg, pelvis/coccyx, skull/face and any non-spine fracture. Age and race adjusted Cox proportional-hazards modeling was used to assess the risk of fracture in 3301 older men with both aBMD (at the femoral neck (FN) and lumbar spine) and vBMD (at the trabecular spine and FN, and cortical FN) measurements, with hazard ratios (HRs) expressed per standard deviation (SD) decrease. Lower FN and spine aBMD were associated with an increased risk of fracture at the hip, spine, wrist, shoulder, rib/chest/sternum, arm, and any non-spine fracture (statistically significant HRs per SD decrease ranged from 1.24 - 3.57). Lower trabecular spine and FN vBMD were associated with increased risk of most fractures with statistically significant HRs ranging between 1.27 and 3.69. There was a statistically significant association between FN cortical vBMD and fracture risk at the hip (HR=1.55) and spine sites (HR=1.26), but no association at other fracture sites. In summary, both lower aBMD and vBMD were associated with increased fracture risk. The stronger associations observed for trabecular vBMD than cortical vBMD may reflect the greater

  17. PET-CT in the evaluation of metastatic breast cancer

    International Nuclear Information System (INIS)

    Sullivan, A.M.; Fulham, M.J.

    2005-01-01

    A 44-year-old woman underwent two PET-CT scans for the evaluation of metastatic breast cancer. A radical left mastectomy with axillary dissection (1 of 43 nodes positive) followed by chemotherapy, was performed in 1998. She represented in October 2003 with a left supraclavicular fossa mass. This was confirmed to be recurrent breast cancer on FNAB. She was considered for a radical neck dissection and the surgeon requested a PET scan. Other imaging at this time included a normal bone scan and CT brain. CT neck/chest/abdomen/pelvis showed soft tissue thickening in the left lower neck. The PET-CT scan showed multiple glucose avid lesions in the sternum, mediastinum and neck lymph nodes as well as a small lesion in the proximal left femur consistent with extensive metastatic disease. Surgery was cancelled and Femara chemotherapy commenced. Femara was stopped in March 2004 and the patient began alternative therapies. In October 2004 she presented to her surgeon with new back and chest pain. CT of the neck/chest/abdomen/pelvis showed a soft tissue mass in the upper sternum and a lymph node at the base of the neck highly suspicious for metastatic disease. There were also 2 suspicious lung nodules and a lesion in the proximal left femur reported as an osteoid osteoma. Wholebody PET-CT scans were performed on a Siemens LSO Biograph, 60mins after the injection of 350Mbq of Fl 8-Fag, with arms at the patient's side and head in the field-of-view. On both occasions the patient had to pay for the scan. On the 2004 PET-CT scan, the CT brain revealed multiple hyperdense lesions consistent with hemorrhagic metastases. In addition, there were innumerable glucose avid foci involving viscera, nodes and skeleton consistent with disseminated disease. Our case illustrates: (i) the value of PET in the management of metastatic breast cancer; (ii) the improved accuracy of PET-CT in delineating sites of disease; (iii) the issues of head movement in PET-CT and. (iv) the problem with lack of

  18. SU-F-T-558: ArcCheck for Patient Specific QA in Stereotactic Ablative Radiotherapy

    International Nuclear Information System (INIS)

    Ramachandran, P; Tajaldeen, A; Esen, N; Geso, M; Taylor, D; Wanigaratne, D; Roozen, K; Kron, T

    2016-01-01

    Purpose: Stereotactic Ablative Radiotherapy (SABR) is one of the most preferred treatment techniques for early stage lung cancer. This technique has been extended to other treatment sites like Spine, Liver, Scapula, Sternum etc., This has resulted in increased physics QA time on machine. In this study, we’ve tested the feasibility of using ArcCheck as an alternative method to replace film dosimetry. Methods: Twelve patients with varied diagnosis of Lung, Liver, scapula, sternum and Spine undergoing SABR were selected for this study. Pre-treatment QA was performed for all the patients which include ionization chamber and film dosimetry. The required gamma criteria for each SABR plan to pass QA and proceed to treatment is 95% (3%,1mm). In addition to this routine process, the treatment plans were exported on to an ArcCheck phantom. The planned and measured dose from the ArcCheck device were compared using four different gamma criteria: 2%,2 mm, 3%,2 mm, 3%,1 mm and 3%, 3 mm. In addition to this, we’ve also introduced errors to gantry, collimator and couch angle to assess sensitivity of the ArcCheck with potential delivery errors. Results: The ArcCheck mean passing rates for all twelve cases were 76.1%±9.7% for gamma criteria 3%,1 mm, 89.5%±5.3% for 2%,2 mm, 92.6%±4.2% for 3%,2 mm, and 97.6%±2.4% for 3%,3 mm gamma criteria. When SABR spine cases are excluded, we observe ArcCheck passing rates higher than 95% for all the studied cases with 3%, 3mm, and ArcCheck results in acceptable agreement with the film gamma results. Conclusion: Our ArcCheck results at 3%, 3 mm were found to correlate well with our non-SABR spine routine patient specific QA results (3%,1 mm). We observed significant reduction in QA time on using ArcCheck for SABR QA. This study shows that ArcCheck could replace film dosimetry for all sites except SABR spine.

  19. Imageological measurement of the sternoclavicular joint and its clinical application.

    Science.gov (United States)

    Li, Ming; Wang, Bo; Zhang, Qi; Chen, Wei; Li, Zhi-Yong; Qin, Shi-Ji; Zhang, Ying-Ze

    2012-01-01

    Dislocation of the sternoclavicular joint is rare. However, posterior dislocation compressing important structures in the mediastinum may be fatal. Early diagnosis and prompt therapy of sternoclavicular joint dislocation are important. Computed tomography (CT) is an optimal means to investigate sternoclavicular joint anatomy; however, there are few reports on the imageological anatomical features of the sternoclavicular joint. The study investigated imageological anatomical features, and a new plate was devised according to these data to treat sternoclavicular joint dislocation. Fifty-three healthy Chinese volunteers examined with chest CT were included in the study. The coronal, sagittal, and axial images of the sternoclavicular region were reconstructed. The sternal head diameter in the inferolateral-to-superomedial direction, length of the clavicular notch, and angle between the clavicular notch and sternum were measured on coronal images. The angle between the presternum and trunk was measured on sagittal images. The following dimensions were measured on axial images: anteroposterior dimensions of the sternal head, clavicular notch, and presternum; width of the sternoclavicular joint; distance between bilateral clavicles; and minimal distance from the presternum to the underlying structures in the thoracic cavity. A new plate was designed according to the above data and was used to repair six sternoclavicular joint dislocations. All cases were followed up with a range of 9 to 12 months. The proximal clavicle is higher than the presternum in a horizontal position. On axial images, the anteroposterior dimension of the sternal head was longer than the presternum, and the center region of the presternum was thinner than the edges. The left sternoclavicular joint space was (0.82 ± 0.21) cm, and the right was (0.87 ± 0.22) cm. Among the structures behind the sternum, the left bilateral innominate vein ran nearest to the presternum. The distance from the anterior

  20. Revision of orthovoltage chest wall treatment using Monte Carlo simulations.

    Science.gov (United States)

    Zeinali-Rafsanjani, B; Faghihi, R; Mosleh-Shirazi, M A; Mosalaei, A; Hadad, K

    2017-01-01

    Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. The results of the treatment study show that the optimized standard and mid sternum treatment for different chest

  1. The Effect of Susceptibility Artifacts Related to Metallic Implants on Adjacent-Lesion Assessment in Simultaneous TOF PET/MR.

    Science.gov (United States)

    Svirydenka, Hanna; Delso, Gaspar; De Galiza Barbosa, Felipe; Huellner, Martin; Davison, Helen; Fanti, Stefano; Veit-Haibach, Patrick; Ter Voert, Edwin E G W

    2017-07-01

    Metalic implants may affect attenuation correction (AC) in PET/MR imaging. The purpose of this study was to evaluate the effect of susceptibility artifacts related to metallic implants on adjacent metabolically active lesions in clinical simultaneous PET/MR scanning for both time-of-flight (TOF) and non-TOF reconstructed PET images. Methods: We included 27 patients without implants but with confirmed 18 F-FDG-avid lesions adjacent to common implant locations. In all patients, a clinically indicated whole-body 18 F-FDG PET/MR scan was acquired. Baseline non-TOF and TOF PET images were reconstructed. Reconstruction was repeated after the introduction of artificial signal voids in the AC map to simulate metallic implants in standard anatomic areas. All reconstructed images were qualitatively and quantitatively assessed and compared with the baseline images. Results: In total, 51 lesions were assessed. In 40 and 50 of these cases (non-TOF and TOF, respectively), the detectability of the lesions did not change; in 9 and 1 cases, the detectability changed; and in 2 non-TOF cases, the lesions were no longer visible after the introduction of metallic artifacts. The inclusion of TOF information significantly reduced artifacts due to simulated implants in the femoral head, sternum, and spine ( P = 0.01, 0.01, and 0.03, respectively). It also improved image quality in these locations ( P = 0.02, 0.01, and 0.01, respectively). The mean percentage error was -3.5% for TOF and -4.8% for non-TOF reconstructions, meaning that the inclusion of TOF information reduced the percentage error in SUV max by 28.5% ( P metallic implants have a significant effect on small, moderately 18 F-FDG-avid lesions near the implant site that possibly may go unnoticed without TOF information. On larger, highly 18 F-FDG-avid lesions, the metallic implants had only a limited effect. The largest significant quantitative difference was found in artifacts of the sternum. There was only a weak inverse

  2. A Paleolithic diet confers higher insulin sensitivity, lower C-reactive protein and lower blood pressure than a cereal-based diet in domestic pigs

    Directory of Open Access Journals (Sweden)

    Ugander Martin

    2006-11-01

    Full Text Available Abstract Background A Paleolithic diet has been suggested to be more in concordance with human evolutionary legacy than a cereal based diet. This might explain the lower incidence among hunter-gatherers of diseases of affluence such as type 2 diabetes, obesity and cardiovascular disease. The aim of this study was to experimentally study the long-term effect of a Paleolithic diet on risk factors for these diseases in domestic pigs. We examined glucose tolerance, post-challenge insulin response, plasma C-reactive protein and blood pressure after 15 months on Paleolithic diet in comparison with a cereal based swine feed. Methods Upon weaning twenty-four piglets were randomly allocated either to cereal based swine feed (Cereal group or cereal free Paleolithic diet consisting of vegetables, fruit, meat and a small amount of tubers (Paleolithic group. At 17 months of age an intravenous glucose tolerance test was performed and pancreas specimens were collected for immunohistochemistry. Group comparisons of continuous variables were made by use of the t-test. P Results At the end of the study the Paleolithic group weighed 22% less and had 43% lower subcutaneous fat thickness at mid sternum. No significant difference was seen in fasting glucose between groups. Dynamic insulin sensitivity was significantly higher (p = 0.004 and the insulin response was significantly lower in the Paleolithic group (p = 0.001. The geometric mean of C-reactive protein was 82% lower (p = 0.0007 and intra-arterial diastolic blood pressure was 13% lower in the Paleolithic group (p = 0.007. In evaluations of multivariate correlations, diet emerged as the strongest explanatory variable for the variations in dynamic insulin sensitivity, insulin response, C-reactive protein and diastolic blood pressure when compared to other relevant variables such as weight and subcutaneous fat thickness at mid sternum. There was no obvious immunohistochemical difference in pancreatic islets

  3. Fetal dosimetry from natural alpha emitters

    Energy Technology Data Exchange (ETDEWEB)

    Purnell, S.J

    1999-09-01

    The size of marrow cavities in fetal vertebra, rib and sternum was investigated using an image analysis system. The average chord lengths through marrow spaces in the vertebrae were found to increase approximately linearly with gestational age from 140 {mu}m at 20 weeks to 300 {mu}m at 40 weeks. Average chord lengths through marrow spaces in fetal rib and sternum were 330 {mu}m at 35 weeks in both cases. These results can be compared with an average chord length across marrow spaces in adult vertebra of 1172 {mu}m. At natural background UK exposure, activity concentrations of supported {sup 210}Po in fetal bone of 0.075 Bq kg{sup -1} and 0.15 Bq kg{sup -1} at mid- and late gestation respectively were calculated. Monte Carlo simulations modelling the paths of alpha-particles in fetal vertebra gave a total alpha-radiation dose to marrow over the second and third trimesters of 32.0 {+-} 0.8 {mu}Sv with the {sup 210}Po in bone contributing 8.9 {+-} 0.9 {mu}Sv. The dose to primitive haemopoietic stem cells, the target cells for acute lymphoblastic leukaemia, and the survival of these stem cells following a hit by an alpha-particle was investigated, also using Monte Carlo simulations. Alpha-particles emitted from bone and marrow contributed an average dose of 1.9 Gy to stem cells with a nuclear diameter of 3.8 {mu}m. This study has estimated that 1% of babies born each year are born with a mutated primitive haemopoietic stem cell due to in utero irradiation from high LET radiation. That is 7,320 babies compared to an estimated 300 incidences of cALL each year initiated in utero. The probability that a mutated cell will go on to give rise to leukaemia is unknown but it would seem not unlikely that irradiation in utero plays a substantial part in the induction of childhood leukaemia. (author)

  4. SU-F-T-558: ArcCheck for Patient Specific QA in Stereotactic Ablative Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ramachandran, P [Peter MacCallum Cancer Centre, Melbourne (Australia); RMIT University, Bundoora (Australia); Tajaldeen, A; Esen, N; Geso, M [RMIT University, Bundoora (Australia); Taylor, D; Wanigaratne, D; Roozen, K; Kron, T [Peter MacCallum Cancer Centre, Melbourne (Australia)

    2016-06-15

    Purpose: Stereotactic Ablative Radiotherapy (SABR) is one of the most preferred treatment techniques for early stage lung cancer. This technique has been extended to other treatment sites like Spine, Liver, Scapula, Sternum etc., This has resulted in increased physics QA time on machine. In this study, we’ve tested the feasibility of using ArcCheck as an alternative method to replace film dosimetry. Methods: Twelve patients with varied diagnosis of Lung, Liver, scapula, sternum and Spine undergoing SABR were selected for this study. Pre-treatment QA was performed for all the patients which include ionization chamber and film dosimetry. The required gamma criteria for each SABR plan to pass QA and proceed to treatment is 95% (3%,1mm). In addition to this routine process, the treatment plans were exported on to an ArcCheck phantom. The planned and measured dose from the ArcCheck device were compared using four different gamma criteria: 2%,2 mm, 3%,2 mm, 3%,1 mm and 3%, 3 mm. In addition to this, we’ve also introduced errors to gantry, collimator and couch angle to assess sensitivity of the ArcCheck with potential delivery errors. Results: The ArcCheck mean passing rates for all twelve cases were 76.1%±9.7% for gamma criteria 3%,1 mm, 89.5%±5.3% for 2%,2 mm, 92.6%±4.2% for 3%,2 mm, and 97.6%±2.4% for 3%,3 mm gamma criteria. When SABR spine cases are excluded, we observe ArcCheck passing rates higher than 95% for all the studied cases with 3%, 3mm, and ArcCheck results in acceptable agreement with the film gamma results. Conclusion: Our ArcCheck results at 3%, 3 mm were found to correlate well with our non-SABR spine routine patient specific QA results (3%,1 mm). We observed significant reduction in QA time on using ArcCheck for SABR QA. This study shows that ArcCheck could replace film dosimetry for all sites except SABR spine.

  5. Spine surgeon's kinematics during discectomy, part II: operating table height and visualization methods, including microscope.

    Science.gov (United States)

    Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2014-05-01

    Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope. We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position. Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method

  6. Human occupants in low-speed frontal sled tests: effects of pre-impact bracing on chest compression, reaction forces, and subject acceleration.

    Science.gov (United States)

    Kemper, Andrew R; Beeman, Stephanie M; Madigan, Michael L; Duma, Stefan M

    2014-01-01

    The purpose of this study was to investigate the effects of pre-impact bracing on the chest compression, reaction forces, and accelerations experienced by human occupants during low-speed frontal sled tests. A total of twenty low-speed frontal sled tests, ten low severity (∼2.5g, Δv=5 kph) and ten medium severity (∼5g, Δv=10 kph), were performed on five 50th-percentile male human volunteers. Each volunteer was exposed to two impulses at each severity, one relaxed and the other braced prior to the impulse. A 59-channel chestband, aligned at the nipple line, was used to quantify the chest contour and anterior-posterior sternum deflection. Three-axis accelerometer cubes were attached to the sternum, 7th cervical vertebra, and sacrum of each subject. In addition, three linear accelerometers and a three-axis angular rate sensor were mounted to a metal mouthpiece worn by each subject. Seatbelt tension load cells were attached to the retractor, shoulder, and lap portions of the standard three-point driver-side seatbelt. In addition, multi-axis load cells were mounted to each interface between the subject and the test buck to quantify reaction forces. For relaxed tests, the higher test severity resulted in significantly larger peak values for all resultant accelerations, all belt forces, and three resultant reaction forces (right foot, seatpan, and seatback). For braced tests, the higher test severity resulted in significantly larger peak values for all resultant accelerations, and two resultant reaction forces (right foot and seatpan). Bracing did not have a significant effect on the occupant accelerations during the low severity tests, but did result in a significant decrease in peak resultant sacrum linear acceleration during the medium severity tests. Bracing was also found to significantly reduce peak shoulder and retractor belt forces for both test severities, and peak lap belt force for the medium test severity. In contrast, bracing resulted in a significant

  7. Automatic detection system for multiple region of interest registration to account for posture changes in head and neck radiotherapy

    Science.gov (United States)

    Mencarelli, A.; van Beek, S.; Zijp, L. J.; Rasch, C.; van Herk, M.; Sonke, J.-J.

    2014-04-01

    Despite immobilization of head and neck (H and N) cancer patients, considerable posture changes occur over the course of radiotherapy (RT). To account for the posture changes, we previously implemented a multiple regions of interest (mROIs) registration system tailored to the H and N region for image-guided RT correction strategies. This paper is focused on the automatic segmentation of the ROIs in the H and N region. We developed a fast and robust automatic detection system suitable for an online image-guided application and quantified its performance. The system was developed to segment nine high contrast structures from the planning CT including cervical vertebrae, mandible, hyoid, manubrium of sternum, larynx and occipital bone. It generates nine 3D rectangular-shaped ROIs and informs the user in case of ambiguities. Two observers evaluated the robustness of the segmentation on 188 H and N cancer patients. Bland-Altman analysis was applied to a sub-group of 50 patients to compare the registration results using only the automatically generated ROIs and those manually set by two independent experts. Finally the time performance and workload were evaluated. Automatic detection of individual anatomical ROIs had a success rate of 97%/53% with/without user notifications respectively. Following the notifications, for 38% of the patients one or more structures were manually adjusted. The processing time was on average 5 s. The limits of agreement between the local registrations of manually and automatically set ROIs was comprised between ±1.4 mm, except for the manubrium of sternum (-1.71 mm and 1.67 mm), and were similar to the limits agreement between the two experts. The workload to place the nine ROIs was reduced from 141 s (±20 s) by the manual procedure to 59 s (±17 s) using the automatic method. An efficient detection system to segment multiple ROIs was developed for Cone-Beam CT image-guided applications in the H and N region and is clinically implemented in

  8. Three dimensional conformal radiotherapy for synchronous bilateral breast irradiation using a mono iso-center technique

    Science.gov (United States)

    Mani, Karthick Raj; Basu, Saumen; Bhuiyan, Md Anisuzzaman; Ahmed, Sharif; Sumon, Mostafa Aziz; Haque, Kh Anamul; Sengupta, Ashim Kumar; Un Nabi, Md Rashid; Das, K. J. Maria

    2017-06-01

    Objective: The purpose of this study is to demonstrate the synchronous bilateral breast irradiation radiotherapy technique using a single isocenter. Materials and Methods: Six patients of synchronous bilateral breast were treated with single isocenter technique from February 2011 to June 2016. All the patients underwent a CT-simulation using appropriate positioning device. Target volumes and critical structures like heart, lung, esophagus, thyroid, etc., were delineated slice by slice in the CT data. An isocenter was placed above the sternum on the skin and both medial tangential and lateral tangential of the breast / chest wall were created using asymmetrical jaws to avoid the beam divergence through the lung and heart. The field weighting were adjusted manually to obtain a homogenous dose distribution. The planning objectives were to deliver uniform doses around the target and keep the doses to the organ at risk within the permissible limit. The beam energy of 6 MV or combination of 6 MV and 15 MV photons were used in the tangential fields according to the tangential separation. Boluses were used for all the mastectomy patients to increase the doses on the chest wall. In addition to that enhanced dynamic wedge and field in field technique were also used to obtain a homogenous distribution around the target volume and reduce the hot spots. The isocenter was just kept on the skin, such that the beam junctions will be overlapped only on the air just above the sternum. Acute toxicity during the treatment and late toxicity were recorded during the patient's follow-up. Results: During the radiotherapy treatment follow-up there were no acute skin reactions in the field junctions, but one patient had grade 1 esophagitis and two patients had grade 2 skin reactions in the chest wall. With a median follow-up of 38.5 months (range: 8 - 49 months), no patients had a local recurrence, but one patients with triple negative disease had a distant metastases in brain and died

  9. Estimation of core body temperature from skin temperature, heat flux, and heart rate using a Kalman filter.

    Science.gov (United States)

    Welles, Alexander P; Xu, Xiaojiang; Santee, William R; Looney, David P; Buller, Mark J; Potter, Adam W; Hoyt, Reed W

    2018-05-18

    Core body temperature (T C ) is a key physiological metric of thermal heat-strain yet it remains difficult to measure non-invasively in the field. This work used combinations of observations of skin temperature (T S ), heat flux (HF), and heart rate (HR) to accurately estimate T C using a Kalman Filter (KF). Data were collected from eight volunteers (age 22 ± 4 yr, height 1.75 ± 0.10 m, body mass 76.4 ± 10.7 kg, and body fat 23.4 ± 5.8%, mean ± standard deviation) while walking at two different metabolic rates (∼350 and ∼550 W) under three conditions (warm: 25 °C, 50% relative humidity (RH); hot-humid: 35 °C, 70% RH; and hot-dry: 40 °C, 20% RH). Skin temperature and HF data were collected from six locations: pectoralis, inner thigh, scapula, sternum, rib cage, and forehead. Kalman filter variables were learned via linear regression and covariance calculations between T C and T S , HF, and HR. Root mean square error (RMSE) and bias were calculated to identify the best performing models. The pectoralis (RMSE 0.18 ± 0.04 °C; bias -0.01 ± 0.09 °C), rib (RMSE 0.18 ± 0.09 °C; bias -0.03 ± 0.09 °C), and sternum (RMSE 0.20 ± 0.10 °C; bias -0.04 ± 0.13 °C) were found to have the lowest error values when using T S , HF, and HR but, using only two of these measures provided similar accuracy. Copyright © 2018. Published by Elsevier Ltd.

  10. Virtual simulation of the postsurgical cosmetic outcome in patients with Pectus Excavatum

    Science.gov (United States)

    Vilaça, João L.; Moreira, António H. J.; L-Rodrigues, Pedro; Rodrigues, Nuno; Fonseca, Jaime C.; Pinho, A. C. M.; Correia-Pinto, Jorge

    2011-03-01

    Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which several ribs and the sternum grow abnormally. Nowadays, the surgical correction is carried out in children and adults through Nuss technic. This technic has been shown to be safe with major drivers as cosmesis and the prevention of psychological problems and social stress. Nowadays, no application is known to predict the cosmetic outcome of the pectus excavatum surgical correction. Such tool could be used to help the surgeon and the patient in the moment of deciding the need for surgery correction. This work is a first step to predict postsurgical outcome in pectus excavatum surgery correction. Facing this goal, it was firstly determined a point cloud of the skin surface along the thoracic wall using Computed Tomography (before surgical correction) and the Polhemus FastSCAN (after the surgical correction). Then, a surface mesh was reconstructed from the two point clouds using a Radial Basis Function algorithm for further affine registration between the meshes. After registration, one studied the surgical correction influence area (SCIA) of the thoracic wall. This SCIA was used to train, test and validate artificial neural networks in order to predict the surgical outcome of pectus excavatum correction and to determine the degree of convergence of SCIA in different patients. Often, ANN did not converge to a satisfactory solution (each patient had its own deformity characteristics), thus invalidating the creation of a mathematical model capable of estimating, with satisfactory results, the postsurgical outcome.

  11. Rates of morphological evolution are heterogeneous in Early Cretaceous birds

    Science.gov (United States)

    Lloyd, Graeme T.

    2016-01-01

    The Early Cretaceous is a critical interval in the early history of birds. Exceptional fossils indicate that important evolutionary novelties such as a pygostyle and a keeled sternum had already arisen in Early Cretaceous taxa, bridging much of the morphological gap between Archaeopteryx and crown birds. However, detailed features of basal bird evolution remain obscure because of both the small sample of fossil taxa previously considered and a lack of quantitative studies assessing rates of morphological evolution. Here we apply a recently available phylogenetic method and associated sensitivity tests to a large data matrix of morphological characters to quantify rates of morphological evolution in Early Cretaceous birds. Our results reveal that although rates were highly heterogeneous between different Early Cretaceous avian lineages, consistent patterns of significantly high or low rates were harder to pinpoint. Nevertheless, evidence for accelerated evolutionary rates is strongest at the point when Ornithuromorpha (the clade comprises all extant birds and descendants from their most recent common ancestors) split from Enantiornithes (a diverse clade that went extinct at the end-Cretaceous), consistent with the hypothesis that this key split opened up new niches and ultimately led to greater diversity for these two dominant clades of Mesozoic birds. PMID:27053742

  12. An investigation of mechanical nociceptive thresholds in dogs with hind limb joint pain compared to healthy control dogs.

    Science.gov (United States)

    Harris, L K; Whay, H R; Murrell, J C

    2018-04-01

    This study investigated the effects of osteoarthritis (OA) on somatosensory processing in dogs using mechanical threshold testing. A pressure algometer was used to measure mechanical thresholds in 27 dogs with presumed hind limb osteoarthritis and 28 healthy dogs. Mechanical thresholds were measured at the stifles, radii and sternum, and were correlated with scores from an owner questionnaire and a clinical checklist, a scoring system that quantified clinical signs of osteoarthritis. The effects of age and bodyweight on mechanical thresholds were also investigated. Multiple regression models indicated that, when bodyweight was taken into account, dogs with presumed osteoarthritis had lower mechanical thresholds at the stifles than control dogs, but not at other sites. Non-parametric correlations showed that clinical checklist scores and questionnaire scores were negatively correlated with mechanical thresholds at the stifles. The results suggest that mechanical threshold testing using a pressure algometer can detect primary, and possibly secondary, hyperalgesia in dogs with presumed osteoarthritis. This suggests that the mechanical threshold testing protocol used in this study might facilitate assessment of somatosensory changes associated with disease progression or response to treatment. Copyright © 2017. Published by Elsevier Ltd.

  13. Extraction of aggrecan-peptide from cartilage by tissue autolysis.

    Science.gov (United States)

    Nakano, Takuo; Srichamroen, Anchalee; Ozimek, Lech

    2014-01-01

    Aggrecan is a cartilage specific proteoglycan containing chondroitin sulfate (CS) and keratan sulfate (KS). CS is an acidic polysaccharide having wide range of applications in pharmaceutical, cosmetic, and food industries. CS is extracted from cartilage by tissue proteolysis with an exogenous proteinase or by activating endogenous proteinases (autolysis) to release aggrecan-peptides from the tissue. This review is focused on the latter technique. Bovine nasal and tracheal cartilages, and broiler chicken sternum cartilage have been used for autolysis studies. To extract aggrecan-peptide, cartilage tissues are cut into small pieces, and incubated in a monovalent or divalent salt solution (e.g., 0.1 M sodium or calcium acetate) at pH 4.5 and 37 °C for 7 - 24 h. Most (~80% or more) of total tissue uronic acid, a constituent sugar of aggrecan, is extracted and released into the salt solution during incubation. Reextraction of the tissue residue results in release of a small amount of uronic acid. Aggrecan-peptides purified using anion exchange chromatography are large compounds containing CS and KS. On gel chromatography, they are excluded from the column of Sephacryl S-300. Chemical composition analysis demonstrated that aggrecan-peptides from either bovine or chicken cartilage contain >90% CS with small amount (autolysis has been used as a plate coating antigen in enzyme- linked immunosorbent assay (ELISA) to determine KS.

  14. The bridge technique for pectus bar fixation: a method to make the bar un-rotatable.

    Science.gov (United States)

    Park, Hyung Joo; Kim, Kyung Soo; Moon, Young Kyu; Lee, Sungsoo

    2015-08-01

    Pectus bar rotation is a major challenge in pectus repair. However, to date, no satisfactory technique to completely eliminate bar displacement has been introduced. Here, we propose a bar fixation technique using a bridge that makes the bar unmovable. The purpose of this study was to determine the efficacy of this bridge technique. A total of 80 patients underwent pectus bar repair of pectus excavatum with the bridge technique from July 2013 to July 2014. The technique involved connecting 2 parallel bars using plate-screws at the ends of the bars. To determine bar position change, the angles between the sternum and pectus bars were measured on postoperative day 5 (POD5) and 4 months (POM4) and compared. The mean patient age was 17.5 years (range, 6-38 years). The mean difference between POD5 and POM4 were 0.23° (P=.602) and 0.35° (P=.338) for the upper and lower bars, respectively. Bar position was virtually unchanged during the follow-up, and there was no bar dislocation or reoperation. A "bridge technique" designed to connect 2 parallel bars using plates and screws was demonstrated as a method to avoid pectus bar displacement. This approach was easy to implement without using sutures or invasive devices. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Primary osteosarcoma of the breast presenting as a large breast abscess

    Directory of Open Access Journals (Sweden)

    Nadeesha J Nawarathna

    2016-01-01

    Full Text Available Primary extra osseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none-phylloides sarcoma of a previously normal breast. Due to its rarity, the natural history and optimal treatment methods remain unclear. Sixty-year-old patient presented to the surgical casualty with a large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent imunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. Patient was referred to the oncologist for further management. Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy aid to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the bones of sternum and ribs was excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

  16. Unusual Clinical Presentation of a Rare Type of Breast Malignancy: A Case Report and a Short Review of Literature

    Directory of Open Access Journals (Sweden)

    Nadeesha J Nawarathna

    2015-01-01

    Full Text Available Primary extra osseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none-phyllodes sarcoma of a previously normal breast. Due to its rarity, natural history and optimal treatment methods remain unclear. A 60-year-old patient presented to the surgical casualty ward with large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent imunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. The patient was referred to the oncologist for further management. Rare types of breast tumors could present as breast abscess. Incision and drainage, together with wall biopsy, helped to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the sternum and ribs were excluded. Treatment was similar to sarcomas affecting other locations and should comprise a multidisciplinary approach.

  17. Unusual presentation of primary extra osseous osteosarcoma: As breast abscess

    Directory of Open Access Journals (Sweden)

    N J Nawarathna

    2016-01-01

    Full Text Available Primary extra osseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none-phylloides sarcoma of a previously normal breast. Due to its rarity, natural history and optimal treatment methods remain unclear. A 60-year-old patient presented to the surgical casualty with large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent imunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. The patient was referred to the oncologist for further management. Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy help to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the sternum and ribs were excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

  18. Chemical rescue of cleft palate and midline defects in conditional GSK-3beta mice.

    Science.gov (United States)

    Liu, Karen J; Arron, Joseph R; Stankunas, Kryn; Crabtree, Gerald R; Longaker, Michael T

    2007-03-01

    Glycogen synthase kinase-3beta (GSK-3beta) has integral roles in a variety of biological processes, including development, diabetes, and the progression of Alzheimer's disease. As such, a thorough understanding of GSK-3beta function will have a broad impact on human biology and therapeutics. Because GSK-3beta interacts with many different pathways, its specific developmental roles remain unclear. We have discovered a genetic requirement for GSK-3beta in midline development. Homozygous null mice display cleft palate, incomplete fusion of the ribs at the midline and bifid sternum as well as delayed sternal ossification. Using a chemically regulated allele of GSK-3beta (ref. 6), we have defined requirements for GSK-3beta activity during discrete temporal windows in palatogenesis and skeletogenesis. The rapamycin-dependent allele of GSK-3beta produces GSK-3beta fused to a tag, FRB* (FKBP/rapamycin binding), resulting in a rapidly destabilized chimaeric protein. In the absence of drug, GSK-3beta(FRB)*(/FRB)* mutants appear phenotypically identical to GSK-3beta-/- mutants. In the presence of drug, GSK-3betaFRB* is rapidly stabilized, restoring protein levels and activity. Using this system, mutant phenotypes were rescued by restoring endogenous GSK-3beta activity during two distinct periods in gestation. This technology provides a powerful tool for defining windows of protein function during development.

  19. A cannonball through the chest: disseminated tuberculosis, threatening the aortic arch.

    Science.gov (United States)

    Feldman, Henry J; Somai, Melek; Dweck, Ezra

    2014-01-01

    In 2012 the World Health Organization reported 8.7 million new cases of Tuberculosis worldwide, causing 1.4 million deaths (1). Despite modern drug therapy, this disease continues to present in novel ways and mimic other diseases causing misdiagnosis. We report this case to educate on the reason to suspect atypical Tuberculosis presentation, even if a common disease is diagnosed, when Tuberculosis remains in the differential. We also demonstrate that with globalization and patient moving between countries, that these presentations can occur in locations, where such atypical manifestations are very uncommon. We report on a 48 year old man with one month of malaise, fever, productive cough, night sweats, chills, pleuritic chest pain, weight loss and progressive non-painful swelling on his thorax. Initial diagnoses of interstitial pneumonia and a thoracic subcutaneous abscess were made. Needle drainage was attempted, with thick purulent material returned. When the sternum was not struck with the needle, a thoracic computed tomography scan was performed. A milliary pattern was noted in the lungs, with a large abscess present anteriorly, completely obliterating the manubrium, approaching the aorta with distant lesions. Subsequent analysis showed the material to be pan-sensitive M. Tuberculosis. The issue that this case raises is that when tuberculosi is in the differential, even common diseases may in fact be atypical manifestations of tuberculosis. In addition, when a shallow surgical procedure is going to be performed on the thoracic soft tissues, particularly when tuberculosis is suspected, imaging of the thorax should be obtained.

  20. Thalassornectes (Alcidectes) aukletae, new subgenus and species (Acari: Hypoderatidae) from the crested and parakeet auklets (Aves: Charadriiformes; Alcidae).

    Science.gov (United States)

    Pence, D B; Hoberg, E P

    1991-03-01

    In the genus Thalassornectes, a new subgenus, Alcidectes, and a new species, T. (Alcidectes) aukletae, are described from deutonymphs in the subcutaneous adipose tissue of the crested auklet, Aethia cristatella (Pallas), and the parakeet auklet, Cyclorrhynchus psittacula (Pallas), from the eastern Pacific USSR. The new subgenus and species differ from one or both of the single species in each of the other two subgenera, Thalassornectes and Rallidectes, by (1) the normal size, position, and parallel arrangement of the genital papillae; (2) the larger size of seta sce; (3) the greater length and stronger development of setae sci, d1, l1, h, and sh; (4) the equal size of tarsi III and IV or their size subequal, with tarsus IV slightly longer than tarsus III; (5) both epimera I and sternum well developed and nearly equal in length; and (6) the free sclerotized posteriad extension from epimerite II on the ventral cuticular surface. This is the first hypoderatid reported from the host order Charadriiformes. The distribution of T. (Alcidectes) aukletae among auklets may be attributed to either cospeciation or may have an ecological basis; data are insufficient at present to sustain either hypothesis.

  1. Challenges in automated estimation of capillary refill time in dogs

    Science.gov (United States)

    Cugmas, Blaž; Spigulis, Janis

    2018-02-01

    Capillary refill time (CRT) is a part of the cardiorespiratory examination in dogs. Changes in CRT can reflect pathological conditions like shock or anemia. Visual CRT estimation has low repeatability; therefore, optical systems for automated estimation have recently appeared. Since existing systems are unsuitable for use in dogs, we designed a simple, small and portable device, which could be easily used at veterinary clinic. The device was preliminarily tested on several measurement sites in two dogs. Not all measurement sites were suitable for CRT measurements due to underlying tissue optical and mechanical properties. The CRT measurements were possible on the labial mucosa, above the sternum and on the digit where CRT was in the range of values, retrieved from the color video of the visual CRT measurement. It seems that light penetration predominantly governs tissue optical response when the pressure is applied. Therefore, it is important to select a proper light, which reaches only superficial capillaries and does not penetrate deeper. Blue or green light is probably suitable for light skin or mucosa, on the other hand, red or near-infrared might be used for skin with pigmented or thick epidermis. Additionally, further improvements of the device design are considered, like adding a calibrated spring, which would insure application of consistent pressure.

  2. Effects of a 4.7 T static magnetic field on fetal development in ICR mice

    International Nuclear Information System (INIS)

    Okazaki, Ryuji; Ootsuyama, Akira; Uchida, Soshi; Norimura, Toshiyuki

    2001-01-01

    In order to determine the effects of a 4.7 T static magnetic field (SMF) on fetal development in mice, we evaluated fetal teratogenesis and endochondral ossification following exposure in utero. Pregnant ICR mice were exposed to a 4.7 T SMF from day 7.5 to 9.5 of gestation in a whole-body dose, and sacrificed on day 18.5 of gestation. We examined with incidence of prenatal death, external malformations and fetal skeletal malformations. There were no significant differences observed in the incidence of prenatal death and/or malformations between SMF-exposed mice and control mice. Further, we evaluated the immunoreactivity for the vascular endothelial growth factor (VEGF), which is implicated in angiogenesis and osteogenesis, in the sternum of fetal mice following magnetic exposure. Our studies also indicated that on day 16.5 of gestation following SMF exposure, the immunoreactivity for VEGF was increased compared to unexposed controls. However, it was decreased in the exposed group compared to the control group on day 18.5 of gestation. DNA and proteoglycan (PG) synthesis were also measured in rabbit costal growth plate chondrocytes in vitro. No significant differences were observed in DNA synthesis between the SMF exposed chondrocytes and the control chondrocytes; however, PG synthesis in SMF exposed chondrocytes increased compared to the controls. Based on these results, we suggest that while SMF exposure promoted the endochondral ossification of chondrocytes, it did not induce any harmful effects on fetal development in ICR mice. (author)

  3. Sequence Learning with Passive RFID Sensors for Real-Time Bed-Egress Recognition in Older People.

    Science.gov (United States)

    Wickramasinghe, Asanga; Ranasinghe, Damith C; Fumeaux, Christophe; Hill, Keith D; Visvanathan, Renuka

    2017-07-01

    Getting out of bed and ambulating without supervision is identified as one of the major causes of patient falls in hospitals and nursing homes. Therefore, increased supervision is proposed as a key strategy toward falls prevention. An emerging generation of batteryless, lightweight, and wearable sensors are creating new possibilities for ambulatory monitoring, where the unobtrusive nature of such sensors makes them particularly adapted for monitoring older people. In this study, we investigate the use of a batteryless radio-frequency identification (RFID) tag response to analyze bed-egress movements. We propose a bed-egress movement detection framework that includes a novel sequence learning classifier with a set of features derived from bed-egress motion analysis. We analyzed data from 14 healthy older people (66-86 years old) who wore a wearable embodiment of a batteryless accelerometer integrated RFID sensor platform loosely attached over their clothes at sternum level, and undertook a series of activities including bed-egress in two clinical room settings. The promising results indicate the efficacy of our batteryless bed-egress monitoring framework.

  4. On the compensating filter in pulmonary hilar tomography

    International Nuclear Information System (INIS)

    Okayama, Akio; Nakanishi, Takashi; Fujikawa, Tsuyoshi; Inaba, Nobuo; Fujii, Shinichi

    1979-01-01

    In recent years, it has been an important theme for the diagnosis of pulmonary hilar cancer to evaluate whether the lesion in hilar lymph nodes and the vicinity of the hilar bronchus exists or does not. It is shown that pulmonary hilar region is from main bronchus to segmental bronchus which is separating subsegmental bronchus. It is difficult to make the optimal density for all area of the pulmonary hilar region on a same film, because there is too much difference of density between medial region under the veil of thoracic vertebra, sternum, heart and great vessels, and lateral region in conventional tomography. Therefore, a compensating filter was constructed to equalize the uneven density of pulmonary hilar region on a X-ray film. As a result, trachea, main bronchus, upper local and segmental bronchus were observed simultaneously and serially on a same film by using this filter. In addition, we could study the condition in the inside and outside of bronchial wall in detail, and have many informations compared with conventional tomogram. Particularly, this is an useful method to determine the range of lesion in the pulmonary hilar cancer. (author)

  5. A review of eleven cases of tuberculosis presenting as sternal wound abscess after open heart surgery.

    Science.gov (United States)

    Tabaja, Hussam; Hajar, Zeina; Kanj, Souha S

    2017-10-01

    Sternal wound infection with Mycobacterium tuberculosis is an uncommon yet highly challenging disease that can be quite insidious with various presentations. We hereby provide a review of 10 cases in current literature and describe an additional case which illustrates the difficulties associated with diagnosis. We used PubMed and Google search engine to search the literature for all published papers reporting on cases of sternal M. tuberculosis infections post open-heart surgeries. A total of 11 cases were presented, including a case of our own. The majority were males and were exposed to endemic areas. The average age was 59.6 ± 15.5 years. Coronary artery bypass surgery accounted for 73% of procedures and the average time to symptoms onset was 12.2 ± 16.6 months. Diabetes was the most reported non-cardiac comorbidity. Presenting symptoms varied and only 5 patients had other organs involved. Blood tests and radiographic studies were neither sensitive nor specific. M. tuberculosis culture on debrided tissues was the most sensitive test but often forgotten initially. Diagnostic delay was seen in almost all cases, often leading to unnecessary courses of antibiotics and aggressive surgical interventions. Finally, all patients responded well to anti-tuberculosis treatment, with reported treatment duration ranging from 9 to 12 months. M. tuberculosis infection of the sternum should be suspected in late-onset sternal wound infections post open-heart surgery especially when the course is chronic and indolent.

  6. Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis.

    Science.gov (United States)

    Juhl, Alexander Andersen; Hody, Sofie; Videbaek, Tina Senholt; Damsgaard, Tine Engberg; Nielsen, Per Hostrup

    2017-04-20

    The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.

  7. Voluminous post-traumatic mediastinal haematoma: late presentation in DEA

    Directory of Open Access Journals (Sweden)

    Luciano Cardinale

    2008-10-01

    Full Text Available Mediastinal haematoma in the settings of blunt chest trauma can produce potentially serious problems. Nonaortic sources include disruption of arch vessels, rupture of small mediastinal veins, fractures of ribs/sternum and injury to the intercostal and internal thoracic vessels. Rupture of the aorta and great vessels is less frequent. Mediastinal haematoma presents a dual threat to haemodynamic stability, both as source of blood loss and because of compression of vascular structures such as the heart and pulmonary arteries. The case presented here tells about a patient who was initially in good conditions and haemodynamically stable, with no radiologic abnormalities. Some hours later he developed chest pain with hypotension due to sudden growth of large mediastinal haematoma. Multiphase multi-detector CT (MDCT in our case allowed prompt detection of active bleeding in the arterial phase, a specific sign of arterial injury, with cardiac tamponade, which required immediate surgical treatment. MDCT is commonly considered the gold standard in severe thoracic trauma. Improvements in CT scanner technology have markedly shortened scanning times and now provide cardiac and vessels images of high quality during routine chest CT examinations.

  8. Bone marrow scintigraphy using 111Indium chloride in patients with aplastic anemia

    International Nuclear Information System (INIS)

    Mabuchi, Nobuhisa; Kumano, Machiko; Matsumoto, Fumiko; Arita, Shigehiro; Nakagawa, Kenichi; Fujii, Koichi; Yoshioka, Hiroyasu; Hamada, Tatsumi; Ishida, Osamu

    1987-01-01

    Bone marrow scintigraphy using 111 Indium chloride ( 111 In-chloride) was performed in 18 patients with aplastic anemia. The scintigrams were taken 48 hours after an intravenous injection of 111 In-chloride 3 mCi. The distribution patterns on scintigram were classified into 5 types: Type I (4 cases) showed no accumulation, Type II (6 cases) showed low accumulation in usual bone marrow sites. Type III (7 cases) showed island-like distribution in bone marrow sites. Type IV, although no case was included in the 18 patients, shows uneven distribution between pelvis and sternum or vertebrae. Type V (one case) showed almost normal accumulation in usual bone marrow sites. Bone marrow uptake of 111 In-chloride correlated well with the cellularity of bone marrow. There was a tendency for the cases of markedly increased saturated iron-binding capacity to show increased renal activity. In type III, both the percentage of cases who had been treated and the count of reticulocytes were higher than those in the other types, which suggested that island-like distribution on scintigram showed the regeneration responded to the therapy, and related to the erythropoietic function. (author)

  9. Bone marrow scintigraphy using /sup 111/Indium chloride in patients with aplastic anemia

    Energy Technology Data Exchange (ETDEWEB)

    Mabuchi, Nobuhisa; Kumano, Machiko; Matsumoto, Fumiko; Arita, Shigehiro; Nakagawa, Kenichi; Fujii, Koichi; Yoshioka, Hiroyasu; Hamada, Tatsumi; Ishida, Osamu

    1987-12-01

    Bone marrow scintigraphy using /sup 111/Indium chloride (/sup 111/In-chloride) was performed in 18 patients with aplastic anemia. The scintigrams were taken 48 hours after an intravenous injection of /sup 111/In-chloride 3 mCi. The distribution patterns on scintigram were classified into 5 types: Type I (4 cases) showed no accumulation, Type II (6 cases) showed low accumulation in usual bone marrow sites. Type III (7 cases) showed island-like distribution in bone marrow sites. Type IV, although no case was included in the 18 patients, shows uneven distribution between pelvis and sternum or vertebrae. Type V (one case) showed almost normal accumulation in usual bone marrow sites. Bone marrow uptake of /sup 111/In-chloride correlated well with the cellularity of bone marrow. There was a tendency for the cases of markedly increased saturated iron-binding capacity to show increased renal activity. In type III, both the percentage of cases who had been treated and the count of reticulocytes were higher than those in the other types, which suggested that island-like distribution on scintigram showed the regeneration responded to the therapy, and related to the erythropoietic function.

  10. Radiological and clinical aspects of M. Paget

    International Nuclear Information System (INIS)

    Reid, W.

    1983-01-01

    Deforming bone dystrophy according to Paget is a disease of uncertain etiology and the affected age group is above 40. Earlier manifestations are rare. The most frequent site of the pathologic process is the pelvis. Further locations are the lumbar section of the vertebral column, the sacrum, extremities, skull, and the thoracal and cervical parts of the vertebral column. The sternum, clavides, hands, feet and ribs are rarely affected. There is no predisposition by sex, but more often the right half of the body seems to be attacked. Monostotic and polyostotic incidence are noted about equally often (Scully et al. 1981). As to the overall diagnostical mode of action, the following is suggested: If a bone has been attacked by M. Paget, skeletal scintiscanning of the total body with a bone-detecting tracer has to follow. If further skeletal sections turn out to be conspicuous, they have to be X-rayed. By proceeding in this manner, firstly, the diagnose can be confirmed and, secondly, the initial findings can be documented. Pharmaceutical therapy should be attempted if patients are severely affected and if there are special indications. (orig.) [de

  11. Effective detection method for falls according to the distance between two tri-axial accelerometers

    Science.gov (United States)

    Kim, Jae-Hyung; Park, Geun-Chul; Kim, Soo-Hong; Kim, Soo-Sung; Lee, Hae-Rim; Jeon, Gye-Rok

    2016-04-01

    Falls and fall-related injuries are a significant problem in the elderly population. A number of different approaches for detecting falls and activities of daily living (ADLs) have been conducted in recent years. However, distinguishing between real falls and certain fall-like ADL is often difficult. The aim of this study is to discriminate falls from fall-like ADLs such as jogging, jumping, and jumping down. The distance between two tri-axial accelerometers attached to the abdomen and the sternum was increased from 10 to 30 cm in 10-cm intervals. Experiments for falls and ADLs were performed to investigate the feasibility of the detection system for falls developed in this study. When the distances between the two tri-axial electrometers were 20 and 30 cm, fall-like ADLs were effectively distinguished from falls. The thresholds for three parameters — SVM, Diff Z, and Sum_diff_Z — were set; falls could be distinguished from ADL action sequences when the SVM value was larger than 4 g (TH1), the Diff_Z parameter was larger than 1.25 g (TH2), and the Sum_diff_Z parameter was larger than 15 m/s (TH3). In particular, when the SVM, Diff_Z, and Sum_diff_Z parameter were sequentially applied to thresholds (TH1, TH2, and TH3), fall-like ADL action sequences were accurately discriminated from falls.

  12. Scintigraphic imaging with technetium-99M-labelled ceftizoxime is a reliable technique for the diagnosis of deep sternal wound infection in rats

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Paulo Henrique Nogueira; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento; Tarabal, Bernardo; Takenaka, Isabella; Braga, Otavio; Vidigal, Paula Vieira Teixeira; Gelape, Claudio Leo; Araujo, Ivana Duval, E-mail: phnc@uol.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil)

    2015-07-01

    Purpose: to evaluate whether scintigraphy with technetium-99m-labeled ceftizoxime ({sup 99m}Tc-CFT) can differentiate mediastinitis from aseptic inflammation associated with sternotomy. Methods: twenty female Wistar rats were randomly distributed into four groups: S (control) -partial upper median sternotomy with no treatment; SW (control) - sternotomy and treatment of sternal wounds with bone wax; SB - sternotomy and infection with Staphylococcus aureus; SWB - sternotomy with bone wax treatment and bacterial infection. Scintigraphy with {sup 99m}Tc-CFT was performed eight days after surgery and images were collected 210 and 360 min after infusion of the radiopharmaceutical. Results: no animals exhibited clinical signs of wound infection at the end of the experiment, although histological data verified acute inflammatory response in those experimentally infected with bacteria. Scintigraphic images revealed that tropism of {sup 99m}Tc-CFT to infected sternums was greater than to their non-infected counterparts. Mean counts of radioactivity in bacteria-infected sternal regions (SB and SWB) were significantly higher (p = 0.0007) than those of the respective controls (S and SW).Conclusion: scintigraphy with technetium-99m-labeled ceftizoxime is a method that can potentially detect infection post sternotomy and differentiate from aseptic inflammation in animals experimentally inoculated with S. aureus (author)

  13. Identification of neural structures involved in stuttering using vibrotactile feedback.

    Science.gov (United States)

    Cheadle, Oliver; Sorger, Clarissa; Howell, Peter

    Feedback delivered over auditory and vibratory afferent pathways has different effects on the fluency of people who stutter (PWS). These features were exploited to investigate the neural structures involved in stuttering. The speech signal vibrated locations on the body (vibrotactile feedback, VTF). Eleven PWS read passages under VTF and control (no-VTF) conditions. All combinations of vibration amplitude, synchronous or delayed VTF and vibrator position (hand, sternum or forehead) were presented. Control conditions were performed at the beginning, middle and end of test sessions. Stuttering rate, but not speaking rate, differed between the control and VTF conditions. Notably, speaking rate did not change between when VTF was delayed versus when it was synchronous in contrast with what happens with auditory feedback. This showed that cerebellar mechanisms, which are affected when auditory feedback is delayed, were not implicated in the fluency-enhancing effects of VTF, suggesting that there is a second fluency-enhancing mechanism. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Minimally invasive repair of pectus excavatum in an adolescent with a history of a median sternotomy as an infant

    Directory of Open Access Journals (Sweden)

    Lauren Huckaby

    2014-10-01

    Full Text Available The report by Nuss et al., in 1998 of their 10-year experience with minimally invasive repair of pectus excavatum introduced the possibility of a less invasive approach for the correction of chest wall abnormalities. This procedure is now well-accepted around the world, although serious complications such as intraoperative cardiac perforation and postoperative bar displacement have been reported. The Nuss procedure has been performed concurrently with sternotomy for cardiac operations. However, there have been no reports of minimally invasive pectus excavatum correction in a child with a remote history of a median sternotomy. With IRB approval (Protocol #1308002283 we report the successful completion of a Nuss procedure in an adolescent with a history of a median sternotomy in infancy. During the procedure, thoracoscopy on the right side revealed significant adhesions of the lung and pericardium to the posterior sternum. Additional trocars were placed bilaterally to facilitate visualization and to allow for lysis of the adhesions with bipolar cautery. Passage of the bar was accomplished uneventfully and the patient has an excellent cosmetic outcome 28 months following the operation. We believe that a previous median sternotomy should not be viewed as a contraindication to the minimally invasive repair of pectus excavatum.

  15. Ventricular septal necrosis after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Alireza Ahmadi

    2012-07-01

    Full Text Available Ventricular Septal Defect (VSD after blunt chest trauma is a very rare traumatic affection.We report here a case of blunt chest injury-related VSD and pseudoaneurysm.A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edemaand echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely theintracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue somehidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinicalsequelae.

  16. Cardiopulmonary resuscitation using the cardio vent device in a resuscitation model.

    Science.gov (United States)

    Suner, Selim; Jay, Gregory D; Kleinman, Gary J; Woolard, Robert H; Jagminas, Liudvikas; Becker, Bruce M

    2002-05-01

    To compare the "Bellows on Sternum Resuscitation" (BSR) device that permits simultaneous compression and ventilation by one rescuer with two person cardiopulmonary resuscitation (CPR) with bag-valve-mask (BVM) ventilation in a single blind crossover study performed in the laboratory setting. Tidal volume and compression depth were recorded continuously during 12-min CPR sessions with the BSR device and two person CPR. Six CPR instructors performed a total of 1,894 ventilations and 10,532 compressions in 3 separate 12-min sessions. Mean tidal volume (MTV) and compression rate (CR) with the BSR device differed significantly from CPR with the BVM group (1242 mL vs. 1065 mL, respectively, p = 0.0018 and 63.2 compressions per minute (cpm) vs. 81.3 cpm, respectively, p = 0.0076). Error in compression depth (ECD) rate of 9.78% was observed with the BSR device compared to 8.49% with BMV CPR (p = 0.1815). Error rate was significantly greater during the second half of CPR sessions for both BSR and BVM groups. It is concluded that one-person CPR with the BSR device is equivalent to two-person CPR with BVM in all measured parameters except for CR. Both groups exhibited greater error rate in CPR performance in the latter half of 12-min CPR sessions.

  17. Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Yousefifard, Mahmoud; Baikpour, Masoud; Ghelichkhani, Parisa; Asady, Hadi; Darafarin, Abolfazl; Amini Esfahani, Mohammad Reza; Hosseini, Mostafa; Yaseri, Mehdi; Safari, Saeed

    2016-01-01

    The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet; therefore, the present study aimed to conduct a thorough meta-analytic systematic review on this subject. Two reviewers independently carried out a comprehensive systematic search in Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest databases. Data were summarized as true positive, false positive, true negative and false negative and were analyzed via STATA 11.0 software using a mixed-effects binary regression model. Sources of heterogeneity were further assessed through subgroup analysis. Data on 1667 patients (807 subjects with and 860 cases without thoracic fractures), whose age ranged from 0 to 92 years, were extracted from 17 surveys. Pooled sensitivity and specificity of ultrasonography in detection of thoracic bone fractures were 0.97 (95% CI: 0.90-0.99; I2= 88.88, prib fractures, compared to fractures of sternum or clavicle (97% vs. 91%). Moreover, the sensitivity was found to be higher when the procedure was carried out by a radiologist in comparison to an emergency medicine specialist (96% vs. 90%). Base on the findings of the present meta-analysis, screening performance characteristic of ultrasonography in detection of thoracic bone fractures was found to be higher than radiography. However, these characteristics were more prominent in detection of rib fractures and in cases where was performed by a radiologist.

  18. Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Jonathan C.; Demertzis, Jennifer L. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, Musculoskeletal Section, St Louis, MO (United States)

    2016-06-15

    In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture. (orig.)

  19. An osteomalacia related to phosphate diabetes - bone scintigraphy with SPECT/CT contribution; Une osteomalacie liee a un diabete phosphore - role de la scintigraphie osseuse couplee a la TEMP-TDM

    Energy Technology Data Exchange (ETDEWEB)

    Ruyer, A.; Granier, P.; Mourad, M. [Centre Hospitalier Antoine-Gayraud, Service de Medecine Nucleaire, 11 - Carcassonne (France)

    2009-12-15

    We report the case of a 59-year-old woman, investigated for disabling pain of the left thigh, unrelated to any traumatic event. Interrogation had found diffuse pain of myalgia-type and arthralgia-type for approximately a year without local inflammatory signs and insufficiency fractures of both calcaneus two years before. The Technetium {sup 99m}-labeled hydroxy-methylene diphosphonate ({sup 99m}Tc-H.D.P.) whole-body bone scintigraphy evidenced multiple hot spots on the higher third of left femur, rib cage, sternum, scapula, pelvis, right hip and both calcaneus. Moreover, a more diffuse and heterogeneous prominent uptake appeared on rib cage, spine and pelvis. These images suggested a diffuse metastatic disease of the skeleton. The single photon emission computerized tomography guided by computerized tomography (SPECT/CT), centered on lumbar spine, pelvis and the upper end of femurs showed that the multiple hot spots were in fact bone fractures. These findings pointed diagnosis to a metabolic disease. The clinical context was in favour of an osteomalacia. Further explorations showed an osteomalacia related to phosphate diabetes. A thorough work-up did not reveal any known aetiology. To date, idiopathic phosphate diabetes seems the most likely diagnosis. Nuclear medicine input in osteomalacia is discussed. (authors)

  20. Thoracic hyperextension injury with complete “bony disruption” of the thoracic cage: Case report of a potentially life-threatening injury

    Directory of Open Access Journals (Sweden)

    Bailey James

    2012-05-01

    Full Text Available Abstract Background Severe chest wall injuries are potentially life-threatening injuries which require a standardized multidisciplinary management strategy for prevention of posttraumatic complications and adverse outcome. Case presentation We report the successful management of a 55-year old man who sustained a complete “bony disruption” of the thoracic cage secondary to an “all-terrain vehicle” roll-over accident. The injury pattern consisted of a bilateral “flail chest” with serial segmental rib fractures, bilateral hemo-pneumothoraces and pulmonary contusions, bilateral midshaft clavicle fractures, a displaced transverse sternum fracture with significant diastasis, and an unstable T9 hyperextension injury. After initial life-saving procedures, the chest wall injuries were sequentially stabilized by surgical fixation of bilateral clavicle fractures, locked plating of the displaced sternal fracture, and a two-level anterior spine fixation of the T9 hyperextension injury. The patient had an excellent radiological and physiological outcome at 6 months post injury. Conclusion Severe chest wall trauma with a complete “bony disruption” of the thoracic cage represents a rare, but detrimental injury pattern. Multidisciplinary management with a staged timing for addressing each of the critical injuries, represents the ideal approach for an excellent long-term outcome.

  1. The application of digital tomosynthesis in diagnosis of occult bone fracture

    International Nuclear Information System (INIS)

    Tian Jun; Gong Wuxian; Zhang Dianxing; Tian Ye; Huang Shiting

    2011-01-01

    Objective: To evaluate the digital tomosynthesis in the diagnosis of occult bone fracture. Methods: Both DR and DTS were performed in 135 cases with traumatic-induced pain. All the cases were suspected of bone fractures but with no abnormal findings in DR images. Two radiologists reviewed all the images and diagnosed in consensus. All cases were followed up and the imaging diagnoses were reviewed. Results: Bone fractures or joint dislocations of 61 cases were shown in DTS images but not in DR images, including atlanto-axial fracture and subluxation in 7 cases, articular fracture of limbs in 20 cases, bone fractures of wrist, hand and foot in 11 cases, fractures of cervical, thoracic and lumbar vertebra in 7 cases, fracture of sacrococcyx in 8 cases, fracture of nasal bone in 4 cases, fractures of' Sternum, rib, orbit and mandible in 1 case. Thirty-four cases with bone fractures were determined by using DTS in suspected cases and 17 cases were denied. Both DR and DTS images showed normal findings in 23 cases. Imaging diagnoses of all cases were consistent with the results of follow up. Conclusion: DTS can depict bone fractures especially in the deep and complex bony structures, which may improve the diagnostic accuracy of bone fracture. (authors)

  2. An osteomalacia related to phosphate diabetes - bone scintigraphy with SPECT/CT contribution

    International Nuclear Information System (INIS)

    Ruyer, A.; Granier, P.; Mourad, M.

    2009-01-01

    We report the case of a 59-year-old woman, investigated for disabling pain of the left thigh, unrelated to any traumatic event. Interrogation had found diffuse pain of myalgia-type and arthralgia-type for approximately a year without local inflammatory signs and insufficiency fractures of both calcaneus two years before. The Technetium 99m -labeled hydroxy-methylene diphosphonate ( 99m Tc-H.D.P.) whole-body bone scintigraphy evidenced multiple hot spots on the higher third of left femur, rib cage, sternum, scapula, pelvis, right hip and both calcaneus. Moreover, a more diffuse and heterogeneous prominent uptake appeared on rib cage, spine and pelvis. These images suggested a diffuse metastatic disease of the skeleton. The single photon emission computerized tomography guided by computerized tomography (SPECT/CT), centered on lumbar spine, pelvis and the upper end of femurs showed that the multiple hot spots were in fact bone fractures. These findings pointed diagnosis to a metabolic disease. The clinical context was in favour of an osteomalacia. Further explorations showed an osteomalacia related to phosphate diabetes. A thorough work-up did not reveal any known aetiology. To date, idiopathic phosphate diabetes seems the most likely diagnosis. Nuclear medicine input in osteomalacia is discussed. (authors)

  3. Skeletal metastases from primary hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kim, So Sun; Huh, Jin Do; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk; Chang, Hee Kyung; Huh, Man Ha

    1988-01-01

    In order to detect and to evaluate the frequency, the distribution, and the radiological findings of skeletal metastases from hepatocellular carcinoma, the authors retrospectively analyzed radiographic, scintigraphic, and CT findings of 257 patients with hepatocellular carcinoma. The results were as follows: 1. Skeletal metastases were demonstrated in 21 patients (8.2%). 2. Frequent symptoms were pain, limitation of motion, paralysis, and mass. In nine of them the initial symptoms were due to skeletal metastases. 3. The common sites of metastases were spine (13 cases), ribs (8 cases), pelvis (8 cases) and femur (6 cases). Humerus, skull and sternum were also frequently involved. 4. Plain film findings were purely osteolytic in all cases and pathologic fractures were noted in 5 cases. 5. The lesions appear expansible in 7 cases, and 4 of them showed associated soft tissue masses on CT scans. 6. Bone scans were performed in 13 cases of them and showed increased radiotracer uptake in all. 7. Angiographic studies of 3 cases showed hypervascularity of the metastatic lesions as well as the primary hepatic tumor.

  4. Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

    International Nuclear Information System (INIS)

    Baker, Jonathan C.; Demertzis, Jennifer L.

    2016-01-01

    In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture. (orig.)

  5. Operative fixation of chest wall fractures: an underused procedure?

    Science.gov (United States)

    Richardson, J David; Franklin, Glen A; Heffley, Susan; Seligson, David

    2007-06-01

    Chest wall fractures, including injuries to the ribs and sternum, usually heal spontaneously without specific treatment. However, a small subset of patients have fractures that produce overlying bone fragments that may produce severe pain, respiratory compromise, and, if untreated mechanically, result in nonunion. We performed open reduction and internal fixation on seven patients with multiple rib fractures-five in the initial hospitalization and two delayed--as well as 35 sternal fractures (19 immediate fixation and 16 delayed). Operative fixation was accomplished using titanium plates and screws in both groups of patients. All patients with rib fractures did well; there were no major complications or infections, and no plates required removal. Clinical results were excellent. There was one death in the sternal fracture group in a patient who was ventilator-dependent preoperatively and extubated himself in the early postoperative period. Otherwise, the results were excellent, with no complications occurring in this group. Three patients had their plates removed after boney union was achieved. No evidence of infection or nonunion occurred. The excellent results achieved in the subset of patients with severe chest wall deformities treated initially at our institution and those referred from outside suggest that operative fixation is a useful modality that is likely underused.

  6. [Rib cage ostheosynthesis. Literature review and case reports].

    Science.gov (United States)

    Jiménez-Quijano, Andrés; Varón-Cotés, Juan Carlos; García-Herreros-Hellal, Luis Gerardo; Espinosa-Moya, Beatriz; Rivero-Rapalino, Oscar; Salazar-Marulanda, Michelle

    2015-01-01

    Fractures of the chest wall include sternum and rib fractures. Traditionally they are managed conservatively due to the anatomy of the rib cage that allows most of them to remain stable and to form a callus that unites the fractured segments. In spite of this management, some patients present with chronic pain or instability of the wall which makes them require some type of fixation. The present article performs a literature review based on 4 cases. The first case was a 61 year-old man with blunt chest trauma, with a great deformity of the chest wall associated with subcutaneous emphysema, and pneumothorax. The second case was a 51 year-old man with blunt chest trauma, initially managed at another institution, who despite treatment, had persistent pain and dyspnoea. The third case was a 30 year-old man that suffered a motor vehicle accident, with resulting pain and crepitation of the rib cage and with diagnostic images showing multiple rib fractures. The last case is a 62 year-old man that fell down the stairs, with blunt chest trauma with high intensity pain, dyspnoea and basal ipsilateral hypoventilation. Rib fracture fixation offers a good alternative in selected patients to decrease associated morbidity, leading to a patient's fast return to his or her working life. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  7. Detecting bony infiltrates in patients with multiple myeloma – Is there a role for computered tomography (CT) as an alternative to the radiographic skeletal survey?

    International Nuclear Information System (INIS)

    Field, L.J.; Clarke, R.

    2013-01-01

    Using 2 case studies, the aim of this article is to discuss if there is a role for the computed tomography (CT) skeletal survey in patients with multiple myeloma. CT has increased sensitivity and demonstrates an ability to characterise trabecular anatomy in difficult areas such as scapulae, ribs and sternum, compared with conventional radiography. It also allows differentiation between benign and pathological compression fractures, and is superior in estimating fracture risk. Other advantages of CT include demonstration of unsuspected associated pathology such as lung disease, soft tissue and visceral masses and identifying suitable biopsy sites, detection of small osteolytic lesions, multiplanar reconstructions, radiotherapy planning and surgical intervention, shorter examination time, no repositioning of the patient and therefore increased patient comfort. CT has previously been associated with increased radiation dose with careful selection of the exposure parameters the effective radiation dose can be comparable to that of conventional radiography. These case studies and examples of scanning techniques will demonstrate that whole body low dose multidetector CT is a viable alternative to the skeletal survey in patients with multiple myeloma and bone pain

  8. Hematologic effects of subcutaneous administration of recombinant human granulocyte colony-stimulating factor (filgrastim) in healthy alpacas.

    Science.gov (United States)

    McKenzie, Erica C; Tornquist, Susan J; Gorman, M Elena; Cebra, Christopher K; Payton, Mark E

    2008-06-01

    To determine the effects of SC administration of filgrastim on cell counts in venous blood and bone marrow of healthy adult alpacas. 10 healthy alpacas. Alpacas were randomly assigned to receive treatment with filgrastim (5 microg/kg, SC; n=5) or an equivalent volume of physiologic saline (0.9% NaCl) solution (5) once a day for 3 days. Blood samples were obtained via jugular venipuncture 1 day prior to treatment and once a day for 5 days commencing 24 hours after the first dose was administered. Complete blood counts were performed for each blood sample. Bone marrow aspirates were obtained from the sternum of each alpaca 48 hours before the first treatment was administered and 72 hours after the third treatment was administered. Myeloid-to-erythroid cell (M:E) ratio was determined via cytologic evaluation of bone marrow aspirates. In filgrastim-treated alpacas, substantial increases in counts of WBCs and neutrophils were detected within 24 hours after the first dose was administered. Band cell count and percentage significantly increased 24 hours after the second dose. Counts of WBCs, neutrophils, and band cells remained high 48 hours after the third dose. Red blood cell counts and PCV were unaffected. The M:E ratio also increased significantly after treatment with filgrastim. Filgrastim induced rapid and substantial increases in numbers of circulating neutrophils and M:E ratios of bone marrow in healthy alpacas. Therefore, filgrastim may be useful in the treatment of camelids with impaired bone marrow function.

  9. Correlation between slaughter practices and the distribution of Salmonella and hygiene indicator bacteria on pig carcasses during slaughter.

    Science.gov (United States)

    Biasino, W; De Zutter, L; Mattheus, W; Bertrand, S; Uyttendaele, M; Van Damme, I

    2018-04-01

    This study investigated the distribution of hygiene indicator bacteria and Salmonella on pig carcasses. Moreover, the relation between hygiene indicator counts and Salmonella presence as well as associations between specific slaughter practices and carcass contamination were determined for each carcass area. Seven Belgian pig slaughterhouses were visited three times to swab five randomly selected carcasses at nine different areas, after evisceration and trimming. Information about slaughter practices was collected using a questionaire. In all samples, the E. coli and Salmonella presence was analyzed and Enterobacteriaceae and total aerobic bacteria were quantified. Average total aerobic counts ranged from 3.1 (loin, pelvic duct, ham) to 4.4 log 10  CFU/cm 2 (foreleg). Median Enterobacteriaceae numbers varied between 0.4 (ham) an 1.8 log 10  CFU/cm 2 (foreleg). E. coli and Salmonella presence ranged from 15% (elbow) to 89% (foreleg) and 5% (elbow) to 38% (foreleg), respectively. Positive relations were found between hygiene indicator counts and Salmonella presence at the head, sternum, loin and throat. Several slaughter practices, such as splitting the head and incising tonsils, were associated with higher levels of hygiene indicator bacteria and Salmonella. These findings can be used to educate slaughterhouse personnel and estimate the public health risk involved in consumption of different pork cuts. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. The clinical application of nuclide bone imaging in malignant lymphomas

    International Nuclear Information System (INIS)

    Jin Xing; Tang Mingdeng; Lin Duanyu; Ni Leichun

    2006-01-01

    Objective: To evaluate the clinical application value of nuclide bone imaging in malignant lymphoma. Methods: 71 cases of patients were diagnosed by pathology as malignant lymphoma, among whom there were 8 cases of Hodgkin disease (HL) and 63 cases of non-Hodgkin disease (NHL). The examinations were performed from 2.5 to 6 hours later after the intravenous injection of 99m Tc-MDP (555-925 MBq). Results: 31 cases were bone-infiltrating lesions, including 3 cases of HL and 28 cases of NHL. The total number of the focus was 103, except 2 cases of bone lack, including 35 foci in vertebral column (34.65%), 30 foci in limb and joint (29.70%), 14 foci in rib (13.86%), 13 foci in elvis (12.0%), 5 foci in skull (4.95%) and 4 foci in sternum (3.96%). Conclusion: The nuclide bone imaging has a high value in the clinical stage, therapeutic observation and prognosis of bone-infiltrating malignant lymphoma. (authors)

  11. Skin flora: Differences between people affected by Albinism and those with normally pigmented skin in Northern Tanzania - cross sectional study.

    Science.gov (United States)

    Kiprono, Samson K; Masenga, John E; Chaula, Baraka M; Naafs, Bernard

    2012-07-30

    Skin flora varies from one site of the body to another. Individual's health, age and gender determine the type and the density of skin flora. A 1  cm² of the skin on the sternum was rubbed with sterile cotton swab socked in 0.9% normal saline and plated on blood agar. This was cultured at 35 °C. The bacteria were identified by culturing on MacConkey agar, coagulase test, catalase test and gram staining. Swabs were obtained from 66 individuals affected by albinism and 31 individuals with normal skin pigmentation. Those with normal skin were either relatives or staying with the individuals affected by albinism who were recruited for the study. The mean age of the 97 recruited individuals was 30.6 (SD ± 14.9) years. The mean of the colony forming units was 1580.5 per cm2. Those affected by albinism had a significantly higher mean colony forming units (1680  CFU per cm²) as compared with 453.5  CFU per cm² in those with normally pigmented skin (p = 0.023). The skin type and the severity of sun- damaged skin was significantly associated with a higher number of colony forming units (p = 0.038). Individuals affected by albinism have a higher number of colony forming units which is associated with sun- damaged skin.

  12. Calibration of the Accuscan II IN Vivo System for High Energy Lung Counting

    Energy Technology Data Exchange (ETDEWEB)

    Ovard R. Perry; David L. Georgeson

    2011-07-01

    This report describes the April 2011 calibration of the Accuscan II HpGe In Vivo system for high energy lung counting. The source used for the calibration was a NIST traceable lung set manufactured at the University of Cincinnati UCLL43AMEU & UCSL43AMEU containing Am-241 and Eu-152 with energies from 26 keV to 1408 keV. The lung set was used in conjunction with a Realistic Torso phantom. The phantom was placed on the RMC II counting table (with pins removed) between the v-ridges on the backwall of the Accuscan II counter. The top of the detector housing was positioned perpendicular to the junction of the phantom clavicle with the sternum. This position places the approximate center line of the detector housing with the center of the lungs. The energy and efficiency calibrations were performed using a Realistic Torso phantom (Appendix I) and the University of Cincinnati lung set. This report includes an overview introduction and records for the energy/FWHM and efficiency calibration including performance verification and validation counting. The Accuscan II system was successfully calibrated for high energy lung counting and verified in accordance with ANSI/HPS N13.30-1996 criteria.

  13. Procedure to describe clavicular motion.

    Science.gov (United States)

    Gutierrez Delgado, Guivey; De Beule, Matthieu; Ortega Cardentey, Dolgis R; Segers, Patrick; Iznaga Benítez, Arsenio M; Rodríguez Moliner, Tania; Verhegghe, Benedict; Palmans, Tanneke; Van Hoof, Tom; Van Tongel, Alexander

    2017-03-01

    For many years, researchers have attempted to describe shoulder motions by using different mathematical methods. The aim of this study was to describe a procedure to quantify clavicular motion. The procedure proposed for the kinematic analysis consists of 4 main processes: 3 transcortical pins in the clavicle, motion capture, obtaining 3-dimensional bone models, and data processing. Clavicular motion by abduction (30° to 150°) and flexion (55° to 165°) were characterized by an increment of retraction of 27° to 33°, elevation of 25° to 28°, and posterior rotation of 14° to 15°, respectively. In circumduction, clavicular movement described an ellipse, which was reflected by retraction and elevation. Kinematic analysis shows that the articular surfaces move by simultaneously rolling and sliding on the convex surface of the sternum for the 3 movements of abduction, flexion, and circumduction. The use of 3 body landmarks in the clavicle and the direct measurement of bone allowed description of the osteokinematic and arthrokinematic movement of the clavicle. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Pulmonary hypertension in patients with chronic pulmonary thromboembolism: chest radiograph and CT evaluation before and after surgery

    International Nuclear Information System (INIS)

    Schmidt, H.C.; Kauczor, H.U.; Schild, H.H.; Renner, C.; Kirchhoff, E.; Lang, P.; Iversen, S.; Thelen, M.

    1996-01-01

    The purpose of this study was to assess the value of morphometric data on conventional radiography and CT predicting the presence and degree of pulmonary hypertension and to assess the reversibility after surgery. On preoperative X-ray films and CT scans of 50 patients with pulmonary hypertension secondary to chronic thromboembolism, we measured the cardiothoracic ratio, basal diameter, length of cardiac contact to sternum, pulmonary trunk, right and left descending pulmonary artery, and the septum angle. These data were correlated with pulmonary arterial pressure. In 14 X-ray patients and 18 CT patients, with follow-up after surgical thromboendarterectomy the reversibility of these changes was assessed. A dilated pulmonary trunk was the most common abnormality (96% each on X-ray and CT). Pulmonary arteries were dilated on X-ray in 40% (right) and 14% (left), and on CT in 92% (right) and 96% (left). The best correlation with mean arterial pressure was found measuring the pulmonary trunk on CT (r=0.43, p<0.01). After surgery, reversibility was most significant for the pulmonary trunk on CT (p<0.0001). In patients with chronic pulmonary embolism, pulmonary hypertension can best be predicted by assessing the diameter of the pulmonary trunk both on X-ray and CT. No close correlation is present between the extent of any parameter and the level of the pulmonary pressure. (orig.)

  15. Bone dosimetry using synthetic images to represent trabecular bones of five regions of the human body

    Energy Technology Data Exchange (ETDEWEB)

    Lima Filho, Jose de M. [Instituto Federal de Educacao, Ciencia e Tecnologia de Pernambuco (IFPE), Recife, PE (Brazil); Vieira, Jose W. [Escola Politecnica de Pernambuco (POLI). Universidade de Pernambuco (UPE), Recife, PE (Brazil); Lima, Vanildo J. de M., E-mail: vjr@ufpe.br [Departamento de Anatomia. Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Lima, Lindeval F., E-mail: lindeval@dmat.ufrr.br [Departamento de Matematica (DMAT). Universidade Federal de Roraima (UFRR), Boa Vista, RR (Brazil); Lima, Fernando R.A., E-mail: falima@cnen.gov.br [Centro Regional de Ciencias Nucleares (CRCN/NE-CNEN-PE), Recife, PE (Brazil); Vasconcelos, Wagner E. de [Departamento de Energia Nuclear (DEN). Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil)

    2011-07-01

    One of the greatest challenges in numerical dosimetry of ionizing radiation is to estimate the absorbed dose by bone tissue in the human body. The bone tissues of greater radiosensitivity are the red bone marrow (RBM), that consist of the hematopoietic cells, located within the trabecular bones, and the bone surface cells (BSC), called osteogenic cells. The report 70 of the ICRP lists five spongiosa regions with their respective volume percent of trabecular bone: ribs (also contemplating the clavicles and sternum), spine, long bones, pelvis and skull (also contemplating mandible). The Grupo de Pesquisa em Dosimetria Numerica (GDN/CNPq) has been built exposure computational models (ECMs) based on voxel phantoms and EGSnrc Monte Carlo code. To estimate the energy deposited in the RBM and in the BSC of a phantom, the GDN/CNPq has used a method based on micro-CT images of the five trabecular regions mentioned above. These images were provided by other research institutes and were obtained from scan of bone samples of adult. Here is the greatest difficulty in reproducing this method: besides the need for bone images of real people with micrometer resolution, the distribution of bone marrow in the human body, according to ICRP 70, varies with age. This article presents some proposals of the GDN/CNPQ for replacing in the ECMs the micro-CT images by images synthesized by the computer, based on Monte Carlo sampling. (author)

  16. Radioactive foodchains in the subarctic environment. Progress report, August 15, 1975--August 14, 1976

    International Nuclear Information System (INIS)

    Miettinen, J.K.

    1976-05-01

    Cesium-137 is accumulated in the foodchain lichen-reindeer-man causing high body burdens in Lapps who have reindeer meat as staple food. A group of Finnish Lapps has been whole body counted for 137 Cs annually since 1961. Results of the measurements made in April 1976 show 18 percent decrease in 137 Cs body burdens from the previous year. A dietary study confirmed that there was no mentionable change in the total amount of reindeer meat consumed although winter consumption has slightly decreased and summer consumption increased in recent years. Plutonium analyses of stockpiled lichen and reindeer samples from 1960 to 1973 were begun in 1973; since then the sampling has continued. Lichen had 200 pCi per kg dry weight in 1963 to 1964, 100 pCi/kg in 1966 to 1970, 20 pCi/kg in 1973 to 1975. Biological half-time of plutonium in lichen is 2 years. Reindeer liver contained about 20 pCi per kg fresh weight in 1963, 2 pCi in 1973. The ratio of plutonium in liver to its lifelong total intake gave a lower limit to absorption in reindeer. Of bones, plutonium concentration is highest in teeth, medium high in sternum, vertebra and humerus, and lowest in solid long bones. Human autopsy samples gave for lungs 0.19 liver 0.02 and bone 0.09 pCi 239 240 Pu per kg of wet weight

  17. Comparison of clinical samples for visceral Leishmaniasis diagnosis in asymptomatic dogs by PCR hybridization

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, Sidney A.; Ituassu, Leonardo T.; Melo, Maria N. [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Parasitologia], e-mail: saninoalmeida@gmail.com, e-mail: Itituassu@yahoo.com.br, e-mail: melo@icb.ufmg.br; Leite, Rodrigo S.; Andrade, Antero S.R. [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN-CNEN/MG), Belo Horizonte, MG (Brazil)], e-mail: rleite2005@gmail.com, e-mail: antero@cdtn.br

    2009-07-01

    The canine visceral leishmaniasis (CVL) diagnosis still represents a challenge because of complexity of this disease. The aim of present study was to compare different clinical samples for diagnosis of CVL by Polymerase Chain Reaction (PCR) combined with hybridization of {sup 32}P labeled probes. Bone marrow (BM), skin biopsy (SB), peripheral blood (PB) and conjunctival swab (CS) were used in this work. With this purpose 40 asymptomatic dogs, all positive by parasitological test, were obtained. From each animal were collected SB with sterile punches from ear internal surface, 1.0 mL of PB, BM aspirates from sternum and CS from both lower eyelid. Each clinical sample was submitted to suitable DNA purification process and PCR-hybridization assays. The positive results obtained with PCR were 55%, 25%, 30% and 22.5% for CS, BM, SB and PB respectively while the PCR followed by hybridization showed a positivity of 87.5%, 50%, 45% and 27.5% respectively. The hybridization assay was able to increase the PCR positivity in all kinds of clinical samples. The best performance was obtained using CS samples. We concluded that the PCR associated with DNA radioactive probes was a very sensitive tool for diagnosis of CVL in asymptomatic dogs and the CS has an important potential for regular screening of dogs. (author)

  18. Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature.

    Science.gov (United States)

    Baker, Jonathan C; Demertzis, Jennifer L

    2016-06-01

    In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture.

  19. A new approach for assessing sleep duration and postures from ambulatory accelerometry.

    Directory of Open Access Journals (Sweden)

    Cornelia Wrzus

    Full Text Available Interest in the effects of sleeping behavior on health and performance is continuously increasing-both in research and with the general public. Ecologically valid investigations of this research topic necessitate the measurement of sleep within people's natural living contexts. We present evidence that a new approach for ambulatory accelerometry data offers a convenient, reliable, and valid measurement of both people's sleeping duration and quality in their natural environment. Ninety-two participants (14-83 years wore acceleration sensors on the sternum and right thigh while spending the night in their natural environment and following their normal routine. Physical activity, body posture, and change in body posture during the night were classified using a newly developed classification algorithm based on angular changes of body axes. The duration of supine posture and objective indicators of sleep quality showed convergent validity with self-reports of sleep duration and quality as well as external validity regarding expected age differences. The algorithms for classifying sleep postures and posture changes very reliably distinguished postures with 99.7% accuracy. We conclude that the new algorithm based on body posture classification using ambulatory accelerometry data offers a feasible and ecologically valid approach to monitor sleeping behavior in sizable and heterogeneous samples at home.

  20. Clinical eveluation of metastasis from carcinoma of the prostate by bone scintiscanning

    International Nuclear Information System (INIS)

    Okada, Kiyoki; Igarashi, Jotaro; Nogaki, Joji; Kinoshita, Masayuki; Kishimoto, Takashi

    1981-01-01

    Eighty radioisotopic bone scintiscans in conjunction with radiographic skeletal survey were carried out in 47 patients with prostatic carcinoma encountered over the past 6 years. Five patients were excluded because of false positive bone scan. None of the patients was found with false negative bone scan irrespective of the presence of osteolytic lesions. In 21 of the remaining 42 cases (40.0%), increased information on bone metastasis was obtained by the bone scan. A positive bone scan was interpreted at 156 sites, of which 67 (42.9%) were negative on bone survey. Bone scan was superior to bone survey for detecting metastatic sites of the sternum, cervical and thoracic spine, ribs, scapula and skull. Serial bone scans in some cases demonstrated an objective response of the metastasis following hormonal treatment. At the time of bone scan, 22 of 47 cases (46.8%) showed an abnormal renal image, which represented the degree of bone metastasis as well as that of renal function. Thus, bone scan represents a useful tool for detecting metastatic lesions from prostatic carcinoma and for assessing the response to treatment. (author)

  1. Comparison of clinical samples for visceral Leishmaniasis diagnosis in asymptomatic dogs by PCR hybridization

    International Nuclear Information System (INIS)

    Ferreira, Sidney A.; Ituassu, Leonardo T.; Melo, Maria N.

    2009-01-01

    The canine visceral leishmaniasis (CVL) diagnosis still represents a challenge because of complexity of this disease. The aim of present study was to compare different clinical samples for diagnosis of CVL by Polymerase Chain Reaction (PCR) combined with hybridization of 32 P labeled probes. Bone marrow (BM), skin biopsy (SB), peripheral blood (PB) and conjunctival swab (CS) were used in this work. With this purpose 40 asymptomatic dogs, all positive by parasitological test, were obtained. From each animal were collected SB with sterile punches from ear internal surface, 1.0 mL of PB, BM aspirates from sternum and CS from both lower eyelid. Each clinical sample was submitted to suitable DNA purification process and PCR-hybridization assays. The positive results obtained with PCR were 55%, 25%, 30% and 22.5% for CS, BM, SB and PB respectively while the PCR followed by hybridization showed a positivity of 87.5%, 50%, 45% and 27.5% respectively. The hybridization assay was able to increase the PCR positivity in all kinds of clinical samples. The best performance was obtained using CS samples. We concluded that the PCR associated with DNA radioactive probes was a very sensitive tool for diagnosis of CVL in asymptomatic dogs and the CS has an important potential for regular screening of dogs. (author)

  2. HOX and TALE signatures specify human stromal stem cell populations from different sources.

    Science.gov (United States)

    Picchi, Jacopo; Trombi, Luisa; Spugnesi, Laura; Barachini, Serena; Maroni, Giorgia; Brodano, Giovanni Barbanti; Boriani, Stefano; Valtieri, Mauro; Petrini, Mario; Magli, Maria Cristina

    2013-04-01

    Human stromal stem cell populations reside in different tissues and anatomical sites, however a critical question related to their efficient use in regenerative medicine is whether they exhibit equivalent biological properties. Here, we compared cellular and molecular characteristics of stromal stem cells derived from the bone marrow, at different body sites (iliac crest, sternum, and vertebrae) and other tissues (dental pulp and colon). In particular, we investigated whether homeobox genes of the HOX and TALE subfamilies might provide suitable markers to identify distinct stromal cell populations, as HOX proteins control cell positional identity and, together with their co-factors TALE, are involved in orchestrating differentiation of adult tissues. Our results show that stromal populations from different sources, although immunophenotypically similar, display distinct HOX and TALE signatures, as well as different growth and differentiation abilities. Stromal stem cells from different tissues are characterized by specific HOX profiles, differing in the number and type of active genes, as well as in their level of expression. Conversely, bone marrow-derived cell populations can be essentially distinguished for the expression levels of specific HOX members, strongly suggesting that quantitative differences in HOX activity may be crucial. Taken together, our data indicate that the HOX and TALE profiles provide positional, embryological and hierarchical identity of human stromal stem cells. Furthermore, our data suggest that cell populations derived from different body sites may not represent equivalent cell sources for cell-based therapeutical strategies for regeneration and repair of specific tissues. Copyright © 2012 Wiley Periodicals, Inc.

  3. Comparison of whole body MR diffusion weighted imaging and skeletal scintigraphy in detecting bone metastasis

    International Nuclear Information System (INIS)

    Xu Xian; Ma Lin; Zhang Jinshan; Cai Youquan; Cheng Liuquan; Guo Xinggao; Xu Baixuan

    2008-01-01

    Objective: To evaluate the application of whole body MR diffusion weighted imaging (DWI) in the detection of bone metastasis using skeletal scintigraphy as the reference. Methods: Forty-two healthy volunteers and 38 patients with malignant tumors were enrolled in our study. All the patients received MR examination and skeletal scintigraphy within one week. MR examination was performed on GE signa 3.0T MR scanner using a build-in body coil. The skeletal system was divided into eight regions and the images of the whole body MR DWI and skeletal scintigraphy were reviewed to compare the two modalities patient by patient and region by region. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of another imaging modality. Results: A total of 169 metastatic lesions in 69 regions of 30 patients were detected by whole body MR DWI while 156 lesions in 68 regions of 29 patients were identified by skeletal scintigraphy. There were two cases negative in scintigraphy but positive in whole body MR DWI and one case positive in scintigraphy only. There were eight lesions negative in scintigraphy but positive in whole body MR DWI, mainly located in the spine, pelvis and femur. Seven lesions were only detected by scintigraphy, mainly located in the skull, sternum, clavicle and scapula. Conclusion: The whole body MR DWI reveals excellent consistency with skeletal scintigraphy regarding bone metastasis, and the two modalities are complementary for each other. (authors)

  4. Venous reflux on contrast-enhanced head and neck magnetic resonance angiography: Analysis of causative factors

    International Nuclear Information System (INIS)

    Shin, Dong Jae; Lee, Eun Ja; Bae, Jong Myon

    2016-01-01

    The purpose of this study was to analyze the causative factors of venous reflux on contrast-enhanced head and neck magnetic resonance angiography. We retrospectively reviewed 150 patients with right-arm injections and 150 patients with left-arm injections. We included the age, gender, body mass index, history of hypertension, and history of diabetes mellitus in the evaluation of all patients. We measured the shortest width of the left or right brachiocephalic vein (BCV), the diameter of the aortic arch, and the distance between the sternum and vertebral body. The relationship between these factors and the venous reflux was analyzed. In patients with venous reflux, we performed qualitative image scoring for suboptimal images. In patients with venous reflux, the image quality of the left-arm injection group was significantly inferior to the image quality of the right-arm injection group. The mean age and the male-to-female ratio of patients with venous reflux were significantly higher than those of patients without venous reflux. In patients receiving the left-arm injection, the mean shortest width of the left BCV was significantly narrower in patients with venous reflux than in patients without venous reflux. A left-arm injection should be avoided, especially in elderly patients, to acquire an optimal image

  5. Culture of equine bone marrow mononuclear fraction and adipose tissue-derived stromal vascular fraction cells in different media

    Directory of Open Access Journals (Sweden)

    Gesiane Ribeiro

    2013-12-01

    Full Text Available The objective of this study was to evaluate the culture of equine bone marrow mononuclear fraction and adipose tissue - derived stromal vascular fraction cells in two different cell culture media. Five adult horses were submitted to bone marrow aspiration from the sternum, and then from the adipose tissue of the gluteal region near the base of the tail. Mononuclear fraction and stromal vascular fraction were isolated from the samples and cultivated in DMEM medium supplemented with 10% fetal bovine serum or in AIM-V medium. The cultures were observed once a week with an inverted microscope, to perform a qualitative analysis of the morphology of the cells as well as the general appearance of the cell culture. Colony-forming units (CFU were counted on days 5, 15 and 25 of cell culture. During the first week of culture, differences were observed between the samples from the same source maintained in different culture media. The number of colonies was significantly higher in samples of bone marrow in relation to samples of adipose tissue.

  6. Venous reflux on contrast-enhanced head and neck magnetic resonance angiography: Analysis of causative factors

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Dong Jae; Lee, Eun Ja [Dept. of Radiology, Dongguk University Ilsan Hospital, Goyang (Korea, Republic of); Bae, Jong Myon [Dept. of Preventive Medicine, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2016-12-15

    The purpose of this study was to analyze the causative factors of venous reflux on contrast-enhanced head and neck magnetic resonance angiography. We retrospectively reviewed 150 patients with right-arm injections and 150 patients with left-arm injections. We included the age, gender, body mass index, history of hypertension, and history of diabetes mellitus in the evaluation of all patients. We measured the shortest width of the left or right brachiocephalic vein (BCV), the diameter of the aortic arch, and the distance between the sternum and vertebral body. The relationship between these factors and the venous reflux was analyzed. In patients with venous reflux, we performed qualitative image scoring for suboptimal images. In patients with venous reflux, the image quality of the left-arm injection group was significantly inferior to the image quality of the right-arm injection group. The mean age and the male-to-female ratio of patients with venous reflux were significantly higher than those of patients without venous reflux. In patients receiving the left-arm injection, the mean shortest width of the left BCV was significantly narrower in patients with venous reflux than in patients without venous reflux. A left-arm injection should be avoided, especially in elderly patients, to acquire an optimal image.

  7. Effects of dietary aluminium in combination with reduced calcium and phosphorous on the ring dove (Streptopelia risoria)

    Energy Technology Data Exchange (ETDEWEB)

    Carriere, D.; Fischer, K.; Peakall, D.; Angehrn, P.

    1986-10-01

    Elevated levels of Al have been reported in surface waters and in certain aquatic organisms including aquatic insects in areas receiving acidic precipitation. It has been suggested that Al can affect avian reproduction. In this study, Ring doves were assigned to a control group fed a diet reduced in Ca and P and to a treated group fed the same diet supplemented with 0.1% Al. A four month dosing period did not result in any effect on egg production, fertility or hatchability. Eggshell permeability was decreased initially but subsequently recovered to a normal level. Dietary aluminium suLphate did not affect plasma Ca, P nor Mg levels of adults nor did it affect the pattern of growth nor the final weight of chicks fed on the same diet. There was a tendency for Al to accumulate in the sternum of growing doves fed levels up to 1500 ppm Al. Neither reproduction nor growth of this species were influenced by levels of Al equivalent to those occuring in areas receiving acid deposition. However, the results of a preliminary experiment suggest that decreasing the dietary levels of Ca and P below 0.9% and 0.5% respectively, in combination with excess Al (0.075%) caused significant impacts upon reproduction and growth. Similar experimental findings have been reported in the literature for domestic birds where levels of dietary Al exceeded those of Ca and P. 21 refs.

  8. A method for defleshing human remains using household bleach.

    Science.gov (United States)

    Mann, Robert W; Berryman, Hugh E

    2012-03-01

    Medical examiners and forensic anthropologists are often faced with the difficult task of removing soft tissue from the human skeleton without damaging the bones, teeth and, in some cases, cartilage. While there are a number of acceptable methods that can be used to remove soft tissue including macerating in water, simmering or boiling, soaking in ammonia, removing with scissors, knife, scalpel or stiff brush, and dermestid beetles, each has its drawback in time, safety, or potential to damage bone. This technical report using the chest plate of a stabbing victim presents a safe and effective alternative method for removing soft tissue from human remains, in particular the chest plate, following autopsy, without damaging or separating the ribs, sternum, and costal cartilage. This method can be used to reveal subtle blunt force trauma to bone, slicing and stabbing injuries, and other forms of trauma obscured by overlying soft tissue. Despite the published cautionary notes, when done properly household bleach (3-6% sodium hypochlorite) is a quick, safe, and effective method for examining cartilage and exposing skeletal trauma by removing soft tissue from human skeletal remains. 2011 American Academy of Forensic Sciences. Published 2011. This article is a U.S. Government work and is in the public domain in the U.S.A.

  9. Central venous stenosis among hemodialysis patients is often not associated with previous central venous catheters.

    Science.gov (United States)

    Kotoda, Atsushi; Akimoto, Tetsu; Kato, Maki; Kanazawa, Hidenori; Nakata, Manabu; Sugase, Taro; Ogura, Manabu; Ito, Chiharu; Sugimoto, Hideharu; Muto, Shigeaki; Kusano, Eiji

    2011-01-01

    It is widely assumed that central venous stenosis (CVS) is most commonly associated with previous central venous catheterization among the chronic hemodialysis (HD) patients. We evaluated the validity of this assumption in this retrospective study. The clinical records from 2,856 consecutive HD patients with vascular access failure during a 5-year period were reviewed, and a total of 26 patients with symptomatic CVS were identified. Combined with radiological findings, their clinical characteristics were examined. Only seven patients had a history of internal jugular dialysis catheterization. Diagnostic multidetector row computed tomography angiography showed that 7 of the 19 patients with no history of catheterization had left innominate vein stenosis due to extrinsic compression between the sternum and arch vessels. These patients had a shorter period from the time of creation of the vascular access to the initial referral (9.2 ± 7.6 months) than the rest of the patients (35.5 ± 18.6 months, p = 0.0017). Our findings suggest that cases without a history of central venous catheterization may not be rare among the HD patients with symptomatic CVS. However, those still need to be confirm by larger prospective studies of overall chronic HD patients with symptomatic CVS.

  10. Dynamical Properties of Postural Control in Obese Community-Dwelling Older Adults †.

    Science.gov (United States)

    Frames, Christopher W; Soangra, Rahul; Lockhart, Thurmon E; Lach, John; Ha, Dong Sam; Roberto, Karen A; Lieberman, Abraham

    2018-05-24

    Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m², using a force plate and an inertial measurement unit affixed at the sternum. Participants' fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance.

  11. Assessment of a head support system to prevent pediatric out-of-position: an observational study.

    Science.gov (United States)

    Lopez-Valdes, Francisco J; Forman, Jason L; Ash, Joseph H; Kent, Richard; Alba, Juan J; Segui-Gomez, Maria

    Head injuries are the most common severe injuries sustained by pediatric occupants in road traffic crashes. Preventing children from adopting positions that can result in an increased injury risk due to unfavorable interactions with the restraints is fundamental. The objective of this paper was to assess the effect of a head support system (SS) on the lateral position of the head, the vertical position of the sternum and the shoulder belt fit. Thirty pediatric rear-seat passengers were exposed to two 75-minute trials. Volunteers were restrained by a three-point belt and, if needed, used the appropriate child restraint system for their anthropometry (high-back booster, low-back booster, no booster). A case crossover study was designed in which the volunteers used the head support system (SS) during one of the trials, acting as their own controls (No SS) in the other. Compared to the control group, the head support reduced significantly the 90(th) percentile value of the absolute value of the relative lateral motion of the head, regardless of the restraint used. The system also reduced the maximum downward position of the sternal notch within the low-back booster group. As for the belt fit, the use of the head support improved significantly the position of the shoulder belt on the occupant in the low-back booster and in the no booster groups.

  12. Further experience with the operative management of asphyxiating thoracic dystrophy after pectus repair.

    Science.gov (United States)

    Weber, Thomas R

    2005-01-01

    Asphyxiating thoracic dystrophy (ATD) can occur years after a Ravitch-type repair of pectus excavatum, resulting in debilitating alteration in pulmonary function (PFT). An operation was devised to attempt repair of this deformity. After institutional review board approval, the records of 10 children (ages 9-18 years) with ATD that developed 4 to 12 years postpectus operation who underwent attempted repair of ATD were reviewed. Data obtained before ATD operation and at 6, 12, and 24 months afterward included chest computed tomography, pulmonary functions (PFT), and a quality of life questionnaire. The operation consisted of sternal split with rib graft placement to permanently hold the sternum apart. All children survived and the bone grafts healed solidly. Computed tomography showed a change from a flat to a round chest contour on cross section, with increased anteroposterior dimension. Two patients had no change in PFT at 24 months whereas the other 8 had 21% to 30% improvement in PFT parameters. All patients reported improved exercise tolerance, and 3 began sports activities who were previously unable to do so. Two patients on oxygen, essentially bedridden, are now active, breathing only room air. Seven of 10 patients continue to have cosmetic concerns. A small population of patients who had postoperative pectus repair developed severe, debilitating ATD. The repair described improves most patients, some dramatically, but does not significantly improve cosmetic appearance. The operation is undergoing further refinement to address these issues.

  13. Utility of CT scan for the diagnosis of chest wall tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Khalil, A.; Le Breton, C.; Tassart, M.; Korzec, J.; Bigot, J.M.; Carette, M.F. [Department of Radiology, Tenon Hospital, Paris (France)

    1999-10-01

    The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan. (orig.) With 5 figs., 2 tabs., 11 refs.

  14. Bone marrow uptake of {sup 18}F-fluorodeoxyglucose in Hodgkin lymphoma without bone involvement: comparison between patients with and without B symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Vale, Rômulo Hermeto Bueno do; Ferraro, Daniela Andrade; Duarte, Paulo Schiavom; Carvalho, Giovana; Lima, Marcos Santos; Coura Filho, George Barbério; Sapienza, Marcelo Tatit; Buchpiguel, Carlos Alberto, E-mail: daniela.ferraro@hc.fm.usp.br [Instituto do Câncer do Estado de São Paulo (ICESP), SP (Brazil)

    2018-03-15

    Objective: To compare the degree of benign bone marrow uptake of {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) between Hodgkin lymphoma patients with and without B symptoms. Materials and Methods: We analyzed the medical charts of 74 Hodgkin lymphoma patients who underwent {sup 18}F-FDG positron emission tomography/computed tomography (PET/CT) prior to the initiation of therapy between October 2010 and September 2013. In all of the patients, the bone marrow biopsy was negative and the {sup 18}F-FDG PET/CT images did not suggest bone marrow involvement. Of the 74 patients evaluated, 54 presented inflammatory (B) symptoms and 20 did not. Regions of interest (ROIs) were drawn on the sternum, the proximal thirds of the humeri, the proximal thirds of the femora, and both iliac wings (totaling seven ROIs per patient). To compare the patients with and without B symptoms, in terms of standardized uptake values (SUVs) for the seven ROIs, we used the Mann-Whitney U test. Results: For six of the ROIs, the SUVs were higher in the patients with B symptoms than in those without, and the difference was statistically significant (p < 0.05). There was also a tendency toward a statistically significant difference between the two groups in terms of the SUV for the right iliac wing ROI (p = 0.06). Conclusion: In our sample, the presence of B symptoms was associated with increased {sup 18}F-FDG uptake in bone marrow. (author)

  15. Anatomy of the Gynecomastia Tissue and Its Clinical Significance

    Science.gov (United States)

    Blau, Mordecai; Hazani, Ron

    2016-01-01

    Background: Gynecomastia is a very common entity in men, and several authors estimate that approximately 50% to 70% of the male population has palpable breast tissue. Much has been published with regard to the etiology, diagnosis, and treatment of gynecomastia. However, the anatomy of the gynecomastia tissue remains elusive to most surgeons. Purpose: The purpose of this article was to define the shape and consistency of the glandular tissue based on the vast experience of the senior author (MB). Patients and Methods: Between the years 1980 and 2014, a total of 5124 patients have been treated for gynecomastia with surgical excision, liposuction, or a combination of both. A total of 3130 specimens were collected with 5% of the cases being unilateral. Results: The specimens appear to have a unifying shape of a head, body, and tail. The head is semicircular in shape and is located more medially toward the sternum. The majority of the glandular tissue consists of a body located immediately deep to the nipple areolar complex. The tail appears to taper off of the body more laterally and toward the insertion of the pectoralis major muscle onto the humerus. Conclusions: This large series of gynecomastia specimens demonstrates a unique and unifying finding of a head, body, and tail. Understanding the anatomy of the gynecomastia gland can serve as a guide to gynecomastia surgeons to facilitate a more thorough exploration and subsequently sufficient gland excision. PMID:27622122

  16. Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

    Directory of Open Access Journals (Sweden)

    Ozlem Bilir

    2014-01-01

    Full Text Available Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

  17. Radiologic findings of adult pelvis and appendicular skeletal Langerhans cell histiocytosis in nine patients

    International Nuclear Information System (INIS)

    Song, You Seon; Lee, In Sook; Kim, Do Kyung; Yi, Jae Hyuck; Cho, Kil Ho; Song, Jong Woon

    2011-01-01

    The purpose of this article was to evaluate the radiologic findings of adult pelvis and appendicular skeletal Langerhans cell histiocytosis (LCH), emphasizing the CT and MR findings. The images of nine patients with pathologically proven LCH (five men and four women; mean age, 37.11 years) were retrospectively reviewed. Imaging analysis was confined to the long and flat bones. CT scans were performed in five patients and MR imaging was performed in eight. Images were assessed for the following features on CT and MRI: the location and number of lesions; the presence of cortical destruction, endosteal scalloping, and a periosteal reaction on CT or MRI; the margin of soft tissue masses, the presence of bone marrow edema, and a ''budding'' appearance on MRI; and the presence of sclerotic margins or septations on CT. The involved skeletal sites were the pelvis (seven), femurs (five), humeri (two), tibias (two), fibula (one), clavicle (one), scapula (one), and sternum (one). Endosteal scalloping, a periosteal reaction, and a budding appearance were common on MRI or CT images. Although cortical destruction and the soft tissue lesion formation were rare, soft tissue masses had well-defined margins. Endosteal scalloping and a budding appearance with a periosteal reaction on CT and MRI may be helpful signs for differentiation of LCH from malignant tumors in adults. (orig.)

  18. Effects of a 4.7 T static magnetic field on fetal development in ICR mice

    Energy Technology Data Exchange (ETDEWEB)

    Okazaki, Ryuji; Ootsuyama, Akira; Uchida, Soshi; Norimura, Toshiyuki [Univ. of Occupational and Environmental Health, Kitakyushu, Fukuoka (Japan). School of Medicine

    2001-09-01

    In order to determine the effects of a 4.7 T static magnetic field (SMF) on fetal development in mice, we evaluated fetal teratogenesis and endochondral ossification following exposure in utero. Pregnant ICR mice were exposed to a 4.7 T SMF from day 7.5 to 9.5 of gestation in a whole-body dose, and sacrificed on day 18.5 of gestation. We examined with incidence of prenatal death, external malformations and fetal skeletal malformations. There were no significant differences observed in the incidence of prenatal death and/or malformations between SMF-exposed mice and control mice. Further, we evaluated the immunoreactivity for the vascular endothelial growth factor (VEGF), which is implicated in angiogenesis and osteogenesis, in the sternum of fetal mice following magnetic exposure. Our studies also indicated that on day 16.5 of gestation following SMF exposure, the immunoreactivity for VEGF was increased compared to unexposed controls. However, it was decreased in the exposed group compared to the control group on day 18.5 of gestation. DNA and proteoglycan (PG) synthesis were also measured in rabbit costal growth plate chondrocytes in vitro. No significant differences were observed in DNA synthesis between the SMF exposed chondrocytes and the control chondrocytes; however, PG synthesis in SMF exposed chondrocytes increased compared to the controls. Based on these results, we suggest that while SMF exposure promoted the endochondral ossification of chondrocytes, it did not induce any harmful effects on fetal development in ICR mice. (author)

  19. Effects of nanotechnologies-based devices on postural control in healthy subjects.

    Science.gov (United States)

    Malchiodi Albedi, Giovanna; Corna, Stefano; Aspesi, Valentina; Clerici, Daniela; Parisio, Cinzia; Seitanidis, Jonathan; Cau, Nicola; Brugliera, Luigia; Capodaglio, Paolo

    2017-09-05

    The aim of the present preliminary randomized controlled study was to ascertain whether the use of newly developed nanotechnologies-based patches can influence posture control of healthy subjects. Thirty healthy female subjects (age 39.4 years, BMI 22.74 kg/m2) were randomly assigned to two groups: one with active patches and a control group with sham patches. Two patches were applied with a tape: one on the subject's sternum and the other on the C7 apophysis. Body sway during quiet upright stance was recorded with a dynamometric platform. Each subject was tested under two visual conditions, eyes open and closed. We used a blocked stratified randomization procedure conducted by a third party. Subjects wearing the sham patches showed a significant increase of the centre of pressure sway area after 4 hours when they performed the habitual moderate-intensity work activities. In the active patch group, a decrease of the sway path was evident, providing evidence of an enhanced balance control. Our preliminary findings on healthy subjects indicate that nanotechnological devices generating ultra-low electromagnetic fields can improve posture control.

  20. Acute mediastinitis: multidetector computed tomography findings following cardiac surgery

    International Nuclear Information System (INIS)

    Macedo, Clarissa Aguiar de; Baena, Marcos Eduardo da Silva; Uezumi, Kiyomi Kato; Castro, Claudio Campi de; Lucarelli, Claudio Luiz; Cerri, Giovanni Guido

    2008-01-01

    Postoperative mediastinitis is defined as an infection of the organs and tissues in the mediastinal space, with an incidence ranging between 0.4% and 5% of cases. This disease severity varies from infection of superficial tissues in the chest wall to fulminant mediastinitis with sternal involvement. Diagnostic criterion for postoperative detection of acute mediastinitis at computed tomography is the presence of fluid collections and gas in the mediastinal space, which might or might not be associated with peristernal abnormalities such as edema of soft tissues, separation of sternal segments with marginal bone resorption, sclerosis and osteomyelitis. Other associated findings include lymphadenomegaly, pulmonary consolidation and pleural/ pericardial effusion. Some of these findings, such as mediastinal gas and small fluid collections can be typically found in the absence of infection, early in the period following thoracic surgery where the effectiveness of computed tomography is limited. After approximately two weeks, computed tomography achieves almost 100% sensitivity and specificity. Patients with clinical suspicion of mediastinitis should be submitted to computed tomography for investigating the presence of fluid collections to identify the extent and nature of the disease. Multidetector computed tomography allows 3D images reconstruction, contributing particularly to the evaluation of the sternum. (author)

  1. Evaluation of clinical and histopathologic prognostic factors for survival in canine osteosarcoma of the extracranial flat and irregular bones.

    Science.gov (United States)

    Kruse, M A; Holmes, E S; Balko, J A; Fernandez, S; Brown, D C; Goldschmidt, M H

    2013-07-01

    Osteosarcoma is the most common bone tumor in dogs. However, current literature focuses primarily on appendicular osteosarcoma. This study examined the prognostic value of histological and clinical factors in flat and irregular bone osteosarcomas and hypothesized that clinical factors would have a significant association with survival time while histological factors would not. All osteosarcoma biopsy samples of the vertebra, rib, sternum, scapula, or pelvis were reviewed while survival information and clinical data were obtained from medical records, veterinarians, and owners. Forty-six dogs were included in the analysis of histopathological variables and 27 dogs with complete clinical data were included in the analysis of clinical variables. In the histopathologic cox regression model, there was no significant association between any histologic feature of osteosarcoma, including grade, and survival time. In the clinical cox regression model, there was a significant association between the location of the tumor and survival time as well as between the percent elevation of alkaline phosphatase (ALP) above normal and survival time. Controlling for ALP elevation, dogs with osteosarcoma located in the scapula had a significantly greater hazard for death (2.8) compared to dogs with tumors in other locations. Controlling for tumor location, every 100% increase in ALP from normal increased the hazard for death by 1.7. For canine osteosarcomas of the flat and irregular bones, histopathological features, including grade do not appear to be rigorous predictors of survival. Clinical variables such as increased ALP levels and tumor location in the scapula were associated with decreased survival times.

  2. Paleopathological description and diagnosis of metastatic carcinoma in an Early Bronze Age (4588+34 Cal. BP forager from the Cis-Baikal region of Eastern Siberia.

    Directory of Open Access Journals (Sweden)

    Angela R Lieverse

    Full Text Available Extensive osteolytic and osteoblastic lesions were observed on the skeletal remains of an adult male excavated from an Early Bronze Age cemetery dated to 4556+32 years BP, located in the Cis-Baikal region of Siberia (Russian Federation. Lytic lesions ranged in size from several mm to over 60 mm in diameter and had irregular, moth-eaten borders. Many of these lesions destroyed trabecular bone, though a hollowed shell of cortical bone often remained observable. Radiographic analysis revealed numerous lytic lesions within trabecular bone that had not yet affected the cortex. Blastic lesions were identified as spiculated lines, bands, or nodules of mostly immature (woven bone formed at irregular intervals. Anatomical elements with the greatest involvement included those of the axial skeleton (skull, vertebrae, sacrum, ribs, and sternum as well as proximal appendicular elements (ossa coxae, proximal femora, clavicles, scapulae, and proximal humeri. Osteocoalescence of destructive foci was observed on the ilium and frontal bone, with the largest lesion found on the right ilium. Differential diagnoses include metastatic carcinoma, mycotic infections, tuberculosis, Langerhan's cell histiocytosis, and multiple myeloma. Based on lesion appearance and distribution, age and sex of the individual, as well as pathogen endemism, the most likely diagnostic option for this set of lesions is metastatic carcinoma. The age and sex of this individual and appearance of the lesions may reflect carcinoma of the lung or, possibly, prostate. This represents one of the earliest cases of metastatic carcinoma worldwide and the oldest case documented thus far from Northeast Asia.

  3. Correlation between clinical severity and type and degree of pectus excavatum in twelve brachycephalic dogs.

    Science.gov (United States)

    Hassan, Elham A; Hassan, Marwa H; Torad, Faisal A

    2018-05-18

    The aim of the study was to correlate the clinical severity of pectus excavatum with its type and degree based on objective radiographic evaluation. Twelve brachycephalic dogs were included. Grading of the clinical severity was done based on a 6-point grading score. Thoracic radiographs were used to calculate the frontosagittal and vertebral indices at the tenth thoracic vertebra and the vertebra overlying the excavatum. Correlation between the clinical severity score and frontosagittal and vertebral indices was evaluated using Pearson's correlation coefficient. Typical pectus excavatum was recorded in the caudal sternum in seven dogs, with a mean clinical severity score of 1.7 ± 1.4, whereas in five dogs, atypical mid-sternal deviation was recorded with a mean clinical severity score of 3.8 ± 0.7. A strong correlation (r=0.7) was recorded between the clinical severity score and vertebral index in the atypical form, whereas a weak correlation (r=0.02) was recorded in the typical form (Pcorrelated (r=0.3) in the typical form of pectus excavatum, whereas it was strongly correlated (r=0.9) in the atypical form. Pectus excavatum in dogs is associated with compressive cardiopulmonary dysfunction, which depends mainly on the site/type of deviation rather than the degree of deviation.

  4. Efficacy of Feed Forward and Feedback Signaling for Inflations and Chest Compression Pressure During Cardiopulmonary Resuscitation in a Newborn Mannequin

    Science.gov (United States)

    Andriessen, Peter; Oetomo, Sidarto Bambang; Chen, Wei; Feijs, Loe MG

    2012-01-01

    Background The objective of the study was to evaluate a device that supports professionals during neonatal cardiopulmonary resuscitation (CPR). The device features a box that generates an audio-prompted rate guidance (feed forward) for inflations and compressions, and a transparent foil that is placed over the chest with marks for inter nipple line and sternum with LED’s incorporated in the foil indicating the exerted force (feedback). Methods Ten pairs (nurse/doctor) performed CPR on a newborn resuscitation mannequin. All pairs initially performed two sessions. Thereafter two sessions were performed in similar way, after randomization in 5 pairs that used the device and 5 pairs that performed CPR without the device (controls). A rhythm score was calculated based on the number of CPR cycles that were performed correctly. Results The rhythm score with the device improved from 85 ± 14 to 99 ± 2% (P CPR device compared to the controls. Conclusion Feed forward and feedback signaling leads to a more constant rhythm and chest compression pressure during CPR. PMID:22870175

  5. Pathological Features of Fatal Crocodile Attacks in Northern Australia, 2005-2014.

    Science.gov (United States)

    Sinton, Terence J; Byard, Roger W

    2016-11-01

    Eleven deaths from crocodile attacks in the Northern Territory, Australia were reviewed. The male:female ratio was 8:3; age range-10-62 years, average 29.4 years. Four children were included (one boy and three girls, aged 10, 11, and two at 12 years), and there were seven aboriginal victims (64%). The attacks were witnessed in eight cases with the victims swimming in freshwater N = 5, standing on a river bank N = 1, fishing in fresh water N = 1, or diving in the sea N = 1. At autopsy, several distinct patterns of injury were observed ranging from complete traumatic disruption of the body with only incomplete remains for examination (N = 5), to crushing of the head with fractures of the skull (N = 4), crushing of the chest with fractures of the ribs and sternum (N = 2), and avulsion of limbs (N = 4). In one case, there was decapitation. Autopsy evaluations were complicated by decomposition and loss of body parts. © 2016 American Academy of Forensic Sciences.

  6. Study on biological effect on mice and use safety of 830 nm semiconductor laser

    International Nuclear Information System (INIS)

    Li Keqiu; Li Jian; Miao Xuhong; Liu Shujuan; Li Guang

    2006-01-01

    Objective: To study biological effect on mice by 830 nm semiconductor laser in different dosage, and determine the optimal irradiating dosage by observing and analyzing the immunoregulation and cytogenetical damage of mice after irradiation. Methods: The spleen and thymus areas of Kunming mice were irradiated in vitro by 830 nm semiconductor laser of 30 mW for 5 min, 10 min and 20 min per day respectively, then the blood samples were collected from orbital vein. Further, the spleen tissue and sternum marrow were collected soon after the mice were killed. Afterwards, IgG, dopamine, serotonin in serum were detected respectively. Besides these, the rate of lymphocyte transformation and the rate of micronuclei in marrow polychromatic erythrocytes were also determined. Results: With the extending of irradiating time, the detected factors changed differently. Statistically, there were differences in IgG concentration and the rate of lymphocyte transformation between 10 min group, 20 min group and control group respectively, but no difference between each experimental group were found. /compare with control group, serotonin concentration in 10 min group increased, and there was statistical difference between these two groups, while there was no difference in dopamine concentration among each group. Besides these, the rate of micronuclei in 20 min group increased. Conclusion: In this study, irradiation by semiconductor laser for appropriate time can improve immuno function of mice, but irradiation in high dosage will result in the damage of genetic material. The optimal time of irradiation by 830 nm semiconductor laser was 10 min. (authors)

  7. Location of Sternal Fractures as a Possible Marker for Associated Injuries

    Directory of Open Access Journals (Sweden)

    Max J. Scheyerer

    2013-01-01

    Full Text Available Introduction. Sternal fractures often occur together with serious and life-threatening additional injuries. This retrospective study was designed to assess concomitant injuries and develop a correlation between fracture location and the severity of injury. Methods. All patients ( diagnosed with a fracture of the sternum by means of a CT scan were analysed with respect to accident circumstances, fracture morphology and topography, associated injuries, and outcome. Results. Isolated sternal fractures occurred in 9%. In all other admissions, concomitant injuries were diagnosed: mainly rip fractures (64%, injury to the head (48%, the thoracic spine (38%, lumbar spine (27%, and cervical spine (22%. Predominant fracture location was the manubrium sterni. In these locations, the observed mean ISS was the highest. They were strongly associated with thoracic spine and other chest injuries. Furthermore, the incidence of head injuries was significantly higher. ICU admission was significantly higher in patients with manubrium sterni fractures. Conclusion. Sternal fractures are frequently associated with other injuries. It appears that the fracture location can provide important information regarding concomitant injuries. In particular, in fractures of manubrium sterni, the need for further detailed clinical and radiologic workup is necessary to detect the frequently associated injuries and reduce the increased mortality.

  8. Pentalogía de Cantrell (ectopia cordis: reporte de un caso Pentalogy of Cantrell (ectopia cordis: report of one case

    Directory of Open Access Journals (Sweden)

    Carlos E Riaño

    2010-12-01

    Full Text Available La pentalogía de Cantrell involucra defectos de la línea media abdominal supraumbilical, parte inferior del esternón, diafragma anterior, pericardio diafragmático y malformaciones congénitas intracardiacas (1, 2. Su pronóstico está supeditado al diagnóstico temprano, la severidad de la malformación cardiaca y las anomalías asociadas (3. Se reporta el caso de una gestante de 28 semanas con diagnóstico fetal de pentalogía de Cantrell: ectopia cordis verdadera toraco-abdominal (con anomalía intracardiaca y fisura esternal, y se resalta el diagnóstico prenatal que permitió definir su pronóstico y planear el manejo.Pentalogy of Cantrell involves defects of the midlline supraumbilical abdomen, lower sternum, anterior diaphragm, diaphragmatic pericardium and intracardiac congenital defects. Prognosis depends on early diagnosis, severity of cardiac malformation and associated anomalies. We report the case of a 28 weeks pregnant woman with fetal diagnosis of pentalogy of Cantrell: true thoraco-abdominal ectopia cordis (with intracardiac anomaly and sternal cleft, and highlight prenatal diagnosis that allowed to define prognosis and plan management.

  9. Partial Ectopia Cordis: A Case Report

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    Reza Saeidi

    2017-09-01

    Full Text Available Background: One-third of all major congenital anomalies are Congenital heart disease (CHD and Reported CHD prevalence increased over time and in Asian countries is more than western countries. Ectopia cordis (EC is a rare congenital anomaly with an estimated incidence of 1:100 000 live births in developed countries. EC is characterized by abnormal heart placement outside the thorax, mostly on the thoracoabdominal side. This form is often associated with pentalogy of Cantrell.Case report: We report one cases of the ectopia cordis at the Emam Reza Hospital in Mashhad. In this report, a rare case with incomplete pentalogy of Cantrell are described. It was a boy with a large omphalocele with evisceration of the heart. He had normal capillary refill and responded to stimuli. This patient was a male fetus with ectopia cordis with intracardiac anomalies; a large omphalocele with evisceration of the heart; a hypoplastic sternum and rib cage.Conclusion: Prognosis seems to be poorer in patients with the complete form of pentalogy of Cantrell, EC, and patients with associated anomalies. Intracardial defects do not seem to be a prognostic factor

  10. Nuss bar migrations: occurrence and classification

    International Nuclear Information System (INIS)

    Binkovitz, Lauren E.; Binkovitz, Larry A.; Zendejas, Benjamin; Moir, Christopher R.

    2016-01-01

    Pectus excavatum results from dorsal deviation of the sternum causing narrowing of the anterior-posterior diameter of the chest. It can result in significant cosmetic deformities and cardiopulmonary compromise if severe. The Nuss procedure is a minimally invasive technique that involves placing a thin horizontally oriented metal bar below the dorsal sternal apex for correction of the pectus deformity. To identify the frequency and types of Nuss bar migrations, to present a new categorization of bar migrations, and to present examples of true migrations and pseudomigrations. We retrospectively reviewed the electronic medical records and all pertinent radiologic studies of 311 pediatric patients who underwent a Nuss procedure. We evaluated the frequency and type of bar migrations. Bar migration was demonstrated in 23 of 311 patients (7%) and occurred within a mean period of 26 days after surgery. Bar migrations were subjectively defined as deviation of the bar from the position demonstrated on the immediate postoperative radiographs and categorized as superior, inferior, rotation, lateral or flipped using a new classification system. Sixteen of the 23 migrations required re-operation. Nuss bar migration can be diagnosed with careful evaluation of serial radiographs. Nuss bar migration has a wide variety of appearances and requires exclusion of pseudomigration resulting from changes in patient positioning between radiologic examinations. (orig.)

  11. A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation

    Directory of Open Access Journals (Sweden)

    Grapow Martin TR

    2012-06-01

    Full Text Available Abstract Background Wire closure still remains the preferred technique despite reasonable disadvantages. Associated complications, such as infection and sternal instability, cause time- and cost-consuming therapies. We present a new tool for sternal closure with its first clinical experience and results. Methods The sternal ZipFixTM System is based on the cable-tie principle. It primarily consists of biocompatible Poly-Ether-Ether-Ketone implants and is predominantly used peristernally through the intercostal space. The system provides a large implant-to-bone contact for better force distribution and for avoiding bone cut through. Results 50 patients were closed with the ZipFixTM system. No sternal instability was observed at 30 days. Two patients developed a mediastinitis that necessitated the removal of the device; however, the ZipFixTM were intact and the sternum remained stable. Conclusions In our initial evaluation, the short-term results have shown that the sternal ZipFixTM can be used safely and effectively. It is fast, easy to use and serves as a potential alternative for traditional wire closure.

  12. [A Case Report on Successful Larynx-Preserving Surgery for a Cervical Esophageal Cancer That Invaded the Hypopharynx].

    Science.gov (United States)

    Shiraishi, Osamu; Kato, Hiroaki; Iwama, Mitsuru; Hiraki, Yoko; Yasuda, Atsushi; Shinkai, Masayuki; Imano, Motohiro; Kimura, Yutaka; Imamoto, Haruhiko; Yasuda, Takushi

    2017-11-01

    The patient was a 58-year-old man suffering from dysphagia. He was diagnosed with T3 cervicalesophagealcancer that invaded the posterior hypopharyngealwal lwith lymph node metastasis. The patient received neoadjuvant chemoradiotherapy (30 Gy with CDDP/5-FU), followed by larynx-preserving surgery(LPS)for cervicalesophagealcancer. Two techniques for successfulLPS consist of the dissections of cricopharyngealmuscl e and the inferior pharyngealsphincter, and the complete division of the bilateral infrahyoid muscles attached to the sternum(CDBIMS). The former technique of releasing the esophagus from the trachea at the cricoid cartilage level results in the extension of the oral surgical margin. The latter technique is expected to prevent postoperative aspiration pneumonia, as the lack of flexibility of scarred infrahyoid muscles is regarded as one of the major causes of dysfunction in swallowing. Free jejunum was transferred for cervical reconstruction. Pathological examination indicated degenerated squamous cell carcinoma(ypT2, INF b, ly0, v0, PM0, ypN0, ypStage II A). Although the patient had recurrent nerve palsy, he could eat meals without aspiration. He returned to normal life after discharge from the hospital. Five years after surgery, no recurrence had been observed.

  13. Comparison of Lower Limb Segments Kinematics in a Taekwondo Kick. An Approach to the Proximal to Distal Motion

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    Estevan Isaac

    2015-09-01

    Full Text Available In taekwondo, there is a lack of consensus about how the kick sequence occurs. The aim of this study was to analyse the peak velocity (resultant and value in each plane of lower limb segments (thigh, shank and foot, and the time to reach this peak velocity in the kicking lower limb during the execution of the roundhouse kick technique. Ten experienced taekwondo athletes (five males and five females; mean age of 25.3 ±5.1 years; mean experience of 12.9 ±5.3 years participated voluntarily in this study performing consecutive kicking trials to a target located at their sternum height. Measurements for the kinematic analysis were performed using two 3D force plates and an eight camera motion capture system. The results showed that the proximal segment reached a lower peak velocity (resultant and in each plane than distal segments (except the peak velocity in the frontal plane where the thigh and shank presented similar values, with the distal segment taking the longest to reach this peak velocity (p < 0.01. Also, at the instant every segment reached the peak velocity, the velocity of the distal segment was higher than the proximal one (p < 0.01. It provides evidence about the sequential movement of the kicking lower limb segments. In conclusion, during the roundhouse kick in taekwondo inter-segment motion seems to be based on a proximo-distal pattern.

  14. Metastatic Sarcomatoid Squamous Cell Carcinoma of the Cervix Presenting with Chest Mass

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    Lilit Karapetyan

    2017-01-01

    Full Text Available Background. Sarcomatoid squamous cell carcinoma is a rare and aggressive form of cervical cancer. We report a case of metastatic sarcomatoid squamous cell carcinoma (SSCC of cervix that presented with an anterior chest wall mass. Case. A 43-year-old Hispanic female presented with a two-month history of a central chest wall mass. The patient’s only past medical history was SSCC of the cervix, stage IIB, diagnosed two years priorly. She underwent neoadjuvant chemoradiation therapy (CRT with cisplatin followed by radical hysterectomy. Surgical margins were positive which led to adjuvant CRT with carboplatin and paclitaxel. PET scan 4 months after the postoperative treatment was negative for recurrence and metastatic disease. On current presentation, the CT chest revealed anterior mediastinal destructive soft tissue mass involving sternum, and the biopsy showed SSCC. The patient received palliative radiation therapy to her chest with improvement in pain and ability to swallow. After discussing the prognosis she refused further chemotherapy and decided on hospice care. Conclusion. Despite good response to first-line therapy, SSCC tends to recur early and does not respond to second-line therapy. Radiation therapy seems to be the most effective modality for treatment, but randomized controlled trials of therapy are impractical.

  15. Vocal anatomy, tongue protrusion behaviour and the acoustics of rutting roars in free-ranging Iberian red deer stags (Cervus elaphus hispanicus).

    Science.gov (United States)

    Frey, Roland; Volodin, Ilya; Volodina, Elena; Carranza, Juan; Torres-Porras, Jerónimo

    2012-03-01

    Roaring in rutting Iberian red deer stags Cervus elaphus hispanicus is unusual compared to other subspecies of red deer, which radiated from the Iberian refugium after the last glacial maximum. In all red deer stags, the larynx occupies a permanent low mid-neck resting position and is momentarily retracted almost down to the rostral end of the sternum during the production of rutting calls. Simultaneous with the retraction of the larynx, male Iberian red deer pronouncedly protrude the tongue during most of their rutting roars. This poses a mechanical challenge for the vocal tract (vt) and for the hyoid apparatus, as tongue and larynx are strongly pulled in opposite directions. This study (i) examines the vocal anatomy and the acoustics of the rutting roars in free-ranging male C. e. hispanicus; (ii) establishes a potential mechanism of simultaneous tongue protrusion and larynx retraction by applying a two-dimensional model based on graphic reconstructions in single video frames of unrestrained animals; and (iii) advances a hypothesis of evaporative cooling by tongue protrusion in the males of a subspecies of red deer constrained to perform all of the exhausting rutting activities, including acoustic display, in a hot and arid season. © 2012 The Authors. Journal of Anatomy © 2012 Anatomical Society.

  16. Dynamical Properties of Postural Control in Obese Community-Dwelling Older Adults

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    Christopher W. Frames

    2018-05-01

    Full Text Available Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI ranging from 18 to 63 kg/m2, using a force plate and an inertial measurement unit affixed at the sternum. Participants’ fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance.

  17. Gallium tomoscintigraphic imaging of esophageal cancer using emission computed tomography

    International Nuclear Information System (INIS)

    Hattori, Takao; Nakagawa, Tsuyoshi; Takeda, Kan; Maeda, Hisato; Taguchi, Mitsuo

    1983-01-01

    Emission computed tomography (ECT) was clinically evaluated in 67 Ga imaging of esophageal cancer. ECT system used in this study is equipped with opposed dual large-field-of-view cameras (GCA 70A-S, Toshiba Co.). Data were acquired by rotating the two cameras 180 0 about the longitudinal axis of the patient. Total acquisition time was about 12 minutes. Multiple slices of transaxial, sagittal and coronal sections were reconstructed in a 64 x 64 matrix form using convolution algorithms. In three out of six cases studied the tumor uptake was not detected on conventional images, because the lesion was small, concentration of activity was poor or the lesion activity was overlapped with the neighbouring activities distributed to normal organs such as sternum, vertebra, liver and hilus. On ECT images, by contrast, abnormal uptake of the tumors was definitively detected in all the six cases. ECT imaging was also useful in estimating the effect of treatment by the decrease in 67 Ga concentration. We have devised a special technique to repeat ECT scan with a thin tube filled with 67 Ga solution inserted through the esophagus. By this technique, comparing paired images with and without the tube activity, exact location of the uptake against the esophagus and extraesophageal extension of the disease could be accurately evaluated in a three-dimensional field of view. ECT in gallium scanning is expected to be of great clinical value to elevate the confidence level of diagnosis in detecting, localizing and following up the diseases. (author)

  18. Subjective and objective analysis of three water pump systems carried by forest firefighters.

    Science.gov (United States)

    Moser, Daniel J; Graham, Ryan B; Stevenson, Joan M; Costigan, Patrick A

    2014-01-01

    The Mark 3 (M3) water power pump is an integral piece of wildfire fighting equipment. However, it is provided to fire stations without a carrying harness. The currently-used carrying harness is very uncomfortable, especially when carrying the pumps considerable distance in a forest to reach a water source. The purpose of this study was to advise the Ontario Ministry of Natural Resources on the selection of a new M3 load carriage system. Twenty Fire Rangers wore the three systems (Original, Prototype, and Modified) through a circuit of tasks representative of their working environment. Subjective and objective approaches were combined to assess and rank the M3 carriage systems. Subjective visual analogue scale ratings were obtained for ease of loading/unloading, comfort, system stability, and overall performance. Tri-axial accelerometers were mounted on each pump and at the sternum of each participant to determine relative pump-carrier accelerations. Overall, the Prototype was ranked as the best system; it resulted in the lowest relative pump-carrier accelerations on 10 out of 15 objective measures, and also received a first place ranking on all subjective measures. It was recommended that the Prototype be implemented as the M3 carriage system for fire suppression teams.

  19. Bone marrow scintigraphy vs bone scintigraphy and radiography in multiple myeloma

    International Nuclear Information System (INIS)

    Feggi, M.; Prandini, N.; Orzincolo, C.; Bagni, B.; Scutellari, P.N.; Spanedda, R.; Gennari, M.; Scapoli, C.L.

    1988-01-01

    The radiography patterns of the skeleton of 73 patients affected by multiple myeloma (MM) were compared to the correspondent scintigraphic findings. Whole body scans were performed using Tc-diphosphonates 99m (bone scintigraphy). And Tc-microcolloides 99m (bone marrow scintigraphy). The results indicate that: a) radiography is more sensitive and accurate than scintigraphy in detecting typical myeloma-related bone lesions; b) bone scintigraphy is useful in detecting alterations in particular locations-i.e. sternum, ribs, scapulae, etc.-which are difficult to demonstrate by plain X-rays; moreover, the recovery of the fractures can be visualized; c) bone marrow scintigraphy is employed to demonstrate the presence of marrow expasion, of cold/hot spots, and relative marrow uptake, related to phagocytic activity. Since in adult men red marrow is confined to the epiphysis of long bones and to the spine, all the diseases affecting bone marrow cause medullary expansion/reduction, which are both easily detected by specific radiopharmaceuticals. The peripheral expasions is clearly documented especially in distal humeri and femora since marrow uptake is included, in healthy adults, in the axial and proximal appendicular skeleton. In spite of its yielding unique informetion, bone marrow scintigraphy remains an additional technique of bone scan, because of its low diagnoditc accuracy

  20. MANAGEMENT OF CONGENITAL SYMMASTIA WITH Z PLASTY : A CASE REPORT

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    Biswajit

    2015-03-01

    Full Text Available BACKGROUND : Symmastia is defined as medial confluence of the breast. The term 'symmastia' is modified from Greek (sym meaning 'together', and mastos meaning 'breast' and was first presented by Spence et al. in 1983. Two forms of symmastia exist: congenital and acquir ed form. Congenital symmastia is a rare condition in which web - like soft tissue traverses the sternum to connect the breasts medially. There is few publication of this condition. Treatment options for this condition are also few. MATERIAL AND METHOD : Thoug h Periareolar approach, and vertical reduction mammoplasty has been described as a method to reduce the size of the breast as well as correct symmastia . We used z plasty in our case because the patient was not willing for reduction of the size of the breas t. RESULT : The patient had well defined midline groove, symmetric breast on each side. CONCLUSION : Z plasty can be an innovative method for creation of midline groove in congenital symmastia in patients of low socioeconomic status as an alternative to redu ction mammoplasty and liposuction

  1. Development of a green fluorescent protein metastatic-cancer chick-embryo drug-screen model.

    Science.gov (United States)

    Bobek, Vladimir; Plachy, Jiri; Pinterova, Daniela; Kolostova, Katarina; Boubelik, Michael; Jiang, Ping; Yang, Meng; Hoffman, Robert M

    2004-01-01

    The chick-embryo model has been an important tool to study tumor growth, metastasis, and angiogenesis. However, an imageable model with a genetic fluorescent tag in the growing and spreading cancer cells that is stable over time has not been developed. We report here the development of such an imageable fluorescent chick-embryo metastatic cancer model with the use of green fluorescent protein (GFP). Lewis lung carcinoma cells, stably expressing GFP, were injected on the 12th day of incubation in the chick embryo. GFP-Lewis lung carcinoma metastases were visualized by fluorescence, after seven days additional incubation, in the brain, heart, and sternum of the developing chick embryo, with the most frequent site being the brain. The combination of streptokinase and gemcitabine was evaluated in this GFP metastatic model. Twelve-day-old chick embryos were injected intravenously with GFP-Lewis lung cancer cells, along with these two agents either alone or in combination. The streptokinase-gemcitabine combination inhibited metastases at all sites. The effective dose of gemcitabine was found to be 10 mg/kg and streptokinase 2000 IU per embryo. The data in this report suggest that this new stably fluorescent imageable metastatic-cancer chick-embryo model will enable rapid screening of new antimetastatic agents.

  2. Railway train versus motor vehicle collisions: a comparative study of injury severity and patterns.

    Science.gov (United States)

    Kligman, M D; Knotts, F B; Buderer, N M; Kerwin, A J; Rodgers, J F

    1999-11-01

    This study compares the demographics, injury severity, resource use, and injury patterns of patients involved in railway train-motor vehicle (RT-MV) to motor vehicle-motor vehicle (MV-MV) collisions. Retrospective trauma registry review of 74 RT-MV and 1,931 MV-MV consecutive patients, age more than 14 years, presenting to two Level I trauma centers, January of 1991 to May of 1998. Compared with MV-MV, RT-MV had significantly more males (72% vs. 54%), higher mortality (15% vs. 7%), higher Injury Severity Score (median, 20 vs. 9), longer intensive care unit length of stay (1.7 vs. 0.04 days), and longer hospital length of stay (7.5 vs. 4 days). RT-MV patients had a higher percentage of scalp/facial lacerations; intracranial hemorrhage; hemothorax and pneumothorax; fractures of the rib/sternum, upper extremity, skull, and face; and lung, splenic, and renal injuries. After adjusting for the difference in Injury Severity Score between groups, the only remaining significant group difference was the odds of a scalp/facial laceration. RT-MV collisions are a marker for more severe injuries, but not a different pattern of injury, compared with MV-MV collisions.

  3. Pneumomediastinum in Blunt Chest Trauma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Gregory Mansella

    2014-01-01

    Full Text Available Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.

  4. MODERN DIAGNOSTIC AND THERAPEUTIC TECHNOLOGIES FOR THE CHEST TRAUMA ASSOCIATED WITH THE FALL FROM A HEIGHT IN THE REPUBLIC RESEARCH CENTRE OF EMERGENCY MEDICINE

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    A. M. Khadzhibayev

    2015-01-01

    Full Text Available BACKGROUND. The rate of the multisystem chest trauma and mortality in patients with catatrauma remains high.OBJECTIVE. To study the diagnosis and treatment of the multisystem chest trauma in patients associated with the fall from a height.MATERIAL AND METHODS. 243 patients (208 multisystem injuries and 35 isolated injuries with a chest trauma associated with the fall from a height were examined in the surgical department of Republic research centre of emergency medicine. We performed X-ray, CT and endosurgical examinations.RESULTS. Instrumental examination revealed pneumothorax and hydrothorax in 24.4% and 22.6% of victims respectively. The rib injuries were observed in 181 patients, sternum fractures in 8 victims and thoracic vertebrae fractures in 84 patients. The puncture and thoracocentesis of the pleural cavities were performed in 85 cases. The thoracoscopy was performed in 21 patients, the thoracotomy – in 15 patients, suturing of the lung – in 22 patients, coagulation – in 15 patients, external plate fixation of multiple injured ribs – in 10 patients. The mortality rate was 21.4%.CONCLuSION. The specifics of the multisystem chest trauma associated with the fall from a height is the development of hemothorax and pneumothorax. Thoracocentesis and videothoracoscopy allow to diagnose and stop the hemorrhage properly, to restore the lung rupture and perform the thoracotomy in severe cases, as well as reduce of complications frequency and mortality rate. 

  5. Experimental transmission of Trypanosoma cruzi through the genitalia of albino mice

    Directory of Open Access Journals (Sweden)

    Leidi Herrera

    2001-07-01

    Full Text Available Trypanosoma cruzi is usually transmitted by contact with the excreta of infected Triatominae; among non-vectorial infections, direct transmission through coitus has been proposed. We investigated this possibility by instilling, through the external meatus of the vagina and the penis of previously anesthetized NMRI albino mice, blood of mice infected with strains isolated from Didelphis marsupialis (opossum, strain CO57, Rattus rattus (rat, strain CO22 and human (strain EP. Some animals were allowed to copulate the same day of the instillation. In other experiments, the strains were inoculated in the scrotum. To determine the effect of immunosuppression, some mice were treated with cyclophosphamide 30 days post-instillation. Controls were instilled orally and ocularly. Vaginal instillation with strain CO22 produced systemic infection with tropism to the heart, skeletal muscle, skin, duodenum, pancreas, ovary and sternum. Scrotal inoculation with strain EP likewise invaded liver, spleen, lung, lymph nodes and urogenital organs; while strain CO57 invaded skeletal and cardiac muscle, pancreas, testis, and vas deferens. Penile infection with strain CO22 was detected by xenodiagnosis. Immunosuppression did not increase parasitemia of vaginally infected mice or controls. Mating did not produce infection. Our results show that contact of blood trypomastigotes of T. cruzi with genital mucosa can produce blood and tissue infections. These results are discussed in relation to reports of frequent experimental tropism of T. cruzi toward urogenital organs.

  6. Bone dosimetry using synthetic images to represent trabecular bones of five regions of the human body

    International Nuclear Information System (INIS)

    Lima Filho, Jose de M.; Vieira, Jose W.; Lima, Vanildo J. de M.; Lima, Lindeval F.; Lima, Fernando R.A.; Vasconcelos, Wagner E. de

    2011-01-01

    One of the greatest challenges in numerical dosimetry of ionizing radiation is to estimate the absorbed dose by bone tissue in the human body. The bone tissues of greater radiosensitivity are the red bone marrow (RBM), that consist of the hematopoietic cells, located within the trabecular bones, and the bone surface cells (BSC), called osteogenic cells. The report 70 of the ICRP lists five spongiosa regions with their respective volume percent of trabecular bone: ribs (also contemplating the clavicles and sternum), spine, long bones, pelvis and skull (also contemplating mandible). The Grupo de Pesquisa em Dosimetria Numerica (GDN/CNPq) has been built exposure computational models (ECMs) based on voxel phantoms and EGSnrc Monte Carlo code. To estimate the energy deposited in the RBM and in the BSC of a phantom, the GDN/CNPq has used a method based on micro-CT images of the five trabecular regions mentioned above. These images were provided by other research institutes and were obtained from scan of bone samples of adult. Here is the greatest difficulty in reproducing this method: besides the need for bone images of real people with micrometer resolution, the distribution of bone marrow in the human body, according to ICRP 70, varies with age. This article presents some proposals of the GDN/CNPQ for replacing in the ECMs the micro-CT images by images synthesized by the computer, based on Monte Carlo sampling. (author)

  7. Computerized tomographic simulation compared with clinical mark-up in palliative radiotherapy: A prospective study

    International Nuclear Information System (INIS)

    Haddad, Peiman; Cheung, Fred; Pond, Gregory; Easton, Debbie; Cops, Frederick; Bezjak, Andrea; McLean, Michael; Levin, Wilfred; Billingsley, Susan; Williams, Diane; Wong, Rebecca

    2006-01-01

    Purpose To evaluate the impact of computed tomographic (CT) planning in comparison to clinical mark-up (CM) for palliative radiation of chest wall metastases. Methods and Materials In patients treated with CM for chest wall bone metastases (without conventional simulation/fluoroscopy), two consecutive planning CT scans were acquired with and without an external marker to delineate the CM treatment field. The two sets of scans were fused for evaluation of clinical tumor volume (CTV) coverage by the CM technique. Under-coverage was defined as the proportion of CTV not covered by the CM 80% isodose. Results Twenty-one treatments (ribs 17, sternum 2, and scapula 2) formed the basis of our study. Due to technical reasons, comparable data between CM and CT plans were available for 19 treatments only. CM resulted in a mean CTV under-coverage of 36%. Eleven sites (58%) had an under-coverage of >20%. Mean volume of normal tissues receiving ≥80% of the dose was 5.4% in CM and 9.3% in CT plans (p = 0.017). Based on dose-volume histogram comparisons, CT planning resulted in a change of treatment technique from direct apposition to a tangential pair in 7 of 19 cases. Conclusions CT planning demonstrated a 36% under-coverage of CTV with CM of ribs and chest wall metastases

  8. Radiography and bone scintigraphy in bone marrow transplant multiple myeloma patients

    International Nuclear Information System (INIS)

    Aagren, B.; Aspelin, P.

    1997-01-01

    Purpose: To compare conventional radiography and bone scintigraphy in relation to clinical outcome in bone marrow transplant multiple myeloma patients. Material and Methods: A total of 70 radiographies and 70 bone scintigraphies were compared in 35 patients. Results: The skull, the extremities, the iliac and public bones were better assessed with radiography. For new vertebral lesions and for lesions in the ribs and sternum, bone scintigraphy proved superior. For the sacrum, the methods were equal. When bone scintigraphy was used as a complement to radiography, 4% more pathological sites were found. No patient had both a normal radiography and a pathological bone scintigraphy, but 5 patients had both a normal bone scintigraphy and a pathological radiography. The results of the radiological examinations did not always correlate with the clinician's grading of the patient's disease. The radiological examinations had no prognostic value for the 7 patients examined on several occasions. Conclusion: The ability of conventional radiography and bone scintigraphy to disclose myeloma lesions varies, depending on location and size of the lesions. Radiography should remain the primary examination modality also for bone marrow transplant multiple myeloma patients. Bone scintigraphy can severe as a complement for investigating unexplained pain, e.g. caused by lesions in vertebrae or ribs. (orig.)

  9. Value of bone scintigraphy in the search for metastases of primary bronchial carcinomas (relative to 8 observation)

    International Nuclear Information System (INIS)

    Lanuit, Robert.

    1976-01-01

    99m-technetium-labelled pyrophosphates are used at present. This technique combines the tropism of inorganic phosphates for the skeleton with the particularly suitable physical characteristics of technetium. The bone receives on irradiation of 0.5 rads for 10 millicuries of technetium, i.e. the equivalent of three lung X-rays, which means that the examination can safety be carried out on children. The scintigraph is performed with a two-head scanner giving a frontal image, showing in particular the shoulders, sternum, ribs and pelvic belt, and a dorsal image giving a better view of the spine and especially the sacro-iliac joints. When bone metastases are investigated by scintigraphic as compared to radiographic examination it should be remembered that 99mTc-labelled pyrophosphate scintigraphy, while revealing bone metastases at a pre-radiological stage in some cases, cannot distinguish between a benign and a malignant hyperfixing lesion nor show whether or not several lesions on the same scintigram are similar in origin. In this respect these two paraclinical examinations are complementary and give excellent results when used together [fr

  10. Nuss bar migrations: occurrence and classification

    Energy Technology Data Exchange (ETDEWEB)

    Binkovitz, Lauren E.; Binkovitz, Larry A. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Zendejas, Benjamin; Moir, Christopher R. [Mayo Clinic, Department of Surgery, Rochester, MN (United States)

    2016-12-15

    Pectus excavatum results from dorsal deviation of the sternum causing narrowing of the anterior-posterior diameter of the chest. It can result in significant cosmetic deformities and cardiopulmonary compromise if severe. The Nuss procedure is a minimally invasive technique that involves placing a thin horizontally oriented metal bar below the dorsal sternal apex for correction of the pectus deformity. To identify the frequency and types of Nuss bar migrations, to present a new categorization of bar migrations, and to present examples of true migrations and pseudomigrations. We retrospectively reviewed the electronic medical records and all pertinent radiologic studies of 311 pediatric patients who underwent a Nuss procedure. We evaluated the frequency and type of bar migrations. Bar migration was demonstrated in 23 of 311 patients (7%) and occurred within a mean period of 26 days after surgery. Bar migrations were subjectively defined as deviation of the bar from the position demonstrated on the immediate postoperative radiographs and categorized as superior, inferior, rotation, lateral or flipped using a new classification system. Sixteen of the 23 migrations required re-operation. Nuss bar migration can be diagnosed with careful evaluation of serial radiographs. Nuss bar migration has a wide variety of appearances and requires exclusion of pseudomigration resulting from changes in patient positioning between radiologic examinations. (orig.)

  11. Investigation of the preventive effect of Sijunzi decoction on mitomycin C-induced immunotoxicity in rats by 1H NMR and MS-based untargeted metabolomic analysis.

    Science.gov (United States)

    Guan, Zhibo; Wu, Juan; Wang, Cancan; Zhang, Fang; Wang, Yinan; Wang, Miao; Zhao, Min; Zhao, Chunjie

    2018-01-10

    Sijunzi decoction (SJZD) is a well known traditional Chinese prescription used for the treatment of gastrointestinal disorders and immunity enhancement. It has been found to indeed improve life quality of chemotherapy patients and extensive used in clinical conbined with chemotherapeutics for the treatment of cancer. The aim of this study was to investigate the preventive effect of the immunotoxicity of SJZD on mitomycin C (MMC) and the metabolic mechanism of action. NMR and MS-based metabolomics approaches were combined for monitoring MMC-induced immunotoxicity and the protective effect of SJZD. Body weight change and mortality, histopathological observations and relative viscera weight determinations of spleen and thymus, sternum micronucleus assay and hematological analysis were used to confirm the immunotoxicity and attenuation effects. An OPLS-DA approach was used to screen potential biomarkers of immunotoxicity and the MetaboAnalyst and KEGG PATHWAY Database were used to investigate the metabolic pathways. 8 biomarkers in plasma samples, 19 in urine samples and 10 in spleen samples were identified as being primarily involved in amino acid metabolism, carbohydrate metabolism and lipid metabolism. The most critical pathway was alanine, aspartate and glutamate metabolism. The variations in biomarkers revealed the preventive effect of the immunotoxicity of SJZD on MMC and significant for speculating the possible metabolic mechanism. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  12. Dosimetric validation of synthetic trabecular bone generated by parametric Monte Carlo Method; Validação dosimétrica de trabéculas ósseas sintéticas geradas por método Monte Carlo paramétrico

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, F.G.; Andrade, A.F.G. de; Vieira, J.W., E-mail: baby.oliveira@hotmail.com.br, E-mail: arthurfelandrade@gmail.com, E-mail: jose.wilson59@uol.com.br [Instituto Federal de Pernambuco (IFPE), Recife, PE (Brazil); Oliveira, A.C.H. de, E-mail: oliveira_ach@yahoo.com [Universidade Federal Rural de Pernambuco (UFRPE), Recife, PE (Brazil); Lima, F.R.A., E-mail: falima@cnen.gov.br [Centro Regional de Ciências Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife-PE (Brazil)

    2017-07-01

    One of the greatest challenges of numerical dosimetry is to estimate the dose of ionizing radiation absorbed by the soft tissues that are located in bone trabecular. Due to the difficulty in obtaining micro-CT images of real bone samples (OR), the need for the generation of synthetic bone trabecular appeared. In this work, virtual synthetic trabecular samples (BU), generated by Monte Carlo methods parameterized by the Burr XII probability density function (FDP), and their OR equivalents were submitted to dosimetric evaluations in the adult male Computational Exposure Model (MCE) in orthostatic position (MSTA) coupled to the EGSnrc software with idealized photon-emitting sources and targeting the two most radiosensitive bone tissues: red bone marrow and the foramen-bone surface of trabecular bones, sternum, spine, femur, pelvis and skull regions. When comparing the dosimetric results of the two sample sets, it was found that the overall relative error presented was 4.34%. It is concluded that the synthetic trabecular generated by FDPs with the same characteristics as the Burr XII FDP can successfully replace the OR bones in similar bone dosimetry tests.

  13. Growth performance and pork fat quality as measured by three methods of pigs fed 20% DDGS and slaughtered using a standard industry split marketing strategy.

    Science.gov (United States)

    Shircliff, K E; Callahan, Z D; Wilmoth, T A; Ohman, C E; Johnson, R C; Wiegand, B R

    2015-10-01

    A total of 40 pens containing 22 crossbred barrows (initial BW = 43.07 ± 1.61 kg; PIC 1050 × PIC 337 genetics) were housed in a commercial wean to finish facility. Pens were randomly allotted to dietary treatments in a 2 × 3 factorial arrangement with 2 levels of dried distillers grains with solubles (DDGS; 0% or 20%) and chosen for 1 of 3 marketing cuts removing 4, 8, and 10 animals from each pen. Fat tissue samples were removed from the anterior tip of the jowl and posterior to the sternum on the belly edge 1d postmortem. Fatty acid composition was determined via the Folch method, and iodine values (IV) were calculated from chemical titrations, fatty acid profile (GC IV), and in-plant Bruker near-infrared (NIR) spectroscopy. Pearson's correlation coefficients for IV determination methods were estimated. Inclusion of 20% DDGS did not change ( > 0.05) growth performance, whereas marketing cut affected performance, with the second cut producing the most efficient pigs ( marketing time changed growth performance.

  14. Bone scan appearance of renal osteodystrophy in diabetic chronic renal failure patients

    International Nuclear Information System (INIS)

    So, Young; Hyun, In Young; Lee, Dong Soo; Ahn, Curie; Chung, June-Key; Kim, Suhnggwon; Lee, Myung Chul; Lee, Jung Sang; Koh, Chang-Soon

    1998-01-01

    To investigate Tc-99m methylenediphosphonate (MDP) bone scan appearance in diabetic chronic renal failure patients, we compared the bone scan images of chronic renal failure patients with and without diabetes. The number of patients studied was 134, of whom 43 had diabetes. Two nuclear medicine physicians read Tc-99m MDP bone scan images and for six areas - the axial skeleton, long bone, skull and mandible, periarticular areas, costochondral junction, and sternum - assigned a score of either 1 or 0. The sums of scores were compared. We also performed multivariate analysis including sex, age, and serum creatinine level using analysis of covariance. DM group patients scored significantly lower (2.01±0.95) than those of the non-DM group (3.26±1.16). Analysis of covariance revealed that the lower DM group score was independent of sex, age, and serum creatinine level. The bone scans of diabetic chronic renal failure patients showed less Tc-99m MDP uptake than those of non-diabetic patients. Thus, diagnosing renal osteodystrophy in diabetic chronic renal failure patients on bone scan images could be difficult. (author)

  15. Spinal cord injury after conducting transcatheter arterial chemoembolization for costal metastasis of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Sang Jung Park

    2012-09-01

    Full Text Available Transcatheter arterial chemoembolization (TACE has been used widely to treat patients with unresectable hepatocellular carcinoma. However, this method can induce various adverse events caused by necrosis of the tumor itself or damage to nontumor tissues. In particular, neurologic side effects such as cerebral infarction and paraplegia, although rare, may cause severe sequelae and permanent disability. Detailed information regarding the treatment process and prognosis associated with this procedure is not yet available. We experienced a case of paraplegia that occurred after conducting TACE through the intercostal artery to treat hepatocellular carcinoma that had metastasized to the rib. In this case, TACE was attempted to relieve severe bone pain, which had persisted even after palliative radiotherapy. A sudden impairment of sensory and motor functions after TACE developed in the trunk below the level of the sternum and in both lower extremities. The patient subsequently received steroid pulse therapy along with supportive care and continuous rehabilitation. At the time of discharge the patient had recovered sufficiently to enable him to walk by himself, although some paresthesia and spasticity remained.

  16. Early embryonic development of the head region of Gryllus assimilis Fabricius, 1775 (Orthoptera, Insecta).

    Science.gov (United States)

    Liu, Yu; Maas, Andreas; Waloszek, Dieter

    2010-09-01

    We report our investigations on the embryonic development of Gryllus assimilis, with particular attention to the head. Significant findings revealed with scanning electron microscopy (SEM) images include: (1) the pre-antennal lobes represent the anterior-most segment that does not bear any appendages; (2) each of the lobes consists of central and marginal regions; (3) the central region thereof develops into the protocerebrum and the optic lobes, whereas the marginal region thereof becomes the anterior portion of the head capsule; (4) the initial position of the antennal segment is posterior to the mouth region; (5) appendage anlagen are transitorily present in the intercalary segment, and they later vanish together with the segment itself; (6) a bulged sternum appears to develop from the ventral surface of the mandibular, maxillary and labial segments. Embryonic features are then compared across the Insecta and further extended to the embryos of a spider (Araneae, Chelicerata). Striking similarities shared by the anterior-most region of the insect and spider embryos lead the authors to conclude that such comparison should be further undertaken to cover the entire Euarthropoda. This will help us to understand the embryology and evolution of the arthropod head. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Acute mediastinitis: multidetector computed tomography findings following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Macedo, Clarissa Aguiar de [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Instituto do Coracao (InCor)]. E-mail: clarissaaguiarm@yahoo.com.br; Baena, Marcos Eduardo da Silva [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Ultrasonography; Uezumi, Kiyomi Kato [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Computed Tomography; Castro, Claudio Campi de [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Magnetic Resonance Imaging; Lucarelli, Claudio Luiz [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Center of Diagnosis; Cerri, Giovanni Guido [Universidade de Sao Paulo (USP), SP (Brazil). School of Medicine. Dept. of Radiology

    2008-07-15

    Postoperative mediastinitis is defined as an infection of the organs and tissues in the mediastinal space, with an incidence ranging between 0.4% and 5% of cases. This disease severity varies from infection of superficial tissues in the chest wall to fulminant mediastinitis with sternal involvement. Diagnostic criterion for postoperative detection of acute mediastinitis at computed tomography is the presence of fluid collections and gas in the mediastinal space, which might or might not be associated with peristernal abnormalities such as edema of soft tissues, separation of sternal segments with marginal bone resorption, sclerosis and osteomyelitis. Other associated findings include lymphadenomegaly, pulmonary consolidation and pleural/ pericardial effusion. Some of these findings, such as mediastinal gas and small fluid collections can be typically found in the absence of infection, early in the period following thoracic surgery where the effectiveness of computed tomography is limited. After approximately two weeks, computed tomography achieves almost 100% sensitivity and specificity. Patients with clinical suspicion of mediastinitis should be submitted to computed tomography for investigating the presence of fluid collections to identify the extent and nature of the disease. Multidetector computed tomography allows 3D images reconstruction, contributing particularly to the evaluation of the sternum. (author)

  18. Abbreviated larval development of Tunicotheres moseri (Rathbun, 1918 (Decapoda, Pinnotheridae, a rare case of parental care in brachyuran crabs

    Directory of Open Access Journals (Sweden)

    Juan Bolaños

    2004-09-01

    Full Text Available Tunicotheres moseri (Rathbun, 1918 presents a rare case of post-hatching parental care not recorded previously among brachyuran decapods. The complete larval development takes place within a brooding enclosure of the parental female, formed by flexure of the broad abdomen against the sternum. The first crab instar is the earliest stage observed to leave this enclosure, doing so without active help from the parental female. The development of stages preceding the first crab was investigated by in vitro culture of eggs obtained from ovigerous crabs inhabiting the atrial cavity of the tunicate Phallusianigra Savigny, 1816, in Venezuela. Eggs were hatched in the laboratory and reared through two zoeal stages and the megalopa. Additional samples of the larval stages were obtained directly from abdominal enclosures of aquarium-held females. All larval stages were described and illustrated in detail. Morphological comparisons were made between larvae from two different populations. Comparisons were also made with other previously described larvae of Pinnotherinae, which led us to conclude that Tunicotheres should not be assigned to the Pinnotherinae sensu stricto. Relationships between the three known disjunct populations assigned to T.moseri remain questionable, especially since the potential for larval dispersal appears to be very limited.

  19. Development of the male reproductive system in Callinectes ornatus Ordway, 1863 (Brachyura: Portunidae

    Directory of Open Access Journals (Sweden)

    Fabiana Aparecida do Nascimento

    Full Text Available This study describes the histology and histochemistry of the male reproductive system in Callinectes ornatus, comparing juvenile and adult developmental stages. We also analyzed changes in the gonadosomatic (GSI and hepatosomatic (HSI indices, and the weights of the testis and vas deferens during the development. The results showed that all stages, beginning with the juvenile (JUV, through developing (DEV and mature (MAT adult males of C. ornatus produce sperm and spermatophores. During development, testicular lobes showed the same characteristics of production and release of sperm into the seminiferous duct. The vas deferens showed little histological and histochemical change in the epithelium in juvenile and adult males. The differences consisted of the larger amount of secretion in MAT males compared to JUV and DEV ones. The chemical composition of the seminal fluid was similar, but MAT males produced a more homogeneous secretion. Morphological and physiological maturation are not synchronized in C. ornatus, since JUV males produced spermatophores similar to those in DEV and MAT males. However, these JUV are not yet able to reproduce, since they still have the abdomen attached to the cephalothoracic sternum. The increase of the GSI during development was significant for MAT males, and is related to the production of sufficient volume of seminal fluid to form the sperm "plug" in the female seminal receptacle. The HSI decreased from DEV to MAT adult stages, indicating that reserves from the hepatopancreas are used to develop the reproductive system after the pubertal molt.

  20. Morfometría geométrica en cinco especies de Buthidae y Scorpionidae (Arachnida: Scorpiones de Venezuela Geometric morphometrics in five species of Buthidae and Scorpionidae (Arachnida: Scorpiones from Venezuela

    Directory of Open Access Journals (Sweden)

    Walter Y. Bechara

    2012-06-01

    clathratus and T. discrepans, and one species of Scorpionidae: Tarsoporosus yustizi. Coordinate (x,y configurations from landmarks and semilandmarks were registered in five structures. The results showed the complete separation in Buthidae species through dorsal trichobotria on patella pedipalp; and a consistent separation at family level in the remaining structures. The thin plate spline showed the sternum horizontal compression in the Buthidae species and the vertical compression in Scorpionidae. Similarity in coxae, chelae and caparace between R. laticauda and C. testaceus was determined. The trichobotria disposition and the sternum conformation allows to discriminate T. discrepans and T. clathratus.

  1. Nano Scale Mechanical Analysis of Biomaterials Using Atomic Force Microscopy

    Science.gov (United States)

    Dutta, Diganta

    The atomic force microscope (AFM) is a probe-based microscope that uses nanoscale and structural imaging where high resolution is desired. AFM has also been used in mechanical, electrical, and thermal engineering applications. This unique technique provides vital local material properties like the modulus of elasticity, hardness, surface potential, Hamaker constant, and the surface charge density from force versus displacement curve. Therefore, AFM was used to measure both the diameter and mechanical properties of the collagen nanostraws in human costal cartilage. Human costal cartilage forms a bridge between the sternum and bony ribs. The chest wall of some humans is deformed due to defective costal cartilage. However, costal cartilage is less studied compared to load bearing cartilage. Results show that there is a difference between chemical fixation and non-chemical fixation treatments. Our findings imply that the patients' chest wall is mechanically weak and protein deposition is abnormal. This may impact the nanostraws' ability to facilitate fluid flow between the ribs and the sternum. At present, AFM is the only tool for imaging cells' ultra-structure at the nanometer scale because cells are not homogeneous. The first layer of the cell is called the cell membrane, and the layer under it is made of the cytoskeleton. Cancerous cells are different from normal cells in term of cell growth, mechanical properties, and ultra-structure. Here, force is measured with very high sensitivity and this is accomplished with highly sensitive probes such as a nano-probe. We performed experiments to determine ultra-structural differences that emerge when such cancerous cells are subject to treatments such as with drugs and electric pulses. Jurkat cells are cancerous cells. These cells were pulsed at different conditions. Pulsed and non-pulsed Jurkat cell ultra-structures were investigated at the nano meter scale using AFM. Jurkat cell mechanical properties were measured under

  2. A new species of Temnocephala Blanchard (Platyhelminthes, Temnocephalida ectosymbiont on creeping water bugs, Cryphocricos granulosus De Carlo (Hemiptera, Naucoridae from southern Brazil Nova espécie de Temnocephala Blanchard (Platyhelminthes, Temnocephalida ectosimbionte sobre naucorídeos, Cryphocricos granulosus De Carlo (Hemiptera, Naucoridae da região Sul do Brasil

    Directory of Open Access Journals (Sweden)

    José F. R. Amato

    2007-12-01

    Full Text Available Temnocephala minutocirrus sp. nov., an ectosymbiont on Cryphocricos granulosus De Carlo, 1967, is described from the State of Rio Grande do Sul, southern Brazil. One hundred and nine naucorids were examined, of which 36 (33% were positive for this species of Temnocephala Blanchard, 1849. In one sample of 94 creeping water bugs, 49 (52% were 4th instar nymphs, 6% of which were infested; 45 (48% were adults, either brachypterous (40 with 18 males and 22 females or macropterous (5 with 1 male and 4 females, 67% of which were infested (29% males and 38% females. Temnocephalan eggs were found both ventrally and dorsally: fixed on coxae, trochanters, and along the sternum between fore middle, and hind pairs of legs; basal of the abdominal area; and on the scutellum, clavus, and hemelytra. Juvenile and adult temnocephalans were always devoid of body pigmentation, and were found living on the ventral body surface, preferably over the sternum, between the middle and hind pairs of legs. The most distinctive features of this new species are: 1 unusually short cirrus, slightly curved, with introvert corresponding to 37% of its total length; 2 dorsolateral 'excretory' syncytial epidermal plates, elliptic, with excretory pore relatively equatorial, closer to inner limit of each plate; 3 two pairs of large disc gland cells (paranephrocytes? located centrally, just ahead of testes; 4 testes relatively large, but unequal in size, anterior pair smaller, always in the same zone, those of the same side, partially superposed; and (5 vagina with weak muscular wall and without muscular sphincters.Temnocephala minutocirrus sp. nov., ectosimbionte sobre Cryphocricos granulosus De Carlo, 1967, é descrita para o Estado do Rio Grande do Sul. Cento e nove naucorídeos foram examinados, dos quais 36 (33% estavam positivos para esta espécie do gênero Temnocephala Blanchard, 1849. Em uma amostra de 94 hemípteros, 49 (52% eram ninfas de 4º instar, das quais, 6% estavam

  3. Poster - 35: Monitoring patient positioning during deep inspiration breath hold with a distance measuring laser

    International Nuclear Information System (INIS)

    Weston, Mark; Juhasz, Janos

    2016-01-01

    Purpose: The accuracy of treatment delivery for left breast/chest wall patients using deep inspiration breath hold (DIBH) is being monitored using a distance measuring laser (DML) Methods: A commercially available DML (DLS-C15, Dimetix) was mounted behind a Varian TrilogyTM linac. Relative to the machine isocenter, the laser from the beam was offset by 8 cm to the left and by 1 cm in the superior direction. This position was selected because this point is situated on the sternum for the majority of the left breast/chest-wall patients treated at our institution. The Varian Real-Time Positioning Management™ (RPM) guided DIBH treatments at our institution is delivered by placing the system’s tracking block on the patient’s abdomen. The treatment beam is enabled only when the block is in between a predefined abdomen motion range as determined during the CT simulation process. A LabVIEW program was developed to record both beam status (i.e. on/off) and distance measurements. In this study the DML was only used to monitor the position of a single point on the chest and no clinical decisions/adjustments were made based on these measurements. Results and Conclusions: Thus far, 34 fractions have been recorded for 4 patients. As such, the performance of our DIBH treatment technique cannot be fairly evaluated at this point. However, deviations between expected and measured distances have been observed and if these are found to be reproducible, then modifications in our treatment procedures and policies will have to take place.

  4. Evolution and functional significance of derived sternal ossification patterns in ornithothoracine birds

    Science.gov (United States)

    O’connor, J. K.; Zheng, X.-T.; Sullivan, C.; Chuong, C.-M.; Wang, X.-L.; Li, A.; Wang, Y.; Zhang, X.-M.; Zhou, Z.-H.

    2017-01-01

    The midline pattern of sternal ossification characteristic of the Cretaceous enantiornithine birds is unique among the Ornithodira, the group containing birds, nonavian dinosaurs and pterosaurs. This has been suggested to indicate that Enantiornithes is not the sister group of Ornithuromorpha, the clade that includes living birds and their close relatives, which would imply rampant convergence in many nonsternal features between enantiornithines and ornithuromorphs. However, detailed comparisons reveal greater similarity between neornithine (i.e. crown group bird) and enantiornithine modes of sternal ossification than previously recognized. Furthermore, a new subadult enantiornithine specimen demonstrates that sternal ossification followed a more typically ornithodiran pattern in basal members of the clade. This new specimen, referable to the Pengornithidae, indicates that the unique ossification pattern observed in other juvenile enantiornithines is derived within Enantiornithes. A similar but clearly distinct pattern appears to have evolved in parallel in the ornithuromorph lineage. The atypical mode of sternal ossification in some derived enantiornithines should be regarded as an autapomorphic condition rather than an indication that enantiornithines are not close relatives of ornithuromorphs. Based on what is known about molecular mechanisms for morphogenesis and the possible selective advantages, the parallel shifts to midline ossification that took place in derived enantiornithines and living neognathous birds appear to have been related to the development of a large ventral keel, which is only present in ornithuromorphs and enantiornithines. Midline ossification can serve to medially reinforce the sternum at a relatively early ontogenetic stage, which would have been especially beneficial during the protracted development of the superprecocial Cretaceous enantiornithines. PMID:26079847

  5. Studies on the distribution of hematopoietic bone marrow by bone marrow scintigraphy, 2. The bone marrow distribution in leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Fujimori, K [Kyoto Univ. (Japan). Faculty of Medicine

    1976-04-01

    Distribution of the leukemic marrow was investigated in 42 cases by bone marrow scintigraphy using sup(99m)Tc sulfur colloid in association with clinical findings and ferrokinetics studies in order to clarify hematopoietic function in leukemia. 17 of chronic myelogenous leukemia, 3 of lymphatic leukemia, 2 of monocytic leukemia, 7 of atypical leukemia and one of erythroleukemia. 12 acute myelogenous leukemia were classified into 3 types A, B and C. Type A showed the distribution similar to those obtained with normal controls. Ferrokinetics studies, however, indicated complete absence of erythropoiesis. Type B showed complete lack of sup(99m)Tc activity in usual marrow sites, although ferrokinetics data showed normal erythropoeitic function. Type C showed abnormal concentration of sup(99m)Tc sulfur colloid in the tibiae. 17 chronic myelogenous leukemia showed reduced sup(99m)Tc activity in usual marrow sites and remarkable expanded marrow extending into distal femurs, proximal and distal tibiae and bones of feet. 2 acute lymphotic leukemia patients showed complete absence of sup(99m)Tc activity. The one chronic type showed almost normal distribution. Monocytic leukemia showed decreased marrow distribution in the sternum and vertebrae. Of 6 atypical leukemias one showed almost normal distribution. The others, including a case with hypoplastic luekemia, demonstrated marrow extension similar to that observed in chronic myelogenous leukemia or monocytic leukemia. Erythroleukemia showed increased concentrations of sup(99m)Tc activity in the usual marrow sites and marked marrow expansion throughout all long bones. These results suggest that there is a discrepancy between bone marrow distribution and hematopoietic function in the cases of acute myelogenous leukemia.

  6. Cutaneous vascular and core temperature responses to sustained cold exposure in hypoxia.

    Science.gov (United States)

    Simmons, Grant H; Barrett-O'Keefe, Zachary; Minson, Christopher T; Halliwill, John R

    2011-10-01

    We tested the effect of hypoxia on cutaneous vascular regulation and defense of core temperature during cold exposure. Twelve subjects had two microdialysis fibres placed in the ventral forearm and were immersed to the sternum in a bathtub on parallel study days (normoxia and poikilocapnic hypoxia with an arterial O(2) saturation of 80%). One fibre served as the control (1 mM propranolol) and the other received 5 mM yohimbine (plus 1 mM propranolol) to block adrenergic receptors. Skin blood flow was assessed at each site (laser Doppler flowmetry), divided by mean arterial pressure to calculate cutaneous vascular conductance (CVC), and scaled to baseline. Cold exposure was first induced by a progressive reduction in water temperature from 36 to 23°C over 30 min to assess cutaneous vascular regulation, then by clamping the water temperature at 10°C for 45 min to test defense of core temperature. During normoxia, cold stress reduced CVC in control (-44 ± 4%) and yohimbine sites (-13 ± 7%; both P cooling but resulted in greater reductions in CVC in control (-67 ± 7%) and yohimbine sites (-35 ± 11%) during cooling (both P cooling rate during the second phase of cold exposure was unaffected by hypoxia (-1.81 ± 0.23°C h(-1) in normoxia versus -1.97 ± 0.33°C h(-1) in hypoxia; P > 0.05). We conclude that hypoxia increases cutaneous (non-noradrenergic) vasoconstriction during prolonged cold exposure, while core cooling rate is not consistently affected.

  7. Subcutaneous Tissue Thickness is an Independent Predictor of Image Noise in Cardiac CT

    International Nuclear Information System (INIS)

    Staniak, Henrique Lane; Sharovsky, Rodolfo; Pereira, Alexandre Costa; Castro, Cláudio Campi de; Benseñor, Isabela M.; Lotufo, Paulo A.; Bittencourt, Márcio Sommer

    2014-01-01

    Few data on the definition of simple robust parameters to predict image noise in cardiac computed tomography (CT) exist. To evaluate the value of a simple measure of subcutaneous tissue as a predictor of image noise in cardiac CT. 86 patients underwent prospective ECG-gated coronary computed tomographic angiography (CTA) and coronary calcium scoring (CAC) with 120 kV and 150 mA. The image quality was objectively measured by the image noise in the aorta in the cardiac CTA, and low noise was defined as noise < 30HU. The chest anteroposterior diameter and lateral width, the image noise in the aorta and the skin-sternum (SS) thickness were measured as predictors of cardiac CTA noise. The association of the predictors and image noise was performed by using Pearson correlation. The mean radiation dose was 3.5 ± 1.5 mSv. The mean image noise in CT was 36.3 ± 8.5 HU, and the mean image noise in non-contrast scan was 17.7 ± 4.4 HU. All predictors were independently associated with cardiac CTA noise. The best predictors were SS thickness, with a correlation of 0.70 (p < 0.001), and noise in the non-contrast images, with a correlation of 0.73 (p < 0.001). When evaluating the ability to predict low image noise, the areas under the ROC curve for the non-contrast noise and for the SS thickness were 0.837 and 0.864, respectively. Both SS thickness and CAC noise are simple accurate predictors of cardiac CTA image noise. Those parameters can be incorporated in standard CT protocols to adequately adjust radiation exposure

  8. Thoracic computer tomography for the evaluation of the thymus gland in cases of myasthenia gravis

    International Nuclear Information System (INIS)

    Druschky, K.F.; Stadler, H.W.; Daun, H.; Erlangen-Nuernberg Univ., Erlangen

    1981-01-01

    Hyperplasia of the thymus gland is observed in 65% of all patients with myasthenia gravis, while the incidence of thymus tumor is reported to be 8.5-28%. Conventional radiological techniques provide little information in the diagnosis of mediastinal lesions. Even a clearly developed thymus tumor can escape clinical detection. Since March 1978 thoracic computer tomography has been performed in addition to X-rays of the chest in a series of 19 patients with myasthenia ravis, 10 women and 9 men ranging in age from 15-71 years and in 3 patients with suspected thymomas but without myasthenia gravis. These examinations were carried out with a Somatom II (Siemens) since September 1979. On the average 15-20 scans were made at the level of the upper two-third of the sternum. The chest X-rays in 2 planes revealed signs of a thymus tumor in 3 female patients. Thoracic computer tomography showed definite signs of a space-occupying lesion in the anterior mediastinum in 11 cases. At thymectomy 6 patients were found to have hyperplasia of the thymus, 2 patients had a benign thymoma and 3 patients a malignant thymoma. In 6 cases computer tomography showed only slight changes and in 5 patients no pathological findings could be demonstrated in the thymus gland. Thoracic computer tomography is a relatively harmless diagnostic measure without any risk for the patient. It has a high resolution and great accuracy in the evaluation of the thymus gland and is therefore the method of choice for the diagnosis of patients with myasthenia gravis. (orig.) [de

  9. Studies on the distribution of hematopoietic bone marrow by bone marrow scintigraphy, 2

    International Nuclear Information System (INIS)

    Fujimori, Katsuhiko

    1976-01-01

    Distribution of the leukemic marrow was investigated in 42 cases by bone marrow scintigraphy using sup(99m)Tc sulfur colloid in association with clinical findings and ferrokinetics studies in order to clarify hematopoietic function in leukemia. 17 of chronic myelogenous leukemia, 3 of lymphatic leukemia, 2 of monocytic leukemia, 7 of atypical leukemia and one of erythroleukemia. 12 acute myelogenous leukemia were classified into 3 types A, B and C. Type A showed the distribution similar to those obtained with normal controls. Ferrokinetics studies, however, indicated complete absence of erythropoiesis. Type B showed complete lack of sup(99m)Tc activity in usual marrow sites, although ferrokinetics data showed normal erythropoeitic function. Type C showed abnormal concentration of sup(99m)Tc sulfur colloid in the tibiae. 17 chronic myelogenous leukemia showed reduced sup(99m)Tc activity in usual marrow sites and remarkable expanded marrow extending into distal femurs, proximal and distal tibiae and bones of feet. 2 acute lymphotic leukemia patients showed complete absence of sup(99m)Tc activity. The one chronic type showed almost normal distribution. Monocytic leukemia showed decreased marrow distribution in the sternum and vertebrae. Of 6 atypical leukemias one showed almost normal distribution. The others, including a case with hypoplastic luekemia, demonstrated marrow extension similar to that observed in chronic myelogenous leukemia or monocytic leukemia. Erythroleukemia showed increased concentrations of sup(99m)Tc activity in the usual marrow sites and marked marrow expansion throughout all long bones. These results suggest that there is a discrepancy between bone marrow distribution and hematopoietic function in the cases of acute myelogenous leukemia. (J.P.N.)

  10. SU-F-T-93: Breast Surface Dose Enhancement Using a Clinical Prone Breast Board

    International Nuclear Information System (INIS)

    Guerra, M; Jozsef, G

    2016-01-01

    Purpose: The use of specialized patient set-up devices in radiotherapy, such as prone breast boards, may have unwanted dosimetric effects. The goal of this study was to evaluate the effect of a clinically used prone breast board on skin dose due to buildup. Methods: GafChromic film (EBT3) was used for dose measurements on the surface of a solid water phantom shaped to mimic the curvature of the breast. We investigated two setup scenarios: the medial field border placed at the medial edge of the board and 1 cm contralaterally from that edge. A strip of film was taped to the medial surface of the phantom. Gantry angles varied from 10 to 30 degrees below the lateral gantry position, representing anterior oblique fields. The measurements were performed with and without the presence of the board; the ratio of their corresponding doses (dose enhancement) was evaluated. Results: For the cases where the field edge is at the edge of the board, the dose enhancement is negligible for all the tested angles. When the field edge is 1 cm inside the board, the maximum surface dose enhancement varies depending on the gantry angle between 2.2 for 30 degrees and 3.2 for 20 degrees. The length on the film at which the presence of the board is detectable (i.e. where there is dose enhancement) is longer for the shallower angles. Conclusion: Even the low-density, thin carbon fiber board with a thin soft foam pad on the top can produce significant dose enhancement on the skin in prone breast treatment due to loss of buildup. However, it happens only when the patient mid-sternum is over the board, i.e. the medial edge of the field traverses through the board and pad. Even then, the effect occurs only at the field edge, i.e. the penumbral region.

  11. Role of nuclear medicine in pulmonary neoplastic processes

    International Nuclear Information System (INIS)

    Waxman, A.D.

    1986-01-01

    It has been demonstrated that the single most important factor in determining survival in patients with bronchogenic carcinoma is the extent of spread of metastasis from the primary lesion. This explains the extensive efforts in developing accurate staging tests for pulmonary tumors, both primary and metastatic, with special emphasis on the determination of pulmonary hilar and mediastinal spread of disease. Continued improvements in nuclear medicine instrumentation along with the development of tumor specific radiopharmaceuticals, as well as agents that have the capability of tracking tumor viability, have changed the orientation of scintigraphic techniques in the evaluation of pulmonary neoplastic processes. Gallium scintigraphy is no longer considered as a primary imaging modality in the staging of pulmonary tumors, and in most institutions has been replaced by computed tomography (CT) for this purpose. It has been demonstrated that gallium, relative to other imaging modalities, is a sensitive indicator of hilar spread of tumor. However, because of the normally high background activity within the sternum and spine, mediastinal abnormalities are poorly detected. Since most pulmonary tumors metastasize via regional nodes to the pulmonary hilum and then to the mediastinum, the high sensitivity for the detection of pulmonary hilar abnormalities and the high specificity for mediastinal lesion detection suggest that gallium scintigraphy is a valuable adjunctive test when used appropriately. Thallium 201 as a tumor agent is being studied by several institutions. Preliminary results indicate a high degree of sensitivity for the detection of pulmonary hilar and mediastinal lesions and there are early indications that thallium is a promising agent to evaluate tumor viability. 52 references

  12. Ventricular Septal Defect: Peculiarities of Early Neonatal and Postnatal Diagnosis, Clinical Manifestations, Treatment and Prognosis at the Contemporary Stage

    Directory of Open Access Journals (Sweden)

    K.A. Kalashnikova

    2016-05-01

    Full Text Available The article presents the literature data on the incidence, the main clinical manifestations, modern methods for early neonatal and postnatal diagnosis and treatment of ventricular septal defect in children, as well as the prognosis of this disease. According to the International Classification of Diseases, 10th revision, ventricular septal defect is classified as Q21.0 Ventricular septal defect. Incidence. In the overall structure of congenital malformations of the cardiovascular system, ventricular septal defect has about 20 %. Diagnosis. Moderate ventricular septal defect is manifested by shortness of breath, rapid fatigability during feeding, delay in physical development. Significant arterial-venous shunt in the first month of life is accompanied by a transient mild cyanosis when the baby is fed and cries. Infants develop high pulmonary hypertension, circulatory failure, malnutrition. Small noise intensity is typical for newborns in the first weeks or even months of life, which is due to physiologically increased intravascular pulmonary resistance. Systolic murmur is extended to the entire systole with maximum amplitude at the left edge of the sternum at the level of III–IV intercostal spaces. Sclerotic phase of pulmonary hypertension with ventricular septal defect is defined as Eisenmenger reaction. The clinical picture of this disorder depends on the degree of hemodynamic instability caused by the defect parameters, the pressure level in the pulmonary artery, vascular pulmonary resistance, the magnitude and direction of the shunt through the defect. Diagnosis is confirmed by characteristic changes in the electrocardiogram, echocardiography and chest radiograph. Treatment. Small muscular ventricular septal defects often close spontaneously during the first 2 years of life. Drug correction is needed in the development of congestive heart failure. The optimum age for surgery — 5–9 years.

  13. Diagnostic value of whole-body low-dose computed tomography (WBLDCT) in bone lesions detection in patients with multiple myeloma (MM)

    Energy Technology Data Exchange (ETDEWEB)

    Ippolito, Davide, E-mail: davide.atena@tiscalinet.it [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Besostri, Valeria, E-mail: valeriabesostri@gmail.com [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Bonaffini, Pietro Andrea, E-mail: pa.bonaffini@gmail.com [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Rossini, Fausto, E-mail: valeriabesostri@hotmail.it [Department of Hematology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Di Lelio, Alessandro, E-mail: valebeso@libero.it [Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy); Sironi, Sandro, E-mail: sandrosironi@libero.it [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza (MB) (Italy); Department of Diagnostic Radiology, H. San Gerardo, Via Pergolesi 33, 20900 Monza (MB) (Italy)

    2013-12-01

    Purpose: To assess the role of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of patients with suspicion of multiple myeloma (MM). Materials and methods: A total of 138 patients (76 male and 62 female; mean age 63.5 years, range 50–81 years), with early MM, underwent WBLDCT protocol study, performed on 16-slice scanner (Brilliance, Philips Medical System, Eindhoven, The Netherlands): tube voltage 120 kV; tube current time product 40 mAs. Diagnosis of osteolytic lesions was performed on the basis of axial and multiplanar reformatted images, whereas the assessment of spinal misalignment and fracture was done by using multiplanar reformatted images. The overall dose delivered to each patient was 4.2 mSv. Every patient gave personal informed consent, as required by our institution guidelines. Results: The diagnosis was established either by histopathology or imaging follow-up (size increase of over a period time). In all 138 patients, image resolution was diagnostic, enabling correct classification of multiple myeloma patients. WBLDCT showed a total of 328 pathologic bone findings in 81/138 patients. CT scanning resulted in complete evaluation of the bone lesions in these areas of the skeleton: skull (42), humerus (15), femur (20), ribs (7), scapulae (13), pelvis (35), clavicle (13), sternum (10), cervical (39), dorsal (65), lombar (48) and sacral rachis (21). In 40/81 bone involvement detected by CT was the only CRAB criterion present. Furthermore, WBLDCT demonstrated pleuro-pulmonary lesions in 20 patients (11 infective, 9 as MM localizations) and 1 renal neoplasia. Conclusion: WBLDCT, detecting bone marrow localizations and demonstrating extra-osseous findings, with a fast scanning time and high resolution images, is a reliable imaging-based tool for a proper management of MM patients.

  14. Studies on the clinical usefulness of the 111indium chloride bone marrow scintigraphy in patients with aplastic anemia

    International Nuclear Information System (INIS)

    Ino, Teruo; Ito, Naoya; Takeda, Nobuhide

    1985-01-01

    111 Indium chloride ( 111 In-Cl 3 ) appears to be a radionuclide appropriate for a bone marrow scanning because of its physical and chemical characteristics; it is, like iron, bound to and transported by transferrin and it has a photopeak suitable for scintigraphy. This study was undertaken to assess the bone marrow function by 111 In-Cl 3 bone marrow scintigraphy in patients with asplastic anemia. Bone marrow scintigraphy was performed in 21 patients with aplastic anemia with varying degrees of severity including 15 who had no previous treatments. The scintigrams were taken 48 hours after intravenous injection of 111 MBq(3 mCi) of 111 In-Cl 3 . All of them showed various degrees of reduction in uptake of 111 In-Cl 3 by the marrow. The abnormal scan grade was classified into 3 types: Type I, non-accumulation (5); Type II, low-accumulation (15); Type III, uneven accumulation (1). In type III, degree of radioisotope accumulation between the sternum and the ilium was different, and this difference correlated with that of bone marrow cellularity. In 2 patients of type II, hematological improvement occurred after treatment, which was also accompanied by simultaneous increase of 111 In-Cl 3 uptake by the marrow. These findings suggested that the degree of radioisotope accumulation in the marrow reflects that of bone marrow cellularity. Type I patients were clinically severe and poor in prognosis as compared to type II and type III patients; four out of 5 died within 2 months. Bone marrow transplantation may be the treatment of choice in type I patients when feasible. (author)

  15. 'Til Poison Phosphorous Brought them Death': A potentially occupationally-related disease in a post-medieval skeleton from north-east England.

    Science.gov (United States)

    Roberts, Charlotte A; Caffell, Anwen; Filipek-Ogden, Kori L; Gowland, Rebecca; Jakob, Tina

    2016-06-01

    This paper describes the pathological changes observed on the skeleton of a c.12-14 year old person buried in a north-east England Quaker cemetery dated to AD 1711-1857. Bone formation (woven and lamellar) and destruction are present mainly on the mandible, clavicles, sternum and scapulae, long bones of the right arm, left ribs, spine, ilia, and the femora and tibiae. Differential diagnoses of tuberculosis and other pulmonary diseases, smallpox, actinomycosis, neoplastic disease, and "phossy jaw" are considered. While the pathological changes could represent all previously described diseases and thus be associated with the insalubrious conditions in which this person lived, it is also possible that this person worked in the matchmaking industry known to be present in the region at the time. Attention is drawn to the previously overlooked condition "phossy jaw" caused by phosphorus poisoning, which was strongly associated with this industry. While matchstick making was an industry often associated with women and girls, DNA analysis of a bone sample from the skeleton did not successfully identify biological sex. Two dental calculus samples from this person were analysed for phosphorus, and comparisons were made with samples from the same and a different site; the levels did not indicate the person was more exposed to phosphorus than any of the other people at Coach Lane. However, the pathological lesions described also have relevance in a clinical context, because "phossy jaw" has been observed in living populations, arising as a consequence of ingesting phosphorous contained within some pharmaceuticals used for treating neoplastic disease and osteoporosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. An anatomically oriented breast model for MRI

    Science.gov (United States)

    Kutra, Dominik; Bergtholdt, Martin; Sabczynski, Jörg; Dössel, Olaf; Buelow, Thomas

    2015-03-01

    Breast cancer is the most common cancer in women in the western world. In the breast cancer care-cycle, MRIis e.g. employed in lesion characterization and therapy assessment. Reading of a single three dimensional image or comparing a multitude of such images in a time series is a time consuming task. Radiological reporting is done manually by translating the spatial position of a finding in an image to a generic representation in the form of a breast diagram, outlining quadrants or clock positions. Currently, registration algorithms are employed to aid with the reading and interpretation of longitudinal studies by providing positional correspondence. To aid with the reporting of findings, knowledge about the breast anatomy has to be introduced to translate from patient specific positions to a generic representation. In our approach we fit a geometric primitive, the semi-super-ellipsoid to patient data. Anatomical knowledge is incorporated by fixing the tip of the super-ellipsoid to the mammilla position and constraining its center-point to a reference plane defined by landmarks on the sternum. A coordinate system is then constructed by linearly scaling the fitted super-ellipsoid, defining a unique set of parameters to each point in the image volume. By fitting such a coordinate system to a different image of the same patient, positional correspondence can be generated. We have validated our method on eight pairs of baseline and follow-up scans (16 breasts) that were acquired for the assessment of neo-adjuvant chemotherapy. On average, the location predicted and the actual location of manually set landmarks are within a distance of 5.6 mm. Our proposed method allows for automatic reporting simply by uniformly dividing the super-ellipsoid around its main axis.

  17. Analysis of the nature of injuries in victims of fall from height

    Directory of Open Access Journals (Sweden)

    Magdalena E. Kusior

    2017-01-01

    Full Text Available Aim of study: To assess the types and extent of injuries sustained by victims of fall from height depending on the height of fall. Material and methods: The study included 338 bodies of victims of fatal falls from different heights (from the 1st to 10th floors who were subjected to medico-legal autopsy at the Department of Forensic Medicine, Jagiellonian University Medical College, between 1995 and 2014. For each individual, selected data were collected including gender, age, body height, injury types and presence of alcohol or other intoxicants in blood. The analysis comprised injuries to the brain, thoracic and abdominal organs, fractures of the skull, extremities, ribs and spine, and fractures of the scapula, clavicle and sternum (considered together. The study focused on determining the frequency of occurrence of different injuries in relation to one another and depending on the height of fall. Results : The number and extent of injuries was found to increase along with the height of fall. Three injury types, including injuries to the mesentery and both kidneys and fractures of upper extremity small bones, were shown to occur from the threshold heights of the 3rd, 4th and 6th floors. Eleven injuries demonstrated a statistically significant correlation with the height of fall. The study also revealed a number of correlations between the frequencies of occurrence of different injuries. Conclusions : Injuries found from the threshold value may suggest the minimal height of fall. The presence of injuries which correlate with increasing height, and the overall number of injuries observed in victims of fall from height, may be useful for inferring the height of the fall.

  18. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries.

    Science.gov (United States)

    Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J

    2015-01-01

    We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently associated with rib cage fracture burden. Severity of head, abdominal, and lung injuries also influence rib fracture outcomes.

  19. Low bone mineral density and risk of incident fracture in HIV-infected adults.

    Science.gov (United States)

    Battalora, Linda; Buchacz, Kate; Armon, Carl; Overton, Edgar T; Hammer, John; Patel, Pragna; Chmiel, Joan S; Wood, Kathy; Bush, Timothy J; Spear, John R; Brooks, John T; Young, Benjamin

    2016-01-01

    Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described. Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004-2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression. Among 1,006 participants analysed (median age 43 years [IQR 36-49], 83% male, 67% non-Hispanic white, median CD4(+) T-cell count 461 cells/mm(3) [IQR 311-658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 person-years of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture. In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population.

  20. Rib cage deformities alter respiratory muscle action and chest wall function in patients with severe osteogenesis imperfecta.

    Directory of Open Access Journals (Sweden)

    Antonella LoMauro

    Full Text Available BACKGROUND: Osteogenesis imperfecta (OI is an inherited connective tissue disorder characterized by bone fragility, multiple fractures and significant chest wall deformities. Cardiopulmonary insufficiency is the leading cause of death in these patients. METHODS: Seven patients with severe OI type III, 15 with moderate OI type IV and 26 healthy subjects were studied. In addition to standard spirometry, rib cage geometry, breathing pattern and regional chest wall volume changes at rest in seated and supine position were assessed by opto-electronic plethysmography to investigate if structural modifications of the rib cage in OI have consequences on ventilatory pattern. One-way or two-way analysis of variance was performed to compare the results between the three groups and the two postures. RESULTS: Both OI type III and IV patients showed reduced FVC and FEV(1 compared to predicted values, on condition that updated reference equations are considered. In both positions, ventilation was lower in OI patients than control because of lower tidal volume (p<0.01. In contrast to OI type IV patients, whose chest wall geometry and function was normal, OI type III patients were characterized by reduced (p<0.01 angle at the sternum (pectus carinatum, paradoxical inspiratory inward motion of the pulmonary rib cage, significant thoraco-abdominal asynchronies and rib cage distortions in supine position (p<0.001. CONCLUSIONS: In conclusion, the restrictive respiratory pattern of Osteogenesis Imperfecta is closely related to the severity of the disease and to the sternal deformities. Pectus carinatum characterizes OI type III patients and alters respiratory muscles coordination, leading to chest wall and rib cage distortions and an inefficient ventilator pattern. OI type IV is characterized by lower alterations in the respiratory function. These findings suggest that functional assessment and treatment of OI should be differentiated in these two forms of the

  1. Traumatic fractures as a result of falls in children and adolescents: A retrospective observational study.

    Science.gov (United States)

    Wang, Hongwei; Yu, Hailong; Zhou, Yue; Li, Changqing; Liu, Jun; Ou, Lan; Zhao, Yiwen; Song, Guoli; Han, Jianda; Chen, Yu; Xiang, Liangbi

    2017-09-01

    The aim of this study is to investigate the incidence and pattern of traumatic fractures (TFs) as a result of falls in a population of children and adolescents (≤18 years old) in China.This was a cross-sectional study. We retrospectively reviewed 1412 patients who were children and adolescents with TFs as a result of falls admitted to our university-affiliated hospitals in China from 2001 to 2010. Etiologies included high fall (height ≥2) and low fall (height fractures in total and 92 patients (6.5%) presented with multiple fractures. The most common fracture sites were upper extremity fractures in 814 patients (57.6%) and lower extremity fractures in 383 patients (27.1%), followed by craniofacial fractures in 233 patients (16.5%). A total of 231 (16.4%) patients suffered a nerve injury. The frequencies of early and late complications/associated injuries were 19.5% (n = 275) and 9.2% (n = 130). The frequencies of emergency admission, nerve injury, spinal fracture, lower extremity fractures, craniofacial fracture, sternum and rib fracture, and early complications/ASOIs were significantly larger in high fall than low fall (all P fractures (P fracture (P = .039), lower extremity fractures (P = .048), and craniofacial fracture (P = .041) were significantly larger in female than the male patients. The frequency of upper extremity fractures (P fracture, and craniofacial fracture were significantly larger in patients with nerve injury than other patients without nerve injury (all P fractures were the most common etiologies and sites, respectively. High fall, spinal fracture and craniofacial fracture were risk factors for nerve injury. Therefore, we should focus on patients who were caused by high fall and presented with spinal and craniofacial fracture to determine the presence of a nerve injury so that we can provide early, timely diagnosis and targeted treatment to children.

  2. The Effect of Fatigue-Induced Changes in Eggbeater-Kick Kinematics on Performance and Risk of Injury.

    Science.gov (United States)

    Oliveira, Nuno; Saunders, David H; Sanders, Ross H

    2016-01-01

    To investigate the effects of fatigue on the vertical force and kinematics of the lower limbs during maximal water polo eggbeater kicking. Twelve male water polo players maintained as high a position as possible while performing the eggbeater kick with the upper limbs raised out of the water until they were unable to keep the top of the sternum (manubrium) above water. Data comprising 27 complete eggbeater-kick cycles were extracted corresponding to 9 cycles of the initial nonfatigued (0%), 50% time point (50%), and final fatigued (100%) periods of the trial. Vertical force, foot speed, and hip-, knee-, and ankle-joint angles were calculated. Mean vertical force (0%, 212.2 N; 50%, 184.5 N; 100%, 164.3 N) progressively decreased with time. Speed of the feet (0.4 m/s), hip abduction (2.9°), and flexion (3.6°) decreased with fatigue, while hip internal rotation (3.6°) and ankle inversion (4°) increased with fatigue. Average angular velocity decreased for all joint motions. Eggbeater-kick performance decreases with fatigue. Inability to maintain foot speeds and hip and ankle actions with progressing fatigue diminishes the ability of the player to produce vertical force during the cycle. Increased internal rotation of the hip when fatigued and the large eversion/abduction of the ankle during the cycle may be predisposing factors for the prevalence of patellofemoral pain syndrome observed among eggbeater-kick performers. Appropriate training interventions that can limit the effects of fatigue on performance and injury risk should be considered.

  3. Usefulness of three dimensional reconstructive images for thoracic trauma induced fractures

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Kyung Hun; Kim, Dong Hun; Kim, Young Sook; Byun, Joo Nam [Chosun University Hospital, Gwangju (Korea, Republic of)

    2006-09-15

    We wanted to evaluate the usefulness of three-dimensional reconstructive images using multidetector computed tomography (MDCT) for thoracic traumatic patients visiting emergency room. 76 patients with fractures of the 105 patients who visited our emergency room with complaints of thoracic trauma were analyzed retrospectively. All the patients had thoracic MDCT performed and the three-dimensional reconstructive images were taken. The fractures were confirmed by axial CT, the clinical information, whole body bone scanning and the multiplanar reformation images. Plain x-ray images were analyzed by the fractured sites in a blind comparison of two radiologists' readings, and then that finding was compared with the axial CT scans and the three-dimensional reconstructive images. The fracture sites were rib (n 68), sternum (n = 14), clavicle (n = 6), scapula (n = 3), spine (n = 5) and combined fractures (n = 14). Plain x-ray and axial CT scans had a correspondency of 0.555 for the rib fractures. Axial CT scans and the three-dimensional reconstructive images had a correspondency of .952. For sternal fractures, those values were 0.692 and 0.928, respectively. The axial CT scans and three-dimensional reconstructive images showed sensitivities of 94% and 91% for rib and other fractures, respectively, and 93% and 100% for sternal fracture, respectively. Three-dimensional reconstructive image had an especially high sensitivity for the diagnosis of sternal fracture. While evaluating thoracic trauma at the emergency room, the three-dimensional reconstructive image was useful to easily diagnose the extent of fracture and it was very sensitive for detecting sternal fracture.

  4. Usefulness of three dimensional reconstructive images for thoracic trauma induced fractures

    International Nuclear Information System (INIS)

    Koh, Kyung Hun; Kim, Dong Hun; Kim, Young Sook; Byun, Joo Nam

    2006-01-01

    We wanted to evaluate the usefulness of three-dimensional reconstructive images using multidetector computed tomography (MDCT) for thoracic traumatic patients visiting emergency room. 76 patients with fractures of the 105 patients who visited our emergency room with complaints of thoracic trauma were analyzed retrospectively. All the patients had thoracic MDCT performed and the three-dimensional reconstructive images were taken. The fractures were confirmed by axial CT, the clinical information, whole body bone scanning and the multiplanar reformation images. Plain x-ray images were analyzed by the fractured sites in a blind comparison of two radiologists' readings, and then that finding was compared with the axial CT scans and the three-dimensional reconstructive images. The fracture sites were rib (n 68), sternum (n = 14), clavicle (n = 6), scapula (n = 3), spine (n = 5) and combined fractures (n = 14). Plain x-ray and axial CT scans had a correspondency of 0.555 for the rib fractures. Axial CT scans and the three-dimensional reconstructive images had a correspondency of .952. For sternal fractures, those values were 0.692 and 0.928, respectively. The axial CT scans and three-dimensional reconstructive images showed sensitivities of 94% and 91% for rib and other fractures, respectively, and 93% and 100% for sternal fracture, respectively. Three-dimensional reconstructive image had an especially high sensitivity for the diagnosis of sternal fracture. While evaluating thoracic trauma at the emergency room, the three-dimensional reconstructive image was useful to easily diagnose the extent of fracture and it was very sensitive for detecting sternal fracture

  5. Validation of the Reflux Disease Questionnaire into Greek

    Directory of Open Access Journals (Sweden)

    Eirini Oikonomidou

    2012-09-01

    Full Text Available Primary care physicians face challenges in diagnosing and managing gastroesophageal reflux disease (GERD. The Reflux Disease Questionnaire (RDQ meets the standards of validity, reliability, and practicability. This paper reports on the validation of the Greek translation of the RDQ. RDQ is a condition specific instrument. For the validation of the questionnaire, the internal consistency of its items was established using the alpha coefficient of Chronbach. The reproducibility (test-retest reliability was measured by kappa correlation coefficient and the criterion of validity was calculated against the diagnosis of another questionnaire already translated and validated into Greek (IDGP using kappa correlation coefficient. A factor analysis was also performed. Greek RDQ showed a high overall internal consistency (alpha value: 0.91 for individual comparison. All 8 items regarding heartburn and regurgitation, GERD, had good reproducibility (Cohen’s κ 0.60-0.79, while the remaining 4 items about dyspepsia had a moderate reproducibility (Cohen’s κ=’ 0.40-0.59 The kappa coefficient for criterion validity for GERD was rather poor (0.20, 95% CI: 0.04, 0.36 and the overall agreement between the results of the RDQ questionnaire and those based on the IDGP questionnaire was 70.5%. Factor analysis indicated 3 factors with Eigenvalue over 1.0, and responsible for 76.91% of variance. Regurgitation items correlated more strongly with the third component but pain behind sternum and upper stomach pain correlated with the second component. The Greek version of RDQ seems to be a reliable and valid instrument following the pattern of the original questionnaire, and could be used in primary care research in Greece.

  6. Distinguishing the causes of falls in humans using an array of wearable tri-axial accelerometers.

    Science.gov (United States)

    Aziz, Omar; Park, Edward J; Mori, Greg; Robinovitch, Stephen N

    2014-01-01

    Falls are the number one cause of injury in older adults. Lack of objective evidence on the cause and circumstances of falls is often a barrier to effective prevention strategies. Previous studies have established the ability of wearable miniature inertial sensors (accelerometers and gyroscopes) to automatically detect falls, for the purpose of delivering medical assistance. In the current study, we extend the applications of this technology, by developing and evaluating the accuracy of wearable sensor systems for determining the cause of falls. Twelve young adults participated in experimental trials involving falls due to seven causes: slips, trips, fainting, and incorrect shifting/transfer of body weight while sitting down, standing up from sitting, reaching and turning. Features (means and variances) of acceleration data acquired from four tri-axial accelerometers during the falling trials were input to a linear discriminant analysis technique. Data from an array of three sensors (left ankle+right ankle+sternum) provided at least 83% sensitivity and 89% specificity in classifying falls due to slips, trips, and incorrect shift of body weight during sitting, reaching and turning. Classification of falls due to fainting and incorrect shift during rising was less successful across all sensor combinations. Furthermore, similar classification accuracy was observed with data from wearable sensors and a video-based motion analysis system. These results establish a basis for the development of sensor-based fall monitoring systems that provide information on the cause and circumstances of falls, to direct fall prevention strategies at a patient or population level. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Safety and toxicological evaluation of a novel, water-soluble undenatured type II collagen.

    Science.gov (United States)

    Yoshinari, Orie; Marone, Palma Ann; Moriyama, Hiroyoshi; Bagchi, Manashi; Shiojima, Yoshiaki

    2013-09-01

    This study was conducted to determine the broad-spectrum safety of a novel, water-soluble undenatured type II collagen (NEXT-II) derived from chicken sternum cartilage. The presence of epitope in NEXT-II was confirmed by using a commercial kit. The acute oral LD₅₀ of NEXT-II was found to be greater than 5000 mg/kg bw in rats, while the single-dose acute dermal LD₅₀ was greater than 2000 mg/kg bw. The primary dermal irritation index (PDII) of NEXT-II was found to be 1.8 and classified as slightly irritating to the skin. In primary eye irritation studies, the maximum mean total score (MMTS) of NEXT-II was observed to be 7.3 and classified as minimally irritating to the eye. Long-term safety studies were conducted in dogs over a period of 150 d, and no significant changes were observed in body weight, heart rate, respiration rate and blood chemistry. NEXT-II does not induce mutagenicity in the bacterial reverse mutation test in five Salmonella typhimurium strains either with or without metabolic activation. Furthermore, two experiments were conducted to assess the potential of NEXT-II to induce mutations with and without metabolic activation at the mouse lymphoma thymidine kinase locus using the cell line L5178Y. No biologically relevant increase of mutants was observed. Also, no dose-dependent toxicity was observed. Furthermore, colony sizing showed no clastogenic effects induced by NEXT-II under the experimental conditions. These studies demonstrated the broad spectrum of safety of NEXT-II.

  8. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    Lugo, James P; Saiyed, Zainulabedin M; Lane, Nancy E

    2016-01-29

    Undenatured type II collagen (UC-II) is a nutritional supplement derived from chicken sternum cartilage. The purpose of this study was to evaluate the efficacy and tolerability of UC-II for knee osteoarthritis (OA) pain and associated symptoms compared to placebo and to glucosamine hydrochloride plus chondroitin sulfate (GC). One hundred ninety one volunteers were randomized into three groups receiving a daily dose of UC-II (40 mg), GC (1500 mg G & 1200 mg C), or placebo for a 180-day period. The primary endpoint was the change in total Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) from baseline through day 180 for the UC-II group versus placebo and GC. Secondary endpoints included the Lequesne Functional Index (LFI), the Visual Analog Scale (VAS) for pain and the WOMAC subscales. Modified intent-to-treat analysis were performed for all endpoints using analysis of covariance and mixed model repeated measures, while incremental area under the curve was calculated by the intent-to-treat method. At day 180, the UC-II group demonstrated a significant reduction in overall WOMAC score compared to placebo (p = 0.002) and GC (p = 0.04). Supplementation with UC-II also resulted in significant changes for all three WOMAC subscales: pain (p = 0.0003 vs. placebo; p = 0.016 vs. GC); stiffness (p = 0.004 vs. placebo; p = 0.044 vs. GC); physical function (p = 0.007 vs. placebo). Safety outcomes did not differ among the groups. UC-II improved knee joint symptoms in knee OA subjects and was well-tolerated. Additional studies that elucidate the mechanism for this supplement's actions are warranted. CTRI/2013/05/003663 ; CTRI/2013/02/003348 .

  9. SU-E-T-86: A Systematic Method for GammaKnife SRS Fetal Dose Estimation

    Energy Technology Data Exchange (ETDEWEB)

    Geneser, S; Paulsson, A; Sneed, P; Braunstein, S; Ma, L [UCSF Comprehensive Cancer Center, San Francisco, CA (United States)

    2015-06-15

    Purpose: Estimating fetal dose is critical to the decision-making process when radiation treatment is indicated during pregnancy. Fetal doses less than 5cGy confer no measurable non-cancer developmental risks but can produce a threefold increase in developing childhood cancer. In this study, we estimate fetal dose for a patient receiving Gamma Knife stereotactic radiosurgery (GKSRS) treatment and develop a method to estimate dose directly from plan details. Methods: A patient underwent GKSRS on a Perfexion unit for eight brain metastases (two infratentorial and one brainstem). Dose measurements were performed using a CC13, head phantom, and solid water. Superficial doses to the thyroid, sternum, and pelvis were measured using MOSFETs during treatment. Because the fetal dose was too low to accurately measure, we obtained measurements proximally to the isocenter, fitted to an exponential function, and extrapolated dose to the fundus of the uterus, uterine midpoint, and pubic synthesis for both the preliminary and delivered plans. Results: The R-squared fit for the delivered doses was 0.995. The estimated fetal doses for the 72 minute preliminary and 138 minute delivered plans range from 0.0014 to 0.028cGy and 0.07 to 0.38cGy, respectively. MOSFET readings during treatment were just above background for the thyroid and negligible for all inferior positions. The method for estimating fetal dose from plan shot information was within 0.2cGy of the measured values at 14cm cranial to the fetal location. Conclusion: Estimated fetal doses for both the preliminary and delivered plan were well below the 5cGy recommended limit. Due to Pefexion shielding, internal dose is primarily governed by attenuation and drops off exponentially. This is the first work that reports fetal dose for a GK Perfexion unit. Although multiple lesions were treated and the duration of treatment was long, the estimated fetal dose remained very low.

  10. MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation.

    Science.gov (United States)

    Holmes, Signy; Kirkpatrick, Iain D C; Zelop, Carolyn M; Jassal, Davinder S

    2015-09-01

    The purpose of this study was to determine, with the use of cardiac magnetic resonance imaging, whether there is vertical displacement of the heart during pregnancy. Cardiopulmonary resuscitation guidelines during pregnancy recommend placing the hands 2-3 cm higher on the sternum than in nonpregnant individuals. This recommendation is based on the presumption that the heart is displaced superiorly by the diaphragm during the third trimester. Whether there is true cardiac displacement because of the expanding uterus in pregnancy remains unknown. A total of 34 healthy female volunteers 18-35 years old were enrolled prospectively from 2010-2012 at 2 tertiary care centers. The conditions of all participants were evaluated with cardiac magnetic resonance imaging in the one-half left lateral decubitus position during the third trimester of pregnancy and again at a minimum of 3 months after delivery (surrogate for the nonpregnant state). Superior displacement of the heart was determined by measurement of the distance between the inferior aspect of the clavicular heads and the coronary sinus at both time points. The study population included 34 women (mean age, 29 ± 3 years; body mass index, 24 ± 4 kg/m(2)). The mean gestational age at third-trimester imaging was 237 ± 16 days (34 weeks ± 16 days); the mean number of days for postpartum imaging (baseline) was 107 ± 25 days (16 weeks ± 25 days). There was no statistical difference between the cardiac position at baseline (10.1 ± 1.2 cm) and during the third trimester (10.3 ± 1.1 cm; P = .22). Contrary to popular assumption, there is no significant vertical displacement of the heart in the third trimester of pregnancy relative to the nonpregnant state. Accordingly, there is no need to alter hand placement for chest compressions during cardiopulmonary resuscitation in pregnancy. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Image-guided total marrow and total lymphatic irradiation using helical tomotherapy

    International Nuclear Information System (INIS)

    Schultheiss, Timothy E.; Wong, Jeffrey; Liu, An; Olivera, Gustavo; Somlo, George

    2007-01-01

    Purpose: To develop a treatment technique to spare normal tissue and allow dose escalation in total body irradiation (TBI). We have developed intensity-modulated radiotherapy techniques for the total marrow irradiation (TMI), total lymphatic irradiation, or total bone marrow plus lymphatic irradiation using helical tomotherapy. Methods and Materials: For TBI, we typically use 12 Gy in 10 fractions delivered at an extended source-to-surface distance (SSD). Using helical tomotherapy, it is possible to deliver equally effective doses to the bone marrow and lymphatics while sparing normal organs to a significant degree. In the TMI patients, whole body skeletal bone, including the ribs and sternum, comprise the treatment target. In the total lymphatic irradiation, the target is expanded to include the spleen and major lymph node areas. Sanctuary sites for disease (brain and testes) are included when clinically indicated. Spared organs include the lungs, esophagus, parotid glands, eyes, oral cavity, liver, kidneys, stomach, small and large intestine, bladder, and ovaries. Results: With TBI, all normal organs received the TBI dose; with TMI, total lymphatic irradiation, and total bone marrow plus lymphatic irradiation, the visceral organs are spared. For the first 6 patients treated with TMI, the median dose to organs at risk averaged 51% lower than would be achieved with TBI. By putting greater weight on the avoidance of specific organs, greater sparing was possible. Conclusion: Sparing of normal tissues and dose escalation is possible using helical tomotherapy. Late effects such as radiation pneumonitis, veno-occlusive disease, cataracts, neurocognitive effects, and the development of second tumors should be diminished in severity and frequency according to the dose reduction realized for the organs at risk

  12. Comparison of Adsorbed Skin Dose Received by Patients in Cone Beam Computed Tomography, Spiral and Conventional Computed Tomography Scanninng

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    Rahimi A

    2011-12-01

    Full Text Available Background and Aims: The evaluation of absorbed dose received by patients could give useful information for radiation risk estimation. This study was performed to compare the entrance skin dose received by patients in cone beam computed tomography (CBCT, conventional and spiral computed tomography (CT.Materials and Methods: In this experimental study, 81 calibrated TLD chips were used. the TLD chips were placed on facial, thyroid and end of sternum skin surface in patients referred for CT of the paranasal sinuses(3 TLD chips for each area to estimate the absorbed dose received by central part of radiation field, thyroid and out of field areas, respectively. The data were analyzed using one-way ANOVA and Tukey tests. Results: The dose delivered to the center of irradiated field was about 0.79±0.09 mGy in CBCT technique compared with 16.31±3.71 and 18.84±4.12 mGy for spiral and conventional CT, respectively. The received dose by the out of field areas was about 54 percent of central area dose. There was statistical significant relationship between the imaging modalities and absorbed dose received by patients (P=0.016. The least absorbed dose was for CBCT and the greatest dose was for conventional CT imaging technique.Conclusion: The dose delivered to central area of irradiated field in conventional and spiral CT imaging modalities was about 24 times greater than of that in CBCT. Also, the highest received dose was for central area of radiated field and the lowest dose was for the out of field areas.

  13. Emergent Median Sternotomy for Mediastinal Hematoma: A Rare Complication following Internal Jugular Vein Catheterization for Chemoport Insertion—A Case Report and Review of Relevant Literature

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    Saptarshi Biswas

    2014-01-01

    Full Text Available Mediastinal hematoma is a rare complication following insertion of a central venous catheter with only few cases reported in the English literature. We report a case of a 71-year-old female who was admitted for elective chemoport placement. USG guided right internal jugular access was attempted using the Seldinger technique. Resistance was met while threading the guidewire. USG showed a chronic clot burden in the RIJ. A microvascular access was established under fluoroscopic guidance. Rest of the procedure was completed without any further issues. Following extubation, the patient complained of right-sided chest pain radiating to the back. Chest X-ray revealed a contained white out in the right upper lung field. She became hemodynamically unstable. Repeated X-ray showed progression of the hematoma. Median Sternotomy showed posterior mediastinal hematoma tracking into right pleural cavity. Active bleeding from the puncture site at RIJ-SCL junction was repaired. Patient had an uneventful recovery. Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case. A possible explanation of our complication may be attributed to the forced manipulation of the dilator or guidewire against resistance. Clavicle and sternum offer bony protection to the underlying vital venous structures and injuries often need sternotomy with or without neck extension. Division of the clavicle and disarticulation of the sternoclavicular joint may be required for optimum exposure. Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance. Chest X-ray showed to be routinely done to detect any complication early.

  14. How does iliac crest bone marrow biopsy compare with imaging in the detection of bone metastases in small cell lung cancer?

    International Nuclear Information System (INIS)

    Perrin-Resche, I.; Bizais, Y.; Buhe, T.; Fiche, M.

    1993-01-01

    Iliac crest bone marrow biopsy (BMB) has often been used as the gold standard for the detection of bone marrow metastases in small cell lung cancer (SCLC). However, it is likely to lead to numerous false-negative results. For this reason, we compared the results of bone scintigraphy (BS), magnetic resonance imaging (MRI), and BMB in 48 sequential patients affected with pathologically confirmed SCLC (47 were evaluable; mean age, 58.4 years). The three procedures were carried out within 1 week, no treatment being performed during this period. Whole-body scans and spot views were obtained in the anterior and posterior projections. For MRI, only the thoracolumbar spine, the sternum and the pelvis were scanned, using spin-echo T1-weighted sequences, resulting in an acquisition time of less than 45 min. Only five BMBs were rated as positive. In these cases, both BS and MRI were also positive. The other 42 biopsies were negative. Among them, in ten cases both BS and MRI were positive. In 21 cases, both BS and MRI were negative. In five cases MRI was positive while BS was negative. Finally, in six cases MRI was negative whilst BS was positive. In most cases in which either BS or MRI was positive, follow-up scans confirmed the initial findings. This study suggests that BMB is more invasive and less sensitive than BS or MRI in detecting bone metastases. MRI seems to be more sensitive than BS in detecting small spinal or pelvic metastases. Whole-body bone scintigraphy is more sensitive in detecting skull, costal or peripheral metastases. BS and MRI should be used in combination and may replace BMB in the detection of bone metastases in SCLC. (orig.)

  15. Topical use of tranexamic acid in open heart surgery.

    Science.gov (United States)

    Chaudhary, Farid Ahmad; Pervaz, Zahid; Ilyas, Sana; Niaz, Muhammad Nabeel

    2018-04-01

    To determine the efficacy of topical pouring of tranexamic acid in reducing post-operative mediastinal bleeding, requirement for blood products and the rate of re-exploration for re-securing haemostasis or relief of pericardial tamponade after open heart surgery. The prospective, randomised, placebo-controlled, double-blind comparative study was conducted from March 2013 to September 2015 at Rehmatul-lil-Alameen Institute of Cardiology, Punjab Employees Social Security Institution, Lahore, and comprised patients scheduled for primary isolated elective or urgent open heart surgery. The subjects were divided into two equal groups. The hetranexamic acid group received cardiac bath with 2gm of tranexamic acid diluted in 50mlof normal saline, while the placebo group received cardiac bath without tranexamic acid. Before the closure of sternum, the solution was poured into pericardial cavity as cardiac bath while the chest tubes were temporarily clamped. Data was entered into a pre-designed proforma. Of the 100 subjects, there were 50(50%) in each of the two groups. There was no difference in surgical characteristics and perioperative complications in the groups (p>0.05). After 48 post-operative hours, total blood loss was significantly less in the tranexamic acid group compared to the placebo group (pacid group than the placebo group (pacid group was re-explored for excessive bleeding compared to 4(8%) in the placebo group. There was significant reduction in post-operative blood drainage, need of blood products and rate of re-exploration after topical use of tranexamic acid in open heart surgery.

  16. Subcutaneous Tissue Thickness is an Independent Predictor of Image Noise in Cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Staniak, Henrique Lane; Sharovsky, Rodolfo [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil); Pereira, Alexandre Costa [Hospital das Clínicas - Universidade de São Paulo, São Paulo, SP (Brazil); Castro, Cláudio Campi de; Benseñor, Isabela M.; Lotufo, Paulo A. [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil); Faculdade de Medicina - Universidade de São Paulo, São Paulo, SP (Brazil); Bittencourt, Márcio Sommer, E-mail: msbittencourt@mail.harvard.edu [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-01-15

    Few data on the definition of simple robust parameters to predict image noise in cardiac computed tomography (CT) exist. To evaluate the value of a simple measure of subcutaneous tissue as a predictor of image noise in cardiac CT. 86 patients underwent prospective ECG-gated coronary computed tomographic angiography (CTA) and coronary calcium scoring (CAC) with 120 kV and 150 mA. The image quality was objectively measured by the image noise in the aorta in the cardiac CTA, and low noise was defined as noise < 30HU. The chest anteroposterior diameter and lateral width, the image noise in the aorta and the skin-sternum (SS) thickness were measured as predictors of cardiac CTA noise. The association of the predictors and image noise was performed by using Pearson correlation. The mean radiation dose was 3.5 ± 1.5 mSv. The mean image noise in CT was 36.3 ± 8.5 HU, and the mean image noise in non-contrast scan was 17.7 ± 4.4 HU. All predictors were independently associated with cardiac CTA noise. The best predictors were SS thickness, with a correlation of 0.70 (p < 0.001), and noise in the non-contrast images, with a correlation of 0.73 (p < 0.001). When evaluating the ability to predict low image noise, the areas under the ROC curve for the non-contrast noise and for the SS thickness were 0.837 and 0.864, respectively. Both SS thickness and CAC noise are simple accurate predictors of cardiac CTA image noise. Those parameters can be incorporated in standard CT protocols to adequately adjust radiation exposure.

  17. Intravascular large B-cell lymphoma of the kidney: A case report

    Directory of Open Access Journals (Sweden)

    Jia Nan

    2011-09-01

    Full Text Available Abstract We report a 41-year-old Chinese woman with intravascular large B-cell lymphoma diagnosed by percutaneous renal biopsy. The patient was admitted to Nanfang Hospital of Southern Medical University, Guangzhou, China with complaints of high spiking fever for a month and bilateral lower limb fatigue with difficulty ambulating for the past 5 months. She had renal dysfunction with a total urinary protein of 5.61 g/dL (56.1 g/L, serum albumin of 2.89 g/dL (28.9 g/L, urea nitrogen of 2.24 mg/dL (1.6 mmol/L, and serum creatinine of 0.54 mg/dL (48 μmol/L. Bone marrow biopsy revealed myeloproliferative disorder without abnormal myeloid or lymphocytic proliferation. Positron Emission Tomography-Computed Tomography (PET-CT showed marked bilateral swelling and enlargement of the renal parenchyma with splenic enlargement and involvement of multiple vertebrae. Percutaneous renal biopsy showed island-like accumulations of medium to large lymphoid cells in many areas of the interstitium, with round vesicular nuclei containing distinct basophilic nucleoli. Immunohistochemical analysis together with other supportive investigation confirmed the diagnosis of intravascular large B-cell lymphoma. Ten days later, she was started on chemotherapy with CHOP (cyclophosphamide, doxorubicin, leurocristime and prednisone for a week. Palliative radiotherapy DT 40Gy/20F with other supportive treatment was provided for metastatic foci in the medullary cavity of the sternum, T1-T7. The patient regained muscle strength in both lower limbs and was able to walk again after three weeks. The patient was discharged after hepatic and renal function and proteinuria values had returned to normal. Follow-up data shows the patient to be alive nine months after discharge.

  18. A case of skeletal tuberculosis and psoas abscess: disease activity evaluated using (18) F-fluorodeoxyglucose positron emission tomography-computed tomography.

    Science.gov (United States)

    Kimizuka, Yoshifumi; Ishii, Makoto; Murakami, Koji; Ishioka, Kota; Yagi, Kazuma; Ishii, Ken; Watanabe, Kota; Soejima, Kenzo; Betsuyaku, Tomoko; Hasegawa, Naoki

    2013-11-14

    Psoas abscess complicating tuberculous spondylitis is a rare morbidity in extrapulmonary tuberculosis. There are no established guidelines for evaluating the clinical response of psoas abscess. Although several studies have shown that positron emission tomography-computed tomography with 18 F-fluorodeoxyglucose can play a potential role in diagnosing multifocal tuberculosis and monitoring the clinical response of pulmonary tuberculosis, to our knowledge, this is the first report demonstrating that positron emission tomography-computed tomography is useful for evaluating local inflammation and disease activity of a tuberculous psoas abscess. We report a case of multifocal bone and lymph node tuberculosis with concomitant lumbar psoas abscess in a 77-year-old man, along with a literature review. An initial positron emission tomography-computed tomography scan showed intense 18 F-fluorodeoxyglucose accumulation in the sternum, ribs, vertebrae, and lymph nodes. The patient was successfully treated with antitubercular agents and computed tomography-guided drainage therapy. A follow-up positron emission tomography-computed tomography after abscess drainage and 9 months of antitubercular drug treatment revealed that the majority of lesions improved; however, protracted inflammation surrounding the psoas abscess was still observed. These results indicate that disease activity of psoas abscess can remain, even after successful drainage and antitubercular medication regime of appropriate duration. We have successfully followed up the extent of skeletal tuberculosis complicated with psoas abscess by positron emission tomography-computed tomography. In this patient, positron emission tomography-computed tomography is useful for evaluating the disease activity of tuberculous psoas abscess and for assessing the appropriate duration of antitubercular drug therapy in psoas abscess.

  19. SU-E-T-86: A Systematic Method for GammaKnife SRS Fetal Dose Estimation

    International Nuclear Information System (INIS)

    Geneser, S; Paulsson, A; Sneed, P; Braunstein, S; Ma, L

    2015-01-01

    Purpose: Estimating fetal dose is critical to the decision-making process when radiation treatment is indicated during pregnancy. Fetal doses less than 5cGy confer no measurable non-cancer developmental risks but can produce a threefold increase in developing childhood cancer. In this study, we estimate fetal dose for a patient receiving Gamma Knife stereotactic radiosurgery (GKSRS) treatment and develop a method to estimate dose directly from plan details. Methods: A patient underwent GKSRS on a Perfexion unit for eight brain metastases (two infratentorial and one brainstem). Dose measurements were performed using a CC13, head phantom, and solid water. Superficial doses to the thyroid, sternum, and pelvis were measured using MOSFETs during treatment. Because the fetal dose was too low to accurately measure, we obtained measurements proximally to the isocenter, fitted to an exponential function, and extrapolated dose to the fundus of the uterus, uterine midpoint, and pubic synthesis for both the preliminary and delivered plans. Results: The R-squared fit for the delivered doses was 0.995. The estimated fetal doses for the 72 minute preliminary and 138 minute delivered plans range from 0.0014 to 0.028cGy and 0.07 to 0.38cGy, respectively. MOSFET readings during treatment were just above background for the thyroid and negligible for all inferior positions. The method for estimating fetal dose from plan shot information was within 0.2cGy of the measured values at 14cm cranial to the fetal location. Conclusion: Estimated fetal doses for both the preliminary and delivered plan were well below the 5cGy recommended limit. Due to Pefexion shielding, internal dose is primarily governed by attenuation and drops off exponentially. This is the first work that reports fetal dose for a GK Perfexion unit. Although multiple lesions were treated and the duration of treatment was long, the estimated fetal dose remained very low

  20. Evaluation by Expert Dancers of a Robot That Performs Partnered Stepping via Haptic Interaction.

    Directory of Open Access Journals (Sweden)

    Tiffany L Chen

    Full Text Available Our long-term goal is to enable a robot to engage in partner dance for use in rehabilitation therapy, assessment, diagnosis, and scientific investigations of two-person whole-body motor coordination. Partner dance has been shown to improve balance and gait in people with Parkinson's disease and in older adults, which motivates our work. During partner dance, dance couples rely heavily on haptic interaction to convey motor intent such as speed and direction. In this paper, we investigate the potential for a wheeled mobile robot with a human-like upper-body to perform partnered stepping with people based on the forces applied to its end effectors. Blindfolded expert dancers (N=10 performed a forward/backward walking step to a recorded drum beat while holding the robot's end effectors. We varied the admittance gain of the robot's mobile base controller and the stiffness of the robot's arms. The robot followed the participants with low lag (M=224, SD=194 ms across all trials. High admittance gain and high arm stiffness conditions resulted in significantly improved performance with respect to subjective and objective measures. Biomechanical measures such as the human hand to human sternum distance, center-of-mass of leader to center-of-mass of follower (CoM-CoM distance, and interaction forces correlated with the expert dancers' subjective ratings of their interactions with the robot, which were internally consistent (Cronbach's α=0.92. In response to a final questionnaire, 1/10 expert dancers strongly agreed, 5/10 agreed, and 1/10 disagreed with the statement "The robot was a good follower." 2/10 strongly agreed, 3/10 agreed, and 2/10 disagreed with the statement "The robot was fun to dance with." The remaining participants were neutral with respect to these two questions.

  1. Evaluation by Expert Dancers of a Robot That Performs Partnered Stepping via Haptic Interaction

    Science.gov (United States)

    Chen, Tiffany L.; Bhattacharjee, Tapomayukh; McKay, J. Lucas; Borinski, Jacquelyn E.; Hackney, Madeleine E.; Ting, Lena H.; Kemp, Charles C.

    2015-01-01

    Our long-term goal is to enable a robot to engage in partner dance for use in rehabilitation therapy, assessment, diagnosis, and scientific investigations of two-person whole-body motor coordination. Partner dance has been shown to improve balance and gait in people with Parkinson's disease and in older adults, which motivates our work. During partner dance, dance couples rely heavily on haptic interaction to convey motor intent such as speed and direction. In this paper, we investigate the potential for a wheeled mobile robot with a human-like upper-body to perform partnered stepping with people based on the forces applied to its end effectors. Blindfolded expert dancers (N=10) performed a forward/backward walking step to a recorded drum beat while holding the robot's end effectors. We varied the admittance gain of the robot's mobile base controller and the stiffness of the robot's arms. The robot followed the participants with low lag (M=224, SD=194 ms) across all trials. High admittance gain and high arm stiffness conditions resulted in significantly improved performance with respect to subjective and objective measures. Biomechanical measures such as the human hand to human sternum distance, center-of-mass of leader to center-of-mass of follower (CoM-CoM) distance, and interaction forces correlated with the expert dancers' subjective ratings of their interactions with the robot, which were internally consistent (Cronbach's α=0.92). In response to a final questionnaire, 1/10 expert dancers strongly agreed, 5/10 agreed, and 1/10 disagreed with the statement "The robot was a good follower." 2/10 strongly agreed, 3/10 agreed, and 2/10 disagreed with the statement "The robot was fun to dance with." The remaining participants were neutral with respect to these two questions. PMID:25993099

  2. The effect of breast anthropometry on the Hybrid III 5th female chest response.

    Science.gov (United States)

    Tylko, Suzanne; Charlebois, Dominique; Bussières, Alain; Dalmotas, Dainius

    2006-11-01

    Two manufacturers, Denton ATD and FTSS, currently produce the Hybrid III 5th percentile female dummy. In response to concerns raised by industry that differences in the anthropometry of the molded breasts between the two manufacturers may influence chest responses, Transport Canada conducted a comparative testing program. Thorax biofidelity tests were conducted to compare force-deflection characteristics; full frontal rigid-barrier tests were conducted at 40, 48 and 56 km/h to compare chest responses, and out-of-position chest on module static airbag deployment tests were conducted to compare peak chest deflections of the Denton and FTSS dummy jackets and of a prototype jacket without breasts. Differences in force-deflection characteristics were observed during biofidelity pendulum impacts of the two dummies, with much of the differences attributed to the different chest jackets. Differences of up to 11 mm in the peak sternum deflection and of the order of 15 g for the 3-ms chest acceleration clips were noted in rigid-barrier vehicle tests. In the out-of-position airbag-deployment tests, differences in the magnitude of peak chest deflections were observed. The prototype chest jacket without breasts was found to improve repeatability in the belted crash tests and in out-of-position airbag testing. Though neither the Denton nor the FTSS chest jackets fully meet the original design intent of the Hybrid III 5th percentile dummy, the Denton dummy more closely met the drawing specifications and had less manufacturing variability. The results demonstrate the importance of detailed chest flesh assembly specifications, provide evidence that a fully molded jacket design would eliminate manufacturing variability and suggest that removal of the breasts may further improve test repeatability.

  3. The findings of F-18 FDG camera-based coincidence PET in acute leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, S. N.; Joh, C. W.; Lee, M. H. [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2002-07-01

    We evaluated the usefulness of F-18 FDG coincidence PET (CoDe-PET) using a dual-head gamma camera in the assessment of patients with acute leukemia. F-18 FDG CoDE-PET studies were performed in 5 patients with acute leukemia (6 ALL and 2 AML) before or after treatment. CoDe-PET was performed utilizing a dual-head gamma camera equipped with 5/8 inch NaI(Tl) crystal. Image acquisition began 60 minutes after the injection of F-18 FDG in the fasting state. A whole trunk from cervical to inguinal regions or selected region were scanned. No attenuation correction was made and image reconstruction was done using filtered back-projection. CoDe-PET studies were evaluated visually. F-18 FDG image performed in 5 patients with ALL before therapy depicted multiple lymph node involvement and diffuse increased uptake involving axial skeleton, pelvis and femurs. F-18 FDG image done in 2 AML after chemotherapy showed only diffuse increased uptake in sternum, ribs, spine, pelvis and proximal femur and these may be due to G-CSF stimulation effect in view of drug history. But bone marrow histology showed scattered blast cell suggesting incomplete remission in one and completer remission in another. F-18 image done in 1 ALL after therapy showed no abnormal uptake. CoDe-PET with F-18 FDG in acute lymphoblastic lymphoma showed multiple lymphnode and bone marrow involvement in whole body. Therefore we conclude that CoDe-PET with F-18 FDG usefulness for evaluation of extent in acute lymphoblastic leukemia. But there was a limitation to assess therapy effectiveness during therapy due to reactive bone marrow.

  4. Falls classification using tri-axial accelerometers during the five-times-sit-to-stand test.

    Science.gov (United States)

    Doheny, Emer P; Walsh, Cathal; Foran, Timothy; Greene, Barry R; Fan, Chie Wei; Cunningham, Clodagh; Kenny, Rose Anne

    2013-09-01

    The five-times-sit-to-stand test (FTSS) is an established assessment of lower limb strength, balance dysfunction and falls risk. Clinically, the time taken to complete the task is recorded with longer times indicating increased falls risk. Quantifying the movement using tri-axial accelerometers may provide a more objective and potentially more accurate falls risk estimate. 39 older adults, 19 with a history of falls, performed four repetitions of the FTSS in their homes. A tri-axial accelerometer was attached to the lateral thigh and used to identify each sit-stand-sit phase and sit-stand and stand-sit transitions. A second tri-axial accelerometer, attached to the sternum, captured torso acceleration. The mean and variation of the root-mean-squared amplitude, jerk and spectral edge frequency of the acceleration during each section of the assessment were examined. The test-retest reliability of each feature was examined using intra-class correlation analysis, ICC(2,k). A model was developed to classify participants according to falls status. Only features with ICC>0.7 were considered during feature selection. Sequential forward feature selection within leave-one-out cross-validation resulted in a model including four reliable accelerometer-derived features, providing 74.4% classification accuracy, 80.0% specificity and 68.7% sensitivity. An alternative model using FTSS time alone resulted in significantly reduced classification performance. Results suggest that the described methodology could provide a robust and accurate falls risk assessment. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Evaluation and performance of arccheck and film using gamma criteria in pre-treatment quality assurance of stereotactic ablative radiotherapy

    Directory of Open Access Journals (Sweden)

    Prabhakar Ramachandran

    2017-01-01

    Full Text Available Aim: The aim of this study is to assess the use of ArcCHECK (AC as an alternative method to replace film dosimetry for pre-treatment quality assurance (QA of three-dimensional conformal radiation therapy, intensity-modulated radiation therapy (IMRT, and volumetric-modulated arc therapy (VMAT stereotactic ablative radiotherapy (SABR treatment plans. Materials and Methods: Twenty-five patients with a varied diagnosis of lung, spine, sacrum, sternum, ribs, scapula, and femur undergoing SABR were selected for this study. Pre-treatment QA was performed for all the patients using ionization chamber and film dosimetry. Measurements were also carried out on an AC phantom. The planned and measured doses from the AC device and EBT3 films were compared using four different gamma criteria: 2%/2 mm, 3%/2 mm, 3%/1 mm, and 3%/3 mm. Results: The mean gamma passing rates at 3%/3 mm for all non-spine SABR cases were 98.79 ± 0.96 and 99.27 ± 1.03 with AC and films, respectively. The mean passing rates at 3%/2 mm for AC and films were 98.76 ± 0.42 and 99.43 ± 0.27 respectively for spine VMAT SABR, and 87.15 ± 2.45 and 99.79 ± 0.14 respectively for spine IMRT SABR. In the case of spine tumors, the gamma criterion was tightened due to the proximity of spinal cord to the planning target volume. Our results show that AC provides good results for all VMAT SABR plans. Conclusion: The AC results at 3%/3 mm were in good agreement with film dosimetry for most cases. We observed a significant reduction in QA time on using AC for SABR QA. This study showed that AC results are comparable to film dosimetry for all studied sites except for spine IMRT SABR.

  6. Fall risks assessment among community dwelling elderly using wearable wireless sensors

    Science.gov (United States)

    Lockhart, Thurmon E.; Soangra, Rahul; Frames, Chris

    2014-06-01

    Postural stability characteristics are considered to be important in maintaining functional independence free of falls and healthy life style especially for the growing elderly population. This study focuses on developing tools of clinical value in fall prevention: 1) Implementation of sensors that are minimally obtrusive and reliably record movement data. 2) Unobtrusively gather data from wearable sensors from four community centers 3) developed and implemented linear and non-linear signal analysis algorithms to extract clinically relevant information using wearable technology. In all a total of 100 community dwelling elderly individuals (66 non-fallers and 34 fallers) participated in the experiment. All participants were asked to stand-still in eyes open (EO) and eyes closed (EC) condition on forceplate with one wireless inertial sensor affixed at sternum level. Participants' history of falls had been recorded for last 2 years, with emphasis on frequency and characteristics of falls. Any participant with at least one fall in the prior year were classified as faller and the others as non-faller. The results indicated several key factors/features of postural characteristics relevant to balance control and stability during quite stance and, showed good predictive capability of fall risks among older adults. Wearable technology allowed us to gather data where it matters the most to answer fall related questions, i.e. the community setting environments. This study opens new prospects of clinical testing using postural variables with a wearable sensor that may be relevant for assessing fall risks at home and patient environment in near future.

  7. Dynamic characteristics of the thorax connected with the heart action.

    Science.gov (United States)

    Juznic, G; Emri, I; Peterec, D; Prepadnik, M

    1979-01-01

    We determined the indices of local vibrations (resonance frequency, damping coefficient, stiffness constant, extinction time) and transfer function H(s) . 10(-6) for three somatotypes and three respiratory positions on 88 points of the thorax. The examinees were males (age 21 years). We found the resonance frequencies of 36.86--54.75 cps, damping coefficient (delta) 0.121--0.217. This means the damping is less than critical (delta = 1). We applied shocks (a force of 2 N) with a reflex hammer on 88 points of the thorax. The force diminished from the exciting place (say ictus) to the recording place (accelerometer on the sternum) from 2 to 0.2 N. The athletic type has the highest resonance frequency and stiffness constant; the leptosomic type has the highest damping; the longest extinction time belongs to the pyknic type. The pyknic type has also the highest value of the transfer function. The respiratory position (quiet respiration, Valsalva and Müller experiment) influences the values of the indices of local vibrations and of the transfer function. The influence is evident especially on the intercostal points: the transfer of the oscillations is alleviated at a higher stiffness of the thorax (Valsalva; the value of H(S) . 10(-6) rises from 7.00 to 9.39 sec2), it deteriorates at a small stiffness of the thorax (in Müller's experiment falls to 2.78 sec2). With the fall in the intrathoracic pressure the damping in the intercostal points decreases. On the basis of experiments the conclusion was made that a short testing of the thorax of an examinee will give the dynamic characteristics of the thorax (indices of local vibrations and transfer functions) of the individual. This procedure will alleviate the quantitative use of noninvasive mechanical methods in the assessment of the cardiovascular function.

  8. Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis.

    Science.gov (United States)

    Ennker, I C; Pietrowski, D; Vöhringer, L; Kojcici, B; Albert, A; Vogt, P M; Ennker, J

    2009-11-01

    In cardiac surgery poststernotomy mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with vacuum-assisted closure (VAC) therapy followed by reconstruction with M. pectoralis muscle flaps as treatment for deep sternal wound infections. Our group performed a retrospective analysis of 3630 consecutive cardiac surgical patients using median sternotomy from 11/2004 to 11/2007. After removing sternal wires, necrotic debris and potentially infective material, restabilisation of the sternum was performed and VAC therapy was employed. Wound closure and subsequent reconstruction were performed using a bilateral pectoralis muscle plasty. Of the analysed patients 16 female and 29 male patients suffered from deep sternal wound infections and were treated with VAC. The most common risk factors were diabetes mellitus odds ratio (OR 3.5), chronic obstructive pulmonary disease (COPD) (OR 2.9), use of bilateral mammarian artery (OR 2.0) and obesity (1.8). The median age of patients with deep sternal infections was similar to control patients. Staphylococcus epidermis was the most common pathogen (37.8%) followed by Enterococcus faecilis (22.2%) and Staphylococcus aureus (17.8). In 22.2% no pathogen could be detected. The 30 day mortality was 0%, the in-hospital mortality was 15.6%. The results of our studies demonstrate that vacuum therapy in conjunction with early and aggressive debridement is an effective strategy for treating poststernotomy mediastinitis. We consider pectoralis major muscle flap reconstruction as a safe technique and regard it as the primary choice for wound closure in poststernotomy mediastinitis. (c) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Computed tomographic-guided iodine-125 interstitial implants for malignant thoracic tumors

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    Huang, Qiming [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); The Department of Radiology, Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan Bei Road, Quanzhou 362000 (China); Chen, Jin; Chen, Qunlin [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); Lai, Qingquan; Cai, Siqing [The Department of Radiology, Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan Bei Road, Quanzhou 362000 (China); Luo, Kaidong [The Department of Radiology, Longyan Hosptial of Traditional Chinese Medical, 59 Longteng Middle Road, Longyan 364000 (China); Lin, Zhengyu, E-mail: linsinlan@yahoo.com.cn [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China)

    2013-11-01

    Purpose: To evaluate the feasibility and efficacy of percutaneous interstitial brachytherapy using iodine-125 ({sup 125}I) radioactive seeds under computed tomographic (CT) guidance for malignant thoracic tumors. Materials and methods: Forty-one patients (34 males, 7 females; 18–90 years; mean, 63.7 years) with 77 lesions (3 in the mediastinum, 7 in the chest wall, 67 in the lung) underwent percutaneous interstitial implantation of {sup 125}I radioactive seeds under CT guidance. A treatment planning system (TPS) was employed to calculate the number and distribution of seeds preoperatively. An 18-G needle was inserted into the lesions under CT guidance and send the seeds according to TPS. Two patients with mediastinal lesions undergoing seed implantation received an artificial pneumothorax. One patient with lung carcinoma adjacent to the anterior mediastinum underwent seed implantation through the sternum. Follow-up CT was done every 2 months postoperatively. Results: The procedure was successful in all patients. No major procedure-associated death occurred. The mean duration of follow-up was 19.4 ± 1.3 months (3–49 months). A complete response (CR) was seen in 49 lesions (63.6%), partial response (PR) in 9 lesions (11.7%), stable disease (SD) in 12 lesions (12.8%), and progressive disease (PD) in 7 lesions (7.4%). The overall response rate (CR + PR) was 75.3%; the local control rate (CR + PR + SD) was 90.9%. The 1-, 2- and 3-year progression-free rates for local tumors were 91%, 88% and 88%, respectively. The 1-, 2- and 3-year survival rates were 87%, 74% and 68%, respectively. Conclusion: Implantation of CT-guided {sup 125}I seeds is feasible and effective for patients with malignant thoracic tumors.

  10. Quantification of radionuclide uptake levels for primary bone tumors

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    Hasford Francis

    2015-04-01

    Full Text Available The purpose of the study is to quantify the level of uptake of administered radionuclide in primary bone tumors for patients undergoing bone scintigraphy. Retrospective study on 48 patient's scintigrams to quantify the uptake levels of administered radiopharmaceuticals was performed in a nuclear medicine unit in Ghana. Patients were administered with activity ranging between 0.555 and 1.110 MBq (15–30 mCi, and scanned on Siemens e.cam SPECT system. Analyses on scintigrams were performed with Image J software by drawing regions of interest (ROIs over identified hot spots (pathologic sites. Nine skeletal parts namely cranium, neck, shoulder, sacrum, sternum, vertebra, femur, ribcage, and knee were considered in the study, which involved 96 identified primary tumors. Radionuclide uptakes were quantified in terms of the estimated counts of activity per patient for identified tumor sites. Average normalized counts of activity (nGMC per patient ranged from 5.2759 ± 0.6590 cts/mm2/MBq in the case of cranium tumors to 72.7569 ± 17.8786 cts/mm2/MBq in the case of ribcage tumors. The differences in uptake levels could be attributed to different mechanisms of Tc-99m MDP uptake in different types of bones, which is directly related to blood flow and degree of osteoblastic activity. The overall normalized count of activity for the 96 identified tumors was estimated to be 23.0350 ± 19.5424 cts/mm2/MBq. The study revealed highest uptake of activity in ribcage and least uptake in cranium. Quantification of radionuclide uptakes in tumors is important and recommended in assessing patient's response to therapy, doses to critical organs and in diagnosing tumors.

  11. Gynecomastia Surgery Is Associated with Improved Nipple Location in Young Korean Patients

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    Bo Hyung Lee

    2014-11-01

    Full Text Available BackgroundGynecomastia is benign enlargement of breast tissue in males and is fairly common. Mastectomy not only helps in improving the shape of anterior chest, but can also improve the location of nipple. Therefore, a principle element of mastectomy design is defining the normal location of nipple based on major anatomical reference points. Here, the nipple location was compared for before and after gynecomastia surgery. In addition, the same was also compared between male patients undergoing gynecomastia surgery and control group of subjects without gynecomastia.MethodsWe retrospectively analyzed gynecomastia patients who underwent conventional subcutaneous mastectomy. Preoperative and postoperative anatomical landmark distances and chest circumferences were measured and compared to the same anthropometric data from 20 healthy adult male controls.ResultsNipple locations were compared among 13 patients and 20 controls. The mean weight of resected breast tissue was 246 g, and overall patient satisfaction grade was 4.3 out of 5. In the patient group, the slopes for the height-distance from the sternal notch to the nipple and chest circumference-distance between the mid-line of the sternum and the nipple were 0.175 and 0.125 postoperatively, respectively. The slopes of the control group were 0.122 and 0.177, respectively; these differences were statistically significant (P<0.05.ConclusionsNipple positions were considerably lower in patients with gynecomastia than in control subjects. Subcutaneous mastectomy was associated with mild elevations, but postoperative locations were still lower compared to controls. Further efforts are needed to improve the location of postoperative nipple-areola complex in patients with gynecomastia.

  12. Candida Osteomyelitis: Analysis of 207 Pediatric and Adult Cases (1970–2011)

    Science.gov (United States)

    Gamaletsou, Maria N.; Kontoyiannis, Dimitrios P.; Sipsas, Nikolaos V.; Moriyama, Brad; Alexander, Elizabeth; Roilides, Emmanuel; Brause, Barry; Walsh, Thomas J.

    2012-01-01

    Background. The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. Methods. Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. Results. Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90%) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90% of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67%), direct inoculation (25%), and contiguous infection (9%). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95% confidence interval [CI], .04–.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95% CI, 8.4–48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35% of cases. Bacteria were recovered concomitantly from 12% of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21%. Combined surgery and antifungal therapy were used in 48% of cases. The overall complete response rate of Candida osteomyelitis of 32% reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32% who ultimately achieved complete response. Conclusions. Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6–12 months of antifungal therapy, and surgical intervention, when indicated, may improve

  13. A case of skeletal tuberculosis and psoas abscess: disease activity evaluated using 18 F-fluorodeoxyglucose positron emission tomography-computed tomography

    International Nuclear Information System (INIS)

    Kimizuka, Yoshifumi; Hasegawa, Naoki; Ishii, Makoto; Murakami, Koji; Ishioka, Kota; Yagi, Kazuma; Ishii, Ken; Watanabe, Kota; Soejima, Kenzo; Betsuyaku, Tomoko

    2013-01-01

    Psoas abscess complicating tuberculous spondylitis is a rare morbidity in extrapulmonary tuberculosis. There are no established guidelines for evaluating the clinical response of psoas abscess. Although several studies have shown that positron emission tomography-computed tomography with 18 F-fluorodeoxyglucose can play a potential role in diagnosing multifocal tuberculosis and monitoring the clinical response of pulmonary tuberculosis, to our knowledge, this is the first report demonstrating that positron emission tomography-computed tomography is useful for evaluating local inflammation and disease activity of a tuberculous psoas abscess. We report a case of multifocal bone and lymph node tuberculosis with concomitant lumbar psoas abscess in a 77-year-old man, along with a literature review. An initial positron emission tomography-computed tomography scan showed intense 18 F-fluorodeoxyglucose accumulation in the sternum, ribs, vertebrae, and lymph nodes. The patient was successfully treated with antitubercular agents and computed tomography-guided drainage therapy. A follow-up positron emission tomography-computed tomography after abscess drainage and 9 months of antitubercular drug treatment revealed that the majority of lesions improved; however, protracted inflammation surrounding the psoas abscess was still observed. These results indicate that disease activity of psoas abscess can remain, even after successful drainage and antitubercular medication regime of appropriate duration. We have successfully followed up the extent of skeletal tuberculosis complicated with psoas abscess by positron emission tomography-computed tomography. In this patient, positron emission tomography-computed tomography is useful for evaluating the disease activity of tuberculous psoas abscess and for assessing the appropriate duration of antitubercular drug therapy in psoas abscess

  14. Seasonal carcass composition and energy balance of female black ducks in Maine

    Science.gov (United States)

    Reinecke, K.J.; Stone, T.L.; Owen, R.B.

    1982-01-01

    Female Black Ducks (Anas rubripes) collected in Maine during the summer, fall, and winter of 1974-1976 showed significant seasonal variation in body weight, nonfat dry weight, gizzard and pectoral muscle weight, and fat, moisture, and protein content. Variation of body weight within and among seasons was correlated more strongly with carcass protein content, and with fat content during seasons of heavy lipid deposition, than with three structural size variables (culmen, tarsus, and sternum). Regression equations including fat and protein as independent variables accounted for 80-90% of the annual and seasonal variation in body weight; structural size variables alone accounted for less than 30%. Immature females averaged 54 and 99 g lighter, and carried 54 and 59 g less fat than adults during the fall and winter. Ducks of both age classes lost weight in December and January. Adult and immature females metabolized 59 and 64 g of fat and 17 and 25 g of protein in winter compared with 46 g of fat during the nesting season. Nutrient reserves are thus equally as important for the winter survival of these birds as for successfurl eproduction. Seasonal changes in carcass composition suggest that (1) fat deposited in late fall provides an energy reserve during winter, (2) a reduction in lean weight during winter may lower daily energy requirements and increase the effective amount of energy reserves, and (3) declining body weights during late winter may be an endogenous rhythm that reflects a shift in the expected benefits of an energy reserve compared to the costs of carrying additional weight,

  15. Wearable Inertial Sensors Allow for Quantitative Assessment of Shoulder and Elbow Kinematics in a Cadaveric Knee Arthroscopy Model.

    Science.gov (United States)

    Rose, Michael; Curtze, Carolin; O'Sullivan, Joseph; El-Gohary, Mahmoud; Crawford, Dennis; Friess, Darin; Brady, Jacqueline M

    2017-12-01

    To develop a model using wearable inertial sensors to assess the performance of orthopaedic residents while performing a diagnostic knee arthroscopy. Fourteen subjects performed a diagnostic arthroscopy on a cadaveric right knee. Participants were divided into novices (5 postgraduate year 3 residents), intermediates (5 postgraduate year 4 residents), and experts (4 faculty) based on experience. Arm movement data were collected by inertial measurement units (Opal sensors) by securing 2 sensors to each upper extremity (dorsal forearm and lateral arm) and 2 sensors to the trunk (sternum and lumbar spine). Kinematics of the elbow and shoulder joints were calculated from the inertial data by biomechanical modeling based on a sequence of links connected by joints. Range of motion required to complete the procedure was calculated for each group. Histograms were used to compare the distribution of joint positions for an expert, intermediate, and novice. For both the right and left upper extremities, skill level corresponded well with shoulder abduction-adduction and elbow prono-supination. Novices required on average 17.2° more motion in the right shoulder abduction-adduction plane than experts to complete the diagnostic arthroscopy (P = .03). For right elbow prono-supination (probe hand), novices required on average 23.7° more motion than experts to complete the procedure (P = .03). Histogram data showed novices had markedly more variability in shoulder abduction-adduction and elbow prono-supination compared with the other groups. Our data show wearable inertial sensors can measure joint kinematics during diagnostic knee arthroscopy. Range-of-motion data in the shoulder and elbow correlated inversely with arthroscopic experience. Motion pattern-based analysis shows promise as a metric of resident skill acquisition and development in arthroscopy. Wearable inertial sensors show promise as metrics of arthroscopic skill acquisition among residents. Copyright © 2017

  16. Wholebody and pinhole bone scan manifestations of reiter's syndorme: distribution pattern and specific and early signs

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    Kim, S. H.; Chung, S. K.; Park, Y. H.; Lee, S. Y.; Sohn, H. S.; Han, B. H.; Bahk, Y. W. [College of Medicine, Catholic Univ., Seoul (Korea, Republic of)

    1998-07-01

    We wish to describe the characteristics panoramic wholebody bone distribution, and specific and preradiographic pinhole bone scan signs of Reiter's syndrome(RS) featured by pauciarthritis and enthesopathies in and about weight-bearing joints of the lower extremities and axial bones. We analyzed 55 sets of wholebody and pinhole bone scintigraphs of 55 patients with RS. The population was 44 men and 11 women with age ranging from 15 to 52 yr (mean=29.3). The scintigraphy was performed 2-2.5 hr pi of Tc-99m-HDP using a single-head gamma camera with a LEHR collimator and a 4-mm pinhole collimator for the wholebody and pinhole scintigraphy, respectively. We found 223 lesions with increased tracer uptake in total. Wholebody scans showed asymmetric pauciarticular distribution in weight bearing joints and periarticular entheses in the lower extremities in 63.2% (calcaneus=24.2%, ankle=8.1%, tibia=8.1% and others). The sternum, sacroiliac joint and spine were involved in 8.5%, 5.8% and 4.5%, respectively. Pinhole scan portrayed many specific signs including the 'tear-drop' sign of paravertebral ossification. 'whiskers' sign of femoral osteophytes and 'knuckle bone' sign of sausage digit. Twenty-four lesions (10.8%) showed preradiogrpahic signs in symptomatic ehthesopathies mostly in the calcaneus and proximal tibia. Nine cases with calcaneal enthesopathies and four cases with proximal tibial enthesopathy without radiographic bone change showed intense tracer uptake. Wholebody and pinhole magnification scans were useful in studying RS. The asymmetric pauciarticular distribution in the weight-bearing bones with enthesopathies was characteristic. Pinhole scan portrayed many specific signs and was sensitive permitting accurate preradiographic diagnosis in many cases.

  17. A Randomized Trial to Assess the Contribution of a Novel Thorax Support Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.

    Science.gov (United States)

    Caimmi, Philippe P; Sabbatini, Maurizio; Kapetanakis, Emmanouil I; Cantone, Silvia; Ferraz, Marcus V; Cannas, Mario; Tesler, Ugo F

    2017-06-01

    Mechanical complications of median sternotomy may cause significant morbidity and mortality in cardiac surgical patients. This study was aimed at assessing the role of Posthorax support vest (Epple, Inc., Vienna, Austria) in the prevention of sternal complications and the improvement of anatomical healing in patients at high risk for mechanical sternal dehiscence after cardiac surgery by mean of median sternotomy. A prospective, randomized, study was performed and 310 patients with predisposing factors for sternal dehiscence after sternotomy for cardiac surgery were included. The patients were divided into two groups: patients who received the Posthorax support vest after surgery, and patients who did not. Primary variables assessed included the incidence of mechanical sternal complications, the quality of sternal healing, the rate of re-operation, the duration of hospitalization, rate and duration of hospital, re-admission for sternal complications. Secondary variables assessed were the post-operative pain, the number of requests for supplemental analgesia and the quality of life measured by means of the EQ-5D format. Patients using vest demonstrated a lower incidence of mechanical sternal complications, a better anatomical sternum healing, lower hospital stay, no re-operations for sternal dehiscence before discharge and lower re-admissions for mechanical sternal complication. In addition, patients using a vest reported a better quality of life with better freedom from limitations in mobility, self-care, and pain. Our findings demonstrate that the use of the Posthorax vest reduces post-sternotomy mechanical complications and improves the healing of the sternotomy, the clinical course, and the post-operative quality of life.

  18. Noninvasive staging of lung cancer. Indications and limitations of gallium-67 citrate imaging

    International Nuclear Information System (INIS)

    Bekerman, C.; Caride, V.J.; Hoffer, P.B.; Boles, C.A.

    1990-01-01

    The results of evaluation of the hila and mediastinum with 67Ga scans are contradictory, as are the recommendations by different investigators on the use of 67Ga scintigraphy in the clinical evaluation of patients with primary lung carcinoma. Nevertheless, the economy and logistic simplicity of evaluating local and distant metastases with a single imaging procedure are attractive, especially because the symptoms may not enable the physician to make a correct identification of the organ systems affected by metastases. Neumann and Hoffer state that at present conventional Ga-67 scanning techniques cannot be recommended for preoperative staging of mediastinal lymph node metastases in lung cancer patients. According to Waxman, 67Ga scintigraphy, relative to other imaging modalities, is a sensitive indicator of hilar spread of a tumor. However, because of the normally high background activity within the sternum and spine, mediastinal abnormalities may be poorly detected. Since most pulmonary tumors metastasize via regional nodes to the pulmonary hilum and then to the mediastinum, the high sensitivity for the detection of pulmonary hilar abnormalities and the high specificity for detection of mediastinal lesions suggest that gallium scintigraphy is a valuable adjunctive test when used appropriately. The results obtained locally are probably the best guide for individual physicians in the selection of diagnostic tests for their patients. Gallium scans may thus be helpful in the clinical evaluation of patients with lung cancer. Although gallium scans identify mediastinal node involvement, there is considerable controversy over the relationship between the sensitivity and specificity of the method. By detecting distant extrathoracic metastases, the 67Ga scan may identify a small group of patients who can be spared a needless operation. 92 references

  19. Remote Effects of Electromagnetic Millimeter Waves on Experimentally Induced Cold Pain: A Double-Blinded Crossover Investigation in Healthy Volunteers.

    Science.gov (United States)

    Partyla, Tomasz; Hacker, Henriette; Edinger, Hardy; Leutzow, Bianca; Lange, Joern; Usichenko, Taras

    2017-03-01

    The hypoalgesic effect of electromagnetic millimeter waves (MW) is well studied in animal model; however, the results of human research are controversial. The aim of this study was to evaluate the effects of various frequency ranges of MW on hypoalgesia using the cold pressor test (CPT). Experimental pain was induced using standardized CPT protocols in 20 healthy male volunteers. The skin of the lower part of sternum was exposed to MW with a frequency of 42.25 GHz (active generator); MW within 50-75 GHz frequency range (noise generator); or an inactive MW device (placebo generator) in a random crossover double-blinded manner. Pain threshold, measured using the CPT, was the primary outcome. Other CPT parameters, heart rate, blood pressure, incidence of subjective sensations (paresthesia) during exposure, as well as quality of volunteers' blinding were also recorded. The end points of the condition with exposure to 42.25 GHz, were compared with baseline; exposure to noise 50-75 GHz; and placebo generators. Pain threshold increased during exposure to the 42.25 GHz generator when compared with baseline: median difference (MD), 1.97 seconds (95% confidence interval [CI], 0.35-3.73) and noise generator: MD, 1.27 seconds (95% CI, 0.05-2.33) but not compared with the placebo generator. Time to onset of cold and increasing pain sensations as well as diastolic blood pressure increased under the exposure to the 42.25 GHz generator when compared with baseline and noise generator. Other outcome measures were comparable among the study conditions. We were able to partially confirm the previously suggested hypoalgesic effects of low-intensity electromagnetic MW. However, the effect was indistinguishable from the placebo condition in our investigation.

  20. Effectiveness of bone cleaning process using chemical and entomology approaches: time and cost.

    Science.gov (United States)

    Lai, Poh Soon; Khoo, Lay See; Mohd Hilmi, Saidin; Ahmad Hafizam, Hasmi; Mohd Shah, Mahmood; Nurliza, Abdullah; Nazni, Wasi Ahmad

    2015-08-01

    Skeletal examination is an important aspect of forensic pathology practice, requiring effective bone cleaning with minimal artefact. This study was conducted to compare between chemical and entomology methods of bone cleaning. Ten subjects between 20 and 40 years old who underwent uncomplicated medico-legal autopsies at the Institute of Forensic Medicine Malaysia were randomly chosen for this descriptive cross sectional study. The sternum bone was divided into 4 parts, each part subjected to a different cleaning method, being two chemical approaches i.e. laundry detergent and a combination of 6% hydrogen peroxide and powder sodium bicarbonate and two entomology approaches using 2nd instar maggots of Chrysomyia rufifacies and Ophyra spinigera. A scoring system for grading the outcome of cleaning was used. The effectiveness of the methods was evaluated based on average weight reduction per day and median number of days to achieve the average score of less than 1.5 within 12 days of the bone cleaning process. Using maggots was the most time-effective and costeffective method, achieving an average weight reduction of 1.4 gm per day, a median of 11.3 days to achieve the desired score and an average cost of MYR 4.10 per case to reach the desired score within 12 days. This conclusion was supported by blind validation by forensic specialists achieving a 77.8% preference for maggots. Emission scanning electron microscopy evaluation also revealed that maggots especially Chrysomyia rufifacies preserved the original condition of the bones better allowing improved elucidation of bone injuries in future real cases.

  1. An Objective Functional Characterisation of Head Movement Impairment in Individuals with Neck Muscle Weakness Due to Amyotrophic Lateral Sclerosis.

    Directory of Open Access Journals (Sweden)

    Silvia Pancani

    Full Text Available Neck muscle weakness and head drop are well recognised in patients with Amyotrophic lateral sclerosis (ALS, but an objective characterisation of the consequent head movement impairment is lacking. The aim of this study was to quantitatively characterise head movements in ALS compared to aged matched controls.We evaluated two groups, one of thirteen patients with ALS and one of thirteen age-matched controls, during the execution of a series of controlled head movements, performed while wearing two inertial sensors attached on the forehead and sternum, respectively. We quantified the differences between the two groups from the sensor data using indices of velocity, smoothness and movement coupling (intended as a measure of undesired out of plane movements.Results confirmed a general limitation in the ability of the ALS patients to perform and control head movements. High inter-patient variability was observed due to a wide range of observed functional impairment levels. The ability to extend the head backward and flex it laterally were the most compromised, with significantly lower angular velocity (P 0.8, reduced smoothness and greater presence of coupled movements with respect to the controls. A significant reduction of angular velocity (P 0.8 in extension, axial rotation and lateral flexion was observed when patients were asked to perform the movements as fast as possible.This pilot study is the first study providing a functional objective quantification of head movements in ALS. Further work involving different body areas and correlation with existing methods of evaluating neuromuscular function, such as dynamometry and EMG, is needed to explore the use of this approach as a marker of disease progression in ALS.

  2. The Sonographic Correlation between The Sternocleidomastoid Muscle Thickness and the Prognosis of Congenital Muscular Torticollis

    International Nuclear Information System (INIS)

    Lim, Dae Keon; Kwon, Woo Cheol; Cha, Seung Whan; Yoo, Ho Seok; Lim, Sang Hyeok; Park, Jeong Mee; Kim, Myung Soon

    2009-01-01

    We wanted to predict the prognosis of patients with CMT by the A/N ratio of the thickness and the circumference of the SCM muscle on ultrasonography, and we wanted to correlate the echogenecity of the affected muscle and the prognosis. Ultrasonography was performed on 24 patients from June 2004 to March 2007. We measured the thickness and the cross sectional circumference of the SCM muscle at three levels; below the mastoid process, at the level of the carotid artery bifurcation and at the level of the sternum and clavicle. The ratio of the affected side to the normal side (the A/N ratio) of the SCM muscle was calculated. We performed followed up ultrasonography at 2 months intervals until the end of treatment. The Wilcoxon signed-rank test was used to correlate the A/N ratio before and after the treatment. Spearman's rank test was used to correlate the A/N ratio and the total treatment duration. Paired T-tests were used to correlate the echogenecity of the SCM muscle and the treatment duration divided by less than or greater than 12 months. With measuring the thickness of the SCM muscle, the A/N ratio after treatment (1.36) was decreased compared with the initial A/N ratio (2.31) (p<0.05). The correlation between the A/N ratio of the thickness with the total treatment duration was statistically significant (p<0.05). The echogenecity of the affected SCM muscle was not correlated with the duration of treatment. The A/N ratio of the thickness of the SCM muscle is useful to predict the prognosis of patients with CMT

  3. Long-Term Complete Remission with nab-Paclitaxel, Bevacizumab, and Gemcitabine Combination Therapy in a Patient with Triple-Negative Metastatic Breast Cancer

    Directory of Open Access Journals (Sweden)

    Alberto Montero

    2012-12-01

    Full Text Available This is a case study of a 52-year-old female patient diagnosed in June 2007 with primary metastatic invasive ductal carcinoma of the left breast and synchronous metastases in the bone, lymph nodes, and lung. Biopsy results of the tumor tissue were negative for the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2. In November 2007, she participated in a phase II study of metastatic HER2-negative breast cancer. Treatment consisted of systemic chemotherapy with gemcitabine 1,500 mg/m2, nab-paclitaxel 150 mg/m2, and bevacizumab 10 mg/kg once every other week. The patient experienced pain relief in her sternum after 5 weeks of chemotherapy, and her analgesic therapy was discontinued. After 7 months, the patient achieved a complete radiographic response, which was maintained for nearly 2 additional years. She continued receiving treatment throughout this period, requiring 1 dose reduction due to fatigue. The patient experienced no other adverse events, including neuropathy, and continued working uninterrupted throughout her treatment. The patient was discontinued from the study in May 2010 after disease progression, almost a full 3 years after diagnosis. The patient showed minimal response to subsequent therapies but had disease stabilization and died from her disease in April 2012. Median overall survival for patients with metastatic triple-negative breast cancer is between 12 and 13.3 months. This patient survived nearly 5 years following diagnosis. This case exemplifies how therapy with nab-paclitaxel, bevacizumab, and gemcitabine may prolong survival, with minimal toxicity, in select patients with triple-negative metastatic breast cancer.

  4. Clinical applications of the superior epigastric artery perforator (SEAP) flap: anatomical studies and preoperative perforator mapping with multidetector CT.

    Science.gov (United States)

    Hamdi, Moustapha; Van Landuyt, Koenraad; Ulens, Sara; Van Hedent, Eddy; Roche, Nathalie; Monstrey, Stan

    2009-09-01

    Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging thoracic defects. We present an anatomical study based on multidetector computerized tomography (MDCT) scan findings of the SEA perforators in addition to the first reported clinical series of SEAP flaps in anterior chest wall reconstruction. (a) In the CT scan study, images of a group of 20 patients who underwent MDCT scan analysis were used to visualise bilaterally the location of musculocutaneous SEAP. X- and Y-axes were used as landmarks to localise the perforators. The X-axis is a horizontal line at the junction of sternum and xyphoid (JCX) and the Y-axis is at the midline. (b) In the clinical study, seven pedicled SEAP flaps were performed in another group of patients. MDCT images revealed totally 157 perforators with a mean of 7.85 perforators per patient. The dominant perforators (137 perforators) were mainly localised in an area between 1.5 and 6.5 cm from the X-axis on both sides and between 3 and 16 cm below the Y-axis. The calibre of these dominant perforators was judged as 'good' to 'very good' in 82.5% of the cases. The average dimension of the flap was 21.7x6.7 cm. All flaps were based on one perforator. Mean harvesting time was 110 min. There were no flap losses. Minor tip necrosis occurred in two flaps. One of them was treated with excision and primary closure. Our clinical experience indicates that the SEAP flap provides a novel and useful approach for reconstruction of anterior chest wall defects. CT-based imaging allows for anatomical assessment of the perforators of the superior epigastric artery (SEA).

  5. Riedel's goitre - rare and difficult to diagnose reason

    International Nuclear Information System (INIS)

    Bula, G.; Truchanowski, W.; Gawrychowski, J.

    2009-01-01

    Introduction: The paper reports a female patient treated surgically for Riedel's goitre. A total of 4775 patients were treated surgically between 1 January 2000 and 31 December 2007 for various types of goitres. Thyroiditis was diagnosed in 193 (4.0%) cases. Among them Riedel's goitre was found in one (0.5%). Case report: A 51-year-old woman P.G. (case record No. 1377/2007) was admitted to our hospital with considerable dyspnea, both inspiratory and expiratory, accompanied by marked stridor and retrosternal goitre, the latter suspected of neoplasmic process. Thyroid gland was hard, its left lobe extending behind the sternum. No disorders in thyroid hormonal function or high antibody titre against thyroid peroxidase were observed. Ultrasonography revealed large thyroid gland with mediastinal invasion, nodulated and hypoechogenic. Fineneedle biopsy suggested thyroid colloidal tumor. X-ray of the chest and neck revealed wide upper portion of the mediastinum and narrow trachea. Laryngological examination confirmed paralysis of left vocal fold. The patient was operated under general endotracheal anesthesia. Both thyroid lobes were partially resected together with the isthmus, and malacic trachea was decompressed. No complications were observed during postoperative period. Paraffin histopathological examination confirmed the presence of Riedel's goitre.The patient was discharged in general good condition. She was under regular follow-up control and died 1.5 year after operation from further progress of the disease. Conclusions: Clinical course of Riedel's goitre may cause remarkable diagnostic problems, and requires a differentiation with thyroid malignant tumor. Surgical treatment of Riedel's goitres helps to quickly obtain correct diagnosis and improve both clinical condition and life comfort of the patients. (authors)

  6. Effectiveness of a simple and real-time baseline shift monitoring system during stereotactic body radiation therapy of lung tumors.

    Science.gov (United States)

    Uchida, Yukihiro; Tachibana, Hidenobu; Kamei, Yoshiyuki; Kashihara, Kenichi

    2017-11-01

    This study aimed to clinically validate a simple real-time baseline shift monitoring system in a prospective study of consecutive patients undergoing stereotactic body radiation therapy (SBRT) of lung tumors, and to investigate baseline shift due to intrafraction motion of the patient's body during lung SBRT. Ten consecutive patients with peripheral lung tumors were treated by SBRT consisting of four fractions of 12 Gy each, with a total dose of 48 Gy. During treatment, each patient's geometric displacement in the anterior-posterior and left-right directions (the baseline shift) was measured using a real-time monitoring webcam system. Displacement between the start and end of treatment was measured using an X-ray fluoroscopic imaging system. The displacement measurements of the two systems were compared, and the measurements of baseline shift acquired by the monitoring system during treatment were analyzed for all patients. There was no significant deviation between the monitoring system and the X-ray imaging system, with the accuracy of measurement being within 1 mm. Measurements using the monitoring system showed that 7 min of treatment generated displacements of more than 1 mm in 50% of the patients. Baseline shift of a patient's body may be measured accurately in real time, using a monitoring system without X-ray exposure. The manubrium of the sternum is a good location for measuring the baseline shift of a patient's body at all times. The real-time monitoring system may be useful for measuring the baseline shift of a patient's body independently of a gating system. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  7. Intrafractional baseline drift during free breathing breast cancer radiation therapy.

    Science.gov (United States)

    Jensen, Christer Andre; Acosta Roa, Ana María; Lund, Jo-Åsmund; Frengen, Jomar

    2017-06-01

    Intrafraction motion in breast cancer radiation therapy (BCRT) has not yet been thoroughly described in the literature. It has been observed that baseline drift occurs as part of the intrafraction motion. This study aims to measure baseline drift and its incidence in free-breathing BCRT patients using an in-house developed laser system for tracking the position of the sternum. Baseline drift was monitored in 20 right-sided breast cancer patients receiving free breathing 3D-conformal RT by using an in-house developed laser system which measures one-dimensional distance in the AP direction. A total of 357 patient respiratory traces from treatment sessions were logged and analysed. Baseline drift was compared to patient positioning error measured from in-field portal imaging. The mean overall baseline drift at end of treatment sessions was -1.3 mm for the patient population. Relatively small baseline drift was observed during the first fraction; however it was clearly detected already at the second fraction. Over 90% of the baseline drift occurs during the first 3 min of each treatment session. The baseline drift rate for the population was -0.5 ± 0.2 mm/min in the posterior direction the first minute after localization. Only 4% of the treatment sessions had a 5 mm or larger baseline drift at 5 min, all towards the posterior direction. Mean baseline drift in the posterior direction in free breathing BCRT was observed in 18 of 20 patients over all treatment sessions. This study shows that there is a substantial baseline drift in free breathing BCRT patients. No clear baseline drift was observed during the first treatment session; however, baseline drift was markedly present at the rest of the sessions. Intrafraction motion due to baseline drift should be accounted for in margin calculations.

  8. Reliability tests and guidelines for B-mode ultrasound assessment of central adiposity.

    Science.gov (United States)

    Stoner, Lee; Chinn, Victoria; Cornwall, Jon; Meikle, Grant; Page, Rachel; Lambrick, Danielle; Faulkner, James

    2015-11-01

    Ultrasound represents a validated and relatively inexpensive diagnostic device for assessing central adiposity; however, widespread adoption has been impeded by the lack of reliable standard operating procedures. To examine the reliability of, and describe guidelines for, ultrasound-derived recording of intra-abdominal fat thickness (IAT) and maximal preperitoneal fat thickness (PFT). Ultrasound scans were obtained from 20 adults (50% female, 26 ± 7 years, 24·5 kg/m(2) ) on three different mornings. IAT was assessed 2 cm above the umbilicus (transverse plane) measuring from linea alba to: (i) anterior aorta, (ii) posterior aorta and (iii) anterior aspect of the vertebral column. PFT was measured from linea alba to visceral peritoneum in (i) sagittal and (ii) transverse planes, immediately over and inferior to the xiphi-sternum, respectively. For IAT, the criterion intraclass correlation coefficient (ICC) of 0·75 was exceeded for measurements to anterior aorta (0·95), posterior aorta (0·94) and vertebra (0·96). The reliability coefficient expressed as a percentage of the mean (RC%) was lowest (better) for measurement to vertebrae (9·8%). For PFT, mean thickness was comparable for sagittal (1·74 cm) and transverse (1·76 cm) planes; ICC values were also comparable for both planes (0·98 vs. 0·98, respectively), as were RC% (7·5% vs. 7·1%, respectively). IAT assessments to the vertebra were marginally more reliable than those to other structures. While PFT assessments were equally reliable for both measurements planes, precise probe placement was easier for the sagittal plane. Based on these findings, guidelines for the reliable measurement of central adiposity using ultrasound are presented. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  9. Thoracic computer tomography for the evaluation of the thymus gland in cases of myasthenia gravis

    Energy Technology Data Exchange (ETDEWEB)

    Druschky, K.F.; Stadler, H.W.; Daun, H.

    1981-01-01

    Hyperplasia of the thymus gland is observed in 65% of all patients with myasthenia gravis, while the incidence of thymus tumor is reported to be 8.5-28%. Conventional radiological techniques provide little information in the diagnosis of mediastinal lesions. Even a clearly developed thymus tumor can escape clinical detection. Since March 1978 thoracic computer tomography has been performed in addition to X-rays of the chest in a series of 19 patients with myasthenia ravis, 10 women and 9 men ranging in age from 15-71 years and in 3 patients with suspected thymomas but without myasthenia gravis. These examinations were carried out with a Somatom II (Siemens) since September 1979. On the average 15-20 scans were made at the level of the upper two-third of the sternum. The chest X-rays in 2 planes revealed signs of a thymus tumor in 3 female patients. Thoracic computer tomography showed definite signs of a space-occupying lesion in the anterior mediastinum in 11 cases. At thymectomy 6 patients were found to have hyperplasia of the thymus, 2 patients had a benign thymoma and 3 patients a malignant thymoma. In 6 cases computer tomography showed only slight changes and in 5 patients no pathological findings could be demonstrated in the thymus gland. Thoracic computer tomography is a relatively harmless diagnostic measure without any risk for the patient. It has a high resolution and great accuracy in the evaluation of the thymus gland and is therefore the method of choice for the diagnosis of patients with myasthenia gravis.

  10. Respiration Induced Heart Motion and Indications of Gated Delivery for Left-Sided Breast Irradiation

    International Nuclear Information System (INIS)

    Qi, X. Sharon; Hu, Angela; Wang Kai; Newman, Francis; Crosby, Marcus; Hu Bin; White, Julia; Li, X. Allen

    2012-01-01

    Purpose: To investigate respiration-induced heart motion for left-sided breast irradiation using a four-dimensional computed tomography (4DCT) technique and to determine novel indications to assess heart motion and identify breast patients who may benefit from a gated treatment. Methods and Materials: Images of 4DCT acquired during free breathing for 20 left-sided breast cancer patients, who underwent whole breast irradiation with or without regional nodal irradiation, were analyzed retrospectively. Dose distributions were reconstructed in the phases of 0%, 20%, and 50%. The intrafractional heart displacement was measured in three selected transverse CT slices using D LAD (the distance from left ascending aorta to a fixed line [connecting middle point of sternum and the body] drawn on each slice) and maximum heart depth (MHD, the distance of the forefront of the heart to the line). Linear regression analysis was used to correlate these indices with mean heart dose and heart dose volume at different breathing phases. Results: Respiration-induced heart displacement resulted in observable variations in dose delivered to the heart. During a normal free-breathing cycle, heart-induced motion D LAD and MHD changed up to 9 and 11 mm respectively, resulting in up to 38% and 39% increases of mean doses and V 25.2 for the heart. MHD and D LAD were positively correlated with mean heart dose and heart dose volume. Respiratory-adapted gated treatment may better spare heart and ipsilateral-lung compared with the conventional non-gated plan in a subset of patients with large D LAD or MHD variations. Conclusion: Proposed indices offer novel assessment of heart displacement based on 4DCT images. MHD and D LAD can be used independently or jointly as selection criteria for respiratory gating procedure before treatment planning. Patients with great intrafractional MHD variations or tumor(s) close to the diaphragm may particularly benefit from the gated treatment.

  11. Quantifying the Reproducibility of Heart Position During Treatment and Corresponding Delivered Heart Dose in Voluntary Deep Inhalation Breath Hold for Left Breast Cancer Patients Treated With External Beam Radiotherapy

    International Nuclear Information System (INIS)

    McIntosh, Alyson; Shoushtari, Asal N.; Benedict, Stanley H.; Read, Paul W.; Wijesooriya, Krishni

    2011-01-01

    Purpose: Voluntary deep inhalation breath hold (VDIBH) reduces heart dose during left breast irradiation. We present results of the first study performed to quantify reproducibility of breath hold using bony anatomy, heart position, and heart dose for VDIBH patients at treatment table. Methods and Materials: Data from 10 left breast cancer patients undergoing VDIBH whole-breast irradiation were analyzed. Two computed tomography (CT) scans, free breathing (FB) and VDIBH, were acquired to compare dose to critical structures. Pretreatment weekly kV orthogonal images and tangential ports were acquired. The displacement difference from spinal cord to sternum across the isocenter between coregistered planning Digitally Reconstructed Radiographs (DRRs) and kV imaging of bony thorax is a measure of breath hold reproducibility. The difference between bony coregistration and heart coregistration was the measured heart shift if the patient is aligned to bony anatomy. Results: Percentage of dose reductions from FB to VDIBH: mean heart dose (48%, SD 19%, p = 0.002), mean LAD dose (43%, SD 19%, p = 0.008), and maximum left anterior descending (LAD) dose (60%, SD 22%, p = 0.008). Average breath hold reproducibility using bony anatomy across the isocenter along the anteroposterior (AP) plane from planning to treatment is 1 (range, 0–3; SD, 1) mm. Average heart shifts with respect to bony anatomy between different breath holds are 2 ± 3 mm inferior, 1 ± 2 mm right, and 1 ± 3 mm posterior. Percentage dose changes from planning to delivery: mean heart dose (7%, SD 6%); mean LAD dose, ((9%, SD 7%)S, and maximum LAD dose, (11%, SD 11%) SD 11%, p = 0.008). Conclusion: We observed excellent three-dimensional bony registration between planning and pretreatment imaging. Reduced delivered dose to heart and LAD is maintained throughout VDIBH treatment.

  12. In vivo measurements of bone-seeking radionuclides. Annual report, December 1, 1982-November 30, 1983

    International Nuclear Information System (INIS)

    Cohen, N.

    1983-01-01

    This report summarizes results obtained in seven areas. Five subjects with well defined Am-241 body burdens have been measured using NaI-CsI(T1) detectors surrounding the head or positioned over the anterior knee surfaces. The observed ratio of net count-rate at the skull to net count-rate at the anterior knee surfaces was found to vary with values ranging from 1.16 to 2.45. Previously developed calibration values for men have been determined to be inadequate for application to female workers due to the variability in chest wall thickness and different photon attenuation characteristics of breast tissue in women. The relative count-rates for each individual among the counting geometries reflected the attenuation of the Nb-92m x-rays in the overlying tissue. The measurement performed with a single phoswich detector positioned centrally over the sternum surprisingly gave the highest count-rate for two out of the four subjects. It is expected that the net counts/x-ray emitted for each individual, when plotted as a function of overlying absorber thickness, will produce a series of single exponential curves which can be used to predict the absolute calibration value for Nb-92m in the lungs. Additional studies describing the time-related fate and distribution in the body of radon and radon daughters present as a result of drinking this well water are currently in progress. There appears to be a possibility of obtaining a significantly increased and variable whole body count-rate as related to a function of the quantity of water consumed and the time of in vivo measurement. Subjects who were treated therapeutically with radon seeds 25 to 34 years ago were observed in our whole body counting facility using NaI-CsI(T1) detectors. The radiation dose due to the characteristic Pu x-ray, the bremsstrahlung continuum and any beta radiation penetrating the gold sheath, is being determined

  13. Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life.

    LENUS (Irish Health Repository)

    Miletin, J

    2012-02-01

    We aimed to assess the relationship between the clinical and biochemical parameters of perfusion and superior vena cava (SVC) flow in a prospective observational cohort study of very low birth weight (VLBW) infants. Newborns with congenital heart disease were excluded. Echocardiographic evaluation of SVC flow was performed in the first 24 h of life. Capillary refill time (forehead, sternum and toe), mean blood pressure, urine output and serum lactate concentration were also measured simultaneously. Thirty-eight VLBW infants were examined. Eight patients (21%) had SVC flow less than 40 ml\\/kg\\/min. There was a poor correlation between the capillary refill time (in all sites), mean blood pressure, urine output and SVC flow. The correlation coefficient for the serum lactate concentration was r = -0.28, p = 0.15. The median serum lactate concentration was 3.5 (range 2.8-8.5) vs. 2.7 (range 1.2-6.9) mmol\\/l (p = 0.01) in low flow versus normal flow states. A serum lactate concentration of >2.8 was 100% sensitive and 60% specific for detecting a low flow state. Combining a capillary refill time of >4 s with a serum lactate concentration of >4 mmol\\/l had a specificity of 97% for detecting a low SVC flow state. Serum lactate concentrations are higher in low SVC flow states. A capillary refill time of >4 s combined with serum lactate concentrations >4 mmol\\/l increased the specificity and positive and negative predictive values of detecting a low SVC flow state.

  14. FDG-PET-based radiotherapy planning in lung cancer. Optimum breathing protocol and patient positioning - an intraindividual comparison; FDG-PET-basierte Bestrahlungsplanung von nicht kleinzelligen Bronchialkarzinomen. Optimales Atemprotokoll und Patientenpositionierung - ein intraindividueller Vergleich

    Energy Technology Data Exchange (ETDEWEB)

    Grgic, A.; Schaefer-Schuler, A.; Kirsch, C.M.; Hellwig, D. [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Nuklearmedizin; Nestle, U. [Universitaetsklinikum Freiburg (Germany). Klinik fuer Strahlenheilkunde; Kremp, S. [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    2008-12-15

    FDG-PET and PET / CT is increasingly used for radiotherapy (RT) planning in non-small-cell lung carcinoma (NSCLC). The planning process is often based on separately-acquired FDG-PET / CT and planning CT. We compared intraindividual differences between PET acquired in diagnostic and radiotherapy treatment position coregistered with planning CTs acquired using different breathing protocols. Sixteen patients with NSCLC underwent two PET acquisitions (diagnostic position-D-PET, radiotherapy position-RT-PET) and three planning-CT acquisitions (expiration-EXP, inspiration-INS, mid-breathhold-MID) on the same day. All scans were rigidly coregistered resulting in six fused datasets: D-INS, D-EXP, D-MID, RT-INS, RT-EXP and RT-MID. Fusion accuracy was assessed by three readers at eight anatomical landmarks: lung apices, aortic arch, heart, spine, sternum, carina, diaphragm and tumor using an alignment score ranging from 1 (no alignment) to 5 (exact alignment). RT-PET showed better alignment with any CT than D-PET (p < 0.001). With regard to breathing, RT-MID showed the best mean alignment score (3.7 {+-} 1.0) followed by RT-EXP (3.5 {+-} 0.9) and RT-INS (3.0 {+-} 0.8), all differences being significant (p < 0.001). Comparing the alignment scores with regard to anatomical landmarks, the largest deviations were found at diaphragm, heart and apices. Overall, there was a fair agreement (? = 0.48; p < 0.001) among the three readers. Significantly better fusion of PET and planning-CT can be reached with PET acquired in RT-position. The best intraindividual fusion results are obtained with the planning-CT performed during mid-breathhold. Our data justify the acquisition of a separate planning-PET in RT-treatment position if only a diagnostic PET-scan is available. (orig.)

  15. A bi-articular model for scapular-humeral rhythm reconstruction through data from wearable sensors.

    Science.gov (United States)

    Lorussi, Federico; Carbonaro, Nicola; De Rossi, Danilo; Tognetti, Alessandro

    2016-04-23

    Patient-specific performance assessment of arm movements in daily life activities is fundamental for neurological rehabilitation therapy. In most applications, the shoulder movement is simplified through a socket-ball joint, neglecting the movement of the scapular-thoracic complex. This may lead to significant errors. We propose an innovative bi-articular model of the human shoulder for estimating the position of the hand in relation to the sternum. The model takes into account both the scapular-toracic and gleno-humeral movements and their ratio governed by the scapular-humeral rhythm, fusing the information of inertial and textile-based strain sensors. To feed the reconstruction algorithm based on the bi-articular model, an ad-hoc sensing shirt was developed. The shirt was equipped with two inertial measurement units (IMUs) and an integrated textile strain sensor. We built the bi-articular model starting from the data obtained in two planar movements (arm abduction and flexion in the sagittal plane) and analysing the error between the reference data - measured through an optical reference system - and the socket-ball approximation of the shoulder. The 3D model was developed by extending the behaviour of the kinematic chain revealed in the planar trajectories through a parameter identification that takes into account the body structure of the subject. The bi-articular model was evaluated in five subjects in comparison with the optical reference system. The errors were computed in terms of distance between the reference position of the trochlea (end-effector) and the correspondent model estimation. The introduced method remarkably improved the estimation of the position of the trochlea (and consequently the estimation of the hand position during reaching activities) reducing position errors from 11.5 cm to 1.8 cm. Thanks to the developed bi-articular model, we demonstrated a reliable estimation of the upper arm kinematics with a minimal sensing system suitable for

  16. Airborne ultrasound surface motion camera: Application to seismocardiography

    Science.gov (United States)

    Shirkovskiy, P.; Laurin, A.; Jeger-Madiot, N.; Chapelle, D.; Fink, M.; Ing, R. K.

    2018-05-01

    The recent achievements in the accelerometer-based seismocardiography field indicate a strong potential for this technique to address a wide variety of clinical needs. Recordings from different locations on the chest can give a more comprehensive observation and interpretation of wave propagation phenomena than a single-point recording, can validate existing modeling assumptions (such as the representation of the sternum as a single solid body), and provide better identifiability for models using richer recordings. Ultimately, the goal is to advance our physiological understanding of the processes to provide useful data to promote cardiovascular health. Accelerometer-based multichannel system is a contact method and laborious for use in practice, and also even ultralight accelerometers can cause non-negligible loading effects. We propose a contactless ultrasound imaging method to measure thoracic and abdominal surface motions, demonstrating that it is adequate for typical seismocardiogram (SCG) use. The developed method extends non-contact surface-vibrometry to fast 2D mapping by originally combining multi-element airborne ultrasound arrays, a synthetic aperture implementation, and pulsed-waves. Experimental results show the ability of the developed method to obtain 2D seismocardiographic maps of the body surface 30 × 40 cm2 in dimension, with a temporal sampling rate of several hundred Hz, using ultrasound waves with the central frequency of 40 kHz. Our implementation was validated in-vivo on eight healthy human participants. The shape and position of the zone of maximal absolute acceleration and velocity during the cardiac cycle were also observed. This technology could potentially be used to obtain more complete cardio-vascular information than single-source SCG in and out of clinical environments, due to enhanced identifiability provided by the distributed measurements, and observation of propagation phenomena.

  17. The efficacy of preventive parasternal single injection of bupivacaine on intubation time, blood gas parameters, narcotic requirement, and pain relief after open heart surgery: A randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Mahmoud Saeidi

    2011-01-01

    Full Text Available Background: Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery. Methods: : In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, arterial blood gas (ABG parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS device. Results: No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than that in control group. Mean PaO 2 in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively. Conclusions: Patients′ pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements.

  18. Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients.

    Science.gov (United States)

    Woodward, Cathy; Taylor, Richard; Son, Minnette; Taeed, Roozbeh; Jacobs, Marshall L; Kane, Lauren; Jacobs, Jeffrey P; Husain, S Adil

    2017-07-01

    Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

  19. Missed injuries in the era of the trauma scan.

    Science.gov (United States)

    Lawson, Christy M; Daley, Brian J; Ormsby, Christine B; Enderson, Blaine

    2011-02-01

    A rapid computed tomography technique or "trauma scan" (TS) provides high-resolution studies of the head, cervical spine, chest, abdomen, and pelvis. We sought to determine whether TS has decreased missed injuries. A previous study of TS found a 3% missed rate. After institutional review board approval, trauma patients from January 2001 through December 2008 were reviewed for delayed diagnosis (DD) of injury to the head, cervical spine, chest, abdomen, or pelvis. Missed extremity injuries were excluded. Injury Severity Score, length of stay, type of injury, outcomes, and days to detection were captured. Of 26,264 patients reviewed, 90 patients had DD, with an incidence of 0.34%. DD most commonly presented on day 2. Injuries included 16 bowel/mesentery, 12 spine, 11 pelvic, 8 spleen, 6 diaphragm, 5 clavicle, 4 scapula, 4 cervical spine, 4 intracranial, 4 sternum, 3 maxillofacial, 3 liver, 2 heart/aorta, 2 vascular, 2 urethra/bladder, 2 pneumothorax, and 2 pancreas/common bile duct. DD resulted in 1 death, 6 prolonged intensive care unit stays, 19 operative interventions, and 38 additional interventions. TS is an effective way of evaluating trauma patients for intracranial, cervical spine, chest, abdomen, and pelvic injuries that have the potential to impact morbidity and mortality. The incidence of injuries missed in these crucial areas has been reduced at our institution by the use of this radiographic modality. The most common missed injury remains bowel, and so a high index of suspicion and the tertiary survey must remain a mainstay of therapy.

  20. Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients.

    Science.gov (United States)

    Akoglu, Haldun; Akoglu, Ebru Unal; Evman, Serdar; Akoglu, Tayfun; Altinok, Arzu Denizbasi; Guneysel, Ozlem; Onur, Ozge Ecmel; Eroglu, Serkan Emre

    2013-09-01

    The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX. All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients. The average CWT for men on the 2nd ICS-MCL was 38mm and for women was 52mm; on the other hand, on the 5th ICS-MAL was 33mm for men and 38mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL. This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Do chondroitin sulfates with different structures have different activities on chondrocytes and macrophages?

    Science.gov (United States)

    da Cunha, André L; Aguiar, Jair A K; Correa da Silva, Flavio S; Michelacci, Yara M

    2017-10-01

    The aim of the present study was to investigate the activities of natural chondroitin sulfates (CS) with different structures on cultured chondrocytes and macrophages. CS were isolated from cartilages of bovine trachea (BT), porcine trachea (PT), chicken sternum (Ch) and skate (Sk). The preparations were 90-98% pure, with ∼1% proteins, nucleic acids and keratan sulfate contaminants. Structural analysis of these CS and of commercial chondroitin 4- and 6-sulfate (C4S, C6S) have shown that most of their disaccharides are monosulfated, with varying proportions of 4- and 6-sulfation, and 2-7% non-sulfated disaccharides. Sk-CS and C6S contained detectable amounts of disulfated disaccharides. All the CS were polydisperse, with modal molecular weights of 26-135kDa. These CS had anti-inflammatory activities on both chondrocytes and macrophages, but with different efficiencies. On horse and human chondrocytes, they reduced the IL-1β-induced liberation of NO and PGE 2 , and on RAW 264.7 immortalized macrophage-like cell line, C4S, C6S, Ch and Sk-CS decreased the LPS-induced liberation of TNF-α, but did not affect IL-6. In contrast, on bone marrow derived macrophages, C4S, C6S, BT and PT-CS reduced the LPS-induced liberation of TNF-α, IL-6, IL-1β and NO, indicating that the RAW response to CS was different from that of primary macrophages. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Risk factors for profuse systemic-to-pulmonary artery collateral burden in hypoplastic left heart syndrome.

    Science.gov (United States)

    Prakash, Ashwin; Satiroglu, Elif; Porras, Diego; McElhinney, Doff B; Keane, John F; Lock, James E; Geva, Tal; King, Wilson; Powell, Andrew J

    2013-08-01

    Risk factors for developing systemic-to-pulmonary artery collaterals (SPCs) in hypoplastic left heart syndrome (HLHS) are unknown. We performed a retrospective case-control study to identify risk factors for developing a profuse SPC burden in HLHS. Angiograms of 439 patients with HLHS (performed <2 years of age) were reviewed using a previously published angiographic grading scale to identify cases (profuse SPC burden, n = 20) and controls (no or minimal SPC burden, n = 35). In univariate analyses, profuse SPC burden was associated with mitral atresia and aortic atresia subtype (MA/AA) (65% vs 14%, p <0.0001), use of a Sano shunt (70% vs 37%, p = 0.03), longer log-transformed durations of intensive care unit stay (p = 0.02), hospital stay (p = 0.002), pleural drainage (p = 0.008) after stage 1 palliation, lower oxygen saturation at discharge after stage 1 palliation (82 ± 4 vs 85 ± 4%, p = 0.03), and a history of severe shunt obstruction (37% vs 11%, p = 0.04). In a multivariate logistic regression model, profuse SPC burden was associated with MA/AA subtype (odds ratio 6.6), Sano shunt type (odds ratio 8.6), and log-transformed duration of hospital stay after stage 1 (odds ratio 7.9, model p <0.0001, area under the curve 0.88). Nonassociated parameters included fetal aortic valve dilation, severe cyanotic episodes, number of days with open sternum or number of additional exploratory thoracotomies after stage 1 palliation, pulmonary vein stenosis, and restrictive atrial septal defect. In conclusion, in the present case-control study of patients with HLHS, the development of a profuse SPC burden was associated with MA/AA subtype, Sano shunt type, and longer duration of hospital stay after stage 1 palliation. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Fully automatic algorithm for segmenting full human diaphragm in non-contrast CT Images

    Science.gov (United States)

    Karami, Elham; Gaede, Stewart; Lee, Ting-Yim; Samani, Abbas

    2015-03-01

    The diaphragm is a sheet of muscle which separates the thorax from the abdomen and it acts as the most important muscle of the respiratory system. As such, an accurate segmentation of the diaphragm, not only provides key information for functional analysis of the respiratory system, but also can be used for locating other abdominal organs such as the liver. However, diaphragm segmentation is extremely challenging in non-contrast CT images due to the diaphragm's similar appearance to other abdominal organs. In this paper, we present a fully automatic algorithm for diaphragm segmentation in non-contrast CT images. The method is mainly based on a priori knowledge about the human diaphragm anatomy. The diaphragm domes are in contact with the lungs and the heart while its circumference runs along the lumbar vertebrae of the spine as well as the inferior border of the ribs and sternum. As such, the diaphragm can be delineated by segmentation of these organs followed by connecting relevant parts of their outline properly. More specifically, the bottom surface of the lungs and heart, the spine borders and the ribs are delineated, leading to a set of scattered points which represent the diaphragm's geometry. Next, a B-spline filter is used to find the smoothest surface which pass through these points. This algorithm was tested on a noncontrast CT image of a lung cancer patient. The results indicate that there is an average Hausdorff distance of 2.96 mm between the automatic and manually segmented diaphragms which implies a favourable accuracy.

  4. The years lived with disability due to road traffic accidents based on the nature of injuries in Kermanshah province (2010

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    Neda Izadi

    2015-03-01

    Full Text Available Background: Traffic accidents, with lots of casualties and injuries, cause a lot of economic loss. This study was conducted to determine the Years Lived with Disability (YLD due to road traffic accidents according to the nature of injuries in Kermanshah province. Methods: following a pilot study, a sample of 3258 people was analyzed in order to calculate the YLD. Then, based on various factors, the age, gender and nature of injury of 10070 people were estimated. The YLD was calculated using the Global Burden of Disease (GBD (2010. The data concerning age and gender of the total population of the province was taken from the Statistical Center of Iran. All calculations were performed based on age and gender in Excel software. Results: The mean age of the injured people was 32.7±17.1. Men constituted 67.7 % of patients. The incidence rate of traffic accidents was 283.6 per 100,000. The highest levels of YLD in outpatients, men and women were reported for patella, tibia, fibula and ankle fractures and fractures of clavicle, scapula, humerus and skull, respectively. The highest rate of inpatient YLDs by nature of injury belonged to the fractures of sternum, ribs and face bone. The years lived with disability was calculated to be 2365.96 years (2.46 per 1000 and 1039.01 years (1.1 per 1000 for men and women, respectively. It was 3404.97 years (1.79 per 1000 in both genders. The highest YLD was in the age group of 15–29. Conclusion: Traffic accidents are high rate of YLD is resulted by traffic accidents. The most affected age group are youngsters and fracture are more frequent.

  5. Monitoring sound to quantify snoring and sleep apnea severity using a smartphone: proof of concept.

    Science.gov (United States)

    Nakano, Hiroshi; Hirayama, Kenji; Sadamitsu, Yumiko; Toshimitsu, Ayaka; Fujita, Hisayuki; Shin, Shizue; Tanigawa, Takeshi

    2014-01-15

    Habitual snoring is a prevalent condition that is not only a marker of obstructive sleep apnea (OSA) but can also lead to vascular risk. However, it is not easy to check snoring status at home. We attempted to develop a snoring sound monitor consisting of a smartphone alone, which is aimed to quantify snoring and OSA severity. The subjects included 50 patients who underwent diagnostic polysomnography (PSG), of which the data of 10 patients were used for developing the program and that of 40 patients were used for validating the program. A smartphone was attached to the anterior chest wall over the sternum. It acquired ambient sound from the built-in microphone and analyzed it using a fast Fourier transform on a real-time basis. Snoring time measured by the smartphone highly correlated with snoring time measured by PSG (r = 0.93). The top 1 percentile value of sound pressure level (L1) determined by the smartphone correlated with the ambient sound L1 during sleep determined by PSG (r = 0.92). Moreover, the respiratory disturbance index estimated by the smartphone (smart-RDI) highly correlated with the apnea-hypopnea index (AHI) obtained by PSG (r = 0.94). The diagnostic sensitivity and specificity of the smart-RDI for diagnosing OSA (AHI ≥ 15) were 0.70 and 0.94, respectively. A smartphone can be used for effectively monitoring snoring and OSA in a controlled laboratory setting. Use of this technology in a noisy home environment remains unproven, and further investigation is needed.

  6. Poster - 35: Monitoring patient positioning during deep inspiration breath hold with a distance measuring laser

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    Weston, Mark; Juhasz, Janos [Juravinski Cancer Centre (Canada)

    2016-08-15

    Purpose: The accuracy of treatment delivery for left breast/chest wall patients using deep inspiration breath hold (DIBH) is being monitored using a distance measuring laser (DML) Methods: A commercially available DML (DLS-C15, Dimetix) was mounted behind a Varian TrilogyTM linac. Relative to the machine isocenter, the laser from the beam was offset by 8 cm to the left and by 1 cm in the superior direction. This position was selected because this point is situated on the sternum for the majority of the left breast/chest-wall patients treated at our institution. The Varian Real-Time Positioning Management™ (RPM) guided DIBH treatments at our institution is delivered by placing the system’s tracking block on the patient’s abdomen. The treatment beam is enabled only when the block is in between a predefined abdomen motion range as determined during the CT simulation process. A LabVIEW program was developed to record both beam status (i.e. on/off) and distance measurements. In this study the DML was only used to monitor the position of a single point on the chest and no clinical decisions/adjustments were made based on these measurements. Results and Conclusions: Thus far, 34 fractions have been recorded for 4 patients. As such, the performance of our DIBH treatment technique cannot be fairly evaluated at this point. However, deviations between expected and measured distances have been observed and if these are found to be reproducible, then modifications in our treatment procedures and policies will have to take place.

  7. Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection.

    Science.gov (United States)

    Tocco, Maria Pia; Costantino, Alberto; Ballardini, Milva; D'Andrea, Claudio; Masala, Marcello; Merico, Eusebio; Mosillo, Luigi; Sordini, Paolo

    2009-05-01

    Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo reactive clips. The advantage of this technique is that the posterior face of the sternum does not have to be separated from the mediastinal structures thus minimising the risk of damage. From October 2006 to October 2008, we prospectively evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen patients had sternotomy for coronary artery bypass grafting (CABG), one patient for aortic valve replacement (AVR) and another one for ascending aortic replacement (AAR). All patients were treated with the VAC system at the time of infection diagnosis. When the wound tissue appeared viable and the microbiological cultures were negative, the chest was closed using the most suitable procedure for the patient in question; nine patients were closed using pectoralis flaps, nine patients using Nitinol clips, one patient with a combined technique (use of Nitinol clips and muscle flap), one patient with a direct wound closure and another patient, who needed AAR with a homograft performed in another institution, was closed using sternal wires. We had no mortality; wound healing was successfully achieved in all patients. In more than 50% of the patients, the VAC therapy allowed direct sternal resynthesis. The average duration of the vacuum therapy was 26 days (range 14-37 days). VAC is a safe and effective option in the treatment of post-sternotomy mediastinitis, with excellent survival and immediate improvement of local wound conditions; furthermore, the use of Nitinol clips after VAC therapy demonstrated to be a safe and non-invasive option for sternal resynthesis. After VAC therapy, a

  8. Automated extraction of pleural effusion in three-dimensional thoracic CT images

    Science.gov (United States)

    Kido, Shoji; Tsunomori, Akinori

    2009-02-01

    It is important for diagnosis of pulmonary diseases to measure volume of accumulating pleural effusion in threedimensional thoracic CT images quantitatively. However, automated extraction of pulmonary effusion correctly is difficult. Conventional extraction algorithm using a gray-level based threshold can not extract pleural effusion from thoracic wall or mediastinum correctly, because density of pleural effusion in CT images is similar to those of thoracic wall or mediastinum. So, we have developed an automated extraction method of pulmonary effusion by use of extracting lung area with pleural effusion. Our method used a template of lung obtained from a normal lung for segmentation of lungs with pleural effusions. Registration process consisted of two steps. First step was a global matching processing between normal and abnormal lungs of organs such as bronchi, bones (ribs, sternum and vertebrae) and upper surfaces of livers which were extracted using a region-growing algorithm. Second step was a local matching processing between normal and abnormal lungs which were deformed by the parameter obtained from the global matching processing. Finally, we segmented a lung with pleural effusion by use of the template which was deformed by two parameters obtained from the global matching processing and the local matching processing. We compared our method with a conventional extraction method using a gray-level based threshold and two published methods. The extraction rates of pleural effusions obtained from our method were much higher than those obtained from other methods. Automated extraction method of pulmonary effusion by use of extracting lung area with pleural effusion is promising for diagnosis of pulmonary diseases by providing quantitative volume of accumulating pleural effusion.

  9. Urotensin II receptor (UTR) exists in hyaline chondrocytes: a study of peripheral distribution of UTR in the African clawed frog, Xenopus laevis.

    Science.gov (United States)

    Konno, Norifumi; Fujii, Yuya; Imae, Haruka; Kaiya, Hiroyuki; Mukuda, Takao; Miyazato, Mikiya; Matsuda, Kouhei; Uchiyama, Minoru

    2013-05-01

    Urotensin II (UII) and UII-related peptide (URP) exhibit diverse physiological actions including vasoconstriction, locomotor activity, osmoregulation, and immune response through UII receptor (UTR), which is expressed in the central nervous system and peripheral tissues of fish and mammals. In amphibians, only UII has been identified. As the first step toward elucidating the actions of UII and URP in amphibians, we cloned and characterized URP and UTR from the African clawed frog Xenopus laevis. Functional analysis showed that treatment of UII or URP with Chinese hamster ovary cells transfected with the cloned receptor increased the intracellular calcium concentration in a concentration-dependent manner, whereas the administration of the UTR antagonist urantide inhibited UII- or URP-induced Ca(2+) mobilization. An immunohistochemical study showed that UTR was expressed in the splenocytes and leukocytes isolated from peripheral blood, suggesting that UII and URP are involved in the regulation of the immune system. UTR was also localized in the apical membrane of the distal tubule of the kidney and in the transitional epithelial cells of the urinary bladder. This result supports the view that the UII/URP-UTR system plays an important role in osmoregulation of amphibians. Interestingly, immunopositive labeling for UTR was first detected in the chondrocytes of various hyaline cartilages (the lung septa, interphalangeal joint and sternum). The expression of UTR was also observed in the costal cartilage, tracheal cartilages, and xiphoid process of the rat. These novel findings probably suggest that UII and URP mediate the formation of the cartilaginous matrix. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Local bone pain and osseous scintigraphic findings in patients with metastatic bone tumor

    International Nuclear Information System (INIS)

    Imaeda, Takeyoshi; Iinuma, Gen; Hirota, Keiichi; Inoue, Akemi; Sone, Yasuhiro; Seki, Matsuzo; Suzuki, Masao; Doi, Hidetaka

    1988-01-01

    Local bone pain and osseous scintigraphic findings were evaluated in patients with cancer of the lung, breast or prostate. (1) In 77-92% out of the patients with local pain, metastatic bone lesions were detected. (2) The sacrum and scapulae were the frequent sites of pain as estimated from the metastatic bone lesions. On the other hand, the incidence of pain was low in the ribs, cervical vertebrae, skull and femurs. (3) When calculated by the weight of red bone marrow, the most likely sites for bone metastases consisted of the scapulae, clavicles, sternum, humeri, ribs and cervical vertebrae, somewhat different from previous reports. Those bones involved were all proximate to the heart. (4) Extensive bone metastases were already detected in more than 50% of patients who complain of pain in the metastatic bone lesion. On the other hand, extensive bone metastases occurred in less than 6% of patients who didn't complain of pain. (5) The appearance of pain in the metastatic bone lesion was earlier in only 3% and was later in 71% than the detection of abnormal radioisotope accumulation on scintigram. (6) Majority of the patients with pain in the metastatic bone lesion showed a high degree of abnormal radioisotope accumulation which measured more than 5 cm in diameter on scintigram. On the other hand, the abnormal radioisotope accumulation in most of patients without pain was mild and mostly measured less than 5 cm in diameter. (7) The positive rate of bone metastasis amounted to 29% by plain X-ray and 41% by local bone pain as compaired to positive bone scintigram. (author)

  11. Local bone pain and osseous scintigraphic findings in patients with metastatic bone tumor

    Energy Technology Data Exchange (ETDEWEB)

    Imaeda, Takeyoshi; Iinuma, Gen; Hirota, Keiichi; Inoue, Akemi; Sone, Yasuhiro; Seki, Matsuzo; Suzuki, Masao; Doi, Hidetaka

    1988-12-01

    Local bone pain and osseous scintigraphic findings were evaluated in patients with cancer of the lung, breast or prostate. (1) In 77-92% out of the patients with local pain, metastatic bone lesions were detected. (2) The sacrum and scapulae were the frequent sites of pain as estimated from the metastatic bone lesions. On the other hand, the incidence of pain was low in the ribs, cervical vertebrae, skull and femurs. (3) When calculated by the weight of red bone marrow, the most likely sites for bone metastases consisted of the scapulae, clavicles, sternum, humeri, ribs and cervical vertebrae, somewhat different from previous reports. Those bones involved were all proximate to the heart. (4) Extensive bone metastases were already detected in more than 50% of patients who complain of pain in the metastatic bone lesion. On the other hand, extensive bone metastases occurred in less than 6% of patients who didn't complain of pain. (5) The appearance of pain in the metastatic bone lesion was earlier in only 3% and was later in 71% than the detection of abnormal radioisotope accumulation on scintigram. (6) Majority of the patients with pain in the metastatic bone lesion showed a high degree of abnormal radioisotope accumulation which measured more than 5 cm in diameter on scintigram. On the other hand, the abnormal radioisotope accumulation in most of patients without pain was mild and mostly measured less than 5 cm in diameter. (7) The positive rate of bone metastasis amounted to 29% by plain X-ray and 41% by local bone pain as compaired to positive bone scintigram.

  12. Hypophosphatemic osteomalacia induced by low-dose adefovir therapy: focus on manifestations in the skeletal system and literature review.

    Science.gov (United States)

    Kim, Du Hwan; Sung, Duk Hyun; Min, Yong Ki

    2013-03-01

    Osteomalacia is a metabolic bone disease that leads to softening of the bones and can be caused by hypophosphatemia. Large clinical studies of low-dose adefovir dipivoxil (adefovir) have found no evidence of renal tubular dysfunction leading to hypophosphatemia after 48 weeks of treatment. We report two cases of low-dose adefovir-induced hypophosphatemic osteomalacia that initially presented with diffuse musculoskeletal pain. The first patient was a 62-year-old man with a 2-year history of bone pain involving the dorsal mid-thorax, lower anterior chest wall, right sacroiliac joint area, and both knees. The patient had been receiving adefovir for 5 years before confirmation of hypophosphatemia and urinary phosphate wasting. Bone scintigraphy revealed multifocal lesions including multiple ribs, costochondral junctions, costovertebral junctions, sacrum, both posterior iliac bones, both proximal tibia, right calcaneus, and the left second metatarsophalangeal joint area, which were suggestive of metabolic bone disorder. Bone pain was significantly reduced within 3 months after supplementation with phosphate and calcitriol. The second patient was a 54-year-old male who presented with an 18-month history of severe bone pain of the right medial knee and low back. The patient had been taking adefovir for approximately 40 months before the development of bone pain. Laboratory data revealed hypophosphatemia and vitamin D deficiency. Bone scintigraphy showed increased uptake in bilateral ribs, sternum, both scapulae, both costovertebral junctions, both pelvic bones, medial cortex of the right proximal femur, right proximal tibia, and the left lateral tarsal bone. The symptoms improved by changing the antiviral agent from adefovir to entecavir. Because osteomalacia often presents with diffuse bone pain, non-specific radiologic findings and non-characteristic routine serum biochemical changes, the disease can be confused with various musculoskeletal diseases and a high index

  13. Skeletal height estimation from regression analysis of sternal lengths in a Northwest Indian population of Chandigarh region: a postmortem study.

    Science.gov (United States)

    Singh, Jagmahender; Pathak, R K; Chavali, Krishnadutt H

    2011-03-20

    Skeletal height estimation from regression analysis of eight sternal lengths in the subjects of Chandigarh zone of Northwest India is the topic of discussion in this study. Analysis of eight sternal lengths (length of manubrium, length of mesosternum, combined length of manubrium and mesosternum, total sternal length and first four intercostals lengths of mesosternum) measured from 252 male and 91 female sternums obtained at postmortems revealed that mean cadaver stature and sternal lengths were more in North Indians and males than the South Indians and females. Except intercostal lengths, all the sternal lengths were positively correlated with stature of the deceased in both sexes (P regression analysis of sternal lengths was found more useful than the linear regression for stature estimation. Using multivariate regression analysis, the combined length of manubrium and mesosternum in both sexes and the length of manubrium along with 2nd and 3rd intercostal lengths of mesosternum in males were selected as best estimators of stature. Nonetheless, the stature of males can be predicted with SEE of 6.66 (R(2) = 0.16, r = 0.318) from combination of MBL+BL_3+LM+BL_2, and in females from MBL only, it can be estimated with SEE of 6.65 (R(2) = 0.10, r = 0.318), whereas from the multiple regression analysis of pooled data, stature can be known with SEE of 6.97 (R(2) = 0.387, r = 575) from the combination of MBL+LM+BL_2+TSL+BL_3. The R(2) and F-ratio were found to be statistically significant for almost all the variables in both the sexes, except 4th intercostal length in males and 2nd to 4th intercostal lengths in females. The 'major' sternal lengths were more useful than the 'minor' ones for stature estimation The universal regression analysis used by Kanchan et al. [39] when applied to sternal lengths, gave satisfactory estimates of stature for males only but female stature was comparatively better estimated from simple linear regressions. But they are not proposed for the

  14. Electron beam collimation with a photon MLC for standard electron treatments

    Science.gov (United States)

    Mueller, S.; Fix, M. K.; Henzen, D.; Frei, D.; Frauchiger, D.; Loessl, K.; Stampanoni, M. F. M.; Manser, P.

    2018-01-01

    Standard electron treatments are currently still performed using standard or molded patient-specific cut-outs placed in the electron applicator. Replacing cut-outs and electron applicators with a photon multileaf collimator (pMLC) for electron beam collimation would make standard electron treatments more efficient and would facilitate advanced treatment techniques like modulated electron radiotherapy (MERT) and mixed beam radiotherapy (MBRT). In this work, a multiple source Monte Carlo beam model for pMLC shaped electron beams commissioned at a source-to-surface distance (SSD) of 70 cm is extended for SSDs of up to 100 cm and validated for several Varian treatment units with field sizes typically used for standard electron treatments. Measurements and dose calculations agree generally within 3% of the maximal dose or 2 mm distance to agreement. To evaluate the dosimetric consequences of using pMLC collimated electron beams for standard electron treatments, pMLC-based and cut-out-based treatment plans are created for a left and a right breast boost, a sternum, a testis and a parotid gland case. The treatment plans consist of a single electron field, either alone (1E) or in combination with two 3D conformal tangential photon fields (1E2X). For each case, a pMLC plan with similar treatment plan quality in terms of dose homogeneity to the target and absolute mean dose values to the organs at risk (OARs) compared to a cut-out plan is found. The absolute mean dose to an OAR is slightly increased for pMLC-based compared to cut-out-based 1E plans if the OAR is located laterally close to the target with respect to beam direction, or if a 6 MeV electron beam is used at an extended SSD. In conclusion, treatment plans using cut-out collimation can be replaced by plans of similar treatment plan quality using pMLC collimation with accurately calculated dose distributions.

  15. Comparing radiation exposure during percutaneous vertebroplasty using one- vs. two-fluoroscopic technique

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    Li Yen-Yao

    2013-01-01

    Full Text Available Abstract Background Percutaneous vertebroplasty (PV requires relatively lengthy fluoroscopic guidance, which might lead to substantial radiation exposure to patients or operators. The two-fluoroscopic technique (two-plane radiographs obtained using two fluoroscopes during PV can provide simultaneous two-planar projections with reducing operative time. However, the two-fluoroscopic technique may expose the operator or patient to increased radiation dose. The aim of this study was to quantify the amount of radiation exposure to the patient or operator that occurs during PV using one- vs. two-fluoroscopic technique. Methods Two radiation dosimeters were placed on the right flank of each patient and on the upper sternum of each operator during 26 single-level PV procedures by one senior surgeon. The use of two-fluoroscopic technique (13 patients and one-fluoroscopic technique (13 patients were allocated in a consecutive and alternative manner. The operative time and mean radiation dose to each patient and operator were monitored and compared between groups. Results Mean radiation dose to the patient was 1.97 ± 1.20 mSv (95% CI, 0.71 to 3.23 for the one-fluoroscopic technique group vs. 0.95 ± 0.34 mSv (95% CI, 0.85 to 1.23 for the two-fluoroscopic technique group (P =0.031. Mean radiation dose to the operator was 0.27 ± 0.12 mSv (95% CI, 0.17–0.56 for the one-fluoroscopic technique group vs. 0.25 ± 0.14 mSv (95% CI, 0.06–0.44 for the two-fluoroscopic technique group (P = 0.653. The operative time was significantly different between groups: 47.15 ± 13.48 min (range, 20–75 for the one-fluoroscopic technique group vs. 36.62 ± 8.42 min (range, 21–50 for the two-fluoroscopic technique group (P =0.019. Conclusion Compared to the one-fluoroscopic technique, the two-fluoroscopic technique used during PV provides not only shorter operative times but also reduces the radiation exposure to the patient. There was no

  16. Ectopic cystoperitoneal shunt demonstrated by valvulography. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Jofre, M J; Sierralta, M P [Military Hospital Nuclear Medicine Department, Santiago (Chile)

    2002-09-01

    The most important and frequent complications in the management of hydrocephalus treated with a derivation system are the infection and obstruction of the ventriculoperitoneal or ventriculoatrial shunt. However, another less frequent problem is the migration of the distal catheter. The case report presented is a 20 year-old girl who started, when she was 12, with severe headaches and epileptogenic seizures. She was diagnosed with a left parietotemporal aracnoidal cyst and a cystoperitoneal shunt was installed. However, she continued to have headaches. In September 1999, the derivation system was controlled with a radionuclide valvulography, which demonstrated shunt patency, with mild ectasis in the distal region. In July 2000, another valvulography showed a malfunction of the cystoperitoneal system. The distal catheter was surgically reviewed and repositioned. A few months of being asymptomatic, the headaches returned with a cough, which didn't respond to treatment. In February of 2002, she was referred to the Military Hospital Nuclear Medicine Department and a radionuclide valvulography was performed with 370 MBq of Tc99m-DTPA, injected in the derivative system reservoir. Images showed a slow descension of the radionuclide until the xifoides region where the distal catheter had formed a loop into the chest. Free activity was observed at the end of the catheter with another abnormal traject in the middle chest up to the top of the sternum. A pumping test was done and the patient coughed and said that she 'felt water' in her mouth. A simple abdomen X-ray was performed confirming the distal catheter in the upper side of the diaphragm. A third surgery was performed demonstrating that the catheter had an intraperitoneal loop with the distal end in the chest. They pulled the catheter and the distal end was repositioned into the peritoneal cavity, controlling its functioning. A simple abdomen X-ray verified the position. In the following days the patient had no headache

  17. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study.

    Science.gov (United States)

    Reddy, N Bayapa; Hanumantha; Madithati, Pallavi; Reddy, N Nagarjuna; Reddy, C Sainarasimha

    2014-04-01

    The statistical profile reflects a global estimate of 5.1 million deaths in 2000, which was due to injuries that accounted for 10% of deaths due to all causes. Out of this, a quarter of injury-related deaths occurred in the South-East Asian region. Road Traffic Accident (RTA) is one among the top 5 causes of morbidity and mortality in South-East Asian countries. Most common cause of blunt abdominal trauma in India is road traffic accident followed by pedestrian accidents, abdominal blows, and fall from heights. To analyze the epidemiology and pattern of fatal thoraco-abdominal injuries in road traffic accidents. An autopsy-based cross-sectional study conducted. A purposive sampling technique was applied to select the study sample of 100 post-mortems of road traffic accident between November 2008 and May 2010 subjected to medico-legal autopsy at the department of Forensic Medicine, KIMS Hospital Bangalore. The majority of the victims were aged 21 to 40 years, 50 (50.0%), most of the victims were male 92 (92.0%); and male/female ratio was 11.5:1. Commonest offending agents in heavy motor vehicles were 54 (54.0%). Bony cage sustained injuries were observed in 71; out of this, fractures of ribs were observed in 45 (63.3%) victims, clavicle in 14 (19.7%), sternum was 6 (8.4%), and vertebrae 6 (8.4%) of fatal road traffic accidents. Internal thoracic injuries were observed in 26 cases. Among internal thoracic injuries, lungs were the most commonly involved organ 24 (92.3%) followed by the heart 2 (7.6%). Lung sustained more lacerations 19 (79.1%) than contusions 5 (20.8%). Internal abdominal injuries were observed in 49 cases. In road traffic accidents, the most commonly injured abdominal organs were solid organs such as liver 16 (32.6%) followed by spleen 9 (18.3%). Majority of the times in road traffic accidents, young and productive males were injured or lost their life. This study may help the planners to take safety measures, to implement strict traffic rules, to

  18. Thoracic and heart biometrics of non-anesthetized agouti (Dasyprocta primnolopha Wagler, 1831 measured on radiographic images

    Directory of Open Access Journals (Sweden)

    Anaemilia das N. Diniz

    2013-03-01

    Full Text Available The agouti is a species intensively hunted throughout the Amazon and the semi-arid regions of northeastern Brazil. Considering the current trend in conservation management of wild species, the aim of this study was to determine the morphometric reference to the heart of agouti raised in captivity, based on thoracic and cardiac measurements in these animals. Thirty adult agoutis, 1 to 3 years of age, without clinical signs of cardiac disease were selected. The animals were physically restrained and radiographies in laterolateral (LL and ventrodorsal (VD recumbence were produced. The following measures were taken: the apicobasilar length of the heart (at the most cranial height of the Carina region to the heart apex (AB, maximum width of the heart perpendicular to AB (CD, heart inclination angle (AIC, trachea inclination angle (AIT, distance from the right heart wall (DPTd, distance from the left heart wall (DPTe and vertical depth of the thorax, and the ventral face of the vertebral column to the dorsal border of the sternum at the level of the trachea bifurcation (H. The ratios between AB/CD, AB/H and CD/H were also analyzed. To calculate the vertebral heart scale (VHS, the AB and CD measurements were laid over the thoracic vertebra starting at T4. Radiographic evaluation showed values consistent with those reported in small animals and some wild and exotic species. The main biometric values in the chest cavity and heart of agouti are arranged as follows: (1 The ratios between AB/H ratio and CD/H were not sensitive for identifying heart increases (p>0.05, while the ratio AB/CD was more sensitive in this identification (p<0.05; (2 AIC: 21.2±6.4º (mean between male and famale; (3 AIT for males and females: 9.93±3.23° and 8.4±3.94°; (4 DPTd and DPTe for males: 0.97±0.40cm and 0.7±0.30cm; (5 DPTd and DPTe for females: 1.12±0.42cm and 01.02±0.43cm; (6 VHS for males and females: 7.75±0.48v e 7.61±0.34v; (7 The caudal vena cava (CVC was

  19. A genome-wide association study meta-analysis of clinical fracture in 10,012 African American women

    Directory of Open Access Journals (Sweden)

    Kira C. Taylor

    2016-12-01

    Full Text Available Background: Osteoporosis is a major public health problem associated with excess disability and mortality. It is estimated that 50–70% of the variation in osteoporotic fracture risk is attributable to genetic factors. The purpose of this hypothesis-generating study was to identify possible genetic determinants of fracture among African American (AA women in a GWAS meta-analysis. Methods: Data on clinical fractures (all fractures except fingers, toes, face, skull or sternum were analyzed among AA female participants in the Women's Health Initiative (WHI (N = 8155, Cardiovascular Health Study (CHS (N = 504, BioVU (N = 704, Health ABC (N = 651, and the Johnston County Osteoarthritis Project (JoCoOA (N = 291. Affymetrix (WHI and Illumina (Health ABC, JoCoOA, BioVU, CHS GWAS panels were used for genotyping, and a 1:1 ratio of YRI:CEU HapMap haplotypes was used as an imputation reference panel. We used Cox proportional hazard models or logistic regression to evaluate the association of ~2.5 million SNPs with fracture risk, adjusting for ancestry, age, and geographic region where applicable. We conducted a fixed-effects, inverse variance-weighted meta-analysis. Genome-wide significance was set at P < 5 × 10−8. Results: One SNP, rs12775980 in an intron of SVIL on chromosome 10p11.2, reached genome-wide significance (P = 4.0 × 10−8. Although this SNP has a low minor allele frequency (0.03, there was no evidence for heterogeneity of effects across the studies (I2 = 0. This locus was not reported in any previous osteoporosis-related GWA studies. We also interrogated previously reported GWA-significant loci associated with fracture or bone mineral density in our data. One locus (SMOC1 generalized, but overall there was not substantial evidence of generalization. Possible reasons for the lack of generalization are discussed. Conclusion: This GWAS meta-analysis of fractures in African American women identified a potentially novel

  20. Real-World Rib Fracture Patterns in Frontal Crashes in Different Restraint Conditions.

    Science.gov (United States)

    Lee, Ellen L; Craig, Matthew; Scarboro, Mark

    2015-01-01

    The purpose of this study was to use the detailed medical injury information in the Crash Injury Research and Engineering Network (CIREN) to evaluate patterns of rib fractures in real-world crash occupants in both belted and unbelted restraint conditions. Fracture patterns binned into rib regional levels were examined to determine normative trends associated with belt use and other possible contributing factors. Front row adult occupants with Abbreviated Injury Scale (AIS) 3+ rib fractures, in frontal crashes with a deployed frontal airbag, were selected from the CIREN database. The circumferential location of each rib fracture (with respect to the sternum) was documented using a previously published method (Ritchie et al. 2006) and digital computed tomography scans. Fracture patterns for different crash and occupant parameters (restraint use, involved physical component, occupant kinematics, crash principal direction of force, and occupant age) were compared qualitatively and quantitatively. There were 158 belted and 44 unbelted occupants included in this study. For belted occupants, fractures were mainly located near the path of the shoulder belt, with the majority of fractures occurring on the inboard (with respect to the vehicle) side of the thorax. For unbelted occupants, fractures were approximately symmetric and distributed across both sides of the thorax. There were negligible differences in fracture patterns between occupants with frontal (0°) and near side (330° to 350° for drivers; 10° to 30° for passengers) crash principal directions of force but substantial differences between groups when occupant kinematics (and contacts within the vehicle) were considered. Age also affected fracture pattern, with fractures tending to occur more anteriorly in older occupants and more laterally in younger occupants (both belted and unbelted). Results of this study confirmed with real-world data that rib fracture patterns in unbelted occupants were more distributed

  1. Reproductive performance and embriotoxicity of rats exposed to carbamazepine Performance reprodutiva e embriotoxicidade de ratos expostos à carbamazepina

    Directory of Open Access Journals (Sweden)

    Marli Gerenutti

    2008-09-01

    Full Text Available To study the possible effects of carbamazepine in rats during pregnancy and fetuses' physical development, carbamazepine solubilized in propilenglycol was orally administered (20 and 40 mg/kg to the female rats from the 2nd to the 19th days of pregnancy. Propilenglycol was administered to the control group. The animals were sacrificed on the 20th day, when 50% of the offspring were fixed in Bouin's solution and the remaining 50% were submitted to diaphanization. The carbamazepine administration caused reduction on weight gain of pregnant rats and did not damage the females' reproductive performance. In the fetuses' physical development, it was observed a flattening on the skull soft tissues and bones; delay in the skull bone development; cartilage calcification increase between hip and femur and reduction in the number of the sternum ossifications. Although carbamazepine has not caused general changes over female rats' reproductive performance, it produced significant alterations in the development of the fetuses' skeletal parameters.Este trabalho teve como objetivo estudar os possíveis efeitos da administração da carbamazepina na gestação de ratas. A solução glicólica de carbamazepina foi administrada por via oral (20 mg/kg e 40 mg/kg, às ratas do 2º ao 19º dia de gestação. O grupo controle recebeu solução de propilenoglicol. Após a realização da cesária, no 20º dia, 50% dos filhotes foram fixados em Bouin e os outros 50% passaram por processo de diafanização. Estes estudos mostraram que embora a administração de carbamazepina tenha promovido redução do ganho de peso de ratas prenhes, não prejudicou a performance reprodutiva de fêmeas. Nos fetos, observou-se achatamento de tecidos moles e ossos do crânio, retardo no desenvolvimento ósseo do crânio, aumento da calcificação da cartilagem entre o quadril e o fêmur e redução no número de ossificações do esterno. Estes dados, tomados em conjunto, indicam que a

  2. Whole-body Vibration Exposure Intervention among Professional Bus and Truck Drivers: A Laboratory Evaluation of Seat-suspension Designs.

    Science.gov (United States)

    Blood, Ryan P; Yost, Michael G; Camp, Janice E; Ching, Randal P

    2015-01-01

    Long-term exposure to seated whole-body vibration (WBV) is one of the leading risk factors for the development of low back disorders. Professional bus and truck drivers are regularly exposed to continuous WBV, since they spend the majority of their working hours driving heavy vehicles. This study measured WBV exposures among professional bus and truck drivers and evaluated the effects of seat-suspension designs using simulated field-collected data on a vibration table. WBV exposures were measured and compared across three different seat designs: an air-ride bus seat, an air-ride truck seat, and an electromagnetically active (EM-active) seat. Air-ride seats use a compressed-air bladder to attenuate vibrations, and they have been in operation throughout the transportation industry for many years. The EM-active seat is a relatively new design that incorporates a microprocessor-controlled actuator to dampen vibration. The vibration table simulated seven WBV exposure scenarios: four segments of vertical vibration and three scenarios that used field-collected driving data on different road surfaces-a city street, a freeway, and a section of rough roadway. The field scenarios used tri-axial WBV data that had been collected at the seat pan and at the driver's sternum, in accordance with ISO 2631-1 and 2631-5. This study found that WBV was significantly greater in the vertical direction (z-axis) than in the lateral directions (x-and y-axes) for each of the three road types and each of the three types of seats. Quantitative comparisons of the results showed that the floor-to-seat-pan transmissibility was significantly lower for the EM-active seat than for either the air-ride bus seat or the air-ride truck seat, across all three road types. This study also demonstrated that seat-suspension designs have a significant effect on the vibrations transmitted to vehicle operators, and the study's results may prove useful in designing future seat suspensions.

  3. Distribution of Proliferating Bone Marrow in Adult Cancer Patients Determined Using FLT-PET Imaging

    International Nuclear Information System (INIS)

    Hayman, James A.; Callahan, Jason W.; Herschtal, Alan; Everitt, Sarah; Binns, David S.; Hicks, Rod J.; Mac Manus, Michael

    2011-01-01

    Purpose: Given that proliferating hematopoietic stem cells are especially radiosensitive, the bone marrow is a potential organ at risk, particularly with the use of concurrent chemotherapy and radiotherapy. Existing data on bone marrow distribution have been determined from the weight and visual appearance of the marrow in cadavers. 18 F-fluoro-L-deoxythymidine concentrates in bone marrow, and we used its intensity on positron emission tomography imaging to quantify the location of the proliferating bone marrow. Methods and Materials: The 18 F-fluoro-L-deoxythymidine positron emission/computed tomography scans performed at the Peter MacCallum Cancer Centre between 2006 and 2009 on adult cancer patients were analyzed. At a minimum, the scans included the mid-skull through the proximal femurs. A software program developed at our institution was used to calculate the percentage of administered activity in 11 separately defined bony regions. Results: The study population consisted of 13 patients, 6 of whom were men. Their median age was 61 years. Of the 13 patients, 9 had lung cancer, 2 had colon cancer, and 1 each had melanoma and leiomyosarcoma; 6 had received previous, but not recent, chemotherapy. The mean percentage of proliferating bone marrow by anatomic site was 2.9% ± 2.1% at the skull, 1.9% ± 1.2% at the proximal humeri, 2.9% ± 1.3% at the sternum, 8.8% ± 4.7% at the ribs and clavicles, 3.8% ± 0.9% at the scapulas, 4.3% ± 1.6% at the cervical spine, 19.9% ± 2.6% at the thoracic spine, 16.6% ± 2.2% at the lumbar spine, 9.2% ± 2.3% at the sacrum, 25.3% ± 4.9% at the pelvis, and 4.5% ± 2.5% at the proximal femurs. Conclusion: Our modern estimates of bone marrow distribution in actual cancer patients using molecular imaging of the proliferating marrow provide updated data for optimizing normal tissue sparing during external beam radiotherapy planning.

  4. The Use of Body Worn Sensors for Detecting the Vibrations Acting on the Lower Back in Alpine Ski Racing

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    Jörg Spörri

    2017-07-01

    Full Text Available This study explored the use of body worn sensors to evaluate the vibrations that act on the human body in alpine ski racing from a general and a back overuse injury prevention perspective. In the course of a biomechanical field experiment, six male European Cup-level athletes each performed two runs on a typical giant slalom (GS and slalom (SL course, resulting in a total of 192 analyzed turns. Three-dimensional accelerations were measured by six inertial measurement units placed on the right and left shanks, right and left thighs, sacrum, and sternum. Based on these data, power spectral density (PSD; i.e., the signal's power distribution over frequency was determined for all segments analyzed. Additionally, as a measure expressing the severity of vibration exposure, root-mean-square (RMS acceleration acting on the lower back was calculated based on the inertial acceleration along the sacrum's longitudinal axis. In both GS and SL skiing, the PSD values of the vibrations acting at the shank were found to be largest for frequencies below 30 Hz. While being transmitted through the body, these vibrations were successively attenuated by the knee and hip joint. At the lower back (i.e., sacrum sensor, PSD values were especially pronounced for frequencies between 4 and 10 Hz, whereas a corresponding comparison between GS and SL revealed higher PSD values and larger RMS values for GS. Because vibrations in this particular range (i.e., 4 to 10 Hz include the spine's resonant frequency and are known to increase the risk of structural deteriorations/abnormalities of the spine, they may be considered potential components of mechanisms leading to overuse injuries of the back in alpine ski racing. Accordingly, any measure to control and/or reduce such skiing-related vibrations to a minimum should be recognized and applied. In this connection, wearable sensor technologies might help to better monitor and manage the overall back overuse-relevant vibration

  5. Technical note: Correlation of respiratory motion between external patient surface and internal anatomical landmarks

    Science.gov (United States)

    Fayad, Hadi; Pan, Tinsu; Clément, Jean-François; Visvikis, Dimitris

    2011-01-01

    Purpose Current respiratory motion monitoring devices used for motion synchronization in medical imaging and radiotherapy provide either 1D respiratory signals over a specific region or 3D information based on few external or internal markers. On the other hand, newer technology may offer the potential to monitor the entire patient external surface in real time. The main objective of this study was to assess the motion correlation between such an external patient surface and internal anatomical landmarks motion. Methods Four dimensional Computed Tomography (4D CT) volumes for ten patients were used in this study. Anatomical landmarks were manually selected in the thoracic region across the 4D CT datasets by two experts. The landmarks included normal structures as well as the tumour location. In addition, a distance map representing the entire external patient surface, which corresponds to surfaces acquired by a Time of Flight (ToF) camera or similar devices, was created by segmenting the skin of all 4D CT volumes using a thresholding algorithm. Finally, the correlation between the internal landmarks and external surface motion was evaluated for different regions (placement and size) throughout a patient’s surface. Results Significant variability was observed in the motion of the different parts of the external patient surface. The larger motion magnitude was consistently measured in the central regions of the abdominal and the thoracic areas for the different patient datasets considered. The highest correlation coefficients were observed between the motion of these external surface areas and internal landmarks such as the diaphragm and mediastinum structures as well as the tumour location landmarks (0.8 ± 0.18 and 0.72 ± 0.12 for the abdominal and the thoracic regions respectively). Worse correlation was observed when one considered landmarks not significantly influenced by respiratory motion such as the apex and the sternum. Discussion and conclusions There

  6. Surto de pitiose cutânea em bovinos Outbreak of cutaneous pythiosis in cattle

    Directory of Open Access Journals (Sweden)

    Adriane L. Gabriel

    2008-12-01

    Full Text Available Setenta e seis bovinos, sem raça definida, jovens, de ambos os sexos, apresentaram lesões cutâneas multifocais nodulares, ulceradas e crostosas nas faces medial e lateral dos membros anteriores e posteriores, região ventral do pescoço, esterno e cauda. A doença ocorreu no verão e as lesões foram observadas nas regiões do corpo que ficavam grande tempo em contato com a água em canais de irrigação. Histologicamente observaram-se múltiplos granulomas e piogranulomas contendo escassas imagens negativas de hifas na área central, as quais foram melhor evidenciadas através da técnica de metenamina nitrato de prata de Grocott. O diagnóstico etiológico definitivo foi baseado na técnica de imuno-histoquímica com anticorpo policlonal anti-Pythium insidiosum. Adicionalmente, foi realizado o teste de ELISA indireto. Surtos de pitiose cutânea bovina são incomuns e, particularmente neste relato, todos os animais afetados tiveram cura espontânea das lesões dentro de duas a três semanas.Seventy-six young mixed breed cattle of both sexes, presented multifocal ulcerated nodular cutaneous lesions localized in the medial and lateral aspects of fore and hindlimbs, ventral neck, sternum, and tail. The disease occurred during summer and lesions were observed on areas of the body which were in contact with water of irrigation channels for long periods. Histologically, there were multiple granulomas and pyogranulomas with few negative profiles of hyphae, which were better visualized throughout Grocott methenamine silver stain. Definitive etiologic diagnosis was based on immuno-histochemistry with anti-Pythium insidiosum polyclonal antibody. Additionally, an indirect ELISA test was performed. Bovine cutaneous pythiosis outbreaks are uncommon and, particularly as occurred in the cattle of this report, all affected animals had spontaneous healing within two to three weeks.

  7. Evaluation of pediatric ATD biofidelity as compared to child volunteers in low-speed far-side oblique and lateral impacts.

    Science.gov (United States)

    Seacrist, Thomas; Locey, Caitlin M; Mathews, Emily A; Jones, Dakota L; Balasubramanian, Sriram; Maltese, Matthew R; Arbogast, Kristy B

    2014-01-01

    Motor vehicle crashes are a leading cause of injury and mortality for children. Mitigation of these injuries requires biofidelic anthropomorphic test devices (ATDs) to design and evaluate automotive safety systems. Effective countermeasures exist for frontal and near-side impacts but are limited for far-side impacts. Consequently, far-side impacts represent increased injury and mortality rates compared to frontal impacts. Thus, the objective of this study was to evaluate the biofidelity of the Hybrid III and Q-series pediatric ATDs in low-speed far-side impacts, with and without shoulder belt pretightening. Low-speed (2 g) far-side oblique (60°) and lateral (90°) sled tests were conducted using the Hybrid III and Q-series 6- and 10-year-old ATDs. ATDs were restrained by a lap and shoulder belt equipped with a precrash belt pretightener. Photoreflective targets were attached to the head, spine, shoulders, and sternum. ATDs were exposed to 8 low-speed sled tests: 2 oblique nontightened, 2 oblique pretightened, 2 lateral nontightened, 2 lateral pretightened. ATDs were compared with previously collected 9- to 11-year-old (n=10) volunteer data and newly collected 6- to 8-year-old volunteer data (n=7) tested with similar methods. Kinematic data were collected from a 3D target tracking system. Metrics of comparison included excursion, seat belt and seat pan reaction loads, belt-to-torso angle, and shoulder belt slip-out. The ATDs exhibited increased lateral excursion of the head top, C4, and T1 as well as increased downward excursion of the head top compared to the volunteers. Volunteers exhibited greater forward excursion than the ATDs in oblique nontightened impacts. These kinematics correspond to increased shoulder belt slip-out for the ATDs in oblique tests (ATDs=90%; volunteers=36%). Contrarily, similar shoulder belt slip-out was observed between ATDs and volunteers in lateral impacts (ATDs=80%; volunteers=78%). In pretightened impacts, the ATDs exhibited reduced

  8. SU-C-BRF-01: Correlation of DIBH Breath Hold Amplitude with Dosimetric Sparing of Heart and Left Anterior Descending Artery in Left Breast Radiotherapy

    International Nuclear Information System (INIS)

    Kim, Taeho; Reardon, Kelli; Sukovich, Kaitlyn; Crandley, Edwin; Read, Paul; Krishni, Wijesooriya

    2014-01-01

    Purpose: A 7.4% increase in major coronary events per 1 Gy increase in mean heart dose has been reported from the population-based analysis of radiation-induced cardiac toxicity following treatment of left sided breast cancer. Deep inhalation breath-hold (DIBH) is clinically utilized to reduce radiation dose to heart and left anterior descending artery (LAD). We investigated the correlation of dose sparing in heart and LAD with internal DIBH amplitude to develop a quantitative predictive model for expected dose to heart and LAD based on internal breath hold amplitude. Methods: A treatment planning study (Prescription Dose = 50 Gy) was performed on 50 left breast cancer patients underwent DIBH whole breast radiotherapy. Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy DIBH amplitude (difference between sternum position at FB and DIBH). The heart and LAD dose between FB and DIBH plans was compared and dose to the heart and LAD as a function of breath hold amplitude was determined. Results: Average DIBH amplitude using internal anatomy was 13.9±4.2 mm. The DIBH amplitude-mean dose reduction correlation is 20%/5mm (0.3 Gy/5mm) for the heart and 18%/5mm (1.1 Gy/5mm) for LAD. The correlation with max dose reduction is 12%/5mm (3.8 Gy/5mm) for the heart and 16%/5mm (3.2 Gy/5mm) for LAD. We found that average dose reductions to LAD from 6.0±6.5 Gy to 2.0±1.6 Gy with DIBH (4.0 Gy reduction: -67%, p < 0.001) and average dose reduction to the heart from 1.3±0.7 Gy to 0.7±0.2 Gy with DIBH (0.6 Gy reduction: -46%, p < 0.001). That suggests using DIBH may reduce the risk of the major coronary event for left sided breast cancer patients. Conclusion: The correlation between breath hold amplitude and dosimetric sparing suggests that dose sparing linearly increases with internal DIBH amplitude

  9. Short communication: The effect of 4 antiseptic compounds on umbilical cord healing and infection rates in the first 24 hours in dairy calves from a commercial herd.

    Science.gov (United States)

    Robinson, A L; Timms, L L; Stalder, K J; Tyler, H D

    2015-08-01

    The objective of this study was to compare the effect of 4 antiseptic compounds on the healing rate and incidence of infection of umbilical cords in newborn calves (n=60). Late gestation Jersey cows were monitored at a commercial farm (Sioux Jersey, Salix, IA) and newborn purebred (n=30) and crossbred (n=30) calves were obtained within 30min after birth. Calves were alternately assigned by birth order to 4 treatment groups: 7% tincture of iodine, 0.1% chlorine created using a novel chlorine disinfectant technology, chlorohexidine gluconate 4.0% wt/vol, and 10% trisodium citrate. Prior to dipping (within 30min of birth), diameter of the umbilical cords (as an indicator of cord drying and healing) were determined using digital calipers. In addition, as an indicator of umbilical infections, surface temperature of the umbilical stump (along with a reference point at the midpoint of the sternum) was determined using a dual-laser infrared thermometer. These measurements were all repeated at 24±1 h of age. All data were analyzed using mixed model methods. All models included fixed effects of breed (Jersey or Jersey cross), sex (bull or heifer), and treatment. Fixed effect interactions were not included in the statistical model due to the relatively small sample size. No treatment differences were noted for healing rate of umbilical cords. Initially, mean umbilical cord diameter was 22.84±3.89mm and cords healed to a mean diameter of 7.64±4.12mm at 24 h of age. No umbilical infections were noted for calves on any treatment during the course of this study. Mean surface temperature of the umbilical stump was 33.1±2.2°C at birth (1.5±1.6°C higher than the sternal reference temperature), and at 24±1 h of age the mean temperature of the umbilical stump was 33.0±4.3°C (0.5±1.8°C lower than the sternal reference temperature). These data suggest that these antiseptic compounds are equally effective for preventing infections and permitting healing of the umbilical cord

  10. Age- and sex-specific thorax finite element model development and simulation.

    Science.gov (United States)

    Schoell, Samantha L; Weaver, Ashley A; Vavalle, Nicholas A; Stitzel, Joel D

    2015-01-01

    The shape, size, bone density, and cortical thickness of the thoracic skeleton vary significantly with age and sex, which can affect the injury tolerance, especially in at-risk populations such as the elderly. Computational modeling has emerged as a powerful and versatile tool to assess injury risk. However, current computational models only represent certain ages and sexes in the population. The purpose of this study was to morph an existing finite element (FE) model of the thorax to depict thorax morphology for males and females of ages 30 and 70 years old (YO) and to investigate the effect on injury risk. Age- and sex-specific FE models were developed using thin-plate spline interpolation. In order to execute the thin-plate spline interpolation, homologous landmarks on the reference, target, and FE model are required. An image segmentation and registration algorithm was used to collect homologous rib and sternum landmark data from males and females aged 0-100 years. The Generalized Procrustes Analysis was applied to the homologous landmark data to quantify age- and sex-specific isolated shape changes in the thorax. The Global Human Body Models Consortium (GHBMC) 50th percentile male occupant model was morphed to create age- and sex-specific thoracic shape change models (scaled to a 50th percentile male size). To evaluate the thoracic response, 2 loading cases (frontal hub impact and lateral impact) were simulated to assess the importance of geometric and material property changes with age and sex. Due to the geometric and material property changes with age and sex, there were observed differences in the response of the thorax in both the frontal and lateral impacts. Material property changes alone had little to no effect on the maximum thoracic force or the maximum percent compression. With age, the thorax becomes stiffer due to superior rotation of the ribs, which can result in increased bone strain that can increase the risk of fracture. For the 70-YO models

  11. Preliminary study of efficacy of cup suction in the correction of typical pectus excavatum.

    Science.gov (United States)

    Lopez, Manuel; Patoir, Arnaud; Costes, Frederic; Varlet, François; Barthelemy, Jean-Claude; Tiffet, Olivier

    2016-01-01

    This preliminary qualitative study evaluates the efficacy of cup suction in the correction of pectus excavatum (PE), and examines the place of this system as a strategic treatment and as an alternative to surgery. Between October 2011 and June 2014, a total of 84 patients (children and adult) presenting with PE were treated by cup suction, in our chest wall deformities unit. On first consultation, the patients with typical PE and with at least partial correction during the first application of cup suction and a maximal suction pressure for correction of less than 300 mbar (millibars) were included in this study. 11 patients were excluded from the present study as they presented with a complex carinatum/excavatum. The remaining 73 patients were divided into two groups: Group I, adult patients ≥ 18 year old, 17 patients. The mean age was 22.8 years old. Group II, pediatric patients cup suction, strengthening exercises, and clinical follow-up every two to three months. The evaluation criteria during, and on the completion of the trial were: depth of the PE, morbidity and treatment compliance. Partial and final results were evaluated by the patients, their parents, and doctor, using a qualitative scoring scale. A total of 73 patients presenting typical PE (symmetric in 52 cases and asymmetric in 21 cases) were treated by cup suction. The mean depth of PE was 23 mm (9-44). Of the 73 patients, one adult abandoned treatment and three children abandoned follow-up. The mean time of use of the device was 4h daily. At six months of treatment, the mean depth of PE was 9 mm (0-30) across all patients. 23 patients completed the treatment and exhibited flattening of the sternum. These patients were considered to have an excellent aesthetic result. The mean treatment duration to normal reshape was achieved at 10 months (4-21). The remaining patients are improving under continuing active treatment. The mean depth of PE in this group was 12 mm (4-30), after a mean treatment

  12. Quantitative and Qualitative Analysis of Bone Marrow CD8(+) T Cells from Different Bones Uncovers a Major Contribution of the Bone Marrow in the Vertebrae.

    Science.gov (United States)

    Geerman, Sulima; Hickson, Sarah; Brasser, Giso; Pascutti, Maria Fernanda; Nolte, Martijn A

    2015-01-01

    Bone marrow (BM) plays an important role in the long-term maintenance of memory T cells. Yet, BM is found in numerous bones throughout the body, which are not equal in structure, as they differ in their ratio of cortical and trabecular bone. This implies that BM cells within different bones are subjected to different microenvironments, possibly leading to differences in their frequencies and function. To address this, we examined BM from murine tibia, femur, pelvis, sternum, radius, humerus, calvarium, and the vertebrae and analyzed the presence of effector memory (TEM), central memory (TCM), and naïve (TNV) CD8(+) T cells. During steady-state conditions, the frequency of the total CD8(+) T cell population was comparable between all bones. Interestingly, most CD8(+) T cells were located in the vertebrae, as it contained the highest amount of BM cells. Furthermore, the frequencies of TEM, TCM, and TNV cells were similar between all bones, with a majority of TNV cells. Additionally, CD8(+) T cells collected from different bones similarly expressed the key survival receptors IL-7Rα and IL-15Rβ. We also examined BM for memory CD8(+) T cells with a tissue-resident memory phenotype and observed that approximately half of all TEM cells expressed the retention marker CD69. Remarkably, in the memory phase of acute infection with the lymphocytic choriomeningitis virus (LCMV), we found a massive compositional change in the BM CD8(+) T cell population, as the TEM cells became the dominant subset at the cost of TNV cells. Analysis of Ki-67 expression established that these TEM cells were in a quiescent state. Finally, we detected higher frequencies of LCMV-specific CD8(+) T cells in BM compared to spleen and found that BM in its entirety contained fivefold more LCMV-specific CD8(+) T cells. In conclusion, although infection with LCMV caused a dramatic change in the BM CD8(+) T cell population, this did not result in noticeable differences between BM collected from different

  13. Development of a computer model to predict aortic rupture due to impact loading.

    Science.gov (United States)

    Shah, C S; Yang, K H; Hardy, W; Wang, H K; King, A I

    2001-11-01

    Aortic injuries during blunt thoracic impacts can lead to life threatening hemorrhagic shock and potential exsanguination. Experimental approaches designed to study the mechanism of aortic rupture such as the testing of cadavers is not only expensive and time consuming, but has also been relatively unsuccessful. The objective of this study was to develop a computer model and to use it to predict modes of loading that are most likely to produce aortic ruptures. Previously, a 3D finite element model of the human thorax was developed and validated against data obtained from lateral pendulum tests. The model included a detailed description of the heart, lungs, rib cage, sternum, spine, diaphragm, major blood vessels and intercostal muscles. However, the aorta was modeled as a hollow tube using shell elements with no fluid within, and its material properties were assumed to be linear and isotropic. In this study fluid elements representing blood have been incorporated into the model in order to simulate pressure changes inside the aorta due to impact. The current model was globally validated against experimental data published in the literature for both frontal and lateral pendulum impact tests. Simulations of the validated model for thoracic impacts from a number of directions indicate that the ligamentum arteriosum, subclavian artery, parietal pleura and pressure changes within the aorta are factors that could influence aortic rupture. The model suggests that a right-sided impact to the chest is potentially more hazardous with respect to aortic rupture than any other impact direction simulated in this study. The aortic isthmus was the most likely site of aortic rupture regardless of impact direction. The reader is cautioned that this model could only be validated on a global scale. Validation of the kinematics and dynamics of the aorta at the local level could not be done due to a lack of experimental data. It is hoped that this model will be used to design

  14. Erdheim-Chester disease with cutaneous features in an Indian patient.

    Science.gov (United States)

    Garg, Taru; Chander, Ram; Gupta, Tanvi; Mendiratta, Vibhu; Jain, Manjula

    2008-01-01

    the fifth lumbar vertebrae, bilateral sacroiliac bone, and left iliac bone and areas of photopenia in sacrum. Bone marrow aspiration from the sternum showed normal cells with a normal erythroid-to-myeloid ratio. Ultrasonographic B scanning of the eyes showed no retro-orbital involvement. Erdheim-Chester disease was diagnosed in this patient on the basis of diagnostic histopathology, radiologic features involving bones, and ILD and treatment with 40 mg oral prednisolone daily was started. Surgical debulking of her skin lesions was planned, but the patient refused due to her worsening ILD.

  15. Imaging of Lymph Flow in Breast Cancer Patients after Microdose Administration of a Near-Infrared Fluorophore: Feasibility Study1

    Science.gov (United States)

    Sevick-Muraca, Eva M.; Sharma, Ruchi; Rasmussen, John C.; Marshall, Milton V.; Wendt, Juliet A.; Pham, Hoang Q.; Bonefas, Elizabeth; Houston, Jessica P.; Sampath, Lakshmi; Adams, Kristen E.; Blanchard, Darlene Kay; Fisher, Ronald E.; Chiang, Stephen B.; Elledge, Richard; Mawad, Michel E.

    2011-01-01

    Purpose To prospectively demonstrate the feasibility of using indocyanine green, a near-infrared (NIR) fluorophore at the minimum dose needed for noninvasive optical imaging of lymph nodes (LNs) in breast cancer patients undergoing sentinel lymph node mapping (SLNM). Materials and Methods Informed consent was obtained from 24 women (age range, 30–85 years) who received intradermal subcutaneous injections of 0.31–100 μg indocyanine green in the breast in this IRB-approved, HIPAA-compliant, dose escalation study to find the minimum microdose for imaging. The breast, axilla, and sternum were illuminated with NIR light and the fluorescence generated in the tissue was collected with an NIR-sensitive intensified charged-coupled device. Lymphoscintigraphy was also performed. Resected LNs were evaluated for the presence of radioactivity, blue dye accumulation, and fluorescence. The associations between the resected LNs that were fluorescent and (a) the time elapsed between NIR fluorophore administration and resection and (b) the dosage of NIR fluorophores were tested with the Spearman rank and Pearson product moment correlation tests, respectively. Results Lymph imaging consistently failed with indocyanine green microdosages between 0.31 and 0.77 μg. When indocyanine green dosages were 10 μg or higher, lymph drainage pathways from the injection site to LNs were imaged in eight of nine women; lymph propulsion was observed in seven of those eight. When propulsion in the breast and axilla regions was present, the mean apparent velocities ranged from 0.08 to 0.32 cm/sec, the time elapsed between “packets” of propelled fluid varied from 14 to 92 seconds. In patients who received 10 μg of indocyanine green or more, a weak negative correlation between the fluorescence status of resected LNs and the time between NIR fluorophore administration and LN resection was found. No statistical association was found between the fluorescence status of resected LNs and the dose of

  16. Equations of prediction for abdominal fat in brown egg-laying hens fed different diets.

    Science.gov (United States)

    Souza, C; Jaimes, J J B; Gewehr, C E

    2017-06-01

    The objective was to use noninvasive measurements to formulate equations for predicting the abdominal fat weight of laying hens in a noninvasive manner. Hens were fed with different diets; the external body measurements of birds were used as regressors. We used 288 Hy-Line Brown laying hens, distributed in a completely randomized design in a factorial arrangement, submitted for 16 wk to 2 metabolizable energy levels (2,550 and 2,800 kcal/kg) and 3 levels of crude protein in the diet (150, 160, and 170 g/kg), totaling 6 treatments, with 48 hens each. Sixteen hens per treatment of 92 wk age were utilized to evaluate body weight, bird length, tarsus and sternum, greater and lesser diameter of the tarsus, and abdominal fat weight, after slaughter. The equations were obtained by using measures evaluated with regressors through simple and multiple linear regression with the stepwise method of indirect elimination (backward), with P abdominal fat as predicted by the equations and observed values for each bird were subjected to Pearson's correlation analysis. The equations generated by energy levels showed coefficients of determination of 0.50 and 0.74 for 2,800 and 2,550 kcal/kg of metabolizable energy, respectively, with correlation coefficients of 0.71 and 0.84, with a highly significant correlation between the calculated and observed values of abdominal fat. For protein levels of 150, 160, and 170 g/kg in the diet, it was possible to obtain coefficients of determination of 0.75, 0.57, and 0.61, with correlation coefficients of 0.86, 0.75, and 0.78, respectively. Regarding the general equation for predicting abdominal fat weight, the coefficient of determination was 0.62; the correlation coefficient was 0.79. The equations for predicting abdominal fat weight in laying hens, based on external measurements of the birds, showed positive coefficients of determination and correlation coefficients, thus allowing researchers to determine abdominal fat weight in vivo.

  17. Uso de fijador externo en la inestabilidad de la pared torácica anterior (volet esternal: Presentación de un caso Use of the external fixative in the instability of the anterior thoraxic wall (sternal volet: A case report

    Directory of Open Access Journals (Sweden)

    Orestes N Mederos Curbelo

    2005-03-01

    Full Text Available Se presenta un paciente con inestabilidad de la pared torácica anterior y esternón tratado previamente con un dispositivo creado por los autores en 1995 para el volet costal. Las costillas artificiales externas del dispositivo, diseñado para el cerclaje subperióstico, actúan como elemento de fijación y han conseguido resultados satisfactorios. Se presenta un paciente, que producto de un accidente automovilístico, sufre lesiones en cráneo, tórax, abdomen y extremidades, entre las que resaltan contusión cerebral, lesión hepática, fractura de fémur e inestabilidad de la pared torácica anterior. Esta última requirió de prioridad extrema, pues habría llevado rápidamente al paciente a la insuficiencia respiratoria de no ser solucionado el problema. Se realizó la estabilización externa mediante un equipo que se utiliza en nuestro hospital, reutilizable y aplicable en cualquier inestabilidad torácica independientemente de la localización de esta. El fijador se confecciona con láminas de duraluminio maleables que permiten su adaptabilidad e introduce una forma de tratamiento en las lesiones torácicas bilaterales con inestabilidad esternal, situación compleja en la que puede resultar un instrumento valioso de tratamientoA patient with instability of the anterior thoracic wall and sternum previously treated with a device created by the authors in 1995 for the costal volet, is presented. The artificial external ribs of the device designed for subperiosteous cerclage act as a fixation element with satisfactory results. The case of a patient that due to a car accident suffers from lesions in the cranium, thorax, abdomen and limbs, among which cerebral contusion, liver lesion, femur fracture and instability of the anterior thoracic wall stand out, is reported. Maximum priority was given to the instability of the anterior thoracic wall, since it could have rapidly led to respiratory failure if the problem would have not been solved. The

  18. Alpha-mannosidosis

    Directory of Open Access Journals (Sweden)

    Nilssen Øivind

    2008-07-01

    Full Text Available Abstract Alpha-mannosidosis is an inherited lysosomal storage disorder characterized by immune deficiency, facial and skeletal abnormalities, hearing impairment, and intellectual disability. It occurs in approximately 1 of 500,000 live births. The children are often born apparently normal, and their condition worsens progressively. Some children are born with ankle equinus or develop hydrocephalus in the first year of life. Main features are immune deficiency (manifested by recurrent infections, especially in the first decade of life, skeletal abnormalities (mild-to-moderate dysostosis multiplex, scoliosis and deformation of the sternum, hearing impairment (moderate-to-severe sensorineural hearing loss, gradual impairment of mental functions and speech, and often, periods of psychosis. Associated motor function disturbances include muscular weakness, joint abnormalities and ataxia. The facial trait include large head with prominent forehead, rounded eyebrows, flattened nasal bridge, macroglossia, widely spaced teeth, and prognathism. Slight strabismus is common. The clinical variability is significant, representing a continuum in severity. The disorder is caused by lysosomal alpha-mannosidase deficiency. Alpha-mannosidosis is inherited in an autosomal recessive fashion and is caused by mutations in the MAN2B1 gene located on chromosome 19 (19 p13.2-q12. Diagnosis is made by measuring acid alpha-mannosidase activity in leukocytes or other nucleated cells and can be confirmed by genetic testing. Elevated urinary secretion of mannose-rich oligosaccharides is suggestive, but not diagnostic. Differential diagnoses are mainly the other lysosomal storage diseases like the mucopolysaccharidoses. Genetic counseling should be given to explain the nature of the disease and to detect carriers. Antenatal diagnosis is possible, based on both biochemical and genetic methods. The management should be pro-active, preventing complications and treating

  19. Deletion of Core-binding factor β (Cbfβ) in mesenchymal progenitor cells provides new insights into Cbfβ/Runxs complex function in cartilage and bone development

    Science.gov (United States)

    Wu, Mengrui; Li, Chenguan; Zhu, Guochun; Wang, Yiping; Jules, Joel; Lu, Yun; McConnell, Matthew; Wang, Yong-Jun; Shao, Jian-Zhong; Li, Yi-Ping; Chen, Wei

    2015-01-01

    Core-binding factor β (Cbfβ) is a subunit of the Cbf family of heterodimeric transcription factors which plays a critical role in skeletal development through its interaction with the Cbfα subunits, also known as Runt-related transcription factors (Runxs). However, the mechanism by which Cbfβ regulates cartilage and bone development remains unclear. Existing Cbfβ-deficient mouse models cannot specify the role of Cbfβ in skeletal cell lineage. Herein, we sought to specifically address the role of Cbfβ in cartilage and bone development by using a conditional knockout (CKO) approach. A mesenchymal-specific Cbfβ CKO mouse model was generated by using the Dermo1-Cre mouse line to specifically delete Cbfβ in mesenchymal stem cells, which give rise to osteoblasts and chondrocytes. Surprisingly, the mutant mice had under-developed larynx and tracheal cartilage causing alveolus defects which led to death shortly after birth from suffocation. Also, the mutant mice exhibited severe skeletal deformities from defective intramembranous and endochondral ossification, owing to delayed chondrocyte maturation and impaired osteoblast differentiation. Almost all bones of the mutant mice, including the calvariae, vertebrae, tibiae, femurs, ribs, limbs and sternums were defective. Importantly, we showed that Cbfβ was expressed throughout the skeleton during both embryonic and postnatal development, which explains the multiple-skeletal defects observed in the mutant mice. Consistently, Cbfβ deficiency impaired both chondrocyte proliferation and hypertrophy zone hypertrophy during growth-plate development in the long bones of mutant mice. Notably, Cbfβ, Runx1 and Runx2 displayed different expression patterns in the growth plates of the wildtype mice indicating that Cbfβ/Runx1 complex and Cbfβ/Runx2 complex may regulate chondrocyte proliferation and hypertrophy, respectively, in a spatial and temporal manner. Cbfβ deletion in the mesenchymal progenitors impacted bone

  20. SURTO DE SARNA CORIÓPTICA EM CAPRINOS NA CIDADE DE GRAVATÁ, REGIÃO AGRESTE DO ESTADO DE PERNAMBUCO OUTBREAK OF CHORIOPTIC MANGE IN GOATS IN THE CITY OF GRAVATÁ IN PERNAMBUCO´S AGRESTE REGION

    Directory of Open Access Journals (Sweden)

    Maria Isabel de Souza

    2009-12-01

    Full Text Available

    A sarna corióptica é de rara ocorrência em caprinos, no entanto trata-se de uma enfermidade cutânea importante, resultando em perdas econômicas decorrentes do retardo no desenvolvimento dos animais, da perda de peso e do prejuízo à indústria de couro. Desse modo, o objetivo do presente artigo é relatar a ocorrência de um surto de sarna corióptica em um rebanho caprino criado no município de Gravatá (Lat. 08° 12’ 04’’ S e Long. 35° 33’ 53’’ O, região Agreste do estado de Pernambuco. Os animais apresentavam extensas áreas de alopecia, eritema, crostas e espessamento da pele na região das axilas, peito, ventre e as faces caudal e craniomedial dos membros posteriores, além de intenso prurido. Foi realizado raspado cutâneo e identificado o ácaro Chorioptes bovis spp.

    PALAVRAS-CHAVES: Caprinos, Chorioptes spp, sarna.

    Chorioptic mange is of rare occurrence in goats, although it is an important skin disease resulting in economic loss due to the delay in the development of the animals, weight loss and economic losses to the leather industry. Thus, the aim of the present article was to report the occurrence of an outbreak of chorioptic mange in a goat flock reared in the city of Gravatá, (Lat. 08° 12’ 04’’ S and Long. 35° 33’ 53’’ W in Pernambuco´s Agreste region. The animals showed wide alopecia areas, erythema, crusts and skin thickness in the following areas: armpits, sternum, ventral abdomen, caudal and cranium-medial facets of the hind legs and severe scratching. Chorioptes bovis spp was identified in skin scrapings.

    KEY WORDS: Chorioptes spp, goats, mange.

  1. Sonographic evaluation of acute osteomyelitis in infants

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

    2002-03-01

    To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

  2. Maternal exposure to nanosized titanium dioxide suppresses embryonic development in mice

    Directory of Open Access Journals (Sweden)

    Hong F

    2017-08-01

    Full Text Available Fashui Hong,1–4 Yingjun Zhou,1–4 Xiaoyang Zhao,5 Lei Sheng,5 Ling Wang6 1Jiangsu Collaborative Innovation Center of Regional Modern Agriculture and Environmental Protection, 2Jiangsu Key Laboratory for Food Safety and Nutritional Function, 3Jiangsu Key Laboratory for Eco-Agricultural Biotechnology around Hongze Lake, 4School of Life Sciences, Huaiyin Normal University, Huaian, 5Medical College of Soochow University, Suzhou, 6Library of Soochow University, Suzhou, Jiangsu, China Abstract: Although nanoscale titanium dioxide (nano-TiO2 has been extensively used in industrial food applications and daily products for pregnant women, infants, and children, its potential toxicity on fetal development has been rarely studied. The main objective of this investigation was to establish the effects of maternal exposure of nano-TiO2 on developing embryos. Female imprinting control region mice were orally administered nano-TiO2 from gestational day 0 to 17. Our findings showed that Ti concentrations in maternal serum, placenta, and fetus were increased in nano-TiO2-exposed mice when compared to controls, which resulted in reductions in the contents of calcium and zinc in maternal serum, placenta, and fetus, maternal weight gain, placental weight, fetal weight, number of live fetuses, and fetal crown–rump length as well as cauda length, and caused an increase in the number of both dead fetuses and resorptions. Furthermore, maternal nano-TiO2 exposure inhibited development of the fetal skeleton, suggesting a significant absence of cartilage, reduced or absent ossification, and an increase in the number of fetuses with dysplasia, including exencephaly, spina bifida, coiled tail, scoliosis, rib absence, and sternum absence. These findings indicated that nano-TiO2 can cross the blood–fetal barrier and placental barrier, thereby delaying the development of fetal mice and inducing skeletal malformation. These factors may be associated with reductions in

  3. Diagnostic accuracy of bone metastases detection in cancer patients. Comparison between bone scintigraphy and whole-body FDG-PET

    International Nuclear Information System (INIS)

    Fujimoto, Ryota; Higashi, Tatsuya; Nakamoto, Yuji

    2006-01-01

    18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has become widely available and an important oncological technique. To evaluate the influence of PET on detection of bone metastasis, we compared the diagnostic accuracy of PET and conventional bone scintigraphy (BS) in a variety of cancer patients. Consecutive ninety-five patients with various cancers, who received both PET and BS within one month, were retrospectively analyzed. A whole-body PET (from face to upper thigh) and a standard whole body BS were performed and these images were interpreted by two experienced nuclear medicine physicians with and without patient information using monitor diagnosis. Each image interpretation was performed according to 8 separate areas (skull, vertebra, upper limbs, sternum and clavicles, scapula, ribs, pelvis, and lower limbs) using a 5-point-scale (0: definitely negative, 1: probably negative, 2: equivocal, 3: probably positive, 4: definitely positive for bone metastasis). Twenty-one of 95 patients (22.1%) with 43 of 760 areas (5.7%) of bone metastases were finally confirmed. In untreated patients, 12 of 14 bone metastasis positive patients were detected by PET, while 9 of 14 were detected by BS. Three cases showed true positive in PET and false negative in BS due to osteolytic type bone metastases. In untreated cases, PET with and without clinical information showed better sensitivity than BS in patient-based diagnosis. For the purpose of treatment effect evaluation, PET showed better results because of its ability in the evaluation of rapid response of tumor cells to chemotherapy. Out of 10 cases of multiple-area metastases, 9 cases included vertebrae. There was only one solitary lesion located outside of field of view (FOV) of PET scan in the femur, but with clinical information that was no problem for PET diagnosis. Diagnostic accuracy of bone metastasis was comparable in PET and BS in the present study. In a usual clinical condition, limited FOV (from

  4. Sonographic evaluation of acute osteomyelitis in infants

    International Nuclear Information System (INIS)

    Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung

    2002-01-01

    To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

  5. Meliponini neotropicais: o gênero Partamona Schwarz, 1939 (Hymenoptera, Apidae

    Directory of Open Access Journals (Sweden)

    Pedro Silvia R. M.

    2003-01-01

    Full Text Available Neotropical Meliponini: the genus Partamona Schwarz, 1939 (Hymenoptera, Apidae. The systematics and biogeography of Partamona Schwarz, a Neotropical genus of stingless bees (Meliponini, Apinae, Apidae, are revised. Seventeen new species are described: P. epiphytophila sp. nov., P. subtilis sp. nov., P. nhambiquara sp. nov., P. batesi sp. nov., P. yungarum sp. nov., P. vitae sp. nov., P. ferreirai sp. nov., P. gregaria sp. nov., P. auripennis sp. nov., P. nigrilabris sp. nov., P. combinata sp. nov., P. chapadicola sp. nov., P. seridoensis sp. nov., P. littoralis sp. nov., P. criptica sp. nov., P. rustica sp. nov. and P. sooretamae sp. nov. Partamona pseudomusarum Camargo, 1980, is considered as junior synonym of P. vicina Camargo, 1980. Types of P. grandipennis (Schwarz, 1951, P. xanthogastra Pedro & Camargo, 1996-1997, P. pearsoni (Schwarz, 1938, P. ailyae Camargo, 1980, P. pseudomusarum, P. vicina, P. mulata Moure in Camargo, 1980, P. aequatoriana Camargo, 1980, P. mourei Camargo, 1980, P. peckolti, (Friese, 1901, P. testacea (Klug, 1807, P. helleri (Friese, 1900 and P. musarum (Cockerell, 1917 were examined. Lectotypes of P. orizabaensis (Strand, 1919, and P. cupira (Smith, 1863 are designated. An identification key for the species and drawings of morphological characters are presented. A phylogenetic hypothesis, based mainly on morphological characters is proposed. Four groups are defined, considering the shape of mandible of workers and sternum VII of males: bilineata / epiphytophila group (western Amazon to México, including P. bilineata (Say, P. grandipennis, P. xanthogastra P. orizabaensis P. peckolti P. epiphytophila sp. nov., P. subtilis sp. nov., P. nhambiquara sp. nov., P. batesi sp. nov., P. yungarum sp. nov. and P. vitae sp. nov.; musarum group (Central Brazil, north of South America to Central America, including P. musarum, P. aequatoriana, P. vicina, P. mourei, P. pearsoni, P. ferreirai sp. nov., P. gregaria sp. nov. and P

  6. Síndrome toracoabdominal. Presentación de un caso Thoracoabdominal síndrome. A case report

    Directory of Open Access Journals (Sweden)

    Sergio Piloña Ruíz

    2007-03-01

    Full Text Available Se trata un caso de un recién nacido de la raza blanca, primogénito, nacido a las 39 semanas de gestación en parto eutócico, que ingresó en el Servicio de Cuidados Intensivos Neonatales por un defecto óseo y músculo aponeurótico, cubierto por piel desde el tercio medio distal del esternón que se extendía hasta el ombligo, siendo portador de una Ectopia Cordis Toracoabdominal, un Onfalocele minor y una persistencia del conducto arterioso sin repercusión hemodinámica, que evolucionó de forma favorable, colocándosele material sintético en el tórax (gorotex como medio de protección. Fue egresado a los 16 días y reingresado a los 2 meses para la reparación del Onfalocele, falleciendo en un cuadro de fallo multiorgánico por sepsis. El fenotipo constatado en el propósitus se consideró compatible con el Síndrome Toracoabdominal, de patrón de herencia dominante ligada al X (MIM: 313850, reportado por Carmi et al en 1990, constituyendo el segundo caso esporádico reconocido en Pinar del Río (Cuba en dos familias no relacionadas.A Caucasian male newborn, first born, delivered at 39 weeks of pregnancy in an eutocic labor was admitted at the Intensive Neonatal Care Unit, presenting an osseous defect and aponeurotic muscle covered by skin of the distal median third of the sternum extended to the navel. He was a carrier of a Thoracoabdominal Ectopia Cordis, a minor Omphalocele and a Patent Ductus Arteriosus without hemodynamic repercussion evolving favorably with the placement of a synthetic material in the thorax (Gorotex as a protection. The patient was discharged from the hospital at 16 days old and readmitted at 2 months old to restore the Omphalocele, dying of multiple organ failure due to sepsis. The phenotype observed on the propositus was compatible with the Thoracoabdominal Syndrome, which has a dominant trait pattern linked to X -chromosome (MIM: 313850 reported by carmi et al. In 1990. This was the second sporadic case

  7. WE-AB-303-11: Verification of a Deformable 4DCT Motion Model for Lung Tumor Tracking Using Different Driving Surrogates

    Energy Technology Data Exchange (ETDEWEB)

    Woelfelschneider, J [University Hospital Erlangen, Erlangen, DE (Germany); Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, DE (Germany); Seregni, M; Fassi, A; Baroni, G; Riboldi, M [Politecnico di Milano, Milano (Italy); Bert, C [University Hospital Erlangen, Erlangen, DE (Germany); Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, DE (Germany); GSI - Helmholtz Centre for Heavy Ion Research, Darmstadt, DE (Germany)

    2015-06-15

    Purpose: Tumor tracking is an advanced technique to treat intra-fractionally moving tumors. The aim of this study is to validate a surrogate-driven model based on four-dimensional computed tomography (4DCT) that is able to predict CT volumes corresponding to arbitrary respiratory states. Further, the comparison of three different driving surrogates is evaluated. Methods: This study is based on multiple 4DCTs of two patients treated for bronchial carcinoma and metastasis. Analyses for 18 additional patients are currently ongoing. The motion model was estimated from the planning 4DCT through deformable image registration. To predict a certain phase of a follow-up 4DCT, the model considers for inter-fractional variations (baseline correction) and intra-fractional respiratory parameters (amplitude and phase) derived from surrogates. In this evaluation, three different approaches were used to extract the motion surrogate: for each 4DCT phase, the 3D thoraco-abdominal surface motion, the body volume and the anterior-posterior motion of a virtual single external marker defined on the sternum were investigated. The estimated volumes resulting from the model were compared to the ground-truth clinical 4DCTs using absolute HU differences in the lung volume and landmarks localized using the Scale Invariant Feature Transform (SIFT). Results: The results show absolute HU differences between estimated and ground-truth images with median values limited to 55 HU and inter-quartile ranges (IQR) lower than 100 HU. Median 3D distances between about 1500 matching landmarks are below 2 mm for 3D surface motion and body volume methods. The single marker surrogates Result in increased median distances up to 0.6 mm. Analyses for the extended database incl. 20 patients are currently in progress. Conclusion: The results depend mainly on the image quality of the initial 4DCTs and the deformable image registration. All investigated surrogates can be used to estimate follow-up 4DCT phases

  8. SU-C-BRF-05: Design and Geometric Validation of An Externally and Internally Deformable, Programmable Lung Motion Phantom

    International Nuclear Information System (INIS)

    Cheung, Y; Sawant, A

    2014-01-01

    Purpose: Most clinically-deployed strategies for respiratory motion management in lung radiotherapy (e.g., gating, tracking) use external markers that serve as surrogates for tumor motion. However, typical lung phantoms used to validate these strategies are rigid-exterior+rigid-interior or rigid-exterior+deformable-interior. Neither class adequately represents the human anatomy, which is deformable internally as well as externally. We describe the construction and experimental validation of a more realistic, externally- and internally-deformable, programmable lung phantom. Methods: The outer shell of a commercially-available lung phantom (RS- 1500, RSD Inc.) was used. The shell consists of a chest cavity with a flexible anterior surface, and embedded vertebrae, rib-cage and sternum. A 3-axis platform was programmed with sinusoidal and six patient-recorded lung tumor trajectories. The platform was used to drive a rigid foam ‘diaphragm’ that compressed/decompressed the phantom interior. Experimental characterization comprised of mapping the superior-inferior (SI) and anterior-posterior (AP) trajectories of external and internal radioopaque markers with kV x-ray fluoroscopy and correlating these with optical surface monitoring using the in-room VisionRT system. Results: The phantom correctly reproduced the programmed motion as well as realisti