Preliminary application of the subxiphoid video-assisted thoracoscopic extended thymectomy / 中国基层医药

Objective:To analyze the preliminary effects of subxiphoid video-assisted thoracoscopic extended thymectomy.Methods:We retrospectively analyzed the clinical data of six patients who underwent subxiphoid video-assisted thoracoscopic extended thymectomy in Peking University International Hospital from August 2018 to June 2020.Results:All six patients underwent successful subxiphoid video-assisted thoracoscopic extended thymectomy without conversion to thoracotomy. The rate of R0 resection was 100%. Operative time was (175.50 ± 67.78) minutes, intraoperative blood loss was (40.83 ± 31.37) mL, and postoperative drainage time was (7.17 ± 3.55) days. The total amount of postoperative drainage was (1781.67 ± 1293.53) mL. Postoperative hospital stay was (10.67 ± 6.35) days. The length of hospital stay was (19.67 ± 5.65) days. The Visual Analog Scale score measured after surgery was (2.12 ± 0.48) points. Three patients had grade 1 complications, with an incidence of complications of 50.00%. Grade 3-5 compilations did not occur in any patient. No patient died during the perioperative period.Conclusion:Subxiphoid video-assisted thoracoscopic extended thymectomy is safe and effective and provides a good visual field. The surgical method allows bilateral thoracic surgery, reduces surgical trauma, and has a broad application prospect.

An elongated dorsally curved xiphoid process / 대한해부학회지

The xiphoid process of the sternum lies in the epigastric region and functions to serve as an attachment point for vital muscles that aid in respiration. With the xiphoid process extending as the most inferior portion of the sternum, variable morphology is widely observed. During a routine dissection of a 44-year-old Caucasian male cadaver, we discovered a hook-shaped, elongated xiphoid process that protruded dorsally. Potential clinical significance can arise leading to misdiagnosis of the hook-shaped xiphoid process as an epigastric mass during imaging. Though various variations of xiphoid process have been well documented, knowledge of a hook-shaped xiphoid process orientated dorsally remains scarce. Herein, this case study provides clinicians, surgeons, and radiologists a rare anomaly of the xiphoid process in order to further the knowledge of morphological variations of the xiphoid to prevent misdiagnosis and surgical complications.

VATS thymectomy with suspension of sternum by double hook through xiphoid / 中华胸心血管外科杂志

Objective Evaluation of self-control suspension under the double hook system used to xiphoid thoracoscope fully the effect of thymectomy.Methods There were 17 cases of thymic adenoma diagnosed before surgery in November to December 2016,including 7 males and 10 females,aged(57 ± 10).The total thymomectomy was performed with a double hook method with a double hook procedure.Results All the 17 patients had smooth operation,and no clear hook related complications were observed after the operation.The operation was convenient and the thymus was completely removed.Conclusion It is worth populating that the double pull hook method is convenient and safe to remove the whole thymus gland.

Location of the umbilicus in Korean women and its changes after breast reconstruction with an ipsilateral pedicled rectus abdominis musculocutaneous flap

BACKGROUND: The umbilicus makes an important contribution to the natural appearance of the abdomen. To date, studies on its position in Korean women are lacking, and no standards have been established. The purpose of this study was to investigate the position of umbilicus in Korean women and to review changes in its position after ipsilateral pedicled rectus abdominis musculocutaneous (IP-RAM) flap. METHODS: This research consisted of two studies. In first study, 100 females who visited the emergency department with gastroenteritis between 2007 and 2011 were included. In second study, 40 women who underwent IP-RAM flap in the same period were included. Using abdominal computed tomography, we measured the distance between xiphoid process and umbilicus, represented by value a, and the distance between umbilicus and symphysis pubis, represented by value b. Thus, the location of the umbilicus was represented by the ratio a/b. The data were analyzed using Pearson correlation test and paired t-test. RESULTS: In study 1, the mean value of a/b was 1.07. Pearson correlation test revealed a significant correlation between age and a/b. In study 2, the mean value of a/b was 1.16 in preoperative measurements and 1.01 in postoperative measurements. The paired t-test showed a significant difference between preoperative and postoperative measurements, indicating cephalic migration of the umbilicus after surgery. CONCLUSIONS: The natural position of the umbilicus showed caudal migration with aging. Additionally, in a comparison of preoperative and postoperative measurements in patients who underwent IP-RAM flap, cephalic migration of the umbilicus was observed after surgery.

Heterotopic Ossification of the Xiphoid Process after Abdominal Surgery for Traumatic Hemoperitoneum

Heterotopic ossification of the xiphoid process is extremely rare, with only three cases previously reported. However, the surgical pathology for postoperative elongation of the xiphoid process after abdominal surgery has not yet been reported. We report a case of the postoperative elongation of the xiphoid process, 8 years after abdominal surgery for traumatic hemoperitoneum in a 53-year-old man. The patient underwent surgical excision of the elongated mass of the xiphoid process. Histopathology revealed multiple exostoses. Heterotopic ossification can occur after surgical trauma to soft or bone tissue. Surgical excision with primary closure is the treatment of choice for symptomatic heterotopic ossification.

A Rare Case with Absent Second Rib, Bifid Costal Cartilages and Bifid Xiphoid Process.

Thoracic cage is made up of twelve thoracic vertebrae, twelve pairs of ribs and costal cartilages (CC) and a sternum. Ribs articulate anteriorly with sternum through CC which are flattened bars of hyaline cartilage considered as unossified anterior part of embryonic cartilaginous ribs. Numerical and structural variations of ribs are well documented. In the present study, we observed both structural and numerical variations of thoracic cage, bilaterally. On both the sides, eleven pair of ribs were present, instead of seven, six true ribs were found and second rib with CC was absent. Second and third CC and third CC of right and third CC of left side were bifid. Cartilaginous bridges were present between various CC on both sides. In the midline xiphoid process was found to be bifid. These variations are of immense help to the physicians, surgeons and radiologists.

Xiphoid Foramen and Its Clinical Implication.

Background: In this case report, we want to present a case of pear shaped foramina at the xiphoid process of sternum. The context and purpose: Variations and foramen in the xiphoid process of sternum are frequent. They are clinically important due to their proximity to heart, lungs, diaphragm, liver and stomach. Results: The pear shaped foramina was present in the xiphoid process. It resembled the glenoid fossa of scapula in shape. The maximum length of the foramina was 1.6cm and breadth 1.4cm. Conclusions, brief summary and potential implications: A sound knowledge of xiphoid process variations and anomalies is very important during sternal bone marrow aspiration, radiological reporting, acupuncture and assessing injuries during autopsy and post mortem examination.

Center of the Chest Versus Inter-nipple Line in the Selection of a Chest Compression Site by Novice Rescuers

PURPOSE: The aim of this study was to compare the distribution and risk from hand positions applied at the center of the chest (CoC) versus the inter-nipple line (INL) during external chest compression by novice rescuers. METHODS: This simulation study included 105 participants. The participants were given photographs of the unexposed male chest and asked to mark a cross at the center of the chest and at the midpoint of the inter-nipple line. The range of contact with the chest was estimated by measuring the participants' palm width. The median and distribution of the two points were then compared and analyzed to determine whether the range in contact with the chest involved the xiphoid process. RESULTS: The level of the INL was approximately 0.8 cm higher at the sternum than the CoC (p<0.001), while the standard deviation of the CoC [1.8(0.6-3.8)] was higher than that of the INL [1.2(0.4-2.4)] (p<0.001). There were more cases in which the palm range involved the xiphoid process in the CoC group [15(14.3%)] than the INL group [1(0.9%)] (p<0.001). CONCLUSION: For male adult patients, chest compression at the level of the INL by novice rescuers is safer and more intensive than compression at the level of the CoC.

Intrarater Reliability of Chest Expansion using Cloth Tape Measure Technique.

Objective: The Objective of this study was to determine the intrarater reliability of chest expansion at three different anatomical landmarks using a cloth tape measure among healthy peoples. Materials and Methods: 120 healthy male and female volunteers were evaluated on two occasions in different days. The measures consisted of chest expansion measurement at axilla, fourth intercostals and xiphoid levels. The measurements were taken in the standing position with the arms hanging sideways at all the three different anatomical landmarks. The test-retest reliability of the measurements was determined by intraclass correlation coefficient (ICC) and standard error of measurements (SEMs). Results: An acceptable reliability was determined by ICC values greater than than 0.85 and SEMs less than 5%. The mean age of the subjects was 21.93 years. ICC of all measures ranged between 0.95 to 0.97 and SEMs were 1.9%, 1.8%, 1.5% at the axillary, fourth intercostals and xiphoid level respectively. Conclusions: The findings of this study suggested that, the cloth tape measurement was reliable at all the three different anatomical landmarks of the chest wall. Therefore, this measurement technique could be used as an outcome measure for chest expansion in the management of cardiorespiratory conditions.

Radiological Age estimation from Xiphi-sternal joint in living person.

Age determination is very important. The perfect way to store the age related data is still lacking in developing countries. For age determination, different parts of the skeleton are more useful at different age ranges. The different age ranges include fetal, children, teen age, young adult, and older adult. Age determination is required in both civil as well as criminal cases. So for these cases, forensic experts are entrusted duty to determine the age. Forensic experts rely on radiographs of various bones and joints to determine age. Most of the age determination data available in middle and old adult is from autopsies and not from living population radiographs. Due to lack of this living person radiograph database, Xiphisternal joint is studied to determine the age in middle and old people. Lateral view radiograph of this joint was done in people whose exact date of birth was known and who had a valid proof of date of birth.

Xiphodynia: 2 cases report / 대한흉부외과학회지

Xiphodynia is a term used to describe a painful xiphoid process, and this is a rare musculoskeletal disorder that can radiate to the anterior chest, epigastrium, neck, shoulders and back. Clinical awareness of xiphodynia is important for making its correct diagnosis. We report here on two cases of xiphodynia. The diagnosis was suggested by the reproduction of the anterior chest pain or/and the epigastrium pain with light pressure on the xiphoid process. The patient of case 1 had suffered from xiphodynia throughout the years, and this patient underwent surgical excision of the xiphoid process. The patient of case 2 received an injection of local anesthetic agent to the xiphoid process.

Computed Tomographic Appearance of the Anterior Diaphragm: Evaluation with 64-slice MDCT

PURPOSE: To re-evaluate the appearance of the anterior diaphragm by the use of MDCT. MATERIALS AND METHODS: We performed a retrospective review of 81 consecutive patients that underwent chest CT by using 64 channel MDCT. We classified the anterior diaphragm as three types (types 1-3) based on 5 mm axial scans: a line behind the xiphoid, a discontinuity and opening anteriorly, and the presence of broad and poorly defined bands. We also classified the anterior diaphragm as three types (types A-C) using 2 mm sagittal reformation images, based on the shape of the anterior diaphragmatic fibers traveling from the base of the pericardium to the xiphoid: a downward slope, an upward slope, and a flat shape, and compared the two groups using a correlation determined by statistical analysis. RESULTS: We could classify the appearance of the anterior diaphragm for all cases on the axial scans and sagittal reformation images. The number of types 1, 2, 3 on the axial scans was 30.9%, 38.3%, and 30.9% and the number of types A, B, C on the sagittal reformation images was 33.3%, 22.2%, and 44.4%, respectively. Type A was seen for 92% of type 1 cases, type C was seen for 88% of type 3 cases, and type B was seen for 54.8% of type 2 cases. The types seen between the axial and sagittal reformation images showed a significant agreement (r=0.868, p < 0.01). CONCLUSION: The shape of the anterior diaphragm correlated with the relationship between the base of the pericardium and the xiphoid.

Value of gas assembling in the recess below the xiphoid in CT diagnosing early gastrointestinal perforation / 中华放射学杂志

Objective To discuss CT examination in the diagnosis of gastrointestinal perforation (GP). Methods All CT data of 13 adult patients with GP were reviewed retrospectively. Results In all 13 cases,gastric perforation occurred in 5 cases,duodenal perforation in 7,and traumatic duodenal avulsion in 1.CT findings of GP included gas accumulation under the recess of xiphoid,gas accumulation in the area of lesser omentum,gas accumulation under the recess of peritoneal cavity,and seroperitoneum. Conclusion As a non-invasive examination means for abdomen,CT examination can discover whether there is dissociative gas or not and estimate the amount of gas in abdomen more rapidly and exactly.CT can also estimate the position of perforation elementarily.The recess under xiphoid is the first place where the dissociative gas assembles after gastrointestinal perforation.