12th Rib Research Articles

Effects Of Increasing Supplemental Zinc To Non-Implanted And Implanted Finishing Steers.

The effects of supplemental Zn within steroidal implant strategy on performance, carcass characteristics, trace mineral status, and muscle gene expression were tested in a 59-d study using 128 Angus-crossbred steers (492 ± 29kg) in a 2 × 4 complete randomized design. Implant strategies included no implant (NoIMP) or Component TE-200 (TE200; Elanco, Greenfield, IN) administered on d 0. Zinc was supplemented at 0, 30, 100, or 150mg Zn/kg dry matter (Zn0, Zn30, Zn100, Zn150, respectively) from ZnSO4. Steers were stratified by body weight (BW) to pens (n = 5 or 6 steers/pen) equipped with GrowSafe bunks (GrowSafe Systems Ltd., Airdrie, AB, Canada) and assigned treatments (n = 15, 16, or 17 steers/treatment). Cattle were weighed on d -1, 0, 18, and 59 with blood collected on d -1, 18, 40, and 59. Muscle samples were collected from the longissimus thoracis on d 11 and liver samples collected on d 55 or 56. Data were analyzed using the Mixed Procedure of SAS via contrast statements testing the linear and quadratic response to Zn supplementation within implant treatment and NoIMP vs. TE200 for performance, carcass, blood, and liver parameters. Specific contrast statements were formed for the analysis of gene expression in muscle including: Zn0 vs. Zn150 within NoIMP and TE200, NoIMP vs. TE200 (Zn0 and Zn150 only), and the linear effect of supplementing Zn0, Zn100, and Zn150 within TE200. Steer was the experimental unit. Day 18 BW and d 0-18 average daily gain (ADG) were linearly increased due to Zn supplementation within TE200 (P ≤ 0.002) in conjunction with a linear increase from Zn in d 11 muscle epidermal growth factor receptor, matrix metalloproteinase 2, and phosphodiesterase 4B gene expression of TE200 steers (P ≤ 0.05). Plasma Zn on d 18 and 40 linearly increased with increasing Zn supplementation regardless of implant treatment (P ≤ 0.03) and was lesser for TE200 than NoIMP steers on d 18 (P = 0.001). Day 59 BW and hot carcass weight (HCW) were greater for TE200 vs. NoIMP (P ≤ 0.002) and HCW of implanted steers tended to linearly increase with increasing Zn supplementation (P = 0.09). No effects of Zn supplementation were observed in NoIMP for HCW, BW, or ADG (P ≥ 0.17). Yield grade and 12th rib fat tended to quadratically decrease within NoIMP (P ≤ 0.09), with Zn100 being most lean. These data indicate increasing supplemental Zn influences steroidal implant signaling machinery while increasing the Zn status and implant-induced growth of feedlot cattle.

Constructing a spinal tuberculosis model in white rabbits using the 12th rib localization method based on MRI radiation imaging and medical thermal modeling

Constructing a spinal tuberculosis model in white rabbits using the 12th rib localization method based on MRI radiation imaging and medical thermal modeling

Complete resection of a giant costal chondrosarcoma with reconstruction of the thoraco-abdominal wall: a case report

BackgroundChondrosarcoma primarily occurs in the pelvis and femur, with occasional cases in the ribs. Surgical resection remains the main treatment method for costal chondrosarcoma. However, complete resection often leads to a large range of chest wall defects and a challenging reconstruction.Case presentationA 49-year-old female patient presented with progressive swelling of the right chest and abdominal wall over 15 years. Chest CT revealed a 20.1 × 15.6 × 13.7 cm multilocular cystic-solid mass with internal calcification, encircling the 8th to 12th ribs and causing elevation of the right diaphragm. Compression of the liver resulting in a significant reduction in volume. Based on an ultrasound-guided biopsy, chondrosarcoma Grade I was diagnosed. After a multi-disciplinary discussion, we performed a complete resection of the tumor, including the 8th to 12th anterolateral ribs and part of the diaphragm. The diaphragm was then reconstructed by suturing it to the ribs and intercostal muscles at the resection margin. The thoraco-abdominal wall defects were reconstructed with a polypropylene mesh. Finally, we excised the excess skin and then closed the incision. Histopathologic diagnosis was chondrosarcoma Grade II. The postoperative course was uneventful. At the 3-month postoperative follow-up, no signs of recurrence were observed.ConclusionsWide en-bloc resection followed by reconstruction using polypropylene mesh is feasible and cost-effective for costal chondrosarcoma with limited invasion. This case illustrates the importance of meticulous preoperative planning and multi-disciplinary discussion.

PRIMARY CHONDROSARCOMA OF RIB: RARE NEOPLASM WITH ATYPICAL PRESENTATION

Background:Chondrosarcoma is uncommon malignant tumor of rib can have atypical presentation based on age, gender and clinical features. However, Computed Tomography is imaging modality of choice and helps aids in diagnosis and guiding treatment. Case Presentation: This was a case of 84 year old lady, who presented as a breast lump. Core needle biopsy gave the differential diagnosis Malignant phylloides with heterologous cartilaginous component, Primary chondroid sarcoma, Metaplastic carcinoma. However, imaging findings led to diagnosis of chondrosarcoma arising from right 4th rib and hence patient underwent en bloc excision of anterior chest wall with chest wall reconstruction. Final histopathology was suggestive of grade 2 chondrosarcoma with medial margin microscopically positive. Patient was kept on 2 monthly follow up after surgery without giving any adjuvant therapy or additional surgery. She was disease free at 6 months follow up. Conclusion: The incidence of rib Chondrosarcoma is rare and presents a diagnostic challenge. Surgical management with wide local excision and reconstruction remains the treatment of choice.

Predicting Chemical Body Composition Using Body Part Composition in Boer × Saanen Goats

Two experiments were conducted to determine which part of the empty body of Boer × Saanen intact male kids can be used to predict the chemical composition of the whole body. In the first experiment, kids were fed ad libitum and slaughtered at 5, 10, and 15 kg body weight (BW). Eighteen animals were group-fed at three intake levels (ad libitum or restricted to 30% and 60% of the ad libitum level). When the ad libitum animal in the group reached 15 kg BW, all animals in the group were slaughtered. In the second experiment, kids were fed ad libitum and slaughtered at 15, 20, and 25 kg BW. Twenty-one animals were group-fed at three intake levels and slaughtered when the ad libitum animal within the group reached 25 kg BW. Analyzed body parts included head + feet, hide, organs, neck, shoulder, ribs, loin, leg, 9–11th ribs, and half carcass. Principal component and cluster analyses showed that the neck, 9–11th ribs, and loin had the highest frequency of grouping with the empty body. These body parts were used to develop prediction models for estimating body composition. The neck, loin, and 9–11th ribs accurately and precisely predicted the dry matter, ash, fat, protein, and energy body composition of goats, with most models also incorporating BW as a predictor variable. The equations showed root mean squared error (RMSE) lower than 13.5% and a concordance correlation coefficient (CCC) greater than 0.84. Fat and protein concentrations in the loin and neck were also reliable predictors of empty body energy composition (RMSE = 2.9% of mean and concordance correlation coefficient = 0.93). Removing the loin and 9–11th ribs could reduce the carcass retail price. Using the neck to estimate body composition in growing Boer × Saanen goats provides a valuable alternative for nutrition studies, given its low commercial value.

Abstract 4129839: Successful Left Atrial Appendage Occlusion (LAAO) with WATCHMAN FLX via Transhepatic Approach

Left atrial appendage occlusion (LAAO) with the WATCHMAN FLX (Boston Scientific) has been proven to reduce stroke risk in patients with paroxysmal atrial fibrillation (PAF). Certain circumstances may preclude LAAO1. In this case, transhepatic vein access was used to successfully deploy a WATCHMAN FLX in a 72 year old male with PAF not on anticoagulation due to recent subdural hemorrhage and recurrent bilateral lower extremity deep venous thrombosis (DVT) post IVC filter placement. Recent attempt at LAAO was unsuccessful due to total occlusion of bilateral femoral veins (Figure 1 A-B) and inability to cross the IVC. Access to the inferior branch of the right hepatic vein was achieved by micropuncture technique at the right mid-axillary line at the level of the 12th rib, which was confirmed by venogram (Figure 2A). The 4F microsheath was upsized to 16F. Intraoperative TEE was used for device sizing and delivery (Figure 3A). The transseptal sheath and dilator were positioned in the right atrium at the level of the fossa ovalis (Figure 3B) before successfully crossing into the left atrium (Figure 2B). After confirming placement (Figure 3C), a pigtail catheter was positioned within the LAA (Figure 3D) and an angiogram was performed (Figure 2C). A 24 mm WATCHMAN FLX was partially unsheathed and positioned (Figure 3E). Repeat LAA angiogram was performed through the WATCHMAN delivery sheath (Figure 2D). A Tug test was performed. The device was released (Figure 3F). Repeat venogram was performed to confirm location (Figure 2E) of the access site, and coil embolization closure of the venotomy access site was performed (Figure 2F). The patient was discharged the following day on dual antiplatelet (aspirin, clopidogrel) without complication. Venous access via right hepatic vein is a viable option for LAAO using the WATCHMAN FLX device.

Gender-Based Differences in the Biomechanical Behavior of the Thorax During CPR Maneuvers.

In this study, 18 rib cages (8 males and 10 females) were segmented from computer tomography (CT) images. In order to analyze the potential differences in thoracic biomechanics during cardiopulmonary resuscitation (CPR), a set of numerical experiments was conducted using finite elements (FE). Compression forces were applied at different points on the rib cage. Results indicated that the optimal compression area for both sexes is the sternum at the 5th rib level, requiring the least force to achieve the desired compression depth. Males required greater force than females. Among females, those with lower width/depth ratios (more rounded thoracic shape) required less force compared to those with higher ratios (more oval-shaped thorax).

Surgical management of multiple rib fractures in polytrauma patients: semi-damage control surgery.

Background: To investigate the timing and extent of surgery for rib fractures in polytrauma patients. Methods: Data from polytrauma patients who underwent early and partial rib fracture fixation after successful resuscitation were retrospectively analyzed. The study encompassed demographic data, clinical data, and outcomes. Results: In total, 71 patients with polytrauma were included. ISS ranged from 16 to 50 with a mean score of 25.3±7.5. The median lactate level was 3.6 mmol/L (IQR: 3.1 to 4.5), the median base deficit (BD) was 8.2 mmol/L (IQR: 6.4 to 9.8) and the shock index (SI) median was 1.2 (IQR: 0.9 to 1.3). Total fractured ribs in 71 patients were 726; individually, the minimum and maximum number of fractured ribs was 3 and 22, respectively (median, 10; mean, 10.2 ± 4.0). The average time to surgery was 42.9±42.6 h. Specifically, 41(57.7%) received the surgery within 24h and 52 (73.2%) patients received the surgery within 3 days following successful resuscitation. A total of 246 (33.9%) ribs underwent open reduction and internal fixation with plate, 3.46 ribs for each patient, with high frequencies of the 6th (49, 19.9%), 5th (46, 18.7%), 4th and 7th ribs (both 36, 14.6%). The average length of ICU stay was 11.5 ± 7.5 days and the duration of hospitalization was 16.3 ± 9.9 days. No surgical site infection or mortality was observed. Conclusions: Early and partial rib fracture fixation to restore the relative stability of the thorax is safe and effective for polytrauma patients after successful resuscitation. This surgery strategy is called semi-damage control surgery.

Distant migration of a broken guide pin following femoral neck fixation: a case report

IntroductionKirschner wires are frequently employed in orthopedic procedures. While most complications are minor, rare instances of distant pin migration can occur. Such migration is more prevalent in the shoulder region but has been reported elsewhere.Case presentationA 50-year-old Persian male with a right femoral neck fracture (Garden type IV) underwent closed reduction and internal fixation with three cannulated screws. During the procedure, a guide pin broke and remained lodged. Follow-up radiographs revealed the migrated pin in the patient’s chest wall near the 11th rib, necessitating surgical removal via thoracotomy.ConclusionThis case underscores the potential for orthopedic implant migration. While often associated with smaller pins, the risk exists for all sizes. The timeframe for diagnosis varies significantly and in some cases it can be asymptomatic and discovered incidentally.

Isolated Rib Response and Fracture Prediction for Young Mid-Size Male, Enabled by Population Specific Material Models and Rib Cross-Sectional Geometry.

Thorax injury remains a primary contributor to mortality in car crash scenarios. Although human body models can be used to investigate thorax response to impact, isolated rib models have not been able to predict age- and sex-specific force-displacement response and fracture location simultaneously, which is a critical step towards developing human thorax models able to accurately predict injury response. Recent advancements in constitutive models and quantification of age- and sex-specific material properties, cross-sectional area, and cortical bone thickness distribution offer opportunities to improve rib computational models. In the present study, improved cortical and trabecular bone constitutive models populated with age-specific material properties, age- and sex-specific population data on rib cross-sectional area, and cortical bone thickness distribution were implemented into an isolated 6th rib from a contemporary human body model. The enhanced rib model was simulated in anterior-posterior loading for comparison to experimental age- and sex-specific (twenty-three mid-size males, age range of 22- to 57-year-old) population force-displacement response and fracture location. The improved constitutive models, populated with age-specific material properties, proved critical to predict the rib failure force and displacement, while the improved cortical bone thickness distribution and cross-sectional area improved the fracture location prediction. The enhanced young mid-size male 6th rib model was able to predict young mid-size male 6th rib experimental force-displacement response and fracture location (overpredicted the displacement at failure by 35% and underpredicted the force at failure by 8% but within ±1 SD). The results of the present study can be integrated into full body models to potentially improve thorax injury prediction capabilities.

Anatomical Study of Abdominal Wall Muscle Innervation to Optimize Retroperitoneal Vascular Approach

INTRODUCTIONDifferent surgical approaches are used in aortic surgery. Retroperitoneal approaches can result in abdominal wall weakness and flank bulging. These approaches often require dissection of the anterolateral or anteromedial muscles of the abdominal wall. During dissection, the underlying nerves are at great risk of injury, which induces significant complications in abdominal wall muscles. Few studies have been conducted to minimize the risk of injury to these nerves. OBJECTIVESThis study aims to describe the trajectory of abdominal muscle motor nerves and their relationship to ribs and other anatomical landmarks. The secondary objective is to optimize surgical approaches by preserving the nerves. METHODWe conducted 12 dissections on fresh cadavers. Nerve trajectories, communication between the intercostal nerves (9th–10th–11th) and the subcostal nerve (12th), and the distance from the nerve to the estimated projection point of intersection with the abdominal midline, umbilicus, and iliac crest was recorded. RESULTSOur dissections identified the 12th subcostal nerve as the largest nerve. The 11th intercostal nerve exhibits more accessory branches than other nerves. Multiple communications and branches were observed between the 10th and 11th intercostal nerves and between the 11th and 12th nerves in the region from the anterior axillary line to the mid-clavicular line. The estimated projection point of intersection with the midline was 7.92 ± 1.24 cm supraumbilical for the 9th intercostal nerve, 3.92 ± 1.18 cm supraumbilical for the 10th, 1.08 ± 1.52 cm at the umbilical level for the 11th, and -3.33 ± 0.83 cm infraumbilical for the subcostal nerve. The distance between the iliac crest and the iliohypogastric nerve in the lateral jackknife position was 2.54 ± 0.65 cm. The 11th nerve had an angle in relation to the rib of between -45° and -10° (average: -24.6°), and the 12th nerve had a similar angle of between -30° and 0° (average: -18.3°). For the 11th nerve, the distance was between 0 and 5.5 cm (average: 2.92 cm); for the 12th nerve, it was between 0 and 3.0 cm (average: 1.71 cm). CONCLUSIONTo preserve the 11th nerve, the optimal approach is a straight incision starting from the upper edge of the 11th rib towards the midline, 4 cm above the umbilicus; for the 12th nerve, the optimal approach is a straight incision starting from the upper edge of the 12th rib towards the midline, 1 cm below the umbilicus; for the iliohypogastric nerve, the optimal approach is an incision close to the iliac crest at a distance <1.5 cm. The estimated projection point of intersection between the nerve directions towards the midline can indicate the anatomical trajectory of nerves. A nerve projection towards the midline can provide valuable information about the anatomical location of a nerve. This study has utility in optimizing surgical approaches. A clinical study can confirm these anatomical results.

Ultrasound-Guided Deep Serratus Plane Block in Cat Cadavers (Felis catus): A Description of Dye and Contrast Media Distribution.

The serratus plane block is an ultrasound-guided anaesthetic technique that aims to provide analgesia to the lateral thoracic wall cranial to the 8th rib. This block can be performed in a superficial (between the latissimus dorsi and the serratus ventralis thoracis (SVT) muscles) or deep plane (between the intercostales externi and the SVT muscles). This study aimed to assess the distribution and nerve staining of a mixture of 0.4 mL kg-1 of methylene blue and iopromide 50:50 performing a deep serratus plane (DSP) block at the level of the 5th rib. We hypothesise that this technique would be feasible and could stain the rami cutanei laterales (RCL) of the intercostales nerves cranial to the 8th rib in cat cadavers. This study was divided into two phases. Phase 1 consisted of an anatomical study of the thoracic wall (2 cadavers). Phase 2 consisted of the ultrasound-guided injection of the aforementioned mixture and the assessment of its distribution by computed tomography and anatomical dissection (12 cadavers). Contrast media spread a median of 5.5 (2.5-7.5) intercostal spaces. The dye stained a median of 3 (0-5) RCL, affecting RCL 2 (17.39%), RCL 3 (57.17%), RCL 4 (78.26%), RCL 5 (91.30%), RCL 6 (78.26%), and RCL 7 (8.70%) within the DSP. Occasionally, the rami dorsales laterales and the thoracicus longus nerve were stained. Based on these findings, the DSP block performed with a volume of 0.4 mL kg-1 of an anaesthetic could provide analgesia in the area innervated from T4 to T6.

Congenital Diaphragmatic Eventration: Should we Maintain Surgical Treatment? A Retrospective Multicentric Cohort Study

BackgroundThe aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France. MethodsRetrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared. Results139 patients were included, with a median age of 8 [1–16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients. ConclusionsDiaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence. ClinicalTrialsNCT04862494, April 28, 2021. Level of evidencelevel III treatment study.

Secondary Chondrosarcoma of the Rib in a Case of Diaphyseal Aclasis: A Rare Case Report

Hereditary multiple exostosis has a 3%–5% chance of converting into chondrosarcoma. It is a rare case report of a 32-year-old female with hereditary multiple exostosis who presented with pain and progressive swelling over her right chest wall for 3 months. A clinical examination revealed a large globular swelling over her right chest. Imaging revealed a large, ill-defined, aggressive, and exophytic lesion with a thick cartilage cap arising from the 8th rib. The lesion was hypermetabolic and avid on PET CT scan. She underwent a core needle biopsy which showed features of malignant transformation. En-bloc resection of the tumor with 7, 8, and 9 ribs followed by plate and mesh reconstruction was carried out.

Impact of Operating Table Height on the Difficulty of Mask Ventilation and Laryngoscopic View.

Background/Objectives: Airway management techniques, including mask ventilation and tracheal intubation, are vital across medical settings. However, these procedures can be challenging, especially when environmental conditions are less than ideal. This study explores how the height of the operating table affects the difficulty of anesthesia techniques involving mask ventilation and tracheal intubation. Methods: Twenty anesthesiologists participated in this study. We assessed the difficulty of procedures such as mask ventilation, Macintosh laryngoscopy, and video laryngoscopy using McGRATH and AWS, on a four-level scale. The operating table's height was adjusted at four points: the operator's umbilicus, the inferior margin of the 12th rib, the xiphoid process, and the nipple. Results: Mask ventilation was easiest at the operating table's height aligned with the inferior margin of the 12th rib. Conversely, direct laryngoscopic exposure was perceived as easier at higher table heights, with nipple height being optimal. The McGRATH laryngoscopy showed consistent difficulty across table heights, whereas the AWS tended to be somewhat more difficult at greater heights. Conclusions: The optimal bed height for video laryngoscopy coincided with that for mask ventilation. Video laryngoscopy offers enhanced flexibility in optimal patient positioning compared to Macintosh laryngoscopy, contributing to its advantages in tracheal intubation procedures.

7183 Histoplasmosis Of Adrenal In An Immunocompetent Patient From Arizona: A Surprising Biopsy

Abstract Disclosure: R. Habibi: None. S. Penquite: None. N. Ebrahimi: None. R. Cardenas Lara: None. Introduction: Histoplasmosis of adrenal gland in the context of disseminated infection is a rare entity in a non-endemic area. Early diagnosis and treatment can save one’s life. Here we present a case of a patient from Arizona who was referred to us with a large adrenal mass initially resembling malignancy. Presentation: A 58-year-old male with no significant medical history from Bisbee Arizona presented to our clinic with significant weight loss of 120 pounds in 8months, jaundice, fatigue, nausea and vague abdominal pain. He had an abdominal CT scan in a rural area hospital which showed a left adrenal 4.2 x 4.3 x 3.7 cm mass with average HU=40, with interval development from a CT scan 6months prior to that which showed left adrenal 1.5 x 1.3 x 1.3 cm mass. He had the initial CT scan after a mechanical fall. He was experiencing sweating, dizziness and low blood pressure of 90/60 mmhg, but used to have hypertension. Physical examination revealed diffuse jaundice in an ill appearing cachectic individual. Laboratory data were significant for total bilirubin of 4.9, direct bilirubin 0.7. Plasma metanephrines and normetanephrines, 24-hour urine free cortisol, morning cortisol levels and DHEA sulfate were normal. Other findings on the CT scans of head, chest and abdomen were soft tissue thickening between the right posterior 10th and 11th ribs along with hepatosplenomegaly, nodular lung lesions with calcified granuloma, sub centimeter brain lesions within the left putamen/external capsule junction with corresponding mild edema. During the following month after initial visit he developed bilateral tongue masses with dysphagia along with enlarging bilateral adrenal lesions, measuring up to 4.4 cm on the right and 5.2 cm on the left. The patient was admitted to hospital for further extensive work up. He underwent biopsies of left adrenal mass and tongue lesions which demonstrated necrotizing granulomatous inflammation with fungal elements compatible with histoplasmosis. Liposomal amphotericin B was started, which was quickly switched to itraconazole 200mg twice a day once lumbar puncture result was normal. His transient low blood pressures resolved. He was seen in clinic after few weeks with overall improving symptoms. Follow up with imaging of adrenal in few months is planned. He is currently in his third month of treatment for histoplasmosis with itraconazole. Discussion: The presentation of disseminated histoplasmosis can resemble malignancy as illustrated in this case. Southwest of the United States is an unusual geographical area for such infection. Initial unilateral involvement of adrenal as a mass in an immunocompetent individual is also uncommon. Considering dramatic response to antifungal treatment, a clinician should suspect such rare infections when seeing a nonfunctional adrenal mass with rapidly progressive constitutional symptoms. Presentation: 6/3/2024

7159 Brown Tumor As Primary Presentation Of Parathyroid Carcinoma In A Young Female

Abstract Disclosure: S.G. Zachariah: None. R. Anand: None. B.Y. Wong: None. H.J. Lee: None. Title Brown Tumor as Primary Presentation of Parathyroid Carcinoma in a Young Female Introduction/Background: Parathyroid carcinoma (PC) is a rare cause of hyperparathyroidism (HPT) accounting for less than 1% of primary HPT cases. The mean age of PC presentation is 62 years. Long-standing HPT can lead to the formation of osteitis fibrosis cystica (brown tumors). In today’s world of advanced screening, they are an increasingly rare presentation of HPT. We present a case of PC presenting as multiple brown tumors in a young woman. Case: A previously healthy 32-year-old woman presented to the emergency department with right shoulder pain after a mechanical fall. MRI revealed multiple osseous lesions of the proximal humerus, glenoid, and scapula, concerning for possible metastatic malignancy. Notable labs: calcium 13.6 mg/dL [8.5 - 10.5 mg/dL], phosphorus 1.7 mg/dL [2.5 - 4.5 mg/dL], alkaline phosphatase 2,369 U/L [&amp;lt; 130 U/L], 25-OH vitamin D 0.8 ng/mL [30 - 60 ng/mL], and parathyroid hormone greater than 2,500 pg/mL [20-80 pg/mL]. Albumin and renal function were normal. CT chest/abdomen/pelvis showed lytic lesions of the left 7th rib, anterior superior iliac spine (with nondisplaced fracture), pelvis, and sacrum. Subsequent pelvic biopsy showed fragmented bony trabeculae with osteoblastic rimming and rare osteoclasts, fragments of fibrous tissue with few plasma cells and hemosiderin laden macrophages, possibly consistent with brown tumor. On parathyroid ultrasound, a 2.2 cm cystic mass was seen along the left common carotid artery. CT neck confirmed the location and also reported C7-T1 spinal lesions. Calcium levels stabilized with IV fluids and 90 mg IV pamidronate. She underwent a left parathyroidectomy and left hemithyroidectomy with central neck dissection. Pathology was consistent with a low-grade parathyroid carcinoma, with a foci of angioinvasion and capsular invasion without lymph node metastases. The Ki-67 index was less than 1%. Post-operatively, the patient was started on calcium and calcitriol supplementation and did not experience hungry bone syndrome. On further discussion, the patient noted that she had a jaw tumor that was previously biopsied and found to be benign. The patient has since been referred for genetic testing. Conclusion/Clinical Lessons: Both PC and its initial presentation with brown tumors are uncommon. Even more rare is the presentation of both in a young, otherwise healthy female. In this context, it is also important to note that brown tumors can mimic osseous metastases and appropriate biochemical, imaging, and histopathological evaluation is needed. The diagnosis of PC under 40 years of age is uncommon and genetic testing is indicated. Syndromes including multiple endocrine neoplasia type 1, familial isolated hyperparathyroidism, and hyperparathyroidism-jaw tumor syndrome are potential causes of inherited PC. Presentation: 6/3/2024

Effect of Ultrasound-Guided External Oblique Intercostal Block on Postoperative Recovery After Subxiphoid Video-Assisted Thoracoscopic Thymectomy: A Randomized Controlled Trial.

Severe postoperative pain can occur after subxiphoid video-assisted thoracoscopic thymectomy (SVATT), affecting the quality of postoperative recovery. This study aimed to evaluate the effect of ultrasound-guided external oblique intercostal (EOI) block on recovery after SVATT. A total of 60 patients undergoing SVATT were randomly divided into the EOI group (group E, n = 30) and the control group (group C, n = 30). Group E underwent ultrasound-guided bilateral EOI block at the 6th rib level and was injected 20 mL of 0.375% ropivacaine on each side. Group C was injected with 20 mL of 0.9% saline at the same site. After the operation, both groups received a patient-controlled intravenous analgesic (PCIA) pump. The 15-item Quality of Recovery (QoR-15) scores were recorded at 24 hours before surgery (T0), 24 hours after surgery (T3), and 48 hours after surgery (T4). The sufentanil usage in the first 24 hours postoperatively, the remifentanil dosage during surgery, the time of first pressing PCIA, and the cases of rescue analgesia were recorded. The visual analog scale (VAS) scores of patients at 6 (T1), 12 (T2), 24 (T3), and 48 hours (T4) after an operation during rest and coughing were recorded. The dermatomes of the sensory plane, block complications in group E, and the incidence of other postoperative adverse reactions in both groups were also recorded. Compared with group C, the QoR-15 scores of patients were significantly higher at T3 and T4 in the group E. The VAS scores were significantly lower at T1, T2, and T3 during rest and coughing in the group E. The sufentanil usage in the first 24 hours postoperatively, the remifentanil dosage during surgery, and the cases of rescue analgesia were significantly lower in group E, and the time of first pressing PCIA was significantly increased in group E (all P < .05). Ultrasound-guided EOI block can be safely used in patients undergoing SVATT, which can improve the quality of postoperative recovery and reduce postoperative pain.

Comparison of ultra-wide band microwave system and ultrasound in live cattle to predict beef carcase subcutaneous fatness

Ultrasound and ultrawide band microwave system (MiS) were directly compared in their ability to scan live cattle to predict carcase traits. Commercial beef cattle (n = 315) were scanned on farm 0–14 days prior to slaughter. Traits measured were subcutaneous fatness at the P8 site (over the gluteus muscle on the rump, at the intersection of a line through the pin bone parallel to the chine and perpendicular through the 3rd sacral crest) and subcutaneous fatness at the rib fat site (between 12th & 13th rib, ¾ of the length ventrally over the longissimus muscle). The precision of prediction of carcase traits was slightly better using MiS. MiS prediction of P8 fat depth had an average RMSEP of 2.48 mm and R2 of 0.65. The MiS could predict carcase rib fat with an average RMSEP of 2.28 mm and R2 of 0.56. The accuracy of prediction was very similar between the two technologies. When predicting P8, the average bias was smallest using MiS at 0.157 mm, but the average slope was smallest using ultrasound at 0.03 mm. When predicting rib fat, MiS had the smallest average bias at 0.204 mm, and smallest average slope deviation at 0.06 mm. The MiS predicted P8 and rib fat carcase traits with similar precision and accuracy as ultrasound.

EP.14C.07 Hyperossosis of the Right 10th Rib the Osteochondral Part that Compresses the Dexter Lobe of the Liver

EP.14C.07 Hyperossosis of the Right 10th Rib the Osteochondral Part that Compresses the Dexter Lobe of the Liver