Infraclavicular Fossa Research Articles

The effect of modified limb electrode positions on electrocardiographic wave amplitudes

Mofidied limb electrode positions are often used in studies which require the recording of rest and exercise ECGs, whereby the arm electrodes are placed at the infraclavicular fossae and the left lef electrode on the left lower abdomen. The effect of the modified limb electrode positions on electrocardiographic waveforms was investigated in 68 supine adult male subjects at rest. The modification produced profound amplitude and waveform changes in the frontal plane ECG leads. The QRS axis shifted on the average by 16 degrees towards a more vertical position with considerable individual variation. Concomitant with the QRS axis shift, the R wave amplitude decreased in leads I and a VL and increased in leads II, III, and aVF. The S wave amplitude increased in leads III and aVF and decreased in lead III. The P and T wave amplitude changes were in a direction similar to those observed for the R waves: a reduction of the amplitude in aVL and an increase in II, III and aFV. Of importance to exercise ECG interpretation are the ST segment waveform changes: The ST slope decreased in aVL and increased in leads II, III and aVF. Waveform changes in the chest leads caused by the modification were less important although statistically significant. These systematic changes in recorded ECG waveforms arise from changes directions and strength of the lead vectors of the six frontal plane leads. Large inter-individual variations in the magnitude of the changes produced by modification of the limb electrode positions prevent effective systematic correction of the distortions by means of a universal lead transformation.

A Case of Mediastinal Teratoma

This paper concerns a patient with a teratoma in the upper part of the mediastinal septum which shifts upward and downward in the right side of the neck and infraclavicular fossa with respiratory movement. This patient was 2 months old when first seen in our clinic, at which time he had a history of wheezing starting around the 3rd day after birth. This symptom appeared to become worse with time and its cause was not confirmed. A mobile tumor appeared in the neck, accompanied by increased wheezing when the patient was 6 months old. It was a solid mass which disappeared into the infraclavicular fossa at the end of the expiratory phase and protruded at the end of the inspiratory phase. It was assumed that the wheezing and labored respiration were caused by the tumor pressing on the larynx and upper trachea. After a close observation period of several months, when the patient was one year old the tumor was surgically removed through an incision in the right lateral part of the neck and it was found to be a teratoma histo-pathologically.

GIANT LYMPH NODE HYPERPLASIA IN EXTRATHORACIC LYMPH NODES‐REPORT OF TWO CASES WITH A REVIEW OF THE LITERATURE

Two cases of giant lymph node hyperplasia occurring in extrathoracic regions are reported, one on the right side of the supra‐and infraclavicular fossa, pectoral muscle and axilla, and the other in the right groin. In both cases enlarged masses were removed several times having arisen from slow growing preexisting smaller masses. The histological features of all masses were identical, although removed at different times during the course of the disease. Both cases were characterized by marked proliferation of lymphoid follicles and capillaries, and infiltration of plasma cells. Fibrous thickening and hyalinization of the capillaries varied somewhat in severity from one case to the other. It is thought that the histogenesis of the lesion is related to chronic inflammation rather than to a hamartoma.

A note on the continuous humming murmur heard in the supra and infraclavicular fossae and over the manubrium sterni in children: Palmer, Robert S., and White, Paul D.: New England J. Med. 199: 1297, 1928

Hyperinflation in patients with severe COPD is associated with an increased anteroposterior (AP) rib cage diameter. We sought to determine whether bilateral lung volume reduction surgery (LVRS) affects bony thorax configuration.Prospective of clinical data collection before and after LVRS.Tertiary-care university medical center.We measured multiple AP and transverse thoracic diameters, by using plain chest roentgenograms (CXRs) in 25 patients (11 men, 14 women), and thoracic CT scans in 14 patients (7 men, 7 women), preoperatively and 3 months postoperatively. A subgroup of 7 patients (reference data) also had CXR thoracic diameter measurements made, using films obtained previously within a year of their presurgical evaluation. Another subgroup of 10 patients had CT scan measurements also made 12 months postoperatively.CXR dimensions were taken at the level of the manubrium sterni (M) and thoracic T7 and T11 levels. CT dimensions were taken at T4, T6, T8, and T10 levels. At each level, left (L), midsagittal (C), and right (R) AP and maximal transverse diameters were measured. The sum of the three AP diameters (Total) was used for calculations. Patients also underwent tests such as spirometry, lung volumes, diffusing capacity of the lung for carbon monoxide, 6-min walk distance (6MWD), and transdiaphragmatic pressures during maximum static inspiratory efforts (Pdimax sniff) measured before and 3 months after LVRS. Patients were (mean ± SD) 58 ± 8 years old, with severe COPD and hyperinflation (FEV1, 0.68 ± 0.23 L; FVC, 2.56 ± 7.3 L; and total lung capacity[TLC], 143 ± 22% predicted). After LVRS, AP diameters were reduced at thoracic level T7 (from 24.2 ± 2.0 cm to 23.3 ± 2.2 cm, p = 0.0002), and transverse diameters were reduced at T7 (from 26.8 ± 1.9 cm to 26.4 ± 1.7 cm, p = 0.001) and T11 (from 29.9 ± 2.2 cm to 29.5 ± 2.2 cm, p = 0.03), as measured using the CXR. In contrast, thoracic diameters were similar in subjects with CXRs before LVRS and within 1 year before evaluation. CT-measured AP diameters were significantly reduced 3 months after LVRS at T6, (from 48.8 ± 6.0 cm to 46.7 ± 5.4 cm, p = 0.02), T8 (from 54.2 ± 7.0 cm to 52.3 ± 6.5 cm, p = 0.004), and T10 (from 53.8 ± 7.5 cm to 51.2 ± 8.0 cm, p = 0.001), but not at T4. These AP diameter reductions directly correlated with the postoperative reductions in TLC and residual volume, and also with the increases in Pdimax sniff and 6MWD after LVRS. The reduction in AP diameters at thoracic levels T8 and T10 seen 3 months after LVRS remained stable at 12-month follow-up, whereas those measured at T6 lost statistical significance. CT-measured transverse diameters were unchanged at all levels after LVRS.We conclude that LVRS decreases mid-to-lower AP rib cage diameter as assessed by CXR and thoracic CT. Although transverse diameters were reduced on CXR, the magnitude was small and was not confirmed with CT. After LVRS, AP diameter reductions are most likely the result of reduction in lung volume, and they are associated with improvements in diaphragm strength and exercise endurance.

A Note on the Continuous Humming Murmur Heard in the Supra- and Infraclavicular Fossae and over the Manubrium Sterni in Children

A Note on the Continuous Humming Murmur Heard in the Supra- and Infraclavicular Fossae and over the Manubrium Sterni in Children