Intercostal Area Research Articles

One stage single port bilateral sympathectomy for palmar hyperhidrosis trans-axillary versus midclavicul arapproache

Objective :, video-assisted thoracoscopicsympathectomy had proven as a safe, minimally invasive process for palmar, axillary hyper-hidrosis. Our look at will speak the successful bilateral unmarried port sympathectomy as opposed to bilateral trans axillary unmarried-port video assisted thoracoscopicsympathectomy.METHODS:Cases underwent up information accumulated, analyzed in Zagazig University, king Khalid health center Najran KSA among December 2017, April 2021. .In our approach all cases inside the supine function with arms lightly kidnapped underwent endoscopic technique treatment thru 3cm incision inside the areola just underneath the nipple in case, 3cm sub mammary incisions incase inside the line, the thoracic hollow space became approached thru the fourth intercostal area. In institution B the sufferers had placed in lateral decubitus function. A unmarried 2-cm lengthy transverse axillary incision turned into made in the fourth intercostal area.Results:There became exceedingly statistically enormous difference among the 2 studied companies as regard imply operative time it become forty eight.2±nine.6 in institution A, 60.3±10.Four in organization B. There become no statistically good sized difference between the 2 studied agencies as regard submit-operative observe up information such as postoperative pain,compensatoryhyperhydrosis,or worsening of the circumstance. There changed into no statistically sizable difference between the two studied businesses as regard different publish-operative headaches inclusive of residual pneumothrax segmental fall apart horners syndrome residual shoulder ache There became huge difference in,superb wound restoration, higher beauty apearence.Conclusion:.Bilateral mid clavicular one-staged video-assisted thoracoscopicsympathectomies had much less operative time less submit-operative difficulty within the shape of much less contamination, pneumothorax, fall apart.

Imaging evaluation of continuous extrapleural intercostal nerve block for minimally invasive cardiac surgery: a case report

BackgroundSpinal nerve block is difficult with minimally invasive cardiac surgery (MICS), because of the risk of serious bleeding complications due to full heparinization. Continuous extrapleural intercostal nerve block (CEINB) is a postoperative pain treatment for intercostal thoracotomy, with fewer complications. Here, we report a case in which imaging evaluation of CEINB with contrast medium was conducted to anatomically confirm the spread of local anesthetics after MICS.Case presentationA 65-year-old woman with severe mitral regurgitation underwent mitral valve plasty under general anesthesia via right-sided mini-thoracotomy. A CEINB catheter was placed before the incision was closed, without creating a conventional extrapleural pocket. We conducted an imaging evaluation with a contrast medium via the inserted catheter and confirmed sufficient spread around the intercostal nerve area. In addition, postoperative pain was well controlled by the nerve block.ConclusionsImaging evaluation of CEINB with contrast medium could increase analgesic quality and decrease complications post-MICS.

ANALYTICAL MANUAL TRAINING TECHNIQUES FOR M. SERRATUS ANTERIOR

In manual healing massage techniques and kinesitherapy analytical exercises, there is no complete information on the targeted effects on separate parts of the m.serratus anterior. It is a protractor, a blade abductor, a helping muscle in the inspiratory breathing movements and participates in the training of the pectoral muscles. Its complex function defines it as muscle, which should be emphasized in shoulder girdle disease, postural abnormalities, pulmonary diseases, peripheral nerve damage, etc. Based on a study of the various techniques available for stretching, healing massage and analytical training, we offer a complex impact on m.serratus anterior. To perform the techniques, we use a tool to work on the muscles around the blade. М..serratus anterior has three parts: m.serattus anterior superior, m.serratus anterior intermedius et inferior. The fibers of the lower part are directed medial-caudal position, the fibers of the middle part are located more horizontally and the upper part moves in the medial direction towards the collarbone. The location of the individual parts and fibers helps to target the muscle. The healing massage methodology includes the following techniques: crunching is available for the serratus anterior muscle. For its crushing, the patient is in a lateral lying position, his arm is lifted and placed behind the head that opens the axillary well. The masseur is behind the patient's back. The well-defined muscles are treated with a pinching technique. In poorly expressed hypotrophic muscles, it is crushed by pressure on the ribs with the cushions of the spread fingers in the intercostal area. The innervation of the muscles starts with roots С5,6,7 , n.thoracicus longus which ends in the axilla under the medial third of v.axillaris and goes down along the serratum anterior muscle of the chest. To perform a therapeutic effect on the individual parts of the muscle, we instruct the patient to perform analytical exercises at the same time and then perform an autostretching at the time the therapist uses the muscle-processing tool. We urge the patient to perform inspiration to activate muscle function. Inspiratory muscle training is used to better strengthen the muscle.

Cholecystocutaneous fistula through the intercostal area: a rare and forgotten entity

Cholecystocutaneous fistula through the intercostal area: a rare and forgotten entity

Post-mortem computed tomography angiography using left ventricle cardiac puncture: A whole-body, angiographic approach.

Post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) are rapidly becoming effective and practical methods in forensic medicine. In this article, the authors introduce a whole-body PMCTA approach involving left ventricle cardiac puncture. This procedure was performed in 9 males and 3 females. PMCT was performed first. Then a biopsy core needle was used for a percutaneous puncture into the left ventricle through the intercostal area under CT guidance. 1000 mL of contrast media (diatrizoate meglumine and normal saline [0.9%] at 1:2 ratio) was injected at a rate of 50 mL/8 s, followed by CT scan. Visualization of systemic arteries was achieved in 11 cases, while only partial visualization was achieved in 1 case, which may have been related to incomplete thawing of the cadaver. PMCTA results revealed no vascular diseases and abnormalities in 10 victims. Among the 10 victims, 4 post-scan autopsies were performed and found no vascular abnormalities, consistent with the PMCTA results. Autopsy of the other 6 victims were refused by the relatives. PMCTA revealed signs of internal carotid artery aneurysm inside the sphenoid sinus in one victim, which was confirmed by autopsy. PMCTA results of another victim showed signs of stenosis and blockage of the distal part of the right vertebral artery and basilar artery. Thromboembolism of those arteries was found during autopsy. Compared with other existing PMCTA methods for examination of vascular injuries and diseases, this technique involves simple procedures, is less time consuming, has lower associated costs, does not require specialized equipment, provides adequate imaging quality, and is suitable for centres not equipped with cardiopulmonary bypass machines or other specialized equipment.

Correct Examination of Pancreas with Ultrasonography

Well visualization of pancreas with ultrasonography is difficult due to its location and overlying stomach and bowel. For correct examination, patient visit clinic with overnight fasting or over 8 hours fasting state and avoid smoking or chewing gums. Most common interfering factor for examination of pancreas with ultrasonography is gas in stomach. To avoid interference with gas, we use some methods (compression, position change, water ingestion). Pancreas is not seen totally in one view. So transverse and longitudinal scan with obligue scan is recommended. Trans-splenic scan at left intercostal area is also useful for visualization of tail of pancreas. Vascular landmarks are also important for correct examination of pancreas. Pancreas ultrasonography can be used for detecting lesions, but pancreas can be poorly visualized due to all efforts. At then abdominal computed tomography or magnetic resonance imaging is recommended for better evaluation. At this article, we will discuss correct examination of pancreas with ultrasonography for better visualization. Keywords: Pancreas; Ultrasonography; Gas; Correct examination 중심 단어: 췌장; 초음파; 가스 및 í•´ê²°ì± ; ì œëŒ€ë¡œ 검사하기

Koroner arter cerrahisi uygulanan hastalarda kullanılan drenaj tüpü tiplerinin ve uygulanma yerlerinin ameliyat sonrası dönemde ağrı ve efüzyon üzerine etkisi

Objective: The study was done to determine the effect of different types of drain to postoperative effusion and pain on patients who enderwent coronary artery bypass grafting (CABG). Material and Methods: 50 patients data were evaluated prospectively. Standart drain was placed into 7-8th intercostal area (Group 1). L drain was placed into pleural area (Group 2). Demographic data, drainage amounts were written from hospital documents. Postoperative phericardial and pleural effusion was determined by echocardiography and chest x-ray. Verbal Rating Scale was used to dedicate pain score. Data were analyzed by T test. Results: Groups demographic data were similar. Drainage was 652.0±328.3 ml (Group 1), 620.0 ± 169.5 ml (p=0.04) in Group 2. Pain score before taking of drain was 2.0±2.6 (Group 1), 1.0±1.6 (p=0.01) in Group 2, after taking of drain was 4.7±3.0 (Group 1), 2.1±2.0 (p=0.05) in Group 2. Fifteen day mean phericardial effusion was 0.2±0.4 cm (Group 1), 0.1±0.3 (p=0.05) in Group 2. There was no difference between other parameters. Conclusion: Using both types of drain seems to be safe but L drain is more comfortable because of less pain.

The combination of percutaneous transapical and transseptal closure of cardiac apex and prosthetic mitral paravalvular leak with loop technique

Article history: Received 11 October 2015 Accepted 18 October 2015 Available online 19 October 2015 Firstly, we decided to try the percutaneous transapical approach with a needle without left minithoracotomy. Under general anesthesia, we performed coronary angiography in order to not puncture the left anterior descending artery in apical region (Fig. 2). After that, under TEE and fluoroscopic angiographic guidance, transapical cannulation of the left ventricle from the sixth intercostal area and midclavicular region with a needle was performed and a 6 F sheath was inserted to

The Rare Presentation of Extraskeletal Ewing's Sarcoma on the Forehead.

The Rare Presentation of Extraskeletal Ewing's Sarcoma on the Forehead.

Isolated interrupted aortic arch in adulthood

A 5-year-old man presented to our hospital with the complaints of dyspnea and chest pain during exercise over  months. He had a history of hypertension for several years, which had been kept under control with nifedipine plus valsartan. In addition, he had a hemorrhagic stroke 2 years earlier but he had no physical limitations. However, he had not undergone a complete evaluation at that time. His brother died at 41 years of age of myocardial infarction. On physical examination, peripheral pulses were palpable over the carotid arteries and in the upper limbs, with a radial pulse stronger in the right arm than in the left arm. Bounding pulses in the neck were also detected. The blood pressure was 135/70 mmHg in the right arm and 95/0 mmHg in the left arm. Lower limb pulses were not palpable. There was 2/ systolic ejection murmur on the second intercostal area at the left. A chest x-ray demonstrated cardiomegaly and increased vascularity. Transthoracic echocardiography from parasternal and apical views showed concentric hypertrophy and moderate aortic regurgitation, but a satisfactory image could not be obtained from the suprasternal view because of poor image quality. During cardiac catheterization, the guidewire did not pass beyond the proximal part of the descending aorta. Aortography via the femoral artery showed a complete interruption of the aortic arch just distal to the origin of the left subclavian artery (. Fig. 1a). We inserted a pigtail catheter distal to the subclavian artery via the right brachial artery and we could e-Herz: Case study

What Else Is Back There?

t e p t m a n p p m s t m c PRESENTATION Chronic back pain is a condition often seen by the internist and rarely requires further testing. When pain is intractable, however, other rare potential causes may need to be evaluated. A 47-year-old Caucasian man with history of chronic back pain presented to our facility for evaluation of suddenonset, severe, mid-thoracic back pain that radiated around to his chest and was worsened by any movement. No trauma was associated with the pain, which had started the previous day. He had experienced a similar pain episode 3 months previously and had been evaluated by a chiropractor, who determined the cause to be musculoskeletal. The pain had resolved with physical therapy. The patient denied any constitutional symptoms, chest pain, shortness of breath, limb weakness, paresthesias, numbness, or bowel or bladder dysfunction. No other significant past medical or family history was noted. He denied any alcohol, tobacco, or illicit drug use.

Perkütan Karaciğer Biyopsileri: Güvenilirlik ve Etkinlikleri

Objective: The aim of this study was to evaluate effecacy and safety of percutaneous liver biopsy performed under the assistance of ultrasonography in diffuse liver disease. Material and Methods: This was a retrospective study. We evaluated the ultrasound-assisted liver biopsy procedures of 784 patients which were performed in an outpatient setting between October 2001 and July 2008. The liver biopsies were performed following one-night fasting using disposable Menghini-type suction needles (16 gauge) after marking the best seen part of the best-thickest liver part distant from the adjacent organs. Liver portion suitable for biopsy was marked in the intercostal area by the use of ultrasonography and performed by an experienced gastroenterologist. After the biopsies, the vital signs of all patients were monitored for 6-8 hours. The patients without any problems were discharged on the same day. The shapes, sizes and number of the biopsy specimens were recorded, and then they were sent to the pathology department for histolopathological examination. The next day, control ultrasounds of all patients were performed. Results: Macroscopically adequate tissue was obtained in 780 cases (99.5%) with a mean tissue length of 15.5 mm. In 755 patients (96.4%), adequate tissue sample was obtained after one pass. After the procedure, severe pain requiring analgesia was seen in 13 patients (1.6%). There was no complication requiring hospitalisation. Major complication requiring intervention occurred in only one patient with chronic renal failure undergoing hemodialysis (0.12%). There were no deaths resulting from liver biopsies. Conclusion: According to the results of our series, we conclude that routine ultrasound of the puncture site is a quick, effective and, safe procedure. The complication rate is very low. The ultrasound assisted percutaneous liver biopsy modality should be used to all cases.

Use of ultrasonography to diagnose large colon volvulus in horses

To describe the use of ultrasonography to diagnose large colon volvulus (LCV) in horses. Descriptive report. 4 horses with clinical signs of abdominal pain. Each horse was administered analgesic agents for pain control and placed in stocks. Ultrasonographic evaluations were performed with a 3.5-MHz sector scanning transducer that was placed parallel to the long axis of the horse (longitudinal imaging) over an area of the left ventral aspect of the abdomen. The boundaries of the evaluated region included the ventral midline, 2 vertical lines at the level of the left 10th and 17th intercostal spaces, and a horizontal line between the 2 vertical lines at the level of the costal arch of the left 10th intercostal area. In all horses, nonsacculated large colon was identified ultrasonographically in the left ventral portion of the abdomen; this finding was considered indicative of LCV. In 3 horses, the LCV involved intestinal rotation of 180 degrees, whereas in 1 horse, the LCV involved intestinal rotation of 540 degrees. As confirmed by surgical or postmortem findings, the degree and location of the volvulus were correctly estimated from ultrasonographic images. In horses, this method of diagnosis of LCV appears to be of value regardless of the location at which the rotation of the large colon occurs. Ultrasonographic findings may aid in the earlier diagnosis of LCV in horses, especially at an early stage of the disease when other clinical signs are equivocal.

Temporal analysis of the depolarization wave of healed myocardial infarction in body surface potential mapping.

We studied the ability of different time segments of the depolarization wave recorded with body surface potential mapping (BSPM) to detect and localize myocardial infarction (MI). BSPM was recorded in 24 patients with remote MI and in 24 healthy controls. Cine and contrast-enhanced magnetic resonance imaging (MRI) was used as a reference method. Patients were grouped according to anatomical location of their MI. The QRS complex was divided into six temporally equal segments, for which time integrals were calculated. The time segments of the QRS complex showed different MI detection capability depending on MI location. For anterior infarction the second segment of the QRS complex was the best in MI detection and the optimal area was on the right inferior quadrant of the thorax (time integral average -1.5 +/- 1.8 mVms patients, 1.0 +/- 1.6 mVms controls, P = 0.002). For lateral infarction the first segment of the QRS complex performed best and the optimal area for MI detection was the left fourth intercostal area (time integral average 1.8 +/- 1.0 mVms patients, 0.7 +/- 0.5 mVms controls, P = 0.024). For inferior and posterior MI the mid-phases of the QRS complex were the best and the optimal area was the mid-inferior area of the thorax (time integral average -6.2 +/- 8.3 mVms patients, 3.3 +/- 4.3 mVms controls, P = 0.002; -9.1 +/- 6.1 mVms patients, 0.6 +/- 7.1 mVms controls, P = 0.001, respectively). Time segment analysis of the depolarization wave offers potential for improving the detection and localization of healed MI.

Arquitectura foliar de tres géneros monotípicos sudamericanos de Fabaceae

The leaf architecture of Tipuana Benth., Cascaronia Griseb. and Bergeronia Micheli, is described and compared, evaluating the importance of these foliar characters in their taxonomy. Each genus presents characters that allow their differentiation: in Tipuana tipu  (Benth.) Kuntze, the basal pairs of secondary veins have an eucamptodromous model, with simple intersecondary veins which move through the intercostal area towards the margin; the last marginal venation is looped. In Cascaronia astragalina Griseb., secondary veins have capillary thickness and the last marginal venation is incomplete. In Bergeronia sericea Micheli, there are abaxial prominent secondary veins, and tertiary veins emerging in rigth angles; the last marginal venation is fimbrated. The venation characters observed are similar to those previously cited for different genera of Dalbergieae and some cited in other tribes of Papilionoideae. However, they cannot define, for themselves, the taxonomic position of the three genera and must be considered together with other morphological and reproductive structures.

FITC‐dextran for measuring apoplast pH and apoplastic pH gradients between various cell types in sunflower leaves

The liquid in the free space of leaf cell walls, the apoplast, is in direct contact with the plasma membrane and its nutrient uptake systems. Therefore, the pH of the apoplast is of utmost interest. We have elaborated a non‐destructive method by which excised sunflower leaves (Helianthus annuuscv. Erika) were perfused with fluorescein isothiocyanate‐dextran (FITC‐dextran) (4 000 Da) via the transpiration stream. We showed that leaf apoplast pH can be measured by using the fluorescence ratio technique together in conjunction with this dye. Evidence is provided that FITC‐dextran does not penetrate the plasma membrane over a period of ca 17 h from the beginning of dye perfusion. Dye enrichment in the leaf apoplast did not cause an ‘inner filter effect’ and thus the fluorescence ratio was only dependent on pH. In vivo calibration yielded a pKa of 5.92, which was virtually identical to the pKa of 5.93 calculated for dye solutions. Hence, FITC‐dextran can be detected in complex environments and covers a pH range prevailing in the leaf apoplast.Based on this method we developed a microscope image technique visualizing pH gradients between various cell types. The pH in the lumen of the xylem vessel was ca 0.3–0.5 units lower than that of the apoplast of surrounding cells. Nitrate present in the leaf apoplast caused an increase in pH, especially in the dark. Under these conditions, in the intercostal area, the apoplast pH around the stomata was ca 0.5–1.0 units higher than that of the surrounding epidermal cells.

An approach to automation of pork grading

In commercial pork grading practice, a government inspector inserts an approved grading probe into a designated spot on the back of a suspended carcass that is moving on an overhead conveyor in an abattoir. The spot is at 7 cm from the split edge of the carcass, in the intercostal area between the last third and the fourth ribs. The probe is inserted once on every carcass, at the rate of 800 carcasses/hour, in a medium sized abattoir. The work presented herein, describes an attempt to automate this labor intensive process.

Ultrastructure of Ascus, Ascospore and Ascocarp in Neurospora lineolata

SUMMARYAscospores of Neurospora lineolata develop from initials which are surrounded by a double membrane. The ascospore wall forms between the two membranes and consists at maturity of three components—a primary, thin and electron-transparent, a secondary thick, and a tertiary thin layer. The secondary rib-vein layer is made of electron-dense material in the costal and electron-transparent material in the intercostal regions. The germ pore is covered by the primary layer and situated in an intercostal area where the thickness of the secondary wall is greatly reduced. The protoplasm of the mature spore contains one or more nuclei and large lipid inclusions. The ascus wall appears essentially single layered. The apex of the ascus is characterized by a somewhat thickened wall which extends into a short cylinder or ring of wall-like material. The epiplasm of the ascus appears to vacuolate by dilations of cisternae of the endoplasmic reticulum. The ascocarp consists of three distinct layers. The two outer layers are richly endowed with lipid granules and other storage material, and also contain microbodies. The paraphyses remain throughout development but their walls drastically swell and fuse thus filling the perithecial cavity with a mass of mucilagenous material.