No description available.

No description available.

Hintergrund: Nach einer Sternotomie müssen die beiden Sternumhälften postoperativ wieder suffizient miteinander verbunden werden. Etablierte Sternum-Verschluss-Systeme fangen longitudinale Scherkräfte zwischen den beiden Sternumhälften nur eingeschränkt ab. Für die Entwicklung stabilerer Verschlusssysteme sind zusätzliche Informationen über die Sternumanatomie erforderlich. Methode: Single-Center Kohortenanalyse von Patienten, die sich einer Sternotomie für einen elektiven chirurgischen Eingriff unterzogen haben. Datengrundlage waren die präoperativ angefertigten CT-Thorax-Aufnahmen sowie der postoperative klinische Verlauf. Mittels definierter Messpunkte wurden Länge, Wölbung, Breite und Dicke des Sternums sowie die Ausdehnung der angrenzenden Rippen und Interkostalräume erfasst. Weitere statistische Untersuchungen umfassten die Suche nach Korrelationen der einzelnen Sternummesswerte untereinander, die Überprüfung möglicher Einflussfaktoren auf die Sternumausdehnung (Geschlecht, Körpergröße, Alter, COPD-Erkrankung, BMI) sowie das Auftreten einer sternalen Wundheilungsstörung. Ergebnis: Von insgesamt 120 Patienten lag eine CT-Bildgebung vor Sternotomie vor. Patienten mit vorbestehenden anatomischen Variationen und von einer longitudinalen medianen Sternotomie abweichendem Zugangsweg wurden ausgeschlossen, sodass 83 Patienten in die Analyse eingingen (51% weiblich; 73 ± 10 Jahre; 167 ± 9 cm). Aus jedem CT-Datensatz wurden 40 Messpunkte für jedes Sternum erhoben. Höhergradige Korrelationen der einzelnen Sternumparameter untereinander konnten nicht festgestellt werden. Den größten Einflussfaktor auf die Sternumanatomie stellt das Geschlecht dar. Körpergrößen-, alters- und gewichtsspezifische Modulationen der Sternumanatomie sowie ein Einfluss durch eine COPD-Erkrankung konnten nicht nachgewiesen werden. 5 Patienten (6%) entwickelten postoperativ eine oberflächliche oder tiefe Wundheilungsstörung. Eine Aussage über Anatomie-bedingte Risikofaktoren für eine postoperative sternale Wundheilungsstörung kann aufgrund der kleinen Fallzahl nicht gemacht werden. Schlussfolgerung: Die Größenausdehnung des Sternums in allen drei Raumebenen ist sehr individuell ausgeprägt. Die anhand der klinischen CT-Bildgebung erarbeitete Datenmatrix ist Grundlage für die Konfektionierung neuer Verschluss-Systeme für den operativen Sternumverschluss. / Objectives: After a sternotomy, both sternal halves must be fixed sufficiently to each other. Longitudinal shear forces between the sternal halves cannot be retained adequately by established sternal closure systems. For the development of more stable sternal closure systems, additional information about the sternal anatomy is required. Methods: Single-center cohort study of patients who underwent an elective surgical procedure with sternotomy. The data basis consisted of the preoperatively acquired CT-thorax- images and the postoperative clinical data. Length, breadth and thickness of the sternum, as well as the extent of the adjacent intercostal spaces and ribs were measured. These values are, henceforth, referred to as sternal values. Statistical analyses examining the correlations between the measured sternal values (between length and breadth, length and thickness, breath and thickness), testing of potential impact factors (gender, body height, age, obesity, COPD) on the physical sternal extent and occurrence of sternal wound healing disorders were performed. Results: CT-thorax-images were available for analyses from a total number of 120 patients, of which patients with preexisting anatomical variations, malformations, and deformations of the thorax or sternum and surgical approaches other than a medial sternotomy, were excluded. Thus, 83 patients were included (51% female, age: 73 ± 10 years; body height: 167 ± 9 cm). From every CT-thorax-dataset, 40 sternal values were determined, from which no strong correlations between those values were observed. The most important impact factor on the physical sternal extent was the gender of a person. An impact of body height, age, obesity and COPD could not be detected. 5 patients (6%) developed a sternal wound healing disorder. Due to this small number of cases, risk factors for postoperative sternal would healing disorders based on the sternal anatomy could not be evaluated. Conclusions: The sternal extent and constitution varies in a patient-dependent manner. Data obtained from CT-thorax-images, might serve as the basis for the development of new sternal closure systems in future.

"The development and clinical adoption of more effective fixation devices for re-approximating and immobilizing the sternum after open-heart surgery to enable bony healing has been limited, in part, by the lack of in vitro test methods used to evaluate these devices which precisely emulate in vivo loading of the sternum. The present study is an initial effort to determine the loading parameters necessary to improve current in vitro and numerical test methods by characterizing the direction, magnitude, and distribution of loading along the sternotomy midline in vivo using a porcine model. Changes in forces incurred by death and embalming were also investigated to estimate the applicability of cadavers as chest models for sternal fixation. Two instrumented plating systems were used to measure the magnitude, direction, and distribution of forces across the bisected sternum in four pigs during spontaneous breathing, ventilated breathing, and coughing for four treatments; live, dead, embalmed, and refrigerated. Forces were highest in the lateral direction and highest at the xiphoid. An important finding was that the magnitude of the respiratory forces in all directions was smaller than anticipated from previous estimations, ranging from 0.37 N to 43.8 N. No significant differences in force were found between the four treatments, most likely due to the very small magnitude of the forces and high variability between animals. These results provide a first approximation of in vivo sternal forces and indicate that small cyclic fatigue loads should be applied for long periods of time, rather than large quasistatic loads, to best evaluate the next generation of sternal fixation devices. "

Sternal malunion is a complication resulting in displacement of the sternal halves following open heart surgery. Currently, little is known about the effectiveness of alternative fixation systems under physiologically relevant loading scenarios. The goal of this study was to mechanically test several currently marketed sternal fixation devices and compare them to a prototype device in different loading conditions to simulate sitting up or breathing. Each system showed unique differences in cost, failure mode and efficiency; however, no statistical difference in failure load or displacement was observed between the testing groups.

It is now well established that certain chemical compounds, administered to animals in early pregnancy, can adversely influence the development of the fetus, resulting in congenital malformations. Recently, it bas been shown that thalidomide, a sedative drug, may induce skeletal defects in the offspring of treated females when administered in the early stages of pregnancy. McColl, Globus and Robinson (1963) reported that certain skeletal defects could be produced in the offspring of Sprague-Dawley rats following chronic oral administration of thalidomide. Notable among the defects produced were malfomations of the sternum. [...]

Thesis (M.S.)--California Polytechnic State University, 2010. / Title from PDF title page; viewed on May 15, 2010. Major professor: Lanny V. Griffin, Ph.D. "Presented to the faculty of California Polytechnic State University, San Luis Obispo." "In partial fulfillment of the requirements for the degree [of] Master of Science in Biomedical Engineering." "April 2010." Includes bibliographical references (p. 104-108).

Precise sexing–97% to 99% accuracy–of adult chest plates is possible when highly predictive costal cartilage ossification patterns are combined with four simple metric determinations. More than 1100 chest plate roentgenograms were evaluated for ossification pattern, fourth rib width, corpus width, sternal length and sternal area in an adult decedent population. An elementary, empirically obtained algorithm using the patternings and measurements, along with simple derivations (sternal length and area indices) was developed and then applied in chest plate sexing. This technique is not only easy, rapid and inexpensive, but it also results in a permanent and easily stored record.

No description available.

ABSTRAKT Bakgrund: Mediastinit är en allvarlig komplikation efter öppen hjärtkirurgi. Syftet med post- thorax västen är att förebygga och förhindra mediastinit genom att stötta upp instabilitet och minska friktion i sternum efter operation. Uttalade osäkerheter och brister i erfarenheter av att jobba med västen väckte författarnas intresse för att intervjua intensivvårdssjuksköterskor och sjuksköterskor om deras erfarenheter med att arbeta med post-thorax västen. Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av att vårda patienter som bar Post-thorax väst. Design: En kvalitativ intervjustudie Metod: Semistrukturerade intervjuer av 14 stycken grundutbildade och intensivvårdsutbildade sjuksköterskor som arbetade vid två enheter på ett sjukhus i Norra Sverige och hade mer än 6 månaders erfarenhet av att arbeta med västen. Intervjuerna analyserades genom en kvalitativ innehållsanalys. Resultat: Sjuksköterskors erfarenheter av att vårda patienter som burit Post-thorax väst resulterade i 4 kategorier och 13 subkategorier. Följande kategorier finns representerade: Ambivanlens, Säkerhet, Svårigheter, Motivation. Konklusion: Resultatet i studien visade att deltagarna hade varierande erfarenheter av att arbeta med patienter som bär väst. Deltagare utryckte svårigheter och fördelar med västen samt sin egen osäkerhet kring den. Deltagare ville ha utbildning och en utvärdering av västen och de beskrev motivationsarbetet och varför det är viktigt. Deltagarnas erfarenheter av patienternas upplevelser var något som genomsyrade alla kategorier. Resultatet kan tala för att implementeringen av västen på berörda enheter inte genomförts på ett optimalt sätt. / ABSTRACT Background: Mediastinitis is an infection in the mediastinum which can be a serious complication after open heart surgery. The purpose of the Post-thorax vest is to prevent mediastinitis by providing the required support to and minimize any friction within the sternum after heart surgery. There are outspoken uncertainties and gaps in the experience of working with the vest which aroused the interest of the authors to interview nurses and intensive care nurses about their experiences of working with the Post-thorax vest. Aim: The aim of this study was to investigate nurses’ experiences of working with patients who wear a Post-thorax vest. Design: A qualitative interview study Method: Semi-structured qualitative interview study of 14 nurses and intensive care nurses who worked at two units in the north of Sweden who had at least 6 months of experience working with the vest. The interviews were analyzed using content analysis. Results: Nurses’ experiences of working with patients who wore Post-thorax vests resulted in 4 categories and 13 sub-categories. The following categories are represented: Ambivalence, Security, Difficulties, Motivation. Conclusion: The result of the study showed that the participants had various experiences of working with patients wearing the vest. Participants expressed difficulties and benefits of the vest, and their own uncertainty about it. Participants wanted education and an evaluation of the vest and they described why motivational work was important. The participants described patients' experiences of the vest in almost every category. The result may indicate that the implementation of the vest at the units in question where not completed in an optimal way.