Of the 206 bones that compose an adult skeleton, only a select few are used in the estimation of sex and age. The best indicator of the sex of an adult skeleton is derived from several morphological features of the pelvis. In addition to the pelvis, characteristics of the sacrum, long bones, and skull have been used to estimate sex in adult remains. The most accurate indicators of age-at-death at the present time are related to features of the pubic bone, the auricular surface of the ilium, and the sternal end of the fourth rib. The current project assesses the utility of the sternum for estimating age and sex using two current methods. The two methods in question are those of Bongiovanni and Spradley (2012) for the estimation of sex and Sun et al., (1995) for the estimation of age. The data gathered at the Robert J. Terry Anatomical Skeletal Collection for this study is used to assess the validity and accuracy of the two different methods utilizing a North American population differing from that of Bongiovanni and Spradley (2012). Results showed a high congruence with the results of Bongiovanni and Spradley (2012) in which an overall classification rate of 81.1% was achieved. The cross-validation classifications for males and females were 79.9% and 83.6% respectively and an overall classification rate of 86.7% was achieved using total sternal length (TL). Results also demonstrate that the mean values of sternal index conform to Hyrtl's Law, however the range of values largely overlap, and demonstrates the law's unreliability for sex estimation. Results showed a lack of congruence with the Sun et al., (1995) method reaching a classification rate for exact age estimates of 14.4%. Overall, the utility of the human sternum for sex estimation seems promising and practically simple. The utility of the human sternum for age estimation merits further research into methods that might provide higher classification rates, however, at this time no methods seem worthwhile.

No description available.

La respiration est un phénomène vital qui implique une synergie entre diverses structures anatomiques qui constituent le thorax. La physiologie articulaire reste un parent pauvre de la physiologie et la littérature concernant la quantification de la cinématique 3D des articulations du thorax durant le mouvement respiratoire est rare. Ce travail se concentre sur le développement et l'application d'une méthodologie permettant de répondre à cet objectif. La méthode développée combine le traitement de données tomodensitométriques réalisées à trois volumes pulmonaires différents et des techniques d'infographies. Les amplitudes (ROMs) et axes de mouvements (axe hélicoïdaux moyen, AHMs) ont été obtenus au niveau des articulations costo-vertébrales de 12 sujets asymptomatiques. En résumé, les amplitudes diminuent graduellement dans les étages inférieurs ; le volume pulmonaire et l'étage costal influencent significativement les amplitudes costales ; l'orientation des AHMs ne diffère pas entre les étages costaux. En complément, la méthode a été appliquée pour un échantillon de 10 patients atteints de mucoviscidose. La condition pathologique influençait significativement les amplitudes de mouvements mais pas l'orientation des AHMs. Enfin, le déplacement sternal, les variations de l'angle sternal et la cinématique des articulations sternocostales a été analysée. Les déplacements angulaires des côtes par rapport au sternum diminuaient dans les étages inférieurs comme au niveau des articulations costo-vertébrales. L'orientation des AHMs des articulations sternocostales ne différait pas entre les étages. Une corrélation linéaire a été mise en évidence entre les déplacements verticaux du sternum et les amplitudes de mouvement costales au niveau costo-vertébral et sternocostal. Ce travail contribue de façon substantielle à la modélisation 3D du thorax humain durant le mouvement respiratoire d'un point de vue qualitatif et quantitatif / Breathing is a vital phenomenon that implies synergy of various anatomical structures that constitute the thorax. Joint physiology remains a relatively poorly-known component of the overall thorax physiology. Quantitative literature related to in vivo thorax kinematics during breathing is scarce. The present work focuses specifically on developing and applying a methodology to reach this goal. The developed method combined processing of CT data obtained at different lung volumes and infographic techniques. Detailed ranges of motion (ROMs) and axes of movement (mean helical axes, MHAs) were obtained at costovertebral joints in 12 asymptomatic subjects; rib ROMs gradually decrease with increasing rib number; lung volume and rib level have a significant influence on rib ROM; MHAs did not differ between rib levels. In addition, the method was applied on a sample of 10 patients with cystic fibrosis. The pathological condition significantly influenced CVJ ROMs while the orientation of the MHAs did not differ. Finally, the sternal displacement, sternal angle variations and sternocostal joints (SCJ at rib1 to 7) kinematics during breathing motion were analyzed. Rib ranges of motion relative to sternum decreased with increasing rib number similarly to CVJ. Orientation of the MHAs did not differ between SCJ levels. A significant linear correlation was demonstrated between sternum vertical displacement and rib ranges of motion at both CVJ and SCJ. The present work substantially contributes to 3D modelling of human thorax in breathing at a joint level both qualitatively and quantitatively

A transição cervicotorácica compreende a região anatômica que envolve as vértebras cervicais distais e as torácicas proximais. Durante a realização de abordagens cirúrgicas anteriores para tratamento de afecções que acometem as vértebras desta região, o esterno pode representar uma barreira mecânica. Assim, diversos métodos de programação pré-operatório foram propostos para avaliar a necessidade de osteotomias do esterno. Até a presente data, não existem trabalhos correlacionando as medidas com as variáveis sexo e idade. Nosso estudo envolveu a avaliação retrospectiva de 300 exames de tomografia computadorizada. Os pacientes foram separados de acordo com o sexo em dois grupos e de acordo com a faixa etária em 3 subgrupos. Os parâmetros estudados foram: nível horizontal em relação ao esterno (NHE), angulação do corpo (AC), nível discal (ND) e angulação do nível discal (AND). O NHE variou de C7 a T4, sendo mais frequente o nível T2 (34,3%). Os NHE menos frequentes foram T4 (0,3%) e C7 (1%). A AC e AND evidenciaram uma média de 18,51o e 19,63o, respectivamente. O AC variou de 1,29o a 54,32o, enquanto o AND variou de 0o a 49o. O ND variou de C5-C6 a T2-T3, sendo C7-T1 o ND mais frequente com 46%. O ND menos frequente foi encontrado nos níveis T2-T3 (1,7%) e C5-C6 (3%). Comparado o AND entre os grupos masculino e feminino, encontramos diferença estatística (p=0,003), sendo maior no grupo masculino. Houve diferença estatisticamente significante quando comparado os valores da AND entre os grupos etários (p=0,01). Com relação a AC, encontramos diferença estatística entre os grupos dos sexos masculino e feminino (p=0,02), sendo maior no grupo masculino. A comparação do AC entre os grupos de diferentes faixas etárias demonstrou uma diferença estatística (p=0,001). Não houve diferença quando comparados os resultados do NHE entre os grupos masculino e feminino (p=0,3), nem comparando valores de NHE entre as diferentes faixas etárias (p=0,79). O ND e NHE de nossa amostra da população brasileira apresenta valores menores quando comparados à outras amostras populacionais. O ND apresentou diferenças entre os grupos etários, sendo que quanto mais velho o grupo, menor eram os valores. Os nossos resultados evidenciaram que o nível discal mais distal acessível com a realização de abordagem anterior à região cervicotorácica da coluna vertebral, sem a teórica necessidade de uma osteotomia do esterno, apresenta valores menores quando comparados aos dados previamente relatados atribuídos a outras populações. Em outras palavras, este achado pode ser traduzido como se os pacientes envolvidos no estudo apresentassem um menor número de vértebras passíveis de serem abordadas por meio de procedimento cirúrgico anterior sem a realização de osteotomia do esterno. Desta forma, o mesmo raciocínio pode ser aplicado para o nível horizontal em relação ao esterno, pois nossos resultados apresentaram valores mais craniais, comparados aos resultados de estudos prévios. Além disso, o nível discal apresentou diferença quando comparamos os pacientes de diferentes faixas etárias, sendo que, quanto maior a faixa etária, menor foram os valores encontrados. Este achado representa uma migração para cranial do nível discal mais distal, conforme aumentamos a faixa etária dos pacientes estudados / The cervicothoracic transition comprises the anatomical region including the distal cervical and proximal thoracic vertebrae. While conducting anterior surgical approaches for treatment of conditions that affect the vertebrae in this region, the sternum may represent a mechanical barrier. Thus, various methods of preoperative programming have been proposed to assess the need for osteotomies of the sternum. To date, there are no studies correlating the measures with gender and age. Our study involved a retrospective review of 300 CT examinations. Patients were separated according to gender into two groups and according to age into 3 subgroups. The studied parameters were: horizontal level in relation to the sternum (LHS), vertebral body angle (VA), disc level (DL) and angulation of the disc level (ADL). The LHS ranged from C7 to T4, and T2 was the most frequent (34.3%). The less frequent LHS were T4 (0.3%) and C7 (1%). The AC and ADL showed an average of 18,51o and 19,63o respectively. The VA varied 1,29o the 54,32o, while the ADL varied from 0o to 49o. DL ranged from C5-C6 to T2-T3, being C7-T1 the most frequent (46%). The less frequent DL found were T2-T3 (1.7%) and C5-C6 (3%). Compared the ADL between male and female groups, we found statistically significant difference (p = 0.003), being higher in the male group. There was a statistically significant difference when compared the values of ADL between the groups (p = 0.01). Regarding VA, we found statistically significant differences between male and female groups (p = 0.02), being higher in the male group. Comparison of VA between groups of different age showed a statistically significant difference (p = 0.001). There was no difference when comparing the results of the LHS between male and female groups (p = 0.3), or comparing LHS values between the different age groups (p = 0.79). The DL and LHS in our sample of the population has lower values compared to other population samples. DL differ between age groups, and the older the group, the lower were the figures. Our results show that the most distal disc level accessible from an anterior approach to the cervicothoracic region of the spine, with no theoretical need for a sternal osteotomy, present lower values when compared to previously reported data assigned to other populations. In other words, this finding can be translated as if the enrolled patients presented fewer vertebrae that can be addressed through anterior surgical procedure without performing sternal osteotomy. Thus, the same thought can be applied to the horizontal level in relation to the sternum, since our results showed more cranial values compared to results of previous studies. In addition, the disc level was different when comparing patients of different age groups, and the higher the age, the lower were the values found. This finding represents a migration to the more distal cranial disc level, as we increase the age of the patients

I investigated the paired sternum V glands in thirty-eight trichopteran families and all lepidopteran families possessing the gland or associated structures. Using my morphological data and literature data on sternum V gland secretions, I examined phylogenetic trends in morphology and gland products and reconstructed ancestral states. I investigated correlations between gland products, between morphological traits and between chemistry and morphology. The gland is present in twenty-five trichopteran families. It is generally present in Annulipalpia, except Dipseudopsidae, and in Spicipalpia. It is widespread in Plenitentoria, but is often absent in Brevitentoria, especially in males. In Lepidoptera, I present the first report on the reduced, but functional glands in Neopseustidae and Nepticulidae. The gland is typically an invagination from sternum V with a duct leading to a reservoir surrounded by secretory tissue. An opening muscle inserts just inside the opening. I found two non-homologous opening-muscle types, one in Lepidoptera and some Trichoptera, another in the remaining Trichoptera. Muscle fibres often surround the reservoir, sometimes also the secretory tissue. Exceptions are found in Psychomyiidae (no opening muscle), female Philopotamidae (fenestra with separate glandular complex), Agathiphagidae (several unique features), Neopseustidae and Nepticulidae (gland present without gland opening). Using variations in gland structure, I identified phylogenetically useful characters from the superorder to the species level. The fenestrae in female Philopotamidae, Eriocraniidae, Neopseustidae and Nepticulidae are perforated, and perforated patches are present in female Psychomyiidae. The perforated patches are associated with a reservoir, secretory tissue and a distinctive sunburst musculature in both Trichoptera and Lepidoptera. The probable ancestral gland compounds are heptan-2-ol, 4-hepten-2-one, 4-hepten-2-ol, nonan-2-one, 6- nonen-2-one and 6-nonen-2-ol, making pheromone production a plausible ancestral function. The most widespread gland compounds are heptan-2-one, heptan-2-ol, nonan-2-one and nonan-2-ol, but these are absent from Apataniidae + Limnephilidae, which instead produce methylated 3-ketones and -ols, unique within Trichoptera. These compounds all probably function as pheromones. Both large and small glands in females can function in sex pheromone production, while large glands in male Hydropsyche (Hydropsychidae) are likely linked to male aggregation pheromone production. Relative sizes of regular gland reservoirs and fenestral gland reservoirs in female philopotamids suggest a complementary function. / Systematics and Evolution

No description available.

A transição cervicotorácica compreende a região anatômica que envolve as vértebras cervicais distais e as torácicas proximais. Durante a realização de abordagens cirúrgicas anteriores para tratamento de afecções que acometem as vértebras desta região, o esterno pode representar uma barreira mecânica. Assim, diversos métodos de programação pré-operatório foram propostos para avaliar a necessidade de osteotomias do esterno. Até a presente data, não existem trabalhos correlacionando as medidas com as variáveis sexo e idade. Nosso estudo envolveu a avaliação retrospectiva de 300 exames de tomografia computadorizada. Os pacientes foram separados de acordo com o sexo em dois grupos e de acordo com a faixa etária em 3 subgrupos. Os parâmetros estudados foram: nível horizontal em relação ao esterno (NHE), angulação do corpo (AC), nível discal (ND) e angulação do nível discal (AND). O NHE variou de C7 a T4, sendo mais frequente o nível T2 (34,3%). Os NHE menos frequentes foram T4 (0,3%) e C7 (1%). A AC e AND evidenciaram uma média de 18,51o e 19,63o, respectivamente. O AC variou de 1,29o a 54,32o, enquanto o AND variou de 0o a 49o. O ND variou de C5-C6 a T2-T3, sendo C7-T1 o ND mais frequente com 46%. O ND menos frequente foi encontrado nos níveis T2-T3 (1,7%) e C5-C6 (3%). Comparado o AND entre os grupos masculino e feminino, encontramos diferença estatística (p=0,003), sendo maior no grupo masculino. Houve diferença estatisticamente significante quando comparado os valores da AND entre os grupos etários (p=0,01). Com relação a AC, encontramos diferença estatística entre os grupos dos sexos masculino e feminino (p=0,02), sendo maior no grupo masculino. A comparação do AC entre os grupos de diferentes faixas etárias demonstrou uma diferença estatística (p=0,001). Não houve diferença quando comparados os resultados do NHE entre os grupos masculino e feminino (p=0,3), nem comparando valores de NHE entre as diferentes faixas etárias (p=0,79). O ND e NHE de nossa amostra da população brasileira apresenta valores menores quando comparados à outras amostras populacionais. O ND apresentou diferenças entre os grupos etários, sendo que quanto mais velho o grupo, menor eram os valores. Os nossos resultados evidenciaram que o nível discal mais distal acessível com a realização de abordagem anterior à região cervicotorácica da coluna vertebral, sem a teórica necessidade de uma osteotomia do esterno, apresenta valores menores quando comparados aos dados previamente relatados atribuídos a outras populações. Em outras palavras, este achado pode ser traduzido como se os pacientes envolvidos no estudo apresentassem um menor número de vértebras passíveis de serem abordadas por meio de procedimento cirúrgico anterior sem a realização de osteotomia do esterno. Desta forma, o mesmo raciocínio pode ser aplicado para o nível horizontal em relação ao esterno, pois nossos resultados apresentaram valores mais craniais, comparados aos resultados de estudos prévios. Além disso, o nível discal apresentou diferença quando comparamos os pacientes de diferentes faixas etárias, sendo que, quanto maior a faixa etária, menor foram os valores encontrados. Este achado representa uma migração para cranial do nível discal mais distal, conforme aumentamos a faixa etária dos pacientes estudados / The cervicothoracic transition comprises the anatomical region including the distal cervical and proximal thoracic vertebrae. While conducting anterior surgical approaches for treatment of conditions that affect the vertebrae in this region, the sternum may represent a mechanical barrier. Thus, various methods of preoperative programming have been proposed to assess the need for osteotomies of the sternum. To date, there are no studies correlating the measures with gender and age. Our study involved a retrospective review of 300 CT examinations. Patients were separated according to gender into two groups and according to age into 3 subgroups. The studied parameters were: horizontal level in relation to the sternum (LHS), vertebral body angle (VA), disc level (DL) and angulation of the disc level (ADL). The LHS ranged from C7 to T4, and T2 was the most frequent (34.3%). The less frequent LHS were T4 (0.3%) and C7 (1%). The AC and ADL showed an average of 18,51o and 19,63o respectively. The VA varied 1,29o the 54,32o, while the ADL varied from 0o to 49o. DL ranged from C5-C6 to T2-T3, being C7-T1 the most frequent (46%). The less frequent DL found were T2-T3 (1.7%) and C5-C6 (3%). Compared the ADL between male and female groups, we found statistically significant difference (p = 0.003), being higher in the male group. There was a statistically significant difference when compared the values of ADL between the groups (p = 0.01). Regarding VA, we found statistically significant differences between male and female groups (p = 0.02), being higher in the male group. Comparison of VA between groups of different age showed a statistically significant difference (p = 0.001). There was no difference when comparing the results of the LHS between male and female groups (p = 0.3), or comparing LHS values between the different age groups (p = 0.79). The DL and LHS in our sample of the population has lower values compared to other population samples. DL differ between age groups, and the older the group, the lower were the figures. Our results show that the most distal disc level accessible from an anterior approach to the cervicothoracic region of the spine, with no theoretical need for a sternal osteotomy, present lower values when compared to previously reported data assigned to other populations. In other words, this finding can be translated as if the enrolled patients presented fewer vertebrae that can be addressed through anterior surgical procedure without performing sternal osteotomy. Thus, the same thought can be applied to the horizontal level in relation to the sternum, since our results showed more cranial values compared to results of previous studies. In addition, the disc level was different when comparing patients of different age groups, and the higher the age, the lower were the values found. This finding represents a migration to the more distal cranial disc level, as we increase the age of the patients

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22646号 / 医博第4629号 / 新制||医||1044(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 篠原 隆司, 教授 松田 秀一, 教授 安達 泰治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: There are many factors are known to increase the risk of sternal wound infection (SWI), some studies have reported that nickel is a risk factor for SWI. Titanium wires have only been used as an alternative to steel wires in patients with known allergy to nickel. However, there is a paucity of literature regarding the safety of using titanium wires compared to that on the safety of steel wires for sternum closure after cardiac surgery. Therefore, this study aimed to demonstrate the non-inferiority of titanium wires, even in patients without a known allergy. Methods: A total of 322 Patients who underwent elective full median sternotomy were randomly assigned to sternal closure either by titanium wires (n=161) or by stainless steel wires. Results: 14 patients had sternal instability, six (3.7%) patients in the titanium group and eight (5%) patients in the stainless steel group (p = 0.585). There was no statistically significant difference between both groups in terms of postoperative wound infection (p=0.147). Patients in the titanium group experienced statistically significant lower postoperative pain than those in the stainless steel group (p = 0.024). The wire type was not an independent risk factor for SI, as shown by univariate and logistic regression analyses. Conclusion: Titanium wires are a good alternative and have been proven to be safe and effective for sternal closure. The surgeon should be aware of the possibility of developing an allergic reaction to the wires especially in patients with previous multiple allergic histories.:Table of Contents 1. Background 5 1.1. Anatomy of the sternum 5 1.2. Blood Supply of the Sternum 6 1.3. Basis and phases of acute Wound healing 7 1.4. Biomechanics of the sternum 7 1.5. Post-sternotomy complications 8 1.5.1. Dehiscence and sternal instability 8 1.5.2. Mediastinitis and Deep Sternal Wound Infection 10 1.5.3. Risk factors 12 1.5.4. Diagnosis 12 1.5.5. Bacteriology of Sterno-Mediastinal fluid and tissues 14 1.5.6. Osteomyelitis 14 1.6. Sternal fixation and Wiring Techniques 15 1.7. Overview of sternal closure techniques in Germany 16 1.7.1 Sternal closure Technique in Heart Center Dresden. 17 1.8. ASEPSIS SCORE 17 1.9. NICKEL Allergy/Suture materials and biocompatibility 19 1.10 Nickel allergy and cardiac surgery 20 1.11 Titanium Allergy 21 1.12. Pathophysiology of Metal Hypersensitivity Reactions 22 1.13. The hypothesis of the study 24 2. Materials and methods 25 2.1. Study Population 25 2.1.1. Inclusion criteria 25 2.1.2. Exclusion criteria 25 2.2. Intervention 25 2.3. Control 26 2.4. Outcome 26 2.5. Time 26 2.6. Sample Size calculation 26 2.7. Sternal closure technique 27 2.8. Handling of the wire 28 2.9. Blinding and randomization technique 29 2.10. Data collection and documentation 29 2.11. Statistics 29 3. Results 31 3.1. Preoperative parameters 31 3.1.1. Entire group 31 3.1.2. Group comparison 32 3.2. Intraoperative parameters 34 3.2.1. Entire group 34 3.2.2. Group comparison 34 3.3. Postoperative parameters 35 3.3.1. Entire group 35 3.3.2. Group comparison 36 3.4. Incidence of postoperative sternal instabilities 38 3.5. Univariate analysis 38 3.5.1. Pre-operative 39 3.5.2. Intra-operative 40 3.5.3. Post-operative 40 3.5.4. Statistically significant data 41 3.5.5. Descriptive presentation of the subgroup analysis (Sternal Instability, wire Classification) 41 3.5.6. Logistic regression 43 3.6. Summary / key result 44 4. Discussion 45 4.1. Sternal Instability 46 4.2. BMI “Obesity” 47 4.3. Wound Infection /ASEPSIS Score 48 4.4. Postoperative Pain 49 4.5. Type of the Wire 51 4.6. The Rising Potential Impact of Metal Hypersensitivity on other specialities 51 4.7. Limitation of the study 52 4.7. Conclusion 55 5. Summary 56 6. Zusammenfassung 58 7. List of figure 60 8. List of tables 60 Bibliography 64

Various skeletal abnormalities, including chest deformity, have been reported with Turner's syndrome. We report radiologic findings of the sternum on lateral chest roentgenograms in 15 children and adolescents with Turner's syndrome, whose ages ranged between 2 weeks and 20 years. Eight had associated congenital heart disease (CHD). Twelve patients (80 percent) had various sternal abnormalities; 5 had short sternum, 3 had premature fusion of the manubrio-sternal junction, and 4 had premature fusion of the mesosternum. Five had decreased ratio of sternal body to manubrium. Three patients had two ossification centers of the manubrium. Four patients had bowing of the mesosternum; three of these had mild pectus excavatum also. In this series, children with and without CHD had similar sternal abnormalities. Although not pathognomonic, sternal abnormalities on a lateral chest roentgenogram are common skeletal abnormalities associated with Turner's syndrome and are independent of associated CHD. In our series of 15 patients, 10 had monosomy (45,X) on blood karyotype; 7 of them had associated CHD. This is the first systematic analysis of radiologic abnormalities of the sternum in Turner's syndrome and includes findings not previously reported.