Deer antler extract potentially facilitates xiphoid cartilage growth and regeneration and prevents inflammatory susceptibility by regulating multiple functional genes.

BACKGROUND: Deer antler is a zoological exception due to its fantastic characteristics, including amazing growth rate and repeatable regeneration. Deer antler has been used as a key ingredient in traditional Chinese medicine relating to kidney and bone health for centuries. The aim of this study was to dissect the molecular regulation of deer antler extract (DAE) on xiphoid cartilage (XC). METHODS: The DAE used in this experiment was same as the one that was prepared as previously described. The specific pathogen-free (SPF) grade Sprague-Dawley (SD) rats were randomly divided into blank group (n =10) and DAE group (n =10) after 1-week adaptive feeding. The DAE used in this experiment was same as the one that was prepared as previously described. The rats in DAE group were fed with DAE for 3 weeks at a dose of 0.2 g/kg per day according to the body surface area normalization method, and the rats in blank group were fed with drinking water. Total RNA was extracted from XC located in the most distal edge of the sternum. Illumina RNA sequencing (RNA-seq) in combination with quantitative real-time polymerase chain reaction (qRT-PCR) validation assay was carried out to dissect the molecular regulation of DAE on XC. RESULTS: We demonstrated that DAE significantly increased the expression levels of DEGs involved in cartilage growth and regeneration, but decreased the expression levels of DEGs involved in inflammation, and mildly increased the expression levels of DEGs involved in chondrogenesis and chondrocyte proliferation. CONCLUSIONS: Our findings suggest that DAE might serve as a complementary therapeutic regent for cartilage growth and regeneration to treat cartilage degenerative disease, such as osteoarthritis.

Heterotopic Ossification of the Xiphoid After Chest Compressions.

This report describes the case of a 56-year-old woman with a 6-year history of severe epigastric pain after chest compressions for cardiac arrest. A comprehensive gastrointestinal workup was negative. However, an abdominal computed tomographic scan demonstrated an elongated xiphoid process. After a xiphoid trigger point injection, she experienced pain relief lasting 4 days, and thus her symptoms were attributed to xiphoidalgia secondary to heterotopic ossification after trauma. She underwent open resection of the xiphoid process. Heterotopic ossification of the xiphoid process is rare. This report documents a case of heterotopic ossification secondary to trauma from chest compressions.

Estudio de la anatomía quirúrgica del ángulo xifoideo / Study of the surgical anatomy of the xiphoid angles

Fundamento: una de las operaciones más laboriosas y complejas son las practicadas en el hiatus esofágico, para el tratamiento de la úlcera péptica y otras enfermedades, dada su localización anatómica y la necesidad de utilizar varios ayudantes en un campo quirúrgico reducido. Objetivo: definir las características anatómicas del ángulo xifoideo que permita diseñar un retractor quirúrgico a utilizar en esta región. Método: se realizó un estudio descriptivo y prospectivo, el universo se constituyó por doscientos dieciocho trabajadores del Hospital Universitario Manuel Ascunce Domenech de Camagüey, se escogió una muestra al azar de cien adultos. Se analizaron las variables biotipo, edad, sexo, peso, talla, medidas del ángulo xifoideo y ancho del apéndice xifoides. Resultados: el promedio de edad fue de 35,5 años; el peso promedio 64,8kg; la talla media fue 1,64m; el ángulo xifoideo 86,8º promedio; el ancho del apéndice xifoideo fue 1,82cm como promedio. Conclusiones: el ancho promedio del apéndice xifoides fue de 1,82cm(AU)

Background: one of the most laborious and complex surgical procedures are those practiced in the hiatus oesophageus, for the treatment of the peptic ulcer and other diseases, given their anatomical localization and the necessity to use several assistants in a reduced surgical field. Objective: to define the anatomical characteristics of xiphoid angles that allows designing a surgical retractor to use in this region. Method: a descriptive and prospective study was carried out, the universe was constituted by two-hundred eighteen workers of the University Hospital Manuel Ascunce Domenech of Camagüey, a random sampling of one-hundred adults was chosen. Variables like biotype, age, sex, weight, height, measures of xiphoid angles and width of the xiphoid appendix were analyzed. Results: the average age was of 35,5 years; the average weight of 64,8 Kg; the average height was of 1,64m; the average xiphoid angle 86,8º; the width of xiphoid appendix was 1,82cm as average. Conclusions: the width average of xiphoid appendix was 1,82cm(AU)

Estudio de la anatomía quirúrgica del ángulo xifoideo / Study of the surgical anatomy of the xiphoid angle’s

Fundamento: una de las operaciones más laboriosas y complejas son las practicadas en el hiatus esofágico, para el tratamiento de la úlcera péptica y otras enfermedades, dada su localización anatómica y la necesidad de utilizar varios ayudantes en un campo quirúrgico reducido. Objetivo: definir las características anatómicas del ángulo xifoideo que permita diseñar un retractor quirúrgico a utilizar en esta región. Método: se realizó un estudio descriptivo y prospectivo, el universo se constituyó por doscientos dieciocho trabajadores del Hospital Universitario Manuel Ascunce Domenech de Camagüey, se escogió una muestra al azar de cien adultos. Se analizaron las variables biotipo, edad, sexo, peso, talla, medidas del ángulo xifoideo y ancho del apéndice xifoides. Resultados: el promedio de edad fue de 35,5 años; el peso promedio 64,8kg; la talla media fue 1,64m; el ángulo xifoideo 86,8º promedio; el ancho del apéndice xifoideo fue 1,82cm como promedio. Conclusiones: el ancho promedio del apéndice xifoides fue de 1,82cm.

Background: one of the most laborious and complex surgical procedures are those practiced in the hiatus oesophageus, for the treatment of the peptic ulcer and other diseases, given their anatomical localization and the necessity to use several assistants in a reduced surgical field. Objective: to define the anatomical characteristics of xiphoid angle’s that allows designing a surgical retractor to use in this region. Method: a descriptive and prospective study was carried out, the universe was constituted by two-hundred eighteen workers of the University Hospital Manuel Ascunce Domenech of Camagüey, a random sampling of one-hundred adults was chosen. Variables like biotype, age, sex, weight, height, measures of xiphoid angle’s and width of the xiphoid appendix were analyzed. Results: the average age was of 35,5 years; the average weight of 64,8 Kg; the average height was of 1,64m; the average xiphoid angle 86,8º; the width of xiphoid appendix was 1,82cm as average. Conclusions: the width average of xiphoid appendix was 1,82cm.

Subxiphoid surgical approach for epicardial catheter-based mapping and ablation in patients with prior cardiac surgery or difficult pericardial access.

BACKGROUND: Percutaneous epicardial mapping and ablation are successful in some patients with ventricular epicardial reentry circuits but may be impossible when pericardial adhesions are present, such as from prior cardiac surgery. The purpose of this study was to evaluate the feasibility of direct surgical exposure of the pericardial space to allow catheter epicardial mapping and ablation in the electrophysiology laboratory when percutaneous access is not feasible. METHODS AND RESULTS: In 6 patients with prior cardiac surgery or failed percutaneous pericardial access, a subxiphoid pericardial window was attempted. In all 6 patients, manual lysis of adhesions exposed the epicardial surface of the heart through a small subxiphoid incision and allowed placement of an 8F sheath into the pericardial space under direct vision. Access to the diaphragmatic surface of the heart with ablation catheters was achieved in all patients, and catheter manipulation to the lateral and anterior walls was possible in 4 patients. Three-dimensional electroanatomic voltage maps revealed low-amplitude regions in the inferior or posterior left ventricular epicardium. A total of 16 ventricular tachycardias were induced, and 14 were abolished by radiofrequency ablation. Ablation was limited by intrapericardial defibrillator patches adherent to the likely target region in 2 patients. All patients had chest pain consistent with pericarditis early after the procedure that resolved within a few days. There were no other complications. CONCLUSIONS: A direct surgical subxiphoid epicardial approach in the electrophysiology laboratory is feasible for patients with difficult pericardial access who require ablation of epicardial arrhythmia foci.

Subxiphoid pericardial window for pericardial effusion in end-stage renal disease.

Fifty-seven patients with end-stage renal disease who were on maintenance dialysis underwent pericardial fluid drainage surgically between January 1980 and December 1991. All patients had echocardiographically proven pericardial effusion of more than 300 to 500 mL. Seven patients had pericardiectomy by left thoracotomy under general anesthesia in the first 2 years. Subsequently, 50 patients underwent a subxiphoid pericardial window by a left subcostal incision. A pericardial drainage tube was inserted at surgery and removed after 4 to 5 days. All but five patients undergoing subxiphoid pericardial window surgery received local anesthesia. The xiphoid process was not resected during surgery and steroids were not instilled in the pericardial cavity. There were minimal complications, no surgery-related deaths, and no recurrence of fluid in patients after pericardial window surgery. With our present experience, we advise a subxiphoid pericardial window with pericardial drainage under local anesthesia for all end-stage renal disease patients on dialysis who have a symptomatic or large pericardial effusion of more than 300 to 500 mL. Steroid instillation is not necessary for the prevention of recurrence of effusion.

Subxiphoid anterior mediastinal exploration.

A new surgical technique for anterior mediastinal exploration is described. The technique involves application of a Carlens mediastinoscope by means of a subxiphoid incision. The procedure provides complete exploration of the anterior mediastinal compartment and allows the surgeon to obtain a positive biopsy of the tumor or its lymph node metastases without sternotomy.

Sutureless epicardial pacemaker lead: a satisfactory preliminary experience.

The first pacemaker systems used the epicardial electrode. The transvenous endocardial electrode rapidly supplanted the epicardial electrode since it could be positioned with less morbidity and mortality and was associated with a lower incidence of wire breakage. The long term complication rate of the transvenous electrode had not been inconsequential. The sutureless epicardial electrode combines the greater reliability of the epicardial lead system with the ease of insertion and low morbidity of the endocardial lead system. We have used this electrode in 33 patients. The electrode was positioned using the subxiphoid approach and local anesthesia in most patients. There have been few complications and none that resulted in long term morbidity. There have been no deaths related either to the operative approach or to the pacing system. There has been no instance of lead failure during the follow-up period.