The purpose of this paper is to discuss sternal instability a problem occasionally associated with midline sternotomy, including the etiology, predisposing conditions, diagnosis and management. Among the methods of repair, sternal weaving and pectoralis muscle advancement are thought to be especially effective.

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Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

Skeletonized and semiskeletonized ITA harvesting techniques caused a similar acute reduction in sternal perfusion during the early postoperative period and this effect lasted for at least 5 hours.

PURPOSE:We seek to describe our experience with reverse end-to-side (RETS) transfer of the spinal accessory (SAN) to the suprascapular (SSN) nerve in the reconstruction of brachial plexus birth injury (BPBI). METHODS:Retrospective review was performed from 2016-2020 to identify BPBI patients who underwent RETS transfer of SAN to SSN. Intraoperative images were reviewed, assessing proximity of SAN to SSN, as well as the relative diameter of the two nerves. Early outcomes were reviewed. RESULTS:Seven patients underwent RETS transfer of SAN to SSN. Mean age at operation was 10.8 ± 4 months. Intraoperative image review demonstrated close proximity of the distal SAN to the distal SSN in all cases. Diameter discrepancy between the SAN and SSN was recorded. RETS transfer of the SAN to the SSN was performed without tension in all 7 cases. No donor morbidity was noted in any patient. Concurrent Botox administration was performed in all cases. Average follow-up after reconstruction is 9.7 ± 10 months.All patients have demonstrated some degree of SSN functional recovery. At most recent follow up, 5 out of 7 patients demonstrate full passive ER; the two remaining are to 80 and 60 degrees. Evidence of early recovery of active external rotation has been observed in all patients.CONCLUSION: RETS transfer of the SAN to the SSN demonstrates potential to augment recovery of the SSN in the setting of neuroma-in-continuity. The technique provides an option for management of neuroma-in-continuity without a downgrade in function and without significant donor site morbidity.

Background. Studies of the cardiovascular system originated in the 60s of the last century, including the work of P. O. Astrand, according to which, with extreme functional loads (FL), accompanied by maximum heart rate, stroke volume (SV) decreases. The study of the mechanism of this effect requires the use of a complex of electro- and echocardiographic methods. The purpose of this work is to determine the dependence of electrocardiographic and echocardiographic parameters on cardiotype and physical activity. Material and methods. The study involved 30 males aged 18 to 32 years. Based on the heart rate indicators in the controls, which were determined by the electrocardiogram (ECG), the participants were divided into three groups: bradycardia (9 people) – 60 or less beats/min, normocardia (9 people) – 61-80 beats/min, tachycardia (12 people) – more than 80 beats/min. The indicators were taken in the standing position (controls) and after exercise (experimental group) – squats (according to Martine) in combination with an arbitrary cessation of external respiration on inspiration (according to Stange) as long as one could. Results. The lower was the heart rate, the greater was the total volume of the transmitral blood flow. With an increase in electrical diastole (TR segment), myocardial excitability decreased. With FL, this dependence persisted. The duration of the PQ ECG element did not differ between groups and depending on the effect of physical activity. But the volumes of blood passing during the duration of PQ varied markedly. In all three groups, they increased, which was probably due to the increasing power of myocardial contraction during atrial systole. Conclusions. In terms of absolute value, the volume of blood flow through the mitral valve of the human heart is increased in bradycardia and reduced in tachycardia. In terms of relative value, in the series from bradycardia to tachycardia and from conditions without exercise to conditions with the use of exercise, the proportion of flow A increases. The share of flow E decreases accordingly.

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