Traditional sternal precautions, given to sternotomy patients as part of their discharge education, are intended to help prevent sternal wound complications. They vary widely but generally include arbitrary load and time restrictions (lifting no more than a specified weight for up to 12 weeks) and may prohibit common shoulder joint and shoulder girdle movements. Having observed the negative effects of restrictive sternal precautions for many years, our research team performed a series of studies that measured the forces exerted during various common activities and their relationship to the sternum. The results, though informative, led us to realize that the goal of identifying "the" appropriate load restriction to prescribe for sternotomy patients was futile. The alternative approach that we introduce applies standard kinesiological principles and teaches patients how to perform load-bearing movements in a way that avoids excessive stress to the sternum.

BackgroundThe cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyrotomy to provide emergency oxygenation. We sought to compare the ability of physicians to correctly identify the CTM in male and female patients.MethodsIn a prospective observational study, anaesthetists were asked to locate the CTM by palpation which was then identified using ultrasound and the distance between the actual and estimated margin of the CTM was measured. Participants assessed the ease of CTM palpation using a visual analog scale. In a second series, the angulation of the posterior junction of the thyroid laminae was measured using ultrasound.Results23 anaesthetists and 44 subjects participated. A total of 36 assessments were carried out in each gender. Incorrect identification of the CTM was more common in females (29/36 vs. 11/36, P < 0.001) and the distance from the CTM in the vertical plane was greater (11.0 [6.5–20.0] vs. 0.0 [0.0–10.0] mm, P < 0.001). In females distance from the CTM correlated positively with neck circumference (P = 0.005) and BMI (P = 0.00005) and negatively with subject height (P = 0.01). Posterior thyroid cartilage angulation was greater in females (118.6 ± 9.4° vs. 95.9 ± 12.9°, P = 0.02) and was lower in patients with correctly identified CTMs (100.0 ± 14.9° vs. 115.6 ± 15.9°, P = 0.02). VRS palpation correlated with decreased posterior thyroid cartilage angulation (P = 0.04).ConclusionsCTM localisation is more difficult in female subjects irrespective of body habitus. It may be prudent to localize this structure by additional means (e.g. ultrasound) in advance of any airway manoeuvres or to modify the cricothyrotomy technique in the event that it is necessary in an emergency.

Abstract. Primary cardiac neoplasms are rare in humans and animals. In humans, the most common primary cardiac tumor is the myxoma, which is frequently found in the left atrium. Cardiac myxoma has been reported in the dog but not in the cat. We describe the gross, immunohistochemical, and light microscopic examination of a myxoma in the right atrium of a 6-year-old domestic shorthair cat. Histologically, the tumor consisted predominantly of mesenchymal cells with several foci of bone and cartilage present. The tumor was encapsulated and benign.

Several surgical approaches for total knee arthroplasty (TKA) have been developed to minimize soft-tissue trauma and expedite functional recovery. A group of 61 subjects undergoing computer-navigated, minimally invasive TKA were randomized to receive a mini-parapatellar, standard parapatellar, mini-midvastus (MV), or minisubvastus approach. Before and after treatment, subjects were asked to negotiate stairs in a self-selected manner. This study used the manner of stair negotiation (i.e., use of handrail, step-over-step, step-by-step) as a proxy for functional ability. Subjects who received TKA through a mini-MV approach demonstrated a significantly lower level of function at 2 and 4 months. If early functional recovery is a goal of TKA, surgeons should be cautious when considering the mini-MV approach, which was found to be inferior to other approaches in this study.

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