Academic literature on the topic 'Xiphoid Process'

Abstract The pericardium is a fibromembranous inelastic sac less than 2 mm in thickness that comprises 2 distinct layers. The outer inelastic fibrous layer (fibrous pericardium) anchors the heart in the mediastinum with attachments anterior to the manubrium and xiphoid process, posterior to the vertebral column, and inferior to the diaphragm. The inner serous double layer (serous pericardium) is divided into the visceral pericardium (epicardium) and the parietal pericardium.

Abstract Anteriorly, in the midline, the abdominal wall extends from the surface of the xiphoid process to the pubic symphysis. On each side, the wall extends from the costal margin to the inguinal ligament. For purposes of description, the anterior abdominal wall is divided into nine regions by two vertical and two horizontal planes. The right and left vertical planes pass through the mid-inguinal points—a point on each inguinal ligament midway between the anterior superior iliac spine and the pubic symphysis. The transpyloric plane lies horizontally midway between the jugular notch of the sternum and the pubic symphysis, approximately midway between the xiphoid process and the umbilicus. It lies at the level of the first lumbar vertebra. The transtubercular plane passes horizontally through the tubercles of the iliac crests at the level of the fifth lumbar vertebra. The nine regions demarcated by these planes: are: (1) epigastric; (2 and 3) right and left hypochondrium; (4) umbilical or central; (5 and 6) right and left lumbar; (7) hypogastric or suprapubic; and (8 and 9) right and left iliac fossae. Common surgical incisions used in opening the abdomen are described.

This chapter describes the functional anatomy of the abdominal wall. The layers of the abdominal wall consist of skin, superficial fascia, deep investing fascia, muscles, and inner fascial layers: transversalis fascia, extraperitoneal fascia, and peritoneum. The layers are variable in different areas of the abdomen. Skeletal support for the abdomen is derived from the lumbar vertebrae, the superior parts of the pelvic bones, and the bony parts of the inferior thoracic skeleton: the lower ribs and their costal cartilages and the xiphoid process.

Chapter 9 discusses truncal peripheral nerve blocks, which are utilized for supplemental analgesia for abdominal surgeries by providing local anesthesia to the anterior abdominal wall. These blocks are adjuvants because they will not block visceral pain. Unilateral analgesia to the skin, muscles, and parietal peritoneum of the abdominal wall is achieved. The transversus abdominis plane block (TAP) reliably provides analgesia to the lower abdominal wall in the T10–L1 distribution. Rectus sheath blocks anesthetize the terminal branches of the lower thoracic intercostal nerves and provide midline analgesia from the xiphoid process to the umbilicus. Surgical indications for TAP blocks include laparotomies, laparoscopies, inguinal hernia repairs, and appendectomies. Rectus sheath block indications include midline surgeries such as single-port appendectomies and umbilical hernia repairs.

In subjects with scoliosis the thoracic cage deformity is a complex 3D phenomenon. There is a deficiency of simple clinical methods of thorax shape evaluation. The study aimed to introduce and assess an anthropometric technique measuring transverse plane deformity of the thorax in patients with idiopathic scoliosis. Thirty scoliotic girls, aged 14.4±1.5 years, thoracic scoliosis type Lenke 1, mean Cobb 54.1±24.7°, and 30 healthy volunteers matched for sex and age were examined. Using a Martin anthropometric caliper the length of the long and the short horizontal axes of the thorax were measured at the level of the xiphoid process (upper index) and of the costal arch (lower index), both on maximum inspiration and expiration. Asymmetry index, defined as difference of the length of the long and the short axes expressed as the percentage of the short one, was calculated. The upper asymmetry index in the study group was 35.2±18.6 (inspiration) while in the control group it was 13.6±13.6, difference significant, p<0.001. The lower asymmetry index in the study group was 26.2±12.9 (inspiration) while in the control group it was 12.5±11.7, difference significant, p<0.001. In conclusion, thorax asymmetry index revealed significantly higher values in scoliotic patients. Asymmetry of respiratory movements could be measured. This simple technique may be used as a helpful tool for clinicians.

Abstract Respiratory gas analyzers to measure functions such as ventilation volume respiratory rate are expensive, and patients with severe motor and intellectual disabilities (SMID) often remove the devices, increasing contact risk and making them difficult to use in institutions. We propose here an inexpensive, non-contact method of measuring respiratory function using the depth camera introduced in our previous study. The method includes an algorithm that differentiates between body tremors, and between movements peculiar to patients with SMID and those caused by respiration, while further detecting appropriate respiration. However, the previous region of interest (ROI) was limited to a simple rectangular area from the navel to the xiphoid process, and we did not compare measurements using the geometry of the thorax and the abdomen as the ROI. In this study, we performed non-contact respiratory measurement using the geometric shape of the upper body of patients as the ROI, and investigated the improvement of measurement accuracy when the ROI was set according to the individual patient’s body. The results indicated that the values from the new method approached those of the respiratory gas analyzer more closely than the conventional method, and its measurement performance was sufficient for respiratory rehabilitation evaluation. We also found that the measured respiratory signal correlated with the ventilation rate in respiration with large ventilation rate fluctuations, and that the respiratory rhythm abnormalities associated with ventilation rate changes could be measured by the respiratory rate per min and apnea time per min evaluation indices.

Blood pressure is an indicator of a cardiovascular functioning and could provide early symptoms of cardiovascular system impairment. Blood pressure measurement using catheterization technique is considered the gold standard for blood pressure measurement [1]. However, due its invasive nature and complexity, non-invasive techniques of blood pressure estimation such as auscultation, oscillometry, and volume clamping have gained wide popularity [1]. While these non-invasive cuff based methodologies provide a good estimate of blood pressure, they are limited by their inability to provide a continuous estimate of blood pressure [1–2]. Continuous blood pressure estimate is critical for monitoring cardiovascular diseases such as hypertension and heart failure. Pulse transit time (PTT) is a time taken by a pulse wave to travel between a proximal and distal arterial site [3]. The speed at which pulse wave travels in the artery has been found to be proportional to blood pressure [1, 3]. A rise in blood pressure would cause blood vessels to increase in diameter resulting in a stiffer arterial wall and shorter PTT [1–3]. To avail such relationship with blood pressure, PTT has been extensively used as a marker of arterial elasticity and a non-invasive surrogate for arterial blood pressure estimation. Typically, a combination of electrocardiogram (ECG) and photoplethysmogram (PPG) or arterial blood pressure (ABP) signal is used for the purpose of blood pressure estimation [3], where the proximal and distal timing of PTT (also referred as pulse arrival time, PAT) is marked by R peak of ECG and a foot/peak of a PPG, respectively. In the literature, it has been shown that PAT derived using ECG-PPG combination infers an inaccurate estimate of blood pressure due to the inclusion of isovolumetric contraction period [1–3, 4]. Seismocardiogram (SCG) is a recording of chest acceleration due to heart movement, from which the opening and closing of the aortic valve can be obtained [5]. There is a distinct point on the dorso-ventral SCG signal that marks the opening of the aortic valve (annotated as AO). In the literature, AO has been proposed for timing the onset of the proximal pulse of the wave [6–8]. A combination of AO as a proximal pulse and PPG as a distal pulse has been used to derive pulse transit time and is shown to be correlated with blood pressure [7]. Ballistocardiogram (BCG) which is a measure of recoil forces of a human body in response to pumping of blood in blood vessels has also been explored as an alternative to ECG for timing proximal pulse [5, 9]. Use of SCG or BCG for timing the proximal point of a pulse can overcome the limitation of ECG-based PTT computation [6–7, 9]. However, a limitation of current blood pressure estimation systems is the requirement of two morphologically different signals, one for annotating the proximal (ECG, SCG, BCG) and other for annotating the distal (PPG, ABP) timing of a pulse wave. In the current research, we introduce a methodology to derive PTT from seismocardiograms alone. Two accelerometers were used for such purpose, one was placed on the xiphoid process of the sternum (marks proximal timing) and the other one was placed on the external carotid artery (marks distal timing). PTT was derived as a time taken by a pulse wave to travel between AO of both the xiphoidal and carotid SCG.