The mass was arising from the pelvis and extending up to xiphisternum
with lateral extensions to both the para colic gutters.
Drivers were asked to sit in their usual driving positions in their cars, and distances were taken between the nasion (junction of the forehead and the nose) and the top of the steering wheel (NT), the nasion and the center of the steering wheel (NC), the sternum and the center of the steering wheel (SC), and the xiphisternum
and the base of the steering wheel (XB; see Figure 1).
A long midline incision was given from xiphisternum
to the pubic symphysis extending across the thoracic cage and a second Incision was given along the inguinal ligament extending from pubic symphysis to the anterior superior iliac spine.
The force displacement transducer was connected to the chest with the thread by securing skin over xiphisternum
. The respiratory movements were recorded on a chart recorder through a bridge amplifier.
A midline incision in the abdomen was given extending from xiphisternum
to symphysis pubis.
There were multiple, evenly placed, zigzagshaped bruise lines on the lateral and anterior aspect of the left arm (Figure 1), continuing across the anterior aspect of the left shoulder, extending on to the anterior left chest wall, and running obliquely downwards to the xiphisternum
The abdomen was opened by midline incision from xiphisternum
to pubic symphysis.
Using a standard incision from the suprasternal notch to the xiphisternum
, the sternum was divided with a pneumatic saw in older children and a Gigli wire in younger children.
The skin over the xiphisternum
was secured with the help of a thread and attached to a force displacement transducer.
We then placed instruments through three further points, one under the xiphisternum
, one under the costal margin in the midclavicular line and another on the anterior axillary line.
Good surgical exposure is achieved by a large subcostal incision, which can be extended to the xiphisternum
in the midline, and by using one of the self-retaining retractor systems.
Systemic examination of the abdomen revealed distension with non tender hepatosplenomegaly (liver firm with smooth surface, rounded margin, 7cm below costal margin in midclavicular line, left lobe enlarged 4cm below xiphisternum
; spleen enlarged 3 cm along the splenic axis).