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Sample records for external intercostal muscles

  1. Distribution of inspiratory drive to the external intercostal muscles in humans

    Science.gov (United States)

    De Troyer, André; Gorman, Robert B; Gandevia, Simon C

    2003-01-01

    The external intercostal muscles in humans show marked regional differences in respiratory effect, and this implies that their action on the lung during breathing is primarily determined by the spatial distribution of neural drive among them. To assess this distribution, monopolar electrodes were implanted under ultrasound guidance in different muscle areas in six healthy individuals and electromyographic recordings were made during resting breathing. The muscles in the dorsal portion of the third and fifth interspace showed phasic inspiratory activity with each breath in every subject. However, the muscle in the ventral portion of the third interspace showed inspiratory activity in only three subjects, and the muscle in the dorsal portion of the seventh interspace was almost invariably silent. Also, activity in the ventral portion of the third interspace, when present, and activity in the dorsal portion of the fifth interspace were delayed relative to the onset of activity in the dorsal portion of the third interspace. In addition, the discharge frequency of the motor units identified in the dorsal portion of the third interspace averaged (mean ± s.e.m.) 11.9 ± 0.3 Hz and was significantly greater than the discharge frequency of the motor units in both the ventral portion of the third interspace (6.0 ± 0.5 Hz) and the dorsal portion of the fifth interspace (6.7 ± 0.4 Hz). The muscle in the dorsal portion of the third interspace started firing simultaneously with the parasternal intercostal in the same interspace, and the discharge frequency of its motor units was even significantly greater (11.4 ± 0.3 vs. 8.9 ± 0.2 Hz). These observations indicate that the distribution of neural inspiratory drive to the external intercostals in humans takes place along dorsoventral and rostrocaudal gradients and mirrors the spatial distribution of inspiratory mechanical advantage. PMID:12563017

  2. Respiratory Action of the Intercostal Muscles

    National Research Council Canada - National Science Library

    André De Troyer; Peter A. Kirkwood; Theodore A. Wilson

    2005-01-01

    The mechanical advantages of the external and internal intercostals depend partly on the orientation of the muscle but mostly on interspace number and the position of the muscle within each interspace...

  3. Distribution of electrical activation to the external intercostal muscles during high frequency spinal cord stimulation in dogs

    Science.gov (United States)

    DiMarco, Anthony F; Kowalski, Krzysztof E

    2011-01-01

    Abstract In contrast to previous methods of electrical stimulation of the inspiratory muscles, high frequency spinal cord stimulation (HF-SCS) results in more physiological activation of these muscles. The spatial distribution of activation to the external intercostal muscles by this method is unknown. In anaesthetized dogs, multiunit and single motor unit (SMU) EMG activity was monitored in the dorsal portion of the 3rd, 5th and 7th interspaces and ventral portion of the 3rd interspace during spontaneous breathing and HF-SCS following C2 spinal section. Stimulus amplitude during HF-SCS was adjusted such that inspired volumes matched spontaneous breathing (Protocol 1). During HF-SCS, mean peak SMU firing frequency was highest in the 3rd interspace (dorsal) (18.8 ± 0.3 Hz) and significantly lower in the 3rd interspace (ventral) (12.2 ± 0.2 Hz) and 5th interspace (dorsal) (15.3 ± 0.3 Hz) (P intercostal muscles during HF-SCS is similar to that occurring during spontaneous breathing and (b) differential descending synaptic input from supraspinal centres is not a required component of the differential spatial distribution of external intercostal muscle activation. HF-SCS may provide a more physiological method of inspiratory muscle pacing. PMID:21242258

  4. Different sensitivity of miniature endplate currents in rat external and internal intercostal muscles to the acetylcholinesterase inhibitor C-547 as compared with diaphragm and extensor digitorum longus.

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    Petrov, K; Kovyazina, I; Zobov, V; Bukharaeva, E; Nikolsky, E E; Vyskocil, F

    2009-01-01

    Derivative of 6-methyluracil, selective cholinesterase inhibitor C-547 potentiates miniature endplate currents (MEPCs) in rat external intercostal muscles (external ICM) more effectively than in internal intercostal muscles (internal ICM). Effect of the C-547 on intercostal muscles was compared with those on extensor digitorum longus (EDL) and diaphragm muscles. Half-effective concentrations for tau of MEPC decay arranged in increasing order were as follows: EDL, locomotor muscle, most sensitive = 1.3 nM, external ICM, inspiration muscle = 6.8 nM, diaphragm, main inspiration muscle = 28 nM, internal ICM, expiration muscle = 71 nM. External ICM might therefore be inhibited, similarly as the limb muscles, by nanomolar concentrations of the drug and do not participate in inspiration in the presence of the C-547. Moreover, internal ICM inhibition can hinder the expiration during exercise-induced fast breathing of C-547- treated experimental animals.

  5. Postural and ventilatory functions of intercostal muscles.

    Science.gov (United States)

    Duron, B

    1973-01-01

    During spontaneous breathing, the interchondral muscles present a pattern of activity similar to that of the diaphragm. The external intercostals and most of the internal intercostals generally show electrical discharges not related to ventilatory rhythm. Studies of the electrical responses of these muscles in experimental variations of their length show that the external and internal intercostals are readily activated by this category of reflexes while the diaphragm and the interchondrals are not. Bilateral multisegmental sections of spinal dorsal roots do not affect the respiratory activity of the diaphragm and of the interchondral muscles; on the contrary, all types of activity - spontaneous or reflex - disappear from the intercostals. Electrical stimulation of appropriate points in the bulbar pyramids in decerebrate cats can activate at the same time different intercostals and leg muscles without modifying the rhythmic inspiratory activity of the diaphragm and the interchondrals. In preparations with chronically implanted electrodes, the intercostals muscles are chiefly involved in posture. These results fit very well with our histological findings which disclose a much greater density of muscle spindles in external intercostals than in the diaphragm or in the interchondral muscles.

  6. Spatial distribution of external and internal intercostal activity in dogs

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    Legrand, Alexandre; De Troyer, André

    1999-01-01

    The observation that the external and internal interosseous intercostal muscles in the dog show marked regional differences in mechanical advantage has prompted us to re-examine the topographic distribution of electrical activity among these muscles during spontaneous breathing. Inspiratory activity was recorded only from the areas of the external intercostals with an inspiratory mechanical advantage, and expiratory activity was recorded only from the areas of the internal intercostals with an expiratory mechanical advantage. The expiratory discharges previously recorded from the caudal external intercostals and the inspiratory discharges recorded from the rostral internal intercostals were probably due to cross-contamination. Activity in each muscle area was also quantified relative to the activity measured during tetanic, supramaximal nerve stimulation (maximal activity). External intercostal inspiratory activity was consistently greater in the areas with a greater inspiratory advantage (i.e. the dorsal aspect of the rostral segments) than in the areas with a smaller inspiratory advantage, and internal intercostal expiratory activity was invariably greatest in the areas with the greatest expiratory advantage (i.e. the dorsal aspect of the caudal segments). This topographic distribution of neural drive confers to the external intercostal muscles an inspiratory action on the lung during breathing and to the internal interosseous intercostals an expiratory action. PMID:10373710

  7. External rib structure can be predicted using mathematical models: An anatomical study with application to understanding fractures and intercostal muscle function.

    Science.gov (United States)

    Casha, Aaron R; Camilleri, Liberato; Manché, Alexander; Gatt, Ruben; Attard, Daphne; Gauci, Marilyn; Camilleri-Podesta, Marie-Therese; Grima, Joseph N

    2015-05-01

    As ribs adapt to stress like all bones, and the chest behaves as a pressure vessel, the effect of stress on the ribs can be determined by measuring rib height and thickness. Rib height and thickness (depth) were measured using CT scans of seven rib cages from anonymized cadavers. A Finite Element Analysis (FEA) model of a rib cage was constructed using a validated approach and used to calculate intramuscular forces as the vectors of both circumferential and axial chest wall forces at right angles to the ribs. Nonlinear quadratic models were used to relate rib height and rib thickness to rib level, and intercostal muscle force to vector stress. Intercostal muscle force was also related to vector stress using Pearson correlation. For comparison, rib height and thickness were measured on CT scans of children. Rib height increased with rib level, increasing by 13% between the 3rd and 7th rib levels, where the 7th/8th rib was the widest part or "equator" of the rib cage, P Intercostal muscle force was significantly related to vector stress, Pearson correlation r = 0.944, P = 0.005. The three nonlinear quadratic models developed all had statistically significant parameter estimates with P intercostal muscle force, showing that environmental factors affect external rib morphology. © 2015 Wiley Periodicals, Inc.

  8. The transduction properties of intercostal muscle mechanoreceptors

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    Johnson Richard D

    2002-10-01

    Full Text Available Abstract Background Intercostal muscles are richly innervated by mechanoreceptors. In vivo studies of cat intercostal muscle have shown that there are 3 populations of intercostal muscle mechanoreceptors: primary muscle spindles (1°, secondary muscle spindles (2° and Golgi tendon organs (GTO. The purpose of this study was to determine the mechanical transduction properties of intercostal muscle mechanoreceptors in response to controlled length and velocity displacements of the intercostal space. Mechanoreceptors, recorded from dorsal root fibers, were localized within an isolated intercostal muscle space (ICS. Changes in ICS displacement and the velocity of ICS displacement were independently controlled with an electromagnetic motor. ICS velocity (0.5 – 100 μm/msec to a displacement of 2,000 μm and displacement (50–2,000 μm at a constant velocity of 10 μm/msec parameters encompassed the full range of rib motion. Results Both 1° and 2° muscle spindles were found evenly distributed within the ICS. GTOs were localized along the rib borders. The 1° spindles had the greatest discharge frequency in response to displacement amplitude followed by the 2° afferents and GTOs. The 1° muscle spindles also possessed the greatest discharge frequency in response to graded velocity changes, 3.0 spikes·sec-1/μm·msec-1. GTOs had a velocity response of 2.4 spikes·sec-1/μm·msec-1 followed by 2° muscle spindles at 0.6 spikes·sec-1/μm·msec-1. Conclusion The results of this study provide a systematic description of the mechanosenitivity of the 3 types of intercostal muscle mechanoreceptors. These mechanoreceptors have discharge properties that transduce the magnitude and velocity of intercostal muscle length.

  9. Mechanical Action of the Intercostal Muscles on the Ribs

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    de Troyer, Andre; Kelly, Suzanne; Zin, Walter A.

    1983-04-01

    The external and internal interosseous intercostal muscles were separately stimulated at end-expiratory lung volume in anesthetized dogs. These muscles were all found to elevate the ribs into which they insert. By attaching weights to the ribs, it was determined that the nonlinear compliance of the ribs was responsible for this phenomenon.

  10. Response of the canine inspiratory intercostal muscles to chest wall vibration.

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    Leduc, D; Brunko, E; De Troyer, A

    2000-02-01

    High-frequency mechanical vibration of the rib cage reduces dyspnea, but the effect of this procedure on the respiratory muscles is largely unknown. In the present studies, we have initially assessed the electrical and mechanical response to vibration (40 Hz) of the canine parasternal and external intercostal muscles (third interspace) during hyperventilation-induced apnea. When the vibrator was applied to the segment investigated, prominent external intercostal activity was recorded in the seven animals studied, whereas low-amplitude parasternal intercostal activity was recorded in only four animals. Similarly, when the vibrator was applied to more rostral and more caudal interspaces, activity was recorded commonly from the external intercostal but only occasionally from the parasternal. The two muscles, however, showed similar changes in length. We next examined the response to vibration of the muscles in seven spontaneously breathing animals. Vibrating the rib cage during inspiration (in-phase) had no effect on parasternal intercostal inspiratory activity but induced a marked increase in neural drive to the external intercostals. For the animal group, peak external intercostal activity during the control, nonvibrated breaths averaged (mean +/- SE) 43.1 +/- 3.7% of the activity recorded during the vibrated breaths (p vibration also occurred earlier at the onset of inspiration and commonly carried on after the cessation of parasternal intercostal activity. Yet tidal volume was unchanged. Vibrating the rib cage during expiration (out-of-phase) did not elicit any parasternal or external intercostal activity in six animals. These observations thus indicate that the external intercostals, with their larger spindle density, are much more sensitive to chest wall vibration than the parasternal intercostals. They also suggest that the impact of this procedure on the mechanical behavior of the respiratory system is relatively small.

  11. Respiratory pattern changes produced by intercostal muscle/rib vibration.

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    Bolser, D C; Lindsey, B G; Shannon, R

    1988-06-01

    Large-amplitude vibration of the intercostal muscles/ribs has an inhibitory effect on inspiratory motor output. This effect has been attributed, in part, to the stimulation of intercostal muscle tendon organs. Intercostal muscle/rib vibration can also produce a decrease or increase in respiratory frequency. Studies were conducted 1) to determine whether, in addition to intercostal tendon organs, costovertebral joint mechanoreceptors (CVJR's) contribute to the inspiratory inhibitory effect of intercostal muscle/rib vibration (IMV) and 2) to explain the different respiratory frequency responses to IMV previously reported. Phrenic (C5) activity was monitored in paralyzed thoracotomized, artificially ventilated cats. Vibration (125 Hz) at amplitudes greater than 1,200 micron of one T6 intercostal space in decerebrated vagotomized rats reduced phrenic activity. This response was still present but weaker in some animals after denervation of the T6 intercostal muscles. Subsequent denervation of the T6 CVJR's by dorsal root sections eliminated this effect. Respiratory frequency decreased during simultaneous vibration (greater than 1,200 micron) of the T5 and T7 intercostal spaces in vagotomized cats. Respiratory frequency increased during IMV of two intercostal spaces (greater than 1,300 micron) in vagal intact cats. The use of different anesthetics (pentobarbital, allobarbital) did not alter these results. We conclude that CVJR's may contribute to the inhibitory effect of IMV on medullary inspiratory activity. The presence or absence of pulmonary vagal afferents can account for the different respiratory frequency responses to IMV, and different anesthetics did not influence these results.

  12. Human intersegmental reflexes from intercostal afferents to scalene muscles.

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    McBain, Rachel A; Taylor, Janet L; Gorman, Robert B; Gandevia, Simon C; Butler, Jane E

    2016-10-01

    What is the central question of this study? The aim was to determine whether specific reflex connections operate between intercostal afferents and the scalene muscles in humans, and whether these connections operate after a clinically complete cervical spinal cord injury. What is the main finding and its importance? This is the first description of a short-latency inhibitory reflex connection between intercostal afferents from intercostal spaces to the scalene muscles in able-bodied participants. We suggest that this reflex is mediated by large-diameter afferents. This intercostal-to-scalene inhibitory reflex is absent after cervical spinal cord injury and may provide a way to monitor the progress of the injury. Short-latency intersegmental reflexes have been described for various respiratory muscles in animals. In humans, however, only short-latency reflex responses to phrenic nerve stimulation have been described. Here, we examined the reflex connections between intercostal afferents and scalene muscles in humans. Surface EMG recordings were made from scalene muscles bilaterally, in seven able-bodied participants and seven participants with motor- and sensory-complete cervical spinal cord injury (median 32 years postinjury, range 5 months to 44 years). We recorded the reflex responses produced by stimulation of the eighth or tenth left intercostal nerve. A short-latency (∼38 ms) inhibitory reflex was evident in able-bodied participants, in ipsilateral and contralateral scalene muscles. This bilateral intersegmental inhibitory reflex occurred in 46% of recordings at low stimulus intensities (at three times motor threshold). It was more frequent (in 75-85% of recordings) at higher stimulus intensities (six and nine times motor threshold), but onset latency (38 ± 9 ms, mean ± SD) and the size of inhibition (23 ± 10%) did not change with stimulus intensity. The reflex was absent in all participants with spinal cord injury. As the intercostal

  13. Recovery of inspiratory intercostal muscle activity following high cervical hemisection.

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    Dougherty, B J; Lee, K Z; Gonzalez-Rothi, E J; Lane, M A; Reier, P J; Fuller, D D

    2012-09-30

    Anatomical and neurophysiological evidence indicates that thoracic interneurons can serve a commissural function and activate contralateral motoneurons. Accordingly, we hypothesized that respiratory-related intercostal (IC) muscle electromyogram (EMG) activity would be only modestly impaired by a unilateral cervical spinal cord injury. Inspiratory tidal volume (VT) was recorded using pneumotachography and EMG activity was recorded bilaterally from the 1st to 2nd intercostal space in anesthetized, spontaneously breathing rats. Studies were conducted at 1-3 days, 2 wks or 8 wks following C2 spinal cord hemisection (C2HS). Data were collected during baseline breathing and a brief respiratory challenge (7% CO(2)). A substantial reduction in inspiratory intercostal EMG bursting ipsilateral to the lesion was observed at 1-3 days post-C2HS. However, a time-dependent return of activity occurred such that by 2 wks post-injury inspiratory intercostal EMG bursts ipsilateral to the lesion were similar to age-matched, uninjured controls. The increases in ipsilateral intercostal EMG activity occurred in parallel with increases in VT following the injury (R=0.55; Pintercostal" circuitry enables a robust, spontaneous recovery of ipsilateral intercostal activity following C2HS in rats. Copyright © 2012. Published by Elsevier B.V.

  14. Upregulation of pro-inflammatory cytokines in the intercostal muscles of COPD patients.

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    Casadevall, C; Coronell, C; Ramírez-Sarmiento, A L; Martínez-Llorens, J; Barreiro, E; Orozco-Levi, M; Gea, J

    2007-10-01

    Muscle dysfunction is a characteristic feature of chronic obstructive pulmonary disease (COPD). Recent studies suggest that cytokines may operate as local regulators of both muscle function and regeneration. The aim of the present study was to characterise the expression of different cytokines in the external intercostal muscle of COPD. Muscle biopsies were obtained from 25 stable COPD patients and eight healthy controls. Local tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta, -6 and -10 expressions (real-time PCR and ELISA), sarcolemmal damage (immunohistochemistry), and the transcript levels of CD18 were assessed. Muscle TNF-alpha and IL-6 transcripts were significantly higher in COPD patients compared with controls, and IL-1beta and sarcolemmal damage showed a strong tendency in the same direction. Similar results were observed at protein level. The CD18 panleukocyte marker was similar in COPD and controls. Respiratory muscle function was impaired in COPD patients and it correlated to both the severity of lung function impairment and TNF-alpha muscle expression. Chronic obstructive pulmonary disease is associated with the upregulation of pro-inflammatory cytokines in the intercostal muscles. This phenomenon might be involved in respiratory muscle dysfunction.

  15. Intercostal muscle flap for repair of bronchopleural fistula

    Directory of Open Access Journals (Sweden)

    Vikas Deep Goyal

    2015-01-01

    Full Text Available A 50-year-old male patient, a known case of chronic obstructive pulmonary disease (COPD, presented with the features of bronchopleural fistula (BPF on the right side for 1 month. The patient was a chronic smoker and did not give any history suggestive of pulmonary Koch′s. The patient had sudden-onset breathlessness and chest pain 1 month before, which was diagnosed to be due to spontaneous pneumothorax. An intercostal drain was inserted but even after 1 month of all conservative measures, the lung remained collapsed and there was large air leak in the intercostal drain. Computed tomogram (CT of the chest revealed collapsed and entrapped lung with surgical emphysema of the subcutaneous tissues due to rupture of the emphysematous bulla on the right side along with the presence of emphysematous bullae on the left upper lobe also. Surgical intervention in the form of decortication of entrapped lung and repair of the BPF with intercostal muscle flap was performed. The patient recovered well and was discharged after 10 days.

  16. Expiratory muscle loading increases intercostal muscle blood flow during leg exercise in healthy humans

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    Athanasopoulos, Dimitris; Louvaris, Zafeiris; Cherouveim, Evgenia; Andrianopoulos, Vasilis; Roussos, Charis; Zakynthinos, Spyros

    2010-01-01

    We investigated whether expiratory muscle loading induced by the application of expiratory flow limitation (EFL) during exercise in healthy subjects causes a reduction in quadriceps muscle blood flow in favor of the blood flow to the intercostal muscles. We hypothesized that, during exercise with EFL quadriceps muscle blood flow would be reduced, whereas intercostal muscle blood flow would be increased compared with exercise without EFL. We initially performed an incremental exercise test on eight healthy male subjects with a Starling resistor in the expiratory line limiting expiratory flow to ∼ 1 l/s to determine peak EFL exercise workload. On a different day, two constant-load exercise trials were performed in a balanced ordering sequence, during which subjects exercised with or without EFL at peak EFL exercise workload for 6 min. Intercostal (probe over the 7th intercostal space) and vastus lateralis muscle blood flow index (BFI) was calculated by near-infrared spectroscopy using indocyanine green, whereas cardiac output (CO) was measured by an impedance cardiography technique. At exercise termination, CO and stroke volume were not significantly different during exercise, with or without EFL (CO: 16.5 vs. 15.2 l/min, stroke volume: 104 vs. 107 ml/beat). Quadriceps muscle BFI during exercise with EFL (5.4 nM/s) was significantly (P = 0.043) lower compared with exercise without EFL (7.6 nM/s), whereas intercostal muscle BFI during exercise with EFL (3.5 nM/s) was significantly (P = 0.021) greater compared with that recorded during control exercise (0.4 nM/s). In conclusion, increased respiratory muscle loading during exercise in healthy humans causes an increase in blood flow to the intercostal muscles and a concomitant decrease in quadriceps muscle blood flow. PMID:20507965

  17. Intercostal retractions

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    ... this page: //medlineplus.gov/ency/article/003322.htm Intercostal retractions To use the sharing features on this page, please enable JavaScript. Intercostal retractions occur when the muscles between the ribs ...

  18. Ipsilateral inspiratory intercostal muscle activity after C2 spinal cord hemisection in rats.

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    Beth Zimmer, M; Grant, Joshua S; Ayar, Angelo E; Goshgarian, Harry G

    2015-03-01

    Upper cervical spinal cord hemisection causes paralysis of the ipsilateral hemidiaphragm; however, the effect of C2 hemisection on the function of the intercostal muscles is not clear. We hypothesized that C2 hemisection would eliminate inspiratory intercostal activity ipsilateral to the injury and that some activity would return in a time-dependent manner. Female Sprague Dawley rats were anesthetized with urethane and inspiratory intercostal electromyogram (EMG) activity was recorded in control rats, acutely injured C2 hemisected rats, and at 1 and 16 weeks post C2 hemisection. Bilateral recordings of intercostal EMG activity showed that inspiratory activity was reduced immediately after injury and increased over time. EMG activity was observed first in rostral spaces followed by recovery occurring in caudal spaces. Theophylline increased respiratory drive and increased intercostal activity, inducing activity that was previously absent. These results suggest that there are crossed, initially latent, respiratory connections to neurons innervating the intercostal muscles similar to those innervating phrenic motor neurons.

  19. Metastasis of Breast Carcinoma to Intercostal Muscle Detected by Breast MRI: A Case Report

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    Cho, Kyung Eun; Son, Eun Ju; Kim, Jeong Ah; Youk, Ji Hyun; Kim, Eun Kyung; Kwak, Jin Young; Jeong, Joon [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-08-15

    Breast cancer can metastasize to any organ; however, distant metastases are unusual at the time of diagnosis. Furthermore metastasis to skeletal muscle is an uncommon manifestation of malignancy. We report a case of a 45-year-old woman diagnosed with cancer of the left breast with metastases to the ipsilateral intercostal muscle. To the best of our knowledge this is the first report of intercostal muscle metastasis from breast cancer in the English literature

  20. Metabolism of perfused pig intercostal muscles evaluated by 31P-magnetic resonance spectroscopy

    DEFF Research Database (Denmark)

    Pedersen, Brian Lindegaard; Arendrup, Henrik; Secher, Niels H

    2006-01-01

    This study presents a perfused preparation for evaluation of metabolism in pig intercostal muscle in vitro. Preserved vessels and nerves to an intercostal segment including two adjacent ribs allowed for tissue perfusion and electrical stimulation with measurement of contraction force, oxygen...... and 3.5 +/- 0.5 micromol min(-1) g(-1) during the two last minutes, corresponding to the drop in force. When the preparation was left unperfused, anaerobic ATP turnover averaged 0.40 +/- 0.15 micromol min(-1) g(-1) for the first 10 min. The preparation can also be applied to human intercostal muscles......, as demonstrated in one preliminary experiment. The results demonstrate a stable and functional in vitro preparation of intact perfused intercostal muscles in the pig....

  1. Intercostal muscle motor behavior during tracheal occlusion conditioning in conscious rats

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    Jaiswal, Poonam B.

    2016-01-01

    A respiratory load compensation response is characterized by increases in activation of primary respiratory muscles and/or recruitment of accessory respiratory muscles. The contribution of the external intercostal (EI) muscles, which are a primary respiratory muscle group, during normal and loaded breathing remains poorly understood in conscious animals. Consciousness has a significant role on modulation of respiratory activity, as it is required for the integration of behavioral respiratory responses and voluntary control of breathing. Studies of respiratory load compensation have been predominantly focused in anesthetized animals, which make their comparison to conscious load compensation responses challenging. Using our established model of intrinsic transient tracheal occlusions (ITTO), our aim was to evaluate the motor behavior of EI muscles during normal and loaded breathing in conscious rats. We hypothesized that 1) conscious rats exposed to ITTO will recruit the EI muscles with an increased electromyogram (EMG) activation and 2) repeated ITTO for 10 days would potentiate the baseline EMG activity of this muscle in conscious rats. Our results demonstrate that conscious rats exposed to ITTO respond by recruiting the EI muscle with a significantly increased EMG activation. This response to occlusion remained consistent over the 10-day experimental period with little or no effect of repeated ITTO exposure on the baseline ∫EI EMG amplitude activity. The pattern of activation of the EI muscle in response to an ITTO is discussed in detail. The results from the present study demonstrate the importance of EI muscles during unloaded breathing and respiratory load compensation in conscious rats. PMID:26823339

  2. Intercostal muscles and purring in the cat: the influence of afferent inputs.

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    Kirkwood, P A; Sears, T A; Stagg, D; Westgaard, R H

    1987-03-03

    Feline purring has previously been reported as originating in a central oscillator, independent of afferent inputs, and also as not involving expiratory muscles. Here we show, via electromyographic recordings from intercostal muscles, quantified by cross-correlation, that expiratory muscles can be involved and that even if the oscillator is central, reflex components nevertheless play a considerable part in the production of the periodic pattern of muscle activation seen during purring.

  3. Recruitment and plasticity in diaphragm, intercostal, and abdominal muscles in unanesthetized rats

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    Navarrete-Opazo, A.

    2014-01-01

    Although rats are a frequent model for studies of plasticity in respiratory motor control, the relative capacity of rat accessory respiratory muscles to express plasticity is not well known, particularly in unanesthetized animals. Here, we characterized external intercostal (T2, T4, T5, T6, T7, T8, T9 EIC) and abdominal muscle (external oblique and rectus abdominis) electromyogram (EMG) activity in unanesthetized rats via radiotelemetry during normoxia (Nx: 21% O2) and following acute intermittent hypoxia (AIH: 10 × 5-min, 10.5% O2; 5-min intervals). Diaphragm and T2–T5 EIC EMG activity, and ventilation were also assessed during maximal chemoreceptor stimulation (MCS: 7% CO2, 10.5% O2) and sustained hypoxia (SH: 10.5% O2). In Nx, T2 EIC exhibits prominent inspiratory activity, whereas T4, T5, T6, and T7 EIC inspiratory activity decreases in a caudal direction. T8 and T9 EIC and abdominal muscles show only tonic or sporadic activity, without consistent respiratory activity. MCS increases diaphragm and T2 EIC EMG amplitude and tidal volume more than SH (0.94 ± 0.10 vs. 0.68 ± 0.05 ml/100 g; P < 0.001). Following AIH, T2 EIC EMG amplitude remained above baseline for more than 60 min post-AIH (i.e., EIC long-term facilitation, LTF), and was greater than diaphragm LTF (41.5 ± 1.3% vs. 19.1 ± 2.0% baseline; P < 0.001). We conclude that 1) diaphragm and rostral T2–T5 EIC muscles exhibit inspiratory activity during Nx; 2) MCS elicits greater ventilatory, diaphragm, and rostral T2–T5 EIC muscle activity vs. SH; and 3) AIH induces greater rostral EIC LTF than diaphragm LTF. PMID:24833779

  4. Intercostal thoracotomy in 20 dogs: muscle-sparing versus traditional techniques

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    Lee, Suhwon; Jeong, Soon-wuk

    2015-01-01

    The levels of pain, duration of approaching and closure, and surgical exposure associated with intercostal thoracotomy were compared between muscle-sparing and traditional techniques in 20 dogs. Postoperative pain was assessed based on numerical pain scores using behavioral observation, heart rate, respiratory rate, and wound palpation. Time for approaching and closure were measured, and the extent of intrathoracic organ exposure for the surgical procedures was described for each technique. There were significant differences in numerical pain scores at 2 h as well as 1, 2, 3, 4, 5, 6, and 7 days after surgery between the two groups (p intercostal thoracotomy. Additionally, the muscle-sparing technique is as effective as the traditional modality for providing an appropriate time for approaching and closure during intercostal thoracotomy as well as adequate organ exposure for the surgical procedures. PMID:25798045

  5. Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: potential role of a respiratory muscle metaboreflex.

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    Moreno, A M; Castro, R R T; Silva, B M; Villacorta, H; Sant'Anna Junior, M; Nóbrega, A C L

    2014-11-01

    The purpose of this study was to determine the effect of respiratory muscle fatigue on intercostal and forearm muscle perfusion and oxygenation in patients with heart failure. Five clinically stable heart failure patients with respiratory muscle weakness (age, 66 ± 12 years; left ventricle ejection fraction, 34 ± 3%) and nine matched healthy controls underwent a respiratory muscle fatigue protocol, breathing against a fixed resistance at 60% of their maximal inspiratory pressure for as long as they could sustain the predetermined inspiratory pressure. Intercostal and forearm muscle blood volume and oxygenation were continuously monitored by near-infrared spectroscopy with transducers placed on the seventh left intercostal space and the left forearm. Data were compared by two-way ANOVA and Bonferroni correction. Respiratory fatigue occurred at 5.1 ± 1.3 min in heart failure patients and at 9.3 ± 1.4 min in controls (P0.05). Respiratory fatigue in heart failure reduced intercostal and forearm muscle blood volume (Pintercostal (heart failure, -2.6 ± 1.6%; controls, +1.6 ± 0.5%; P<0.05) and in forearm muscles (heart failure, -4.5 ± 0.5%; controls, +0.5 ± 0.8%; P<0.05). These results suggest that respiratory fatigue in patients with heart failure causes an oxygen demand/delivery mismatch in respiratory muscles, probably leading to a reflex reduction in peripheral limb muscle perfusion, featuring a respiratory metaboreflex.

  6. Mechanical advantage of the human parasternal intercostal and triangularis sterni muscles.

    Science.gov (United States)

    De Troyer, A; Legrand, A; Gevenois, P A; Wilson, T A

    1998-12-15

    1. Previous studies in dogs have demonstrated that the maximum change in airway pressure (DeltaPao) produced by a particular respiratory muscle is the product of three factors, namely the mass of the muscle, the maximal active muscle tension per unit cross-sectional area ( approximately 3.0 kg cm-2), and the fractional change in muscle length per unit volume increase of the relaxed chest wall (i.e. the muscle's mechanical advantage). In the present studies, we have used this principle to infer the DeltaPao values generated by the parasternal intercostal and triangularis sterni muscles in man. 2. The mass of the muscles and the direction of the muscle fibres relative to the sternum were first assessed in six cadavers. Seven healthy individuals were then placed in a computed tomographic scanner to determine the orientation of the costal cartilages relative to the sternum and their rotation during passive inflation to total lung capacity. The fractional changes in length of the muscles during inflation, their mechanical advantages, and their DeltaPao values were then calculated. 3. Passive inflation induced shortening of the parasternal intercostals in all interspaces and lengthening of the triangularis sterni. The fractional shortening of the parasternal intercostals decreased gradually from 7.7 % in the second interspace to 2.0 % in the fifth, whereas the fractional lengthening of the triangularis sterni increased progressively from 5.9 to 13.8 %. These rostrocaudal gradients were well accounted for by the more caudal orientation of the cartilages of the lower ribs. 4. Since these fractional changes in length corresponded to a maximal inflation, the inspiratory mechanical advantage of the parasternal intercostals was only 2.2-0. 6 % l-1, and the expiratory mechanical advantage of the triangularis sterni was only 1.6-3.8 % l-1. In addition, whatever the interspace, parasternal and triangularis muscle mass was 3-5 and 1-3 g, respectively. As a result, the magnitude of

  7. Diaphragm and intercostal muscle activity following mid-cervical spinal cord contusion in the rat.

    Science.gov (United States)

    Wen, Ming-Han; Lee, Kun-Ze

    2017-08-26

    The present study was designed to investigate the diaphragm and intercostal muscle activity following unilateral mid-cervical spinal cord contusion in rats. Electromyogram (EMG) activity of the bilateral diaphragm and T2 intercostal muscle was measured in anesthetized and spontaneously breathing rats. Unilateral mid-cervical contusion caused an immediate reduction in inspiratory bursting in the bilateral diaphragm and intercostal muscles. From 3 days to 8 weeks post-contusion, the contused animals displayed significantly lower tidal volume than uninjured animals, regardless of the time point after injury. The burst amplitude of the contralateral diaphragm EMG was augmented in contused animals at 3 days post-injury. When the data were normalized by the maximal response during hypoxic-hypercapnic challenge (12-13 % O2, 3-4 % CO2), the ipsilateral diaphragm EMG of contused animals was greater than that of uninjured animals at 3 days and 2 weeks post-injury. Moreover, hypoxia-hypercapnia induced increases in ipsilateral diaphragm EMG activity were blunted in contused animals at 2 weeks post-injury but recovered at 8 weeks post-injury. Bilateral diaphragm EMG activity in contused animals was comparable to uninjured animals at 8 weeks post-injury. Notably, intercostal muscle activity was not substantially changed by mid-cervical spinal cord contusion from 3 days to 8 weeks post-contusion. These results suggest that mid-cervical spinal contusion induces a compensatory increase in contralateral diaphragmatic activity and greater utilization of a percentage of maximal inspiratory activity in the ipsilateral diaphragm. The maintenance of intercostal muscle activity may enable the animal to sustain essential breathing capacity following cervical spinal cord injury.

  8. Mass and fat infiltration of intercostal muscles measured by CT histogram analysis and their correlations with COPD severity.

    Science.gov (United States)

    Park, Mi Jung; Cho, Jae Min; Jeon, Kyung Nyeo; Bae, Kyung Soo; Kim, Ho Cheol; Choi, Dae Seob; Na, Jae Boem; Choi, Ho Cheol; Choi, Hye Young; Kim, Ji Eun; Shin, Hwa Seon

    2014-06-01

    Chronic obstructive pulmonary disease (COPD) is characterized by progressive respiratory function impairment and respiratory muscle dysfunction. We hypothesized that the mass and fat infiltration of respiratory muscles correlates with COPD severity and emphysema extent. Ninety-eight male patients with COPD underwent chest computed tomography (CT) and spirometry. The mass and fat infiltrations of intercostal and latissimus muscles were quantified as the cross-sectional area (CSA) and attenuation of these muscles using CT histogram analysis. Intercostal index and latissimus index were defined as intercostal CSAs and latissimus CSAs divided by body mass index. The emphysema extent was measured as the ratio of the emphysematous lung volume to the total lung volume using a density-mask technique. Pearson correlation analyses were performed to evaluate the relationships between these parameters. Multiple regression analysis was performed using forced expiratory volume in 1 second (FEV1) as the dependent parameter and the clinical and CT data as the independent parameters. FEV1 was significantly correlated with intercostal index (r = 0.57), latissimus index (r = 0.34), intercostal attenuation (r = 0.62), and latissimus attenuation (r = 0.38). Emphysema extent was significantly correlated with intercostal index (r = -0.36) and intercostal attenuation (r = -0.50). Multiple regression analysis showed that FEV1 was predicted by intercostal attenuation (B = 0.40), intercostal CSA (B = 0.23), emphysema extent (B = -0.23), and age (B = -0.21, R(2) = 0.64, P increase in intercostal fat are associated with worsening of COPD severity. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  9. Rostrocaudal gradient of mechanical advantage in the parasternal intercostal muscles of the dog.

    Science.gov (United States)

    De Troyer, A; Legrand, A; Wilson, T A

    1996-08-15

    1. Previous theoretical studies have led to the predictions that, in the dog, the parasternal intercostal muscles in the rostral interspaces shorten more during passive inflation than those in the caudal interspaces and have, therefore, a greater inspiratory mechanical advantage. The present studies were undertaken to test these predictions. 2. The effects of passive inflation on the length of the parasternal intercostals interspaces 1 to 7 were evaluated with markers implanted in the costal cartilages. Although the muscles in all interspaces shortened with passive inflation, the fractional shortening increased from the first to the second and third interspaces and then decreased continuously to the seventh interspace. 3. To understand this peculiar distribution, a geometric model of the parasternal area was then developed and a relation was obtained between muscle shortening and the angles that describe the orientation of the muscle and costal cartilage relative to the sternum. Measurement of these angles indicated that the rostrocaudal gradient of parasternal shortening resulted from the different orientations of the costal cartilages and their different rotations during passive inflation. 4. The changes in airway pressure generated by the parasternal intercostals in interspaces 3, 5 and 7 were finally measured during selective, maximal stimulation. The fall in pressure was invariably greatest during contraction of the third interspace and smallest during contraction of the seventh. 5. These observations indicate that, in the dog, the rostrocaudal gradient in rib rotation induces a rostrocaudal gradient of mechanical advantage in the parasternal intercostals, which has its climax in the second and third interspaces. These observations also support the concept that the respiratory effect of a given respiratory muscle can be computed from its behaviour during passive inflation.

  10. Electrical activation to the parasternal intercostal muscles during high-frequency spinal cord stimulation in dogs

    Science.gov (United States)

    Kowalski, Krzysztof E.

    2014-01-01

    High-frequency spinal cord stimulation (HF-SCS) is a novel technique of inspiratory muscle activation involving stimulation of spinal cord pathways, which may have application as a method to provide inspiratory muscle pacing in ventilator-dependent patients with spinal cord injury. The purpose of the present study was to compare the spatial distribution of motor drive to the parasternal intercostal muscles during spontaneous breathing with that occurring during HF-SCS. In nine anesthetized dogs, HF-SCS was applied at the T2 spinal level. Fine-wire recording electrodes were used to assess single motor unit (SMU) pattern of activation in the medial bundles of the 2nd and 4th and lateral bundles of the 2nd interspaces during spontaneous breathing and HF-SCS following C1 spinal section. Stimulus amplitude during HF-SCS was adjusted such that inspired volumes matched that occurring during spontaneous breathing (protocol 1). During HF-SCS mean peak SMU firing frequency was highest in the medial bundles of the 2nd interspace (17.1 ± 0.6 Hz) and significantly lower in the lateral bundles of the 2nd interspace (13.5 ± 0.5 Hz) and medial bundles of the 4th (15.2 ± 0.7 Hz) (P intercostal muscles during HF-SCS is similar to that occurring during spontaneous breathing, and 2) differential spatial distribution of parasternal intercostal activation does not depend upon differential descending synaptic input from supraspinal centers. PMID:25342707

  11. Adherent primary cultures of mouse intercostal muscle fibers for isolated fiber studies.

    Science.gov (United States)

    Robison, Patrick; Hernández-Ochoa, Erick O; Schneider, Martin F

    2011-01-01

    Primary culture models of single adult skeletal muscle fibers dissociated from locomotor muscles adhered to glass coverslips are routine and allow monitoring of functional processes in living cultured fibers. To date, such isolated fiber cultures have not been established for respiratory muscles, despite the fact that dysfunction of core respiratory muscles leading to respiratory arrest is the most common cause of death in many muscular diseases. Here we present the first description of an adherent culture system for single adult intercostal muscle fibers from the adult mouse. This system allows for monitoring functional properties of these living muscle fibers in culture with or without electrical field stimulation to drive muscle fiber contraction at physiological or pathological respiratory firing patterns. We also provide initial characterization of these fibers, demonstrating several common techniques in this new model system in the context of the established Flexor Digitorum Brevis muscle primary culture model.

  12. Adherent Primary Cultures of Mouse Intercostal Muscle Fibers for Isolated Fiber Studies

    Directory of Open Access Journals (Sweden)

    Patrick Robison

    2011-01-01

    Full Text Available Primary culture models of single adult skeletal muscle fibers dissociated from locomotor muscles adhered to glass coverslips are routine and allow monitoring of functional processes in living cultured fibers. To date, such isolated fiber cultures have not been established for respiratory muscles, despite the fact that dysfunction of core respiratory muscles leading to respiratory arrest is the most common cause of death in many muscular diseases. Here we present the first description of an adherent culture system for single adult intercostal muscle fibers from the adult mouse. This system allows for monitoring functional properties of these living muscle fibers in culture with or without electrical field stimulation to drive muscle fiber contraction at physiological or pathological respiratory firing patterns. We also provide initial characterization of these fibers, demonstrating several common techniques in this new model system in the context of the established Flexor Digitorum Brevis muscle primary culture model.

  13. Adherent Primary Cultures of Mouse Intercostal Muscle Fibers for Isolated Fiber Studies

    Science.gov (United States)

    Robison, Patrick; Hernández-Ochoa, Erick O.; Schneider, Martin F.

    2011-01-01

    Primary culture models of single adult skeletal muscle fibers dissociated from locomotor muscles adhered to glass coverslips are routine and allow monitoring of functional processes in living cultured fibers. To date, such isolated fiber cultures have not been established for respiratory muscles, despite the fact that dysfunction of core respiratory muscles leading to respiratory arrest is the most common cause of death in many muscular diseases. Here we present the first description of an adherent culture system for single adult intercostal muscle fibers from the adult mouse. This system allows for monitoring functional properties of these living muscle fibers in culture with or without electrical field stimulation to drive muscle fiber contraction at physiological or pathological respiratory firing patterns. We also provide initial characterization of these fibers, demonstrating several common techniques in this new model system in the context of the established Flexor Digitorum Brevis muscle primary culture model. PMID:21869860

  14. Effect of intercostal muscle and costovertebral joint material properties on human ribcage stiffness and kinematics.

    Science.gov (United States)

    Kindig, Matthew; Li, Zuoping; Kent, Richard; Subit, Damien

    2015-01-01

    Current finite element (FE) models of the human thorax are limited by the lack of local-level validation, especially in the ribcage. This study exercised an existing FE ribcage model for a 50th percentile male under quasi-static point loading and dynamic sternal loading. Both force-displacement and kinematic responses of the ribcage were compared against experimental data. The sensitivity of the model response to changes in the material properties of the costovertebral (CV) joints and intercostal muscles was assessed. The simulations found that adjustments to the CV joints tended to change the amount of rib rotation in the sagittal plane, while changes to the elastic modulus and thickness of the intercostal muscles tended to alter both the stiffness and the direction and magnitude of rib motions. This study can lend insight into the role that the material properties of these two thoracic structures play in the dynamics of the ribcage during a frontal loading condition.

  15. Characterization of Intercostal Muscle Pathology in Canine Degenerative Myelopathy: A Disease Model for Amyotrophic Lateral Sclerosis

    Science.gov (United States)

    Morgan, Brandie R.; Coates, Joan R.; Johnson, Gayle C.; Bujnak, Alyssa C.; Katz, Martin L.

    2014-01-01

    Dogs homozygous for missense mutations in the SOD1 gene develop a late-onset neuromuscular disorder called degenerative myelopathy (DM) that has many similarities to amyotrophic lateral sclerosis (ALS). Both disorders are characterized by widespread progressive declines in motor functions accompanied by atrophic changes in the descending spinal cord tracts , and some forms of ALS are also associated with SOD1 mutations. In end-stage ALS, death usually occurs as a result of respiratory failure due to severe functional impairment of respiratory muscles. The mechanisms that lead to this loss of function are not known. Dogs with DM are euthanized at all stages of disease progression providing an opportunity to characterize the onset and progression of any pathological changes in the respiratory muscles that may precede respiratory failure. To characterize such potential disease-related pathology we evaluated intercostal muscles from Boxer and Pembroke Welsh Corgi dogs that were euthanized at various stages of DM disease progression. DM was found to result in intercostal muscle atrophy, fibrosis, increased variability in muscle fiber size and shape, and an alteration in muscle fiber type composition. This pathology was not accompanied by retraction of the motor neuron terminals from the muscle acetylcholine receptor complexes, suggesting that the muscle atrophy did not result from physical denervation. These findings provide a better understanding of the mechanisms that likely lead to respiratory failure in at least some forms of ALS and will be useful in the development and evaluation of potential therapeutic interventions using the DM model. PMID:24043596

  16. Spatial distribution of inspiratory drive to the parasternal intercostal muscles in humans

    Science.gov (United States)

    Gandevia, Simon C; Hudson, Anna L; Gorman, Robert B; Butler, Jane E; De Troyer, André

    2006-01-01

    The human parasternal intercostal muscles are obligatory inspiratory muscles with a diminishing mechanical advantage from cranial to caudal interspaces. This study determined whether inspiratory neural drive to these muscles is graded, and whether this distribution matches regional differences in inspiratory mechanical advantage. To determine the neural drive, intramuscular EMG was recorded from the first to the fifth parasternal intercostals during resting breathing in six subjects. All interspaces showed phasic inspiratory activity but the onset of activity relative to inspiratory flow in the fourth and fifth spaces was delayed compared with that in cranial interspaces. Activity in the first, second and third interspaces commenced, on average, within the first 10% of inspiratory time, and sometimes preceded inspiratory airflow. In contrast, activity in the fourth and fifth interspaces began after an average 33% of inspiratory time. The peak inspiratory discharge frequency of motor units in the first interspace averaged 13.4 ± 1.0 Hz (mean ± s.e.m.) and was significantly greater than in all other interspaces, in particular in the fifth space (8.0 ± 1.0 Hz). Phasic inspiratory activity was sometimes superimposed on tonic activity. In the first interspace, only 3% of units had tonic firing, but this proportion increased to 34% in the fifth space. In five subjects, recordings were also made from the medial and lateral extent of the second parasternal intercostal. Both portions showed phasic inspiratory activity which began within the first 6% of inspiratory time. Motor units from the lateral and medial portions fired at the same peak discharge rate (10.4 ± 0.7 versus 10.7 ± 0.6 Hz). These observations indicate that the distribution of neural drive to the parasternal intercostals in humans has a rostrocaudal gradient, but that the drive is uniform along the mediolateral extent of the second interspace. The distribution of inspiratory neural drive to the

  17. Operative access to kidney without damage of lumbar and intercostal muscles, vessels and nerves

    Directory of Open Access Journals (Sweden)

    Anatoliy Zalewsky

    2012-10-01

    Full Text Available The purpose of the study is a search of operative access to the kidney with less surgical trauma and associated complications. Specific research tasks included experiment on the dead bodies of people to develop operative access to the kidney without the transversal section of muscles and damage of intercostal and lumbar vessels and nerves. The research also studied the parameters of access using the Sozon-Yaroshevich method (1954 to estimate his appropriateness in surgical practice.Operative access to the kidney with the longitudinal section of latissimus dorsi muscle and the XII rib is anatomically justified and possesses parameters which are sufficient for the successful conducting of operations on a kidney and upper departments of the urine excretion system. The suggested operative access to the kidney eliminates the damage of intercostal and lumbar muscles, vessels and nerves. Application of this operative access method to the kidney in treatment of urology patients decreases time of their treatment and eliminates relaxation of abdominal muscles and development of postoperative lumbar hernia.

  18. Intercostal Muscle Pacing with High Frequency Spinal Cord Stimulation in Dogs

    Science.gov (United States)

    DiMarco, Anthony F.; Kowalski, Krzysztof E.

    2010-01-01

    High frequency spinal cord stimulation (HF-SCS) is a novel and more physiologic method of inspiratory muscle activation which involves stimulation of spinal cord pathways. In the present study, we determined if activation of the inspiratory intercostal muscles alone by this technique could be utilized to maintain artificial ventilation. In 7 anesthetized dogs, following C2 spinal cord section and bilateral phrenicotomy, trains of electrical stimulation (12 times/min) were applied at the T2 level. Eucapnea was maintained during an initial 5.5 hour period of continuous stimulation. During a subsequent 0.5 hour period, stimulus parameters were increased to induce hyperventilation resulting in a sustained fall in end-tidal PCO2 to 29.3 ± 0.4 mmHg. Single motor unit peak firing frequencies of the intercostal muscles during HF-SCS were similar to those occurring during spontaneous breathing. This technique holds promise as a method to restore ventilation in ventilator-dependent tetraplegics who do not have adequate phrenic nerve function for diaphragm pacing. PMID:20338266

  19. Effect of a combined thoracic and backward lifting exercise on the thoracic kyphosis angle and intercostal muscle pain.

    Science.gov (United States)

    Yoo, Won-Gyu

    2017-08-01

    [Purpose] This study developed a combined thoracic and backward lifting exercise for thoracic kyphosis angle and intercostal muscle pain. [Subject and Methods] The subject was a 41-year-old man who complained of upper thoracic and intercostal pain. He performed the combined thoracic and backward lifting exercise for 15 days. [Results] The initial VAS score for the intercostal area was 4/10. The VAS score decreased to 1/10 after the thoracic exercise combined with backward lifting. The initial thoracic kyphosis angle was 38° and it decreased to 32° after the exercise period. [Conclusion] Therefore, backward lifting and thoracic extension is a good posture for activating the different layers of muscle that are attached to the ribs. The kyphosis angle is also reduced by providing sufficient resistance during the thoracic exercise.

  20. Control of abdominal and expiratory intercostal muscle activity during vomiting - Role of ventral respiratory group expiratory neurons

    Science.gov (United States)

    Miller, Alan D.; Tan, L. K.; Suzuki, Ichiro

    1987-01-01

    The role of ventral respiratory group (VRG) expiratory (E) neurons in the control of abdominal and internal intercostal muscle activity during vomiting was investigated in cats. Two series of experiments were performed: in one, the activity of VRG E neurons was recorded during fictive vomiting in cats that were decerebrated, paralyzed, and artificially ventilated; in the second, the abdominal muscle activity during vomiting was compared before and after sectioning the axons of descending VRG E neurons in decerebrate spontaneously breathing cats. The results show that about two-thirds of VRG E neurons that project at least as far caudally as the lower thoracic cord contribute to internal intercostal muscle activity during vomiting. The remaining VRG E neurons contribute to abdominal muscle activation. As shown by severing the axons of the VRG E neurons, other, as yet unidenified, inputs (either descending from the brain stem or arising from spinal reflexes) can also produce abdominal muscle activation.

  1. Control of abdominal and expiratory intercostal muscle activity during vomiting - Role of ventral respiratory group expiratory neurons

    Science.gov (United States)

    Miller, Alan D.; Tan, L. K.; Suzuki, Ichiro

    1987-01-01

    The role of ventral respiratory group (VRG) expiratory (E) neurons in the control of abdominal and internal intercostal muscle activity during vomiting was investigated in cats. Two series of experiments were performed: in one, the activity of VRG E neurons was recorded during fictive vomiting in cats that were decerebrated, paralyzed, and artificially ventilated; in the second, the abdominal muscle activity during vomiting was compared before and after sectioning the axons of descending VRG E neurons in decerebrate spontaneously breathing cats. The results show that about two-thirds of VRG E neurons that project at least as far caudally as the lower thoracic cord contribute to internal intercostal muscle activity during vomiting. The remaining VRG E neurons contribute to abdominal muscle activation. As shown by severing the axons of the VRG E neurons, other, as yet unidenified, inputs (either descending from the brain stem or arising from spinal reflexes) can also produce abdominal muscle activation.

  2. Effect of spaceflight on oxidative and antioxidant enzyme activity in rat diaphragm and intercostal muscles

    Science.gov (United States)

    Lee, Mona D.; Tuttle, Ronald; Girten, Beverly

    1995-01-01

    There are limited data regarding changes in oxidative and antioxidant enzymes induced by simulated or actual weightlessness, and any additional information would provide insight into potential mechanisms involving other changes observed in muscles from animals previously flown in space. Thus, the NASA Biospecimen Sharing Program was an opportunity to collect valuable information. Oxidative and antioxidant enzyme levels, as well as lipid peroxidation, were measured in respiratory muscles from rates flown on board Space Shuttle mission STS-54. The results indicated that there was an increasing trend in citrate synthase activity in the flight diaphragm when compared to ground based controls, and there were no significant changes observed in the intercostal muscles for any of the parameters. However, the lipid peroxidation was significantly (p less than 0.05) decreased in the flight diaphragm. These results indicate that 6 day exposure to microgravity may have a different effect on oxidative and antioxidant activity in rat respiratory muscles when compared to data from previous 14 day hindlimb suspension studies.

  3. Analysis of activity of motor units in the biceps brachii muscle after intercostal-musculocutaneous nerve transfer.

    Science.gov (United States)

    Sakuta, Naoki; Sasaki, Sei-Ichi; Ochiai, Naoyuki

    2005-04-01

    We examined respiratory activity of motor units (MUs) in the internal intercostal nerves (IICNs)-transferred biceps brachii muscle (IC-biceps) in cats. MUs of IC-biceps showed respiratory discharges in inspiratory and expiratory phases, and these were enhanced by CO2 inhalation. Narrowing the airway also enhanced inspiratory and expiratory MUs activity. A mechanical load to the thorax immediately enhanced inspiratory MUs activity and weakened expiratory MUs activity. We analyzed the cross-correlation of MUs activity in interchondral muscle and IC-biceps to characterize the respiratory spinal descending inputs to motoneurons. We confirmed the short-term synchronization from interchondral muscles indicating divergence of a single respiratory presynaptic axon to thoracic motoneurons, but could not find synchronization from IC-biceps. The motor axonal conduction velocity (axonal CV) of IC-biceps MUs was lower than that of interchondral muscles. There was no correlation between the respiratory recruitment order of IC-biceps MUs and their axonal CV. These results indicate that IC-biceps shows the respiratory activities and afferent inputs from intercostal muscle spindles in the neighboring segments remain influential on activity of IC-biceps. In addition, the short-term synchronization from IC-biceps could not be found, suggesting that the intercostal nerve transfer alters the respiratory spinal descending inputs to thoracic motoneurons.

  4. Free Functioning Gracilis Muscle Transfer versus Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion after Traumatic Adult Brachial Pan-Plexus Injury.

    Science.gov (United States)

    Maldonado, Andrés A; Kircher, Michelle F; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2016-09-01

    After complete five-level root brachial plexus injury, free functional muscle transfer and intercostal nerve transfer to the musculocutaneous nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus intercostal nerve-to-musculocutaneous nerve transfers with respect to strength. Sixty-two patients who underwent free functional muscle transfer reconstruction or intercostal nerve-to-musculocutaneous nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores. In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the intercostal nerve-to-musculocutaneous nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p intercostal nerves used for the musculocutaneous nerve transfer did not correlate with better elbow flexion grade. Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than intercostal nerve-to-musculocutaneous nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction. Therapeutic, III.

  5. Respiratory responses to stimulation of abdominal and upper-thorax intercostal muscles using multiple Permaloc electrodes.

    Science.gov (United States)

    Walter, James S; Thomas, Donald; Sayers, Scott; Perez-Tamayo, R Anthony; Crish, Timothy; Singh, Sanjay

    2015-01-01

    Stimulation of abdominal and upper-thoracic muscles was studied with the long-term goal of improved respiratory care for spinal cord injury (SCI) patients. A 12-channel stimulator and multiple surface and implanted Permaloc electrodes were evaluated in five anesthetized canines. Abdominal stimulation with 100 mA using four bilateral sets of surface electrodes placed on the midaxillary line at the 7th through 13th intercostal spaces and with a closed airway at a large lung volume produced an expiratory tracheal pressure of 109 +/- 29 cm H2O (n = 2, mean +/- standard error of the mean). Similar high pressures were induced with implanted electrodes at the same locations. Upper-thoracic stimulation with 40 mA and four sets of implanted electrodes ventral to the axilla induced inspiratory pressures of -12 +/- 2 cm H2O (n = 5). Combined extradiaphragmatic pacing with an open airway produced a tidal volume of 440 +/- 45 mL (n = 4). The robust respiratory volumes and pressures suggest applications in SCI respiratory care.

  6. Respiratory responses to stimulation of abdominal and upper-thorax intercostal muscles using multiple Permaloc electrodes

    National Research Council Canada - National Science Library

    Walter, James S; Thomas, Donald; Sayers, Scott; Perez-Tamayo, R Anthony; Crish, Timothy; Singh, Sanjay

    2015-01-01

    .... Abdominal stimulation with 100 mA using four bilateral sets of surface electrodes placed on the midaxillary line at the 7th through 13th intercostal spaces and with a closed airway at a large lung...

  7. Indocyanine green fluorescence in the assessment of the quality of the pedicled intercostal muscle flap: a pilot study.

    Science.gov (United States)

    Piwkowski, Cezary; Gabryel, Piotr; Gąsiorowskia, Łukasz; Zieliński, Paweł; Murawa, Dawid; Roszak, Magdalena; Dyszkiewicz, Wojciech

    2013-07-01

    The pedicled intercostal muscle flap (IMF) is a high quality vascularized tissue commonly used to buttress the bronchial stump after pneumonectomy or bronchial anastomosis after sleeve lobectomy in order to prevent bronchopleural fistula formation. The evaluation of the viability of the muscle flap is difficult. The aim of this study was the assessment of the application of indicyanine green fluorescence for the evaluation of IMF perfusion. The study included 27 patients (10 males and 17 females), mean age 62.6 years (47-77 years). Indocyanine green fluorescence (ICG) was used for objective assessment of the IMF quality by a near-infrared camera system (Photodynamic Eye(®), Hamamatsu Photonics, Japan). The following factors that may have an impact on the quality of the IMF were assessed: age, gender, body mass index, comorbidities, IMF length and thickness and timing of the harvesting during the procedure. The following surgical pulmonary resections with IMF harvesting were performed: 12 pneumonectomies, 2 sleeve lobectomies and 13 lobectomies. Intercostal muscle flap (IMF) was harvested before rib spreader insertion in 23 patients (85%) and at the end of the surgery in 4 patients (15%). The mean length and thickness of the harvested intercostal muscle were 19.9 ± 2.9 cm (range 13-24 cm) and 2.4 cm ± 0.7 cm (range 1.0-3.5 cm), respectively. Indocyanine green angiography showed ischaemia in the distal part of the muscle in all cases, despite the lack of obvious macroscopic signs. Median length of the ischaemic part was 4 cm (range 0.5-20 cm). The IMF length and thickness had a significant impact on the length of the ischaemic segment. In 24 patients, the ischaemic part of the muscle flap was severed. In 3 patients with the longest ischaemic segment (11, 13 and 20 cm), an alternative tissue was used to cover the bronchial stump. No major complications occurred. Our preliminary results confirmed the simplicity and high efficacy of ICG in the assessment of

  8. Daily acute intermittent hypoxia elicits functional recovery of diaphragm and inspiratory intercostal muscle activity after acute cervical spinal injury

    Science.gov (United States)

    Navarrete-Opazo, A.; Vinit, S; Dougherty, B.J.; Mitchell, G.S.

    2015-01-01

    A major cause of mortality after spinal cord injury is respiratory failure. In normal rats, acute intermittent hypoxia (AIH) induces respiratory motor plasticity, expressed as diaphragm (Dia) and second external intercostal (T2 EIC) long-term facilitation (LTF). Dia (not T2 EIC) LTF is enhanced by systemic adenosine 2A (A2a) receptor inhibition in normal rats. We investigated the respective contributions of Dia and T2 EIC to daily AIH-induced functional recovery of breathing capacity with/without A2a receptor antagonist (KW6002, i.p.) following C2 hemisection (C2HS). Rats received daily AIH (dAIH: 10, 5-min episodes, 10.5% O2; 5-min normoxic intervals; 7 successive days beginning 7 days post-C2HS) or daily normoxia (dNx) with/without KW6002, followed by weekly (reminder) presentations for 8 weeks. Ventilation and EMGs from bilateral diaphragm and T2 EIC muscles were measured with room air breathing (21% O2) and maximum chemoreceptor stimulation (MCS: 7% CO2, 10.5% O2). dAIH increased tidal volume (Vt) in C2HS rats breathing room air (dAIH + vehicle: 0.47 ± 0.02, dNx + vehicle: 0.40 ± 0.01ml/100 g; p<0.05) and MCS (dAIH + vehicle: 0.83 ± 0.01, dNx + vehicle: 0.73 ± 0.01ml/100g; p<0.001); KW6002 had no significant effect. dAIH enhanced contralateral (uninjured) diaphragm EMG activity, an effect attenuated by KW6002, during room air breathing and MCS (p<0.05). Although dAIH enhanced contralateral T2 EIC EMG activity during room air breathing, KW6002 had no effect. dAIH had no statistically significant effects on diaphragm or T2 EIC EMG activity ipsilateral to injury. Thus, two weeks post-C2HS: 1) dAIH enhances breathing capacity by effects on contralateral diaphragm and T2 EIC activity; and 2) dAIH-induced recovery is A2a dependent in diaphragm, but not T2 EIC. Daily AIH may be a useful in promoting functional recovery of breathing capacity after cervical spinal injury, but A2a receptor antagonists (eg. caffeine) may undermine its effectiveness shortly after

  9. Adherent Primary Cultures of Mouse Intercostal Muscle Fibers for Isolated Fiber Studies

    OpenAIRE

    2011-01-01

    Primary culture models of single adult skeletal muscle fibers dissociated from locomotor muscles adhered to glass coverslips are routine and allow monitoring of functional processes in living cultured fibers. To date, such isolated fiber cultures have not been established for respiratory muscles, despite the fact that dysfunction of core respiratory muscles leading to respiratory arrest is the most common cause of death in many muscular diseases. Here we present the first description of an ad...

  10. Role of joint receptors in modulation of inspiratory intercostal activity by rib motion in dogs.

    Science.gov (United States)

    De Troyer, A

    1997-09-01

    1. Inspiratory activity in the canine external intercostal muscles is exquisitely sensitive to the direction and amplitude of the inspiratory displacement of the ribs. This study was designed to investigate the role of muscle receptors, in particular the muscle spindles, in mediating this phenomenon. 2. External intercostal inspiratory activity showed a reflex increase when the normal cranial motion of the ribs and the normal shortening of the muscles was reduced, and showed a reflex decrease when the cranial motion of the ribs and the shortening of the muscles was augmented. However, clamping the two ribs making up the interspace and maintaining muscle length constant only moderately attenuated these responses. 3. These persistent responses remained unchanged after section of the levator costae muscles. 4. The responses were attenuated but still present after section of the external intercostals in the contiguous segments and denervation of the internal intercostals. 5. These reflex responses are therefore mediated in part by non-muscular receptors, which most likely lie within the costovertebral joints. These joint receptors might be a primary determinant of the load-compensating reflex.

  11. Clinicoradiological diagnosis of cough-induced intercostal hernia.

    Science.gov (United States)

    Dobradin, Andrew; Bello, Jessica

    2013-07-01

    Cough-induced intercostal hernias without any type of external trauma are very uncommon. There have been less than 10 cases documented in literature. This clinical report describes a 66-year-old male who developed an intercostal hernia induced by a severe cough due to bilateral pneumonia and a subsequent rib fracture. It took almost a full year to diagnose this patient's chest wall mass. Only after taking careful history and reviewing all the images, the diagnosis of intercostal hernia was made. He was referred to a cardiothoracic surgeon for treatment. Intercostal hernias can be caused by the sheer exertion of coughing without any prior history of trauma to the chest wall or abdomen. Early diagnosis is difficult and had to be based on clinical signs and symptoms. The imaging studies might help to establish diagnosis, but cannot replace a diligent examination and clinical interview. The treatment of the chest wall defect is case dependent. Surgical repair reinforcement of the intercostal muscles might be required with prosthetic nonabsorbable (polypropylene) mesh.

  12. Effects of unilateral airway occlusion on rib motion and inspiratory intercostal activity in dogs.

    Science.gov (United States)

    Leduc, Dimitri; Marechal, Sarah; Taton, Olivier; Blairon, Bernard; Legrand, Alexandre

    2017-04-01

    Unilateral bronchial occlusion, a complication of many lung diseases, causes dyspnea but the mechanism of this symptom is uncertain. In this study, electromyographic (EMG) activity in the parasternal and external intercostal muscles in the third intercostal space and inspiratory motion of the third rib on both sides of the thorax were assessed during occlusion of a main bronchus for a single breath in anesthetized dogs. Occlusion produced a 65% increase in external intercostal EMG activity in both hemithoraces without altering parasternal EMG activity. Concomitantly, the inspiratory cranial rib motion showed a 50% decrease on both sides of the thorax. These changes were unaffected by bilateral vagotomy. However, when an external, caudally oriented force was applied to the third rib on the right or left side so that its inspiratory cranial displacement was abolished, activity in the adjacent external intercostals showed a twofold increase, but rib motion and external activity in the contralateral hemithorax remained unchanged. It is concluded that during occlusion of a main bronchus, the increase in external intercostal activity is induced by the decrease in inspiratory cranial rib displacement in both hemithoraces, and that this decrease is determined by the increase in pleural pressure swings on both sides of the mediastinum. This mechanism, combined with the decrease in PaO2, induces similar alterations when unilateral bronchial occlusion is maintained for a series of consecutive breaths. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

  13. Absence of synergy for monosynaptic Group I inputs between abdominal and internal intercostal motoneurons

    DEFF Research Database (Denmark)

    Ford, T W; Meehan, Claire Francesca; Kirkwood, P A

    2014-01-01

    , and the specificity of the monosynaptic connections from afferents in each of the two main branches of this nerve was investigated. Motoneurons were shown by antidromic excitation to innervate three muscle groups: external abdominal oblique [EO; innervated by the lateral branch (Lat)], the region of the internal...... motoneurons showed one from Lat. Expiratory Dist motoneurons fell into two groups. Those with Dist EPSPs and none from Lat (group A) were assumed to innervate distal internal intercostal muscle. Those with Lat EPSPs (group B) were assumed to innervate abdominal muscle (transversus abdominis or rectus......Internal intercostal and abdominal motoneurons are strongly coactivated during expiration. We investigated whether that synergy was paralleled by synergistic Group I reflex excitation. Intracellular recordings were made from motoneurons of the internal intercostal nerve of T8 in anesthetized cats...

  14. Lesão complexa da traqueia: correção com retalho pediculado de músculo intercostal Complex tracheal lesion: correction with an intercostal muscle pedicle flap

    Directory of Open Access Journals (Sweden)

    Hylas Paiva da Costa Ferreira

    2009-12-01

    Full Text Available A reconstrução esofágica é uma das mais complexas cirurgias do aparelho digestivo, principalmente quando realizada por técnicas minimamente invasivas. Esse procedimento está associado a inúmeras complicações, como deiscência de anastomose, quilotórax, necrose do tubo gástrico e fistulas. Relatamos o caso de um paciente com o diagnóstico de carcinoma epidermoide no terço distal do esôfago que foi submetido à uma esofagectomia por videotoracoscopia e laparoscopia. Durante o ato operatório, houve lesão do brônquio principal esquerdo, sendo necessária a correção cirúrgica imediata da lesão. No pós-operatório, o paciente evoluiu com insuficiência respiratória aguda e grande escape aéreo pelos drenos de tórax e pela ferida operatória cervical. Foi submetido à nova intervenção cirúrgica, através da qual se observou uma grande lesão na parede membranosa da traqueia, que foi corrigida com um retalho de músculo intercostal.Esophageal reconstruction is one of the most complex types of gastrointestinal surgery, principally when it is performed using minimally invasive techniques. The procedure is associated with various complications, such as anastomotic dehiscence, chylothorax, esophageal necrosis and fistulae. We report the case of a patient diagnosed with epidermoid carcinoma in the distal third of the esophagus. The patient was submitted to esophagectomy by video-assisted thoracoscopy and laparoscopy. During the operation, the left main bronchus was injured, and this required immediate surgical correction. In the postoperative period, the patient presented with acute respiratory failure and profuse air leak through the thoracic drains and through the cervical surgical wound. The patient underwent a second surgical procedure, during which a large lesion was discovered in the membranous wall of the trachea. The lesion was corrected with an intercostal muscle pedicle flap.

  15. An Intercostal Muscular Hernia as a Consequence of Intercostal Nerve Root Compromise After Trauma to the Thoracic Spine.

    Science.gov (United States)

    LaBan, Myron M

    2017-04-01

    'True' intercostal hernias, that is, those containing both pleura and lung components, occur infrequently. Only 300 cases have been reported since Rolland's initial description in 1499. Rarer still are intercostal muscle hernias, which occur without containing pulmonary components. In both instances, males predominate, usually a consequence of direct blunt chest trauma. In many instances, recognition of the intercostal muscle hernia may be delayed from weeks to months, its diagnosis masked by more obvious evidence of physical trauma.

  16. Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report.

    Science.gov (United States)

    Kumar, Naveen; Guru, Anitha; Patil, Jyothsna; Ravindra, Swamy; Badagabettu, Satheesha Nayak

    2013-01-08

    In the thorax there are normally 11 pairs of intercostal spaces: the spaces between adjacent ribs. The intercostal spaces contain intercostal muscles, intercostal nerves and vessels. During a routine dissection for undergraduate medical students, we observed a variation involving the left 3rd rib and 3rd costal cartilage in the cadaver of a man of Indian ethnicity aged about 65 years. The left 3rd rib and its costal cartilage were bifurcated at their costochondral junction enclosing a small circular additional intercostal space. Muscle tissue covered by deep fascia was present in this circular intercostal space. The muscle in the circular intercostal space received its nerve supply from a branch of the 2nd intercostal nerve. Knowledge of such variations is helpful to surgeons operating on the anterior thoracic wall involving ribs and intercostal spaces. Knowing the possibility of the presence of an additional space between normal intercostal spaces can guide a surgeon through to a successful surgery.

  17. Excess VO2 during ramp exercise is positively correlated to intercostal muscles deoxyhemoglobin levels above the gas exchange threshold in young trained cyclists.

    Science.gov (United States)

    Oueslati, Ferid; Girard, Olivier; Tabka, Zouhair; Ahmaidi, Said

    2016-07-01

    We assessed respiratory muscles oxygenation responses during a ramp exercise to exhaustion and further explored their relationship with the non-linear increase of VO2 (VO2 excess) observed above the gas-exchange threshold. Ten male cyclists completed a ramp exercise to exhaustion on an electromagnetically braked cycle-ergometer with a rate of increment of 30Wmin(-1) with continuous monitoring of expired gases (breath-by-breath) and oxygenation status of intercostal muscles. Maximal inspiratory and expiratory pressure measurements were taken at rest and at exhaustion. The VO2 excess represents the difference between VO2max observed and VO2max expected using linear equation between the VO2 and the intensity before gas-exchange threshold. The deoxyhemoglobin remained unchanged until 60% of maximal aerobic power (MAP) and thereafter increased significantly by 37±18% and 40±22% at 80% and 100% of MAP, respectively. Additionally, the amplitude of deoxyhemoglobin increase between 60 and 100% of MAP positively correlated with the VO2 excess (r=0.69, p<0.05). Compared to exercise start, the oxygen tissue saturation index decreased from 80% of MAP (-4.8±3.2%, p<0.05) onwards. At exhaustion, maximal inspiratory and expiratory pressures declined by 7.8±16% and 12.6±10% (both p<0.05), respectively. In summary, our results suggest a significant contribution of respiratory muscles to the VO2 excess phenomenon.

  18. Feasibility of intercostal blood flow measurement by echo-Doppler technique in healthy subjects.

    Science.gov (United States)

    de Bisschop, Claire; Montaudon, Michel; Glénet, Stéphane; Guénard, Hervé

    2017-05-01

    Intercostal artery blood flow supplies the external and internal intercostal muscles, which are inspiratory and expiratory muscles. Intercostal blood flow measured by the echo-Doppler (ED) technique has not previously been reported in humans. This study describes the feasibility of this measurement during free and loaded breathing in healthy subjects. Systolic, diastolic and mean blood flows were measured in the eighth dorsal intercostal space during free and loaded breathing using the ED technique. Flows were calculated as the product of the artery intraluminal surface and blood velocity. Ten healthy subjects (42 ± 13·6 years) were included. Integrated electromyogram (iEMG), arterial pressure, cardiac frequency and breathing pattern were also recorded. Mean blood flows were 3·5 ± 1·2 ml min(-1) at rest, 6 ± 2·6 ml min(-1) while breathing through a combined inspiratory and expiratory resistance and 4·0 ± 1·3 ml min(-1) 1 min after unloading. Diastolic blood flow was about one-third the systolic blood flow. The changes in blood flows were consistent with those in iEMG. No change in mean blood flow was observed between inspiration and expiration, suggesting a balance in the perfusion of external and internal muscles during breathing. In conclusion, ED is a feasible technique for non-invasive, real-time measurement of intercostal blood flow in humans. In healthy subjects, mean blood flow appeared tightly matched to iEMG activity. This technique may provide a way to assess the vascular adaptations induced by diseases in which respiratory work is increased or cardiac blood flow altered. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  19. Absence of synergy for monosynaptic Group I inputs between abdominal and internal intercostal motoneurons.

    Science.gov (United States)

    Ford, T W; Meehan, C F; Kirkwood, P A

    2014-09-01

    Internal intercostal and abdominal motoneurons are strongly coactivated during expiration. We investigated whether that synergy was paralleled by synergistic Group I reflex excitation. Intracellular recordings were made from motoneurons of the internal intercostal nerve of T8 in anesthetized cats, and the specificity of the monosynaptic connections from afferents in each of the two main branches of this nerve was investigated. Motoneurons were shown by antidromic excitation to innervate three muscle groups: external abdominal oblique [EO; innervated by the lateral branch (Lat)], the region of the internal intercostal muscle proximal to the branch point (IIm), and muscles innervated from the distal remainder (Dist). Strong specificity was observed, only 2 of 54 motoneurons showing excitatory postsynaptic potentials (EPSPs) from both Lat and Dist. No EO motoneurons showed an EPSP from Dist, and no IIm motoneurons showed one from Lat. Expiratory Dist motoneurons fell into two groups. Those with Dist EPSPs and none from Lat (group A) were assumed to innervate distal internal intercostal muscle. Those with Lat EPSPs (group B) were assumed to innervate abdominal muscle (transversus abdominis or rectus abdominis). Inspiratory Dist motoneurons (assumed to innervate interchondral muscle) showed Dist EPSPs. Stimulation of dorsal ramus nerves gave EPSPs in 12 instances, 9 being in group B Dist motoneurons. The complete absence of heteronymous monosynaptic Group I reflex excitation between muscles that are synergistically activated in expiration leads us to conclude that such connections from muscle spindle afferents of the thoracic nerves have little role in controlling expiratory movements but, where present, support other motor acts. Copyright © 2014 the American Physiological Society.

  20. MUSCLE ACTIVATION DURING LOW-INTENSITY MUSCLE CONTRACTIONS WITH VARYING LEVELS OF EXTERNAL LIMB COMPRESSION

    Directory of Open Access Journals (Sweden)

    Tomohiro Yasuda

    2008-12-01

    Full Text Available The purpose was to investigate muscle activation during low- intensity muscle contractions with various levels of external limb compression to reduce muscle perfusion/outflow. A series of unilateral elbow flexion muscle contractions (30 repetitive contractions followed by 3 sets x 15 contractions was performed at 20% of 1RM with varying levels of external compression (0 (without compression, 98, 121, and 147 mmHg external compression around the upper arm. Electromyography (EMG signals were recorded from surface electrodes placed on the biceps brachii muscle and analyzed for integrated EMG (iEMG. Maximal voluntary isometric contraction (MVC decreased similarly during the control (0 mmHg and 98 mmHg external compression bout (~18%; the decline in MVC with 121 and 147 mmHg external compression was significantly greater (~37%. Muscle activation increased progressively throughout the contraction bout with each level of external compression, but iEMG was significantly greater during 147 mmHg external compression. In conclusion, low-intensity muscle contractions performed with external compression of 147 mmHg appears to alter muscle perfusion/outflow leading to increased muscle activation without decrements in work performed during the contraction bout

  1. Spatiotemporal distribution of heparan sulfate epitopes during myogenesis and synaptogenesis: a study in developing mouse intercostal muscle.

    NARCIS (Netherlands)

    Jenniskens, G.J.; Hafmans, T.G.M.; Veerkamp, J.H.; Kuppevelt, A.H.M.S.M. van

    2002-01-01

    Formation of a basal lamina (BL) ensheathing developing skeletal muscle cells is one of the earliest events in mammalian skeletal muscle myogenesis. BL-resident heparan sulfate proteoglycans have been implicated in various processes during myogenesis, including synaptic differentiation. However,

  2. Post pneumonectomy empyema with bronchopleural fistula; A successful management using pedicled intercostal muscle flap on an atypical mycobacteriosis following the irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Hirata, Seiyu (Tomiyama-machi Kokuho Hospital, Chiba (Japan)); Yamamoto, Kensuke

    1991-01-01

    A 48-year-old woman underwent a right pneumonectomy for advanced mycobacterial disease (M. avium Complex), which followed the postoperative radiotherapy against a malignant schwannoma of the right lower chest wall treated seven years ago. On the 13th postoperative day, re-suture of the bronchial stump was performed urgently because of early bronchopleural fistula development. On the heels of that, reclosure of the bronchial fistula with coverage of the stump by parietal pleural flap was performed on the forty-first post operative day. On the 110th day, however, open drainage with thoracoplasty was performed because development of insidious aspergillous empyema was detected. Since then, local instillation of amphotellisin B, with an oral administration of antifungus drug was started. After succeeding to control the mycotic infection, reclosure of the bronchofistula, covered with pedicled intercostal muscle flap were performed on the 280th postoperative day and extraperiostal air-plombage for reducing empyema cavity. Postoperative course was uneventful and the patient was discharged one year later. With respect to pathogenetic relationship between radiation pneumonitis and feasibility of infection to atypical mycobacteria, preoperative radiotherapy and concurrence of postoperative bronchofistula, and some problems on management of empyema bronchofistula were briefly discussed. (author).

  3. Intercostal block with cryotherapy.

    OpenAIRE

    Jones, M.J.; Murrin, K. R.

    1987-01-01

    A retrospective survey of 70 patients treated from 1982 to 1984 for chronic intercostal pain with cryotherapy to the intercostal nerves is presented. The results with patients suffering from postherpetic neuralgia are so poor that the authors cannot recommend this form of treatment for this condition. The results with patients suffering from thoracic surgical scar pain are significantly better (P less than 0.005) and support the use of the cryoprobe for this condition.

  4. Short-term synchronization of intercostal motoneurone activity.

    Science.gov (United States)

    Sears, T A; Stagg, D

    1976-12-01

    1. The hypothesis is advanced that the joint occurrence of unitary excitatory post-synaptic potentials e.p.s.p.s) evoked in motoneurones by branches of common stem pre-synaptic fibres causes short-term synchronization of their discharge during the rising phases of the unitary e.p.s.p.s. 2. This hypothesis was tested using the pre- and post-stimulus time (PPST) histogram to detect synchronized firing among groups of intercostal motoneurones discharging in response to their natural synaptic drives. 3. Motor nerve action potentials were recorded monophasically from nerve filaments of the external intercostal muscles of anaesthetized, paralysed cats maintained on artificial ventilation. 4. Computer methods were used to measure peak spike amplitude, spike amplitude, spike interval and filament identification for simultaneous recordings from four filaments. The spike amplitude histograms were derived for each filament and groups of spikes were selected for analysis. 5. With spikes of one group designated as 'stimuli' (occurring at zero time) and those of a second as 'response' the PPST histogram was computed with different time bin widths. 6. With bin widths of 100 and 10 msec the central respiratory periodicity was apparent in the PPST histogram. With 1.0 msec bins the PPST histogram showed a narrow central peak extending to +/- 3.0 msec at its base. This 'short-term synchronization' supports the hypothesis of joint firing due to common presynaptic connectivity. 7. It was shown that detection of short-term synchronization was critically dependent on a sufficient quantity of data but that provided a simple criterion of adequate counts per bin in the PPST histogram was met, short-term synchronization could be detected between intercostal motoneurones of the same and adjacent segments.

  5. Intercostal neuroma pain after laparoscopic cholecystectomy: diagnosis and treatment.

    Science.gov (United States)

    Dellon, A Lee

    2014-03-01

    Chest wall or abdominal pain after laparoscopic cholecystectomy is perceived as residual gastrointestinal problems. Some patients will have tenderness at the laparoscopic portal site(s), representing injury to one or more intercostal nerves. The author describes this patient population for the first time, outlining a diagnostic and therapeutic algorithm. Inclusion criteria included (1) right chest wall or abdominal pain persisting more than 1 year after laparoscopic cholecystectomy, (2) relief of that pain with intercostal nerve block, (3) resection of intercostal nerves identified by nerve block, and (4) at least a 6-month postoperative follow-up by telephone. Review from 2009 through 2011 identified one man and seven women meeting these criteria. Mean age was 44 years (range, 18 to 74 years). Mean interval between cholecystectomy and intercostal neurectomy was 44.3 months (range, 13 to 72 months). Two intercostal nerves were resected in two patients, three in four patients, four in one patient, and five in one patient, most commonly intercostal nerves T6, T7, and T8. Proximal nerves were implanted into the serratus or latissimus dorsi. At a mean period of 18.3 months after surgery, the preoperative mean visual analogue score of 8.9 (range, 7 to 10) decreased to 3.6 (range, 0 to 6) (p intercostal nerve injury. Diagnostic blocks are essential to confirm diagnosis. Nerve resection and implantation of the proximal ends into muscle can give good to excellent results in most patients. Therapeutic, IV.

  6. A Rare Complication of External Dacryocystorhinostomy: Transient Orbicularis Muscle Weakness

    Directory of Open Access Journals (Sweden)

    Didem Serin

    2014-10-01

    Full Text Available In this study, we present 4 patients with transient orbicularis oculi muscle weakness following external dacryocystorhinostomy (DCR. Preoperative and postoperative records of 4 patients who presented with either a delay in blinking or lagophthalmos on the first postoperative day were evaluated. None of the patients had a history of facial palsy or any symptom of lagophthalmos. All 4 patients had undergone external DCR without silicone intubation under general anesthesia. Three of the patients had a delay in blinking, while one patient developed a 4-mm lagophthalmos postoperatively. A mild punctate keratopathy was observed in one patient. The condition resolved in all patients after an average of 8 weeks. (Turk J Ophthalmol 2014; 44: 413-5

  7. Posterior intercostal artery tortuosity and collateral branch points: a cadaveric study.

    Science.gov (United States)

    Shurtleff, E; Olinger, A

    2012-11-01

    Publications report observing tortuosity in the posterior intercostal arteries of elderly patients. Studies also describe the size and course of the collateral intercostal arteries. This information is clinically significant when performing thoracentesis and video-assisted thorascopic surgery. To the best of our knowledge, no studies have examined arterial tortuosity or described collateral artery origins relative to bony landmarks. The purpose of this study was to define a safe surgical zone for thoracic access using palpable external bony landmarks. A total of 348 intercostal spaces (3rd-8th) of 29 male and female embalmed cadavers were dissected from the vertebral body to the mid-axillary line to observe the posterior intercostal artery and its collateral branch. The origins of the collateral intercostal arteries relative to the midline of thoracic spinous processes were measured. Mild to moderate tortuosity (arterial curves covering 25- -50% of the intercostal space) was observed in at least one posterior intercostal artery in the majority of cadavers. The origins of the collateral intercostal arteries were variable relative to the midline. Additional collateral intercostal arteries distal to the primary collateral branch were observed, most commonly in the 5th intercostal space, which is used in video-assisted thorascopic surgery and thoracentesis. Tortuosity is common in the 3rd to the 8th posterior intercostal arteries, especially in individuals over the age of 60 years. Given the findings of this study, we recommend that any procedure involving placement of a surgical instrument into these intercostal spaces does so at least 120 mm lateral to the midline of the spinous processes. We also recommend pre-procedure ultrasound (intercostal scan) of the posterior and collateral intercostal arteries when performing non-emergent thoracentesis and video-assisted thorascopic surgery, particularly in patients over 60 years of age.

  8. Incisional intercostal hernia with prolapse of the colon after right partial nephrectomy.

    Science.gov (United States)

    Yamamoto, Takatsugu; Kurashima, Yukiko; Watanabe, Chie; Ohata, Kazunori; Hashiba, Ryoya; Tanaka, Shogo; Uenishi, Takahiro; Ohno, Koichi

    2013-01-01

    A 75-year-old woman with a history of myocardial infarction, gallstones, and right renal cancer was referred to our department because of right flank pain. She had a surgical scar on the right abdomen between the 10th and 11th ribs; computed tomography demonstrated intercostal herniation of the colon. Recognizing the possibility of adhesions of the hernia and colon, we used a median skin incision and patched a polyester mesh coated with absorbent collagen. The patient had an uneventful postoperative course, with no pain for 6 months postoperatively. Transdiaphragmatic intercostal hernias with abdominal contents commonly develop after trauma or thoracic surgery. Incisional intercostal hernias seldom develop after nephrectomy; the present case is only the fourth report. We conjecture that a costochondral incision can induce subluxation of the costotransverse joint, intercostal nerve injury, and atrophy of the intercostal and abdominal oblique muscles. Surgeons must therefore recognize the potential, albeit rare, for intercostal hernia after nephrectomy.

  9. Changes in Shoulder External Rotator Muscle Activity during Shoulder External Rotation in Various Arm Positions in the Sagittal Plane

    OpenAIRE

    Jang, Jun-Hyeok; Oh, Jae-Seop

    2014-01-01

    [Purpose] The aim of this study was to investigate changes in electromyographic (EMG) activity of the infraspinatus and posterior deltoid muscles during shoulder external rotation under different shoulder flexion angles. [Subjects] Thirteen participants were included in this study. [Methods] The participants performed isometric shoulder external rotation at 45°, 90°, and 135° of shoulder flexion. A surface EMG system recorded the EMG activity of the infraspinatus and posterior deltoid muscles...

  10. The Effect of Fatigued External Rotator Muscles of the Shoulder on the Shoulder Position Sense

    OpenAIRE

    Naoya Iida; Fuminari Kaneko; Nobuhiro Aoki; Yoshinari Sakaki

    2011-01-01

    This study aimed to investigate the effect of fatigue in shoulder external rotator muscles on position sense of shoulder abduction, internal rotation, and external rotation. The study included 10 healthy subjects. Shoulder position sense was measured before and after a fatigue task involving shoulder external rotator muscles. The fatigue task was performed using an isokinetic machine. To confirm the muscle fatigue, electromyography (EMG) was recorded, and an integrated EMG and median power fr...

  11. Dorsolateral musculocutaneous perforators of posterior intercostal artery: an anatomical study.

    Science.gov (United States)

    Prasad, Vani; Almutairi, Khalid; Kimble, Frank W; Stewart, Fiona; Morris, Steven F

    2012-11-01

    The posterior intercostal artery (PICA) is divided into four segments, vertebral, costal, intermuscular, and rectus, based on the neurovascular branching pattern. Dorsal branches arise from the vertebral segment. Several musculocutaneous perforators and a lateral branch originate from the costal segment. Musculocutaneous branches arise from the intermuscular and rectus segments. The purpose of this study is to describe in detail the musculocutaneous perforators of the costal segment of the posterior intercostal artery. Fresh cadavers were injected with a modified lead oxide-gelatin mixture. Intercostal spaces (8-11) were dissected in twelve cadavers (six preserved cadavers and six fresh cadavers). Angiograms were assembled with Adobe Photoshop. Two fresh cadavers underwent CT angiography and three dimensional reconstructions of the intercostal perforators were performed using Materialise's Interactive Medical Image Control System (MIMICS). In twelve cadavers, a total of 356 perforators (size > 0.5 mm) were found to arise from the posterior intercostal arteries in 96 intercostal (IC) spaces. 154 perforators (>0.5 mm) were found in the costal segment of the PICA. An average of 6.4 perforators was found in each hemithorax. All perforators were found within 2 cm of the midscapular line. At least one perforator was found in all intercostal spaces. Two or more perforators were found in 40% of the 8th and 9th IC spaces and 60% of the 10th and 11th IC spaces. Perforators were oriented perpendicular to the direction of the muscle fibres of the latissimus dorsi and were usually present one or two intercostal spaces below their origin from the PICA. Perforators of the costal segment of the PICA are described in detail. We propose to call these currently unnamed musculocutaneous perforators "dorsolateral" branches of the PICA, as they are located between dorsal and lateral branches of PICA. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  12. Análise histológica e histoquímica das fibras dos músculos reto do abdome e intercostal paraesternal de ratos submetidos ao exercício da natação Histologic and histochemical analysis of fibers of rectus of abdomen and paraesternal intercostal muscles of Wistar rats after swimming exercise

    Directory of Open Access Journals (Sweden)

    Paulo César Bálade Saad

    2002-08-01

    ção aeróbica, com conseqüente aumento do percentual de fibras oxidativas, induzindo maior resistência à fadiga.The objective of the present study was to evaluate the influence of swimming exercise on metabolic and contractile abilities of rectus of abdomen and the paraesternal intercostal muscle fibers. Adult Wistar rats were initially submitted to an adaptation period and then divided into control and exercise groups. Exercised animals were submitted to swimming for 15, 30, 45, and 60 days, 1 hr/day, 5days/week. At the end of each period, the animals were killed. Small segments of the above muscles were frozen in N-hexane at -70ºC, pre-cooled with liquid nitrogen for two minutes. Histological transverse sections (7 µm were obtained in a cryostat microtome at -20ºC. Some serial sections were stained with HE. Subsequent sections were reacted for NADH-TR to evaluate the oxidizing capacity, and for m-ATPase, after acid and alkaline pre-incubations mediums. Under microscopic examination, the frequencies of fiber types were sampled. Muscle fibers revealed to be grouped in different fascicles, presenting polygonal outlines, with different diameters. Three kind of fibers were detected: SO (slow oxidative, FOG (fast oxidative glycolytic and FG (fast glycolytic, presenting a mosaic pattern distribution. The analysis of the results demonstrated that after 60 days of exercise, the abdominal muscles showed a significant increase in the frequency of SO fibers. After 15 days, a significant decrease in frequency of intermediate FOG fibers and an increase of FG fibers. The paraesternal intercostal muscles revealed a significant increase in the percentage of SO fibers in the 60 day-exercised animals, a percentage increase of FOG fibers in the animals of 45 and 60 days, and a percentage decrease of FG fibers in those of 30, 45 and 60 days. So, due to hydrostatic pressure in swimming exercise, the degree of work was greater in the inspiration muscles. This increase was parallel with

  13. Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report

    Directory of Open Access Journals (Sweden)

    Kumar Naveen

    2013-01-01

    Full Text Available Abstract Introduction In the thorax there are normally 11 pairs of intercostal spaces: the spaces between adjacent ribs. The intercostal spaces contain intercostal muscles, intercostal nerves and vessels. Case presentation During a routine dissection for undergraduate medical students, we observed a variation involving the left 3rd rib and 3rd costal cartilage in the cadaver of a man of Indian ethnicity aged about 65 years. The left 3rd rib and its costal cartilage were bifurcated at their costochondral junction enclosing a small circular additional intercostal space. Muscle tissue covered by deep fascia was present in this circular intercostal space. The muscle in the circular intercostal space received its nerve supply from a branch of the 2nd intercostal nerve. Conclusions Knowledge of such variations is helpful to surgeons operating on the anterior thoracic wall involving ribs and intercostal spaces. Knowing the possibility of the presence of an additional space between normal intercostal spaces can guide a surgeon through to a successful surgery.

  14. Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection.

    Science.gov (United States)

    Zang, Mengqing; Yu, Shengji; Xu, Libin; Zhao, Zhenguo; Zhu, Shan; Ding, Qiang; Liu, Yuanbo

    2015-06-01

    Trunk defects following soft tissue sarcoma resection are usually managed by myocutaneous flaps or free flaps. However, harvesting muscle will cause functional morbidities and some trunk regions lack reliable recipient vessels. The intercostal arteries give off multiple perforators, which distribute widely over the trunk and can supply various pedicle flaps. Our purpose is to use various intercostal artery perforator propeller flaps for trunk oncologic reconstruction. Between November 2013 and July 2014, nine intercostal artery perforator propeller flaps were performed in seven patients to reconstruct the defects following sarcoma resection in different regions of the trunk, including the back, lumbar, chest, and abdomen. Two perforators from intercostal arteries were identified for each flap using Doppler ultrasound probe adjacent to the defect. The perforator with visible pulsation was chosen as the pedicle vessel. An elliptical flap was raised and rotated in a propeller fashion to repair the defects. There were one dorsal intercostal artery perforator flap, four dorsolateral intercostal artery perforator flaps, three lateral intercostal artery perforator flaps, and one anterior intercostal artery perforator flap. The mean skin paddle dimension was 9.38 cm in width (range 6-14 cm) and 21.22 cm in length (range 13-28 cm). All intercostal artery perforator flaps survived completely, except for marginal necrosis in one flap harvested close to the previous flap donor site. The intercostal artery perforator propeller flap provides various and valuable options in our reconstructive armamentarium for trunk oncologic reconstruction. To our knowledge, this is the first case series of using intercostal artery perforator propeller flaps for trunk oncologic reconstruction and clinical application of dorsolateral intercostal artery perforator flaps. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All

  15. Rotator cuff muscles perform different functional roles during shoulder external rotation exercises.

    Science.gov (United States)

    Tardo, Daniel T; Halaki, Mark; Cathers, Ian; Ginn, Karen A

    2013-03-01

    The aim of this study was to compare activity in shoulder muscles during an external rotation task under conditions of increasing arm support to investigate whether changing support requirements would influence muscle recruitment levels, particularly in the rotator cuff (RC) muscles. Electromyographic recordings were collected from seven shoulder muscles using surface and indwelling electrodes. The dominant shoulder of 14 healthy participants were examined during dynamic shoulder external rotation performed at 90° abduction with the arm fully supported, partially supported, and unsupported. Linear regressions between arm support load and the averaged muscle activity across participants for each muscle showed infraspinatus predominantly contributing to rotating the shoulder whilst supraspinatus, deltoid, upper trapezius, and serratus anterior were predominantly functioning in support/stabilization roles. During dynamic shoulder external rotation in mid-range abduction, the RC muscles perform different functional roles. Infraspinatus is responsible for producing external rotation torque, supraspinatus is playing a larger joint stabilizer role, and subscapularis is contributing minimally to joint stability. The results also indicate that increasing support load requirements during an external rotation task may be a functionally specific way to retrain the stabilization function of axioscapular muscles. Manipulating joint stabilization requirements while maintaining constant rotational load is a novel method of investigating the differential contribution of muscles to joint movement and stabilization during a given task. Copyright © 2012 Wiley Periodicals, Inc.

  16. Musculoskeletal modelling of muscle activation and applied external forces for the correction of scoliosis.

    Science.gov (United States)

    Curtin, Maurice; Lowery, Madeleine M

    2014-04-07

    This study uses biomechanical modelling and computational optimization to investigate muscle activation in combination with applied external forces as a treatment for scoliosis. Bracing, which incorporates applied external forces, is the most popular non surgical treatment for scoliosis. Non surgical treatments which make use of muscle activation include electrical stimulation, postural control, and therapeutic exercises. Electrical stimulation has been largely dismissed as a viable treatment for scoliosis, although previous studies have suggested that it can potentially deliver similarly effective corrective forces to the spine as bracing. The potential of muscle activation for scoliosis correction was investigated over different curvatures both with and without the addition of externally applied forces. The five King's classifications of scoliosis were investigated over a range of Cobb angles. A biomechanical model of the spine was used to represent various scoliotic curvatures. Optimization was applied to the model to reduce the curves using combinations of both deep and superficial muscle activation and applied external forces. Simulating applied external forces in combination with muscle activation at low Cobb angles (forces were applied in combination, lower levels of muscle activation or less external force was required to reduce the curvature of the spine, when compared with either muscle activation or external force applied in isolation. The results of this study suggest that activation of superficial and deep muscles may be effective in reducing spinal curvature at low Cobb angles when muscle groups are selected for activation based on the curve type. The findings further suggest the potential for a hybrid treatment involving combined muscle activation and applied external forces at larger Cobb angles.

  17. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  18. The Effect of Fatigued External Rotator Muscles of the Shoulder on the Shoulder Position Sense

    Directory of Open Access Journals (Sweden)

    Naoya Iida

    2011-10-01

    Full Text Available This study aimed to investigate the effect of fatigue in shoulder external rotator muscles on position sense of shoulder abduction, internal rotation, and external rotation. The study included 10 healthy subjects. Shoulder position sense was measured before and after a fatigue task involving shoulder external rotator muscles. The fatigue task was performed using an isokinetic machine. To confirm the muscle fatigue, electromyography (EMG was recorded, and an integrated EMG and median power frequency (MDF during 3 sec performed target torque were calculated. After the fatigue task, the MDF of the infraspinatus muscle significantly decreased. This indicates that the infraspinatus muscle was involved in the fatigue task. In addition, the shoulder position sense of internal and external rotation significantly decreased after the fatigue task. These results suggest that the fatigue reduced the accuracy of sensory input from muscle spindles. However, no significant difference was observed in shoulder position sense of abduction before and after the fatigue task. This may be due to the fact that infraspinatus muscle did not act as prime movers in shoulder abduction. These results suggest that muscle fatigue decreased position sense during movements in which the affected muscles acted as prime movers.

  19. The male bulbospongiosus muscle and its relation to the external anal sphincter.

    Science.gov (United States)

    Peikert, Kevin; Platzek, Ivan; Bessède, Thomas; May, Christian Albrecht

    2015-04-01

    The bulbospongiosus muscle is part of the superficial muscular layer of the perineum and pelvic floor. Its morphology remains controversial in the literature. Therefore, we reinvestigated the fascial arrangement and fiber courses of the bulbospongiosus muscle and its topographical relation to the external anal sphincter. The perineum was dissected in 9 male cadavers (mean ± SD age 78.3 ± 10.7 years). Select samples were obtained for histology and immunohistochemistry. In 43 patients (mean age 60.7 ± 12 years) the topographical relation between the bulbospongiosus muscle and the external anal sphincter was determined by magnetic resonance imaging. The perineum contains several fascial layers consisting of elastic and collagen fibers as well as bundles of smooth muscle cells. The bulbospongiosus muscle was subdivided into a ventral and dorsal portion, which developed in 4 variants. The ventral insertion formed a morphological unity with the ischiocavernous muscle while the dorsal origin had a variable relation to the external anal sphincter (5 variants). A muscle-like or connective tissue-like connection was frequently present between the muscles. However, in some cases the muscles were completely separated. We suggest a concept of variations of bulbospongiosus muscle morphology that unifies the conflicting literature. Its ventral fiber group and the ischiocavernosus muscle form a functional and morphological unity. While the bulbospongiosus muscle and the external anal sphincter remain independent muscles, their frequent connection might have clinical implications for perineal surgery and anogenital disorders. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  20. Rehabilitation, Using Guided Cerebral Plasticity, of a Brachial Plexus Injury Treated with Intercostal and Phrenic Nerve Transfers.

    Science.gov (United States)

    Dahlin, Lars B; Andersson, Gert; Backman, Clas; Svensson, Hampus; Björkman, Anders

    2017-01-01

    Recovery after surgical reconstruction of a brachial plexus injury using nerve grafting and nerve transfer procedures is a function of peripheral nerve regeneration and cerebral reorganization. A 15-year-old boy, with traumatic avulsion of nerve roots C5-C7 and a non-rupture of C8-T1, was operated 3 weeks after the injury with nerve transfers: (a) terminal part of the accessory nerve to the suprascapular nerve, (b) the second and third intercostal nerves to the axillary nerve, and (c) the fourth to sixth intercostal nerves to the musculocutaneous nerve. A second operation-free contralateral gracilis muscle transfer directly innervated by the phrenic nerve-was done after 2 years due to insufficient recovery of the biceps muscle function. One year later, electromyography showed activation of the biceps muscle essentially with coughing through the intercostal nerves, and of the transferred gracilis muscle by deep breathing through the phrenic nerve. Voluntary flexion of the elbow elicited clear activity in the biceps/gracilis muscles with decreasing activity in intercostal muscles distal to the transferred intercostal nerves (i.e., corresponding to eighth intercostal), indicating cerebral plasticity, where neural control of elbow flexion is gradually separated from control of breathing. To restore voluntary elbow function after nerve transfers, the rehabilitation of patients operated with intercostal nerve transfers should concentrate on transferring coughing function, while patients with phrenic nerve transfers should focus on transferring deep breathing function.

  1. Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery.

    Science.gov (United States)

    Celik, Sezai; Aydemir, Cüneyt; Gürer, Onur; Işık, Omer

    2013-01-01

    Patient: Male, 60Final Diagnosis: Iatrogenic intercostal lung herniaSymptoms: -Medication: No medicationClinical Procedure: Surgically cerrectedSpecialty: Thoracic surgery. Unusual clinical course. Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea. A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well. Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery.

  2. Two unusual cases of external rotator muscle pathology producing hip pain

    Directory of Open Access Journals (Sweden)

    Graeme Thompson

    2015-03-01

    Full Text Available Two unusual cases of inflammation of the external rotator muscles of the hip are presented. In each case, the patient presented with acute hip pain. The diagnoses of acute calcific periarthritis involving the gluteus medius muscle, and pyomyositis of the obturator internus muscle secondary to a perianal fistula, were made with the aid of diagnostic imaging and histology. The importance of reviewing the pelvic viscera is highlighted.

  3. Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

    Science.gov (United States)

    Lykissas, Marios G; Kostas-Agnantis, Ioannis P; Korompilias, Ananstasios V; Vekris, Marios D; Beris, Alexandros E

    2013-01-01

    Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration. PMID:23878776

  4. The posterior intercostal vein: a thermoregulatory gateway to the internal vertebral venous plexus.

    Science.gov (United States)

    Hoogland, P V; Wessels, Q; Vorster, W; Groen, R J M; Wettstein, R; Greyling, L M; Kotzé, S H

    2013-09-01

    The internal vertebral venous plexus (IVVP) plays a putative role in thermoregulation of the spinal cord. Cold cutaneous venous blood may cool, while warm venous blood from muscles and brown fat areas may warm the spinal cord. The regulating mechanisms for both cooling and warming are still unknown. Warm venous blood mainly enters the IVVP via the intervertebral veins. In the thoracic area these veins are connected to the posterior intercostal veins. In this study, anatomical structures were investigated that might support the mechanisms by which warmed venous blood from the intercostal muscles and the recently described paravertebral patches of brown adipose tissue are able to drain into the vertebral venous plexus. Therefore, tissue samples from human cadavers (n = 21) containing the posterior intercostal vein and its connections to the IVVP and the azygos veins were removed and processed for histology. Serial sections revealed that the proximal parts of the posterior intercostal veins contained abundant smooth muscle fibers at their opening into the azygos vein. Furthermore, the walls of the proximal parts of the posterior intercostal veins contain plicae that allow the vessel to dilate, thereby allowing it to serve as a pressure chamber. It is suggested that a cold induced closure of the intercostal/azygos opening can result in retrograde blood flow from the proximal posterior intercostal vein towards the IVVP. This blood flow would be composed of warm blood from the paravertebral brown adipose tissue and blood containing metabolic heat from the muscles draining into the intercostal veins. Copyright © 2013 Wiley Periodicals, Inc.

  5. Muscle fibre types in the external eye muscles of the pigeon, Columba livia.

    OpenAIRE

    McVean, A; Stelling, J; Rowlerson, A.

    1987-01-01

    Fibre typing with antisera raised against specific myosin types from muscles of known physiological properties were used to characterise the fibre types within the oculorotatory muscles of pigeons. Fibres reacting strongly to antiserum anti-ALD (specific for tonic fibre myosin) were found lying along the global margin of the muscle and also in a layer lying immediately beneath a discrete band of fibres running along the orbital margin. These fibres resembled those of the skeletal muscle ALD i...

  6. Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: a case report

    OpenAIRE

    Zgonis, Thomas; Ramanujam, Crystal L.; Facaros, Zacharia

    2011-01-01

    Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and ...

  7. Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2011-05-01

    Full Text Available Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and osteomyelitis in a diabetic patient.

  8. Action and interaction of respiratory muscles in dogs.

    Science.gov (United States)

    Decramer, M

    1990-01-01

    How the respiratory muscles, the so-called "vital pump", works is relevant to medicine and nevertheless, poorly understood. The present studies attempt to obtain a better insight in the action and interaction of respiratory muscles by measuring the mechanical outcome of individual respiratory muscle contraction with two different techniques in anesthetized dogs. First, we measured the changes in length undergone by respiratory muscles using sonomicrometry. We observed that the costal and crural parts of the diaphragm frequently behaved differently, supporting the concept that these two parts behave as two different muscles. Moreover, crural diaphragmatic length appeared to be linked to abdominal dimensions, the classical used estimate of diaphragmatic length, whereas costal diaphragmatic length was not. The parasternal or the interchondral parts of the internal intercostals invariably shortened with inspiration supporting their role as inspiratory agonists. By way of contrast, the respiratory length changes in the external and interosseus internal intercostal were variable and not consistently in different directions for the two layers. The changes in length, during rotation of the trunk were consistent, larger and systematically in opposite directions for these two layers, suggesting that these muscles predominantly function as rotators of the trunk or at least that a role in rotation of the trunk explains better the need for two layers of intercostal muscles with different fiber orientation than a respiratory role. Second, we measured changes in intramuscular pressure in the costal and crural parts of the diaphragm, and in the parasternal intercostals, using mini-transducers. In the diaphragm intramuscular pressure appeared to be a complex variable determined by the tension developed by the muscle as well as the pleural and abdominal pressures applied to the muscle. As a consequence, intramuscular pressure often decreased during contraction, suggesting that in

  9. Muscle fibre types in the external eye muscles of the pigeon, Columba livia.

    Science.gov (United States)

    McVean, A; Stelling, J; Rowlerson, A

    1987-10-01

    Fibre typing with antisera raised against specific myosin types from muscles of known physiological properties were used to characterise the fibre types within the oculorotatory muscles of pigeons. Fibres reacting strongly to antiserum anti-ALD (specific for tonic fibre myosin) were found lying along the global margin of the muscle and also in a layer lying immediately beneath a discrete band of fibres running along the orbital margin. These fibres resembled those of the skeletal muscle ALD in their type properties. Using another antiserum, anti-I, specific for slow twitch and to a lesser extent, slow tonic myosins, it was possible to identify another slow fibre type which formed the orbital layer and also lay scattered randomly through the body of the muscle. No equivalent to this type was found in the skeletal muscles ALD or iliofibularis. The remaining fibres which did not react with either anti-ALD or anti-I formed 58% of the fibre population and reacted with an antiserum specific for fast myosin. However, their response to alkali preincubation suggests that the fast fibres of eye muscles also contain a myosin which is different from those in skeletal muscle.

  10. Alleviating Thoracotomy Pain With Intercostal Liposomal Bupivacaine: A Case Report.

    Science.gov (United States)

    Saby, Adam; Swaminathan, Kavitha; Pangarkar, Sanjog; Tribuzio, Bianca

    2016-11-01

    Thoracotomy pain is common after chest surgery and may result from injury to the lung pleura, intercostal muscles, costovertebral joint, or intercostal nerves. Inappropriately controlled postoperative pain can hinder recovery and increase the risk of complications such as infection, atelectasis, blood clots, and development of post-thoracotomy pain syndrome. A number of treatment options for acute pain are available, most of which require systemic medications or indwelling catheters that may be contraindicated in patients on anticoagulants. We present the case of a patient with post-thoracotomy pain that effectively was treated with an ultrasound-guided nerve block with liposomal bupivacaine. The patient experienced pain relief without adverse event. Liposomal bupivacaine may be considered a potential treatment option for patients with severe acute post-thoracotomy pain in whom other modalities have not worked or are contraindicated. N/A. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  11. Influence of lumbar muscle fatigue on trunk adaptations during sudden external perturbations

    Directory of Open Access Journals (Sweden)

    Jacques Abboud

    2016-11-01

    Full Text Available IntroductionWhen the spine is subjected to perturbations, neuromuscular responses such as reflex muscle contractions contribute to the overall balance control and spinal stabilization mechanisms. These responses are influenced by muscle fatigue, which has been shown to trigger changes in muscle recruitment patterns. Neuromuscular adaptations, e.g. attenuation of reflex activation and/or postural oscillations following repeated unexpected external perturbations, have also been described. However, the characterization of these adaptations still remains unclear. Using high-density electromyography (EMG may help understand how the nervous system chooses to deal with an unknown perturbation in different physiological and/or mechanical perturbation environments. AimTo characterize trunk neuromuscular adaptations following repeated sudden external perturbations after a back muscle fatigue task using high-density EMG.MethodsTwenty-five healthy participants experienced a series of 15 sudden external perturbations before and after back muscle fatigue. Erector spinae muscle activity was recorded using high-density EMG. Trunk kinematics during perturbation trials were collected using a 3-D motion analysis system. A two-way repeated measure ANOVA was conducted to assess 1 the adaptation effect across trials, 2 the fatigue effect, and 3 the interaction effect (fatigue x adaptation for the baseline activity, the reflex latency, the reflex peak and trunk kinematic variables (flexion angle, velocity and time to peak velocity. Muscle activity spatial distribution before and following the fatigue task was also compared using t-tests for dependent samples. ResultsAn attenuation of muscle reflex peak was observed across perturbation trials before the fatigue task, but not after. The spatial distribution of muscle activity was significantly higher before the fatigue task compared to post-fatigue trials. Baseline activity showed a trend to higher values after muscle

  12. Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia

    Directory of Open Access Journals (Sweden)

    Masoud Nazem

    2015-01-01

    Full Text Available Background: Considering that complications and outcome of each method of pediatric inguinal hernia repair are one of the determinants for pediatric surgeons for selection of the appropriate surgical technique, we compared the early and late complications of two inguinal repair techniques, with and without opening the external oblique muscle fascia. Materials and Methods: In this double-blind clinical trial study, boy children aged 1-month to 6 years with diagnosed inguinal hernia were included and randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal edema and hematoma, and wound infections classified as early complication and recurrence, testis atrophy and sensory impairment of inguinal area classified as late complications. The rates of mentioned early and late complications were compared in the two interventional groups. Results: In this study, 66 patients were selected and allocated to the two interventional groups. The prevalence of early and late complications in two studied groups were not different significantly in two interventional groups (P > 0.05. Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied technique (P = 0.001. Conclusion: The findings of our study indicated that though early and late complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle, which considered the superiority of this method than inguinal hernia repair with opening the external oblique muscle.

  13. Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia

    Science.gov (United States)

    Nazem, Masoud; Dastgerdi, Mohamad Masoud Heydari; Sirousfard, Motaherh

    2015-01-01

    Background: Considering that complications and outcome of each method of pediatric inguinal hernia repair are one of the determinants for pediatric surgeons for selection of the appropriate surgical technique, we compared the early and late complications of two inguinal repair techniques, with and without opening the external oblique muscle fascia. Materials and Methods: In this double-blind clinical trial study, boy children aged 1-month to 6 years with diagnosed inguinal hernia were included and randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal edema and hematoma, and wound infections classified as early complication and recurrence, testis atrophy and sensory impairment of inguinal area classified as late complications. The rates of mentioned early and late complications were compared in the two interventional groups. Results: In this study, 66 patients were selected and allocated to the two interventional groups. The prevalence of early and late complications in two studied groups were not different significantly in two interventional groups (P > 0.05). Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied technique (P = 0.001). Conclusion: The findings of our study indicated that though early and late complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle, which considered the superiority of this method than inguinal hernia repair with opening the external oblique muscle. PMID:26958052

  14. Face reconstruction using lateral intercostal artery perforator-based adipofascial free flap.

    Science.gov (United States)

    Jeong, Jae Hoon; Hong, Jin Myung; Imanishi, Nobuaki; Lee, Yoonho; Chang, Hak

    2014-01-01

    The aim of this study was to determine the efficacy of lateral intercostal artery perforator-based adipofascial free flaps for facial reconstruction in patients with facial soft tissue deficiency. We conducted a retrospective study of five consecutive patients diagnosed with facial soft tissue deficiency who underwent operations between July 2006 and November 2011. Flap design included the area containing the perforators. A linear incision was made along the rib, which had the main intercostal pedicle. First, we dissected below Scarpa's fascia as the dorsal limit of the flap. Then, the adipofascial flap was elevated from the medial to the lateral side, including the perforator that pierces the serratus anterior muscle after emerging from the lateral intercostal artery. After confirming the location of the perforator, pedicle dissection was performed dorsally. Dominant perforators were located on the sixth to eighth intercostal space, and more than four perforators were found in fresh-cadaver angiography. In the clinical case series, the seventh or eighth intercostal artery perforators were used for the free flaps. The mean diameter of the pedicle artery was 1.36 mm, and the mean pedicle length was 61.4 mm. There was one case of partial fat necrosis. No severe complications occurred. This is the first study of facial contour reconstruction using lateral intercostal artery perforator-based adipofascial free flaps. The use of this type of flap was effective and can be considered a good alternative for restoring facial symmetry in patients with severe facial soft tissue deficiency.

  15. Abdominal and internal intercostal motoneurones are strong synergists for expiration but are not synergists for Group I monosynaptic afferent inputs

    DEFF Research Database (Denmark)

    Ford, Tim W; Meehan, Claire Francesca; Kirkwood, Peter

    2014-01-01

    internal intercostal muscle. Those with Lat EPSPs (Group B) were assumed to innervate abdominal muscle (transversus abdominis or rectus abdominis). Inspiratory Dist motoneurones (assumed to innervate interchondral muscle) showed EPSPs from Dist. Stimulation of dorsal ramus nerves gave EPSPs in 11 instances...

  16. Intercostal schwannoma simulating pulmonary Neoplasia

    OpenAIRE

    1998-01-01

    RESUMO – Schwannoma é uma neoplasia mesenquimal, usualmente solitária, encontrada no mediastino, retroperitônio ou pelve, sendo rara sua apresentação na parede torácica. OBJETIVO. Relatar o caso de um paciente masculino, tabagista, com um nódulo pulmonar direito com características de malignidade, detectado em radiografia de tórax de rotina, cujo diagnóstico anatomopatológico foi de schwannoma benigno de nervo intercostal. MÉTODOS. Revisaram-se os dados referentes ao quadro clínico, exames la...

  17. The intercostal nerve as a target for diagnostic biopsy.

    Science.gov (United States)

    Nguyen, Khoi D; Choudhri, Haroon F; Macomson, Samuel D

    2017-05-12

    OBJECTIVE Peripheral nerve biopsy is a useful tool in diagnosing peripheral neuropathies. Sural and gracilis nerves have become the most common targets for nerve biopsy. However, the yield of sural nerve biopsy is limited in patients who have motor neuropathies, and gracilis nerve biopsy presents technical challenges and increased complications. The authors propose the intercostal nerve as an alternative motor nerve target for biopsy. METHODS A total of 4 patients with suspected peripheral neuropathies underwent intercostal nerve biopsy at the authors' institution. A rib interspace that is inferior to the pectoralis muscle and anterior to the anterior axillary line is selected for the procedure. Generally the lower intercostal nerves (i.e., T7-11) are targeted. An incision is made over the inferior aspect of the superior rib at the chosen interspace. Blunt dissection is carried down to the neurovascular bundle and the nerve is isolated, ligated, and cut to send for pathological examination. RESULTS The average operative time for all cases was 73 minutes, with average blood loss of 8 ml. Biopsy results from 1 patient exhibited axonopathy, and the other 3 patients demonstrated axonopathy with demyelination. There were no short- or long-term postoperative complications. None of the patients reported sensory or motor deficits related to the biopsy at 6 weeks postoperatively. CONCLUSIONS The intercostal nerve can be an alternative target for biopsy, especially in patients with predominantly motor neuropathies, due to its mixed sensory and motor fibers, straightforward anatomy, minimal risk of serious sensory deficits, and no risk of motor impairment.

  18. Chronic progressive external ophthalmoplegia: II. A qualitative and quantitative electronmicroscopy study of skeletal muscles

    Directory of Open Access Journals (Sweden)

    Elza Dias-Tosta

    1988-06-01

    Full Text Available This study quantifies the maior electron microscopic changes in limb muscle biopsies from 31 out of 34 patients with the syndrome of chronic progressive external ophthalmoplegia. Patients were divided into three clinical groups - A 10 sporadic cases with muscle weakness only; B 9 familial cases with muscle weakness only; C 15 cases with muscle weakness and one or more of the following features: pigmentary retinopathy, cerebellar ataxia, pyramidal signs and peripheral neuropathy. Electron microscopic mitochondrial abnormalities were found in all groups (8 patients from group A, 3 from group B, 14 from group C. Quantitative measurements of certain muscle fibre constituents, using a point-counting technique, revealed decreased myofibril volume-fractions and increased volume-fractions of mitochondria, glycogen and lipid in some biopsies from each group. Mitochondrial volume-fractions correlated positively with lipid content, the proportion of type 1 fibres, and the percentage of fibres with increased oxidative enzyme activity. The three groups defined clinically showed no significant differences in terms of the relative proportions of these measured constituents.

  19. Strangulated intercostal liver herniation subsequent to blunt trauma. First report with review of the world literature

    Directory of Open Access Journals (Sweden)

    Bendinelli Cino

    2012-07-01

    Full Text Available Abstract Traumatic transdiaphragmatic intercostal hernia, defined as an acquired herniation of abdominal contents through disrupted intercostal muscles, is a rarely reported entity. We present the first reported case of a traumatic transdiaphragmatic intercostal hernia complicated by strangulation of the herniated visceral contents. Following blunt trauma, a 61-year old man developed a traumatic transdiaphragmatic intercostal hernia complicated by strangulation of liver segment VI. Due to pre-existing respiratory problems and the presence of multiple other injuries (grade III kidney laceration and lung contusion the hernia was managed non-operatively for the first 2 weeks. The strangulated liver segment eventually underwent ischemic necrosis. Six weeks later the resulting subcutaneous abscess required surgical drainage. Nine months post injury the large symptomatic intercostal hernia was treated with laparoscopic mesh repair. Twelve months after the initial trauma, a small recurrence of the hernia required laparoscopic re-fixation of the mesh. This paper outlines important steps in managing a rare post traumatic entity. Early liver reduction and hernia repair would have been ideal. The adopted conservative approach caused liver necrosis and required staged procedures to achieve a good outcome.

  20. Schwannoma intercostal simulando neoplasia pulmonar

    Directory of Open Access Journals (Sweden)

    Henn L.A.

    1998-01-01

    Full Text Available Schwannoma é uma neoplasia mesenquimal, usualmente solitária, encontrada no mediastino, retroperitônio ou pelve, sendo rara sua apresentação na parede torácica. OBJETIVO: Relatar o caso de um paciente masculino, tabagista, com um nódulo pulmonar direito com características de malignidade, detectado em radiografia de tórax de rotina, cujo diagnóstico anatomopatológico foi de schwannoma benigno de nervo intercostal. MÉTODOS: Revisaram-se os dados referentes ao quadro clínico, exames laboratoriais e de imagem (radiografia e tomografia computadorizada de tórax do caso em estudo, assim como os exames anatomopatológico e imuno-histoquímico do espécime cirúrgico. RESULTADOS: O paciente foi submetido à toracotomia direita diagnóstica com ressecção da tumoração. O exame anatomopatológico convencional mostrou células tumorais de aspecto fusiforme, dispostas em paliçada, formando os corpos de Verocay, compatível com schwannoma intercostal. A imuno-histoquímica foi positiva para proteína S-100, vimentina e enolase, e negativa para neurofilamentos. CONCLUSÃO: O diagnóstico definitivo de schwannoma só é possível por meio da análise histopatológica e imuno-histoquímica da lesão. Seu aspecto celular, associado à atividade mitótica e a áreas de pleomorfismo, pode levar ao diagnóstico incorreto de malignidade. A imuno-histoquímica, por meio da proteína S-100, é útil na caracterização da benignidade da lesão, já que não é detectada nas lesões malignas. Os schwannomas de parede torácica podem simular neoplasias pulmonares na radiografia e tomografia computadorizada de tórax.

  1. Extended mesh repair with external oblique muscle reinforcement for abdominal wall contour abnormalities following TRAM flap.

    Science.gov (United States)

    Israeli, Ron; Hazani, Ron; Feingold, Randall S; DeNoto, George; Scheiner, Marc S

    2009-12-01

    Many patients undergoing reconstructive surgery after mastectomy opt for reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap. Among the morbidities related to TRAM flap reconstruction is the development of abdominal wall contour abnormalities, including bulges or hernias. Several repair techniques at the flap abdominal wall donor site have been described for use at the time of flap harvest in an attempt to reduce the risk of such abdominal wall complications. For patients that develop abdominal wall contour abnormalities, numerous reconstructive options have been reported, with mixed results. Ten patients were identified as having abdominal wall contour abnormalities after a TRAM flap and underwent an extended mesh repair with external oblique muscle reinforcement. The mesh was secured to the bony landmarks of the lower abdomen and the abdominal wall fascia. All patients achieved complete resolution of abdominal wall bulging. In the follow-up period, no recurrences, infections, or seromas were noted. One patient, who failed an earlier repair at the inferior abdominal wall, reported symptoms consistent with a scar neuroma. Symptoms were treated successfully with gabapentin and a nonsteroidal anti-inflammatory drug. We propose a novel and reliable method of lower abdominal wall reconstruction for patients with post-TRAM flap abdominal wall contour abnormalities. This technique incorporates the use of a large Marlex mesh reinforced with bilateral external oblique muscle flaps. We report a series of 10 patients who have achieved resolution of their symptoms and have regained a natural, flat-appearing abdominal wall contour.

  2. Percutaneous nephrolithotomy through an intercostal approach

    Energy Technology Data Exchange (ETDEWEB)

    Narasimham, D.L.; Jacobsson, B.; Vijayan, P.; Bhuyan, B.C.; Nyman, U.; Holmquist, B. (Hamad General Hospital (Qatar). Dept. of Diagnostic Radiology Hamad General Hospital (Qatar). Dept. of Urology)

    1991-03-01

    During a 5-year period percutaneous nephrolithotripsy through an intercostal space was performed in 56 of 231 procedures. Minimal thoracic complications were seen in 3 of 53 patients with 11th intercostal space tracts into a lower, middle, or upper pole calyx. A working sheath and a pyelostomy drainage catheter were used in all these cases. Hydro- and pneumothorax requiring treatment occurred in 2 of 3 patients with a 10th intercostal space approach into an upper pole calyx combined with improper use of the working sheath and/or the pyelostomy catheter. Review of the literature also indicates that an intercostal approach appears safe when performed via the 11th intercostal space into a lower or middle pole calyx. Thoracic complications occurred when punctures were made towards an upper pole calyx or above the 11th rib. The complications may be limited by identifying the posterior inferior lung border by fluoroscopy during puncture, and performing it under general anesthesia with controlled breath-holding. The use of a working sheath to seal the pleural opening during the procedure and an efficient pyelostomy drainage catheter to allow free drainage of uring and to tamponade the tract postoperatively are also recommended. (orig.).

  3. Sling-based Exercise for External Rotator Muscles: Effects on Shoulder Profile in Young Recreational Tennis Players

    Science.gov (United States)

    Goulet, Charles; Rogowski, Isabelle

    2016-12-19

    Context: Tennis playing generates specific adaptations, particularly at the dominant shoulder. It remains to be established whether shoulder strength balance can be restored by sling-based training for adolescent recreational tennis players. Objective: We added a sling-based exercise for shoulder external rotators to investigate its effects on external rotator muscle strength, on internal rotator muscle strength, on glenohumeral range of motion and on tennis serve performance. Design: Test-retest design. Setting: Tennis training sports facilities. Participants: Twelve adolescent male players volunteered to participate in this study (age: 13.3 ± 0.5 years; height: 1.64 ± 0.07 cm, mass: 51.7 ± 5.8 kg, International Tennis Number: 8). Intervention: The procedure spanned 10 weeks. For the first five weeks, players performed their regular training (RT) twice a week. For the last five weeks, a sling-based exercise (SE) for strengthening the shoulder external rotator muscles was added to their regular training. Main Outcome Measures: Maximal isometric strength of shoulder external and internal rotator muscles and glenohumeral range of motion in external and internal rotation were assessed in both shoulders. Serve performance was also evaluated by accuracy and post-impact ball velocity, using a radar gun. Results: No change was found in any measurement after the RT period. Significant increases in external (~+5%; pmuscle strength and in external/internal strength ratio (~+4%; pshoulder external rotator muscles appears effective in restoring strength balance at the dominant shoulder, and may prevent adolescent tennis players from sustaining degenerative shoulder problems which could later impair their performance of daily and work-related tasks.

  4. Ultrasound evaluation of muscle thickness changes in the external oblique, internal oblique, and transversus abdominis muscles considering the influence of posture and muscle contraction.

    Science.gov (United States)

    Sugaya, Tomoaki; Abe, Yota; Sakamoto, Masaaki

    2014-09-01

    [Purpose] The aim of this study was to investigate muscle thickness changes in the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) muscles between the neutral position and trunk rotation, under a state of rest without voluntary contractions, and isometric contractions to both sides with resistance of 50% of the maximum trunk rotation strength. [Subjects] The subjects of this study were 21 healthy young men. [Methods] Muscle thickness changes in the EO, IO, and TrA in each position and state were evaluated by ultrasound. The range of motion at maximum trunk rotation and the maximum strength of trunk rotation were measured using a hand-held dynamometer. [Results] In the neutral position and at 50% trunk rotation to the right side, the thicknesses of the IO and TrA significantly increased with resistance. In both states, the thicknesses of the IO and TrA significantly increased at 50% trunk rotation to the right side. [Conclusion] The muscular contractions of the IO and TrA were stronger during ipsilateral rotation than in the neutral position and with resistance than at rest. Moreover, the muscular contraction was strongest in the resistive state during ipsilateral rotation.

  5. A Simple Method for Thoracotomy Closure Avoiding Intercostal Nerve Damage

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    Ufuk Cagirici

    2016-09-01

    Full Text Available It is well known that intercostal nerve damage during thoracotomy closure causes severe postoperative pain. A simple closure technique is proposed for intercostal nerve-sparing during thoracotomy opening and closure. We think that this maneuver may avoid intercostal nerve compression.

  6. The Effects of External Focus of Attention on Shoulder Muscle Activities during Forehand Drive in Table Tennis

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Hatami

    2016-06-01

    Full Text Available Objective: The aim of this study was to evaluate the impact of the external focus of attention on the rotator cuff muscle activity for the timely hit forehand drive by table tennis players. Methods: Twelve professional table tennis players with mean age of 26.5 years voluntarily participated in this study. The electrical activities of the muscles of the shoulder girdle using M.A 300 machine and bipolar electrodes surface under two conditions .First with external focus of attention and then without such attention were recorded, first without any guidance blows forehand drive was carried out by subjects (without focus. Then such subject was asked to focus their attention on the area marked for the ball landing (external focus of attention.      Muscle activities in both preparation and tapping phases were analyzed the three –dimensional (200 Hz, Vicon, with four camera series T motion analysis system was used to obtain the data. Data was analyzed by running reported measures ANOVA at a significance level of p0.05 but the different between the intensity of muscle activity was meaningful. This suggests that there is a mutual influence between the two attention factors and muscles (p=0.03, that is, orientation can have a significant effect on the severity of muscle contraction. Intensities of muscle contraction in the preparation and tapping were different (p<0.05. Conclusion: On the forehand drive technique, the anterior deltoid muscle has the most activity. The type of focus and attention had a significant impact on the change of activity of muscles relative to each other, and the greatest impact is on the reduction of activity of the infraspinatus muscle. This type of focus delays fatigue and results in an increase in the efficiency of neuromuscular in the activities of skills.

  7. Distribution patterns and predilection muscles of Trichinella zimbabwensis larvae in experimentally infected Nile crocodiles (Crocodylus niloticus Laurenti

    Directory of Open Access Journals (Sweden)

    Louis J. La Grange

    2014-02-01

    Full Text Available No controlled studies have been conducted to determine the predilection muscles of Trichinella zimbabwensis larvae in Nile crocodiles (Crocodylus niloticus or the influence of infection intensity on the distribution of the larvae in crocodiles. The distribution of larvae in muscles of naturally infected Nile crocodiles and experimentally infected caimans (Caiman crocodilus and varans (Varanus exanthematicus have been reported in literature. To determine the distribution patterns of T. zimbabwensis larvae and predilection muscles, 15 crocodiles were randomly divided into three cohorts of five animals each, representing high infection (642 larvae/kg of bodyweight average, medium infection (414 larvae/kg of bodyweight average and low infection (134 larvae/kg of bodyweight average cohorts. In the high infection cohort, high percentages of larvae were observed in the triceps muscles (26% and hind limb muscles (13%. In the medium infection cohort, high percentages of larvae were found in the triceps muscles (50%, sternomastoid (18% and hind limb muscles (13%. In the low infection cohort, larvae were mainly found in the intercostal muscles (36%, longissimus complex (27%, forelimb muscles (20% and hind limb muscles (10%. Predilection muscles in the high and medium infection cohorts were similar to those reported in naturally infected crocodiles despite changes in infection intensity. The high infection cohort had significantly higher numbers of larvae in the sternomastoid, triceps, intercostal, longissimus complex, external tibial flexor, longissimus caudalis and caudal femoral muscles (p < 0.05 compared with the medium infection cohort. In comparison with the low infection cohort, the high infection cohort harboured significantly higher numbers of larvae in all muscles (p < 0.05 except for the tongue. The high infection cohort harboured significantly higher numbers of larvae (p < 0.05 in the sternomastoid, triceps, intercostal, longissimus complex

  8. Surgical anatomy of the 10th and 11th intercostal, and subcostal nerves: prevention of damage during lumbotomy.

    Science.gov (United States)

    van der Graaf, Teunette; Verhagen, Paul C M S; Kerver, Anton L A; Kleinrensink, Gert-Jan

    2011-08-01

    In a descriptive, inventorial anatomical study we mapped the course of the 10th and 11th intercostal nerves, and the subcostal nerve in the abdominal wall to determine a safe zone for lumbotomy. We dissected 11 embalmed cadavers, of which 10 were analyzed. The 10th and 11th intercostal nerves, and the subcostal nerve were dissected from the intercostal space to the rectus sheath. Analysis was done using computer assisted surgical anatomy mapping. A safe zone and an incision line with a minimum of nerve crossings were determined. The 10th and 11th intercostal nerves were invariably positioned subcostally. The subcostal nerve lay subcostally but caudal to the rib in 4 specimens. The main branches were located between the internal oblique and transverse abdominal muscles. The nerves branched and extensively varied in the abdominal wall. A straight line extended from the superior surface of the 11th and 12th ribs indicated a zone with lower nerve density. In 5 specimens the 10th and 11th intercostal nerves crossed this line from the superior surface of the 11th rib. In 5 specimens neither the 11th intercostal nerve nor the subcostal nerve crossed this extended line from the superior surface of the 12th rib up to 15 cm from the tip of the rib. Damage is inevitable to branches of the 10th or 11th intercostal nerve, or the subcostal nerve during lumbotomy. However, an incision extending from the superior surface of the 11th or 12th rib is less prone to damage these nerves. Closing the abdominal wall in 3 layers with the transverse abdominal muscle separately might prevent damage to neighboring nerves. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Electromyographic analysis of the infraspinatus and scapular stabilizing muscles during isometric shoulder external rotation at various shoulder elevation angles

    OpenAIRE

    Uga, Daisuke; Endo, Yasuhiro; Nakazawa, Rie; Sakamoto, Masaaki

    2016-01-01

    [Purpose] This study aimed to clarify activation of the infraspinatus and scapular stabilizing muscles during shoulder external rotation at various shoulder elevation angles. [Subjects] Twenty subjects participated in this study and all measurements were performed on the right shoulder. [Methods] Isometric shoulder external rotation strength and surface electromyographic data were measured with the shoulder at 0°, 45°, 90°, and 135° elevation in the scapular plane. The electromyographic data ...

  10. Electromyographic analysis of the infraspinatus and scapular stabilizing muscles during isometric shoulder external rotation at various shoulder elevation angles

    OpenAIRE

    Uga, Daisuke; Endo, Yasuhiro; Nakazawa, Rie; Sakamoto, Masaaki

    2016-01-01

    [Purpose] This study aimed to clarify activation of the infraspinatus and scapular stabilizing muscles during shoulder external rotation at various shoulder elevation angles. [Subjects] Twenty subjects participated in this study and all measurements were performed on the right shoulder. [Methods] Isometric shoulder external rotation strength and surface electromyographic data were measured with the shoulder at 0°, 45°, 90°, and 135° elevation in the scapular plane. The electromyographic data ...

  11. Rib approximation without intercostal nerve compression reduces post-thoracotomy pain: a prospective randomized study.

    Science.gov (United States)

    Bayram, Ahmet Sami; Ozcan, Metin; Kaya, Fatma Nur; Gebitekin, Cengiz

    2011-04-01

    One of the most important considerations in the care of thoracic surgery patients is the control of pain, which leads to increased morbidity and relevant mortality. Between February and May 2009, 60 patients undergoing full muscle-sparing posterior minithoracotomy were prospectively randomized into two groups, according to the thoracotomy closure techniques. In the first group (group A), two holes were drilled into the sixth rib using a hand perforator, and sutures were passed through the holes in the sixth rib and were circled from the upper edge of the fifth rib, thereby compressing the intercostal nerve underneath the fifth rib. In the second group (group B), the intercostal muscle underneath the fifth rib was partially dissected along with the intercostal nerve, corresponding to the holes on the sixth rib. Two 1/0 polyglactin (Vicyrl) sutures were passed through the holes in the sixth rib and above the intercostal nerve. There were 30 patients in each group. The visual analog score, observer verbal ranking scale (OVRS) scores for pain, and Ramsay sedation scores were used to follow-up on postoperative analgesia and sedation. The von Frey hair test was used to evaluate hyperalgesia of the patients. The patients in group B had lower visual analog scores at rest and during coughing. The patients in group B had lower OVRS scores than group A patients. The groups were not statistically different in terms of the Ramsay sedation scores and von Frey hair tests. Thoracotomy closure by a technique that avoids intercostal nerve compression significantly decreases post-thoracotomy pain. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  12. Cough-induced intercostal lung herniation

    Institute of Scientific and Technical Information of China (English)

    Eva Genbrugge; Jayant R. Kichari

    2015-01-01

    Intercostal lung herniation is an uncommon entity, defined as protrusion of lung tissue between the ribs. The disease is mostly diagnosed either congenitally or acquired following post-surgery or after chest wall trauma. A spontaneous lung herniation is rarely described.

  13. The effect of fatigued internal rotator and external rotator muscles of the shoulder on the shoulder position sense.

    Science.gov (United States)

    Iida, Naoya; Kaneko, Fuminari; Aoki, Nobuhiro; Shibata, Eriko

    2014-02-01

    The purpose of this study was to investigate which muscle group, the agonist or antagonist, contributes most to the shoulder position sense (SPS). The SPS was tested under 2 conditions: fatigued shoulder internal rotator (IR) muscles (pectoralis major and latissimus dorsi) and fatigued external rotator (ER) muscles (infraspinatus). In each condition, the SPS was measured before and after a fatiguing task involving the IR or ER muscles by repeating shoulder joint rotation. SPS was measured using a method in which subjects reproduced a memorized shoulder joint rotation angle. The position error values in all conditions (fatigued IR and ER muscles) and measurement periods (before- and after-fatigue task) were compared using 2-way analysis of variance with repeated measures (IR/ER×before/after). Position error increased significantly after both fatigue tasks (before- vs. after-fatigue: IR muscle, 2.68° vs. 4.19°; ER muscle, 2.32° vs. 4.05°). In other words, SPS accuracy decreased when either the agonist or antagonist muscle was fatigued. This finding indicated that SPS may be affected by an integrated information of the afferent signals in the agonist and antagonist muscles. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Anatomic study of the intercostal nerve transfer to the suprascapular nerve and a case report.

    Science.gov (United States)

    Hu, S; Chu, B; Song, J; Chen, L

    2014-02-01

    The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer.

  15. The synaptic connexions to intercostal motoneurones as revealed by the average common excitation potential.

    Science.gov (United States)

    Kirkwood, P A; Sears, T A

    1978-02-01

    1. The hypothesis is advanced that the joint occurrence of unitary e.p.s.p.s evoked in motoneurones by branches of common stem presynaptic fibres causes, on average, transient depolarization in one motoneurone at the time of discharge in another motoneurone of the same pool. 2. The hypothesis was tested in anaesthetized, paralysed cats by averaging the naturally occurring synpatic noise of thoracic inspiratory motoneurones with an averager triggered by spikes from other inspiratory motoneurones. These spikes were obtained as efferent discharges in nerve filaments supplying the proximal regions of the external intercostal muscles. 3. A transient depolarization centred around the time of the trigger spikes was consistently observed and was designated the average common excitation (a.c.e.) potential. 4. The peak depolarization lay between -1.0 and +4.6 msec (mean +0.7 msec) with respect to the trigger spikes and the rise times of its most prominent component ranged from 4 to 16 msec (mean 8.4 msec). 5. The amplitudes of the a.c.e. potentials ranged from 6 to 104 muV (mean 32 muV) when the trigger spikes were derived from a filament in the same segment as the relevant motoneurones, and from 3 to 42 muV (mean 19 muV) when the filament was two segments rostral to the motoneurone. 6. Cells innervating the proximal region of the intercostal space gave larger a.c.e. potentials than those innervating more distal regions and also showed larger central respiratory drive potentials. 7. A.c.e. potentials were observed for either alpha or gamma spikes as triggers. The potentials were usually smaller for the gamma than for the alpha spikes, the mean ration being about 0.6. The presence of the a.c.e. potentials from the gamma spikes was taken as evidence for alpha-gamma coactivation by common presynaptic axons. 8. A theory is developed which quantitatively accounts for the main features of both the a.c.e. potential and the short term synchrony observed by Sears & Stagg (1976). 9

  16. [Anatomic study on intercostal nerve transfer to suprascapular nerve].

    Science.gov (United States)

    Chu, Bin; Hu, Shaonan; Chen, Liang; Song, Jie

    2012-09-01

    To investigate the feasibility of the 3rd-6th intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. Fifteen thoracic walls (30 sides) were collected from cadavers. The 3rd-6th intercostal nerve length which can be dissected between the midaxillary line and midclavicular the transfer distance between the midaxillary line and midpoint of the clavicular bone (prepared point for neurotization) measured. In 30 sides of specimens, the 3rd and 4th intercostal nerves could be obtained between the midaxillary and midclavicular line, the available length of which was significantly greater than the transfer distance (P intercostal nerve and 16 sides of 6th intercostal nerve were covered by the costal cartilage before reaching the midclavicular line. The available length of the 5th intercostal nerve was similar to the transfer distance (P > 0.01), while the available the 6th intercostal nerve was significantly less than transfer distance (P intercostal nerve length and length (2 cm) of suprascapular nerve was significantly greater than the transfer distance (P intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. And 6th intercostal nerve, longer dissociated length may be required for direct coaptation or using a graft for nerve repair.

  17. Hepatocellular carcinomas smaller than 4 cm supplied by the intercostal artery: can we predict which intercostal artery supplies the tumor?

    Science.gov (United States)

    Hur, Saebeom; Kim, Hyo-Cheol; Chung, Jin Wook; Kim, Min-Uk; Kim, Ji Dae; Kim, Gyoung Min; Lee, In Joon; Kim, Young Il; Jae, Hwan Jun; Park, Jae Hyung

    2011-01-01

    To predict which intercostal artery supplies a tumor by examining the spatial relationship between hepatocellular carcinoma (HCC) and the intercostal artery feeding the tumor on transverse computed tomography (CT) images. Between January 2000 and September 2009, 46 intercostal arteries supplying HCCs smaller than 4 cm were noted in 44 patients, and CT scans and angiograms of these patients were retrospectively reviewed. The intercostal artery feeding the tumor was marked on the CT scan showing the center of the tumor. In addition, its spatial relationship with the tumor center was examined. The angle of the tumor location was measured on the transverse CT scan in the clockwise direction from the sagittal line on the virtual circle centered in the right hemithorax. Correlations between the angle of the tumor location and the level of the tumor-feeding intercostal artery were assessed with the Spearman rank coefficient. Of 46 intercostal arteries feeding HCC, 39 (85%) were the first ones observed from the tumor center in a counterclockwise direction on the transverse CT image containing the tumor center. The level of the tumor-feeding intercostal artery was significantly correlated with the angle of the tumor, as the posteriorly located tumor tends to be supplied by lower intercostal arteries, while the laterally located tumor by upper intercostal arteries (Spearman coefficient = -0.537; p intercostal artery encountered from the tumor center in a counterclockwise direction on a transverse CT image.

  18. Hepatocellular Carcinomas Smaller Than 4 cm Supplied by the Intercostal Artery: Can We Predict Which Intercostal Artery Supplies the Tumor?

    Energy Technology Data Exchange (ETDEWEB)

    Hur, Sae Beom; Kim, Hyo Cheol; Chung, Jin Wook [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); and others

    2011-11-15

    To predict which intercostal artery supplies a tumor by examining the spatial relationship between hepatocellular carcinoma (HCC) and the intercostal artery feeding the tumor on transverse computed tomography (CT) images. Between January 2000 and September 2009, 46 intercostal arteries supplying HCCs smaller than 4 cm were noted in 44 patients, and CT scans and angiograms of these patients were retrospectively reviewed. The intercostal artery feeding the tumor was marked on the CT scan showing the center of the tumor. In addition, its spatial relationship with the tumor center was examined. The angle of the tumor location was measured on the transverse CT scan in the clockwise direction from the sagittal line on the virtual circle centered in the right hemithorax. Correlations between the angle of the tumor location and the level of the tumor-feeding intercostal artery were assessed with the Spearman rank coefficient. Of 46 intercostal arteries feeding HCC, 39 (85%) were the first ones observed from the tumor center in a counterclockwise direction on the transverse CT image containing the tumor center. The level of the tumor-feeding intercostal artery was significantly correlated with the angle of the tumor, as the posteriorly located tumor tends to be supplied by lower intercostal arteries, while the laterally located tumor by upper intercostal arteries (Spearman coefficient = -0.537; p < 0.001). We can predict the tumor feeder with an accuracy of 85% as the first intercostal artery encountered from the tumor center in a counterclockwise direction on a transverse CT image.

  19. Paraplegia after intercostal neurolysis with phenol

    Directory of Open Access Journals (Sweden)

    Gollapalli L

    2014-11-01

    Full Text Available Lakshman Gollapalli, Rudramanaidu Muppuri Department of Anesthesiology and Pain Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA Abstract: In patients with advanced stages of cancer, severe pain is commonly encountered and is very difficult to treat. It affects the quality of life of the patient and the families involved. Pain can be managed using analgesics and adjuvant therapy. However, studies have shown that at least 10%–15% of patients fail to control pain adequately and will experience severe pain. We discuss the case of a 66-year-old female with metastatic adenoid cystic carcinoma of the left submandibular gland and developed paraplegia following intercostal neurolysis with phenol. After a successful diagnostic T6 to T12 intercostal nerve block, the patient was scheduled for an intercostal neurolytic block. We injected 2 mL of 10% aqueous phenol at each level on the left from the T6 to T12 ribs. One hour after the procedure, the patient developed bilateral lower extremity weakness with difficulty moving. A physical examination showed the absence of sensation to pinpricks and vibration from T10 to S5 and an absence of anal sphincter tone and sensation. Magnetic resonance images of the thoracic and lumbar spine showed leptomeningeal metastatic disease and myelitis. We postulate that the paraplegia could be from phenol diffusing along either the spinal nerves or the paravertebral venous plexus into the subarachnoid space. This case report points to the risks involved with phenol neurolysis close to the spine, and we propose alternative methods to minimize neurological complications. Keywords: intercostal neurolysis, pain, phenol, paraplegia 

  20. Traumatic intercostal arterial bleeding controlled with a novel surgical technique: a case report

    Directory of Open Access Journals (Sweden)

    Miettinen Simo

    2012-09-01

    Full Text Available Abstract Introduction A blunt thoracic trauma may cause arterial bleeding requiring operative treatment or endovascular embolization or endovascular aortic stenting. A novel damage control technique to stop such bleeding is presented. Case presentation We present the case of an 82-year-old Caucasian man who experienced rib fractures I-VII on the left side and bleeding from damaged intercostal arteries after a blunt thoracic trauma. Emergency thoracotomy was performed. Conclusions Effective hemostasis was achieved by using a rolled surgical swab and inserting it against the chest wall next to the aorta with sutures pulled through the intercostal muscles and then sutured to the back side of the patient. The patient died four days after the surgery due to a head injury sustained in the car crash.

  1. Extraocular muscle atrophy and central nervous system involvement in chronic progressive external ophthalmoplegia.

    Directory of Open Access Journals (Sweden)

    Cynthia Yu-Wai-Man

    Full Text Available Chronic progressive external ophthalmoplegia (CPEO is a classical mitochondrial ocular disorder characterised by bilateral progressive ptosis and ophthalmoplegia. These ocular features can develop either in isolation or in association with other prominent neurological deficits (CPEO+. Molecularly, CPEO can be classified into two distinct genetic subgroups depending on whether patients harbour single, large-scale mitochondrial DNA (mtDNA deletions or multiple mtDNA deletions secondary to a nuclear mutation disrupting mtDNA replication or repair. The aim of this magnetic resonance imaging (MRI study was to investigate whether the ophthalmoplegia in CPEO is primarily myopathic in origin or whether there is evidence of contributory supranuclear pathway dysfunction.Ten age-matched normal controls and twenty patients with CPEO were recruited nine patients with single, large-scale mtDNA deletions and eleven patients with multiple mtDNA deletions secondary to mutations in POLG, PEO1, OPA1, and RRM2B. All subjects underwent a standardised brain and orbital MRI protocol, together with proton magnetic resonance spectroscopy in two voxels located within the parietal white matter and the brainstem.There was evidence of significant extraocular muscle atrophy in patients with single or multiple mtDNA deletions compared with controls. There was no significant difference in metabolite concentrations between the patient and control groups in both the parietal white matter and brainstem voxels. Volumetric brain measurements revealed marked cortical and cerebellar atrophy among patients with CPEO+ phenotypes.The results of this study support a primary myopathic aetiology for the progressive limitation of eye movements that develops in CPEO.

  2. [Clinical evaluation of in-plane ultrasound-guided thoracic paravertebral block using laterally intercostal approach].

    Science.gov (United States)

    Xu, T; Li, M; Tian, Y; Song, J T; Ni, C; Guo, X Y

    2017-02-18

    To evaluate the feasibility and success rate of in-plane ultrasound-guided paravertebral block using laterally intercostal approach. In the study, 27 patients undergoing elective thoracic surgery were selected to do paravertebral block preoperatively. The fifth intercostal space was scanned by ultrasound probe which was placed along the long axis of the rib and 8 cm lateral to the midline of the spine. The needle was advanced in increments aiming at the space between the internal and innermost intercostal muscles. Once the space between the muscles was achieved, 20 mL of 0.5% (mass fraction) ropivacaine was injected and a catheter was inserted. Whether the tip of catheter was in right place was evaluated by ultrasound image. The block dermatomes of cold sensation were recorded 10, 20 and 30 min after the bolus drug was given. Then 0.2% ropivacaine was infused with 6 mL/h via the catheter by an analgesia pump postoperatively. The block dermatomes of cold sensation and pain score were recorded 1, 6, 24 and 48 h postoperatively. The first attempt success rate of catheteration was 81.48% (22/27); the tips of catheter were proved in right places after the second or third attempt in 5 patients. The median numbers of the block dermatomes 10, 20 and 30 min after the bolus drug was given were 2, 3, 4; the median numbers of block dermatomes were 5, 5, 5, 4, and of pain score were 1, 1, 2, 2 at 1, 6, 24, 48 h postoperatively; no case of bilateral block, pneumothorax or vessel puncture occurred. Thoracic paravertebral block using laterally intercostal approach is feasible, which has high success rate of block and low rate of complications.

  3. Electromyographic analysis of the infraspinatus and scapular stabilizing muscles during isometric shoulder external rotation at various shoulder elevation angles

    Science.gov (United States)

    Uga, Daisuke; Endo, Yasuhiro; Nakazawa, Rie; Sakamoto, Masaaki

    2016-01-01

    [Purpose] This study aimed to clarify activation of the infraspinatus and scapular stabilizing muscles during shoulder external rotation at various shoulder elevation angles. [Subjects] Twenty subjects participated in this study and all measurements were performed on the right shoulder. [Methods] Isometric shoulder external rotation strength and surface electromyographic data were measured with the shoulder at 0°, 45°, 90°, and 135° elevation in the scapular plane. The electromyographic data were collected from the infraspinatus, upper trapezius, middle trapezius, lower trapezius, and serratus anterior muscles. These measurements were compared across the various shoulder elevation angles. [Results] The strength measurements did not differ significantly by angulation. The infraspinatus activity was 92%, 75%, 68%, and 57% of the maximum voluntary contraction, which significantly decreased as shoulder elevation increased. The serratus anterior activity was 24%, 48%, 53%, and 62% of the maximum voluntary contraction, which significantly increased as shoulder elevation increased. [Conclusion] Shoulder external rotation torque was maintained regardless of shoulder elevation angle. The shoulder approximated to the zero position as the shoulder elevation increased so that infraspinatus activity decreased and the scapular posterior tilting by the serratus anterior might generate shoulder external rotation torque. PMID:26957748

  4. Transdiaphragmatic intercostal hernia: imaging aspects in three cases*

    Science.gov (United States)

    Macedo, Ana Carolina Sandoval; Kay, Fernando Uliana; Terra, Ricardo Mingarini; de Campos, José Ribas Milanez; Aranha, André Galante Alencar; Funari, Marcelo Buarque de Gusmão

    2013-01-01

    Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases. PMID:24068274

  5. Transdiaphragmatic intercostal hernia: imaging aspects in three cases

    Directory of Open Access Journals (Sweden)

    Ana Carolina Sandoval Macedo

    2013-06-01

    Full Text Available Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance in each of the cases.

  6. 3D Image Fusion to Localise Intercostal Arteries During TEVAR.

    Science.gov (United States)

    Koutouzi, G; Sandström, C; Skoog, P; Roos, H; Falkenberg, M

    2017-01-01

    Preservation of intercostal arteries during thoracic aortic procedures reduces the risk of post-operative paraparesis. The origins of the intercostal arteries are visible on pre-operative computed tomography angiography (CTA), but rarely on intra-operative angiography. The purpose of this report is to suggest an image fusion technique for intra-operative localisation of the intercostal arteries during thoracic endovascular repair (TEVAR). The ostia of the intercostal arteries are identified and manually marked with rings on the pre-operative CTA. The optimal distal landing site in the descending aorta is determined and marked, allowing enough length for an adequate seal and attachment without covering more intercostal arteries than necessary. After 3D/3D fusion of the pre-operative CTA with an intra-operative cone-beam CT (CBCT), the markings are overlaid on the live fluoroscopy screen for guidance. The accuracy of the overlay is confirmed with digital subtraction angiography (DSA) and the overlay is adjusted when needed. Stent graft deployment is guided by the markings. The initial experience of this technique in seven patients is presented. 3D image fusion was feasible in all cases. Follow-up CTA after 1 month revealed that all intercostal arteries planned for preservation, were patent. None of the patients developed signs of spinal cord ischaemia. 3D image fusion can be used to localise the intercostal arteries during TEVAR. This may preserve some intercostal arteries and reduce the risk of post-operative spinal cord ischaemia.

  7. Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy.

    Science.gov (United States)

    Grazziotin Dos Santos, C; Pagnussat, Aline S; Simon, A S; Py, Rodrigo; Pinho, Alexandre Severo do; Wagner, Mário B

    2014-10-20

    This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Abscess of the iliopsoas muscle associated external fistula of the rectum caused by radiation proctitis. A case report

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    Hasegawa, Shigeru; Imazu, Hiroki; Matubara, Toshiki; Sakurai, Yoichi; Ochiai, Masahiro; Funabiki, Takahiko [Fujita Health Univ., Toyoake, Aichi (Japan). School of Medicine

    1999-12-01

    This paper deals with a case of abscess of the iliopsoas muscle, an intractable external fistula of the rectum caused by radiation proctitis in a 68-year-old man. There were previous histories of undergoing an A-C bypass operation for coronary stricture 10 years before; and undergoing aportial resection of the bladder with radiation therapy for urinary bladder cancer, followed by colostomy for hemorrhage and stricture of the rectum for radiation proctitis 2 years before admission. In April, 1997 when he had been treated at outpatient clinic, exhumation of pusfrom the sacurred that was diagnosed external fistula of the rectum on a fistulography and he was continuously treated on an ambulant basis. On November 17, 1997, the patient had a temperature 38.7deg C, the white blood cell count increased to 35 x 10{sup 4} /ml, inflammation reaction increased, and unconsciousness appeared. An emergency CT revealed retention of fluid in the retroperitoneum covering from the fistulation through the iliopsoas muscle to pelvis. An abscess of the iliopsoas muscle was diagnosed. It was determined that any operations under general anesthesia were impossible due to poor general condition, and an emergency incision drainage was performed under local anesthesia. Thereafter, the patient developed MRSA septicemia which demanded redrainage and strict general management, but he was successfully freed from the management. Although the intractable fistula in persistently present, he was discharged after a resection of sequestrum and is followed on an ambulant basis. (author)

  9. Accommodation: The role of the external muscles of the eye: A consideration of refractive errors in relation to extraocular malfunction.

    Science.gov (United States)

    Hargrave, B K

    2014-11-01

    Speculation as to optical malfunction has led to dissatisfaction with the theory that the lens is the sole agent in accommodation and to the suggestion that other parts of the eye are also conjointly involved. Around half-a-century ago, Robert Brooks Simpkins suggested that the mechanical features of the human eye were precisely such as to allow for a lengthening of the globe when the eye accommodated. Simpkins was not an optical man but his theory is both imaginative and comprehensive and deserves consideration. It is submitted here that accommodation is in fact a twofold process, and that although involving the lens, is achieved primarily by means of a give - and - take interplay between adducting and abducting external muscles, whereby an elongation of the eyeball is brought about by a stretching of the delicate elastic fibres immediately behind the cornea. The three muscles responsible for convergence (superior, internal and inferior recti) all pull from in front backwards, while of the three abductors (external rectus and the two obliques) the obliques pull from behind forwards, allowing for an easy elongation as the eye turns inwards and a return to its original length as the abducting muscles regain their former tension, returning the eye to distance vision. In refractive errors, the altered length of the eyeball disturbs the harmonious give - and - take relationship between adductors and abductors. Such stresses are likely to be perpetuated and the error exacerbated. Speculation is not directed towards a search for a possible cause of the muscular imbalance, since none is suspected. Muscles not used rapidly lose tone, as evidenced after removal of a limb from plaster. Early attention to the need for restorative exercise is essential and results usually impressive. If flexibility of the external muscles of the eyes is essential for continuing good sight, presbyopia can be avoided and with it the supposed necessity of glasses in middle life. Early attention

  10. Relative activity of respiratory muscles during prescribed inspiratory muscle training in healthy people.

    Science.gov (United States)

    Jung, Ju-Hyeon; Kim, Nan-Soo

    2016-03-01

    [Purpose] This study aimed to determine the effects of different intensities of inspiratory muscle training on the relative respiratory muscle activity in healthy adults. [Subjects and Methods] Thirteen healthy male volunteers were instructed to perform inspiratory muscle training (0%, 40%, 60%, and 80% maximal inspiratory pressure) on the basis of their individual intensities. The inspiratory muscle training was performed in random order of intensities. Surface electromyography data were collected from the right-side diaphragm, external intercostal, and sternocleidomastoid, and pulmonary functions (forced expiratory volume in 1 s, forced vital capacity, and their ratio; peak expiratory flow; and maximal inspiratory pressure) were measured. [Results] Comparison of the relative activity of the diaphragm showed significant differences between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. Furthermore, significant differences were found in sternocleidomastoid relative activity between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. [Conclusion] During inspiratory muscle training in the clinic, the patients were assisted (verbally or through feedback) by therapists to avoid overactivation of their accessory muscles (sternocleidomastoid). This study recommends that inspiratory muscle training be performed at an accurate and appropriate intensity through the practice of proper deep breathing.

  11. Muscle contributions to elbow joint rotational stiffness in preparation for sudden external arm perturbations.

    Science.gov (United States)

    Holmes, Michael W R; Keir, Peter J

    2014-04-01

    Understanding joint stiffness and stability is beneficial for assessing injury risk. The purpose of this study was to examine joint rotational stiffness for individual muscles contributing to elbow joint stability. Fifteen male participants maintained combinations of three body orientations (standing, supine, sitting) and three hand preloads (no load, solid tube, fluid filled tube) while a device imposed a sudden elbow extension. Elbow angle and activity from nine muscles were inputs to a biomechanical model to determine relative contributions to elbow joint rotational stiffness, reported as percent of total stiffness. A body orientation by preload interaction was evident for most muscles (Pelbow perturbations, found that forearm muscles contribute marginally and showed that orientation and preload should be considered when evaluating elbow joint stiffness and safety.

  12. Strong relationships exist between muscle volume, joint power and whole-body external mechanical power in adults and children.

    Science.gov (United States)

    O'Brien, Thomas D; Reeves, Neil D; Baltzopoulos, Vasilios; Jones, David A; Maganaris, Constantinos N

    2009-06-01

    The present study investigated whether differences between adults and children in mechanical power during single-joint knee extension tasks and the complex multijoint task of jumping could be explained by differences in the quadriceps femoris muscle volume. Peak power was calculated during squat jumps, from the integral of the vertical force measured by a force plate, and during concentric knee extensions at 30, 90, 120, 180 and 240 deg s(-1), and muscle volume was measured from magnetic resonance images for 10 men, 10 women, 10 prepubertal boys and 10 prepubertal girls. Peak power during jumping and isokinetic knee extension was significantly higher in men than in women, and in both adult groups compared with children (P power was normalized to muscle volume, the intergroup differences ceased to exist for both tasks. Peak power correlated significantly with quadriceps volume (P power that occurs with maturation in the two genders not only in kinematically constrained knee extensions but also in multijoint tasks. Future studies should examine the role of other factors relating to the generation and transmission of contractile power, such as muscle architecture, tendon stiffness and external mechanical leverage.

  13. The Sternocleidomastoid Muscle Flap: A Versatile Local Method for Repair of External Penetrating Injuries of Hypopharyngeal-Cervical Esophageal Funnel.

    Science.gov (United States)

    Ellabban, Mohamed A

    2016-04-01

    A primary repair of external penetrating injury to hypopharyngeal-cervical esophageal (HP-CE) funnel without reinforcement has more complications if compared with muscle reinforcement. The aim of the present study was to assess the outcome of using sternocleidomastoid (SCM) muscle flap for reinforcement of primary repair of HP-CE funnel injury. The study proposed an algorithm for different uses of SCM flap repair according to site and size of funnel perforation. A prospective analysis of 12 patients, who had surgical treatment for external penetrating injuries of HP-CE funnel between January 2011 and September 2014, was recorded. The following factors were studied for each case: demographic data, Revised Trauma Score (RTS), mechanism of injury, time interval between injury and definitive surgical care, injury morphology, any associated injuries, technique of SCM flap used, length of hospital stay, and surgical outcome and complications. They were 10 males and 2 females and the mean age was 31.9 years. The cause of injury was stab wound in 5 (41.7 %) cases, gunshot injury in 4 (33.3 %) cases and 3 (25 %) cases after anterior cervical spine surgery. Isolated injury to HP and CE was recorded in 5 cases (41.7 %) for each site. However, 2 (16.7 %) cases had injury to both HP and CE. Cranially based SCM flap was mainly used in cases with HP injury and caudally based flap in CE cases with some limitations. The whole muscle flap was used in large (≥ 1 cm) defects while and the split muscle flap in small (SCM flap is a very useful and versatile tool in reinforcement of HP-CE funnel injury with the advantages of high success rates of leakage prevention.

  14. Course and variation of the intercostal artery by CT scan.

    Science.gov (United States)

    Helm, Emma J; Rahman, Najib M; Talakoub, Omid; Fox, Danial L; Gleeson, Fergus V

    2013-03-01

    It is conventionally taught that the intercostal artery is shielded in the intercostal groove of the superior rib. The continuous course and variability of the intercostal artery, and factors that may influence them, have not been described in a large number of arteries in vivo. Maximal intensity projection reformats in the coronal plane were produced from CT scan pulmonary angiograms to identify the posterolateral course of the intercostal artery (seventh to 11th rib spaces). A novel semiautomated computer segmentation algorithm was used to measure distances between the lower border of the superior rib, the upper border of the inferior rib, and the position of the intercostal artery when exposed in the intercostal space. The position and variability of the artery were analyzed for association with clinical factors. Two hundred ninety-eight arteries from 47 patients were analyzed. The mean lateral distance from the spine over which the artery was exposed within the intercostal space was 39 mm, with wide variability (SD, 10 mm; 10th-90th centile, 28-51 mm). At 3 cm lateral distance from the spine, 17% of arteries were shielded by the superior rib, compared with 97% at 6 cm. Exposed artery length was not associated with age, sex, rib space, or side. The variability of arterial position was significantly associated with age (coefficient, 0.91; P intercostal artery is exposed within the intercostal space in the first 6 cm lateral to the spine. The variability of its vertical position is greater in older patients and in more cephalad rib spaces.

  15. Successful Reinnervation of the Diaphragm After Intercostal to Phrenic Nerve Neurotization in Patients With High Spinal Cord Injury.

    Science.gov (United States)

    Nandra, Kulvir S; Harari, Martin; Price, Thea P; Greaney, Patrick J; Weinstein, Michael S

    2017-08-01

    Our objective in this study was to extend diaphragmatic pacing therapy to include paraplegic patients with high cervical spinal cord injuries between C3 and C5. Diaphragmatic pacing has been used in patients experiencing ventilator-dependent respiratory failure due to spinal cord injury as a means to reduce or eliminate the need for mechanical ventilation. However, this technique relies on intact phrenic nerve function. Recently, phrenic nerve reconstruction with intercostal nerve grafting has expanded the indications for diaphragmatic pacing. Our study aimed to evaluate early outcomes and efficacy of intercostal nerve transfer in diaphragmatic pacing. Four ventilator-dependent patients with high cervical spinal cord injuries were selected for this study. Each patient demonstrated absence of phrenic nerve function via external neck stimulation and laparoscopic diaphragm mapping. Each patient underwent intercostal to phrenic nerve grafting with implantation of a phrenic nerve pacer. The patients were followed, and ventilator dependence was reassessed at 1 year postoperatively. Our primary outcome was measured by the amount of time our patients tolerated off the ventilator per day. We found that all 4 patients have tolerated paced breathing independent of mechanical ventilation, with 1 patient achieving 24 hours of tracheostomy collar. From this study, intercostal to phrenic nerve transfer seems to be a promising approach in reducing or eliminating ventilator support in patients with C3 to C5 high spinal cord injury.

  16. Pre-expanded Intercostal Perforator Super-Thin Skin Flap.

    Science.gov (United States)

    Liao, Yunjun; Luo, Yong; Lu, Feng; Hyakusoku, Hiko; Gao, Jianhua; Jiang, Ping

    2017-01-01

    This article introduces pre-expanded super-thin intercostal perforator flaps, particularly the flap that has a perforator from the first to second intercostal spaces. The key techniques, advantages and disadvantages, and complications and management of this flap are described. At present, the thinnest possible flap is achieved by thinning the pre-expanded flap that has a perforator from the first to second intercostal spaces. It is used to reconstruct large defects on the face and neck, thus restoring function and cosmetic appearance. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Thoracic skeletal defects in myogenin- and MRF4-deficient mice correlate with early defects in myotome and intercostal musculature.

    Science.gov (United States)

    Vivian, J L; Olson, E N; Klein, W H

    2000-08-01

    Myogenin and MRF4 are skeletal muscle-specific bHLH transcription factors critical for muscle development. In addition to a variety of skeletal muscle defects, embryos homozygous for mutations in myogenin or MRF4 display phenotypes in the thoracic skeleton, including rib fusions and sternal defects. These skeletal defects are likely to be secondary because myogenin and MRF4 are not expressed in the rib cartilage or sternum. In this study, the requirement for myogenin and MRF4 in thoracic skeletal development was further examined. When a hypomorphic allele of myogenin and an MRF4-null mutation were placed together, the severity of the thoracic skeletal defects was greatly increased and included extensive rib cartilage fusion and fused sternebrae. Additionally, new rib defects were observed in myogenin/MRF4 compound mutants, including a failure of the rib cartilage to contact the sternum. These results suggested that myogenin and MRF4 share overlapping functions in thoracic skeletal formation. Spatial expression patterns of skeletal muscle-specific markers in myogenin- and MRF4-mutant embryos revealed early skeletal muscle defects not previously reported. MRF4-/- mice displayed abnormal intercostal muscle morphology, including bifurcation and fusion of adjacent intercostals. myogenin/MRF4-mutant combinations displayed ventral myotome defects, including a failure to express normal levels of myf5. The results suggested that the early muscle defects observed in myogenin and MRF4 mutants may cause subsequent thoracic skeletal defects, and that myogenin and MRF4 have overlapping functions in ventral myotome differentiation and intercostal muscle morphogenesis. Copyright 2000 Academic Press.

  18. Angiographic analysis of the lateral intercostal artery perforator of the posterior intercostal artery: anatomic variation and clinical significance.

    Science.gov (United States)

    Jeon, Eui Yong; Cho, Young Kwon; Yoon, Dae Young; Seo, Young Lan; Lim, Kyoung Ja; Yun, Eun Joo

    2015-01-01

    Knowledge of the anatomic variations of the posterior intercostal artery (PICA) and its major branches is important during transthoracic procedures and surgery. We aimed to identify the anatomic features and variations of the lateral intercostal artery perforator (LICAP) of the PICA with selective PICA arteriography. We retrospectively evaluated 353 PICAs in 75 patients with selective PICA arteriography for the following characteristics: incidence, length (as number of traversed intercostal spaces), distribution at the hemithorax (medial half vs. lateral half), and size as compared to the collateral intercostal artery of the PICA. The incidence of LICAPs was 35.9% (127/353). LICAPs were most commonly observed in the right 8th-11th intercostal spaces (33%, 42/127) and in the medial half of the hemithorax (85%, 108/127). Most LICAPs were as long as two (35.4%, 45/127) or three intercostal spaces (60.6%, 77/127). Compared to the collateral intercostal artery, 42.5% of LICAPs were larger (54/127), with most of these observed in the right 4th-7th intercostal spaces (48.8%, 22/54). We propose the clinical significance of the LICAP as a potential risk factor for iatrogenic injury during posterior transthoracic intervention and thoracic surgery. For example, skin incisions must be as superficial as possible and directed vertically at the right 4th-7th intercostal spaces and the medial half of the thorax. Awareness of the anatomical variations of the LICAPs of the PICA will allow surgeons and interventional radiologists to avoid iatrogenic arterial injuries during posterior transthoracic procedures and surgery.

  19. Incidental Finding of Intercostal Artery Aneurysm During Coarctation Surgery.

    Science.gov (United States)

    Sabzi, Feridoun; Ghasemi, Fahime

    2017-06-01

    Intercostal artery aneurysms (ICAA) are very rare vascular complication of coarctation. The most cases are asymptomatic and could be found incidentally during thoracotomy for others vascular pathology or may present with fatal problems such as rupture that is leading to bleeding and hypovolemic shock. Intercostal artery aneurysm most commonly accompanies with neurofibromatosis, aortic coarctation, or in chest trauma. We report a 10-year-old girl who complained of lower extremities pain and hypertension for a few months. His final diagnosis was coarctation of the aorta. She was scheduled for thoracotomy and coarctation repair by resection and end to end anastomosis. During thoracotomy at lateral side of coarctation, an ICAA distal to coarctation site was seen that by a collateral artery connects to its upper intercostals artery. The patient was treated by ligation and resection of the affected intercostal artery and subsequent coarctation repair. The postoperative course was uneventful and, she was discharged on 7th postoperative day.

  20. Electromyographic activity of erector spinae and external oblique muscles during trunk lateral bending and axial rotation in patients with adolescent idiopathic scoliosis and healthy subjects.

    Science.gov (United States)

    Farahpour, Nader; Younesian, Hananeh; Bahrpeyma, Farid

    2015-06-01

    The aim of this study was to analyze electrical activity of trunk muscles in adolescent idiopathic scoliosis patients and healthy subjects during trunk lateral bending and rotation movements. Ten patients with right thoracic scoliosis [Cobb angle: 29.1° (10.4°)] and 10 control adolescents were studied. Electrical activities of erector spinae muscle at 6th and 10th thoracic and 3rd lumbar vertebral level, and external oblique muscles were measured bilaterally during the right and left bending from standing and prone positions, and trunk rotation in sitting position. In trunk rotation to the right, the right-side external oblique (antagonist) muscle in scoliosis group was greater than that in control group (pscoliosis group, the antagonistic activity of EST6 muscle was greater than its agonistic activity (pscoliosis group was higher than that of control group (p=0.02). During the left bending from prone position, right-side EST6 and right-side ESL3 muscles of scoliosis group were greater than that of control group (pscoliosis group, the greater antagonistic activity of erector spinae muscle at 6th thoracic vertebral level than its agonistic activity, indicates that scoliosis is associated with asymmetrical muscle activity. Lateral bending from standing position is appropriate test to distinguish between scoliosis and control subjects. In scoliosis, the asymmetrical muscle activity is not an inherent characteristic since it was not displayed in all back motions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Constancy and characteristics of the anterior cutaneous branch of the first intercostal nerve: correcting the descriptions in human anatomy texts.

    Science.gov (United States)

    Miyawaki, Makoto

    2006-12-01

    Human anatomy texts state that the anterior cutaneous branch of the first intercostal nerve (Rca-Th1) does not exist or that, even if it does, it is poorly developed. However, an anterior cutaneous branch in the first intercostal space (Rca-1) was observed in 74.8% of cases examined (104/139 sides) and was not poorly developed at all. Some of the observed Rca-I were even larger than the anterior cutaneous branches in the second intercostal space (Rca-ll). The segment of origin of the Rca-I was analyzed in 37 sides and 66.2% (49/74 branches) were confirmed to be from Th1. As a result, in contrast with traditional beliefs, it was shown that Rca-Th1 exists. The Rca-I was classified into two types according to the course and distribution: (i) an anterior cutaneous branch that appeared at the anterior end of the first intercostal space (ICS), ran through the pectoralis major muscle and extended in the first ICS (Rca-1); and (ii) another branch that appeared at the same place but ran downward along the anterior surface of the second costal cartilage, deep to the pectoralis major muscle, to reach the inferior edge of the second costal cartilage or the second ICS, passed through the pectoralis major muscle and extended to the second rib or the second ICS (pseudo Rca-2). It was found that 77.8% (35/45 branches) of Rca-1 and 48.3% (14/29 branches) of pseudo Rca-2 were derived from Th1. Accordingly, the author suggests that the description in human anatomy texts should be revised to read, '... the Rca-Th1 exists quite constantly and some of appear at a position resembling Rca-Th2'.

  2. Smaller external notebook mice have different effects on posture and muscle activity.

    Science.gov (United States)

    Oude Hengel, Karen M; Houwink, Annemieke; Odell, Dan; van Dieën, Jaap H; Dennerlein, Jack T

    2008-07-01

    Extensive computer mouse use is an identified risk factor for computer work-related musculoskeletal disorders; however, notebook computer mouse designs of varying sizes have not been formally evaluated but may affect biomechanical risk factors. Thirty adults performed a set of mouse tasks with five notebook mice, ranging in length from 75 to 105 mm and in width from 35 to 65 mm, and a reference desktop mouse. An electro-magnetic motion analysis system measured index finger (metacarpophalangeal joint), wrist and forearm postures, and surface electromyography measured muscle activity of three extensor muscles in the forearm and the first dorsal interosseus. The smallest notebook mice were found to promote less neutral postures (up to 3.2 degrees higher metacarpophalangeal joint adduction; 6.5 degrees higher metacarpophalangeal joint flexion, 2.3 degrees higher wrist extension) and higher muscle activity (up to 4.1% of maximum voluntary contraction higher wrist extensor muscle activity). Participants with smaller hands had overall more non-neutral postures than participants with larger hands (up to 5.6 degrees higher wrist extension and 5.9 degrees higher pronation); while participants with larger hands were more influenced by the smallest notebook mice (up to 3.6 degrees higher wrist extension and 5.5% of maximum voluntary contraction higher wrist extensor values). Self-reported ratings showed that while participants preferred smaller mice for portability; larger mice scored higher on comfort and usability. The smallest notebook mice increased the intensity of biomechanical exposures. Longer term mouse use could enhance these differences, having a potential impact on the prevention of work-related musculoskeletal disorders.

  3. Variation in External Rotation Moment Arms among Subregions of Supraspinatus, Infraspinatus, and Teres Minor Muscles

    OpenAIRE

    Langenderfer, Joseph E.; Patthanacharoenphon, Cameron; Carpenter, James E.; Hughes, Richard E.

    2006-01-01

    A rotator cuff tear causes morphologic changes in rotator cuff muscles and tendons and reduced shoulder strength. The mechanisms by which these changes affect joint strength are not understood. This study’s purpose was to empirically determine rotation moment arms for subregions of supraspinatus, infraspinatus, and for teres minor, and to test the hypothesis that subregions of the cuff tendons increase their effective moment arms through connections to other subregions. Tendon excursions were...

  4. Effects of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes.

    Science.gov (United States)

    Niederbracht, Yvonne; Shim, Andrew L; Sloniger, Mark A; Paternostro-Bayles, Madeline; Short, Thomas H

    2008-01-01

    Imbalance of the eccentrically-activated external rotator cuff muscles versus the concentrically-activated internal rotator cuff muscles is a primary risk factor for glenohumeral joint injuries in overhead activity athletes. Nonisokinetic dynamometer based strength training studies, however, have focused exclusively on resulting concentric instead of applicable eccentric strength gains of the external rotator cuff muscles. Furthermore, previous strength training studies did not result in a reduction in glenoumeral joint muscle imbalance, thereby suggesting that currently used shoulder strength training programs do not effectively reduce the risk of shoulder injury to the overhead activity athlete. Two collegiate women tennis teams, consisting of 12 women, participated in this study throughout their preseason training. One team (n = 6) participated in a 5-week, 4 times a week, external shoulder rotator muscle strength training program next to their preseason tennis training. The other team (n = 6) participated in a comparable preseason tennis training program, but did not conduct any upper body strength training. Effects of this strength training program were evaluated by comparing pre- and posttraining data of 5 maximal eccentric external immediately followed by concentric internal contractions on a Kin-Com isokinetic dynamometer (Chattecx Corp., Hixson, Tennessee). Overall, the shoulder strength training program significantly increased eccentric external total work without significant effects on concentric internal total work, concentric internal mean peak force, or eccentric external mean peak force. In conclusion, by increasing the eccentric external total exercise capacity without a subsequent increase in the concentric internal total exercise capacity, this strength training program potentially decreases shoulder rotator muscle imbalances and the risk for shoulder injuries to overhead activity athletes.

  5. Distribution patterns and predilection muscles of Trichinella zimbabwensis larvae in experimentally infected Nile crocodiles (Crocodylus niloticus Laurenti).

    Science.gov (United States)

    La Grange, Louis J; Mukaratirwa, Samson

    2014-02-21

    No controlled studies have been conducted to determine the predilection muscles of Trichinella zimbabwensis larvae in Nile crocodiles (Crocodylus niloticus) or the influence of infection intensity on the distribution of the larvae in crocodiles. The distribution of larvae in muscles of naturally infected Nile crocodiles and experimentally infected caimans (Caiman crocodilus) and varans (Varanus exanthematicus) have been reported in literature. To determine the distribution patterns of T. zimbabwensis larvae and predilection muscles, 15 crocodiles were randomly divided into three cohorts of five animals each, representing high infection (642 larvae/kg of bodyweight average), medium infection (414 larvae/kg of bodyweight average) and low infection (134 larvae/kg of bodyweight average) cohorts. In the high infection cohort, high percentages of larvae were observed in the triceps muscles (26%) and hind limb muscles (13%). In the medium infection cohort, high percentages of larvae were found in the triceps muscles (50%), sternomastoid (18%) and hind limb muscles (13%). In the low infection cohort, larvae were mainly found in the intercostal muscles (36%), longissimus complex (27%), forelimb muscles (20%) and hind limb muscles (10%). Predilection muscles in the high and medium infection cohorts were similar to those reported in naturally infected crocodiles despite changes in infection intensity. The high infection cohort had significantly higher numbers of larvae in the sternomastoid, triceps, intercostal, longissimus complex, external tibial flexor, longissimus caudalis and caudal femoral muscles (p crocodiles. Results from this study show that, in Nile crocodiles, larvae of T. zimbabwensis appear first to invade predilection muscles closest to their release site in the small intestine before occupying those muscles situated further away. The recommendation for the use of masseter, pterygoid and intercostal muscles as sampling sites for the detection of T. zimbabwensis

  6. Variation in external rotation moment arms among subregions of supraspinatus, infraspinatus, and teres minor muscles.

    Science.gov (United States)

    Langenderfer, Joseph E; Patthanacharoenphon, Cameron; Carpenter, James E; Hughes, Richard E

    2006-08-01

    A rotator cuff tear causes morphologic changes in rotator cuff muscles and tendons and reduced shoulder strength. The mechanisms by which these changes affect joint strength are not understood. This study's purpose was to empirically determine rotation moment arms for subregions of supraspinatus, infraspinatus, and for teres minor, and to test the hypothesis that subregions of the cuff tendons increase their effective moment arms through connections to other subregions. Tendon excursions were measured for full ranges of rotation on 10 independent glenohumeral specimens with the humerus abducted in the scapular plane at 10 and 60 degrees . Supraspinatus and infraspinatus tendons were divided into equal width subregions. Two conditions were tested: tendon divided to the musculotendinous junction, and tendon divided to the insertion on the humerus. Moment arms were determined from tendon excursion via the principle of virtual work. Moment arms for the infraspinatus (p muscle subregions and for tendon division conditions have clinical implications. Interaction between cuff regions could explain why some subjects retain strength after a small cuff tear. This finding helps explain why a partial cuff repair may be beneficial when a complete repair is not possible. Data presented here can help differentiate between cuff tear cases that would benefit from cuff repair and cases for which cuff repair might not be as favorable.

  7. The influence of age, muscle strength and speed of information processing on recovery responses to external perturbations in gait.

    Science.gov (United States)

    Senden, R; Savelberg, H H C M; Adam, J; Grimm, B; Heyligers, I C; Meijer, K

    2014-01-01

    Dynamic imbalance caused by external perturbations to gait can successfully be counteracted by adequate recovery responses. The current study investigated how the recovery response is moderated by age, walking speed, muscle strength and speed of information processing. The gait pattern of 50 young and 45 elderly subjects was repeatedly perturbed at 20% and 80% of the first half of the swing phase using the Timed Rapid impact Perturbation (TRiP) set-up. Recovery responses were identified using 2D cameras. Muscular factors (dynamometer) and speed of information processing parameters (computer-based reaction time task) were determined. The stronger, faster reacting and faster walking young subjects recovered more often by an elevating strategy than elderly subjects. Twenty three per cent of the differences in recovery responses were explained by a combination of walking speed (B=-13.85), reaction time (B=-0.82), maximum extension strength (B=0.01) and rate of extension moment development (B=0.19). The recovery response that subjects employed when gait was perturbed by the TRiP set-up was modified by several factors; the individual contribution of walking speed, muscle strength and speed of information processing was small. Insight into remaining modifying factors is needed to assist and optimise fall prevention programmes.

  8. Impact of external pneumatic compression target inflation pressure on transcriptome-wide RNA expression in skeletal muscle.

    Science.gov (United States)

    Martin, Jeffrey S; Kephart, Wesley C; Haun, Cody T; McCloskey, Anna E; Shake, Joshua J; Mobley, Christopher B; Goodlett, Michael D; Kavazis, Andreas; Pascoe, David D; Zhang, Lee; Roberts, Michael D

    2016-11-01

    Next-generation RNA sequencing was employed to determine the acute and subchronic impact of peristaltic pulse external pneumatic compression (PEPC) of different target inflation pressures on global gene expression in human vastus lateralis skeletal muscle biopsy samples. Eighteen (N = 18) male participants were randomly assigned to one of the three groups: (1) sham (n = 6), 2) EPC at 30-40 mmHg (LP-EPC; n = 6), and 3) EPC at 70-80 mmHg (MP-EPC; n = 6). One hour treatment with sham/EPC occurred for seven consecutive days. Vastus lateralis skeletal muscle biopsies were performed at baseline (before first treatment; PRE), 1 h following the first treatment (POST1), and 24 h following the last (7th) treatment (POST2). Changes from PRE in gene expression were analyzed via paired comparisons within each group. Genes were filtered to include only those that had an RPKM ≥ 1.0, a fold-change of ≥1.5 and a paired t-test value of <0.01. For the sham condition, two genes at POST1 and one gene at POST2 were significantly altered. For the LP-EPC condition, nine genes were up-regulated and 0 genes were down-regulated at POST1 while 39 genes were up-regulated and one gene down-regulated at POST2. For the MP-EPC condition, two genes were significantly up-regulated and 21 genes were down-regulated at POST1 and 0 genes were altered at POST2. Both LP-EPC and MP-EPC acutely alter skeletal muscle gene expression, though only LP-EPC appeared to affect gene expression with subchronic application. Moreover, the transcriptome response to EPC demonstrated marked heterogeneity (i.e., genes and directionality) with different target inflation pressures.

  9. Tandem intercostal thoracic schwannomas resected using a thoracoscopic nerve-sparing technique: case report.

    Science.gov (United States)

    Gantwerker, Brian R; Dickman, Curtis A

    2011-07-01

    To describe a novel nerve-sparing technique for the resection of intercostal nerve schwannomas. This case demonstrates that intercostal neuralgia can be caused by intercostal schwannomas and that it can be relieved by their removal. A young woman with schwannomatosis had progressively worsening intercostal neuralgia caused by compression of the intercostal nerve against the rib by tandem intercostal schwannomas. After the tumors were removed, her symptoms were completely relieved. A thoracoscopic technique was used to define the involved fascicles and to facilitate removal of the tumors while sparing the uninvolved nerve. The patient's radicular pain was relieved completely by the tumor resection. Thoracoscopic surgery offers a safe and minimally invasive technique for removal of intercostal schwannomas and is a valid alternative to open thoracotomy. Removal of thoracic schwannomas can relieve intercostal neuralgia.

  10. Denervation of the infraspinatus and release of the posterior deltoid muscles in the management of dyskinetic external shoulder rotation in cerebral palsy.

    Science.gov (United States)

    Blaszczyk, Izabela; Granström, Anna Cecilia; Wiberg, Mikael

    2015-04-01

    The dyskinetic subtype of cerebral palsy is difficult to manage, and there is no established gold standard for treatment. External rotation of the shoulder(s) is often managed nonsurgically using injections of botulinum toxin A into the external rotator muscles. This article reports a new surgical technique for managing external rotation when botulinum toxin A treatment is not sufficient or possible. Six patients with dyskinetic cerebral palsy underwent denervation of the infraspinatus muscle and release of the posterior part of the deltoid muscle. Postoperative questionnaires were given to the patients/caregivers, and video recordings were made both pre- and postoperatively. Preoperative and postoperative Assisting Hand Assessment was possible in only 1 case. Five patients were very satisfied with their outcome. Four patients' video recordings showed improvement in their condition. One patient developed postoperative complications. The results indicate that denervation of the infraspinatus muscle and posterior deltoid release can be an option for patients with dyskinetic cerebral palsy to manage external rotation of the shoulder when other treatment alternatives are insufficient.

  11. Acquired Abdominal Intercostal Hernia: A Case Report and Literature Review

    Science.gov (United States)

    Tripodi, Giuseppe

    2014-01-01

    Acquired abdominal intercostal hernia (AAIH) is a rare disease phenomenon where intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. We discuss a case of a 51-year-old obese female who arrived to the emergency room with a painful swelling between her left 10th rib and 11th rib. She gave a history of a stab wound to the area 15 years earlier. A CT scan revealed a fat containing intercostal hernia with no diaphragmatic defect. An open operative approach with a hernia patch was used to repair this hernia. These hernias are difficult to diagnose, so a high clinical suspicion and thorough history and physical exam are important. This review discusses pathogenesis, clinical presentation, complications, and appropriate treatment strategies of AAIH. PMID:25197605

  12. [Interventional Radiological Treatment of Intercostal Artery Bleedings - a Retrospective Analysis].

    Science.gov (United States)

    Kupczyk, Patrick; Meyer, Carsten; Thomas, Daniel; Schild, Hans Heinz; Pieper, Claus Christian

    2017-08-01

    Background Intercostal artery bleedings are potentially fatal injuries. Apart from conservative and surgical treatment options, emergency interventional radiological treatment can also be performed. We report our experience with emergency intercostal artery embolisation. Materials and Methods Patients with acute arterial bleedings from the intercostal artery who were treated interventionally over a period of 7 years were identified retrospectively. Technical and clinical success, clinical and procedural parameters as well as overall survival were analysed. Results Between 2010 and 2017, a total of 27 embolisation procedures was performed in 24 patients (14 male, mean age 65.7 ± 13.9 years). The majority of patients suffered from iatrogenic intercostal artery bleedings (n = 17; 70.1%; especially after thoracocentesis). In five cases, thoracoscopic surgery was attempted prior to intervention but was unsuccessful. Primary technical success was obtained in 25/27 interventions. In two cases, there was re-bleeding via collateral arteries so that re-intervention became necessary (secondary technical success). In 15 cases, secondary surgery after successful interventional treatment was necessary to evacuate the haematoma/haemothorax. Intercostal artery embolisation was clinically successful in 23/24 patients. One patient died despite technically successful embolisation, due to extensive haemothorax. One case of spinal ischaemia was observed as a major complication. Conclusion Intercostal artery embolisation is an effective interventional radiological emergency measure in patients with acute bleeding and is an alternative to surgical treatment even after attempted, unsuccessful surgery. Because of potentially severe complications, the interventional procedure should be performed by an experienced interventionalist. Georg Thieme Verlag KG Stuttgart · New York.

  13. Activity of periscapular muscles and its correlation with external oblique during push-up: Does scapular dyskinesis change the electromyographic response?

    Science.gov (United States)

    de Araújo, Rodrigo Cappatode; Pirauá, André Luiz Torres; Beltrão, Natália Barros; Pitangui, Ana Carolina Rodarti

    2017-05-24

    Scapular dyskinesis is the term used to describe changes in the positioning or movement of the scapula. Such dysfunction is associated with changes in the activation of the scapular muscles. However, the influence of the axial muscles on the scapular muscles activity of subjects with scapular dyskinesis is unknown. This study aimed to compare the electromyography (EMG) activity of periscapular muscles and its correlation with the external oblique muscle during the execution of push-up performed in different surfaces, in volunteers with and without scapular dyskinesis. Thirty-six men, divided in two groups (control and dyskinesis), performed push-up on stable and unstable surface. The EMG activity of serratus anterior (SA_5th and SA_7th fibers), upper (UT) and lower (LT) trapezius, external oblique (EO) was recorded during execution of each task condition. Statistical analyzes were performed using two way ANOVA repeated measures and Pearson correlation. It was observed effect of interaction between factors, being evidenced increased activity of UT, SA_7th and OE for the control group and decreased activity of SA_5th, SA_7th and EO for dyskinesis group during execution of push-up on unstable surface. In both groups positive correlations (r > 0.47) were observed between EMG activity of SA and EO. In the exercises tested, there seems to be an anatomical and functional relationship between the SA and EO muscles. The use of the unstable surface promotes increased neuromuscular demand, but the neuromuscular strategies appear to differ between groups.

  14. Relationships between core strength, hip external rotator muscle strength, and star excursion balance test performance in female lacrosse players.

    Science.gov (United States)

    Gordon, Angela T; Ambegaonkar, Jatin P; Caswell, Shane V

    2013-04-01

    PURPOSEBACKGROUND: Female athletes have high rates of lower extremity (LE) injuries. Core strength (CS) and hip external rotator (HER) strength have been suggested to be factors that influence LE injury risk. Better balance has also been shown to decrease LE injury risk. Still, little research has examined whether core strength and hip muscle strength can influence LE balance. Therefore the purpose of the current study was to examine the relationships between core strength, hip ER strength and lower extremity balance as measured by the Star Excursion Balance Test (SEBT). CS was examined via the bent knee lowering test (BKLT) (grades 1-5). Hip external rotator (HER) strength was measured singularly (HERL and HERR and combined (HERCOM) assessed via hand held dynamometry (reported in Newtons), and balance assessed via the SEBT expressed as % leg length, bilaterally in the postero-medial, postero-lateral, anterior directions and as a combined score (SEBTCOM). All outcomes were assessed in 45 female lacrosse players (16.0 ± 5.9 yrs, 65.1 ± 2.4 cm, 57.3 ± 7.4 kgs, experience=5.9 ± 2.9 yrs). Pearson product-moment correlations examined relationships between the BKLT, HER and SEBT. Linear regression analyses examined possible influences of CS and HER on balance (p ≤ .05). SEBTCOM was not correlated with BKLT [r(45)=-.20, p=.18] or HERCOM [r(45)=.20, p=.18]. There was no correlation between HER strength and CS (BKLT) [r(45)=.20, p=.20]. Overall scores on the BKLT were not correlated with any of the three balance SEBT scores. HERL [r(45)=.36, p=.02] and HERR [r(45)=.30, p=.05] were moderately positively correlated with left posteromedial SEBT direction. HERCOM and BKLT did not predict overall SEBTCOM balance scores (r(2)=.068, p=.23). BKLT scores and combined HER strength did not correlate with LE balance, as measured by the SEBT, in female lacrosse players. However, HER strength of both the left and right LE's (singularly) was moderately correlated with scores on one

  15. The role of intercostal nerve preservation in acute pain control after thoracotomy*

    Science.gov (United States)

    Marchetti-Filho, Marco Aurélio; Leão, Luiz Eduardo Villaça; Costa-Junior, Altair da Silva

    2014-01-01

    OBJECTIVE: To evaluate whether the acute pain experienced during in-hospital recovery from thoracotomy can be effectively reduced by the use of intraoperative measures (dissection of the neurovascular bundle prior to the positioning of the Finochietto retractor and preservation of the intercostal nerve during closure). METHODS: We selected 40 patients who were candidates for elective thoracotomy in the Thoracic Surgery Department of the Federal University of São Paulo/Paulista School of Medicine, in the city of São Paulo, Brazil. The patients were randomized into two groups: conventional thoracotomy (CT, n = 20) and neurovascular bundle preservation (NBP, n = 20). All of the patients underwent thoracic epidural anesthesia and muscle-sparing thoracotomy. Pain intensity was assessed with a visual analog scale on postoperative days 1, 3, and 5, as well as by monitoring patient requests for/consumption of analgesics. RESULTS: On postoperative day 5, the self-reported pain intensity was significantly lower in the NBP group than in the CT group (visual analog scale score, 1.50 vs. 3.29; p = 0.04). No significant differences were found between the groups regarding the number of requests for/consumption of analgesics. CONCLUSIONS: In patients undergoing thoracotomy, protecting the neurovascular bundle prior to positioning the retractor and preserving the intercostal nerve during closure can minimize pain during in-hospital recovery. PMID:24831401

  16. The role of intercostal nerve preservation in acute pain control after thoracotomy

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Marchetti-Filho

    2014-04-01

    Full Text Available OBJECTIVE: To evaluate whether the acute pain experienced during in-hospital recovery from thoracotomy can be effectively reduced by the use of intraoperative measures (dissection of the neurovascular bundle prior to the positioning of the Finochietto retractor and preservation of the intercostal nerve during closure. METHODS: We selected 40 patients who were candidates for elective thoracotomy in the Thoracic Surgery Department of the Federal University of São Paulo/Paulista School of Medicine, in the city of São Paulo, Brazil. The patients were randomized into two groups: conventional thoracotomy (CT, n = 20 and neurovascular bundle preservation (NBP, n = 20. All of the patients underwent thoracic epidural anesthesia and muscle-sparing thoracotomy. Pain intensity was assessed with a visual analog scale on postoperative days 1, 3, and 5, as well as by monitoring patient requests for/consumption of analgesics. RESULTS: On postoperative day 5, the self-reported pain intensity was significantly lower in the NBP group than in the CT group (visual analog scale score, 1.50 vs. 3.29; p = 0.04. No significant differences were found between the groups regarding the number of requests for/consumption of analgesics. CONCLUSIONS: In patients undergoing thoracotomy, protecting the neurovascular bundle prior to positioning the retractor and preserving the intercostal nerve during closure can minimize pain during in-hospital recovery.

  17. Blood flow index using near-infrared spectroscopy and indocyanine green as a minimally invasive tool to assess respiratory muscle blood flow in humans

    DEFF Research Database (Denmark)

    Guenette, Jordan A; Henderson, William R; Dominelli, Paolo B

    2011-01-01

    humans. BFI was calculated as the change in maximal [ICG] divided by the rise time of the NIRS-derived ICG curve. Intercostal and sternocleidomastoid muscle BFI were correlated with simultaneously measured work of breathing and electromyography (EMG) data from the same muscles. BFI showed strong...... relationships with the work of breathing and EMG for both respiratory muscles. The coefficients of determination (R(2)) comparing BFI vs. the work of breathing for the intercostal and sternocleidomastoid muscles were 0.887 (P ... for the intercostal and sternocleidomastoid muscles were 0.879 (P

  18. Respiratory muscle activity during asphyxic apnoea and opisthotonus in the rabbit.

    Science.gov (United States)

    Davis, P J; Macefield, G; Nail, B S

    1986-09-01

    The behaviour of submandibular, cervical, thoracic and abdominal respiratory muscles was examined in the pentobarbitone-urethane-anaesthetized rabbit during progressive asphyxia induced by rebreathing. During asphyxic hyperpnoea the external intercostal, interchondral and scalene inspiratory activities augmented until succeeded by the apnoeic period, in which all were inhibited with the diaphragm. Likewise, the genioglossus, sternohyoid and thyrohyoid muscles exhibited inspiratory augmentation during asphyxic hyperpnoea until the onset of apnoeic inhibition. However, late in the apnoea these muscles, together with the sternothyroid, sternomastoid and digastric muscles, generated an augmenting tonic discharge associated with an intense abdominal constriction, and with the extension of the limbs characteristic of opisthotonus. This intense tonic activity, which was never expressed by the diaphragm and thoracic inspiratory muscles, was immediately interrupted or terminated by the subsequent inspiratory efforts of gasping respiration, during which the abdominal muscles were inhibited but all the submandibular, cervical and thoracic inspiratory muscles greatly participated. The mylohyoid muscles presented augmenting expiratory activity during asphyxic hyperpnoea which declined during the apnoea. These muscles, however, did not exhibit the intense tonic discharge expressed by the expiratory abdominal and inspiratory submandibular and cervical muscles in late apnoea and were not active in gasping.

  19. Magnetic stimulation of biceps after intercostal cross-innervation for brachial plexus palsy. A study of motor evoked potentials in 25 patients.

    Science.gov (United States)

    Kawai, H; Murase, T; Shibuya, R; Kawabata, H; Yonenobu, K; Masatomi, T; Ono, K

    1994-07-01

    We studied the motor evoked potentials (MEP) in the biceps of 25 patients with traumatic brachial plexus palsy from root avulsion after cross-innervation by intercostal nerves. We used transcranial, transcervical and transthoracic magnetic stimulation at 8 to 235 months (mean 51) after transfer of intercostal nerves to the musculocutaneous nerve. Biceps strength recovered to MRC grade 2 in eight patients, grade 3 in three and grade 4 in 14. The mean latency of the MEP in the normal biceps on transcranial stimulation was 12.5 +/- 1.3 ms and on transcervical stimulation 6.3 +/- 1.1 ms. After intercostal reinnervation the mean latency on transcranial stimulation was 21.7 +/- 4.5 ms and on transthoracic stimulation 11.6 +/- 3.8 ms. The latency of the biceps MEP after reinnervation by intercostal nerves on transcranial and transthoracic magnetic stimulation correlated well with the duration of follow-up and the latency of the MEP on transthoracic magnetic stimulation correlated significantly with muscle power.

  20. Risks and benefits of the intercostal approach for percutaneous nephrolithotripsy

    Directory of Open Access Journals (Sweden)

    Erich K. Lang

    2009-06-01

    Full Text Available OBJECTIVE:The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIAL AND METHODS: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th; 515 had a subcostal access tract. RESULTS: Major complications included one pneumothorax (1.0%, one arterio-calyceal fistula (1.0% and three arteriovenous fistulae (2.7% for intercostal upper pole access; two pneumothoraces (1.7%, one arteriovenous fistula (1.0%, one pseudoaneurysm (1.0%, one ruptured uretero-pelvic junction (1.0%, 4 perforated ureters (3.4% for subcostal upper pole access; one hemothorax (1.6%, one colo-calyceal fistula (1.6%, one AV fistula (1.6%, and two perforated ureters (3.2% with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2% of the time compared with 2.4% with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. CONCLUSION: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion.

  1. Breast Reinnervation: DIEP Neurotization Using the Third Anterior Intercostal Nerve

    Directory of Open Access Journals (Sweden)

    Aldona J. Spiegel, MD

    2013-11-01

    Conclusion: DIEP flap neurotization using the third anterior intercostal nerve is an effective technique to provide a significant increase in sensory recovery for breast reconstruction patients, while adding minimal surgical time. Additionally, the use of a nerve conduit produces increased sensory recovery when compared direct coaptation.

  2. The Anterior Intercostal Artery Flap: Anatomical and Radiologic Study.

    Science.gov (United States)

    Carrasco-López, Cristian; Julian Ibañez, Juan Francisco; Vilà, Jordi; Rodriguez-Baeza, Alfonso; Carrera-Burgaya, Anna; Reina-de-la-Torre, Francisco; Damaso-Margelí-Cervera, Victor; Fernandez-Llamazares-Rodriguez, Jaime; Higueras-Suñe, Carmen

    2017-03-01

    Reconstruction of the anterior thorax is complex because of the presence of aesthetically important areas such as the breast, sternum, and upper abdomen. For this reason, a wide variety of pedicled perforator flaps have been described. The anterior intercostal perforator flap is one of these perforators flaps and is valuable for use in breast reconstruction surgery. The location and characteristics of the anterior intercostal perforators were evaluated both anatomically and radiologically. The anatomical study was conducted in a set of 14 hemitrunk cadavers, and the radiologic study was performed retrospectively from a randomly selected set of images obtained from 30 female patients who underwent thoracic computed tomographic angiography for other health problems at the authors' institution during the year 2015. The findings were then compared. A total of 60 perforators in 14 hemitrunks were identified and mapped. Perforators were found in all hemithoraces. The lateral third donor location was the most reliable zone, containing larger and more numerous perforators compared with the other donor regions. According to the radiologic study, a total of 164 perforators in 30 computed tomographic angiographs were identified and mapped. Perforators were found in all thoraxes. The authors found that the intercostal perforator flap has a consistent vascularization. Computed tomographic angiography is less reliable than dissection in identifying the number of perforators. The authors' findings suggest that intercostal perforator flaps are reliable and consistent flaps for reconstruction of the upper trunk.

  3. Extended locoregional use of intercostal artery perforator propeller flaps.

    Science.gov (United States)

    Baghaki, Semih; Diyarbakirlioglu, Murat; Sahin, Ugur; Kucuksucu, Muge Anil; Turna, Akif; Baca, Bilgi; Aydın, Yağmur

    2017-05-01

    Besides conventional flaps, intercostal artery perforator flaps have been reported to cover trunk defects. In this report the use of anterior intercostal artery perforator (AICAP) flap, lateral intercostal artery perforator (LICAP) flap and dorsal intercostal artery perforator (DICAP) flap for thoracic, abdominal, cervical, lumbar and sacral defects with larger dimensions and extended indications beyond the reported literature were reevaluated. Thirty-nine patients underwent surgery between August 2012 and August 2014. The age of the patients ranged between 16 and 79 with a mean of 49 years. The distribution of defects were as follows; 12 thoracic, 8 parascapular, 3 cervical, 8 abdominal, 4 sacral and 4 lumbar. AICAP, LICAP and DICAP flaps were used for reconstruction. Fifty-two ICAP flaps were performed on 39 patients. Flap dimensions ranged between 6 × 9 cm and 14 × 35 cm. Twenty-six patients had single flap coverage and 13 patients had double flap coverage. Forty-six flaps have been transferred as propeller flaps and 6 flaps have been transferred as perforator plus flap. Forty flaps (75%) went through transient venous congestion. In one DICAP flap, 30% of flap was lost. No infection, hematoma or seroma were observed in any patient. Follow-up period ranged between 3 and 32 months with a mean of 9 months. The ICAP flaps provide reliable and versatile options in reconstructive surgery and can be used for challenging defects in trunk. © 2016 Wiley Periodicals, Inc.

  4. Diaphragmatic and intercostal electromyographic activity during neostigmine, sugammadex and neostigmine-sugammadex-enhanced recovery after neuromuscular blockade: A randomised controlled volunteer study.

    Science.gov (United States)

    Cammu, Guy; Schepens, Tom; De Neve, Nikolaas; Wildemeersch, Davina; Foubert, Luc; Jorens, Philippe G

    2017-01-01

    Electromyographic activity of the diaphragm (EMGdi) during weaning from mechanical ventilation is increased after sugammadex compared with neostigmine. To determine the effect of neostigmine on EMGdi and surface EMG (sEMG) of the intercostal muscles during antagonism of rocuronium block with neostigmine, sugammadex and neostigmine followed by sugammadex. Randomised, controlled, double-blind study. Intensive care research unit. Eighteen male volunteers. A transoesophageal EMGdi recorder was inserted into three groups of six anaesthetised study participants, and sEMG was recorded on their intercostal muscles. To reverse rocuronium, volunteers received 50 μg kg neostigmine, 2 mg kg sugammadex or 50 μg kg neostigmine, followed 3 min later by 2 mg kg sugammadex. We examined the EMGdi and sEMG at the intercostal muscles during recovery enhanced by neostigmine or sugammadex or neostigmine-sugammadex as primary outcomes. Secondary objectives were the tidal volume, PaO2 recorded between the onset of spontaneous breathing and extubation of the trachea and SpO2 during and after anaesthesia. During weaning, median peak EMGdi was 0.76 (95% confidence interval: 1.20 to 1.80) μV in the neostigmine group, 1.00 (1.23 to 1.82) μV in the sugammadex group and 0.70 (0.91 to 1.21) μV in the neostigmine-sugammadex group (P sugammadex vs. neostigmine and neostigmine-sugammadex). The median peak intercostal sEMG for the neostigmine group was 0.39 (0.65 to 0.93) μV vs. 0.77 (1.15 to 1.51) μV in the sugammadex group and 0.82 (1.28 to 2.38) μV in the neostigmine-sugammadex group (P sugammadex and after neostigmine-sugammadex vs. neostigmine). EMGdi and sEMG on the intercostal muscles were increased after sugammadex alone compared with neostigmine. Adding sugammadex after neostigmine reduced the EMGdi compared with sugammadex alone. Unlike the diaphragm, intercostal EMG was preserved with neostigmine followed by sugammadex. EudraCT: 2015-001278-16; ClinicalTrials.gov: NCT

  5. Satisfactory elbow flexion in complete (preganglionic) brachial plexus injuries: produced by suture of third and fourth intercostal nerves to musculocutaneous nerve.

    Science.gov (United States)

    Minami, M; Ishii, S

    1987-11-01

    The third and fourth intercostal nerves were sutured to the musculocutaneous nerve to restore flexion of the elbow joint in complete (preganglionic) brachial plexus injuries. Seventeen patients were followed on the average for 5 years and 7 months after surgery. The results were evaluated by means of manual muscle tests and electrical diagnostic tests. Good (grade IV), or better, flexion of the elbow joint occurred in 12 patients over 3 years after the operation.

  6. Spinal cord bypass surgery with intercostal and spinal accessory nerves: an anatomical feasibility study in human cadavers.

    Science.gov (United States)

    Haque, Raqeeb M; Malone, Hani R; Bauknight, Martin W; Kellner, Michael A; Ogden, Alfred T; Martin, John H; Tanji, Kurenai; Winfree, Christopher J

    2012-02-01

    Despite extensive study, no meaningful progress has been made in encouraging healing and recovery across the site of spinal cord injury (SCI) in humans. Spinal cord bypass surgery is an unconventional strategy in which intact peripheral nerves rostral to the level of injury are transferred into the spinal cord below the injury. This report details the feasibility of using spinal accessory nerves to bypass cervical SCI and intercostal nerves to bypass thoracolumbar SCI in human cadavers. Twenty-three human cadavers underwent cervical and/or lumbar laminectomy and dural opening to expose the cervical cord and/or conus medullaris. Spinal accessory nerves were harvested from the Erb point to the origin of the nerve's first major branch into the trapezius. Intercostal nerves from the T6-12 levels were dissected from the lateral border of paraspinal muscles to the posterior axillary line. The distal ends of dissected nerves were then transferred medially and sequentially inserted 4 mm deep into the ipsilateral cervical cord (spinal accessory nerve) or conus medullaris (intercostals). The length of each transferred nerve was measured, and representative distal and proximal cross-sections were preserved for axonal counting. Spinal accessory nerves were consistently of sufficient length to be transferred to caudal cervical spinal cord levels (C4-8). Similarly, intercostal nerves (from T-7 to T-12) were of sufficient length to be transferred in a tension-free manner to the conus medullaris. Spinal accessory data revealed an average harvested nerve length of 15.85 cm with the average length needed to reach C4-8 of 4.7, 5.9, 6.5, 7.1, and 7.8 cm. The average length of available intercostal nerve from each thoracic level compared with the average length required to reach the conus medullaris in a tension-free manner was determined to be as follows (available, required in cm): T-7 (18.0, 14.5), T-8 (18.7, 11.7), T-9 (18.8, 9.0), T-10 (19.6, 7.0), T-11 (18.8, 4.6), and T-12 (15

  7. Effects of augmented trunk stabilization with external compression support on shoulder and scapular muscle activity and maximum strength during isometric shoulder abduction.

    Science.gov (United States)

    Jang, Hyun-jeong; Kim, Suhn-yeop; Oh, Duck-won

    2015-04-01

    The aim of the present study was to investigate the effects of augmented trunk stabilization with external compression support (ECS) on the electromyography (EMG) activity of shoulder and scapular muscles and shoulder abductor strength during isometric shoulder abduction. Twenty-six women volunteered for the study. Surface EMG was used to monitor the activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and middle deltoid (MD), and shoulder abductor strength was measured using a dynamometer during three experimental conditions: (1) no external support (condition-1), (2) pelvic support (condition-2), and (3) pelvic and thoracic supports (condition-3) in an active therapeutic movement device. EMG activities were significantly lower for UT and higher for MD during condition 3 than during condition 1 (p Shoulder abductor strength was significantly higher during condition 3 than during condition 1 (p muscle effort of the UT during isometric shoulder abduction and increasing shoulder abductor strength. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Continuous wound infiltration with 0.2% ropivacaine versus a single intercostal nerve block with 0.75% ropivacaine for postoperative pain management after reconstructive surgery for microtia.

    Science.gov (United States)

    Niiyama, Yukitoshi; Yotsuyanagi, Takatoshi; Yamakage, Michiaki

    2016-10-01

    In reconstructive surgery for microtia during childhood, costal cartilage is used for pinna formation. Postoperative pain in the region from which the costal cartilage is taken is severe, which delays recovery after surgery. We evaluated prospectively whether continuous wound infiltration (CWI) of a local anesthetic (LA) reduces pain and enables rapid recovery compared with a single intercostal nerve block (ICNB). Forty-eight patients were randomly divided into two groups. In Group I, a single ICNB with 10 ml of 0.75% ropivacaine was performed at the end of surgery. In Group C, a catheter was inserted into the space between the abdominal external oblique muscle and the rectus abdominis muscle. Then, a 0.4-ml/kg bolus of 0.2% ropivacaine was administered, followed by continuous infusion at 2-4 ml/h for 48 h. Postoperative pain intensity evaluated using the Face Scale, dose of supplemental analgesics, and time until mobilization were evaluated. In Group C, the plasma concentrations of ropivacaine were analyzed. The pain intensity at rest was significantly lower in Group C than in Group I, but the values during coughing were comparable. The number of patients receiving a supplemental analgesic and the median number of doses were significantly larger in Group I than in Group C (P = 0.029, P = 0.0007, respectively). The plasma concentrations of ropivacaine were within the safe range over 48 h. The times until mobilization were comparable. CWI of 0.2% ropivacaine is a better and safe technique for postoperative pain management after costal cartilage graft harvest in children. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Reconstruction with latissimus dorsi, external abdominal oblique and cranial sartorius muscle flaps for a large defect of abdominal wall in a dog after surgical removal of infiltrative lipoma

    OpenAIRE

    2016-01-01

    This animal was presented with a large-sized infiltrative lipoma in the abdominal wall that had been noted for 4 years. This lipoma was confirmed by histological examination from a previous biopsy, and the infiltrative features were identified by a computerized tomography scan. The surgical removal created a large-sized abdominal defect that was closed by a combination of latissimus dorsi and external abdominal oblique muscle flaps in a pedicle pattern. A small dehiscence at the most distal e...

  10. [New formation of elastic fiber material in aortic defects covered with muscle flaps].

    Science.gov (United States)

    Klima, G; Papp, C

    1985-01-01

    The examination of the coverage of vascular defects with intercostal muscles showed during an observation period of 7 weeks the development of cartilage tissue with thick elastic fiber nettings running between the chondroma.

  11. Spinal cord injury from fluoroscopically guided intercostal blocks with phenol.

    Science.gov (United States)

    Kissoon, Narayan R; Graff-Radford, Jonathan; Watson, James C; Laughin, Ruple S

    2014-01-01

    Image guided intercostal blocks are commonly performed and considered relatively safe. Chemical denervation is commonly used in clinical practice for treatment of chronic non-cancer associated pain. To report a case of spinal cord injury resulting from fluoroscopically guided intercostal blocks with phenol. Case report. Inpatient hospital service. RESULTS/CASE REPORTS: A 53 year-old women was transferred from her local facility for acute onset of lower extremity paresis beginning shortly after right intercostal nerve injections of 2 mL of preservative-free phenol at the T7, 8, 9 levels. She had previous intercostal blocks for chronic right-sided mid thoracic/abdominal pain every 3 months for at least one year without sequelae. Within 20 minutes of the injection, she developed a sensation of right leg weakness and heaviness. Over several hours she developed worsening right leg weakness, and then left leg weakness, followed by urinary retention. Admission examination revealed severe right greater than left leg weakness, right lower extremity hyperesthesia to T10, absent lower extremity reflexes, and bilateral extensor plantar responses. Magnetic resonance imaging (MRI) of the entire spine demonstrated extensive T2/DWI hyperintensity in the central spinal cord from T1 to L1 with mild cord enlargement and enhancement at T7-9 (sites of injection). Extensive serum and cerebrospinal fluid (CSF) evaluation did not show any evidence of an infectious, inflammatory, or metabolic cause to her myelopathy. Repeat MRI of the entire spine demonstrated near complete resolution of the T2 signal abnormality. One month after presentation, despite radiographic improvement, the patient showed some clinical improvement, but remained walker dependent and with neurogenic bowel and bladder. This report describes a single case report. This case offers several lessons for a pain specialist including 1) the potential for a neurologic catastrophe (spinal cord injury) from aqueous neurolytic

  12. Effect of procainamide on transmembrane action potentials in guinea-pig papillary muscles as affected by external potassium concentration.

    Science.gov (United States)

    Sada, H; Kojima, M; Ban, T

    1979-11-01

    Effects of procainamide (PA), 0.18, 0.37 and 0.74 mmol/l, on the transmembrane potential were studied in isolated guinea-pig papillary muscles, superfused with modified Tyrode's solution (external K concentration, [K]0 = 5.4 mmol/l) at the basic driving rate of 1 Hz. PA, at 0.37 mmol/l, significantly reduced the maximum rate of rise of action potential (Vmax) with no change in the resting potential. When 2.7 mmol/l [K]0 of the superfusate was exchanged for 15 mmol/l [K]0 solution a decrease in Vmax induced by 0.37 mmol/l PA became more prominent with decrease in resting potential. The reduction of Vmax at steady state was less at lower driving rates (0.25 and 0.5 Hz) and more at higher driving rates (2-5 Hz) than at 1 Hz in 2.7, 5.4 and 10.0 mmol/l [K]0 solution. Such changes were enhanced concentration-dependently by PA at 5.4 mmol/l [K]0. Also, the changes became more significant with an increase in [K]0 from 2.7 mmol/l to 5.4 mmol/l and then to 10.0 mmol/l. The recovery process of Vmax proceeded with two components. The time course of the slow component seen in the Vmax of the first response after interruption of basic driving stimulation at 1 Hz, followed an approximate monoexponential function. The time constants were 6.3, 4.4 and 5.8 s in the presence of 0.18, 0.37 and 0.74 mmol/l PA at 5.4 mmol/l [K]0 and 3.4 and 3.7 s both in the presence of 0.37 mmol/l PA at 2.7 and 10.0 mmol/l [K]0. Vmax values after 30 or 60 s interruption of stimulation were 80-92% of the predrug Vmax value at 1 Hz. The time constants of the first component, estimated by the peeling-off methods at the driving rate of 0.1 Hz, were 11, 31 and 5-22 ms in the presence of 0.37 mmol/l at 5.4, 10.0 and 2.7 mmol/l [K]0 and did not differ significantly from the time constants in control preparations. The results were found to be consistent, to a certain extent, with the model proposed by Hondeghem and Katzung (1977).

  13. Video-assisted thoracoscopic resection of intercostal neurofibroma.

    Science.gov (United States)

    Lyons, M K; Gharagozloo, F

    1995-06-01

    BACKGROUND Video-assisted thoracoscopy (VAT) is being increasingly utilized by thoracic surgeons as an alternative to thoracotomy for several thoracic disorders. Neuroendoscopy is an exciting addition to the neurosurgical armamentarium. These procedures are attractive alternatives in the era of minimally invasive surgery and cost containment, while providing the highest quality medical care to patients. METHODS We report the application of this technology in a patient presenting with intractable thoracic radicular pain secondary to an intercostal neurofibroma. Complete excision of the intercostal neurofibroma was performed utilizing VAT. RESULTS The patient reported good relief of her preoperative thoracic radicular pain. She was ready for discharge from the hospital within 72 hours of surgery. CONCLUSIONS With the advent of improved instrumentation, video-assisted thoracoscopy offers a safe alternative to thoracotomy and the potential benefits of less postoperative discomfort and shorter hospital stays. The potential neurosurgical applications of VAT should not be overlooked.

  14. Intrinsic Transient Tracheal Occlusion Training and Myogenic Remodeling of Rodent Parasternal Intercostal Fibers

    Science.gov (United States)

    Smith, Barbara K.; Mathur, Sunita; Ye, Fan; Martin, A. Daniel; Truelson, Sara Attia; Vandenborne, Krista; Davenport, Paul W.

    2014-01-01

    It is recognized that diaphragm muscle plasticity occurs with mechanical overloads, yet less is known regarding synergistic parasternal intercostal muscle fiber remodeling. We conducted overload training with intrinsic transient tracheal occlusion (ITTO) exercises in conscious animals. We hypothesized ITTO would yield significant fiber hypertrophy and myogenic activation that would parallel diaphragm fiber remodeling. Sprague-Dawley rats underwent placement of a tracheal cuff and were randomly assigned to receive daily ten-minute sessions of conscious ITTO or observation (SHAM) over two weeks. After training, fiber morphology, myosin heavy chain isoform composition, cross-sectional area, proportion of Pax7-positive nuclei, and presence of embryonic myosin (eMHC) were quantified. Type IIx/b fibers were 20% larger after ITTO training than with SHAM training (ITTO: 4431±676 μm2, SHAM: 3689±400 μm2, p<0.05), and type I fibers were more prevalent after ITTO (p<0.01). Expression of Pax7 was increased in ITTO parasternals and diaphragm (p<0.05). In contrast, the proportion of eMHC-positive fibers was increased only in ITTO parasternals (1.2 (3.4-0.6)%, SHAM: 0 (0.6-0%, p<0.05). Although diaphragm and parasternal type II fibers hypertrophy to a similar degree, myogenic remodeling appears to differ between the two muscles. PMID:25509059

  15. Intercostal nerve blockade for evaluation of local anaesthetic agents.

    Science.gov (United States)

    Bridenbaugh, P O

    1975-02-01

    Bilateral intercostal nerve block provides the opportunity to subject as many as 16 separate peripheral nerves in a single subject to known or unknown local anaesthetic agents in a variety of concentrations, volumes, and additives. It permits the observation of local (e.g., neuritis), clinical (e.g., onset and duration), and systemic (e.g., toxicity and blood concentration) effects of these variables. In double-blind studies, bilateral intercostal nerve block allows the use of each side of the trunk for comparison of two experimental drugs, a new drug against a standard, or two new drugs. Subtle differences in clinical properties as well as simultaneous blood concentrations may be detected in these studies. The advantages of this technique in evaluating local anaesthetic agents are primarily the use of a single subject as his own control while studying may separate peripheral nerves. This aids appreciably in limiting the variable of age, temperature, and perfusion, as well as techniques of administration and evaluation. The constancy of the anatomy of the intercostal nerve provides a highly reliable and reproducible block technique.

  16. Intercostal Nerve Block and Neurolysis for Intractable Cancer Pain.

    Science.gov (United States)

    Matchett, Gerald

    2016-06-01

    Management of intractable cancer-associated chest wall pain is difficult once patients have reached dose-limiting side effects of opioids and coanalgesic medications. This case series describes 11 patients with intractable cancer-associated chest wall pain who were treated with a diagnostic intercostal nerve block. Six patients subsequently received chemical neurolysis with phenol using the same approach. No serious adverse events were observed. Radiopaque contrast dye spread into the paravertebral space in all 11 patients, and in 1 patient contrast dye spread into the epidural space. Seven of 11 patients experienced pain relief from the diagnostic blockade. Four of six patients experienced pain relief from the neurolytic blockade. The principal reportable finding from this case series is the observation that contrast dye spread liberally from the intercostal space into other anatomic spaces, even though very small volumes of injectate (less than 5 mL) were used. Definitive evidence of safety and efficacy of intercostal nerve block and neurolysis for cancer pain will require a prospective randomized clinical trial.

  17. Hybrid Thoracic Endovascular Aortic Repair for Intercostal Patch Aneurysm after Thoracoabdominal Aortic Replacement.

    Science.gov (United States)

    Kitahara, Hiroto; Yoshitake, Akihiro; Hachiya, Takashi; Okamoto, Kazuma; Hirano, Akinori; Kasai, Mio; Akamatsu, Yuta; Oka, Hidetoshi; Shimizu, Hideyuki

    2015-01-01

    We report a case of hybrid thoracic endovascular aortic repair for intercostal patch aneurysm after thoracoabdominal aortic replacement. Eighteen years ago, a 63-year-old woman with Marfan syndrome had undergone thoracoabdominal aortic replacement with reimplantation of the intercostal artery in an island fashion. Follow-up computed tomography (CT) revealed a remaining intercostal patch aneurysm of diameter 60 mm 17 years after the last operation. Hybrid thoracic endovascular aortic repair for exclusion of this intercostal patch aneurysm was successfully performed, with visceral artery bypasses. Postoperative CT showed no anastomotic stenosis or endoleak.

  18. Utility of intercostal nerve conventional thermal radiofrequency ablations in the injured worker after blunt trauma.

    Science.gov (United States)

    Engel, Andrew J

    2012-01-01

    Intercostal nerve blocks offer short-term therapeutic relief and serve as a diagnostic test for intercostal neuralgia. This original case report demonstrates the efficacy of radiofrequency ablations for long-term pain relief of intercostal neuralgia. To date, there have been no studies that demonstrate the efficacy of thermal conventional intercostal nerve radiofrequency ablations for intercostal neuralgia. Describe the use of conventional thermal radiofrequency ablations of the intercostal nerves to treat blunt chest wall trauma. Case report. Clinical practice. Six patients suffering from work-related injuries to the chest wall whose treatment focused on conventional thermal radiofrequency ablations of the intercostal nerves. Four of the 6 patients were pain free by their final visit. The remaining 2 patients experienced pain relief until one began wearing a brace after an L5-S1 fusion; the other required repeat treatment after 5.5 months. Case series. There was limited follow-up as patients were either discharged after receiving potentially curative care or were lost to follow-up. Following conventional thermal radiofrequency ablations of the intercostal nerves, 5 of the 6 patients experienced either long-term pain relief or required no additional care. The treatment has potential efficacy for injuries, including rib fractures or intercostal neuralgia, stemming from blunt trauma to the chest wall. In addition, there may be a potential for this treatment to help patients suffering from postthoracotomy pain.

  19. Giant congenital intercostal arteriovenous malformation with extensive involvement of chest wall and ribs: surgical experience.

    Science.gov (United States)

    Parashi, Hrishikesh Sukhadeo; Bhosle, Krishnarao Narayan; Thakare, Nitin Dashrath; Sharma, Ajay; Potwar, Sushrut Suhas

    2013-06-01

    Intercostal arteriovenous malformations (AVMs) are rare lesions. Review of literature shows that most reported cases are secondary to trauma or iatrogenic in origin. Congenital intercostal AVMs are extremely rare. We believe that only 1 case report of congenital intercostal arteriovenous malformation has been reported previously in the literature. We present an exceedingly rare case of giant congenital intercostal AVM in a young patient diagnosed on contrast-enhanced computed tomography of the thorax and treated by surgical resection of the involved chest wall and ribs with reconstruction of the surgical defect. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Changes in Energy Cost and Total External Work of Muscles in Elite Race Walkers Walking at Different Speeds

    Directory of Open Access Journals (Sweden)

    Chwała Wiesław

    2014-12-01

    Full Text Available The aim of the study was to assess energy cost and total external work (total energy depending on the speed of race walking. Another objective was to determine the contribution of external work to total energy cost of walking at technical, threshold and racing speed in elite competitive race walkers.

  1. Early patency rate and fate of reattached intercostal arteries after repair of thoracoabdominal aortic aneurysms.

    Science.gov (United States)

    Omura, Atsushi; Yamanaka, Katsuhiro; Miyahara, Shunsuke; Sakamoto, Toshihito; Inoue, Takeshi; Okada, Kenji; Okita, Yutaka

    2014-06-01

    The present study analyzes the early patency of intercostal artery reconstruction, using graft interposition and aortic patch anastomosis, and determines the fate of reattached intercostal arteries after repair of thoracoabdominal aortic aneurysms. We selected 115 patients (mean age, 63 ± 15 years; range, 19-83 years; male, n = 83) treated by thoracoabdominal aortic aneurysm repair with 1 or more reconstructed intercostal arteries at the Kobe University Graduate School of Medicine between October 1999 and December 2012. The intercostal arteries were reconstructed using graft interposition (n = 66), aortic patch anastomosis (n = 42), or both (n = 7). The hospital mortality rate was 7.8% (n = 9). Eleven patients (9.6%) developed spinal cord ischemic injury (permanent, n = 6, transient, n = 5). The average number of reconstructed intercostal arteries per patient was 3.0 ± 1.5 (1-7), and 345 intercostal arteries were reattached. The overall patency rate was 74.2% (256/345) and that of aortic patch anastomosis was significantly better than that of graft interposition (90.8% [109/120] vs 65.3% [147/225], P intercostal arteries became dilated in 2 patients. Aortic patch anastomosis might offer better patency rates and prevent spinal cord ischemic injury compared with graft interposition. Although aneurysmal changes in intercostal artery reconstructions are rare, large blocks of aortic wall reconstruction should be closely monitored. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  2. Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors.

    Science.gov (United States)

    Ichida, Hirofumi; Ishizawa, Takeaki; Tanaka, Masayuki; Terasawa, Muga; Watanabe, Genki; Takeda, Yoshinori; Matsuki, Ryota; Matsumura, Masaru; Hata, Taigo; Mise, Yoshinori; Inoue, Yosuke; Takahashi, Yu; Saiura, Akio

    2017-03-01

    The aim of this study was to demonstrate the detailed surgical techniques of laparoscopic hepatectomy using intercostal transthoracic trocars for subcapsular tumors located in segment VII or VIII. Intercostal transthoracic trocars were used in patients undergoing laparoscopic hepatectomy for tumors located in segment VII or VIII. Following establishment of pneumoperitoneum and placement of abdominal trocars, balloon-tipped trocars were inserted into the abdominal cavity from the intercostal space and through the pleural space and diaphragm. Upon placement of the intercostal trocars, the lung edge was confirmed by ultrasonography and laparoscopic examination. Following minimal mobilization of the right liver, hemispherical wedge resection of segment VII or VIII was performed using the intercostal trocars as a camera port or for the forceps of the surgeon's left hand. After the hepatectomy, the holes in the diaphragm were sutured closed. Among the 79 patients who underwent laparoscopic hepatectomy, intercostal trocars were used in 14 patients for resection of tumors located in segment VII (4 nodules) or VIII (10 nodules). The median (range) operation time and amount of blood loss for hepatectomy were 225 (109-477) min and 60 (20-310) mL, respectively. No postoperative complications associated with hepatectomy or the use of intercostal trocars occurred. Use of intercostal transthoracic trocars is safe and effective not only for complicated laparoscopic hepatectomy but also for hemispherical wedge resections of subcapsular hepatic tumors located in segment VII or VIII.

  3. Hepatocellular carcinoma: prediction of blood supply from an intercostal artery with multidetector row computed tomography.

    Science.gov (United States)

    Kim, Min-Uk; Kim, Hyo-Cheol; Chung, Jin Wook; An, Sangbu; Seong, Nak Jong; Jae, Hwan Jun; Park, Jae Hyung

    2011-10-01

    To evaluate the ability of multidetector row computed tomography (CT) to detect blood supply from the intercostal artery in patients with hepatocellular carcinoma (HCC). Between January 2003 and December 2007, angiography of the intercostal artery was performed in 93 patients (76 men and 17 women, mean age 58 years) with HCC who had also undergone multidetector row CT. CT scans and digital subtraction angiograms of these patients were retrospectively reviewed by two investigators in consensus to evaluate tumor feeding vessels. Multiple logistic regression analysis was used to identify factors that predict the presence of an HCC blood supply from an intercostal artery. Tumor staining fed by an intercostal artery was noted in 65 patients (70%; 112 tumor feeding vessels) by intercostal angiography. Readers interpreted that tumor feeding vessels were evident by CT in 35 (54%) of these 65 patients with tumor staining supplied by an intercostal artery by angiography. Multiple logistic regression analysis showed that a visible tumor feeding vessel by CT (P = .003) and hepatic artery attenuation by angiography (P = .014) were significantly related to the presence of a blood supply from an intercostal artery. Visualization of a tumor feeding vessel from the intercostal artery by multidetector row CT is an important sign of parasitic supply to an HCC. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  4. The application of an external wrist extension force reduces electromyographic activity of wrist extensor muscles during gripping.

    NARCIS (Netherlands)

    Elk, N. van; Faes, M.C.; Degens, H.; Kooloos, J.G.M.; Lint, J.A. de; Hopman, M.T.E.

    2004-01-01

    STUDY DESIGN: Experimental repeated-measures study. OBJECTIVE: To investigate the effect of different extension forces applied to the palm of the hand on electromyographic (EMG) activity of the wrist extensor muscles during hand gripping. BACKGROUND: Lateral epicondylitis is usually caused by repeti

  5. Estimating internal pelvic sizes using external body measurements in the double-muscled Belgian Bleu beef breed

    NARCIS (Netherlands)

    Coopman, F.; Smet, S.; Gengler, N.; Haegeman, A.; Jacobs, K.; Poucke, van M.; Laevens, H.; Zeveren, van A.; Groen, A.F.

    2003-01-01

    In the double-muscled (DM) Belgian Blue beef (BBB) breed, caesarean section (CS) is being applied systematically as a management tool to prevent dystocia. As a matter of fact, CS is the only possible way of calving in the breed. High birth weight and a relatively small pelvic area are the main cause

  6. Robotic intercostal nerve harvest: a feasibility study in a pig model.

    Science.gov (United States)

    Miyamoto, Hideaki; Serradori, Thomas; Mikami, Yoji; Selber, Jesse; Santelmo, Nicola; Facca, Sybille; Liverneaux, Philippe

    2016-01-01

    The aim of this study was to report the feasibility of robotic intercostal nerve harvest in a pig model. A surgical robot, the da Vinci Model S system, was installed after the creation of 3 ports in the pig's left chest. The posterior edges of the fourth, fifth, and sixth intercostal nerves were isolated at the level of the anterior axillary line. The anterior edges of the nerves were transected at the rib cartilage zone. Three intercostal nerve harvesting procedures, requiring an average of 33 minutes, were successfully performed in 3 pigs without major complications. The advantages of robotic microsurgery for intercostal nerve harvest include elimination of physiological tremor, free movement of joint-equipped robotic arms, and amplification of the surgeon's hand motion by as much as 5 times. Robot-assisted neurolysis may be clinically useful for intercostal nerve harvest for brachial plexus reconstruction.

  7. Robotic repair of a large abdominal intercostal hernia: a case report and review of literature.

    Science.gov (United States)

    Wang, Stephani C; Singh, Tejinder P

    2017-06-01

    Abdominal intercostal hernia is an uncommon phenomenon, reported in few case reports and small case series. If left untreated, it can lead to strangulation and visceral ischemia. Prompt diagnosis and appropriate surgical intervention are thus critical to prevent resulting morbidity. We present a 50-year-old woman with a large abdominal intercostal hernia after an open nephrectomy. She underwent a successful robotic repair of the hernia with mesh placement. Through the presentation, we would like to raise awareness of intercostal hernia as a complication of open nephrectomy and significance of early diagnosis in avoiding potential morbidity. We also performed a review of literature especially focusing on acquired abdominal intercostal hernia secondary to prior surgery. Although intercostal hernias can be difficult to repair secondary to the size and location, adequate visualization and surgical planning are critical to successful repair.

  8. A propos d'activites musculaires locales contemporaines de la realisation phonatoire d'intentions differentes (Using Specific Speech Muscles to Realize Phonatory Intentions of the Speaker)

    Science.gov (United States)

    Wuilmart, Claude

    1970-01-01

    Study attempts to compare variations of certain acoustic parameters with those of electromyographic recordings of the digastric, orbicularis oris, and internal intercostal muscles in the case of three subjects using three different modes of expression. (DS)

  9. Safety of an intercostal approach for imaging-guided percutaneous drainage of subdiaphragmatic abscesses.

    Science.gov (United States)

    Preece, Stephen R; Nelson, Rendon C; Bashir, Mustafa R; Jaffe, Tracy A; Kim, Charles Y; Haystead, Clare M

    2014-06-01

    The objective of our study was to test the hypothesis that an intercostal approach to imaging-guided percutaneous subdiaphragmatic abscess drainage is as safe as a subcostal approach. A cohort of 258 consecutive patients with one or more subdiaphragmatic abscesses referred for imaging-guided (CT or ultrasound) percutaneous drainage was identified. Demographic characteristics and clinical outcomes were compared between patients who underwent drainage catheter placement via an intercostal approach versus those who underwent drainage catheter placement via a subcostal approach. Percutaneous drainage was performed for 441 abscesses in 258 patients in 409 separate procedures (214 via an intercostal approach, 186 by a subcostal approach, and nine by a combined approach). The total number of pleural complications was significantly higher in the intercostal group (56/214 [26.2%]) than the subcostal group (15/186 [8.1%]; p intercostal group than the subcostal group (15/214 [7.0%] vs 0/186 [0%], respectively; p intercostal vs subcostal, 3/214 [1.4%] vs 1/186 [0.5%]; p = 0.63). A few of the complications in the patients who underwent an intercostal-approach drainage were clinically significant. Four of the 15 pneumothoraces required thoracostomy tubes and eight of 38 (21.1%) pleural effusions required thoracentesis, none of which was considered infected. An intercostal approach for imaging-guided percutaneous drainage is associated with a higher risk of pleural complications; however, most of these complications are minor and should not preclude use of the intercostal approach.

  10. Finding the fifth intercostal space for chest drain insertion: guidelines and ultrasound.

    Science.gov (United States)

    Bowness, J S; Nicholls, K; Kilgour, P M; Ferris, J; Whiten, S; Parkin, I; Mooney, J; Driscoll, P

    2015-12-01

    International guidelines exist for chest drain insertion and recommend identifying the fifth intercostal space or above, around the midaxillary line. In a recent study, applying these guidelines in cadavers risked insertion in the 6th intercostal space or below in 80% of cases. However, there are limitations of cadaveric studies and this investigation uses ultrasound to determine the intercostal space identified when applying these guidelines in healthy adult volunteers. On each side of the chest wall in 31 volunteers, the position for drain insertion was identified using the European Trauma Course method, Advanced Trauma Life Support (ATLS) method, British Thoracic Society's 'safe triangle' and the 'traditional' method of palpation. Ultrasound imaging was used to determine the relationship of the skin marks with the underlying intercostal spaces. Five methods were assessed on 60 sides. In contrast to the cadaveric study, 94% of skin marks lay over a safe intercostal space. However, the range of intercostal spaces found spanned the second to the seventh space. In 44% of women, the inferior boundary of the 'safe triangle' and the ATLS guidelines located the sixth intercostal space or below. Current guidelines often identify a safe site for chest drain insertion, although the same site is not reproducibly found. In addition, women appear to be at risk of subdiaphragmatic drain insertion when the nipple is used to identify the fifth intercostal space. Real-time ultrasonography can be used to confirm the intercostal space during this procedure, although a safe guideline is still needed for circumstances in which ultrasound is not possible. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Studies on conversion of motor function in intercostal nerves crossing for complete brachial plexus injuries of root avulsion type.

    Science.gov (United States)

    Takahashi, M

    1983-11-01

    The progress of the functional conversion in cases where the 3rd and 4th intercostal nerves were crossed to the musculocutaneous nerve to regain elbow flexion after a total avulsion type of brachial plexus injury was followed up by means of the electromyogram, goniogram and spirogram in 25 patients. The joint position sense was further studied. It was found that in the early stage of reinnervation, spontaneous activity which synchronized with respiration was found in the biceps brachii muscles, but this involuntary element disappeared gradually and followed this the volitional control and endurance improved and became quite satisfactory within several years. It was observed that skin sensation played an important role in judging joint position.

  12. Human pulmonary dirofilariasis coexisting with intercostal neurilemmoma: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Chia-Ying Li

    2013-10-01

    Full Text Available Human pulmonary dirofilariasis (HPD is a rare zoonotic infection caused by Dirofilaria immitis. Dogs are the definite hosts and humans are infected occasionally via a vector, generally a mosquito. Most thoracic neurilemmoma arise in the mediastinum and fewer tumors originate peripherally from the intercostal nerves. Most patients with HPD or thoracic neurilemmoma are asymptomatic and these diseases are often discovered incidentally. We present a 53-year-old female who was found to have a pulmonary nodule and a chest wall nodule during a routine health examination. She underwent a video-assisted thoracoscopic surgery (VATS with partial lung resection and local excision of the chest wall. The pathological examination revealed a coiled, degenerating Dirofilariasis immitis worm surrounded by granulomatous inflammation with caseous necrosis and a neurilemmoma composed of S-100 protein immunoreactive but smooth muscle actin negative spindle cells. Because these diseases are self-limiting and make further treatment unnecessary, video-assisted thoracoscopic surgery (VATS is considered preferable and less invasive for definitive diagnosis and management.

  13. Ultrasound-guided paravertebral block using an intercostal approach.

    Science.gov (United States)

    Ben-Ari, Alon; Moreno, Milena; Chelly, Jacques E; Bigeleisen, Paul E

    2009-11-01

    We describe an ultrasound-guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient's paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient's catheters was infused with 0.2% ropivacaine at 10 mL/h. Using a pinprick test, the median number of dermatomes blocked after the initial bolus was 5 (interquartile range, 4-6), and 23 of 24 catheters produced a local anesthetic block. The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5-6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7-5.05). All catheters were removed within 72 h after surgery.

  14. Does breathing type influence electromyographic activity of obligatory and accessory respiratory muscles?

    Science.gov (United States)

    Gutiérrez, M F; Valenzuela, S; Miralles, R; Portus, C; Santander, H; Fuentes, A D; Celhay, I

    2014-11-01

    Craniomandibular electromyographic (EMG) studies frequently include several parameters, e.g. resting, chewing and tooth-clenching. EMG activity during these parameters has been recorded in the elevator muscles, but little is known about the respiratory muscles. The aim of this study was to compare EMG activity in obligatory and accessory respiratory muscles between subjects with different breathing types. Forty male subjects were classified according to their breathing type into two groups of 20 each: costo-diaphragmatic breathing type and upper costal breathing type. Bipolar surface electrodes were placed on the sternocleidomastoid, diaphragm, external intercostal and latissimus dorsi muscles. EMG activity was recorded during the following tasks: (i) normal quiet breathing, (ii) maximal voluntary clenching in intercuspal position, (iii) natural rate chewing until swallowing threshold, (iv) short-time chewing. Diaphragm EMG activity was significantly higher in the upper costal breathing type than in the costo-diaphragmatic breathing type in all tasks (P breathing type than in the costo-diaphragmatic breathing type in tasks 3 and 4 (P breathing types in the tasks studied (P > 0·05). The significantly higher EMG activity observed in subjects with upper costal breathing than in the costo-diaphragmatic breathing type suggests that there could be differences in motor unit recruitment strategies depending on the breathing type. This may be an expression of the adaptive capability of muscle chains in subjects who clinically have a different thoraco-abdominal expansion during inspiration at rest.

  15. [Effectiveness of intercostal nerve block with ropivacaine in analgesia of patients undergoing emergency open cholecystectomy under general anesthesia].

    Science.gov (United States)

    Vizcarra-Román, M A; Bahena-Aponte, J A; Cruz-Jarquín, A; Vázquez-García, Ja C; Cárdenas-Lailson, L E

    2012-01-01

    Postoperative pain after open cholecystectomy is associated with reduced respiratory function, longer recovery period before deambulation and oral food intake, and prolonged hospital stay. Intercostal nerve block provides satisfactory analgesia and ropivacaine is the most widely used local anesthetic agent in intercostal nerve block due to its excellent effectiveness, lower cardiovascular toxicity, and longer half-life. To evaluate intercostal nerve block effectiveness with ropivacaine in patients undergoing emergency open cholecystectomy under general anesthesia compared with conventional management. A controlled clinical trial was carried out on 50 patients undergoing open cholecystectomy, 25 patients without intercostal nerve block versus 25 patients with intercostal nerve block using ropivacaine at 0.5% combined with epinephrine. Intraoperative minimum alveolar concentration and inhalation anesthetic use were evaluated. Tramadol as rescue analgesic agent and pain were evaluated during immediate postoperative period by means of the Visual Analog Scale at 8, 16, and 24 hours. Mean inhalation anesthetic use was lower in the intercostal nerve block group with 13% vs 37% in the group without intercostal nerve block (p= 0.01). Rescue tramadol requirement was lower in the intercostal nerve block group than in the group without intercostal nerve block at 8 hours (8% vs 67%), 16 hours (0% vs 83%), and 24 hours (12% vs 79%) (pIntercostal nerve block reduces intraoperative inhalation anesthetic use, immediate postoperative pain, and tramadol intake as rescue analgesic agent in patients undergoing open cholecystectomy.

  16. Electromyographic comparison of various exercises to improve elbow flexion following intercostal nerve transfer

    National Research Council Canada - National Science Library

    Chalidapong, P; Sananpanich, K; Klaphajone, J

    2006-01-01

    ... (forced inspiration, forced expiration, trunk flexion and attempted elbow flexion), following intercostal nerve transfer to the musculocutaneous nerve in 32 patients who had sustained root avulsion brachial plexus injuries...

  17. Pain relief from preganglionic injury to the brachial plexus by late intercostal nerve transfer.

    Science.gov (United States)

    Berman, J; Anand, P; Chen, L; Taggart, M; Birch, R

    1996-09-01

    We performed intercostal nerve transfer in 19 patients to relieve pain from preganglionic injury to the brachial plexus. The procedure was successful in 16 patients at a mean of 28.6 months (12 to 68) after the injury.

  18. Concomitant percutaneous treatment of aortic coarctation and associated intercostal aneurysms: pre-procedural recognition is key.

    Science.gov (United States)

    Batlivala, Sarosh P; Rome, Jonathan J

    2016-02-01

    Intercostal aneurysms are associated with aortic coarctation. Their aetiology is not well-understood but may be related to intrinsic vascular pathology and altered flow dynamics through the intercostal artery. We present the cases of two patients with coarctation and intercostal aneurysms. The aneurysms were recognised on pre-catheterisation imaging studies and were selectively occluded during the same procedure to treat the coarctation. There were no complications; both the patients have no residual coarctation at the most recent follow-up. Intercostal aneurysms associated with coarctation can have significant consequences including late rupture, paralysis, and even death. These aneurysms are common with an incidence of up to 40% with adult-diagnosed coarctation; one treatment plan is to treat both the coarctation and aneurysm during a single catheterisation. Pre-catheterisation CT or MRI may play a role in this strategy.

  19. Posttraumatic transdiaphragmatic intercostal hernia: report of a case and review of the literature.

    Science.gov (United States)

    Kalles, Vasileios; Dasiou, Maria; Doga, Georgia; Papapanagiotou, Ioannis; Konstantinou, Evangelos A; Mekras, Alexandros; Mariolis-Sapsakos, Theodoros; Anastasiou, Nikolaos

    2015-03-01

    Intercostal hernias are rare, and usually occur following injuries of the thoracic wall. The scope of this report is to present a case of a 53-year-old obese patient that developed a transdiaphragmatic intercostal hernia. The patient presented with a palpable, sizeable, reducible mass in the right lateral thoracic wall, with evident bowel sounds in the area, 6 months after a motor-vehicle accident. On computed tomography (CT), the hernia sac contained part of the liver and part of the ascending colon. A surgical repair of the defect was performed, using a prosthetic patch. The patient's postoperative course was uneventful and she remains recurrence free at 12 months after surgery. Intercostal hernias should be suspected following high-impact injuries of the thoracic wall, and CT scans will facilitate the diagnosis of intercostal hernia. We consider the surgical repair of the defect, with placement of a prosthetic mesh, as the treatment of choice to ensure a favorable outcome.

  20. Intercostal neuralgia as a symptom of an osteoblastoma in thoracic spine.

    Science.gov (United States)

    Kobayashi, Hiroshi; Shinoda, Yusuke; Ohki, Takahiro; Kawano, Hirotaka

    2015-07-02

    An osteoblastoma is a benign bone lesion most commonly affecting the spine; it is frequently found in the posterior elements of the vertebra. When an osteoblastoma originates in the spine, it usually causes dull and localised dorsal pain, but the period between symptom development and diagnosis can be long. MRI shows intense peritumoural oedema accompanying the osteoblastoma. We present a case of a 15-year-old boy with osteoblastoma at the level of the T8-9 left laminae causing intercostal neuralgia without direct invasion to the intercostal nerve. Immediately after surgery, intercostal neuralgia was diminished. To our knowledge, this is the first case of an osteoblastoma with intercostal neuralgia, which is possibly the key symptom for diagnosing an osteoblastoma in the thoracic spine. 2015 BMJ Publishing Group Ltd.

  1. Laparoscopic Liver Resection Using the Lateral Approach from Intercostal Ports in Segments VI, VII, and VIII.

    Science.gov (United States)

    Inoue, Yoshihiro; Suzuki, Yusuke; Fujii, Kensuke; Kawaguchi, Nao; Ishii, Masatsugu; Masubuchi, Shinsuke; Yamamoto, Masashi; Hirokawa, Fumitoshi; Hayashi, Michihiro; Uchiyama, Kazuhisa

    2017-07-31

    Laparoscopic liver resection (LLR) has been developed as a minimally invasive surgery. However, challenges such as difficulty securing visibility and limited control of forceps make it difficult to complete LLR in hepatic segments VI, VII, and VIII. To overcome these challenges, we devised a surgical technique using intercostal ports. We termed this approach the lateral approach. This work describes our experience performing LLR using this approach and discusses the safety and effectiveness of this approach. Between April 2011 and December 2016, data from 91 patients who underwent LLR with or without the intercostal port at a single institution were retrospectively analyzed regarding surgical outcomes, safety, and utility. LLR was performed for 32 patients with the intercostal port and for 59 patients without the intercostal port. The conversion rates to open surgery with and without intercostal ports were 3.1 and 25.4% (P = 0.008). In hepatic segments VII and VIII, the rates of conversion to open surgery were significantly lower for cases involving intercostal ports (6.7 vs. 42.9 and 0 vs. 38.9%; P = 0.035 and 0026, respectively); however, there were no differences in hepatic segment VI (0 vs. 7.4%; P = 0.563). There were no differences in operative time, blood loss volume, surgical margin, curative resection rate, or postoperative complication rate for LLR in all segments (VI, VII, and VIII). No adverse events due to placement of the intercostal port were observed in this set of patients. LLR using the lateral approach and intercostal ports for hepatic segments VII and VIII resulted in a significant decrease in conversion rates to open surgery.

  2. Emergency embolization for the treatment of acute hemorrhage from intercostal arteries.

    Science.gov (United States)

    Stampfl, Ulrike; Sommer, Christof-Matthias; Bellemann, Nadine; Kortes, Nikolas; Gnutzmann, Daniel; Mokry, Theresa; Gockner, Theresa; Schmitz, Anne; Ott, Katja; Kauczor, Hans-Ulrich; Radeleff, Boris

    2014-12-01

    To evaluate embolotherapy for the emergency management of acute bleeding from intercostal arteries. Between October 2003 and August 2012, 19 consecutive patients with hemorrhage from intercostal arteries were scheduled for emergency embolization. The primary study endpoints were technical and clinical success, which were defined as angiographic cessation of bleeding, and cessation of clinical signs of hemorrhage. The secondary study endpoints were periprocedural complications and 30-day mortality rate. In most patients (74 %), hemorrhage was caused by iatrogenic procedures with subsequent intercostal artery laceration. One of the patients was treated twice for recurrent hemothorax caused by a new intercostal artery pseudoaneurysm 7.5 years after the initial procedure. Thus, 20 procedures were performed in these 19 patients. Overall technical success was 85 %. In six patients, no embolization of the "backdoor" was feasible, and in two of these patients additional embolization of other intercostal arteries was necessary to prevent hemorrhage via collateral vessels. Clinical signs of hemorrhage ceased after embolotherapy in 16 of 20 procedures (clinical success 80 %). The mean follow-up was 358.7 ± 637.1 days. One minor procedure-related complication occurred. The 30-day mortality rate was 21 %, however, this was unrelated to intercostal artery hemorrhage. Embolotherapy is an effective emergency therapy for patients with acute hemorrhage from intercostal arteries. Especially if embolization of the backdoor is not feasible, collateral supply via other intercostal arteries should be either ruled out or embolized to prevent ongoing hemorrhage. Despite successful embolotherapy, a majority of patients underwent surgery during follow-up to remove the symptomatic hematoma.

  3. Comparative study of phrenic and intercostal nerve transfers for elbow flexion after global brachial plexus injury.

    Science.gov (United States)

    Liu, Yuzhou; Lao, Jie; Zhao, Xin

    2015-04-01

    Global brachial plexus injuries (BPIs) are devastating events frequently resulting in severe functional impairment. The widely used nerve transfer sources for elbow flexion in patients with global BPIs include intercostal and phrenic nerves. The aim of this study was to compare phrenic and intercostal nerve transfers for elbow flexion after global BPI. A retrospective review of 33 patients treated with phrenic and intercostal nerve transfer for elbow flexion in posttraumatic global root avulsion BPI was carried out. In the phrenic nerve transfer group, the phrenic nerve was transferred to the anterolateral bundle of the anterior division of the upper trunk (23 patients); in the intercostal nerve transfer group, three intercostal nerves were coapted to the anterolateral bundles of the musculocutaneous nerve. The British Medical Research Council (MRC) grading system, angle of elbow flexion, and electromyography (EMG) were used to evaluate the recovery of elbow flexion at least 3 years postoperatively. The efficiency of motor function in the phrenic nerve transfer group was 83%, while it was 70% in the intercostal nerve transfer group. The two groups were not statistically different in terms of the MRC grade (p=0.646) and EMG results (p=0.646). The outstanding rates of angle of elbow flexion were 48% and 40% in the phrenic and intercostal nerve transfer groups, respectively. There was no significant difference of outstanding rates in the angle of elbow flexion between the two groups. Phrenic nerve transfer had a higher proportion of good prognosis for elbow flexion than intercostal nerve transfer, but the effective and outstanding rate had no significant difference for biceps reinnervation between the two groups according to MRC grading, angle of elbow flexion, and EMG. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. New Advances in Molecular Therapy for Muscle Repair after Diseases and Injuries

    Science.gov (United States)

    2011-01-01

    detected some myofibers that expressed dystrophin within the intercostal muscles of the MDX mice that received systemic delivery of our MMP1...bone and cartilage regeneration in vivo. We therefore demonstrate that human myoendothelial cells possess some fundamental properties of stem cells.17... cartilage cells 1-5. In addition, we have demonstrated novel myoendothelial cells in human skeletal muscle that exhibit exceptional myogenic

  5. Inhomogeneous response of expiratory muscle activity to cold block of the ventral medullary surface.

    Science.gov (United States)

    Chonan, T; Okabe, S; Hida, W; Izumiyama, T; Kikuchi, Y; Takishima, T

    1991-11-01

    We assessed the effects of cooling the ventral medullary surface (VMS) on the activity of chest wall and abdominal expiratory muscles in eight anesthetized artificially ventilated dogs after vagotomy and denervation of the carotid sinus nerves. Electromyograms (EMGs) of the triangularis sterni, internal intercostal, abdominal external oblique, abdominal internal oblique, and transversus abdominis muscles were measured with EMG of the diaphragm as an index of inspiratory activity. Bilateral localized cooling (2 x 2 mm) in the thermosensitive intermediate part of the VMS produced temperature-dependent reduction in the EMG of diaphragm and abdominal muscles. The rib cage expiratory EMGs were little affected at 25 degrees C; their amplitudes decreased at lower VMS temperatures (less than 20 degrees C) but by significantly fewer degrees than the diaphragmatic and abdominal expiratory EMGs at a constant VMS temperature. With moderate to severe cooling (less than 20 degrees C) diaphragmatic EMG disappeared, but rib cage expiratory EMGs became tonic and resumed a phasic pattern shortly before the recovery of diaphragmatic EMG during rewarming of the VMS. These results indicate that the effects of cooling the VMS differ between the activity of rib cage and abdominal expiratory muscles. This variability may be due to inhomogeneous inputs from the VMS to expiratory motoneurons or to a different responsiveness of various expiratory motoneurons to the same input either from the VMS or the inspiratory neurons.

  6. Recurrence in skeletal muscle from squamous cell carcinoma of the uterine cervix: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Zannoni Gian

    2006-06-01

    Full Text Available Abstract Background The occurrence of skeletal muscle metastases is a very rare event. Only two cases of late skeletal muscle recurrence from cervical cancer have been documented until now. Case presentation A 38-year old patient, submitted to radical hysterectomy and pelvic lymphadenectomy for a squamous FIGO stage IB1 cervical carcinoma, presented after 76 months with a palpable, and painless swelling on the left hemithorax. MRI showed a nodule located in the context of the intercostal muscles. Pathology revealed the presence of metastasis of squamous cell carcinoma of similar morphology as the primary. On the basis of FDG-PET findings, which excluded other sites of disease, surgical excision of the lesion was performed. The patient was triaged to chemotherapy plus external radiotherapy. Conclusion A case of skeletal muscle recurrence from cervical cancer after a very long interval from primary diagnosis is reported. Muscular pain or weakness, or just a palpable mass in a patient with a history of cancer has always to raise the suspicion of muscle metastasis.

  7. A randomized, double-blinded, placebo-controlled trial of intercostal nerve block after percutaneous nephrolithotomy.

    Science.gov (United States)

    Honey, R John D'A; Ghiculete, Daniela; Ray, A Andrew; Pace, Kenneth T

    2013-04-01

    The optimal method of pain control after percutaneous nephrolithotomy (PCNL) remains controversial. We sought to determine whether intercostal nerve block with bupivicaine provided superior pain control, when compared with placebo, with a lower need for narcotics and improved health-related quality of life (HRQL) in the immediate postoperative period. Sixty-three patients were randomized to receive intercostal blockade with either 20 mL of 0.5% bupivacaine with epinephrine or 20 mL physiologic saline. All patients received intravenous narcotic patient-controlled analgesia (PCA) postoperatively. Data were collected on stone parameters, demographics, analgesic usage, length of stay, and HRQL as assessed by the Postoperative Recovery Scale. The mean age was 47.7±1.2 years; mean body mass index was 28.0±5.0 kg/m(2); mean stone diameter was 29.2±15.8 mm. Within the first 3 to 6 hours after surgery, there was a significant reduction in narcotic use for the group receiving intercostal nerve blockade with bupivacaine compared with placebo. At 3 hours, narcotic use was 2.4±3.1 mg vs 4.3±3.8 mg morphine equivalents (P=0.034), and within 6 hours of surgery, narcotic use was 5.9±6.1 mg vs 8.8±7.4 mg (P=0.096). Durable improvement in HRQL was also observed in patients receiving intercostal nerve blockade with bupivacaine compared with placebo (P=0.034). No complications were attributable to the intercostal nerve blocks in either group. Intercostal blockade with bupivacaine significantly improves both pain control and HRQL in the early postoperative period. The effectiveness of bupivacaine disappears within 6 hours of surgery, after which narcotic use becomes indistinguishable. Intercostal nerve blockade is an easy, safe, and inexpensive method that can be used to optimize pain control after PCNL.

  8. Rib Composite Flap With Intercostal Nerve and Internal Thoracic Vessels for Mandibular Reconstruction.

    Science.gov (United States)

    Zhang, Bin; Li, Ke-Yi; Jiang, Li-Cheng; Meng, Zhen; Wang, Xiu-Mei; Cui, Fu-Zhai; Zhu, Ying-Nan; Wu, Ya-Ping

    2016-10-01

    The purpose of this study was to present the outcome and discuss the feasibility of rib composite flap with intercostal nerve and internal thoracic vessels for reconstructing mandibular defect. Rib composite flaps have been used in 82 patients for reconstructing benign tumor-caused large mandibular defects: 66 of the 82 patients were reconstructed using rib composite flap with intercostal nerve and internal thoracic vessels, whereas the other 16 patients were reconstructed using rib composite flap with internal thoracic vessels, without intercostal nerve. After operation, clinical observation, imageological examination, and sensory detection were used to evaluate the effect of reconstruction. All rib composite flaps with intercostal nerve and internal thoracic vessels were successfully harvested and transplanted. Both immediate and long-term examination showed good appearance reconstruction. All followed-up patients conveyed good satisfaction degree with function and appearance reconstruction. Postoperative panoramic x-ray examination showed new bone formation between the transplanted rib and mandibular stump. Good recoveries of mandibular nerve sensory were observed when followed up after reconstruction surgery. Rib composite flap with intercostal nerve and internal thoracic vessels could be a promising method for reconstruction of mandibular defects.

  9. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery.

    Science.gov (United States)

    Miyazaki, Takuro; Sakai, Tetsuya; Yamasaki, Naoya; Tsuchiya, Tomoshi; Matsumoto, Keitaro; Tagawa, Tsutomu; Hatachi, Go; Tomoshige, Koichi; Mine, Mariko; Nagayasu, Takeshi

    2014-01-01

    Chest tube insertion seems to be one important factor leading to intercostal nerve impairment. The purpose of this prospective study was to objectively evaluate intercostal nerve damage using current perception threshold testing in association with chest tube insertion. Sixteen patients were enrolled in this study. Intercostal nerve function was assessed with a series of 2000-Hz (Aβ fiber), 250-Hz (Aδ fiber), and 5-Hz (C fiber) stimuli using current perception threshold testing (Neurometer CPT/C(®)). Current perception threshold values at chest tube insertion were measured before surgery, during chest tube insertion and after removal of the chest tube. Intensities of ongoing pain were also assessed using a numeric rating scale (0-10). Current perception thresholds at each frequency after surgery were significantly higher than before surgery. Numeric rating scale scores for pain were significantly reduced from 3.3 to 1.9 after removal of the chest tube (p = 0.004). The correlation between current perception threshold value at 2000 Hz and intensity of ongoing pain was marginally significant (p = 0.058). This is the first study to objectively evaluate intercostal nerve damage at chest tube insertion. The results confirmed that chest tube insertion has clearly deleterious effects on intercostal nerve function.

  10. Influence of changes in external potassium and chloride ions on membrane potential and intracellular potassium ion activity in rabbit ventricular muscle.

    Science.gov (United States)

    Fozzard, H A; Lee, C O

    1976-04-01

    1. The membrane responses of rabbit papillary muscles to rapid changes in [K](o) and [Cl](o) were measured with open-tipped micropipettes and with closed micropipettes made from K-selective glass.2. The muscle cells behaved primarily as a K electrode, and responses to changes in [K](o) with constant [Cl](o) or with constant [K](o) x [Cl](o) were substantially the same.3. When [Cl](o) was changed at a constant [K](o) the membrane potentials changed rapidly and symmetrically by a small value and remained constant for 30 min.4. Measurement of potential with K(+)-selective micro-electrodes in these experiments showed no change in intracellular K activity. In addition to permitting calculation of K permeability, these measurements reassured us that the K(+)-selective electrodes were well insulated and not influenced by electrical shunts at the impalement site.5. Although the membrane response to changes in [Cl](o) was small, it was possible to calculate that the permeability ratio (P(Cl)/P(K)), was 0.11. The Cl and K conductances were about 0.015 mmho/cm(2) and 0.09 mmho/cm(2) respectively, resulting in a conductance ratio (g(Cl)/g(K)) of about 0.17.6. The time course of depolarization by increase in [K](o) was rapid (half-time 5 sec), but repolarization on return to lower [K](o) was much slower (half-time 50 sec). The depolarization time course was easily fitted by the potential change calculated by assuming the need for K diffusion into the extracellular spaces and taking account of the logarithmic relation between membrane potential and [K](o). These calculations did not fit the time course of repolarization, which was slowed in the fashion expected from an inward-rectifying membrane.7. The influence of [K](i) on membrane potential was investigated by changes in tonicity of the external solution. Hypotonic solution produced a change in intracellular K activity close to that produced by ideal water movement. However, in hypertonic solution, intracellular K activity

  11. Clinical location of the fourth and fifth intercostal spaces as a percent of the length of the sternum.

    Science.gov (United States)

    Marcus, Frank; Hughes, Trina; Barrios, Phillip; Borgstrom, Mark

    2017-05-18

    To verify accurate placement of the precordial ECG leads by identifying the 4th and 5th intercostal spaces as a function of the length of the sternum. This should decrease the percentage of lead misplacement leading to misdiagnoses. The population consisted of patients and healthy volunteers. The proposed method compared palpation of the 4th and 5th intercostal spaces to a percentile of the sternal length. Location of the 4th and 5th intercostal space using a simple device was evaluated to assist in proper placement of the precordial leads to obtain accurate diagnosis. The location of the 4th and 5th intercostal space is related to the length of the sternum. It is 77% of the sternal length that measures 15cm for the 4th intercostal space. The position of the V1 and V2 electrodes decreases to 57% when the sternal length is 26cm. Similar data was obtained to locate the 5th intercostal space with proper position of V4-V6 electrodes. Tables are provided to facilitate this process. An instrument was designed to measure the 4th and 5th intercostal space as a function of the sternal length. The location of the 4th and 5th intercostal space is identified based on the length of the sternum. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Chemoembolization through intercostal arteries in hepatocellular carcinoma: Report of a case of transient spinal cord injury

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Tae Yong; Hwang, In Tae; Kim, Byung Soo; Ko, Hyun Yoon; Yang, Ung Suk; Kim, Hak Jin [Pusan National University College of Medicine, Pusan (Korea, Republic of)

    1994-07-15

    Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective . However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experienced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction by anterior spinal arterial occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.

  13. Intercostal Trocars Enable Easier Laparoscopic Resection of Liver Tumors in Segments 7 and 8.

    Science.gov (United States)

    Hirokawa, Fumitoshi; Hayashi, Michihiro; Asakuma, Mitsuhiro; Shimizu, Tetsunosuke; Inoue, Yoshihiro; Uchiyama, Kazuhisa

    2017-05-01

    Laparoscopic resection of posterosuperior (PS) tumors of the liver is more difficult than that of anterolateral (AL) tumors, owing to the narrow surgical field in the PS location. In this retrospective cohort study, our aim was to determine if port insertion through the intercostal space would lead to improved outcomes for laparoscopic resection of tumors in PS liver segments 7 and 8. Between January 2006 and December 2015, 153 patients underwent laparoscopic resection of solitary liver tumors at Osaka Medical College Hospital. Of these, 107 patients had AL lesions, and 46 had PS lesions. Of the 46 patients with a PS lesion, 23 underwent an abdominal-only approach, and 23 underwent the intercostal trocar approach. Multivariate analyses were performed to investigate outcomes. Conventional abdominal-only laparoscopic resection of PS liver tumors resulted in prolonged surgical time (P = 0.031), increased bleeding (P = 0.012), and a higher open conversion rate (P = 0.022) compared with AL tumors. Among patients with PS tumors, the open conversion rate was significantly higher for those treated with the abdominal-only approach than with the intercostal trocar approach (P = 0.047). Appropriate surgical margins were obtained equally using the intercostal trocar approach (P = 0.648). There was no significant difference in occurrence of complications between the abdominal-only group and the intercostal trocar group. Using the intercostal trocar approach for PS liver lesions is a safe and effective method, which significantly reduced the open conversion rate compared with the conventional abdominal-only approach.

  14. Electromyographic comparison of various exercises to improve elbow flexion following intercostal nerve transfer.

    Science.gov (United States)

    Chalidapong, P; Sananpanich, K; Klaphajone, J

    2006-05-01

    We compared the quantitative electromyographic activity of the elbow flexors during four exercises (forced inspiration, forced expiration, trunk flexion and attempted elbow flexion), following intercostal nerve transfer to the musculocutaneous nerve in 32 patients who had sustained root avulsion brachial plexus injuries. Quantitative electromyographic evaluation of the mean and maximum amplitude was repeated three times for each exercise. We found that mean and maximum elbow flexor activity was highest during trunk flexion, followed by attempted elbow flexion, forced inspiration and finally forced expiration. The difference between each group was significant (p intercostal nerve transfer.

  15. Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Oguz, B.; Oguz, K.K.; Cila, A. [Dept. of Radiology, Hacettepe Univ. Faculty of Medicine, Ankara (Turkey); Tan, E. [Dept. of Neurology, Hacettepe Univ. Faculty of Medicine, Ankara (Turkey)

    2003-12-01

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history. (orig.)

  16. Eye muscle repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100062.htm Eye muscle repair - series—Normal anatomy To use the sharing ... the eyeball to the eye socket. The external muscles of the eye are found behind the conjunctiva. ...

  17. Improved intercostal HIFU ablation using a phased array transducer based on Fermat's spiral and Voronoi tessellation: A numerical evaluation.

    Science.gov (United States)

    Ramaekers, Pascal; Ries, Mario; Moonen, Chrit T W; de Greef, Martijn

    2017-03-01

    A major complication for abdominal High Intensity Focused Ultrasound (HIFU) applications is the obstruction of the acoustic beam path by the thoracic cage, which absorbs and reflects the ultrasonic energy leading to undesired overheating of healthy tissues in the pre-focal area. Prior work has investigated the determination of optimized transducer apodization laws, which allow for a reduced rib exposure whilst (partially) restoring focal point intensity through power compensation. Although such methods provide an excellent means of reducing rib exposure, they generally increase the local energy density in the pre-focal area, which similarly can lead to undesired overheating. Therefore, this numerical study aimed at evaluating whether a novel transducer design could provide improvement for intercostal HIFU applications, in particular with respect to the pre-focal area. A combination of acoustic and thermal simulations was used to evaluate 2 mono-element transducers, 2 clinical phased array transducers, and 4 novel transducers based on Fermat's Spiral (FS), two of which were Voronoi-tessellated (VTFS). Binary apodizations were determined for the phased array transducers using a collision detection algorithm. A tissue geometry was modeled to represent an intercostal HIFU sonication in the liver at 30 and 50 mm behind the ribs, including subsequent layers of gel pad, skin, subcutaneous fat, muscle, and liver tissue. Acoustic simulations were then conducted using propagation of the angular spectrum of plane waves (ASPW). The results of these simulations were used to evaluate pre-focal intensity levels. Subsequently, a finite difference scheme based on the Pennes bioheat equation was used for thermal simulations. The results of these simulations were used to calculate both the energy density in the pre-focal skin, fat, and muscle layers, as well as the energy exposure of the ribs. The acoustic simulations showed that for a sonication in a single point without

  18. Right intercostal insertion of a Veress needle for laparoscopy in dogs.

    Science.gov (United States)

    Fiorbianco, Valentina; Skalicky, Monika; Doerner, Judith; Findik, Murat; Dupré, Gilles

    2012-04-01

    To evaluate right intercostal Veress needle (VN) insertion for laparoscopy in dogs. Longitudinal cohort study. Female dogs (n = 56). The VN was inserted in the last palpable right intercostal space, either 1/3 (Group T; 28 dogs) or mid distance (Group H; 28 dogs) from the xiphoid cartilage to the most caudal extent of the costal arch. Problems encountered during VN insertion and injuries were recorded, graded, and compared between groups, and also between the first and last 20 insertions. Pneumoperitoneum was successfully achieved by VN insertion in 49 (88%) dogs after a single (45 dogs) or 2nd attempt (4 dogs). Frequency of complications was as follows: 20 grade 1 (subcutaneous emphysema, omentum, or falciform injuries); 6 grade 2 (liver or spleen injury), and 1 grade 3 complication (pneumothorax occurred). No significant difference was found between the 2 groups or between the first and last 20 dogs. Right intercostal VN insertion facilitates pneumoperitoneum in dogs with few consequential complications. No significant difference was found between entry sites; however, the mid distance insertion site in the last palpable intercostal space with dog positioned in dorsal recumbency is likely to result in less complications. © Copyright 2012 by The American College of Veterinary Surgeons.

  19. Endovascular management of bilateral superior intercostal artery aneurysms following late repair of coarctation of the aorta.

    Science.gov (United States)

    Tapping, C R; Ettles, D F

    2011-08-01

    Endovascular management of massive bilateral superior intercostal artery aneurysms following late surgical repair of juxtaductal coarctation of the aorta is described in a 40-year-old male patient. Both aneurysms were successfully treated by coil embolisation without the need for further surgical intervention.

  20. The investigation of intercostal Somatosensory Evoked Potentials in senile patients with diabetes

    Institute of Scientific and Technical Information of China (English)

    Xu lanping; pan yonghua; lu weihong; wu yue; zhou lichun

    2000-01-01

    Objective: To explove intercostal Somatosensory evoked potcntials(ISEP)and MEP,SEP,BAEP,ECoG,VEP in the evaluation on senile patients with DM Methods:fffth-tvo neurologialy normal subjects and 35 senile patients with clinic ally definited Dm were used in this inrestigation to general intercostal SEPs were studied.It is that the stimulation site for the fifth,seventh and nineth intercostal nervcs is at the anterior axillary line, whereas the third intercostal nerve is excited just lateral to the stemum. Result:.ISEP latency date(X+2.5SD),ISEP side to side analysis, T test of ISEP in normal compared with diabetes, β cell function in 35 senile patients with DM were compared with plasma glucose,Ralation between ISEP and other multimodal evoked potential,the abnormal rate of ISEP26 case .Respectively comparison of ISEP between DM patients with healths controlsexcept LN3 RN3 LN9 t=0.147-1.57,p=0.22-1.gl,the others were t=2.3-7.3,p=0. 000-0.02.The ISEPresult were comparedwith FPG, PPG、 HbAlc,disease duration,insulin. C peptid r=0.243-0.905,p=0.0l-0.05.Conclusion:ISEP could evaluate sternum lesions affecting the thoracic nerve roots disease,but also might be help in judging peripheral nerve disease with DM early diagnosis and predict the course of the disease.

  1. MUSCLE ACTIVITY RESPONSE TO EXTERNAL MOMENT DURING SINGLE-LEG DROP LANDING IN YOUNG BASKETBALL PLAYERS: THE IMPORTANCE OF BICEPS FEMORIS IN REDUCING INTERNAL ROTATION OF KNEE DURING LANDING

    Directory of Open Access Journals (Sweden)

    Meguru Fujii

    2012-06-01

    Full Text Available Internal tibial rotation with the knee close to full extension combined with valgus collapse during drop landing generally results in non-contact anterior cruciate ligament (ACL injury. The purpose of this study was to investigate the relationship between internal rotation of the knee and muscle activity from internal and external rotator muscles, and between the internal rotation of knee and externally applied loads on the knee during landing in collegiate basketball players. Our hypothesis was that the activity of biceps femoris muscle would be an important factor reducing internal knee rotation during landing. The subjects were 10 collegiate basketball students: 5 females and 5 males. The subjects performed a single-leg drop landing from a 25-cm height. Femoral and tibial kinematics were measured using a 3D optoelectronic tracking system during the drop landings, and then the knee angular motions were determined. Ground reaction forces and muscle activation patterns (lateral hamstring and medial hamstring were simultaneously measured and computed. Results indicated that lower peak internal tibial rotation angle at the time of landing was associated with greater lateral hamstring activity (r = -0.623, p < 0.001. When gender was considered, the statistically significant correlation remained only in females. There was no association between the peak internal tibial rotation angle and the knee internal rotation moment. Control of muscle activity in the lateral to medial hamstring would be an important factor in generating sufficient force to inhibit excessive internal rotation during landing. Strengthening the biceps femoris might mitigate the higher incidence of non-contact ACL injury in female athletes

  2. Sleep disturbances in chronic progressive external ophthalmoplegia.

    NARCIS (Netherlands)

    Smits, B.W.; Westeneng, H.J.; Hal, M.A. van; Engelen, B.G.M. van; Overeem, S.

    2012-01-01

    BACKGROUND: Chronic progressive external ophthalmoplegia (CPEO) is a relatively common mitochondrial disorder. In addition to extraocular muscle weakness, various other organs can typically be affected, including laryngeal and limb muscles, cerebrum, cerebellum, and peripheral nerves. Given this mul

  3. Correlation and interventional embolization therapy of posterior intercostal arteries-induced hemoptysis.

    Science.gov (United States)

    Chen, Y P; Chen, Y G; Jiang, F; Chen, J M

    2014-06-09

    The incidence of posterior intercostal arteries-induced hemoptysis, its correlation with primary diseases, and the value of interventional embolization therapy were investigated. Clinical data, multislice spiral computed tomography (MSCT), digital subtraction angiography (DSA), and other imaging data of 143 cases of hemoptysis were retrospectively analyzed. After the offending vessels were subjected to interventional embolization therapy, patients were followed-up for observations of clinical efficacies and complications. Thirty-one patients (21.7%) showed 65 branches of posterior intercostal arteries as the non-bronchial systemic arteries involved in hemoptysis; pleural thickening was evident in 25 (80.6%) cases. Posterior intercostal arteries-induced hemoptysis was observed in 16 of the 27 (59.3%) patients with pulmonary tuberculosis, and in 9 of the 10 (90.0%) patients with pulmonary tuberculosis and pulmonary damage. Posterior intercostal arteries-induced hemoptysis was correlated to pleural thickening (Pintercostal arteries were found to be involved in hemoptysis by preoperative chest CT angiogram (CTA); the intraoperative matching rates were 90.3% (28/31) and 89.2% (58/65), respectively. Thirty-one patients received transcatheter arterial embolization (TAE), of which 29 (93.5%) showed immediate hemostasis; 1 case had surgical treatment for ineffectuality, and 2 cases showed recurrence without serious complications. The posterior intercostal arteries were commonly involved in hemoptysis, and were closely associated with pleural thickening and pulmonary tuberculosis, especially when accompanied by pulmonary damage. Complete TAE could improve the treatment effect of hemoptysis and preoperative chest CTA was helpful for interventional embolization therapy.

  4. Acquired abdominal intercostal hernia: case report and systematic review of the literature.

    Science.gov (United States)

    Erdas, E; Licheri, S; Calò, P G; Pomata, M

    2014-10-01

    The protrusion of abdominal viscera through an intercostal space under an intact diaphragm is a very rare condition. The aim of this study is to elucidate the etiology, clinical features, and therapeutic options on what several authors call "abdominal intercostal hernia" (AIH). A typical case of AIH of the 9th left intercostal space in a 48-year-old man is presented. A literature search was conducted on the Medline and Scopus databases. Only acquired AIHs (AAIHs) were considered, while lung, transdiaphragmatic, and congenital intercostal hernias were excluded. Eighteen studies met selection criteria and a total of 20 patients were useful for analysis. Etiology was related mainly to traumatism (65 %) or to previous surgery (20 %). The intercostal defects were mostly located under the 9th rib without significant differences as to side. The main symptom was chest swelling (85 %), often associated with discomfort or pain (76 %). Acute complications such as incarceration and strangulation occurred in three patients. CT was the most employed diagnostic tool (80 %). Early diagnosis was made in 25 % of cases. Seventeen patients underwent hernia repair with either open (73 %) or laparoscopic approach (28 %), and various techniques with and without prosthesis were described. Recurrence occurred in 28.6 % of patients, during a mean follow-up of 8.6 months. AAIH should be always suspected when chest swelling occurs after a minor or major trauma, and CT must be promptly performed to rule out diaphragmatic or abdominal viscera injury. This condition requires surgery to prevent serious complications, the first-choice technique should be mesh tension-free repair.

  5. Posterior Intercostal Nerve Block With Liposomal Bupivacaine: An Alternative to Thoracic Epidural Analgesia.

    Science.gov (United States)

    Rice, David C; Cata, Juan P; Mena, Gabriel E; Rodriguez-Restrepo, Andrea; Correa, Arlene M; Mehran, Reza J

    2015-06-01

    Pain relief using regional neuroaxial blockade is standard care for patients undergoing major thoracic surgery. Thoracic epidural analgesia (TEA) provides effective postoperative analgesia but has unwanted side effects, including hypotension, urinary retention, nausea, and vomiting, and is highly operator dependent. Single-shot intercostal nerve and paravertebral blockade have not been widely used because of the short duration of action of most local anesthetics; however, the recent availability of liposomal bupivacaine (LipoB) offers the potential to provide prolonged blockade of intercostal nerves (72 to 96 hours). We hypothesized that a five-level unilateral posterior intercostal nerve block using LipoB would provide effective analgesia for patients undergoing thoracic surgery. We identified patients who underwent lung resection using intraoperative LipoB posterior intercostal nerve blockade and retrospectively compared them with a group of patients who had TEA and who were matched for age, sex, type of surgery, and surgical approach. We analyzed perioperative morbidity, pain scores and narcotic requirements. There were 54 patients in each group. Mean hospital stay was 3.5 days and 4.5 days (p = 0.004) for LipoB group and TEA group, respectively. There were no significant differences in perioperative complications, postoperative pain scores, or in narcotic utilization between LipoB group and TEA group. No acute toxicity related to LipoB was observed. Posterior intercostal nerve blockade using LipoB is safe and provides effective analgesia for patients undergoing thoracic surgery. It may be considered as a suitable alternative to TEA. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Does a Multimodal No-Compression Suture Technique of the Intercostal Space Reduce Chronic Postthoracotomy Pain? A Prospective Randomized Study.

    Science.gov (United States)

    Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Puyo, Carlos; Maurizi, Giulio; D'Andrilli, Antonio; Ciccone, Anna Maria; Massullo, Domenico; Vanni, Camilla; Berardi, Giammauro; Baldini, Rossella; Rendina, Erino Angelo

    2016-09-01

    Chronic postthoracotomy pain is a significant adverse outcome of thoracic surgery. We evaluated with a prospective randomized trial the effect of a multimodal no-compression suture technique of the intercostal space on postoperative pain occurrence in patients undergoing minithoracotomy. Patients undergoing a muscle-sparing lateral minithoracotomy for different thoracic diseases were randomly divided into two groups: 146 patients received intercostal muscle flap harvesting and pericostal no-compression "edge" suture (the IMF group), and 151 patients received a standard suture technique associated with an intrapleural intercostal nerve block (the IINB group). Pain scores and interference of pain with daily activities were assessed by using the Italian version of the Brief Pain Inventory on day 1, and at 1 to 6 months postoperatively. The results of pulmonary function tests (spirometry and the 6-minute walking test ) were evaluated preoperatively and at 1 and 6 months postoperatively. Postthoracotomy pain scores throughout the first postoperative day were significantly lower in the IMF group. After 1 and 6 months, patients in the IMF group had a significantly lower average pain score (p = 0.001). There were no significant differences in pain interference scores at each evaluation time point in either group. However, differences were shown in lung function test results at 1 and 6 months postoperatively (the forced expiratory volume in 1 second in the IINB group averaged 68.8 ± 17.4% of predicted value and 72.8 ± 10.5%, respectively, and in the IMF group it averaged 83.1 ± 7.4% and 86.4 ± 12.8%, respectively [p = 0.023 and 0.013, respectively]; the 6-minute walking test results in the IINB group averaged 311.1 ± 51.0 and 329.9 ± 54.8 m, respectively, and those in the IMF group averaged 371.2 ± 54.8 and 395.7 ± 56.4 m, respectively [p = 0.0001]). The multimodal no-compression suture technique is a rapid and feasible procedure that reduces the intensity of

  7. Respiratory muscle activity measured with a noninvasive EMG technique : technical aspects and reproducibility

    NARCIS (Netherlands)

    Maarsingh, EJW; Van Eykern, LA; Sprikkelman, AB; Hoekstra, MO; Van Aalderen, WMC

    A new method is being developed to investigate airway obstruction in young children by means of noninvasive electromyography (EMG) of diaphragmatic and intercostal muscles. The purpose of this study was to evaluate the reproducibility of the EMG measurements. Eleven adults, 39 school children (20

  8. Respiratory muscle activity measured with a noninvasive EMG technique : technical aspects and reproducibility

    NARCIS (Netherlands)

    Maarsingh, EJW; Van Eykern, LA; Sprikkelman, AB; Hoekstra, MO; Van Aalderen, WMC

    2000-01-01

    A new method is being developed to investigate airway obstruction in young children by means of noninvasive electromyography (EMG) of diaphragmatic and intercostal muscles. The purpose of this study was to evaluate the reproducibility of the EMG measurements. Eleven adults, 39 school children (20 he

  9. Respiratory muscle activity in the assessment of bronchial responsiveness in asthmatic children

    NARCIS (Netherlands)

    Sprikkelman, AB; Van Eykern, LA; Lourens, MS; Heymans, HSA; Van Aalderen, WMC

    We investigated whether an increase in transcutaneous electromyographic (EMG) activity of the diaphragm and intercostal muscles corresponds with the concentration of histamine that induces a 20% fall in the forced expiratory volume in one second (FEV1; PC20). Eleven asthmatic children (mean age 11.9

  10. Identification of 4th intercostal space using sternal notch to xiphoid length for accurate electrocardiogram lead placement.

    Science.gov (United States)

    Day, Kevin; Oliva, Isabel; Krupinski, Elizabeth; Marcus, Frank

    2015-01-01

    Precordial ECG lead placement is difficult in obese patients with increased chest wall soft tissues due to inaccurate palpation of the intercostal spaces. We investigated whether the length of the sternum (distance between the sternal notch and xiphoid process) can accurately predict the location of the 4th intercostal space, which is the traditional location for V1 lead position. Fifty-five consecutive adult chest computed tomography examinations were reviewed for measurements. The sternal notch to right 4th intercostal space distance was 67% of the sternal notch to xiphoid process length with an overall correlation of r=0.600 (pintercostal space for accurate placement of the precordial electrodes in adults in whom the 4th intercostal space cannot be found by physical exam. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Non-Angled Intercostal Percutaneous Access Under Full Expiration: Safety Is Not an Issue Anymore.

    Science.gov (United States)

    Ajib, Khaled M; Matta, Imad F; Zgheib, Joseph T; Jabbour, Michel E

    2017-08-01

    Percutaneous nephrolithotomy (PCNL) is a well-established procedure for the management of urinary calculi and can be performed intercostally or subcostally. Favoring one approach vs the other is still debatable, and literature has been inconclusive regarding the efficacy and safety of both approaches. Hence, this study aims to assess the safety and efficacy of direct non-angled intercostal technique performed under full expiration and to compare it to the subcostal approach. PCNL was conducted among 361 patients during 2010-2015 at Saint George Hospital University Medical Center in Beirut, Lebanon. PCNL was done by one operator and by following a standard technique. After reviewing the medical records, 304 patients were included. Data analysis was conducted using Stata/IC 10.0. Bivariate analysis was conducted using Pearson's Chi-square, and logistic regression model was run. Alpha level was set at 0.05. Of the total patients, 54.6% and 45.4% underwent intercostal (Group I) and subcostal (Group II) access, respectively. Mean drop in hemoglobin in Group II was 1.9 g/dL vs 1.48 g/dL in Group I (p-value = 0.0040). The mean difference in operation time between group I (88.61 minutes) and group II (102.58 minutes) was statistically significant (p-value = 0.0064). Patients were stone free in 88.05% of the intercostal cases and 78.52% of the subcostal cases. Group II patients were twice more likely to have residual stones compared to Group I (p-value = 0.029). No statistical significance was observed in postoperative complications among both groups. In addition, no cases of pneumothorax were reported. Compared to subcostal access, intercostal approach under full expiration is a safe technique that provides optimal approach to the intrarenal collecting system and allows less angulation, less bleeding, and yields higher stone clearance with minimal complications. When performed by a well-trained urologist, intercostal access should be advocated in PCNL to

  12. Sonographic analysis of the intercostal spaces for the application of high-intensity focused ultrasound therapy to the liver.

    Science.gov (United States)

    Kim, Young-Sun; Park, Min Jung; Rhim, Hyunchul; Lee, Min Woo; Lim, Hyo Keun

    2014-07-01

    The purposes of this study were to assess the widths of the intercostal spaces of the right inferior human rib cage through which high-intensity focused ultrasound therapy would be applied for treating liver cancer and to elucidate the demographic factors associated with intercostal space width. From March 2013 to June 2013, the widths of the intercostal spaces and the ribs at six areas of the right inferior rib cage (area 1, lowest intercostal space on anterior axillary line and the adjacent upper rib; area 2, second-lowest intercostal space on anterior axillary line and the adjacent upper rib; areas 3 and 4, lowest and second-lowest spaces on midaxillary line; areas 5 and 6, lowest and second-lowest spaces on posterior axillary line) were sonographically measured in 466 patients (214 men, 252 women; mean age, 53.0 years) after an abdominal sonographic examination. Demographic factors and the presence or absence of chronic liver disease were evaluated by multivariate analysis to investigate which factors influence intercostal width. The width of the intercostal space was 19.7 ± 3.7 mm (range, 9-33 mm) at area 1, 18.3 ± 3.4 mm (range, 9-33 mm) at area 2, 17.4 ± 4.0 mm (range, 7-33 mm) at area 3, 15.4 ± 3.5 mm (range, 5-26 mm) at area 4, 17.2 ± 3.7 mm (range, 7-28 mm) at area 5, and 14.5 ± 3.6 mm (range, 4-26 mm) at area 6. The corresponding widths of the ribs were 15.2 ± 2.3 mm (range, 8-22 mm), 14.5 ± 2.3 mm (range, 9-22 mm), 13.2 ± 2.0 mm (range, 9-20), 14.3 ± 2.2 mm (range, 9-20 mm), 15.0 ± 2.2 mm (range, 10-22 mm), and 15.1 ± 2.3 mm (range, 8-21 mm). Only female sex was significantly associated with the narrower intercostal width at areas 1, 2, 3, and 5 (regression coefficient, 1.124-1.885; p = 0.01-0.04). There was substantial variation in the widths of the intercostal spaces of the right inferior rib cage such that the anterior and inferior aspects of the intercostal space were relatively wider. Women had significantly narrower intercostal spaces

  13. Non-traumatic trans-diaphragmatic intercostal hernia and cor pulmonale in a patient with poorly controlled obstructive sleep apnoea.

    Science.gov (United States)

    Mehdi, Syed Basharath; Madi, Salem; Sudworth, Jordan

    2016-10-28

    Trans-diaphragmatic intercostal hernia is a rare entity. Patient with multiple medical comorbidities, including obstructive sleep apnoea, presents with shortness of breath, leg oedema and a bulging swelling through the right chest wall. CT shows partial herniation of the right lung and liver through intercostal space and an echocardiogram reveals right heart failure. He was treated initially with continuous positive airway pressure with poor response and subsequently treated with adaptive servo ventilation with much better symptomatic relief and treatment tolerance.

  14. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases.

    Science.gov (United States)

    Hung, Ming-Hui; Chan, Kuang-Cheng; Liu, Ying-Ju; Hsu, Hsao-Hsun; Chen, Ke-Cheng; Cheng, Ya-Jung; Chen, Jin-Shing

    2015-04-01

    Intubated general anesthesia with single-lung ventilation has been considered mandatory for thoracoscopic lobectomy for nonsmall cell lung cancer. Few reports of thoracoscopic lobectomy without tracheal intubation are published, using either thoracic epidural anesthesia (TEA) or intercostal blockade. The comparisons of perioperative outcomes of nonintubated thoracoscopic lobectomy using epidural anesthesia and intercostal blockade are not reported previously. From September 2009 to August 2014, a total of 238 patients with lung cancer who underwent nonintubated thoracoscopic lobectomy were recruited from our prospectively maintained database of all patients undergoing nonintubated thoracoscopic surgery using TEA or intercostal blockade. A multiple regression analysis, adjusting for preoperative variables, was performed to compare the perioperative outcomes of the 2 anesthesia methods. Overall, 130 patients underwent nonintubated thoracoscopic lobectomy using epidural anesthesia whereas 108 had intercostal blockade. The 2 groups were similar in demographic data, except for sex, preoperative lung function, physical status classification, and history of smoking. After adjustment for the preoperative variables, nonintubated thoracoscopic lobectomy using intercostal blockade was associated with shorter durations of anesthetic induction and surgery (P intercostal blockade group had a shorter average duration of chest tube drainage (P = 0.064) but a similar average length of hospital stay (P = 0.569). Conversion to tracheal intubation was required in 13 patients (5.5%), and no in-hospital mortality occurred in either group. Nonintubated thoracoscopic lobectomy using either epidural anesthesia or intercostal blockade is feasible and safe. Intercostal blockade is a simpler alternative to epidural anesthesia for nonintubated thoracoscopic lobectomy in selected patients with lung cancer.

  15. Novel use of noninvasive high-intensity focused ultrasonography for intercostal nerve neurolysis in a swine model.

    Science.gov (United States)

    Gulati, Amitabh; Loh, Jeffrey; Gutta, Narendra B; Ezell, Paula C; Monette, Sébastien; Erinjeri, Joseph P; Maybody, Majid; Solomon, Stephen

    2014-01-01

    High-intensity focused ultrasound (HIFU) is a noninvasive thermal ablation technique. High-intensity focused ultrasound has been used in small-animal models to lesion neural tissue selectively. This study aimed to evaluate the efficacy of HIFU in a large-animal model for ablation of nerves similar in size to human nerves. Twelve acute magnetic resonance-guided HIFU ablation lesions were created in intercostal nerves in a swine model. In a second pig, as a control, 4 radiofrequency ablation and 4 alcohol lesions were performed on intercostal nerves under ultrasound guidance. Preprocedural and postprocedural magnetic resonance imaging was then performed to evaluate radiologically the lesion size created by HIFU. Animals were euthanized 1 hour postprocedure, and necropsy was performed to collect tissue samples for histopathologic analysis. On gross and histological examination of the intercostal nerve, acute HIFU nerve lesions showed evidence of well-demarcated, acute, focally extensive thermal necrosis. Four intercostal nerves ablated with HIFU were sent for histopathologic analysis, with 2 of 4 lesions showing pathologic damage to the intercostal nerve. Similar results were shown with radiofrequency ablation technique, whereas the intercostal nerves appeared histologically intact with alcohol ablation. High-intensity focused ultrasound may be used as a noninvasive neurolytic technique in swine. High-intensity focused ultrasound may have potential as a neuroablation technique for patients with chronic and cancer pain.

  16. Surgical technique: The intercostal space approach to the internal mammary vessels in 463 microvascular breast reconstructions.

    Science.gov (United States)

    Darcy, Catharine M; Smit, Jeroen M; Audolfsson, Thorir; Acosta, Rafael

    2011-01-01

    The internal mammary vessels are one of the most frequently used recipient sites for microsurgical free-flap breast reconstruction, and an accepted technique to expose these vessels involves removal of a segment of costal cartilage of the rib. However, in some patients, cartilage removal may result in a visible medial chest-wall depression that requires corrective procedures. We, therefore, use an intercostal space approach to the internal mammary vessels, as there is minimal disturbance of the costal cartilage with this technique. We have developed and performed our technique over an 8-year period in 463 microvascular breast reconstructions, and present it here as it contains modifications not previously described that may be of interest to other surgeons. There was no serious morbidity associated with the intercostal space approach, the internal mammary vessels were reliably and safely exposed in all these cases and the flap success rate was 95.8%. Copyright © 2010. Published by Elsevier Ltd.

  17. Needle aspiration versus intercostal tube drainage for pneumothorax in the newborn.

    Science.gov (United States)

    Bruschettini, Matteo; Romantsik, Olga; Ramenghi, Luca Antonio; Zappettini, Simona; O'Donnell, Colm P F; Calevo, Maria Grazia

    2016-01-11

    Pneumothorax occurs more frequently in the neonatal period than at any other time of life and is associated with increased mortality and morbidity. It may be treated with either needle aspiration or insertion of a chest tube. The former consists of aspiration of air with a syringe through a needle or an angiocatheter, usually through the second or third intercostal space in the midclavicular line. The chest tube is usually placed in the anterior pleural space passing through the sixth intercostal space into the pleural opening, turned anteriorly and directed to the location of the pneumothorax, and then connected to a Heimlich valve or an underwater seal with continuous suction. To compare the efficacy and safety of needle aspiration and intercostal tube drainage in the management of neonatal pneumothorax. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 11), MEDLINE via PubMed (1966 to 30 November 2015), EMBASE (1980 to 30 November 2015), and CINAHL (1982 to 30 November 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised controlled trials, quasi-randomised controlled trials and cluster trials comparing needle aspiration (either with the needle or angiocatheter left in situ or removed immediately after aspiration) to intercostal tube drainage in newborn infants with pneumothorax. For each of the included trial, two authors independently extracted data (e.g. number of participants, birth weight, gestational age, kind of needle and chest tube, choice of intercostal space, pressure and device for drainage) and assessed the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). The primary outcomes considered in this review are mortality during the neonatal period and during hospitalisation. One

  18. Intercostal Artery Laceration: Rare Complication of Thoracentesis and Role of Ultrasound in Early Detection

    Directory of Open Access Journals (Sweden)

    Wissam Mansour

    2017-01-01

    Full Text Available Hemothorax is a rare but potentially fatal postthoracentesis complication. Early clinical signs may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further bleeding. Following procedure, early bedside ultrasound findings can be vital for early detection. We report a case of massive hemothorax in a 63-year-old male following therapeutic thoracentesis. Diagnosis was made following highly suggestive sonographic findings prompting thoracotomy and lacerated intercostal artery cauterization.

  19. Schwannomatosis with Cystic Degeneration Arising from a Single Intercostal Nerve: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Woo; Lee, Young Kyung [Dept. of Radiology, Kyung Hee University College of Medicine, Seoul (Korea, Republic of); Kim, Dae Hyun [Dept. of Thoracic and Cardiovascular, Kyung Hee Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul (Korea, Republic of); Sung, Dong Wook [Dept. of Radiology, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    An intrathoracic schwannoma is a benign neurogenic tumor that arises from the posterior mediastinum and is commonly found to be solitary. Schwannomatosis that manifests as multiple cysts is extremely rare. In this case study, we report a rare case of a 36-year-old man with no respiratory symptoms, with multiple cystic tumors in the posterior chest wall and pathologically confirmed schwannomatosis with cystic degeneration arising from a single intercostal nerve.

  20. Transcatheter coil embolization of an intercostal artery to pulmonary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Cantasdemir, Murat; Kantarci, Fatih; Islak, Civan; Kocer, Naci; Numan, Furuzan [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University (Turkey); Saltuk, Levent [Institute of Cardiology, Cerrahpasa Medical Faculty, Istanbul University (Turkey)

    2002-02-01

    An 18-year-old asymptomatic male was found to have a high-flow systemic arterial to pulmonary arterial fistula fed by dilated lower intercostal arteries draining via pulmonary artery toward the left main pulmonary trunk. Transcatheter Guglielmi Detachable Coil (GDC; Target Ther, Fremont, Calif.) embolization was performed. Transcatheter embolization is a reasonable and less invasive mode in the treatment of systemic artery to pulmonary artery fistula, and GDC offers more precise coil placement over other conventional coils. (orig.)

  1. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation.

    Science.gov (United States)

    Hung, Ming-Hui; Hsu, Hsao-Hsun; Chan, Kuang-Cheng; Chen, Ke-Cheng; Yie, Jr-Chi; Cheng, Ya-Jung; Chen, Jin-Shing

    2014-10-01

    Thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation without endotracheal intubation is a promising technique for selected patients, but little is known about its feasibility and safety. We evaluated 109 patients with lung (105), mediastinal (3) or pleural (1) tumours treated using non-intubated thoracoscopic surgery. Internal, intercostal nerve block was performed at the T3-T8 intercostal level and vagal block was performed adjacent to the vagus nerve at the level of the lower trachea for right-sided operations and at the level of the aortopulmonary window for left-sided operations. Sedation was performed with propofol infusion to achieve a bispectral index value between 40 and 60. Thoracoscopic lobectomy was performed in 43 patients, wedge resection in 50, segmentectomy in 12 and mediastinal or pleural tumour excision in 4. Three patients (2.8%) required conversion to intubated one-lung ventilation because of vigorous mediastinal movement and dense diaphragmatic adhesions. Anaesthetic induction and operation had a median duration of 10.0 and 127.0 min, respectively. Operative complications developed in 13 patients with air leaks for more than 3 days and 1 patient required transfusion of blood products. The median postoperative chest drainage and hospital stay were 2.0 and 4.0 days, respectively. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation is technically feasible and safe in surgical treatment of lung, mediastinal and pleural tumours in selected patients. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. Comparison of external morphological traits of newborns to inner morpholical traits of the dam in the double-muscled Belgian Blue Beef breed.

    NARCIS (Netherlands)

    Coopman, F.; Gengler, N.; Groen, A.F.; Smet, de S.; Zeveren, van A.

    2004-01-01

    In the double-muscled (DM) Belgian Blue Beef (BBB) breed, caesarean section (CS) is used as a routine management tool to prevent dystocia. This practice is criticized on animal welfare grounds. With unassisted (natural) births, difficulties arise because of disproportion between the sizes of the new

  3. Improving the Odds: Intercostal Metal Coils Mark Area to Resect in Rib Lesions.

    Science.gov (United States)

    Riggs, Kyle W; Zeltsman, David; Gu, Bo; Sung, Chris C; Lobko, Igor

    Precise localization of a rib lesion for its resection remains a challenge because of multiple factors including nonpalpable pathology, unfavorable body habitus, inaccurate clinical examination, and unreliable rib count on physical examination, unfavorable lesion location within a rib (its posterior aspect), and resection of sclerotic lesions with grossly intact rib cortex. We describe a novel rib localization technique that eliminates potential mistakes and avoids resection of an inappropriate rib. Our method of rib localization includes placement of metallic coils by interventional radiologists under computed tomography guidance where two coils are deployed within the intercostal spaces, one superior and one inferior to the rib lesion. Intraoperative use of fluoroscopy results in precise localization of rib lesions even in cases where the pathology is not grossly apparent. We implemented this approach in 2014 and have since performed it in five patients for both lytic and sclerotic lesions. Placement of markers superficial to the intercostal spaces resulted in their displacement in one case. Successfully, we removed the correct ribs in each patient without technical difficulties or complications. Our series demonstrates a novel strategy for a highly accurate and relatively easy way to identify the exact portion of the rib for surgical resection. Intercostal space positioning of the coil markers superior and inferior to the lesion prevents their dislodgement during patient transport and positioning on the operating room table, which improves rib identification accuracy and reliability. When combined with intraoperative fluoroscopy, it will greatly eliminate resection of incorrect ribs.

  4. Subcapsular hematoma of the liver due to intercostal anesthesic blockage after cholecystectomy: case report.

    Science.gov (United States)

    Santos Rodrigues, A L; Silva Santana, A C; Crociati Meguins, L; Felgueiras Rolo, D; Lobato Ferreira, M; Ribeiro Braga, C A

    2009-01-01

    The subcapsular hematoma of the liver (SHL) are the results of injuries such as liver needle biopsy, liver trauma, pregnancy illnesses, parasitic diseases and others. The approach of these lesions depends on the various clinical presentations of subcapsular hematoma of the liver because it may be small with minimal clinical repercussion, managed only by ultrasound observation. In some situations the SHL may present large dimensions with hemodinamic instability. A case of subcapsular hematoma of the liver secondary to anesthetic intercostal blockade to control the postoperative pain after cholecystectomy is reported. A 34-year-old woman was submitted to intercostal anesthetic blockade after cholecystectomy for treatment of cholelithiasis. The blockade evolved with pain in right flank followed of mucocutaneous pallor and fall of the haematocrit and hemoglobin levels. At relaparotomy, subcapsular hematoma of the liver was proven and tamponed with compresses. The patient had good postoperative evolution being discharged from hospital, after removing the compresses. In conclusion, the intercostal anesthesic blockade, as any other medical procedure, is not exempt of complications. Therefore, it must be carried through in well selected cases; Anyway nowadays, there are efficient drugs for the control of postoperative pain.

  5. NERVE BLOCKING (PAIN CONTROL AFTER THORACOTOMY WITH BUPIVACAINE:EPIDURAL VS INTERCOSTAL

    Directory of Open Access Journals (Sweden)

    A GHAFOURI

    2001-09-01

    Full Text Available Introduction. Use of analgesics is an evitable and necessary part of thoracic surgery. This study was designed to compare analgesic effects of persistent thoracic epidural anesthesia versus persistent intercostal nerve block and determine their role in opioid need after thoracotomy. Methods. 116 patients above 20 years old who were candidate for thoracotomy through either posterolateral or thoracoabdominal incision were situatedin one of three group for pain relief. For the first group, pain relieved by petidine and pentazosin. In 2nd group, pain relived by thoracic epidural anesthesia with bupivacaine catheters which were inserted between costal and plural space. In 3rd group, bupivacaine was introduced through 3rd and 4th intercostal space by catheter (2 mg/kg in devided doses. Pain was meseared by visual analogue scale and quantified by surgical residents through a method bupivacaine was injected. If Bupivacaine did not relieve pain, then opioid was used as adjuvant. Results. The study showed that epidural group needed less opioids and had more cooperation in comparison with two other group. The intercostal group complained of pain at chest tube site. Discussion. In thoracotomized patients, pain control is more effective via epidural anesthesia in turns of opioid side effects, expenses and patient comfort.

  6. Intercostal Artery Reconstruction: The Simple and Effective Technique on Spinal Cord Protection during Thoracoabdominal Aortic Replacement.

    Science.gov (United States)

    Zhang, Liang; Sun, Xiao-Gang; Yu, Cun-Tao; Chang, Qian; Qian, Xiang-Yang

    2016-07-01

    To retrospectively analyze the role of intercostal artery reconstruction in the spinal cord protection for patients undergoing extensive thoracoabdominal aortic aneurysm repair. From August 2007 to 2014, thoracoabdominal aortas (Crawford II) of 81 consecutive patients with mean age 39.4 ± 10.32 years were repaired. Seventy-three of these patients (90.12%) were diagnosed with aortic dissection in our group, 25 (30.86%) with Stanford type A dissection and 48 (59.26%) with Stanford B aortic dissection. All 25 patients with type A dissection have previously undergone surgical procedures which include Bentall's procedures in 11 cases, ascending aortic replacement in 6 cases, and total aortic arch replacement in 8 cases. All procedures were performed under profound hypothermia with interval cardiac arrest after making a thoracoabdominal incision. Extracorporeal circulation was instituted with 2 arterial cannulae and a single venous cannula in the right atrium. T6-T12 intercostal arteries and L1 and L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8 mm branch or joined to the patch. The other 10 mm branches were anastomosed to iliac arteries. With 100% follow-up, early mortality was 7.4%. Six deaths were recorded; 1 patient died of cerebral hemorrhage, 3 of renal failure, 1 of heart failure because of myocardial infarction, and the last one died from the rupture of celiac artery dissection. The rate of postoperative spinal cord deficits was 3.7%, 2 patients with paraplegia and 1 patient with paraparesis. None had bladder or rectum dysfunction. Neo-intercostal arteries were clogged in 12 patients within follow-up period and formed pseudoaneurysm in 2 patients with Marfan syndrome. The mean survival time in this group was 54.22 ± 3.03

  7. Oxygenation, local muscle oxygen consumption and joint specific power in cycling: the effect of cadence at a constant external work rate.

    Science.gov (United States)

    Skovereng, Knut; Ettema, Gertjan; van Beekvelt, Mireille C P

    2016-06-01

    The present study investigates the effect of cadence on joint specific power and oxygenation and local muscle oxygen consumption in the vastus lateralis and vastus medialis in addition to the relationship between joint specific power and local muscle oxygen consumption (mVO2). Seventeen recreationally active cyclists performed 6 stages of constant load cycling using cadences of 60, 70, 80, 90, 100 and 110 rpm. Joint specific power was calculated using inverse dynamics and mVO2 and oxygenation were measured using near-infrared spectroscopy. Increasing cadence led to increased knee joint power and decreased hip joint power while the ankle joint was unaffected. Increasing cadence also led to an increased deoxygenation in both the vastus lateralis and vastus medialis. Vastus lateralis mVO2 increased when cadence was increased. No effect of cadence was found for vastus medialis mVO2. This study demonstrates a different effect of cadence on the mVO2 of the vastus lateralis and vastus medialis. The combined mVO2 of the vastus lateralis and medialis showed a linear increase with increasing knee joint specific power, demonstrating that the muscles combined related to power generated over the joint.

  8. The effect of low-dose intravenous ketamine on continuous intercostal analgesia following thoracotomy

    Directory of Open Access Journals (Sweden)

    Alexandre Yazigi

    2012-01-01

    Full Text Available Ketamine, a noncompetitive N-methyl-d-aspartate antagonist, provides analgesia and prevents chronic pain following thoracotomy. The study was aimed to assess the effect of intravenous low-dose ketamine on continuous intercostal nerve block analgesia following thoracotomy. The study was a prospective, randomized, double-blinded, and placebo-controlled clinical study, performed in a single university hospital. Sixty patients, undergoing elective lobectomy through an open posterolateral thoracotomy, were included. For postoperative pain, all patients received a continuous intercostal nerve block with bupivacaine plus intravenous paracetamol and ketoprofen. In addition, patients were randomized to have intravenous ketamine (0.1 mg/kg as a preincisional bolus followed by a continuous infusion of 0.05 mg/kg/h in group 1 or intravenous placebo in group 2. Patients reporting a visual analog scale pain score at rest ≥40 mm received intravenous morphine sulfate as rescue analgesia. The following parameters were assessed every 6 hours for 3 postoperative days: Visual analog scale pain scores at rest and during coughing, requirement of rescue analgesia with morphine, Ramsay sedation scores and psychomimetic adverse effects. Both the groups were statistically comparable regarding visual analog scale pain scores at rest (P=0.75 and during coughing (P=0.70, number of morphine deliveries (P=0.17, cumulative dose of rescue morphine (P=0.2, sedation scores (P=0.4, and psychomimetic adverse effects (P=0.09. Intravenous low-dose ketamine, when combined with continuous intercostal nerve block, did not decrease acute pain scores and supplemental morphine consumption following thoracotomy.

  9. A Single Intercostal Space Thoracoscopic Approach for Minimally Invasive Ivor Lewis Esophagectomy.

    Science.gov (United States)

    Pan, Saibo; Wang, Lian; Wu, Ming; Wang, Qi; Shen, Gang; Chen, Gang

    2017-05-15

    We present a laparoscopic and single intercostal space thoracoscopic approach (SICS group) for Ivor Lewis minimally invasive esophagectomy (MIE) and provide postoperative analgesia with a continuous multiple intercostal nerve blocking technique. The characters of this technique are evaluated. From October 2015 to April 2016, 18 consecutive patients with esophageal cancer were treated with Ivor Lewis MIE by a SICS group. Moreover, from July 2014 to September 2015, 48 patients with esophageal cancer received Ivor Lewis MIE by four-port video-assisted thoracic surgery (VATS) approach. Among those patients, by using propensity-score matching, 18 matched patients who underwent four-port VATS MIE (four-port group) were retrospectively selected for further statistical analysis. Patient demographics, short-term postoperative outcomes were recorded. None of the patients in the SICS group required conversion to an open procedure. No failure of the intrathoracic esophagogastrostomy occurred. No perioperative mortality or readmission was observed in this series. No patient suffered from anastomotic leak or complained remarkable dysphasia during follow-up. SICS group had a shorter duration of both docking procedure and closure of chest incisions compared with four-port group. The visual analog scale (VAS) pain scores on 24 hours after surgery was significantly lower in SICS group than in four-port group, while the values on 6 hours were comparable. The level of creatine kinase on postoperative day (POD) 1 was significantly lower in SICS group than in four-port group. Single intercostal space thoracoscopic procedure is safe and technically feasible and can therefore be viewed as an attractive alternative approach for performing Ivor Lewis MIE.

  10. The inframammary extending lateral intercostal artery perforator flap for reconstruction of axillary contractures: a case report.

    Science.gov (United States)

    Stillaert, F B; Casaer, B; Roche, N; Van Landuyt, K; Hamdi, M; Blondeel, P N; Monstrey, S

    2008-12-01

    Release and reconstruction of axillary scar contractures can be challenging due to the specific anatomic site and contouring of the axillary region. Pliable and unscarred skin coverage of resulting defects after scar release is needed which enhances the postoperative recovery and revalidation. When traditional donor regions of fasciocutaneous flaps are involved in the scarred area, options are few. We describe the design and versatility of an inframammary extended lateral intercostal artery perforator (LICAP) flap to reconstruct an axillary defect after wide scar release and debridement. The postoperative recovery was uneventful with restoration of the range of motion of the shoulder joint.

  11. Choosing the Access Site in Percuaneous Nephrolithotomy: Is Intercostal Approach as Safe as Subcostal?

    Directory of Open Access Journals (Sweden)

    Tarik Yonguc

    2015-11-01

    Full Text Available Aim: In this study, we aimed to compare the success and complication rates of intercostal and subcostal aproaches in percutaneous nephrolithotomy which is applied for renal stones in different locations and upper ureteral stones. Material and Method: We record retrospectively of 378 patients operated at Izmir Bozyaka Training and Research Hospital Department of Urology between January 2011-January 2015 for renal stones in different locations and upper ureteral stones. The patients were divided into two different groups according to access site. Group 1 consists of 228 patients with subcostal access and group 2 consists of 150 patients with intercostal access. Results: Mean ages of group 1 and group 2 were 48.65±12.87 and 48.57±12.91 respectively (p=0.949. Mean stone burden was not statistically significiant between the groups. Mean stone burden of group 1 and group 2 were 788.6±475.47 mm2 and 657.5±469.63 mm2 respectively (p=0.081. Mean operative time was statistically significant between the groups (p=0.042. Mean operative time was 113.84±41.34 min. in group 1 and 105.07±40.30 min. in group 2. Scopy times were 92.38±58.06 sec. in group 1 and 95.51±70.06 sec in group 2 (p=0.637. At the post-operative first day heamothocrit loss was 1.81±1.25 g/dl and 1.62±1.34 g/dl for groups 1 and 2 respectively (p=0.175. Residual fragmants were detected in 47 and 29 patients for groups 1 and 2 respectively (p=0.761. Duration of hospitalization was 4.16±2.68 days and 4.0±2.01 days (p=0.514 in groups 1 and 2 respectively. Discussion: Intercostal access is as safe as the subcostal access when the access is performed between 11 and 12th intercostal spaces according to lung complications. In this way, we determined that stone-free rates, blood losses, hospitalization and scopy durations were similar in both groups.

  12. Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers.

    Science.gov (United States)

    Bhatia, Anuj; Gofeld, Michael; Ganapathy, Sugantha; Hanlon, John; Johnson, Marjorie

    2013-01-01

    Intercostal nerve (ICN) injections are routinely performed under anatomic landmark or fluoroscopic guidance for acute and chronic pain indications. Ultrasound (US) is being used increasingly to perform ICN injections, but there is lack of evidence to support categorically the benefits of US over conventional techniques. We compared guidance with US versus anatomic landmarks for accuracy and safety of ICN injections in cadavers in a 2-phase study that included evaluation of deposition of injected dye by dissection and spread of contrast on fluoroscopy. A cadaver experiment was performed to validate US as an imaging modality for ICN blocks. In the first phase of the study, 12 ICN injections with 2 different volumes of dye were performed in 1 cadaver using anatomic landmarks on one side and US-guidance on the other (6 injections on each side). The cadaver was then dissected to evaluate spread of the dye. The second phase of the study consisted of 74 ICN injections (37 US-guided and 37 using anatomic landmarks) of contrast dye in 6 non-embalmed cadavers followed by fluoroscopy to evaluate spread of the contrast dye. In the first phase of the study, the intercostal space was identified with US at all levels. Injection of 2 mL of dye was sufficient to ensure compete staining of the ICN for 5 of 6 US-guided injections but anatomic landmark guidance resulted in correct injection at only 2 of 6 intercostal spaces. No intravascular injection was found on dissection with either of the guidance techniques. In the second phase of the study, US-guidance was associated with a higher rate of intercostal spread of 1 mL of contrast dye on fluoroscopy compared with anatomic landmarks guidance (97% vs 70%; P = 0.017). Ultrasound confers higher accuracy and allows use of lower volumes of injectate compared with anatomic landmarks as a guidance method for ICN injections in cadavers. Ultrasound may be a viable alternative to anatomic landmarks as a guidance method for ICN injections.

  13. The role of proprioceptive afferents in the control of respiratory muscles.

    Science.gov (United States)

    von Euler, C

    1973-01-01

    Building largely on the results of previous studies of motor control in respiration the role of proprioceptive control of respiratory movements is discussed with particular reference to the significance of the following points: (i) The co-activation of fusimotor and alpha motoneurons in load compensation and in the control of velocity and force of the respiratory movements. (ii) The convergence onto the same intercostal spindle of fusimotor fibres for respiratory movements and for postural activity. (iii) The difference between proprioceptive control of intercostal muscles on the one hand and the diaphragm on the other, and of the control of the phrenic motoneuron pool exerted by intercostal proprioceptors. (iv) The cerebellar control both of the fusimotor-alpha balance between the indirect drive of the intercostal motoneurons and of the responsiveness of the phrenic motoneuron pool to respiratory and reflex influences. (v) Results suggesting spinobulbar reflex effects on the control of rate and depth of respiration from muscle and joint receptors of the thoracic wall.

  14. Thoracic Intercostal Nerve Blocks Reduce Opioid Consumption and Length of Stay in Patients Undergoing Implant-Based Breast Reconstruction.

    Science.gov (United States)

    Shah, Ajul; Rowlands, Megan; Krishnan, Naveen; Patel, Anup; Ott-Young, Anke

    2015-11-01

    Traditionally, narcotics have been used for analgesia after breast surgery. However, these agents have unpleasant side effects. Intercostal nerve blockade is an alternative technique to improve postoperative pain. In this study, the authors investigate outcomes in patients who receive thoracic intercostal nerve blocks for implant-based breast reconstruction. A retrospective chart review was performed. The operative technique for breast reconstruction and administration of nerve blocks is detailed. Demographic factors, length of stay, and complications were recorded. The consumption of morphine, Valium, Zofran, and oxycodone was recorded. Data sets for patients receiving thoracic intercostal nerve blocks were compared against those that did not. One hundred thirty-two patients were included. For patients undergoing bilateral reconstruction with nerve blocks, there was a significant reduction in length of stay (1.87 days versus 2.32 days; p = 0.001), consumption of intravenous morphine (5.15 mg versus 12.68 mg; p = 0.041) and Valium (22.24 mg versus 31.13 mg; p = 0.026). For patients undergoing unilateral reconstruction with nerve blocks, there was a significant reduction in consumption of intravenous morphine (2.80 mg versus 8.17 mg; p = 0.007). For bilateral reconstruction with intercostal nerve block, cost savings equaled $2873.14 per patient. For unilateral reconstruction with intercostal nerve block, cost savings equaled $1532.34 per patient. The authors' data demonstrate a reduction in the consumption of pain medication, in the hospital length of stay, and in hospital costs for patients receiving intercostal nerve blocks at the time of pectoralis elevation for implant-based breast reconstruction. Therapeutic, III.

  15. Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods.

    Science.gov (United States)

    Kim, Min Joung; Park, Incheol; Park, Joon Min; Kim, Kyung Hwan; Park, Junseok; Shin, Dong Wun

    2017-01-01

    The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults. Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications. Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%). Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of

  16. Pneumomediastinum and the aortic nipple: the clinical relevance of the left superior intercostal vein.

    Science.gov (United States)

    Walters, Andy; Cassidy, Lindsey; Muhleman, Mitchel; Peterson, Ashley; Blaak, Christa; Loukas, Marios

    2014-07-01

    This article discusses the appearance of the "aortic nipple" in chest radiography, and reviews the embryology and anatomy of the left superior intercostal vein which causes the appearance of an "aortic nipple." This radiological sign is useful in differentiating certain thoracic pathologies, such as pneumomediastinum, pneumopericardium, and medial pneumothorax. Pneumomediastinum is an encompassing term describing the presence of air in the mediastinum, and may arise from a wide range of pathological conditions. Despite the well-described imaging of pneumomediastinum, it is sometimes difficult to differentiate from other conditions such as pneumopericardium and medial pneumothorax. A separate finding, "aortic nipple" is the radiographic term used to describe the lateral nipple-like projection from the aortic knob present in a small number of individuals. The aortic nipple corresponds to the end-on appearance of the left superior intercostal vein coursing around the aortic knob, and may be mistaken radiologically for lymphadenopathy or a neoplasm. Despite their relative independence, the aortic nipple is defined by new contours in cases of pneumomediastinum, taking on an "inverted aortic nipple" appearance. In this position, the inverted aortic nipple may facilitate radiographic discrimination of pneumomediastinum from similar conditions. This study aims to review the common clinical and radiographic features of both pneumomediastinum and the aortic nipple. The radiologic appearance of the aortic nipple occurring in unison with pneumomediastinum, and its potential role as a tool in the differentiation of pneumomediastinum from similarly presenting conditions will also be described. Copyright © 2013 Wiley Periodicals, Inc.

  17. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults.

    Science.gov (United States)

    Carson-Chahhoud, Kristin V; Wakai, Abel; van Agteren, Joseph Em; Smith, Brian J; McCabe, Grainne; Brinn, Malcolm P; O'Sullivan, Ronan

    2017-09-07

    For management of pneumothorax that occurs without underlying lung disease, also referred to as primary spontaneous pneumothorax, simple aspiration is technically easier to perform than intercostal tube drainage. In this systematic review, we seek to compare the clinical efficacy and safety of simple aspiration versus intercostal tube drainage for management of primary spontaneous pneumothorax. This review was first published in 2007 and was updated in 2017. To compare the clinical efficacy and safety of simple aspiration versus intercostal tube drainage for management of primary spontaneous pneumothorax. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1) in the Cochrane Library; MEDLINE (1966 to January 2017); and Embase (1980 to January 2017). We searched the World Health Organization (WHO) International Clinical Trials Registry for ongoing trials (August 2017). We checked the reference lists of included trials and contacted trial authors. We imposed no language restrictions. We included randomized controlled trials (RCTs) of adults 18 years of age and older with primary spontaneous pneumothorax that compared simple aspiration versus intercostal tube drainage. Two review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We combined studies using the random-effects model. Of 2332 publications obtained through the search strategy, seven studies met the inclusion criteria; one study was ongoing and six studies of 435 participants were eligible for inclusion in the updated review. Data show a significant difference in immediate success rates of procedures favouring tube drainage over simple aspiration for management of primary spontaneous pneumothorax (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.69 to 0.89; 435 participants, 6 studies; moderate-quality evidence). Duration of hospitalization however was significantly less for patients treated by simple aspiration (mean

  18. Construction of cell-containing, anisotropic, three-dimensional collagen fibril scaffolds using external vibration and their influence on smooth muscle cell phenotype modulation.

    Science.gov (United States)

    Zeng, Yao-Nan; Kang, Yi-Lin; Rau, Lih-Rou; Hsu, Fu-Yin; Tsai, Shiao-Wen

    2017-08-09

    Numerous methods have been developed for preparing guiding channels/tracks to promote the alignment of highly oriented cell types. However, these manufacture methods cannot fabricate interconnected guiding channels within three-dimensional (3D) scaffolds. Providing a suitable architectural scaffold for cell attachment could lead cells to more rapidly display a desired phenotype and perform their unique functions. Previously, we developed a simple device composed of a pneumatic membrane that can generate a tunable vibration frequency to apply physical stimulation for fabricating a 3D aligned collagen fibril matrix with the characteristic D-period structure in one step. In the present study, we aimed to evaluate the cellular responses of thoracic aortic smooth muscle cells (A7r5) incorporated during the fabrication of 3D-aligned collagen fibrils with D-periods and compared these cells with those incorporated in a 3D, randomly distributed collagen matrix and in a two-dimensional (2D) aligned substrate after up to 10 days of culture. The results consistently demonstrated that A7r5 cells cultured within the 3D and 2D anisotropic matrices were aligned. Cells cultured in the 3D aligned scaffolds exhibited a higher proliferation rate as well as higher F-actin and smoothelin expression levels compared with cells cultured in 3D randomly distributed scaffolds. Together, these results indicate that a 3D-reconstituted, anisotropic collagen matrix fabricated by our process provides synergistic effects of tension stimulation and matrix stiffness on encapsulated cells and can direct A7r5 cells to transform from a synthetic phenotype into a contractile state.

  19. Effects of tocainide and lidocaine on the transmembrane action potentials as related to external potassium and calcium concentrations in guinea-pig papillary muscles.

    Science.gov (United States)

    Oshita, S; Sada, H; Kojima, M; Ban, T

    1980-10-01

    Effects of lidocaine and tocainide on transmembrane potentials were studied in isolated guinea-pig papillary muscles, superfused with modified Tyrode's solution containing either 5.4, 2.7, 10.0 or 8.1 mmol/l potassium concentration, [K]0. The last solution applied contained either 1.8 (normal [Ca]0) or 7.2 mmol/l [Ca]0 (high [Ca]0. The concentrations of lidocaine and tocainide used were 18.5, 36.9 and 73.9 mumol/l and 43.7, 87.5 and 174.9 mumol/l in 5.4 mmol/l [K]0 solution and 36.9 and 87.5 mumol/l in the other solutions, respectively. At the driving rate of 1 Hz in 5.4 mmol/l "K]0 solution, both drugs produced dose-dependently a reduction of maximum rate of rise of action potential (Vmax), together with a prolongation of the relative refractory period. Vmax decreased progressively as the driving rate was increased from 1 Hz (for lidocaine) and from 0.25 Hz (for tocainide) to 5 Hz. This action was accentuated dose-dependently. A slow component (time constant tau = 232 ms for lidocaine, 281--303 ms for tocainide) and slower component (tau = 2.1--3.8 s for tocainide) of the recovery (reactivation) of Vmax were observed in premature responses at 0.25 Hz and in the first response after interruption of the basic driving rate at 1 Hz. All these effects were accentuated with rising [K]0 and attenuated in the high [Ca]0 solution. Both drugs abbreviated the action potential duration at 50% (APD50) and 90% (APD90) levels at 5.4, 8.1 and 10.0 mmol/l [K]0 but not at 2.7 mmol/l [K]0 nor a high [Ca]0 at 1 Hz. These [K]0-dependent effects of lidocaine on Vmax were successfully simulated by the model proposed by Hondeghem and Katzung (1977), with a slight change in parameter values. The mode of interaction of lidocaine with sodium channels in the open, closed and rested states was deduced from these results.

  20. Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: A randomized controlled trial.

    Science.gov (United States)

    Ahmed, Zulfiqar; Samad, Khalid; Ullah, Hameed

    2017-01-01

    The main advantages of video assisted thoracoscopic surgery (VATS) include less post-operative pain, rapid recovery, less postoperative complications, shorter hospital stay and early discharge. Although pain intensity is less as compared to conventional thoracotomy but still patients experience upto moderate pain postoperatively. The objective of this study was to assess the efficacy and morphine sparing effect of intercostal nerve block in alleviating immediate post-operative pain in patients undergoing VATS. Sixty ASA I-III patients, aged between 16 to 60 years, undergoing mediastinal lymph node biopsy through VATS under general anaesthesia were randomly divided into two groups. The intercostal nerve block (ICNB group) received the block along with patient control intravenous analgesia (PCIA) with morphine, while control group received only PCIA with morphine for post-operative analgesia. Patients were followed for twenty four hours post operatively for intervention of post-operative pain in the recovery room and ward. The pain was assessed using visual analogue scale (VAS) at 1, 6, 12 and 24 hours. There was a significant decrease in pain score and morphine consumption in ICNB group as compared to control group in first 6 hours postoperatively. There was no significant difference in pain scores and morphine consumption between the two groups after 6 hours. Patients receiving intercostal nerve block have better pain control and less morphine consumption as compared to those patients who did not receive intercostal nerve block in early (6 hours) post-operative period.

  1. Rare case of a strangulated intercostal flank hernia following open nephrectomy: A case report and review of literature.

    Science.gov (United States)

    Akinduro, Oluwaseun O; Jones, Frank; Turner, Jacquelyn; Cason, Frederick; Clark, Clarence

    2015-01-01

    Flank incisions may be associated with incisional flank hernias, which may progress to incarceration and strangulation. Compromised integrity of the abdominal and intercostal musculature due to previous surgery may be associated with herniation of abdominal contents into the intercostal space. There have been six previously reported cases of herniation into the intercostal space after a flank incision for a surgical procedure. This case highlights the clinical picture associated with an emergent strangulated hernia and highlights the critical steps in its management. We present a case of a 79-year-old adult man with multiple comorbidities presenting with a strangulated flank hernia secondary to an intercostal incision for a right-sided open nephrectomy. The strangulated hernia required emergent intervention including right-sided hemi-colectomy with ileostomy and mucous fistula. Abdominal incisional hernias are rare and therefore easily overlooked, but may result in significant morbidity or even death in the patient.. The diagnosis can be made with a thorough clinical examination and ultrasound or computed topographical investigation. Once a hernia has become incarcerated, emergent surgical management is necessary to avoid strangulation and small bowel obstruction. Urgent diagnosis and treatment of this extremely rare hernia is paramount especially in the setting of strangulation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Postoperative pain management in pediatric patients undergoing minimally invasive repair of pectus excavatum: the role of intercostal block.

    Science.gov (United States)

    Lukosiene, Laura; Rugyte, Danguole Ceslava; Macas, Andrius; Kalibatiene, Lina; Malcius, Dalius; Barauskas, Vidmantas

    2013-12-01

    There are no published data regarding value of intercostal block following pectus excavatum repair. Our aim was to evaluate the efficacy of intercostal block in children following minimally invasive repair of pectus excavatum (MIRPE). Forty-five patients given patient-controlled analgesia (PCA) with morphine postoperatively were studied. Twenty-six patients were given bilateral intercostal blocks after induction of anesthesia (PCA-IB group), and nineteen patients were retrospective controls without regional blockade (PCA group). All patients were followed up 24 h postoperatively. A loading dose of morphine (0,1±0,49 mg/kg) before starting PCA was used in seventeen patients in PCA group vs. no patient in PCA-IB group. Cumulative used morphine doses were lower up to 12 h after surgery in PCA-IB group (0,29±0,08 μg/kg) than in the PCA group (0,46±0,18 μg/kg), pintercostal blocks were observed. Bilateral intercostal blocks following MIRPE are safe and easy to perform and can diminish postoperative opioid requirement. Double-blind randomized study is required to confirm the potential to diminish opioid related side effects. © 2013 Elsevier Inc. All rights reserved.

  3. 'Aorta-in-aorta' sign on chest radiograph representing enlarged left superior intercostal and hemiazygos veins

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Yon Mi; Lee, Kyung Soo; Kim, Tae Sung [School of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of)

    2002-06-01

    We recently encountered a patient with membranous obstruction of the inferior vena cava in whom the left superior intercostal and hemiazygos veins were dilated. At chest radiography, the dilation simulated the presence of a second aortic knob and descending thoracic aorta lateral to the originals, and an 'aorta-in-aorta' appearance was thus created.

  4. Comparison between partial ulnar and intercostal nerve transfers for reconstructing elbow flexion in patients with upper brachial plexus injuries.

    Science.gov (United States)

    Kakinoki, Ryosuke; Ikeguchi, Ryosuke; Dunkan, Scott Fm; Nakayama, Ken; Matsumoto, Taiichi; Ohta, Soichi; Nakamura, Takashi

    2010-01-26

    There have been several reports that partial ulnar transfer (PUNT) is preferable for reconstructing elbow flexion in patients with upper brachial plexus injuries (BPIs) compared with intercostal nerve transfer (ICNT). The purpose of this study was to compare the recovery of elbow flexion between patients subjected to PUNT and patients subjected to ICNT. Sixteen patients (13 men and three women) with BPIs for whom PUNT (eight patients) or ICNT (eight patients) had been performed to restore elbow flexion function were studied. The time required in obtaining M1, M3 (Medical Research Council scale grades recovery) for elbow flexion and a full range of elbow joint movement against gravity with the wrist and fingers extended maximally and the outcomes of a manual muscle test (MMT) for elbow flexion were examined in both groups. There were no significant differences between the PUNT and ICNT groups in terms of the age of patients at the time of surgery or the interval between injury and surgery. There were significantly more injured nerve roots in the ICNT group (mean 3.6) than in the PUNT group (mean 2.1) (P = 0.0006). The times required to obtain grades M1 and M3 in elbow flexion were significantly shorter in the PUNT group than in the ICNT group (P = 0.04 for M1 and P = 0.002 for M3). However, there was no significant difference between the two groups in the time required to obtain full flexion of the elbow joint with maximally extended fingers and wrist or in the final MMT scores for elbow flexion. PUNT is technically easy, not associated with significant complications, and provides rapid recovery of the elbow flexion. However, separation of elbow flexion from finger and wrist motions needed more time in the PUNT group than in the ICNT group. Although the final mean MMT score for elbow flexion in the PUNT group was greater than in the ICNT group, no statistically significant difference was found between the two groups.

  5. Comparison between partial ulnar and intercostal nerve transfers for reconstructing elbow flexion in patients with upper brachial plexus injuries

    Directory of Open Access Journals (Sweden)

    Matsumoto Taiichi

    2010-01-01

    Full Text Available Abstract Background There have been several reports that partial ulnar transfer (PUNT is preferable for reconstructing elbow flexion in patients with upper brachial plexus injuries (BPIs compared with intercostal nerve transfer (ICNT. The purpose of this study was to compare the recovery of elbow flexion between patients subjected to PUNT and patients subjected to ICNT. Methods Sixteen patients (13 men and three women with BPIs for whom PUNT (eight patients or ICNT (eight patients had been performed to restore elbow flexion function were studied. The time required in obtaining M1, M3 (Medical Research Council scale grades recovery for elbow flexion and a full range of elbow joint movement against gravity with the wrist and fingers extended maximally and the outcomes of a manual muscle test (MMT for elbow flexion were examined in both groups. Results There were no significant differences between the PUNT and ICNT groups in terms of the age of patients at the time of surgery or the interval between injury and surgery. There were significantly more injured nerve roots in the ICNT group (mean 3.6 than in the PUNT group (mean 2.1 (P = 0.0006. The times required to obtain grades M1 and M3 in elbow flexion were significantly shorter in the PUNT group than in the ICNT group (P = 0.04 for M1 and P = 0.002 for M3. However, there was no significant difference between the two groups in the time required to obtain full flexion of the elbow joint with maximally extended fingers and wrist or in the final MMT scores for elbow flexion. Conclusions PUNT is technically easy, not associated with significant complications, and provides rapid recovery of the elbow flexion. However, separation of elbow flexion from finger and wrist motions needed more time in the PUNT group than in the ICNT group. Although the final mean MMT score for elbow flexion in the PUNT group was greater than in the ICNT group, no statistically significant difference was found between the two

  6. Effectiveness of intercostal nerve block for management of pain in rib fracture patients.

    Science.gov (United States)

    Hwang, Eun Gu; Lee, Yunjung

    2014-08-01

    Controlling pain in patients with fractured ribs is essential for preventing secondary complications. Conventional medications that are administered orally or by using injections are sufficient for the treatment of most patients. However, additional aggressive pain control measures are needed for patients whose pain cannot be controlled effectively as well as for those in whom complications or a transition to chronic pain needs to be prevented. In this study, we retrospectively analyzed the medical records of patients in our hospital to identify the efficacy and characteristics of intercostal nerve block (ICNB), as a pain control method for rib fractures. Although ICNB, compared to conventional methods, showed dramatic pain reduction immediately after the procedure, the pain control effects decreased over time. These findings suggest that the use of additional pain control methods (e.g. intravenous patient-controlled analgesia and/or a fentanyl patch) is recommended for patients in who the pain level increases as the ICNB efficacy decreases.

  7. Intercostal myositis ossificans misdiagnosed as osteosarcoma in a 10-year-old child

    Energy Technology Data Exchange (ETDEWEB)

    Koob, Meriam; Durckel, Jean; Dosch, Jean-Claude; Dietemann, Jean-Louis [Hopital de Hautepierre, Service de Radiologie II, Hopitaux Universitaires, Strasbourg Cedex (France); Entz-Werle, Natacha [Hopitaux Universitaires, Hopital de Hautepierre, Service d' Onco-hematologie pediatrique, Strasbourg Cedex (France)

    2010-12-15

    Myositis ossificans (MO) is a rare benign cause of heterotopic bone formation within soft tissue. It most commonly affects adolescents and young adults, typically in the limbs and following trauma. Very few cases have been reported in children. We report here a case of nontraumatic MO occurring in a 10-year-old girl with an uncommon location in the 5th right intercostal space; it was initially misdiagnosed and treated as osteosarcoma. Imaging findings including plain radiographs, CT, MRI, bone scintigraphy and PET-CT are described. This case highlights the central role played by imaging in diagnosis, thus avoiding biopsy that can erroneously suggest osteosarcoma as the diagnosis, as occurred in this case. (orig.)

  8. Intercostal thoracotomy closure: transcostal sutures as a less painful alternative to circumcostal suture placement.

    Science.gov (United States)

    Rooney, Matthew B; Mehl, Margo; Monnet, Eric

    2004-01-01

    To determine if transcostal thoracotomy closure resulted in less pain than circumcostal closure. Experimental cadaver and prospective clinical study. Two canine cadavers and 13 adult, 22-29 kg dogs. Phase 1: In 2 cadavers, 4 suture passage techniques were evaluated to determine the incidence of nerve entrapment in circumcostal intercostal thoracotomy closure. Phase 2: Pain after circumcostal closure (7 dogs) or transcostal closure (6 dogs) of a 4th intercostal space thoracotomy was evaluated by use of pain threshold scores, fentanyl administration rates, heart and respiratory rates, and numerical ratings for behavior. Arterial blood gas analyses were obtained 4 hours postoperatively. Transcostal closure was accomplished by drilling 5-6 small holes in the 5th rib and passing sutures through the holes and around the 4th rib to achieve closure. Pain threshold scores (PTS) were measured by an observer unaware of closure assignment, at 2, 4, 12, and 24 hours after closure by applying slowly increasing pressure to the incision line using a load cell. Rates of fentanyl administration were adjusted based on subjective impressions of dog comfort by a second observer unaware of closure assignment. A 70-100% incidence of nerve entrapment was found for all circumcostal techniques. PTS was higher (P=.045) and fentanyl infusion rates were lower (P=.001) for the transcostal group at 2, 4, 12, and 24 hour postoperatively compared with the circumcostal group. There is a high incidence of nerve entrapment using circumcostal closure techniques. A transcostal technique appears to be associated with less pain during the first 24 hours postoperatively. Based on lower pain scores, transcostal thoracotomy closure may be preferable to circumcostal closure techniques.

  9. Double muscle transfer for upper extremity reconstruction following complete avulsion of the brachial plexus.

    Science.gov (United States)

    Doi, K; Kuwata, N; Muramatsu, K; Hottori, Y; Kawai, S

    1999-11-01

    Recent interest in reconstruction of the upper limb following brachial plexus injuries has focused on the restoration of prehension following complete avulsion of the brachial plexus. The authors use free muscle transfers for reconstruction of the upper limb to resolve the difficult problems in complete avulsion of the brachial plexus. This article describes the authors' updated technique--the double free muscle procedure. Reconstruction of prehension to achieve independent voluntary finger and elbow flexion and extension by the use of double free muscle and multiple nerve transfers following complete avulsion of the brachial plexus (nerve roots C5 to T1) is presented. The procedure involves transferring the first free muscle, neurotized by the spinal accessory nerve for elbow flexion and finger extension, a second free muscle transfer reinnervated by the fifth and sixth intercostal nerves for finger flexion, and neurotization of the triceps brachii via its motor nerve by the third and fourth intercostal motor nerves to extend and stabilize the elbow. Restoration of hand sensibility is obtained via the suturing of sensory rami from the intercostal nerves to the median nerve. Secondary reconstruction, including arthrodesis of the carpometacarpal joint of the thumb and glenohumeral joint, and tenolysis of the transferred muscle and distal tendons, improve the functional outcome. Based on the long-term result, selection of the patient, donor muscle, and donor motor nerve were indicated. Most patients were able to achieve prehensile functions such as holding a can and lifting a heavy box. This double free muscle transfer has provided prehension for patients with complete avulsion of the brachial plexus and has given them new hope to be able to use their otherwise useless limbs.

  10. Free muscle transfer in posttraumatic plexopathies: part III. The hand.

    Science.gov (United States)

    Terzis, Julia K; Kostopoulos, Vasileios K

    2009-10-01

    In lower root avulsion plexopathies, free muscle transfers for hand reanimation provide the only hope for the paralyzed hand, as the outcomes of hand functional restoration after primary brachial plexus reconstruction are uniformly poor. The purpose of this study was to analyze the outcomes of free gracilis muscle transfers for hand reanimation in severe brachial plexus injuries in relation to the respective motor donors. Since 1981, 71 free gracilis muscles have been transplanted for hand reanimation. Thirty-eight were for finger flexion and 33 were for finger extension. Neurotizations included motor donors such as intercostal nerves (n = 29), contralateral C7 root (n = 28), spinal accessory nerve (n = 7), or upper roots of the ipsilateral plexus (n = 5). Preoperative and postoperative muscle grading and range of motion were found to be significantly different. The strongest motor donor for finger extension was the distal spinal accessory. The medial antebrachial cutaneous nerve as a conduit nerve carrying motor axons yielded worse results than other motor donors. Intercostals were useful for finger flexion and the contralateral C7 root was useful for finger extension. Scar formation in the volar wrist area was frequently a problem. After securing the stability and function of the proximal joints of the upper limb, attention should be shifted to the hand, and in compliant patients with supple finger joints, hand reanimation should be attempted. It is only through these efforts that the future of the paralytic limb can be upgraded to a useful assist extremity.

  11. Reconstruction of Anal External Sphincter Complex by Free Autogenous Double Palmalis Longus Muscle Transplantation for Fecal Incontinence%自体双侧掌长肌游离移植肛门括约肌复合体重建术治疗小儿肛门失禁

    Institute of Scientific and Technical Information of China (English)

    刘贵林; 马承宣; 高艳华

    1986-01-01

    @@ 自从Stephens~(1)确立耻骨直肠肌在控制排便中的作用之后,许多作者~(2~4)设计出旨在替代耻骨直肠肌的手术方法,以治疗直肠肛门发育不全术后并发的肛门失禁.1978年Hakelius首先应用自体掌长肌游离移植耻骨直肠肌成形术治疗小儿肛门失禁获得成功~(4).%In this paper we present a new technique for anal incontinence in children.The proce dure which entails simultaneous free transplan tation of autogenous double palmalis longus muscles consists of two steps:the double palmalis longus denervation and the muscle free transplantation.The denervated muscles are transplanted two weeks later,as a sling around the rectum,immitating position and function of top loop and intermediate loop of external sphincter complex.The contraction of the top transplanted muscle can draw the posterior anal wall toward the anterior and contraction of the intermediate loop sling draws the ante rior wall posteriorly.The transplanted muscles are voluntary muscles which get fatigued easily.The double muscles affect an anal occlusion not only by direct compression but also by"kinking mechanism"which contributes to a rapid and tight closure of tubular structures with thel east muscular energy.The loop arrangement can provide the muscles with maximal efficiency necessary for its func tional performance.From 1984 to 1985 we performed this procedure in five cases of fecal incontinence in children.We believe that this modified procedure is better than single muscle trans plantation.

  12. Spontaneous hemothorax caused by rupture of an intercostal artery aneurysm in neurofibromatosis Type I: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Chang Min; Na, Jae Beom; You, Jin Jong; Chung, Sung Hoon [Gyeongsang National Univ. College of Medicine, Pusan (Korea, Republic of)

    2001-01-01

    Neurofibromatosis type I (NF-1) is the most common neurocutaneous syndrome. Associated vascular abnormalities are arterial occlusion, aneurysm, ectasia and arteriovenous malformation. Spontaneous massive hemothorax due to rupture of an arterial aneurysm is rare but fatal. It is, therefore, essential to determine the location of an aneurysm and provide immediate surgical or the interventional treatment. We report a case of spotaneous hemothorax caused by rupture of an intercostal arterial aneurysm diagnosed by CT and angiography.

  13. Intercostal Neuralgia Occurring as a Complication of Splanchnic Nerve Radiofrequency Ablation in a Patient with Chronic Pancreatitis.

    Science.gov (United States)

    Tewari, Saipriya; Agarwal, Anil; Gautam, Sujeet K; Madabushi, Rajashree

    2017-07-01

    Our intent is to report a case of intercostal neuralgia occuring as a complication of splanchnic radiofreqency ablation (RFA), due to a breach in the integrity of the insulating sheath of the RFA needle.A 48-year-old man presented to our pain clinic with upper abdominal pain due to chronic pancreatitis, recalcitrant to medical management. We decided to perform bilateral splanchnic nerve RFA in this patient. After confirmation of bilateral correct needle placement under fluoroscopic guidance and sensorimotor testing, RFA was performed on the right side uneventfully. However, during RFA on the left side, the patient experienced severe pain in the epigastric region. A bolus of fentanyl 50 µg was given intravenously in order to minimise discomfort, and RFA was performed. In the post-procedure period, the patient described severe pain in the left subcostal and epigastric region, with features suggestive of intercostal neuralgia of the left 11th intercostal nerve. We went back and analysed all the fluoroscopic images again. Convinced of correct needle placement, we examined the RFA needles which had been used for ablation in this patient. One of the needles was discovered to have a fine breach in its insulating sheath, at a distance of approximately 30 mm from the active tip. It is of utmost importance for all interventional pain physicians to perform a thorough pre-use check of the equipment prior to any RFA procedure, with special emphasis on ensuring the integrity of the insulating sheath of the needles which are to be used, in order to prevent injury of non target nerves. Splanchnic nerve block, radiofrequency ablation, intercostal neuralgia, radiofrequency ablation complications, radiofrequency equipment check, radiofrequency needle.

  14. Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures.

    Science.gov (United States)

    Hashemzadeh, Shahryar; Hashemzadeh, Khosrov; Hosseinzadeh, Hamzeh; Aligholipour Maleki, Raheleh; Golzari, Samad E J; Golzari, Samad

    2011-01-01

    Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may require such high dose that they produce respiratory depression, especially in elderly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or intercostal block with 0.25% bupivacaine. The patients were assessed through ICU and hospital stay length, ventilation function tests. Pain score among the patients was measured with verbal rating scale, before and after administration of the analgesia. We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P pain at rest and pain caused by coughing and deep breathing in group A compared group B... ICU and hospital stay markedly reduced in Group A. thoracic epidural analgesia is superior to intercostals block regarding pain relief of rib fractures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

  15. Comparison of postoperative pain relief by intercostal block between pre-rib harvest and post-rib harvest groups.

    Science.gov (United States)

    Bashir, Muhammad Mustehsan; Shahzad, Muhammad Ateeq; Yousaf, Muhammad Nadeem; Khan, Bilal Ahmad; Khan, Farid Ahmad

    2014-01-01

    To compare intercostal nerve block before and after rib harvest in terms of mean postoperative pain score and mean postoperative tramadol usage. Randomized controlled trial. Department of Plastic Surgery, Mayo Hospital, KEMU, Lahore, from January 2011 to July 2012. Patients (n = 120) of either gender with ASA class-I and II requiring autogenous costal cartilage graft were inducted. Patients having history of local anaesthetic hypersensitivity and age 60 years were excluded. Subjects were randomly assigned to pre-rib harvest (group-1) and post-rib harvest (group-2). Local anaesthetic mixture was prepared by adding 10 milliliters 2% lidocaine to 10 milliliters 0.5% bupivacaine to obtain a total 20 ml solution. Group-1 received local anaesthetic infiltration along the proposed incision lines and intercostals block before the rib harvest. Group-2 received the infiltration and block after rib harvest. Postoperative consumption of tramadol and pain scores were measured at 6 and 12 hours postoperatively using VAS. Mean age was 31.43 ± 10.78 years. The mean pain scores at 6 hours postoperatively were 1.033 ± 0.609 and 2.4667 ± 0.812 in pre-rib harvest and post-rib harvest groups respectively (p Intercostal block administered before rib harvest as preemptive strategy result in decreased postoperative pain scores and narcotic use.

  16. Ultrasound-Guided Radiofrequency Treatment of Intercostal Nerves for the Prevention of Incidental Pain Arising Due to Rib Metastasis.

    Science.gov (United States)

    Ahmed, Arif; Bhatnagar, Sushma; Khurana, Deepa; Joshi, Saurabh; Thulkar, Sanjay

    2017-03-01

    Breakthrough pain (BTP) arising due to rib metastasis is very distressing and often very difficult to manage by titration of traditional analgesics. This study is undertaken to determine the efficacy of radiofrequency (RF) treatment of intercostal nerves for the prevention of BTP. The RF treatment of the intercostal nerves was carried out in 25 patients with uncontrolled BTP arising out of the rib metastasis. The intensity and episode of BTP, background pain, opioid dose, functional status (Karnofky score), and quality of life (Short-Form Health Survey [SF-36]) were noted at baseline visit and subsequently after the RF treatment. After the RF treatment, there was more than 50% decrease in both intensity and frequency of BTP in more than 50% of patients for 3 months, and there was more than 50% decrease in BTP opioid dose in more than 50% of patients throughout the study period. There was also significant improvement in background pain, functional status, and the quality of life after the RF. Interestingly, pain relief, lowering of opioid dose, and functional status improvement were found mostly in patients with mixed and neuropathic type of pain and in patients in whom the metastasis were confined to the ribs only. RF of the intercostal nerves is effective in preventing and deceasing the severity of BTP arising due to rib metastasis in selected group of patients with mixed and neuropathic type of pain and with the metastasis involving the ribs only.

  17. Near-infrared spectroscopy and indocyanine green derived blood flow index for noninvasive measurement of muscle perfusion during exercise.

    Science.gov (United States)

    Habazettl, Helmut; Athanasopoulos, Dimitris; Kuebler, Wolfgang M; Wagner, Harrieth; Roussos, Charis; Wagner, Peter D; Ungruhe, Juergen; Zakynthinos, Spyros; Vogiatzis, Ioannis

    2010-04-01

    Near-infrared spectroscopy (NIRS) with the tracer indocyanine green (ICG) may be used for measuring muscle blood flow (MBF) during exercise, if arterial ICG concentration is measured simultaneously. Although pulse dye densitometry allows for noninvasive measurement of arterial dye concentration, this technique is sensitive to motion and may not be applicable during exercise. The aim of this study was to evaluate a noninvasive blood flow index (BFI), which is derived solely from the muscle ICG concentration curve. In 10 male cyclists 5 mg ICG were injected into an antecubital vein at rest and during cycling at 30, 60, 70, 80, 90, and 100% of previously determined maximal work load. Simultaneously blood was withdrawn through a photodensitometer at 20 ml/min from the radial artery to measure arterial ICG concentration. To measure muscle tissue ICG concentrations, two sets of NIRS optodes were positioned on the skin, one over the left seventh intercostal space and the other over the left vastus lateralis muscle. MBF was calculated from the arterial and muscle concentration data according to Fick's principle. BFI was calculated solely from the muscle concentration curve as ICG concentration difference divided by rise time between 10 and 90% of peak. During exercise mean BFI values changed similarly to MBF in both intercostal and quadriceps muscles and showed excellent correlations with MBF: r = 0.98 and 0.96, respectively. Individual data showed some scattering among BFI and MBF values but still reasonable correlations of BFI with MBF: r = 0.73 and 0.72 for intercostal and quadriceps muscles, respectively. Interobserver variability, as analyzed by Bland-Altman plots, was considerably less for BFI than MBF. These data suggest that BFI can be used for measuring changes in muscle perfusion from rest to maximal exercise. Although absolute blood flow cannot be determined, BFI has the advantages of being essentially noninvasive and having low interobserver variability.

  18. Intercostal high intensity focused ultrasound for liver ablation: The influence of beam shaping on sonication efficacy and near-field risks

    Energy Technology Data Exchange (ETDEWEB)

    Greef, M. de, E-mail: m.degreef@umcutrecht.nl; Wijlemans, J. W.; Bartels, L. W.; Moonen, C. T. W.; Ries, M. [Imaging Division, University Medical Center Utrecht, Utrecht 3508GA (Netherlands); Schubert, G.; Koskela, J. [Philips Healthcare, Vantaa FI-01511 (Finland)

    2015-08-15

    Purpose: One of the major issues in high intensity focused ultrasound ablation of abdominal lesions is obstruction of the ultrasound beam by the thoracic cage. Beam shaping strategies have been shown by several authors to increase focal point intensity while limiting rib exposure. However, as rib obstruction leaves only part of the aperture available for energy transmission, conserving total emitted acoustic power, the intensity in the near-field tissues inherently increases after beam shaping. Despite of effective rib sparing, those tissues are therefore subjected to increased risk of thermal damage. In this study, for a number of clinically representative intercostal sonication geometries, modeling clinically available hardware, the effect of beam shaping on both the exposure of the ribs and near-field to acoustic energy was evaluated and the implications for the volumetric ablation rate were addressed. Methods: A relationship between rib temperature rise and acoustic energy density was established by means of in vivo MR thermometry and simulations of the incident acoustic energy for the corresponding anatomies. This relationship was used for interpretation of rib exposure in subsequent numerical simulations in which rib spacing, focal point placement, and the focal point trajectory were varied. The time required to heat a targeted region to 65 °C was determined without and with the application of beam shaping. The required sonication time was used to calculate the acoustic energy density at the fat–muscle interface and at the surface of the ribs. At the fat–muscle interface, exposure was compared to available literature data and rib exposure was interpreted based on the earlier obtained relation between measured temperature rise and simulated acoustic energy density. To estimate the volumetric ablation rate, the cool-down time between periods of energy exposure was estimated using a time-averaged power limit of 100 kJ/h. Results: At the level of the ribs

  19. Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter.

    Science.gov (United States)

    Wildgaard, Kim; Petersen, Rene H; Hansen, Henrik J; Møller-Sørensen, Hasse; Ringsted, Thomas K; Kehlet, Henrik

    2012-05-01

    No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area. Prospective observational cohort. Forty-eight consecutive patients received a standardized regimen consisting of paracetamol, non-steroidal anti-inflammatory drug and gabapentin. Further, surgeons performed a single-shot paravertebral block (PVB) at five levels (15 ml of 0.5% bupivacaine) and inserted an ICC at the drain site level for continuous delivery of 6 ml of 0.25% bupivacaine h(-1). Pain scores at rest, mobilization and with the extended arms were followed until discharge or for 4 days. Forty-eight patients, mean age 64 years (CI: 61-68), were included. The mean time for the PVB and ICC placement was 5 min (CI: 4.7-5.9). The mean pain score at rest using a numerical rating scale (NRS, 0-10) was 85% of patients reporting satisfactory or very satisfactory pain treatment all days. Acute pain after VATS lobectomy may be adequately controlled using a multimodal non-opioid regime including PVB and an ICC. The low pain scores and reduced time used inserting the ICC may present an alternative to continuous epidural analgesia or conventional PVB.

  20. Versatility of lateral cutaneous branches of intercostal vessels and nerves: anatomical study and clinical application.

    Science.gov (United States)

    Iida, Takuya; Narushima, Mitsunaga; Yoshimatsu, Hidehiko; Mihara, Makoto; Kikuchi, Kazuki; Hara, Hisako; Yamamoto, Takumi; Araki, Jun; Koshima, Isao

    2013-11-01

    The use of the intercostal artery perforator (ICAP) flap has recently become popular in reconstructions of the breast, upper arm and trunk. Lateral cutaneous branches (LCBs) are a group of the ICAPs that penetrate the fascia near the middle axillary line. However, reports on its precise anatomy and clinical applications are quite limited. We performed an anatomical study of LCBs using cadavers. Based on the findings, we developed novel clinical application methods as follows: (1) sensate superficial circumflex iliac perforator (SCIP) flap, (2) supercharged SCIP flap, (3) ICAP-based propeller flap (IBPF) and (4) free ICAP flap based on LCB. LCBs have the following advantages: (1) Long pedicles can be obtained in the supine position without risk of pneumothorax. (2) The neurovascular bundle is consistently available, allowing elevation of sensate flaps. (3) Donor-site morbidity is low. Therefore, we believe that LCBs offer a versatile option in reconstructive surgery. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. External Otitis (Swimmer's Ear)

    Science.gov (United States)

    ... to Pneumococcal Vaccine Additional Content Medical News External Otitis (Swimmer's Ear) By Bradley W. Kesser, MD, Associate ... the Outer Ear Ear Blockages Ear Tumors External Otitis (Swimmer's Ear) Malignant External Otitis Perichondritis External otitis ...

  2. Electrical muscle stimulation for deep stabilizing muscles in abdominal wall.

    Science.gov (United States)

    Coghlan, Simon; Crowe, Louis; McCarthyPersson, Ulrik; Minogue, Conor; Caulfield, Brian

    2008-01-01

    Low back pain is associated with dysfunction in recruitment of muscles in the lumbopelvic region. Effective rehabilitation requires preferential activation of deep stabilizing muscle groups. This study was carried out in order to quantify the response of deep stabilizing muscles (transverses abdominis) and superficial muscle in the abdominal wall (external oblique) to electrical muscle stimulation (EMS). Results demonstrate that EMS can preferentially stimulate contractions in the deep stabilizers and may have significant potential as a therapeutic intervention in this area, pending further refinements to the technology.

  3. Significance of elbow extension in reconstruction of prehension with reinnervated free-muscle transfer following complete brachial plexus avulsion.

    Science.gov (United States)

    Doi, K; Shigetomi, M; Kaneko, K; Soo-Heong, T; Hiura, Y; Hattori, Y; Kawakami, F

    1997-08-01

    Thirty-one patients with complete avulsion of the brachial plexus underwent reconstruction of elbow extension by intercostal nerve transfer following reconstruction of prehension with either a single or double free-muscle transfer. Long-term results of elbow extension were evaluated in 24 patients. Reinnervation of the triceps muscle took longer than that of the transferred muscle on serial electromyographic examinations, and the eventual strength of the triceps muscle was weak. None attained M5 grade, 2 achieved M4 grade, 4 achieved M3 grade, 8 achieved M2 grade, 5 achieved M1 grade, and another 5 achieved M0 grade. However, despite the weak recovery, 14 patients were able to obtain useful functional recovery of the triceps muscle, enabling it to stabilize the elbow joint against the transferred muscle, which acted as simultaneous elbow flexor and wrist or finger extensor. Elbow stability is imperative in order to obtain voluntary finger function following free-muscle transfer. Should the triceps muscle fail to recover following intercostal nerves neurotization, transferring the reinnervated infraspinatus to the triceps is an optional procedure to provide stabilization of the elbow.

  4. The reins of the soul: the centrality of the intercostal nerves to the neurology of Thomas Willis and to Samuel Parker's theology.

    Science.gov (United States)

    Knoeff, Rina

    2004-07-01

    Thomas Willis's description of the intercostal nerves has not received much attention by historians of medicine. Yet the intercostal nerves are of paramount importance for his neurology. Willis explained that via these nerves, which connect the brain to the heart and lower viscera, the brain controls the passions and instincts of the lower body. In other words, Willis believed that the intercostal nerves mediate a kind of rationality and that therefore they make a human a rational being. Willis's theory, I argue, must be seen in the context of the early modern mind-body problem. In the second part of the article I discuss how Oxford theologian Samuel Parker took up Willis's argument while stating that the intercostal nerves are the most important instruments (reins) of the soul. They control the bodily passions so that humans can transform into more virtuous beings. The explanation of the intercostal nerves offered by Willis and Parker fits the Anglican optimism about the abilities of human reason as well as about the moral potential of humankind.

  5. The presence of disease-associated prion protein in skeletal muscle of cattle infected with classical bovine spongiform encephalopathy.

    Science.gov (United States)

    Okada, Hiroyuki; Miyazawa, Kohtaro; Fukuda, Shigeo; Iwamaru, Yoshifumi; Imamura, Morikazu; Masujin, Kentaro; Matsuura, Yuichi; Fujii, Takashi; Fujii, Kei; Kageyama, Soichi; Yoshioka, Miyako; Murayama, Yuichi; Yokoyama, Takashi

    2014-01-01

    The aim of this study was to investigate the presence of disease-associated prion protein (PrP(Sc)) in the skeletal muscle of cattle infected with classical bovine spongiform encephalopathy (C-BSE). The study was carried out systematically in 12 different muscle samples from 43 (3 field and 40 experimental) cases of C-BSE; however, muscle spindles were not available in many of these cases. Therefore, analysis became restricted to a total of 31 muscles in 23 cattle. Even after this restriction, low levels of PrP(Sc) were detected in the muscle spindles of the masseter, intercostal, triceps brachii, psoas major, quadriceps femoris and semitendinosus muscles from 3 field and 6 experimental clinical-stage cases. The present data indicate that small amounts of PrP(Sc) are detectable by immunohistochemistry in the skeletal muscles of animals terminally affected with C-BSE.

  6. Muscle Disorders

    Science.gov (United States)

    Your muscles help you move and help your body work. Different types of muscles have different jobs. There are many problems that can affect muscles. Muscle disorders can cause weakness, pain or even ...

  7. Muscle Cramps

    Science.gov (United States)

    Muscle cramps are sudden, involuntary contractions or spasms in one or more of your muscles. They often occur ... minutes. It is a very common muscle problem. Muscle cramps can be caused by nerves that malfunction. Sometimes ...

  8. Onion artificial muscles

    Science.gov (United States)

    Chen, Chien-Chun; Shih, Wen-Pin; Chang, Pei-Zen; Lai, Hsi-Mei; Chang, Shing-Yun; Huang, Pin-Chun; Jeng, Huai-An

    2015-05-01

    Artificial muscles are soft actuators with the capability of either bending or contraction/elongation subjected to external stimulation. However, there are currently no artificial muscles that can accomplish these actions simultaneously. We found that the single layered, latticed microstructure of onion epidermal cells after acid treatment became elastic and could simultaneously stretch and bend when an electric field was applied. By modulating the magnitude of the voltage, the artificial muscle made of onion epidermal cells would deflect in opposing directions while either contracting or elongating. At voltages of 0-50 V, the artificial muscle elongated and had a maximum deflection of -30 μm; at voltages of 50-1000 V, the artificial muscle contracted and deflected 1.0 mm. The maximum force response is 20 μN at 1000 V.

  9. Hérnia intercostal transdiafragmática após fratura espontânea de costelas secundária à crise de tosse Transdiaphragmatic intercostal hernia after spontaneous rib fractures secondary to coughing fit

    Directory of Open Access Journals (Sweden)

    Alexandre Cruz Henriques

    2010-02-01

    Full Text Available One case of transdiafragmatic intercostal hernia after intense coughing fit followed by rib fractures in patient with history of pneumonia is presented. He had a severe coughing fit, developed a right toracoabdominal hematoma and then a tumor that was gradually enlarging. Image exams confirmed the diagnosis. Treatment consisted of surgical repair with the use of a polypropylene prosthetic mesh. It is a rare type of hernia. Only four cases were found in literature. The sooner the disease is diagnosed and treated the better the prognoses will be since it will prevent hernia from strangulation and incarceration.

  10. Imaging findings in external snapping hip syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Krishnamurthy, Ganesh; Connolly, Bairbre L. [The Hospital for Sick Children, Image Guided Therapy, Diagnostic Imaging, Toronto (Canada); Narayanan, Unni [The Hospital for Sick Children, Pediatric Orthopedic Surgery, Toronto (Canada); Babyn, Paul S. [The Hospital for Sick Children, Diagnostic Imaging, Toronto (Canada)

    2007-12-15

    We describe a case of external snapping hip diagnosed by dynamic sonography. The case prompted us to retrospectively review the imaging findings of children who clinically had presented with snapping hip. From this review we identified the features on MRI and CT of either thickening of the iliotibial band or thickening of the anterior edge of the gluteus maximus muscle as the cause of snapping and atrophy of the bulk of gluteus maximus muscle as an important secondary sign associated with snapping. (orig.)

  11. Motor evoked potentials of the respiratory muscles in tetraplegic patients.

    Science.gov (United States)

    Lissens, M A; Vanderstraeten, G G

    1996-11-01

    We studied the respiratory muscles with magnetic transcranial stimulation (TCS) in four spinal cord injured (SCI) patients as compared to age-matched controls from a database of 40 healthy subjects. These SCI patients all had spinal cord lesions above C6 level with a clinically incomplete tetraplegia. One patient was artificially ventilated. Motor evoked potentials (MEPs) were recorded from the diaphragm, the scalenes, the parasternal intercostals and the expiratory rectus abdominis during inspiration and expiration. In patients with incomplete tetraplegia MEP latency times were significantly prolonged in the scalenes and the parasternal intercostals, both during inspiration and expiration, and were nearly normal for the diaphragm, which was found to be more or less preserved. The mean MEP amplitudes in these patients for all inspiratory muscles studied were significantly decreased in tetraplegic patients, in part due to a decreased number of innervating axons and muscle hypotrophy. No MEPs could be obtained from the abdominal muscles, except in one C3 tetraplegic patient, in whom only a very small response was seen during expiration, with a very delayed latency time. The much lower location of their innervating nerve roots (T10) and the much longer distance of their spinal exit zone from the level of injury at the cervical spinal cord might at least partially explain this phenomenon. In the ventilator-dependent tetraplegic patient no MEPs could be obtained from any of the muscles studied. Thus, magnetic TCS is a painless and easily applicable technique to investigate the central motor conduction properties of the respiratory muscles, both in healthy humans and in tetraplegic patients.

  12. Contractile Properties of Esophageal Striated Muscle: Comparison with Cardiac and Skeletal Muscles in Rats

    Directory of Open Access Journals (Sweden)

    Takahiko Shiina

    2010-01-01

    Full Text Available The external muscle layer of the mammalian esophagus consists of striated muscles. We investigated the contractile properties of esophageal striated muscle by comparison with those of skeletal and cardiac muscles. Electrical field stimulation with single pulses evoked twitch-like contractile responses in esophageal muscle, similar to those in skeletal muscle in duration and similar to those in cardiac muscle in amplitude. The contractions of esophageal muscle were not affected by an inhibitor of gap junctions. Contractile responses induced by high potassium or caffeine in esophageal muscle were analogous to those in skeletal muscle. High-frequency stimulation induced a transient summation of contractions followed by sustained contractions with amplitudes similar to those of twitch-like contractions, although a large summation was observed in skeletal muscle. The results demonstrate that esophageal muscle has properties similar but not identical to those of skeletal muscle and that some specific properties may be beneficial for esophageal peristalsis.

  13. Factors influencing the diameter of human anterior and posterior intercostal arteries.

    Science.gov (United States)

    Kuhlman, David R; Khuder, Sadik A; Lane, Richard D

    2015-03-01

    At present, there have not been any detailed studies examining the size relationships of the intercostal arteries. This study was carried out to investigate the relationship between the vessel lumenal diameter of ipsilateral, paired anterior and posterior IC arteries, as well as with the length of the IC space supplied by each artery. Samples were collected from the second-sixth anterior and posterior IC arteries near their site of origin, and the lengths of the corresponding IC spaces were measured in 42 cadavers. Lumenal diameters of both the anterior and posterior IC arteries at consecutive IC space closely followed second degree polynomial regression models (R(2) = 0.9655, and R(2) = 0.9741, respectively), and reached maximum size at the fifth IC space, which was found to be the longest of the IC spaces. No direct relationship was observed between diameters of the paired anterior and posterior IC arteries, although there was a trend for the larger anterior IC arteries to be paired with the larger posterior IC arteries. The calculated rate of blood flow at each IC artery was approximately two-fold greater in males than in females. These results suggest that the length of the IC space, and hence the extent of the thoracic wall supplied, is a major factor in determining the diameter of both anterior and posterior IC arteries. Since COPD is such a prevalent disease, this study also examined its influence on the IC arteries, and found that the posterior IC arteries are significantly larger among afflicted subjects. © 2014 Wiley Periodicals, Inc.

  14. Treatment of intercostal neuralgia with acupuncture on Jiájǐ(夹脊EX-13 2): analysis of 56 cases%针刺夹脊穴为主治疗肋间神经痛56例

    Institute of Scientific and Technical Information of China (English)

    赵春梅

    2010-01-01

    @@ Intercostal neuralgia is a common clinical disease featured by pain in intercostal spaces.It relates to many other diseases and is classified into "hypochondriac pain" in Chinese medicine.The author has treated 56 cases of the disease with acupuncture on Jiaji(夹脊EX-B 2) as the major therapy.The experience is as follows.

  15. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block.

    Science.gov (United States)

    Pérez Herrero, M A; López Álvarez, S; Fadrique Fuentes, A; Manzano Lorefice, F; Bartolomé Bartolomé, C; González de Zárate, J

    2016-12-01

    The quality of postoperative recovery is one of the most important among all the quality indicators used in clinical situations. This is even more important after cancer surgery. Our aim was to evaluate this after non-reconstructive breast surgery under general anesthesia and paravertebral blockade or serratus-intercostal plane blockade, in the early and late post-operative period. A prospective observational study was conducted on 60 patients (25 paravertebral blockade group and 35 serratus-intercostal plane blockade group) scheduled for non-reconstructive breast surgery during a 6 month period. Every patient received general anaesthesia and were randomised to receive either paravertebral blockade or serratus-intercostal plane blockade. The quality of post-anaesthetic recovery was quantified by Postoperative Quality Recovery Scale, which is used to assess physiological, nociceptive, emotional, autonomy, cognitive and general state domains at different times: baseline (before surgery), 15min after the end of surgery, at discharge to home, and one month after surgery. A total recovery of 95.93% was achieved in the early postoperative period (15min PACU), 99.07% at discharge to home, and 99.25% at one month after the intervention. No significant differences were found between groups in total score or in each evaluated area. A progressive improvement was observed in the scores assessed with the Postoperative Quality Recovery Scale, reaching values that would allow the discharge to home and early return to usual active life from the immediate postoperative period, with no significant differences between the 2 analgesic techniques. Savings in opioid use and the excellent recovery were observed in all measured domains observed. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

    Directory of Open Access Journals (Sweden)

    Raheleh Aligholipour Maleki

    2011-08-01

    Full Text Available Introduction: Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may re-quire such high dose that they produce respiratory depression, especially in el-derly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. Methods: sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or inter-costal block with %0.25 bupivacaine. The patients were assessed through ICU and hos-pital stay length, ventilation function tests. Pain score among the patients was meas-ured with verbal rating scale, before and after administration of the analgesia. Results: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P < 0.004. Changes in the visual Analogue Scale were associated with marked improvement re-garding pain at rest and pain caused by coughing and deep breathing in group A com-pared group B... ICU and hospital stay markedly reduced in Group A. Conclusion: tho-racic epidural analgesia is superior to intercostals block regarding pain relief of rib frac-tures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

  17. Respiratory muscle blood flow during exercise: effects of sex and ovarian cycle.

    Science.gov (United States)

    Smith, Joshua R; Hageman, K Sue; Harms, Craig A; Poole, David C; Musch, Timothy I

    2017-01-26

    Sex and ovarian cycle have been speculated to modify respiratory muscle(s) blood flow control during exercise, but the findings are inconclusive. We tested the hypotheses that females would have higher respiratory muscle blood flow and vascular conductance (VC) compared to males during exercise and that this difference would be accentuated in proestrus versus ovariectomized (OVA) females. Mean arterial pressure (carotid artery catheter) and respiratory muscle blood flow (radiolabeled microspheres) were measured during moderate-intensity (24m/min, 10% grade) exercise in male (n=9), female (n=9), and OVA female (n=7) rats and near-maximal (60m/min, 5% grade) exercise in male (n=5) and female (n=7) rats. At rest, diaphragm, intercostal, and transversus abdominis blood flow were not different (p=0.33) among groups. During moderate-intensity exercise, diaphragm (M: 124±16; F: 140±14; OVA: 140±20mL/min/100g), intercostal (M: 33±5; F: 34±5; OVA: 30±5mL/min/100g), and transversus abdominis blood flow (M: 24±4; F: 35±7; OVA: 35±9mL/min/100g) significantly increased in all groups compared to rest, but were not different (p=0.12) among groups. From rest to moderate-intensity exercise, diaphragm (p0.13) existed in VC among groups. During near-maximal exercise, diaphragm (M: 304±62; F: 283±17mL/min/100g), intercostal (M: 29±8; F: 40±6mL/min/100g), and transversus abdominis (M: 85±14; F: 86±9mL/min/100g) blood flow and VC were not different (p>0.27) between males and females. These data demonstrate that respiratory muscle blood flow and vascular conductance at rest and during exercise are not affected by sex or ovarian cycle in rats.

  18. Iatrogenic gastric fistula due to inappropriate placement of intercostal drainage tube in a case of traumatic diaphragmatic hernia.

    Directory of Open Access Journals (Sweden)

    Rege S

    2001-04-01

    Full Text Available A 26-year-old, 30 weeks primigravida presented with a gastric fistula through a left intercostal drain, which was inserted for drainage of suspected haemopneumothorax following minor trauma. It was confirmed to be a diaphragmatic hernia, with stomach and omentum as its contents. On exploratory laparotomy, disconnection of the tube and fistulous tract, with reduction of herniated contents and primary suturing of stomach was carried out. Diaphragmatic reconstruction with polypropylene mesh was also carried out. Post-operative recovery was uneventful with full lung expansion by 3rd postoperative day. Patient was asymptomatic at follow-up 6 months.

  19. The Combination of IV and Perineural Dexamethasone Prolongs the Analgesic Duration of Intercostal Nerve Blocks Compared with IV Dexamethasone Alone.

    Science.gov (United States)

    Maher, Dermot P; Serna-Gallegos, Derek; Mardirosian, Rodney; Thomas, Otto J; Zhang, Xiao; McKenna, Robert; Yumul, Roya; Zhang, Vida

    2017-06-01

     The use of multiple-level, single-injection intercostal nerve blocks for pain control following video-assisted thorascopic surgery (VATS) is limited by the analgesic duration of local anesthetics. This study examines whether the combination of perineural and intravenous (IV) dexamethasone will prolong the duration of intraoperatively placed intercostal nerve blocks following VATS compared with IV dexamethasone and a perineural saline placebo.  Prospective, double-blind, randomized placebo-controlled trial.  Single level-1 academic trauma center.  Forty patients undergoing a unilateral VATS under the care of a single surgeon.  Patients were randomly assigned to two groups and received an intercostal nerve block containing 1) 0.5% bupivacaine with epinephrine and 1 ml of 0.9% saline or 2) 0.5% bupivacaine with epinephrine and 1 ml of a 4 mg/ml dexamethasone solution. All patients received 8 mg of IV dexamethasone.  Group 2 had lower NRS-11 scores at post-operative hours 8 (5.05, SD = 2.13 vs 3.50, SD = 2.50; p  = 0.04), 20 (4.30, SD = 2.96 vs 2.26, SD = 2.31; p  = 0.02), and 24 (4.53, SD = 1.95 vs 2.26, SD = 2.31; p  = 0.02). Equianalgesic opioid requirement was decreased in group 2 at 32 hours (5.78 mg, SD = 5.77 vs 1.67 mg, SD = 3.49; p  = 0.02). Group 2 also had greater FEV1 measured at 8, 12, 24, and 44 hours; greater FVC at 24 hours; greater PEF at 28 through 48 hours; and greater FEV1/FVC at 8 and 36 hours.  The combination of IV and perineural dexamethasone prolonged the duration of a single-injection bupivacaine intercostal nerve block as measured by NRS-11 compared with IV dexamethasone alone at 24 hours. Reduced NRS-11 at other times, reduced opioid requirements, and increased PFTs were observed in group 2.

  20. F-18 FDG uptake in respiratory muscle mimicking metastasis in patients with gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Jin; Hyun, In Young [Inha University College of Medicine, Incheon (Korea, Republic of); Kim, Jeong Ho [Gachon Medical School Gil Medical Center, Incheon (Korea, Republic of)

    2006-08-15

    A 67-year-old man with a history of chronic obstructive pulmonary disease (COPD) underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging of gastric cancer. The projection images of F-18 FDG PET/CT showed intensely increased F-18 FDG uptake in the anterior neck, chest wall, and upper abdomen. We suspected distant metastases of cervical lymph nodes, ribs, and peritoneum in gastric cancer. However, the transaxial images of F-18 FDG PET/CT showed abnormal F-18 FDG uptake in scalene muscles of anterior neck, intercostal muscles of chest wall, and diaphragm of upper abdomen. Patients with COPD use respiratory muscles extensively on the resting condition. These excessive physiologic use of respiratory muscles causes increased F-18 FDG uptake as a result of increased glucose metabolism. The F-18 FDG uptake in respiratory muscles of gastric cancer patient with COPD mimicked distant metastases in cervical lymph nodes, ribs, and peritoneum.

  1. VATS biopsy for undetermined interstitial lung disease under non-general anesthesia: comparison between uniportal approach under intercostal block vs. three-ports in epidural anesthesia.

    Science.gov (United States)

    Ambrogi, Vincenzo; Mineo, Tommaso Claudio

    2014-07-01

    Video-assisted thoracoscopic (VATS) biopsy is the gold standard to achieve diagnosis in undetermined interstitial lung disease (ILD). VATS lung biopsy can be performed under thoracic epidural anesthesia (TEA), or more recently under simple intercostal block. Comparative merits of the two procedures were analyzed. From January 2002 onwards, a total of 40 consecutive patients with undetermined ILD underwent VATS biopsy under non-general anesthesia. In the first 20 patients, the procedures were performed under TEA and in the last 20 with intercostal block through a unique access. Intraoperative and postoperative variables were retrospectively matched. Two patients, one from each group, required shift to general anesthesia. There was no 30-day postoperative mortality and two cases of major morbidity, one for each group. Global operative time was shorter for operations performed under intercostal block (P=0.041). End-operation parameters significantly diverged between groups with better values in intercostal block group: one-second forced expiratory flow (P=0.026), forced vital capacity (P=0.017), oxygenation (P=0.038), PaCO2 (P=0.041) and central venous pressure (P=0.045). Intraoperative pain coverage was similar. Significant differences with better values in intercostal block group were also experienced in 24-hour postoperative quality of recovery-40 questionnaire (P=0.038), hospital stay (P=0.033) and economic expenses (P=0.038). Histology was concordant with radiologic diagnosis in 82.5% (33/40) of patients. Therapy was adjusted or modified in 21 patients (52.5%). Uniportal VATS biopsies under intercostal block can provide better intraoperative and postoperative outcomes compared to TEA. They allow the indications for VATS biopsy in patients with undetermined ILD to be extended.

  2. Role of skeletal muscle in lung development.

    Science.gov (United States)

    Baguma-Nibasheka, Mark; Gugic, Dijana; Saraga-Babic, Mirna; Kablar, Boris

    2012-07-01

    Skeletal (striated) muscle is one of the four basic tissue types, together with the epithelium, connective and nervous tissues. Lungs, on the other hand, develop from the foregut and among various cell types contain smooth, but not skeletal muscle. Therefore, during earlier stages of development, it is unlikely that skeletal muscle and lung depend on each other. However, during the later stages of development, respiratory muscle, primarily the diaphragm and the intercostal muscles, execute so called fetal breathing-like movements (FBMs), that are essential for lung growth and cell differentiation. In fact, the absence of FBMs results in pulmonary hypoplasia, the most common cause of death in the first week of human neonatal life. Most knowledge on this topic arises from in vivo experiments on larger animals and from various in vitro experiments. In the current era of mouse mutagenesis and functional genomics, it was our goal to develop a mouse model for pulmonary hypoplasia. We employed various genetically engineered mice lacking different groups of respiratory muscles or lacking all the skeletal muscle and established the criteria for pulmonary hypoplasia in mice, and therefore established a mouse model for this disease. We followed up this discovery with systematic subtractive microarray analysis approach and revealed novel functions in lung development and disease for several molecules. We believe that our approach combines elements of both in vivo and in vitro approaches and allows us to study the function of a series of molecules in the context of lung development and disease and, simultaneously, in the context of lung's dependence on skeletal muscle-executed FBMs.

  3. 齐刺法配合中药外敷治疗急性钙化性冈上肌肌腱炎的护理分析%Nursing Analysis of Triple Puncture Combined with External Application of Chinese Medicine Treating Acute Calcific Tendinitis of Supraspinatus Muscle

    Institute of Scientific and Technical Information of China (English)

    亓效勤

    2015-01-01

    目的:探讨齐刺配合中药外敷治疗护理急性钙化性冈上肌肌腱炎的临床疗效。方法:57例急性钙化性冈上肌肌腱炎门诊患者随机分为治疗组及对照组,治疗组采用齐刺法及外敷郑氏伤科中药新伤肿痛散,对照组口服塞来昔布胶囊,两组均采用围手术期护理,比较两组疗效。结果:治疗组总有效率为100.00%,显著高于对照组的67.86%(P<0.01)。结论:齐刺配合中药外敷治疗急性钙化性冈上肌肌腱炎疗效显著。%Objective:To investigate the clinical effects of triple puncture combined with external application of Chinese medicine treating acute cal-cific tendinitis of supraspinatus muscle. Methods:57 cases of outpatients with acute calcific tendinitis of supraspinatus muscle were randomly divid-ed into treatment group and control group, treatment group was treated with triple puncture and external application of Zheng’s traumatology Chi-nese medicine, Xinshang Zhongtong powder, control group with oral celecoxib capsule, two groups both with perioperative nursing, curative effect of the two groups was compared. Results:The total effective rate of treatment group was 100.00%, significantly higher than that of control group by 67.86%(P<0.01). Conclusion:Triple puncture combined with external application of Chinese medicine treating acute calcific tendinitis of supraspi-natus muscle is significantly effective.

  4. Nature and frequency of respiratory involvement in chronic progressive external ophthalmoplegia

    NARCIS (Netherlands)

    Smits, B.W.; Heijdra, Y.F.; Cuppen, F.; Engelen, B.G. van

    2011-01-01

    Chronic progressive external ophthalmoplegia (CPEO) is a relatively common mitochondrial disorder. Weakness of the extra-ocular, limb girdle and laryngeal muscles are established clinical features. Respiratory muscle involvement however has never been studied systematically, even though respiratory

  5. Skeletal muscle

    Science.gov (United States)

    There are approximately 650-850 muscles in the human body these include skeletal (striated), smooth and cardiac muscle. The approximation is based on what some anatomists consider separate muscle or muscle systems. Muscles are classified based on their anatomy (striated vs. smooth) and if they are v...

  6. Force encoding in muscle spindles during stretch of passive muscle.

    Science.gov (United States)

    Blum, Kyle P; Lamotte D'Incamps, Boris; Zytnicki, Daniel; Ting, Lena H

    2017-09-01

    Muscle spindle proprioceptive receptors play a primary role in encoding the effects of external mechanical perturbations to the body. During externally-imposed stretches of passive, i.e. electrically-quiescent, muscles, the instantaneous firing rates (IFRs) of muscle spindles are associated with characteristics of stretch such as length and velocity. However, even in passive muscle, there are history-dependent transients of muscle spindle firing that are not uniquely related to muscle length and velocity, nor reproduced by current muscle spindle models. These include acceleration-dependent initial bursts, increased dynamic response to stretch velocity if a muscle has been isometric, and rate relaxation, i.e., a decrease in tonic IFR when a muscle is held at a constant length after being stretched. We collected muscle spindle spike trains across a variety of muscle stretch kinematic conditions, including systematic changes in peak length, velocity, and acceleration. We demonstrate that muscle spindle primary afferents in passive muscle fire in direct relationship to muscle force-related variables, rather than length-related variables. Linear combinations of whole muscle-tendon force and the first time derivative of force (dF/dt) predict the entire time course of transient IFRs in muscle spindle Ia afferents during stretch (i.e., lengthening) of passive muscle, including the initial burst, the dynamic response to lengthening, and rate relaxation following lengthening. Similar to acceleration scaling found previously in postural responses to perturbations, initial burst amplitude scaled equally well to initial stretch acceleration or dF/dt, though later transients were only described by dF/dt. The transient increase in dF/dt at the onset of lengthening reflects muscle short-range stiffness due to cross-bridge dynamics. Our work demonstrates a critical role of muscle cross-bridge dynamics in history-dependent muscle spindle IFRs in passive muscle lengthening conditions

  7. Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection

    Science.gov (United States)

    Hsieh, Ming-Ju; Wang, Kuo-Cheng; Liu, Hung-Pin; Gonzalez-Rivas, Diego; Wu, Ching-Yang; Liu, Yun-Hen; Wu, Yi-Cheng; Chao, Yin-Kai

    2016-01-01

    Background Effective postoperative pain control for thoracic surgery is very important, not only because it reduces pulmonary complications but also because it accelerates the pace of recovery. Moreover, it increases patients’ satisfaction with the surgery. In this study, we present a simple approach involving the safe placement of intercostal catheter (ICC) after single port video-assisted thoracoscopic surgery (VATS) anatomic resection and we evaluate postoperative analgesic function with and without it. Methods We identified patients who underwent single port anatomic resection with ICC placed intraoperatively as a route for continuous postoperative levobupivacaine (0.5%) administration and retrospectively compared them with a group of single port anatomic resection patients without ICC. The operation time, postoperative day 0, 1, 2, 3 and discharge day pain score, triflow numbers, narcotic requirements, drainage duration and post-operative hospital stay were compared. Results In total, 78 patients were enrolled in the final analysis (39 patients with ICC and 39 without). We found patients with ICC had less pain sensation numerical rating scale (NRS) on postoperative day 0, 1 (P=0.023, intercostal nerve blockade by placing an ICC intraoperatively provides effective analgesia for patients undergoing single port VATS anatomic resection. This may be considered a viable alternative for postoperative pain management. PMID:28149550

  8. Muscle Deoxygenation Causes Muscle Fatigue

    Science.gov (United States)

    Murthy, G.; Hargens, A. R.; Lehman, S.; Rempel, D.

    1999-01-01

    Muscle fatigue is a common musculoskeletal disorder in the work place, and may be a harbinger for more disabling cumulative trauma disorders. Although the cause of fatigue is multifactorial, reduced blood flow and muscle oxygenation may be the primary factor in causing muscle fatigue during low intensity muscle exertion. Muscle fatigue is defined as a reduction in muscle force production, and also occurs among astronauts who are subjected to postural constraints while performing lengthy, repetitive tasks. The objectives of this research are to: 1) develop an objective tool to study the role of decreased muscle oxygenation on muscle force production, and 2) to evaluate muscle fatigue during prolonged glovebox work.

  9. Muscle disorder

    Science.gov (United States)

    Myopathic changes; Myopathy; Muscle problem ... Blood tests sometimes show abnormally high muscle enzymes. If a muscle disorder might also affect other family members, genetic testing may be done. When someone has symptoms and signs ...

  10. The External Degree.

    Science.gov (United States)

    Houle, Cyril O.

    This book examines the external degree in relation to the extremes of attitudes, myths, and data. Emphasis is placed on the emergence of the American external degree, foreign external-degree programs, the purpose of the external degree, the current scene, institutional issues, and problems of general policy. (MJM)

  11. Overexpression of IGF-1 attenuates skeletal muscle damage and accelerates muscle regeneration and functional recovery after disuse

    OpenAIRE

    Ye, Fan; Mathur, Sunita; Liu, Min; Stephen E Borst; Walter, Glenn A; Sweeney, H. Lee; Vandenborne, Krista

    2013-01-01

    Skeletal muscle is a highly dynamic tissue that responds to endogenous and external stimuli, including alterations in mechanical loading and growth factors. In particular, the antigravity soleus muscle experiences significant muscle atrophy during disuse and extensive muscle damage upon reloading. Since insulin-like growth factor-1 (IGF-1) has been implicated as a central regulator of muscle repair and modulation of muscle size, we examined the effect of viral mediated overexpression of IGF-1...

  12. Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: Preliminary outcomes in twenty-six cryoablation patients.

    Science.gov (United States)

    Keller, Benjamin A; Kabagambe, Sandra K; Becker, James C; Chen, Y Julia; Goodman, Laura F; Clark-Wronski, Julianna M; Furukawa, Kenneth; Stark, Rebecca A; Rahm, Amy L; Hirose, Shinjiro; Raff, Gary W

    2016-12-01

    Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia. A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n=26) or thoracic epidural analgesia (n=26) from March 2013 to January 2016 was conducted. The primary outcome was hospital length of stay. Secondary outcomes included telemetry unit monitoring time, total intravenous narcotic use, duration of intravenous narcotic use, and postoperative complications. Patients who underwent intercostal cryoablation had a significant reduction in the mean hospital length of stay, time in a monitored telemetry bed, total use of intravenous narcotics, and the duration of intravenous narcotic administration when compared to thoracic epidural patients. Cryoablation patients had a slightly higher rate of postoperative complications. Intercostal cryoablation is a promising technique for postoperative pain management in children undergoing repair of pectus excavatum. This therapy results in reduced time to hospital discharge, decreased intravenous narcotic utilization, and has eliminated epidurals from our practice. Retrospective study - level III. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Expiratory muscle control during vomiting - Role of brain stem expiratory neurons

    Science.gov (United States)

    Miller, A. D.; Tan, L. K.

    1987-01-01

    The neural mechanisms controlling the muscles involved during vomiting were examined using decerebrated cats. In one experiment, the activity of the ventral respiratory group (VRG) expiratory (E) neurons was recorded during induced 'fictive vomiting' (i.e., a series of bursts of coactivation of abdominal and phrenic nerves that would be expected to produce expulsion in unparalyzed animals) and vomiting. In a second, abdominal muscle electromyographic and nerve activity were compared before and after sectioning the axons of descending VRG E neurons as they cross the midline between C1 and the obex (the procedure that is known to abolish expiratory modulation of internal intercostal muscle activity). The results of the study indicate that the abdominal muscles are controlled differently during respiration and vomiting.

  14. [Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery].

    Science.gov (United States)

    Diéguez García, P; Fajardo Pérez, M; López Álvarez, S; Alfaro de la Torre, P; Pensado Castiñeiras, A P

    2013-01-01

    Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons. Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights

  15. Management of post-operative pain by placement of an intraoperative intercostal catheter after single port video-assisted thoracoscopic surgery: a propensity-score matched study.

    Science.gov (United States)

    Wu, Ching-Feng; Hsieh, Ming-Ju; Liu, Hung-Pin; Gonzalez-Rivas, Diego; Liu, Yun-Hen; Wu, Yi-Cheng; Chao, Yin-Kai; Wu, Ching-Yang

    2016-06-01

    The establishment of a golden standard for post-operative analgesia after thoracic surgery remains an unresolved issue. Benefiting from the rapid development of single port video-assisted thoracoscopic surgery (VATS), a good candidate for the alleviation of patients' pain is the placement of an intercostal catheter (ICC) safely after uniport VATS. We hypothesized that continual infusion through ICC could provide effective analgesia for patients with only one wound and we evaluate its postoperative analgesic function in uniport VATS patients with or without intercostal nerve blockade. Since March 2014, 235 patients received various kinds of single port VATS. We identified 50 patients who received single port VATS with intercostal nerve blockade and retrospectively compared them with a group of patients who had received single port VATS without intercostal nerve blockade. The operative time, post operation day 0, 1, 2, 3 and discharge day pain score, narcotic requirements, drainage duration and post-operative hospital stay were collected. In order to establish a well-balanced cohort study, we also used propensity scores matching (1:1) to compare the short term clinical outcome in two groups. No operative deaths occurred in this study. The uniport VATS with intercostal nerve blockade group was associated with less post operation day 0 and day 1 pain score, and narcotic requirements in our cohort study (Pintercostal nerve blockade (Pintercostal nerve block with levobupivacaine infusion appears to be a safe, effective and promising technique in our study, associated with a shorter hospital stay and less post-operative pain. Further prospective trials are needed to determine the long term outcomes.

  16. Blood flow index using near-infrared spectroscopy and indocyanine green as a minimally invasive tool to assess respiratory muscle blood flow in humans.

    Science.gov (United States)

    Guenette, Jordan A; Henderson, William R; Dominelli, Paolo B; Querido, Jordan S; Brasher, Penelope M; Griesdale, Donald E G; Boushel, Robert; Sheel, A William

    2011-04-01

    Near-infrared spectroscopy (NIRS) in combination with indocyanine green (ICG) dye has recently been used to measure respiratory muscle blood flow (RMBF) in humans. This method is based on the Fick principle and is determined by measuring ICG in the respiratory muscles using transcutaneous NIRS in relation to the [ICG] in arterial blood as measured using photodensitometry. This method is invasive since it requires arterial cannulation, repeated blood withdrawals, and reinfusions. A less invasive alternative is to calculate a relative measure of blood flow known as the blood flow index (BFI), which is based solely on the NIRS ICG curve, thus negating the need for arterial cannulation. Accordingly, the purpose of this study was to determine whether BFI can be used to measure RMBF at rest and during voluntary isocapnic hyperpnea at 25, 40, 55, and 70% of maximal voluntary ventilation in seven healthy humans. BFI was calculated as the change in maximal [ICG] divided by the rise time of the NIRS-derived ICG curve. Intercostal and sternocleidomastoid muscle BFI were correlated with simultaneously measured work of breathing and electromyography (EMG) data from the same muscles. BFI showed strong relationships with the work of breathing and EMG for both respiratory muscles. The coefficients of determination (R(2)) comparing BFI vs. the work of breathing for the intercostal and sternocleidomastoid muscles were 0.887 (P < 0.001) and 0.863 (P < 0.001), respectively, whereas the R(2) for BFI vs. EMG for the intercostal and sternocleidomastoid muscles were 0.879 (P < 0.001) and 0.930 (P < 0.001), respectively. These data suggest that the BFI closely reflects RMBF in conscious humans across a wide range of ventilations and provides a less invasive and less technically demanding alternative to measuring RMBF.

  17. The posterior intercostal vein : A thermoregulatory gateway to the internal vertebral venous plexus

    NARCIS (Netherlands)

    Hoogland, P. V.; Wessels, Q.; Vorster, W.; Groen, R. J. M.; Wettstein, R.; Greyling, L. M.; Kotze, S. H.

    The internal vertebral venous plexus (IVVP) plays a putative role in thermoregulation of the spinal cord. Cold cutaneous venous blood may cool, while warm venous blood from muscles and brown fat areas may warm the spinal cord. The regulating mechanisms for both cooling and warming are still unknown.

  18. Regulating multiple externalities

    DEFF Research Database (Denmark)

    Waldo, Staffan; Jensen, Frank; Nielsen, Max

    2016-01-01

    Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory instrume......Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory...

  19. ExternE National Implementation Finland

    Energy Technology Data Exchange (ETDEWEB)

    Pingoud, K.; Maelkki, H.; Wihersaari, M.; Pirilae, P. [VTT Energy, Espoo (Finland); Hongisto, M. [Imatran Voima Oy, Vantaa (Finland); Siitonen, S. [Ekono Energy Ltd, Espoo (Finland); Johansson, M. [Finnish Environment Institute, Helsinki (Finland)

    1999-07-01

    ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

  20. Massive Hemothorax Caused by a Single Intercostal Artery Bleed Ten Days after Solitary Minimally Displaced Rib Fracture

    Directory of Open Access Journals (Sweden)

    Karleigh R. Curfman

    2015-01-01

    Full Text Available Delayed hemothorax (DHX following blunt thoracic trauma is a rare occurrence with an extremely variable incidence and time to diagnosis that is generally associated with clinically insignificant blood loss. In this report, we present a case of acute onset DHX ten days after a relatively mild traumatic event that resulted in a single minimally displaced rib fracture. The patient awoke from sleep suddenly with acute onset dyspnea and chest pain and reported to the emergency department (ED. The patient lost over six and a half liters of blood during the first 9 hours of his admission, the largest volume yet reported in the literature for DHX, which was eventually found to be due to a single intercostal artery bleed. Successful management in this case entailed two emergent thoracotomies and placement of multiple thoracostomy tubes to control blood loss. The patient was discharged home on postoperative day 5.

  1. Laughing: a demanding exercise for trunk muscles.

    Science.gov (United States)

    Wagner, Heiko; Rehmes, Ulrich; Kohle, Daniel; Puta, Christian

    2014-01-01

    Social, psychological, and physiological studies have provided evidence indicating that laughter imposes an increased demand on trunk muscles. It was the aim of this study to quantify the activation of trunk muscles during laughter yoga in comparison with crunch and back lifting exercises regarding the mean trunk muscle activity. Muscular activity during laughter yoga exercises was measured by surface electromyography of 5 trunk muscles. The activation level of internal oblique muscle during laughter yoga is higher compared to the traditional exercises. The multifidus, erector spinae, and rectus abdominis muscles were nearly half activated during laughter yoga, while the activation of the external oblique muscle was comparable with the crunch and back lifting exercises. Our results indicate that laughter yoga has a positive effect on trunk muscle activation. Thus, laughter seems to be a good activator of trunk muscles, but further research is required whether laughter yoga is a good exercise to improve neuromuscular recruitment patterns for spine stability.

  2. Anatomic study of intercostal to axillary nerve transfer%肋间神经移位腋神经的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    楚彬; 胡韶楠; 陈亮; 宋捷

    2012-01-01

    Objective To provide the anatomical basis for intercostal to axillary nerve transfer to restore shoulder abduction.Methods Thirty sides of thoracic walls of human cadaver specimens were used.The intercostal nerves Ⅲ to Ⅵ were dissected to measure the lengths of the intercostal nerves from the midaxillary line to the midclavicular line.Meanwhile the distances from the relevant intercostal space to the quadrilateral foramen (with 45° of shoulder abduction and 90° of shoulder abduction) through the subcutaneous tunnel were also measured.Results The differences between the length of the intercostal nerve Ⅲ to Ⅵ and the distance from the relevant intercostal space to the quadrilateral foramen were (3.89 ± 0.85) cm,(4.14 ± 1.15) cm,(2.99 ±1.33) cm and (0.25± 1.49) cm with 45° of shoulder abduction,and (2.54 ±0.87) cm,(2.37 ± 1.51) cm,(1.04 ± 1.74) cm and (-1.59 ± 1.95) cm with 90° of shoulder abduction.Conclusion It is feasible to perform direct coaptation between the axillary nerve and the intercostal nerves Ⅲ to Ⅴ at the quadrilateral foreman without nerve graft.To achieve tension-free coaptation of intercostal nerve Ⅵ and the axillary nerve at 90° of shoulder abduction,extra-length of the intercostal nerve Ⅵ or axillary nerve should be obtained.%目的 为利用肋间神经移位腋神经恢复肩外展功能提供解剖学依据.方法对30侧成人尸体标本中第三至第六肋间神经自腋中线至锁骨中线的长度和相应肋间神经自腋中线起点处穿过皮下隧道至四边孔腋神经缝合口处的距离(在肩外展45°和90°两种情况下)进行比较.结果 在肩外展45°时第三肋间至第六肋间自腋中线到锁骨中线的选取长度与相应肋间自腋中线自皮下隧道至四边孔距离差值分别为(3.89±0.85) cm、(4.14± 1.15)cm、(2.99± 1.33) cm和(0.25±1.49)cm.在肩外展90°时,差值分别为(2.54±0.87) cm、(2.37± 1.51)cm、(1.04± 1.74) cm和(-1.59± 1.95)cm.结论 第三、第

  3. ASH External Web Portal (External Portal) -

    Data.gov (United States)

    Department of Transportation — The ASH External Web Portal is a web-based portal that provides single sign-on functionality, making the web portal a single location from which to be authenticated...

  4. Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation

    OpenAIRE

    Fujiwara, Atsushi; Komasawa, Nobuyasu; Minami, Toshiaki

    2014-01-01

    A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered ri...

  5. Alteracions respiratòries durant el son inflamació i canvis fenotípics al múscul intercostal extern /

    OpenAIRE

    Pallàs i Villaronga, Josep Oriol

    2012-01-01

    En pacients amb Malaltia Pulmonar Obstructiva Crònica (MPOC) la disfunció muscular, tant a nivell dels músculs perifèrics com respiratoris, ha estat estudiada per múltiples grups d'investigació, però les alteracions musculars en els trastorns respiratoris durant el son (Síndrome d'Apnees i Hipopnees del Son -SAHS- i Overlap Syndrome respiratori -OS-) són poc conegudes. Aquesta tesi estudia els canvis inflamatoris i de l'estructura muscular que es produeixen en un dels principals músculs respi...

  6. Muscle biopsy

    Science.gov (United States)

    ... Inflammatory diseases of muscle (such as polymyositis or dermatomyositis ) Diseases of the connective tissue and blood vessels ( ... disease that involves inflammation and a skin rash ( dermatomyositis ) Inherited muscle disorder ( Duchenne muscular dystrophy ) Inflammation of ...

  7. Muscle atrophy

    Science.gov (United States)

    ... atrophy. Exercises may include ones done in a swimming pool to reduce the muscle workload, and other types ... a physical examination and ask about your medical history and symptoms, including: When did the muscle atrophy ...

  8. A case of spontaneous transdiaphragmatic intercostal hernia of bowel loops and omentum with herniation of lung – A very rare entity

    Directory of Open Access Journals (Sweden)

    Arnab Sit

    2016-04-01

    Full Text Available Herein we report a case of spontaneous transdiaphragmatic intercostal hernia of bowel loops and omentum with lung herniation in an elderly gentleman with Chronic Obstructive Pulmonary Disease (COPD. Initially he presented with severe cough followed by pain and small fluctuating swelling over the right chest wall. In-patient investigations were suggestive of hemothorax without any chest wall abnormality. Later the swelling gradually increased to a significant size for which he was further evaluated. Detailed imaging studies revealed it was a case of spontaneous intercostal hernia of bowel loops and omentum with herniation of lung. The patient is kept under regular follow up for optimization for his obstructive airway component for the required surgical repair of the parietal defect.

  9. Contribution of respiratory muscle blood flow to exercise-induced diaphragmatic fatigue in trained cyclists

    DEFF Research Database (Denmark)

    Vogiatzis, Ioannis; Athanasopoulos, Dimitris; Boushel, Robert Christopher

    2008-01-01

    We investigated whether the greater degree of exercise-induced diaphragmatic fatigue previously reported in highly trained athletes in hypoxia (compared with normoxia) could have a contribution from limited respiratory muscle blood flow. Seven trained cyclists completed three constant load 5 min...... exercise tests at inspired O(2) fractions (FIO2) of 0.13, 0.21 and 1.00 in balanced order. Work rates were selected to produce the same tidal volume, breathing frequency and respiratory muscle load at each FIO2 (63 +/- 1, 78 +/- 1 and 87 +/- 1% of normoxic maximal work rate, respectively). Intercostals......(-1) and 95.1 +/- 7.8 ml (100 ml)(-1) min(-1), respectively). Neither IMBF was different across hypoxia, normoxia and hyperoxia (53.6 +/- 8.5, 49.9 +/- 5.9 and 52.9 +/- 5.9 ml (100 ml)(-1) min(-1), respectively). We conclude that when respiratory muscle energy requirement is not different between...

  10. Your Muscles

    Science.gov (United States)

    ... develops. There they help to push the baby out of the mother's body when it's time to be born. You'll find smooth muscles at work behind the scenes in your eyes, too. These muscles keep the eyes ... thick muscles of the heart contract to pump blood out and then relax to let blood back in ...

  11. Modeling Muscles

    Science.gov (United States)

    Goodwyn, Lauren; Salm, Sarah

    2007-01-01

    Teaching the anatomy of the muscle system to high school students can be challenging. Students often learn about muscle anatomy by memorizing information from textbooks or by observing plastic, inflexible models. Although these mediums help students learn about muscle placement, the mediums do not facilitate understanding regarding integration of…

  12. Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs.

    Science.gov (United States)

    Shimeno, Kenji; Takagi, Masahiko; Maeda, Keiko; Tatsumi, Hiroaki; Doi, Atsushi; Yoshiyama, Minoru

    2009-09-01

    Type 1 Brugada ECG is essential for the diagnosis of Brugada syndrome. We aimed to evaluate the usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG. We enrolled 60 consecutive individuals with type 1 Brugada ECG and 31 individuals with type 2 or 3 Brugada ECG, in the presence or absence of Na+ channel blockers. All individuals underwent 12-lead ECGs recorded in the standard position and the third intercostal space at least 5 times every 3 months (4L-ECGs, 3L-ECGs, respectively) and multichannel Holter ECG. On multichannel Holter ECG, the precordial electrodes were attached at standard positions (4L-Holter) and the third intercostal space (3L-Holter) for leads V1 and V2. Among the 60 individuals, type 1 Brugada ECG in 4L-ECGs, 3L-ECGs, 4L-Holter, and 3L-Holter was detected in 15 (25%), 26 (43.3%), 23 (38.3%), and 33 individuals (55%), respectively, whereas detected in none of the 31 individuals. The documented duration of type 1 Brugada ECG on 3L-Holter was significantly longer than that on 4L-Holter (700 +/- 467 vs 372 +/- 422 min; P = 0.01, 3L-Holter vs 4L-Holter, respectively), and type 1 Brugada ECG was most frequently observed between 6 pm and 12 pm. Neither the presence nor the duration of the appearance of type 1 Brugada ECG differed significantly between symptomatic and asymptomatic individuals. Multichannel Holter ECG recording in the third intercostal space is more sensitive and useful for the diagnosis of type 1 Brugada ECG than repeated 12-lead ECGs or multichannel Holter ECG in the standard position.

  13. Combination of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery for bilateral lung lesions: report of two cases and review of the literature.

    Science.gov (United States)

    Wang, Linlin; Ge, Lihui; Yang, Xueying

    2017-06-01

    Uniportal video-assisted thoracic surgery (VATS) is carried out to reduce postoperative pain after treatment of thoracic diseases. Here, we report a novel method that combines a subxiphoid and intercostal uniportal VATS approach that can be used to treat bilateral pulmonary lesions simultaneously. The first case is a 50-year-old female with bilateral pulmonary lesions who received left lower lobectomy associated with right middle lobe wedge resection synchronously; the other case is a 14-year-old male who was admitted for resection of bilateral lung metastases as a result of previous osteosarcoma. We combined a subxiphoid approach with intercostal uniportal surgical procedure for bilateral pulmonary lesions. Less postoperative pain, faster postoperative recovery, and a better aesthetic effect are possible superiorities of this method if patients are selected carefully. Our results show that the combining of a subxiphoid approach with intercostal uniportal VATS is a feasible and efficient surgical procedure for bilateral pulmonary lesions, with good outcomes. Moreover, this procedure is more suitable for patients with bilateral pulmonary lesions.

  14. External radiation surveillance

    Energy Technology Data Exchange (ETDEWEB)

    Antonio, E.J.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report describes how external radiation was measured, how surveys were performed, and the results of these measurements and surveys. External radiation exposure rates were measured at locations on and off the Hanford Site using thermoluminescent dosimeters (TLD). External radiation and contamination surveys were also performed with portable radiation survey instruments at locations on and around the Hanford Site.

  15. The ventilatory effect of external oscillation.

    Science.gov (United States)

    Isabey, D; Piquet, J

    1989-01-01

    High frequency ventilation (HFV) may be achieved by external oscillation (external HFV) applied around the chest wall (HFCWO) in large animals and humans, or over the entire body (HFBSO) in small animals, instead of being applied via the trachea (internal HFV). We present a synthesis of the results obtained with external HFV in both normal and bronchoconstricted subjects. Whereas external and internal HFV were found to be equivalent in terms of gas exchange in normal rats, external HFV was found to have a beneficial effect in bronchoconstricted rabbits, but internal HFV did not. From the frequency-oscillatory tidal volume relationship determined in normocapnic rabbits, HFBSO at 5 Hz was found to be the optimal frequency at which to ventilate with tidal volumes close to the dead space volume, and which was also shown to be the optimal volume to obtain normocapnia. Moreover, 5 Hz oscillations (HFCWO) at 20 ml and 40 ml superimposed on tidal breathing accelerated nitrogen washout, i.e., gas exchange in normal humans. Unfortunately, only oscillations with much smaller volumes (5-10 ml) were obtainable in COPD patients. Nevertheless, they produced a clear change in breathing pattern associated with a slight improvement in gas exchange and a potentially positive effect on inspiratory muscle fatigue. These results support the concept that non-invasive external HFV technique may be of use in assisting ventilation in bronchoconstricted subjects and may possibly replace conventional controlled ventilation, at least in subjects with high lung compliance, such as babies, neonates and normal adults.

  16. Effects of prostaglandin E1 (PGE1) on the positive inotropic response of heart muscle to elevation of external Ca++-concentration, to increased driving frequency, and to paired stimulation.

    Science.gov (United States)

    Hadházy, P

    1976-01-01

    Electrically driven left guinea pig atria were exposed to positive inotropic stimuli which are thought to be related to the turnover of calcium ions. For increasing contractibility, the following procedures were used: a) varying the concentration of CaCl2 in the bath fluid; b) stimulation at frequencies from 1.0 to 3.0 Hz; c) paired stimulation. Positive inotropic responses to the increase of the rate of stimulation and to paired stimulation were not affected by 0.1 microgram/ml tetrodotoxin (TTX). This excludes the adrenergic contribution to the positive inotropic effects observed. Actions of the positive inotropic stimuli were studied both in the absence and in the presence of 0.1--1.0--10.0--1000.0 ng/ml of PGE1-PGE1 in the highest concentration used increased contractile force. The inotropic stimulus-response curves were not affected by PGE1 at any concentration. This finding suggests there is no interaction between Ca ions and PGE1 in the contractile mechanism of the guinea pig heart muscle.

  17. Management of Implant Exposure in One-Stage Breast Reconstruction Using Titanium-Coated Polypropylene Mesh: Sub-Mammary Intercostal Perforator Flap.

    Science.gov (United States)

    De Riggi, Michele Antonio; Rocco, Nicola; Gherardini, Giulio; Esposito, Emanuela; D'Aiuto, Massimiliano

    2016-12-01

    One-stage implant-based breast reconstruction using titanium-coated polypropylene mesh is a novel approach widely used in Europe. Complication rates in breast reconstruction with the use of titanium-coated meshes seem to be comparable to those in patients with implant-based breast reconstruction alone. However, the use of synthetic meshes in implant-based breast reconstructive surgery leads to new clinical scenarios with the need for the breast surgeon to face new complications. We present an innovative treatment of implant exposure in the absence of infection in patients who underwent nipple-sparing mastectomy and immediate breast reconstruction with silicone implants and titanium-coated polypropylene mesh by using a pedicled sub-mammary intercostal perforator flap. Four patients who experienced implant exposure without infection have been treated with the use of a sub-mammary intercostal perforator flap. Whole coverage of the exposed implant/mesh with a sub-mammary intercostal perforator flap was obtained in all cases. No post-operative complications have been observed, whereas a pleasant aesthetic result has been achieved. Patients' post-operative quality of life and satisfaction levels were measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality of life QLQ-BR23 questionnaire and showed an average good satisfaction with the post-operative outcomes (mean QLQ-BR23 score 1.9). For the first time, a sub-mammary intercostal perforator flap has been used with the aim of treating implant exposures without removing the prosthesis even in the presence of synthetic meshes, when wound infection was excluded. Although tested on a small series, the sub-mammary intercostal perforator flap might represent a simple, versatile and cost-effective procedure for the management of implant exposure following nipple-sparing mastectomy and immediate reconstruction with silicone implants and synthetic meshes. It should be considered to

  18. Relative Activity of Abdominal Muscles during Commonly Prescribed Strengthening Exercises.

    Science.gov (United States)

    Willett, Gilbert M.; Hyde, Jennifer E.; Uhrlaub, Michael B.; Wendel, Cara L.; Karst, Gregory M.

    2001-01-01

    Examined the relative electromyographic (EMG) activity of upper and lower rectus abdominis (LRA) and external oblique (EOA) muscles during five abdominal strengthening exercises. Isometric and dynamic EMG data indicated that abdominal strengthening exercises activated various abdominal muscle groups. For the LRA and EOA muscle groups, there were…

  19. Skeletal muscle regeneration after damage by needle penetration and trauma.

    Science.gov (United States)

    McGeachie, J K

    2000-10-01

    Skeletal muscles actually surround the dento-alveolar area. However, most dentists would be unaware that they damage skeletal muscle during routine procedures. Simple puncturing of buccinator muscle during an inferior alveolar block kills thousands of fibres. What happens to muscle fibres following such trauma? Pathology texts suggest that skeletal muscle does not regenerate and is replaced by fibrous scar tissue. However, for some decades it has been recognized that muscle fibres do in fact regenerate. In the early 1960s the "satellite" cell was discovered, lying between the muscle cell membrane and the external lamina. After 30 years of intensive research it has been clearly demonstrated that satellite cells are reserve mesenchyme cells which, once the adjacent muscle fibres are damaged, proliferate and provide a new population of young muscle cells, called "myoblasts". Myoblasts rapidly produce muscle specific proteins and fuse together in long chains, called "myotubes", which mature into typical muscle fibres.

  20. Trunk extensor muscle fatigue influences trunk muscle activities.

    Science.gov (United States)

    Hoseinpoor, Tahere Seyed; Kahrizi, Sedighe; Mobini, Bahram

    2015-01-01

    Trunk muscles fatigue is one of the risk factors in workplaces and daily activities. Loads would be redistributed among active and passive tissues in a non-optimal manner in fatigue conditions. Therefore, a single tissue might be overloaded with minimal loads and as a result the risk of injury would increase. The goal of this paper was to assess the electromyographic response of trunk extensor and abdominal muscles after trunk extensor muscles fatigue induced by cyclic lifting task. This was an experimental study that twenty healthy women participated. For assessing automatic response of trunk extensor and abdominal muscles before and after the fatigue task, electromyographic activities of 6 muscles: thorasic erector spine (TES), lumbar erector spine (LES), lumbar multifidus (LMF), transverse abdominis/ internal oblique (TrA/IO), rectus abdominis (RA) and external oblique (EO) were recorded in standing position with no load and symmetric axial loads equal to 25% of their body weights. Statistical analysis showed that all the abdominal muscles activity decreased with axial loads after performing fatigue task but trunk extensor activity remained constant. Results of the current study indicated that muscle recruitment strategies changed with muscle fatigue and load bearing, therefore risks of tissue injury may increase in fatigue conditions.

  1. Bedside thoracic ultrasonography of the fourth intercostal space reliably determines safe removal of tube thoracostomy after traumatic injury.

    Science.gov (United States)

    Kwan, Rita O; Miraflor, Emily; Yeung, Louise; Strumwasser, Aaron; Victorino, Gregory P

    2012-12-01

    Thoracic ultrasonography is more sensitive than chest radiography (CXR) in detecting pneumothorax; however, the role of ultrasonography to determine resolution of pneumothorax after thoracostomy tube placement for traumatic injury remains unclear. We hypothesized that ultrasonography can be used to determine pneumothorax resolution and facilitate efficient thoracostomy tube removal. We sought to compare the ability of thoracic ultrasonography at the second through fifth intercostal space (ICS) to detect pneumothorax with that of CXR and determine which ICS maximizes the positive and negative predictive value of thoracic ultrasonography for detecting clinically relevant pneumothorax resolution. A prospective, blinded clinical study of trauma patients requiring tube thoracostomy placement was performed at a university-based urban trauma center. A surgeon performed daily thoracic ultrasonographies consisting of midclavicular lung evaluation for pleural sliding in ICS 2 through 5. Ultrasonography findings were compared with findings on concurrently obtained portable CXR. Of the patients, 33 underwent 119 ultrasonographies, 109 of which had concomitant portable CXR results for comparison. Ultrasonography of ICS 4 or 5 was better than ICS 2 and 3 at detecting a pneumothorax, with a positive predictive value of 100% and a negative predictive value of 92%. The positive and negative predictive values for ICS 2 were 46% and 93% and for ICS 3 were 63% and 92%, respectively. Bedside, surgeon-performed, thoracic ultrasonography of ICS 4 for pneumothorax can safely and efficiently determine clinical resolution of traumatic pneumothorax and aid in the timely removal of thoracostomy tubes. Diagnostic study, level II.

  2. Noninvasive evaluation of respiratory muscles in pre-clinical model of Duchenne Muscular Dystrophy

    Directory of Open Access Journals (Sweden)

    Daniela M. Oliveira

    2016-04-01

    Full Text Available Abstract Since respiratory insufficiency is the main cause of death in patients affected by Duchenne Muscular Dystrophy (DMD, the present study aims at establishing a new non-invasive method to evaluate the clinical parameters of respiratory conditions of experimental models affected by DMD. With this purpose in mind, we evaluated the cardiorespiratory clinical conditions, the changes in the intercostal muscles, the diaphragmatic mobility, and the respiratory cycles in Golden Retriever Muscular Dystrophy (GRMD employing ultrasonography (US. A control group consisting of dogs of the same race, but not affected by muscular dystrophy, were used in this study. The results showed that inspiration, expiration and plateau movements (diaphragm mobility were lower in the affected group. Plateau phase in the affected group was practically non-existent and showed that the diaphragm remained in constant motion. Respiratory rate reached 15.5 per minute for affected group and 26.93 per minute for the control group. Expiration and inspiration movements of intercostal muscles reached 8.99mm and 8.79mm, respectively, for control group and 7.42mm and 7.40mm, respectively, for affected group. Methodology used in the present analysis proved to be viable for the follow-up and evaluation of the respiratory model in GRMD and may be adapted to other muscular dystrophy experimental models.

  3. Primary skeletal muscle lymphoma presenting as refractory cellulitis.

    Science.gov (United States)

    Baddour, L M; Haden, K H; Allen, J W

    2001-09-01

    The right torso of a 55-year-old woman showed diffuse skin and soft-tissue changes suggestive of cellulitis. However, several clinical and radiologic features, including the subacute and non-toxic nature of the illness and the patient's lack of response to antibiotic therapy, indicated a noninfectious etiology. Malignancy was suggested by striking changes seen on computed tomographic scanning--including extensive infiltration and enlargement of the musculature of the right shoulder girdle, the intercostal musculature, the latissimus dorsi, and the rhomboids; focal enlargement of the right paraspinal muscles; and enlargement of the psoas and the iliacus muscles and of the musculature around the hip joint. The mediastinal, hilar, and paraaortic regions showed no adenopathy. A large hypodense lesion of approximately 4.5 cm, which was seen in the caudate lobe of the liver, raised the concern of a metastatic focus of malignancy. Because of these findings, an immediate muscle biopsy was performed. Results showed a non-Hodgkin's lymphoma with a B-cell phenotype. Although primary skeletal muscle lymphoma is very uncommon in patients without human immunodeficiency virus infection, clinical presentation of refractory cellulitis, as seen in the current case, is extremely rare.

  4. Estudo comparativo dos bloqueios intercostal e interpleural para analgesia pós-operatória em colecistectomias abertas Estudio comparativo de los bloqueos intercostal e interpleural para analgesia pós-operatoria en colecistectomias abiertas Comparative study of intercostal and interpleural block for post-cholecystectomy analgesia

    Directory of Open Access Journals (Sweden)

    Antonio Mauro Vieira

    2003-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A analgesia no pós-operatório é desejada pelos pacientes e tem sido praticada pela maioria dos anestesiologistas. Além dos opióides, os anestésicos locais têm sido utilizados nos bloqueios periféricos e centrais para se obter a analgesia pós-operatória. O objetivo deste estudo foi comparar duas técnicas de bloqueio dos nervos intercostais para analgesia pós-operatória em colecistectomias abertas. MÉTODO: Sessenta pacientes foram submetidos a colecistectomias abertas com incisão subcostal e receberam bloqueio intercostal (Grupo IC, n=30 ou bloqueio interpleural (Grupo IP, n=30, ambos com 100 mg de bupivacaína a 0,5% com adrenalina, para analgesia pós-operatória. Foram avaliados os tempos de analgesia e as queixas relatadas pelos pacientes. RESULTADOS: A qualidade da analgesia foi considerada boa para ambas as técnicas. A duração média de analgesia foi de 505 minutos no grupo IP e 620 minutos no grupo IC, não havendo diferença estatística entre eles. Náuseas, vômitos e dor abdominal leve foram as queixas pós-operatórias mais freqüentes. Não se constatou qualquer complicação pós-operatória associada exclusivamente aos bloqueios, assim como não foi evidenciado nenhum caso de pneumotórax. CONCLUSÕES: Concluiu-se que as técnicas promoveram analgesia satisfatória após colecistectomia, sendo que o bloqueio interpleural apresentou maior facilidade de execução.JUSTIFICATIVA Y OBJETIVOS: La analgesia en el pós-operatorio es deseada por los pacientes y ha sido practicada por la mayoría de los anestesiologistas. Además de los opioides, los anestésicos locales han sido utilizados en los bloqueos periféricos y centrales para obtenerse la analgesia pós-operatoria. El objetivo de este estudio fue comparar dos técnicas de bloqueo de los nervios intercostales para analgesia pós-operatoria en colecistectomias abiertas. MÉTODO: Sesenta pacientes fueron sometidos a colecistectomias

  5. Externally Verifiable Oblivious RAM

    Directory of Open Access Journals (Sweden)

    Gancher Joshua

    2017-04-01

    Full Text Available We present the idea of externally verifiable oblivious RAM (ORAM. Our goal is to allow a client and server carrying out an ORAM protocol to have disputes adjudicated by a third party, allowing for the enforcement of penalties against an unreliable or malicious server. We give a security definition that guarantees protection not only against a malicious server but also against a client making false accusations. We then give modifications of the Path ORAM [15] and Ring ORAM [9] protocols that meet this security definition. These protocols both have the same asymptotic runtimes as the semi-honest original versions and require the external verifier to be involved only when the client or server deviates from the protocol. Finally, we implement externally verified ORAM, along with an automated cryptocurrency contract to use as the external verifier.

  6. External Beam Therapy (EBT)

    Science.gov (United States)

    ... Esophageal Cancer Treatment Head and Neck Cancer Treatment Lung Cancer Treatment Prostate Cancer Treatment Brain Tumor Treatment Why is ... Radiation Oncology) Breast Cancer Treatment Esophageal Cancer Treatment Lung Cancer Treatment Images related to External Beam Therapy (EBT) Sponsored ...

  7. MALIGNANT EXTERNAL OTITIS

    OpenAIRE

    Massoud Moghaddam

    1993-01-01

    Two case reports of malignant external otitis in the elderly diabetics and their complications and management with regard to our experience at Amir Alam Hospital, Department of ENT will be discussed here.

  8. Checklists for external validity

    DEFF Research Database (Denmark)

    Dyrvig, Anne-Kirstine; Kidholm, Kristian; Gerke, Oke;

    2014-01-01

    RATIONALE, AIMS AND OBJECTIVES: The quality of the current literature on external validity varies considerably. An improved checklist with validated items on external validity would aid decision-makers in judging similarities among circumstances when transferring evidence from a study setting...... to an implementation setting. In this paper, currently available checklists on external validity are identified, assessed and used as a basis for proposing a new improved instrument. METHOD: A systematic literature review was carried out in Pubmed, Embase and Cinahl on English-language papers without time restrictions....... The retrieved checklist items were assessed for (i) the methodology used in primary literature, justifying inclusion of each item; and (ii) the number of times each item appeared in checklists. RESULTS: Fifteen papers were identified, presenting a total of 21 checklists for external validity, yielding a total...

  9. Migration with fiscal externalities.

    Science.gov (United States)

    Hercowitz, Z; Pines, D

    1991-11-01

    "This paper analyses the distribution of a country's population among regions when migration involves fiscal externalities. The main question addressed is whether a decentralized decision making [by] regional governments can produce an optimal population distribution...or a centralized intervention is indispensable, as argued before in the literature.... It turns out that, while with costless mobility the fiscal externality is fully internalized by voluntary interregional transfers, with costly mobility, centrally coordinated transfers still remain indispensable for achieving the socially optimal allocation."

  10. Sen cycles and externalities

    OpenAIRE

    Piggins, Ashley; Salerno, Gillian

    2016-01-01

    It has long been understood that externalities of some kind are responsible for Sen’s (1970) theorem on the impossibility of a Paretian liberal. However, Saari and Petron (2006) show that for any social preference cycle generated by combining the weak Pareto principle and individual decisiveness, every decisive individual must suffer at least one strong negative externality. We show that this fundamental result only holds when individual preferences are strict. Building on their contribution,...

  11. 3D finite element models of shoulder muscles for computing lines of actions and moment arms.

    Science.gov (United States)

    Webb, Joshua D; Blemker, Silvia S; Delp, Scott L

    2014-01-01

    Accurate representation of musculoskeletal geometry is needed to characterise the function of shoulder muscles. Previous models of shoulder muscles have represented muscle geometry as a collection of line segments, making it difficult to account for the large attachment areas, muscle-muscle interactions and complex muscle fibre trajectories typical of shoulder muscles. To better represent shoulder muscle geometry, we developed 3D finite element models of the deltoid and rotator cuff muscles and used the models to examine muscle function. Muscle fibre paths within the muscles were approximated, and moment arms were calculated for two motions: thoracohumeral abduction and internal/external rotation. We found that muscle fibre moment arms varied substantially across each muscle. For example, supraspinatus is considered a weak external rotator, but the 3D model of supraspinatus showed that the anterior fibres provide substantial internal rotation while the posterior fibres act as external rotators. Including the effects of large attachment regions and 3D mechanical interactions of muscle fibres constrains muscle motion, generates more realistic muscle paths and allows deeper analysis of shoulder muscle function.

  12. An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

    Science.gov (United States)

    Oosthuizen, GV; Sartorius, B; Keene, C; Clarke, DL

    2014-01-01

    Introduction Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. Methods This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013. Results A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20–29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54). Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the ‘triangle of safety’ but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p<0.001). There was no mortality as a direct result of ICD insertion. Conclusions ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation. PMID:25350185

  13. Atypical findings of perineural cysts on postmyelographic computed tomography: a case report of intermittent intercostal neuralgia caused by thoracic perineural cysts.

    Science.gov (United States)

    Iwamuro, Hirokazu; Yanagawa, Taro; Takamizawa, Sachiko; Taniguchi, Makoto

    2017-06-13

    Perineural cysts are sometimes found incidentally with magnetic resonance imaging, and clinical symptoms requiring treatment are rare. Perineural cysts typically exhibit delayed filling with contrast medium on myelography, which is one of the criteria used by Tarlov to distinguish perineural cysts from meningeal diverticula. We present a case of multiple thoracolumbar perineural cysts, one of which was considered the cause of intermittent intercostal neuralgia with atypical findings on postmyelographic computed tomography seen as selective filling of contrast medium. A 61-year-old woman presented with intermittent pain on her left chest wall with distribution of the pain corresponding to the T10 dermatome. Magnetic resonance imaging showed multiple thoracolumbar perineural cysts with the largest located at the left T10 nerve root. On postmyelographic computed tomography immediately after contrast medium injection, the largest cyst and another at left T9 showed selective filling of contrast medium, suggesting that inflow of cerebrospinal fluid to the cyst exceeded outflow. Three hours after the injection, the intensity of the cysts was similar to the intensity of the thecal sac, and by the next day, contrast enhancement was undetectable. The patient was treated with an intercostal nerve block at T10, and the pain subsided. However, after 9 months of observation, the neuralgia recurred, and the nerve block was repeated with good effect. There was no recurrence 22 months after the last nerve block. We concluded that intermittent elevation of cerebrospinal fluid pressure in the cyst caused the neuralgia because of an imbalance between cerebrospinal fluid inflow and outflow, and repeated intercostal nerve blocks resolved the neuralgia. Our case demonstrates the mechanism of cyst expansion.

  14. Environmental external effects from wind power based on the EU ExternE methodology

    DEFF Research Database (Denmark)

    Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

    1998-01-01

    The European Commission has launched a major study project, ExternE, to develop a methodology to quantify externalities. A “National Implementation Phase”, was started under the Joule II programme with the purpose of implementing the ExternE methodology in all member states. The main objective...

  15. 重建后关节囊及外旋肌群人工全髋关节置换术在股骨颈骨折的临床疗效%Therapeutic effect of total hip replacement with Posterior arthrosis cpsule reconstruction and Short external rotator muscle repair on Femoral neck fractures

    Institute of Scientific and Technical Information of China (English)

    陈春雷; 李拱榆

    2014-01-01

    Objective To explore the therapeutic effect of total hip replacement with Posterior arthrosis cpsule reconstruction and Short external rotator muscle repair on Femoral neck fractures. Methods Fourty patients with Femoral neck fractures. were select-ed and divided into two groups with 20 cases in each groups. A group was given the treatment of total hip replacement with Poste-rior arthrosis cpsule reconstruction and external rotator muscle repair whiIe B group was given the treatment of traditional total hip replacement only with external rotator muscle repair. The operation incision length, operation time, intraoperative bleeding volume, postoperative drainage volume and hospital stay were all recorded. And postoperative complication in 6 months of two groups in-cluding infection, hematoma, nerve injury, joint dislocation, deep vein thrombosis and Harris hip score were observed and com-pared. Results ①The intraoperative bleeding volume and postoperative drainage volume in A group were less than those in A group (P0.05). ②There was no significant difference of Harris hip score at 6 months after surgery between the two groups (95%VS 85%, P>0.05). ③There were lower incidence of postoperative infection, hematoma and joint dislocation in group A than those in group B (P0.05). Conclusion The therapeutic effect of total hip replacement with Posterior arthrosis cpsule reconstruction and Short external rotator muscle repair on Femoral neck fractures is obvious were less postoperative infection, hematoma and joint disloca-tion, which is worthy of clinical application.%目的:探讨重建后关节囊及外旋肌群人工全髋关节置换术在股骨颈骨折中的临床疗效。方法选择我院2012年3月-2013年3月收治的股骨颈骨折的患者40例,根据手术方式不同随机分为两组,每组20例:A 组采取重建后关节囊及外旋肌群人工全髋关节置换术;B组采取传统经后侧入路行髋关节置换术(仅修补外旋肌群

  16. Externality or sustainability economics?

    Energy Technology Data Exchange (ETDEWEB)

    Bergh, Jeroen C.J.M. van den [ICREA, Barcelona (Spain); Department of Economics and Economic History and Institute for Environmental Science and Technology, Universitat Autonoma de Barcelona (Spain)

    2010-09-15

    In an effort to develop 'sustainability economics' Baumgaertner and Quaas (2010) neglect the central concept of environmental economics-'environmental externality'. This note proposes a possible connection between the concepts of environmental externality and sustainability. In addition, attention is asked for other aspects of 'sustainability economics', namely the distinction weak/strong sustainability, spatial sustainability and sustainable trade, distinctive sustainability policy, and the ideas of early 'sustainability economists'. I argue that both sustainability and externalities reflect a systems perspective and propose that effective sustainability solutions require that more attention is given to system feedbacks, notably other-regarding preferences and social interactions, and energy and environmental rebound. The case of climate change and policy is used to illustrate particular statements. As a conclusion, a list of 20 insights and suggestions for research is offered. (author)

  17. Metasurface external cavity laser

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Luyao, E-mail: luyaoxu.ee@ucla.edu; Curwen, Christopher A.; Williams, Benjamin S. [Department of Electrical Engineering, University of California, Los Angeles, California 90095 (United States); California NanoSystems Institute, University of California, Los Angeles, California 90095 (United States); Hon, Philip W. C.; Itoh, Tatsuo [Department of Electrical Engineering, University of California, Los Angeles, California 90095 (United States); Chen, Qi-Sheng [Northrop Grumman Aerospace Systems, Redondo Beach, California 90278 (United States)

    2015-11-30

    A vertical-external-cavity surface-emitting-laser is demonstrated in the terahertz range, which is based upon an amplifying metasurface reflector composed of a sub-wavelength array of antenna-coupled quantum-cascade sub-cavities. Lasing is possible when the metasurface reflector is placed into a low-loss external cavity such that the external cavity—not the sub-cavities—determines the beam properties. A near-Gaussian beam of 4.3° × 5.1° divergence is observed and an output power level >5 mW is achieved. The polarized response of the metasurface allows the use of a wire-grid polarizer as an output coupler that is continuously tunable.

  18. Muscle pain

    African Journals Online (AJOL)

    Causes of muscle pain include stress, physical activity, infections, hyper or .... Acupuncture. It is a traditional Chinese-based therapeutic method which ..... and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical.

  19. On the clinical significance of the sternalis muscle.

    Science.gov (United States)

    Georgiev, Georgi P; Jelev, Lazar; Ovtscharoff, Vladimir A

    2009-01-01

    During routine anatomical dissection, two cases of sternalis muscle were described. In the first case a unilateral sternalis on the left side was observed. It started from the fibres of the sternal membrane, then passed downwards in a slightly arch-shaped course and ended in the pectoral fascia at the level of 6-7 costal cartilages. In the second case, a bilateral sternalis muscle composed of two bellies (right and left) was detected. It arose from the sternal membrane covering the sternal angle. The right belly was attached to the fourth costal cartilage at the sternal junction; the left one was inserted into the third costal cartilage also at the sternal junction. In these cases sternalis muscles were supplied by perforating branches of the internal thoracic arteries and innervated by anterior branches of the intercostal nerves. We have also reviewed the available literature concerning the clinical importance of the sternalis and summarized it clearly for clinical anatomists, plastic surgeons, breast surgeons and radiologists.

  20. External jugular venous aneurysm: A clinical curiosity

    Science.gov (United States)

    Mohanty, Debajyoti; Jain, Bhupendra Kumar; Garg, Pankaj Kumar; Tandon, Anupama

    2013-01-01

    Jugular venous aneurysm is an extremely rare condition. The patients presented with a painless swelling in the neck that appears while coughing, straining, bending, or breath holding. Detection of a soft and compressible swelling in the course of an external jugular vein (EJV) superficial to the sternomastoid muscle, non-filling on compression of the EJV during Valsalva maneuver clinches the diagnosis of EJV aneurysm. Color Doppler ultrasound allows precise delineation of the lesion and is considered the gold standard for confirming the diagnosis. Surgical excision is indicated mostly for cosmetic reasons and symptomatic aneurysms. We, herein, report a patient with saccular external jugular venous aneurysm to highlight the typical clinical presentation and diagnosis of this rare entity. PMID:23633867

  1. [Progressive external ophthalmoplegia and distal myopathy].

    Science.gov (United States)

    Damian, C

    1993-01-01

    A patient, 58 years old, presents progressive blepharoptosis, in both eyes and external ophthalmoplegia. The general somatic examination, shows, at the level of the higher limbs, distal myopathy with muscular hypotony and articular deformities fibrosis and tendinous retraction. On examining the eye bottom we found colloid degeneration in the muscle region. Within the same family a ten-year-old nephew presents congenital ptosis. The muscular biopsy from the levator palpebrae shows muscular degenerative lesions with the reduction of nuclei and the proliferation of conjunctive tissue. It is shown that progressive external ophthalmoplegia must be interpreted as an ocular myopathy. The association with the distal myopathy at the level of the higher limbs, in the presented observation, upholds this pathogeny.

  2. Stochastic Control - External Models

    DEFF Research Database (Denmark)

    Poulsen, Niels Kjølstad

    2005-01-01

    This note is devoted to control of stochastic systems described in discrete time. We are concerned with external descriptions or transfer function model, where we have a dynamic model for the input output relation only (i.e.. no direct internal information). The methods are based on LTI systems...

  3. Productivity Change and Externalities

    DEFF Research Database (Denmark)

    Kravtsova, Victoria

    2014-01-01

    firms and the economy as a whole. The approach used in the current research accounts for different internal as well as external factors that individual firms face and evaluates the effect on changes in productivity, technology as well as the efficiency of domestic firms. The empirical analysis focuses...... change in different types of firms and sectors of the economy...

  4. Multiple external root resorption.

    Science.gov (United States)

    Yusof, W Z; Ghazali, M N

    1989-04-01

    Presented is an unusual case of multiple external root resorption. Although the cause of this resorption was not determined, several possibilities are presented. Trauma from occlusion, periodontal and pulpal inflammation, and resorption of idiopathic origin are all discussed as possible causes.

  5. Power, muscular work, and external forces in cycling.

    Science.gov (United States)

    de Groot, G; Welbergen, E; Clijsen, L; Clarijs, J; Cabri, J; Antonis, J

    1994-01-01

    Cycling performance is affected by the interaction of a number of variables, including environment, mechanical, and human factors. Engineers have focused on the development of more efficient bicycles. Kinesiologists have examined cycling performance from a human perspective. This paper summarizes only certain aspects of human ergonomics of cycling, especially those which are important for the recent current research in our departments. Power is a key to performance of physical work. During locomotion an imaginary flow of energy takes place from the metabolism to the environment, with some efficiency. The 'useful' mechanical muscle power output might be used to perform movements and to do work against the environment. The external power is defined as the sum of joint powers, each calculated as the product of the joint (net) moment and angular velocity. This definition of external power is closely related to the mean external power as applied to exercise physiology: the sum of joint powers reflects all mechanical power which in principle can be used to fulfil a certain task. In this paper, the flow of energy for cycling is traced quantitatively as far as possible. Studies on the total lower limb can give insight into the contribution of individual muscles to external power. The muscle velocity (positive or negative) is obtained from the positions and orientations of body segments and a bar linkage model of the lower limb. The muscle activity can be measured by electromyography. In this way, positive and negative work regions in individual muscles are identified. Synergy between active agonistic/antagonistic muscle groups occurs in order to deliver external power. Maximum power is influenced by body position, geometry of the bicycle and pedalling rate. This has to be interpreted in terms of the length-tension and force-velocity-power relationships of the involved muscles. Flat road and uphill cycling at different saddle-tube angles is simulated on an ergometer. The

  6. Artificial muscle: facts and fiction.

    Science.gov (United States)

    Schaub, Marcus C

    2011-12-19

    Mechanical devices are sought to support insufficient or paralysed striated muscles including the failing heart. Nickel-titanium alloys (nitinol) present the following two properties: (i) super-elasticity, and (ii) the potential to assume different crystal structures depending on temperature and/or stress. Starting from the martensite state nitinol is able to resume the austenite form (state of low potential energy and high entropy) even against an external resistance. This one-way shape change is deployed in self-expanding vascular stents. Heating induces the force generating transformation from martensite to the austenite state while cooling induces relaxation back to the martensite state. This two-way shape change oscillating between the two states may be used in cyclically contracting support devices of silicon-coated nitinol wires. Such a contractile device sutured to the right atrium has been tested in vitro in a bench model and in vivo in sheep. The contraction properties of natural muscles, specifically of the myocardium, and the tight correlation with ATP production by oxidative phosphorylation in the mitochondria is briefly outlined. Force development by the nitinol device cannot be smoothly regulated as in natural muscle. Its mechanical impact is forced onto the natural muscle regardless of the actual condition with regard to metabolism and Ca2+-homeostasis. The development of artificial muscle on the basis of nitinol wires is still in its infancy. The nitinol artificial muscle will have to prove its viability in the various clinical settings.

  7. Diaphragm compound muscle action potential measured with magnetic stimulation and chest wall surface electrodes.

    Science.gov (United States)

    Luo, Y M; Mustfa, N; Lyall, R A; Man, W D C; Glérant, J C; Polkey, M I; Moxham, J

    2002-06-01

    To seek a method to reliably measure phrenic nerve conduction time (PNCT) with magnetic stimulation we investigated two stimulus sites, placing the magnetic coil at the cricoid cartilage (high position) or close to the clavicle (low position). We also compared compound muscle action potential (CMAP) recorded from three different sites: in the sixth to eighth intercostal spaces in the anterior axillary line (Ant-a); in the 8th intercostal space close to the midclavicular line; and with one electrode at the lower sternum and the other at the costal margin. Fourteen normal subjects were studied. The PNCT measured by magnetic stimulation in the high position recorded from (Ant-a) was 7.6+/-0.6 on the left side and 8.4+/-0.7 on the right. The PNCT recorded from all three sites become much shorter when the magnetic coil was moved from the high to the low position. Our results show that PNCT can be accurately measured with magnetic stimulation when care is taken to avoid coactivation of the brachial plexus.

  8. ExternE transport methodology for external cost evaluation of air pollution

    DEFF Research Database (Denmark)

    Jensen, S. S.; Berkowicz, R.; Brandt, J.

    The report describes how the human exposure estimates based on NERI's human exposure modelling system (AirGIS) can improve the Danish data used for exposure factors in the ExternE Transport methodology. Initially, a brief description of the ExternE Tranport methodology is given and it is summaris...

  9. The External Mind

    DEFF Research Database (Denmark)

    The External Mind: an Introduction by Riccardo Fusaroli, Claudio Paolucci pp. 3-31 The sign of the Hand: Symbolic Practices and the Extended Mind by Massimiliano Cappuccio, Michael Wheeler pp. 33-55 The Overextended Mind by Shaun Gallagher pp. 57-68 The "External Mind": Semiotics, Pragmatism......, Extended Mind and Distributed Cognition by Claudio Paolucci pp. 69-96 The Social Horizon of Embodied Language and Material Symbols by Riccardo Fusaroli pp. 97-123 Semiotics and Theories of Situated/Distributed Action and Cognition: a Dialogue and Many Intersections by Tommaso Granelli pp. 125-167 Building...... Action in Public Environments with Diverse Semiotic Resources by Charles Goodwin pp. 169-182 How Marking in Dance Constitutes Thinking with the Body by David Kirsh pp. 183-214 Ambiguous Coordination: Collaboration in Informal Science Education Research by Ivan Rosero, Robert Lecusay, Michael Cole pp. 215-240...

  10. External-Memory Multimaps

    CERN Document Server

    Angelino, Elaine; Mitzenmacher, Michael; Thaler, Justin

    2011-01-01

    Many data structures support dictionaries, also known as maps or associative arrays, which store and manage a set of key-value pairs. A \\emph{multimap} is generalization that allows multiple values to be associated with the same key. For example, the inverted file data structure that is used prevalently in the infrastructure supporting search engines is a type of multimap, where words are used as keys and document pointers are used as values. We study the multimap abstract data type and how it can be implemented efficiently online in external memory frameworks, with constant expected I/O performance. The key technique used to achieve our results is a combination of cuckoo hashing using buckets that hold multiple items with a multiqueue implementation to cope with varying numbers of values per key. Our external-memory results are for the standard two-level memory model.

  11. Topographic study of the sphenomandibular muscle

    Directory of Open Access Journals (Sweden)

    Raulino Naves Borges

    2012-01-01

    Full Text Available The temporal muscle is housed in the fossa of the bone bearing its name – the temporal bone. Its origin, body, and insertion have been well studied, and it has been described as a muscle consisting of three bundles and responsible for various functions. The advancement of technology has allowed the observation of yet another muscle next to this bundle of fi bers and above the temporal muscle, namely the sphenomandibular muscle. The present study was designed to study the topography of the sphenomandibular muscle. Ten anatomical sets (fi ve cadavers were dissected with the intention of displaying the topography of the temporal and sphenomandibular muscles using the techniques of cutting and folding and conventional cross cuts. The folding of the structures and mapping of the muscles was carried out on four cadavers, analyzing their origins and describing their bodies and insertions. On another cadaver, cross-sectional (horizontal, 2 mm-thick slices were made in a sequential manner. We observed the topography of the muscle and its relationship with adjacent structures. The sphenomandibular muscle was found to be independent of the temporal muscle, for its origin is in the zygomatic-frontal complex, lateral to the orbit and overlaying the fi ber of the anterior bundle of the temporal muscle. Its body is separated from the body of the temporal muscle by a thin fascia and is inserted on an oblique line external to the mandible presenting, therefore, its origin, body, and insertion independent of the origin, body, and insertion of the temporal muscle.

  12. The arterial supply of the cervical and thoracic spinal muscles and overlying skin: Anatomical study with implications for surgical wound complications.

    Science.gov (United States)

    Yue, Brian Yin Ting; le Roux, Cara Michelle; Corlett, Russell; De La Harpe, David; Richardson, Martin; Ashton, Mark

    2013-07-01

    Postoperative spinal wound dehiscence is a significant complication following the posterior midline approach. It is postulated that this approach disrupts the vasculature supplying the paraspinal muscles and overlying skin. Although the spinal vasculature has been investigated previously, the smaller arterioles have not been described in the context of the posterior midline approach. Eight cadaveric neck and posterior torso specimens were dissected after injection with a radio-opaque lead oxide mixture and subsequent radiographs taken were analyzed. The deep cervical, vertebral, superficial cervical, and occipital arteries consistently supplied the cervical paraspinal muscles. The latter two arteries also vascularized the overlying skin. The deep cervical arteries were found to be located lateral to the C3 to C6 vertebrae, vulnerable to damage with the posterior approach. In the thoracic region, the superior and posterior intercostal arteries consistently supplied the spinal muscles. In all specimens, two small anastomotic vessels posterior to the laminae were found connecting the intercostal artery perforators. Both the arterial perforators and their anastomotic channels were situated in the surgical field and susceptible to damage with the posterior approach. It is likely that the disruption in spinal vasculature contributes to the multifactorial problem of wound dehiscence with the posterior midline approach. Copyright © 2012 Wiley Periodicals, Inc.

  13. Core Muscle Activation in Suspension Training Exercises.

    Science.gov (United States)

    Cugliari, Giovanni; Boccia, Gennaro

    2017-02-01

    A quantitative observational laboratory study was conducted to characterize and classify core training exercises executed in a suspension modality on the base of muscle activation. In a prospective single-group repeated measures design, seventeen active male participants performed four suspension exercises typically associated with core training (roll-out, bodysaw, pike and knee-tuck). Surface electromyographic signals were recorded from lower and upper parts of rectus abdominis, external oblique, internal oblique, lower and upper parts of erector spinae muscles using concentric bipolar electrodes. The average rectified values of electromyographic signals were normalized with respect to individual maximum voluntary isometric contraction of each muscle. Roll-out exercise showed the highest activation of rectus abdominis and oblique muscles compared to the other exercises. The rectus abdominis and external oblique reached an activation higher than 60% of the maximal voluntary contraction (or very close to that threshold, 55%) in roll-out and bodysaw exercises. Findings from this study allow the selection of suspension core training exercises on the basis of quantitative information about the activation of muscles of interest. Roll-out and bodysaw exercises can be considered as suitable for strength training of rectus abdominis and external oblique muscles.

  14. Clinical effect of reconstruction of posterolateral hip joint capsule and external rotator muscles in total hip arthroplasty%全髋关节置换术中重建关节囊及外旋肌群的临床疗效

    Institute of Scientific and Technical Information of China (English)

    刘子璇; 张欣; 章云童; 王攀峰; 汤洋; 张春才

    2016-01-01

    Objective To study the efficacy and complications of total hip arthroplasty (THA) with rivet system for reconstruction of joint capsule and external rotator muscles.Methods Data of 170 patients managed with THA of femoral neck fracture between January 2009 and January 2012 were reviewed retrospectively.Hip fracture was the result of a fall and all were subcapital fractures.The fracture patterns were classified as Garden Ⅳ in 139 patients and Garden Ⅱ in 31 patients according to the degree of displacement.In all,85 patients (37 males and 48 females;age between 61 and 84 years,mean 73 years) underwent joint capsule as well as external rotator muscle reconstruction by rivet system (study group).The remaining 85 patients (36 males and 49 females;age between 64-87 years,mean 74 years) were served as control group.The MOS 36-item short form health survey (SF-36),dislocation rate and complications were evaluated at postoperative follow-up.Results Duration of follow-up was 36 to 60 months (mean,46 months).SF-36 questionnaire scale was (45.95 ±4.27)points in study group and (45.38 ± 4.67) points in control group before operation (P > 0.05),while (83.67 ± 3.93) points in study group and (82.16 ± 3.21) points in control group at postoperative follow-up (P < 0.05).Six patients in control group suffered from early prosthetic dislocation,but none in study control.Perioperative incidence of complications was comparable between the two groups (P >0.05).Conclusions Application of rivet system for reconstruction of joint capsule and external rotator muscles in THA of patients with femoral neck fracture can reduce incidence of prosthetic dislocation after operation.The operation is simple and will not increase the rate of perioperative complications.%目的 探讨全髋关节置换术(THA)中应用铆钉重建关节囊及外旋肌群的临床疗效及并发症. 方法 回顾性分析2009年1月—2012年1月因股骨颈骨折接受THA的患者170例,致伤原因均为

  15. Muscle strain (image)

    Science.gov (United States)

    A muscle strain is the stretching or tearing of muscle fibers. A muscle strain can be caused by sports, exercise, a ... something that is too heavy. Symptoms of a muscle strain include pain, tightness, swelling, tenderness, and the ...

  16. Atividade elétrica dos músculos oblíquos externos e multífidos durante o exercício de flexoextensão do quadril realizado no Cadillac com diferentes regulagens de mola e posições do indivíduo Electrical activity of external oblique and multifidus muscles during the hip flexion-extension exercise performed in the Cadillac with different adjustments of springs and individual positions

    Directory of Open Access Journals (Sweden)

    Jefferson F. Loss

    2010-12-01

    Full Text Available CONTEXTUALIZAÇÃO: Apesar do amplo uso do Pilates na Fisioterapia, há poucos estudos que avaliaram a ativação elétrica dos músculos nos exercícios. OBJETIVO: Verificar a influência de diferentes regulagens de mola e posições do indivíduo sobre a ativação elétrica dos multífidos (MU e oblíquos externos (OE durante a flexoextensão do quadril (FEQ no Cadillac. MÉTODOS: Oito mulheres praticantes de Pilates por seis meses realizaram 10 repetições de FEQ nas situações: mola baixa (MB, mola fixada a 30 cm do nível em que estava o indivíduo; mola alta (MA, mola fixada a 90 cm do nível em que estava o indivíduo; posição próxima (PP, distância de 10 cm da fixação da mola; posição distante (PD, distância de 30 cm da fixação da mola. Dados cinemáticos e de eletromiografia (EMG foram coletados sincronizadamente, e os músculos monitorados bilateralmente foram os OE e os MU. Cada movimento de FEQ foi recortado em duas fases (extensão e flexão. O sinal de EMG foi calculado e normalizado usando a contração voluntária máxima (CVM. O Wilcoxon test foi usado para investigar diferenças entre as situações (pBACKGROUND: Despite of the widepread use of Pilates in Physical Therapy, there are few studies that have assessed the muscle electrical activation during Pilates exercises. OBJECTIVE: Verify the influence of different spring adjustments and individual positions on the electrical activation of multifidus (MU and oblique external (OE muscles during hip flexion-extension (HFE exercise on the Cadillac. METHODS: Eight women practicing Pilates exercises for at least six months performed 10 repetitions of HFE in the following situations: Lower Spring, spring fixed at 30 cm in relation to level which the individuals were positioned. Higher Spring, spring fixed at 90 cm in relation to level which the individuals were positioned. Near Position, distance of 10 cm from the fixed spring. Distant Position, distance of 30 cm from

  17. Regularization by External Variables

    DEFF Research Database (Denmark)

    Bossolini, Elena; Edwards, R.; Glendinning, P. A.

    2016-01-01

    Regularization was a big topic at the 2016 CRM Intensive Research Program on Advances in Nonsmooth Dynamics. There are many open questions concerning well known kinds of regularization (e.g., by smoothing or hysteresis). Here, we propose a framework for an alternative and important kind of regula...... of regularization, by external variables that shadow either the state or the switch of the original system. The shadow systems are derived from and inspired by various applications in electronic control, predator-prey preference, time delay, and genetic regulation....

  18. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results.

    Science.gov (United States)

    Doi, K; Muramatsu, K; Hattori, Y; Otsuka, K; Tan, S H; Nanda, V; Watanabe, M

    2000-05-01

    Recent interest in reconstruction of the upper limb following brachial plexus injuries has focused on the restoration of prehension following complete avulsion of the brachial plexus. Double free muscle transfer was performed in patients who had complete avulsion of the brachial plexus. After initial exploration of the brachial plexus and (if possible) repair of the fifth cervical nerve root, the first free muscle, used to restore elbow flexion and finger extension, is transferred and reinnervated by the spinal accessory nerve. The second free muscle, transferred to restore finger flexion, is reinnervated by the fifth and sixth intercostal nerves. The motor branch of the triceps brachii is reinnervated by the third and fourth intercostal nerves to restore elbow extension. Hand sensibility is restored by suturing of the sensory rami of the intercostal nerves to the median nerve or the ulnar nerve component of the medial cord. Secondary reconstructive procedures, such as arthrodesis of the carpometacarpal joint of the thumb, shoulder arthrodesis, and tenolysis of the transferred muscle and the distal tendons, may be required to improve the functional outcome. The early results were evaluated in thirty-two patients who had had reconstruction with use of the double free muscle procedure. Twenty-six of these patients were followed for at least twenty-four months (mean duration, thirty-nine months) after the second free muscle transfer, and they were assessed with regard to the long-term outcome as well. Satisfactory (excellent or good) elbow flexion was restored in twenty-five (96 percent) of the twenty-six patients and satisfactory prehension (more than 30 degrees of total active motion of the fingers), in seventeen (65 percent). Fourteen patients (54 percent) could position the hand in space, negating simultaneous flexion of the elbow, while moving the fingers at least 30 degrees and could use the reconstructed hand for activities requiring the use of two hands, such

  19. Diaphragmatic, thoracic and limb motor effects of amyl nitrite inhalation.

    Science.gov (United States)

    Macefield, G; Nail, B S

    1985-11-01

    In the pentobarbitone/urethane anaesthetized rabbit and pentobarbitone anaesthetized cat intratracheal inhalation of amyl nitrite, a non-specific smooth muscle relaxant, caused a vagally dependent depression of patellar reflex and spontaneous (thermal shivering and external intercostal inspiratory) motor activities. A prolonged vagally-independent potentiation succeeded the initial inhibition. The potentiation of intercostal activity may account for the increase in tidal volume produced by amyl nitrite after vagotomy. The patellar reflex potentiation survived thoracolumbar spinal transection but could not be attributed to a direct facilitation of neuromuscular or muscular events. A correlation existed between the relative dependence of fusimotor support of a muscle and its susceptibility to the inhibitory and subsequent facilitatory affects of amyl nitrite inhalation. The diaphragm and interchondral muscles, essentially independent of the autogenetic facilitation provided by muscle spindles, demonstrated neither of these effects. Conversely, the intercostal muscles depend greatly on such facilitation, as do the pectoral and limb muscles during thermal shivering.

  20. Surgical excision of the breast giant fibroadenoma under regional anesthesia by Pecs II and internal intercostal plane block: a case report and brief technical description: a case report.

    Science.gov (United States)

    Kim, Hyungtae; Shim, Junho; Kim, Ikthae

    2017-02-01

    A 22-years-old female patient at 171 cm and 67 kg visited the Department of Breast Surgery of the hospital with a mass accompanied with pain on the left side breast as chief complaints. Since physical examination revealed a suspected huge mass, breast surgeon decided to perform surgical excision and requested anesthesia to our department. Surgery of breast tumor is often under local anesthesia. However, in case of big size tumor, surgery is usually performed under general anesthesia. The patient feared general anesthesia. Unlike abdominal surgery, there is no need to control visceral pain for breast and anterior thoracic wall surgery. Therefore, we decided to perform resection under regional anesthesia. Herein, we report a successful anesthetic and pain management of the patient undergoing excision of a huge breast fibroadenoma under regional anesthesia using Pecs II and internal intercostal plane block.

  1. Anatomical study on The Arm Greater Yang Small Intestine Meridian Muscle in Human

    Directory of Open Access Journals (Sweden)

    Kyoung-Sik, Park

    2004-06-01

    Full Text Available This study was carried to identify the component of Small Intestine Meridian Muscle in human, dividing the regional muscle group into outer, middle, and inner layer. the inner part of body surface were opened widely to demonstrate muscles, nerve, blood vessels and the others, displaying the inner structure of Small Intestine Meridian Muscle. We obtained the results as follows; 1. Small Intestine Meridian Muscle is composed of the muscle, nerve and blood vessels. 2. In human anatomy, it is present the difference between a term of nerve or blood vessels which control the muscle of Meridian Muscle and those which pass near by Meridian Muscle. 3. The inner composition of meridian muscle in human arm is as follows ; 1 Muscle ; Abd. digiti minimi muscle(SI-2, 3, 4, pisometacarpal lig.(SI-4, ext. retinaculum. ext. carpi ulnaris m. tendon.(SI-5, 6, ulnar collateral lig.(SI-5, ext. digiti minimi m. tendon(SI-6, ext. carpi ulnaris(SI-7, triceps brachii(SI-9, teres major(SI-9, deltoid(SI-10, infraspinatus(SI-10, 11, trapezius(Sl-12, 13, 14, 15, supraspinatus(SI-12, 13, lesser rhomboid(SI-14, erector spinae(SI-14, 15, levator scapular(SI-15, sternocleidomastoid(SI-16, 17, splenius capitis(SI-16, semispinalis capitis(SI-16, digasuicus(SI-17, zygomaticus major(Il-18, masseter(SI-18, auriculoris anterior(SI-19 2 Nerve ; Dorsal branch of ulnar nerve(SI-1, 2, 3, 4, 5, 6, br. of mod. antebrachial cutaneous n.(SI-6, 7, br. of post. antebrachial cutaneous n.(SI-6,7, br. of radial n.(SI-7, ulnar n.(SI-8, br. of axillary n.(SI-9, radial n.(SI-9, subscapular n. br.(SI-9, cutaneous n. br. from C7, 8(SI-10, 14, suprascapular n.(SI-10, 11, 12, 13, intercostal n. br. from T2(SI-11, lat. supraclavicular n. br.(SI-12, intercostal n. br. from C8, T1(SI-12, accessory n. br.(SI-12, 13, 14, 15, 16, 17, intercostal n. br. from T1,2(SI-13, dorsal scapular n.(SI-14, 15, cutaneous n. br. from C6, C7(SI-15, transverse cervical n.(SI-16, lesser occipital n. & great auricular n. from

  2. 选择性肋间动脉灌注在降主动脉手术中的应用%Selective intercostal arterial perfusion during descending aortic surgery

    Institute of Scientific and Technical Information of China (English)

    王东进; 周庆; 李庆国; 武忠

    2009-01-01

    目的 探讨选择性肋间动脉灌注在降主动脉手术中对脊髓的保护作用.方法 2007年8月至2009年3月,5例降主动脉夹层和2例降主动脉瘤病人行降主动脉置换术.术中保留置换降主动脉上所有肋间动脉,进行选择性肋间动脉灌注,以减少脊髓缺血时间及程度以达到脊髓保护的目的 .术后早期观察和中期随访是否有截瘫发生.结果 术中脊髓缺血23~27 min,平均(24.8±1.6) min.7例术后均未发生截瘫,治愈出院.随访1~19个月,全组无截瘫,生活质量良好.结论 选择性肋间动脉灌注可缩短脊髓缺血时间和程度,脊髓保护效果良好,并可大大降低手术操作难度.%Objective This clinical study evaluated the efficacy of selective intercostal arterial perfusion for protection of spinal cord during descending aortic surgery.Methods From August 2007 to March 2009,7 patients received descending aorta replacement for type B dissection (5 patients) or thoracic aortic aneurysm (2 patients).Descending aorta replacement was performed through a posterolateral incision and left femoral vein-artery bypass in 1 case and left atrial-left femoral artery (LA-FA) bypass in 6.The grafts extended from the distal arch at the root of subclavian artery to the descending aorta at the T10-11 vertebra.The posterior wall of the descending aorta with intercostal arteries was sutured to form an 15 mm tube in diameter and an end-to-side anastomosis was made to an 8 mm graft branch.Selective intercostal arterial perfusion was performed from the T1 intercostal artery to the T10-11 intercostal artery through the 8 mm graft branch to protect spinal cord from ischemia.Cerebrospinal fluid pressure was monitored and cerebrospinal fluid drainage was performed necessarily.Results The replaced grafts measured from 19 to 23 cm [mean (20.2±1.4) cm].The CPB duration ranged from73-84 min [mean (24.8 ± 1.6) min].The mean ischemic duration was 23 to 27min [mean(24.8 ± 1.6) min

  3. External Measures of Cognition

    Directory of Open Access Journals (Sweden)

    Osvaldo eCairo

    2011-10-01

    Full Text Available The human brain is undoubtedly the most impressive, complex and intricate organ that has evolved over time. It is also probably the least understood, and for that reason, the one that is currently attracting the most attention. In fact, the number of comparative analyses that focus on the evolution of brain size in Homo sapiens and other species has increased dramatically in recent years. In neuroscience, no other issue has generated so much interest and been the topic of so many heated debates as the difference in brain size between socially defined population groups, both its connotations and implications. For over a century, external measures of cognition have been related to intelligence. However, it is still unclear whether these measures actually correspond to cognitive abilities. In summary, this paper must be reviewed with this premise in mind.

  4. Observational Study on the Occurrence of Muscle Spindles in Human Digastric and Mylohyoideus Muscles

    Directory of Open Access Journals (Sweden)

    Daniele Saverino

    2014-01-01

    Full Text Available Although the occurrence of muscle spindles (MS is quite high in most skeletal muscles of humans, few MS, or even absence, have been reported in digastric and mylohyoideus muscles. Even if this condition is generally accepted and quoted in many papers and books, observational studies are scarce and based on histological sections of a low number of specimens. The aim of the present study is to confirm previous data, assessing MS number in a sample of digastric and mylohyoideus muscles. We investigated 11 digastric and 6 mylohyoideus muscles from 13 donors. Muscle samples were embedded in paraffin wax, cross-sectioned in a rostrocaudal direction, and stained using haematoxylin-eosin. A mean of 5.1 ± 1.1 (range 3–7 MS was found in digastric muscles and mean of 0.5 ± 0.8 (range 0–2 in mylohyoideus muscles. A significant difference (P<0.001 was found with the control sample, confirming the correctness of the histological procedure. Our results support general belief that the absolute number of spindles is sparse in digastric and mylohyoideus muscles. External forces, such as food resistance during chewing or gravity, do not counteract jaw-opening muscles. It is conceivable that this condition gives them a limited proprioceptive importance and a reduced need for having specific receptors as MS.

  5. Comparison between muscle activation measured by electromyography and muscle thickness measured using ultrasonography for effective muscle assessment.

    Science.gov (United States)

    Kim, Chang-Yong; Choi, Jong-Duk; Kim, Suhn-Yeop; Oh, Duck-Won; Kim, Jin-Kyung; Park, Ji-Whan

    2014-10-01

    In this study, we aimed to compare the intrarater reliability and validity of muscle thickness measured using ultrasonography (US) and muscle activity via electromyography (EMG) during manual muscle testing (MMT) of the external oblique (EO) and lumbar multifidus (MF) muscles. The study subjects were 30 healthy individuals who underwent MMT at different grades. EMG was used to measure the muscle activity in terms of ratio to maximum voluntary contraction (MVC) and root mean square (RMS) metrics. US was used to measure the raw muscle thickness, the ratio of muscle thickness at MVC, and the ratio of muscle thickness at rest. One examiner performed measurements on each subject in 3 trials. The intrarater reliabilities of the % MVC RMS and raw RMS metrics for EMG and the % MVC thickness metrics for US were excellent (ICC=0.81-0.98). There was a significant difference between all the grades measured using the % MVC thickness metric (pEMG measurement methods than with the others (r=0.51-0.61). Our findings suggest that the % MVC thickness determined by US was the most sensitive of all methods for assessing the MMT grade.

  6. Muscle disease.

    Science.gov (United States)

    Tsao, Chang-Yong

    2014-02-01

    On the basis of strong research evidence, Duchenne muscular dystrophy (DMD), the most common severe childhood form of muscular dystrophy, is an X-linked recessive disorder caused by out-of-frame mutations of the dystrophin gene. Thus, it is classified asa dystrophinopathy. The disease onset is before age 5 years. Patients with DMD present with progressive symmetrical limb-girdle muscle weakness and become wheelchair dependent after age 12 years. (2)(3). On the basis of some research evidence,cardiomyopathy and congestive heart failure are usually seen in the late teens in patients with DMD. Progressive scoliosis and respiratory in sufficiency often develop once wheelchair dependency occurs. Respiratory failure and cardiomyopathy are common causes of death, and few survive beyond the third decade of life. (2)(3)(4)(5)(6)(7). On the basis of some research evidence, prednisone at 0.75 mg/kg daily (maximum dose, 40 mg/d) or deflazacort at 0.9 mg/kg daily (maximum dose, 39 mg/d), a derivative of prednisolone (not available in the United States), as a single morning dose is recommended for DMD patients older than 5 years, which may prolong independent walking from a few months to 2 years. (2)(3)(16)(17). Based on some research evidence, treatment with angiotensin-converting enzyme inhibitors, b-blockers, and diuretics has been reported to be beneficial in DMD patients with cardiac abnormalities. (2)(3)(5)(18). Based on expert opinion, children with muscle weakness and increased serum creatine kinase levels may be associated with either genetic or acquired muscle disorders (Tables 1 and 3). (14)(15)

  7. Muscle channelopathies.

    Science.gov (United States)

    Statland, Jeffrey; Phillips, Lauren; Trivedi, Jaya R

    2014-08-01

    Skeletal muscle channelopathies are rare heterogeneous diseases with marked genotypic and phenotypic variability. Despite advances in understanding of the molecular pathology of these disorders, the diverse phenotypic manifestations remain a challenge in diagnosis and therapeutics. These disorders can cause lifetime disability and affect quality of life. There is no treatment of these disorders approved by the US Food and Drug Administration at this time. Recognition and treatment of symptoms might reduce morbidity and improve quality of life. This article summarizes the clinical manifestations, diagnostic studies, pathophysiology, and treatment options in nondystrophic myotonia, congenital myasthenic syndrome, and periodic paralyses. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. External fixators in haemophilia.

    Science.gov (United States)

    Lee, V; Srivastava, A; PalaniKumar, C; Daniel, A J; Mathews, V; Babu, N; Chandy, M; Sundararaj, G D

    2004-01-01

    External fixators (EF) are not commonly used for patients with haemophilia. We describe the use of EF (Ilizarov, AO- uni- and bi-planar fixators and Charnley clamp) in nine patients (mean age: 19.2 years; range: 9-37) with haemophilia for the following indications - arthrodesis of infected joints, treatment of open fractures and osteoclasis. EF required an average of nine skin punctures [range: 4-17 were maintained for a period of 15 weeks (range: 8-29.5), without regular factor replacement, till bone healing was adequate and were removed with a single dose of factor infusion]. The mean preoperative factor level achieved was 85% (range: 64-102%). Much lower levels were subsequently maintained till wound healing. The average total factor consumption was 430 IU kg(-1) (range: 240-870), administered over a period of 17 days (range: 9-44). There were no major complications related to EF except in a patient who developed inhibitors. In conclusion, EF can be used safely in haemophilic patients who do not have inhibitors and does not require prolonged factor replacement.

  9. Skepticism, contextualism, externalism and modality

    National Research Council Canada - National Science Library

    Ron Wilburn

    2006-01-01

    .... However, because efforts to contextualize externalism via subjunctive conditional analysis court circularity, it is only on an internalistic interpretation that contextualist strategies can even be motivated...

  10. A Relationship Between the EMG Silent Period and Muscle Fatigue of the Masticatory Muscle

    Energy Technology Data Exchange (ETDEWEB)

    Kim, T. H.; Cho, I. J.; Kim, S. H. [The University of Seoul, Seoul (Korea); Yang, D. J. [Samsung Electronics Co., Ltd., Seoul (Korea); Lee, J. [Samchok National University, Samchok (Korea)

    2001-05-01

    Silent period(SP) is transient stops of muscle activity that are induced by mechanical or electrical stimulus and the duration of silent period is a important parameter that have been associated with symptoms of masticatory dysfunction. Muscle fatigue is induced by sustained muscular contractions. It is associated with the external manifestations as the inability to maintain a desired force output, muscular tremor, and localized pain. Muscle fatigue is a parameter that have been measured or monitored the deterioration of a performance of muscles. On the study of relationship between SP and masticatory muscle fatigue, Nagasawa suggested that SP increase up to 3 min. from the beginning of clenching when the subjects performed sustained contractions at 50% maximum clenching level. In this paper, in order to evaluate a relationship between SP and muscle fatigue, 10 SPs per 1 minute are measured at 10%, 30%, 50% maximum clenching level. We used the median frequency in order to quantify the degree of muscle fatigue. However, the results shows that the duration of silent period was not significantly affected by differing levels of muscle fatigue. Therefore, we suggest that the SP is not increased or decreased as the results of muscle fatigue, also the origin of the SP generation mechanism is discussed. (author). 18 refs., 10 figs., 1 tab.

  11. Human Muscle Fatigue Model in Dynamic Motions

    CERN Document Server

    Ma, Ruina; Bennis, Fouad; Ma, Liang

    2012-01-01

    Human muscle fatigue is considered to be one of the main reasons for Musculoskeletal Disorder (MSD). Recent models have been introduced to define muscle fatigue for static postures. However, the main drawbacks of these models are that the dynamic effect of the human and the external load are not taken into account. In this paper, each human joint is assumed to be controlled by two muscle groups to generate motions such as push/pull. The joint torques are computed using Lagrange's formulation to evaluate the dynamic factors of the muscle fatigue model. An experiment is defined to validate this assumption and the result for one person confirms its feasibility. The evaluation of this model can predict the fatigue and MSD risk in industry production quickly.

  12. Eye muscle repair - discharge

    Science.gov (United States)

    ... Lazy eye repair - discharge; Strabismus repair - discharge; Extraocular muscle surgery - discharge ... You or your child had eye muscle repair surgery to correct eye muscle ... term for crossed eyes is strabismus. Children most often ...

  13. Muscle strain treatment

    Science.gov (United States)

    Treatment - muscle strain ... Question: How do you treat a muscle strain ? Answer: Rest the strained muscle and apply ice for the first few days after the injury. Anti-inflammatory medicines or acetaminophen ( ...

  14. External Cooling Coupled to Reduced Extremity Pressure Device

    Science.gov (United States)

    Kuznetz, Lawrence H.

    2011-01-01

    Although suited astronauts are currently cooled with a Liquid Cooled Ventilation Garment (LCVG), which can remove up to 85 percent of body heat, their effectiveness is limited because cooling must penetrate layers of skin, muscle, fat, bone, and tissue to reach the bloodstream, where its effect is prominent. Vasoconstriction further reduces the effectiveness by limiting arterial flow when exposed to cold (the frostbite response), resulting in a time constant on the order of 20 minutes from application to maximum effect. This delay can be crucial in severe exposure to hypo- or hyper-thermic conditions, compromising homeostasis. The purpose of this innovation is to provide a lightweight, effective means of delivering heat or cold from an external source directly to the bloodstream. The effectiveness of this ECCREP (External Cooling Coupled to Reduced Extremity Pressure) device is based on not having to penetrate layers of skin, muscle, fat, and tissue, thereby avoiding the thermal lag associated with their mass and heat capacity. This is accomplished by means of an outer boot operating at a slightly reduced pressure than the rest of the body, combined with an inner boot cooled or heated by an external source via water or chemicals. Heat transfer from the external source to the foot takes place by means of circulating water or flexible heat pipes.

  15. Dynamic ultrasound of the external snapping hip syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yun Sun; Song, Baek Yong; Paik, Sang Hyun; Lee, Tae Gyu; Yoon, Yong Kyu [Eulji Hospital, Eulji University School of Medicine, Deajeon (Korea, Republic of); Lee, Sung Moon [Keimyung University School of Medicine, Deagu (Korea, Republic of)

    2002-09-15

    Snapping hip syndrome has been described as a hip pain accompanied by an audible snapping during motion of the hip or while walking. The variable causes of its external, internal, and intra-articular origins have been described. The most common extemal snapping hip has been associated with a thickened posterior border of the iliotibial band or of the anterior border of the gluteus maximus muscle slipping over the greater trochanter. The aim of this study was to evaluate the dynamic ultrasound findings of external snapping hip syndrome with review of the literature. We studied 5 patients (7 cases) with external snapping hip and pain over the greater trochanter during walking or hip motion (3 males and 2 females, age range, 14-32 years; mean, 19 years). Two patients reported bilateral snapping hips.

  16. ExternE transport methodology for external cost evaluation of air pollution

    DEFF Research Database (Denmark)

    Jensen, S. S.; Berkowicz, R.; Brandt, J.

    The report describes how the human exposure estimates based on NERI's human exposure modelling system (AirGIS) can improve the Danish data used for exposure factors in the ExternE Transport methodology. Initially, a brief description of the ExternE Tranport methodology is given and it is summaris...... how the methodology has been applied so far in a previous Danish study. Finally, results of a case study are reported. Exposure factors have been calculated for various urban categories in the Greater Copenhagen Area...

  17. ExternE transport methodology for external cost evaluation of air pollution (DK)

    Energy Technology Data Exchange (ETDEWEB)

    Solvang Jensen, S.; Berkowicz, R.; Brandt, J. [National Environmental Research Inst., Dept. of Atmospheric Environment (Denmark); Willumsen, E.; Kristensen, N.B. [COWI (Denmark)

    2004-07-01

    The report describes how the human exposure estimates based on NERI's human exposure modelling system (AiGIS) can improve the Danish data used for exposure factors in the ExternE Transport methodology. Inititally, a brief description of the ExternE Transport methodology is given and it is summarised how the methodology has been applied so far in a previous Danish study. Finally, results of a case study are reported. Exposure factors have been calculated for various urban categories in the Greater Copenhagen Area. (au)

  18. External coating of colonic anastomoses

    DEFF Research Database (Denmark)

    Pommergaard, Hans-Christian; Achiam, Michael Patrick; Rosenberg, Jacob

    2012-01-01

    Colon anastomotic leakage remains both a frequent and serious complication in gastrointestinal surgery. External coating of colonic anastomoses has been proposed as a means to lower the rate of this complication. The aim of this review was to evaluate existing studies on external coating of colonic...

  19. Retrofitting Systems for External Walls

    DEFF Research Database (Denmark)

    Rose, Jørgen

    1997-01-01

    In this report, 9 different external and internal retrofitting systems are analyzed using numerical calculations. The analysis focuses on the thermal bridge effects in the different systems, and on this basis it is discussed whether internal or external retrofitting has the most advantages...

  20. Performance Targets and External Benchmarking

    DEFF Research Database (Denmark)

    Friis, Ivar; Hansen, Allan; Vámosi, Tamás S.

    Research on relative performance measures, transfer pricing, beyond budgeting initiatives, target costing, piece rates systems and value based management has for decades underlined the importance of external benchmarking in performance management. Research conceptualises external benchmarking...... the conditions upon which the market mechanism is performing within organizations. This paper aims to contribute to research by providing more insight to the conditions for the use of external benchmarking as an element in performance management in organizations. Our study explores a particular type of external...... towards the conditions for the use of the external benchmarks we provide more insights to some of the issues and challenges that are related to using this mechanism for performance management and advance competitiveness in organizations....

  1. The role of shoulder muscles is task specific.

    Science.gov (United States)

    Boettcher, Craig E; Cathers, Ian; Ginn, Karen A

    2010-11-01

    The aim of this study was to compare activity in shoulder muscles during unsupported internal and external rotation to examine their functional roles, and determine whether they retain their 'stabiliser' or 'mover' role regardless of the shoulder task. Electromyographic recordings in the dominant shoulder of 15 normal subjects were taken from 13 shoulder muscle sites using a combination of surface and intramuscular electrodes during isometric shoulder internal and external rotation in an unsupported abducted position under conditions of increasing load. During internal rotation significantly higher activity levels were found in subscapularis (pmuscle sites activated above low levels (r(2)=0.93±0.07; mean±s.d.). This study has shown that shoulder muscle function is task specific and that shoulder muscle motor strategy for a particular task does not change with increasing torque. As the only shoulder rotators that demonstrated direction specificity the rotator cuff muscles are likely to be functioning to provide rotation torque while the deltoid is likely to be providing dynamic shoulder stability during the task examined. Higher scapulothoracic muscle activity during external rotation indicated the need for greater dynamic scapular stability as a result of higher rotator cuff activity during external than internal rotation. Copyright © 2010 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  2. Alterações cardiovasculares de gatos submetidos à toracotomia intercostal, pré-medicados com associação de tramadol, butorfanol e atropina e anestesiados com propofol e halotano Cardiovascular changes in cats submitted to intercostal thoracotomy, premedication with association tramadol, butorphanol, atropine, anesthetised with propofol and halothane

    Directory of Open Access Journals (Sweden)

    Juliana Tabarelli Brondani

    2003-10-01

    Full Text Available A toracotomia é um procedimento cirúrgico que produz estímulo doloroso intenso. O objetivo deste estudo foi avaliar o efeito cardiovascular da associação tramadol, butorfanol e atropina na medicação pré-anestésica de gatos anestesiados com propofol e halotano. Doze animais, SRD, machos ou fêmeas, com peso médio de 2,7 ± 0,62kg receberam como medicação pré-anestésica (MPA, a associação de tramadol (2,0mg kg-1, butorfanol (0,4mg kg-1 e atropina (0,044mg kg-1, via intramuscular. Trinta minutos após MPA, a indução foi realizada com propofol (5,0mg kg-1 por via intravenosa. A manutenção anestésica foi obtida com halotano e oxigênio 100% sob ventilação artificial manual. Os gatos foram submetidos à toracotomia intercostal para implante de um segmento autólogo de pericárdio no diafragma. As variáveis avaliadas foram: freqüência cardíaca (bpm, saturação de oxigênio da hemoglobina (%, pressão arterial sistólica (mmHg e vaporização de halotano (%. As variáveis foram mensuradas 20 minutos após a MPA (TMPA, 10 minutos após indução e a cada 10 minutos até o final do procedimento cirúrgico (T10 a T100.Os dados obtidos foram analisados estatisticamente através de ANOVA e teste de Bonferroni (pIntercostal thoracotomy is a very painful procedure that deserves proper prevention and treatment. In this study we aimed to investigate the cardiovascular effect of the association of tramadol, butorphanol and atropine in the premedication of cats anesthetised with propofol and halothane. Twelve cats of mixed breed, female and male, with mean body weight of 2.7 ± 0.62kg were premedicated with 2.0mg kg-1 tramadol and 0.4mg kg-1 butorphanol and 0.044mg kg-1 atropine combined in the same syringe intramuscularly administered. After 30 minutes of premedication, anesthetic induction was obtained with 5.0mg kg-1 propofol intravenously. Anesthetic maintenance was done with halothane and 100% oxygen with manual artificial

  3. Estudo comparativo entre toracotomia intercostal, esternotomia mediana parcial e total em cães sadios (Canis familiaris : avaliação clínica e hemogasométrica Comparative study among intercostal thoracotomy, parcial median sternotomy and total in health dogs (Canis familiaris: clinical and hemogasometric avaliation

    Directory of Open Access Journals (Sweden)

    Marcus Paulo de Souza Ferreira Pinto

    2000-12-01

    Full Text Available O objetivo deste experimento foi comparar as alterações hemogasométricas e as possíveis complicações trans e pós-operatórias encontradas na toracotomia intercostal direita, esternotomia mediana parcial e esternotomia mediana total, determinando qual das técnicas produziu menor grau de intercorrências. Foram utilizados dezoito cães, sem raça definida, adultos, machos e fêmeas, com peso entre quinze e vinte quilos e em condições de saúde julgadas satisfatórias para o experimento. Os cães foram divididos em três grupos de seis animais, de acordo com a técnica cirúrgica empregada: GRUPO A -animais submetidos à toracotomia intercostal direita; GRUPO B - animais submetidos à esternotomia mediana parcial e GRUPO C - animais submetidos à esternotomia mediana total. Os cães foram avaliados quanto às possíveis intercorrências intra e pós-operatórias, alterações das freqüências cardíaca e respiratória, temperatura, oxigenação, ventilação, equilíbrio ácido-básico e dor. Durante sete dias foi feita avaliação da ferida cirúrgica, não observando-se intercorrências com cicatrização, infecção, presença de fístulas e deiscência de sutura. Os resultados obtidos foram analisados estatisticamente. Concluiu-se que as três técnicas foram exeqüíveis em cães, pois permitiram recuperação pós-operatória satisfatória e comparativamente não foram verificadas alterações significativas quanto ao pH, gases sangüíneos e dor.The experiment’s objective was to compare hemogasometric changes and possible complications during and after Right Intercostal Thoracotomy, Partial Median Sternotomy and Total Median Sternotomy; determining which technique(s would produce less problems. Eighteen dogs were used, without any breeding, all adults, males and females, weighting between fifteen and twenty kilos and with health judged satisfactory for the experiment. The dogs were divided in three groups of six, according to

  4. External costs related to power production technologies. ExternE national implementation for Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Schleisner, L.; Sieverts Nielsen, P.

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results; to aggregate these site- and technology-specific results to more general figures. The current report covers the results of the national implementation for Denmark. Three different fuel cycles have been chosen as case studies. These are fuel cycles for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant based on biogas. The report covers all the details of the application of the methodology to these fuel cycles aggregation to a national level. (au) EU-JOULE 3. 59 tabs., 25 ills., 61 refs.

  5. External fuel thermionic reactor system.

    Science.gov (United States)

    Mondt, J. F.; Peelgren, M. L.

    1971-01-01

    Thermionic reactors are prime candidates for nuclear electric propulsion. The national thermionic reactor effort is concentrated on the flashlight concept with the external-fuel concept as the backup. The external-fuel concept is very adaptable to a completely modular power subsystem which is attractive for highly reliable long-life applications. The 20- to 25-cm long, externally-fueled converters have been designed, fabricated, and successfully tested with many thermal cycles by electrical heating. However, difficulties have been encountered during encapsulation for nuclear heated tests and none have been started to date. These nuclear tests are required to demonstrate the concept feasibility.

  6. Use of Automated External Defibrillators

    Energy Technology Data Exchange (ETDEWEB)

    Gregory K Christensen

    2009-02-01

    In an effort to improve survival from cardiac arrest, the American Heart Association (AHA) has promoted the Chain of Survival concept, describing a sequence of prehospital steps that result in improved survival after sudden cardiac arrest. These interventions include immediate deployment of emergency medical services, prompt cardiopulmonary resuscitation, early defibrillation when indicated, and early initiation of advanced medical care. Early defibrillation has emerged as the most important intervention with survival decreasing by 10% with each minute of delay in defibrillation. Ventricular Fibrillation (VF) is a condition in which there is uncoordinated contraction of the heart cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. VF is a medical emergency and if the arrhythmia continues for more than a few seconds, blood circulation will cease, and death can occur in a matter of minutes. During VF, contractions of the heart are not synchronized, blood flow ceases, organs begin to fail from oxygen deprivation and within 10 minutes, death will occur. When VF occurs, the victim must be defibrillated in order to establish the heart’s normal rhythm. On average, the wait for an ambulance in populated areas of the United States is about 11 minutes. In view of these facts, the EFCOG Electrical Safety Task Group initiated this review to evaluate the potential value of deployment and use of automated external defibrillators (AEDs) for treatment of SCA victims. This evaluation indicates the long term survival benefit to victims of SCA is high if treated with CPR plus defibrillation within the first 3-5 minutes after collapse. According to the American Heart Association (AHA), survival rates as high as 74% are possible if treatment and defibrillation is performed in the first 3 minutes. In contrast survival rates are only 5% where no AED programs have been established to provide prompt CPR and defibrillation. ["CPR statistics

  7. The Pilates Method increases respiratory muscle strength and performance as well as abdominal muscle thickness.

    Science.gov (United States)

    Giacomini, Mateus Beltrame; da Silva, Antônio Marcos Vargas; Weber, Laura Menezes; Monteiro, Mariane Borba

    2016-04-01

    The aim of this study was to verify the effects of the Pilates Method (PM) training program on the thickness of the abdominal wall muscles, respiratory muscle strength and performance, and lung function. This uncontrolled clinical trial involved 16 sedentary women who were assessed before and after eight weeks of PM training. The thickness of the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles was assessed. The respiratory muscle strength was assessed by measuring the maximum inspiratory (MIP) and expiratory (MEP) pressure. The lung function and respiratory muscle performance were assessed by spirometry. An increase was found in MIP (p = 0.001), MEP (p = 0.031), maximum voluntary ventilation (p = 0.020) and the TrA (p abdominal wall muscle hypertrophy and an increase in respiratory muscle strength and performance, preventing weakness in abdominal muscles and dysfunction in ventilatory mechanics, which could favor the appearance of illnesses.

  8. DRY NEEDLING INCREASES MUSCLE THICKNESS IN A SUBJECT WITH PERSISTENT MUSCLE DYSFUNCTION: A CASE REPORT.

    Science.gov (United States)

    Cross, Kevin M; McMurray, Michael

    2017-06-01

    Muscle dysfunction is very common following musculoskeletal injury. There is very little evidence to suggest that muscle function may be positively impacted by soft tissue interventions, such as dry needling. The purpose of this case report is to describe the immediate effect of dry needling on muscle thickness in a subject after shoulder surgery. A 22 year-old competitive gymnast presented seven months post shoulder surgery with significant impairments and functional limitations. Previous physical therapy focused on restoration of range of motion and strength using general exercise interventions, but the subject had persistent tightness and weakness of musculature of the shoulder complex. A subject-specific physical therapy program including manual physical therapy resulted in significant initial improvement, but lack of flexibility and weakness of the rotator cuff limited progress. Dry needling was used to address persistent myofascial trigger points. Immediately after dry needling the infraspinatus, the muscle's thickness was significantly improved as measured by rehabilitative ultrasound imaging. There was a corresponding increase in force production of external rotation at 90 degrees of abduction. Minimal research exists that validates the potential of dry needling on muscle function, as assessed by muscle thickness measured using rehabilitative ultrasound imaging. The results of this case report suggest that dry needling contributed to improvement in muscle thickness and strength in a subject with muscle dysfunction following an injury. 4.

  9. Combination of external loads

    Energy Technology Data Exchange (ETDEWEB)

    Frandsen, S.; Tarp Johansen, N.J.; Joergensen, H. [Forskningscenter Risoe, Roskilde (Denmark); Gravesen, H.; Soerensen, S.L. [Carl Bro, Glostrup (Denmark); Pedersen, J. [Elsam Engineering, Fredericia (Denmark); Zorn, R.; Hvidberg Knudsen, M. [DHI Water and Environment, Hoersholm (Denmark); Voelund, P. [Energi E2, Koebenhavn (Denmark)

    2003-09-01

    The project onbectives have been: To improve and consequently opimise the basis for design of offshore wind turbines. This is done through 1) mapping the wind, wave ice and current as well as correlations of these, and 2) by clarifyring how these external conditions transform into loads. A comprehensive effort has been made to get a thorough understanding of the uncertainties that govern the reliability of wind turbines with respect to wind and wave loading. One of the conclusions is that the reliability of wind turbines is generally lower, than the average reliability of building structures that are subject not only to environmental loads, which are very uncertain, but also imposed loads and self weight, which are less uncertain than the environmental loads. The implication is that, at the moment lower load partial safety factors for onshore wind turbines cannot be recommended. For the combination of wind and wave design loads the problem is twofold: 1). A very conservative design will be generated by simply adding the individual wind and wave design loads disregarding the independence of the short-term fluctuations of wind and wave loads. 2). Characteristic values and partial safety factors for wind and wave loads are not defined similarly. This implies that the reliability levels of turbine support structures subject to purely aerodynamic loads and subject to purely hydrodynamic loads are not identical. For the problem of combining aerodynamic design loads and hydrodynamic design loads two results have been obtained in the project: 1). By simple means a site specific wave load safety factor rendering the same safety level for hydrodynamic loads as for aerodynamic loads is derived, and next, by direct square summation of extreme fluctuations, the wind and wave load safety factors are weighted. 2). Under the assumptions that a deep water site is considered and that the wave loading is a fifty-fifty mix of drag and inertia the same wind and wave load safety factor

  10. Assessment of isokinetic muscle function in Korea male volleyball athletes

    Science.gov (United States)

    Kim, Chang-Gyun; Jeoung, Bog Ja

    2016-01-01

    Volleyball players performed numerous repetitions of spike actions, which uses and requires strong and explosive force, and control of the muscles of the shoulder, lower back, and legs. Muscle imbalance is one of the main causes of sport injuries. The purpose of this study was to assess isokinetic muscle functions in male volleyball players. We thus aim to accurately evaluate their muscle functions, and identify the best training strategy to achieve optimal muscle strength balance in future training programs. The participants in this study consisted of 14 male volleyball players. Muscle strength was measured using the isokinetic dynamometer. Muscle strength was evaluated in terms of peak torque and average power, calculated from five repeated measurements at an angular speed of 60°/sec. Three players who were left attackers showed shoulder imbalance, four players showed trunk joint imbalance, nine players had knee joint of extension/flexion imbalance and four players showed left/right imbalance. The results showed that the number of volleyball players with differences between the strength of the bilateral knee muscles, and between the strength of the hamstrings and quadriceps muscles was higher than the number of players with differences between the strength of the shoulder internal and external rotation muscles, and higher than the number of players with differences between the strength of the lower back extension and flexion muscles. PMID:27807521

  11. Shoulder muscle firing patterns during the windmill softball pitch.

    Science.gov (United States)

    Maffet, M W; Jobe, F W; Pink, M M; Brault, J; Mathiyakom, W

    1997-01-01

    The purpose of this study was to describe the activity of eight shoulder muscles during the windmill fast-pitch softball throw. Ten collegiate female pitchers were analyzed with intramuscular electromyography, high-speed cinematography, and motion analysis. The supraspinatus muscle fired maximally during arm elevation from the 6 to 3 o'clock position phase, centralizing the humeral head within the glenoid. The posterior deltoid and teres minor muscles acted maximally from the 3 to 12 o'clock position phase to continue arm elevation and externally rotate the humerus. The pectoralis major muscle accelerated the arm from the 12 o'clock position to ball release phase. The serratus anterior muscle characteristically acted to position the scapula for optimal glenohumeral congruency, and the subscapularis muscle functioned as an internal rotator and to protect the anterior capsule. Although the windmill softball pitch is overtly different from the baseball pitch, several surprising similarities were revealed. The serratus anterior and pectoralis major muscles work in synchrony and seem to have similar functions in both pitches. Although the infraspinatus and teres minor muscles are both posterior cuff muscles, they are characteristically uncoupled during the 6 to 3 o'clock position phase, with the infraspinatus muscle acting more independently below 90 degrees. Subscapularis muscle activity seems important in dynamic anterior glenohumeral stabilization and as an internal rotator in both the baseball and softball throws.

  12. Low level termination of external carotid artery and its clinical significance: A case report

    Directory of Open Access Journals (Sweden)

    Surekha Devadasa Shetty

    2015-09-01

    Full Text Available The external carotid arterial system is a complex vascular system providing nourishment to the territorial areas of the head and neck. The branches of the external carotid artery are the key landmarks for adequate exposure and appropriate placement of cross-clamps on the carotid arteries during carotid endarterectomy. Knowledge of anatomical variation of the external carotid artery is important in head and neck surgeries. Variations in the branching pattern of the external carotid artery are well known and documented. We report a rare case of low-level termination of the external carotid artery. It terminated by dividing into maxillary and superficial temporal arteries deep into the posterior belly of the digastric muscle, one inch below the angle of the mandible. The occipital and posterior auricular arteries arose from a common trunk given off by the external carotid artery. [Arch Clin Exp Surg 2015; 4(3.000: 160-163

  13. Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats

    OpenAIRE

    2014-01-01

    The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to t...

  14. Muscle Weakness

    Science.gov (United States)

    Al Kaissi, Ali; Ryabykh, Sergey; Ochirova, Polina; Kenis, Vladimir; Hofstätter, Jochen G.; Grill, Franz; Ganger, Rudolf; Kircher, Susanne Gerit

    2017-01-01

    Marked ligamentous hyperlaxity and muscle weakness/wasting associated with awkward gait are the main deficits confused with the diagnosis of myopathy. Seven children (6 boys and 1 girl with an average age of 8 years) were referred to our department because of diverse forms of skeletal abnormalities. No definitive diagnosis was made, and all underwent a series of sophisticated investigations in other institutes in favor of myopathy. We applied our methodology through the clinical and radiographic phenotypes followed by targeted genotypic confirmation. Three children (2 boys and 1 girl) were compatible with the diagnosis of progressive pseudorheumatoid chondrodysplasia. The genetic mutation was correlated with the WISP 3 gene actively expressed by articular chondrocytes and located on chromosome 6. Klinefelter syndrome was the diagnosis in 2 boys. Karyotyping confirmed 47,XXY (aneuploidy of Klinefelter syndrome). And 2 boys were finally diagnosed with Morquio syndrome (MPS type IV A) as both showed missense mutations in the N-acetylgalactosamine-sulfate sulfatase gene. Misdiagnosis can lead to the initiation of a long list of sophisticated investigations. PMID:28210640

  15. Characterization of macrophage-like cells in the external layers of human small and large intestine

    DEFF Research Database (Denmark)

    Mikkelsen, H B; Rumessen, J J

    1992-01-01

    -DR-positive (expressing the MHC class-II antigen), in contrast to macrophage-like cells in the subserosa and submucosa. Macrophage-like cells in the external muscle layer were mostly acid phosphatase-negative, and at the electron-microscopic level they were found to have features of macrophages: primary lysosomes, coated...... vesicles and pits. However, very few secondary lysosomes were present. Birbeck granules were not observed. It is concluded that in the external muscle layer of human small and large intestine numerous macrophages of a special type are present. It is discussed whether this cell type plays a role...

  16. Alterations of thoraco-abdominal volumes and asynchronies in patients with spinal muscle atrophy type III.

    Science.gov (United States)

    LoMauro, Antonella; Romei, Marianna; Priori, Rita; Laviola, Marianna; D'Angelo, Maria Grazia; Aliverti, Andrea

    2014-06-15

    Spinal muscular atrophy (SMA) is characterized by degeneration of motor neurons resulting in muscle weakness. For the mild type III form, a sub-classification into type IIIA and IIIB, based on age of motor impairment, was recently proposed. To investigate if SMA IIIA (more severe) and IIIB differ also in terms of respiratory function, thoracoabdominal kinematics was measured during quiet breathing, inspiration preceding cough and inspiratory capacity on 5 type IIIA and 9 type IIIB patients. Four patients with SMA II (more severe than types III) and 19 healthy controls were also studied. Rib cage motion was similar in SMA IIIB and controls. Conversely, in SMA IIIA and SMA II it was significantly reduced and sometime paradoxical during quiet breathing in supine position. Our results suggest that in SMA IIIA intercostal muscles are weakened and the diaphragm is preserved similarly to SMA II, while in SMA IIIB the action of all inspiratory muscles is maintained. Sub-classification of type III seems feasible also for respiratory function.

  17. Intracellular ionized calcium concentration in muscles from humans with malignant hyperthermia.

    Science.gov (United States)

    López, J R; Alamo, L; Caputo, C; Wikinski, J; Ledezma, D

    1985-06-01

    Ca2+ selective microelectrodes have been used to determine the free myoplasmic [Ca2+] in human skeletal muscle obtained from patients who had developed early signs associated with malignant hyperthermia (MH) during anesthesia. Intercostal muscle biopsies were performed under local anesthesia in four MH patients 15 days to 4 months after developing the MH crisis and in three control subjects. We used only microelectrodes that showed a Nernstian response between pCa3 and pCa7 (30.5 mV per decade at 37 degrees C). Membrane resting potential (V(m)) and calcium potential (V(Ca)) were obtained from superficial fibers. The free cytosolic [Ca2+] was 0.39 +/- 0.1 microM (mean +/- SEM, n = 18) in muscle fibers obtained from malignant hyperthermic patients, whereas in control subjects it was 0.11 +/- 0.02 microM (n = 10). These results suggest that this syndrome might be related to an abnormally high myoplasmic free resting calcium concentration, probably due to a defective function of the plasma membrane or the sarcoplasmic reticulum.

  18. Mechanically induced alterations in cultured skeletal muscle growth

    Science.gov (United States)

    Vandenburgh, H. H.; Hatfaludy, S.; Karlisch, P.; Shansky, J.

    1991-01-01

    Model systems are available for mechanically stimulating cultured skeletal muscle cells by passive tensile forces which simulate those found in vivo. When applied to embryonic muscle cells in vitro these forces induce tissue organogenesis, metabolic adaptations, and muscle cell growth. The mechanical stimulation of muscle cell growth correlates with stretch-induced increases in the efflux of prostaglandins PGE2 and PGF2(alpha) in a time and frequency dependent manner. These prostaglandins act as mechanical 'second messengers' regulating skeletal muscle protein turnover rates. Since they also effect bone remodelling in response to tissue loading and unloading, secreted prostaglandins may serve as paracrine growth factors, coordinating the growth rates of muscle and bone in response to external mechanical forces. Cell culture model systems will supplement other models in understanding mechanical transduction processes at the molecular level.

  19. Mechanically induced alterations in cultured skeletal muscle growth

    Science.gov (United States)

    Vandenburgh, H. H.; Hatfaludy, S.; Karlisch, P.; Shansky, J.

    1991-01-01

    Model systems are available for mechanically stimulating cultured skeletal muscle cells by passive tensile forces which simulate those found in vivo. When applied to embryonic muscle cells in vitro these forces induce tissue organogenesis, metabolic adaptations, and muscle cell growth. The mechanical stimulation of muscle cell growth correlates with stretch-induced increases in the efflux of prostaglandins PGE2 and PGF2(alpha) in a time and frequency dependent manner. These prostaglandins act as mechanical 'second messengers' regulating skeletal muscle protein turnover rates. Since they also effect bone remodelling in response to tissue loading and unloading, secreted prostaglandins may serve as paracrine growth factors, coordinating the growth rates of muscle and bone in response to external mechanical forces. Cell culture model systems will supplement other models in understanding mechanical transduction processes at the molecular level.

  20. Reconditioning aging muscles.

    Science.gov (United States)

    Kraus, H

    1978-06-01

    Weakness or stiffness of key posture muscles can cause much of the disability seen in elderly patients. Too much tension and too little exercise greatly increase the natural loss of muscular fitness with age. A systematic program of exercise, stressing relaxation and stretching of tight muscles and strenghthening of weak muscles, can improve physical fitness. The program must be tailored to the patient, starting with relaxation and gentle limbering exercises and proceeding ultimately to vigorous muscle-stretching exercises. Muscle aches and pain from tension and muscle imbalance are to be expected. Relaxation relieves tension pain, and strengthening weak muscles and stretching tight muscles will correct muscle imbalance. To prevent acute muscle spasm, the patient should avoid excessive exertion and increase exercise intensity gradually.

  1. External costs related to power production technologies. ExternE national implementation for Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Schleisner, L.; Sieverts Nielsen, P. [eds.

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results, to aggregate these site- and technology-specific results to more general figures. The current report covers the detailed information concerning the ExternE methodology. Importance is attached to the computer system used in the project and the assessment of air pollution effects on health, materials and ecological effects. Also the assessment of global warming damages are described. Finally the report covers the detailed information concerning the national implementation for Denmark for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant base on biogas. (au) EU-JOULE 3. 79 tabs., 11 ills., 201 refs.

  2. Trunk muscle activities during abdominal bracing: comparison among muscles and exercises.

    Science.gov (United States)

    Maeo, Sumiaki; Takahashi, Takumi; Takai, Yohei; Kanehisa, Hiroaki

    2013-01-01

    Abdominal bracing is often adopted in fitness and sports conditioning programs. However, there is little information on how muscular activities during the task differ among the muscle groups located in the trunk and from those during other trunk exercises. The present study aimed to quantify muscular activity levels during abdominal bracing with respect to muscle- and exercise-related differences. Ten healthy young adult men performed five static (abdominal bracing, abdominal hollowing, prone, side, and supine plank) and five dynamic (V- sits, curl-ups, sit-ups, and back extensions on the floor and on a bench) exercises. Surface electromyogram (EMG) activities of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES) muscles were recorded in each of the exercises. The EMG data were normalized to those obtained during maximal voluntary contraction of each muscle (% EMGmax). The % EMGmax value during abdominal bracing was significantly higher in IO (60%) than in the other muscles (RA: 18%, EO: 27%, ES: 19%). The % EMGmax values for RA, EO, and ES were significantly lower in the abdominal bracing than in some of the other exercises such as V-sits and sit-ups for RA and EO and back extensions for ES muscle. However, the % EMGmax value for IO during the abdominal bracing was significantly higher than those in most of the other exercises including dynamic ones such as curl-ups and sit-ups. These results suggest that abdominal bracing is one of the most effective techniques for inducing a higher activation in deep abdominal muscles, such as IO muscle, even compared to dynamic exercises involving trunk flexion/extension movements. Key PointsTrunk muscle activities during abdominal bracing was examined with regard to muscle- and exercise-related differences.Abdominal bracing preferentially activates internal oblique muscles even compared to dynamic exercises involving trunk flexion/extension movements.Abdominal bracing should be

  3. Influence of different control strategies on muscle activation patterns in trunk muscles.

    Science.gov (United States)

    Hansen, Laura; Anders, Christoph

    2014-12-01

    Adequate training of the trunk muscles is essential to prevent low back pain. Although sit-ups are simple to perform, the perceived high effort is the reason why training the abdominal muscles is seldom continued over a longer period of time. It is well known that the abdominal muscles are inferior to the back muscles in terms of force, but this cannot explain the extreme difference in perceived effort between trunk flexion and extension tasks. Therefore, this study was aimed at the identification of control strategy influences on the muscular stress level. Thirty-nine subjects were investigated. The performed tasks were restricted to the sagittal plane and were implemented with simulated and realized tilt angles. Subjects were investigated in an upright position with their lower bodies fixed and their upper bodies free. Posture-controlled tasks involved graded forward and backward tilting, while force-controlled tasks involved the application of force based on a virtual tilt angle. The Surface EMG (SEMG) was taken from five trunk muscles on both sides. Control strategies seemed to have no systematic influence on the SEMG amplitudes of the back muscles. In contrast, the abdominal muscles exhibited significantly higher stress levels under posture-controlled conditions without relevantly increasing antagonistic co-activation of back muscles. The abdominal muscles' relative differences ranged from an average of 20% for the external oblique abdominal muscle to approximately 40% for the rectus abdominal muscle. The perceived high effort expended during sit-ups can now be explained by the posture-controlled contractions that are required.

  4. Externality and burnout among dentists.

    Science.gov (United States)

    St-Yves, A; Freeston, M H; Godbout, F; Poulin, L; St-Amand, C; Verret, M

    1989-12-01

    This study investigates the relationship between burnout as measured by the Maslach Burnout Inventory and locus of control as measured by the Adult Nowicki-Strickland Internal-External Locus of Control (ANS-IE) for 82 dentists. Significant Pearson correlations between two Maslach subscales and locus of control show Personal Accomplishment to be negatively associated -.31 and Emotional Exhaustion to be positively correlated .21 to externality.

  5. Relatie interne en externe audit

    OpenAIRE

    Ghys, Emelie

    2011-01-01

    In het eerste hoofdstuk wordt de probleemstelling van deze eindverhandeling besproken. Interne en externe audit worden de laatste jaren internationaal en nationaal meer en meer erkend in het bedrijfsleven. Aanleiding voor de toenemende belangstelling van de interne en externe auditfunctie zijn de verschillende boekhoudschandalen rond corporate governance of deugdelijk bestuur. Deze financiële mislukkingen leidden wereldwijd tot diverse wetten, nieuwe regels en verbeterde standaarden om zo een...

  6. Performance Targets and External Benchmarking

    DEFF Research Database (Denmark)

    Friis, Ivar; Hansen, Allan; Vámosi, Tamás S.

    as a market mechanism that can be brought inside the firm to provide incentives for continuous improvement and the development of competitive advances. However, whereas extant research primarily has focused on the importance and effects of using external benchmarks, less attention has been directed towards...... towards the conditions for the use of the external benchmarks we provide more insights to some of the issues and challenges that are related to using this mechanism for performance management and advance competitiveness in organizations....

  7. Parallel External Memory Graph Algorithms

    DEFF Research Database (Denmark)

    Arge, Lars Allan; Goodrich, Michael T.; Sitchinava, Nodari

    2010-01-01

    In this paper, we study parallel I/O efficient graph algorithms in the Parallel External Memory (PEM) model, one o f the private-cache chip multiprocessor (CMP) models. We study the fundamental problem of list ranking which leads to efficient solutions to problems on trees, such as computing lowest...... an optimal speedup of ¿(P) in parallel I/O complexity and parallel computation time, compared to the single-processor external memory counterparts....

  8. The enigmatic subcostal muscle: Anatomical study with application to spine and chest pain syndromes and avoidance of confusion on imaging.

    Science.gov (United States)

    Kim, Jun-Ho; Won, Hyung-Sun; Chung, In-Hyuk; Kim, In-Beom

    2015-11-01

    The aim of this study was to revisit the morphological characteristics of the subcostal muscle and to obtain its morphometric data. One hundred and two sides of the thorax from 51 adult cadavers were used. The total number of subcostal muscles in the 102 specimens was 559. The subcostal muscle commonly comprised an aponeurosis at its superior and inferior attachments. This muscle had a thin band-like shape in 64.2% cases, while in the other 35.8% either its superior or inferior attachment was wider. It was classified into the following four types on the basis of its inferior attachment: in Types I and II it extended to two (79.3%) and three (12.0%) lower ribs, respectively; in Type III it joined adjacent muscles such as the psoas major (2.2%) or quadratus lumborum (0.7%); and in Type IV it was attached to the transverse process (0.4%) or body (3.9%) of the 12th thoracic vertebra and the body of the 1st lumbar vertebra (1.4%). The subcostal muscle was found at the deepest layer of the intercostal space, and mainly presented in the upper and lower parts of the thorax. Its width and height were 18.2 ± 10.9 mm (mean ± SD) and 56.0 ± 13.3 mm, respectively. The distances from the midsagittal line to the superior and inferior attachments of the subcostal muscle were 77.1 ± 13.0 mm and 48.9 ± 13.5 mm, respectively. The results of this study will help to advance current understanding of the subcostal muscle.

  9. Muscle shortening velocity depends on tissue inertia and level of activation during submaximal contractions.

    Science.gov (United States)

    Ross, Stephanie A; Wakeling, James M

    2016-06-01

    In order to perform external work, muscles must do additional internal work to deform their tissue, and in particular, to overcome the inertia due to their internal mass. However, the contribution of the internal mass within a muscle to the mechanical output of that muscle has only rarely been studied. Here, we use a dynamic, multi-element Hill-type muscle model to examine the effects of the inertial mass within muscle on its contractile performance. We find that the maximum strain-rate of muscle is slower for lower activations and larger muscle sizes. As muscle size increases, the ability of the muscle to overcome its inertial load will decrease, as muscle tension is proportional to cross-sectional area and inertial load is proportional to mass. Thus, muscles that are larger in size will have a higher inertial cost to contraction. Similarly, when muscle size and inertial load are held constant, decreasing muscle activation will increase inertial cost to contraction by reducing muscle tension. These results show that inertial loads within muscle contribute to a slowing of muscle contractile velocities (strain-rates), particularly at the submaximal activations that are typical during animal locomotion.

  10. External Costs Related to Power Production Technologies

    DEFF Research Database (Denmark)

    Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

    1997-01-01

    The European Commission has launched a major study project, ExternE, to develop a methodology to quantify externalities. A “National Implementation Phase”, was started under the Joule II programme with the purpose of implementing the ExternE methodology in all member states. The main objective...

  11. External Costs Related to Power Production Technologies

    DEFF Research Database (Denmark)

    Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

    1997-01-01

    The European Commission has launched a major study project, ExternE, to develop a methodology to quantify externalities. A “National Implementation Phase”, was started under the Joule II programme with the purpose of implementing the ExternE methodology in all member states. The main objective of...

  12. Overexpression of insulin-like growth factor-1 attenuates skeletal muscle damage and accelerates muscle regeneration and functional recovery after disuse.

    Science.gov (United States)

    Ye, Fan; Mathur, Sunita; Liu, Min; Borst, Stephen E; Walter, Glenn A; Sweeney, H Lee; Vandenborne, Krista

    2013-05-01

    Skeletal muscle is a highly dynamic tissue that responds to endogenous and external stimuli, including alterations in mechanical loading and growth factors. In particular, the antigravity soleus muscle experiences significant muscle atrophy during disuse and extensive muscle damage upon reloading. Given that insulin-like growth factor-1 (IGF-1) has been implicated as a central regulator of muscle repair and modulation of muscle size, we examined the effect of virally mediated overexpression of IGF-1 on the soleus muscle following hindlimb cast immobilization and upon reloading. Recombinant IGF-1 cDNA virus was injected into one of the posterior hindlimbs of the mice, while the contralateral limb was injected with saline (control). At 20 weeks of age, both hindlimbs were immobilized for 2 weeks to induce muscle atrophy in the soleus and ankle plantarflexor muscle group. Subsequently, the mice were allowed to reambulate, and muscle damage and recovery were monitored over a period of 2-21 days. The primary finding of this study was that IGF-1 overexpression attenuated reloading-induced muscle damage in the soleus muscle, and accelerated muscle regeneration and force recovery. Muscle T2 assessed by magnetic resonance imaging, a non-specific marker of muscle damage, was significantly lower in IGF-1-injected compared with contralateral soleus muscles at 2 and 5 days reambulation (Pmuscle damage in IGF-1-injected soleus muscles was confirmed on histology, with a lower fractional area of abnormal muscle tissue in IGF-1-injected muscles at 2 days reambulation (33.2±3.3 versus 54.1±3.6%, Pmuscle regeneration included timely increases in the number of central nuclei (21% at 5 days reambulation), paired-box transcription factor 7 (36% at 5 days), embryonic myosin (37% at 10 days) and elevated MyoD mRNA (7-fold at 2 days) in IGF-1-injected limbs (Pmuscles from damage and accelerating muscle repair and regeneration.

  13. Persistence of external signs in Pacific herring Clupea pallasii Valenciennes with ichthyophoniasis

    Science.gov (United States)

    Hart, Lucas M.; Conway, Carla M.; Elliott, Diane G.; Hershberger, Paul K.

    2016-01-01

    The progression of external signs of Ichthyophonus infection in Pacific herring Clupea pallasii Valenciennes was highly variable and asynchronous after intraperitoneal injection with pure parasite preparations; however, external signs generally persisted through the end of the study (429 days post-exposure). Observed signs included papules, erosions and ulcers. The prevalence of external signs plateaued 35 days post-exposure and persisted in 73–79% of exposed individuals through the end of the first experiment (147 days post-exposure). Among a second group of infected herring, external signs completely resolved in only 10% of the fish after 429 days. The onset of mortality preceded the appearance of external signs. Histological examination of infected skin and skeletal muscle tissues indicated an apparent affinity of the parasite for host red muscle. Host responses consisted primarily of granulomatous inflammation, fibrosis and necrosis in the skeletal muscle and other tissues. The persistence and asynchrony of external signs and host response indicated that they were neither a precursor to host mortality nor did they provide reliable metrics for hindcasting on the date of exposure. However, the long-term persistence of clinical signs in Pacific herring may be useful in ascertaining the population-level impacts of ichthyophoniasis in regularly observed populations.

  14. Muscle recruitment and coordination with an ankle exoskeleton.

    Science.gov (United States)

    Steele, Katherine M; Jackson, Rachel W; Shuman, Benjamin R; Collins, Steven H

    2017-07-05

    Exoskeletons have the potential to assist and augment human performance. Understanding how users adapt their movement and neuromuscular control in response to external assistance is important to inform the design of these devices. The aim of this research was to evaluate changes in muscle recruitment and coordination for ten unimpaired individuals walking with an ankle exoskeleton. We evaluated changes in the activity of individual muscles, cocontraction levels, and synergistic patterns of muscle coordination with increasing exoskeleton work and torque. Participants were able to selectively reduce activity of the ankle plantarflexors with increasing exoskeleton assistance. Increasing exoskeleton net work resulted in greater reductions in muscle activity than increasing exoskeleton torque. Patterns of muscle coordination were not restricted or constrained to synergistic patterns observed during unassisted walking. While three synergies could describe nearly 95% of the variance in electromyography data during unassisted walking, these same synergies could describe only 85-90% of the variance in muscle activity while walking with the exoskeleton. Synergies calculated with the exoskeleton demonstrated greater changes in synergy weights with increasing exoskeleton work versus greater changes in synergy activations with increasing exoskeleton torque. These results support the theory that unimpaired individuals do not exclusively use central pattern generators or other low-level building blocks to coordinate muscle activity, especially when learning a new task or adapting to external assistance, and demonstrate the potential for using exoskeletons to modulate muscle recruitment and coordination patterns for rehabilitation or performance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Simultaneous bilateral contracture of the infraspinatus muscle.

    Science.gov (United States)

    Franch, J; Bertran, J; Remolins, G; Fontecha, P; Díaz-Bertrana, M C; Durall, I

    2009-01-01

    A case of bilateral fibrotic contracture of the infraspinatus muscles in a five-year-old Belgian Shepherd dog is described. The dog was presented with progressive forelimb lameness with postural and gait abnormalities three months after an episode of overexertion. When walking, the lower part of both forelimbs swung in a lateral arc causing a circumduction movement and in the standing position, the dog showed elbow adduction with external rotation of the distal part of both front limbs. Orthopaedic examination revealed bilateral atrophy of both infraspinatus and supraspinatus muscles and restriction in the range of motion of both shoulders, especially when attempting abduction and flexion. No specific findings were observed in the shoulder or elbow radiographs but hyperechogenic areas were evident in the ultrasonographic examination of both infraspinatus muscles. A diagnosis of fibrotic contracture of both infraspinatus muscles was established and bilateral tenectomy of the insertion tendons of the infraspinatus muscles was performed. Complete recovery of the animal was achieved after the surgery, which was confirmed in a long-term follow-up (10 months). In conclusion, physical examination and ultrasonography allowed a proper diagnosis of the condition, and tenectomy of the infraspinatus muscles resulted in a complete recovery of the patient even with bilateral involvement.

  16. Thermal dependence of passive electrical properties of lizard muscle fibres.

    Science.gov (United States)

    Adams, B A

    1987-11-01

    1. The thermal dependence of passive electrical properties was determined for twitch fibres from the white region of the iliofibularis (IF) muscle of Anolis cristatellus (15-35 degrees C) and Sceloporus occidentalis (15-40 degrees C), and for twitch fibres from the white (15-45 degrees C) and red (15-40 degrees C) regions of the IF of Dipsosaurus dorsalis. These species differ in thermal ecology, with Anolis being the least thermophilic and Dipsosaurus the most thermophilic. 2. Iliofibularis fibres from the three species reacted similarly to changing temperature. As temperature was increased, input resistance (Rin) decreased (average R10 = 0.7), length constant (L) decreased (average R10 = 0.9), time constant (tau) decreased (average R10 = 0.8), sarcoplasmic resistivity (Rs) decreased (average R10 = 0.8) and apparent membrane resistance (Rm) decreased (average R10 = 0.7). In contrast, apparent membrane capacitance (Cm) increased with increasing temperature (average R10 = 1.3). 3. Rin, L, tau and apparent Rm were lowest in fibres from Anolis (the least thermophilic species) and highest in fibres from Dipsosaurus (the most thermophilic species). Anolis had the largest and Dipsosaurus the smallest diameter fibres (126 and 57 micron, respectively). Apparent Cm was highest in fibres from Sceloporus, which had fibres of intermediate diameter (101 micron). Rs did not differ significantly among species. 4. The effect of temperature on the passive electrical properties of these lizard fibres was similar to that reported for muscle fibres from other ectothermic animals (crustaceans, insects, fish and amphibians) but qualitatively different from that reported for some mammalian (cat tenuissimus, goat intercostal) fibres. The changes that occur in the passive electrical properties render the fibres less excitable as temperature increases.

  17. A muscle stem cell for every muscle: variability of satellite cell biology among different muscle groups

    OpenAIRE

    Matthew Emerson Randolph; Pavlath, Grace K.

    2015-01-01

    The human body contains approximately 640 individual skeletal muscles. Despite the fact that all of these muscles are composed of striated muscle tissue, the biology of these muscles and their associated muscle stem cell populations are quite diverse. Skeletal muscles are affected differentially by various muscular dystrophies, such that certain genetic mutations specifically alter muscle function in only a subset of muscles. Additionally, defective muscle stem cells have been implicated in t...

  18. Thermodynamic cost of external control

    Science.gov (United States)

    Barato, Andre C.; Seifert, Udo

    2017-07-01

    Artificial molecular machines are often driven by the periodic variation of an external parameter. This external control exerts work on the system of which a part can be extracted as output if the system runs against an applied load. Usually, the thermodynamic cost of the process that generates the external control is ignored. Here, we derive a refined second law for such small machines that include this cost, which is, for example, generated by free energy consumption of a chemical reaction that modifies the energy landscape for such a machine. In the limit of irreversible control, this refined second law becomes the standard one. Beyond this ideal limiting case, our analysis shows that due to a new entropic term unexpected regimes can occur: the control work can be smaller than the extracted work and the work required to generate the control can be smaller than this control work. Our general inequalities are illustrated by a paradigmatic three-state system.

  19. Leveraging External Sources of Innovation

    DEFF Research Database (Denmark)

    West, Joel; Bogers, Marcel

    2014-01-01

    This paper reviews research on open innovation that considers how and why firms commercialize external sources of innovations. It examines both the “outside-in” and “coupled” modes of open innovation. From an analysis of prior research on how firms leverage external sources of innovation...... cited work beyond those journals. A review of 291 open innovation-related publications from these sources shows that the majority of these articles indeed address elements of this inbound open innovation process model. Specifically, it finds that researchers have front-loaded their examination...... external innovations create value rather than how firms capture value from those innovations. Finally, the interaction phase considers both feedback for the linear process and reciprocal innovation processes such as cocreation, network collaboration, and community innovation. This review and synthesis...

  20. Effects of modified intercostal nerve freezing technique on postoperative recovery of traditional thoracotomy%改良肋间神经冷冻技术在传统开胸手术后恢复中的应用

    Institute of Scientific and Technical Information of China (English)

    陈计赏; 颜玉贤

    2011-01-01

    Objective To explore the application value and advantages of modified intercostal nerve freezing technique on postoperative recovery of traditional thoracotomy. Methods 100 patients undergoing conventional thoracotomy incision patients were randomly divided into 2 groups, group A as the modified intercostal nerve freezing group (n = 50) using the Beijing K001AND company JT-Ⅰ treatment only in the off-type freezer chest incision locating on intercostal and upper and lower intercostal space and the indwelling chest tube where the intercostal nerves were frozen;group B, continuous epidural analgesia group (n=50), using the Japanese company's electronic pump wells, plus droperidol with morphine-line continuous epidural analgesia (Patient control epidural analgesia, PCEA). All patients in two groups were using a visual analogue scale (Visual analogue scale, VAS) assessment of postoperative pain,observing patients 2 hours, 4 hours, 12 hours, 24 hours and 48 hours after surgery when the VAS score, nausea,vomiting, respiratory depression, itching, the incidence of intestinal paralysis. Results The post-operative pain of group A was better than that of group B, and the incidence rate of side effect was also lower than that of group B.Conclusions It suggested that the modified intercostal nerve freezing technique could effectively promote postoperative recovery after thoracotomy.%目的 探讨改良肋间神经冷冻技术在促进传统开胸手术后恢复中的应用价值及优势.方法 将100例择期传统切口开胸的病人随机分为A组和B组;A组为改良肋间神经冷冻组(n=50),使用北京K001AND公司JT-Ⅰ型冷冻治疗仪在关胸前对切口所在肋间及上、下各一个肋间和留置胸腔引流管所在肋间的肋间神经进行冷冻;B组为连续硬膜外自控镇痛组(n=50),采用日本wells公司的电子泵,用吗啡加氟哌利多行连续硬膜外自控镇痛(patient control epidural analgesia,PCEA).二组病人均

  1. Muscle strain injuries.

    Science.gov (United States)

    Garrett, W E

    1996-01-01

    One of the most common injuries seen in the office of the practicing physician is the muscle strain. Until recently, little data were available on the basic science and clinical application of this basic science for the treatment and prevention of muscle strains. Studies in the last 10 years represent action taken on the direction of investigation into muscle strain injuries from the laboratory and clinical fronts. Findings from the laboratory indicate that certain muscles are susceptible to strain injury (muscles that cross multiple joints or have complex architecture). These muscles have a strain threshold for both passive and active injury. Strain injury is not the result of muscle contraction alone, rather, strains are the result of excessive stretch or stretch while the muscle is being activated. When the muscle tears, the damage is localized very near the muscle-tendon junction. After injury, the muscle is weaker and at risk for further injury. The force output of the muscle returns over the following days as the muscle undertakes a predictable progression toward tissue healing. Current imaging studies have been used clinically to document the site of injury to the muscle-tendon junction. The commonly injured muscles have been described and include the hamstring, the rectus femoris, gastrocnemius, and adductor longus muscles. Injuries inconsistent with involvement of a single muscle-tendon junction proved to be at tendinous origins rather than within the muscle belly. Important information has also been provided regarding injuries with poor prognosis, which are potentially repairable surgically, including injuries to the rectus femoris muscle, the hamstring origin, and the abdominal wall. Data important to the management of common muscle injuries have been published. The risks of reinjury have been documented. The early efficacy and potential for long-term risks of nonsteroidal antiinflammatory agents have been shown. New data can also be applied to the field

  2. Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury.

    Science.gov (United States)

    Nikolaou, Sia; Peterson, Elizabeth; Kim, Annie; Wylie, Christopher; Cornwall, Roger

    2011-03-02

    The etiology of shoulder and elbow contractures following neonatal brachial plexus injury is incompletely understood. With use of a mouse model, the current study tests the novel hypothesis that reduced growth of denervated muscle contributes to contractures following neonatal brachial plexus injury. Unilateral brachial plexus injuries were created in neonatal mice by supraclavicular C5-C6 nerve root excision. Shoulder and elbow range of motion was measured four weeks after injury. Fibrosis, cross-sectional area, and functional length of the biceps, brachialis, and subscapularis muscles were measured over four weeks following injury. Muscle satellite cells were cultured from denervated and control biceps muscles to assess myogenic capability. In a comparison group, shoulder motion and subscapularis length were assessed following surgical excision of external rotator muscles. Shoulder internal rotation and elbow flexion contractures developed on the involved side within four weeks following brachial plexus injury. Excision of the biceps and brachialis muscles relieved the elbow flexion contractures. The biceps muscles were histologically fibrotic, whereas fatty infiltration predominated in the brachialis and rotator cuff muscles. The biceps and brachialis muscles displayed reduced cross-sectional and longitudinal growth compared with the contralateral muscles. The upper subscapularis muscle similarly displayed reduced longitudinal growth, with the subscapularis shortening correlating with internal rotation contracture. However, excision of the external rotators without brachial plexus injury caused no contractures or subscapularis shortening. Myogenically capable satellite cells were present in denervated biceps muscles despite impaired muscle growth in vivo. Injury of the upper trunk of the brachial plexus leads to impaired growth of the biceps and brachialis muscles, which are responsible for elbow flexion contractures, and impaired growth of the subscapularis

  3. Extraocular muscle function testing

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003397.htm Extraocular muscle function testing To use the sharing features on this page, please enable JavaScript. Extraocular muscle function testing examines the function of the eye ...

  4. Localization of motoneurons innervating individual abdominal muscles of the cat

    Science.gov (United States)

    Miller, Alan D.

    1987-01-01

    The paper presents the results of a systematic investigation of the innervation of the cat's individual abdominal muscles. The segmental distribution of the different motor pools was determined by using electrical microstimulation of the ventral horn to produce visible localized muscle twitches and by retrograde transport of horseradish peroxidase injected into individual muscles. The segmental distribution of each motor pool was as follows: rectus abdominis, T4-L3; external oblique, T6-L3; transverse abdominis, T9-L3; and internal oblique, T13-L3.

  5. Further observations on the relationship of EMG and muscle force

    Science.gov (United States)

    Agarwal, G. C.; Cecchini, L. R.; Gottlieb, G. L.

    1972-01-01

    Human skeletal muscle may be regarded as an electro-mechanical transducer. Its physiological input is a neural signal originating at the alpha motoneurons in the spinal cord and its output is force and muscle contraction, these both being dependent on the external load. Some experimental data taken during voluntary efforts around the ankle joint and by direct electrical stimulation of the nerve are described. Some of these experiments are simulated by an analog model, the input of which is recorded physiological soleus muscle EMG. The output is simulated foot torque. Limitations of a linear model and effect of some nonlinearities are discussed.

  6. Optimal Auctions with Financial Externalities

    NARCIS (Netherlands)

    Maasland, E.; Onderstal, A.M.

    2002-01-01

    We construct optimal auctions when bidders face financial externalities.In a Coasean World, in which the seller cannot prevent a perfect resale market, nor withhold the object, the lowest-price all-pay auction is optimal.In a Myersonean World, in which the seller can both prevent resale after the au

  7. Organizing for External Knowledge Sourcing

    DEFF Research Database (Denmark)

    Rabbiosi, Larissa; Reichstein, Toke

    2011-01-01

    The aim of this article is to provide an introduction to the special issue. We briefly consider the external knowledge sourcing and organizing for innovation literatures, which offer a background for the special issue, and we highlight their mutual dialogue. We then illustrate the main findings...

  8. Measuring Externalities in Program Evaluation

    NARCIS (Netherlands)

    Janssens, Wendy

    2005-01-01

    Impact evaluations of development programmes usually focus on a comparison of participants with a control group. However, if the programme generates externalities for non-participants such an approach will capture only part of the programme's impact. Based on a unique large-scale quantitative survey

  9. Lupus vulgaris of external nose.

    Science.gov (United States)

    Bhandary, Satheesh Kumar; Ranganna, B Usha

    2008-12-01

    Lupus vulgaris is the commonest form of cutaneous tuberculosis which commonly involve trunk and buttocks. Lupus vulgaris affecting nose and face, are rarely reported in India. This study reports an unusual case of lupus vulgaris involving the external nose that showed dramatic outcome after six months of anti- tubercular treatment.

  10. [Treatment by external insulin pump].

    Science.gov (United States)

    Clavel, Sylvaine

    2010-12-01

    Since the recent recommendations by the French speaking association for research on diabetes and metabolic illnesses (Alfediam), treatment by insulin pump has found itself in competition with basal-bolus, a procedure using similar injections of insulin which has become a benchmark treatment. The latest Alfediam guidelines focus on defining ways of treating diabetics with an external insulin pump.

  11. Matchings with Externalities and Attitudes

    DEFF Research Database (Denmark)

    Branzei, Simina; Michalak, Tomasz; Rahwan, Talal;

    2013-01-01

    Two-sided matchings are an important theoretical tool used to model markets and social interactions. In many real-life problems the utility of an agent is influenced not only by their own choices, but also by the choices that other agents make. Such an influence is called an externality. Whereas ...

  12. Post-external dacryocystorhinostomy lagophthalmos.

    Science.gov (United States)

    Odat, Thabit A; Odat, Haitham A; Khraisat, Heba; Odat, Mohannad A; Alzoubi, Firas Q

    2015-06-01

    To describe lagophthalmos and eyelid closure abnormality after external dacryocystorhinostomy (DCR). A retrospective review of medical records and postoperative photographs of 79 patients who underwent external DCR for nasolacrimal duct obstruction and developed eyelid closure abnormality and lagophthalmos with or without exposure keratopathy was conducted. Collected data included age, sex, indication for surgery, laterality, length and type of incision, length of follow-up duration, presence of punctate epithelial keratopathy, and time for resolution of eyelid closure abnormalities. Twenty-seven patients with 28 external dacryocystorhinostomy had postoperative eyelid closure abnormalities. Male to female ratio was 1:6. The mean age was 40.1 years (range 9-80 years). All surgeries were performed through diagonal skin incision. Lagophthalmos involving the medial third of the palpebral fissure was noticed in 28.6 % of cases. All patients had hypometric blink mainly of the upper eyelid. One patient had punctate epithelial keratopathy. Resolution of lagophthalmos was noticed over a period of 1-5 weeks with an average of 3 weeks. None of the patients continued to have residual hypometric blink or punctate keratopathy at the last follow-up time. The mean follow-up period was 4.2 months (range 3-6 months). Eyelid closure abnormality and lagophthalmos after external DCR are underestimated problems. Spontaneous resolution is seen in all cases weeks to months after surgery.

  13. Femoral Reconstruction Using External Fixation

    Directory of Open Access Journals (Sweden)

    Yevgeniy Palatnik

    2011-01-01

    Full Text Available Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur. Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD, limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups. Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD and lateral distal femoral angle (LDFA for the entire group as well as the subgroups. Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction.

  14. Flunixin meglumine ou bupivacaína como técnicas analgésicas pós-toracotomia lateral intercostal em cães Flunixin meglumine or bupivacaine as postoperative analgesic techniques for lateral intercostal thoracotomy in dogs

    Directory of Open Access Journals (Sweden)

    Simone Dal Pai

    1997-12-01

    Full Text Available Dezesseis cães, adultos, sem raça definida, foram submetidos à toracotomia lateral intercostal e separados em dois grupos para estudo de diferentes protocolos analgésicos. Os animais receberam como terapia analgésica flunixin meglumine no período pré-operatório (grupo I ou bupivacaína intratorácica (grupo II. Todos os crães estiveram sob cuidados intensivos em sala de recuperação durante quatro horas de período pós-operatório quando foram monitorados o volume corrente pulmonar, a gasometria arterial, o tempo de reperfusão capilar, a coloração das mucosas ocular e oral, as freqüências respiratória e cardíaca e a temperatura retal. Uma ficha de escores para avaliação de dor pós-operatória foi elaborada para o acompanhamento dos animais de ambos os grupos. Os resultados demonstraram a ocorrência de diminuição dos valores de pressão parcial arterial de oxigênio abaixo dos índices fisiológicos após a toracotomia. A análise estatística de comparação entre os valores meédios calculados, não revelou diferença significativa entre os cães do grupo I e os do grupo II. No presente estudo, tanto a utilização intravenosa do flunixin meglumine quanto a administração intratorácica de bupivacaína foram efetivas na analgesia pós-operatória.Lateral intercostal thoracotomy was performed in sixteen mongrel adult dogs divided in two groups for diferent analgesic treatments. The dogs of group I received intravenous flunixin meglumine before surgery as an analgesic protocol, and those of group II received interpleural bupivacaine for the same purpose of pain control. All animals were maintained in a recovery room during four hours in which were monitored the pulmonary tidal volume, blood gas, capillary refill time, mucous membrane color, respiratory and heart rates and rectal temperature. Pain scores were used to evaluate the effect of the analgesic technics in groups I and II. The results showed a reduction on the

  15. Avaliação ventilométrica e hemogasométrica da oxigenoterapia por cateterização nasal em cães após toracotomia lateral intercostal Ventilometric and hemogasometric evaluation of oxygenotherapy by nasal catheter in dogs after lateral intercostal thoracotomy

    Directory of Open Access Journals (Sweden)

    Simone Dal Pai

    1995-01-01

    Full Text Available Doze cães, sem raça definida, foram submetidos à toracotomia lateral intercostal e divididos em dois grupos de diferentes tratamentos pós-operatórios, sendo que seis animais receberam oxigenoterapia por cateterização nasal e os demais não receberam este tratamento. Os animais de ambos os grupos estiveram sob cuidados intensivos em sala de recuperação por quatro horas de período pós-operatório, quando foram monitorados o volume corrente pulmonar, a gasometria arterial, o tempo de reperfusão capilar, a coloração de mucosas ocular e oral, as frequências respiratória e cardíaca, a temperatura retal e a tolerância ao uso do cateter nasal. Os resultados obtidos demonstraram que ocorre diminuição dos valores de pressão parcial arterial de oxigênio abaixo dos índices fisiológicos. A análise estatística dos dados revelou diferença significativa entre os cães que receberam oxigênio via cateter nasal e os não tratados, no período pós-toracotomia.Lateral intercostal thoracotomy was performed in twelve mongrel dogs divided in two groups for different postoperative treatments. Six animais received oxigen by nasal catheter after surgery. Both groups were maintained in a recovery room during four hours in wich were monitored the pulmonary tidal volume, the arterial blood gas values, the capilar refil l time, the mucous membrane color, the respiratory and heart rates, the rectal temperature, and the tolerance to the nasal catheter. The results demonstrated a reduction on the arterial oxygen parcial pressure levels after the thoracotomy. The comparativo statistical analyse showed a significant diference between the group that received oxygen by nasal catheter and the group that recived no treatment.

  16. Obturator internus muscle strains

    Directory of Open Access Journals (Sweden)

    Caoimhe Byrne, MB BCh, BAO

    2017-03-01

    Full Text Available We report 2 cases of obturator internus muscle strains. The injuries occurred in young male athletes involved in kicking sports. Case 1 details an acute obturator internus muscle strain with associated adductor longus strain. Case 2 details an overuse injury of the bilateral obturator internus muscles. In each case, magnetic resonance imaging played a crucial role in accurate diagnosis.

  17. The activity pattern of shoulder muscles in subjects with and without subacromial impingement

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Nørregaard, Jesper; Dyhre-Poulsen, Poul

    2009-01-01

    motion. In the symptomatic shoulder, there was a significantly greater EMG activity during abduction in the supraspinatus and latissimus muscles and less activity in serratus anterior compared to the healthy subjects. During external rotation, there was significantly less activity of the infraspinatus...... and serratus anterior muscles on the symptomatic side compared to the healthy subjects. On the asymptomatic side, the groups showed different muscle activity during external rotation. Our findings of an altered shoulder muscle activity pattern on both the symptomatic and asymptomatic side in patients indicate...... in patients with SI. The aim of the study was to determine and compare the activity pattern of the shoulder muscles in subjects with and without SI. Twenty-one subjects with SI and 20 healthy controls were included. Electromyography (EMG) was assessed from eight shoulder muscles from both shoulders during...

  18. Variable camber wing based on pneumatic artificial muscles

    Science.gov (United States)

    Yin, Weilong; Liu, Libo; Chen, Yijin; Leng, Jinsong

    2009-07-01

    As a novel bionic actuator, pneumatic artificial muscle has high power to weight ratio. In this paper, a variable camber wing with the pneumatic artificial muscle is developed. Firstly, the experimental setup to measure the static output force of pneumatic artificial muscle is designed. The relationship between the static output force and the air pressure is investigated. Experimental result shows the static output force of pneumatic artificial muscle decreases nonlinearly with increasing contraction ratio. Secondly, the finite element model of the variable camber wing is developed. Numerical results show that the tip displacement of the trailing-edge increases linearly with increasing external load and limited with the maximum static output force of pneumatic artificial muscles. Finally, the variable camber wing model is manufactured to validate the variable camber concept. Experimental result shows that the wing camber increases with increasing air pressure and that it compare very well with the FEM result.

  19. Framework for Dynamic Evaluation of Muscle Fatigue in Manual Handling Work

    CERN Document Server

    Ma, Liang; Chablat, Damien; Zhang, Wei

    2008-01-01

    Muscle fatigue is defined as the point at which the muscle is no longer able to sustain the required force or work output level. The overexertion of muscle force and muscle fatigue can induce acute pain and chronic pain in human body. When muscle fatigue is accumulated, the functional disability can be resulted as musculoskeletal disorders (MSD). There are several posture exposure analysis methods useful for rating the MSD risks, but they are mainly based on static postures. Even in some fatigue evaluation methods, muscle fatigue evaluation is only available for static postures, but not suitable for dynamic working process. Meanwhile, some existing muscle fatigue models based on physiological models cannot be easily used in industrial ergonomic evaluations. The external dynamic load is definitely the most important factor resulting muscle fatigue, thus we propose a new fatigue model under a framework for evaluating fatigue in dynamic working processes. Under this framework, virtual reality system is taken to ...

  20. High efficiency in human muscle: an anomaly and an opportunity?

    Science.gov (United States)

    Nelson, Frank E; Ortega, Justus D; Jubrias, Sharon A; Conley, Kevin E; Kushmerick, Martin J

    2011-08-15

    Can human muscle be highly efficient in vivo? Animal muscles typically show contraction-coupling efficiencies FDI) muscle of the hand has an efficiency value in vivo of 68%. We examine two key factors that could account for this apparently high efficiency value: (1) transfer of cross-bridge work into mechanical work and (2) the use of elastic energy to do external work. Our analysis supports a high contractile efficiency reflective of nearly complete transfer of muscular to mechanical work with no contribution by recycling of elastic energy to mechanical work. Our survey of reported contraction-coupling efficiency values puts the FDI value higher than typical values found in small animals in vitro but within the range of values for human muscle in vivo. These high efficiency values support recent studies that suggest lower Ca(2+) cycling costs in working contractions and a decline in cost during repeated contractions. In the end, our analysis indicates that the FDI muscle may be exceptional in having an efficiency value on the higher end of that reported for human muscle. Thus, the FDI muscle may be an exception both in contraction-coupling efficiency and in Ca(2+) cycling costs, which makes it an ideal muscle model system offering prime conditions for studying the energetics of muscle contraction in vivo.

  1. Defensive externality and blame projection following failure.

    Science.gov (United States)

    Hochreich, D J

    1975-09-01

    This study focuses upon the relationship between internal-external control and defensive blame projection. Trust was used as a moderator variable for making differential predictions concerning the behavior of two subgroups of externals: defensive externals, whose externality is presumed to reflect primarily a verbal technique of defense, and congruent externals, whose externality reflects a more genuine belief that most outcomes are determined by forces beyond their personal control. As predicted, defensive externals showed a stronger tendency than did congruent externals and internals to resort to blame projection following failure at an achievement task. There were no group differences in attribution following task success. Defensive externals were found to be more responsive to negative feedback than were congruent externals.

  2. Optical characterization of muscle

    Science.gov (United States)

    Oliveira, Luís; Lage, Armindo; Pais Clemente, Manuel; Tuchin, Valery V.

    2012-03-01

    Optical characterization and internal structure of biological tissues is highly important for biomedical optics. In particular for optical clearing processes, such information is of vital importance to understand the mechanisms involved through the variation of the refractive indices of tissue components. The skeletal muscle presents a fibrous structure with an internal arrangement of muscle fiber cords surrounded by interstitial fluid that is responsible for strong light scattering. To determine the refractive index of muscle components we have used a simple method of measuring tissue mass and refractive index during dehydration. After performing measurements for natural and ten dehydration states of the muscle samples, we have determined the dependence between the refractive index of the muscle and its water content. Also, we have joined our measurements with some values reported in literature to perform some calculations that have permitted to determine the refractive index of the dried muscle fibers and their corresponding volume percentage inside the natural muscle.

  3. Jaw adductor muscles across lepidosaurs: a reappraisal.

    Science.gov (United States)

    Daza, Juan Diego; Diogo, Rui; Johnston, Peter; Abdala, Virginia

    2011-10-01

    The exact homologies of tetrapod jaw muscles remain unresolved, and this provides a barrier for phylogenetic analysis and tracing character evolution. Here, lepidosaur jaw muscles are surveyed using direct examination of species from 23 families and published descriptions of species from 10 families. A revised nomenclature is applied according to proposed homologies with Latimeria. Among lepidosaurs, variation was found in many aspects of jaw muscle anatomy. The superficial layers mm. levator and retractor anguli oris (LAO and RAO) are present in Sphenodon but not all squamates. The external jaw adductor muscles universally present in lepidosaurs are homologous with the main adductor muscle, A2, of Latimeria and include four layers: superficialis (A2-SUP), medialis (A2-M), profundus (A2-PRO), and posterior (A2-PVM). The A2-SUP appears divided in Agamidae, Gekkota, Xantusiidae, and Varanidae. The A2-M is layered lateromedial in lizards but anteroposterior in snakes. The names pseudotemporalis (PS) and pterygomandibularis (PTM) are recommended for subdivisions of the internal adductors of reptiles and amphibians, because the homology of this muscle with the A3' and A3 ″ of Latimeria remains inconclusive. The intramandibularis of lepidosaurs and Latimeria (A-ω) are homologous. The distribution of six jaw muscle characters was found to plot more parsimoniously on phylogenies based on morphological rather than and molecular data. Character mapping indicates that Squamata presents reduction in the divisions of the A2-M, Scincoidea presents reduction or loss of LAO, and two apomorphic features are found for the Gekkota. Copyright © 2011 Wiley-Liss, Inc.

  4. Dipolar fluids under external perturbations

    Energy Technology Data Exchange (ETDEWEB)

    Klapp, Sabine H L [Stranski-Laboratorium fuer Physikalische und Theoretische Chemie Sekretariat TC7, Technische Universitaet Berlin, Strasse des 17. Juni 124, D-10623 Berlin (Germany)

    2005-04-20

    We discuss recent developments and present new findings on the structural and phase properties of dipolar model fluids influenced by various external perturbations. We concentrate on systems of spherical particles with permanent (point) dipole moments. Starting from what is known about the three-dimensional systems, particular emphasis is given to dipolar fluids in different confining situations involving both simple and complex (disordered) pore geometries. Further topics concern the effect of quenched positional disorder, the influence of external (electric or magnetic) fields, and the fluid-fluid phase behaviour of various dipolar mixtures. It is demonstrated that due to the translational-orientational coupling and due to the long range of dipolar interactions even simple perturbations such as hard walls can have a profound impact on the systems. (topical review)

  5. External observer reflections on QBism

    CERN Document Server

    Khrennikov, Andrei

    2015-01-01

    In this short review I present my personal reflections on QBism. I have no intrinsic sympathy neither to QBism nor to subjective interpretation of probability in general. However, I have been following development of QBism from its very beginning, observing its evolution and success, sometimes with big surprise. Therefore my reflections on QBism can be treated as "external observer" reflections. I hope that my representation of this interpretation of quantum mechanics (QM) has some degree of objectivity. It may be useful for researchers who are interested in quantum foundations, but do not belong to the QBism-community, because I tried to analyze essentials of QBism critically (i.e., not just emphasizing its advantages, as in a typical publication of QBists). QBists may be interested as well - in comments of an external observer who monitored development of this approach to QM during last 16 years. The second part of the paper is devoted to interpretations of probability, objective versus subjective, and view...

  6. Firm Search for External Knowledge

    DEFF Research Database (Denmark)

    Sofka, Wolfgang; Grimpe, Christoph

    2012-01-01

    The innovation performance of modern firms is increasingly determined by their ability to search and absorb external knowledge. However, after a certain threshold firms "oversearch" their environment and innovation performance declines. In this paper, we argue that prior literature has largely...... ignored the institutional context that provides or denies access to external knowledge at the country level. Combining institutional and knowledge search theory, we suggest that the market orientation of the institutional environment and the magnitude of institutional change influence when firms begin...... to experience the negative performance effects of oversearch. Based on a comprehensive sample of almost 8,000 firms from ten European countries, we find that institutions matter considerably for firms' search activity. Higher market orientation of institutions increases the effectiveness of firms' search...

  7. MGR External Events Hazards Analysis

    Energy Technology Data Exchange (ETDEWEB)

    L. Booth

    1999-11-06

    The purpose and objective of this analysis is to apply an external events Hazards Analysis (HA) to the License Application Design Selection Enhanced Design Alternative 11 [(LADS EDA II design (Reference 8.32))]. The output of the HA is called a Hazards List (HL). This analysis supersedes the external hazards portion of Rev. 00 of the PHA (Reference 8.1). The PHA for internal events will also be updated to the LADS EDA II design but under a separate analysis. Like the PHA methodology, the HA methodology provides a systematic method to identify potential hazards during the 100-year Monitored Geologic Repository (MGR) operating period updated to reflect the EDA II design. The resulting events on the HL are candidates that may have potential radiological consequences as determined during Design Basis Events (DBEs) analyses. Therefore, the HL that results from this analysis will undergo further screening and analysis based on the criteria that apply during the performance of DBE analyses.

  8. Network externalities across financial institutions

    OpenAIRE

    Castro Iragorri, Carlos Alberto; Preciado Pua, Sergio Andrés; Ordóñez Herrera, Juan Sebastián

    2016-01-01

    We propose and estimate a financial distress model that explicitly accounts for the interactions or spill-over effects between financial institutions, through the use of a spatial continuity matrix that is build from financial network data of inter bank transactions. Such setup of the financial distress model allows for the empirical validation of the importance of network externalities in determining financial distress, in addition to institution specific and macroeconomic covariates. The re...

  9. Externe Kosten in der Energiewirtschaft

    OpenAIRE

    Voß, Alfred; Friedrich, Rainer

    1994-01-01

    Als externe Effekte werden unbeteiligte Dritte betreffende Zusatzkosten oder Zusatznutzen verstanden, die sich in den jeweiligen Güterpreisen nicht wiederfinden und denen die Betroffenen nicht indifferent gegenüberstehen. Die gegenwärtige Energiebereitstellung und -nutzung ist in vielen Bereichen eine wesentliche Quelle der Belastung von Umwelt und Natur. Begriffe und Schlagworte wie Waldsterben, Tankerunglücke, Tschernobyl und Treibhauseffekt seien in diesem Zusammenhang erwähnt.

  10. Matching Games with Additive Externalities

    DEFF Research Database (Denmark)

    Branzei, Simina; Michalak, Tomasz; Rahwan, Talal

    2012-01-01

    Two-sided matchings are an important theoretical tool used to model markets and social interactions. In many real life problems the utility of an agent is influenced not only by their own choices, but also by the choices that other agents make. Such an influence is called an externality. Whereas......, optimistic, and pessimistic behaviour, and provide both computational hardness results and polynomial-time algorithms for computing stable outcomes....

  11. A muscle stem cell for every muscle: variability of satellite cell biology among different muscle groups

    Directory of Open Access Journals (Sweden)

    Matthew Emerson Randolph

    2015-10-01

    Full Text Available The human body contains approximately 640 individual skeletal muscles. Despite the fact that all of these muscles are composed of striated muscle tissue, the biology of these muscles and their associated muscle stem cell populations are quite diverse. Skeletal muscles are affected differentially by various muscular dystrophies, such that certain genetic mutations specifically alter muscle function in only a subset of muscles. Additionally, defective muscle stem cells have been implicated in the pathology of some muscular dystrophies. The biology of muscle stem cells varies depending on their embryologic origins and the muscles with which they are associated. Here we review the biology of skeletal muscle stem cell populations of eight different muscle groups. Understanding the biological variation of skeletal muscles and their resident stem cells could provide valuable insight into mechanisms underlying the susceptibility of certain muscles to myopathic disease.

  12. The anterior to midaxillary line between the 4th or 5th intercostal space (Buelau position) is safe for the use of thoracostomy tubes in preterm and term infants.

    Science.gov (United States)

    Eifinger, Frank; Lenze, Miriam; Brisken, Katrin; Welzing, Lars; Roth, Bernhard; Koebke, Jürgen

    2009-06-01

    Thoracostomy tubes are widely used in neonatology. Complications occurred significantly more frequently in infants, especially neonates, than in adults. Principally, the access is the modified Buelau position which takes place in the anterior axillary line at the 4th or 5th intercostal space above the margin of the ribs. This study seeks to determine the characteristics and topographic conditions of the anatomical structures at the ventral and lateral thoracic wall in the preterm and term neonate. Fifteen formalin-fixed stillborns were prepared (nine male, six female, 28-43 weeks gestational age). The anatomical preparation involved the complete thoracic wall region. In all preparations, a venous vessel was detected at the lateral wall and was identified as v. thoracoepigastrica without accompanying artery. Arteria (a.) and vena (v.) thoracica interna were regularly found close to the sternal plate on both sides between rib and fascia. With increasing gestational ages the course of the v. thoracoepigastrica varied significantly between the left and right thoracic wall. It was demonstrated that the v. thoracoepigastrica regularly arose within the abdominal or thoracic subcutaneous fat and drained into the v. subclavia. The variance between its course was almost 5-12 mm to the lateral or medial side. At both thoracic sides, no other organs or organ structures except lung parenchyma could be detected when using the Buelau position. The anterior to midaxillary line between the 4th or 5th intercostal space (Buelau position) is safe for the use of thoracostomy tubes in preterm and term infants.

  13. ENDOSCOPIC DCR VERSUS EXTERNAL DCR

    Directory of Open Access Journals (Sweden)

    Rukma

    2015-04-01

    Full Text Available PURPOSE: To compare success rates of endoscopic dacryocystorhinostomy (DCR and external DCR for acquired nasolacrimal duct obstruction (NLDO. MATERIALS AND METHODS: A prospective comparative non randomized study of 64 patients who presented with acquired NLD obstruction to a tertiary hospital. They were fully evaluated to ascertain the site of obstruction and patients with distal obstruction were included in the study. 34 patients underwent endoscopic DCR and 30 patients underwent external DCR RESULTS: 64 patients were included in the study and 72 procedures carried out. Success was achieved in 65 cases and failure in 7. Of the 7 failed cases, anatomical obstruction at the fistula site was found in 3, whereas functional failure was found in 4. In our patients, endoscopic DCR had a significantly higher success rate than external DCR, 95.23% versus 83.33% (P = 0.03. CONCLUSIONS: The success rate of Endoscopic DCR for acquired NLDO in our group of patients was 95.23%, with endoscopic surgery showing better results.

  14. Conceptual challenges for internalising externalities

    DEFF Research Database (Denmark)

    Miguel, Brandão; Weidema, Bo Pedersen

    2013-01-01

    We analyse a number of different externalities to identify conceptual challenges for the practical implementation of their internalisation. Three issues were identified: i) The balance between compensation and technology change and the respective effects on the nominal and real GDP; ii) The relev......We analyse a number of different externalities to identify conceptual challenges for the practical implementation of their internalisation. Three issues were identified: i) The balance between compensation and technology change and the respective effects on the nominal and real GDP; ii......) The relevance and efficiency of different instruments for internalisation and compensation; and iii) Implementing internalisation over large geographical and temporal distances. We find taxation to be a more relevant and efficient tool for internalisation than insurance and litigation. With increasing...... geographical and especially temporal distance between the benefitting actor and the victim of the external cost, the involvement of a non-governmental intermediate actor becomes increasingly necessary to provide the short-term capital required to ensure a successful implementation....

  15. Individuals' insight into intrapersonal externalities

    Directory of Open Access Journals (Sweden)

    David J. Stillwell

    2012-07-01

    Full Text Available An intrapersonal externality exists when an individual's decisions affect the outcomes of her future decisions. It can result in decreasing or increasing average returns to the rate of consumption, as occurs in addiction or exercise. Experimentation using the Harvard Game, which models intrapersonal externalities, has found differences in decision making between drug users and control subjects, leading to the argument that these externalities influence the course of illicit drug use. Nevertheless, it is unclear how participants who behave optimally conceptualise the problem. We report two experiments using a simplified Harvard Game, which tested the differences in contingency knowledge between participants who chose optimally and participants who did not. Those who demonstrated optimal performance exhibited both a pattern of correct responses and systematic errors to questions about the payoff schedules. The pattern suggested that they learned explicit knowledge of the change in reinforcement on a trail-by-trial basis. They did not have, or need, a full knowledge of the historical interaction leading to each payoff. We also found no evidence of choice differences between participants who were given a guaranteed payment and participants who were paid contingent on their performance, but those given a guaranteed payment were able to report more contingency knowledge as the experiment progressed, suggesting that they explored more rather than settling into a routine. Experiment 2 showed that using a fixed inter-trial interval did not change the results.

  16. Temporary Medial Upper Eyelid Lagophthalmos after External Dacryocystorhinostomy.

    Science.gov (United States)

    Haefliger, I O; Meienberg, O; Pimentel de Figueiredo, A R

    2016-04-01

    Background. Report of three cases of medial upper eyelid lagophthalmos as complication of external dacryocystorhinostomy. History and Signs. Shortly after dacryocystorhinostomy (skin incision on the side of the nose), three of ten consecutive patients (28 ± 4 years; mean ± standard deviation), presented with an ipsilateral lagophthalmos of 4 ± 1 mm in voluntary eyelid closure and 6 ± 1 mm in spontaneous blink. The lagophthalmos was due to a selective paresis of the medial part of the orbicularis oculi muscle of the upper eyelid. Patient 1 complained bitterly of dry eye symptoms and of her lagophthalmos. Patient 2 had mild symptoms but became very concerned after peers made her aware of her asymmetric blink. Patient 3 was asymptomatic and did not notice anything particular. Therapy and Outcome. Lagophthalmos resolved spontaneously within three months after surgery, first by improvement of voluntary eyelid closure and then of spontaneous blinking. Conclusions. Temporary lagophthalmos can occur as a complication of external dacryocystorhinostomy, most likely due to damage of the (only recently described) superficial buccal and/or zygomatic branches of the facial nerve that run upward to cross over the medial ligament and innervate the medial part of the orbicularis oculi muscle. Georg Thieme Verlag KG Stuttgart · New York.

  17. Increased jump height and reduced EMG activity with an external focus.

    Science.gov (United States)

    Wulf, Gabriele; Dufek, Janet S; Lozano, Leonardo; Pettigrew, Christina

    2010-06-01

    Jump height is increased when performers are given external focus instructions, relative to an internal focus or no focus instructions (Wulf & Dufek, 2009; Wulf, Zachry, Granados, & Dufek, 2007). The purpose of present study was to examine possible underlying neurophysiological mechanisms of this effect by using electromyography (EMG). Participants performed a vertical jump-and-reach task under two conditions in a counterbalanced order: external focus (i.e., focus on the rungs of the measurement device) and internal focus (i.e., focus on the fingers with which the rungs were to be touched). EMG activity of various muscles (anterior tibialis, biceps femoris, vastus lateralis, rectus femoris, gastrocnemius) was measured during jumps. Jump height was greater with an external compared to an internal focus. While there were no differences in muscle onset times between attentional focus conditions, EMG activity was generally lower with an external focus. These results suggest that neuromuscular coordination is enhanced by an external focus of attention. The present findings add to the evidence that an external focus facilitates the production of effective and efficient movement patterns.

  18. Determination of the chest wall thicknesses and needle thoracostomy success rates at second and fifth intercostal spaces: a cadaver-based study.

    Science.gov (United States)

    Ozen, Can; Akoglu, Haldun; Ozdemirel, Rifat Ozgur; Omeroglu, Elif; Ozpolat, Cigdem Ulubay; Onur, Ozge; Buyuk, Yalcin; Denizbasi, Arzu

    2016-12-01

    The purposes of this study were to measure the chest wall thicknesses (CWTs) at second intercostal space (ICS) mid-clavicular line (MCL) and fifth ICS MAL directly, and compare the actual success rates of needle thoracostomies (NTs) by inserting a 5-cm-long syringe needle. Predictive values of weight, body mass index (BMI) and CWT were also analyzed. This study included 199 measurements of 50 adult fresh cadavers from both hemithoraces. Five-centimeter-long syringe needles were inserted and secured. Penetration into the pleural cavity was assessed, and CWTs at 4 locations were measured. Achieved power of this study for the primary aim of CWT comparison from 2(nd) and 5(th) ICSs was .94. Overall mean CWTs at 2(nd) ICS MCL and 5(th) ICS MAL were measured as 2.46 ± 0.78 and 2.89 ± 1.09, respectively, and 5(th) ICS MAL was found to be statistically thicker (P = .002). The success rate of NT at 2(nd) ICS MCL was 87% (95% CI, 80-94), and that at 5(th) ICS MAL was 78% (95% CI, 70-86; P = .3570). Only 6 (17.1%) of 35 failed NTs had a CWT greater than 5-cm. Needle thoracostomy has failed in 29 (14.9%) of 194 locations, despite a CWT less than 5-cm. Below a weight of 72 kg, BMI of 23 kg/m(2), or CWT of 2.4 cm, all NTs were successful. In this report, we present the largest cadaver-based cohort to date to the best of our knowledge, and we observed a statistically nonsignificant 9% more NT success rate at 2(nd) ICS at a power of 88% and statistically significant more success rate in males at 5(th) ICS was (47.7%). We also observed thinner CWTs and higher success rates than previous imaging-based studies. A BMI of 23 kg/m(2) or less and weight of 72 kg or less seem to accurately rule-out NT failure in cadavers, and they seem to be better predictors at the bedside. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Age-related functional changes and susceptibility to eccentric contraction-induced damage in skeletal muscle cell

    Directory of Open Access Journals (Sweden)

    Seung-Jun Choi

    2016-09-01

    Full Text Available Depending upon external loading conditions, skeletal muscles can either shorten, lengthen, or remain at a fixed length as they produce force. Fixed-end or isometric contractions stabilize joints and allow muscles to act as active struts during locomotion. Active muscles dissipate energy when they are lengthened by an external force that exceeds their current force producing capacity. These unaccustomed eccentric activities often lead to muscle weakness, soreness, and inflammation. During aging, the ability to produce force under these conditions is reduced and appears to be due to not only reductions in muscle mass but also to alterations in the basic mechanisms of contraction. These alterations include impairments in the excitation–contraction process, and the action of the cross-bridges. Also, it is well known that age-related skeletal muscle atrophy is characterized by a preferential atrophy of fast fibers, and increased susceptibility to fast muscle fiber when aged muscles are exposed to eccentric contraction followed by the impaired recovery process has been reported. Taken together, the selective loss of fast muscle fiber in aged muscle could be affected by eccentric-induced muscle damage, which has significant implication to identify the etiology of the age-related functional changes. Therefore, in this review the alteration of age-related muscle function and its impact to/of eccentric induced muscle damage and recovery will be addressed in detail.

  20. Artificial muscle using nonlinear elastomers

    Science.gov (United States)

    Ratna, Banahalli

    2002-03-01

    Anisotropic freestanding films or fibers of nematic elastomers from laterally attached side-chain polymers show muscle-like mechanical properties. The orientational order of the liquid crystal side groups imposes a conformational anisotropy in the polymer backbone. When a large change in the order parameter occurs, as at the nematic-isotropic phase transition, there is a concomitant loss of order in the backbone which results in a contraction of the film in the direction of the director orientation. The crosslinked network imposes a symmetry-breaking field on the nematic and drives the nematic-isotropic transition towards a critical point with the application of external stress. Isostrain studies on these nonlinear elastomers, show that there are large deviations from ideal classical rubber elasticity and the contributions from total internal energy to the elastic restoring force cannot be ignored. The liquid crystal elastomers exhibiting anisoptopic contraction/extension coupled with a graded strain response to an applied external stimulus provide an excellent framework for mimicking muscular action. Liquid crystal elastomers by their very chemical nature have a number of ‘handles’ such as the liquid crystalline phase range, density of crosslinking, flexibility of the backbone, coupling between the backbone and the mesogen and the coupling between the mesogen and the external stimulus, that can be tuned to optimize the mechanical properties. We have demonstrated actuation in nematic elastomers under thermal and optical stimuli. We have been able to dope the elastomers with dyes to make them optically active. We have also doped them with carbon nanotubes in order to increase the thermal and electrical conductivity of the elastomer.

  1. TRUNK MUSCLE ACTIVITIES DURING ABDOMINAL BRACING: COMPARISON AMONG MUSCLES AND EXERCISES

    Directory of Open Access Journals (Sweden)

    Sumiaki Maeo

    2013-09-01

    Full Text Available Abdominal bracing is often adopted in fitness and sports conditioning programs. However, there is little information on how muscular activities during the task differ among the muscle groups located in the trunk and from those during other trunk exercises. The present study aimed to quantify muscular activity levels during abdominal bracing with respect to muscle- and exercise-related differences. Ten healthy young adult men performed five static (abdominal bracing, abdominal hollowing, prone, side, and supine plank and five dynamic (V- sits, curl-ups, sit-ups, and back extensions on the floor and on a bench exercises. Surface electromyogram (EMG activities of the rectus abdominis (RA, external oblique (EO, internal oblique (IO, and erector spinae (ES muscles were recorded in each of the exercises. The EMG data were normalized to those obtained during maximal voluntary contraction of each muscle (% EMGmax. The % EMGmax value during abdominal bracing was significantly higher in IO (60% than in the other muscles (RA: 18%, EO: 27%, ES: 19%. The % EMGmax values for RA, EO, and ES were significantly lower in the abdominal bracing than in some of the other exercises such as V-sits and sit-ups for RA and EO and back extensions for ES muscle. However, the % EMGmax value for IO during the abdominal bracing was significantly higher than those in most of the other exercises including dynamic ones such as curl-ups and sit-ups. These results suggest that abdominal bracing is one of the most effective techniques for inducing a higher activation in deep abdominal muscles, such as IO muscle, even compared to dynamic exercises involving trunk flexion/extension movements

  2. Muscles, exercise and obesity

    DEFF Research Database (Denmark)

    Pedersen, Bente K; Febbraio, Mark A

    2012-01-01

    . The finding that the muscle secretome consists of several hundred secreted peptides provides a conceptual basis and a whole new paradigm for understanding how muscles communicate with other organs, such as adipose tissue, liver, pancreas, bones and brain. However, some myokines exert their effects within......During the past decade, skeletal muscle has been identified as a secretory organ. Accordingly, we have suggested that cytokines and other peptides that are produced, expressed and released by muscle fibres and exert either autocrine, paracrine or endocrine effects should be classified as myokines...... the muscle itself. Thus, myostatin, LIF, IL-6 and IL-7 are involved in muscle hypertrophy and myogenesis, whereas BDNF and IL-6 are involved in AMPK-mediated fat oxidation. IL-6 also appears to have systemic effects on the liver, adipose tissue and the immune system, and mediates crosstalk between intestinal...

  3. Proteomics of Skeletal Muscle

    DEFF Research Database (Denmark)

    Deshmukh, Atul

    2016-01-01

    Skeletal muscle is the largest tissue in the human body and plays an important role in locomotion and whole body metabolism. It accounts for ~80% of insulin stimulated glucose disposal. Skeletal muscle insulin resistance, a primary feature of Type 2 diabetes, is caused by a decreased ability...... of muscle to respond to circulating insulin. Physical exercise improves insulin sensitivity and whole body metabolism and remains one of the most promising interventions for the prevention of Type 2 diabetes. Insulin resistance and exercise adaptations in skeletal muscle might be a cause, or consequence......, of altered protein expressions profiles and/or their posttranslational modifications (PTMs). Mass spectrometry (MS)-based proteomics offer enormous promise for investigating the molecular mechanisms underlying skeletal muscle insulin resistance and exercise-induced adaptation; however, skeletal muscle...

  4. The hamstring muscle complex.

    Science.gov (United States)

    van der Made, A D; Wieldraaijer, T; Kerkhoffs, G M; Kleipool, R P; Engebretsen, L; van Dijk, C N; Golanó, P

    2015-07-01

    The anatomical appearance of the hamstring muscle complex was studied to provide hypotheses for the hamstring injury pattern and to provide reference values of origin dimensions, muscle length, tendon length, musculotendinous junction (MTJ) length as well as width and length of a tendinous inscription in the semitendinosus muscle known as the raphe. Fifty-six hamstring muscle groups were dissected in prone position from 29 human cadaveric specimens with a median age of 71.5 (range 45-98). Data pertaining to origin dimensions, muscle length, tendon length, MTJ length and length as well as width of the raphe were collected. Besides these data, we also encountered interesting findings that might lead to a better understanding of the hamstring injury pattern. These include overlapping proximal and distal tendons of both the long head of the biceps femoris muscle and the semimembranosus muscle (SM), a twist in the proximal SM tendon and a tendinous inscription (raphe) in the semitendinosus muscle present in 96 % of specimens. No obvious hypothesis can be provided purely based on either muscle length, tendon length or MTJ length. However, it is possible that overlapping proximal and distal tendons as well as muscle architecture leading to a resultant force not in line with the tendon predispose to muscle injury, whereas the presence of a raphe might plays a role in protecting the muscle against gross injury. Apart from these architectural characteristics that may contribute to a better understanding of the hamstring injury pattern, the provided reference values complement current knowledge on surgically relevant hamstring anatomy. IV.

  5. Skepticism, Contextualism, Externalism and Modality

    Directory of Open Access Journals (Sweden)

    Ron Wilburn

    2006-12-01

    Full Text Available In this paper, I argue for the following claims. Contextualist strategies to tame or localize epistemic skepticism are hopeless if contextualist factors are construed internalistically. However, because efforts to contextualize externalism via subjunctive conditional analysis court circularity, it is only on an internalistic interpretation that contextualist strategies can even be motivated. While these claims do not give us an argument for skepticism, they do give us an argument that contextualism, as such, is not likely to provide us with an argument against skepticism.

  6. Leveraging External Sources of Innovation

    DEFF Research Database (Denmark)

    West, Joel; Bogers, Marcel

    2014-01-01

    own specific set of mechanisms and conditions. Integrating innovations has been mostly studied from an absorptive capacity perspective, with less attention given to the impact of competencies and culture (including “not invented here”). Commercializing innovations puts the most emphasis on how......” in a way inconsistent with earlier definitions in innovation management. The paper concludes with recommendations for future research that include examining the end-to-end innovation commercialization process, and studying the moderators and limits of leveraging external sources of innovation....

  7. MUSCLE INJURIES IN ATHLETES.

    Science.gov (United States)

    Barroso, Guilherme Campos; Thiele, Edilson Schwansee

    2011-01-01

    This article had the aim of demonstrating the physiology, diagnosis and treatment of muscle injuries, focusing on athletes and their demands and expectations. Muscle injuries are among the most common complaints in orthopedic practice, occurring both among athletes and among non-athletes. These injuries present a challenge for specialists, due to the slow recovery, during which time athletes are unable to take part in training and competitions, and due to frequent sequelae and recurrences of the injuries. Most muscle injuries (between 10% and 55% of all injuries) occur during sports activities. The muscles most commonly affected are the ischiotibial, quadriceps and gastrocnemius. These muscles go across two joints and are more subject to acceleration and deceleration forces. The treatment for muscle injuries varies from conservative treatment to surgery. New procedures are being used, like the hyperbaric chamber and the use of growth factors. However, there is still a high rate of injury recurrence. Muscle injury continues to be a topic of much controversy. New treatments are being researched and developed, but prevention through muscle strengthening, stretching exercises and muscle balance continues to be the best "treatment".

  8. Accessory piriformis muscle

    Directory of Open Access Journals (Sweden)

    Sedat Develi

    2017-03-01

    Full Text Available Piriformis muscle originates from facies pelvica of sacrum and inserts on the trochanter major. It is one of the lateral rotator muscles of the hip and a landmark point in the gluteal region since n. ischiadicus descends to the thigh by passing close to the muscle. This contiguity may be associated with the irritation of the nerve which is known as piriformis syndrome. A rare anatomic variation of the muscle which observed on 74 years old male cadaver is discussed in this case report. [Cukurova Med J 2017; 42(1.000: 182-183

  9. Proteomics of Skeletal Muscle

    DEFF Research Database (Denmark)

    Deshmukh, Atul

    2016-01-01

    Skeletal muscle is the largest tissue in the human body and plays an important role in locomotion and whole body metabolism. It accounts for ~80% of insulin stimulated glucose disposal. Skeletal muscle insulin resistance, a primary feature of Type 2 diabetes, is caused by a decreased ability...... of muscle to respond to circulating insulin. Physical exercise improves insulin sensitivity and whole body metabolism and remains one of the most promising interventions for the prevention of Type 2 diabetes. Insulin resistance and exercise adaptations in skeletal muscle might be a cause, or consequence...

  10. Skeletal muscle development and regeneration.

    NARCIS (Netherlands)

    Grefte, S.; Kuijpers-Jagtman, A.M.; Torensma, R.; Hoff, J.W. Von den

    2007-01-01

    In the late stages of muscle development, a unique cell population emerges that is a key player in postnatal muscle growth and muscle regeneration. The location of these cells next to the muscle fibers triggers their designation as satellite cells. During the healing of injured muscle tissue, satell

  11. Skeletal muscle development and regeneration.

    NARCIS (Netherlands)

    Grefte, S.; Kuijpers-Jagtman, A.M.; Torensma, R.; Hoff, J.W. Von den

    2007-01-01

    In the late stages of muscle development, a unique cell population emerges that is a key player in postnatal muscle growth and muscle regeneration. The location of these cells next to the muscle fibers triggers their designation as satellite cells. During the healing of injured muscle tissue,

  12. Metastases of esophageal carcinoma to skeletal muscle:Single center experience

    Institute of Scientific and Technical Information of China (English)

    Jan Cincibuch; Miroslav Myslive(c)ek; Bohuslav Melichar; (C)estmír Neoral; Iva Metelková; Michaela Zezulová; Hana Procházková-(S)tudentová