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PubMed1995

Phasic motor activity reduction occurring with horizontal rapid eye movements during active sleep in human.

We describe the phasic reduction of motor activity occurring with horizontal rapid eye movements (REMs) during active sleep in 15 children (12 healthy children and 3 patients with severe brain damage). A REM-related decrease in intercostal muscle activity was demonstrated by averaging integrated surface electromyograms. In the healthy subjects, this reduction had a mean latency from the REM onset of 37.1 ms and a duration of 225.9 ms. This phenomenon was also observed in the 3 patients who had lost cerebral function. We hypothesized a brainstem origin for the effect. A REM-related mentalis muscle activity loss, detected by averaging mentalis muscle twitches, was observed in 10 healthy children among the subjects. This loss began at 59.1 ms before the onset of REMs and lasted for 230.2 ms on average. In addition, a transient decrease in integrated REM activity surrounding mentalis muscle twitches (a twitch-related reduction of REMs) was observed. We discuss the similarity between REM-related phasic reduction of muscle activity obtained for intercostal and mentalis muscles and pontogeniculo-occipital (PGO) wave-related inhibitory postsynaptic potentials reported for feline lumbar and trigeminal motoneurons, respectively. We then assume the presence of a phasic event generator, functioning during active sleep in healthy humans, which triggers at least three generators; that is, the generator of PGO waves (or REMs), motor inhibition, and of motor excitation including muscle twitches.

Brain Stem↗

PubMed1991

Reinnervation of developing rat muscle by non-axotomized motoneurons.

To study the ability of developing motoneurons to reinnervate their denervated muscle, axotomized motoneurons in rat neonates and pups were retrogradely labeled with two fluorescent tracers. Fluorogold (FG), a long-lasting fluorescent dye, was injected into intercostal muscle T8 to retrogradely label the motoneurons that innervated it. Two days later intercostal nerves T7-T9 were cut. The intercostal muscle denervated at birth was reinnervated within 10-20 days, as evidenced by nerve-evoked muscle contraction. Three weeks following axotomy, tetramethylrhodamine isothiocyanate (TRITC) was injected into the same muscle to label the motoneurons that reinnervated it. The motoneurons double-labeled with FG and TRITC were, therefore, axotomized motoneurons that regenerated to reinnervate T8. In neonates, axotomy resulted in a significant reduction in the number of FG-labeled motoneurons, which suggests that axon transection at early postnatal days causes a massive motoneuron death. The percentage of double-labeled motoneurons was significantly smaller than that in non-axotomized rats. TRITC-labeled motoneurons constituted the majority of stained motoneurons; these were located in different nuclei than the intercostal motoneurons. These findings suggest that muscle reinnervation is, at least in part, by motoneurons which originally did not innervate intercostal muscle T8. Unlike axotomy at birth, axotomy performed 2-3 weeks after birth did not result in a significant motoneuron loss. The number of stained motoneurons labeled with both FG and TRITC was significantly smaller, however, than in non-axotomized spinal cords. Our data indicate that in pups only a small percentage of axotomized motoneurons reinnervated the denervated muscle.

Animals↗

PubMed2004

Gene transfer into intact fetal skeletal muscle grown in vitro.

The development of an organ culture system for growing prenatal intercostal muscle in vitro and its use to study gene function is described. Fetal skeletal muscle is relatively inaccessible during the key stages of its development, and this method enables DNA transfections and other manipulations to be carried out. The system allows cell proliferation and differentiation to continue and also maintains the morphology and fiber types of developing muscle. Gene transfer into cultured embryonic intercostal muscle was achieved by square-pulse electroporation of intact pieces of tissue. Expression of a marker gene (GFP) was found within 5 h and maintained for 2 days in muscle fibers and cells. The technique should enable the function of genes implicated in muscle development and disease to be studied at stages when access is difficult and in a controlled environment.

Animals↗

PubMed1994

Respiratory responses to stimulation of spinal or medullary locomotor structures in decerebrate cats.

Respiratory and locomotor EMG activity was recorded in cats after a precollicular post-mamillary decerebration. Locomotion was induced by stimulating either the dorsolateral funiculus (DLF) in the cervical spinal cord or the medullary locomotor strip (MLS). At the onset of locomotion, both ventilation and blood pressure were enhanced. During locomotion, the activity of external intercostal muscles decreased but that of the internal intercostal muscles increased. The respiratory pattern changed with the onset of stimulation. The locomotor movements were evoked after a delay. The inspiratory-inhibitory Hering-Breuer reflex was attenuated. Stimulation of the MLS and DLF evoked similar respiratory and circulatory effects. Our data resemble the effects observed during stimulation of the subthalamic or mesencephalic locomotor regions. We conclude that respiratory changes are part of an integrated response involved in the onset of exercise and are independent of the neuronal site where stimulation evoked locomotion. In contrast to previous reports, we suggest that the pattern of interaction among respiratory, circulatory, and locomotor systems does not have to be the specialty of supramedullary structures. Coupling between locomotion and breathing during the post-inspiratory phase suggests that this interaction occurs at the medullary level.

Animals↗

PubMed1998

[Results of surgical treatment in patients with T3 non-small cell lung cancer].

To investigate the prognosis of pathological proven T3N0-1M0 non-small cell lung cancer (NSCLC), 73 patients who underwent pulmonary resection between 1975 and 1993 were reviewed. The 5-year survival rate for all patients was 46.3%. The subject included chest wall invasion in 34 (parietal pleura 17, intercostal muscle or ribs 17), invasion to another lobe in 30, main bronchus involvement less than 2 cm distal to the carina in 12, invasion to pericardium in 6 and invasion to diaphragm in 3. The 5-year survival rates was as follows: chest wall invasion 46.7%, invasion to another lobe 51.7%, main bronchus involvement 41.7%, invasion to pericardium and diaphragm 33.3% respectively. The 5-year survival rate was 58.8% when invasion was limited within parietal pleura, whereas 35.3% when invasion extended outside intercostal muscle. Patients invaded within parietal pleura had better prognosis than that of outside intercostal muscle. In conclusion, good outcome would be expected in patients with T3N0-1M0 non-small cell lung cancer when the invasion limited within parietal pleura.

Adult↗

PubMed1984

Responses of upper airway, intercostal and diaphragm muscle activity to stimulation of oesophageal afferents in dogs.

The effects of oesophageal distension on respiratory patterns and the moving average electromyogram (e.m.g.) activity of three upper airway muscles--the alae nasi, the genioglossus, and the posterior cricoarytenoid--and four chest wall muscles--the costal and crural diaphragm and the inspiratory and expiratory intercostals--were examined in ten anaesthetized, tracheostomized, spontaneously breathing dogs. Distension was produced by inflations of a balloon placed in the middle part of the thoracic oesophagus with volumes of air ranging from 50 to 200 ml. Oesophageal distension increased respiratory frequency, mainly due to a significant shortening of the expiratory time. Activity of both the costal and crural parts of the diaphragm was inhibited with oesophageal distension, whereas that of the inspiratory intercostal muscles increased, tending to maintain a near-normal tidal volume and end-tidal CO2. Phasic inspiratory activity of all three upper airway muscles increased in response to oesophageal distension, as did the activity of the expiratory intercostal muscles. The changes in the breathing pattern and the electrical activity of all muscles in response to oesophageal distension were immediate, occurring during the first breath after the balloon was inflated. The responses were graded, so that increases in the volume of the oesophageal balloon progressively increased the activity of the upper airway and intercostal muscles, and decreased diaphragm activity. Bilateral vagotomy abolished the effects of oesophageal distension on upper airway and chest wall muscle activity, suggesting that vagal afferents constitute the major pathway for the reflex.

Animals↗

PubMed1990

[A case report of diaphragmatic flutter].

A 18-year-old female complained of a dyspneic sensation and involuntary movements in the epigastrium. On physical examination, fine rhythmic movements in the epigastrium were observed on each inspiration with a rate of 5-10 per breath. Arterial blood gas analysis was normal. Recording of the respiratory parameters and the EMG of respiratory muscles were performed. Analysis of the respiratory flow revealed that her spontaneous inspirations consisted of short inspirations (i.e., flutter wave) (150-170 beats per minute). EMG of respiratory muscles demonstrated that these flutter waves were driven by intercostal muscles and diaphragm. The flutter waves were not suppressed by breath holding at the maximal inspiration. With intravenous injection of 200 mg of diphenylhydantoin, flutter waves disappeared within 10 minutes. There were no abnormal findings on chest roentgenogram, electrocardiogram, head CT scan and MRI of the cervical spine. During one year's follow up no attack developed again. We have encountered 3 cases of the syndrome since 1981. In two of them, the spontaneous respiration was superimposed on a high-frequency wave throughout the whole respiratory cycle while in one case the high-frequency wave developed only in the inspiratory phase of spontaneous respiration. In the present case the respiratory flow pattern was similar to the last mentioned and the EMG-analysis of respiratory muscles confirmed that the flutter waves were driven by intercostal muscles and diaphragm. Furthermore, synchronization of activities of the two respiratory muscles suggests that the syndrome is of central origin.

Adolescent↗

PubMed1997

Save the child's esophagus, Part II: Colic patch repair.

PURPOSE: In a previous report, the authors documented the procedures necessary to regain esophageal continuity in infants who had massive disruption of the suture line following esophagoplasty. As a corollary, this study shows the feasibility of preserving the esophagus in older children by using an esophageal patch. METHODS: Fifteen children ranging in age from 8 months to 16 years at the time of surgery had repair of esophageal strictures or tracheoesophageal fistulae by the use of a vascularized patch rather than esophageal resection and interposition with colon or stomach. The technique of "colonic-patch oesophagoplasty" was described by Hecker and Hollman in 1975. From 1976 to 1995, the authors have used a modification of their procedure in 14 children, and in one patient an intercostal muscle flap was interposed. The technique consists of esophagotomy through the area of stricture with application of a vascularized patch of colon to the resulting defect. RESULTS: Ten of the patients were boys and four were girls with an additional girl considered for the procedure at 8 months of age. However, during surgery, an intercostal muscle flap interposition was used. Eight children had esophageal stricture caused by lye ingestion; two from anastomotic stricture; two from gastroesophageal reflux; two from recurrent tracheoesophageal fistula; and one from long-term nasogastric intubation. Follow-up showed excellent results in nine patients who had the colic patch operation. All had good swallowing. A tenth patient, the child with the vascularized intercostal muscle flap, is currently eating a regular diet but it has only been 4 months since the operation. However, one of these excellent patients continues to have a small focus of Barrett's esophagus and another one was killed in an automobile accident one year after operation. Three children have good results but with occasional difficulty in swallowing boluses of meat or with continuing reflux. Two patients had poor results and both have undergone reoperation. In one of these children with Down's syndrome and diabetes, the colic patch worked well for 6 years but because of continuing reflux, distal esophageal scarring and obstruction eventually ensued. After reoperation for distal esophageal resection and colic interposition, the patient died of pulmonary failure. The second child with poor results has recently undergone reoperation to extend the esophagotomy through the distal scarred esophagus and to revise the colic patch. CONCLUSION: The use of a vascular colic patch for treatment of severe esophageal strictures is a viable alternative to esophageal resection and interposition. However, patients with continuing reflux or Barrett's esophagus, or both, may progress with distal esophageal scarring and obstruction and subsequent dilation of the patch. Those patients will require reoperation.

Adolescent↗

PubMed1977

Effects of thoracic dorsal rhizotomies on the respiratory pattern in anesthetized cats.

Experiments were conducted to determine if thoracic wall proprioceptor afferents are involved in the modulation of respiratory activity during eupnea. The effects of elimination of thoracic wall afferents (thoracic dorsal rhizotomies (TDR) on tidal volume (VT), frequency (f), inspiratory time (ti) and expiratory time (te) were studied in vagotomized cats anesthetized with diallylbarbituric acid (Dial). Dorsal rhizotomies 1-12 resulted primarily in a decreased VT and ti, and an increased f. Further experiments were performed to determine if these changes in respiratory pattern could be correlated with known reflexes from the middle and lower intercostal muscles, or lungs, via thoracic dorsal roots. Afferents from these sources were eliminated by TDR 5-9, 10-13, and 1-4. TDR 1-4 had no significant effect on the respiratory pattern. TDR 5-9 and TDR 10-13 produced changes similar in direction to TDR 1-12. The results indicate that: a) afferents 1-4 from the upper intercostal muscles and lungs (sympathetic afferents) do not contribute significantly to the control of the spontaneous respiratory rhythm, and b) afferents via the middle thoracic roots, 5-9, and the lower thoracic roots, 10-13, contribute significantly to the rhythm. The results do not completely correlate with known intercostal reflexes, but it is suggested that elimination of intercostal muscle proprioceptor afferents is responsible for the observed effects of thoracic dorsal rhizotomies.

Animals↗

PubMed1996

Save the child's esophagus: management of major disruption after repair of esophageal atresia.

PURPOSE: Given the bias that the native esophagus is the best conduit between the oropharynx and the stomach, the authors report a "conservative" approach to massive esophageal leak, which may be considered "radical" by others. Major disruption of the anastomosis after primary repair of esophageal atresia is a recognized and feared complication. Historically, management has been the performance of cervical esophagostomy and gastrostomy. The aim of this report is to describe the authors' approach to this difficult and serious complication. METHODS: A 15-year retrospective analysis was performed of all patients having esophageal atresia. Data collection focused on the management of all patients with clinically significant esophageal disruption. Radiographically detected (clinically asymptomatic) leaks were managed by continuation of drainage by thoracostomy tubes already in place and are not included. Reoperative thoracotomies were performed, which included primary repair (2), placement of pleural patch alone (2), pleural patch with intercostal muscle flap buttress (2), and operative debridement and drainage alone (1). RESULTS: It was noted that seven patients had clinically significant esophageal disruption requiring reoperation, with circumferential disruptions ranging from 15% to 85%. Presentation included persistent pleural collection (4) and pneumothorax (3). Both patients who underwent primary repair had no evidence of leakage on follow-up esophagograms, neither did one with a pleural patch alone and one with an intercostal muscle flap. Five of the seven patients were tolerating oral feedings at the time of follow-up (range, 6 months to 8 years). One of the two others (both currently inpatients), has a recurrent leak associated with mediastinitis, and the other (who had primary repair) has a presumed neurological impairment of eating. CONCLUSION: Clinically significant disruption of primary esophageal repair should not warrant a cervical esophagostomy and placement of a gastrostomy tube, thus precluding eventual use of the native esophagus. The authors have shown that management by reoperation with primary repair, intercostal muscle flap with or without pleural patch, and/or drainage allows the patient to maintain the native esophagus and yields a generally good outcome after a prolonged healing time.

Esophageal Atresia↗

PubMed1981

Choline acetyltransferase in skeletal muscle from patients with myasthenia gravis.

Acetylcholine synthesis in homogenates of human intercostal muscle was measured by a radiochemical method. Choline acetyltransferase activity in control muscle was about 20 nmol . g-1 . h-1. The enzyme was found only in the endplate area of the muscle. At high substrate concentrations its activity was overshadowed by the acetylcholine synthesizing activity of a different enzyme not saturated by 10 mM-choline. The nonspecific enzyme was present at and away from the endplate area. Choline acetyltransferase in parasternal samples of intercostal muscle from myasthenia gravis patients was about 2.5 times higher than in samples, taken from a more lateral location, of control patients, but the Km for choline was not altered (0.24 mM). It is suggested that in myasthenia gravis the shortage of acetylcholine receptors is partially compensated for by increased synthesis, storage, and release of the transmitter.

Choline↗

PubMed1988

Glycogen utilization in rat respiratory muscles during intense running.

Glycogen concentration in the adult rat diaphragm and intercostal muscles has been examined following heavy treadmill exercise to determine the recruitment strategy and the significance of glycogen as a substrate to satisfy the elevated energy requirements accompanying hyperpnea. Short-term continuous running at 60 m/min and a 12 degree grade resulted in a reduction (p less than 0.05) in the concentration of glycogen (39%) in the costal region of the rat diaphragm. Similarly, glycogen concentration was significantly reduced (p less than 0.05) with this exercise protocol in all respiratory muscles studied, with the exception of the sternal region of the diaphragm. With the less intense running protocols, glycogen degradation continued to be pronounced (p less than 0.05) in the majority of the respiratory muscles sampled. The significance of muscle glycogen as a substrate for energy metabolism in the respiratory muscles was not affected by the procedure used to prepare the animal for tissue sampling (Somnitol, diethyl ether, decapitation). Examination of selected locomotor muscles revealed extensive glycogen loss in muscles composed of essentially slow oxidative fibres (soleus), fast oxidative glycolytic fibres (vastus lateralis red), and fast glycolytic fibres (vastus lateralis white). It is concluded that during heavy exercise in the rat, recruitment of motor units occurs in all regions of the diaphragm and in the intercostal muscles. At least for the costal region of the diaphragm and as evidenced by the modest (two- to four-fold) but significant (p less than 0.05) increases in lactate concentration, the increased ATP requirements in these muscles are met to a large degree by increases in aerobic metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗

PubMed1994

Anesthesia and chest wall function in dogs.

Three anesthetics (pentobarbital, halothane, and isoflurane) were studied in six mongrel dogs to systematically compare their effects on chest wall function during spontaneous breathing. Each dog received each anesthetic on separate occasions. Electrical activities of several respiratory muscles were measured with chronically implanted electrodes, and chest wall motion was assessed by high-speed three-dimensional computed tomography scanning. Phasic expiratory muscle activity was markedly depressed by volatile anesthetics halothane and isoflurane compared with pentobarbital. In contrast, inspiratory activity in parasternal intercostal muscles was relatively well preserved during anesthesia with these volatile agents. The contribution of expiratory muscles to tidal volume was diminished during halothane and isoflurane compared with pentobarbital anesthesia. As anesthesia was deepened, expiratory muscle activity was unchanged during pentobarbital anesthesia, enhanced in some dogs during isoflurane anesthesia, and remained absent during halothane anesthesia. Activity in parasternal intercostal muscle was depressed as inspired concentration of halothane or isoflurane was increased, whereas diaphragmatic activity was unchanged. Depression of expiratory muscle activity by halothane persisted when breathing was stimulated by positive end-expiratory pressure, with significant mechanical consequences for chest wall configuration. Many of these findings are in contrast with previous observations in humans and suggest that the dog is not a suitable model for the study of the effects of anesthetic drugs on the pattern of human respiratory muscle activity.

Abdominal Muscles↗

PubMed2004

[Changes of energy metabolism in canine respiratory muscles after phrenic nerve transection].

OBJECTIVE: To examine the changes in energy metabolism in the respiratory muscles of canines with unilateral phrenic nerve transection using high-performance liquid chromatography (HPLC). METHODS: The left phrenic nerve of 8 canines was transected and the contents of adenine nucleotide in respiratory muscles were determined by HPLC before and 1 and 2 months after the operation. RESULTS: In the intercostal muscles, ATP contents remained almost unchanged during the entire course of the observation, while ADP content was elevated 2 months after the operation as compared with that measured before and 1 month after the operation (P<0.05). One month postoperatively, the content of total adenylic acid (TAN) decreased to the lowest point, but the difference between the measurements was not statistically significant; also at 1 month after the operation, the content of adenylate energy charge (AEC) was the lowest, with statistically significant difference from the measurements before and 2 months after the operation (P<0.05). In the diaphragm, the contents of ATP, ADP, TAN and AEC 2 months postoperatively were 9.05+/-12.70, 2.99+/-2.57, 14.72+/-13.98, 0.57+/-0.29, significantly different from the levels at the other two time points (P<0.05). CONCLUSION: After unilateral phrenic nerve transection in canines, the energy metabolism of the diaphragm declines significantly, whereas that of the intercostal muscle can be compensated to some extent.

Adenine Nucleotides↗

PubMed1998

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

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 yr) were studied after they were given histamine challenge. EMG activity at PC20 or at the highest histamine concentration was compared with activity at baseline by calculating the ratio of the mean peak-to-peak excursion at the highest histamine dose to that at baseline [EMG activity ratio (EMGAR)]. In all children reaching PC20, an increase in diaphragmatic and intercostal EMGAR was observed. No increase was found at the dose step before PC20 was reached. In six challenges, no fall in FEV1 was induced, and no increase in EMGAR was seen. In two challenges, no fall in FEV1 was induced, but increase in diaphragmatic or intercostal EMGAR was observed. Increase in the electrical activity of the diaphragm and intercostal muscles in asthmatic children corresponds closely to a 20% fall in FEV1 induced by histamine challenge.

Administration, Inhalation↗

PubMed1988

Metabolic enzymatic activities in the intercostal and serratus muscles and in the latissimus dorsi of middle-aged normal men and patients with moderate obstructive pulmonary disease.

The glycolytic and oxidative enzyme activities (lactate dehydrogenase (LDH), hexokinase (HK), citrate synthase (CS) and 3-hydroxyacyl-CoA-dehydrogenase (HAD] were measured in the fifth internal and external intercostal muscles, in the vertical and horizontal parts of the serratus, an accessory inspiratory muscle, and in a non-respiratory muscle, the latissimus dorsi (LD) of twenty middle-aged men: nine subjects with normal lung function and eleven patients with moderate chronic obstructive pulmonary disease (COPD). In the normal subjects the enzyme activities of the respiratory muscles were similar to those of the LD, and there were no differences between the internal and the external intercostal muscles. In the COPD patients the metabolic activities of HK, CS and HAD were higher in both intercostals than in LD. Furthermore, there was a significant increase in these enzymatic activities as compared to the intercostals of the normal subjects. These data support the hypothesis that the internal and external intercostal muscles play a more important role in COPD patients than in normal subjects. They are consistent with the hypothesis that COPD has an endurance training effect on both intercostal muscles which could compensate for diaphragmatic disuse.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMed1992

Influence of volume on the spread of local anesthetic-methylene blue solution after injection for intercostal block.

The purpose of this study was to evaluate the influence of the volume of methylene blue-local anesthetic on the spread of the injectate along the costal pleura. Twenty patients undergoing elective thoracotomy were studied. Twelve patients received intercostal nerve injection with 10 mL of 0.5% bupivacaine with methylene blue (10-mL group), and eight patients received 5 mL of 0.5% bupivacaine with methylene blue (5-mL group). The area of spread of the methylene blue was measured after the pleural cavity was incised. The 10-mL group had a mean area of spread of 51.1 cm2 as opposed to 17.6 cm2 for the 5-mL group (P less than 0.05). In the 10-mL group, eight patients had bupivacaine-methylene blue spread to two intercostal spaces, three patients to three intercostal spaces, and one patient to four intercostal spaces. In the 5-mL group, seven patients had bupivacaine methylene blue spread confined to one intercostal space and one patient to two intercostal spaces. We conclude that a potential anatomic space exists between the costal pleura and the internal intercostal muscle and that the spread of local anesthetic after intercostal nerve block injection is volume dependent.

Anesthesia, Local↗

PubMed1978

Developmental pattern of muscle fiber types in human ventilatory muscles.

Premature infants tolerate respiratory loads poorly. This may reflect incomplete development of the ventilatory muscles (VM) causing poor resistance to fatigue. To study the developmental pattern of human VM, 31 postmortem specimens of diaphragm and intercostal muscles were obtained. Individual muscle fibers were classified as type I (slow-twitch, high-oxidative) or type II (fast-twich, low-oxidative) using histochemical staining methods for myofibrillar adenosine triphosphatase (M-ATPase) (pH 10.30) and nicotinamide adenine dinucleotide (NADH) tetrazolium reductase. In the diaphragm, premature infants (less than 37 wk gestation) had only 9.7 +/- 1.3% type I fibers, full-term newborns 25.0 +/- 1.1%, and older subjects (greater than 2 yr of age) 54.9 +/- 1.3%. There was no further increase after 8 mo postpartum. In the intercostal muscles, premature infants had only 19.0 +/- 4.8% type I fibers, full-term newborns 45.7 +/- 1.3%, and older subjects 65.2 +/- 2.6%. There was no further increase after 2 mo postpartum. These findings suggest the ventilatory muscles of newborn infants are more susceptible to fatigue than those of older subjects. This may contribute significantly to respiratory problems in the neonate.

Adenosine Triphosphatases↗