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[The respiratory muscles and the thoracic cage during respiration at rest].

Even though the diaphragm is the primary respiratory muscle in humans, resting breathing involves other muscles. The diaphragm acting alone is not able to expand the entire rib cage. The expansion of the upper rib cage results from the combined actions of the scalene and intercostal muscles, in particular the parasternals. The external intercostals and the levator costae might constitute a reserve system that is called into action when the load placed on the inspiratory pump is increased.

Diaphragm↗

[The respiratory movement of rib cage in relation to electromyographic activity of the biceps brachii muscle neurotized by the intercostal nerves].

The motor unit potentials of biceps brachii muscle innervated by intercostal nerves and those of second intercostal muscle in relation to respiratory cycle were studied by electromyography (EMG) in 23 patients with traumatic brachial plexus palsies. These patients were followed from about 2 years to 17 years averaging 5 years after intercostal nerves crossing to musculocutaneous nerve. The integrated EMG of biceps brachii muscle ranged from 4 muVS to 244 muVS per second during respiratory phase, with voluntary elbow flexion weighted 500 grams in the hand. Twelve cases showed no significant differences of integrated EMG of biceps brachii muscle between the inspiratory and the expiratory phase. Eleven cases exhibited a significant difference (p < 0.05) between the inspiratory and the expiratory phase. Four out of 11 cases displayed much more integrated EMG activities of biceps brachii muscle in the expiratory phase than those in the inspiratory phase; all these four showed excellent biceps brachii muscle strength. Departure of voluntary elbow movement from the respiratory cycles did not always give the biceps brachii muscle satisfactory strength and did not relate to the postoperative time after nerve surgery.

Action Potentials↗

Types of human intrafusal muscle fibers.

The histochemical and fine structural profiles of human intrafusal muscle fibers were studied. Spindles were located in freshly frozen specimens taken from biopsied normal external intercostal muscles, and periodic 10- and 50-mum-thick cross sections were processed alternately for enzyme histochemical and electron microscopic examination. Nuclear bag fibers were of two types, bag1 and bag2, histochemically, and they displayed two distinct types of ultrastructure. Nuclear chain fibers were histochemically and ultrastructurally homogeneous. Regional differences in enzymatic staining and ultrastructure occurred along individual intrafusal fibers. Human bag1 and bag2 fibers appear to be analogous to the two types of nuclear bag fiber identified in animal spindles and are considered to have different roles in spindle function. The presence of three types of intrafusal fibers should be taken into account when studying spindle abnormalities in human neuromuscular disorders.

Adenosine Triphosphatases↗

Spatial organization within rat motoneuron pools.

Topographical maps form the basis of the organization in many projections within the central nervous system, but in the neuromuscular system such detailed spatial organization has generally been assumed to be absent and indeed unnecessary for normal function (see, for example, ref. 1). However, there is some physiological evidence for a degree of spatial organization within the discrete, longitudinal motor columns which supply individual muscles. We have used horseradish peroxidase as a retrograde tracer to confirm the topographical relationship between the rostro-caudal location of motoneuron cell bodies and the antero-posterior motor unit distribution in the rat gluteus maximus muscle. We also provide evidence for a further axis of intracolumnar organization. The motor pools of the rat intercostal muscles, whose axons lie in a single, segmental nerve, have a ventro-dorsal axis in the ventral horn on which is mapped the proximo-distal position of the motor units. This suggests that during development, not only are motoneurons specified to innervate a particular muscle, but project within that muscle to a predictable location according to their position in the motoneuron pool. The presence of such topographical maps suggests that motoneurons are subject to greater developmental constraints than previously thought.

Animals↗

Determining epidural catheter location using nerve stimulation with radiological confirmation.

BACKGROUND AND OBJECTIVES: The use of epidural stimulation to confirm epidural catheter placement has been shown. This case report describes the benefits and problems of using the epidural stimulation test to confirm epidural catheter placement and provides supporting evidence for these observations using radiological imaging. CASE REPORT METHODS: A nerve stimulator was connected to the proximal end of an epidural catheter via an adapter. The cathode lead was connected to the adapter. The anode lead was connected to an electrode placed on the upper extremity as a grounding site. Using 1 to 10 mA current, a segmental motor response indicated that the catheter was in the epidural space. The absence of a motor response indicated that it was not. CASES: In the first patient, the new test predicted subcutaneous epidural catheter placement, which was subsequently confirmed radiologically. In the second patient, the catheter tip was found to be lying near a nerve root, which was again confirmed radiologically. In the third case, a negative test was initially observed with only local muscle movement over the biceps area (T2). After relocation of the grounding electrode to the lower extremity, segmental intercostal muscle movement (T4-5 level) was observed. The catheter placement was radiologically shown to be in the T4-5 region. CONCLUSION: This report illustrates some of the potential benefits and problems of using the nerve stimulation test to confirm epidural catheter placement, with radiological verification.

Adult↗

Primary malignant fibrous histiocytoma of the chest wall: CT and MR appearance.

PURPOSE: The purpose of this work is to describe the CT and MR appearance of primary malignant fibrous histiocytoma (MFH) of the chest wall. METHOD: Eleven men and eight women (45-76 years old) with primary MFH of the chest wall who underwent both CT and MRI were enrolled, and the imaging interpretation was retrospectively compared to the pathologic specimen. RESULTS: All tumors were inhomogeneous in appearance on CT scans. All tumors showed high signal intensity on T2-weighted images. On T1-weighted MR images, tumors displayed inhomogeneous isosignal intensity in 15 cases (79%) and low signal intensity in 5 (21%) compared with the surrounding muscle. Tumors exhibited inhomogeneous enhancement in all except three localized tumors on enhanced CT and MRI. Invasion of intercostal muscle was noted on MR images in 18 patients (95%) and on CT in 11 patients (58%). CONCLUSION: There might be various radiologic appearances of MFH. However, CT and MRI are able to demonstrate the exact localization and disease extent of MFH arising in the chest wall.

Aged↗

Intercostal nerve conduction study in man.

A new surface technique for the conduction study of the lower intercostal nerves has been developed and applied to 30 normal subjects. The problem of the short available nerve segment of the intercostal nerves and the bizzare compound motor action potential (CMAP) of inconsistent latency while recording over the intercostal muscles, is overcome by applying recording electrodes over the rectus abdominis muscle and stimulating the nerves at two points at a fair distance away. With the use of multiple recording sites over the rectus abdominis, the motor points for different intercostal nerves were delineated. CMAP of reproducible latencies and waveforms with sharp take-off points were obtained. Conduction velocity of the intercostal nerves could be determined.

Abdominal Muscles↗

Changes in expiratory muscle function following spinal cord section.

Following spinal cord injury, muscles below the level of injury develop variable degrees of disuse atrophy. The present study assessed the physiological changes of the expiratory muscles in a cat model of spinal cord injury. Muscle fiber typing, cross-sectional area, muscle weight, and changes in pressure-generating capacity were assessed in five cats spinalized at the T(6) level. Airway pressure (P)-generating capacity was monitored during lower thoracic spinal cord stimulation before and 6 mo after spinalization. These parameters were also assessed in five acute animals, which served as controls. In spinalized animals, P fell from 41 +/- l to 28 +/- 3 cm H2O (means +/- SE; P < 0.001). Muscle weight of the external oblique, internal oblique, transversus abdominis, and internal intercostal muscles decreased significantly (P < 0.05 for each). Muscle weight of the external oblique, internal oblique, transversus abdominis, and internal intercostal, but not rectus abdominis (RA), correlated linearly with P (r > 0.7 for each; P < 0.05 for each). Mean muscle fiber cross-sectional area of these muscles was significantly smaller (P < 0.05 for each; except RA) and also correlated linearly with P (r > 0.55 for each; P < 0.05 for each, except RA). In spinalized animals, the expiratory muscles demonstrated a significant increase in the population of fast muscle fibers. These results indicate that, following spinalization, 1) the expiratory muscles undergo significant atrophy and fiber-type transformation and 2) the P-generating capacity of the expiratory muscles falls significantly secondary to reductions in muscle mass.

Abdominal Muscles↗

Electrical muscle stimulation on the spine. Three-dimensional effects in rabbits.

We investigated the 3-dimensional effect of electrostimulation of the latissimus dorsi, the erector spinae and the intercostal muscles on spinal configuration in 16 New Zealand white rabbits. Electrostimulation on the right side of the spine resulted in a left convex, hypokyphotic curve and vertebral body rotation towards the convexity of the curve in all rabbits. The Cobb angle in the coronal plane increased with stimulation of each of the muscles examined. The kyphosis decreased with stimulation of the latissimus dorsi and the erector spinae. The vertebral rotation increased with stimulation of all muscles. Stimulation of the tested muscles resulted in the simultaneous occurrence of a 3-dimensional spinal deformity with the characteristics of idiopathic scoliosis.

Animals↗

Muscle kinematics for minimal work of breathing.

A mathematical model was analyzed to obtain a quantitative and testable representation of the long-standing hypothesis that the respiratory muscles drive the chest wall along the trajectory for which the work of breathing is minimal. The respiratory system was modeled as a linear elastic system that can be expanded either by pressure applied at the airway opening (passive inflation) or by active forces in respiratory muscles (active inflation). The work of active expansion was calculated, and the distribution of muscle forces that produces a given lung expansion with minimal work was computed. The calculated expression for muscle force is complicated, but the corresponding kinematics of muscle shortening is simple: active inspiratory muscles shorten more during active inflation than during passive inflation, and the ratio of active to passive shortening is the same for all active muscles. In addition, the ratio of the minimal work done by respiratory muscles during active inflation to work required for passive inflation is the same as the ratio of active to passive muscle shortening. The minimal-work hypothesis was tested by measurement of the passive and active shortening of the internal intercostal muscles in the parasternal region of two interspaces in five supine anesthetized dogs. Fractional changes in muscle length were measured by sonomicrometry during passive inflation, during quiet breathing, and during forceful inspiratory efforts against a closed airway. Active muscle shortening during quiet breathing was, on average, 70% greater than passive shortening, but it was only weakly correlated with passive shortening. Active shortening inferred from the data for more forceful inspiratory efforts was approximately 40% greater than passive shortening and was highly correlated with passive shortening. These data support the hypothesis that, during forceful inspiratory efforts, muscle activation is coordinated so as to expand the chest wall with minimal work.

Airway Obstruction↗

Respiratory muscle function during CO2 rebreathing with inspiratory flow-resistive loading.

We investigated the respiratory muscle contribution to inspiratory load compensation by measuring diaphragmatic and intercostal electromyograms (EMGdi and EMGic), transdiaphragmatic pressure (Pdi), and thoracoabdominal motion during CO2 rebreathing with and without 15 cmH2O X l-1 X s inspiratory flow resistance (IRL) in normal sitting volunteers. During IRL compared with control, Pdi measured during airflow and during airway occlusion increased for a given change in CO2 partial pressure and EMGdi, and there was a greater decrease in abdominal (AB) end expiratory anteroposterior dimensions with increased expiratory gastric pressure (Pga), this leading to an inspiratory decline in Pga with outward AB movement, indicating a passive component to the descent of the abdomen-diaphragm. The response of EMGic to IRL was similar to that of EMGdi, though rib cage (RC)-Pga plots did infer intercostal muscle contribution. We conclude that during CO2 rebreathing with IRL there is improved diaphragmatic neuromuscular coupling, the prolongation of inspiration promoting a force-velocity advantage, and increased AB action serving to optimize diaphragm length and configuration, as well as to provide its own passive inspiratory action. Intercostal action provides increased assistance also. Therefore, compensation for inspiratory resistive loads results from the combined and integrated effort of all respiratory muscle groups.

Abdominal Muscles↗

Development of histochemical and functional properties of baboon respiratory muscles.

We assessed morphological, histochemical, and physiological characteristics of respiratory muscles of a non-human primate, Papio cynocephalus, from midgestation through adult life. Samples were taken of diaphragm muscles for histochemical analysis, electron microscopy, and assessment of contractile properties and fatigability. Histochemical analyses were also performed on samples of intercostal muscles. Initially, developing fibers are type IIc but differentiate into types I and IIa fibers by term. We observed no IIb fibers in respiratory muscles of premature baboons. Beginning late in gestation, muscle fibers grew rapidly. After term, IIb fibers were found, and fiber size ranked by increasing mean fiber area became types I, IIa, and IIb. After term, we rarely observed type IIc fibers. In electron micrographs we observed large numbers of interfibrillar mitochondria in all muscle fibers of premature baboons but not in all IIb fibers of adults. Histochemical observations were supported by contractile properties. Muscles of premature baboons had significantly longer contraction and relaxation times than adult muscles. Muscles from premature baboons were more resistant to fatigue than those of adult baboons. We conclude that the fibers of respiratory muscles are high in oxidative capacity and are resistant to fatigue during gestation. Fatigue of the respiratory muscle fibers secondary to low oxidative capacity is not a likely cause of respiratory distress in premature baboons.

Animals↗

Polymyositis presenting with respiratory failure.

A 36-year-old woman presented with a 3-month history of increasing dyspnoea, culminating in respiratory failure due to paralysis of respiratory muscles. She required assisted ventilation. Subsequently, mild limb and neck weakness was noted. Muscle biopsy of the right vastus lateralis showed polymyositis. The patient died suddenly and the postmortem revealed polymyositis with predominant involvement of the diaphragm and intercostal muscles.

Adult↗

Inspiratory muscle interaction in the generation of changes in airway pressure.

The mechanical interaction of the inspiratory muscles in the generation of changes in airway pressure is unclear. Using upper thoracic spinal cord stimulation to activate the intercostal muscles (IC) and bilateral supramaximal phrenic nerve stimulation to activate the diaphragm (D), we measured the changes in airway pressure produced by separate and combined IC and D activation over a wide range of lung volumes. Changes in parasternal IC and D length were assessed by sonomicrometry. With increasing lung volume, activation of the IC and D resulted in progressive decrements in generated airway pressure. Combined IC and D contraction produced greater negative swings in airway pressure than the arithmetic sum of separate IC and D contraction alone, indicating a synergistic effect. Moreover, synergism increased progressively with increasing lung volume. During combined muscle contraction, both the IC and D shortened less than during contraction of either muscle group alone. The tendency for the parasternal muscle to lengthen for a given change in airway pressure during D contraction alone increased with increasing lung volume, suggesting that the tendency for the rib cage to recoil inward increased progressively with increasing lung volume. Likewise, the tendency of the D to lengthen for a given change in airway pressure during IC contraction alone also increased progressively with increasing lung volume, suggesting that the tendency for the abdomen-D compartment to recoil inward also increased with increasing lung volume. We conclude that the IC and D interact synergistically to produce changes in airway pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Changes in the pattern of breathing caused by chest vibration.

Vibration of 100 Hz was delivered longitudinally onto the sternum of anaesthetized cats and rabbits. Vibration consistently reduced the tidal volume by 10-15% without altering the end-expiratory point, and occasionally reduced the respiratory rate. Vibration applied during inspiration reduced the tidal volume as much as if delivered over several breaths. Expiratory vibration did not alter the course of the expiration, nor the volume of the following inspiration. The inhibition of inspiration was unaffected by deafferentation of chest wall skin, bilateral vagotomy, bilateral division of the phrenic nerves and low thoracic spinal transection. Spinal transection above the thoracic cord (C8/T1) abolished usual responses to vibration. The receptors for this reflex probably lie in the chest wall. Vibration inhibited the development of alae nasi tension during inspiration indicating that supraspinal reflex loops were involved. A role for intercostal muscle spindles is suggested.

Adult↗

Mechanical contribution of expiratory muscles to pressure generation during spinal cord stimulation.

Lower thoracic spinal cord stimulation (SCS) results in the generation of large positive airway pressures (Paw) and may be a useful method of restoring cough in patients with spinal cord injury. The purpose of the present study was to assess the mechanical contribution of individual respiratory muscles to pressure generation during SCS. In anesthetized dogs, SCS was applied at different spinal cord levels by using a 15-lead multicontact electrode before and after sequential ablation of the external and internal obliques, transversus abdominis (TA), rectus abdominis, and internal intercostal muscles. Paw was monitored after tracheal occlusion. SCS at the T(9) spinal cord level resulted in maximal changes in Paw (60 +/- 3 cmH(2)O). Section of the oblique muscles resulted in a fall in Paw to 29 +/- 2 cmH(2)O. After subsequent section of the rectus abdominis and TA, Paw fell to 25 +/- 2 and 12 +/- 1 cmH(2)O respectively. There was a small remaining Paw (4 +/- 1 cmH(2)O) after section of the internal intercostal nerves. Stimulation with a two-electrode lead system (T(9) + T(13)) resulted in significantly greater pressure generation compared with a single-electrode lead due to increased contributions from the obliques and transversus muscles. In a separate group of animals, Paw generation was monitored after section of the abdominal muscles and again after section of the external intercostal and levator costae muscles. These studies demonstrated that inspiratory intercostal muscle stimulation resulted in only a small opposing inspiratory action (</=3 cmH(2)O). We conclude that, during SCS, 1) contraction of the obliques and TA muscles makes the largest contribution to changes in Paw, and 2) stimulation with a two-electrode lead system results in more complete abdominal muscle activation and enhanced mechanical actions of the obliques and transversus muscles.

Abdominal Muscles↗

Electromyographic response of respiratory muscles during elastic loading.

The response of respiratory motor neurons to graded elastic loading was assessed in anesthetized dogs by recording the electromyogram (EMG) from the diaphragm (ED) and the intercostal muscle (EIC). Elastic loads were applied for 1-20 breaths. The effects of changes in PCO2 on respiratory motor neuron output was assessed by applying loads during the course of CO2 rebreathing. On the first loaded breath, ED and EIC increased reflexly due chiefly to prolongation of inspiration. Vagotomy or vagal cooling to block the Hering-Breuer reflex eliminated the increase in ED and diminished the increase in EIC. During the second to fifth breath, the level of EMG activity was disproportionately high for the level of PCO2, suggesting an additional reflex component over and above the reflex activity present on the first loaded breath.

Animals↗