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PubMed1981

[Anatomical study of the twelfth intercostal nerve and oblique lumbotomies (author's transl)].

After a very precise anatomical review, the authors report the results of an anatomo-radiological study involving 244 urography films. The usual length of the 12th rib is 11 cm, with a width of 1 cm in the female and 1.5 cm in the male. The costo-lumbar angle was 45 degrees in 3/4 of the films. The kidney was often lower in the female than in the male. The renal artery was almost always given off at the level of the 12th rib or below, whilst at the level of the hilum, the renal artery and 12th rib having crossed, the artery was always above the 12th rib. Study of 173 usable cases of patients operated upon by lumbotomy revealed the following data: --lumbotomies on the 12th rib never opened the pleura, and gave rise to transient wall pain (7%) and one single case of abdominal wall hypotonia (1.4%) with no incisional hernias; --lumbotomies over the 11th rib were associated with 13% of cases of damage to the pleura, 16% of spontaneously resolving wall pain, 7 cases of prolonged parietal hypotonia and one incisional hernia out of 60 lumbotomies; --lumbotomies sub-jacent to the 12th rib were associated with residual abdominal wall pain in 3 cases out of 16. Lumbotomies over the 11th rib are associated with the risk of section of the superficial and deep abdominal branch of the 12th nerve and are hence those exposing to the greatest risk of abdominal wall hypotonia and neuralgia. Incision over the 12th rib would thus appear to be that associated with the least abdominal wall complications.

Female↗
PubMed1971

The form and distribution of the surface evoked responses in cerebellar cortex from intercostal nerves in the cat.

1. The form and distribution of the cerebellar evoked responses to electrical stimulation of intercostal and other thoracic segmental nerves were investigated in anaesthetized cats.2. Low intensity stimulation (< 2 x nerve threshold) evoked short latency, low amplitude (< 20 muV), initially surface positive responses which could only be distinguished with certainty from the electrocorticogram with averaging.3. On the basis of experiments involving sectioning of afferent tracts it is concluded that intercostal evoked responses of less than 7.0 msec latency are conducted in dorsal spino-cerebellar, ventral spino-cerebellar and dorsal column (cuneo-cerebellar) pathways.4. The surface positive waves have a highly punctate distribution with a steep potential gradient extending over an area of about 1 mm diameter. It is postulated that these small fields represent activation of single or few mossy fibre inputs.5. Short latency responses to thoracic inputs were found only in the ipsilateral intermediate cortex and lateral margin of the vermis of the anterior lobe (lateral two thirds of Larsell's lobules IV and V of the accessible cortex). The responses were distributed throughout the fore and hind limb areas of the anterior lobe and no rostro-caudal or medio-lateral segmental organization was seen.6. It is suggested that the overlapping distribution of thoracic and fore and hind limb mossy fibre inputs within the cerebellar cortex provides an anatomical basis for the integration of information from the trunk and from the limbs.

Animals↗
PubMed1990

[Effects of lumbar or thoracic epidural anesthesia on median nerve somatosensory evoked potentials].

Somatosensory evoked potentials (SSEP) are used increasingly to monitor the integrity of neural pathways in anesthetized patients. To evaluate the influence of epidural anesthesia on the central nervous system, we studied the effects of lumbar or thoracic epidural anesthesia with lidocaine on the median nerve SSEP in 9 patients. The peak latencies (N1, P2, N2) and amplitudes (N1-P2, P2-N2) of the SSEP response over the sensory cortex were recorded before and 15 min after epidural anesthesia. The peak latencies of control and post epidural anesthesia of N1, P1, N2 were 19.2 +/- 1.7 msec, 19.6 +/- 1.6 msec (N1), 24.7 +/- 2.3 msec, 25.7 +/- 2.0 msec (P2), 32.8 +/- 2.8 msec and 34.6 +/- 2.5 msec (N2), respectively. The amplitude of control and post epidural anesthesia of N1-P2, P2-N2 were 4.5 +/- 2.9 microV, 5.9 +/- 6.6 microV (N1-P2), 4.4 +/- 3.2 microV and 5.6 +/- 5.2 microV (P2-N2), respectively. Peak latencies of all components (L1, P2, N2) increased after epidural anesthesia compared with control values. Amplitude of N1-P2 increased significantly following epidural anesthesia compared with control values. The data obtained in this study were contrary to the previous concept that anesthetic agents generally increase the latency of SSEP and decrease their amplitude.

Adult↗
PubMed1978

Macroscopical observations on a human anencephalous fetus with multiple malformations (author's transl).

The present report treats a female stillborn human anencephalous fetus with the craniorrhachischisis, cleft palate, left-sided congenital diaphragmatic hernia, hypoplasia of lungs, imperforate vagina and anus, absent left kidney and sternal muscle on the left side. In view of the rarity of the records of autopsied cases of anencephaly, authors made efforts to obtain informations on how all the organs in this fetus and their topographical relation in each other are affected by the anencephaly. The findings are summarized as follows. 1) This case falls under Anencephalus craniorrhachischisis in NANAGAS (1925)'S classification. 2) The greater part of thoracic and lumbar vertebral column except T10, 11, 12 and L1 segments shows several segmental malformations. The lumbar vertebral column is twisted towards right and the left posterior abdominal wall is nearly absent. Due to these changes, only two ribs are present on the left side. 3) In this case, there is a congenital diaphragmatic hernia through persistent left sided pleuroperitoneal canal. The abdominal viscera protruded into the pleural cavity are the caecum, vermiform appendix, colon, spleen and pancreas. 4) On both sides, the ventral rami of the thoracic, lumbar and sacral nerves are normal in number. Their spinal ganglia situated on these nerve roots are, however, fused to form eight ganglionic masses. 5) The five short left thoracic ventral rami arise from a ganglion lying on the posterior thoracic wall. This ganglion gives off the two branches communicating with the right 7th, 8th and 11th thoracic nerves. On the other hand, the right lumbar plexus receives the left 1st, 2nd and 3rd lumbar nerves. In the left pelvic part, there is another ganglion which gives off the two large branches to the right 1st and 2nd sacral nerves. 6) From the findings mentioned above, it is advisable to examine not only the ectodermal structures but also mesodermal ones to promote the studies on a factor in the genesis of anencephaly.

Abdomen↗
PubMed1978

F wave evaluation of thoracic outlet syndrome: a multiple regression derived F wave latency predicting technique.

To assess the occurrence of a neurologic verus a vascular component of thoracic outlet syndrome (TOS), ulnar nerve function via the F wave was studied in 16 patients with clinically diagnosed TOS and 38 control subjects. To simplify the procedure the following formula was developed, through multiple regression analysis, which can predict the ulnar F wave latency in an individual: [arm length (cm) x 0.31] minus [ulnar nerve forearm velocity (meters/sec) x 0.123] plus [11.05]. The mean plus 2 standard deviations, the maximum acceptable prolongation above the predicted value, is 2.5 msec. This formula can be used for assessment of any ulnar nerve conduction defect. Using this technique, some patients with clinically diagnosed TOS were shown to have slowed conduction of the ulnar nerve through the thoracic outlet.

Adolescent↗
PubMed1988

Distribution and origin of peptide-containing nerve fibers in the celiac superior mesenteric ganglion of the guinea-pig.

The origin of the peptidergic nerve fibers and terminals in the celiac superior mesenteric ganglion of the guinea-pig was studied. The distribution of immunoreactivity to enkephalin, substance P, calcitonin gene-related peptide, cholecystokinin, vasoactive intestinal polypeptide/peptide histidine isoleucine, bombesin and dynorphin was analysed in intact animals and in animals subjected to various denervation and ligation procedures. The present results show that each of the connected nerve trunks carries peptidergic pathways and contributes to the peptidergic networks in the celiac superior mesenteric ganglion. Thus, the thoracic splanchnic nerves contain enkephalin-, substance P- and calcitonin gene-related peptide-immunoreactivity of which substance P and calcitonin gene-related peptide coexist in the same nerve fibers. In addition, cholecystokinin-, vasoactive intestinal polypeptide/peptide histidine isoleucine- and dynorphin-immunoreactivity is present in some fibers. All of these immunoreactivities are present in sensory neurons except enkephalin which probably originates in the spinal cord. The mesenteric nerves carry enkephalin-, calcitonin gene-related peptide-, cholecystokinin-, vasoactive intestinal polypeptide/peptide histidine isoleucine-, bombesin- and dynorphin-immunoreactive fibers from the intestine and are the main source for cholecystokinin, vasoactive intestinal polypeptide/peptide histidine isoleucine, bombesin and dynorphin fibers. Double-staining experiments indicate that many of these peptides are synthesized in the same enteric neurons. Also the intermesenteric nerve contains peptide-immunoreactive fibers to the celiac superior mesenteric ganglion from different sources, probably including the distal colon as well as dorsal root ganglia and spinal cord at lower thoracic and lumbar levels. The results are discussed in relation to earlier morphological and physiological studies supporting the view of a role of the celiac superior mesenteric ganglion in local reflex mechanisms involved in regulation of gastrointestinal functions.

Animals↗
PubMed2006

The gross anatomy of the extrathoracic course of the intercostobrachial nerve.

Recent reports emphasize the importance of preserving the intercostobrachial nerve (ICBN) during surgical procedures (i.e., mastectomy, axillary clearance). However, a limited number of scientific reports explore the surgical anatomy of this nerve. We dissected 100 adult human formalin-fixed cadavers (200 axillae). In all the cadavers the ICBN was present with variant contributions from intercostal nerves T1, T2, T3, and T4. The arrangements of the ICBN were typed as I through VIII. The components of Type I (45% or 90 of our specimens) included a branch to the posterior antebrachial cutaneous nerve, a branch to the anterior and lateral parts of the axilla, a branch to the medial side of the arm, and a branch to the medial antebrachial cutaneous nerve. Type II (25%) describes the ICBN arising from T2 and giving off a branch to the brachial plexus. In Type III (10%), lateral cutaneous branches of T2 and T3 fuse as a common trunk and then split immediately after exiting the intercostal space to form an ICBN. In type IV (5%), T2 and T3 join distally to form an ICBN that ends as its terminal branches. Type V (5%): T3 joins T2 from the same intercostal space proximally, with Type VI (3%) showing a very proximal branching of the sensory terminal nerves. Type VII (5%) displayed a contribution from T3 and a branch to the brachial plexus with multiple terminating branches. A contribution from T3 and T4 and a branch to the brachial plexus with multiple branches of termination comprised Type VIII (2%).

Aged↗
PubMed1975

Syndrome of the rectus abdominis muscle: A peripheral neurological condition causing abdominal diagnostic problems.

Four cases of a painful abdominal syndrome are presented, the pain occurring in the distribution of the medial cutaneous branch of the 7th--12th intercostal nerves. The diagnosis presents difficulties because of severe abdominal pain. In 2 cases the clinical observations were corroborated by EMG findings. The symptoms, physical manifestations, mode of development and therapy are described. The term proposed for the condition is: Syndrome of the Rectus Abdominis Muscle.

Abdomen, Acute↗
PubMed1982

The spatial distribution of synchronization of intercostal motoneurones in the cat.

1. The three different types of synchronization of intercostal motoneurones which were described in the preceding paper (Kirkwood, Sears, Tuck & Westgaard, 1982) were studied for motoneurones of the same segment or for different segmental separations (up to five segments) and for motoneurones on opposite sides of the same segment.2. The strength of synchronization declined with segmental separation for all three categories, although the rate of decline was more variable for broad-peak synchronization than for the two other types. Short-term synchronization was undetectable for separations greater than three or four segments but clear peaks were still visible in the cross correlation histograms for high-frequency oscillation (h.f.o.) or broad-peak synchronization at a segmental separation of five. Synchronization between motoneurones on opposite sides of the cord was generally weak although less so for broad-peak or h.f.o. components.3. The decline in strength of short-term synchronization with segmental separation could not be explained by temporal dispersion of impulses in presynaptic axons.4. A time shift was observed in the position of the cross-correlation histogram peak which was dependent on segmental separation and equivalent to a mean descending conduction velocity of 28 m/s in the assumed common input. This figure is similar to the mean conduction velocity of bulbospinal respiratory neurones derived from published values.5. We conclude that the short-term synchronization in these preparations is generated by the bulbospinal respiratory neurones and that the majority of their axons do not branch to make strong synaptic connexions to motoneurones over more than three to four segments.6. Interpretations of the different distributions of the other types of synchronization are discussed.

Action Potentials↗
PubMed1985

Caudal medullary expiratory neurone and internal intercostal nerve discharges in the cat: effects of lung inflation.

In midcollicular decerebrate, thoracotomized, paralysed cats that were ventilated by a cycle-triggered pump and had an expiratory load, recordings were taken from expiratory neurones in the nucleus retroambigualis of the caudal medulla and from the internal intercostal nerves at T8-T9 levels. Expiratory neurone and internal intercostal activities had augmenting patterns of two types: (a) step-ramp (one-third of the neurones): a large initial increase of activity synchronous with inspiratory termination, followed by a ramp increase throughout the expiratory phase; (b) ramp (two-thirds of the neurones): a steady rise of activity without a sharp initial increase, discharge usually starting after a delay (as much as several hundred milliseconds) from the onset of expiration. Both types of unit pattern could occur together with each type of internal intercostal pattern. At the end of expiration, unit activity shut off abruptly just prior (0-120 ms) to the onset of phrenic discharge. The effects of pulmonary afferent discharge on unit and internal intercostal activities were evaluated by use of inflation tests: withholding inflation during the preceding inspiratory phase; maintaining inflation at the end-inspiratory level during expiration. Both tests produced lengthening of expiratory phase duration (TE), but their effects on activity differed. Following no-inflation during inspiration, the discharge onset delay was lengthened for most ramp neurones, but for only a minority of step-ramp neurones; the slope of activity augmentation did not change on the average; and the peak (end-expiratory) discharge frequency was only slightly increased. The predominant effect of maintained expiratory inflation was reduction of activity slope for ramp neurones and for a minority of step-ramp neurones, as well as increase of peak frequency; there was a moderate increase of discharge onset delay for ramp neurones, but not for step-ramp neurones. The lengthening of TE produced by no-inflation in the preceding inspiration was associated with lengthening of the durations of both the discharge onset delay and the discharge burst, but there was no correlation between changes of these two variables. We observed a 'reversal phenomenon': moderate inflation facilitated activity, whereas higher inflation levels depressed activity, as demonstrated by: comparison of effects of maintained expiratory deflation (removal of the expiratory load) and of maintained expiratory inflation, both of which reduced activity; comparison of effects of phasic expiratory inflations having different magnitudes.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed1976

Open-loop respiratory chemosensitivity in chickens and ducks.

In order to study the behavior of the avian respiratory center under open-loop conditions, recordings of respiratory motor discharges were made from an intercostal nerve in a unidirectionally ventilated paralyzed preparation during normoxic hypercapnia, hypoxic normocapnia and asphyxia, and under control conditions. Respiratory motor burst rate (RMBR) in ducks showed a maximum at 40 mmHg Paco2 with depression at higher and lower values, both in the steady state and during rapid transients. RMBR was apparently independent of Paco2 in chickens, and of Pao2 in both species. During asphyxia, RMBR in ducks fell steadily while the number of spikes in each burst did not change. RMBR during asphyxia bore the same relationship to Paco2 as during unidirectional ventilation. Chickens did not respond consistently to asphyxia, but RMBR tended to increase and, in some cases, the number of spikes per burst also increased. Possible mechanisms and functions of the asphyxic respiratory depression observed in ducks are discussed.

Animals↗
PubMed1989

Interpleural administration of bupivacaine after cholecystectomy: a comparison with intercostal nerve block.

Pethidine requirements and verbal pain scores were recorded in 36 patients after cholecystectomy via subcostal incision. All patients also received 20 ml 0.5% bupivacaine with adrenaline 1/200,000. Group 1 (12 patients) received unilateral intercostal nerve blocks. Interpleural catheters were inserted through the 8th intercostal space in the remaining patients; 12 received local anaesthetic via the catheter immediately after surgery (Group 2) and 12 were given local anaesthetic at three hours (Group 3). Small asymptomatic pneumothoraces were noted on chest X-ray in six of the 24 patients with interpleural catheters. Both types of local anaesthesia produced lower pain scores than pethidine alone (P less than 0.05) with 25% of intercostal nerve blocks and 63% of interpleural catheters requiring no pethidine in the following three hours. The provision of catheter 'top-ups' between six and 18 hours after surgery also resulted in lower pain scores and a reduction in pethidine requirements (P less than 0.05).

Adult↗
PubMed1988

Reduction of post-thoracotomy pain by cryotherapy of intercostal nerves.

In a prospective study, 144 patients undergoing thoracotomy were randomized to two groups: In 71 cases cryoanalgesia was applied intraoperatively to the intercostal nerves above and below the incision to relieve postoperative pain, and 73 (control group) received bupivacaine-adrenaline intercostal blockade at the end of the operation. The amount of administered narcotic and mild analgesics, the visual analogue pain scores, the need for further intercostal blockade and the number of postoperative bronchoscopies to clear retained secretion were significantly less in the cryoanalgesia group than in the controls. There were no late nerve complications after cryoanalgesia, which is recommended for routine use in thoracotomy.

Analgesia↗