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PubMed1998

Myofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve.

Chronic pain in the chest wall is a major complication after herpes zoster infection of intercostal nerves. It is usually difficult to control pain of such origin. Two cases are reported of postherpetic neuralgia after herpes zoster infection involving the intercostal nerves. Both patients had shooting, burning, aching, and localized pain in the muscle supplied by the involved intercostal nerves 1 to 3 months after onset. Compression palpation of a tender spot in one of these muscles induced a referred pain that followed the corresponding interspace, usually in the distal anterior direction. Local twitch responses could be elicited during injection of 0.5% or 1% lidocaine into one of these tender spots; the pain in the interspace was consistently eliminated immediately after injection. One patient had complete pain relief after three series of injections. The effect of pain relief for the other patient lasted for 1 to 2 weeks after the initial injection and lasted progressively longer (up to 2 months) after repeated injections. It appears that many of the tender spots formed in intercostal muscles after herpes zoster are myofascial trigger points that respond to injection with referred pain, local twitch responses, and immediate pain relief.

Anesthetics, Local↗

PubMed1975

Hyperthyroid myopathy. Intracellular electrophysiological measurements in biopsied human intercostal muscle.

Morphological and electrophysiological studies were performed on intercostal muscle biopsies from 2 thyrotoxic patients. The diseased fibers had numerous areas of subsarcolemmal glyogen accumulations and abnormal membranous projections. Both Type I and Type II muscle fibers were atrophied. Diseased fibers were substantially depolarized and when artifically hyperpolarized showed earlier inactivation of the sodium conductance as a function of membrane potential, and a critical depolarization potential more depolarized than in normal fibers. When stimulated at 20 pulses/sec, or faster, the diseased fibers could not generate normal action potentials due to membrane depolarization and the appearance of a marked after-hyperpolarization. Muscle weakness associated with hyperthyroidism is attributed to the reduced membrane excitability.

Adult↗

PubMed1993

Structure of parasternal intercostal muscles in the adult hamster: topographic effects.

The parasternal intercostals are primary inspiratory muscles like the costal and crural diaphragm. However, the structure of the rib cage and its impedance to inspiration and expiration varies regionally. We questioned whether topographic differences in rib cage structure and impedance were associated with regional differences in parasternal intercostal muscle structure. Therefore, we examined the size and percentage of histochemically stained fibers in the parasternal intercostal muscles in the first, second, third, fourth, and sixth interspaces in the hamster. We observed a rostrocaudal gradient in the percentage and size of slow oxidative (SO), fast oxidative-glycolytic, and fast glycolytic (FG) fibers in the parasternal intercostal muscles. In particular, the percentage of SO decreased while the percentage of FG increased in a rostrocaudal direction in the first through sixth interspaces. In addition, the size of SO and FG fibers increased from the first to sixth interspace. Furthermore, changes in the size and percent of the three fiber types produced, in a rostrocaudal direction, significant reductions in the relative mass of the parasternal intercostal muscle made up of SO fibers and increases in the mass of fast fibers. We speculate that topographical differences in the size and percentage of fast and slow twitch fibers in the parasternal intercostal are likely to alter force-generating capacity of the parasternal muscles in a rostrocaudal direction and likely reflect regional differences in muscle load and/or activity.

Analysis of Variance↗

PubMed1981

[Mechanism of the functional transformation of paralyzed intercostal muscles in rats with experimental botulism].

The rest membrane potential (RMP) and action potential (AP) of muscle fibers of external and internal intercostal muscles were examined in the local form of botulism. There was a decrease in the RMP and AP magnitudes in both groups of the muscles. This decrease was coupled with a greater proportion of the fibers with a low RMP. The excitability of the muscle fibers varied biphasically; it rose in the early period of paralysis and fell in the later one. The variations found might be accounted for by dystrophy of motoneurons innervating muscles.

Action Potentials↗

PubMed2002

Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps.

OBJECTIVE: Prospective non-randomised comparison of full-thickness pedicled diaphragm flap with intercostal muscle flap in terms of morbidity and efficiency for bronchial stump coverage after induction therapy followed by pneumonectomy for non-small cell lung cancer (NSCLC). METHODS: Between 1996 and 1998, a consecutive series of 26 patients underwent pneumonectomy following induction therapy. Half of the patients underwent mediastinal reinforcement by use of a pedicled intercostal muscle flap (IF) and half of the patients by use of a pedicled full-thickness diaphragm muscle flap (DF). Patients in both groups were matched according to age, gender, side of pneumonectomy and stage of NSCLC. Postoperative morbidity and mortality were recorded. Six months follow-up including physical examination and pulmonary function testing was performed to examine the incidence of bronchial stump fistulae, gastro-esophageal disorders or chest wall complaints. RESULTS: There was no 30-day mortality in both groups. Complications were observed in one of 13 patients after IF and five of 13 after DF including pneumonia in two (one IF and one DF), visceral herniations in three (DF) and bronchopleural fistula in one patient (DF). There were no symptoms of gastro-esophageal reflux disease (GERD). Postoperative pulmonary function testing revealed no significant differences between the two groups. CONCLUSIONS: Pedicled intercostal and diaphragmatic muscle flaps are both valuable and effective tools for prophylactic mediastinal reinforcement following induction therapy and pneumonectomy. In our series of patients, IF seemed to be associated with a smaller operation-related morbidity than DF, although the difference was not significant. Pedicled full-thickness diaphragmatic flaps may be indicated after induction therapy and extended pneumonectomy with pericardial resection in order to cover the stump and close the pericardial defect since they do not adversely influence pulmonary function.

Aged↗

PubMed2001

Bronchial anastomotic stricutre caused by ossification of an intercostal muscle flap.

We report a case of heterotopic ossification of a pedicled intercostal muscle flap that had been wrapped circumferentially around a bronchial sleeve anastomosis. This ossification caused severe bronchial stenosis and recurrent pneumonias. Stent insertion failed, and the patient ultimately required completion pneumonectomy. We recommended that caution be used when wrapping intercostal muscle around any important lumen.

Airway Obstruction↗

PubMed1999

Closure of bronchopleural fistula after pneumonectomy with a pedicled intercostal muscle flap.

OBJECTIVES: The value of the pedicled intercostal muscle flap for the closure of postpneumonectomy bronchopleural fistulas was studied retrospectively. METHODS: Bronchopleural fistula was suspected in case of fever, cough, putrid or haemorrhagic expectoration, in combination with a rise of WBC and CRP. Fistula diagnosis was established bronchoscopically. Two patients underwent an initial trial of bronchoscopic sealing, the rest were reoperated immediately after fistula diagnosis. Immediately after operation antibiotic irrigation according to culture sensitivity was started via a single chest tube drainage twice a day. After instillation of antibiotics the drain was kept clamped for 3 h. Culture samples were obtained twice a week. Empyema was considered eradicated, if three subsequent cultures showed no bacterial growth. After drain removal the patients were kept in hospital for another week and observed for clinical signs of infection, WBC and CRP were controlled. Age, side, sex, histology, TNM-stage, duration of hospital stay after fistula diagnosis (days), duration of treatment (defined as the duration of chest tube drainage in days after operation), total hospital stay (including the initial hospital stay for primary resection and the hospital stay for fistula treatment in case of readmission), fistula size (mm), interval (days) between primary operation and fistula formation, and bacteriology were recorded. RESULTS: Eight patients (seven male) were treated. Age ranged from 46 to 70 years (mean 57.86). Six fistulas were located on the right side. All patients had non small cell lung cancer. Interval ranged from 2 to 72 days (mean 26.9 days). Fistula size ranged from 1 to 7 mm (mean 3.43). Seven fistulas were successfully closed. Duration of treatment lasted from 15 to 28 days in those patients treated successfully (mean 17). Hospital stay ranged from 15 to 31 days (mean 24.4). In one patient the flap became necrotic, he was successfully treated with total thoracoplasty. One patient died on the 38th day after rethoracotomy due to aspiration pneumonia. At postmortem examination the bronchial stump was closed. CONCLUSION: The use of the pedicled intercostal muscular flap is an efficient method for the closure of bronchopleural fistula after pneumonectomy.

Aged↗

PubMed1982

Intercostal muscle activity during sleep in the cat: an augmentation of expiratory activity.

Intercostal-muscle activity (I-EMG) was studied in sleep and wakefulness in ten adult cats. The animals were implanted with electrodes for recording the electroencephalogram (EEG), electrooculogram (EOG), and pontogeniculooccipital (PGO) waves as well as intercostal- and neck-muscle activity. A small-animal pneumotachograph connected to a tracheal cannula was used to monitor respiration. The data were obtained in 87 recording sessions, each lasting 5-6 h. Total EEG power (fast Fourier analysis) and integrated I-EMG activity were computed over consecutive 5.12-sec periods of wakefulness and nonrapid eye movement (NREM) sleep. Cycle-triggered histograms based on 50 breaths were computed also in wakefulness and NREM sleep. I-EMG was classified as expiratory or inspiratory according to when the activity was maximal during the respiratory cycle. Expiratory I-EMG augmented progressively during NREM sleep with the maximal activity occurring just before rapid eye movement (REM) sleep. The mean correlation between total EEG power and expiratory I-EMG for all expiratory muscles was 0.441 (+/- 0.16 SD; n=24). In contrast to the consistent augmentation of expiratory I-EMG, inspiratory I-EMG changes from wakefulness to deep NREM sleep varied within and between muscle groups: in 21% of the cases, activity decreased from wakefulness to NREM sleep; in 16% of the cases, activity increased; in 56% of the cases, activity did not change; and in 7% of the cases, activity increased in only the expiratory phase. We conclude the consistent augmentation of expiratory intercostal muscle indicates an active, NREM sleep-specific respiratory process that may have important implications for lung mechanics in that state.

Animals↗

PubMed1993

Respiratory effect of the intercostal muscles in the dog.

In a previous paper (J. Appl. Physiol. 73: 2283-2288, 1992), respiratory effect was defined as the change in airway pressure produced by active tension in a muscle with the airway closed, mechanical advantage was defined as the respiratory effect per unit mass per unit active stress, and it was shown that mechanical advantage is proportional to muscle shortening during the relaxation maneuver. Here, we report values of mechanical advantage and maximum respiratory effect of the intercostal muscles of the dog. Orientations of the intercostal muscles in the third and sixth interspaces were measured. Mechanical advantages of the muscles in these interspaces were computed by computing their shortening from these data and data in the literature on rib displacement. We found that parasternal internal intercostals and dorsal external intercostals of the upper interspace have large inspiratory mechanical advantages and that dorsal internal intercostals of the lower interspace and triangularis sterni have large expiratory mechanical advantages. Mass distributions in the two interspaces were also measured, and maximum respiratory effects of the muscles were calculated from their mass, mechanical advantage, and the value for maximum stress in skeletal muscle. Estimated maximum respiratory effects of the inspiratory and expiratory muscle groups of the entire rib cage were tested by measuring the maximum inspiratory pressures that were generated by the parasternal and external intercostals acting alone. Measured pressures, -13 cmH2O for the parasternals and -11 cmH2O for the external intercostals, agreed well with the computed values.

Animals↗

PubMed1989

Structural and metabolic integrity of sheep external intercostal muscle during extended culture.

The objectives of this study were to examine the structural and metabolic integrity of isolated sheep external intercostal muscle bundles following variable lengths of preincubation (0 to 192 h). Samples of intact external intercostal muscle (10 to 15 g), with tendons attached, were prepared from growing wethers and maintained at their resting lengths during preincubation for 0 to 192 h. Protein synthesis (PS), protein degradation (PD), acetate oxidation and ultrastructural integrity of muscle samples were examined at 0 to 192 h, 0 to 96 h, 0 to 48 h and 0 to 96 h following isolation, respectively. Additionally, the effects of variable fetal calf serum (FCS) concentrations (0 to 20%; w/v) on PS and PD and acetate oxidation were examined. Rate of PS increased as preincubation time increased to 192 h; however, most of this increase was due to the proliferation of fibroblasts on the surface of the muscle sample. Addition of cytosine arabinoside to the incubation media prevented the fibroblast-dependent increase in PS; however, it did not entirely prevent the preincubation time-dependent increase in PS. Rate of PD increased greatly upon preincubation. The nitrogen balance of incubated muscles was negative at all times examined. Acetate oxidation was maintained through 12 h of preincubation and thereafter declined. Relatively normal myofibrillar structure was maintained through 48 h of preincubation; however, loss of mitochondrial integrity and dissolution of Z-disks at 48 h and at 96 h of preincubation were evident. Isolated tissues were able to respond to FCS concentration in medium following 48 h of preincubation.

Animals↗

PubMed1991

Differential control of the inspiratory intercostal muscles during airway occlusion in the dog.

1. The effect of airway occlusion on the electrical activity of the three groups of inspiratory intercostal muscles (external intercostal, levator costae, parasternal intercostal) situated in the cranial portion of the rib-cage has been studied in thirty anaesthetized, spontaneously breathing dogs. 2. The three muscles were active during normal inspiration, and their activity was prolonged similarly during airway occlusion. However, a comparison of activity during occluded and unoccluded inspirations indicated that airway occlusion caused a facilitation of external intercostal and levator costae activities but an inhibition of parasternal intercostal activity. 3. The facilitation of external intercostal and levator costae activities was markedly reduced after section of the phrenic nerves and completely suppressed after section of the appropriate thoracic dorsal roots. 4. The inhibition of parasternal intercostal activity was not affected by section of the phrenic nerves or by section of the thoracic dorsal roots. This phenomenon, however, was abolished after bilateral cervical vagotomy. 5. Activation of the external intercostals and levator costae during inspiratory efforts are thus highly dependent on segmental reflexes arising in these muscles. In contrast, activation of the parasternal intercostals resembles that of the diaphragm in the sense that it depends primarily on the central respiratory drive.

Airway Obstruction↗

PubMed1992

The electro-mechanical response of canine inspiratory intercostal muscles to increased resistance: the caudal rib-cage.

1. The effect of graded increases in inspiratory airflow resistance and airway occlusion on the electrical activity and the mechanical behaviour of the levator costae and external intercostal muscles situated in the caudal interspaces (zone of apposition of the diaphragm to the rib-cage) has been studied in spontaneously breathing dogs. 2. The external intercostal and levator costae muscles in the cranial interspaces were invariably active during unloaded inspiration and showed progressive facilitation of activity with increases in inspiratory resistance. In contrast, whether in the supine or in the prone position, the levator costae muscles of the caudal interspaces did not show any facilitation of activity, and the caudal external intercostal muscles never showed any inspiratory electrical activity, including during airway occlusion. 3. With graded increases in inspiratory airflow resistance, the cranial external intercostals demonstrated a gradual inspiratory lengthening and the cranial ribs were progressively displaced in the caudal direction. The caudal ribs, however, were invariably displaced in the cranial direction. As a result, the caudal external intercostals showed a progressive inspiratory shortening. 4. Shortening of the caudal external intercostals and cranial displacement of the caudal ribs were reproduced by isolated stimulation of the phrenic nerves. Thus, as inspiratory resistance increases, contraction of the diaphragm causes unloading, rather than loading, of the spindles present in the caudal external intercostal muscles. 5. After the phrenic nerves were sectioned, however, the caudal external intercostals invariably lengthened a substantial amount during inspiration, but they still did not show any inspiratory electrical activity. Accentuating the inspiratory lengthening of these muscles by external rib fixation and increasing the chemical respiratory drive did not elicit any inspiratory electrical activity either. The alpha-motoneurones of the external intercostal muscles in the caudal interspaces thus have very small central respiratory drive potentials with respect to their critical firing threshold.

Airway Obstruction↗

PubMed1991

Rostrocaudal variation of fiber type composition in rat intercostal muscles.

We used the histochemical stain for ATPase to compare the fiber-type composition of rat internal and external intercostal muscles from thoracic (T) segments 2-5, 8, and 11. At each level, type II fibers were more numerous than type I fibers, type II B fibers were more numerous than II A fibers, and type I fibers were more numerous in external than in internal intercostals. However, fiber type composition varied from segment to segment. For example, the proportion of type II A fibers increased in a rostrocaudal gradient in internal but not external intercostals, and type I fibers were more prevalent at rostral and caudal than at intermediate levels in both internal and external intercostals. These results provide a basis for interpreting previous physiological and molecular studies which have compared intercostal muscles from different segmental levels.

Adenosine Triphosphatases↗

PubMed2004

Video-assisted bronchial stump reinforcement with an intercostal muscle flap.

For lobectomy patients at considerable risk of developing a postoperative bronchopleural fistula, the bronchial stump reinforcement with an intercostal muscle flap is sometimes performed. This procedure usually requires a standard thoracotomy, even if video-assisted thoracoscopic surgery (VATS) is better for the patient. Our patient was a 76-year-old male with lung cancer and severe diabetes mellitus. He underwent lobectomy and systematic nodal dissection combined with bronchial stump reinforcement using an intercostal muscle flap, performed as a VATS procedure. No postoperative complications were observed. This procedure is applicable to patients who are candidates for VATS lobectomy.

Aged↗

PubMed1981

Intercostal muscle biopsy studies in myasthenia gravis: clinical correlations and the direct effects of drugs and myasthenic serum.

We have found a wide range of mean MEPP amplitude in intercostal muscle biopsies from 43 patients with MG, including several values in the normal range. There was no correlation between MEPP amplitude and the severity of clinical disease as assessed by manual muscle testing or by single-fiber EMG measurements of jitter in arm muscles. Through most of these patients were in a state of clinical remission or marked improvement after treatment with prednisone, we could not attribute the difference between our results and those of others to this factor alone. The application of morphine, meperidine and aminoglycoside antibiotics to intercostal muscle in vitro confirms effects previously demonstrated in rat muscle: (1) At equal therapeutic concentrations, meperidine has greater neuromuscular blocking effects than does morphine, but neither has significant effects at concentrations achieved in the serum clinically. (2) Tobramycin, netilmicin and neomycin have varying severity and sites of action, but their effects are the same in human myasthenic muscle as in normal rat muscle. Bath application of serum from myasthenic patients produces an acute, reversible worsening of neuromuscular blockade in myasthenic muscle. Electrophysiologic measurements in intercostal biopsies from patients with MG can provide information about the basic abnormality of neuromuscular transmission in this disease and can confirm the relevance of studies made in animal muscle.

Action Potentials↗

PubMed1983

Mechanical action of the intercostal muscles on the ribs.

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.

Animals↗

PubMed1989

Depression of diaphragmatic and external intercostal muscle activities elicited by stimulation of midpontine dorsal tegmentum in decerebrate cats.

This paper describes the inhibitory influences on external intercostal muscle activity and diaphragmatic activity, evoked by stimulation of the dorsal tegmental field (DTF) of the pons in decerebrate cats. Stimulation of the DTF along the midline decreased both the diaphragmatic and the external intercostal activities. However, the inhibitory influences on the above two kinds of respiratory muscle activities were different in nature. Diaphragmatic activity, once suppressed by stimulation, recovered in spite of the continuation of stimulation. In contrast, DTF stimulation depressed tonic discharges of external intercostal muscle, and the depressed or abolished tonic discharges did not resume even after termination of stimulation. Rhythmic external intercostal muscle activity, synchronized with diaphragmatic activity, was also suppressed by DTF stimulation and the suppressed rhythmic activity seemed difficult to recover during stimulation, compared with the recovery process of the diaphragmatic activity.

Animals↗

PubMed1983

[Thermoregulatory activity of the intercostal muscles under a hypercapnic load].

In experiments on anesthetized cats, the reactions elicited by CO2 inhalation were studied in single motor units of the intercostal muscles activated during shivering. The excitation of the bulbar respiratory center during shivering was found to modify the activity of the respiratory and tonic motor units. Most of the respiratory motor units in a hypercapnic state increased the mean firing rate by 1.5/sec. The tonic motor units both diminished the mean firing rate and changed the pattern of activity: they began to produce bursts of spikes synchronous with the respiratory rhythm. The problems of supraspinal regulation of activity of the intercostal muscles motoneuron pool are discussed.

Animals↗