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At least 19 recordsLinked to original sources
PubMed2002

Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome.

OBJECTIVE: Cervical and anomalous first ribs are rare conditions, occurring in less than 1% of the population. This manuscript reviews our management of neurogenic thoracic outlet syndrome (TOS) associated with these congenital anomalies. METHODS: During the past 26 years, 65 operations were performed for abnormal ribs that produced symptoms of TOS. Of these, 54 operations were for neurogenic TOS and are covered in this paper. Indications for surgery were disabling pain and paresthesia and failure to respond to conservative treatment. Surgical technique for neurogenic TOS was supraclavicular cervical rib resection and scalenectomy without first rib resection in 22 cases, supraclavicular cervical and first rib resection in 17 cases, supraclavicular excision of anomalous first ribs in five cases, and transaxillary anomalous first rib resections in two cases (total, 46 cases). Eight reoperations were performed for recurrent TOS in patients who previously had undergone cervical and first rib resections. RESULTS: Neck trauma was the cause of neurogenic symptoms in 80% of patients with cervical or anomalous first ribs. The surgical failure rate was 28% for 46 primary operations. A significant variable in results was the etiology of the symptoms. The failure rate for patients in whom symptoms developed after work-related injuries or repetitive stress at work was 42%, and the failure rates for patients whose symptoms followed an auto accident or developed spontaneously were 26% and 18%, respectively. The failure rate in each etiology group also was affected by the operation performed. The failure rate for cervical rib resection without first rib resection in the work-related group was 75% compared with a failure rate of 38% in the non-work-related group. In contrast, when both cervical and first ribs were resected, the failure rate in the work-related group fell to 25% and in the non-work-related group to 20%. These failure rates for the work-related and non-work-related groups are similar to our failure rates in patients without cervical ribs. CONCLUSION: Surgery for neurogenic TOS in patients with cervical ribs should include both cervical and first rib resection. The presence of cervical or anomalous first ribs in patients with neurogenic TOS does not improve the success rate from surgery compared with patients without abnormal ribs. Neck trauma is the most common cause for neurogenic TOS in patients with abnormal ribs. Cervical and anomalous first ribs are the predisposing factors rather than the cause.

Adolescent↗
PubMed1993

Rib cage deformities in scoliosis: spine morphology, rib cage stiffness, and tomography imaging.

A computer-implemented biomechanical model of a thoracolumbar spine and deformable rib cage was used to investigate the influence of spine morphology and rib cage stiffness properties on the rib cage deformities that arise from scoliosis and to study the relationship of actual rib distortions with those seen on computed tomography (CT) scans. For the purposes of this study, it was assumed that rib cage deformities result from forces imposed on the ribs by the deforming spine. When a structurally normal rib cage was allowed to follow freely the imposition of scoliotic curves on the spine, different configurations of scoliosis led to substantial differences in the resulting rib cage deformities. Rib cage lateral offset correlated well with the Cobb angle of the scoliosis but not with the apical vertebral axial rotation, whereas rib cage axial rotation correlated well with apical vertebral axial rotation but not with the Cobb angle. These model-obtained findings mirror clinical findings that correction of the Cobb angle leads to correction of the lateral offset of the rib cage but does not correlate well with correction of the rib cage axial rotation. The stiffnesses of the ligamentous tissue connecting the sternum to the pelvis, of the costovertebral joints, and of the ribs themselves also influenced the rib deformities substantially. The influence of the sternopelvic ligamentous ties has not been recognized previously. The total rib cage volume remained essentially constant regardless of the severity of the resulting deformity, but the distribution of this volume between convex and concave sides varied somewhat.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1972

Biosynthesis of riboflavine in Saccharomyces cerevisiae: the role of genes rib 1 and rib 7 .

Haploid strains of Saccharomyces cerevisiae with mutations in two different rib genes were constructed. These strains were studied by tetrad analysis and by quantitative determination of accumulation products. The genes rib(1), rib(7), and rib(2) are not linked to each other. rib(1)-rib(7) strains and rib(1)-rib(2) strains exhibit the phenotypic properties of rib(1) strains. rib(7)-rib(2) strains show the phenotypic properties of rib(7) strains. The results support the conclusion that the genes rib(1) and rib(7) code for the first and second enzyme of the riboflavine pathway, respectively.

Chemical Phenomena↗
PubMedDate not supplied

Keep your eyes on the ribs: the spectrum of normal variants and diseases that involve the ribs.

A variety of normal variants or pathologic conditions of the ribs may be overlooked at chest radiography if the ribs are not evaluated carefully. Rib lesions may simulate pulmonary disease as well. Normal rib variants include cervical, intrathoracic, and pelvic ribs; forked rib; fusion and bridging; and pseudarthrosis of the first rib. Trauma-related lesions are common and usually occur in isolation but can alert the radiologist to other injuries. Metastases may appear as vague areas of increased opacity overlying the lung if seen en face and typically have a smooth interface with the lung on oblique images. Chondroid lesions nearly always arise at or near the anterior end of the rib. Osteochondroma (exostosis) typically manifests as a deformity or expansion of the rib with calcification of the cartilaginous cap. Acute rib infections are seen as focal areas of bone destruction, whereas chronic infections may manifest as periosteal reaction or a bone sequestrum. Inferior rib notching may be seen in a wide variety of pathologic conditions. Rib abnormalities may also be seen in fibrous dysplasia, Langerhans cell histiocytosis, Paget disease, and various hemoglobinopathies. In most cases, radiography is sufficient for the identification and diagnosis of normal variants and pathologic conditions of the ribs.

Adult↗
PubMed1993

Identification of rib number and assessment of intercostal variation at the sternal rib end.

A technique for the identification of anatomical rib number is presented here. Preliminary tests indicate that with experience, percent accuracy for identification may approach 100%. This technique was then applied to a skeletal collection where rib number was not documented in order to determine the effects of intercostal variation on the application of rib four age-at-death estimation standards to other ribs. Spearman rank correlations between rib four and ribs three through nine range from 0.89 to 0.91. No significant differences were found between ribs conforming to or deviating from the phase observed on rib four. There is a significant proportion of deviations falling below the phase set by rib four, however these deviations are not statistically associated with rib number and are usually within one phase. These results indicate that rib four standards can be cautiously applied to other sternal ends when rib four is not preserved.

Adolescent↗
PubMed1989

Use of rib belts in acute rib fractures.

The current treatment for uncomplicated rib fractures is the exclusion of associated injuries followed by symptomatic treatment with analgesics. Encouragement of deep breathing is also recommended to avoid secondary or delayed pulmonary complications. The use of circumferential rib belts in treating patients with acute rib fractures has been discouraged because of possible complications from restricted ventilation. A review of the literature revealed no previous clinical studies to support this view. We designed and conducted a controlled, prospective, randomized pilot study to determine if there was any increased morbidity associated with the use of rib belts in the treatment of patients with acute rib fractures. Twenty-five adult patients with radiographically proven acute rib fractures were randomized into two groups. The first group was treated with analgesics and a standard circumferential rib belt (Zimmer Universal Rib Belt). The second group was treated with oral analgesics alone. Patients were contacted by telephone three days after the initial injury and then reexamined 14 days postinjury. Rates of pain resolution, compliance, and delayed complications were determined. Rib belts were not found to significantly reduce the severity of pain. Four complications (one case of bloody pleural effusion requiring hospitalization, two cases of asymptomatic discoid atelectasis, and one case of allergic contact dermatitis) were identified, all occurring in the group of patients receiving rib belts. This pilot study indicates that while rib belts are widely accepted by patients for control of pain, they appear to be associated with an increased incidence of complications. Clinical studies with larger sample sizes will be needed to confirm these findings.

Acetaminophen↗
PubMed1975

[Role of the somitic mesoderm in the development of the rib cage of bird embryos. I. Origin of the sternal component and conditions for the development of the ribs (author's transl)].

The developmental origin of the sternal component of the ribs and the conditions for the development of the rib cage have been elucidated in bird embryos. Experiments consisted in homo- or heterospecific transplantations of 2-day-old quail or chick embryo somitic mesoderm into chick hosts of the same age in ortho- or heterotopic position along the cephalo-caudal axis. Results show that vertebral halves, ribs (not only their vertebral segment, but also their sternal component when they possess one), the trunk and intercostal muscles, as well as at least part of the scapula originate exclusively from the somitic material, while the sternum, ventral muscles and the other parts of the pectoral girdle are derived from the somatopleural mesoderm. The development of the rib basket is subjected to following rules: -only the somitic mesoderm of the prospective thoracic region (somites 19-26) is able to give rise to ribs. -only the somitic mesoderm of the posterior thoacic region (somites 22-26) is able to develop ribs with a sternal component. -the vertebral component of ribs can develop outside the thoracic region. -contrariwise, the sternal component can form only in the vicinity of the sternal anlage, i.e. within about three somites in front and rear of the normal limits of the thoracic region. It is concluded that the somitic mesoderm is already regionalized at a stage slightly preceding its metamerization and that the somatopleural territory of the sternum plays a morphogenetic role in the development of the sternal component of ribs, although it does not make a cellular contribution to their construction.

Animals↗
PubMedDate not supplied

Supernumerary lumbar rib: manifestation of basic alteration in embryonic development of ribs.

Supernumerary ribs (SNR) are a common variant in some strains of mice used in standard teratology bioassays. We have previously demonstrated that increased incidence of SNR may be induced by a wide variety of xenobiotics and/or general maternal stress. The significance of this defect in cross-species extrapolations has been problematic and recent studies, including this one, have shown that this anomaly is more complex than previously thought. The SNR in mice have a bimodal distribution composed of 'rudimentary ribs' (RR) with a mode of 0.3-0.4 mm and 'extra ribs' (ER) with a mode of 0.9-1.1 mm. The studies reported here examine the relationship between the presence of SNR and the 13th rib length and the gross morphological development of the anomaly. Supernumerary ribs were induced in CD-1 mice by surgical stress (subcutaneous micropump implanted on gestational day (GD), restraint stress (GD8), food and water deprivation (GD8) or maternal administration of the pesticide dinoseb (50 mg kg-1 on GD7 and GD8). Fetuses from untreated litters were also examined. Dinoseb-treated mice were killed on GD14, 15, 16 or 17. All other groups were killed on GD17. The lengths of the 13th and 14th ribs were measured and other anomalies were recorded. Femur length was used as an indicator of fetal size. The SNR frequency was higher in all treatment groups compared to controls. We found that ER and RR were morphologically distinct. The ER were flat ended and distally joined by a cartilaginous portion, while RR were usually rounded distally and were without cartilaginous extensions. The 13th ribs were significantly longer in fetuses having SNR than in those not having SNR, whether treated or untreated. This relationship was present in all fetal ages examined and with both ER and RR groups. These results suggest that SNR are indicative of basic alterations in the development of the axial skeleton.

2,4-Dinitrophenol↗
PubMed2004

Intercostal variation for age estimation--are the standards for the right 4th rib applicable for other ribs?

Age estimation of unknown skeletal remains is very important in forensic medicine. Morphologic methods are fast and easy to use for purpose of age determination. The sternal ends of the ribs are a reliable method of age estimation from late adolescence to old age. Iscan et al developed a phase analysis method for the right 4th rib that was sex and race specific. The purpose of this study is to determine the accuracy of the standards of age estimation from the right 4th and other rib using the phase analysis for the Turkish population. The sample consisted of right and left 3rd, 4th and 5th ribs from 34 Turkish women and 76 men. There were statistically significant variations found on the right 5th, left 3rd, 4th, and 5th ribs according to these standards in men for phases 5, 6, and 7. For women, all the right and left ribs included in this study were in concordance with right 4th rib standards in all phases.

Adolescent↗
PubMed1979

Phosphorus content of bovine rib: influence of earlier biopsy of the same rib.

Serial sampling of bovine rib is undertaken experimentally to monitor changes in the degree of skeletal mineralisation. The validity of this approach depends on the assumption that the previous sampling of a bone does not influence the composition of a sample obtained subsequently. To test this, the effect of a prior biopsy sampling on phosphorus content of the remaining bone was determined at various times after the initial sampling. A preliminary biopsy sample was taken with a 1.5 cm diameter trephine from the left 12th rib of 40 cattle; experimental samples were taken from the same rib of 10 of the cattle at three, six, nine and 12 months later, for comparison with similar samples taken concurrently from the right 12th rib. The phosphorus content of the second left rib was significantly lower than that of the right (control) rib at the three-month interval, particularly where the sampling site was ventral, rather than dorsal, to the site from which the initial biopsy was obtained. No effects of previous biopsy sampling were observed after six, nine or 12 months.

Animals↗
PubMed2005

The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes.

STUDY DESIGN: Prospective clinical trial of vertical expandable prosthetic titanium rib (VEPTR) in patients with combined spine and chest wall deformity with scoliosis and fused ribs. OBJECTIVE: Report the efficacy and safety of expansion thoracostomy and VEPTR surgery in the treatment of thoracic insufficiency syndrome (TIS) associated with fused ribs. SUMMARY OF BACKGROUND DATA: Traditional attitudes toward early-onset combined chest and spine deformity assume that thoracic deformity is best controlled by treatment directed at spine deformity, often involving early spinal arthrodesis. Campbell and others have heightened awareness of the interrelationship between lung, chest, and spine development during growth and characterized TIS as the inability of the thorax to support normal respiration or lung growth. Expansion thoracostomy and VEPTR insertion was developed to directly control both spine and chest wall deformity during growth, while permitting continued vertebral column and chest growth at an early stage. METHODS: Multidisciplinary evaluation of children with combined spine and chest wall deformity included pediatric pulmonologist, thoracic, and orthopedic surgeon evaluations. One or more opening wedge expansion thoracostomies and placement of VEPTR devices were performed as described by Campbell, with repeated device lengthenings during growth. Parameters measured included Cobb angle, length of thoracic spine, CT-derived lung volumes, and in older children pulmonary function tests. RESULTS: Thirty-one patients with fused ribs and TIS were treated, 4 of whom had undergone prior spinal arthrodesis at other institutions with continued progression of deformity. In 30 patients, the spinal deformity was controlled and growth continued in the thoracic spine during treatment at rates similar to normals. Increased volume of the constricted hemithorax and total lung volumes obtained during expansion thoracostomy were maintained at follow-up. Complications included device migration, infection, and brachial plexus palsy. CONCLUSIONS: Expansion thoracostomy and VEPTR insertion with serial lengthening may be the preferred treatment for young children with chest wall deformity and scoliosis associated with fused ribs but requires multidisciplinary care and attention to details of soft tissue management. When indicated, surgical intervention with VEPTR can be considered early in growth, before deformity is severe, since spinal growth will continue with treatment.

Abnormalities, Multiple↗
PubMedDate not supplied

Rib transposition vascularized bone grafts. Hemodynamic assessment of donor rib graft and recipient vertebral body.

Twelve canine rib transposition grafts were harvested and evaluated for preservation of subperiosteal and medullary canal blood flow using the hydrogen washout technique. Blood flow using hydrogen washout technique also was studied in the T11 vertebral body. The mean hydrogen washout blood flow was 0.201 ml/min/ml tissue for the subperiosteal rib measurement, 0.058 ml/min/ml tissue for a rib medullary measurement, and 0.085 ml/min/ml tissue for the vertebral body. The medullary canal hydrogen washout values were consistently less than the subperiosteal values. The results have demonstrated that the blood supply to the vascularized rib pedicle can be retained and quantitated in harvesting the rib graft using the hydrogen washout technique.

Animals↗
PubMed1998

Bifid ribs observed in the third and the fourth ribs.

Three cases of bifid ribs were found in two cadavers during routine dissections at the Iwate Medical University School of Dentistry. All of the cases were found in the third or the fourth rib. The distal parts of the osseous rib bifurcated with an angle of 60 degrees and both of the branches had their own costal cartilage. The costal cartilage fused again to form the trunk which was connected to the sternum. The space between the two branches was filled with presumably normal intercostal muscles. Blood supply was maintained by a small branch from the interthoracic artery to the upper branches. However, the intercostal nerves did not branch toward the upper branch but only ran along the lower margins of the lower branches of the bifid ribs.

Aged↗
PubMed1994

De novo 17q paracentric inversion mosaicism in a patient with Beemer-Langer type short rib-polydactyly syndrome with special consideration to the classification of short rib polydactyly syndromes.

A de novo 17q paracentric inversion mosaicism is detected in a fetus with type IV short rib (polydactyly) syndrome (Beemer-Langer). The cytogenetic finding in our case suggests a possible location of the gene or cluster of linked genes responsible for SR (P) S type IV to 17q21 or 17q23. Since this chromosome abnormality has not been described in short rib polydactyly syndromes and the existence of type IV SR (P) S has been controversial, the literature of this entity is reviewed with special consideration to the classification of short rib polydactyly syndromes.

Chromosome Aberrations↗
PubMed1976

The vascular anatomy of the dorsal part of the caudal ribs in the dog. A microangiographic study with special reference to the microvascular free transfer of living rib grafts.

The arterial blood supply to the head, neck and tubercle of the caudal ribs in the adult dog was studied by means of microangiography. While the tubercle and the neck are supplied solely by medullary branches of the main nutrient artery, the rib head receives an additional supply via two groups of epiphyseal arteries. This vascular pattern is discussed with special reference to the free microvascular transfer of composite posterior rib grafts.

Animals↗
PubMed1992

Tuberculosis of the ribs: a recurrent attack of rib caries.

Rib tuberculosis is an extremely rare condition with the incidence not exceeding 3 percent of all skeletal tuberculosis. The authors experienced a recalcitrant case of pulmonary tuberculosis accompanied by chest wall cold abscesses involving ribs recurring at a new site in approximately 10 months despite of medical and surgical treatment. The patient has twice taken thoracotomy for abscess drainage and during the second thoracotomy, a partial resection of involved ribs was performed.

Adolescent↗