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At least 253 records · Page 14Linked to original sources
PubMed1991

Comparative increases of lead and barium with age in human tooth enamel, rib and ulna.

Lead and Ba in postmortem tooth enamel, rib and ulna of six contemporary people (67-96 years; ave. 80) were shown to exhibit similar accumulations with age in the three different types of osseous tissue: Pb/Ca (wt) = 3.0, 5.2, and 3.9 x 10(-5) in rib, ulna, and tooth enamel; and Ba/Ca (wt) = 2.4, 2.4, and 1.8 x 10(-5) in rib, ulna, and tooth enamel, respectively. Mean concentrations of Pb were 11, 19, and 14 micrograms g-1 in rib (ash), ulna (ash), and enamel (dry), respectively. Means for Ba were 8.7, 8.9, and 6.4 micrograms g-1 in rib (ash), ulna (ash), and enamel (dry), respectively. Comparison of Ba in ulna of our 80-year-old subjects with Ba determined by other investigators in bones of younger contemporary populations indicated that Ba accumulates with age at about half the rate of Pb accumulation in bone. Concentrations of Ba in rib, ulna and enamel were positively correlated and similar within an individual, but varied among subjects in proportion to variations in absorptive uptake in portal blood. Barium may diffuse from a blood-dentine source into enamel, where it replaces Ca and accumulates with age. Because of extreme Pb pollution of our 80-year-old subjects and its variation of intake with age, the correlation of Pb in tooth enamel with Pb in bone was more scattered than for Ba. It is shown by means of stable Pb isotopic tracers that: (i) among the three types of osseous tissue, the residence time of Pb is longest in enamel, where it apparently accumulates with age by diffusion with little loss through exchange; and (ii) the residence time of Pb is longer in compact ulna than in trabecular rib, as it accompanies Ca in its osteoblastic transfer from blood to bone and then in its osteoclastic transfer back to blood from bone.

Aged↗
PubMed2005

Rib fractures in chronic alcoholic men: Relationship with feeding habits, social problems, malnutrition, bone alterations, and liver dysfunction.

Rib fractures are common in alcoholics. This high prevalence might be due to ethanol-associated malnutrition, bone disease, liver dysfunction, or the peculiar lifestyle of the alcoholic with frequent trauma and altercations. In this study we try to discern the role of these factors on rib fracture (assessed on a plain thoracic X-ray film) in 81 consecutive alcoholic patients, 25 of them cirrhotics. Serum albumin, prothrombin aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), gamma-glutamyl transpeptidase, C-terminal cross-linking telopeptide of type 1 collagen, osteocalcin, insulin growth factor 1, 1,25-dihydroxyvitamin D, parathyroid hormone, estradiol, free testosterone, and corticosterone were measured, and the patients also underwent assessment of bone mineral density by a HOLOGIC QDR-2000 bone densitometer (Waltham, MA, USA). Body mass index, triceps skinfold, and brachial perimeter were also determined, and the patients and their families were asked about tobacco consumption, social and familial links, consumption of ethanol by other members of the family, kind of job, and feeding habits. Forty-two male nondrinker sanitary workers of similar age served as controls. Forty of the 81 patients showed rib fractures. There was a statistically significant association between rib fractures and disruption of social and familial links, irregular feeding habits (in bars or pubs, not at home), ethanol consumption by close relatives, and intensity of tobacco consumption, but not between rib fractures and liver function tests, nutritional parameters, or bone mineral density, besides a nearly significant trend (p = .053) with the presence of osteopenia at the femoral neck. Patients with major withdrawal symptoms at admission also presented more frequent rib fractures. We conclude that rib fractures in alcoholics are related to the peculiar lifestyle of these patients rather than to bone alterations, liver dysfunction, or nutritional status.

Absorptiometry, Photon↗
PubMed2006

Repair of long intercalated rib defects using porous beta-tricalcium phosphate cylinders containing recombinant human bone morphogenetic protein-2 in dogs.

A new method to repair rib defects with biomaterials containing recombinant human bone morphogenetic protein-2 (rhBMP-2) is presented in this report. We had reported previously the successful regeneration of bony rib defects by placing a short chain of small beta-tricalcium phosphate (beta-TCP) cylinders on the intact periosteum. The multi-cylinder implants were ineffective in promoting rib repair when the periosteum was absent. By adding rhBMP-2 to the beta-TCP cylinders, we were able to promote rib bone regeneration in the presence or absence of the periosteum. The osteogenic capacity of the rhBMP-2/beta-TCP composite implant and the time required to complete regeneration were evaluated in a canine model. An 8cm long section of rib bone, including the periosteum, was removed and replaced with a chain of the rhBMP-2/beta-TCP cylinders. At 6 weeks after implantation, the ribs were restored to their original configuration and mechanical strength. The multi-cylinder beta-TCP implants were degraded and replaced by new bone in 12 weeks. This new degradable bone-inducing implant material has significant clinical potential for rib repair.

Absorbable Implants↗
PubMed1982

Severity of intrathoracic injuries associated with first rib fractures.

The benign condition of isolated first rib fracture is compared with the severity of intrathoracic injuries resulting from first rib fracture associated with multiple rib injuries. Seventy-five patients with 90 first rib fractures were divided into two groups. Group 1 (n = 13) included those with isolated first rib fractures and Group 2 (n = 62), those with first-rib fractures associated with multiple rib injuries. In Group 1 patients, intrathoracic injuries were mild with no major vascular injuries. Conversely, Group 2 patients sustained severe intrathoracic injury, 58% of them with aortic injury. Stress is placed on early diagnosis, assigning of priority to associated injuries, and early operative intervention.

Accidents, Home↗
PubMed1983

Upper rib fractures and mediastinal widening: indications for aortography.

Survival of patients with posttraumatic thoracic aortic rupture depends on early diagnosis. It is frequently stated that fracture of the first or second ribs and mediastinal widening are findings suggestive of thoracic aortic rupture. We found that the probability of sustaining thoracic aortic rupture is the same for patients with upper rib fractures as for those with other rib fractures (1/64 versus 5/149; p = 0.85). Also, our data fail to show a statistical difference in the incidence of thoracic aortic rupture associated with upper (first and second) rib fractures compared with no rib fracture at all (1/64 versus 9/304; p = 0.85). Thus, patients with thoracic aortic rupture are not more likely to have rib fractures (7/21 versus 14/21; p = 0.15), and if a rib fracture is present, the probability of it being at the upper level is the same as that for a fracture at any other level (1/7 versus 6/7; p = 0.06). Ratios of mediastinal width to chest width were used as a measure of mediastinal widening, and were found to be an accurate predictor of thoracic aortic rupture. Ratios greater than 0.28 at the aortic knob were 100% specific and 85% sensitive for this condition.

Aorta, Thoracic↗
PubMed1997

Transthoracic video endoscopic electrocautery of sympathetic ganglia for hyperhidrosis palmaris: special reference to localization of the first and second ribs.

BACKGROUND: The surgical technique for transthoracic endoscopic sympathectomy varies from one to three skin incisions, room air to carbon dioxide pneumothorax, and destruction of the second (T2), third (T3), and fourth sympathetic ganglia to destruction of the T2 ganglion only. A knowledge of the surgical anatomy of the apex may help the surgeon to safely use this technique. METHODS: Forty-seven patients with palmar hyperhidrosis underwent video-assisted endoscopic electrocautery of the T2 and T3 ganglia with the use of one-lumen endotracheal tube for general anesthesia, one skin incision, and carbon dioxide pneumothorax. Surgical anatomy, palm temperature, and surgical results were analyzed. RESULTS: The first ribs of 23 patients were endoscopically visible and most of these first ribs were not as parallel to the second ribs as the third ribs were. The first ribs of the remaining 24 patients were palpable with a diathermy bar. In all but three patients with dense pulmonary adhesions, the distal end of the intrathoracic segment of the subclavian artery was seen to pierce the pleura at the upper border of the first rib. Ninety-one palms remain dry and 27 patients develop compensatory sweating in an average follow-up of 12 months. Excluding three patients whose sympathetic ganglia could not be electrocauterized because of severe pulmonary adhesions, 95% of the remaining 44 patients are satisfied with the results. CONCLUSIONS: Transthoracic video endoscopic electrocautery of the T2 and T3 ganglia for patients with palmar hyperhidrosis may yield excellent results if the first rib can be properly identified.

Adolescent↗
PubMed1999

Chest wall reconstruction with autologas rib grafts in dogs and report of a clinic case.

OBJECTIVE: Nowadays, in chest wall reconstruction prosthetic materials are generally used. However, the rejections of prosthetic materials and infections frequently occur in chest wall reconstruction, especially after radiotherapy or resection that is performed due to infections. METHODS: We used 10 mongrel dogs and performed resections of 8 cm diameter on their chest walls. In the reconstruction of these defects, in five of the subjects, we used two free rib grafts with periosteum to be resected from the contralateral side and in other five subjects, we used free rib grafts without periosteum. After this experimental study, sternal resection was performed in a 24-year-old man because of sternal osteomyelitis. First to obtain rib grafts with periosteum, partial resection was performed to 5th, 7th, and 9th ribs of the lateral left side. After, total sternal resection, end to end anastomosis was performed to the 2nd, 3rd, 4th and 5th anterior ends of the ribs. RESULTS: Autogeneous rib grafts were found to be enough to provide chest wall stabilization. CONCLUSIONS: The contralateral autogeneous free rib grafts can successfully be used in reconstruction of wide chest wall defects. This method is found to be effective and sufficient to prevent infection, rejection and to provide stabilization.

Adult↗
PubMedDate not supplied

The first rib as a fluoroscopic marker for subclavian vein access.

PURPOSE: To determine whether the anatomic relationship between the subclavian vein (SCV) and the first rib is sufficiently constant to allow safe and reproducible fluoroscopically guided SCV puncture. MATERIALS AND METHODS: Forty-four subclavian venograms were obtained from 42 consecutive adult patients. Position and width of the SCV crossing over the first rib were recorded by using radial coordinates. Based on this anatomic study, 42 SCV access procedures were performed with use of the first rib as a fluoroscopic marker. Technical success, complications, number of 21-gauge needle passes, physician experience, and patients' body habitus were recorded. RESULTS: Mean angular position of SCV/first rib crossover was 94.7 degrees (standard deviation [SD], 7.42 degrees). Mean radial width of the SCV was 14.9 degrees (SD, 3.1 degrees). On 25 of the 44 subclavian venograms (60%), the SCV/first rib crossover lay within the 90 degrees-99 degrees segment, and on 36 of 44 (82%) it lay within the 85 degrees-104 degrees segment. Technical success in accessing the SCV was 100% (42 of 42 procedures). Two minor complications involved subclavian artery puncture with the 21-gauge needle without sequelae. The mean number of needle passes required was 2.86 (median, 1.7). There was no correlation between needle passes and patients' body habitus or physician experience. CONCLUSION: The SCV is reliably constant in its relation to the first rib. The first rib alone provides a reliable fluoroscopic marker for safe SCV access without the need for ultrasound guidance or peripheral contrast material administration.

Adult↗
PubMed1996

Prenatal ultrasonographic fetal rib length measurement: correlation with gestational age.

The availability of normal data on fetal rib bone length would be of value in a variety of circumstances under which ultrasound examinations are performed. Fetal rib length measurements were obtained in 257 singleton fetuses in a prospective cross-sectional study. The study population consisted of pregnancies between 14 and 40 weeks with no evidence of growth disturbances, or structural or karyotypic abnormalities. Fetal rib length, as a function of gestational age, was expressed by the regression equation: RL = -0.5834 + 0.2030 (GA), where RL is the rib length in centimeters and GA the gestational age in weeks. The correlation was R = 0.94 (p < 0.0001). The normal limits of fetal rib length are defined, and a high correlation between fetal rib length, gestational age, and other standard determinants of fetal growth is demonstrated. Our results indicate that fetal rib length can be a useful adjunct in determining normal fetal growth and in the management of the pregnancy with fetal skeletal dysplasia.

Cross-Sectional Studies↗
PubMed1999

The vertical displacement sign: a technique for differentiating between left and right ribs on the lateral chest radiograph.

AIM: To evaluate a new approach to the differentiation of the right and left ribs, the vertical displacement sign, and to compare its efficacy with the big rib sign. MATERIALS AND METHODS: One hundred and nine lateral chest radiographs that clearly showed both the gastric air bubble sign and the cardiac silhouette sign were retrospectively reviewed by two radiologists. Each study was evaluated by consensus. Each radiograph was assessed for suitability of reading with each technique. Suitable radiographs were then reviewed using both the big rib sign and vertical displacement sign independently. RESULTS: Applicability of the vertical displacement sign [107 of 109 (98%)] was greater than that of the big rib sign [95 of 109 (87%)] (P = 0.0017). The accuracy of the vertical displacement sign [105 of 107 (98%)] was higher than that of the big rib sign [74 of 95 (78%)] (P < 0.001). CONCLUSION: The vertical displacement sign seems to be a reliable technique for the differentiation of right and left ribs on the lateral chest radiograph and can be used as a complementary technique when the big rib sign is not applicable.

Adult↗
PubMed2001

[Microtia: technique for external ear reconstruction with autologous rib cartilage].

Various methods for treatment of classic microtia are known. Beside a prosthesis, the most common way of auricle reconstruction is the use of autogenous rib cartilage; a process that requires two to three operations. In the first operation, rib cartilage is harvested from the 6th to the 9th rib. The base of the framework is the 6th and 7th rib cartilage which is taken under preservation of the synchondrosis. To mimic a 3-dimensional structure, the triangular fossa and scapha are carved into the groundplate and the 8th rib is fixed as a helical rim. After optimising the framework, it is placed in a subcutaneous pocket on the mastoid plane. In a second operation, approximately three months later, the auriculocephalic angle is reconstructed with a cartilage wedge, which is covered by a temporalis fascia flap and split skin-graft from the hairbearing skull. Commonly, a third operation is needed for minor refinements. Currently, autogenous rib cartilage is the ideal material available for ear reconstruction resulting in an excellent cosmetical outcome, although harvesting of the cartilage causes a specific donor-site morbidity. Operations improving the hearing ability by building up the external hearing channel and middle ear are mainly done in cases of bilateral microtia. Ear reconstruction with autogenous rib cartilage produces a replicable aesthetic result. The patients should be at least eight years old.

Adolescent↗
PubMed1997

[Ultrasound diagnosis of rib and sternum fractures].

PURPOSE: Lesions of the thoracic skeleton can sometimes be a problem in radiological diagnosis. Aim of the study was to investigate the value of ultrasound in the diagnosis of thoracic trauma in clinical practice. METHOD: Patients with thoracic trauma and suspected rib or sternal fracture were entered in the study. The results of the thoracic x-ray including a special target film and thoracic sonography were compared. RESULTS: 103 patients took part in the study (32 women, 71 men, average age 54.3 years). In x-ray the diagnosis of rib fracture was certain in 27 patients (30%). In US 56 patients (58%) had definitive signs of rib fracture. Because of multiple fractures in the same patients the total number of radiologically found rib fractures was 49, whereas 101 fractures could be detected by sonography. Also minimal pleural effusions could be found in 31 patients (32%) sonographically, only 18 of them were seen in x-ray. Larger effusions in six patients (6%) with serial rib fractures and haematothorax could all be diagnosed in x-ray and also US. The seven patients with suspected sternum fracture showed clear fracture signs in x-ray as well as US. CONCLUSIONS: Rib fractures could be found about twice as often US than x-ray. There was no difference in the diagnosis of sternal fracture. Detection of fluids (local haematoma and pleural effusion) is better via US than by x-ray. Therapeutical consequences may follow a quick bed-side diagnosis by US in a patient who needs intensive care. Other aspects after detection of a rib fracture US apart from thoracic contusion are psychological effects for the patients (usually they can cope better with their pain), the importance in the interpretation of the duration of incapacity to work and the additional information provided by expert opinions.

Female↗
PubMedDate not supplied

Rib counting on CT using the sternal approach.

To devise a new method for counting ribs on CT scan, we evaluated the CT anatomy of the costal cartilages and the proximal xiphoid in 20 control patients without rib pathology. The sternal end of costal cartilages seen on the same image as the proximal xiphoid was always the seventh (n = 20). These costal cartilages were located anterolateral (n = 13) or lateral (n = 7) to the proximal xiphoid. In fifteen patients with rib pathology, 23 abnormal ribs were localized by our method. All of these ribs correlated with those seen on chest radiographs and rib cage views or with resected ribs on postoperative films.

Adult↗
PubMed1995

The aetiology of solitary hot spots in the ribs on planar bone scans.

The aim of this study was to determine the aetiology of solitary hot spots in the ribs found at bone scintigraphy in patients with known extraskeletal malignancy. A group of 34 patients whose bone scans showed a solitary hot spot in a rib were identified retrospectively over a 4-year period. They all had a known extraskeletal malignancy. Aetiology of the rib hot spot was established in 26 patients based on a review of clinical features, radiographic findings and clinical follow-up. In eight cases it remained indeterminate. In 14 (41%) cases, the rib lesion was malignant in origin, 9 were due to metastasis and 5 due to direct spread from intrapulmonary malignancy. In 12 (35%) cases, it was benign. In the remaining 8 (24%) cases, the aetiology was indeterminate. In the subgroup of 14 hot spots confined to the anterior rib end, 5 (36%) were due to malignancy, 4 (28%) were benign and 5 (36%) were indeterminate. We conclude that solitary hot spots in the ribs of patients with known extraskeletal malignancy undergoing bone scintigraphy are frequently (41%) malignant in origin. This also applies when the hot spot is in the anterior rib end (36% malignant). Thus, such hot spots are far more sinister than previously reported and require careful clinical and radiographic evaluation.

Adult↗
PubMed1984

Augmentation of the atrophic mandible with a vascularized rib graft.

A patient with a 29-year history of denture wearing had her mandible augmented with a vascularized rib graft. The rib was contoured to fit the arch of the mandible and vascularized by means of the facial arteries to the intercostal vessels. The nutrient artery was not included in the vascularized bone graft. Cortical cancellous bone chips were packed around the rib to augment the buccal surface of the rib graft. Periosteal perfusion and vascularity of the transferred rib were well documented at 1 week, 1 month, and 6 months postoperatively by radionuclide scintigraphy. It is now 24 months after surgery and the patient began wearing a denture 2 months after the rib transfer. She underwent a split-thickness skin graft vestibuloplasty and floor-of-the-mouth lowering 12 months following the rib transfer with improvement in her denture-wearing capabilities, which has remained constant for 10 months. Vertical resorption of the graft at 3 months was 10 percent, at 6 months 15 percent, and it has stabilized at 25 percent.

Atrophy↗
PubMed1985

Rib fractures in children.

We reviewed the charts of 21 children admitted to the hospital with rib fractures to determine the cause of trauma, the relationship of the number and location of rib fractures to other injuries, the course of flail chest in children, and the frequency and characteristics of injuries caused by child abuse. Sixteen (76%) of 21 children were injured by accidental causes, most commonly by motor vehicles. However, five (24%) children were victims of child abuse. Nineteen children fractured an average of 3.5 ribs (range 1 to 8), while two other children fractured 22 and 23 ribs. Neither an increased number of fractures, nor first or second rib fractures were associated with more severe intrathoracic injuries. Two children with flail chest required intubation but recovered without further complications. The five children with nonaccidental rib fractures were young, had an unexplained history, and a paucity of multiple trauma. These characteristics should alert the physician to the possibility of child abuse in the patient with rib fractures.

Accidents, Traffic↗
PubMed2003

Solitary rib lesions in bone scans of patients with breast carcinoma.

The aetiology of solitary rib lesions detected on bone scans was evaluated retrospectively. Seventy-five patients with breast carcinoma, and each with a solitary hot spot on a bone scan, were included in the study. The aetiology of the solitary rib lesions was determined by using all available clinical, laboratory and radiological data, and was clarified in 65 of the 75 patients, and not clarified in the remaining 10. In 17 of those 65 (26.1%), the aetiology of increased uptake was malignant; while in 48 of the 65 (73.8%) it was benign in origin. Linear lesions were mainly metastatic in origin (seven of nine, 77.7%) whereas focal lesions were mostly benign in origin (46 of 56, 82.19%). In the group of 16 hot spots located at the anterior rib end, 14 (87.5%) were benign, and two (12.5%) were malignant in origin. The relation between mastectomy side and the distribution of anterior and anterior rib end localization of hot spots was also investigated. Twenty-three of 32 rib lesions (71.8%) were on the same side as the surgery. In conclusion, solitary rib lesions on bone scans in patients with breast carcinoma are frequently benign in origin, especially if they are focal and located at the anterior rib end.

Bone Cysts↗
PubMed2004

The tenth rib line as a new landmark of the lumbar vertebral level during spinal block.

The purpose of this study was to assess whether the tenth rib line (an imaginary line that joins the lowest points of the rib cage on the flanks) could be used as a marker of the lumbar vertebral level. Simple X-rays (n = 100) were taken with radiopaque markers attached on the lowest points of the rib cage and the uppermost points of the iliac crests on both flanks. The spinous process or interspinous space that the tenth rib or Tuffier's lines crossed was identified and recorded, respectively, in the neutral and fully flexed positions. With lumbar flexion, the tenth rib line (median (25th to 75th percentiles)) moved upward (L(2) (L(1-2) - L(2)) vs. L(1-2) (L(1-2) - L(1-2)); p < 0.01), but Tuffier's line moved downward (L(4-5) (L(4) - L(4-5)) vs. L(4-5) (L(4) - L(5)); p < 0.01). Because the ease of palpating the tenth rib line and its distribution patterns are comparable to those of the Tuffier's line, the tenth rib line may be useful as a new landmark of the lumbar vertebral level as well as a safeguard to prevent spinal puncture from being mistakenly performed at a dangerously high level.

Adult↗