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At least 343 records · Page 19Linked to original sources
PubMed1986

Mechanisms of paradoxical rib cage motion in patients with chronic obstructive pulmonary disease.

Paradoxical motion of the rib cage is well recognized in patients with chronic obstructive pulmonary disease (COPD); most often this is seen in the lateral dimension (Hoover's sign), but paradoxical indrawing of the lower sternum during inspiration has also been described. We have examined the possible mechanisms of these abnormalities by relating rib cage motion (using magnetometers) to the changes in pleural (Ppl), abdominal (Pab), and transdiaphragmatic (Pdi) pressures in 13 patients with COPD and hyperinflation who had previously documented abnormal rib cage motion. During tidal breathing, Pab became more negative in early inspiration in 11 of the 13 patients. Paradox of the lateral rib cage was present in 11 patients, and in these, the abnormal movement related well to increasing Pdi or decreasing Ppl, but the peak distortion fitted more closely with Pdi. During attempted voluntary relaxation at full inflation, the lateral rib cage dimensions always increased as Pdi declined. Five of the 13 patients showed indrawing of the sternum in early inspiration, and in 4, the abnormal motion was confined to the lower sternum, with qualitatively normal motion at the angle of Louis. In these 4 patients, the peak distortion coincided with the nadir of Pab in early inspiration. In all 5 patients, an increase in Pab during expiration suggested expiratory muscle contraction, and this was associated with a paradoxical increase in the anteroposterior diameter of the rib cage.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMedDate not supplied

Computer-assisted instrumentation during endoscopic transaxillary first rib resection for thoracic outlet syndrome: a safe alternate approach.

UNLABELLED: The purpose of this article is to discuss the feasibility of using computer-enhanced instrumentation to improve visualization and therefore patient safety during transaxillary first rib resection. From November 1998 to July 2005, 105 patients who had failed conservative treatment underwent 131 procedures for thoracic outlet decompression. Eighty-nine endoscopic transaxillary first rib resections were completed using Aesop/Hermes integrated voice control instrumentation (Computer Motion, Goleta, CA). Since February 2003, dissection in 42 procedures was performed using the daVinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA). The surgical findings with cervical bands correlated with the preoperative symptoms. One hundred percent of patients with a combination of neurogenic and arterial thoracic outlet syndrome (TOS) requiring cervical rib resection had Roos type I and/or II bands. Additional surgical findings included the following: combination of neurogenic and arterial TOS without cervical ribs or neurogenic TOS alone had type III, IV, or V bands, and patients with venous compression (100%) had type VII bands. No mortalities or permanent neurovascular injuries occurred. There was a 6.1% postoperative complication rate. Persistent myofibrositis was found in 34% of patients with ongoing symptoms. CONCLUSION: The daVinci three-dimensional optical imaging system enhances visualization, thereby promoting telemanipulation of soft tissue structures in a relatively inaccessible working space. Endoscopic computerized instrumentation in transaxillary first rib resection decreases the risk of neurovascular injury, promotes complete decompression, and therefore provides a safe alternative to standard first rib resections.

Adult↗
PubMed1976

The rib hump in idiopathic scoliosis. Measurement, analysis and response to treatment.

This paper describes a simple method for the recording of rib deformity in idiopathic scoliosis. The relationships have been recorded between the measured rib hump and rib depression deformities and 1) the rotation of the vertebral bodies (as measured by the method of Nash and Moe on the standing radiograph); 2) the degree of lateral curvature (as measured by the method of Cobb on the standing radiograph); and 3) the rib-vertebra angles and their differences (as described by Mehta). No clear linear relationships were found. Many examples of irregular relationship were recorded, for example, marked spinal rotation with minimal rib hump. The response of the rib deformities to treatment by Milwaukee brace in fifty-two patients is described; the hump is little changed but the depression on the opposite side may be considerably reduced. Harrington instrumentation may have a similar effect.

Adolescent↗
PubMed2004

The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis.

BACKGROUND: Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth and is seen in patients who have severe congenital scoliosis with fused ribs. Traditional spinal surgery does not directly address this syndrome. METHODS: Twenty-seven patients with congenital scoliosis associated with fused ribs of the concave hemithorax had an opening wedge thoracostomy with primary longitudinal lengthening with use of a chest-wall distractor known as a vertical, expandable prosthetic titanium rib. Repeat lengthenings of the prosthesis were performed at intervals of four to six months. Radiographs were analyzed with respect to correction of the spinal deformity, as indicated by a change in the Cobb angle, and lateral deviation of the spine, as indicated by the interpedicular line ratio. Spinal growth was assessed by measuring the change in the length of the spine. Correction of the thoracic deformity and thoracic growth were assessed on the basis of the increase in the height of the concave hemithorax compared with the height of the convex hemithorax (the space available for the lung), the increase in the thoracic spinal height, and the increase in the thoracic depth and width. The thoracic deformity in the transverse plane was measured with computed tomography, and the scans were analyzed for spinal rotation, thoracic rotation, and the posterior hemithoracic symmetry ratio. Clinically, the patients were assessed on the basis of the relative heights of the shoulders and of head and thorax compensation. Pulmonary status was evaluated on the basis of the respiratory rate, capillary blood gas levels, and pulmonary function studies. RESULTS: The mean age at the time of the surgery was 3.2 years (range, 0.6 to 12.5 years), and the mean duration of follow-up was 5.7 years. All patients had progressive congenital scoliosis, with a mean increase of 15 degrees /yr before the operation. The scoliosis decreased from a mean of 74 degrees preoperatively to a mean of 49 degrees at the time of the last follow-up. Both the mean interpedicular line ratio and the space available for the lung ratio improved significantly. The height of the thoracic spine increased by a mean of 0.71 cm/yr. At the time of the last follow-up, the mean percentage of the predicted normal vital capacity was 58% for patients younger than two years of age at the time of the surgery, 44% for those older than two years of age (p < 0.001), and 36% for those older than two years of age who had had prior spine surgery. In a group of patients who had sequential testing, all increases in the volume of vital capacity were significant (p < 0.0001), but the changes in the percentages of the predicted normal vital capacity were not. There was a total of fifty-two complications in twenty-two patients, with the most common being asymptomatic proximal migration of the device through the ribs in seven patients. CONCLUSIONS: Opening wedge thoracostomy with use of a chest-wall distractor directly treats segmental hypoplasia of the hemithorax resulting from fused ribs associated with congenital scoliosis. The operation addresses thoracic insufficiency syndrome by lengthening and expanding the constricted hemithorax and allowing growth of the thoracic spine and the rib cage. The procedure corrects most components of chest-wall deformity and indirectly corrects congenital scoliosis, without the need for spine fusion. The technique requires special training and should be performed by a multispecialty team.

Abnormalities, Multiple↗
PubMed2001

Use of folded vascularized rib graft in anterior fusion after treatment of thoracic and upper lumbar lesions. Technical note.

For lesions involving the anterior and/or middle column of the spine, an anterior approach is adequate for curetting the lesion and restoring spinal stability. Materials such as autogenous bone grafts, cages with bone chips, some artificial materials, or allografts are used as strut materials. Rib material is usually removed when the anterior approach is conducted for thoracic or thoracolumbar lesions. A rib itself is not rigid enough to support the load, and a bone union is not easily obtained. The purpose of this paper is to describe a method of grafting vascularized rib in folded form to fill the defects left after removal of a spinal lesion. The rib, with the artery and vein at two levels cranial to the involved vertebral body, was isolated from surrounding tissues such as the intercostal nerve, muscles, and pleura. After curetting the lesion, the rib was folded into three or four pieces to a length adequate to fill the defect and inserted as a pedicled vascularized graft. A total of 23 cases, including 14 men and nine women, underwent surgery in which this grafting technique was used. The pathological conditions requiring anterior decompression and fusion were spinal trauma in nine cases, spinal infection in six cases, osteoporotic fracture in seven cases, and spinal metastasis in one case. In all cases a solid bone union was obtained and all infections resolved. With vascularized rib graft folded into three to four pieces, solid bone union can be obtained without use of any other grafted materials even in cases of infection and osteoporosis.

Adolescent↗
PubMed1999

Severe micrognathia, cleft palate, absent olfactory tract, and abnormal rib development: cerebro-costo-mandibular syndrome or a new syndrome?

We report on a family in which two sibs had apparently absent ribs and severe micrognathia on prenatal ultrasonography. The pregnancies were terminated at 19 and 12 weeks of gestation, respectively. Autopsy findings in the first fetus (19 weeks of gestation) included severe micrognathia, a U-shaped defect of the soft palate, marked postnuchal edema, absent olfactory bulbs, and cribriform plate and rib abnormalities. The ribs consisted of cartilage anteriorly, with only a small amount of fibrous tissue present laterally and posteriorly. The second fetus (12 weeks gestation) had agnathia, with a large U-shaped defect in the soft palate. There was moderate postnuchal edema. The ribs were unossified and there were gaps in the cartilage where primitive mesenchyme was present posteriorly and laterally. These findings are consistent with a severe form of cerebro-costo-mandibular syndrome. The early fetal histopathology of both cases suggests a possible mechanism by which the characteristic "rib gaps" of cerebro-costo-mandibular syndrome may develop, with evidence for abnormal function of a gene or genes involved in regulation of rib chondrogenesis.

Abnormalities, Multiple↗
PubMedDate not supplied

Detection of disseminated cancer cells in rib marrow of patients with esophageal cancer.

In the present study, micrometastasis in the rib marrow of 24 patients with esophageal cancer was examined using RT-PCR. RT-PCR was done using primers corresponding to cytokeratin 18 (CK18), squamous cell carcinoma antigen (SCC), and carcinoembryonic antigen (CEA). In 18 cases, CK18 was also detected in the rib marrow. Only one patient exhibited CEA amplification in the rib marrow. No cases demonstrated SCC amplification as a marker of micrometastasis in the rib marrow. The information from micrometastasis detected in the rib marrow using RT-PCR is useful in deciding whether or not adjuvant therapy is necessary after surgery. However, combined analysis using plural markers should be required since sensitivity or specificity of each marker may vary. Further follow-up of the patients is necessary to clarify the clinical impact of micrometastasis in rib marrow.

Aged↗
PubMed2004

[Solitary hemangioma of the rib; report of a case].

A case of solitary hemangioma which occurred in the rib. Tumor located in the right seventh rib, incidentally taken X-ray film demonstrated bone tumor, but she had no symptoms. Four years after, chest pain occurred and taken X-ray film, tumor size was inceeced. Computed tomography (CT) showed an expansile, well demarcated lesion, with thin corices and fine trabeclae. Chest wall, from the sixth rib to the eighth rib resection was performed and surgical margin was 4 cm. This case were diagnosed hemangioma of the rib. Hemangiomas of the bone are rare benign vascular tumors that account for less than 1% of all bony neoplasms. These lesions are most often occurring in the vertebral column or in the skull. The localization to the ribs is even more rare, with only sporadic case reports in the literature.

Aged↗
PubMed2004

Effects of expiratory rib cage compression combined with endotracheal suctioning on gas exchange in mechanically ventilated rabbits with induced atelectasis.

INTRODUCTION: In Japan, expiratory rib cage compression (a chest physiotherapy technique) is frequently used with mechanically ventilated patients. It has not been determined whether rib cage compression combined with endotracheal suctioning improves oxygenation, ventilation, and mucus clearance. We evaluated the effects of rib cage compression with and without endotracheal suctioning on P(aO(2)), P(aCO(2)), dynamic compliance of the respiratory system (C(RS)), and mucus clearance in rabbits with induced atelectasis. METHODS: Anesthetized adult rabbits had an 18-gauge catheter placed into the airway, together with a tracheal tube via tracheostoma, and were mechanically ventilated. To create atelectasis, artificial mucus was infused into the airway via the catheter. Each rabbit was randomly assigned to one of 4 groups (= 7 in each): (1) control, (2) received endotracheal suctioning alone, (3) received rib cage compression alone, and (4) received both rib cage compression and endotracheal suctioning. After these interventions, for 30 min, each animal was placed supine without intervention for 120 min. RESULTS: In the groups that received rib cage compression, oxygenation, ventilation, and C.

Animals↗
PubMed2002

Preliminary study of a new real-time ultrasound method for measuring spinal and rib rotation in preoperative patients with adolescent idiopathic scoliosis.

A portable ultrasound machine with a linear array transducer was used by one observer (ASK) to evaluate the reproducibility for each of spinal (laminal) rotation and rib rotation in 13 preoperative patients with AIS (thoracic 7, thoracolumbar 6, mean Cobb angle 50 degrees, right 9, left 4, age 15.4 years, girls 10). With the subject in a prone position and her head supported, readings of spinal (laminal) and rib rotations were made directly on the back at 18 and 12 levels respectively. The subject was repositioned after walking around the room and a second set of spinal and rib rotations obtained (repeats). Conclusious. Repositioning the patient significantly alters some single level readings of lam inal rotation and rib rotation. Although the mean average spinal rotation and rib rotation each have acceptable reproducibility, repositioning the patient significantly alters the findings. In the appraisal of surgery by ultrasound the positional change reported here for (I) single level laminal rotation and rib rotation, and (2) mean average rotation imposes caution on the interpretation of the findings. The method enables the axial spine-nh rotation differences to be evaluated which is the subject of a separate paper.

Adolescent↗
PubMed2005

Regional variation in the structural response and geometrical properties of human ribs.

By incorporating material and geometrical properties into a model of the human thorax one can develop an injury criterion that is a function of stress and strain of the material and not a function of the global response of the thorax. Previous research on the mechanical properties of ribs has focused on a limited set of specific ribs. For this study a total of 52 rib specimens were removed from four cadaver subjects. Variation in peak moment by thoracic region was significant (p < 0.01) with average values of 2, 2.9 and 3.9 N-m for the anterior, lateral and posterior regions respectively. Two geometrical properties, radius of gyration and distance from the neutral axis, showed significant variation by region (p < 0.0001) as well as by rib level (p = < 0.01, 0.05). The results of this study can be used to update current models of the human thorax to account for the variation in strength and geometrical properties throughout the rib cage. Accounting for the variation in rib properties by region will improve injury predictive measures and, therefore, the ability to design systems to prevent thoracic injury.

Accidents, Traffic↗
PubMed1991

[The mechanism of fatigue fracture of the ribs].

To elucidate the mechanism of fatigue-rib-fracture, 8 rib-fractured cases were investigated. In assuming the M. serratus anterior (MSA) as the major cause from the anatomical muscle route, EMG was taken, and three-dimensional resultant forces from the muscles around the shoulder of a fresh cadaver were estimated. Most fractures were found in the sixth or seventh ribs, with a tendency to occur along the posterolateral segment. Biomechanical analysis revealed 12 and 62 kg forces applied on the scapulo-thoracic joint and gleno-humeral joint respectively by adding 90 degrees-anterior-elevation under no load. The maximum muscle-force of MSA occurring at 90 degrees-anterior-elevation was 1.2 kg in the sixth serratus in our study. These data were supported by the results with EMG. The stress on the ribs were calculated by two-dimensional finite element method, using the data. The maximum compressive stress on one rib was 4.75 kg/mm2 when 13.0 kg of MSA-force was added. In considering the limit of fatigue endurance of bones, these results suggest that muscle-force which causes fatigue fracture of ribs arises from lifting an object weighing more than 20 kg.

Adolescent↗
PubMed1986

Stippled ribs: a potential pitfall in bone scan interpretation.

A retrospective evaluation of 100 consecutive bone scans was performed to determine the incidence and clinical importance, if any, of increased uptake at the insertion of the iliocostalis thoracis portion of the erector spinae muscle group (rib stippling). Rib stippling was deemed present if a focal area of increased technetium-99m methylene diphosphonate [( 99mTc]MDP) was identified within the posterior angle of three or more consecutive ribs. Seven of 100 (three bilateral, four unilateral) patients demonstrated rib stippling. Foci intensity was less than the scapular tips, but greater than the adjacent ribs. No patient had a history of chest trauma, pain and/or an abnormal radiograph. Even though increased uptake within the posterior angle of the ribs is an uncommon finding (7%), its recognition as a normal bone scan finding is important to prevent bone scan misinterpretations. Its characteristic scintigraphic appearance and location should serve to differentiate it from the increased uptake of trauma and/or tumor.

Back↗
PubMed1985

Age estimation from the rib by phase analysis: white females.

Metamorphosis at the sternal extremity of the rib has already been established as a reliable indicator of age at death. Using a sample of white males, it was shown that an accurate estimation of age can be made by direct examination of the bone itself. However, because of sexual differences in hormonal production and dimorphism in the skeleton, the present study was carried out to develop an appropriate standard for age determination from the sternal rib in white females. The sample consisted of 86 ribs of known age, sex, and race. Observations were made at the costochondral junction with special attention to pit formation (its shape and depth), changes in the walls and rim surrounding it, and overall bone density and texture. Based on changes in these areas, the ribs were separated into nine phases (0 through 8). The most rapid metamorphosis occurred in Phases 1 through 4 (mean ages 14-28) with changes noticeable at 3 to 4 year intervals. After mean age 28, this process slowed, considerably expanding the interval between phases to 10 to 15 years. The female ribs showed both earlier initial pit formation and a different morphologic pattern of aging as compared with males. Statistical analysis revealed that the features chosen to delineate the phases are valid predictors of age. This study has shown that the sternal rib can provide an accurate estimation of age in females spanning a mean age of 14 to 76 years.

Adolescent↗
PubMed1984

Age estimation from the rib by phase analysis: white males.

The determination of age at death is an important part of physical and forensic anthropology. Techniques now in use vary from direct observation of a bone to microscopic examination of a given segment. This study introduces the sternal end of the rib as a new site for age estimation by direct observation. The sample consisted of 118 white male ribs of verified age, sex, and race. The ribs were assigned to one of nine phases (0 through 8) based on changes noted at the costochondral junction. These included the formation of a pit, its depth and shape, configuration of the walls and rim surrounding it, and the overall texture and quality of the bone. Statistical analysis indicated that these changes were age related. It was further revealed that metamorphosis was most rapid and uniform from the mean age of 17 to 28 years (Phases 1 through 4). The rib morphology was more varied after age 39 (Phase 5) resulting in a wider range for the predicted age. Our study concluded that the sternal rib end may yield a similar degree of accuracy to the pubic symphysis and perhaps better than that for cranial sutural closure. Our technique also enables the forensic scientist to use the rib for corroboration with age estimations obtained by traditional methods.

Adolescent↗
PubMed1995

[Solitary plasmacytoma of the rib--a case report and review of Japanese literatures].

A 72-year-old woman with solitary plasmacytoma of the right fifth rib was surgically treated. She underwent radical resection of the bony chest wall including the right fifth rib, the ribs above and below the involved rib, the intercostal muscle, and the parietal pleura. Histological finding of the tumor was plasmacytoma of the rib. The type of monoclonal protein was IgG and lamda. She is doing well one year and eleven months after surgery without any signs of recurrence. Solitary plasmacytoma is rare as compared with multiple myeloma. Patients with solitary plasmacytoma originating in the rib have a feasibility of operative indication, and radical treatment is expected to be by adequate surgical resection. Seventeen cases of solitary chest wall plasmacytoma described in the Japanese literature are reviewed.

Adult↗
PubMed1994

Imaging diagnosis of cavernous hemangioma of the rib--one case report and review of the literature.

Osseous hemangioma is a benign neoplasm, rarely located in the ribs. A 56-year-old female patient without specific complaint had a large extrapleural lesion on chest posteroanterior radiograph. Expansile destruction of left seventh rib and relatively fine trabeculation were noticed in the mass from plain roentgenogram and computed tomography (CT). Contrast enhancement in noncalcified component of the lesion was revealed. Pleural effusion, lung parenchymal or mediastinal abnormality were not identified. Resection of the lesion with part of the originating rib was carried out. The pathologic diagnosis was cavernous hemangioma. We present a case with a large rib hemangioma which often leads to difficulty in radiologically differential diagnosis with other common malignant rib tumors. We also review the literature about hemangioma and malignant neoplasms of the ribs.

Bone Neoplasms↗
PubMed1993

Hyperostosis of ribs: association with vertebral ossification.

OBJECTIVE: Costal hyperostosis occurring with vertebral disorders, although not well known, has been described in patients with diffuse idiopathic skeletal hyperostosis (DISH). Our purpose was to examine the possible association of similar hyperostosis in other spinal conditions. METHODS: We investigated the frequency of hyperostotic rib changes on routine radiographs in 191 patients with various spinal disorders, including DISH (51 cases), ankylosing spondylitis (AS) (58 cases), psoriasis (21 cases) and quadriplegia (61 cases), and in a healthy control group (191 cases). RESULTS: Results showed that the frequency of rib hyperostosis was significantly higher in DISH (21.6%), AS (10.3%) and quadriplegia (6.6%) than in the healthy control group (0.5%). There was no significant difference in the frequency of right and left-sided involvement. The main radiographic features were a short segment of cortical thickening and sclerosis, which predominated in the medial aspect of the posterior portion of the rib. Some patients had a long segment of bone enlargement and extensive sclerosis. The resulting radiographic features simulated the appearance of Paget's disease. Osseous excrescences of adjacent costovertebral articulations were significantly related to the rib hyperostosis, seen in 73% of instances of rib involvement. CONCLUSION: Our observations suggest that diseases that lead to bone formation and resultant hypomobility of costovertebral articulations are associated with rib hyperostosis.

Adult↗