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PubMed1992

Secondary changes of the motor endplate in Lambert-Eaton myasthenic syndrome: a quantitative study.

Underlying the Lambert-Eaton myasthenic syndrome (LEMS) is a decrease in the release of the neurotransmitter acetylcholine. Only few reports on light and transmission electron microscopical observations of motor endplates in LEMS are available and changes reported so far differ from those found in experimental blocking of acetylcholine release. We performed a quantitative study on intercostal muscle biopsies of five patients. The main light microscopical finding was an enlargement of the area of contact between nerve and muscle, which was interpreted as a compensatory phenomenon. At the ultrastructural level we found the mean postsynaptic area and membrane length of the neuromuscular junctions to be decreased, putatively due to small postsynaptic regions of newly created neuromuscular junctions. The secondary changes in LEMS endplates as seen in this study are similar to those reported in experimental blocking of acetylcholine release.

Aged↗
PubMed1995

Use of a pericardial fat pad flap for preventing bronchopleural fistula: an experimental study focusing on the angiogenesis and cytokine production of the fat pad.

An experimental study was conducted to determine whether pericardial fat tissue could induce neovascularization and produce cytokines related to tissue repair. Neovascularization was examined using chick chorioallantoic membranes. Pieces of pericardial fat tissue, omentum, and intercostal muscle were individually placed on a number of chorioallantoic membranes and neovascularization induced by each material was assayed 6 days after the implantation. The intensity of neovascularization was in the order of pericardial fat > or = omentum > muscle. Cytokines, such as interleukin 1 (IL-1) alpha and beta, tumor necrosis factor-alpha (TNF alpha), interferon-gamma (IFN-gamma), and interleukin 6 (IL-6) were assayed in a culture supernatant of pericardial fat tissue. The latter was obtained 24 h after the addition of lipopolysaccharide (LPS) following various incubation times. All cytokines other than IFN gamma are known to play a part in tissue repair, whereas IFN gamma is negatively related to tissue repair because it inhibits fibroblast growth. The pericardial fat tissue incubated with LPS produced a certain amount of IL-1 on day 1, and TNF alpha on days 1 and 8, whereafter these values decreased to an undetectable level. Irrespective of the addition of LPS, a large amount of IL-6 was observed in the supernatant of pericardial fat tissue and it was detectable until day 29. On the contrary, INF gamma was not detected at any assay time. These observations suggest that a pericardial fat pad flap could possibly be beneficial in the prevention of bronchopleural fistula after pulmonary resection.

Adipose Tissue↗
PubMed1995

Elevated myoplasmic calcium in exercise-induced equine rhabdomyolysis.

Exertional rhabdomyolysis is a myopathy of unknown pathophysiology. We measured intracellular resting calcium concentration ([Ca2+]i) by means of Ca(2+)-selective microelectrodes in intercostal muscle fibers from horses suffering from rhabdomyolysis, and from horses with no evidence of neuromuscular disorder. [Ca2+]i was several-fold higher in muscle fibers from horses suffering from rhabdomyolysis when compared to controls. Treatment of rhabdomyolytic horses with dantrolene, an agent that prevents Ca2+ release from the sarcoplasmic reticulum, reduced [Ca2+]i toward control values, and accelerated the recovery from this myopathy. These results indicate that an acute episode of rhabdomyolysis is associated with elevation in [Ca2+]i in skeletal muscles, and that dantrolene might be of benefit in treating this disease.

Animals↗
PubMed1997

Rib-vertebral angle asymmetry in idiopathic, neuromuscular and experimentally induced scoliosis.

The concave and convex rib-vertebral angle (RVA) at levels T2-T12 was measured on AP radiographs of 19 patients with right convex idiopathic thoracic scoliosis and 10 patients with major thoracic right convex neuromuscular scoliosis. The difference between the angles on the concave and the convex sides, the RVAD, was calculated. The RVAs were also measured on radiographs from three animal groups in which spinal curves had been induced experimentally in a variety of ways. Group 1 comprised 16 rabbits that had been subjected to selective electrostimulation of the latissimus dorsi, the erector spinae and the intercostal muscles. Group 2 comprised four dead rabbits whose spines had been subjected to manual bending. Group 3 comprised eight rabbits that had undergone mechanical elongation of one rib. In both the idiopathic and the neuromuscular group, the convex RVA was smaller than the concave RVA between levels T2 and T8, with a maximal difference between T4 to T5. From T9 to T12 the concave RVA was smaller than the convex. The RVA in relation to the scoliotic segment, i.e. the apex level of the curve and the two neighbouring vertebrae above and below this level, showed similar results. With increasing Cobb angle the RVADs increased linearly with the greatest difference at the second vertebra above the apex. In the three experimental groups the pattern of the RVADs between T6 to T12 was basically similar to the findings of the clinical study. From the results of these clinical and experimental studies, it is concluded that the typical pattern of the RVAs on the concave and convex sides seems to be independent of the underlying cause of the spinal curvature. It is likely that the RVADs result from a passive mechanical adaptation of the ribs to the lateral curvature of the spine.

Adolescent↗
PubMed1984

Anatomical bases of transaxillary resection of the first rib.

Anatomical study of the costoclavicular space, with approach via inferolateral axillary route, allowing resection of the first rib. With the patient in the semisupine position, lifting the arm to the zenith allows the costoclavicular space to be opened widely and separation of the plane of the first rib from the neurovascular structures of the lateral wall of the axillary pyramid. In the first part of our work, we study successively the bony frame and its anatomical variations, the muscular frame and its anomalies, the cervical pleura and its associated fibromembranous complex. The second part is a succinct summary of the different stages of transaxillary resection of the first rib, with mention of the operative risks and landmarks in this approach.

Axilla↗
PubMed1998

[Repair of intrathoracic visceral damage using video-assisted thoracoscopic surgery for blunt chest trauma and rib fixation at the site of mini-thoracotomy].

We treated three patients with intrathoracic visceral damage caused by severely dislocated fractured ribs resulting from blunt trauma by using video-assisted thoracoscopic surgery (VATS) and rib fixation through a mini-thoracotomy. Under general anesthesia and unilateral respiration, the thoracic cavity was inspected with a thoracic video scope through the port inserted through the thoracic drainage opening which was made upon arrival at hospital. As the visceral damage seemed restorable under VATS, a mini-thoracotomy was positioned just above the rib fracture. Two thoracic ports were inserted through the site of rib fracture or through the intercostal space and then VATS was performed using three ports. After the restoration of intrathoracic visceral damage, the fractured rib was fixated using a bioabsorbable poly-L-lactide rib fixation pin or a marlex mesh. Lung injuries were sutured and ligated under VATS in two of our cases and a spur of the fractured rib was shaved in one case. Only severely dislocated ribs were fixated through the mini-thoracotomy in all cases. Air leakage stopped just after this procedure and there were no complications. The rib fixation and bone regeneration were excellent after this procedure. The advantages of this method are the visceral restoration under VATS through a mini-thoracotomy and the ability to perform rib fixation without injuries to the intercostal muscle, artery, vein or nerve. This operative procedure is recommended for intrathoracic visceral damage caused by severely dislocated rib fracture.

Adult↗
PubMed1998

[Combined rupture of trachea and esophagus following blunt trauma--a case report].

A 49-year-old man was involved in a motor vehicle crash and was admitted to a local hospital. The following day, he was transferred to our hospital because of worsening dyspnea. Initial examination revealed no subcutaneous emphysema, and chest computed tomography (CT) demonstrated no mediastinal air. A left thoracentesis tube was placed for pneumothorax, which reduced the patient's respiratory distress. He had a persistent, productive cough, which worsened when he drank water. A repeat chest CT on the fifth hospital day revealed a tracheo-esophageal fistula. Bronchoscopy and esophagoscopy confirmed the diagnosis. He underwent repair of the trachea and esophagus. The ruptured membraneous portion of the trachea was closed with interrupted sutures and covered with pedicled pericardial flap. The perforated anterior esophageal wall was sutured in layers and reinforced with a fifth intercostal muscle flap. A gastrostomy tuve was placed for feeding access. Within 6 weeks, the patient recovered completely.

Esophagus↗
PubMed1998

Primary anastomosis of the trachea: management and pitfalls.

Twenty-four patients with tracheal lesions were managed by various procedures, including primary anastomosis in 16, tracheoplasty in 2, and a terminal tracheostomy in 6. The patients undergoing anastomosis included 4 with primary tumors, 7 with secondary tumors, and 5 with benign stricture. Except for 2 patients, there was no leakage or stenosis after a resection of from two to nine tracheal rings. There were 4 patients in whom the laryngeal nerve was paralyzed on one side prior to resection and then was sacrificed on the other side because of tumor involvement. Because of difficulty in swallowing, the outcome was not satisfactory in the 3 patients despite a good anastomosis. Cricotracheal anastomosis was performed in 3 patients, and thyrotracheal anastomosis in 1. Two patients in whom the trachea and esophagus communicated were treated using pedicled intercostal muscle grafts. Tracheal stenosis can be observed in various pathological conditions. Consequently, the optimal treatment varies from patient to patient according to the type of a disease, the location and extent of a disease, and the condition of the laryngeal nerve, while it is also important to carefully select the most appropriate anesthetic method, approach, and type of reconstruction.

Adolescent↗
PubMed2004

Intercostal hemangioma.

This paper presents a case of intercostal hemangioma, in which a complete surgical resection was accomplished based upon a tentative diagnosis provided by magnetic resonance imaging (MRI). A 27-year-old man visited our hospital for the evaluation of chest pain and shortness of breath after exertion. Computed tomography showed a soft tissue mass, 5.5 x 3.5 cm in size, arising from the right lateral 7th intercostal space. Dynamic MRI showed that the mass was enhanced rapidly in the early phase and that this early enhancement was maintained during the delayed phase, which was compatible with a diagnosis of intercostal hemangioma. The patient underwent surgery, and a complete resection of the tumor with the right 7th and 8th ribs and their intercostal muscles was accomplished. Histopathological examination confirmed the diagnosis of intramuscular hemangioma of the large-vessel type. Presently, 6 months after the operation, the patient is doing well, without any evidence of local recurrence.

Adult↗
PubMed2004

Rupture of infectious aneurysm of the thoracic aorta into the lung after radical esophageal cancer surgery.

A 60-year-old male underwent radical operation for esophageal cancer 45 days prior to complaining of several incidents of hemoptysis. The hemoptysis was found to be caused by infectious aneurysm of the descending thoracic aorta penetrating the lung. The aneurysm was resected and the aortic wall was sutured directly under percutaneous circulatory pulmonary support system. The sutured thoracic aorta was wrapped with the pedicle of an intercostal muscle flap to prevent reinfection. Forty-eight days after the aortic wall suture operation, however, the patient experienced massive hemoptysis and went into shock. Angiography was reveal no arterial lesions, so emergency left lower lobectomy was performed on suspicion of lung vessel rupture. Immediately after the lower lobectomy, recurrence of the aortic wall rupture caused uncontrollable bleeding. The patient died intraoperatively.

Aneurysm, False↗
PubMed1992

Chest pain and breathlessness: relationship to psychiatric illness.

Chest pain and breathlessness are common somatic symptoms of emotional disorder in ambulatory care. Chronic chest pain has a prevalence of 12% and is associated with high utilization of health care. Of patients with chest pain and breathlessness who are referred to a cardiac clinic but subsequently shown not to have heart disease, the majority continue to report symptoms. Those patients with the worst outcome, in terms of continuing limitation of activity and use of medical resources, are those with chest pain but normal coronary arteries. A number of studies that fail to support a unitary theory of causation of noncardiac chest pain are described. A multifactorial, interactive model is proposed, with contributions from physical factors, such as palpitations and intercostal muscle pain; psychologic factors, which include enhanced awareness of and selective attention to bodily sensation; and environmental factors, such as previous exposure to cardiorespiratory disease in first-degree relatives or significant others. Although there have been few controlled intervention studies in patients with unexplained cardiorespiratory symptoms, there is evidence for the efficacy of both drug treatments and psychologic treatment. The results of intervention studies in patients with chest pain and normal coronary arteries are eagerly awaited. Atypical chest pain and breathlessness are common causes of office consultations and/or functional disability. The diagnoses should be established on the basis of positive evidence of psychiatric illness rather than by exclusion. The etiology is multifactorial, and management is aimed at treating the underlying psychosocial problems and/or psychiatric illness. Cognitive-behavioral treatments are probably as effective as drug treatments in the short-term, and the care of these patients would be improved by a more detailed explanation of noncardiac causes and a greater opportunity for patients to discuss their fears.

Chest Pain↗
PubMed1981

Repair of tracheal intubation injuries.

Occult tracheal injuries occurring at the time of intubation frequently leave a posterior defect and lead to the rapid development of mediastinal infection. Some protection is provided by the endotracheal tube, which may further contribute to delay in diagnosis. Current descriptions of tracheal reconstruction emphasize circumferential excision and reanastomosis, but advanced infection and a probable need for ventilatory support are considered contraindications. Two cases of tracheal injury are reported in which a considerable delay in diagnosis resulted in severe mediastinal infection and respiratory failure. Use of an earlier method of tracheal repair, with pedicled intercostal muscle, resulted in control of mediastinal infection. Respiratory failure was treated effectively with a volume ventilator. It is recommended that the operation be given first consideration for such posterior injuries when they are accompanied by infection or respiratory failure.

Female↗
PubMed1990

Thoracoplasty: current application to the infected pleural space.

Thoracoplasty, once commonly used in the management of cavitary pulmonary disease, continues to find application in the obliteration of infected pleural spaces. This study reports a series of 13 patients receiving thoracoplasty between 1976 and 1989. Five patients had chronic apical empyema spaces without prior resection of lung tissue. Two of the empyemas were due to tuberculosis, two were due to atypical mycobacteria, and one was due to postpneumonic empyema. All patients had extensive destruction of upper lobe tissue. Eight patients had undergone prior pulmonary resection; 3 had persistent infected spaces in the early postoperative period, 3 had development of empyemas and bronchopleural fistulas late (5 to 19 years) after pulmonary resection, and 2 had postpneumonectomy empyema. All patients had rigid cavity walls preventing space obliteration by rib removal alone and required concomitant resection of the thickened pleura and intercostal muscle tissues. Bronchopleural fistulas were present in 11 patients and were closed with adjacent nonintercostal muscle. All patients survived and had successful obliteration of the infected spaces with acceptable physiological and cosmetic results. We conclude that thoracoplasty remains a useful procedure in the management of the infected pleural space in select patients.

Adult↗
PubMed1991

Chest wall involvement by lung cancer: computed tomographic detection and results of operation.

The aim of this prospective study was to evaluate: (1) the role of computed tomographic scanning in predicting chest wall invasion by peripheral lung cancer and (2) the results of operation according to the depth of chest wall involvement and other potential indicators of long-term survival. One hundred twelve patients with non-small cell lung cancer adjacent to the pleural surface who underwent computed tomographic scanning and subsequent thoracotomy were entered into this study. Tumor invasion was confined to the visceral pleura in 53 patients, to the parietal pleura in 18 patients, and to intercostal muscles in 25 patients; invasion extended beyond this layer in 16 patients. The computed tomographic criteria for chest wall invasion were (1) obliteration of the extrapleural fat plane, (2) the length of the tumor-pleura contact, (3) the ratio between the tumor-pleura contact and the tumor diameter, (4) the angle of the tumor with the pleura, (5) a mass involving the chest wall, and (6) rib destruction. The computed tomographic criteria 1 and 3 were significantly related to pathologic findings. Sensitivity was 85% for criterion 1 and 83% for criterion 3, specificity being 87% and 80%, respectively. Long-term survival of patients with T3 disease critically depended on the lymph node state and completeness of resection. The adenocarcinoma cell type and the T4 category were unfavorable prognostic factors. The depth of chest wall invasion did not affect survival, except for extensive rib and soft tissue infiltration. En bloc resection yielded better results than discontinuous resection.

Adenocarcinoma↗
PubMed1991

Total unilateral lung gangrene in Hodgkin's disease: treatment by thoracostomy.

Total gangrene of the left lung developed in a 30-year-old male patient with a pulmonary recurrence of Hodgkin's disease after mediastinal irradiation and chemotherapy. Clinically, tension pyopneumothorax and severe septic shock were present. Surgical repair was done by thoracostomy, resecting three ribs. A 2 x 0.5-cm hole in the necrotic wall of the left main bronchus was covered with an intercostal muscle bundle. The necrotic pleural surfaces were treated openly by daily change of dressings. The patient recovered satisfactorily and underwent four further courses of chemotherapy without any complications.

Adult↗
PubMed1993

Completion pneumonectomy and thoracoplasty for bronchopleural fistula and fungal empyema.

Achieving sterilization of the postpneumonectomy space and bronchial healing may be difficult when active granulomatous infection of the pleural space and lung parenchyma is present at the time of operation. Three patients with chronic bronchopleural fistula, fungal empyema, and fungal cavities of the remaining ipsilateral lobe were managed with one-stage completion pneumonectomy and modified eight-rib thoracoplasty. Two patients had infection with Aspergillus fumigatis and 1 patient had Coccidioides immitis. Two patients had received mediastinal radiation after prior upper lobectomy for carcinoma of the lung. Two patients were having massive hemoptysis at the time of pneumonectomy. Eight-rib thoracoplasty with suturing of the intercostal muscles to the bronchial stump was performed on all patients. In 2 patients a mass closure of hilar vessels and bronchus was used because of inability to individually close the vessels and bronchus due to ligneous scarring of the hilum. Antibiotic and antifungal irrigations into the operative area were used postoperatively. Chest tubes were left in place 6 to 8 weeks. All wounds healed primarily. Patients were alive without recurrent local infection or tumor at follow-up 3 to 13 years postoperatively.

Adult↗
PubMed1989

Calcitonin gene-related peptide immunoreactivity at the human neuromuscular junction.

We have studied the presence of calcitonin gene-related peptide (CGRP) immunoreactivity at the human motor end-plate in intercostal muscles from 6 normal subjects. Only a small proportion of end-plates were positively stained in the muscle. Different metabolic states at single motor end-plates or variable rates of CGRP synthesis in separate motoneurones could account for the uneven distribution of CGRP immunoreactivity at the human neuromuscular junction, or else, extremely low amounts of the peptide are below the threshold of sensitivity of the immunofluorescence method used in the present study.

Calcitonin Gene-Related Peptide↗
PubMed1993

Ephedrine: effects on neuromuscular transmission.

(-)-Ephedrine has been used in the treatment of patients with myasthenia gravis. To investigate the possible effects of ephedrine on neuromuscular transmission, canine intercostal muscle endplates were studied by microelectrode techniques. At concentrations less than 10(-4) M, ephedrine had no effect on neuromuscular transmission. At a concentration of 10(-4) M, ephedrine increased the quantal content of the endplate potential by 21%. The presynaptic store of acetylcholine quanta available for immediate release was unchanged, but the probability of quantal release was increased by 16%. At this concentration, ephedrine decreased the amplitude of the miniature endplate potential by 38%. In the presence of 10(-3) M ephedrine, the miniature endplate potentials and currents became undetectable. The kinetic properties of the acetylcholine receptor channel were studied by analysis of acetylcholine-induced endplate current noise. At 10(-4) M, ephedrine reduced the channel conductance by 43% but had no effect on the open time. At 5 x 10(-4) M, ephedrine reduced the channel conductance by 84% and increased the open time by 23 percent.

Animals↗