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Artykuły w czasopismach na temat „Internal intercostal”

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Data publikacji: 4 czerwca 2021

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De Troyer, A., and V. Ninane. "Respiratory function of intercostal muscles in supine dog: an electromyographic study." Journal of Applied Physiology 60, no. 5 (May 1, 1986): 1692–99. http://dx.doi.org/10.1152/jappl.1986.60.5.1692.

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It is traditionally considered that the difference in orientation of the muscle fibers makes the external intercostals elevate the ribs and the internal interosseous intercostals lower the ribs during breathing. This traditional view, however, has recently been challenged by the observation that the external and internal interosseous intercostals, when contracting alone in a single interspace, have a similar effect on the ribs into which they insert. This view has also been challenged by the observation that the external and internal intercostals in a given interspace often change their length in the same direction during breathing. In an attempt to clarify the respiratory function of these muscles, we studied eight supine lightly anesthetized dogs during quiet breathing and during static inspiratory efforts. In each animal electromyographic (EMG) recordings from the external and internal interosseous intercostals were obtained in all interspaces from the second to the eighth, and selective denervations were systematically performed to ensure with complete certainty the origin of the recorded EMG activities. The external intercostals were only activated in phase with inspiration, whereas the internal interosseous intercostals were only activated in phase with expiration. These phasic EMG activities, however, were generally small in magnitude, and the muscles were often silent. Indeed, activation of the externals was always confined to the upper portion of the rib cage, whereas activation of the internals was limited to the lower portion of the rib cage. Internal intercostal activation always occurred sequentially along a caudocephalic gradient. These observations are thus compatible with the traditional view of intercostal muscle action.(ABSTRACT TRUNCATED AT 250 WORDS)

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Iscoe, Steve, and Laurent Grélot. "Regional intercostal activity during coughing and vomiting in decerebrate cats." Canadian Journal of Physiology and Pharmacology 70, no. 8 (August 1, 1992): 1195–99. http://dx.doi.org/10.1139/y92-166.

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Regional variations in the discharge patterns of the internal and external intercostal muscles of the middle and caudad thorax were studied in decerebrate, spontaneously breathing cats during coughing and vomiting. Coughing, induced by electrical stimulation of the superior laryngeal nerves, consisted of increased and prolonged diaphragmatic activity followed by a burst of abdominal activity. Mid-thoracic external and internal intercostal muscles discharged synchronously with the diaphragm and abdominal muscles, respectively. Caudal external and internal intercostal muscles, however, discharged synchronously with the abdominal muscles. Vomiting, induced by stimulation of the lower thoracic vagi, consisted of a series of synchronous bursts of diaphragmatic and abdominal activity (retching) followed by a prolonged abdominal discharge after the cessation of diaphragmatic activity (expulsion). Caudal external and internal intercostals discharged in phase with diaphragmatic and abdominal activity but both mid-thoracic intercostal muscles discharged out of phase with these muscles. These results indicate major differences in the control and functional roles of intercostal muscles at different thoracic levels during these behaviours.Key words: diaphragm, abdominal muscles, intercostal muscles.

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Greer, J. J., and T. P. Martin. "Distribution of muscle fiber types and EMG activity in cat intercostal muscles." Journal of Applied Physiology 69, no. 4 (October 1, 1990): 1208–11. http://dx.doi.org/10.1152/jappl.1990.69.4.1208.

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The electromyogram (EMG) activity and histochemical properties of intercostal muscles in the anesthetized cat were studied. The parasternal muscles were consistently active during inspiration. The external intercostals in the rostral spaces and the ventral portions of the midthoracic spaces were also recruited during inspiration. The remaining external intercostals were typically silent, regardless of the level of respiratory drive. The internal intercostal muscles located in the caudal spaces were occasionally recruited during expiration. There was a clear correlation between recruitment patterns of the intercostals and the histochemically defined fiber type properties of the muscles. Intercostal muscles that were routinely recruited during inspiration had a significantly higher proportion of slow-oxidative muscle fibers.

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Oliven, A., E. C. Deal, S. G. Kelsen, and N. S. Cherniack. "Effects of bronchoconstriction on respiratory muscle activity during expiration." Journal of Applied Physiology 62, no. 1 (January 1, 1987): 308–14. http://dx.doi.org/10.1152/jappl.1987.62.1.308.

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The effect of methacholine-induced bronchoconstriction on the electrical activity of respiratory muscles during expiration was studied in 12 anesthetized spontaneously breathing dogs. Before and after aerosols of methacholine, diaphragm, parasternal intercostal, internal intercostal, and external oblique electromyograms were recorded during 100% O2 breathing and CO2 rebreathing. While breathing 100% O2, five dogs showed prolonged electrical activity of the diaphragm and parasternal intercostals in early expiration, postinspiratory inspiratory activity (PIIA). Aerosols of methacholine increased pulmonary resistance, decreased tidal volume, and elevated arterial PCO2. During bronchoconstriction, when PCO2 was varied by CO2 rebreathing, PIIA was shorter at low levels of PCO2, and external oblique and internal intercostal were higher at all levels of PCO2. Vagotomy shortened PIIA in dogs with prolonged PIIA. After vagotomy, methacholine had no effects on PIIA but continued to increase external oblique and internal intercostal activity at all levels of PCO2. These findings indicate that bronchoconstriction influences PIIA through a vagal reflex but augments expiratory activity, at least in part, by extravagal mechanisms.

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Ninane, V., M. Gorini, and M. Estenne. "Action of intercostal muscles on the lung in dogs." Journal of Applied Physiology 70, no. 6 (June 1, 1991): 2388–94. http://dx.doi.org/10.1152/jappl.1991.70.6.2388.

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The action on the lung of interosseous intercostal muscles located in the third and the seventh interspaces was studied in 15 anesthetized-curarized supine dogs. Changes in pleural pressure, airflow rate, and lung volume produced by maximal stimulation of both intercostal muscle layers were measured at and above functional residual capacity (FRC). In five animals measurements were also obtained during isolated stimulation of the internal layer. At FRC, intercostal stimulation in the upper interspaces had invariably an inspiratory effect on the lung but no effect was detectable in the lower interspaces. Qualitatively similar results were obtained during isolated stimulation of the internal layer. Increasing lung volume reduced the inspiratory action of the upper intercostals and conferred an expiratory action to the lower intercostals. These results indicate the following: 1) when contracting in a single interspace, the external and internal intercostals have a qualitatively similar action on the lung; and 2) this action, however, depends critically on their location along the cephalocaudal axis of the rib cage: in the upper portion of the rib cage, both muscle layers have an inspiratory effect at and above FRC; in the lower portion of the rib cage, they have no respiratory action at FRC and act in the expiratory direction at higher lung volumes.

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Wilson, T. A., and A. De Troyer. "Respiratory effect of the intercostal muscles in the dog." Journal of Applied Physiology 75, no. 6 (December 1, 1993): 2636–45. http://dx.doi.org/10.1152/jappl.1993.75.6.2636.

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

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Bolser, D. C., B. G. Lindsey, and R. Shannon. "Medullary inspiratory activity: influence of intercostal tendon organs and muscle spindle endings." Journal of Applied Physiology 62, no. 3 (March 1, 1987): 1046–56. http://dx.doi.org/10.1152/jappl.1987.62.3.1046.

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Studies were conducted to determine the effects of intercostal muscle spindle endings (MSEs) and tendon organs (TOs) on medullary inspiratory activity in decerebrate and allobarbital-anesthetized cats. Impeded muscle contractions, elicited by electrical stimulation of the peripheral cut end of the T6 ventral root, were used to stimulate external and internal intercostal TOs without MSEs. Impeded contractions of either the external or internal intercostal muscles reduced phrenic and medullary inspiratory neuronal activities. Vibration was used to selectively stimulate external or internal intercostal MSEs (90 and 40 micron amplitude, respectively). Selective stimulation of either external or internal intercostal MSEs did not change phrenic or medullary inspiratory neuronal activities. It is concluded that both external and internal intercostal TOs have a generalized inhibitory effect on medullary inspiratory activity and intercostal MSEs have no effect on medullary inspiratory activity.

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Reid, M. B., G. C. Ericson, H. A. Feldman, and R. L. Johnson. "Fiber types and fiber diameters in canine respiratory muscles." Journal of Applied Physiology 62, no. 4 (April 1, 1987): 1705–12. http://dx.doi.org/10.1152/jappl.1987.62.4.1705.

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In the present study, we measured fiber types and fiber diameters in canine respiratory muscles and examined regional variation within the diaphragm. Samples of eight diaphragm regions, internal intercostals, external intercostals, transversus abdominis, and triceps brachii were removed from eight adult mongrel dogs, frozen, and histochemically processed for standard fiber type and fiber diameter determinations. The respiratory muscles were composed of types I and IIa fibers; no IIb fibers were identified. Fiber composition differed between muscles (P less than 0.0001). Normal type I percent (+/- SE) were: diaphragm 46 +/- 2, external intercostal 85 +/- 6, internal intercostals 48 +/- 3, transversus abdominis 53 +/- 1, and triceps 33 +/- 7. The diaphragm also contained a type I subtype [6 +/- 1% (SE)] previously thought only to occur in developing muscle. Fiber composition varied between diaphragm regions (P less than 0.01). Most notably, left medial crus contained 64% type I fibers. Fiber size also varied systematically among muscles (P less than 0.025) and diaphragm regions (P less than 0.0005). External intercostal fiber diameter was largest (47–50 microns) and diaphragm was smallest (34 microns). Within diaphragm, crural fibers were larger than costal (P less than 0.05). We conclude that there are systematic differences in fiber composition and fiber diameter of the canine respiratory muscles.

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De Troyer, A., S. Kelly, P. T. Macklem, and W. A. Zin. "Mechanics of intercostal space and actions of external and internal intercostal muscles." Journal of Clinical Investigation 75, no. 3 (March 1, 1985): 850–57. http://dx.doi.org/10.1172/jci111782.

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Carrier, D. R. "Ventilatory action of the hypaxial muscles of the lizard Iguana iguana: a function of slow muscle." Journal of Experimental Biology 143, no. 1 (May 1, 1989): 435–57. http://dx.doi.org/10.1242/jeb.143.1.435.

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Patterns of muscle activity during lung ventilation, patterns of innervation and some contractile properties were measured in the hypaxial muscles of green iguanas. Electromyography shows that only four hypaxial muscles are involved in breathing. Expiration is produced by two deep hypaxial muscles, the transversalis and the retrahentes costarum. Inspiration is produced by the external and internal intercostal muscles. Although the two intercostal muscles are the main agonists of inspiration, neither is involved in expiration. This conflicts with the widely held notion that the different fibre orientations of the two intercostal muscles determine their ventilatory action. Several observations indicate that ventilation is produced by slow (i.e. nontwitch) fibres of these four muscles. First, electromyographic (EMG) activity recorded from these muscles during ventilation has an unusually low range of frequencies (less than 100 Hz). Such low-frequency signals have been suggested to be characteristic of muscle fibres that do not propagate action potentials (i.e. slow fibres). Second, during inspiration, EMG activity is restricted to he medical sides of the two intercostal muscles. Muscle fibres from this region have multiple motor endplates and exhibit tonic contraction when immersed in saline solutions of high potassium content. Like the intercostals, the transversalis and retrahentes costarum muscles also contain fibres with multiple motor endplates. Thus, although breathing is a phasic activity, it is produced by tonic (i.e. slow) muscle fibres. The intercostal muscles are also involved in postural and locomotor movements of the trunk. However, such movements employ twitch as well as slow fibres of the intercostal muscles.

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Loring, S. H., and J. A. Woodbridge. "Intercostal muscle action inferred from finite-element analysis." Journal of Applied Physiology 70, no. 6 (June 1, 1991): 2712–18. http://dx.doi.org/10.1152/jappl.1991.70.6.2712.

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The external and internal intercostal muscles are important respiratory muscles in humans, but their mechanical actions have been controversial. We used finite-element analysis based on anatomic and mechanical measurements in dogs to assess the action of the intercostal and other rib cage muscles in a model of an isolated canine rib cage. When intercostal muscle forces of either the internal or the external layer were applied in a single interspace, they pulled the adjacent ribs together, consistent with published observations in dogs. However, when the forces were applied in all interspaces, the external layer caused an inspiratory motion and the internal layer caused an expiratory motion, consistent with conventional understanding of intercostal muscle actions. Parasternal intercostal, levator costae, and transversus thoracis (triangularis sterni) muscle actions were also simulated. These muscles caused expected movements of the ribs and sternum. We conclude that the actions of intercostal muscles depend on the spatial extent of their activation. Their actions in a single interspace and in multiple interspaces can be observed and explained with three-dimensional finite-element models.

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Rimmer, K. P., G. T. Ford, and W. A. Whitelaw. "Interaction between postural and respiratory control of human intercostal muscles." Journal of Applied Physiology 79, no. 5 (November 1, 1995): 1556–61. http://dx.doi.org/10.1152/jappl.1995.79.5.1556.

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To study the interaction between postural and respiratory control of intercostal muscles, we used electromyography of intercostal muscles of the lateral chest wall in conscious humans. Bipolar fine-wire electrodes were placed in external and internal intercostal muscles in the midaxillary line of four subjects who sat on a bench and breathed through a pneumotachograph. They were instructed to hold their breath at end expiration, rotate their thorax to the right or left, and then hold the rotation while resuming breathing. Holding a rotation induces steady tonic activity in either internal or external intercostal muscles, depending on the direction of the rotation. The degree of rotation was varied from one run to the next, resulting in varied levels of tonic postural activity. When breathing resumes, internal intercostal muscles have their activity almost completely suppressed with each inspiration independently of whether the tonic postural tone is small or large. External intercostal muscles show inspiratory increases in activity superimposed on the postural tone, which apparently amplifies the effect of respiratory input to their motoneurons.

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Shannon, R., D. C. Bolser, and B. G. Lindsey. "Medullary expiratory activity: influence of intercostal tendon organs and muscle spindle endings." Journal of Applied Physiology 62, no. 3 (March 1, 1987): 1057–62. http://dx.doi.org/10.1152/jappl.1987.62.3.1057.

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Studies were conducted to determine the effects of intercostal muscle spindle endings (MSEs) and tendon organs (TOs) on medullary expiratory activity in decerebrate cats. Impeded intercostal muscle contractions, elicited by electrical stimulation of the peripheral cut end of the T6 ventral root, were used to stimulate intercostal TOs without MSEs. Impeded contractions of the intercostal muscles augmented expiratory laryngeal motoneuron activity, and either had no effect on or reduced the activity of bulbospinal expiratory neurons. Vibration was used to stimulate intercostal MSEs. Intercostal MSEs had no effect on medullary expiratory neuron activity. It is concluded that both external and internal intercostal TOs have an excitatory effect on expiratory laryngeal motoneuron activity and an inhibitory effect on a subpopulation of expiratory neurons driving intercostal and/or abdominal muscles, and intercostal MSEs have no direct influence on medullary expiratory activity.

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CONACHER, I. D., J. C. DOIG, L. RIVAS, and A. K. PRIDIE. "Intercostal neuralgia associated with internal mammary artery grafting." Anaesthesia 48, no. 12 (February 22, 2007): 1070–71. http://dx.doi.org/10.1111/j.1365-2044.1993.tb07530.x.

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De Troyer, André, Peter A. Kirkwood, and Theodore A. Wilson. "Respiratory Action of the Intercostal Muscles." Physiological Reviews 85, no. 2 (April 2005): 717–56. http://dx.doi.org/10.1152/physrev.00007.2004.

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The mechanical advantages of the external and internal intercostals depend partly on the orientation of the muscle but mostly on interspace number and the position of the muscle within each interspace. Thus the external intercostals in the dorsal portion of the rostral interspaces have a large inspiratory mechanical advantage, but this advantage decreases ventrally and caudally such that in the ventral portion of the caudal interspaces, it is reversed into an expiratory mechanical advantage. The internal interosseous intercostals in the caudal interspaces also have a large expiratory mechanical advantage, but this advantage decreases cranially and, for the upper interspaces, ventrally as well. The intercartilaginous portion of the internal intercostals (the so-called parasternal intercostals), therefore, has an inspiratory mechanical advantage, whereas the triangularis sterni has a large expiratory mechanical advantage. These rostrocaudal gradients result from the nonuniform coupling between rib displacement and lung expansion, and the dorsoventral gradients result from the three-dimensional configuration of the rib cage. Such topographic differences in mechanical advantage imply that the functions of the muscles during breathing are largely determined by the topographic distributions of neural drive. The distributions of inspiratory and expiratory activity among the muscles are strikingly similar to the distributions of inspiratory and expiratory mechanical advantages, respectively. As a result, the external intercostals and the parasternal intercostals have an inspiratory function during breathing, whereas the internal interosseous intercostals and the triangularis sterni have an expiratory function.

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Farkas, G. A., M. Decramer, D. F. Rochester, and A. De Troyer. "Contractile properties of intercostal muscles and their functional significance." Journal of Applied Physiology 59, no. 2 (August 1, 1985): 528–35. http://dx.doi.org/10.1152/jappl.1985.59.2.528.

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To have some insight into the functional coupling between the parasternal intercostals (PS) and the diaphragm (DPM), we have examined the isometric contractile properties of bundles from canine PS and DPM muscles. Bundles of external (EXT) and internal (INT) interosseous intercostals were studied for comparison. In addition we have related sonometrically measured length of the intercostals in vivo at supine functional residual capacity (FRC) to in vitro optimal force-producing length (Lo). We found that 1) intercostal twitch speed is significantly faster than DPM, thus displacing their relative force-frequency curve to the right of that of the DPM; 2) the ascending limb of the active length-tension curve of all intercostals lies below the DPM curve; i.e., at 85% Lo, PS force is 46% of maximal force (Po), whereas DPM force is still 87% Po; 3) for any given length change beyond Lo, all intercostals generate greater passive tension than the DPM; 4) Po is greater for the intercostals than the DPM; and 5) at supine FRC, both EXT and INT in dogs are nearly operating at Lo, whereas the PS are operating at a length greater than Lo. We conclude that 1) PS produce less force than DPM during breathing efforts involving low- (10–20 Hz) stimulation frequencies, but they generate more force than DPM when high- (greater than 50 Hz) stimulation frequencies are required; and 2) the pressure-generating ability of the PS is better preserved than that of the DPM with increases in lung volume.

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Carrier, D. R. "Function of the intercostal muscles in trotting dogs: ventilation or locomotion?" Journal of Experimental Biology 199, no. 7 (July 1, 1996): 1455–65. http://dx.doi.org/10.1242/jeb.199.7.1455.

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Although the intercostal muscles play an important role in lung ventilation, observations from fishes and ectothermic tetrapods suggest that their primary function may be locomotion. To provide a broader understanding of the role these muscles play in locomotion, I measured ventilatory airflow at the mouth and activity of the fourth and ninth intercostal muscles in four dogs trotting on a treadmill. During rest and thermoregulatory panting, activity of the intercostal muscles was associated with inspiratory and expiratory airflow. However, during trotting, activity of the interosseous portions of the intercostal muscles was correlated with locomotion. When ventilation and stride cycles were not synchronized, activity of the interosseous intercostal muscles stayed locked to the locomotor events and drifted in time relative to ventilation. In contrast, activity of the parasternal portion of the internal intercostal muscles was always associated with inspiratory airflow. These observations suggest that, in dogs, locomotion is the dominant function of the interosseous portions of the intercostal muscles. However, the parasternal intercostal muscles are primarily inspiratory in function.

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Whitelaw, W. A., G. T. Ford, K. P. Rimmer, and A. De Troyer. "Intercostal muscles are used during rotation of the thorax in humans." Journal of Applied Physiology 72, no. 5 (May 1, 1992): 1940–44. http://dx.doi.org/10.1152/jappl.1992.72.5.1940.

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To test the idea that the lateral intercostal muscles may be more suited to aid in rotational than respiratory movements of the thorax, we inserted bipolar fine-wire electrodes in external and internal intercostal muscles in the right midaxillary line in nine sitting subjects and examined the pattern of contraction of these muscles during voluntary axial rotations of the thorax (30–35 degrees), resting breathing, and CO2-induced hyperpnea. The right external intercostal muscles were strongly recruited in rotations to the left but were not active in rotations to the right. In contrast, the right internal intercostal muscles were active in rotations to the right but not in rotations to the left. Rotations completed in 1 or 2 s were associated with an early burst of electromyographic activity, followed by a low plateau that persisted while the rotation was held. Rotations made very gradually over 5–10 s were associated with gradually rising electromyographic activity. The amplitude of activity recorded during 30–35 degrees rotations was equivalent to that measured when minute ventilation was increased by CO2 to 50 l/min. We conclude that the lateral intercostal muscles have a major role in producing axial rotations of the thorax.

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DiMarco, A. F., G. S. Supinski, B. Simhai, and J. R. Romaniuk. "Mechanical action of the internal intercostal muscles in dogs." Journal of Applied Physiology 75, no. 6 (December 1, 1993): 2360–67. http://dx.doi.org/10.1152/jappl.1993.75.6.2360.

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The pattern of electrical activation and muscle length changes of the internal intercostal (II) muscles (9th or 10th interspace) of the lower rib cage were evaluated in supine anesthetized dogs. Studies were performed during resting breathing and expiratory threshold loading. Results were compared with simultaneous measurements of the better-studied triangularis sterni muscle (4th interspace). In general, both muscles lengthened with passive inflation and shortened with passive deflation. During resting breathing, both the II and TS muscles were electrically active and shortened below resting length, 7.7 +/- 1.6% (SE) and 5.3 +/- 1.7%, respectively. With the addition of positive end-expiratory pressure, the degree of electrical activation and muscle shortening increased progressively for both muscles, although to a somewhat greater extent for II muscles. Isolated denervation of the II muscles eliminated their shortening during resting breathing and often resulted in muscle lengthening, indicating that II muscle shortening was secondary to its own activation. Expiration was associated with lateral inward movement of the lower rib cage below its relaxation position. This motion was not significantly affected by abdominal muscle section but was markedly reduced by bilateral II denervation (7th-11th spaces). Our results indicate that the II muscles of the lower rib cage 1) are electrically active and shorten below resting length during resting breathing, 2) respond to positive end-expiratory pressure by increasing their level of activation and degree of shortening, and 3) are primarily responsible for inward lateral motion of the lower rib cage below its relaxation position during expiration.

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Sibuya, M., I. Homma, T. Hara, and N. Tsuyama. "Expiratory activity in transferred intercostal nerves in brachial plexus injury patients." Journal of Applied Physiology 62, no. 5 (May 1, 1987): 1780–85. http://dx.doi.org/10.1152/jappl.1987.62.5.1780.

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Involuntary activity of transferred intercostal motor units was examined in patients with brachial plexus injury. Since the internal intercostal nerves were detached from the thorax to reinnervate the musculus biceps brachii, it was possible to record pure intercostal motor activity in humans. Respiratory activity was seen in the latter part of the expiratory phase, thus dividing the phase into two substages (E1 and E2) by the onset of the activity. CO2 rebreathing prolonged the duration of the intercostal motor activity and increased the tidal activity as determined from the integration curve. There was a close linear correlation between these two variables. These observations indicate that expiratory activity and its duration are actively controlled in humans.

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Elton, C., A. Rahim, B. Youl, G. Goldspink, and M. Winslet. "Intercostal muscles in the rabbit: surgical anatomy and flap construction." Laboratory Animals 32, no. 4 (October 1, 1998): 422–26. http://dx.doi.org/10.1258/002367798780599901.

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Demos and colleagues (1967) obtained good antireflux results from transposing an intercostal myoneurovascular pedicle around the gastro-oesophageal junction in dogs. An intact neurovascular supply is essential for the viability of a muscle flap. The aim of this study was to delineate the nerve and arterial supply to the left 11th intercostal muscle in the rabbit and to assess whether this muscle could be mobilized as a viable flap. The innervation of the muscle was studied using the methods of gross dissection in cadaveric specimens, and histological staining techniques. The arterial supply was studied using gross dissection, and aortography. In three non-recovery experiments, intercostal muscle was transposed around the gastro-oesophageal junction. The distal motor latency was recorded after electrical stimulation of the intercostal wraps. Gross dissection, histological staining techniques, and aortography showed that the left 11th intercostal muscle group in the rabbit is supplied by segmental vein, artery and nerve, running between external and internal intercostal muscles. Aortography and electrical stimulation demonstrated that the muscle group could be mobilized with an intact neurovascular supply. The left 11th intercostal muscle group has potential as a viable muscle flap for use in surgical procedures within the upper abdomen.

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Ford, T. W., C. F. Meehan, and P. A. Kirkwood. "Absence of synergy for monosynaptic Group I inputs between abdominal and internal intercostal motoneurons." Journal of Neurophysiology 112, no. 5 (September 1, 2014): 1159–68. http://dx.doi.org/10.1152/jn.00245.2014.

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Internal intercostal and abdominal motoneurons are strongly coactivated during expiration. We investigated whether that synergy was paralleled by synergistic Group I reflex excitation. Intracellular recordings were made from motoneurons of the internal intercostal nerve of T8 in anesthetized cats, and the specificity of the monosynaptic connections from afferents in each of the two main branches of this nerve was investigated. Motoneurons were shown by antidromic excitation to innervate three muscle groups: external abdominal oblique [EO; innervated by the lateral branch (Lat)], the region of the internal intercostal muscle proximal to the branch point (IIm), and muscles innervated from the distal remainder (Dist). Strong specificity was observed, only 2 of 54 motoneurons showing excitatory postsynaptic potentials (EPSPs) from both Lat and Dist. No EO motoneurons showed an EPSP from Dist, and no IIm motoneurons showed one from Lat. Expiratory Dist motoneurons fell into two groups. Those with Dist EPSPs and none from Lat ( group A) were assumed to innervate distal internal intercostal muscle. Those with Lat EPSPs ( group B) were assumed to innervate abdominal muscle (transversus abdominis or rectus abdominis). Inspiratory Dist motoneurons (assumed to innervate interchondral muscle) showed Dist EPSPs. Stimulation of dorsal ramus nerves gave EPSPs in 12 instances, 9 being in group B Dist motoneurons. The complete absence of heteronymous monosynaptic Group I reflex excitation between muscles that are synergistically activated in expiration leads us to conclude that such connections from muscle spindle afferents of the thoracic nerves have little role in controlling expiratory movements but, where present, support other motor acts.

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Zitoun, Omar, Erik La Hei, and Jacob Goldstein. "Left internal mammary artery originating from the third intercostal artery." Asia Pacific Heart Journal 7, no. 3 (December 1998): 223–24. http://dx.doi.org/10.1016/s1328-0163(98)90040-9.

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Legrand, Alexandre, and André De Troyer. "Spatial distribution of external and internal intercostal activity in dogs." Journal of Physiology 518, no. 1 (July 1999): 291–300. http://dx.doi.org/10.1111/j.1469-7793.1999.0291r.x.

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Miller, Alan D. "Respiratory muscle control during vomiting." Canadian Journal of Physiology and Pharmacology 68, no. 2 (February 1, 1990): 237–41. http://dx.doi.org/10.1139/y90-037.

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The changes in thoracic and abdominal pressures that generate vomiting are produced by coordinated action of the major respiratory muscles. During vomiting, the diaphragm and external intercostal (inspiratory) muscles co-contract with abdominal (expiratory) muscles in a series of bursts of activity that culminates in expulsion. Internal intercostal (expiratory) muscles contract out of phase with these muscles during retching and are inactive during expulsion. The periesophageal portion of the diaphragm relaxes during expulsion, presumably facilitating rostral movement of gastric contents. Recent studies have begun to examine to what extent medullary respiratory neurons are involved in the control of these muscles during vomiting. Bulbospinal expiratory neurons in the ventral respiratory group caudal to the obex discharge at the appropriate time during (fictive) vomiting to activate either abdominal or internal intercostal motoneurons. The pathways that drive phrenic and external intercostal motoneurons during vomiting have yet to be identified. Most bulbospinal inspiratory neurons in the dorsal and ventral respiratory groups do not have the appropriate response pattern to initiate activation of these motoneurons during (fictive) vomiting. Relaxation of the periesophageal diaphragm during vomiting could be brought about, at least in part, by reduced firing of bulbospinal inspiratory neurons.Key words: brain stem, bulbospinal respiratory neurons, vomiting center critique, diaphragm, abdominal muscles.

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SÖDERBERGH, GOTTHARD. "Zona intercostal et symptômes moteurs du côté de l'abdomen." Acta Medica Scandinavica 52, no. 1 (April 24, 2009): 225–26. http://dx.doi.org/10.1111/j.0954-6820.1919.tb08281.x.

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SÖDERBERGH, GOTTHARD. "Syndromes moteurs de l'abdomen en présence de zona intercostal." Acta Medica Scandinavica 54, no. 1 (April 24, 2009): 170–81. http://dx.doi.org/10.1111/j.0954-6820.1921.tb15175.x.

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Seok Nam, Yong, Eunah Hong, Jin Geun Kwon, In-Beom Kim, Jin Sup Eom, and Hyun Ho Han. "Safety of Retrograde Flow of Internal Mammary Vein: Cadaveric Study and Anatomical Evidence." Journal of Reconstructive Microsurgery 36, no. 05 (January 28, 2020): 316–24. http://dx.doi.org/10.1055/s-0039-1701032.

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Abstract Background Additional second vessels may be required to handle multiple flaps used to add breast volume, boost blood flow for supercharging, or use salvage recipient vessels. In these situations, retrograde internal mammary vessel flow can be used although this causes doubts and concerns. Patients and Methods Forty sides of the chests of 20 fresh cadavers with intact thoracic cages and internal mammary veins (IMV) were used in the study. IMV valve numbers and locations were checked, and the bifurcation was confirmed. A retrograde fluorescent angiography and a saline infusion test were followed to confirm flow direction. Results Twenty-eight vessels were identified in 40 sides of the chest; of them, 45% had no valves. A mean 0.7 valves per chest side were identified; 23 (82.1%) of 28 valves were located above the second intercostal space (ICS). A mean 1.76 communicating veins were found between the IMV bifurcation. In all cadavers, a crossing vein connecting the left and right medial IMV was confirmed just below the xiphoid process. Fluorescent angiography and a saline infusion test proved that the retrograde flow was caudal through the bifurcated IMV to the communicating, intercostal, and crossing veins. Conclusion The IMV valve was present in 55% of our subjects and located concentrically above the second ICS level. It is highly unlikely that the retrograde flow was disturbed because the retrograde anastomosis level was below the second ICS. Furthermore, the bifurcation, intercostal, and crossing veins across the xiphoid process enabled valve-less detour flow. Thus, retrograde IMV flow is considered safe.

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Sbarouni, Eftihia, Laura Corr, and Albert Fenech. "Microcoil embolization of large intercostal branches of internal mammary artery grafts." Catheterization and Cardiovascular Diagnosis 31, no. 4 (April 1994): 334–36. http://dx.doi.org/10.1002/ccd.1810310417.

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Fregosi, R. F., and D. Bartlett. "Internal intercostal nerve discharges in the cat: influence of chemical stimuli." Journal of Applied Physiology 66, no. 2 (February 1, 1989): 687–94. http://dx.doi.org/10.1152/jappl.1989.66.2.687.

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We studied the influence of central and peripheral chemoreceptor stimulation on the activities of the phrenic and internal intercostal (iic) nerves in decerebrate, vagotomized, and paralyzed cats with bilateral pneumothoraces. Whole iic nerves of the rostral thorax (T2-T5) usually discharged during neural inspiration, whereas those of the caudal thorax (T7-T11) were primarily active during neural expiration. Filaments of rostral iic nerves that terminated in iic muscles generally discharged during expiration, suggesting that inspiratory activity recorded in whole iic nerves may have innervated other structures, possibly parasternal muscles. All nerves were phasically active at hyperoxic normocapnia and increased their activities systematically with hypercapnia. Isocapnic hypoxia or intra-arterial NaCN injection consistently increased phrenic and inspiratory iic nerve activities. In contrast, expiratory iic nerve discharges were either decreased (10 cats) or increased (7 cats) by hypoxia. Furthermore, expiratory responses to NaCN were highly variable and could not be predicted from the corresponding response to hypoxia. The results show that central and peripheral chemoreceptor stimulation can affect inspiratory and expiratory motoneuron activities differentially. The variable effects of hypoxia on expiratory iic nerve activity may reflect a relatively weak influence of carotid body afferents on expiratory bulbospinal neurons. However, the possibility that the magnitude of expiratory motoneuron activity is influenced by the intensity of the preceding centrally generated inspiratory discharge is also discussed.

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LEDUC, DIMITRI, ERIC BRUNKO, and ANDRÉ DE TROYER. "Response of the Canine Internal Intercostal Muscles to Chest Wall Vibration." American Journal of Respiratory and Critical Care Medicine 163, no. 1 (January 2001): 49–54. http://dx.doi.org/10.1164/ajrccm.163.1.2004166.

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Townsley, M. I., D. Negrini, and J. L. Ardell. "Regional blood flow to canine parietal pleura and internal intercostal muscle." Journal of Applied Physiology 70, no. 1 (January 1, 1991): 97–102. http://dx.doi.org/10.1152/jappl.1991.70.1.97.

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Transcapillary Starling forces in the parietal pleura and the underlying interstitium may potentially contribute to the exchange of fluid across this barrier. However, the extent of blood flow to the parietal pleura has not been measured. Thus, using standard microsphere techniques, we compared blood flow to the parietal pleura, including the subpleural interstitium, with blood flow to the adjacent internal intercostal muscle, as well as with flows to other serous tissues, including mediastinal pleura, pericardium, and parietal peritoneum, in anesthetized dogs that were either breathing spontaneously (n = 9) or ventilated to control arterial PCO2 (n = 5). Blood flow (ml.min-1.g-1) was measured after 20 min of equilibration in four successive body positions: right lateral decubitus, supine, left lateral decubitus, and prone. Overall, flow to parietal pleura was not different in spontaneous [1.07 +/- 0.14 (SE)] and mechanically ventilated animals (0.74 +/- 0.11). Flow to the internal intercostal muscle was significantly less than pleural blood flow, averaging 0.24 +/- 0.03 and 0.16 +/- 0.03 in the same groups, although again there was no effect of ventilation mode. Blood flow to other serous tissues in the thoracic cavity, specifically the mediastinal pleura (0.67 +/- 0.14) and pericardium (0.88 +/- 0.22), was similar to parietal pleural flow, whereas that to the parietal peritoneum was an order of magnitude lower (0.09 +/- 0.02, P less than 0.05). Changing body position had no effect on blood flow to any of the sampled tissues. Blood flow to the dorsal aspect of the chest wall muscle in spontaneously breathing animals tended to be greater than that to lateral or ventral portions of the chest wall.(ABSTRACT TRUNCATED AT 250 WORDS)

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De Troyer, André, Alexandre Legrand, and Theodore A. Wilson. "Respiratory mechanical advantage of the canine external and internal intercostal muscles." Journal of Physiology 518, no. 1 (July 1999): 283–89. http://dx.doi.org/10.1111/j.1469-7793.1999.0283r.x.

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Wilson, Theodore A., Alexandre Legrand, Pierre‐Alain Gevenois, and André Troyer. "Respiratory effects of the external and internal intercostal muscles in humans." Journal of Physiology 530, no. 2 (January 2001): 319–30. http://dx.doi.org/10.1111/j.1469-7793.2001.0319l.x.

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Bellingham, Mark C. "Synaptic Inhibition of Cat Phrenic Motoneurons by Internal Intercostal Nerve Stimulation." Journal of Neurophysiology 82, no. 3 (September 1, 1999): 1224–32. http://dx.doi.org/10.1152/jn.1999.82.3.1224.

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Intracellular recordings from 65 phrenic motoneurons (PMNs) in the C5 segment and recordings of C5 phrenic nerve activity were made in 27 pentobarbitone-anesthetized, paralyzed, and artificially ventilated adult cats. Inhibition of phrenic nerve activity and PMN membrane potential hyperpolarization (48/55 PMNs tested) was seen after stimulation of the internal intercostal nerve (IIN) at a mean latency to onset of 10.3 ± 2.7 ms. Reversal of IIN-evoked hyperpolarization ( n = 14) by injection of negative current or diffusion of chloride ions occurred in six cases, and the hyperpolarization was reduced in seven others. Stimulation of the IIN thus activates chloride-dependent inhibitory synaptic inputs to most PMNs. The inhibitory phrenic nerve response to IIN stimulation was reduced by ipsilateral transection of the lateral white matter at the C3 level and was converted to an excitatory response by complete ipsilateral cord hemisection at the same level. After complete ipsilateral hemisection of the spinal cord at C3 level, stimulation of the IIN evoked both excitatory and inhibitory postsynaptic potentials (EPSPs and IPSPs) in PMNs ( n = 10). It was concluded that IIN stimulation can evoke both excitatory and inhibitory responses in PMNs using purely spinal circuitry, but that excitatory responses are normally suppressed by a descending pathway in intact animals. Fifteen PMNs were tested for possible presynaptic convergence of inputs in these reflex pathways, using test and conditioning stimuli. Significant enhancement (>20%) of IPSPs were seen in seven of eight IIN-evoked responses using pericruciate sensorimotor cortex (SMC) conditioning stimuli, but only one of five IIN-evoked responses were enhanced by superior laryngeal nerve (SLN) conditioning stimuli. The IIN-evoked IPSP was enhanced in one of two motoneurons by stimulation of the contralateral phrenic nerve. It was concluded that presynaptic interneurons were shared by the IIN and SMC pathways, but uncommonly by other pathways. These results indicate that PMNs receive inhibitory synaptic inputs from ascending thoracocervical pathways and from spinal interneurons. These inhibitory reflex pathways activated by afferent inputs from the chest wall may play a significant role in the control of PMN discharge, in parallel with disfacilitation following reduced activity in bulbospinal neurons projecting to PMNs.

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Matsumoto, Shigeji, and Takeshi Nagamine. "Effects of acetylcholine on internal intercostal muscle activity in the rabbit." Neuroscience Letters 80, no. 1 (September 1987): 66–70. http://dx.doi.org/10.1016/0304-3940(87)90496-4.

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Abe, Tomonobu, Hiroto Suenaga, Hideki Oshima, Yoshimori Araki, Masato Mutsuga, Kazuro Fujimoto, and Akihiko Usui. "An L-Shaped Incision for an Extensive Thoracic Aortic Aneurysm and Coronary Artery Bypass Using the Left Internal Thoracic Artery." AORTA 03, no. 02 (April 2015): 86–89. http://dx.doi.org/10.12945/j.aorta.2015.14-061.

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AbstractAn L-shaped incision combining an upper half mid-sternotomy and a left antero-lateral thoracotomy at the fourth intercostal space has been proposed by several authors for extensive aneurysms involving the aortic arch and the proximal thoracic descending aorta. This approach usually requires the division of the left internal thoracic artery at its mid position, thus making it unusable for coronary artery bypass. We herein report a modified surgical approach for simultaneous extensive arch and proximal thoracic descending aorta replacement and coronary artery bypass using the left internal thoracic artery combining a left antero-lateral thoracotomy at the sixth intercostal space and upper mid-sternotomy. The visualization of the whole diseased aorta down to the level below the hilum of the left lung was good, and the integrity of the left internal thoracic artery graft was preserved by early heparin administration before sternotomy.

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DiMarco, A. F., J. R. Romaniuk, K. E. Kowalski, and G. Supinski. "Mechanical contribution of expiratory muscles to pressure generation during spinal cord stimulation." Journal of Applied Physiology 87, no. 4 (October 1, 1999): 1433–39. http://dx.doi.org/10.1152/jappl.1999.87.4.1433.

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Lower thoracic spinal cord stimulation (SCS) results in the generation of large positive airway pressures (Paw) and may be a useful method of restoring cough in patients with spinal cord injury. The purpose of the present study was to assess the mechanical contribution of individual respiratory muscles to pressure generation during SCS. In anesthetized dogs, SCS was applied at different spinal cord levels by using a 15-lead multicontact electrode before and after sequential ablation of the external and internal obliques, transversus abdominis (TA), rectus abdominis, and internal intercostal muscles. Paw was monitored after tracheal occlusion. SCS at the T9 spinal cord level resulted in maximal changes in Paw (60 ± 3 cmH2O). Section of the oblique muscles resulted in a fall in Paw to 29 ± 2 cmH2O. After subsequent section of the rectus abdominis and TA, Paw fell to 25 ± 2 and 12 ± 1 cmH2O respectively. There was a small remaining Paw (4 ± 1 cmH2O) after section of the internal intercostal nerves. Stimulation with a two-electrode lead system (T9 + T13) resulted in significantly greater pressure generation compared with a single-electrode lead due to increased contributions from the obliques and transversus muscles. In a separate group of animals, Paw generation was monitored after section of the abdominal muscles and again after section of the external intercostal and levator costae muscles. These studies demonstrated that inspiratory intercostal muscle stimulation resulted in only a small opposing inspiratory action (≤3 cmH2O). We conclude that, during SCS, 1) contraction of the obliques and TA muscles makes the largest contribution to changes in Paw, and 2) stimulation with a two-electrode lead system results in more complete abdominal muscle activation and enhanced mechanical actions of the obliques and transversus muscles.

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De Troyer, A., and A. Legrand. "Inhomogeneous activation of the parasternal intercostals during breathing." Journal of Applied Physiology 79, no. 1 (July 1, 1995): 55–62. http://dx.doi.org/10.1152/jappl.1995.79.1.55.

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Recent computations of the mechanical advantage of the canine intercostal muscles have suggested that the inspiratory advantage of the parasternal intercostals is not uniform. In the present studies, we have initially tested this hypothesis. Using a caliper and markers implanted in the costal cartilages, we have thus measured, in four supine paralyzed dogs, the length of the medial, middle, and lateral parasternal fibers at functional residual capacity and after a 1-liter mechanical inflation. With inflation, the medial fibers always shortened more than did the middle fibers (-9.8 +/- 0.8 vs. -6.0 +/- 0.8%; P < 0.001), whereas the lateral fibers remained virtually constant in length (-0.2 +/- 0.8%). This gradient of mechanical advantage agreed well with the gradient of orientation of the muscle fibers. Therefore, we have also recorded the electromyograms of the medial, middle, and lateral parasternal bundles during spontaneous breathing in nine anesthetized animals (20 interspaces); each activity was expressed as a percentage of the activity recorded during tetanic, supramaximal stimulation of the internal intercostal nerve (maximal activity). The medial bundle was invariably more active than was the middle bundle during resting breathing (57.3 +/- 3.3 vs. 25.5 +/- 3.4% of maximum; P < 0.001), and in 10 interspaces, medial activity consistently preceded middle activity at the onset of inspiration. These differences persisted during hypercapnia, during inspiratory resistive loading, as well as after phrenicotomy. Activity was never recorded from the lateral bundle.

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He, Qingqing. "Internal mammary node biopsy for breast cancer patients: Issues for discussion and our practice." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e22089-e22089. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e22089.

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e22089 Background: The aims of this study was to determine the clinical implications of internal mammary node biopsy as staging, treatment with radiotherapy and systemic treatment and a prognostic factor in patients with breast cancer. Methods: Internal mammary node biopsy via intercostal space was performed in 344 cases of breast cancer. Anatomical location of internal mammary nodes were recorded. Pathological status of internal mammary node were detected by H and E stains. Results: Internal mammary node biopsy was successfully finished in 344 patients.There were 162 cases (48.26%) with positive axillary nodes, while the internal mammary nodes were involved in 72 cases (20.93%).53 patients (32.72%) had regional metastases in both the axillary and internal mammary lymph nodes.19 (5.52%) patients had internal mammary node metastasis but no axillary node metastases. PN stage migration was seen in 72 patients with a positive internal mammary node. There was no statistic relation between internal mammary nodes metastases and tumor location (X2 =0.48, P>0.05). There was no complication such as pneumothorax or haemorrhagia. Conclusions: The approach used is a reliable surgical technique for removing lymph node from intercostal space. Without exploring internal mammary nodes status, pN stage was incomplete. Internal mammary node biopsy enables treatment to be better adjusted to the needs of the individual patient. Using internal mammary node biopsy, patients with a negative internal mammary node can be prevented from radiation to internal mammary nodal areas. This leads to optimization of treatment.

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MATSUMOTO, Shigeji. "Effects of transient hypoxia on internal intercostal muscle activity in vagotomized rabbits." Japanese Journal of Physiology 37, no. 2 (1987): 197–206. http://dx.doi.org/10.2170/jjphysiol.37.197.

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Sarnak, Mark J., and Andrew S. Levey. "Placement of an internal jugular dialysis catheter into the superior intercostal vein." Nephrology Dialysis Transplantation 14, no. 8 (August 1, 1999): 2028–29. http://dx.doi.org/10.1093/ndt/14.8.2028.

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Mehmet, O. C., O. C. Bahar, and Ilhan Pasaoglu. "Anomalous Origin of Left Internal Thoracic Artery from the Second Intercostal Artery." International Journal of Morphology 30, no. 4 (December 2012): 1590–92. http://dx.doi.org/10.4067/s0717-95022012000400051.

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La Hei, Erik R., and Cedric W. Deal. "Intercostal lung hernia subsequent to harvesting of the left internal mammary artery." Annals of Thoracic Surgery 59, no. 6 (June 1995): 1579–80. http://dx.doi.org/10.1016/0003-4975(94)01035-b.

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Oliven, A., E. C. Deal, S. G. Kelsen, and N. S. Cherniack. "Effects of hypercapnia on inspiratory and expiratory muscle activity during expiration." Journal of Applied Physiology 59, no. 5 (November 1, 1985): 1560–65. http://dx.doi.org/10.1152/jappl.1985.59.5.1560.

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Persistence of inspiratory muscle activity during the early phase of expiratory airflow slows the rate of lung deflation, whereas heightened expiratory muscle activity produces the opposite effect. To examine the influence of increased chemoreceptor drive and the role of vagal afferent activity on these processes, the effects of progressive hypercapnia were evaluated in 12 anesthetized tracheotomized dogs before and after vagotomy. Postinspiratory activity of inspiratory muscles (PIIA) and the activity of expiratory muscles were studied. During resting breathing, the duration of PIIA correlated with the duration of inspiration but not with expiration. Parasternal intercostal PIIA was directly related to that of the diaphragm. Based on their PIIA, dogs could be divided into two groups: one with prolonged PIIA (mean 0.57 s) and the other with brief PIIA (mean 0.16 s). Hypercapnia caused progressive shortening of the PIIA in the dogs with prolonged PIIA during resting breathing. The electrical activity of the external oblique and internal intercostal muscles increased gradually during CO2 rebreathing in all dogs both pre- and postvagotomy. After vagotomy, abdominal activity continued to increase with hypercapnia but was less at all levels of PCO2. The internal intercostal response to hypercapnia was not affected by vagotomy. The combination of shorter PIIA and augmented expiratory activity with hypercapnia might, in addition to changes in lung recoil pressure and airway resistance, hasten exhalation.

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Comtois, A., W. Gorczyca, and A. Grassino. "Anatomy of diaphragmatic circulation." Journal of Applied Physiology 62, no. 1 (January 1, 1987): 238–44. http://dx.doi.org/10.1152/jappl.1987.62.1.238.

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The diaphragmatic circulation was studied in 48 mongrel dogs weighing 10–35 kg by injecting acrylic coloring into the arteries and veins of the diaphragm. The phrenic arteries and internal mammary arteries were found to anastomose head to head, forming an internal arterial circle around the medial leaflet of the diaphragm tendon. This arterial circle emitted vascular branches that traveled between muscle fibers toward the periphery of the diaphragm. These branches anastomosed with vessels of the intercostal arteries to form costophrenic arcades all along the fibers of the crural and costal diaphragms. The intercostal arteries were anastomosed to one another by small vessels within the muscular diaphragm, thus forming an arterial ring around the insertions of the diaphragm on the ribs. The venous drainage has an anatomic distribution similar to that observed on the arterial side, but with the additional presence of valves that could play a role in directing blood flow.

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Barsoum, Emad A., Vratika Agarwal, Nikhil Nalluri, Samer Saouma, Peter Olson, Frank Tamburrino, James Lafferty, and Mohammad Zgheib. "CORONARY STEAL SYNDROME DUE TO LEFT INTERNAL MAMMARY INTERCOSTAL BRANCH: IMPROVED WITH COILING." Journal of the American College of Cardiology 71, no. 11 (March 2018): A2140. http://dx.doi.org/10.1016/s0735-1097(18)32681-0.

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Zhang, Bin, Ke-Yi Li, Li-Cheng Jiang, Zhen Meng, Xiu-Mei Wang, Fu-Zhai Cui, Ying-Nan Zhu, and Ya-Ping Wu. "Rib Composite Flap With Intercostal Nerve and Internal Thoracic Vessels for Mandibular Reconstruction." Journal of Craniofacial Surgery 27, no. 7 (October 2016): 1815–18. http://dx.doi.org/10.1097/scs.0000000000003060.

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Kim, K. O., J. O. Jo, H. S. Kim, and C. S. Kim. "Positioning internal jugular venous catheters using the right third intercostal space in children." Acta Anaesthesiologica Scandinavica 47, no. 10 (November 2003): 1284–86. http://dx.doi.org/10.1046/j.1399-6576.2003.00247.x.

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Patel, Vipool, Steven R. Bailey, Edward O'Leary, and Mark H. Hoyer. "Novel technique for coil embolization of intercostal branch of internal mammary artery graft." Catheterization and Cardiovascular Diagnosis 42, no. 2 (October 1997): 229–31. http://dx.doi.org/10.1002/(sici)1097-0304(199710)42:2<229::aid-ccd32>3.0.co;2-g.

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