External Intercostal Muscle Biopsy

Abstract

External intercostal muscle biopsies were performed on 36 patients with neuromuscular disease, 13 patients un¬ dergoing thoracotomy for other diseases, and 3 healthy volunteers. The procedure is safe, of diagnostic value, and uniquely useful as a research tool, as it allows cor¬ relation of results of histochemical, ul¬ trastructural, physiological, pharmaco¬ logical, and biochemical studies on the same specimens. (Arch Neurol 32:779-780, 1975) External intercostal muscle biopsy has been shown to be of unique usefulness in the study of human neuromuscular disease.112 Providing intact fibers, it allows direct corre¬ lation of results of morphological, physiological, pharmacological, and biochemical studies on the same specimens. Recently, we presented evidence that the same histochemical and ultrastructural changes known to occur in limb muscle that had under¬ gone biopsy also occur in intercostal muscle in the muscular dystrophies and motor neuron disease.11 Previous reports have not, however, detailed the method of performing intercostal biopsy and treating the tissue. The purpose of this communication is to describe the surgical aspects of the biopsy, preparation of specimens, and our clinical experience. SUBJECTS AND METHODSThirty-six patients were recruited from among those being observed at the Univer¬ sity of Arizona Clinic for Neuromuscular Disorders. The diagnostic categories in¬ cluded various forms of muscular dys¬ trophy and spinal muscular atrophy, motor neuron disease, paramyotonia congenita, and the myopathies associated with acro¬ megaly and hyperthyroidism. Of these, seven had previously had diagnostic limb muscle biopsies elsewhere and two patients had both limb and intercostal biopsies here. Biopsies were also obtained from 13 adult patients without neuromuscular dis¬ ease, who were undergoing thoracotomy for other diseases, and from 3 healthy adult volunteers. Control subjects were all under 60 years of age. Informed consent was obtained after the nature of the proce¬ dure had been fully explained.A chest roentgenogram and pulmonary function studies were performed on all subjects prior to biopsy. As a precaution, patients were kept in the hospital for one night after the biopsy. Except in the tho¬ racotomy cases, specimens were obtained from the left sixth intercostal space in the midaxillary line, using paravertebral nerve block anesthesia. Blockage of four or five intercostal nerves (usually the fifth to ninth) gave consistently satisfactory anes¬ thesia. Lidocaine (1.5%) or bupivacaine (Marcaine) (0.25%) were the local anesthet¬ ics employed (each usually with 1:200,000 epinephrine). With the patient in the right lateral decubitus position, a 4.5-cm incision was made through the superficial thoracic fascia. The latissimus dorsi and the under¬ lying serratus anterior were divided in the direction of the fibers, exposing the sixth intercostal space. A 2 x 3-cm parallelogram of external intercostal muscle, weighing about 3.5 gm, was removed, with a rim of periosteum left attached to either e...

Complement deposition at the neuromuscular junction in seronegative myasthenia gravis

“…Hence, their use is currently confined to specialized research centers [8]. In this study, we opted for external intercostal muscle biopsy, since it has been shown to be of unique usefulness in the study of human neuromuscular disease [9,10]. The external intercostal muscle is a short, flat muscle with abundant motor endplates allowing for detailed examinations of the NMJ.…”

A Study of the Contractility, Biochemistry and Morphology of an Isolated Preparation of Human Skeletal Muscle

“…An intercostal preparation is the only one which satisfies this criterion, and it is both difficult to obtain and not representative of all skeletal muscle (Dillon, Fields, Guman, Jenden & Taylor, 1955;Elmqvist, Johns & Thesleff, 1960;Stern, Gruener & Anderson, 1975). In this paper a detailed evaluation has been made of an isolated preparation of human muscle comprising fibres with cut ends.…”

Protection of human muscle acetylcholinesterase from soman by pyridostigmine bromide

“…Biopsy of the external intercostal muscle was performed as described elsewhere 13. Patients undergoing thoracic surgery under general anesthesia, who were not receiving chemotherapy and had not had prior local radiation, had a 1–1.5‐cm strip of external intercostal muscle surgically removed prior to thoracotomy.…”