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Caesarean Section
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Disadvantages: The scar becomes uncomfortable when the pubic hair grows back. The formation of panniculus increases the humidity and warmth around the scar area, increasing the risk of infection in obese women. A higher incision called the Joel-Cohen incision does not have these disadvantages. It was introduced by Professor Joel-Cohen in 1974. The skin is incised 3 cm below the line joining the anterior superior iliac spines. The subcutaneous tissue and the rectus sheath are incised horizontally only in the midline. Thereafter the tissue, including fat and rectus sheath, is split open by finger dissection. Splitting avoids cutting a lot of vessels, including perforator vessels. The rectus muscle is retracted laterally. The parietal peritoneum is opened at a point as high as possible and incised vertically downwards. It is a good idea to incise the peritoneal under vision by sharp dissection rather than bluntly by finger dissection. Picking up the peritoneum between two artery forceps and ensuring translucency or palpating to rule out any intraperitoneal contents before incising is an important step to prevent accidental injury to the abdominal viscera like intestine.
Upper Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo
Panniculus carnosus is a cutaneous muscle sheet arising from the pectoral muscle mass and covering various trunk regions (Smith et al. 2015). It is present in many mammals and derives from the pectoralis muscle of amphibians and reptiles (Diogo et al. 2018). Bergman et al. (1988) state that panniculus carnosus is represented only by vestigial remnants in humans, which may present as extra muscular slips in the pectoral region. These slips may have attachments to the abdominal aponeurosis, rectus sheath, serratus anterior fascia, axillary fascia, the fascia between coracobrachialis and pectoralis minor, the humerus, or the coracoid process (Bergman et al. 1988). Several muscles in adult humans are considered to be remnants of panniculus carnosus, including some craniofacial muscles, platysma, pectorodorsalis, sternalis, abdominal external oblique, palmaris brevis, and potentially several other striated muscles in the upper limb, pectoral region, and trunk (Naldaiz-Gastesi et al. 2018).
Obesity
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Women with obesity can be a challenge because of related OSA and asthma. Positioning and placement of the panniculus can impair respiratory function [249]. In a morbidly obese patient (BMI > 40 kg/m2) undergoing a planned cesarean delivery, the overall conductive anesthesia complication rate is about 8%. General anesthesia in the obese pregnant woman also poses its own challenges including difficult endotracheal intubation due to excessive tissue and edema and intraoperative respiratory events from failed or difficult intubation [250]. General anesthesia is used more frequently in patients with obesity and intraoperative hypotension can be a problem [251]. Of about 1% maternal deaths that were anesthesia related, 75% were noted to be obese [252]. The incidence of partially obliterated oropharyngeal anatomy among obese parturients is double that among non-obese parturients. This leads to an increased risk of difficult intubations, gastric aspiration, and difficulty in maintaining adequate mask ventilation [249]. Mask ventilation tends to be difficult because of low chest wall compliance and increased intra-abdominal pressure. The anesthesiologist should have long epidural needles, and equipment such as a laryngeal mask ventilation, fiberoptic guidance, and/or ultrasound available for these challenging cases [2, 253]. In addition, women with obesity undergoing a cesarean delivery with spinal anesthesia who received a phenylephrine infusion (compared to bolus dosing) had less nausea and vomiting [254]. See also Chapter 12 in Obstetric Evidence Based Guidelines.
The ‘worm’ in our brain. An anatomical, historical, and philological study on the vermis cerebelli
Published in Journal of the History of the Neurosciences, 2023
Panniculus can be translated as a piece of cloth, a rag (see Dictionary of Medieval Latin from British Sources, abbr. DMLBS). Such a rag cannot move actively like the Galenic worm; but the mechanism of a valve is not explained further. Panniculus was a term already used by Avicenna to describe a membrane (Arráez-Aybar, Bueno-López, and Raio 2015), including what we call meninges, membraneous coverings of the brain and spinal cord: dura and arachnoidea/pia, the hard and the soft meninges.16See Liber Canonis III Fen I Tract. I. The philological history of dura mater/pia mater is specified comprehensively by Strohmaier (1996). Therefore, we cannot exclude that William was referring to a kind of membrane inside the ventricle, an ambiguity that persisted with later authorities.
Association of physical activity and trajectories of physical activity with cardiovascular disease
Published in Expert Review of Cardiovascular Therapy, 2023
Steven G. Chrysant, George S. Chrysant
Obesity is a major global health problem and is rising globally with an estimated incidence of 573 millon subjects to suffer with T2DM by 2030 [68–70]. In addition, obesity is associated with an increased incidence of T2DM, hypertension, and CVD. In this regard, the increased PA has been shown to decrease and prevent the incidence of CVD, T2DM, and hypertension [71–73]. Overweight and obesity are defined as BMI 25–29.9 kg/m2 and obesity as BMI ≥ 30 kg/m2 [74]. Maintenance of normal body weight is associated with reduced incidence of CV complications and death in both men and women [75–81]. In the Pathological Determinants of Atherosclerosis in the Youth Study, atherosclerotic lesions were observed only in those subjects with thick abdominal panniculus, indicating the fundamental role of central obesity in the development of atherosclerotic disease [82].
Impairment of wound healing by reactive skin decontamination lotion (RSDL®) in a Göttingen minipig® model
Published in Cutaneous and Ocular Toxicology, 2020
Jessica M. Connolly, Robert S. Stevenson, Roy F. Railer, Offie E. Clark, Kimberly A. Whitten, Robyn B. Lee-Stubbs, Dana R. Anderson
Additionally, although rodent models are established in the area of wound-healing research, they possess several dermatological dissimilarities to humans. They are described as loose-skinned animals with a contractile wound healing phenotype partly due to the panniculus carnosus muscle that is not present in humans15–18. This produces rapid wound closure post injury which is dissimilar from the re-epithelialization and granulation tissue formation that predominates in humans18. Additionally, rodents have a higher epidermal appendage density and non-similar hair follicles when compared to humans. Their skin thickness is disproportionate from humans and it is difficult to recreate a partial-thickness lesion15–18. The inherent differences in skin physiology and healing mechanisms of rodents warrant the use of a more anatomically and physiologically similar model to humans when assessing the effect of RSDL on superficial wound healing.