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Lymphatic anatomy: lymphatics of the breast and axilla
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
The pectoralis major muscle is a fan-shaped muscle with two divisions. The clavicular division originates from the clavicle and can be easily distinguished from the larger costosternal division that originates from the sternum and costal cartilage of ribs 2–6. These fibers converge on the greater tubercle of the humerus. The pectoralis minor muscle is located beneath the pectoralis major muscle and arises from the external surface of ribs 2–5. The posterior suspensory ligaments extend from the deep surface of the breast to the deep pectoral fascia. The subscapular muscle arises from the first rib near the costochondral junction and extends laterally to insert on the inferior surface of the clavicle.
Complications of surgery for thoracic outlet syndrome
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Neurogenic TOS (85–95% of all patients with TOS) is characterized by compression of the brachial plexus nerve roots within the scalene triangle and/or subcoracoid space. This may arise as a result of two factors: (a) predisposing variations in anatomy, such as anomalous scalene musculature, aberrant fibrofascial bands, or cervical ribs; and (b) neck or upper extremity injury that has resulted in chronic spasm, fibrosis, and other pathological changes affecting the scalene and pectoralis minor muscles. The symptoms of brachial plexus nerve root compression consist of variable degrees of pain, numbness, and tingling (paresthesias) in the neck, shoulder, arm, and hand, aggravated by arm elevation and activity.2–5
Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
A clavicular osteotomy may be required to facilitate access, especially if there is a vascular injury. In this case a plate should be precontoured and holes predrilled for easy fixation at the end of the procedure, remembering that the bone will be shortened by the thickness of the saw blade. Distally the pectoralis major muscle is detached from the humerus in its upper portion or, if required, its entirety. The muscle is then reflected medially exposing the clavicle, pectoralis minor muscle and clavipectoral fascia (Figure 5.12). The pectoralis minor muscle is divided at its tendon taking care not to damage the musculocutaneous nerve. The subclavius muscle is divided with the suprascapular vessels (once ligated). This exposes the entire plexus and vasculature from the first rib to the axilla.
Modified Taohong Siwu decoction improves cardiac function after myocardial ischaemia and reperfusion in rats by promoting endogenous stem cell mobilization and regulating metabolites
Published in Pharmaceutical Biology, 2022
Wan-ting Meng, Zhong-Xin Xiao, Han Li, Ya-chao Wang, Yue Zhao, Yan Zhu, Hai-dong Guo
Sixty Sprague-Dawley (SD) rats (180–200 g) were purchased from the Experimental Animal Centre of Shanghai University of TCM (Shanghai, China). The rats were anaesthetized with isoflurane (Hebei Yipin Pharmaceutical, Co., Ltd., Shijiazhuang, China) at a flow rate of 0.25 L/min, and fixed on the surgical table in a supine position. After successful endotracheal intubation, the endotracheal tube was connected to a rodent ventilator (Harvard Apparatus; Holliston, MA, USA). Next, the rats were maintained under anaesthesia, and the ventilation rate was set to 120/min. A longitudinal incision was made and the pectoralis major and pectoralis minor muscle layers were separated until the ribs were exposed. To expose the heart, the thoracic cavity of the rats was opened using a chest expander in the intercostal space of the third rib. The lower edge of the left anterior descending coronary artery (LAD) was passed through a suture needle, and a latex tube was placed at the ligation site to avoid damaging the artery. After successful ligation, the outer surface of the left ventricle anterior wall became pale. The chest expander was removed, and the surgical opening was closed for 30 min of ischaemia. After the ischaemia was completed, a chest expander was placed to expose the heart again to untie the knot and remove the latex tube. The incision was closed and disinfected using iodophor. This study was approved by the Animal Ethics Committee of Shanghai University of TCM (No. PZSHUTCM190628003). We attempted to minimize the number of rats used and animal suffering during the experimental procedure.
Could kinesiology taping of the inspiratory muscles help manage chronic breathlessness? An opinion paper
Published in Progress in Palliative Care, 2022
G. Banerjee, A. Rose, M. Briggs, P. Plant, M. I. Johnson
The findings of explanatory studies using healthy human participants are generally inconsistent. Zübeyir et al.28 conducted a study without a comparison group and found no significant improvements in MIP and maximal expiratory pressure (MEP) associated with kinesiology taping of the primary muscle of inspiration (diaphragm) (n = 23), nor kinesiology taping of the accessory muscles of inspiration (sternocleidomastoid, scalene anterior and middle) and expiration (rectus obliquus externus and internus) (n = 24). In contrast, Malehorn et al.29 found that kinesiology taping of the thorax was associated with a greater expiratory tidal volume and a significant improvement in mechanical efficiency compared with no taping control (n = 12). Lee et al.30 compared the combined effect of inspiratory muscle training (IMT) plus kinesiology taping of diaphragm, scalene, sternocleidomastoid and pectoralis minor muscles with IMT alone (n = 10 per group) and found significant improvements in MIP, peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1)/FVC from pre-intervention values in both the groups. There was a significant improvement in minute volume from pre-intervention in kinesiology taping plus IMT group but not in IMT group.
Role of Intraoperative Nerve Monitoring in Postoperative Muscle and Nerve Function of Patients Undergoing Modified Radical Mastectomy
Published in Journal of Investigative Surgery, 2021
Serhat Tokgöz, Ebru Karaca Umay, Kerim Bora Yilmaz, Muzaffer Akkoca, Melih Akinci, Cem Azili, Mehmet Saydam, Yasin Ucar, Şener Balas
A total of 22 patients who underwent MRM at the Breast Surgery Unit of our hospital were included in the study after the necessary ethics committee approvals and patient consents were obtained (approval no. 51-08). Patients who underwent breast-conserving surgery and patients for whom axillary dissection had been chosen according to sentinel lymph node biopsy results were excluded from the study. In 11 patients included in the study, the LPN, MPN, TLN, and TDN were identified and protected by nerve monitoring during the axillary dissection (IONM group). In another 11 patients, nerve monitoring was not performed; however, protection of the same nerves was attempted through careful nerve dissection with the technique described below (CND group). In addition to the study patients, 22 patients with no previous breast surgery, no active symptoms related to the anterior chest and arm, and no cervical neuropathy were included as the control group. The pectoralis minor muscle (PMM) was preserved and a standard Level II axillary dissection was performed. Patients with nerve injury detected preoperatively, with nerve invasion, who underwent Level III axillary dissection, or who underwent PMM resection were excluded from the study.