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Lung Matters
Published in Namrita Lall, Medicinal Plants for Cosmetics, Health and Diseases, 2022
The lungs are the major organs of the respiratory system, with this pulmonary circulation aiding in gaseous exchange. Each of the lungs is paired and separated into lobes, with the left lung consisting of two lobes and the right lung consisting of three lobes. Blood circulation to the lungs plays a vital role, as blood is required to transport oxygen from the lungs to other tissues throughout the body. Deoxygenated blood from the body is delivered to the lungs via the pulmonary artery to the capillaries that form respiratory membranes with the alveoli, where oxygen is replenished. The pulmonary veins then return newly oxygenated blood to the heart for further transport throughout the body. Parasympathetic and sympathetic nervous systems throughout the lungs coordinate both bronchodilation and bronchoconstriction of the airways. The pleural membrane that is composed of visceral and parietal pleural layers encloses the lungs. These two layers have a space between them known as the pleural cavity. The pleural membrane has mesothelial cells which create pleural fluid, serving as a lubricant to reduce friction during breathing and as an adhesive to adhere the lungs to the thoracic wall, thereby facilitating the movement of the lungs during ventilation (Baile, 1996).
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
Lymphatic mapping of the breast is altering the long-standing approach to the breast cancer treatment model: radical mastectomy with complete axillary lymphadenectomy. It is a dramatic departure from Halsted’s modality of 100 years ago.1 The status of the axillary lymph node has consistently been shown to be the most significant prognostic factor in patients with breast cancer.2 The breast lies within the superficial fascia of the anterior thoracic wall. It is situated between the second and sixth ribs and the sternal edge and midaxillary line. The posterior surface of the breast ends abruptly at the chest wall, where it reaches the pectoralis major fascia. It is composed of skin, parenchyma, and stroma. The stroma and connective tissue are intertwined with blood vessels, nerves, and lymphatics. Beneath the nipples are five to ten milk ducts which connect to five to ten additional ducts, each draining an individual breast lobe. Each lobe is composed of 20–40 lobules, which in turn connect to 10–100 tubulosaccular units called alveoli. The subcutaneous connective tissue surrounds glands and extends as septa between the lobes and lobules, providing support for the glandular elements. Cooper’s ligaments are suspensory structures that insert perpendicular to the dermis.
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
Sternalis has several presentations and varies widely in width, length, and attachments (Macalister 1875; Snosek and Loukas 2016; Standring 2016). When present, sternalis is a vertical slip of fibers in the anterior thoracic wall that lies close to the sternum and runs on top of pectoralis major, extending from the sternal/infraclavicular area to the upper abdominal wall or costal cartilages (Mori 1964; Jouffroy 1971; Jelev et al. 2001; Snosek and Loukas 2016; Standring 2016). It may originate from the manubrium, sternum, clavicle, upper ribs, upper costal cartilages, pectoralis fascia, pectoralis major and/or sternocleidomastoid and its fascia (Macalister 1875; Mori 1964; Jelev et al. 2001; Hung et al. 2012; Poveda et al. 2013; Snosek and Loukas 2016; Standring 2016; Duque-Parra et al. 2019). It may insert into the lower ribs and costal cartilages, pectoral fascia, pectoralis major, external oblique aponeurosis, and/or the rectus sheath (Macalister 1875; Mori 1964; Jelev et al. 2001; Hung et al. 2012; Poveda et al. 2013; Snosek and Loukas 2016; Standring 2016; Duque-Parra et al. 2019). Duque-Parra et al. (2019) found that sternalis fibers extended between sternocleidomastoid to the fascia of the seventh intercostal muscle. In this case, the muscle had two bellies.
The use of Fat-Augmented Latissimus Dorsi (FALD) flap for male Poland Syndrome correction: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Fabio Santanelli di Pompeo, Michail Sorotos, Guido Paolini, Gennaro D’Orsi, Guido Firmani
A 23-year-old male patient came to our attention with noticeable anterior thoracic wall asymmetry and left rib cage deformity, suggestive for PS. The patient presented a severe infra-clavicular hollowing on the left thoracic wall caused by lack of soft tissues along with a deformity of the costal cartilage ribs. This was classified as grade 3 severity according to Foucras classification. The left NAC appeared displaced toward the axilla, where the left anterior axillary pillar was missing (Figure 1). No limb deformity nor any alteration in the contralateral chest wall were observed. The ipsilateral LD muscle showed no morphological alteration during clinical examination. A chest Magnetic Resonance Imaging (MRI) scan was performed prior to surgery, showing agenesis of the left PM muscle belly, hypoplasia of the left mammary gland and a depression of the second, third, fourth and fifth chondro-costal junctions [11].
Deployment of acute mechanical circulatory support devices via the axillary artery
Published in Expert Review of Cardiovascular Therapy, 2019
Raj Tayal, Colin S. Hirst, Aakash Garg, Navin K. Kapur
Best practices for percutaneous axillary access are lacking. An understanding of the anatomy of the anterior superior thoracic wall and shoulder is crucial for successful and safe vascular access and hemostasis. Vascular access can be organized into three distinct phases: obtaining access, maintaining access and obtaining hemostatic closure. We underscore the importance of ultrasound-guided vascular access and espouse the tools, like micropuncture needles and sheaths, to ensure accurate percutaneous arterial entry. While these tools are a part of the evolving literature regarding best practice patterns for arterial access of all endovascular procedures, we present a unique and user-friendly radiographic approach to successful axillary arterial access using the head of the humerus and the inferior aspect of the glenoid cavity. We hope this approach may encourage the interventional cardiologist, vascular surgeon or cardiothoracic surgeon to pursue this percutaneous skillset as a means to offer alternative access for those patients without patent conduits of the iliofemoral tree. Our foresight lends our group to believe that this skillset, in fact, will help to develop the next phase of subacute mechanical circulatory support devices: dischargeable endovascular pumps deployed via the axillary artery. Although this device subtype remains purely speculative, the development in this space may turn theory into reality.
Bilateral open pneumothorax resulting in a sucking chest wound
Published in Acta Chirurgica Belgica, 2018
Sami Karapolat, Alaaddin Buran, Atila Turkyilmaz
The patient was operated on while in the prone position under general anesthesia. A thoracotomy was performed on the right side and then on the left to access the defect areas on the thoracic wall. The lacerated areas on the posterior basal segments of the lower lobes of both lungs were primarily sutured before the thoracotomies were closed. The vertebral defect area was then explored and bone fragments were removed. It was seen that, the dura mater was absent in the cut area, leaving the lacerated spinal cord uncovered. Finally, the muscle, fascia, and the subcutaneous and skin tissues of the posterior thoracic wall were primarily sutured. The patient was discharged on day seven with paraplegia due to the injury. At a six-month follow-up, he was still receiving physiotherapy for the paraplegia.