The superior thyroid veins accompany the superior thyroid arteries; they drain the superior poles of the thyroid gland; the middle thyroid veins do not accompany but run essentially parallel courses with the inferior thyroid arteries; they drain the middle of the lobes. The sudden pulling of the upper limb tears the distal attachment of the anular ligament, where it is loosely attached to the neck of the radius. The instrument is inserted transurethrally through the external urethral orifice and spongy urethra into the prostatic urethra. The significance of micro-aneurysms in hypertensive haemorrhage has been questioned. After passing through the pupil into the anterior chamber, the aqueous humor drains through a trabecular meshwork at the iridocorneal angle into the scleral venous sinus (L. The rich arterial supply of the thymus is derived mainly from the anterior intercostal and anterior mediastinal branches of the internal thoracic arteries. Although the rolling movement of the femoral condyles during flexion and extension is limited (converted to spin) by the cruciate ligaments, some rolling does occur, and the point of contact between the femur and the tibia moves posteriorly with flexion and returns anteriorly with extension. Special needles designed for manual insertion are used; battery-powered or impact-driven devices also are available to help aid insertion. Reactive microgliosis engages distinct responses by microglial subpopulations after minor central nervous system injury. Lymphatic vessels from the inferior surface of the diaphragm drain into the anterior diaphragmatic, phrenic, and superior lumbar (caval/aortic) lymph nodes. Branches of cervical plexus arising from the nerve loop between the anterior rami of C2 and C3 are the 2248 lesser occipital nerve (C2): supplies the skin of the neck and scalp posterosuperior to the auricle. Because of the arterial anastomosis, intracranial structures such as the brain can receive blood from the connection of the facial artery to the dorsal nasal branch of the ophthalmic artery. The transversalis fascia on the internal abdominal wall is continuous with the psoas fascia, where it forms a fascial covering for the psoas major that accompanies the muscle into the anterior region of the thigh. The peritoneum has been removed superior to sacral promontory and right iliac fossa, revealing the superior hypogastric plexus lying in the bifurcation of the abdominal aorta and the internal iliac artery, ureter, and ductus deferens crossing the pelvic brim to enter the lesser pelvis. The fleshy part of the muscle contributes primarily to the lateral part of the abdominal wall. The nerves to the ureters derive from adjacent autonomic plexuses (renal, aortic, superior, and inferior hypogastric;. The femoral condyles are subcutaneous and easily palpated when the knee is flexed or extended. The central processes of those concerned with taste end in the nuclei of the solitary tract in the medulla. The approximate incidences of various locations of the appendix, based on an analysis of 10,000 cases, are shown. However, all those with occlusion for over 31 minutes had both clinical and radiological evidence of infarction. Vasculature and Innervation of Nose the arterial supply of the medial and lateral walls of the nasal cavity. The atherosclerotic plaques serve as sites of thrombosis when the endothelium has become ulcerated and/or stenosis has critically reduced the blood flow. This is also true of the uterus, the veins and lymph vessels of which mostly drain via deep routes. Lateral rotators pass inferior and posterior to the hip joint; the inferior aspect of the joint is innervated by the obturator nerve and the posterior aspect is innervated by branches from the nerve to the quadratus femoris. The voice is poor initially because the paralyzed vocal fold cannot adduct to meet the normal vocal fold. The isthmus of the fauces is the short, constricted space that establishes the connection between the oral cavity proper and oropharynx.
The laryngeal muscles are divided into extrinsic and intrinsic groups: Extrinsic laryngeal muscles move the larynx as a whole. To safeguard these glands during thyroidectomy, surgeons usually preserve the posterior part of the lobes of the thyroid gland. The inferior comb-shaped limit of the anal valves forms an irregular line, the pectinate line (dentate line). Organization: the muscles and tendons of the hand are organized into five fascial compartments: two radial compartments (thenar and adductor) that serve the thumb, an ulnar (hypothenar) compartment that serves the little finger, and two more central compartments that serve the medial four digits (a palmar one for the long flexor tendons and lumbricals, and a deep one between the metacarpals for the interossei). The tensor tympani is a short muscle that arises from the superior surface of the cartilaginous part of the pharyngotympanic tube, the greater wing of the sphenoid, and the petrous part of the temporal bone. These sexual differences are related mainly to the heavier build and larger muscles of most men and to the adaptation of the pelvis (particularly the lesser pelvis) in women for parturition (childbearing). The veins from the proximal two parts of the urethra drain into the prostatic venous plexus. The posterior border of the ischium forms the inferior margin of a deep indentation, the greater sciatic notch. The margin of the acetabulum is incomplete inferiorly at the acetabular notch, which makes the fossa resemble a cup with a piece of its lip missing. Anastomoses occur between the portal and systemic veins in the wall of the anal canal. Consequently, the ovaries are typically found laterally between the uterus and the lateral pelvic wall during a manual or ultrasonic pelvic examination. Rupture of the pancreas frequently tears its duct system, allowing pancreatic juice to enter the parenchyma of the gland and to invade adjacent tissues. The lumen of the larger artery is filled by thrombus and there has been leakage of plasma proteins into the surrounding cortical parenchyma (anti-fibrinogen antibody and haematoxylin counterstain). The muscles that are truly thoracic, however, provide few if any surface features. Clinically, shunt placement to treat hydrocephalus is one of the most commonly performed operations by paediatric neurosurgeons and the procedure has completely changed the natural history of hydrocephalus. Dura mater 2376 has been removed opening the trigeminal cave, cavernous sinus and hypophysial fossa, demonstrating contained cranial nerves, internal carotid artery, and hypophysis. The tympanic membrane becomes red and bulges, and the person may complain of "ear popping" or crackling. Instead of ascending during expiration, the paralyzed dome descends in response to the positive pressure in the lungs. Complete section of the right optic tract at the midline eliminates vision from the left temporal and right nasal visual fields. The bronchial arteries supply the supporting tissues of the lungs and visceral pleura. The inferior trunk of the brachial plexus lies directly posterior to the third part of the artery. The phrenic nerves also supply sensory fibers to the pericardium and mediastinal pleura. The four intrinsic and four extrinsic muscles in each half of the tongue are separated by a median fibrous lingual septum. The anterior fibers of the bulbospongiosus, encircling the most proximal part of the body of the penis, also assist erection by increasing the pressure on the erectile tissue in the root of the penis. Fractures in the pubo-obturator area are relatively common and are often complicated because of their relationship to the urinary bladder 1314 and urethra, which may be ruptured or torn. Enlarged internal iliac lymph nodes, pathological thickening of the ureters, swellings in the ischio-anal fossae [e. The syndrome includes the following signs: constriction of the pupil (miosis), drooping of the superior eyelid (ptosis), redness and increased temperature of the skin (vasodilation), and absence of sweating (anhydrosis). In these cases, the morula (early embryo) may not be able to pass along the tube to the uterus, although sperms have obviously done so. The floor of the cranial cavity is divisible into three levels (steps): anterior, middle, and posterior cranial fossae. The weight of the upper body, transmitted centrally through the vertebral column (1), is divided and directed laterally by means of the bony arch formed by the sacrum and ilia (2). A transverse section of the abdomen demonstrates various aspects of the wall and its components.
Diseases
This spreading is limited especially by the strong interosseous tibiofibular ligament as well as the anterior and posterior tibiofibular ligaments that unite the tibia and fibula. The vertical dimension (height) of the central part of the thoracic cavity increases during inspiration as contraction of the diaphragm causes it to descend, compressing the abdominal viscera. Throughout the length of the sheath, the fibers of the anterior and posterior layers of the sheath interlace in the anterior median line to form the complex linea alba. Inferior epigastric and deep circumflex iliac vessels from the external iliac vessels. Consequently, the helicine arteries straighten, enlarging their lumina and allowing blood to flow into and dilate the cavernous spaces in the corpora of the penis. The mechanical arrangement of the joints and muscles are such that a minimum of muscular activity is required to keep from falling. Because of its longer course, lesions of the left recurrent laryngeal nerve are more common than those of the right. The deep cervical fascial layers also afford the slipperiness that allows structures in the neck to move and pass over one another without difficulty, for example, when swallowing and turning the head and neck. At the superior end of the anterior border, a broad, oblong tibial tuberosity provides distal attachment for the patellar ligament, which stretches between the inferior margin of the patella and the tibial tuberosity. Within minutes, neuronal mitochondria swell and loose their cristae, giving the cells a micro-vacuolated appearance. For meaningful comparison of incidence rates, these should be adjusted according to the age distribution of the population. Parathyroid veins drain into the thyroid plexus of veins of the thyroid gland and trachea. This superficial dissection of the neck displays the submandibular gland and lymph nodes. It arises from the external carotid artery and winds its way to the inferior border of the mandible, just anterior to the masseter. Contraction of 1020 the musculature that forms the lateral part of the arcades of the internal oblique and transversus abdominis muscles makes the roof of the canal descend, constricting the canal. This coronal section demonstrates the internal structure of the female genital organs. The trachea (described with the superior mediastinum, later in this chapter), located within the superior mediastinum, constitutes the trunk of the tree. Innervation of the colon occurs by means of mixed peri-arterial plexuses extending from the superior and inferior mesenteric ganglia along the respective arteries. The superior part of the gluteus medius can be palpated between the superior part of the gluteus maximus and the iliac crest. Range of motion of lateral end of clavicle permitted by movements at the sternoclavicular joint. T11 and T12 also have only a single pair of (whole) costal facets, located on their pedicles. Breast size and shape are determined in part by genetic, ethnic, and dietary factors. Basis for Naming Cusps and Sinuses of Aortic and Pulmonary Valves the following account explains the embryological basis for naming the pulmonary and aortic valves. Somatic (Branchial) Motor Motor fibers pass to one muscle, the stylopharyngeus, derived from the 3rd pharyngeal arch. In older people, the obstruction usually results from a fecalith (coprolith), a concretion that forms around a center of fecal matter. The frontal suture divides the frontal bones of the fetal cranium (see the clinical box "Development of Cranium"). Another term commonly used is "charley horse," which may refer either to the cramping of an individual thigh muscle because of ischemia or to contusion and rupture of blood vessels sufficient enough to form a hematoma. It is usually indicated by an H-shaped formation of sutures that unite the frontal, parietal, sphenoid (greater wing), and temporal bones. It supplies the pharynx, palatine tonsil, pharyngotympanic tube, and the medial wall of the tympanic cavity before it terminates by sending meningeal branches to the cranial cavity. The bodies of the pubic bones, and the pubic symphysis uniting them, form an antero-inferior wall that is much shallower (shorter) than the posterosuperior wall and ceiling formed by the sacrum and coccyx.
The deep veins are more variable and anastomose much more frequently than the arteries they accompany. Paralysis of both recurrent laryngeal nerves causes aphonia (loss of voice) and inspiratory stridor (a harsh, high-pitched respiratory sound). The two bones are firmly united distally by the articular disc, referred to clinically as the 678 triangular ligament of the distal radio-ulnar joint. Blood from the skin and subcutaneous tissue of the penis drains into the superficial dorsal vein(s), which drain(s) into the superficial external pudendal vein. An inferolateral (lower lateral) lobule directly lateral to the urethra, forming the major part of the right or left lobe. Specificity of acidophilic neurons Acidophilic neurons are seen in several acute, non-ischaemic causes of neuronal death, such as viral encephalitis or experimental seizure activity. All visceral afferent fibers from the uterus and vagina not concerned with pain (those conveying unconscious sensations) also follow the latter route. Patella: the patella is a triangular bone that articulates posteriorly with the distal femur. The vertebral lines of pleural reflection are much rounder, gradual 801 reflections and occur where the costal pleura becomes continuous with the mediastinal pleura posteriorly. This glistening lubricated surface allows the heart (attached only by its afferent and efferent vessels and related reflections of serous membrane) the free movement required for its "wringing-out" motions during contraction. Partial clefts involving the manubrium and superior half of the body are V- or U-shaped and can be repaired during infancy by direct apposition and fixation of the sternal halves. A border zone is created, usually at a lower thoracic level than the traditionally stated T4. Isolation and characterization of tumorigenic, stemlike neural precursors from human glioblastoma. It also carries proprioceptive fibers from the muscles it innervates, although the muscles of facial expression include relatively few muscle spindles (mechanoreceptors for muscle stretch), so proprioceptive sensory fibers are fewer than in other motor nerves (Haines, 2013). A distal skin incision was made along the transverse wrist crease, crossing the pisiform bone. The lesser palatine artery, a smaller branch of the descending palatine artery, enters the palate through the lesser palatine foramen and anastomoses with the ascending palatine artery, a branch of the facial artery. If the talar head is difficult to palpate, draw a line from the tip of the medial malleolus to the navicular tuberosity; the head of the talus lies deep to the center of this line. The epigastric fossa (pit of the stomach) is a slight depression in the epigastric region, just inferior to the xiphoid process. The great auricular nerve innervates the inferior 1934 aspect of the auricle (external ear) and much of the parotid region of the face (the area overlying the angle of the jaw). Initially, volume loss may cause a mediastinal shift to the side of the atelectasis, but ipsilateral segment(s) may expand to compensate for the reduced volume of the collapsed segment. The main efferent innervation of the kidney is vasomotor, autonomic nerves supplying the afferent and efferent arterioles. However, the volume of blood forced through the collateral routes may be 1182 excessive, resulting in potentially fatal varices (abnormally dilated veins) (see the Clinical Box "Portal Hypertension," p. In the surgical treatment of hyperthyroidism, the posterior part of each lobe of the enlarged thyroid is usually preserved, a procedure called near-total thyroidectomy, to protect the recurrent and superior laryngeal nerves and to spare the parathyroid glands. Perineal branches of the posterior cutaneous nerve of the thigh (S2, S3): supplying the postero-inferior surface. Subsequently, any process that would normally induce a diffuse increase in intracranial pressure will increase the transtentorial pressure gradient and accentuate the process of herniation; major degrees of lateral midline shift may cause blockage of the foramen of Monro and narrowing of the cerebral aqueduct, resulting in hydrocephalus. Passive and dynamic supports together resist the tendency for the uterus to fall or be pushed through the hollow tube formed by the vagina (uterine prolapse). It is surrounded by the prostate, the muscular anterior "lobe" that includes the trough-like superior extension of the external urethral sphincter anteriorly, and by the glandular lobes posteriorly. The resulting blockage may completely seal off the larynx (laryngeal obstruction) and choke the person, leaving the individual speechless because the larynx is blocked. The sympathetic fibers mainly innervate the blood vessels of abdominal viscera and are inhibitory to the parasympathetic stimulation. In multiparous women (those who have given birth two or more times), the breasts often become large and pendulous. The tendons of the four parts of the quadriceps unite in the distal portion of the thigh to form a single, strong, broad quadriceps tendon.
Exercise tolerance tests are of considerable importance in detecting the cause of heartbeat irregularities. Neuropil cavitation, or pannecrosis, does not result from pure hypoglycaemia, as acidosis cannot occur. The flexures are formed in relation to three internal infoldings (transverse rectal folds): two on the left side and one on the right side. The arterial circle is formed sequentially in an anterior to posterior direction by the following arteries: Anterior communicating artery. The anastomoses between the ovarian and tubal branches of the ovarian and uterine arteries and between the vaginal branch of the uterine artery and the vaginal artery provide potential pathways of collateral circulation. The tympanic membrane, approximately 1 cm in diameter, is a thin, oval semitransparent membrane at the medial end of the external acoustic meatus. These changes are most likely due to proliferation of the glandular tissues of the breast caused by shifting levels of the hormones estrogen and progesterone. Following complete loss or extraction of maxillary teeth, the tooth sockets begin to fill in with bone, and the alveolar process begins to resorb. On the right of the esophagus is the right lobe of the thyroid gland and the right carotid sheath and its contents. The tegmen tympani, forming the roof of the tympanic cavity and the mastoid antrum, is fairly thick in this specimen; usually, it is extremely thin. Axonal plasticity and functional recovery after spinal cord injury in mice deficient in both glial fibrillary acidic protein and vimentin genes. The apex of the bladder points toward the superior edge of the pubic symphysis when the bladder is empty. When barefoot, this thrust is delivered by the great toe; but with soled shoes on, it becomes part of the thrust of plantarflexion delivered by the forefoot. This artery leaves the pelvis through the greater sciatic foramen, superior to the piriformis, and divides immediately into superficial and deep branches. The plantar digital arteries typically provide most of the blood reaching the distal toes, including the nail bed, via perforating and dorsal branches. Some cranial nerves are purely sensory, others are considered purely motor, and several are mixed. The looseness of the subcutaneous tissue also enables fluid and blood to accumulate in the loose connective tissue following bruising of the face. Relatively thin (but mostly curved) flat bones provide the necessary strength to maintain cavities and protect their contents. Dense connective tissue attaches the capsule to the cricoid cartilage and superior tracheal rings. Whereas the gyri and sulci demonstrate much variation, the other features of the brain, including overall brain size, are remarkably consistent from individual to individual. In terms of the vascular supply to the lower limb as a whole, the majority of the arterial blood coming to the limb and most of the venous blood and lymph exiting from it pass along the more protected anteromedial aspect of the limb. The three flat muscles are the external oblique, internal oblique, and transversus abdominis. Most commonly, 1143 the appendix is retrocecal in position, but 32% of the time, it descends into the lesser pelvis. The surgeon splits the muscles of the anterior abdominal wall and moves the peritoneum medially and anteriorly to expose the medial edge of the psoas major, along which the sympathetic trunk lies. Capillaries and venules are also more numerous per unit volume in rats (a) than in humans (b). By midswing, 1610 knee extension is added to the flexion and momentum of the thigh to realize anterior swing fully. In addition to the movements listed, studies indicate that the superior head of the lateral pterygoid muscle is active during the retraction movement produced by the posterior fibers of the temporalis. The oblique and transverse muscles, acting together bilaterally, form a 991 muscular girdle that exerts firm pressure on the abdominal viscera. Sympathetic fibers are derived from the cervical ganglia through the external carotid nerve plexus on the external carotid artery. The enlargement usually disappears when the person lies down, particularly if the scrotum is elevated while supine, allowing gravity to empty the veins. The prevailing hypothesis is that abnormal development of the cranial base creates exaggerated forces on the dura mater (outer covering membrane of the brain) that disrupt normal cranial sutural development.
The relationship of the ductus deferens to the ureter in the male is similar, although of lesser clinical importance, to that of the uterine artery to the ureter in the female. The axon terminals that synapse with the swollen dendritic spines are not swollen and contain dark mitochondria. The calvaria has been removed to reveal the external (periosteal layer) of the dura mater. The vessel is stretched to increase the size of the lumen, thus improving blood flow. The ridge and the balanced pull of the vastus muscles keeps the patella centered in the intercondylar groove of the femur as it provides mechanical advantage to the quadriceps femoris in extending the leg at the knee. The muscular sheet differentiates into muscles that surround the facial orifices (mouth, eyes, and nose), serving as sphincter and dilator mechanisms that also produce many facial expressions. The space below the 12th rib does not lie between ribs and thus is referred to as the subcostal space, and the anterior ramus (branch) of spinal nerve T12 is the subcostal nerve. The incidence of postoperative neurological complications correlates with the grade according to this scheme. The intra-orbital extensions of the cranial dura and arachnoid constitute the optic nerve sheath, which becomes continuous anteriorly with the fascial sheath of the eyeball and the sclera. Extra-ocular muscles: There are seven extra-ocular muscles: four recti, two obliques, and a levator of the superior eyelid. The six common causes of abdominal protrusion begin with the letter F: food, fluid, fat, feces, flatus, and fetus. The stomach is continuous with the duodenum, which receives the openings of the ducts from the pancreas and liver, the major glands of the alimentary system. They are rudimentary and functionless in men, consisting of only a few small ducts or epithelial cords. The inferior wall is demarcated from the lateral wall of the orbit by the inferior orbital fissure, a gap between the orbital surfaces of the maxilla and the sphenoid. The medial surface of the shaft of the tibia is also subcutaneous, except at its proximal end. It keeps the orbital fat contained and, owing to its continuity with the periorbita, can limit the spread of infection to and from the orbit. The relationships of the muscles, aponeurotic muscle sheaths, and fascia of the abdominal wall are 1261 demonstrated in transverse section. The neck of the femur is trapezoidal, with its narrow end supporting the head and its broader base being continuous with the shaft. The intertrochanteric line runs from the greater trochanter and winds around the lesser trochanter to continue posteriorly and inferiorly as a less distinct ridge, the spiral line. Compression of the recurrent laryngeal nerves by an esophageal tumor produces hoarseness. The nerves are next conveyed to the duodenum via periarterial plexuses extending to the pancreaticoduodenal arteries (see also "Summary of the Innervation of Abdominal Viscera," p. The ability of the ampulla to relax to accommodate the initial and subsequent arrivals of fecal material is another essential element of maintaining fecal continence. The articular disc separates the cavity of the distal radio-ulnar joint from the cavity of the wrist joint. The collection of lymphoid tissue in the submucosa of the pharynx near the nasopharyngeal opening, or orifice of the pharyngotympanic tube, is the tubal tonsils. Lateral radiographs allow better viewing of a lesion or anomaly confined to one side of the thorax. The pulmonary ligament is comparable to the slack of the sleeve as it hangs from your forearm. The tuberculum sellae (horn of saddle): a variable slight to prominent median elevation forming the posterior boundary of the prechiasmatic sulcus and the anterior boundary of the hypophysial fossa. Coxa Vara and Coxa Valga the angle of inclination between the long axis of the femoral neck and the femoral shaft.
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The septum constitutes in large part the posterior fascia of the orbicularis oculi muscle. The thymus plays an important role in the development and maintenance of the immune system. Infra-Orbital Nerve Block For treating wounds of the upper lip and cheek or, more commonly, for repairing the maxillary incisor teeth, local anesthesia of the inferior part of the face is achieved by infiltration of the infra-orbital nerve with an anesthetic agent. These cells are transformed into intimal foam cells, clusters of which form the initial lesion visible to the naked eye as yellowish fatty streaks. The puborectalis thus forms a puborectal sling, the tonus of which is responsible for maintaining the anorectal angle (perineal flexure). The superior branch of the most superior sigmoid artery anastomoses with the descending branch of the left colic artery, thereby forming a part of the marginal artery. Pericarditis, Pericardial Effusion Pericardial Rub, and the pericardium may be involved in several disease processes. It is an important anastomosis at the base of the brain between four arteries (two vertebral and two internal carotid arteries) that supply the brain. Fractures of Mandible A broken mandible usually involves two fractures, which frequently occur on opposite sides of the mandible. Infarction in territories supplied by the anterior choroidal, posterior cerebral and superior cerebellar arteries is also a frequent occurrence. The size of the gap between the hamstring and gastrocnemius muscles is misleading, however, in terms of the actual size and extent of the fossa. The posterior mediastinal lymph nodes receive lymph from the esophagus, the posterior aspect of the pericardium and diaphragm, and the middle posterior intercostal spaces. Renal Transplantation Renal transplantation is the preferred treatment for selected cases of chronic renal failure. In current clinical use, the cystohepatic triangle is defined inferiorly by the cystic duct, medially by the common hepatic duct, and superiorly by the inferior surface of the liver. The omental foramen can be located by running a finger along the gallbladder to the free edge of the lesser omentum. The choroid plexuses consist of fringes of vascular pia mater (tela choroidea) covered by cuboidal epithelial cells. Lesions between the geniculate ganglion and the origin of the chorda tympani produce the same effects as that resulting from injury near the ganglion, except that lacrimal secretion is not affected. These anomalies result from division of the ureteric bud (metanephric diverticulum), the primordium of the renal pelvis and ureter. Immunohistochemical differences between neurofilaments in perikarya, dendrites and axons. The lesser omentum, enclosing the portal triad (bile duct, hepatic artery, and hepatic portal vein), passes from the liver to the lesser curvature of the stomach and the first 2 cm of the superior part of the duodenum. A weak fascial septum separates the glands from the kidneys; thus, they are not actually attached to each other. It then runs medially, dividing into an ovarian branch and a tubal branch, which supply the ovary and uterine tube, respectively. Cystocele, Urethrocele, and Urinary Incontinence Damage to the pelvic floor during childbirth. Iliohypogastric and ilio-inguinal nerves: terminal branches of the anterior ramus of spinal nerve L1. The otic capsule is made of bone that is denser than the remainder of the petrous temporal bone and can be isolated (carved) from it using a dental drill. An inflamed or injured pancreas can also result in the passage of pancreatic fluid into the bursa, forming a pancreatic pseudocyst. The most common and serious complication of saccular aneurysms is rupture, with consequent subarachnoid haemorrhage, and possible arterial vasospasm and infarction or intracerebral haemorrhage. Pulmonic regurgitation may be heard through a stethoscope as a heart murmur, an abnormal sound from the heart, produced in this case by damage to the cusps of the pulmonary valve. The anterior cardiac veins pass deep to the edge of the right auricle to drain directly into the right atrium.
The remainder of this chapter discusses several of these regions in detail, as well as some deep regions not represented on the surface. Plantarflexion of the ankle is produced by the muscles in the posterior compartment of the leg (see Table 7. Passing posteriorly in the midline of the palate from the incisive papilla is a narrow whitish streak, the palatine raphe. Disruption of the epiphysial plate at the tibial tuberosity may cause inflammation of the tuberosity and chronic recurring pain during adolescence (Osgood-Schlatter disease), especially in young athletes. In progressive lesions of the recurrent laryngeal nerve, abduction of the vocal ligaments is lost before adduction; conversely, during recovery, adduction returns before abduction. The bones of the free lower limb are contained within and specifically serve that part of the limb. This coronal section of the right hand demonstrates the distal radio-ulnar, wrist, intercarpal, carpometacarpal, and intermetacarpal joints. The superior parathyroid glands, more constant in position than the inferior ones, are usually at the level of the inferior border of the cricoid cartilage. The perforating arteries are large vessels, unusual in the limbs for their transverse, intercompartmental course. Throughout its course, the vein lies close to the popliteal artery, lying superficial to it in the same fibrous sheath. This axon-sparing dendritic lesion is a hallmark of the excitotoxic neuronal death, seen in ischaemia, hypoglycaemia and epilepsy. The entry of the bile duct and pancreatic duct into the duodenum through the hepatopancreatic ampulla. It is further reinforced by overlying tendons of the rectus femoris and iliopsoas muscles. The anterior abdominal wall and soft tissues of the anterior thoracic wall have been removed. Regional anesthesia induces complete blockade of pain and feeling and does not allow a woman to assist with labor. Infections may spread superiorly into the middle cranial fossa through the petrosquamous fissure in children and cause osteomyelitis (bone infection) of the tegmen tympani. Lateral planes of paired visceral branches serving viscera other than the gut and its derivatives (B). For example, treatment of ventriculomegaly secondary to a posterior fossa mass is surgical resection of this mass. With toes actively extended, the small fleshy belly of the extensor digitorum brevis may be seen and palpated anterior to the lateral malleolus. To compensate, the individual leans 1691 away from the unsupported side, raising the pelvis to allow adequate room for the foot to clear the ground as it swings forward. The psoas fascia covering the psoas major muscle (psoas sheath) is attached medially to the lumbar vertebrae and pelvic brim. The pectoralis major has been removed on the left side to expose the pectoralis minor, subclavius, and external intercostal muscles. Fractures of the body of the mandible frequently pass through the socket of a canine tooth. It is distinguished from the primary syndrome in which there is no underlying medical condition. Irritation of the costal and peripheral parts of the diaphragmatic pleura results in local pain and referred pain to the dermatomes of the thoracic and abdominal walls. The tubular, muscular left 876 auricle, its wall trabeculated with pectinate muscles, forms the superior part of the left border of the heart and overlaps the root of the pulmonary trunk. The dermatome pattern of the lower limb according to Keegan and Garrett (1948) is preferred by others for its aesthetic uniformity and obvious correlation with development. In some respects, atherosclerosis also has some features of an inflammatory disease (see earlier). Intracapsular fractures (occurring within the hip joint capsule) are complicated by degeneration of the femoral head, owing to vascular trauma (see the clinical boxes "Fractures of Femoral Neck" and "Surgical Hip Replacement"). While the sclera is relatively avascular, the cornea is completely avascular, receiving its nourishment from capillary beds around its periphery and fluids on its external and internal surfaces (lacrimal fluid and aqueous humor, respectively). Alternately, the suprascapular artery may arise directly from the third part of the subclavian artery.
This ragged foramen lies posterolateral to the hypophysial fossa and is an artifact of a dried cranium. Inferior to this pouch, the weak rectovaginal septum separates the superior half of the posterior wall of the vagina from the rectum. Observe the nearly equal proximal articular surfaces of the scaphoid and lunate and that the lunate articulates with both the radius and the articular disc. Contraction of this muscle widens the angle of the duodenojejunal flexure, facilitating movement of the intestinal contents. The lymphatic vessels of the scrotum drain into the superficial inguinal lymph nodes. The deep palmar arch lies approximately 1 cm proximal to the superficial palmar arch. The external anal sphincter is a large voluntary sphincter that forms a broad band on each side of the inferior two thirds of the anal canal. This dissection shows the muscles of the anterolateral leg and dorsum of the foot. The cycle begins with a period of ventricular elongation and filling (diastole) and ends with a period of ventricular shortening and emptying (systole). Knowledge of the tolerance of human brain to focal ischaemia is important clinically. The greater vestibular glands are round or oval and are partly overlapped posteriorly by the bulbs of the vestibule. Rupture of Urethra in Males and Extravasation of Urine Fractures of the pelvic girdle, especially those resulting from separation of the pubic symphysis and puboprostatic ligaments, often cause a rupture of the intermediate part of the urethra. Lifetime Changes in Anatomy of Uterus 1437 the uterus is possibly the most dynamic structure in human anatomy. Although not clearly distinct anatomically, the following lobes of the prostate are traditionally described. The so-called flat bones and flat portions of the bones forming the neurocranium are actually curved, with convex external and concave internal surfaces. The clinical manifestations are bilateral ptosis and failure of upward gaze, followed by loss of the pupillary light reflex. The actions of the biceps brachii and supinator in producing supination from the pronated position at the radio-ulnar joints. The main part of the superior hypogastric plexus is a prolongation of the intermesenteric plexus (see Chapter 2, Back), which lies inferior to the bifurcation of the aorta. Both layers of peritoneum consist of mesothelium, a layer of simple squamous epithelial cells. The pain is often initiated by touching an especially sensitive trigger zone, frequently located around the tip of the nose or the cheek (Haines, 2013). Cremasteric Reflex Contraction of the cremaster muscle is elicited by lightly stroking the skin on the medial aspect of the superior part of the thigh with an applicator stick or tongue depressor. If the choking victim is inverted to make use of gravity to expel the foreign body (postural drainage of the lungs), lung secretions passing the carina also cause coughing, which assists the expulsion. Although the actions produced by the extra-ocular muscles have been considered individually, all motions require the action of several muscles in the same eye, assisting each other as synergists or opposing each other as antagonists. Vasculature: the vasculature of the hand is characterized by multiple anastomoses between both radial and ulnar vessels and palmar and dorsal vessels. The plane of the knee joint, between 1837 femoral condyles and tibial plateau, may be palpated on each side of the junction of patellar apex and ligament when the knee is extended. In the midfoot and forefoot, vertical intermuscular septa extend deeply (superiorly) from the margins of the plantar aponeurosis toward the 1st and 5th metatarsals, forming the three compartments of the sole. Injections of an anesthetic agent around these branches in the ankle region, anterior to the palpable portion of the fibula, anesthetize the skin on the dorsum of the foot (except the web between and adjacent surfaces of the 1st and 2nd toes) more broadly and effectively than more local injections on the dorsum of the foot for superficial surgery. Reduced density in the ischaemic region is usually accompanied by space-occupying effects that depend on the size of infarct. Compression of the contralateral cerebral peduncle against the free edge of the tentorium may lead to infarction, with or without haemorrhage in the dorsal part of the peduncle and adjacent tegmentum.
Between the divisions are the right, intermediate (middle), and left hepatic veins, which are intersegmental in their distribution and function, draining parts of adjacent segments. At the ankle joint, midway between the malleoli, the anterior tibial artery changes names, becoming the dorsalis pedis artery (dorsal artery of the foot). Female Urogenital Triangle 1512 the female urogenital triangle includes the female external genitalia, perineal muscles, and anal canal. The location of a hernia in one of these fossae determines how the hernia is classified. The parasympathetic fibers are motor to the smooth muscle of the bronchial tree (bronchoconstrictor), inhibitory to the pulmonary vessels (vasodilator), and secretory to the glands of the bronchial tree (secretomotor). Such deviation occurs especially in females, and its frequency increases with age. The retinacular arteries arising from this artery are often torn when the femoral neck is fractured or the hip joint is dislocated. Distal Radio-Ulnar Joint the distal (inferior) radio-ulnar joint is a pivot type of synovial joint. An inferior mesenteric ganglion may also appear just superior to the root of the inferior mesenteric artery. Invasion of the pulp by a deep carious lesion results in infection and irritation of the tissues (pulpitis). The plexus provides sensory innervation for the mucosa of the tympanic cavity, antrum of mastoid air cells, and the posterolateral portion of the pharyngotympanic tube. In moderately athletic individuals, the contour of the pectoralis major muscles is apparent, separated in the midline by the intermammary cleft overlying the sternum, with the lateral border forming the anterior axillary fold. Using a high-frequency electrical current, the tumor is removed in small fragments, which are washed from the bladder with water. The intermediate part follows visceral paths and the spongy part follows somatic paths. Central transtentorial herniation this form of herniation occurs particularly in response to frontal and parietal lesions or to bilateral expanding lesions such as chronic subdural hematomas. The bulbs lie along the sides of the vaginal orifice, superior or deep to (not within) the labia minora, immediately inferior to the perineal membrane. Fibers from the lateral geniculate body project to the visual cortices of the occipital lobes. They include the anterior and posterior fontanelles and the paired sphenoidal and mastoid fontanelles. The scalp is composed of five layers, the first three of which are connected intimately and move as a unit. Thus, in terms of the gastrointestinal tract, the vagus nerves provide parasympathetic innervation of the smooth muscle and glands of the gut as far as the left colic flexure; the pelvic splanchnic nerves provide the remainder. The branches of the descending (thoracic and abdominal) aorta may be described as arising and coursing in three "vascular planes" and can be classified as being visceral or parietal and paired or unpaired. Sometimes a perforation (sternal foramen) remains in the sternal body because of incomplete fusion. Posterior dislocation is uncommon, being resisted by the presence of the postglenoid tubercle and the strong intrinsic lateral ligament. It contains the muscles (extensors hallucis brevis and extensor digitorum brevis) and neurovascular structures of the dorsum of the foot. The musculo-aponeurotic fibers of the internal oblique and transversus abdominis are then split in the line of their fibers and retracted. Sustained astrocytic clusterin expression improves remodeling after brain ischemia. All parasympathetic innervation but only some of the sensory and sympathetic innervation to the eyeball traverses the ganglion. Most flexion and adduction occur mainly at the wrist joint, whereas extension and abduction occur primarily at the midcarpal joint. The lower six or seven intercostal and subcostal nerves provide sensory innervation peripherally. Olfactory Hallucinations Occasionally olfactory hallucinations (false perceptions of smell) may accompany lesions in the temporal lobe of the cerebral hemisphere.
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