DOCSLIB.ORG

Notes on Thoracic Anaesthesia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Notes on Thoracic Anaesthesia Notes on Thoracic Anaesthesia April 2011 .......................... ......... ......... ......... .. ......... ............................. ........ ................. ............... .. ............... ........................ .. ........................ ................... .. ..................... ........... .. ........... ... .. .. .. ... .. .. .. .. ........................... .. ..... .. ....... ....... .. .. ....................................... ... ......... ....... ... .. ....... ..... .. ... .... lul........... ... ... .. .. ...... ........ .. .... .. ... ... .. .. .... .....li...... ... ... ................. ... .. .... .... ...... .... ...... ........ ......... ..... ........ .... .......................... .............. ........... ......... ...... .... ..... ... .... ... .. ... .. lll. .. .. ..... .. .. ................. .. ... ... ... .. ... .. ... .... .. ..... .... .. ............................. ...........a..... ...... .......... ... ... ................... .............. .... .... .................... ........ ..... .... ... tube .......... ............. .... .... Richard W. D. Nickalls 2 Notes on Thoracic Anaesthesia Richard W. D. Nickalls Department of Anaesthesia, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK [email protected] http://www.nickalls.org/ r w d n revision 6 April 2011 3 Comprehensive TEX Archive Network (CTAN) http://www.ctan.org/tex-archive/ TEX Users Group http://www.tug.org/ http://uk.tug.org/ TEX Usenet comp.text.tex LATEX Project http://www.latex-project.org/ Typesetting — RWD Nickalls Typeface — Times Roman 10/12pt. System —LATEX Cover — RWD Nickalls, mathsPICPerl Printing — Union Print Shop, University of Nottingham http://www.su.nottingham.ac.uk/services/printshop/ The author gratefully acknowledges generous financial sup- port from the Nottingham Anaesthetic Trust Fund (Depart- ment of Anaesthesia, City Hospital), the City Hospital Medical Staff Research Fund, Smiths Medical (http://www.smiths- medical.com), SonoSite (http://www.sonosite.com) and the Anthony Booth Trust (http://www.aplasticanaemia.co. uk), and Stewart’s (http://www.stewartscoffees.co.uk) to cover printing costs and enable this booklet to be made freely available to those on the Thoracic and Intensive Care training modules. Copyright © RWD Nickalls 2003–2011 All rights reserved 4 PORTEX | Smiths Medical, Hythe, Kent, UK The single biggest problem we face is that of visualisation. Richard P. Feynman (1918–1988)1 1The Mathematical Gazette, (1996); 80, 267 5 A unique local service with over 30 years roasting experience Freshly roasted coffee delivered free to your door in the Nottingham area, available as beans or ground in 500 gram or kilo sealed valve bags. Visit www.stewartscoffees.co.uk to view our excellent range of original coffees. We also specialise in Italian Espresso beans for Espresso Coffee machines. Email: [email protected] Preface HIS introductory booklet is essentially a collection of practical notes on some of the topics relevant to the thoracic anaesthesia training module, and reflects a distinctly T personal approach. It is largely a vehicle for useful references, and still represents ‘work in progress’; for example, Chapter 1 is clearly rudimentary—waiting to be distilled further. The main topics are essentially those for which I developed some interest and tried to establish some underlying conceptual structure. Most chapters were motivated by a particular question or line of approach, as follows. Anatomy — what is the useful functional anatomy for thoracic anaesthetists? Bronchoscopy — how does the fibreoptic bronchoscope influence our per- ceived orientation of the anatomy? Tracheostomy — how can we avoid tracheostomy-related problems? One-lung anaesthesia — is there an optimum sequence for placing a double- lumen tube? Drugs — can particular dilutions facilitate administering vasoactive drugs? Supporting technologies — how did some of the key developments arise? I would like to thank Dr J James 2 for help with the virtual bronchoscopy part of Figure 5.1, and all those anaesthetists who contributed data to the TEPID database. Finally, I would also like to acknowledge the considerable help and assistance I have received from the Operating Department Practitioners, the Theatre Practitioners, and the staff at the PGMEC library and Department of Medical Illustration. RWD Nickalls April 2011 2Department of Radiology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK. 6 Contents Preface6 1 General topics 12 1.1 Syllabus . 12 1.2 General resources . 12 1.3 Preoperative evaluation . 18 1.3.1 Lung function evaluation . 18 1.3.2 Cardiac function evaluation . 20 1.3.3 Obesity-related problems . 20 1.4 Open lung biopsy . 20 1.5 Tracheal resection . 21 1.6 Differential lung ventilation . 21 1.7 Thymectomy and myasthenia gravis . 21 1.8 Bilateral pleurectomy via sternal split . 22 1.9 Lung-volume reduction surgery . 22 1.10 Management of flail-chest . 23 1.11 Pneumothorax . 23 1.11.1 Radiology . 23 1.11.2 Cavity expansion with N2O.................... 23 1.11.3 Chest drains . 24 1.11.4 Chest-drain bottles . 24 1.11.5 Subcutaneous emphysema . 25 1.12 Empyema . 25 1.13 Sickle cell disease . 25 1.13.1 Anaesthesia . 25 1.13.2 The transfusion controversy . 27 1.13.3 Managing sickle-cell crisis . 27 1.13.4 Pathophysiology . 28 1.13.5 Haemoglobin molecular-chemistry . 28 1.13.6 HbS & O2 dissociation curve . 29 7 CONTENTS 8 2 Epidural block 30 2.1 Anatomy . 31 2.1.1 The epidural database (TEPID) . 32 2.2 General aspects . 33 2.2.1 Awake or under GA? . 33 2.2.2 Midline approach . 33 2.2.3 Paramedian approach . 33 2.2.4 Reducing catheter migration / fallout . 34 2.2.5 Radiographic placement . 34 2.2.6 Fibreoptic guided placement . 34 2.3 Drugs . 34 2.4 Complications . 36 2.4.1 Epidural catheter disconnection . 36 2.4.2 Abscess . 36 2.4.3 Haematoma & DVT prophylaxis . 37 2.5 Paravertebral block . 37 3 Tracheostomy & related airway problems 40 3.1 Introduction . 41 3.1.1 Local anaesthetic for fibreoptic bronchoscopy of the trachea . 41 3.2 Tracheostomy tubes . 41 3.2.1 Portex . 42 3.2.2 Tracoe . 42 3.2.3 Rusch¨ . 43 3.2.4 Moore tube . 43 3.3 Tracheostomy—when? . 43 3.4 Percutaneous tracheostomy . 43 3.5 Surgical tracheostomy . 45 3.5.1 Recommendations . 45 3.6 Changing a tracheostomy tube . 49 3.6.1 Preparation . 50 3.6.2 Changing the tube . 51 3.6.3 Check the position bronchoscopically . 52 3.7 Anaesthetising a patient with a laryngectomy . 52 3.8 Anaesthetising a patient with a tracheostomy in situ . 52 3.8.1 Postoperative management . 54 3.9 Montgomery T-tube placement . 54 3.10 Difficult airway & trans-tracheal needle ventilation . 54 3.11 Miscellaneous problems . 55 3.11.1 Obstruction . 56 3.11.2 Difficulty inserting the inner tube . 57 3.11.3 Air leak . 57 CONTENTS 9 3.11.4 Tracheostomy recently removed . 58 4 Lung anatomy 59 4.1 Anatomical terms . 59 4.2 History of lung anatomy . 61 4.2.1 Bronchopulmonary segment . 61 4.3 Lung development & embryology . 63 4.4 Nomenclature . 64 4.4.1 Right lung . 64 4.4.2 Left lung . 64 4.5 Carina . 65 4.5.1 Factors moving the carina . 65 4.6 Right-upper lobe orifice . 66 4.7 Aberrant bronchus . 66 4.8 References . 74 5 Fibreoptic bronchoscopy 78 5.1 History . 79 5.2 Bronchoscopy simulator . 80 5.3 Carina . 80 5.4 Left subcarina & beyond . 81 5.5 Right subcarina & beyond . 83 5.6 Image orientation . 85 5.6.1 Axial rotation . 85 5.6.2 Bending . 86 5.6.3 Camera-mode . 86 5.7 Anaesthesia for bronchoscopy . 87 5.7.1 Short duration . 87 5.7.2 Long duration . 87 5.7.3 Local anaesthesia & sedation . 89 5.7.4 Venturi jet ventilation . 89 5.8 References . 89 5.8.1 Complications . 90 5.8.2 Fibreoptic intubation . 90 6 Tubes and bronchus blockers 92 6.1 The Univent tube, 1984 . 92 6.2 The Hunsaker jet ventilation.
Load more

Recommended publications
  • Te2, Part Iii
    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
    [Show full text]
  • Lower Respiratory Tract – Larynx – Trachea – Tracheobronchial Tree – Respiratory Compartment
    Respiratory system II. © David Kachlík 30.9.2015 Anatomical division • upper respiratory tract – nasal cavity – paranasal cavities – nasopharynx • lower respiratory tract – larynx – trachea – tracheobronchial tree – respiratory compartment © David Kachlík 30.9.2015 Anatomical Surgical division division • upper respiratory tract • upper respiratory tract – nasal cavity – nasal cavity – paranasal cavities – paranasal cavities – nasopharynx – nasopharynx – larynx • lower respiratory tract • lower respiratory tract – larynx border: apertura thoracis sup. – trachea – trachea – tracheobronchial tree – tracheobronchial tree – respiratory compartment – respiratory compartment © David Kachlík 30.9.2015 General structure of respiratory system wall • tunica mucosa (mucosa) – epithelium - ciliated pseudostratified columnar (respiratory epithelium) - non-keratinized stratified squamous - lamina basalis – lamina propria • glands (seromucinous tuboalveolar), lymph nodes (noduli lymphoidei) • tunica fibromusculocartilaginea – collagenous and elastic tissue (and its ligaments – larynx, trachea) – smooth muscles (trachea, bronchi, bronchioli) – skeletal muscles (larynx) • tunica serosa or tunica adventitia – tunica serosa (pleura) has three layers: • mesothelium – lamina basalis • lamina propria • tela subserosa © David Kachlík 30.9.2015 © David Kachlík 30.9.2015 Trachea • pars cervicalis (C6- C7) • pars thoracica (T1-T4) newborn at the level of C4, child C5 • bifurcatio tracheae (T4) = 1st branching of tracheobronchial tree • carina tracheae • calibers:
    [Show full text]
  • Ta2, Part Iii
    TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART III Contents: Systemata visceralia Visceral systems Caput V: Systema digestorium Chapter 5: Digestive system Caput VI: Systema respiratorium Chapter 6: Respiratory system Caput VII: Cavitas thoracis Chapter 7: Thoracic cavity Caput VIII: Systema urinarium Chapter 8: Urinary system Caput IX: Systemata genitalia Chapter 9: Genital systems Caput X: Cavitas abdominopelvica Chapter 10: Abdominopelvic cavity Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: SYSTEMA DIGESTORIUM Chapter 5: DIGESTIVE SYSTEM Latin term Latin synonym UK English US English English synonym Other 2772 Systemata visceralia Visceral systems Visceral systems Splanchnologia 2773 Systema digestorium Systema alimentarium Digestive system Digestive system Alimentary system Apparatus digestorius; Gastrointestinal system 2774 Stoma Ostium orale; Os Mouth Mouth 2775 Labia oris Lips Lips See Anatomia generalis (Ch.
    [Show full text]
  • 26 April 2010 TE Prepublication Page 1 Nomina Generalia General Terms
    26 April 2010 TE PrePublication Page 1 Nomina generalia General terms E1.0.0.0.0.0.1 Modus reproductionis Reproductive mode E1.0.0.0.0.0.2 Reproductio sexualis Sexual reproduction E1.0.0.0.0.0.3 Viviparitas Viviparity E1.0.0.0.0.0.4 Heterogamia Heterogamy E1.0.0.0.0.0.5 Endogamia Endogamy E1.0.0.0.0.0.6 Sequentia reproductionis Reproductive sequence E1.0.0.0.0.0.7 Ovulatio Ovulation E1.0.0.0.0.0.8 Erectio Erection E1.0.0.0.0.0.9 Coitus Coitus; Sexual intercourse E1.0.0.0.0.0.10 Ejaculatio1 Ejaculation E1.0.0.0.0.0.11 Emissio Emission E1.0.0.0.0.0.12 Ejaculatio vera Ejaculation proper E1.0.0.0.0.0.13 Semen Semen; Ejaculate E1.0.0.0.0.0.14 Inseminatio Insemination E1.0.0.0.0.0.15 Fertilisatio Fertilization E1.0.0.0.0.0.16 Fecundatio Fecundation; Impregnation E1.0.0.0.0.0.17 Superfecundatio Superfecundation E1.0.0.0.0.0.18 Superimpregnatio Superimpregnation E1.0.0.0.0.0.19 Superfetatio Superfetation E1.0.0.0.0.0.20 Ontogenesis Ontogeny E1.0.0.0.0.0.21 Ontogenesis praenatalis Prenatal ontogeny E1.0.0.0.0.0.22 Tempus praenatale; Tempus gestationis Prenatal period; Gestation period E1.0.0.0.0.0.23 Vita praenatalis Prenatal life E1.0.0.0.0.0.24 Vita intrauterina Intra-uterine life E1.0.0.0.0.0.25 Embryogenesis2 Embryogenesis; Embryogeny E1.0.0.0.0.0.26 Fetogenesis3 Fetogenesis E1.0.0.0.0.0.27 Tempus natale Birth period E1.0.0.0.0.0.28 Ontogenesis postnatalis Postnatal ontogeny E1.0.0.0.0.0.29 Vita postnatalis Postnatal life E1.0.1.0.0.0.1 Mensurae embryonicae et fetales4 Embryonic and fetal measurements E1.0.1.0.0.0.2 Aetas a fecundatione5 Fertilization
    [Show full text]
  • Tracheal Bronchus
    Joshua O Benditt MD, Section Editor Teaching Case of the Month Tracheal Bronchus Naim Y Aoun MD, Eduardo Velez MD, Lawrence A Kenney MD, and Edwin E Trayner MD Introduction At a 6-month follow-up visit the patient’s hemoptysis had not recurred. The term tracheal bronchus refers to an abnormal bron- chus that comes directly off the lateral wall of the trachea Discussion (ie, above the main carina) and supplies ventilation to the upper lobe. It is most often an asymptomatic anatomical variant found on bronchoscopy as seen in the following The patient had an anatomical variant called tracheal case presentation. bronchus or eparterial bronchus. We believe her symptoms were unrelated to the tracheal bronchus and that it was an incidental bronchoscopy finding. Case Report Sandifort first described tracheal bronchus in 1785.1 Its incidence2,3 is 0.1–2% and in most cases it is incidentally A 65-year-old white woman was seen because of 2 ep- found during bronchoscopy or tomography.4,5 In the ma- isodes of mild hemoptysis complicating a persistent cough. jority of cases a tracheal bronchus arises from the right Her medical history was positive for 8 years of mild short- wall of the trachea. In a recent series of 35 tracheal bron- ness of breath and an indirect exposure to asbestos. Her chus patients 28 originated from the right wall and 7 from review of systems was unremarkable and physical exam- the left,4 which disproves the previous belief that tracheal ination showed normal vital signs and blood oxygen sat- bronchi are exclusively right-sided.2 There is an associa- uration of 97% on room air.
    [Show full text]
  • Anatomy of Lungs 6
    ANATOMYANATOMY OFOF LUNGSLUNGS - 1. Gross Anatomy of Lungs 6. Histopathology of Alveoli 2. Surfaces and Borders of Lungs 7. Surfactant 3. Hilum and Root of Lungs 8. Blood supply of lungs 4. Fissures and Lobes of 9. Lymphatics of Lungs Lungs 10. Nerve supply of Lungs 5. Bronchopulmonary 11. Pleura segments 12. Mediastinum GROSSGROSS ANATOMYANATOMY OFOF LUNGSLUNGS Lungs are a pair of respiratory organs situated in a thoracic cavity. Right and left lung are separated by the mediastinum. Texture -- Spongy Color – Young – brown Adults -- mottled black due to deposition of carbon particles Weight- Right lung - 600 gms Left lung - 550 gms THORACICTHORACIC CAVITYCAVITY SHAPE - Conical Apex (apex pulmonis) Base (basis pulmonis) 3 Borders -anterior (margo anterior) -posterior (margo posterior) - Inferior (margo inferior) 2 Surfaces -costal (facies costalis) - medial (facies mediastinus) - anterior (mediastinal) - posterior (vertebral) APEXAPEX Blunt Grooved byb - Lies above the level of Subclavian artery anterior end of 1st Rib. Subclavian vein Reaches 1-2 cm above medial 1/3rd of clavicle. Coverings – cervical pleura. suprapleural membane BASEBASE SemilunarSemilunar andand concave.concave. RestsRests onon domedome ofof Diaphragm.Diaphragm. RightRight sidedsided domedome isis higherhigher thanthan left.left. BORDERSBORDERS ANTERIORANTERIOR BORDERBORDER –– 1.1. CorrespondsCorresponds toto thethe anterioranterior ((CostomediastinalCostomediastinal)) lineline ofof pleuralpleural reflection.reflection. 2.2. ItIt isis deeplydeeply notchednotched inin
    [Show full text]
  • Dissertation on ANATOMY of the BRONCHO PULMONARY SEGMENTS
    Dissertation on ANATOMY OF THE BRONCHO PULMONARY SEGMENTS Submitted in partial fulfillment for M.S.Degree Examination Branch - V -Anatomy Upgraded Institute of Anatomy Madras Medical College & Research Institute, Chennai - 600 003 THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI - 600 003 Tamil Nadu MARCH 2007 CERTIFICATE This is to certify that the dissertation on “ANATOMY OF THE BRONCHO PULMONARY SEGMENTS” is a bonafide work, carried out in the Upgraded Institute of Anatomy, Madras Medical College, Chennai - 600 003, during 2004-2007 by Dr.A.SENTHAMIL SELVI, under my supervision and guidance in partial fulfillment of the regulation laid down by the Tamil Nadu Dr.M.G.R.Medical University, for the M.S., Anatomy, Branch-V Degree Examination to be held in March 2007. DR. KALAVATHY PONNIRAIVAN, Dr. CHRISTILDA FELICIA B.Sc., M.D JEBAKANI, M.S., [Anatomy], DEAN Director & Professor, Madras Medical College & Upgraded Institute of Anatomy, Government General Hospital, Madras Medical College, Chennai – 600 003 Chennai – 600 003 Date: Date: Station: Station: ACKNOWLEDGEMENT My sincere thanks are submitted to the efficient Director and Guide Dr.CHRISTILDA FELICIA JEBAKANI M.S., Director & Professor, Upgraded Institute of Anatomy, Madras Medical College, Chennai – 03, for the guidance in an enthusiastic, perfect, methodical, advising manner for the study by providing all the facilities available in this institution. My faithful thanks to Dr. KALAVATHY PONNIRAIVAN B.Sc, M.D., Dean & Chairman of Ethical Committee, Madras Medical College, Chennai – 03, for the kind permission granted me to perform the study in this campus. I wish to extend my esteemed thanks to Mrs.M.S.
    [Show full text]
  • Anatomy of the Thoracic Wall, Pulmonary Cavities, and Mediastinum
    3 Anatomy of the Thoracic Wall, Pulmonary Cavities, and Mediastinum KENNETH P. ROBERTS, PhD AND ANTHONY J. WEINHAUS, PhD CONTENTS INTRODUCTION OVERVIEW OF THE THORAX BONES OF THE THORACIC WALL MUSCLES OF THE THORACIC WALL NERVES OF THE THORACIC WALL VESSELS OF THE THORACIC WALL THE SUPERIOR MEDIASTINUM THE MIDDLE MEDIASTINUM THE ANTERIOR MEDIASTINUM THE POSTERIOR MEDIASTINUM PLEURA AND LUNGS SURFACE ANATOMY SOURCES 1. INTRODUCTION the thorax and its associated muscles, nerves, and vessels are The thorax is the body cavity, surrounded by the bony rib covered in relationship to respiration. The surface anatomical cage, that contains the heart and lungs, the great vessels, the landmarks that designate deeper anatomical structures and sites esophagus and trachea, the thoracic duct, and the autonomic of access and auscultation are reviewed. The goal of this chapter innervation for these structures. The inferior boundary of the is to provide a complete picture of the thorax and its contents, thoracic cavity is the respiratory diaphragm, which separates with detailed anatomy of thoracic structures excluding the heart. the thoracic and abdominal cavities. Superiorly, the thorax A detailed description of cardiac anatomy is the subject of communicates with the root of the neck and the upper extrem- Chapter 4. ity. The wall of the thorax contains the muscles involved with 2. OVERVIEW OF THE THORAX respiration and those connecting the upper extremity to the axial skeleton. The wall of the thorax is responsible for protecting the Anatomically, the thorax is typically divided into compart- contents of the thoracic cavity and for generating the negative ments; there are two bilateral pulmonary cavities; each contains pressure required for respiration.
    [Show full text]
  • Anatomical Arrangement of the Lobar Bronchi, Broncho- Pulmonary Segments and Their Variations
    International Journal of Research in Medical Sciences Sathidevi VK. Int J Res Med Sci. 2016 Nov;4(11):4928-4932 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20163793 Original Research Article Anatomical arrangement of the lobar bronchi, broncho- pulmonary segments and their variations Sathidevi V. K.* Department of Anatomy, Government Medical College Campus, Medical College Rd, Kozhikode, Kerala- 673008, India Received: 02 September 2016 Accepted: 28 September 2016 *Correspondence: Dr. Sathidevi VK, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: The segmental concept of lungs was still in dispute in the literature. Although the segments differ considerably in shape and size, they all contain a well-defined area of lung and they are all well demarcated from the neighbouring segments. Therefore, in the present study, an attempt has been made to demonstrate the anatomical arrangement of the lobar bronchi, broncho-pulmonary segments and their variations. Methods: The study was conducted in fifty human lungs, obtained from autopsies, dissection hall cadavers and full term foetuses. The bronchial tree was investigated by air inflation, dye injection and using dissection, preparation of casts, air inflation, dye injection and bronchographic techniques. The external morphology of lungs and their lobes has been studied and the bronchopulmonary segments are described in detail.
    [Show full text]
  • Columna Vertebralis
    THE VERTEBRAL COLUMN The vertebral column (columna vertebralis) or the spine has a metameric structure (a feature connecting the vertebrates with the earliest invertebrates) and consists of separate bone segments, vertebrae, placed one over another in a series; they are short spongy bones. Function of the spine. The spine acts as the axial skeleton supporting the body. It protects the spinal cord enclosed in its canal and takes part in the movements of the trunk and head. The position and shape of the vertebral column are determined by the upright position of man. Common features of the vertebrae. In accordance with the three functions of the spine, each vertebra (Gk. spondylos1) has the following features an anterior part, which is responsible for support and which thickens in the shape of a short column, this is the body (corpus vertebrae); an arch (arcus vertebrae), which is attached to the posterior surface of the body by two pedincles (pedinculi arcus vertebrae) and contributes to the formation of the vertebral foramen (foramen vertebrate); a series of these foramina forms the vertebral or spinal canal (canalis vertebralis), which protects the spinal cord lodged in it from external injury. the arch also carries structures permitting movement on the vertebra called processes. A spinous process (processus spinosus) arises from the arch on the midline; a transverse process (processus transversus) projects laterally on each side; paired superior and inferior articular processes (processus articulares superiores and inferiores) project upward and downward. The articular processus bind notches on the posterior aspect; these are the paired incisurae vertebrates superiores and inferiores from which the intervertebral foramina (foramina intervertebralia) form when one vertebra is placed on another.
    [Show full text]
  • The Eparterialbronchi
    The UOEHAssociationUOEH Association ofofHealth Health Sciences J. UOEH, 2(4): 463-468 (1980) 463 (Original) Corrosion Anatomy of the Eparterial Bronchi in the Rough Toothed Porpoise, Steno bredanensis Teruyuki HoJo DePartment of Anatomy and Anthropology, Schooi of Medicine, Uhaiversit), of OccuPational and Environmental Heaith, JaPan, Kitakyushu 807, faPan Abstract: The lungs of a rough toothed porpoise, Steno bredanensis, were $tudied from the corrosion anatomical viewpoint by preparing the corrosion cast ift sit". It is the most suitable meLhod of studying the three-climensional relationship of the tracheobronehial tree and the pulmonary vascular tree within the lungs, There is one lobe on each side, but feur secondary bronchi on the right, and three secondary ones and a cardiac impression on the left. There are three eparterial bronchi: the tracheal bronchus and the second closest bronchus to the cranium on the right side; the closest bronchus ,to the cranium en the left, While the pulmonary arteries ge along almost the samel course of the tracheobronchial tree, the pulmonary veins come intersegmentally from the peripheral parts making a four-forked convergence ventrally. One dorsal vein adds to this conver- gence, resulting in a five-forked form. Key tvords: corrosion anatemy, eparterial bronchus, rough toothed porpoise, (Received 16 August 1980) Introductien Various patterns of the regional relationship between the tracheobronchia] tree and the pulmenary vascular one in the lungs of sea mammals have been attracting the at- tention of not a few investigators (Aeby, 1880; Boeckh, 1914; Huntington, 1920; Ping, 1926; Marcus, 1937; Arai, 1958; Brown, 1958; Sakai & Tsuneishi, 1962; Hojo, l975, 1979; Yamasaki', et al., 1977).
    [Show full text]
  • Lungs/Pulmones
    Lungs/pulmones ©NotesMed.com Lungs/pulmones • Principal organs of respiration. • The two lungs (right and left) are situated in the thoracic cavity, one on either side of the mediastinum enclosed in the pleural sac. • Each lung is large conical/pyramidal shaped with its base resting on the diaphragm and its apex extending into the root of the neck. • The right lung is larger and heavier than the left lung. • The right lung weighs about 700 g and left lung 650 g. • The right lung has three lobes and the left lung has two lobes. • The lobes are separated by deep prominent fissures on the surface of the lung and are supplied by two lobar bronchi. © NotesMed.com External features • Apex. • Base. • Three borders – Anterior – Posterior – Inferior • Two surfaces – Costal – Medial ©NotesMed.com ©NotesMed.com Anatomical position and side determination • Its conical end (apex) is directed upwards and its broader end (base) is directed downwards. • Its convex surface (costal surface) is directed outwards and its flat medial surface presenting hilum is directed inwards. • Its thin margin (anterior margin) should face forwards and its rounded border (posterior border) should face backwards. ©NotesMed.com Apex • The apex is rounded/blunt superior end of the lung. • Extends into the root of the neck about 3 cm superior to the anterior end of the 1st rib and 2.5 cm above the medial 1/3rd of the clavicle. • Covered by cervical pleura and suprapleural membrane. • Covered with cervical pleura and strengthened externally by Sibson’s fascia. Relations: • Anterior: – Subclavian artery. – Internal thoracic artery. – Scalenus anterior.
    [Show full text]