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Sentinel Lymph Node Definition

The Sentinel Lymph Node is the hypothetical lymph node or lymph nodes that is the closest to the primary lesion, and is the first one to receive direct drainage from the injection site. It is the first lymph node that is reached by the metastasizing cancer cells. If this node is found free of cancer cells, then there is comparatively less chances of other nodes being full of malignant cancer cells and thereby the need for surgical removal of tumor and other complications is removed.

Image of Sentinal Lymph Node
Picture 1 – Sentinel Lymph Node

Source -

Sentinel Lymph Node Location

The sentinel lymph node is located along the lymphatic vessels, as a part of the lymphatic system, which is the body’s primary immune system.

Sentinel Lymph Node Anatomy

It is the First lymph node that the cancer cells from a primary tumor reach. These cancer cells follow a very orderly progression to reach theses nodes. They first spread to the regional lymph nodes, and then to the echelon of these nodes. We can therefore say that the lymph flow is directional.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      The cancer cells first spread to these lymph nodes, before they reach other parts of the body.  So, cancer also first spreads to lymph nodes, and then to the other parts of the body.  If the sentinel node is free of cancer cells, then there is a high probability that it will not spread to other parts of the body as well.

Sentinel Lymph Node Mapping

Sentinel Lymph Node Mapping is a method that determines whether the cancer has spread beyond the tumor, deep into the lymph system. This procedure is used in addition to that of sentinel lymph node biopsy and dissection.  Since the lymph node is the primary defense against infection in the body, it is very important that the cancer cells do not permanently stay in this system. When the cells reach this system, biopsy or dissection is performed.

What is Urethra?

The urethra is the opening that allows the urine to be discharged from the urinary bladder. It is due to the presence of the urethra tube that we can expel the urine from our body. It is a tube that connects the bladder to the genitals to allow the expulsion of urine. It has sphincter muscles that allow the urine to stay in the bladder till it is expelled out. The sphincter muscle expands and contracts to allow the excretion and storage of urine.

Urethra Definition

Urethra is a small duct that releases urine from the bladder to the outside of the body, through the genitals, i.e. the penis in males and the vagina in males.

Urethra Anatomy

There are certain structural differences between male and female urethra.

Female Urethra

The female urethra is about 1.5 to 2 (about 35 mm) inches long. It is located posterior to the pubic symphysis and is situated in the front wall of the vagina. The urethra is slightly curved and is directed in the forward direction. It is a membranous canal made up of the following three layers:

  • Muscular layer – this is the continuation of the muscular layer of the urinary bladder.
  • Mucous layer – this layer is also continuous with that of the bladder. It is lined with laminated epithelium.
  • Spongy erectile tissues – It is a thin layer that is made up of the spongy epithelial tissues, which includes plexus of veins and smooth muscle fibers.

The urethra is surrounded by the urethral sphincter, which gets its supply from the pudendal nerve.  The female urethra ends at the external orifice of urethra.  The structure of the female urethra is simpler than that of the male urethra, for the fact that female urethra carries only urine, unlike the male urethra which is designed to carry both urine and semen.

Male Urethra

The male urethra is 8 to 9 inches (200mm) long. It is in the shape of a tube. Its prostatic section is arched in shape. The male urethra is longer than the female one, as it has an additional reproductive function to perform along with the excretion of urine. It is concerned with the conveyance of semen out of the body at the time of ejaculation.

The male urethra is divided into three parts:

  • The Prostatic urethra – The prostatic part of the urethra is the widest and the most dilatable part of the urethra that begins at the neck of the bladder and continues through the prostrate gland.
  • Membranous urethra – this is the shortest and a very narrow part of the male urethra. It passes through the urogenital diaphragm. It is here that the sphincter is located that controls the storage and expulsion of urine from the bladder.
  • Spongy urethra – it is the longest of the three sections, being approximately 6 inches in length. It extends from the end of the membranous portion, continuous through the penis and ends at the external orifice of the urethra. At this point, the urine leaves the body.

The ejaculation of semen takes place from the urethra itself, and this is the reason that the structure of the male urethra is more complicated than the female one.

Urethra Histology

When the urethra exits the bladder, initially it starts off as transitional cells. As it continues, stratified columnar cells and stratified squamous cells enter the urethral orifice. All through the urethral glands there are mucus secreting glands. These mucous secreting glands protect the epithelium from corrosive urine. The walls of urethra are smooth muscle.

Acromion Definition

Shoulder Joint Pictures
Picture 1 - The Shoulder Joint
Source - wikipedia

The Acromion is an anatomical feature on the scapula (the shoulder blade). It is a lateral of extension of the spine on the scapula, forming the highest point on the shoulder and is triangular in shape. It occurs along with the coracoids process over the shoulder joint.

Acromion Process

The acromion may also be called the acromion process. This acromion process, an extension of the scapular spine, extends laterally over the shoulder joint. The acromion process and the clavicle together make up the acriomioclavicular joint.

Acromion Anatomy

Acromion shoulder is the lateral extension of the spine of the scapula. Scapula is the scientific name for the shoulder blade. The spine leads to a ‘head’ and here it bears two processes – the acromion process and the carocoid process. The acromion process, when joins the clavicle, together with it provides the attachments for muscle of the arm and the chest.

The superior surface of the acromion bone is convex shaped and is directed to all three sides – upwards, laterally and backwards.  The surface is rough, so as to provide for the attachment of the Deltoideus fibres. The inferior surface is smooth and concave, whereas the superior one is rough and convex.

On the basis of the lateral and medial borders, we can explain the anatomy of the acromion process in a slightly different manner. The lateral border of the acromion is thick and irregular, lined by 3-4 tubercles. The medial one is concave, and comparatively shorter in length. To this medial border, we also find a part of the trapezius attached.

Acromion Fracture

The acromion fractures can be of many kinds –Type 1, Type 2, Type 3 and the Stress fractures.  They may be further sub-divided into Type 1a, 2a, 2b etc. The Types of Acromion are described in detail below.

Type 1 Acromion

This class of fracture is known as Flat Acromion. This kind of fracture records a comparatively low number of impingement cases. It is subdivided into type 1A and type 1B. Type 1A requires less time for healing. This kind of bone fracture is mainly caused due to tearing and pushing actions. So it is also known as Avulsion fractures. Type 1B is the kind in which the displacement of the bone is not much. The primary cause behind this type is trauma.

Type 2 Acromion

This is the curved kind of Acromion, also called the curved acromion, which records cases with a high impingement injury. This acromion appears on the occurrence of many kinds too many displacements in the bone, which may be lateral or anterior. There may or may not be the reduction in the subacromial space. The patient can recover within 6 weeks without any surgical or operative treatment.

Type 3 Acromion

This is the Hooked Acromion or the beaked acromion. This kind of fracture is the most commonly occurring one. It results into a kind of inferior displacement. The pain caused by this fracture is greater than the other two.  It may either be an anatomical feature, or degenerative. This fracture cannot be cured without surgical treatment. Surgery is indispensable if the acromion is a degenerative one.

Type 4 Acromion

This is the most recent classification of acromion process. In this type of acromion, the undersurface is convex near the distal end. The frequency of this acromion is increasing in the present day.

Acromion Morphology

One of the most important factors which are related to rotator cuff pathology is Acromion morphology. The surgeons who are performing angioplasty based on preoperative radiographs, base their surgery on this important rationale of acromion morphology. Variation of this moprphology has been related with the pathogenesis syndrome also.

What is Femoral Artery?

The Femoral Artery is a term used for a group of few arteries which passes fairly close to the outer surface of the thighs. It begins at the inguinal ligament, called the Femoral Head, and ends just above the knee at p place called the Adductor canal or the hunter’s canal. It divides into smaller branches so as to supply blood to the muscles and to the tissues which lie in the superficial region of the thigh.

Femoral Artery Location

This artery begins immediately behind the inguinal ligament. This place is known as the femoral head. From here, it passes midway between the anterior spine of the ilium and symphysis pubis and continues down the medial and front side of the thigh. At the juncture, where the middle and the lower third of the thigh meet, this artery ends, and here it passes through an opening in the Adductor magnus, and becomes the popliteal artery. The upper third of the artery is contained in the femoral triangle, which is also known as the Scarpa’s triangle, and its middle third is contained in the Hunter’s canal, or the Adductors canal, as it is commonly called.

Femoral Artery Anatomy

The external iliac artery supplies blood to the femoral artery. This artery lies within the femoral triangle, behind the inguinal ligament, usually near the head of the femur bone. This region is known as the inguinal-femoral area. The inguinal ligament borders the trianglre on the superior end, the addustor longus forms the medial border and the lateral border is by the sartorious muscle.  The top part of the triangle is made up of skin, fascia lata, cribiform fascia and the subcutaneous tissue. The lower part is composed of iliopsoas muscles, underlying adductor longus and the adductor brevis.

Common Femoral Artery

The proximal section of the femoral artery is known as the Common femoral artery (CFA). It is used as a catheter access artery, as it can be easily felt from the skin. The common femoral artery often comes to use, when the blood pressure is too low, so as to draw arterial blood, as the low blood pressure does not allow the arterial or radial arteries to be located.

This part of the artery is often susceptible to the Peripheral arterial disease.  Sometimes the common femoral artery may be blocked through the atherosclerosis. At this stage, we may need to access the Common femoral artery from the opposite side through a Percutaneous intervention. A surgical cut down, called the Endarcetectomy may also help.

Superficial Femoral Artery

The femoral artery leaves the femoral triangle through an apex beneath the sartorious muscle.  Here it divides itself into the deep and superficial artery .the superficial branch is called the superficial femoral artery (SFA). This superficial femoral artery connects to the popliteal artery at the opening of the Adductor magnus or the Hunter’s canal at the end of the femur bone.

Profunda Femoral Artery

The profunda femoral artery, also known as the Deep femoral artery, is the posterior branch of the femoral artery. It is the largest branch of the femoral artery in the entire femoral triangle. It arises on the lateral side of the femoral artery, about 3 to 5 cm below the inguinal canal. From here, it travels down the thigh, to the femur, passing between the pectineus and the adductor brevis, and then passes posteriorly behind the adductor longus.

The profunda femoral artery branches into the following:

  • Lateral circumflex artery
  • Medial circumflex femoral artery
  • Perforating arteries
  • Terminal branches

Femoral Artery Sheath

The femoral sheath is formed by a downward prolongation, behind the inguinal ligament, transversalis fascia and the iliac fascia. The sheath is in the form of a short tunnel and it is directed upwards. It is also called the crural sheath. This sheath is strengthened by a band called the deep crural arch.

Femoral Artery Branches

Femoral Artery Pictures
Picture 1 – Femoral Artery and Its Major Branches
Source – wikipedia

The femoral artery has the following branches:

  • Superficial Epigastric – This artery arises from the front of the femoral artery, about a cm below the inguinal canal. From here, it travels through the femoral sheath and the fabscia cribrosa, turning upward in front of the inginual ligament, and then ascends between the layers of the superficial fascisa. Its branches are distributed all over the subinguinal lymph glands.
  • Superficial Iliac Circumflex Artery – This is the smallest of the cutaneous branches. It arises close to the superficial epigastric artery and runs parallel with the inguinal ligament.
  • Superficial External Pudendal Artery – arises medially from the femoral artery, and courses medialwards, across the spermatic cord in males, or the round ligament in females. It is distributed to the integument in the lower part of the abdomen – the penis and scrotum in males and the labia majora in females.
  • Deep External Pudendal Artery – this artery is more deeply placed than the superficial pudendal artery.  It is covered by the fascia lata, pierces in the middle of the thigh, and is distributed to the intugement of the scrotum and perineum in males, amd to the labius majus in females.
  • Muscular Branches – these branches are supplied by the femoral artery t the Vastus medialis, Sartorius and Adductores.
  • Highest Genicular

Do you often suffer from acute shoulder pain? Is it accompanied by muscle weakness and upper arm pain? If you possess these problems, you may be suffering from a disease called Parsonage turner Syndrome. Read to know all about this disease and its symptoms, causes and treatment.

What is Parsonage turner Syndrome?

Parsonage Turner syndrome, characterized by sudden onset of excruciating unilateral shoulder and upper arm pain, is a rare syndrome bearing upon the lower motor neurons of the brachial plexus. The brachial plexus is a network of nerve bundles, through which impulses from the spinal cord are transferred to the shoulder, arms and chest.

The pain in the upper arm and shoulder is often accompanied by the paralysis of the shoulder, marked upper arm weakness and atrophy. This syndrome varies from individual to individual in terms of nerve involvement and presentation.

Parsonage turner Syndrome is also called:

  • Brachial Plexopathy
  • Acute Brachial Neuropathy
  • Parsonage Turner syndrome Idiopathic Brachial Neuritis
  • Brachial Plexitis
  • Acute Brachial Radiculitis

Parsonage Turner Syndrome Signs

While examining the wrist, arm or hand, the following signs may reveal a problem of the nerves:

  • Malformation of the hand or arm
  • Trouble in moving the arm, shoulders, or fingers
  • Weakness of the hand
  • Reduced arm reflexes

Parsonage Turner syndrome Symptoms

There are some distinct symptoms which reveal the occurrence of this disease. These include:

  • Numbness of the shoulder arm
  • Hyperesthesia
  • Shoulder pain
  • Muscle Fatigue and Weakness
  • Upper Arm pain
  • Weakness of the shoulder, wrist or arm
  • Muscle wasting and Atrophy
  • Paralysis of the shoulder muscles and atrophy

Parsonage Turner Syndrome Causes

Parsonage Turner Syndrome is a form of peripheral neuropathy, which is caused by an inflammatory damage to the brachial plexus, which is a group of nerve bundles which stretch from the spinal cord to the shoulders, hands and arm. The Brachial plexus can be damaged due to a direct injury to the nerve, birth injury, tumor pressure in that area, or impairment due to radiation therapy.

The dysfunction caused to the brachial plexus in the form of Parsonage Turner Syndrome occurs also due to – Inflammatory conditions, exposure to chemical drugs or toxins, or birth defects.

Parsonage Turner Syndrome Disability

Parsonage turner syndrome may cause severe disabilities in the patients. The sufferers may face a traumatic injury, such as jerking of the arm, stab wounds and falling off a ladder, fever followed by an infection and so on. Males are more prone to this disease than females, expect in cases where the disease is a hereditary one.

Parsonage Turner Syndrome HIV

The clinical cases of acute infection with human immunodeficiency virus (HIV) associated with acute Brachial neuritis is very rare. Many of the people who are diagnosed to possess both this infection actually suffer from an acute illness which resembles infectious mononucleosis. There is a significant clinical heterogeneity of the acute phase of HIV