INTERSCALENE TRIANGLE!!

SUBCLAVIAN VEIN

Each subclavian vein is a continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle.
From here it joins with the internal jugular vein to form the brachiocephalic vein (also known as "innominate vein"). The angle of union is termed the venous angle.
The subclavian vein follows the subclavian artery and is separated posteriorly by the insertion of anterior scalene.
[edit]Lymph

The thoracic duct drains into the left subclavian vein, near its junction with the left internal jugular vein.
It carries lymph (water and solutes) from the lymphatic system, as well as chylomicrons or chyle, formed in the intestines from dietary fat and lipids.
The right lymphatic duct drains its lymph into the junction of the right internal jugular vein, and the right subclavian vein.
[edit]Etymology

The term subclavian can be broken down to: sub (below), and clavian (pertaining to the clavicle).

SUBCLAVIAN ARTERY BRANCHES


In human anatomy, the subclavian artery is a major artery of the upper thorax that mainly supplies blood to the head and arms. It is located below the clavicle, hence the name. There is a left subclavian and a right subclavian.
On the left side of the body, the subclavian comes directly off the arch of aorta.
On the right side of the body, the subclavian arises from the relatively short brachiocephalic artery (trunk) when it bifurcates into the subclavian and the right common carotid artery.
The usual branches of the subclavian on both sides of the body are the vertebral artery, the internal thoracic artery, the thyrocervical trunk, the costocervical trunk and the dorsal scapular artery. The subclavian becomes the axillary artery at the lateral border of the first rib.
Course

From its origin, the subclavian artery travels laterally, passing between anterior and middle scalene muscles, with the anterior scalene (scalenus anterior) on its anterior side and the middle scalene (scalenus medius) on its posterior. This is in contrast to the subclavian vein, which travels anterior to the scalenus anterior. As the subclavian artery crosses the border of the first rib, it becomes the axillary artery.
[edit]Branches



Superficial dissection of the right side of the neck, showing the carotid and subclavian arteries. Branch of vertebral artery and thyrocervical trunk is labeled. Internal thoracic artery branches from same segment, but inferiorily, and is therefore not visible.
Part Branches Course
First part
From its origin to the medial border of scalenus anterior
Vertebral artery Runs cranially in the transverse foramina of the cervical vertebrae to join the circle of Willis.
Internal thoracic artery Runs caudally behind the ribs, giving off anterior intercostal branches, perforating vessels to the breast and anastomosing with the superior epigastric artery
Thyrocervical trunk Very short. Divides into inferior thyroid artery, suprascapular artery and transverse cervical artery
Second part
Lying behind scalenus anterior
Costocervical trunk Splits into highest intercostal artery and deep cervical artery.
Dorsal scapular artery From either second or third part. Passes backwards to supply latissimus dorsi, levator scapulae, rhomboids, and trapezius.
Third part
Between the lateral border of scalenus anterior and the outer border of the first rib
[edit]Mnemonic
These may be remembered by the mnemonic VITamin C and D.
[edit]Embryology

Embryologically, the left subclavian simply arises from the left 7th intersegmental artery, while the right subclavian arises, proximal to distal:
aortic arch IV
right dorsal aorta (between the 4th and the 7th intersegmental arteries)
right 7th intersegmental artery
[edit]Anatomical details

On the right side the subclavian artery arises from the innominate artery behind the right sternoclavicular articulation; on the left side it springs from the arch of the aorta. The two vessels, therefore, in the first part of their course, differ in length, direction, and relation with neighboring structures.
In order to facilitate the description, each subclavian artery is divided into three parts:
The first portion extends from the origin of the vessel to the medial border of the Scalenus anterior.
The second lies behind this muscle.
The third extends from the lateral margin of the muscle to the outer border of the first rib, where it becomes the axillary artery.
The first portions of the two vessels require separate descriptions; the second and third parts of the two arteries are practically alike.
[edit]First Part of the Right Subclavian Artery
The first part of the right subclavian artery arises from the innominate artery, behind the upper part of the right sternoclavicular articulation, and passes upward and lateralward to the medial margin of the Scalenus anterior. It ascends a little above the clavicle, the extent to which it does so varying in different cases.
[edit]Relations
It is covered, in front, by the integument, superficial fascia, Platysma, deep fascia, the clavicular origin of the Sternocleidomastoideus, the Sternohyoideus, and Sternothyreoideus, and another layer of the deep fascia. It is crossed by the internal jugular and vertebral veins, by the vagus nerve and the cardiac branches of the vagus and sympathetic, and by the subclavian loop of the sympathetic trunk which forms a ring around the vessel. The anterior jugular vein is directed lateralward in front of the artery, but is separated from it by the Sternohyoideus and Sternothyreoideus. Below and behind the artery is the pleura, which separates it from the apex of the lung; behind is the sympathetic trunk, the Longus collie and the first thoracic vertebra. The right recurrent nerve winds around the lower and back part of the vessel.
[edit]First Part of the Left Subclavian Artery
The first part of the left subclavian artery arises from the arch of the aorta, behind the left common carotid, and at the level of the fourth thoracic vertebra; it ascends in the superior mediastinal cavity to the root of the neck and then arches lateralward to the medial border of the Scalenus anterior.
[edit]Relations
It is in relation, in front, with the vagus, cardiac, and phrenic nerves, which lie parallel with it, the left common carotid artery, left internal jugular and vertebral veins, and the commencement of the left innominate vein, and is covered by the Sternothyreoideus, Sternohyoideus, and Sternocleidomastoideus; behind, it is in relation with the esophagus, thoracic duct, left recurrent nerve, inferior cervical ganglion of the sympathetic trunk, and Longus colli; higher up, however, the esophagus and thoracic duct lie to its right side; the latter ultimately arching over the vessel to join the angle of union between the subclavian and internal jugular veins. Medial to it are the esophagus, trachea, thoracic duct, and left recurrent nerve; lateral to it, the left pleura and lung.
[edit]Second Part of the Subclavian Artery
The second portion of the subclavian artery lies behind the Scalenus anterior; it is very short, and forms the highest part of the arch described by the vessel.
[edit]Relations
It is covered, in front, by the skin, superficial fascia, Platysma, deep cervical fascia, Sternocleidomastoideus, and Scalenus anterior. On the right side of the neck the phrenic nerve is separated from the second part of the artery by the Scalenus anterior, while on the left side it crosses the first part of the artery close to the medial edge of the muscle. Behind the vessel are the pleura and the Scalenus medius; above, the brachial plexus of nerves; below, the pleura. The subclavian vein lies below and in front of the artery, separated from it by the Scalenus anterior.
[edit]Third Part of the Subclavian Artery
The third portion of the subclavian artery runs downward and lateralward from the lateral margin of the Scalenus anterior to the outer border of the first rib, where it becomes the axillary artery. This is the most superficial portion of the vessel, and is contained in the subclavian triangle.
[edit]Relations
It is covered, in front, by the skin, the superficial fascia, the Platysma, the supraclavicular nerves, and the deep cervical fascia. The external jugular vein crosses its medial part and receives the transverse scapular, transverse cervical, and anterior jugular veins, which frequently form a plexus in front of the artery. Behind the veins, the nerve to the Subclavius descends in front of the artery. The terminal part of the artery lies behind the clavicle and the Subclavius and is crossed by the transverse scapular vessels. The subclavian vein is in front of and at a slightly lower level than the artery. Behind, it lies on the lowest trunk of the brachial plexus, which intervenes between it and the Scalenus medius. Above and to its lateral side are the upper trunks of the brachial plexus and the Omohyoideus. Below, it rests on the upper surface of the first rib.
[edit]Peculiarities
The subclavian arteries vary in their origin, their course, and the height to which they rise in the neck.
The origin of the right subclavian from the innominate takes place, in some cases, above the sternoclavicular articulation, and occasionally, but less frequently, below that joint. The artery may arise as a separate trunk from the arch of the aorta, and in such cases it may be either the first, second, third, or even the last branch derived from that vessel; in the majority, however, it is the first or last, rarely the second or third. When it is the first branch, it occupies the ordinary position of the innominate artery; when the second or third, it gains its usual position by passing behind the right carotid; and when the last branch, it arises from the left extremity of the arch, and passes obliquely toward the right side, usually behind the trachea, esophagus, and right carotid, sometimes between the esophagus and trachea, to the upper border of the first rib, whence it follows its ordinary course. In very rare instances, this vessel arises from the thoracic aorta, as low down as the fourth thoracic vertebra. Occasionally, it perforates the Scalenus anterior; more rarely it passes in front of that muscle. Sometimes the subclavian vein passes with the artery behind the Scalenus anterior. The artery may ascend as high as 4 cm. above the clavicle, or any intermediate point between this and the upper border of the bone, the right subclavian usually ascending higher than the left.
The left subclavian is occasionally joined at its origin with the left carotid.
The left subclavian artery is more deeply placed than the right in the first part of its course, and, as a rule, does not reach quite as high a level in the neck. The posterior border of the Sternocleidomastoideus corresponds pretty closely to the lateral border of the Scalenus anterior, so that the third portion of the artery, the part most accessible for operation, lies immediately lateral to the posterior border of the Sternocleidomastoideus.

Forget illegible handwriting! Have you ever witnessed the results of what happens when doctors pay little attention to spelling, grammar and interpretation?
Here is a list of medical notes written by doctors about certain patients.

1. The baby was delivered, the cord clamped and cut, and handed to the paediatrician, who breathed and cried immediately.

2. The patient has been depressed since she began seeing me in 1993. .

3. Patient has chest pain if she lies on her left side for over a year.

4. On the second day the knee was better, and on the third day it disappeared.

5. The patient is tearful and crying constantly. She also appears to be depressed.

6. Discharge status: Alive but without my permission.

7. Healthy appearing decrepit 69 year old male, mentally alert but forgetful.

8. The patient refused autopsy.

9. The patient has no previous history of suicides.

10. Patient has left white blood cells at another hospital.

11. She is numb from her toes down.

12. The skin was moist and dry.

13. Patient had waffles for breakfast and anorexia for lunch

¨ Cervical Spinal Nerves

C3-4-5 keeps the phrenic alive (innervation of phrenic nerve)
C3-4-5 keep the diaphragm alive (innervation of diaphragm)
C5-6-7 raise your arms to heaven (nerve roots of long thoracic nerve innervate serratus anterior)

¨ V3 innervated muscles
My A$$ Meets The Toilet
Mylohyoid Anterior digastric Muscles of Mastication
Tensor veli palatini Tensor tympani
¨V3: sensory branches

"Buccaneers Are Inferior Linguists"
Buccal Auriculotemporal
Inferior alveolar Lingual

¨ Lacrimal nerve course

Lacrimal's story of 8 L's
Lacrimal nerve runs on Lateral wall of orbit above Lateral rectus, then Lets communicating branch join in, then supplies Lacrimal gland, then Leaves it and supplies Lateral upper eye Lid!

¨ CN VII innervated muscles (branchial arch 2 derivatives)

"Imagine someone making the facial expression to say 'PSS...'
Facial expression muscles:
Posterior belly of digastric
Stapedius
Stylohyoid

¨ Scalp: nerve supply

GLASS
Greater occipital/ Greater auricular
Lesser occipital
Auriculotemporal
Supratrochlear
Supraorbital

Horner's syndrome components "PAM"
· Horner's is:
Ptosis
Anhidrosis
Miosis

Course Of FACIAL NERVE

The motor part of the facial nerve arises from the facial nerve nucleus in the pons while the sensory part of the facial nerve arises from the nervus intermedius.
The motor part and sensory part of the facial nerve enters the petrous temporal bone into the internal auditory meatus (intimately close to the inner ear) then runs a tortuous course (including two tight turns) through the facial canal, emerges from the stylomastoid foramen and passes through the parotid gland, where it divides into five major branches. Though it passes through the parotid gland, it does not innervate the gland. This action is the responsibility of cranial nerve IX, the glossopharyngeal nerve.
The facial nerve forms the geniculate ganglion prior to entering the facial canal.

[edit]Branches
Greater petrosal nerve - provides parasympathetic innervation to lacrimal gland, sphenoid sinus, frontal sinus, maxillary sinus, ethmoid sinus, nasal cavity, as well as special sensory taste fibers to the palate via the Vidian nerve.
Nerve to stapedius - provides motor innervation for stapedius muscle in middle ear
Chorda tympani - provides parasympathetic innervation to submandibular gland and sublingual gland and special sensory taste fibers for the anterior 2/3 of the tongue.
[edit]Outside skull (distal to stylomastoid foramen)
Posterior auricular nerve - controls movements of some of the scalp muscles around the ear
Branch to Posterior belly of Digastric and Stylohyoid muscle
Five major facial branches (in parotid gland) - from top to bottom:
Temporal (frontal) branch of the facial nerve
Zygomatic branch of the facial nerve
Buccal branch of the facial nerve
Marginal mandibular branch of the facial nerve
Cervical branch of the facial nerve
A traditional mnemonic device for the five major branches of the facial nerve is, "The Zebra Bummed My Cat." Other mnemonics for the divisions of the facial nerve include, "Today Zoe Bummed My Car", "To Zanzibar By Motor Car", "Tell Ziggy Bob Marley Called", "Ten Zebras Bullied My Cat", "Two Zulus buggered my cat" and "The Zoo Bought Monkey Clothes."

New Alzheimer vaccine to be tested in Europe By AFP - Fri Apr 23, 7:39 AM PDT
VIENNA (AFP) - A new vaccine against Alzheimer's, developed by the Austrian biotechnology firm Affiris, will soon be tested in six European countries, the company announced Friday.


Life Lessons from Travel


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A woman is pictured holding the hand of a person suffering from Alzheimer's disease. A new vaccine against Alzheimer's, developed by the Austrian biotechnology firm Affiris, will soon be tested in six European countries, the company has announced.(AFP/File/Sebastien Bozon)
Some 420 patients will be recruited to take part in clinical trials in Austria, Croatia, Czech Republic, France, Germany and Slovakia, Affiris said in a statement.

The AD02 vaccine, developed with British drugmaker GlaxoSmithKline, was already tested for safety and tolerability over the past year.

The clinical trials will now test its efficacy, with results expected as early as 2012, the company said.

ADO2 is meant to prevent the building up of beta-amyloid plaques in the brain, which cause the degradation of nerve cells and are believed to play a crucial role in causing Alzheimer's disease.

The vaccine works by causing the body to attack these plaques by producing more antibodies, Till Jelitto, a spokesman for Affiris, told AFP.

More specifically, these antibodies are meant to attack only the part of the beta-amyloid protein that causes the plaques, he added.

This would reduce the risk for patients, as the protein as a whole already exists in healthy individuals.

The current vaccine is therapeutic, meaning it is aimed at treating patients already affected by the disease. But if results are positive, the technology could also be used to manufacture a prophylactic, or preventative, vaccine, Jelitto said.

In 2001, tests for a first vaccine against Alzheimer's disease were conducted in the United States and Europe but had to be cut short after serious side effects emerged.

Another vaccine was tested in Sweden in 2005.

Alzheimer's disease, also known as AD, is a neuro-degenerative disease that affects cognitive functions, further impacting patients' behaviour and social adaptation.

The disease, which still has no known cure, affects about six million people in Europe every year.

Affiris is also working on vaccines against Parkinson's and atherosclerosis

Spanish hospital claims first full face transplant By DANIEL WOOLLS, Associated Press Writer - Fri Apr 23, 7:13 AM PDT


MADRID - A hospital in Spain said it has carried out the world's first full-face transplant, giving a young man who lost his in an accident a new nose, skin, jaws, cheekbones, teeth and other features.

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In this combo of computer-generated images released by the Vall d'Hebron Hospital in Barcelona, Spain on Friday, April 23, 2010, the various steps undertaken to perform a full-face transplant on a young male patient in late March 2010 are graphically illustrated. The hospital in Spain says it has carried out the world's first full-face transplant, giving a young man who lost his in an accident a new nose, skin, jaws, cheekbones, teeth and other features. (AP Photo/Vall d'Hebron Hospital) ** EDITORIAL USE ONLY **
The operation was carried out by a 30-member medical team in late March and took 24 hours to perform, according to Vall d'Hebron Hospital in Barcelona.

The patient now has a completely new face from his hairline down and only one visible scar, which looks like a wrinkle running across his neck, said Dr. Joan Pere Barret, the surgeon who led the team.

"If you look him in the face, you see a normal person, like anyone else we have as a patient in the hospital," Barret told The Associated Press on Friday.

He declined to name the patient or give details of the accident five years ago in which he lost his face, saying only that he was a Spaniard between the ages of 20 and 40 and is recovering well.

He cannot yet speak, eat or smile, but can see and swallow saliva.

"He is coming along well. He sits up, he walks in his hospital room and he watches television," Barret said.

Barret said there have been 10 partial face transplant operations carried out in the world so far but this is the first involving a person's whole face. The world's first partial face transplant was carried out on a woman in France in 2005. Others have been done in the U.S. and China.

Barret said his team used the same techniques of plastic and microsurgery as in those cases, and simply chose to try for a full-face transplant because the damage suffered by this man was so severe.

Since the accident, the patient has had to breathe and be fed through tubes and had problems speaking. Before this, he underwent surgery nine times.

A week after the operation, the patient asked to look at himself in the mirror and was satisfied with what he saw, Barret said.

The patient underwent psychiatric tests before the operation to determine if he would be able to confront having a totally new face, the hospital said.

He is expected to remain hospitalized for two months.

Hospitals in Spain have performed two partial face transplants, in Valencia and Seville.

The Brain

The human brain is the most complex and least understood part of the human anatomy. There may be a lot we don’t know, but here are a few interesting facts that we’ve got covered.

Nerve impulses to and from the brain travel as fast as 170 miles per hour. Ever wonder how you can react so fast to things around you or why that stubbed toe hurts right away? It’s due to the super-speedy movement of nerve impulses from your brain to the rest of your body and vice versa, bringing reactions at the speed of a high powered luxury sports car.
The brain operates on the same amount of power as 10-watt light bulb. The cartoon image of a light bulb over your head when a great thought occurs isn’t too far off the mark. Your brain generates as much energy as a small light bulb even when you’re sleeping.
The human brain cell can hold 5 times as much information as the Encyclopedia Britannica. Or any other encyclopedia for that matter. Scientists have yet to settle on a definitive amount, but the storage capacity of the brain in electronic terms is thought to be between 3 or even 1,000 terabytes. The National Archives of Britain, containing over 900 years of history, only takes up 70 terabytes, making your brain’s memory power pretty darn impressive.
Your brain uses 20% of the oxygen that enters your bloodstream. The brain only makes up about 2% of our body mass, yet consumes more oxygen than any other organ in the body, making it extremely susceptible to damage related to oxygen deprivation. So breathe deep to keep your brain happy and swimming in oxygenated cells.
The brain is much more active at night than during the day. Logically, you would think that all the moving around, complicated calculations and tasks and general interaction we do on a daily basis during our working hours would take a lot more brain power than, say, lying in bed. Turns out, the opposite is true. When you turn off your brain turns on. Scientists don’t yet know why this is but you can thank the hard work of your brain while you sleep for all those pleasant dreams.
Scientists say the higher your I.Q. the more you dream. While this may be true, don’t take it as a sign you’re mentally lacking if you can’t recall your dreams. Most of us don’t remember many of our dreams and the average length of most dreams is only 2-3 seconds–barely long enough to register.
Neurons continue to grow throughout human life. For years scientists and doctors thought that brain and neural tissue couldn’t grow or regenerate. While it doesn’t act in the same manner as tissues in many other parts of the body, neurons can and do grow throughout your life, adding a whole new dimension to the study of the brain and the illnesses that affect it.
Information travels at different speeds within different types of neurons. Not all neurons are the same. There are a few different types within the body and transmission along these different kinds can be as slow as 0.5 meters/sec or as fast as 120 meters/sec.
The brain itself cannot feel pain. While the brain might be the pain center when you cut your finger or burn yourself, the brain itself does not have pain receptors and cannot feel pain. That doesn’t mean your head can’t hurt. The brain is surrounded by loads of tissues, nerves and blood vessels that are plenty receptive to pain and can give you a pounding headache.
80% of the brain is water. Your brain isn’t the firm, gray mass you’ve seen on TV. Living brain tissue is a squishy, pink and jelly-like organ thanks to the loads of blood and high water content of the tissue. So the next time you’re feeling dehydrated get a drink to keep your brain hydrated.