Langer’s muscular axillary arch, features and importance.

Anatomical variations are common in axilla. These are usually encountered during axillary explorations for breast cancer and other surgical procedures. The most common being the presence of a muscular slip known as the axillary arch. This muscle, usually arises from the latissimus dorsi to be attached to the pectoralis major (which is more common) or to the coracobrachialis or to the fascia over the biceps brachii. This may be single or present as multiple bands and may or may not be clinically apparent. The axillary arch may cause thoracic outlet syndrome like symptoms, may pose difficulty in axillary explorations for various surgical procedures, reconstruction techniques and axillary bypass operations. The current case report is to discuss the features of this variation, with an emphasis on its surgical implications.

Skeletal Muscle Ventricle Mechanics / 대한흉부외과학회지

BACKGROUND: It has been shown that low-grade electrical stimulus can transform fatigue resistant muscles which then can be used to protect the heart. The bulky and cumbersome power sources of the artificial heart or implantable ventricular assist devices are still in need of solution; however, on the other hand, the implantable ventricular assist devices using the resistant muscles as the power source have the advantages of using its own muscle contractions. The purpose of this study was to determine the possibility of a clinical application of the skeletal muscle ventricle. MATERIAL AND METHOD: Latissimus dorsi muscles (LDM) of 8 canines were used for skeletal muscle ventricle. A latex chamber was wrapped one and a half times with LDM. The chamber was attached to a pressure transducer via Tygon tube. An electrode stimulator was placed around the thoracodorsal nerve and LDM was stimulated in cyclic bursts of 0.31 sec on time and 6.0 sec off time using 3.0 volt Itrel stimulator. The preload volume was added to the system in 25cc increments. Ejection volumes, pressures, and peak power outputs were measured. RESULT: Ejection volume was 76.3cc with 0cc of preload. Ejection volumes were less than 70ml with increments of preload over 75cc Pressures were more than 107 mmHg when the preloads were less than 75cc and less than 100 mmHg when the preloads were more than 100cc. Peak power output of 16.6 W/kg was observed at 50cc preload. CONCLUSION: Depending on the changes of preload, the volumes ejected from skeletal muscle ventricle and pressures from the skeletal muscle contraction surpassed those of the normal heart. These data suggest that there are clinical applications for skeletal muscle ventricular assist system.