62 - Great Saphenous Vein

The great saphenous vein (GSV), also long saphenous vein, is the large (subcutaneous) superficial vein of the leg and thigh.
The GSV originates from where the dorsal vein of the first digit (the large toe) merges with the dorsal venous arch of the foot.
After passing anterior to the medial malleolus (where it often can be visualized and palpated), it runs up the medial side of the leg.
At the knee, it runs over the posterior border of the medial epicondyle of the femur bone.
The great saphenous vein then courses medially to lie on the anterior surface of the thigh before entering an opening in the fascia lata called the saphenous opening.
It joins with the femoral vein in the region of the femoral triangle at the saphenofemoral junction.

TRIBUTARIES:
At the ankle it receives branches from the sole of the foot through the medial marginal vein; in the lower leg it anastomoses freely with the small saphenous vein, communicates with the anterior and posterior tibial veins and receives many cutaneous veins; in the thigh it communicates with the femoral vein and receives numerous tributaries; those from the medial and posterior parts of the thigh frequently unite to form a large accessory saphenous vein which joins the main vein at a variable level.
Near the fossa ovalis it is joined by the superficial epigastric, superficial iliac circumflex, and superficial external pudendal veins.
The thoracoepigastric vein runs along the lateral aspect of the trunk between the superficial epigastric vein below and the lateral thoracic vein above and establishes an important communication between the femoral vein and the axillary vein .

USES IN SURGICAL PRACTICE:
The vein is often removed by vascular surgeons and used for autotransplantation in coronary artery bypass operations, when arterial grafts are not available or many grafts are required, such as in a triple bypass or quadruple bypass.
The great saphenous vein is the conduit of choice for vascular surgeons, when available, for doing peripheral arterial bypass operations because it has superior long-term patency compared to synthetic grafts (PTFE, PETE (Dacron)), human umbilical vein grafts or biosynthetic grafts [Omniflow]. Often, it is used in situ (in place), after tying off smaller tributaries and stripping the valves with a device called LeMaitre's valvulotome.
The saphenous nerve is a branch of the femoral nerve that runs with the great saphenous vein and is often damaged in surgeries that make use of the similarly named vein.

When emergency resuscitation with fluids is necessary, and standard intravenous access can not achieved due to venous collapse, saphenous vein cutdown may be necessary.

PATHOLOGIES ASSOCIATED:
Pathology of the great saphenous vein is relatively common, but in isolation typically not life threatening.
Varicose veins: The great saphenous vein, like other superficial veins, can develop varices, which are generally considered to be unsightly. Various treatment options exist for treating varicose veins. Varicose veins are not life threatening.
Phlebitis: The great saphenous vein can become infected.
Thrombophlebitis: The great saphenous vein can thrombose and become infected. Thrombophlebitis of the great saphenous vein is not life threatening in isolation; however, it may be associated with deep vein thrombosis which can be and thus requires further investigation.

61 - FEMORAL TRIANGLE

BOUNDARIES OF FEMORAL CANAL : 

It is bounded by:

(superiorly) the inguinal ligament

(medially) the medial border of the adductor longus muscle

(laterally) medial border of the sartorius muscle 

Its floor is provided laterally by iliopsoas, medially by pectineus and adductor longus. Its roof is formed by the fascia lata.

The femoral triangle is shaped like the sail of a ship.

Its boundaries can be remembered using the mnemonic, "SAIL" for Sartorius, Adductor longus and Inguinal Ligament. 

CONTENTS :

It is important as a number of vital structures pass through it, right under the skin. The following structures are contained within the femoral triangle (from lateral to medial):

terminal part of the femoral nerve and its branches

femoral sheath

femoral artery and its branches

femoral veins and its tributaries

femoral canal, containing the deep inguinal lymph nodes (snell, 8th edition)

- FLOOR

iliopsoas

pectineus

adductor longus

Lacunar Ligament

- ROOF is formed by the skin and fascia lata.

CLINICAL SIGNIFICANCE: 

 Since the femoral triangle provides easy access to a major artery, coronary angioplasty and peripheral angioplasty is often performed by entering the femoral artery at the femoral triangle. Heavy bleeding in the leg can be stopped by applying pressure to points in the femoral triangle. Another clinical significance of the femoral triangle is that the femoral artery is positioned at the midinguinal point (midpoint between the pubic symphysis and the anterior superior iliac spine); medial to it lies the femoral vein. Thus the femoral vein, once located, allows for femoral venopuncture[citation needed]. Femoral venopuncture is useful when there are no superficial veins that can be aspirated in a patient, in the case of collapse. 

The positive pulsation of the femoral artery signifies that the heart is beating and also blood is flowing to the lower extremity[citation needed].It is also necessary to appreciate clinically that this is a case where the nerve is more lateral than the vein. In most other cases the a nerve (relative to its associated artery and vein)would be the deepest or more medial followed by the artery and then the vein. But in this case it is the opposite. This must be remembered when venous or arterial samples are required from the femoral vessels. The order of this neurovascular bundle can be remembered using the mnemonic, "NAVY" for Nerve, Artery, Vein, Y -fronts (the British term of a style of men's underwear with a "Y" shaped front that acts as a fly). The "Y" is midline (corresponding with the penis) and the mnemonic always reads from the outside - in, so that the Femoral Nerve is always lateral. An alternate to this mnemonic is "NAVaL" for Nerve, Artery, Vein, and Lymph, to include the deep inguinal lymph nodes located medial to the Femoral vein.

60 - Inion

The inion is the most prominent projection of the occipital bone at the posterioinferior (lower rear) part of the skull. The ligamentum nuchae and trapezius muscle attach to it.

The term external occipital protuberance (protuberantia occipitalis externa) is sometimes used as a synonym, but more precisely the term "inion" refers to the highest point of the external occipital protuberance.

The word "inion" is the Greek word for the occipital bone.

An Anatolian bump is a protuberance on the back of the skull said to be related to East and Central Asian ancestry, especially Turkic tribes.It is an unusually large external occipital protuberance.

59 - Third ventricle

The third ventricle (ventriculus tertius) is one of four connected fluid-filled cavities comprising the ventricular system within the human brain. It is a median cleft between the two thalami, and is filled with cerebrospinal fluid (CSF).

It is in the midline, between the left and right lateral ventricles.

It communicates with the lateral ventricles anteriorly by the interventricular foramina (of Monro).

It communicates with the fourth ventricle posteriorly by the cerebral aqueduct (of Sylvius).

The third ventricle, similarly to other parts of the ventricular system of the brain, develop from the central canal of the neural tube. Specifically, the third ventricle originates from the portion of the tube that is present in the developing prosencephalon, and subsequently in the developing encephalopathy.

It is bounded by the thalamus and hypothalamus on both the left and right sides. The lamina terminalis forms the anterior wall of the third ventricle.

There are two protrusions on the front of the third ventricle:

the supra-optic recess (above the optic chiasma)
the infundibular recess (above the pituitary stalk).
In casts of the ventricular system, a small 'hole' may be seen in the body of the third ventricle. This is formed where the two thalami are joined together at the interthalamic adhesion (not seen in all people).
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Now that u have finished reading go here and try answering a question. Read and try answering question 103 in that paper given in the link. Answers are given below the presentation.