By Jay Y. Gillenwater MD, John T. Grayhack MD, Stuart S. Howards MD, Michael E. Mitchell MD
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Sample text
21 Division of the Diaphragm. The transversus abdominis fibers are divided close to the costal arch, followed by incision of the diaphragm. The diaphragm is incised as far laterally as possible to preserve the phrenic nerve branches (Fig. 34). 34. Division of the diaphragm. Modification of the Thoracoabdominal Approach for a Stage II or III Tumor Thrombus in the Vena Cava. After the abdominal cavity and chest have been opened, the incision in the mesocolon is carried along the colon and is continued along the mesentery to the duodenojejunal flexure.
Anatomy and Innervation of the Rhabdosphincter: Female On macroscopic examination, the sphincteric muscle is encountered on the ventral and lateral aspects of the urethra. Microscopically, this muscle corresponds to the omega-shaped rhabdosphincter in the male. On histologic examination, in the cranial two-thirds of the urethra, three smooth muscle layers can be identified forming an outer and an inner longitudinal and a middle transverse layer. The inner longitudinal layer is delicate, thinning out toward the external meatus.
The lymph vessels of the bladder communicate with one another in the paravesical space and may end directly at the external iliac and interiliac lymph nodes or may reach them by way of smaller nodes (anterior, lateral, and posterior vesical nodes). Connections with the internal iliac lymph nodes are occasionally observed. The nerves supplying the bladder are derived from the pelvic plexuses (Fig. 59). The parasympathetic fibers (pelvic splanchnic nerves) of these plexuses originate from the second to fourth sacral segments and supply the detrusor muscle.