A REVIEW ON COMPREHENSIVE UNDERSTANDING OF APASTAMBHA MARMA AND ITS CLINICAL SIGNIFICANCE

The word Marma denotes the vital spots of the body. Marma Shareera is widely discussed in Ayurveda. The structural entity of these spots is not clearly explained in the classical texts so we cannot rule out the exact structural components involved. Apastambha Marma is one among 107 Marma explained in Classical textbooks. According to Sushruta, it is classified under Sira variety and it is an Urogata Kalantara Pranahara Marma. But Vagbhata has mentioned it as a type of Dhamani Marma on the basis of its structural entity. It measures about 1/2 Angula Pramana. Acharya Sushruta mentions its location as Uras, bilaterally where two Vatavaha Sira (tubular structures carrying air) are seen. Vagbhata says that it is situated in the Uras on both sides of the Parshwa. The Viddha Lakshana of this Marma as per Sushruta is Vatapoornakoshtataya, Kasa, Shwasa and Marana. However, there is a difference of opinion with Vagbhata; he has explained Raktena Poornakoshta instead of Vatapoornakoshtataya. Result: The marked area for the Apastambha Marma is at the level of 3rd costal cartilage on both the sides of the chest just lateral to the midline. As the measurement in Angula (1 cm) is not apparent so it is taken as the lengthwise, breadth wise and depth-wise. Conclusion: The area of about 2 cm lateral to carina which is the common site of injury in the bronchus can be taken as the site of Apastambha Marma as rupture of the bronchus leads to pneumothorax and the individual will show symptoms of breathing difficulty such as Kasa, Shwasa and in severe cases it may lead to the death. This explanation holds true for the Viddha Lakshana mentioned by Sushruta. Taking Shonitapoornakoshta this into consideration, pulmonary and bronchial vessels can be taken as the structures involved in Apastambha Marma which also holds good for the explanation of structural composition as per Vagbhata also i.e., it is a Dhamani Marma. Thus, we can conclude that the two Principal Bronchus along with the pulmonary vessels and bronchial vessels should be considered as the site of Apastambha Marma.

Treatment of haemoptysis in pulmonary atresia with tranexamic acid

We report the case of a young woman with continuing haemoptysis, pulmonary atresia, previous shunt surgery, and pulmonary hypertension. She was not suitable for further surgery or for therapeutic embolisation of bronchial vessels. Treatment with tranexamic acid resolved the haemoptysis.

On the purported discovery of the bronchial circulation by Leonardo da Vinci

Among modern physiologists and anatomists, there has been a nearly universal acceptance that Leonardo da Vinci was the first to identify the anatomy of the bronchial circulation. However, because of certain ambiguities in both his anatomic drawing that was supposed to have shown this circulation and the accompanying descriptive text, we questioned whether he really could have been the first to discover this small but important vasculature. To address this question, we set out to repeat Leonardo's dissections in the ox. We reasoned that perhaps the normally tiny bronchial vessels would be considerably more noticeable in this very large species. Our dissections, however, failed to provide any evidence that Leonardo's drawing was that of the bronchial circulation. Furthermore we observed a set of distinct small pulmonary veins to the left upper and right middle lobes that Leonardo, given his lack of understanding of the function of the lung and its circulation, could have easily mistaken for a separate circulation. We thus conclude that Leonardo da Vinci did not describe the anatomy of the bronchial circulation. We believe that the first person to clearly and unequivocally describe the anatomy of this circulation was the Dutch Professor of Anatomy and Botany, Frederich Ruysch.