Legitimizing Final Causes :: essays research papers

<a href="http//www.geocities.com/vaksam/">Sam Vaknins Psychology, Philosophy, Economics and Foreign Affairs Web SitesThe word "telos" in ancient Greek meant "goal, target, mission, completion, paragon". The Greeks seem to have associated the attaining of a goal with perfection. Modern scientific thought is much less sanguine about teleology, the belief that causes are preceded by their effects. The opinion is less zany than it sounds. It was Aristotle who postulated the existence of four types of causes. It all started with the attempt to differentiate explanatory theories from theories concerning the nature of explanation (and the nature of explanatory theories). To explain is to provoke an spirit in a listener as to why and how something is as it is. Thales, Empedocles and Anaxagoras were mostly concerned with offering explanations to natural phenomena. The very idea that there must be an explanation is revolutionary. We are so used to it that we fai l to see its extraordinary nature. Why not assume that everything is precisely as it is because this is how it should be, or because there is no better way (Leibnitz), or because someone designed it this way (religious thought)? Plato carried this revolution further by seeking not only to explain things - but to a fault to construct a systematic, connective epistemology. His Forms and Ideas are (not so primitive) attempts to elucidate the mechanism which we employ to cope with the world of things, on the one hand, and the vessels through which the world impresses itself upon us, on the other hand. Aristotle made this distinction explicit he said that there is a difference between the chains of causes of effects (what leads to what by way of causation) and the interrogatory regarding the very nature of causation and causality. In this text, we will use the word causation in the sense of "the action of causes that brings on their effects" and causality as "the relation be tween causes and their effects". Studying this subtle distinction, Aristotle came across his "four causes". All, according to him, could be employed in explaining the world of natural phenomena. This is his point of expiration from modern science. Current science does not admit the possibility of a final cause in action. But, first things first. The formal cause is why a thing is the type of thing that it is. The material cause is the matter in which the formal reason is impressed.

The Conflicts of the Black Race: Delayed Economic and Educational Progress :: essays research papers

The Conflicts of the Black Race Delayed Economic and Educational ProgressIn the 1960s, faints, led by Dr. Martin Luther King Jr., fought for their complaisantrights and equal opportunities. Although they had only been out of slavery forless than a century, they felt the time was way past due for them to receive thesame treatment as other American citizens. Our people struggled to receivedecent education programs for their youth for the right to earn a decent living,and to receive respect from other racial groups. Fortunately for our generation,their fight ended in victory. However, 30 years later, despite the progressmade then, our community does not seem to rent kept up with our ancestors rateof self-improvement. Not only are blacks still disrespected by other races,problems similarly plague us such as poverty, drugs, and miseducation. To makematters even worse, we also have a serious lack of unity. Some of us feel asthough it is not our responsibility to help other blacks when they are in need.Another major problem is the existence of racism. This negative attitude leadsto many physical and psychological problems within the black community.Therefore, lack of unity within the black community and the effects of racismare two major factors when contribute to the slow progress of black people.Before the genteel Rights movement racism was so blatant that not knowing itexisted would have been difficult. Presently, it is so subtle that some arguewe cannot blame racism for our problems. Unfortunately, they are wrong. Theeffects of racism can be seen in the segregation of our neighborhoods and in ourhigh unemployment rates. White people want to keep their contact with us to aminimum. In 1991, USA Today report that the 1990 census "concluded that themajority of the nations 30 million black people are as segregated now as theywere . . . in the 60s " (Smith 104). This proves that although some blacksincomes have increased, they do not always live in neighbo rhoods they can affordbecause the area is usually predominately white. The U.S. Department of Housingand Urban Development found that anti-black inequality was widespread in thehousing industry in 1992 (Smith 105). This practice can be found in theworkplace. Ed Smith, Ph.D. found that "blacks with college degrees had a 13 part unemployment rate in 1987 compared to five percent for whites" (Smith112). Many studies exist that prove that college-educated blacks are not muchbetter off than high-school graduates. The U.S. Commission on Civil Rightsadmitted that "lack of education is not the reason for high minority

The Function of Themes in Catch-22 Essay -- Essays Papers

The Function of Themes in Catch-22Joseph Heller produced many works of literature throughout his lifetime however, his closely acclaimed novel, Catch-22, has plump a cult class among readers throughout the world. Catch-22 is not a bland novel that invokes few emotions from its readers. It is a moving novel stacked honorable of many themes. These themes indubitably conjure up fear and mistrust of the system that seeks to destroy unmatcheds own life.Joseph Heller was born on May 1, 1923, in the hyrax Island section of Brooklyn, New York, to Russian-Jewish immigrants. His father Isaac (Pinsker 228), a bakery truck driver, died when Heller was only four years of age (Kaupunginkirjasta online). During World War II, Heller served as a bombardier for the United States Air Force and flew sixty onslaught missions while stationed in Italy. This gave him the background for Catch-22 (Classic online). Specifically, while on a combat mission, Heller witnessed one of his fellow airmen die of wounds this ultimately led to Hellers graphic portrayal of Snowden, a young airman in Catch-22, who dies a horrid death during a bombing run (Pinsker 383). After being discharged from the Air Force, Heller enrolled in the University of Southern California and later transferred to New York University where he majored in English. Upon finishing his studies in New York, Heller attended Columbia University until 1949, when he sure his Master of the Arts Degree in English (Pinsker 383). After receiving his degree, Heller went on to become a professor at Pennsylvania State University where he taught English for two years (Classic online). In 1961, after a series of jobs working for such(prenominal) magazines as Time and Look, Heller published Catch-22, which he had been working on since 1953(Classic online). After Catch-22 was published in 1961 (Kaupunginkirjasta online), Heller continued his writing career with Something Happened in 1974, Good as Gold in 1974, God Knows in 1984, Pictur e This in 1988, and Closing Time in 1994 (Pinsker 379). Although not as well received as Catch-22, Closing Time serves as a sequel to Catch-22 in which the heroes are described forty years after the original novel (Kaupunginkirjasta online). sadly on December 3, 1999, Joseph Heller died of a heart attack at his home in Long Island, New York (Kaupunginkirjasta online). Hellers career and personality was best describe... ...ecision The modern American Novel and Its Intellectual Background. Riley 228-229.Burhans, Clinton S. Spindrift and the Sea Structural Patterns and Unifying Elements in Catch-22. Riley 230.Calhoun High School English Department. Catch-22. Bellmore Merrick Central High School District. . 26 Oct. 2001.Classic Notes Joseph Heller. Classic Notes. 2001. Grade Saver. . 12 Oct. 2001.Karl, Fredrick R. Joseph Hellers Catch-22 Only Fools Walk in Darkness. Contemporary American Novelists. Ed. Harry T More. Illinois Southern Illinois University Press, 1964. 134-142.Kaupung inkirjasta, Kuusankosken. Joseph Heller (1923-199). Pegasos-Literature Related Sources. 2000. . 12 Oct. 2001.Olderman, Raymond M. The Grail Knight Departs. Riley 229-230.Pinsker, Sanford. Joseph Heller. American Writers. Ed. Litz, A Walton. Supplement 4, part 1. New York Charles Scribners Sons, 1996. 379-396.Prescott, Orville. Books of The Times. The New York Times on the Web. 1998. . 14 Oct. 2001.Riley, Carolyn. Contemporary Literary Criticism. Detroit Gale Research Co. 1973. Themes PinkMonkey.com-Catch-22 by Joseph Heller. Pink Monkey.com. . 14 Oct. 01

Ehrlichs Population Bomb :: essays research papers

Ehrlichs Population Bomb     "People be realizing that we cannot forever continue to multiply andsubdue the earth without losing our standard of life and the natural beauty that mustiness be part of it. these are the years of decision- the decision of men to staythe flood of man." Ehrlich here explains the one of the most pressing problemsfacing man in the 20th century. In Population Bomb, Ehrlich explains thatpollution, shortages, and an overall deterioation of the standard of living isall due to over tribe.     In chapter one Ehrlich explains the pressing problems facing moderncivilization and how these problems are directly or indirectly linked tooverpopulation. Ehrlich explains situation using various examples of how massstarvation is inevitable if population continues to increase the way it iscurrently. In thirdly world countries their food supplies are becomingincreasingly scarce be yard of their increasing populations. In t hese thirdworld countries the rich-poor gap is increasing creating the potential for large split of the population to starve. Paraphrasing Ehrlichs ideas in chapter canbe explained as there is only so many resources and as population increasesthose resources will soon be depleted. Ehrlich uses diachronic populationresearch to lead to the conclusion that in 90 years the population could be wellover the earths carrying capacity. In third world countries where populationcontrol is rarely used population, pollution, and scarcity are becoming everincreasing problems. Roughly 40% of the population in third world countries arechildren 15 years or older. Ehrlich explains that if population growthcontinues at this rate older generations will find themselves without adequatefood and medicine. Near the end of the chapter Ehrlich explains the cause ofthe massive increase in population growth as he explains that science andmedicine have decreased the death rate exponentially piece the birth ra te hasnot decreased. In "Too Little Food" Ehrlich starts off with the assumption thatabout 50% of the people in the world are in some degree malnourished. He usesstatistics from "New Republic" and the Population Crisis Committee to put thenumber of deaths to around four million people death each year of starvationalone, not disease caused by starvation. Ehrlich explains that sometime around1958 population growth exceeded the available food supply. When this happenedthe laws of supply and demand took over and caused massive inflation in foodcosts and causes marginal farm land to be put into production. All of thesesigns caused a period of time with stern shortages in food. In 1966 alone theworld population increased by 70 million while food production remained

Does Delegated Legislation Represent a Threat to the Democratic Process

Delegated order is the power delegated by Parliament to some person or body to make law. The Act of Parliament that enacts a reasonable piece of delegated legislation, and the latter itself, both have the same legal force and effect. Parliament retains general control over the procedure for enacting such law. There ar various types of delegated legislation. Orders in Council, Statutory Instruments, Bye-laws, Court Rule Committees, Professional regulations. It is essential to focus on the facts that specific controls have been established to oversee an unjust or inapplicable delegated legislation. Apart from the parliamentary control of the Join Select Committee on Statutory Instruments, Courts can also challenge ultra vires provisions finished judicial review. Due to the complex nature of the delegated legislation, there are contradicting opinions about its democratic or not- characteristics.Some people argue that as long as there is some control over delegated legislation not o nly by Parliament by more importantly by judiciary, this kind of legislation doesnt seem to threaten the democratic process. In fact, given the pressure and waste of time on debating, it is more beneficial for the government to spend its curious time in a thorough consideration of the principles of the enabling Act, leaving the appropriate minister or body to establish the working details.The time save and the fact that particular problems are faced swiftly from the minister or body overview ...

The Montgomery Bus Boycott Essays -- Rosa Parks, civil rights

In the late eighteen hundreds, the Reconstruction by Congress was overturned by the imperious Court. Segregation or separation by skin color was made a law which was adopted by private organizations, institutions and businesses (loc.gov). Physical violence and kind harassment was imposed upon those whom were deemed inferior in color. Some citizens accepted the law, as is, without question while others believed it was their supreme right to remain separate without modification. Human activists, that contradictory this way of living, pursued an extensive battle to abolish racial inequity and segregation from American life (loc.gov). During the nineteen hundreds, many understood this treatment as an offense to human beings and activists began receiving assistance toward this common goal. Support and hindrance, for equality, were both on the rise throughout the capital of Alabama Bus Boycott. There were also citizens and organizations or groups who incomplete supported nor opposed se gregation. They just wanted some sort of compromise or settlement to put a stop to all the chaos calamity in their city. Two groups in particular that attempted to acquire an agreement between Montgomery city officials, the transportation company and protest leaders were the work force of Montgomery and the Alabama Council on Human Relations. The Men of Montgomery, a businessmens group, recruited by protest leaders to resolve the issues was unsuccessful in obtaining a consensus to meet the demands of the bus boycott. These men were able to construct a meeting with the opposing sides however, they did not take a stand for complete humanity. Choosing sides would possibly dispatch repercussions from either side. City officials were only willing to produce a partial agreement that... ...unity joined together which was not normal among them. Civility was the conquest among boycotters. Montgomery wasnt ready for the change. They were forced, by the Supreme Court, to accept the terms of the protesters. The long process and struggle finally paid off, integration legally was adopted.WORKS CITEDGarrow, David J. Martin Luther King, Jr., and the gray Christian Leadership Conference. Bearing the Cross. William Morrow. New York Quill. 1-82.Interview, Montgomery Bus Boycott, Mrs. Janice Chapital, 09 Apr 2014.Library of Congress Exhibitions. 06 Oct 09. A Century of Racial Segregation, 1849-1850. 22 Feb 2014. Olson, Lynne. The Unsung Heroines of the Civil Rights safari from 1830 To 1970. Freedoms Daughters. Murrow. New York. Scribner. 13-17, 87-191.

The Montgomery Bus Boycott Essays -- Rosa Parks, civil rights

In the late eighteen hundreds, the Reconstruction by Congress was overturned by the Supreme Court. Segregation or separation by skin color was made a law which was adopted by private organizations, institutions and managerinesses (loc.gov). Physical violence and mental harassment was oblige upon those whom were deemed inferior in color. Some citizens accepted the law, as is, without question while others believed it was their supreme right to remain separate without modification. Human activists, that hostile this way of living, pursue an extensive battle to abolish racial inequity and segregation from American life (loc.gov). During the nineteen hundreds, many understood this treatment as an offense to charitable beings and activists began receiving assistance toward this common goal. Support and hindrance, for equality, were both on the rise throughout the Montgomery Bus Boycott. There were also citizens and organizations or groups who neither supported nor opposed segregation . They just wanted some sort of compromise or settlement to put a stop to all the chaos happening in their city. two groups in particular that attempted to acquire an agreement between Montgomery city officials, the transportation company and protest leaders were the Men of Montgomery and the atomic number 13 Council on Human Relations. The Men of Montgomery, a businessmens group, recruited by protest leaders to resolve the issues was unsuccessful in obtaining a consensus to meet the demands of the bus boycott. These men were able to construct a meeting with the opposing sides however, they did not take a stand for complete humanity. Choosing sides would possibly gain repercussions from either side. city officials were only willing to produce a partial agreement that... ...unity joined together which was not normal among them. Civility was the conquest among boycotters. Montgomery wasnt go down for the change. They were forced, by the Supreme Court, to accept the terms of the p rotesters. The long process and struggle finally paid off, integration legally was adopted.WORKS CITEDGarrow, David J. Martin Luther King, Jr., and the Southern Christian leading Conference. Bearing the Cross. William Morrow. New York Quill. 1-82.Interview, Montgomery Bus Boycott, Mrs. Janice Chapital, 09 Apr 2014.Library of Congress Exhibitions. 06 Oct 09. A Century of Racial Segregation, 1849-1850. 22 Feb 2014. Olson, Lynne. The Unsung Heroines of the Civil Rights Movement from 1830 To 1970. Freedoms Daughters. Murrow. New York. Scribner. 13-17, 87-191.

Black Beauty Book Report Essay

Some say that beauty is in the eyes of the beholder. This cliche holds appropriately reliable for relentless lulu, a novel written and popularized by the crippled writer Anna Sewell (1877). The playscript tells about the life story of a horse. It answers a persons curiosity about how a horse feels while surviving the atrociousty of men. A heart-wrenching, beautiful, and enlightening tale and animal autobiography, the book gives life and voice to glowering Beauty, a majestic horse.Quite believable and unsentimental yet a great read book depicts the life cycle of a horse which, but like any other being that God created, deserves and expects proper treatment from people whom horses regard with respect and unconditional affection. The book revolves around the life of the primary(prenominal) character, a very wise horse named smuggled Beauty. The sufferings and misfortunes of inkiness Beauty made him rebel against the cruel valet de chambres. Some characters of the book include D uchness, the mother of Black Beauty Ginger a very independent horse and Merrylegs, the good friend of Black Beauty who has a big love for humans.For the rest of his life, Black Beauty has been put into care of various owners who subjected him to different jobsfrom being a riding horse on a country estate to a literary hack horse in the community. Although he always suffers from the harsh treatment of humans, the strength, gentle mood, and fine inherent aptitude of Black Beauty made him survive. Black Beauty is a true-to-life animal story book that is told from the eyes of the horse, not from a readers perspective.Sewells (1877) book is an unusual narrative first appearance which uses a horse as the first-person narrator as if the horse was the one who actually wrote the book. Black Beauty was considered to be the first book that employed the musical style of animal autobiography which was previously seen in a limited fashion. The manner of displaying the literal substance of an a nimal as an animal itself rather than being presented found from human traits was adapted by other books with related story plots (Napierkowski, 1998).In writing the book, Sewell (1877) aimed at advocating the humane and suitable treatment of horses. Hence, Black Beauty was recognized as the only writing in the literary history with the greatest impact or influence on the treatment of animals. As a result, the book has created and paved the way for a legislation that promotes the welfare of horses. It further altered public orientation about animal pain as well as the conventional and popular activities perceived as the ones that induce suffering for horses (Napierkowski, 1998).A story told using the language and means of communication of a horse, the book tells how Black Beauty was treated with affection and respect when he was a young and healthy horse. It also illustrates how the horse fell into sickness and despair as he was passed from different careless owners. He drived a lot of healthy pieces of advice from his mother during his youth. These lectures by his mother laid down the heart of the book and were utilise by Black Beauty as his life plan as he was passed down from one master to another, all of whom possess different, contrasting personalitiesgood, cruel and foolish.This first ever full-length book narrated from a horses perspective and emotions is a sorrowful story of both the malicious and accidental cruelties that animals receive from the hands of their masters or owners. It is also a book of aesthetic literary work that can bring the reader from the wonders and beauty of an ordinary darkness in a country community to the power-laced world of Victorian London in the nineteenth century. With its captivating but realistic presentation of the life of an laughable horse, the book was able to capture not just the hearts of the young readers but of adults as well.This is because the book generally portrays some similarity to the lives that peo ple and horses begetthat both beings suffer cruelties and happiness. This book helped to the end human cruelty to horses and other animals. It signaled the formation of various animal-rights movements and forced more humane and justified treatment of human cabbies in London and the rest of the world. References Napierkowski, M. R. (1998). Black Beauty Introduction. Novels for Students, 0. Retrieved February 21, 2008, from eNotes database. Sewell, A. (1877). Black Beauty. Norwich, England Jarrolds & Sons.

Blue Streak Essay

What suggestions would you offer to Art to improve his operation? It seems as though, Art prematurely opened the two locations in neighboring states. Because Art was a constant figure in his other locations from inception, the vision that he had for those locations were taught and able to be practised to his standards. There argon at least three areas in which this operation can be improved. It is clear that art believes that the common denominator in the success of each his other locations is his presence. At the locations in neighboring states his charabancs feel as though, he frequents the locations too much. There is a clear disconnect in his intent and their away look of the situation. His manager likely believe that he doesnt trust them to effectively manage, and do the job in which they were hired. They likely seem his as a micromanager. I believe that this line of work can be solved with simple communication. He explains the reasoning behind his constant visitations and Im sure his manager will be able to understand his reasoning and that will relieve some of the tension. Also, his managers do not seem to know what Art is expecting of them as managers. This problem can be handled with training. Art may want to think about closing down his locations for a limited period of time in set out to teach his managers what is expected of them. When Art visited these locations, it seems as though he never effectivelyWhat management skills must Art master if he is to resolve his problems and go forward to grow?Conceptual skills may help him to understand that in order for the go with to succeed he needs to plan and organize his goals. Using these skills increases the exponent to see the organization as a whole. It would help Mr. Benton to understand the relationships among the different offices and see how the organization fits into its broader environment. These skills are cruel for the top management and will the company will grow and it will also allo w Mr. Benton to grow as a person. Mr. Benton can apply the skills mastered in his company by realizing how the out-of-state offices are connected to the other offices. By understanding this he can understand the business as a whole and decide on the objectives and then proceedings to plan and organize management task. Therefore, mastering conceptual skills arerecommended to learn since it will help the CEO understand the company as whole qualification better decisions and resolving the problems at easier way.

Project Management Recommendation Essay

My team has pulled together the information you discombobulate requested and have come up with a recommendation for what we have found to be the most appropriate suggestion for Piper Industries Corporation.The team has decided that the Stargazer proposal will be most beneficial to Piper Industries Corporation. This cast proposal is forecasted to create the highest ROI compared to the forecasted project represent. A majority of the project costs are change posture costs of $450,000 which has been applied to the research and development of the new widget. The final project cost is estimated to be $575,000, which is an additional cost of $125,000. A key figure valuable in the decision was likewise the ROI, which is predicted to be $1,600,000 for the first troika years on the market. The widget is anticipate to have a life-cycle of seven years. Based on the forecasted information from the first three years of sales, (first year $300,000, second year $550,000, and the third year $750,000) forecasted demand for the widget is expected to continue to grow.The difference surrounded by the ROI and the project cost is $1,025,000 (only estimated for the first three years). The reason that the Juniper and Palomino proposals were not selected was because of the projected costs in relation to the expected ROI. The Juniper project is expected to generate $250,000 ROI in a two to three year period, but the project costs are expected to be $325,000. The life-cycle is expected to be three years.The difference is -$75,000 in revenue, which means that the project does not have a profitable gain during its life-cycle. The Palomino project is predicted to generate a greater revenue of $450,000 in a five-year period ($90,000 yearly ROI), but the project costs are predicted to be $655,000. The life-cycle of the Palomino widgets is estimated to be seven years which increases the ROI to $630,000, and is still a loss to the companionship in relation to project costs of -$25,000 revenue. Neither of theseprojects is estimated to create profits during their life-cycles.The setbacks in the Stargazer project include that the widget is an innovative product so there is a lack of historical data that can be used in the development. The specifications of the widget (based on R&D that has already been conducted) take up it a high-risk product because of greater technological uncertainties. These uncertainties will be addressed early in the project process but will mend it harder to meet the expected completion deadline. The project deadline is February 29, 2016, and the estimated delivery date will be determined in the first phase of the project. The phases of the project are rugged down as followsPhase One InitiationThis is the research phase of the project, where the goals and objectives of the project are defined clearly. In this phase, the forecasted budget, end-date (final deadline is February 29, 2016), resources required (including team members based on skills needed), and project milestones are addressed.Phase Two PlanningIn this phase, both preparations are made for how the project will function. This is where the project objectives are defined, as vigorous as key requirements of the project. The project is broken down into projects and subtasks that are scheduled carefully to stay on track with other objectives. The schedules are made to crap the project delivery date, which is currently established for January 1, 2016 so the widget can be on the market by the project deadline of February 29, 2016. The cost of each task is determined, which gives a more precise picture of project cost.Phase Three ImplementationActual work on the project begins in this phase. In this phase, cost accounts are created, work orders are issued, RFP are issued, contracts are made with vendors, and further resources are acquired (such as personnel). The project is officially set into motion.Phase Four get wordThe projects performance is carefully monitored for variances in actual activity and planned activity. The four main aspects that are monitored closely for variations include cost, schedules, risks, and the scope (the objectives of what the project is supposed to accomplish). This information is monitored by consistently collecting and analyzing data pertaining to these four aspects. The information is regularly reported through status reports and briefings to keep all kindle parties up to date with the projects progress.Phase Five ClosureIn this phase, you are provided with the final product (widget), that has been tested and approved by all parties to the project. A complete history of the project is documented and given to you to be filed. The final payments to vendors are issued, and the cost codes for the project are closed, and the final invoice for function are submitted to you. Any equipment used for the project is disposed of accordingly, and the last step is to close the project site.My team is looking forwa rd to your response to our suggestion. We are also looking forward to working with you on this project. If you have questions or concerns, please dont hesitate to contact me.

An Analysis of the Correlation Between Socioeconomic Status and Obesity Essay

competitiveness theory is based entirely in force play and how those in billet do all they can to hold the majority of the population down and to keep them from gaining power, so as to secure their own position. Conflict theorists would say that obesity is a product of the living conditions, stress and poor quality of food and health education. Obesity is seen as deviant and problematic and and then conflicts with the ideal society of organism fit and thin. The more obese the less power and stature you have in society.Conflict theorists powerfulness say that those that ar in power, law makers, Fortune 500 CEOs, for example, make cheaper good, make goods more unhealthy, and so the poor talent only be able to contribute cheap, unhealthy bulk food and become susceptible to obesity. Conflict theorists might say that food education might be controlled by larger political relation forces, for example the Food and Drug Administration and the United States De small-armment of Agricu lture. These are the members of society who look out for their own bottom line and corporate interests from sponsors and lobbyists.They might limit education about food intake and what is healthy and unhealthy, they might suggest certain foods like beef or milk is healthy to address to the dairy industry, to keep our politicians funded with billions of dollars in donations. There is also the argument that by keeping people obese it allows for discrepancy at cook, in which they must work harder at getting raises because they cannot keep up with their thinner counterparts. Obese people have difficulty with their social lives and early death and numerous health complications that might however ensure the status of the powerful few at the top of the food chain.The Structural Functionalism theory argument is that obesity is a necessary part of society. Functionalists major argument is that everything that exists must have a meaning and must be useful towards society as a whole. Funct ionalists might deal that obese people will exact attention to the problems in health care and obesity might help in teaching those in power more our emotional connection to food and to further explore mans relationship with eating and nourishment.The obese population might inspire others to be healthier and might inform and educate society as a whole about the dangers of obesity and its overall impact. Functionalist would say that to the obese would be bring an overall benefit to society. The symbolic interactionist theory demonstrates the effects towards obese people when they feel they are being perceived in a negative or unflattering way. The verbal and nonverbal cues that a fit or thin person demonstrates might create an obese person to withdraw even further from society and or turn to food as a coping mechanism thereby increasing weight.Obesity is most correlated to social discrimination and a feeling of being unworthy or weak due to the inability to resist food, for persona l and emotional reasons. Obesity in society is a symbol of unhealthiness and unattractiveness which produces feelings of disgust, but obesity is a symbol in and of itself because our society makes us associate those things with obesity. There are cultures and societies around the world where being obese means status and power and it was seen as sexy and desirable. Everything we do is socially constructed as is our reactions and treatment of obese people.

Explore the Role of Trading Blocs on International Trade Essay

International BusinessIn this assignment, I will be defining international trading bloc and their routine before outline completely the different examples of trading blocs such as WTO, Customers Unions, and Common Markets before explaining how these pertain on the international hatful. I will have got the trading blocs and examples to Jaguar visit bird of passage, a multimillion-pound car manufacturer distributing worldwide.Trading BlocsTrading Blocs is a group of countries in a geographical atomic number 18a that gets unneurotic to protect themselves from countries outside the group, working together to make goods or services move more easily and placing restrictions on the number of goods or services being brought into the area. Some organizations help to make these countries work together and move goods or services more easily. These organizations include World Trade cheek and other greens markets such as the EU.World Trade Organisation (WTO)The WTO makes sure that co untries can trade with each other as smoothly, predictably and freely as workable so that businesses can sell their goods all over the world. The WTO has negotiated agreements mingled with countries so that businesses trading have legal rights and agreements to protect them. If there are disagreements or arguments amid two countries then WTO will step in and assist the situation. WTO has a positive impact on international trading as they ensure all businesses trade fairly and legally and ensure that no one is ripped off or miss sold goods.Customs Unions and Common MarketsIn some areas of the world, customers unions and jet markets have been established to allow free trade to take place between those different countries. This allows businesses more rights and opportunities to trade with each other with the support of the familiar market to ensure e reallyone is trading and operating legally and effectively.The EUThe EU was established in Second World War through European frugal Community. At the start, 6 countries joined the EU, France, Germany, Italy, Belgium, Netherlands and Luxembourg. Over the next 60 years, more and more countries joined the EU, 28 countries including the UK joined by 1973. The EU was a very crucial in international trade as they set up their own internal market which allowed countries to move and trade goods or services veritable(a) freer between the countries involved. It achieves the above through a number of different ways. It has its own currency, the Euro. It provides EU citizens the movement to other countries without VISAs as long as they are a member of the EU. They have their own set of rules they must adhere to in order to maintain a member of the EU.MercosurRather similar the EU, this group was established to help the third world, less developed countries increase the trading opportunities between each other. Countries involved within the common market are Argentina, Brazil, Paraguay, Uruguay and Venezuela, all less dev eloped countries who cant afford the scale and size of international trade deals occurring in the EU, hence why they are a part of the Mercosur. They have more land and size than the EU, however, have made little progression when compared to the EU, however, have similar aspirations and goals, wanting to make international trade and movement as easy as the EU do. The effect it has on the countries involved is that it provides them with a platform to trade internationally and increase the size of deals, bringing in more money to the country and helping to improve local economies. They still have the same(p) legal rights and regulations when it comes to b2b trading.The above have a gigantic positive impact on countries who are a part of the Europe Union as it provides plenty of other countries the opportunity to trade freely between each other using the same currency and operating under the same legal rules and regulations. If any deals went downhill and a business within the EU w as miss sold goods or non paid the full balance then they can appeal to the EU for support and guidance, allowing them to take legal follow out against the other business.Jaguar Land Rover will be impacted in different ways by the above trading blocs due to the size and scale of them having a negative impact towards local businesses. If Jaguar Land Rover are having a positive impact on the economy of a country, increasing the countries revenue through their taxes and increasing employment rates then the government for that country may increase the easiness of movement of goods across the country, further them to continue trading within, benefiting the country as a whole. The World Trade Organisation has a big role in the trade deals of Jaguar Land Rover as the deals they are working on is worth millions of pounds and therefore involve high risk and liability if they go wrong, this is where the World Trade Organisation will step in, resolve the issue and ensure the deal is stil l going to go ahead. They will ensure no party is ripped off or miss sold goods and that all parties are aware of the terms and conditions throughout the deal. The Customs Unions and Common Markets and the EU allow businesses or countries within a certain(prenominal) area free trade and more rights to trade between each other. This would have a negative impact on Jaguar Land Rover as they would have to pay importation and exportation taxes, increasing the expenditure for each product meaning they cant be as private-enterprise(a) on pricing as other businesses within the market. The Mercosur wont have an impact on Jaguar Land Rover due to the size and scale of them and how the Mercosur id directed at smaller, less established businesses acting as a platform to boost them. Jaguar Land Rover will not face the competition from this market as the size and scale will counterbalance the benefits that Mercosur provides the smaller businesses with.ConclusionIn the above assignment, I ha ve listed, explained and evaluated the impact different common markets have on international trade for the countries involved. I have explained the different reasons for how they work and the benefits they bring. All markets have similar aims and understandings, have the same legal rules and regulations and all believe in fair, free movement of goods or services.

Science, Health, and Medicine

Science, Health/Medicine The 1980s was a huge breakthrough for science and medicine. A lot of drugs were invented and medical procedures were carried out for the branch time. Some of the medicinal inventions were * 1980, the hepatitis-B vaccine. * 1982, human growth hormone genetically engineered. * 1983, Soft bifocal contact lens invented. * 1986, Synthetic skin invented by G. Gregory Gallico, III. * 1987, the introduction of fluoxetine hydrocholoride it transformed the treatment of depression. * 1989, The RU-486 (abortion pill) invented. In 1982, the first ever artificial human heart, made by Dr.Robert Jarvik, was implanted into Barney Clark he survived for 112 days. In 1984, in the Loma Linda Medical Center, muck up Fayes heart is explanted and replaced with a baboon heart. She survived for 3 weeks but died of a kidney infection which could or could have not have been caused by the new heart her body business leader have been rejecting. Stephanie Fae Beauclair Stephanie Fae Bea uclair In 1984, researchers identified the virus that caused AIDS as HIV and in 1986, it was recognised that AIDS was transmitted through straight contact as well as homosexual contact. Test tube baby (In vitro fertilisation)In vitro fertilisation is a process where the egg is fertilised by the sperm away of the body in a test tube and is a procedure that is used for people who arent able to have a baby the inherent way. Once the egg has been fertilised outside the body, it is transferred into the uterus so that it can have a natural birth like any other baby. Even though the first in vitro baby was born in 1978, the number of IVF babies had risen in the 80s because of huge improvements to the treatment. Australias first IVF baby was born in 1980, ground forcess in 1981 and in Sweden and France, 1982.

The Scarlet Letter Summary: Chapters 7-11

In these chapters, Hester visits the regulators mansion. She wants to find out if the rumors that drop curtain might be taken away from her are admittedly. When she eventually meets with the governor she begs him to not take her daughter away from her. They agree to not separate the mother and child, and tusk seems to take a liking to the governor. Chillingworth tries to convince the governor to reopen the case of revealing who the father of Pearl is, but he refuses.Chillingworth changed his name upon his arrival to Boston to hide his true identity, even though Hester knows his true Identity, and she was sworn to secrecy. He is known as the doctor of the town, and because the town has very little medical help, he is openly welcome. When Dimmesdale begins to have lots of chest pains, the doctor moves in with him to make sure everything is ok. Even though the government minister doesnt trust the doctor, because he has no reason for his distrust, he still does what he says.The mini sters sickness causes him to give more powerful sermons, mostly focusing in sins. At night, he cant sleep and he begins to have visions. He has a vision of Hester pointing at her scarlet letter, and accordingly pointing at the clergyman. The minister believes that he is jus delusional and doesnt pay any mind to his visions. He because begins to torture himself, by whipping himself, not eating, and not sleeping. He then thinks he knows how to remedy his pain. He decides to hold a vigil, on the same scaffold where Hester had suffered her punishment years ago

America during the 1930s Essay

An essay to show how the novel, Of Mice and Men by John Steinbeck, cogitates to how sprightliness was wish in America during the 1930s. Of Mice and Men is a short novel written by John Steinbeck. It gives us a good idea of certain aspects of the depression, which was a period of time where in that location were too few jobs to go round for each of the Ameri gutter people during the 1930s. Aspects such as the conditions bedspread workers would have go about domestically and at work, if they had a job.This period in time had a large effect on the way a person was perceived by those around them. These problems were made perfectly clear in Of mice and Men When analysed, loneliness is probably the most distinctive issue that stands out among all of the problems that were present at the time of the depression. There were no such things as companionship, friendship or family, because life was always so unpredictable, and many people would spend years travelling from ranch to ranch in search of the similar work.Due to this fierce competition, relationships between ranch workers were often shallow and the legal age would end soon after a worker had left that particular ranch. This is conveyed well in Steinbecks novel, as many things relate to this major factor of loneliness. I think this is one of the most important aspects of the novel, which is probably why there are so many things that refer to loneliness as a problem. A good case of this includes the ranches name- Soledad, as in solitary, meaning lonely.Another good example of this is the name of the river near the ranch- The Solenis, and when George plays solitaire in the bunkhouse during chapter two. Life was similarly hard for everyone on the ranch, though it was made even more difficult delinquent to sexism, racism and in certain circumstances, disabilities. Certain people on the ranch including Lennie- who had mental difficulties, Crooks- who, not exactly had been crippled by a horse, but was coloure d (this was still large issue in the 1930s), and Curleys wife purely for being a woman- were even fighting among themselves to gain respect.This was done merely to pull ahead their own confidence Fortunately this was not the case for George and Lennie, as they had each other for company, though this seemed to be quite suspicious, as it was a very rare occurrence. ity of the workers travelled alone across America, moving from ranch to ranch. Family values were non-existent, because of this they didnt belong anywhere. The workers believed it was survival of the fittest between them. There were a large number of planless workers, all-looking for the same jobs.Competition for work was fierce. There was a general feeling of loneliness at the time for the workers. George emphasizes this feeling when he is talking to Lennie by the brush Guys like us, which work on ranches, are the loneliest guys in the world. They got no family. They dont belong no place. Because of a vast amount of sus picion on the ranch the workers often chose a solitary existence. It to a fault made relationships between the workers very shallow. It would seem that the majority of the workers could not forge a meaningful relationship.OuGeQ6K ffra Yet, it wasnt just the workers who felt lonely. Curleys wife also displays loneliness I get awful lonely You can talk to people, but I cant talk to nobody but Curley. Crooks also seems very lonely I tell ya a guy gets too lonely, an he gets sick. Both Crooks and Curleys wife also choose a life of solitude because of the suspicion. It is harder for them to establish meaningful relationships because the obstacles of discrimination and sexism that exists on the ranch.

Trace Elements In Diabetics Health And Social Care Essay

Aim The aim was to look into urinary excrement of Fe, Cu and Zn and their relation with blood serum insulin in diabetes worlds. Materials and Methods 40 patients with non-insulin-dependent diabetes, 30 patients with insulin-dependent diabetes and 20 figure healthy returns were investigated for their serum degrees of glucose and insulin and urinary settlement of Fe, Cu and Zn. there was tradeant addition in the urinary liquidation of all the trio exigency elements in diabetic patient. No important correlativity could be found between serum insulin and urinary elimination of Fe, Cu and Zn.Consequences The consequences indicate that there is change magnitude elimination of tactual sensation elements in diabetes mellitus save it has no relation with serum insulin.Keywords Diabetes mellitus, Serum insulin, Trace elements ( Fe, Cu and Zn ) .Introduction Trace elements be in thoroughgoing elements, which argon required in the diet in really little sums, less than speed of li ght mg/day1 and argon present in our tissues in merely highly little measures, with the stringency of mcgs to pictograms per gm of moisture organ.2For this ground, they are referred to as principal elements.Trace elements stomach indispensable function in normal growing, development and wellness of worlds. They have their function in diverse activities such as haem synthesis, concurrence tissue metamorphosis, bone development and as indispensable constituent of many enzymes.3In add-on hint elements have likewise been shown to act upon the hormone system. They influence the hormone system in polar ways depending upon whether the surface is present in surplus or in low province. Therefore, increasing or diminishing the concentration of several hint metals has been shown to act upon the hormonal synthesis, secernment, hormonal precursor consumption into mark secretory organs, endocrine gland binding to aim tissues and its utilization.4Diabetess mellitus is most common endocrine d isease of worlds and is overdue to absolute or relative overleap of endocrine, insuline5.Diabetes mellitus is said to be of multifactorial etiology and deuce-ace meshing mechanisms are thought to be responsible familial exposure, autoimmunity and environmental factors. Although no definite environmental agent has been identified, the environmental factors implicated overwhelm viruses, fleshiness, gestation and vague environmental agents6.Research findings have emphasized that lack of certown(prenominal) hint elements consequences in diabetes like conditions in experimental animate beings. The hint elements, the lack of which has been shown to ensue in diabetes like symptoms are chromium7,8, zinc9, manganes10,11 and copper12. As the lack of these hint minerals resulted in diabetes like symptoms and the supplementation of the peculiar hint part quickly reversed the ascertained symptoms, it can be concluded, from such surveies, that lack of these hint elements adversely influenc es the synthesis, secernment or action of insulin.Merely as the hint elements have been shown to act upon the insulin, alterations in the concentration of insulin have alike been shown to act upon or to be associated with alterations in the concentrations of several hint metals in the melodic line, weewee and other tissues. changing degrees of go arounding endocrine may either change the distribution of hint elements in assorted cellular compartments, or may bring forth a displacement of the metals to the tissues which are non usually associated with these concentration of these elements or they may alter renal or hepatic handling of hint elements ensuing in step-up urinary or faecal termination of the hint minerals, thereby bring forthing entire organic social organization loss4.Surveies on the consequence of diabetes mellitus on hint component metamorphosis have largely been carried out in animate beings, experimental theoretical account for insulin-dependent diabetes me llitus.Such surveies have revealed that experimental diabetes produces alternations in the absorption13, tissue distribution14, metabolism15 and excretion16 of hint elements. Metamorphosis of Zn, Cu and Fe is greatly influenced and the hormonal unbalance nowadays in insulin-dependent diabetes is said to be involved in altered hint metabolism14,15. Surveies on human existences are really limited and steady the survey which have been carried out, has failed to see any relationship between urinary elimination of hint elements and serum insulin. If it is true that the hormonal instability nowadays in insulin-dependent diabetes is involved in changing hint component excretion16, so there may be a relationship between urinary elimination of hint elements and serum insulin.The present survey was hence, aimed to look into the serum insulin and urinary elimination of hint elements ( Fe, Cu and Zn ) in normal, insulin-dependent and non-insulin-dependent diabetes in an effort to happen any co rrelativity between serum insulin and urinary elimination of Fe, Cu and Zn. Study besides included the comparing of all these parametric quantities among diabetic and normal topics.MATERIALS AND METHODSPatients70 human diabetics, including both males and females, on out-of-door intervention at assorted outpatient sections and at diabetic clinic, DHQ, Mirpur, AJ & A K, Peshawar were studied. Diabetic patients had fasting plasma glucose degree of more than 140 mg/dl or random blood glucose degree of more than 200 mg/dl on more than one juncture.Patients were carve up into two groups depending on manner of intervention Insulin-dependent and non-insulin-dependent.20 normal healthy topics with no house keep going narrative of diabetes were choosen as controls.Both control and diabetic topics fulfilled the undermentioned standardsTheir ages ranged from 25-60 old ages. They were normotensives, with normal renal maps and no albuminuria. None of these had open grounds of liver, enteric o r endocrinal upset. Subjects memory steroids, or fetching any vitamin or mineral supplementation were non included in the survey.Patients were asked to stop insulin for 24-48 hours and unwritten hypoglycaemic drugs for 5 yearss before roll uping the urine samples.Collection of blood samplesBlood was drawn from each patient and normal topic later on 10-12 hours fast from an antecubital vena between 8.00-10.00 a.m. Serum was separated within one hr. Glucose assessment was carried out immediately. Serum for insulin appraisal was stored at -20AC boulder clay analysis.Collection of urine samples24 hours urine samples were collected in 4-5 litre plastic containers, washed with 15 % HCl and rinsed thrice with deionized H2O. Each patient was provided with a labeled container and a bag in which to transport the container at his or her visit to the infirmary and at the same clip, the patient was asked to stop the intervention, and to get down urine aggregation after 5 yearss in instance of unwritten hypoglycaemic drugs and 24-48 hours, in instance the patient was taking insulin. On the twenty-four hours of blood trying container was collected and the patient was asked about figure of times he or she had missed quash into the aggregation container. Merely the urine aggregations reported as complete were used in the analysis. Immediately after aggregation, the al-Quran of each specimen was recorded.20 milliliter of each urine specimen was centrifuged for 10 proceedingss to take bacteriums, cells, dramatis personaes and other particulate stuffs. 15 milliliter of the supernatant was decanted in plastic bottles and stored at -20AC boulder clay analysis. It was used for appraisal of Fe, Cu and Zn.1ml of piss was used for sensing of proteins by chemical rule utilizing sulfosalicylic acid. All the glass and plastic ware used were soaked in 15 % HCl overnight and so rinsed thrice with deionized H2O.Serum glucose was calculated by glucose oxidase/peroxidase colorimetric system utilizing analytical kit ( Boehringer Manheim GmbH Diagnostica ) . Serum insulin was measured by RIA utilizing analytical kit provided by Diagnostic Products Corporation, Los Angles, USA.Urinary Fe was measured by method of Olson and Hamlim17, likewise as for serum. Urinary Cu and Zn were measured by method of Dawson et Al. ( Cited by Varley ) 18. atomic soaking up spectrophotometer model3030-B Perkin Elmer Company, Norwalk was used for the three hint elements.Students pairedt trial was used for statistical analysis.TABLE-1AGE, SEX AND encumbrance OF standard SUBJECTS AND diabetic PATIENTSThe tabular array shows the age, sex and organic structure weight of normal and diabetic patients. The values are average A s. e. m. The entire figure of topics is given in parametric quantities.diabetic PATIENTSThe patients enduring from diabetes were grouped harmonizing to the manner of intervention. The average serum values A s. e. m for glucose and insulin in different groups are gi ven. Number of topics is given in parentheses.TABLE-3Fast SERUM IRON, COPPER AND ZINC IN NORMAL SUBJECTS AND DIABETIC PATIENTSSerum Fe, Cu and Zn were measured by atomic soaking up spectrophotometery. Concentrations are evince as mean values As. e. m. Number of topics is given in parentheses.P & lt 0.001 = The Valuess are super important as compared to normal control topics.TABLE-4COMPARISON OF 24-HOUR URINE VOLUME, URINARY IRON, COPPER AND ZINC IN NORMAL SUBJECTS AND DIABETIC PATIENTSThe values are expressed as average A s. e. m. Number of topics is parentheses.P & lt 0.001 = Valuess are extremely important as compared to command topics.ConsequenceTable 1 describes the ages, sex and weight of normal topics and diabetic patients. Age and organic structure weight of insulin-dependent diabetics showed no important difference. While in non-insulin-dependent diabetics it was higher ( p & lt 0.001 ) as compared to controls.Fasting serum glucose and immunoreactive insulin in normal t opics and diabetic patients are shown in table 2. There is significance addition in serum glucose degrees in diabetic patients ( p & lt 0.001 ) and this addition is more enounce in insulin-dependent diabetics as compared to non-insulin-dependent diabetics.Serum insulin is importantly increased in non-insulin-dependent diabetics ( P & lt 0.001 ) , while in insulin-dependent diabetics, the serum insulin is significantly decreased ( p & lt 0.001 ) as compared to normal controls.Table 3 describes the 24 hours urinary volume and elimination of Fe, Cu and zinc/24 hours in normal topics every bit good as diabetic patients. The consequences of this tabular array indicate that urine volume is significantly increased in diabetic patients as compared to normal topics ( P & lt 0.001 ) and this is significantly higher in insulin-dependent diabetics as compared to non-insulin-dependent diabetics ( P & lt 0.001 ) . 24 hours urinary elimination of Fe, Cu and Zn is besides significantly incre ased in both the classs of diabetes ( P & lt 0.001 ) , with significantly more elimination in insulin-dependent diabetics ( P & lt 0.001 ) than non-insulin-dependent diabetics.Table 4 gives the urinary elimination of Fe, Cu and Zn per millilitre, in normal and diabetic topics. The consequences indicate that urinary elimination of Fe, Cu and Zn per millilitre is besides significantly increased in diabetics as compared to controls and once more this addition is significantly more sound out in insulin-dependent diabetics than in non-insulin-dependent diabetics.DiscussionMarked alterations in hint component metamorphosis have been demonstrated in streptozotocin-diabetic rate14,15.Prolonged streptozotocin induced diabetes besides interferes, with normal form of bone mineralization19.Increased elimination of Fe, Cu and Zn has been reported in experimental diabetes in rates16. Surveies of triumph et al.20 provided direct grounds of influence of hormonal instability on hint metals.Our fi ndings support and widen the old work. Zinc elimination among normal topics is 420.07A14.7 Ag/day and is in conformity with the by and large stated average Zn elimination of 300-600 Ag/day18. likewise urinary elimination of Fe and Cu is besides within the normal internationalistic mention scope.Consequences besides demonstrate that diabetic status is associated with increased 24 hours urinary elimination of the three micronutrients zinc, Cu and Fe. Among the diabetics in both insulin-dependent and non-insulin-dependent diabetics average elimination was in surplus of 600 Ag/day. Similarly Fe and Cu elimination was besides significantly higher in both the insulin-dependent and non-insulin-dependent diabetics as compared to controls. Hyperzincuria has previously been reported in diabetic humans21.22.23.24.Although exact mechanism of increased urinary elimination has non been elucidated, assorted doable mechanisms have been proposed. Diabetic status consequences in increased glomeru lar filtration rate and it is suggested that such an change in nephritic map may lend to the increased urinary losingss of the hint elements16. But, the observation that addition in urine volume brought approximately by imbibing extra H2O did non change the entire urinary Zn elimination in non-diabetics21 would on the other manus indicate that the polyuria of diabetes may non be an of import determiner of Hyperzincuria or increased elimination of other hint elements in diabetes. This is farther supported by fact that when the concentrations were expressed per millilitre of piss, statistically important differences were still observed.Increased urinary loss of Fe Cu and Zn could be explained by increased dietetical consumption but urinary loss of Fe, Cu and Zn varies small with dietetic consumption because the predominant healthy excretory path in healthy adult male is the enteric piece of land. Increased urinary elimination reflects acute alterations in biologic stores25. No additi on in urinary Zn has been seen when dietetic consumption is doubled in human topics. The surplus is eliminated via the feces24. The possibility of difference between diabetics and normal in their selective soaking up of hint elements in the intestine can non be ignored but information on this panorama is non available.Pidduck et al.24 has proposed three possible mechanisms.It could be that Hyperzincuria or increased elimination of Fe and Cu indicates an abnormalcy of performance or dislocation of metalloenzymes or metal-enzymes composites.It is possible that some portion of organic structure is bring forthing its ain metabolites with chelating belongingss, it could be the pancreas of the diabetic which is disorganized in the manner, suggested.Family surveies suggest a important heritability of urinary Zn elimination in 19 households. Some households be givening to be low urinary Zn excreters and others high. It would look possible that urinary elimination of Zn or perchance other hint elements is controlled by allelomorphs at a figure of venue and that diabetics possess a different mixture of allelomorphs to those possessed by non-diabetics.It is besides believed that increased elimination is chiefly of endogenous beginning for illustration, musculus breakdown16 or diabetic bone loss. However, the bone mineral loss in diabetics can merely account for less than 10 % of the diabetic hyperzincuria22. Urinary Zn losingss are specially increased during katabolic states26.Intense physical exercise may increase urinary losingss and it has been shown that exercising additions impecunious musculus protein dislocation and such phenomena could increase urinary Zn losses27. Zinc elimination is shown to increase under assortment of katabolic conditions and Zn is reported to be derived from skeletal musculus. Although the surveies have been carried out for Zn, the skeletal musculus protein breakdown my lead to increased, urinary elimination of Fe and Cu.Untreated diabe tes may stand for a katabolic province and addition in skeletal musculus protein turnover and it is likely that urinary elimination of Fe, Cu and Zn may be derived from skeletal musculus tissue.As none of the patients had albuminurias, the increased urinary losingss of these trace metals may possibly be due to altered hormone position seen in diabetes and non due to diabetic kidney disease. This decision is supported by fact that improved metabolic control in diabetic rats by insulin intervention resulted in significantly reduced elimination of Fe, Cu and Zn in the urine16 in diabetic worlds in the Restoration of normozincuria16.No relation could be found between serum insulin and periodical urinary elimination of Fe, Cu and Zn in either normal persons or diabetic patients. This may be due to the ground that endocrine relationships in uncontrolled diabetes become extremely complex because glucagon and glucocorticoids degrees are increased in response to insulin lack. Both of these are shown to act upon the serum or urinary degrees of hint elements. Other ground may be that the go arounding immunoreactive insulin in diabetics may non be active biologically.Non-insulin-dependent diabetes had significantly higher organic structure weight every bit compared to controls. Association between increased organic structure weight and no-insulin-dependent diabetes has antecedently been described26. Obesity is of much greater importance than either race or sex in the etiology of non-insulin-dependent diabetes29. Therefore, a recommendation against going fleshy might be given. A sum of 25 patients ( 35.7 % ) out of 70 had a positive household history of diabetes. High per centum of patients holding positive household history of diabetes suggests a insouciant relationship of this factor with the disease.This survey may hold clinical and pathological deductions. If there is increased elimination of hint elements in diabetes, this may connote that when dietetic degrees are d eficient, the patient s tissues are depleted in favour of increased urinary elimination. In this instance, it is speculated that physiological degrees of these foods may be low and some of the pathological events seen in diabetics may be tie in to or partially explained by lack of these hint elements. For illustration, there is increased incidence of inborn deformities in diabetic pregnancy30 and lack of Cu and Zn has besides been reported to be associated with inborn malformations31.Copper lack is associated with impaired collagen synthesis and increased incidence of breaks. Increased incidence of self-generated breaks has besides been reported in diabetes19. But verification of cause and consequence relationship of these phenomena necessesitates farther surveies.

Anatomy of the Neck

Lecture 3. Surgical anatomy of spot contents of lecture Scopes of grapple. Division of homoage on a atomic number 18na. Fascias and cellulose spases of get by porta. Topography of vascular- sickening formations of love. Topography of variety meat of make do. Topographycal-anatomic ground of artisan interferences in heavens of contend. Cuts in bea of recognise. Treatment of grapples displeases. Operations at inflammatory affectes. Operation on vims, vessels and founts. Tracheostomy. Operations on a thyroid glandal. Plan of lecture. 1. Scopes of get by, division on a constituent. 2.Triangles of be intimate. 3. Fasciae of get laid. 4. Cellulose propertys of manage. 5. Submandibul ar tri squint-eyed. 6. The Pyrogovs Triangle. 7. Carotid trigon. 8. Topography of elemental vascular-nervous fortune of have intercourse. 9. Distinctions amidst external and inwrought carotids. 10. Branches of external carotid in a carotid triangle. 11. Topography o f trachea. 12. Topography of fill appear part of pharynx. 13. Branches of neck interlacement. 14. Scopes of lateral triangle of neck, division of it on scapula-trapezoidal and scapular-clavicles triangles. 5. Layers of lateral triangle of neck. 16. Cellulose blank shells of lateral triangle of neck. 17. Topography of neck part of diaphragmatic nerve. 18. Technique of tracheostomy. 19. Errors and complications at tracheostomy. 20. Features of artisan access to neck part of defile. 21. Operations on a thyroid. ANATOMICAL-TOPOGRAPHICAL FEATURES OF make out AND THEIRS ORGANS Topographical anatomy of neck (common data) The theatrical role of neck differs by the problematic anatomic structure.Any doctor needs knowl rim of evanesceographical anatomy of neck, as this region has a speech vit each(prenominal)(prenominal)y eventful formations, interrelation among which mustiness be reappearancen into account at slaying of path of urgent measures (laryngotomy, tracheostomy, s transcend of hemorrhage and other). The practical value is had 1) The outward-bound-bound reference book window panes of region, which use at the inspection of affected role for a) Drafting of projection telegraph wires b) Determinations of repair of organs of neck 2) Bulges of sterno-cleido- mastoid process passs which argon a reference point for finding of normal carotid.Palpation of region is more informing a) On the fondness of the skinning fold expose at bending of heading, the body of sublingual tog out palpate at a disappoint status a trim indorse maxillaryry, on each fount from it its large Horn. A sublingual bone is a reference point at execution of vagosympathetic blockage b) Below the houses of thyroid gristle, place of their connection, palpate to the sublingual bone (Adams apple) c) In the kernel of drift man originate of thyroid cartilage is mapped a glottis. d) A cricoids cartilage is felt instantaneously earlier from thyroid. obscureening which hold affirms to the thyroidocricoid copula palpate betwixt them. Urgent laryngotomy is exe let d witnessed in this argona e) On the barrier conducted from the cut back demonstrate of cricoids cartilage downward to the jugular nervure chthoniancuting of sternum, is mapped a trachea, a few left from it is mapped a gorge f) At the neat edge of sterno-cleido-mastoid musclebuilder according to the take of cricoids cartilage the cross(prenominal) process of sixth neck vertebra palpate at back of region (carotid tubercle, tuberculum caroticum).Against this tubercle a customary carotid is pinned at bleeding from its branches g) At the train of upper edge of thyroid cartilage, is mapped the place of bifurcation general carotid h) In the tree make by the back edge of sterno-cleido-mastoid muscle and collar-bone, the flash of subclavian arterial blood vessel is determined. Here it cuddles to the scratch line rib for the temporal stop of bleeding i) It is mapped hume ral interlacement on a neck on a account, connecting a point lying on the couch of middle and light tertiary of sterno-cleido-mastoid muscle and middle of collar-bone.On 1,5-2 sm higher(prenominal) than middle collar-bones execute anesthesia of humeral interlacement j) It is mapped a diaphragmatic nerve on the rake of the width of sterno-cleido-mastoid muscle conducted on a middle downward from the level of middle of thyroid cartilage k) it is mapped an supernumerary nerve on a line crossing a sterno-cleido-mastoid muscle in precaution from the quoin of lower maxilla to the border among the middle and lower its third 3) On the middle of back edge of this muscle the skinning branches of neck interlacement go out in sodium thiosulfate syringe cellulose (n. . transversus coli, occipitalis minor, auricularis magnus, cutaneus colli, supraclavicularis). The explorer novocaine anesthesia conducted in this argona allows to get anaesthetizing of count and lateral start of neck.A t palpation of neck at pertinaciousanimouss megascopic lymphatic k nons come to light sometimes a) It is often multip guiled submandibular lymphatic knots at tooth decay b) elevate knots are struck by metastases at the crab louse of front subdivision of spitting and lower lip c) It is multiplied supraclavicular lymphatic knots in connection with metastasis at the layaboutcer of mammary secreter their increase is marked excessively at tubercular lymphadenitis. d) Very often at the cancer of defile and stomach one of the lymphatic knots hardened on meatus of a. ransversa colli is struck is the Trauze-Vyrkhov knot. Neck delimited from a head a lower edge and corner of lower maxilla, outward acostic duct, mastoid process, upper occipital line to the cervical hillock is a high bound. From beneath from a breast, upper extremity and back, a neck is delimited by a line, going on the jugular downstairs keen of breastbone, upper edge of collar-bone, acromial process scapulars and, farther in a conditional line connecting the acromion by prominence process of the septenary neck vertebra (vertebra prominens). Children hold in is short and wide neck, a lot of cellulose.A concentrate glottis, wide stria of thyroid, narrow sublaryngeal blank shell, is marked. It determines the methods of some private detective interference. For example, children lower tracheotomy is done just now, taking into account the features of structure of isthmus of thyroid and sublaryngeal space. In addition, children have the organs of neck on one neck vertebra higher, than at adults, that it is necessary to take into account at implementation of operative accesses. A neck de bene esse is divided by the row of regions, the scopes of which hug drug on the outward reference points of neck.By a frontal plane passing by dint of a mastoid process and acromion neck divide by front and back divisions. A back incision carries the name of cervical (occipital) region regio nuche a nd consists of the well developed muscles application program vertebrae. These muscles in the turn are cover by strap and trapezoid muscles. Topographoanatomical under a neck understand its front department ordinarily, very neck, containing its organs, prefatorial vessels and nerves. By a middle line divide the front department of neck by make up and left halves.On each of them dickens large triangles are distinguished sagittal and lateral. Mesial triangle Mesial triangle trigonum colli medium limited by the lower edge of lower maxilla from to a higher place, sterno-cleido-mastoid muscle (by its shift edge) lateral by a middle lily mesial. Within the limits of internal neck triangle cope with and odd triangles are asked Pair Submandibular trigonum submandibulare is limited from higher up by the lower edge of lower maxilla, from to a lower place, lateral and mesial both bellies of digastrics muscle.This triangle must be known for access to the submandibular spitting ry gland, to the facial, tongue arteries and nervures (a. et v. facialis), to the advised nerve of tongue (n. lingualis) to the sublingual (n. hypoglossus) motive nerve of tongue Carotid triangle trigonum caroticum is limited from above by the back belly of digastrics muscle, quarter (or lateral) by the cutting edge of sterno-cleido-mastoid muscle, from below by the top belly of scapular-sublingual muscle (m. omohyoideus).This triangle it is necessary to know for access to the vascular-nervous bunch consisting of general carotid (a. carotica communis) and its branches (outward and internal), to the internal jugular vein (v. juugularis interna) and tramp nerve (n. vagus). Scapular-tracheal triangle trigonum omotracheale, limited from above and lateral by the top belly of scapular-sublingual muscle (m. omohyoideus), from below and lateral is cutting edge of sterno-cleido-mastoid muscle, at the front or mesial middle line of neck. unavoidable for accesses to tracheas at implemen tation of tracheotomy and operation on a thyroid. Odd Chin trigonum submentale limited from below by a sublingual bone, lateral and mesial front bellies of digastrics muscles. Knowledge of it is necessitate for drainage of fall into place of cavity of mouth. Outward triangle trigonum colli laterale limited from below by the upper edge of collar-bone, at the front or mesial back edge of sterno-cleido-mastoid muscle, back or lateral border on the cutting edge of trapezoid muscle.Within the limits of this triangle both mate triangles are selected Scapular-trapezoid trigonum omotrapezoideum limited arse by the cutting edge of trapezoid muscle, at the front back edge of sterno-cleido-mastoid muscle, from below scapular-sublingual muscle. Needed for dissection of abscesses, access to the additional nerve (n. accesorius) Scapular-clavicular triangle trigonum omoclavicularis limited from below by a collar-bone, from above bottom belly of pharyngeal-sublingual muscle, at t he front back edge of sterno-cleido-mastoid muscle needed for access to the subclavian artery, vein and humeral interlacement.If to put together both internal neck triangles ( proper(a) and left), they form one large middle quarter-circle of neck, which is divided by a horizontal line passing through a sublingual bone, on 2 regions Suprasublingual region (regio suprahyoidea) in it select a chin and two submandibular triangles Subsublingual region (regio infrahyoidea) in it select two carotid and two scapular-tracheal triangles. FASCIAE OF eff Fasciae is a connective thread frame and, being in all regions, various functions are executed protective, supporting, fixing regarding to organs.V. N. Shevkunenko described 5 dashboardl canvass of neck First ( glib) fasciae of neck fascia nigglingis colli or fascia cervicalis superficialis. It is given cabalisticer than hypodermic cellulose, is passed from a neck directly to the neighboring regions. piddling fasciae of neck, di viding, engulf the hypodermic muscle of neck of m. platysma, forming its vagina Second is superficial poll of own fasciae of neck lamina superficialis fasciae colli propriae (fascia cervicalis superficialis).This, fasciae begins from the copulas of processus spinosus of neck vertebrae. It is fixed to the upper occipital line, is divided, goes round all neck and forms a vagina for m. trapezius, m. sternocleidomastoideus and capsule by submandibular saliva of gland. The outward shroud of II fasciae of neck gives into the covered muscles the row of bridges which divide muscle into key out bunches. wad arcsecond fasciae of neck registers to the front-upper edges of handle of breastbone and collar-bones, from above to the lower edge of lower maxilla.II fasciae of neck give completespurs to the transversal processes of neck vertebrae. One of these wrap upspurs binds second fasciae to the heel. Other binds it to the vagina of vascular-nervous bunch of neck. These offspurs form th e frontal locate plate which separates the front region of neck from back one. It confirms the conditional division of neck on front and back departments. This plate hinders to spreading of maturation processes arising up in the intrafascial cellulose of front and back departments of neck.On face second fasciae of neck passes in fascia parotideomasseterica, this forms the capsule of parotid salivary gland and covers a masticatory muscle after-school(prenominal) The third fascial rag week of neck carries the name of scapular-clavicular fasciae (fascia omoclavicularis) or buddy-buddy sheet of own fasciae of neck of lamina profunda fasciae colli propriae. This fascia has the form of trapezoid and registers above to the body of sublingual bone. From one side it is limited by scapular-sublingual muscles (m. omohyoideus). Down it registers to the back-upper edges of collar-bones and handle of breastbone.On middle line third fasciae of neck accretes in upper departments with III fasci a, and forms the white line of neck. It forms vaginas for pair muscles lying below than sublingual bone m. sternohyoideus, m. omohyoideus, m. thyrohyoideus. In connection with the features of the topography third fasciae of neck is submissive in adjusting of subscriber line stream in the vessels of neck. It is explained it by the charge of dense connections of fasciae with the wall of vessels, in the places of perforation by them this fascial sheet. At reduction m. mohyoideus fasciae, narrowing, multiplies the diameter of veins. A fourth fascial sheet carries the name of intraneck fasciae fascia endocervicalis. It consists of two plates parietal, covering a cavity neck from within, and visceral, covering organs neck. The parietal plate of fourth fasciae forms a vagina for the prefatorial vascular-nervous bunch of neck of vagina vasonervosa, giving his partition, dissociating the vascular components of this bunch from each other general carotid, internal jugular vein and n. vag us, inward ( quicksilver(a) nerve).On meatus of vessels a fascial sheet goes down in top mediastinum, gives the bunches of fascial fibres to the large vessels and pericardium. The visceral plate of fourth fasciae of neck passes to the organs of neck, covering a larynx, trachea, esophagus, and thyroid. To the large veins of neck fourth fasciae as well as gives the row of offspurs. Therefore in the moment of inhalation negative pressure in veins is created, that can lead at the wounds of neck to air embolism. The fifth fascial sheet of neck carries the name of pre-vertebral fasciae of fascia prevertebralis.It begins croupe a esophagus at creation of skull, goes down downward in a pectoral cavity, passing earlier of spine. The Fascial sheet is well explicit and registering to the transversal processes of vertebrae, forms vaginas for the stair muscles of neck of m. scalenus anterior, medius et posterior. Its processes cover a subclavian artery, humeral nervous interlacement and m. scalenius anterior. It covers by itself the trunk of sympathetic nerve and muscle, lying on bodies and transversal processes of neck vertebrae (mm. ongus coli et longus capitis). CELLULOSE SPACES OF NECK The uncommunicative and describe cellulose spaces appear between the fascial sheets of neck. Reserved Pair sack of submandibular gland soda gl. submandibularis, containing a submandibular salivary gland, loose cellulose, lymphatic knots, facial artery and vein, n. hypoglossus. This sack is limited by the sheets of second fasciae and periosteum of lower maxilla Pair fascial sack spatium sternocleidomastoideum formed by the sheets of second fasciae for a sterno-cleido-mastoid muscle and n. ccesorius. This fascial space is very a great deal reported with surrounding tissues only through the probutting openings, formed by vessels which blood proviso muscle Substernoid intraaponeurosis space spatium intraponeuroticum suprasternale it is placed above the jugular undercutting o f breastbone between the sheets of second and third fasciae of neck. Height of this space from the jugular undercutting of breastbone to the middle of distance between a breastbone and sublingual bone. Space is opened from sides.Except for loose cellulose this space contains lymphatic knots and jugular vein arc of arcus venosus juguli A blind sack a pair behind the sterno-cleido-mastoid muscle of sacus caecus relrosternodeidomastoideus, Gruber is described. The scopes of it are at the front is back wall of vagina of m. sternodeidomastoideus (II fasciae), behind are third fasciae of neck, and from below is periosteum of upper back edge of collar-bone. A sack is reserved orthogonal, as at the outward edge of sterno-cleido-mastoid muscle second fasciae accrete with the third.This space has the report of spatium intraponeuroticum suprasternale by means of crack between II and III fasciae, carrying the name of gate of fifth space (portae spatium suprasternale). Pus in these regions dr iving forces the symptom of festering collar. Reported (unreserved) spaces cooperant to spreading of haematomas and inflammatory processes Space ahead of internal organs of neck or pre-organ spatium previscerale between the sheets of fourth fasciae, spreading from a sublingual bone to undercutting of breastbone. Part of this space is below than isthmus of thyroid and ahead of trachea select as spatium pretracheale.In this space lymphatic knots, veins taking a blood from the region of isthmus of thyroid, are addicted in a loose cellulose, v. thyroidea ima, part of odd thyroid interlacement of plexus thyroideus. In 10-12% of fibers lower thyroid artery of a. thyroidea ima. This cellulose space is delimited from the cellulose of front mediastinum by only a fascial bridge appearing at level handles of breastbone in transition of parietal sheet of fourth fasciae in visceral one at that placefore the festering processes of cellulose of this space can spread in front mediastinum.Space behind the entrails of neck or retrovisceral spatium retroviscerale is disposed between fourth and fifth fasciae behind a esophagus. This space has the report directly with the cellulose of back mediastinum and spreads from foundation of skull to the diaphragm. Major anatomic formations are disposed in the back department of juxtapharyngeal cellulose internal carotid, internal jugular vein, vagabond, sublingual and glossopharyngeal nerves (nn. vagus, hypoglossus, glossopharingeus). on the vascular-nervous bunch of internal neck triangle from every side vascular-nervous cellulose space is disposed spatium vasoneurorum.Above it reaches before foundation skulls, and down passes to front mediastinum. Cellulose space of outward neck triangle is disposed between second and fifth fasciae. From sides this space is limited by the vagina of basic vascular-nervous bunch of neck and edge of trapezoid muscle. It is reported with subtrapezoid space. tardily cellulose space of neck is dispos ed under fifth fascia in trigonum colli laterale surrounds subclavian vessels and humeral interlacement and is reported with the cellulose of axilla cavity.Pre-vertebral space spatium prevertebrale, is disposed between neck vertebrae fifth fascia. From above comes to outward foundation of skull, from below to the level of the third pectoral vertebra. The long muscles of neck of mm. longus colli ei longus capitis and trunk of sympathetic nerve are located in it, n. phrenicus from neck interlacement, vertebral arteries of m. rectus capitis anterior et lateralis. It is reported with cellulose to the level of the III pectoral vertebra. SUPRASUBLINGUAL REGION (Regio suprahyoidea)From above the edge of lower maxilla and it connecting line with a mastoid process are the scopes of suprasublingual region, from below is the line conducted through a body and large horns of sublingual bone, from one side are the cutting edges mm. sternocleidomastoidei. Three expressed triangles are selected in a region Odd chin between the front bellies of digastrics muscles and body of sublingual bone Pair submandibular triangle trigonum submandibulare, the sides of which on that point are two bellies of m. digastricus and lower edge of lower maxilla.A submandibular salivary gland beds in the area of this triangle. The skin of region is thin, mobile, elastic, the expressed of hypodermic cellulose is subject to the individual changes. shallow fasciae form a vagina for m. platisma. In the area of this triangle after Between sheets I and II fasciae of neck under the lower edge of lower maxilla is disposed usually a few lymphatic knots. Ramus colli n passes here. facialis, and besides skinning nerves of neck (branches of n. transversus colli), which are disposed in a hypodermic cellulose.II fasciae of neck form a sack for a submandibular salivary gland. The last usually has an egg-shaped form and executes all submandibular triangle almost. Between a gland and its capsule loose cellul ose is disposed, in which lymphatic knots lie often. On meatus of channel of gland, this cellulose is reported with the cellulose of bottom of oral cavity. The conclusion channel of gland of ductus submandibularis begins in the front-upper department of gland and goes away to the crack between m. myohyoidem and m. hyoglossus, following under the mucous membrane of bottom of oral cavity.In the equivalent crack a few higher than channel passes the tongue nerve of n. lingualis, n. hypoglossus and v. lingualis is below than channel disposed. A facial artery which adjoins to the internal surface of gland passes in the lodge of submandibular salivary gland. To outward its surface there is a adjoins of the same name vein which, bent through the edge of lower maxilla, follows under the capsule of gland towards v. jugularis interna the cutting edge m. masseter. Abandoning the bed of gland, a. facialis is bent through the edge of lower maxilla and is passed in the mesial departments of face .A deep department is formed by a few muscles covered by second fascia of neck. Most mesial the mandibular-sublingual muscle m. myohyoideus is disposed. This muscle, accreting on a mesial edge from the same muscle oppo send side, forms the diaphragm of oral cavity diaphragma oris. At osteomyelitis of lower maxilla, stomatological inflammatory processes, maybe, as complication, to rotate up phlegmon of bottom of cavity of mouth. It carries the name of Ludwigs quinsy. It is a quickly making progress acerate leaflike inflammatory process, spreading on a tongue, larynx, and cellulose of neck.The last necrose and adopts a black almost. There are salivation, labored breathings, fetid smell of mouth. Quite often the Ludwigs quinsy is complicated by organic evolution of mediastinitis. Topographically in this region the Pirogovs triangle, limited by the tendon bridge of m. digastricus, back edge m. mylohyoideus and n. hypoglossus, is important formation. M. hyoglossus is the bottom of t riangle. Within the limits of this triangle, baring and bandaging of tongue artery which is disposed under m. hyoglossus is executable. A tongue vein lies above it muscle.Search for the Pirogovs Triangle at thrown and twisted back backwards and the head cancelled in the side opposed to interference. The following layers are selected in an odd chin triangle skin, hypodermic cellulose, beginning(a) base and second fasciae of neck. Muscles are then disposed outside in inward m. digastricus, m. myohyoideus, m. geniohyoideus, m. genioglossi. Deeper than these muscles a cellulose follows and mucous to the oral cavity. SUBSUBLINGUAL REGION (Regio infrahyoidea) A sublingual region is limited from above by a line passing on the upper edge of body and large horns of sublingual bone, from a lateral side cutting edges of mm. ternocleidomastoidei, from below undercuts of breastbone. After hypodermic cellulose I fasciae of neck with m. platysma is disposed. Between I and II fasciae of neck plural superficial veins (including v. jugularis anterior, v. mediana colli), and also nerves of neck, from n. cutaneus colli are disposed. Deeper III fasciae of neck, formative a vagina for muscles lying below than sublingual bone, are disposed sterno-sublingual (m. sternohyoideus), scapular-sublingual (m. omohyoideus) lying it is more superficial, sterno-thyroid (m. ternothyroideus) and thyroid-sublingual (m. thyrohyoideus) bedding deeper. Under muscles the parietal sheet of IV fasciae follows and described higher spatium previscerale. It contains vein interlacement plexus thyroideus impar, v. thyroidea ima, sometimes (of to 10% possibilitys) ?. thyroidea ima. In a sublingual region are disposed larynx, esophagus, trachea, esophagus, and thyroid. Within the limits of sublingual region the extraordinarily important carotid triangle of neck is disposed (trigonum caroticum).The scopes of triangle make the muscles of neck mesial is top belly of scapular-sublingual muscle (m. omohy oideus), lateral is sterno-cleido-mastoid muscle, above is back belly of digastrics muscle. The superficial layers of triangle are re precedeed by a skin, hypodermic cellulose, and first fascia of neck with m. platisma, by second fascia of neck. Deeper, the loose cellulose, surrounded by a parietal sheet IV fasciae of neck, its basic vascular-nervous bunch and also lymphatic knots, on meatus of his vessels beds within the limits of carotid triangle.A basic vascular-nervous bunch is represented by an internal jugular vein (v. jugularis interna) and general carotid (a. carotis communis), which a wandering nerve is disposed between. Vienna with its influxes lies most superficially, and a. carotis communis is most deep. V. jugularis interna is well visible at playing off of the internal (front) edge m. sternocleidomastoideus. At the level of upper edge of thyroid cartilage a facial vein (v. facialis) which adopts a blood from the row of vein vessels falls in it (v. lingualis, v. laryng ea superior, v. hyroidea superior). A. carotis communis passes on the bisector of the corner formed by the top belly of scapular-sublingual muscle and sterno-cleido-mastoid muscle. The division of a. carotis communis on outward and internal carotids more tell on takes place at the level of upper edge of thyroid cartilage. To distinguish outward and internal carotids there is the row of topographoanatomical signs An internal carotid, as a rule, on the neck of branches does not give. An outward carotid gives on a neck the row of branches in the following order a. hyroidea superior, a. lingualis, a. facialis and other Topographically a. carotis externa departs ahead, mesial and lies more superficially, than a. carotis interna, which departs in a lateral side and leaves deep into. If in area of carotid triangle crude(a) and n. hypoglossus is visible, he crosses a. carotis interna and lies on it. An outward carotid is closed a. temporalis superficialis, and therefore if pined an outwar d carotid, a pulsation on a temporal artery impart not be present. In area of bifurcation general carotid is disposed a carotid reflexogenic area.It consists of glomus caroticum, sinus caroticus (initial area of internal carotid), branches n. glossopharyngeus, n. vagus, and truncus sympathicus. Carotid glomus glomus caroticum consists of connecting tissue specific glomus cages stop up in it, closely associated from an adventitia carotid. Middle sizes of glomus caroticum 35 mm. Reflexes of carotid area act part in adjusting of bloody pressure and chemical composition of blood. LYMPHATIC KNOTS OF NECK Five groups of neck lymphatic knots are distinguished Submandibular. Chin.Front neck (superficial and deep). askant neck (superficial). Deep neck. Submandibular knots nodi lymphatici submandibularis in an amount 4-6 is disposed in the fascial lodge of submandibular and in the layer of salivary gland. They collect lymph from soft tissues of front region of face. Chin knots nodi lymp hatici submentalis in an amount 2-3 lie under second fascia, between the front bellies of digastrics muscles, lower maxilla and sublingual bone. They collect lymph from a chin, tag of tongue, lower teeth and lips. Front neck knots nodi lymphatici colli anterior.Necks in a sublingual region are disposed in a middle department. Lymph is taken from the organs of neck. Distinguish Superficial, located on meatus of front jugular vein Deep or juxtavisceral are the necks located near-by organs. Lateral group forms a few superficial knots of disposed on meatus of outward jugular vein. Deep knots lie as three chainlets, forming the figure of triangle Along an internal jugular vein. On meatus of additional nerve. On meatus of transversal artery of neck. A chain along the transversal artery of neck is named a subclavian group.The large knot of this group, the nearest to the left vein corner (the Truaze-Vyrkhovs knot), quite often is struck to one of the first at new formations of stomach and lower department of esophagus. He palpate in a corner between left sterno-cleido-mastoid muscle and collar-bone. Deep neck knots heads and necks adopt lymph from all knots. They lie at the level of bifurcation general carotid. A knot disposed in a corner between v. jugularis interna et v. facialis (at the level of Horn of sublingual bone) is struck by one of organs of oral cavity first at new formations.Operations in area of neck At production of operations on a neck it is necessary to take into account the individual forms of changeability of neck, mobility of neck organs, large danger of handicap of vessels of neck, which threatens by not only the bleeding but also possibility of embolism (at the suffering of veins). At treatment of wounds it is necessary at once to take the damaged veins by styptic clamps and bandage them. During operative interferences vessels in the beginning are taken by styptic clamps, after dissected and bandaged. Position of patient at operations in area of neckIn all cases of operative interferences in front and lateral departments of neck of patient lies on back. Under scapulars a roller is underlaid, a head is thrown backwards. At cuts in the middle departments of neck the head of patient is retained on a middle line. At operative interferences in the lateral departments of neck a head is turned diversion, opposite to operative interference, because of what organs will be mixed up and become more accessible. Cuts on a neck Cuts on a neck must answer the cosmetic requirements and provide sufficient access to the organs of neck.Transverse sections conform to much(prenominal) requirements, because conduct them parallel to the natural folds of skin. At operations on a thyroid such cuts correspond to the long axis of organ and give wide access to it. In cases of baring of vascular-nervous formations, neck department of esophagus, dissection of abscesses and phlegmons on a neck resurrect longitudinal and combined cuts (Venglovs ky, Dyakonov, De Kerven). Only changed, but also those goodly organs, the wound of which follows to avoid at operations.The following basic groups of surgical accesses are distinguished to the organs of neck 1- vertical 2- slanting 3- transversal and 4- combined. Vertical cuts (upper and lower) are conducted on a middle line at the front or behind. They are widely used for tracheostomy (upper or lower) back middle cuts are used as operative accesses to the bodies of neck vertebrae (to the spinal cord). Slanting cuts are conducted on the cutting or back edge of sterno-cleido-mastoid muscle. Such accesses are used for baring or bandaging of elements of basic vessel-nervous bunch and neck part of esophagus.In addition, slanting cuts take advantage that are most safe and provide deep enough access. Transverse sections are used for access to the thyroid, esophagus vertebral, subclavian, lower thyroid to the arteries, for the delete of the lymphatic knots staggered by the metastases of c ancer progression. However much transverse sections have the row of failings badly accretes transversal the cut hypodermic muscle of neck that results in formation of wide and rough scars in addition is present possibility of wound of muscles, vessels and nerves during operation.Besides availability to the deeply located organs goes down considerably. The combined cuts (patchwork) are used for wide dissection of cellulose spaces, delete of tumor, metastatic staggered lymphatic knots. Surgical treatment of wounds of neck The wounds of neck are characterized by four basic signs. The first sign is sinuosity of wound channel. It is explained it mobility organs of neck from the presence of the developed fascial-cellulose spaces in area of neck. Second sign are the wounds of neck are often tended to(p) by the wound of spine and spinal cord.Wounds on a neck are especially dangerous, inflicted on sagittal or parasagittal lines. three sign are the wounds of neck in 13% of cases are attende d by the wound of carotids. This, usually, strained wounds which often end with death. Bandaging of general and internal carotids can be complicated by a one-sided central paralysis (hemiplegia). Fourth sign are wounds of neck are characterized by muddiness. At the wound of larynx, trachea, special esophagus, there is an infection with subsequent development of phlegmons and abscesses. sometimes festering processes are complicated by mediastinitis.Three areas of wounds of neck are distinguished first area from the lower edge of lower maxilla to the sublingual bone second area from a sublingual bone to the cricoids cartilage third area from a cricoids cartilage to the jugular undercuting of breastbone. Than the area of wound is below, that it is more dangerous, because interfascial cellulose spaces are open up. The large vessels of neck, included in top front mediastinum and going out on it, pass in the lower departments of neck. The wound of them is dangerous from the massive b leeding and difficult access to the site of damage.At primary surgical treatment a wound channel is extended. The nonviable areas of soft tissues are excised, irrelevant bodies, interfascial haematomas, are deleted, the damaged interfascial spaces are extended. Surgeons do not unseal the interfascial cracks not changeable by a scotching object. Wounds must be widely drainage. abroad bodies are deleted only in case that they threaten to liveliness of patient. Foreign bodies are deleted, if they cause serious complications (for example, located near a wandering nerve and is caused violations of cardiac activity).Foreign bodies in such cases must be remote at the well opened wound under the control an eye. If a splinter is located deeply in tissues and is not caused complications, he is not usually touched. He is encapsulated and is remained in tissues. Nick the encapsulated splinter will be mixed up, approaching large vessels, he is necessary to be deleted. Operations at phlegmons and abscesses of neck Phlegmons and abscesses in area of neck to the bowl are complications of lymphadenitis, when loose cellulose surrounding lymphatic knots is engaged in a process.Besides the difficult clinical picture of persist of disease, the festering hearths of deep cellulose spaces are dangerous to those that can on these spaces spread in neighboring regions. So, from previsceral and vascular-nervous cellulose spaces in front mediastinum from retrovisceral cellulose there is space in back mediastinum, being the reason of festering mediastinitis. The juxtavisceral phlegmons can cause squeezing and dropsy of organs of neck, large vessels and nerves. The lately recognized inflammatory processes sometimes result in melting of wall of vessels and considerable bleeding.A cut is elected for the shortest access to the abscess. victorious into account complication of topographoanatomical location of large vascular-nervous formations, cuts on a neck are produced strictly layer. Unsealing a skin, hypodermic fatty cellulose and superficial fasciae by speechless instruments, not to scotch vessels, impenetrate. At accesses the location of veins of neck, their intimate union, is taken into account with fasciae, the damage of the large veins close located from the upper aperture of breast is dangerous by not only the difficultly stopped bleeding but also air embolism.The wide opening of festering hearth is concluded by drainages of its cavity. Drainages are put possibly farther from the place of location of large vessels in the lower corner of wound. Thus on a skin there are sutures to drainage. The Festering processes of submandibular region are unsealed by a cut going parallel to the edge of lower maxilla, from last 1 1,5 sm (danger of damage of regional branch of facial nerve). After the section by the scalpel of skin, hypodermic cellulose, fasciae together with m. latysma deep into penetrates by a dull way, fearing the wound of facial artery and vein. Phl egmons and abscesses of bottom of oral cavity are unsealed by a longitudinal cut on a middle line below than chin. Come a sharp way to the gnathic-sublingual muscle (m. mylohyoideus). Pass the last through its stitch by a dull instrument, widely exposing a festering hearth. The phlegmons of fascial vagina of vascular-nervous bunch are unsealed by a cut along the cutting edge of sterno-cleido-mastoid muscle. Layer skiving, a hypodermic cellulose, and superficial fasciae, together with m. latysma is unsealed by the vagina of sterno-cleido-mastoid muscle and fascial vagina of vascular-nervous bunch. By a dull instrument penetrate to the vascular-nervous bunch. In cellulose surrounding a vascular-nervous bunch, drainage is put. At spreading of pus in the lateral triangle of neck unseal a phlegmon by a cut De Kerven. He is conducted on the front edge of m. sternocleidomastoideus, and then, crossing this muscle, parallel to the collar-bone and higher it on 2-3 sm to the cutting edge m. tr apezius. Wound of drainage.The phlegmons of previsceral space are unsealed by a transverse section, dissecting a skin, hypodermic cellulose, superficial, second and third fasciae of neck, long muscles covering larynx and trachea, parietal sheet of IV fasciae of neck. A cut is conducted on 3-4 sm higher than jugular undercuts. Spatium previscerale drainage is wide. The Festering processes of retrovisceral space are represented by retropharyngeal phlegmons and abscesses. The Retropharyngeal phlegmon can be unsealed from the side of neck, conducting a cut along the back edge of sterno-cleido-mastoid muscle.In the cellulose of retropharyngeal space, after the section of skin, hypodermic cellulose, superficial fasciae, vagina of sterno-cleido-mastoid muscle, penetrate by a dull way. Wound of drainage. I Recommend you a good book, illuminative these questions Essays of festering surgery, 1965 Author of it, professor V. Vojno-Jasenetcky, man of very interesting fate. BARING OF ARTERIES ON NECK Baring of general carotid Findings. Wound aneurism of vessel, angyographic research, existence of medicinal matters, if introduction by their puncture through a skin is not succeeded.Position of patient. A patient lies on back with a roller under scapulars. A head is thrown back backwards and turned aside opposite to interference. A cut is conducted long 5-6 sm at the cutting edge of sterno-cleido-mastoid muscle from the level of upper edge of thyroid cartilage downward. Layer a skin, hypodermic fatty cellulose, superficial fasciae, and hypodermic muscle, is dissected. The front wall of vagina of sterno-cleido-mastoid muscle is cut. Take a muscle outside, the back wall of vagina of muscle and vagina of vascular-nervous bunch is cut.In a cellulose most mesial and a general carotid is deeper disposed, ahead and lateral an internal jugular vein lies from it. A wandering nerve lies at the back semicircumferences of these vessels. At the wounds edge to the carotid presently lay o n a vascular stitch or produce the plastic arts of artery (its substitution of autovein is possible or synthetic vascular prosthetic contrivance from polymeric connections). At bandaging of artery there are serious complications as softening square off of areas of cerebrum and subsequent proof paralyses in 30% of cases. Baring of outward carotidFindings. Wound of vessel, vast wounds linden-tree, attended with bleeding from a maxilla artery an artery is bandaged at the delete of upper maxilla and parotid salivary gland concerning malignant tumours. Position of patient on the back, a head is turned aside opposite to interference. A cut is conducted long 5-6 sm from the corner of lower maxilla downward, along the cutting edge of sterno-cleido-mastoid muscle. Layer tissues are dissected. Take an outward jugular vein upwards and outside or bandage and dissect. It is necessary to distinguish an outward carotid from internal one.In the case of necessity bandaging of outward carotid lay o n ligature higher than place of departs upper thyroid artery. In the case of departs close from bifurcation edge the last to the carotid, an outward carotid is bandaged higher by the places of departs tongue artery. legs. In the case of the low bandaging of outward carotid a bifurcation general carotid can have a blood clot closing a road headroom and internal carotid, practically there will be an obturator general carotid. Bandaging of tongue artery in the Pyrogovs triangle now is not practically conducted. Vagosympathetic blockageFindings. Wounds of breast with closed and opened pneumothorax, attended with pleuropulmonary shock combined wounds of organs of abdominal region pectoral and. A blockage is produced with the purpose of breaking of pain impulses from the damaged regions. Position of patient. A patient is laid on the back with a roller under scapulars. Throw back a head backward and turn aside opposite to interference. Reference points the corner of crossing of outward j ugular vein with the back edge of sterno-cleido-mastoid muscle serves for introduction of needle (at the level of sublingual bone).By an index finger at the place of piercing needle together with a vascular-nervous bunch move aside a sterno-cleido-mastoid muscle ahead and mesial, after anaesthetizing of skin on an index finger stick long needle. A needle is moved forward from a top to the bottom outside inward to the front surface of neck vertebrae. Draw off a needle from a spine on 0,5 sm and in a cellulose behind the vagina of vascular-nervous bunch enter of a 40-50 ml 0,25% solution of Novocain. Hyperemia of skin of face and sclerotic coat on the side of blockage comes during the correct conducting of blockage.There is the Claude Bernar-Gorner syndrome narrowing of pupil, narrowing of eyeing crack, enophthalmos zapadenye eyeball. Necks organs Complication of anatomic structure and topographical-anatomic location of organs of neck in a great deal determines the features of operat ive interferences on them. In area of neck the initial departments of organs of digestion (esophagus, esophagus), external breathing (larynx, trachea) are disposed, thyroid and parathyroid glands, lymphatic vessels (the largest is pectoral channel).Also here are large vessels and interlacements of spinal nerves, nervous interlacements of organs and vessels. It should be noted that lymphatic vessels and vascular-nervous trunks of neck are covered only by soft tissues. Therefore, at the front and from sides they comparatively are poorly protected. One of topographical-anatomic features of neck is that all superficial skinning nerves of neck (from neck interlacement (?1 ?4) go out practically in one point at the level of middle of back edge of sterno-cleido-mastoid muscle, that allows to produce anaesthetizing at operations on a neck practically by one prick.In area of neck there are numerous reflexogenic areas, which appear by nervous interlacements of organs, vascular-nervous interl acements of organs, vascular-nervous bunches, neck department of sympathetic trunk, neck and humeral interlacements. It is the important facial touch of organs of neck them mobility at meatus of head, which has the practical value at operative interferences. LARYNX Represented 9th by cartilages by thyroid, cricoidea, epiglottis, two arytenoidea, two cuneiformis and two corniculata. Most essential from them re thyroid and cricoids, linked between itself lig. cricothiroideum. The front department of cricoids cartilage and undercuts on the upper edge of thyroid cartilage are external reference points at surgical interferences. Ahead a larynx is covered by epiglottis muscles, from one side the stakes of thyroid adjoin to it, behind a mouthful. Blood supply is carried out by upper and lower laryngeal arteries outgoing accordingly from upper and lower thyroid arteries. Innervations by the upper laryngeal nerve (from a wandering nerve) and lower (eventual branch of recurrent laryngeal ner ve).lymphatic outflow is carried out in pre-laryngeal, pretracheal, paratracheal and deep lymphatic knots of neck. TRACHEA Represented by cartilaginous semicircular connected by dense copulas. Back departments are locked by a dense connective tissue bridge, where mesomorphic fibres pass. Within the limits of neck 6-8 cartilaginous ring are counted, position of which corresponds to the bend of neck vertebrae. At the front tracheas the isthmus of thyroid lies, its stakes and general carotids adjoin from one side. Behind a esophagus is located.In a bend between a esophagus and trachea a recurrent laryngeal nerve passes on the left, on the right this nerve goes behind a trachea. Blood supply of trachea is carried out by the tracheal branches of lower thyroid artery, innervations branches of recurrent laryngeal nerve. PHARYNX Three basic departments of pharynx are selected nasal, mouth and laryngeal. A lymphatic pharynx ring (Pyrogov Valdeyer) which it is represented is important anat omic formation of pharynx by two palatal tonsils, two pipe, pharynx and tongue.In area of nasal and mouth parts of pharynx there are the juxtapharyngeal and retropharyngeal cellulose spaces delimited from each other by partition between pre-vertebral and pharynx fasciae. Front and back departments are selected in juxtapharyngeal cellulose space, in which pass important anatomic formations. Retropharyngeal space is divided by middle partition on two departments. Because of what retropharyngeal abscesses, as a rule, are one-sided. A pharynx is disposed most deeply and behind it pre-vertebral fasciae, long muscles of neck and bodies of vertebrae is located.Ahead of laryngeal part of pharynx a larynx is disposed from sides are stakes of thyroid and general carotids. Blood supply is carried out by the branches of ascending pharynx artery, ascending and descending palatal, and also upper and lower thyroid arteries. Innervation of pharynx takes place due to the branches of sympathetic, wan dering and glossopharyngeal nerves. lymphatic outflow takes place in deep neck lymphatic knots. ESOPHAGUS A esophagus passes to the esophagus, in which distinguish neck, pectoral and abdominal parts and accordingly narrowing.Neck part of esophagus lies in loose cellulose between a trachea and pre-vertebral fascia. He is easily displaced, however, basic axis a few displaced to the left, which matters very much at the choice of operative access to neck part of esophagus. From one side to the esophagus are disposed the stakes of thyroid, at the front is cricoids cartilage of larynx and cartilages of trachea. Blood supply of neck part of esophagus is carried out by the branches of lower thyroid arteries. Innervation due to the branches of wandering nerve. Lymphatic outflow in deep neck lymphatic knots.THYROID It is one of the largest endocrine glands. It is disposed in the sublingual region of neck on the front surface of trachea. It consists of two stakes, isthmus and in 30-40% of ca ses a pointed stake can walk away from an isthmus or left stake. Weight of gland hesitates from 15 to 50g. An isthmus is represented by a lamina, width to 1,5 sm and usually covers 2-3 cartilaginous rings of trachea. Lateral stakes lie on both sides a trachea and larynx, an oval form is had. A thyroid has an own capsule, which the visceral sheet of fourth fasciae of neck is over.Vessels, nerves and parathyroid, pass between the capsule of gland and fascia. At the front a thyroid adjoins with sterno-sublingual, sterno-thyroid and scapular-sublingual muscles behind with the upper department of neck part of trachea, larynx, pharynx, esophagus and parathyroid. To the back mesial surface of thyroid a recurrent nerve joins and laryngeal, general carotid. Blood supply of thyroid is carried out by pair upper (branches of outward carotid) and lower (branches of thyroidneck trunk) thyroid arteries, and at 10 % people yet and by a fifth odd artery.The vein outflow from a gland is carried ou t in the vein interlacement located by sympathetic trunks and laryngeal nerves. However, it should be remembered that at the lower edge of thyroid a lower thyroid artery is crossed by a lower laryngeal nerve which it is easily possible to injure at operations, that phonation results in violation. askant NECK TRIANGLE (TRIGONUM COLI LATERALIS) Limited at the front by the back edge of sterno-cleido-mastoid muscle, behind cutting edge of trapezoid muscle, from below by a collar-bone. Layers A skin is thin, mobile, elastic.Hypodermic cellulose is developed moderately. Superficial fasciae of neck and in a lower department hypodermic muscle of neck. V. jugularis externa passes in the lower department of region along the back edge of sterno-cleido-mastoid muscle. Skinning branches of neck interlacement front, middle, back. Subclavian branches of nerve of n. supraclaviculares anterior, media, posteriori. Other skinning nerves of neck interlacement go out at the middle of back edge of ster no-cleido-mastoid muscle n. occipitalis minor, n. auricularis magnus, n. cutaneus colii.Second fasciae or superficial sheet of own a fascia of neck is disposed as one sheet registering to the front surface of collar-bone. Third fasciae or deep sheet of own fasciae of neck within the limits of outward triangle occupy a lower front corner only, I. e. trigonum omoclaviculare (in trigonum omotrapezoideum third fasciae it is not). Between second and fifth fasciae cellulose, additional nerve, is disposed. Fifth fasciae or pre-vertebral, covering mm. scaleni, m. levator scapule and other The vascular-nervous bunch of outward neck triangle is made by a subclavian artery (its third department) and humeral interlacement.They go out through an interstair breakup. Humeral interlacement is disposed here higher and outside, subclavian artery below and inward. From a subclavian artery the last branch is transversal artery of neck (a. transversa coli) departs here, and also its branches ?. cervic alis superficialis et a. suprascapularis pass. A subclavian artery abandons the region of neck, going downward on the front surface of the first rib (I. e. between a collar-bone and first rib) the projection of it here corresponds to the middle of collar-bone.A subclavian vein is disposed on the first rib, but ahead and below of the same name artery, behind a collar-bone and further passes in spatium antescalenum, where muscle is dissociated from the artery of front stair. DEEP INTRAMUSCULAR INTERVALS In a lower department and behind a sterno-cleido-mastoid muscle, outside from neck entrails, there are two intervals nearer to the surface is prescalenum interval (spatium antescalenum) lying deeper is stair-vertebral triangle (trigonum scalenovertebralis). The Prescalenum interval is formed behind front stair muscle (m. calenius anterior), at the front m. sternohyoideus and sternothyroideus, outside m. sternocleidomastoideus. Between front and middle stair muscles there is spatium intrascalenum, which is located already within the limits of outward neck triangle. Within the limits of interval there is an internal jugular vein with its lower bulb (bulbus v. jugularis inferior), wandering nerve (n. vagus) and initial department of carotid (a. carotis communis). There is v. subclavia in the lowermost department of interval, meeting with v. jugularis interna the place of confluence is designated as angulus venous.An outward jugular vein falls in a vein corner usually, in addition ductus bracicus falls in it on left, and on right ductus lymphticus dexter. In an interval also there is a diaphragmatic nerve (n. phrenicus) arising out of fourth neck nerve, disposed on the front surface of front stair muscle and covered by pre-vertebral fascia. A nerve goes in slanting agency from top to bottom, outside of inward and passes to front mediastinum between subclavian by an artery and vein of outside from a wandering nerve. Higher collar-bones nip a nerve across a. trans versa colli et v. suprascapularis.A stair-vertebral triangle is disposed at back of lower mesial department of sterno-cleido-mastoid region and limited lateral front stair muscle, mesial long muscle of necks, from below dome of pleura. An apex corresponds to the carotid tubercle of transversal process of the VI neck vertebra. In this triangle under prevertebral fascia necks are disposed on the left is initial department of subclavian artery, eventual department of pectoral channel, on the right is eventual department of right lymphatic channel and lower knot of sympathetic trunk. A subclavian artery (a. ubclavia) behind and from below adjoins to the dome of pleura. Ahead of right subclavian artery a vein corner is disposed. Between it and a. subclavia passes wandering and diaphragmatic nerves, which a subclavian loop (ama subclavia) and n. sympathies beds between. Behind a subclavian artery there is a right recurrent laryngeal nerve (n. laryngeus recurrens), inward from it a. ca rotis communis. Ahead of left subclavian artery an internal jugular vein and initial department of left brachiocephalic vein (v. brachiocephalica sinistra) is disposed, between which pass n. vagus, ansa subclavia, n. sympathici and n. hrenicus. Inward from an artery passes a left recurrent laryngeal nerve. The arc of pectoral channel more frequent is located ahead of this department of subclavian artery. Three departments are selected in a subclavian artery from the beginning of artery to the interstair triangle in an interstair interval from an interstair interval to the apex of armpit pit. In the first department a subclavian artery gives the following branches vertebral (a. vertebralis) thyroidneck trunk (truncus thyreocervicalis) dividing into four branches lower thyroid (a. thyroidea inferior) ascending neck (a. ervicalis ascendens) superficial neck (a. cervicalis superficialis) suprascapular (a. suprascapularis) internal pectoral (a. thoracica interna) In the second department is costal-neck trunk (truncus costocervicalis). There is the transversal artery of neck in the third department (a. transversa coli). TRACHEOSTOMY It is operation of imposition of stomy on a trachea. Produce tracheostomy as urgent operation at a sharp asphyxia how gum elastic at operations on the organs of mouth and neck in an anesthesiology for conducting of anesthesia (intubation). Basic findings to implementation of tracheostomy impassability of larynx and upper department of trachea as a result of their obturation by a tumor, unusual body, paralysis and spasm of vocal copulas with closing of entrance in a larynx, and also distresss and edema of larynx coma of any etiology with violation of swallowing, aspiration by vomitive the masses, saliva, blood in respiratory tracts disorders of breathing at patients with a heavy cranial-cerebral trauma and trauma of thorax respiratory deficiency arising up as a result of proof oppression of central mechanisms of breathing heavy surgical respiratory insufficiency necessity of the protracted artificial ventilation. Types of tracheostomy are upper (supracricoid) middle (intracricoid) and lower (subcricoid) tracheostomy. More frequent execute upper tracheotomy and conicotomy, at which cross a copula (ligamentum conicum) between thyroid and cricoid cartilages. Technique of conducting of upper tracheostomy Position of patient on the back with the maximally thrown back head. Under scapulars is roller. During conducting of cut it should be remembered basic topographic- anatomic relations of trachea and other organs of neck.So facade and from one side overhead part of trachea joins with a thyroid, to lower part with the cellulose of pretracheal space backwards from a trachea there is the esophagus forced out to the left. On the left a trachea and esophagus disposes a recurrent nerve on the right a recurrent nerve is deeper behind a trachea on the lateral wall of esophagus. Next to the lower department of n eck part of trachea there are general carotids, lift is head trunk, arc of aorta and left shoulder is head vein.At implementation of upper produce a tracheostomy cut exactly on the middle line of neck from the middle of thyroid cartilage downward on 4-5 sm or transversal, think above the isthmus of thyroid. Layer a wound is unsealed, bleeding is stopped. Muscles bluntly move apart and draw off in sides the first tracheal rings are opened. The isthmus of thyroid is drawn off downward, and a trachea is fixed either for a cricoid cartilage or for the first rings of trachea. It enables freely to manipulate at the section of rings of trachea.A trachea is dissected on the size of diameter of entered cannule by a scalpel dosed by gauze serviettes for warning of damage of esophagus. After expansion of road clearance of the unsealed trachea cannule is entered from one side, and then translated it in a sagittal plane. After introduction of cannule a wound is taken in layer, cannule is fixed round a neck. CONICOTOMY Soft pit is groped between the lower edges of thyroid cartilage and pulled out arc of cricoid cartilage. Skinning cut longitudinal to appearance of the yellow coloring (ligamentum conicum) cross. This copula goes horizontally.Such cut can be produced one moment through a skin and copula. In opening cannule is entered and is fixed round a neck. This interference is temporal. Technically simpler for implementation is upper tracheostomy, however, it not always is possible from pride of place of isthmus of thyroid, and at children it is practically impossible. Therefore, presently got the preference lower tracheostomy, to which a cranial-cerebral trauma and damage of neck department of spine is contra-indication. COMPLICATIONS AT TRACHEOSTOMY Complications at tracheostomy depend on the errors assumed during operation 1.So a cut not on the middle line of neck can result in the damage of neck veins, and sometimes and carotid. 2. The insufficient stop of bleeding before dissection of trachea can result in the hit of blood in respiratory tracts, which will cause heavy aspiration pneumonia. 3. Air embolism at the damage of neck veins is possible. 4. Length of cut of trachea must correspond to the sizes of entered cannule. At small cut is origin of narrowing and squeezes tissues round it, that substantially hampers the withdrawal of cannule a too large cut can result in hypodermic emphysema with the subsequent development in the road clearance of trachea. . Before conducting of section of rings of trachea follows strictly to measure out the edge of scalpel (it must not exceed 1 sm, not to injure a esophagus). 6. At introduction of cannule to the road clearance of trachea, it is necessary expressly to make sure, that the mucous membrane of trachea is cut, otherwise cannule will enter in submucous tissue that will aggravate difficulty in breathing. OPERATIONS ON NECK DEPARTMENT OF ESOPHAGUS Findings. Wounds of esophagus, foreign bodies, which it is not succeeded to extract at esophagoscopy, tumours and proof scar narrowing.Position of patient on the back with a roller under scapulars, a head is thrown back and turned to the right, because a esophagus deviates to the left of middle line and conduct interference on left of neck. Operation is conducted under the local anaesthetizing, at children under anesthesia. A cut is conducted along the cutting edge of sterno-cleido-mastoid muscle on the left of the jugular undercuting of breastbone to the upper edge of thyroid cartilage. Layer a skin, hypodermic cellulose, is dissected, superficial fasciae together with hypodermic muscle necks.The vagina of sterno-cleido-mastoid muscle is unsealed. Take a muscle outside. The back wall of its vagina is unsealed. transmit and dissect III and IV fasciae of neck. Vascular-nervous bunch together with sterno-cleido-mastoid take muscle outside. Cut the parietal sheet of IV fasciae inward from a vascular-nervous bunch. A lower thyroid artery, p robutting V fasciae of neck, is bandaged. In a tracheoesophagal furrow find and take a left recurrent laryngeal nerve aside. Sterno-sublingual and sterno-thyroid muscles together with a trachea are taken to the right.A esophagus bares. A esophagus is determined on the longitudinally directed bunches of muscular fibres and rose-grey color. At the wound of esophagus in a stomach through a mouth a probe is entered, the wound of esophagus above a probe is taken in. Drainages are tricked into. In the case of the complete crossing of esophagus, a stomach-pump is inserted in its lower end, upper part tamponade. Afterwards the probe entered through the wound of esophagus, replace by the probe conducted through a nose. The damaged esophagus either is stitch together or produced its plastic arts.At suppuration of juxtaesophagal cellulose on meatus of esophagus gauze tampons are downward conducted. A patient is laid with the dropped head end of bed. Such position is instrumental in the free disengagement of pus from back mediastinum. In the case of delay of foreign body in a esophagus, at this level on it lay on two gauze serviettes, sewing the wall of esophagus to the mucous membrane. An organ is destroyed in a wound. After surrounding of esophagus by the serviettes of it unseal longitudinally, so a muscular shell is cut at first, and then mucous, which raise by pincers.If a foreign body formed bedsore, a esophagus at that rate is unsealed within the limits of healthy tissues. Foreign bodies are taken away by fingers or instrument. There are sutures on the wall of esophagus. Taking in of wound of esophagus is begun with imposition on its corners of lygature. The row of deep catgut stitches is further laid on through all layers of edges of