Social Attitudes of Recent Russian Immigrants essays

Social Attitudes of Recent Russian Immigrants essays Social Attitudes of Recent Russian Immigrants This paper is concerned with social attitudes of the recent immigrants from the former Soviet Union in the United States. They come in large numbers from a society, which is very different from American, and the process of blending into new system is extremely complicated and even painful for them. Interestingly enough, Russian immigrants in general manage to assimilate very well and it is considered to be the most successful immigrant group in a nation of immigrants (Barry V. Johnston, p.72). I am particularly interested in this topic because Russian immigrants are in a transition between two very dissimilar ideological and social systems. At the same time it has a specific significance for me because almost four years ago my family moved to America from Moscow as refugees. I would like to apply the order theory of assimilation processes in this paper since this theory fits perfectly to my personal experiences and the experiences of my family in this country. After a long and scrupulous research I have decided to use two journal articles, which give excellent information on the type of Russian community in Los Angeles and social attitudes of Russian immigrants in the US in general. Acceptance of prevailing U.S. attitudes toward social issues is believed to be a reliable indicator of immigrants adjustment to U.S. society (M. Gordon). An immigrant cannot be expected to obtain American values if the individual does not assimilate for example, if he or she does not learn English. Such factors as aging slows attitude change and tends to produce more conservative positions on social problems; education, in contrast is associated with expression of tolerant view. Newly arrived immigrants tend to preserve deeply carved cultural traditions and values of the home country. A person can live in Russian neighborhood in West Hollywood without speaking Engli...

House Centipedes, Scutigera coleoptrata

House Centipedes, Scutigera coleoptrata Put down that newspaper! House centipedes look like spiders on steroids, and your first reaction to seeing one might be to kill it. But scary as it may seem, the house centipede, Scutigera coleoptrata, is really quite harmless. And if youve got other pests in your home, its actually doing some good. What Do House Centipedes Look Like? Even people who appreciate bugs can be startled by a house centipede. A fully grown adult may reach 1.5 inches in body length, but its many long legs make it appear much larger. The last pair of legs on a female house centipede is elongated and may be twice as long as the body. The house centipede is light yellow-brown in color, with three dark longitudinal stripes down its body. Its legs are marked with alternating bands of light and dark. House centipedes also have large compound eyes, which is unusual for centipedes. Although the house centipede does possess venom, it rarely bites anything larger than itself. If you are bitten by  Scutigera coleoptrata,  you arent likely to suffer much pain.  Do take care to clean the wound to prevent a secondary infection. How Are House Centipedes Classified? Kingdom - AnimaliaPhylum - ArthropodaClass - ChilopodaOrder - ScutigeromorphaFamily - ScutigeridaeGenus - ScutigeraSpecies - coleoptrata What Do House Centipedes Eat? House centipedes are skilled hunters that prey on insects and other arthropods. Like all centipedes, their front legs are modified into poison claws used to inject venom into their prey. Within your home, they provide efficient (and free) pest control services for you, as they feed on silverfish, firebrats, cockroaches, carpet beetles, and other household pests. The House Centipede Life Cycle Female house centipedes can live as long as 3 years and produce between 35 and 150 eggs during their lifetimes. The first instar larvae have only four pairs of legs. Larvae progress through 6 instars, gaining legs with each molt. Although it has its full complement of 15 pairs of legs, the immature house centipede will then molt 4 more times to reach adulthood. Interesting Behaviors ofHouse Centipedes The centipede makes good use of its long legs. It can run at alarming speeds –the equivalent of over 40 mph in human terms. It stops and starts quickly, which can make even the most diehard arthropod enthusiast squeal with fright. This athleticism isnt meant to scare you, though, the house centipede is simply well-equipped to pursue and catch prey. Just as their speed helps them capture prey, it also enables the centipede to escape predators. If a predator does manage to grab a leg, the house centipede can shed the limb and flee. Strangely, the house centipedes detached leg will continue to move for several minutes after its owner has left the scene. House centipedes continue to molt as adults and will regenerate lost limbs when they do. Where DoHouse Centipedes Live? Whether it lives outdoors or in, the house centipede prefers cool, damp, and dark locations. In a natural habitat, it can be found hiding under leaf litter or hidden in shady crevices in rocks or tree bark. In human dwellings, house centipedes often inhabit basements and bathrooms. In northern climates, house centipedes remain indoors during cold months but may be seen outside from spring to fall. The house centipede is thought to be native to the Mediterranean region, but Scutigera coleoptrata Is now well-established throughout Europe, North America, and Asia. Sources: House Centipedes, Entomology Dept., Penn State University. Accessed online June 3, 2014.Species Scutigera coleoptrata - House Centipede, Bugguide.net. Accessed online June 3, 2014.House Centipedes on the Move, Whats Bugging You?, Dr. Arthur Evans. Accessed online

Commercial Clause and its Effect on Business Essay

Commercial Clause and its Effect on Business - Essay Example The Commerce clause is regarded as major legal bedrock in the regulation of commercial activities especially those involving dealings with foreign countries. However, the Supreme Court upon review of the injunction, it found out that it was not in line with the federal statute, which was supposed to be only valid within the New York state. Therefore, the court withdrew the injunction because the Commercial Clause gave an authority to the Congress to pass laws/acts, which could have an effect in a single state when it had some commercial dealings with another state. Thus, this is in tandem with the book of Luke 16: 17 which states that â€Å"And it is easier for heaven and earth to pass, than one title of the law to fail."According to Wickard v. Filburn, the original understanding or rather the interpretation of the commerce clause was elaborated by the Supreme Court to include intrastate commercial/economic activities. In this case, the defendant grew wheat with an intention for per sonal consumption but later sold the excess to the public. The court of Supreme ruled that the excess wheat sold could have a significant effect on the interstate commerce hence affecting prices and output. Therefore, the rationale applied in this context can be linked to the book of 1 Kings 5: 11 which states that â€Å"And Solomon gave Hiram twenty thousand measures of wheat for food to his household, and twenty measures of pure oil: thus gave Solomon to Hiram year by year.†

High Paid CEOs Essay Example | Topics and Well Written Essays - 1000 words

High Paid CEOs - Essay Example Most of the CEOs get their pay with many components. These may include monthly salary, bonuses, stock options, and others. Quite often, when we look at the data regarding the compensation of CEOs, that data includes in itself the expected value of stock options, which is usually much higher than the current value and is set up the board of directors anticipating the performance of the company (Kay & Putten, pp. 59- 61, 2007). In addition, many CEOs have a considerable amount of their compensation in form of stock options and that is not liquid neither does the CEO walks away any morning with his stock options. Therefore, the liquid cash or variable salary that the CEOs receive is often much less than what we see and hear through various sources (The Economist, 2010). Most critics of the CEO pay often forget that like any other employee of the company, the pay of the CEO is decided by looking at his job description, the sensitivity of his job, the authority, task significance and the risk associated with it. Quite understandably, the job of a CEO is tricky and a risky one because history has witnessed revolutions in companies due to great CEOs and destruction of many companies as well due to incompetent. Besides, if we look this issue from the lens of a free market economist then this issue would cease to exist. These high salaries of CEOs are something, which the free market has come upon through market mechanisms and market driven forces (Beauchamp, Bowie & Arnold, pp. 158-159, 2008).

Yes, College is Worth the Money Essay Example for Free

Yes, College is Worth the Money Essay According to College Board, higher earning potential is number one when it comes to benefits of going to college. The median earnings of bachelors degree recipients working full-time year-round in 2008 were $55,700. (Hardy) A lot of current college students say that college is not worth the money, but they are still in college because they know without some type of degree it is going to be difficult to be financially stable and career ready but along with that they will learn some sort of responsibility. To start off, considering the fact that no one wants to struggle and everyone wants to be financially stable a college degree is required. With a college degree you are not always guaranteed a job as soon as you graduate but when you do get in your career field you will always be paid more than a person who just has a high school diploma. On average, the salary given to a person with a with a four year degree is approximately 45,000 dollars verses a lower income coming from someone with just a high school diploma. Studies show that those holding bachelor’s degree will earn about 2.2million dollars in a lifetime and those with a masters, doctorial and professional degrees will earn about 2.67 million, 3.25million and 3.65 million dollars in a lifetime. So, furthering your education will determine you financial stability. Daughtry2 Being career ready is very important before going out in to you designated career field. Going to college will help you become career ready both academically, socially and hands on. Of course coming toschool doing book work is a necessity. Also, you are going to have most likely take courses that are not related to your career and as well as the ones that are your focus. But, all of the course you take will help you in the long run somehow or another, even if it looks pointless it’s probably a class to make you look at life differently. For instance, an Elementary Education major’s  curriculum guide requires a current student to take African American Studies as a freshmen. This class has nothing to do with the chosen major but it will show individuals enrolled in this course so many different things they can use when they start their career. Socially, college has been a major help due to the fact that most freshmen are easily intimidated and shy when they begin college. College professors assign group assignments and various other group activities to help them out. Socializing with peers as well as children, who will one day consume most of my time. Hands on, field experience, is actually for an Elementary Education major going to the classroom and talking with students and reading to them etc. Field experience lets you know if this is what you still want to do and if so it allows you to get hands on experience. In addition, going to college teaches you how to be responsible. For those who have time management issues and problems with procrastination coming to school will show you that if you do not have somewhat of a set schedule you will fail. As a college student you have to learn how to wash your own clothes if you did not already know how, you have to learn how to budget and the biggest thing coming to college you will learn fast is self-discipline. Self-discipline is knowing you have class in the morning so you do not go out with your friends the night before Daughtry3 because you know you are not going to make it to that eight o’ clock. That’s discipline yourself in college, having this practice will have you responsible enough to go out in the work force. Often times though, high school students feel as if college is not for them due to the previous struggles, failures and or experiences they have had in high school. â€Å"Failure is punished instead of seen as a learning opportunity. We think of college as a stepping-stone to success rather than a means to gain knowledge. College fails to empower us with the skills necessary to become productive members of Today’s global entrepreneurial economy.† (Stephens) His point of view is very understandable and realistic. Agreeing with Dale Stephens, Marty Nemko, says too that college is a waste of time.  In an article entitled â€Å"We send too many to college†, Nemko practically states that parents are wasting their money by sending their â€Å"bottom 40 percentile† child to college because they barely made it out of high school so why would you send them to college. â€Å"Even worse, most of those college dropouts leave college having learned little of practic al value and with devastated self-esteem†¦ those people rarely leave with a career path likely to lead to more than McWages.† (Nemko) Going against the idea that college is worth the money the two authors have very valid points. All in all, college is still worth the money and although a lot of current college students say that college is not worth the money, where are they? They are still in college because they know without some type of degree it is going to be difficult to be financially stable and career ready. Coming to college will teach them some responsibilities that they have probably never had to do. College is definitely worth the money. Daughtry 4 Works Cited Kirszner, Laurie G., and Stephen R. Mandell. Practical Argument. 2nd ed. Boston, NY: Print. Hardy, Marcelina. 7 Benefits of Having a College Degree. Yahoo Education. 2013. Web. 23 Jan. 2014.http://education.yahoo.net/articles/benefits_of_higher_education.htm.

Organic Consumers Association :: Web Internet Food Cyberspace Essays

Organic Consumers Association The World Wide Web, so vast, so fast, what’s the page you’ll look up last? Well it may not be the last page you would ever search for but it probably is not on the list of your top ten web sites. However it should be on the top ten, dare I say number one? The Organic Consumers Association is an extremely interesting and informative web page that most Americans will probably never see. It deals with a broad range of issues, mainly those concerning organic foodstuffs. The web page also has many other aspects to it including discussion boards and ways to search for related material over the web. The Organic Consumers Association (OCA) web page offers a broad range of places to explore and issues to learn about while incorporating rhetorical devices and various illustrations. Well awesome, now it is understood that the OCA webpage offers a plethora of opportunity for hours and hours of internet fun. But why does this concern me and why do I care? The fact of the matter is many people are inadequately informed about many issues happening in the world today. Most people get their news from the television or a newspaper but those are only small samples of things happening in this wondrous country of ours. This is where the OCA website comes into play. It offers hundreds of different articles from newspapers around the world based on less mainstream but equally important topics. These topics range from research done about organic foods to air pollution crack downs. One topic that I guarantee most would not expect to encounter goes a little like this, â€Å"Flame Retardants Found in Mothers’ Breast Milk in U.S† (OCA website). Clearly there are a wide range of topics to read about to make yourself more aware of less common things happen ing around the globe. The majority of topics covered on the site are obviously going to about be organic foods. This may pertain to growing foods organically or what types of organic foods are the most popular or health facts about eating organic foods. There are also many articles about genetically engineered foods that are becoming more and more problematic. Being more specific, there is an article to make people aware that Starbucks Coffee (a place where many American visit one to two times per day) uses genetically altered coffee beans.

American involvement In N. Africa during world war II (Revised)

The second world II was a world wide conflict which started in 1939 and ended in 1945. The war was fought in different places in the world. One was fought in Asia at around 1937, the other in Europe in 1939 with the invasion of Poland by Germany. Another one was also fought in African continent. It led the world nations to split into two that is. Allies (Britain and America) and the axis (Germany and Italy) The Second World War started when Hitler invaded Poland on September first in 1939.About million Australians fought in the Second World War in campaigns against Germany and Italy in Europe, North Africa, Mediterranean and against Japan in South East Asia as well as in other parts of the Pacific. The main focus in this paper will be to discuss on the US military involvement in North Africa during the Second World War. In 1942, November, United Kingdom military forces in conjunction with US military forces staged war against the French North Africa. It was the result of the long con tentious argument between American planners of war and those of Britain.The turbulence of this argument was calmed by the American president’s Franklin D Roosevelt intervention. American dream about the Second World War in 1942 was to attack and defeat Germany before proceeding to Asia to see the harm the Japanese were causing to Pacific territories. In the same year, the Soviet Army was far much pressed by the Germany-panzers division who were leveling attacks on Russia. Some American planners thought it was not necessary to attack North Western Europe.They planned that come 1943, the American army would be well prepared, trained and equipped to meet the Germany’s aggressive troops. The American planners believed that its army’s knowledge and resources could help them to accomplish their mission of bringing Germany troops down. The British military leaders under the field marshal Alan Brooke (Dennis P. 2002; 78) adopted a different approach. They never thought it wise to start launching their attacks in 1942. The main reason why they were opposed to this idea was because taking such a move would force United Kingdom to bear much of the military burden.At this time, they could not have afforded to have a division in the army because they were experiencing a fierce fight against Germany which had already inflicted a lot of harm to their army. Most of their military had met stiff resistance of the Wehrmatch in France during the disastrous 1940 campaign. At this time their forces under field marshal Erwin Rommel, they had done practically nothing to end or reduce the German military process in North Africa and in Libya. After the war, Brooke found the strategy of the Marshal very incompatible and that he did not appreciate what the operations in France would mean.He could not figure out how the Germans could reinforce their attacks about three to four times faster than theirs and he could not understand how they could suffer from the shortage of sea transport if the Mediterranean was not opened. The British opposed this idea though America promised to provide the invading forces. They wanted the Americans to clear the axis force in the Mediterranean shores of North America and open up that great inland sea for the allied convoys to move in.This culminated into a deadlock that made Brooke to consider switching the America army’s emphasis from European theatre of operations to the pacific, but Roosevelt the then president of America could not accept such an idea that was central to their war strategy. This emphasy from Britain never worked to the Americans instead it led Roosevelt to do something that Winston Churchill would never dream of doing. In fact he intervened and overruled his advisers who used to advise him on war matters. This was in the summer of 1942.He ordered his generals to direct their forces to the French North Africa to support the British proposal for landing along the coast of North Africa. He did this so that he could divide the attention Germans were giving to European war. He wanted to divide the concentration of German because he thought that if he did not do that, then he would come to face German some where in Europe. He knew that his move would be embraced by Britain though it was only done due to political necessity and national interests. At this time the British soldiers had no choice but to gang with USA in attacking Morocco and Algeria.From this time the attention that German had on war in Europe, half of it shifted to the battle in the Mediterranean. The plan was well strategized. About 65,000 men under lieutenant General Durlght D. Eisenhower were to be transported by the allies to invade Casablanca, Roan and Algers. These were the possessions of the French North Africa. Everything went according the plan and they had a lot of quick success that was attributed to the fact that the Axis attention was focused elsewhere. This time the Germans were trying to sub jugate Stalingrad and the Caucasus.In Egypt at the same period, the Rummel’s African Korps renewed their offensive attacks on the British area of interests. The British forces under Lieutenant General Bernard Montgomery organized his army to liaise the move of the Rummel’s the Montgomery’s force entered into a fierce battle with the axis forces. The axis powers had no hope of winning this war and by early November Rummel’s armies yielded back to Libya. The move they took was against the wishes of Hitler who had ordered them to keep soldering on. Hitler never at any time contemplated of defeat. He would rather die that witness such humiliations (Ambrose S.2001; 58) At the onset of November 1942, the allied forces had started to build up their ships at Gibraltar. The German spies were aware but they down played the idea as simply as another large supply convoy for reinforcing Malta. The Germany’s companion had a different view; Italy was not so sure of this though Germany never thought about this seriously but had been ignoring Italy’s decision. In November eighth 1942 the foreign German foreign minister Ulrich Joachim who was also known as Von Ribbentrop was so sure about the American troops who had landed in Algerian as well as in Moroccan ports.These allied forces leveled attacks that had positive results as it was expected, the allied forces thought that the dissident French military officers who had supported them would turn against them however, this did not happen but to their surprise the Vichy French government just as it happened in Dakar and in Syria in the following year, they fought against the Allied forces though they did not manage to keep off the invading Germans in France and in Tunisia in the same year, that is 1942. The Vichy French military men couldn’t have resisted the German who were very adamant and determined to crash the French’s down.The Vichy’s weapons were not up to the standard when compared with those of the Germans. They used tanks while he German possessed combat aircrafts though they were not enough. The Germans never trusted the French Vichy government and that was why they could never let them to modify their war technology. They thought that French’s would rise up against them if let to acquire modern weapons. Due to lack of proper weapons the Vichy French’s were unable to keep sustained resistance against the Allied forces who comprised of British soldiers and America soldiers(Atkinson R 2003;152)In the initial stage of the war, America thought the French North Africa would not attack the Americans though this is not what happened. Though they tried to resist they could not resist the American’s advancements. They had no effective troops that would manage to keep Americans at bay. Though the American’s landings defeated the Frenchs, not all of them were successful. In fact a landing at Fedela costed the transpor t Leonard wood its 21 landing crafts and many lives perished. Also in another landing, the transport Thomas Jefferson 16 crafts was destroyed completely beyond revival.The most affected landing was of the transport canal which lost 18 out of its 25 crafts and in the second wave; five of them were ruined leaving only two boats that could carry troops and other supplies. There was serious landing opposition at Mehdia by the French forces. The landing was not safe and was very dangerous. By November 10th, the Americans under major general Lucian Truscott were able to capture the airfield from the hands of French military men. This was as a result of a very heavy naval gun fire between French’s and Americans but later after the negotiations between French leader and the allies in Algeria, fighting stopped.On 8th November 1992, the infantry division had already actualized its dreams in almost all areas apart from St. Cloud where they met a very strong French force. During this tim e the combat was spearheaded by Roosevelt who was by then who was brigadier general. However, the landings begun to be interfered with by the rising surfs on 8th of November, the landing activities were to be suspended. In the following day the Vichy government tried to counter attack but they met a lot of resistance from Allied force who had support from air bases and naval baseOran was secured from the hands by the American though the French looked like they would never go but an armistice was signed when the confronting parties came together. The most operation assignment that the allied forces faced was at the port of Algiers. The French had enough ground force plus 52 fighter aircrafts. They also had 39 bombers. The port was heavily guarded so there was no way the British’s and Americans could have an easy access to the port. The American troops of the 168th regimental combat landed on the West while the 39th combat team went to the East of the port and they raided the p ort.They used two British destroyers which carried the royal navy personnel and the American troops. Before they could succeed, one of the destroyers was destroyed and it had to go back immediately while the other one succeeded and crossed the barriers. These forces that succeeded captured the power station and petroleum tank firm and the Frenchs responded to this attack immediately. After some time when the 168th combat group failed to turn up, the American commander was forced to surrender his troops. The North Africa mission was called â€Å"operation torch† and the city that was their target was Casablanca and was under the command of Eisenhower.These nations (Sam M. 2006; 102) were fighting for the control of the Suez Canal that linked Africa with the Middle East. Suez Canal was the inlet of oil from the Middle East and other raw materials from Asia. Due to the mechanization of their armies, oil was a very crucial commodity and because Britain which had already a mechani zed army it totally relied on oil from the Middle East. Britain used Suez Canal as a link to her overseas dominions. This was all made possible by the Mediterranean Sea hence, the struggle. This struggle started at around 1935 when Ethiopia was invaded by Italy which by then had made Somali land its colony.The move frightened Egypt which was not yet a British colony. They started getting worried of its imperialistic aspirations thus in order to protect its interest and country, it allowed Britain to station its army in its territory so as to keep off any advances from Italy. Thereafter, Britain and France took upon themselves the responsibility of maintaining naval control over the Mediterranean with the main British’s base at Alexandria, Egypt. The British and American troops met little resistance at Algiers, Oran and Casablanca on 8th of November 1942. The war took place in the North African desert.By the time the war took place the Italian dictator Mussolini had a better e quipped army than that of the Britain and America. He had about a million soldiers who were based in Libya while Britain had only 3600 soldiers who were based in Egypt. They were supposed to protect the Suez Canal and the oil fields in Arabia. At this time the Italians were a threat to Britain. They had already started showing interest in the red sea and Suez Canal supply routes. The North Africa campaign in the beginning was hampered by lack of enough supplies on both sides but later they got equipped.Tough battles took place which either rendered one group to advance against each other along the supply routes. Many of these fights took place in the Far East region out of the Mediterranean where they enjoyed free transport (Breuer W. 1985; 26) In April 1941, the allied forces were under the leadership of General Bernard Montgomery. While the British troops worked to keep Germans forces at bay to the West, the US forces were supposed to confront the Frenchs in North Africa underâ₠¬  Operation Touch† The main reason for this reason for this operation was to take over Morocco which was already a French colony, to take Algeria and Tunisia.They wanted to offer support to their colleague in the Libyan Desert. They also wanted to make Mediterranean shipping route free to their ships and for other major operations in North Africa. They hoped that they would force the axis of out of the region. They also wanted the axis to reduce their concentration on the Russian forces or in other words, they wanted the Axis forces to divide their war attention between North Africa and Russia. The attack took Germans by surprise because they did not expect it to happen. Later, the French stopped being hostile to the allied forces and allowed them to nave access to Tunisia.Rommel led his armies to various defensive operations. One of the most key operations was of the Kasserine pass where American defenses were crashed by Germans modern tanks. This operation saw 1000 allied troops dead and hundred of them were held prisoners by Germans. They also lost most of their fighting equipments. Though the axis powers thought they were winners, to the allied forces was an awakening call. They went back to their drawing board, assessed their weaknesses and came up with the way forward (Funk A. L. 1974; 86)Americans never gave up; they sent Rommel back to conquer the Kasserine pass so that they could get the Merith line. This time, the axis forces gained advanced and suppressed the resistance that until they let 275000 prisoners free. The axis forces in Africa surrendered on may 2nd 1943 after about 350,000 soldiers were captured by the allied forces and 70,000 were casualties. After they quit from the war, the stage was left open for Italian campaign. The axis surrendered because of ruthlessness of ‘the operation retribution’ which was designed to evacuate German and Italian forces from Tunisia.About 897 were held captives, 653 escaped and were assum ed to have might drowned. In conclusion, we have seen how the North African war costed many lives. Many people perished and others were injured. Though the war was took place in Africa, it was not as fierce that one in Europe. These wars were fought by these nations to protect their national interests. No country wanted their competitors to have an access or even go near its spheres of influence. Another reason for the fight was to gain supremacy.The Allied Forces were determined to silence Germany and its colleagues which were proving to be a big threat in Europe. Their plan worked as it was expected that is, they engaged Germany to another front so as to divide its concentration on war in Europe. So, it was not war for the sake of war but war for different reasons. In this war America in conjunction with Britain were the main aggressors. They left North African countries highly damaged. A lot of people perished while others were injured. The harm this American led war did was more than what one could have expected.Reference: Dennis P. The oxford Companion to Australian Military History. Melbourne. Oxford University press. 2002; 78 Breuer W. Operation Torch: The Allied Gamble to Invade North. St. Martins Press. 1985; 26 Funk A. L. The Politics of Torch, University press. 1974; 86 Sam M. At all costs: How crippled and two American Merchant mariners Turned the Tide of world WarII. Random House. 2006; 102 Ambrose S. The good Fight: How World War II Was Won. Atheneum. New York. 2001; 58 Atkinson R. An army at Dawn The war in North Africa 1942-1943. Newyork: Henry Holt. 2003; 152

Anatomy of the Neck

Lecture 3. Surgical anatomy of neck Contents of lecture Scopes of neck. Division of neck on a region. Fascias and cellulose spases of neck. Topography of vascular-nervous formations of neck. Topography of organs of neck. Topographycal-anatomic ground of operative interferences in area of neck. Cuts in area of neck. Treatment of neck’s wounds. Operations at inflammatory processes. Operation on muscles, vessels and nerves. Tracheostomy. Operations on a thyroid. Plan of lecture. 1. Scopes of neck, division on a region. 2.Triangles of neck. 3. Fasciae of neck. 4. Cellulose spaces of neck. 5. Submandibulare triangle. 6. The Pyrogov’s Triangle. 7. Carotid triangle. 8. Topography of basic vascular-nervous bunch of neck. 9. Distinctions between external and internal carotids. 10. Branches of external carotid in a carotid triangle. 11. Topography of trachea. 12. Topography of neck part of pharynx. 13. Branches of neck interlacement. 14. Scopes of lateral triangle of neck, divisi on of it on scapula-trapezoidal and scapular-clavicles triangles. 5. Layers of lateral triangle of neck. 16. Cellulose spaces 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 operative access to neck part of esophagus. 21. Operations on a thyroid. ANATOMICAL-TOPOGRAPHICAL FEATURES OF NECK AND THEIRS ORGANS Topographical anatomy of neck (common data) The region of neck differs by the difficult anatomic structure.Any doctor needs knowledge of topographical   anatomy of neck, as this region has a row vitally important formations, interrelation between which must be taken into account at implementation of row of urgent measures (laryngotomy, tracheostomy, stop of bleeding and other). The practical value is had: 1) The outward reference points of region, which use at the inspection of patient for: a) Drafting of projection lines; b) Determinations of location of organs of neck 2) Bulges of sterno-cleido-mastoid muscles which are a reference point for finding of general carotid.Palpation of region is more informing: a) On the middle of the skinning fold exposed at bending of head, the body of sublingual bone palpate under a lower maxilla, on each side from it it’s large Horn. A sublingual bone is a reference point at implementation of vagosympathetic blockage; b) Below the plates of thyroid cartilage, place of their connection, palpate to the sublingual bone (Adam's apple); c) In the middle of front surface of thyroid cartilage is mapped a glottis. d) A cricoids cartilage is felt directly ahead from thyroid.Deepening which corresponds to the thyroidocricoid copula palpate between them. Urgent laryngotomy is executed in this area; e) On the line conducted from the lower edge of cricoids cartilage downward to the jugular undercuting of breastbone, is mapped a trachea, a few left from it is mapped a esophagus; f) At the cutting edge of s terno-cleido-mastoid muscle according to the level of cricoids cartilage the transversal process of sixth neck vertebra palpate at back of region (carotid tubercle, tuberculum caroticum).Against this tubercle a general carotid is pinned at bleeding from its branches; g) At the level of upper edge of thyroid cartilage, is mapped the place of bifurcation general carotid; h) In the corner formed by the back edge of sterno-cleido-mastoid muscle and collar-bone, the pulsation of subclavian artery is determined. Here it cuddles to the first rib for the temporal stop of bleeding; i) It is mapped humeral interlacement on a neck on a line, connecting a point lying on the border of middle and lower third of sterno-cleido-mastoid muscle and middle of collar-bone.On 1,5-2 sm higher than middle collar-bones execute anesthesia of humeral interlacement; j) It is mapped a diaphragmatic nerve on the line of the width of sterno-cleido-mastoid muscle conducted on a middle downward from the level of mi ddle of thyroid cartilage; k) it is mapped an additional nerve on a line crossing a sterno-cleido-mastoid muscle in direction from the corner of lower maxilla to the border between 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 hypodermic cellulose (n. . transversus coli, occipitalis minor, auricularis magnus, cutaneus colli, supraclavicularis). The explorer Novocain anesthesia conducted in this area allows to get anaesthetizing of front and lateral surface of neck.At palpation of neck at patient’s megascopic lymphatic knots come to light sometimes: a) It is often multiplied submandibular lymphatic knots at tooth decay; b) Chin knots are struck by metastases at the cancer of front department of tongue and lower lip; c) It is multiplied supraclavicular lymphatic knots in connection with metastasis at the cancer of mammary gland; their increase is marked also at tubercular lymphadenitis. d) Very often at the cancer of esophagus and stomach one of the lymphatic knots located on meatus of a. ransversa colli is struck is the Trauz'e-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 below from a breast, upper extremity and back, a neck is delimited by a line, going on the jugular undercutting of breastbone, upper edge of collar-bone, acromion scapulars and, further in a conditional line connecting the acromion by prominence process of the VII neck vertebra (vertebra prominens). Children have is short and wide neck, a lot of cellulose.A narrow glottis, wide isthmus of thyroid, narrow sublaryngeal space, is marked. It determines the methods of some operative interference. For example, children lower tracheotomy is done only, 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 pass on the outward reference points of neck.By a frontal plane passing through a mastoid process and acromion neck divide by front and back departments. A back department carries the name of cervical (occipital) region – regio nuche – and consists of the well developed muscles covering vertebrae. These muscles in the turn are covered by strap and trapezoid muscles. Topographoanatomical under a neck understand its front department usually, actually neck, containing its organs, basic vessels and nerves. By a middle line divide the front department of neck by right and left halves.On each of them two large triangles are distinguished: mesial and lateral. Mesial triangle Mesial triangle – trigonum colli medium limited by the lower edge of lower max illa from above, sterno-cleido-mastoid muscle (by its cutting edge) – lateral by a middle lily mesial. Within the limits of internal neck triangle pair and odd triangles are selected: Pair: Submandibular – trigonum submandibulare is limited from above by the lower edge of lower maxilla, from below, lateral and mesial – both bellies of digastrics muscle.This triangle must be known for access to the submandibular salivary gland, to the facial, tongue arteries and veins (a. et v. facialis), to the sensible 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, behind (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 wandering 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.Needed for accesses to tracheas at implementation 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 needed for drainage of bottom 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 two pair triangles are selected: Scapular-trapezoid – trigonum omotrapezoideum – limited behind 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 the 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 (right and left), they form one large middle quadrant of neck, which is divided by a horizontal line passing through a sublingual bone, on two 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 NECK Fasciae is a connective tissue frame and, being in all regions, various functions are executed: protective, supporting, fixing regarding to organs.V. N. Shevkunenko described 5 fascial sheets of neck: First (superficial) fasciae of neck – fascia superficialis colli – or fascia cervicalis superficialis. It is disposed deeper than hypodermic cellulose, is passed from a neck directly to the neighboring regions. Superficial fasciae of neck, dividing, engulf the hypodermic muscle of neck of m. platysma, forming its vagina; Second is superficial sheet 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 sheet of II fasciae of neck gives into the covered muscles the row of bridges which divide muscle into separate bunches. Down second 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 offspurs to the transversal processes of neck vertebrae. One of these offspurs binds second fasciae to the heel. Other – binds it to the vagina of vascular-nervous bunch of neck. These offspurs form the frontal located 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 festering 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 outside; The third fascial sheet of neck carries the name of scapular-clavicular fasciae (fascia omoclavicularis) or deep 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 fascia, 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 instrumental in adjusting of blood stream in the vessels of neck. It is explained it by the presence 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 basic 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. vagus, inward (wandering 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 also gives the row of offspurs. Therefore in the moment of inhalation negative pressure in v eins 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 behind a esophagus at foundation of skull, goes down downward in a pectoral cavity, passing ahead of spine. The Fascial sheet is well expressed 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 reserved and reported 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, fa cial 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 practically reported with surrounding tissues only through the probutting openings, formed by vessels which blood supply muscle; Substernoid intraaponeurosis space – spatium intraponeuroticum suprasternale – it is located above the jugular undercutting of 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 r elrosternodeidomastoideus, 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 outside, 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 causes the symptom of â€Å"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 disposed in a loose cellulose, v. thyroidea ima, part of odd thyroid interlacement of plexus thyroideus. In 10-12% of cases 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; therefore 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, wandering, sublingual and glossopharyngeal nerves (nn. vagus, hypoglossus, glossopharingeus). Along 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. Deep cellulose space of neck is disposed under fifth fascia in trigonum colli laterale surrounds subclavian vessels and humeral interlacement and is reported with the cellulose of armpit 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 mus cles 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 there 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, elast ic, the expressed of hypodermic cellulose is subject to the individual changes. Superficial 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 also 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 cellulose 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 membr ane of bottom of oral cavity.In the same 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 opposite side, forms the diaphragm of oral cavity – diaphragma oris. At osteomyelitis of lower maxilla, stomatological inflammatory processes, mayb e, as complication, to arise up phlegmon of bottom of cavity of mouth. It carries the name of Ludwig’s quinsy. It is a quickly making progress sharp 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 Ludwig’s quinsy is complicated by development of mediastinitis. Topographically in this region the Pirogov's 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 triangle. Within the limits of this triangle, baring and bandaging of tongue artery which is disposed under m. hyoglossus is possible. A tongue vein lies above it muscle.Search for the Pirogov’s Triangle at thrown back backwards and the head turned in the side opposed to interference. The following layers are selected in an odd chin triangle: skin, hypodermi c cellulose, first 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-thyr oid (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% cases) ?. 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. omohyoideus), lateral is sterno-cleido-mastoid muscle, above is back belly of digastrics muscle. The superficial layers of triangle are represented 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 bun ch 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 drawing 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. laryngea 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 frequent takes place at the level of upper edge of thyroid cartilage. To distinguish outward and inter nal 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 bare 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 outward carotid, a pulsation on a temporal artery will 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 – cons ists of connecting tissue specific â€Å"glomus cages† stopped up in it, closely associated from an adventitia carotid. Middle sizes of glomus caroticum: 3Ãâ€"5 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). Lateral 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 lymphatici 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 re gion 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 Truaz'e-Vyrkhov's 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 dispos ed 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 damage of vessels of neck, which threatens by not only the bleeding but also possibility of embolism (at the damage 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 re tained on a middle line. At operative interferences in the lateral departments of neck a head is turned aside, 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 such 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 produce longitudinal and combined cuts (Venglovsky, D'yakonov, De Kerven). Only changed, but also those healthy 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. Vert ical 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 cancer 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 duri ng 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 accompanied by the wound of spine and spinal cord.Wounds on a neck are especially dangerous, inflicted on sagittal or parasagittal lines. Third sign are the wounds of neck in 13% of cases are accompanied by the wound of carotids. This, usually, heavy 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 woun d 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 cricoid’s cartilage; third area – from a cricoid’s cartilage to the jugular undercuting of breastbone. Than the area of wound is below, that it is more dangerous, because interfascial cellulose spaces are unsealed. 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 bleeding 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, foreign bodies, interfascial haematomas, are deleted, the damaged int erfascial spaces are extended. Surgeons do not unseal the interfascial cracks not unsealed by a scotching object. Wounds must be widely drainage. Foreign bodies are deleted only in case that they threaten to life 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 flow 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 edema 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. Taking 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 dull instruments, not to scotch vessels, impenetrate. At accesses the location of veins of neck, their intimate union, is taken into account with fasciae, the dama ge 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. Phlegmons 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 instrume nt, 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. trapezius. 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, parie tal 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 – â€Å"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, introduction 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 on a vascular stitch or produce the plastic arts of artery (its substitution of autovein is possible or synthetic vascular prosthetic appliance from polymeric connections). At bandaging of artery there are serious complications as softening influence 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 on 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. Complications. In the case of the low bandaging of outward carotid a bifurcation general carotid can have a blood clot closing a road clearance and internal carotid, practically there will be an obturator general carotid. Bandaging of tongue artery in the Pyrogov's 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 jugular 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 sclera 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. Neck’s organs Complication of anatomic structure and topographical-anatomic location of organs of neck in a great deal determines the features of operative 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 interlacements 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 hea d, 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 cricoid’s, linked between itself lig. cricothiroideum. The front department of cricoid’s 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 nerve).Lymphatic outflow is carried out in pre-laryngeal, pretracheal, paratracheal and deep lymphatic knots of neck. TRACHEA Represented by cartilaginous semicircular connected by dens e copulas. Back departments are locked by a dense connective tissue bridge, where muscular fibres pass. Within the limits of neck 6-8 cartilaginous rings 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 furrow 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 – Val'deyer) which it is represented is important anatomic 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 retroph aryngeal 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, wandering 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 cricoid’s 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 cases a pyramidal 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 out 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. LATERAL 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 sterno-cleido-mastoid muscle: n. occipitalis minor, n. auricularis magnus, n. cutaneus colii.Second fasciae or supe rficial 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 interval. 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 ?. cervicalis 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 direction 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. transversa 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. carotis 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); †¢ i nternal 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 prophylactic 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, foreign body, paralysis and spasm of vocal copulas with closing of entrance in a larynx, and also traumas 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 insuffici ency arising up as a result of proof oppression of central mechanisms of breathing; – heavy postoperative 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 ne rve is deeper behind a trachea on the lateral wall of esophagus. Next to the lower department of neck part of trachea there are general carotids, shoulder 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, approximate 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 â€Å"dosed by gauze serviettes† for warning of damage of esophagus. After expansion of road clearance of the unsealed trachea cannule is entered from one si de, 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 â€Å"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 growing in the road clearance of trachea. . Before conducting of section of rings of trachea follows strictly â€Å"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 tiss ue 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. Bare and dissect III and IV fasciae of neck. Vascular-nervous bunch together with s terno-cleido-mastoid take muscle outside. Cut the parietal sheet of IV fasciae inward from a vascular-nervous bunch. A lower thyroid artery, probutting 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 sewn together or produced its plastic arts.At suppuration of juxtaesophagal cellulose on meatus of esop hagus gauze tampons are downward conducted. A patient is laid with the dropped head end of bed. Such position is instrumental in the free separation 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, thus 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

Government Survelance essays

Government Survelance essays Everyone has probably seen those people walking around with those shirts that say I Read Your Email, but does one ever stop to think, Who really does read my email besides myself? This may be a question that people should start asking themselves. With todays technology and the governments ever-growing need to increase national security, email and other web-based documents may not be as private as one may think. Although controversial, some government surveillance of electronic communications plays an important role in national security. In todays technical world, there are many ways to communicate with others. With the uprising of the Internet in recent years, people have the world at their fingertips. Research is easier than ever to accomplish, and communication is easier and more fun. This technology is wonderful in the fact that it makes our lives easier. The problem is that it is making it too easy for criminals to communicate and plot their plans. These cyber-crimes are at an unbelievable high, and show no sign of slowing down. Crimes like terrorism, espionage, information warfare, child pornography, and serious fraud are all rising in occurrences, due in part to the Internet. The Internet makes it easy for people to confer about the crimes that they are getting ready to perform. Email and private Internet sites can be very useful to a group of terrorists. The FBI recently uncovered a plot that developed online between several groups of potential felons, to break into National Guard armories and to steal the armaments and explosives necessary to simultaneously destroy multiple power transmission facilities in the southern United States (FBI 2). After further investigation, they found that many of the communications of the group were occurring via email. Further investigation also showed that the group had been researching a chemical called Ricin, the world&a...

Weltering in Gore

Weltering in Gore Weltering in Gore Weltering in Gore By Maeve Maddox The expression â€Å"weltering in gore† has been around at least since 1593 when Christopher Marlowe used it in Edward II: Upon my weapons point here shouldst thou fall, And welter in thy goare I just noticed it in an Amelia Peabody mystery by Elizabeth Peters. In The Curse of the Pharaohs (1981), Amelia is reluctant for her husband to stand guard over a tomb. He asks if she’s afraid she’ll find him in the morning â€Å"weltering in his own gore.† The novel’s setting is the nineteenth century, so the use of the phrase is right on target. It was quite popular with journalists of the 1800s: There lay the criminal, weltering in his gore, on the grass in the yard. newspaper account of the execution of William Cocroft, Salt Lake City, 1861 Alonzo Bee, a son of the farmer hastened to the Doyle residence, where upon entering, the horrible sight of three human beings weltering in their own gore met his gaze. account of a murder, 1883 An 1808 reading textbook. (then in its 9th edition). designed for the use of schools includes this description of a man who survived a murderous attack with the help of his faithful dog. The man was found wounded, scalped, weltering in his own gore, and faint with the loss of blood. The dog was credited with saving its master’s life by licking the wound. Both weltering and gore have a place in this 1922 National Geographic story about a drawing that depicts the dedication of a temple to Huitzilipochtli: To this is attached, on the right, the figure of a priest who has just sacrificed a human victim, the latter pictured as dying on the ground,weltering in his own blood. To the left is the great temple of the War God, the stairway being shown as plentifully besprinkled with the gore of the hecatomb of victims. In current usage weltering in gore isn’t entirely gone. Here’s an example from the movie review of a documentary about an Australian criminal: [Chopper is] alternately shocking and hilarious, as Chopper launches a vicious attack on a fellow inmate and then, as his victim is literally weltering in his gore, takes pity on him and offers him a cigarette. DVD Times. Too bad the writer thought it necessary to insert the â€Å"literally.† Whether classed as a clichà © or not, the phrase is wonderfully expressive on its own. The word gore has several meanings. As a noun gore can mean â€Å"clotted blood,† as in the weltering expression. It can also mean â€Å"a triangular piece of ground.† The surname Gore comes from this land sense. And gore can mean a â€Å"triangular piece of cloth† used in sewing to make a â€Å"gored skirt† or to enlarge an article of clothing. As a verb gore means â€Å"to pierce or stab.† It is usually used to describe the action of a horned animal. Ex. The toreador was gored by the bull. Both the verb and the noun with triangular connotations derive from an OE word for spear: gar. The point of the Anglo-Saxon gar was triangular in shape. The origin of the noun in the sense of â€Å"clotted blood† is OE gor, â€Å"dirt, dung, shit.† The sense â€Å"clotted blood† had developed by the1560s. Like gore, welter has more than one meaning, both as noun and verb. As a verb, welter means â€Å"to roll or twist the body.† It can also be used to describe the rolling, writhing motion of inanimate objects. Ex. The ship weltered in the waves. As a noun, welter can mean â€Å"a confused mass.† Ex. a welter of contradictions, a welter of fans, a welter of evidence, a welter of misunderstandings. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:Arrive To vs. Arrive At30 Baseball Idioms50 Synonyms for "Song"