MedicinNews

Jan 31, 2009 at 10:53 o\clock

Examine a capsule of a liver and note

Examine a capsule of a liver and note its condition: smoothness, shine, granularity, rugosity, sulcuses, applyings, wounds and so forth Fixing a liver by a palm buy cheap ultram of the left arm for it diafrag-malnuju a part, the big amputating knife do 159 Its steep cut. To cut it is necessary one movement to itself, not rendering thus the big ultram pressure not to crush an organ. The cut should pass on the organ middle through the left and right share and should be not finished to a centimetre table on two not to part an organ on a part completely. If necessary do additional cuts, but necessarily parallel to the first, also not parting an organ on pieces. So the liver parted by parallel sections does not lose the form, being accurately laid, is well fixed, can be kept for a ultram museum and at any time is seen on cuts as book sheets are looked through.

Examine surfaces of cuts and note large vessels, colour of an organ, shine, , greasiness, and so forth, smoothness, Flatness of a surface of a cut or retraction and vybuha - , a drawing of lobes of a liver and so forth Normally drawing of lobes of a liver is indiscernible. If the drawing buy cheap ultram is visible well find out the reason of this phenomenon; it can depend on a cirrhosis, from irregular stagnation, adiposity of a liver and so forth On a cut examine the intrahepatic cholic ducts, well appreciable biles at stagnation. Squeezing a liver, observe allocated bile, an exsudate, parasites () and so forth The cholic bubble at a connecting tissue, a tumour and so forth can be found out with the big work. In such cases according to its locating do cross-section topographical cuts of a tissue of a liver. If between a bubble and a stomach or intestines reports, fistulas and so forth are found out, how usually, at opening of these organs them bypass, in detail investigate and write down. PANCREAS RESEARCH again put a convex surface of a liver on a little table, and a stomach reject on buy cheap ultram a liver. At such position a pancreas 160 Becomes accessible to research. It release fingers from a surrounding fat, note its form, and size, measure and define a consistence of a head, a body, a tail. Spend a cross-section on border between a head and a body. Thus on a cut surface it is possible to see well a duct with which open with scissors in that and buy cheap ultram in other direction. Now make a longitudinal section of a gland through decadron online a tail, a body and a head for what a forceps, holding it in the left arm, strongly fix an organ for a tail, having it on a liver. Note , a drawing of a surface of a cut, the fatty necrosises which are looking like yellow-white maculae, and so forth Survey buy cheap ultram of a mesentery and diaphragm finish research of this complex of organs. Mesentery. Note length of a root, the maintenance it of Adeps, a condition of the peritoneum covering it, lymphatic vessels and so forth Diaphragm. Note a thickness and a condition of its muscular layer and fascias both from a breast cavity, and from a stomach cavity, and also, on the one hand - a pleura condition, and with another - peritoneums. Now separate organs for weighing and clean with a little table. LIEN RESEARCH The lien taken separately put on a little table collars buy cheap ultram downwards. Examine its capsule which can be smooth, thin or rugosity, , the covered applyings, broken off and so forth Note the form and measure organ size. Normally lien approximately corresponds to size of a palm of the right arm of its owner. Define a consistence of an organ which can be soft, flabby, as at a sepsis, or firm, ligneous, as at an amyloidosis. Having buy cheap ultram turned a lien, examine its hiluses and the cut vessels. Now, again having put it on a little table collars from top to bottom and fixing its left arm, make a cut on an organ one movement of a knife 11 Pathoanatomical technicians 161 To itself, not an organ up to the end, i.e. Not parting it on . Having moved apart cut edges, examine a pulp of a lien and note its colour - red, rusty, aspidno-grey, mutno-grey and so forth, humidity of a pulp or its dryness and so forth Note a condition of follicles and , and also the centres of necrosises, infiltrates and so forth The buy cheap ultram knife blade, the cut put perpendicularly to a surface, do pulps and note quantity and its quality - liquid blood or a meal. If one cut it has appeared insufficiently make a number of the additional cuts parallel first. These cuts do not spoil an organ, promote full bracing and give the chance to survey an organ, as book sheets. In summary a lien weigh and clean with a little table. Then start research of organs of genitourinary system. RESEARCH OF GENITOURINARY ORGANS As together with kidneys adrenals research begin with them buy cheap ultram are allocated also. have on a little table kidneys buy cheap ultram from itself, and a bladder to itself, a forward surface up. Adrenals. The adrenals taken together with kidneys separate from kidneys and release from a fatty tissue. Note the form and their size (measure), define their consistence and dissect in kra-niokaudalnom a direction in parallel planes. Examine surfaces of a cut and note a condition of cortical and their cerebral substance: colour, humidity or dryness, a ramollissement, a hemorrhage, , tumours and so forth At last, weigh them. For microscopical research it is recommended to fix them not in a pure solution of formalin, and with an impurity of chromic salts, for example, 3-4 % of a solution a potassium - 90 ml and formalin available on sale - 10 ml. 162 Kidneys. Investigate at first right, then a left kidney, as well as all didymous organs. Examining a fatty capsule of a kidney, separate its stupid by or by means of a knife. Note the form and size of a kidney and its consistence. Then strongly grasp the left arm of a kidney for so that it has appeared cliped between the big finger on the one hand both index and average - with another, and the convex surface of a kidney has been turned up. So, strongly fixing a kidney in the left arm, movement of the big amputating knife to itself dissect an organ on a convex surface on two symmetric half.

Jan 31, 2009 at 10:53 o\clock

Having reached to , cautiously and confidently

Having reached to , cautiously and confidently continue this cut further, passing a knife blade between fingers. Thus fingers of the left arm should feel a knife blade and supervise its movement. At such method always it is unmistakably and symmetrically opened , and fingers order ultracet are never damaged if to work confidently and cautiously. That fingers of the left arm felt a knife blade is better, it is necessary to make it a little movements to the right and to the left. - Having opened a kidney, examine surfaces of a cut and note degree , degree of clearness of a drawing of a kidney, border between a cortical and cerebral layer, a thickness of a cortical layer, its protrusion, the granularity depending on a condition ultracet of glomuluses, examine columns; note a condition of a cerebral layer, pyramids and so forth Examine , its volume, a mucosa condition, contents - urine, its transparency, , sand, stones and so forth

Then, having pinched fingers or a forceps ultracet the edge of a cut of a kidney, take out from it a fibrous capsule and note, easily or hardly she is taken out, with loss of substance of a kidney or not. Note its thickness, an internal surface, examine a surface of a kidney and note its colour and smoothness, roughness, retractions, granularity, cysts, abscesses, infarcts and so forth In case of need make reaction to an amyloid, as well as liens, adrenals, a liver and so forth 163 Having finished opening of kidneys, all have on a little table how it laid in a corpse, i.e. A forward surface up, and a bladder to itself, also make opening the channel, a bladder and ureters. The technics of opening of these organs at men and women has some differences. At men, having found the cut aperture the channel, a probe define its passableness, make opening by scissors on a forward wall and, continuing further this cut, open a forward wall ultracet of a bladder on a median line to the bottom it. If the bladder is taken together ultracet with a sexual member a probe define passableness of all the channel and on a fluted probe scissors dissect its top wall and further this cut continue on a forward wall of a bladder. That the cut of a sexual member has been made correctly, it is necessary to pull strongly enough a sexual member a forceps for a head then the cut easily will pass strictly on an average line and a preparation if it is of interest, will be suitable for a museum. At women a cut the channel make to the left of an average line (from itself on the right) not to damage a clitoris. Having dissolved edges of a cut of an urethra and a bladder, examine their mucosa, contents, bubble volume, a thickness of its walls, vessels, damages, diverticulums, tumours and so forth Ureters. Ureters open from ultracet a bladder, and at first them probe. It is robaxin 750 mg necessary to remember thus, that ureters run into a bubble slantwise, therefore and the probe needs to be put to a mucosa. Having entered a probe at first in the right ureter, open with its small bellied scissors on all its extent, to , dissecting its wall on a forward surface. As ultracet open also a left ureter. Note size of its lumen, contents, a mucosa condition and so forth For conservation of a bladder and deferent ducts in an integrity when they are of interest for 164 Museum, it is possible to open ureters and from the party to a bladder. Research of ureters at a hydronephrosis is better for making ultracet in a corpse, on a place (in situ) before extraction of organs as far not always happens it is clear and it is simple the reason which has caused an obstacle to movement of urine. To open ureters thus it is necessary from the party or it is immediate from them, or to dissect ureters close , from here open them downwards, to a bladder. Further ultracet open genitals and arrive variously depending on a floor. At men research conduct as follows. Prostate. it is necessary to lay in the same ultracet position - a lobby up, a bladder to the prosector. Examine a gland, note its form, size, a consistence, establish its relation to a neck of a bubble and to the channel. At survey of the channel pay attention on seed in which apex is utriculus masculinus, and on each ultracet side - apertures of deferent ducts. If all is taken the channel in a webby part of an urethra examine apertures kupero-vyh glands. Prostate open with cross-section section the channel through seed . If to dissect an urethra it is impossible to open a gland it is necessary behind. Examine a surface of a cut and note colour, Humidity, brown points - "amyloid" little bodies, , nodosity, compress a gland and examine from Etc.; Seed blisters. For their research turn all a back surface ultracet up. seed blisters and semjavy-wearing ducts over a prostate. Note their sizes, the form, cut in a longitudinal direction, survey their contents which can have character owing to an appreciable impurity of spermatozoons that it is possible to establish under a microscope. 165 It is necessary to mean, that an internal surface of seed blisters at adults always yellowish or even brownish colour. wearing ducts. Deferent ducts investigate there and then, simultaneously. Them also from-preparovyvajut also note their thickness; dissect in a cross-section direction and examine. Testicles.n??? it is possible to investigate at their extraction. If testicles are taken together with deferent ducts investigate also ducts on all extent up to testicles. Examine their vulval cover, funicle veins, note size, the form of testicles, their consistence and so forth Now dissect an epididymis on all extent from a head to a tail, and together with it and a testicle.

Jan 29, 2009 at 06:44 o\clock

Having passed a place a duct, make

Having passed a place a duct, make cuts a scalpel an aorta and with scissors open it on all its extent. Now make detailed survey of cavities of heart also on a current of blood and in the same order as opened heart. In passing at opening note a condition, quantity and colour of blood, its parcels - red and white, their consistence. At a leukaemia, for example, they blurring, chartreuse toradol or colours; at a poisoning with potassium chloride - is dirty-brown and so forth Foamy blood is observed at an air embolism, at air entering through the cut veins during opening of a corpse, at bacteriemic cadaveric decomposing of blood. Liquid blood wash off an easy stream of water, convolutions cautiously delete arms or a forceps. Note size of cavities of each auricle, an ear and a ventricle. Examine an endocardium and note its transparency or dimness, thickenings, colour, hemorrhages, thrombuses and so forth Especially attentively examine hearts, their intervals and an ear, especially right where are often formed thrombuses. Distinguish convolutions from thrombuses by the form and consistences, on durability of communication with an endocardium, on an endocardium condition under them. Further examine sails of valves: three-cusps, a pulmonary artery, a two-cusp and an aorta, note their subtlety and a transparency, bloom, adnations, applyings, define, how applyings - easily (fresh) or hardly (old, organised) are taken out and so forth

Examine threads of atrioventricular valves and muscles. Then investigate a heart muscle, measure by a ruler a thickness of a wall of auricles and ventricles, note a thickness , a consistence of a muscle of heart which can be dense, soft, flabby and so forth 137 Make a plane cut of a muscle of heart from the made cut at opening, parting a ventricle muscle on two parts - internal and external, cut muscles from an apex to the basis and, at last, dissect a septum in the middle on the right and left parts. Examine heart muscles on the made cuts and note colour of a myocardium: yellow-red, slightly brilliant (normal) or acyanotic, brownish, grayish, yellowish, dim and so forth; whether uniform colouring or irregular, motley, , as at a fatty degeneration. Further note hemorrhages, necrosises, development of a connecting tissue and so forth if they are. It is necessary to examine also area of a nervously-muscular ventriculonector - (spending system of heart). Its initial part also is called and and o-ventrikuljarnym as knot - . It is in the bottom department of a septum between, auricles, at a first line of the coronal vein opening in the right auricle, above the basis of an average sail of a three-cusp, under an endocardium of the right auricle. Muscular , departing from knot - , passes through the fibrous ring which is settling down between auricles and ventricles; in an interventricular septum it branches maxalt on right and left a knee. The right knee settles down under a right ventricle endocardium, goes behind the top part medial muscles and in a kind about 2 mm in width to the basis of a forward papillary muscle where branches. The left knee, wider, settles down under a left ventricle endocardium, goes downwards under the right valve of an aorta, further it fanlikely breaks up to the branches referred to forward and back papillary muscles and to an apex of a ventricle. Keats's knot - (Keith - Flack) lays in a wall of the right auricle on border between an ear and venas cava, in a sulcus at an ear first line (fig. 38). 1 See also: V.I.Vitushinsky. Technics of opening of some areas of a human body. , 1961. 138 The knowledge of topography of a ventriculonector - matters at an endocarditis, tumours, a gumma and so forth which can extend on a fascicle and damage it. With open years the fascicle is not visible, unless only sometimes appear through through an endocardium of its knee in a kind . The fascicle condition can be found out only at its microscopical research. and-; - a nerve - the heart apparatus (branches of a vagus nerve, returnable and sympathetic) otpreparovyva-jut and then investigate . Fig. 38. The scheme of spending system in heart (on V.P.Vorobevu). 1 - Keats-Flakka sinus knot; 2 - knot Gisa-Tavara; 3 - the left knee of a ventriculonector; 4 - the right knee of a ventriculonector; 5 - a network of fibers ; 6 - the top vena cava; 7 - a coronal sine; 8 - the bottom vena cava; 9 - a septum between ventricles; 10 - a right ventricle;//-a left ventricle; 12 - the right auricle; 13 - the left auricle; 14 - the valve. Sometimes research of vagus nerves and their centres in an oblong brain and cervical department of sympathetic nervous system is of great importance. For research of coronal arteries them open small blunt-ended, not pricking Scissors from an aorta, examine on cross-sections and note plaques, petrifications, thrombuses and so forth Pulmonary artery investigate in passing at research of the right department of heart, and an aorta - at research of the left department of heart. Measure by a ruler their circle in the area of short circuit of valves; note an intima condition - whether smooth it and brilliant (normal) or on it plaques, ulcerations, thrombuses, rugosity and so forth are visible It is necessary to mean, that at internal free edge of each valve of a pulmonary artery and an aorta at vzros - 139 there is a small dense nodule (nodulus val-vulae semilunaris Arantii), not representing to a pathology. Over a line of short circuit of semilunar valves and in them at elderly subjects small apertures with smooth edges as result of an atrophy are often observed. Such valves have received the name "window" (valvula fe-nistrata). They also do not represent a pathology. Settling down over a short circuit line, these apertures do not break a circulation. By inexperience they can be wrongly apprehended as defect - insufficiency of valves.

Jan 29, 2009 at 06:44 o\clock

For more easy approach to heart

For more easy approach to heart both arms put on external edges of lungs, simultaneously lungs, a little pulling together arms, paternal forward surfaces of lungs disperse also heart becomes easily accessible to survey, 132 Examine an epicardium: take out, stroking robaxin a knife, a liquid, its covering, and shine, dimness note, applyings, hemorrhages, Adeps maintenance under an epicardium, a condition fats - it , puffiness and so forth; note a condition of vessels, their tortuosity. Once again examine a warm shirt. Define the sizes of heart on a view. The size of normal heart approximately corresponds to size of a fist of the owner of this heart. This comparison gives the basis for approximate judgement about augmentation or heart reduction. Fig. 35. Heart opening. Heart (back surface) is located by an apex aside from the prosector. A continuous line-direction of a cut for opening auricles. A dotted line-direction of a cut for opening of the left auricle. Measuring ruler define length of heart from a place aortas to an apex, width at level of its cross-section sulcus and a thickness in the most towering place. By itself it is clear, that heart thus should lay immediately on a table. Heart opening, as a rule, needs to be made on a blood current in a following order: the right auricle, a right ventricle, a pulmonary artery; then the left auricle, a left ventricle and an aorta. For opening of the right half of heart by the left arm cautiously reject heart an apex from itself, to tongue, and a back surface up (fig. 35). The right arm enter stupid warm 1 (fig. 36)

into an aperture bottom and top on - 1 If warm scissors are not present, they can be made from intestinal, Having ground off on a tool-grinding machine a hook. 133 the veins cut at extraction of organs from a thorax, and, having advanced scissors through atrio-ventrikuljarnoe an aperture in a right ventricle, do a cut of a back wall of heart to in parallel warm septum, from it approximately on 0,5 see Having moved apart cut edges, examine cavities of an auricle, its ear and a ventricle. Then cautiously reject heart an apex to itself, a forward surface up, enter the stupid Fig. 36. Warm scissors. warm scissors through the cut made just in a cavity of a right ventricle and further in a pulmonary artery also continue a cut of a forward wall of a right ventricle also in parallel a heart septum, from it on 0,5 sm, further open a pulmonary artery to a bifurcation. At opening of a pulmonary artery it is necessary top scissors strongly enough to reject to the right from the prosector that the cut has passed about the small fatty lobe which always are available on an external surface of a pulmonary artery, in its beginning. skelaxin 800mg At such direction the cut will pass between the forward and left valve of a pulmonary artery and its all valves will appear whole. Having dissolved cut edges, examine a funnel - conus arteriosus and a pulmonary artery with its valves. Opening of the left half of heart. Slightly and cautiously left arm raise heart an apex up, examine 4 pulmonary veins which have stretched thus and cut the left pair with their knife in a cross-section direction, and heart put an apex from itself and a back surface up (fig. 35 see). Through made in the left pair pulmonary veins an aperture enter stupid warm scissors 134 In the left auricle, pass it through left atrio-ventrikuljarnoe an aperture in a left ventricle and make a cut of a wall to an apex to its in parallel warm septum, from it on 0,5 see Having moved apart cut edges, examine the left auricle with its ear and a left ventricle. Now reject heart to itself, a forward surface up. Enter scissors into a left ventricle through just made cut and continue it on a forward wall from an apex to an aorta, in parallel a septum, from it on 0,5 see Further, having advanced scissors in an aorta, dissect it to an arch. Now raise the left arm all preparation for cervical organs and continue opening of an aortic arch and its thoracal part. Thus inevitably cross a pulmonary artery because it anatomically crosses with an aorta. To avoid unnecessary, but the compelled section of a pulmonary artery, in case of need it from an aorta and reject aside. Besides, at such opening there is a section of the left valve of an aorta. If its valves wish to keep, the beginning of a pulmonary artery is necessary, from an aorta, to delay a pulmonary artery to the left from the prosector and an aorta cut to conduct, strongly having rejected top scissors also to the left from . At such method of opening of heart all its cavities appear widely opened and convenient for research; sails of three-cuspidate and two-cuspidate valves are well shown at a deviation of an apex of heart from themselves and position by its back surface up; all changes of a septum also are well visible (fig. 37). Before opening of the right and left departments of heart it is possible to measure by fingers atrioventricular apertures, but it is necessary to remember, that gentle, fresh warts on valves at endocarditises this rasping method can be taken out and remain not noticed. Usually right venous aperture passes three fingers, and left two. However apertures of heart of the small subject will pass less fingers of the prosector-man, than an aperture of heart of the large subject of fingers of the prosector-wives - 135 . Therefore it is more correct, objectively and safely concerning damage or putting off of warts from valves to measure a circle atrioven - Fig. 37. The opened heart. Septum rupture. apertures (perimetre) a ruler on a line the bases valves After heart opening, having put its apex from itself Back surface up and having dissolved in the edge parties . Further open an anonymous artery and its branches - the right general carotid and right subclavial, 136 Then the left general carotid and the left subclavial. At last, open coronal arteries of heart with small blunt scissorses from an aorta. At a duct dissect only the aorta beginning.

Jan 26, 2009 at 18:29 o\clock

Now, having got to a peritoneal bag

Now, having got to a peritoneal bag, stupid by separate a peritoneum from frontlateral walls of a stomach on other extent. At costal arches from within ultram cut soft tissues and from-separovyvajut from a thorax. The cut muscles remain bound to a forward wall of the vaginas, as intersections of these muscles with an internal slanting muscle. Now access to a peritoneal bag buy ultram online became wide enough, and, bypassing adnations, open a peritoneal cavity for survey of organs in situ. If it and is not possible now because of continuous adnations open a thorax and "ascending" by take all in not opened serous covers. As already it has been noted above, it is impossible constantly, in all cases, to use one any method. 8 Pathoanatomical technicians FROM Each method has the advantages and the also represents not end in itself, but only an agent For research. - Correctly and purposefully made , technically irreproachably executed, shows pledge of correct research, and so, And the correct conclusion about pathological about - . 1 Each case demands to itself the attentive relation and a choice or one any method, either variations, or combinations of methods.

On opening it is necessary to go with the accepted decision: what method in this case will be applied. Opening of a corpse is art, and its success you depends on resource, and ingenuity The prosector. l and in and And EXTRACTION OF GANGLIONS OF VEGETATIVE NERVOUS SYSTEM And the subsequent research of ganglions it is necessary to make opening of corpses for extraction soon after mors, not later than in 12 hours as they rather quickly are exposed to cadaveric changes. To take them it is necessary extremely cautiously, together with surrounding tissues and a fatty tissue for which and it is necessary ultram to take a forceps. The immediate capture of ganglions a forceps spoils them and does unsuitable for microscopical research. The successful capture of any ganglion demands big That and skills. After extraction, not washing water, it is necessary to place immediately ' in a fixative. If research is supposed to be made at colouring on , 114 Ganglions lower in 96 ° ethyl alcohol of the first-rate quality, without an impurity of other alcohols and at all in or a raw; if research make on Bilshovsky - ganglions place in 42 % a neutral solution of formalin or (on B.I.Lavrentevu) at 1 o'clock in an admixture of peer parts of formalin available on sale, 96 ° alcohol and 1 % of a solution acids, and then transfer to 20 % a neutral solution of formalin. GANGLIONS OF VEGETATIVE NERVOUS SYSTEM Settle down: 1) in the field of a head; 2) along all backbone on its frontlateral departments; 3) in walls of cavitary organs and in internal organs. In the field of a head there are knots: ciliary, The nebno-basic, aural, submandibular and changeable The sublingual. Their extraction is very difficult and difficult. For successful performance of this operation it is necessary to get experience. Ganglions can be taken as from a skull cavity, after brain extraction, and from the person that is much easier and easier if the person has been etodolac opened on Medvedev's method or Vitushinsky. The ciliary knot - ganglion ciliare - in the form of an oblong lump in length about 1,5 mm lays on to the optic nerve party in a back part of an ultram orbit. For its extraction from a cavity of a skull after brain extraction it is necessary to open widely with a gouge the top wall of an orbit, to cut an optic nerve, from an eyeball on 0,5 sm, and to allocate it together with ciliary knot up to a back pole of an orbit. ciliary knot it is not necessary, as it is possible hardly and the knot can be spoilt. It is better to investigate it together with an optic nerve in one microscopical preparation. If opening of the person on Medvedev's method (in this case not on a method Vitushinsky) eyeballs allocate together with centuries has been made, and zri - 8*. 115 a nerve cut, on 0,5 sm from an eyeball. The optic nerve rest in an orbit from-separovyvajut up to a back pole of an orbit also take together with ciliary knot. The nebno-basic (covered-palatal) knot - ganglion pterigo (spheno) palatinum - in the form of a flat small lump lays in the top part of a covered-palatal fossa of the basic bone of a skull, medially and from top to bottom from the item maxillaris (the second branch of a trigeminal nerve). Its capture represents the greatest difficulties which, however, are quickly overcome with experience accumulation. From a cavity of a skull it take after excision of a brain ultram and after extraction of ciliary knot. It is necessary to be guided thus the second branch of a trigeminal nerve (the item maxillaris), the big petrous nerve (the item petrosus superficialis major) and its continuation - a nerve (n. vidiamis). At first it is necessary the second branch of a trigeminal nerve (n. maxillaris), going behind forward, beginning from knot to a round aperture of the basic bone (foramen rotundum). Then it is necessary to bare a nerve, having opened canalis pterygoideus in which it is. Further dilate a thin gouge a round aperture (fora,-men rotundum). Then it is necessary to open a covered-palatal fossa with the nebno-core being in it (covered-palatal) ganglion. For this purpose it is necessary to find a place of an input of the second branch of a trigeminal nerve (n. maxillaris) in an orbit - the bottom orbital cleft - and from it with a gouge to open a covered-palatal fossa. Now it is possible to see a ganglion, and behind it - a lump of a fatty tissue which can be wrongly ultram accepted for a ganglion. To take it it is necessary rather cautiously, together with the second branch of a trigeminal nerve to which it is bridged by thin branches.

Jan 26, 2009 at 18:29 o\clock

These branches need to be kept

These branches need to be kept (!), and to cut with scissors others, going from a ganglion in surrounding tissues. Much easier the nebno-basic ganglion is accessible from the person if it has been opened on Medvedev's method or Vitushinsky. Thus it is necessary voltaren gel to remove sob - 116 a masseter (m. masseter) and to go under a malar arch, deleting soft parts, on a nizhne-temporal surface of the top jaw to a covered-palatal fossa (fossa pterygo-palatina) in which top part there is a nebno-basic ganglion medially and. From top to bottom from the second branch voltaren of a trigeminal nerve. For simplification of access it is possible to saw off a malar process of a temporal bone in a slanting direction, and from a malar bone it to break off. Owing to a nervous surface of a break the malar process easily can be installed into place at cleaning ' a corpse for elimination of deformation of the person. The aural knot - ganglion oticum - represents small a nodule laying under foramen ovale of the basic bone, on the medial party n. mandibularis (the third branch of a trigeminal nerve), between it and an Eustachian tube. For its capture from a cavity of a skull after brain extraction at first it is necessary to open with scissors cavum Meckeli - the semilunar cord of a firm cerebral cover covering knot. Then knot from a pyramid of a temporal bone. Further it is necessary to allocate the third branch of a trigeminal nerve (n. mandibularis) with a part knot.

Then a thin gouge to dilate an oval aperture of the basic bone of voltaren a skull and scissors to separate the third branch of a trigeminal nerve from surrounding tissues and to take it together with an otoganglion. At extraction of an otoganglion from the person if it has been opened on Medvedev's method or Vitu-shinskogo, it is necessary to be guided the third branch of a trigeminal nerve (the item mandibularis) on which medial party near to an Eustachian tube it and lays. For simplification of access it is possible to remove a malar process as it is described above, and soft tissues. The submandibular ganglion - ganglion subma-xillare - lays at a first line m. pterygoideus interims, over a submandibular sialaden and under n. Lin-gualis. It is accessible to extraction at opening of the person on Medvedev's method or Vitushinsky. Thus it is necessary to be guided by a submandibular sialaden, a lingual nerve and an internal pterygoid muscle. 117 The sublingual knot - ganglion sublinguale - is rather small, it is found out voltaren only under a microscope, and sometimes instead of it there is a plexus. To search for it it is necessary at opening of the person about a sublingual gland on a hypoglossal nerve. To take it it is necessary blindfold, at random, colchicine together with surrounding tissues. GANGLIONS OF SYMPATHETIC BOUNDARY TRUNKS Their extraction needs to be made after organs of a neck, a breast, a stomach and a basin are taken. However for simplification of orientation and in order to avoid casual damages of cervical ganglions it is better, cleaning neck organs to leave the general and internal carotid on a place, and then together with them to take and ganglions which it is more convenient after bracing. Needless to say, what to take ganglions of sympathetic boundary trunks it is voltaren necessary before spinal cord opening in front. Boundary sympathetic trunk part on department: cervical, thoracal, abdominal, or , and , or . Cervical department Settles down from the basis of a skull to a neck of I rib. It consists of three knots: top, average and bottom. Them, it is possible and on the Place, but it is more convenient - after their extraction together with a carotid, and a fascia. Thus it is useful to take for researches and a ganglion . The top cervical knot - the largest, length to 20 mm and width to 4-6 mm. It lays at level II and partly III cervical vertebra, the beginning behind of an internal carotid, medially voltaren from a vagus nerve, under a fascia, ahead of cross-section processes of cervical vertebra. The average cervical knot is small, quite often is absent, sometimes breaks up to two nodules. It lays usually on a. thyreoidea inferior where it crosses with a carotid. The bottom cervical knot of appreciable size, but is less than top. It lays behind an initial part arteries between a cross-section process 118 VII cervical vertebra and a neck of I rib, above under Clavicular artery. Sometimes it merges with the first In thoracal knot, forming knot - ganglion stellatum. Thoracal department Lays ahead of costal necks and it is covered intraheaps th by a fascia and a costal pleura through which it appears through. It consists of 10-12 knots having the form, coming nearer to a triangle. In it are inherent pregan-glionarnye fibers - rami communicantes albi. Abdominal (lumbar) department Medial th consists of 3 or 4 knots which are settling down, than knots of thoracal department, therefore them it is necessary to search on front for surfaces of lumbar vertebra along medial edge m. psoas. Preganglionic fibers go only to two top lumbar sympathetic knots from I and II lumbar spinal nerves. () department Consists usually of 4 knots. It settles down on surfaces of a sacrum along medial edge apertures also comes to an end unpaired in the knot laying on a forward surface . Preganglionic fibers are absent, as in sew th department and in the bottom part voltaren of abdominal department. The solar (celiac) plexus - plexus Solaris - is on a forward surface abdominal, aortas between adrenals, in area a. coeliaca podkovo - or it covering. Mesenteric knots – ganglion voltaren mesentericum superius and inferius - are on an aorta at corresponding arteries. Extraction of ganglions of a boundary sympathetic trunk, solar plexus and mesenteric knots does not represent the big difficulties, it is necessary only them carefully and cautiously , that is reached as a result of the got experience. 119

Jan 23, 2009 at 11:44 o\clock

Kerner have developed a method

Kerner have developed a method of opening of all organs on a place, in a corpse, without their extraction. At last, Letul has offered, and G.V.Shor has developed a method of extraction of all organs of a neck, a breast and a stomach together - a method of full evisceration. In the present management two methods will be stated: 1) the modern method developed by a number order decadron now of researchers, being typical and characteristic in the symmetry and clearness, that is why and named the basic, or classical, a method; 2) a method of full and incomplete evisceration. Owning these two methods, the prosector can feel in the relation of technics of opening quite assured of all cases. . the method is the most widespread And standard. It consists in extraction of the internal . in the form of complexes. Extraction order the following. At first take organs of a neck and a thoracal cavity - all together. Then take separately an intestine and a lien which can be taken in common with the following - to a liver, a stomach, etc. 101 Further - a liver and a stomach with a duodenum, a pancreas and a mesentery all together. At last, take kidneys with adrenals, the ureters, all organs of a small basin, with an abdominal aorta and the bottom vena cava. Thus, it turns out three complexes of organs and two organs separately - an intestine and a lien. EXTRACTION OF ORGANS OF THE NECK AND BREAST Taking the right arm a small post-mortem knife as a writing feather, and the left arm fixing and rejecting a head, pierce a knife blade a mouth diaphragm in a mental part on the right and short sawing movements, keeping closely to an internal surface of a horizontal part of a mandible, cut a diaphragm of a mouth with right, and then and on the left side.

Then cross the remained muscular ponticulus at a chin - a podborodochno-pod-lingual muscle and a tongue bridle. Through the formed aperture in a bottom of a mouth extend an end of tongue and, having grasped its fingers of the left arm, delay to itself. Now it is possible to see a soft palate and its handles. Having entered a knife blade in a mouth over tongue through the formed aperture, a cross-section separate a soft palate from firm with one and on the other hand. Continuing these cuts aside to mandible angles (angulus mandibulae), them bridge to the cuts spent for renunciation of muscles from a horizontal-'noj of a part of a jaw. All these cuts, thus, cover outside both tonsils, and handles of a soft palate, and a uvula. Then as it is possible above, approximately at atlas level, do a pyridium online cross-section of a back wall of a pharynx. To cut it is necessary to a backbone. -Continuing to delay tongue, a knife separate a back wall of a pharynx from bodies of cervical vertebra. At the basis of a skull dissect internal and external carotids, bulbar veins and vagus nerves. Continuing to delay tongue to itself, all organs of a neck from a backbone. Having reached a thorax, grasp now all organs of a neck in the left arm and, rejecting them at first in the left 102 The party , cut with a knife under the right clavicle The right subclavial artery, vein and nerves; then Neck organs reject in the right party of a corpse and , - the left neurovascular fascicle under left . Now all keeps communication with a corpse only by means of the quaggy fat of a postmediastinum going down to hiatus oesophagus diaphragms and informed sometimes through a cleft with a fat, being between omentulum leaves. Last circumstance should be meant at transition of a purulent inflammation from a postmediastinum in an abdominal cavity. Taking neck organs in the right arm and having pulled in a direction to feet of a corpse, it is possible to break off a postmediastinum fat and by that to allocate all organs from a thoracic cavity without the big effort. If thus the arm tests appreciable resistance to make the big effort not, follows, as it is possible to break off organs. In particular it is dangerous at wounds, ulcerations And esophagus and trachea tumours, and also at () aneurysmal aortectasias And so forth; preparations will be spoilt, research will be Incomplete, and not skilled prosector of an artefact, is made by it , can accept for the pathological phenomena. In these Cases it is necessary not to break off a fat of a mediastinum, And to dissect its knife, taking organs the left arm in that Direction. - At strong adnations it is better to arrive as follows. The right lung needs to be deduced from a pleural cavity on a left-hand side of a thorax and a knife to make a discission of the pleura and intercostal vessels along a backbone, between it and an unpaired vein v. azygos). Now the right lung needs to be laid on a place, to deduce the left lung on the right half of thorax and to make a discission of the pleura and vessels between a backbone and a semiunpaired vein v. hemiazygos). After that organs already easily separate. Having separated organs of a breast from a postmediastinum, them deduce from a corpse and throw through a thorax right edge. The aorta, the bottom vena cava and an esophagus which is passing through a diaphragm become thus visible. All They are dissected by a cross-section out of a corpse, at the edge of ribs. If lungs strongly with a diaphragm she should be taken together with lungs. For this purpose before cutting off of an esophagus, an aorta and so forth it is necessary to cut a diaphragm from ribs, and on the right still and the ligament supporting a liver. Taken stack on a little table. Now start extraction of organs of a stomach, and begin with an intestine. INTESTINE EXTRACTION Having rejected the big epiploon with Intestine and its mesentery on a thorax, remove All loops of small bowels to itself, i.e. In the right half Corpse. At the left at level of II lumbar vertebra find the beginning of a jejunum and, having delayed its left arm to itself, cut a knife a window in the beginning of a mesentery about the intestine.

Jan 23, 2009 at 11:44 o\clock

Having dressed an intestine in this place

Having dressed an intestine in this place two ligatures, a cross-section dissect an intestine between ligatures. Now, strongly having grasped fingers of the left arm the jejunum beginning, separate its knife from bry-zhejki, all time delaying an intestine to itself. To medrol separate an intestine from a mesentery it is necessary long a knife, holding it for the handle, as a bow, its plane perpendicularly to an intestine, Doing thus, as a bow, wide free a knife to the right and to the left to cut all edge, Instead of its part, and not rendering thus any having given .,--. When the jejunum, will be separated on distance of the lifted left arm, it better accurately to put on a neck of a corpse then not to lose its beginning and not to spend time for searches. The left arm grasp a new loop at the mesentery where the cut has stopped, and continue in its same way, separating and an ileal intestine '. Length of a jejunum approximately 2,5 m, and ileal - 3,5. 104 Now separated loops of intestines stack directly on a dissecting table to the right of a corpse, i.e. About itself. For this purpose it is necessary to take place, that the intestine and its contents casually have not polluted a floor and feet of the prosector. Therefore we recommend a corpse to stack not on the table middle, and a little bit further, from ourselves, leaving to the right of a corpse on a table there is more than place,

than at the left. Having reached a place of a confluence of an ileal intestine in blind, start unit of colons. For this purpose, having rejected a caecum to the left, dissect a knife a peritoneum on the right side of its and ascending colonic, and - fields to the right, separate a part a knife, a part stupid by from a back wall of an abdominal cavity. Having reached so to the right flexure of a colon, delay "it in a caudal direction and dissect ligament intestines with a stomach (lig. gastro-colicum) and its mesentery (mesocolon transversum). Continuing to delay the left arm in the same direction the subsequent parts of a colon, approach to its left flexure, a descending colonic intestine and sigmoid. Separate last from its mesentery and reach a rectum. Here, in the heart of a basin, dress an intestine two ligatures and between them dissect it. All intestines lay now on the middle of a table to the right of a corpse, and their beginning - on a neck of a corpse. So usually take an intestine. If there are indicatings on the pathological processes proceeding simultaneously in an intestine and in a mesentery in that case it is better to take an intestine together with a mesentery. For this purpose at first allocate colons, since blind as it is already described, not separating it from the ileal. After otde - a sigmoid intestine from a straight line postpone colons in the right party of a corpse, and small bowels allocate together with a mesentery, having cut off it. places ' attachments to a backbone. If there are fistulous reports, strong solderings or enteroanastomoses they should buy tramadol ultram not be separated, and it is necessary to take separately, preliminary having dressed loops of intestines ligatures. In the same way arrive and at an adnation of intestines with - a liver, a stomach, a cholic bubble, with the loop of a small bowel filed to a stomach at operation of a gastroenterostomy, fecal fistulas etc. . 105 In detection cases about m about and vessels of a mesentery the unit of intestines is better to suspend and take an intestine together with a mesentery and an aorta at a clottage of arteries or together with a portal vein, a liver, a stomach, a duodenum, a pancreas and a lien at a vein thrombosis. LIEN EXTRACTION Lien extraction make usually separately From other organs. For this purpose the right arm reject In the right party of a corpse a greater cul-de-sac, and the left arm for a lien also delay it to itself; thus It is possible to examine hiluses lienis, vessels and its ligaments - lig. gastro-lienale and lig. phreni, ligaments dissect a knife, And the separated lien stack on a table to the left of Corpse., In cases when there are strong adnations of a lien with a stomach or a pancreas, at wounds, a clottage of its vessels or at germination by a tumour, the lien needs to be taken not separately, and together with a stomach, a liver and others 1. LIVER AND STOMACH EXTRACTION WITH THE DUODENUM, PANCREAS AND MESENTERY These organs take all together in the form of one . First of all dissect a diaphragm. For this purpose the left arm reject a liver in a left-hand side of a corpse, paternal right . stretches. Thus it is convenient enough for cutting from ribs usual movement 1 In the press to us the reproach concerning separate extraction of a lien as the integrity of portal system of a circulation is thus broken is made. This reproach quite lawfully can be carried and to an intestine. However hardly probable there is a necessity to take every time all , that considerably complicates opening. If for joint extraction of a liver, a stomach, a duodenum, a pancreas, a mesentery, a lien and an intestine there are indications it us is recommended both in the first, and in the second edition of the book both for a lien, and for an intestine. About it also it is spoken and in introduction (p. 8) and. p. 114 given editions. 106 Amputating knife from left to right. Having reached a right kidney and continuing to reject a liver further, it is cautious the right adrenal from a liver under the control of eyes. - Then cross in a cross-section direction the bottom vena cava, leaving its part which has been-bound to a liver; with a liver separate also a vertical part of a duodenum with a pancreas head. After that a liver return in former position. Now, having grasped the left arm the left part of a diaphragm and delaying it to itself, cut it from ribs. Further, removing the left arm in the right party of a corpse a stomach and having grasped fingers a pancreas tail, from the left adrenal and a back abdominal wall under the control of eyes.

Jan 21, 2009 at 06:25 o\clock

Examine a mesentery of a cross-section

Examine a mesentery of a cross-section colonic intestine and feel through its root a pancreas. Examine intestines, not tampering with them, and note position, an inflation or fall of their departments. Then, having removed loops of small bowels from a blind corpse in a left-hand side, examine a caecum and its process. Then examine all colon to a straight line. After that, buy ultram tramadol cautiously moving apart loops of intestines, note their interposition, further choose intestines from an abdominal cavity to itself, in the right party of a corpse, examine a mesentery notice its thickness that depends on larger or smaller quantity of Adeps, lymph nodes, a condition of vascular and lactiferous vessels. If the last are dilated and look like narrow strias, it is necessary to investigate the lactiferous tank (cister-na chyli) and a thoracal duct. Further examine organs of a small basin, them Position, bladder size, and at women - on a uterus and its appendages and their relation to the neighbour It to organs and to a peritoneum. '

Then feel kidneys and find out their position and degree of mobility and, at last, as far as possible, examine a back wall of an abdominal cavity. If there are operational cuts or stomach wounds, carefully examine the channel, not concerning it, and then cautiously separate the organs, all time under the strict control of eyes, Only now it is possible to make the necessary cuts. Having entered a finger in an epiploon pocket (bursa omentalis) che-rez foramen epipiocum Winslowi, it is possible to open a portal vein a hepatic artery and the general cholic duct, not damaging ; open an epiploon pocket, cut mesentery lymph nodes, part adnations, mesentery vessels, open them and investigate on presence of thrombuses and so forth At a strong gastrectasia A.I.Abrikosov recommends to look, whether the duodenum to a backbone by the tense mesentery of small bowels and the top mesenteric artery, , is pressed. Whether is not present arterio-mezenterialnogo duodenum closing. Having finished survey and research of an abdominal cavity, note a condition of a visceral peritoneum at which on a research course all time it is necessary to look narrowly (colour, vessels, a hemorrhage, dimness or a transparency, humidity or dryness, a roughness from applyings of fibrin, pus and so forth). At last, note quantity and character of a liquid in brjush - Ache cavities, its colour, a transparency or , a consistence, a smell, an impurity of a feces, nutrition, gas and so forth If in an abdominal cavity the feces, nutrition, ascarides and so forth it is necessary to find a place of a perforation of the stomach or intestines before extraction of organs, carefully looking through a stomach, an intestine, an appendix are found out. Can meet and exsudates; in these cases for soldering research it is necessary to dissect. THORAX OPENING After survey of a cavity of a stomach start thorax opening. However before to open a thorax, it once again examine, already bared, and note the form, size, symmetry and asymmetry; then note the breast bone form (for example, a "chicken" breast and so forth) and its relation to ribs, junctions of ribs with cartilages, places of operations and so forth For pulmonary collapse prevention it is necessary to dress a trachea before thorax opening to have possibility to judge a lung expansion buy pyridium online and atelectases. The last can arise and be lethal after a narcosis and after operations on heart and on lungs. Now, taking in a fist a costochondral knife (fig. 32) and holding it it is horizontal, put its cutting edge on a cartilage of II rib. An eye plan a line of its movement which should pass on cartilages of all ribs from II to X, for 0,5 sm from a junction of cartilages with ribs. For development of larger force by a palm of the left arm press a knife to a cartilage of II rib. Now one movement of arms to the right dissect all costal cartilages on the planned line. This operation make at first on the right, and then and at the left. To work it is necessary resolutely and confidently, but it is cautious not to damage organs. It is easier for observing, giving to a knife blade the position parallel to a surface of a thorax, cutting all cutting party and doing fast movement. Last circumstance provides fast hit of a knife on the following costal cartilage and prevents it in depth. 90 If there is no costochondral knife this operation can be made and a small post-mortem knife, observing the same conditions. Together with crossing of cartilages dissect intercostal muscles and a pleura. Having grasped a breast bone fingers of the left arm at a xiphoid process, it raise also a post-mortem knife cut from it a diaphragm and mediastinal th fat a little, holding a knife all time as is possible more close to costal cartilages and a breast bone not to wound organs and not to open a warm shirt. Fig. 32 Costochondral knife. Now, taking a post-mortem knife in a fist for the handle and holding it upright an edge upwards and an edge from itself forward and having raised the left arm a breast bone, simultaneously take away it in a left-hand side of a corpse, enter a fist into the Thoracal cavity under a breast bone so that the knife blade came out through the right cut of cartilages. Having referred an edge obliquely outside, to the left from itself, dissect a cartilage of I rib on the right and further, without efforts turning an edge inside, to the right from itself, to a median line, then forward, to a head, easily make a section of grudino-kljuchich th joint with right, and then and on the left side. At correct movements it is possible easily and vessels thus will not be wounded.

Jan 21, 2009 at 06:25 o\clock

Then cut soft parts from the breast

Then cut soft parts from the breast bone handle, take out a breast bone, examine its internal surface and put aside, on a dissecting table. At survey of a breast bone pay attention to a fat of its back surface, on a periosteum. For elasticity definition incurvate a breast bone, for density definition stick in it a knife, for survey and research of an osteal brain saw it and squeeze edge to squeeze buy decadron now out an osteal brain, do a breast bone on which the osteal brain is widely bared. 91 Examine costal cartilages and note obyzvest-vlenie, ossification (advanced age), a thickening (rachitic "beads"), unit of cartilages from ribs, hemorrhages (a scorbutus, illness ). It is useful happens to make longitudinal ribs for survey of an osteal brain. This operation - thorax opening - is easy on children's corpses and corpses of young subjects; at elderly and old men there is an ossification of costal cartilages, since I rib. Therefore at corpses Fig. 33. Costal scissors. Such subjects to cut a cartilage of I rib it is not possible, and it is necessary to have a bite it costal scissors (fig. 33).

At ossification of all costal cartilages and an ankylosis to a breast bone-clavicular of a joint the section should be made costal scissors or a saw. For wider opening of a thoracal cavity dissect ribs scissors on an axillary line. So recommend to arrive at opening of corpses of newborns and children of early age. Water assay At suspicion on a pheumothorax before thorax opening it is necessary to separate dermo-myshech th flap from a breast in the form of a pocket, to pour in it waters and to cut an intercostal space under water, of course, not a lung. Occurrence of bubbles will specify in positive water assay on a pheumothorax. At suspicion on an air embolism of heart opening begin not with a skull, and from brjushch th and thoracal cavity. To work it is necessary extremely cautiously not to wound vessels. 92 The breast bone handle is better to begin the basic cut not on a neck, and on the basis. Cartilages of the first ribs and grudino-kljuchichnye are better be not to tampering with a joint. Having separated a breast bone, it raise and or fix or a cord for a head of a corpse if the assistant, saw at level of the second intercostal spaces. A warm shirt open with a linear cut scissors. Strongly having grasped forcepses of edge of a cut of a shirt, plant them and, having transferred to hold to the assistant, pour in a warm shirt water. Now a peaked scalpel under water cut a wall of a right ventricle of heart. If in it there is air it will leave through water blisters. It also is water assay on an air embolism of heart. It is necessary to mean, that at late opening cadaveric gases can be formed. buy medrol That a breast bone to keep on a place and that it did not sink down under a skin mending of a corpse, it is possible to apply the following reception. Dissect costal cartilages I switch off a clavicle only with the parties of a corpse. The assistant standing to the left of a corpse, delays a breast bone on itself as a cover, for the cut cock, having wrapped it , not to wound an arm, framing access for extraction of organs of a neck and a breast. Conservation of costal cartilages at the left prevents breast bones after mending of a corpse and the deformation of a breast bound to it. N.F.Melnikov-Razvedenkov (1922) for detailed survey of lungs before their extraction has suggested to cut through all intercostal spaces and to exsect some ribs. Through the formed apertures (window) it is possible well and to examine and feel in details lungs, to investigate wounds, and so forth This way it is possible to recommend their topography, character of adnations for research of wounds of lungs, survey of reactive changes around the channel, exsudates and so forth In case of wound of a breast bone or tumours of a mediastinum the breast bone should not be separated: she needs to be taken together with organs and then already to arrive depending on necessity. 93 G.A.Berlov (1953) has offered updating of a way Melnikova-Razvedenkova for research of lungs at a fusion of pleural cavities and for orientation of pathological processes in relation to ribs. Dermal flap of a torso to back under-kryltsovoj lines. A lung dissect through intercostal spaces up to a spine column. Planting the extremities of ribs on 15-35 sm, it is possible to investigate in detail a lung on cuts and to focus pathological changes in relation to ribs. The author recommends to do these horizontal sections in the taken lungs on a little table, combining them with usual face-to-face or instead of face-to-face cuts. SURVEY AND NECK RESEARCH The general review of a neck make immediately at external survey of a corpse and at its skins. Now it is possible to examine all its organs in details. Most conveniently and more full it is possible at cuts on Medvedev's method (Opening of the person see). Examine muscles, channels, their direction, inflammatory reactions, exsudates and so forth Cut from a clavicle the bottom extremities of grudino-klju-chichno-mamillar muscles, cross lopatochno-djazych th muscles (m. omohyoideus) also delete them. Examine opened supraclavicular hollows and neurovascular fascicles from both parties. Here sometimes there are traumatic aneurysms of vessels. Investigate lymph nodes; find out mutual relations and a condition of the general carotids, bulbar veins and vagus nerves from both parties on all their accessible extent. In a place of a bifurcation of the general carotids where they are parted on internal and external, examine carotid glomes. Having cut a carotid wall in the bottom part, open with its scissors in a longitudinal direction and note a condition of an intima, a lumen, a thickness of walls, contents (liquid blood, convolutions, thrombuses and so forth).

Jan 10, 2009 at 11:10 o\clock

To manipulate more freely, it is possible

To manipulate more freely, it is possible to remove two-three top cervical vertebra. This way can use and not opening a skull, When skull opening for some reason or other to make it is impossible, and a nasal cavity and nasopharynxes to examine it is necessary, it is possible to use also way on which exarticulate a mandible, take away it on the person and, by means of a decadron online gouge having blasted the firm sky, get into a nasal cavity and nasopharynxes. This way with full excision of a mandible is more convenient a wasp-shchestvrt at neck cuts on a method of Medvedev, It is possible to open adnexal cavities of yokes separately. Sinuses to open the basic with a wide gouge, making two-sections. The first section do ahead of visual apertures, putting a gouge in a face-to-face direction and strong blow of a hammer driving in a gouge on 1 the Second section see do by horizontally put gouge on the right sideways from a Turkish saddle which entirely chop off from right to left (see fig. 23). Frontal sinuses quite often happen are opened already at skulls. If it has not occurred, them open with a gouge. Cells of a trellised bone * (os ethmoidale) open, deleting a bone gouge between it lamina cribrosa and internal walls of orbits (fig. 23 see, and). If thus still to separate the top part of a trellised bone (lamina eribrosa and crista galei) and a forward part of a body of the basic bone the top department of a nasal cavity will open. 77

Antrums of Highmore open after opening of orbits and extraction of eyes. Having released the bottom walls of orbits from soft tissues and having delayed them upwards and to front a hook (which give to hold to the assistant), hollow out at the bottom of orbits an aperture through which antrums of Highmore examine. Thus they open extremely insufficiently and in detail them to examine it is impossible. More well antrums of Highmore open at opening of the person on Medvedev's method. After face skin putting off the top jaw that gives the chance to investigate easily and in detail antrums of Highmore and a teeth which usually do not investigate though it can have essential value is completely bared. the cavity widely opens a gouge of its forward wall. Possibility of full and clear representation about its form, size, a condition of its walls, apertures (hiatus maxillaris), opening in an average nasal course is thus framed. Teeth becomes quite accessible to research, can be taken, and lunulas are easily opened with a gouge. In the opened sinuses examine mucosas, their condition contained, an exsudate and so forth write down. sialadens with their ducts are convenient for investigating, applying a method of opening of the person on a method Vitushinsky or Medvedev. Chapter 8 OPENING OF THE NECK, BREAST AND STOMACH For opening of a neck, a breast and a stomach a corpse stack on a back a head to light; under a neck and shoulders of a corpse podkla-dyvajut so that the head overhung a little and completely the neck opened. 78 The prosector becomes to the right of a corpse and keeps a position during all time of opening. It is more convenient to lefthander to stand to the left of a corpse (fig. 26). TEHKA CUTS By small post-mortem knife do the basic cut (fig. 26) from a chin to help avandamet a pubis on a median line, bypassing a belly-button on the left side of a corpse not to damage round ligament of a liver. The post-mortem knife thus needs to be held horizontally, having grasped its handle in a palm and to cut not the extremity, and an edge paunch (2 fig. see p. 23). On a neck cut only a skin not to damage subject organs. Rice 26 Basic cut of a wall of a trunk. On all extent of a breast bone to a xiphoid process the cut should get to a bone. On a stomach, as well as on a neck, cut only a skin and a hypodermic fat. If on a way of this basic cut wounds, fistulas, operational wounds are located, they need to be bypassed, instead of to cut. After the basic cut of a skin of a stomach do a cut of all depth of an abdominal wall. For this purpose at a cut right edge under a xiphoid process grasp a skin fingers or a gear forceps, delay up and to itself and a knife paunch cautiously rasse - ' cabins an abdominal wall throughout 3-4 see Through the formed aperture air enters into a cavity of a stomach with some hum, the abdominal wall finishes, and the impression of an inspiration (the corpse has sighed) is made. It is a sign of that the prosector has got into a stomach cavity. Now enter index and average fingers of the left arm turned by a palm up, through a cut in brjush - 79 a cavity and, fingers, raise an abdominal wall, and a post-mortem knife between fingers cut it to a direction of already made basic cut of a skin, advancing fingers of the left arm to a pubis. At this way of a cut stomach organs are damaged. If at a strong inflation of an intestine there is a danger to damage organs the cut should be spent warm or bellied scissors If there is a suspicion on presence of gases at a stomach cavity, preliminary a skin in the form of a pocket in which pour water. An abdominal section do cautiously under water. If in a stomach cavity there is a gas it will leave through water blisters. If there are adnations of abdominal interiors with Peritoneum of a forward wall and fingers of the left arm or a knife them will come across, them it is cautious and without efforts part. When adnations are very strong, time them does not follow, and it is necessary in their place Skin and muscles, and a peritoneum to leave in connection with organs and This place to bypass a knife.

Jan 10, 2009 at 11:09 o\clock

That a lens not , it is necessary to put an eye

That a lens not , it is necessary to put an eye a cornea downwards and slightly to press it and to cut from a back surface one movement of the razor to itself. The lens thus lays on an iris of the eye and nestles on a cornea. Plaintive glands settle down in on an angle of buy ultram online an orbit and everyone is parted by the fascial leaf going from m. levator palpebralae superioris, on two unequal parts. The most part lays over a fascia is top, or orbital, plaintive gland - gl. lacrimalis superior s. orbitalis, and smaller bottom - gl. lacrimalis inferior s. palpebralis. Top (orbital), the size to 25X14 the mm, lays in a frontal bone fossa - fossa gl. lacrimalis also cannot be palpated. Bottom () consists only of 15-20 lobes, to a conjunctiva of the top crest and can be examined at live and at a corpse if to delay an upper eyelid up and . It looks like a yellowish, hilly body. Ducts of plaintive glands open in thirds of top crest in number of 12-15. Through them tear arrives in a conjunctival bag, washing off an eyeball, and flows down to a medial angle of a palpebral fissure. Here it arrives in the plaintive ways beginning two points - puncta lacrimalia. They are on back ribs of eyelids and are an input in plaintive canaliculuses which go perpendicularly to edge of eyelids. Soon they turn under a right angle and 74 Are referred to a nose, running in a dacryocyst - saccus lacrimalis.

Canaliculuses are surrounded by elastic fibers and (any) muscles departing from m. orbicularis oculi. At blinking tear arrives from a conjunctival bag in a dacryocyst and forces the way in the nasolacrimal channel. Narrowing of the nasolacrimal channel involves a dacryagogue, and stagnation of tear in a dacryocyst happens quite often the reason of its inflammation. The dacryocyst is the top blind extremity of the nasolacrimal channel - ductus naso-larcimalis. It lays in the osteal excavation formed by a plaintive ossicle and a frontal process of the top jaw - fossa sacci lacrimalis. From top to bottom the dacryocyst is narrowed and passes in the nasolacrimal channel laying in the osteal channel, going from top to bottom, and a little . The channel direction varies depending on width of a ridge of the nose and width aperturae piriformis, that it is necessary to consider at its sounding. Lumen of the nasolacrimal channel , very narrow, length 12 mm and more. Its bottom aperture lays in a forward part of the bottom nasal course. In plaintive glands there can be inflammations, tumours, both good-quality, and malignant - adenocarcinomas, sarcoadenomas. In the plaintive channel there can be a narrowing, as congenital, and as a result of an inflammation (mushrooms - streptothrix and ), stones - dacryoliths. In a dacryocyst there can be inflammations - dacryocystites, cysts and tumours: polyps, fibromas, carcinomas, sarcomas. It is possible to open a dacryocyst, dissecting lig.palpeb-ralae mediale and then the nasolacrimal channel to probe which more conveniently from the opened dacryocyst very much a stylet. The Nasolacrimal channel. At opening of the nasolacrimal channel an antrum of Highmore laying from it, do not open. If processus frontalis it is is appreciable developed and covers the nasolacrimal channel, a way to the channel prokla - ~ through an antrum of Highmore on which medial wall it is possible to see a channel diverticulum. 75 OPENING OF THE NASOPHARYNX, NOSE AND ADNEXAL CAVITIES For this purpose it is considered the best a way Khark, giving the chance to examine not only a nose and a nasopharynx, but also the basic bone, frontal sinuses, cells of a trellised bone and antrums of Highmore. order pyridium After brain and pituitary body extraction from a frontal bone to edges of orbits and roots of a nose also reject a forward dermal flap of a head on the person. A back dermal flap from an occipital bone and cervical vertebra. A sheet saw saw on a median line in a direction a frontal bone to a nose root, and to work it is necessary rather cautiously not to damage a forehead skin. Then in the same direction saw an occipital bone to an occipital aperture. Now a saw cloth insert into both made , and saw: a trellised bone, the basic, an average part of an occipital bone and the top cervical vertebra. - For performance of this operation it is better to put a corpse prone. Two previous a frontal and occipital bone keep a saw in the necessary direction. After that, having grasped arms of edge of half of basis of a skull, with force plant them from each other (or by means of a wide gouge). Nasal bones and the top jaw are thus separated. A mucosa of a nose and a nasopharynx dissect a knife or scissors. On one of half of basis of a skull it is well visible One half of nasal cavity. For survey of other it on it is necessary to cut its septum at . If to remove nasal conchas it is possible osmot - a mucosa under them and an aperture of the plaintive The channel under the bottom concha. For survey of an antrum of Highmore dissect a lateral wall of a nasal course. Further examine a nasopharynx parted lengthways, apertures of postnarises, and in top they be apertures of Eustachian tubes and a pharyngeal tonsil. In depth it is possible to examine a soft palate, a fauces, a root of tongue and an input in a larynx. 76 Thus are opened frontal , cells of a trellised bone and a sinus of the basic bone, in the cervical part of a spinal cord is inevitably damaged, therefore, if it is necessary to investigate a spinal cord, it take to Khark. Except described, various ways from which the greatest attention the way deserves a skull on are offered more many. After it? To a way the Back dermal flap of a head from cervical vertebra, exarticulate an occipital bone, cutting solderings with I cervical vertebra, and a spinal cord and a skull to front. Between an occipital bone and an atlas the space in which the back wall of a pharynx is visible, and after its section - postnarises, nasal courses, a fauces, a soft palate, a root of tongue and an input in a larynx is formed.

Jan 10, 2009 at 11:09 o\clock

Thus the drum-type cavity opens and

Thus the drum-type cavity opens and becomes accessible to survey, as well as acoustical ossicles - , an anvil and (fig. 23 and 24). Opening of an internal ear, osteal labyrinth with its semicircular channels and a cochlea, together with 9 Internal acoustical passage make too a gouge from a skull cavity, but more slowly, than for middle ear opening. Mastoid opening (its cells) make outside. For this purpose also it is convenient to use Rice 24. A kind of the opened adnexal cavities. Cut on Medvedev's method, baring a mastoid and chopping off from it a gouge a superficial osteal plate. Thus open medrol dospak process cells, investigate their and their contents. For full and for microscopical research a hearing aid allocate all temporal bone. Thus, having spent a cut (Medvedev) and all soft tissues together with an auricle from a temporal bone, do cross-section the skull bases vpere - 70 Di pyramids - from scales of a temporal bone to a Turkish saddle. The second spend behind a mastoid, referring it forward to a clivus of the basic bone (clivus Fig. 25, middle ear Opening on Merkulov's method. Blumenbachii). Then dissect a gouge the basic bone between on a median line and separate the bottom surface of a temporal bone from soft tissues. If necessary to take both hearing aids do not lead up to a median line, and finish at the extremities of pyramids here again dissect a gouge, 71 Keeping the basic bone. If it not to make, o the skull breaks up to two half, and the head will be disfigured. Defects of bones can be closed liver or lien pieces that on a skin they were not found out. The cut part clip in a vice and saw a fret saw in a direction from back Edge of external acoustical passage to a first line of internal acoustical passage -

Thus a tympanic membrane remains whole, external acoustical passage, a vestibule, a back wall of a drum-type cavity, a stirrup etc. is bared., the cochlea is cut in the middle, and by mastoid cells - in a forward part. G.A.Merkulov (1951) recommends some different way of opening of internal departments of the ear, consisting in in one step all forward wall and an osteal plate of a forward surface at level internal acoustical apertures. For this purpose after putting off of a firm cerebral cover, it is added put immediately at the edge of an internal acoustical aperture, at level of its average line and approximately in parallel to a forward surface or a little under an angle to it (fig. 25)> At such position of a gouge an osteal plate of a forward surface chop off almost on all extent one strong blow of a hammer on a gouge. After putting off of an osteal plate internal acoustical passage and all tympanic membrane are well visible both cavities of an average and internal ear, and a cavity mastoid cells. On fig. 25 gouge position, and at the left the opened middle ear is shown on the right For successful single-step an osteal plate of a forward surface it is necessary to use a wide gouge, not already 1,5 sm, differently an osteal plate will be chopped off not entirely, and partially and operation should be repeated, establishing a gouge on other sites, but all as at level of internal acoustical aperture 1 Opening of a hearing aid has most in detail described In And in the book Technics of opening of some areas of a human body , 1961 72 ORBIT AND EYE OPENING If the person has not been opened, for extraction of eyeballs an orbit open o the parties of the basis of a skull. After putting off of a firm cerebral cover the top wall of an orbit you-deljaja dissect a gouge in three directions, a plate and a kind of the rectangular triangle which top is necessary on foramen opticum, the medial party goes in a direction, - under an angle 45 ° and facial - in parallel a frontal bone (fig. 23, and, see,). After a section a gouge in the specified directions a plate take out a forceps. Examine buy levitra a fatty tissue of an orbit and delete it together with oculomotor muscles. Now it is possible to take an eye, grasping its forceps for a fatty tissue or for a sclera (not to rumple a nerve) and separating a scalpel from eyelids. After that it is necessary to sew cautiously eyelids ton thread and to fill orbits cotton wool. In order to avoid a disfiguration take roofing felt at a back part of an eye where usually and meet naibo-lee the important pathological processes is more often. For this purpose, fiksi-ruja the eye a forceps for a sclera, sticks in it acute scissors or, having made preliminary a cut a scalpel, cross it on equator an eyeball. Back part of an eye take, and the vitreous follows. Examine an eyeground, a retina, and after putting off by its forceps - and a vascular cover. Instead of a remote back part of an eye vkladyva-jut a lien or liver piece that the pupil was dark. If opening is made on Medvedev's method eyes appear on centuries from which they can be easily separated, the released orbits are examined, and their opening from a skull disappears. That it is better to be guided in in definition of the right and left eye after their extraction, it is necessary before taking eye, to note on a sclera a rod of an argentum nitricum or ink the extremities 73 Eye meridians or on an internal direct muscle to leave ku-sochek threads. If it preliminary is not made, it is necessary to use anatomic features of a back part of an eye - an attachment of tendons of a back bottom slanting muscle in relation to back long to arteries which enter into an eyeball near to an optic nerve and go on a horizontal meridian. The tendon of the bottom slanting muscle is under an external artery. If back long arteries appear through well it is possible to give to an eye its normal position and to define, what is an eye - right or left. Opening of the taken eyes is better for making two horizontal cuts, leaving the most valuable average part whole.

Jan 10, 2009 at 11:08 o\clock

Since one, and then and from other angle,

Since one, and then and from other angle, this flap of a skin separate together with a hypodermic fat to a mandible, all organs of a neck which can be more exhaustively investigated thus are easily and well bared. Fig. 22. Cuts on a method Medvedev for neck opening And persons. For research of jaws and the person separate a skin behind an ear, delay it together with an ear to front and dissect external acoustical passage closely at a bone. Further it is cautious by means of a knife bare voltaren emulgel jelly-z at, a mandible, the top jaw, a malar arch, completely separate mucous labiums from jaws from that and other party and cut a cartilaginous septum of a nose. Separating consistently and a forward flap of a skin of a head, for research of orbits it is necessary to allocate and eyeballs, keeping their communication with centuries and cutting optic nerves for 0,5 sm from eyeballs. The huge flap of a skin of a neck, the person and head keeps communication with at about m only in the field of a nose root. At it in this or that party there are accessible persons all to part, forward department mucous a nose and completely both jaws. Thus easily and quite sialadens, lymph nodes can be more exhaustively investigated, 66 Muscles, bones, vessels and nerves. A teeth easily can be are taken for microscopical research. Antrums of Highmore are opened with a gouge outside or from an orbit and can be completely bared and examined. For research can be any parts of bones of a facial skeleton are taken, and their defects are closed by pieces of the hypodermic fat taken from a stomach, or pieces of muscles, a liver and so forth At last, it is possible to take all facial skeleton of a skull, having replaced with its plaster cast! All places of wounds on a face skin, cicatrixes of the begun to live wounds, entrance and outlet openings of wounds, fistulas and so forth remain completely and can be tracked at skins into place and it after orientation.

Thus as the mucosa of labiums, cheeks, a mouth can be more exhaustively examined, koto - usually almost never sees. Further, to organs of a mouth and survey of jaws it is possible to make for wider access in case of need exarticulation of the left joint of a mandible, crossing masseters, actually a masseter (m. masseter), a temporal muscle (. tempo ' ralis) both external and internal pterygoid muscles (mm. pterygoideus externus et internus). Now to turn away a mandible in the right party of a corpse, keeping it in this position by a dorsum of a brush or a forearm of the left arm and freely to operate with both arms. After the termination of research a mandible establish into place. To warn its lowering, it is possible to strengthen it , made of, about-drag, exhausting the extremities of brackets between molars, and labiums can be sewed a thin thread from within at the turned on flap. Then all dermal flap stack on a place. The skin, possessing the big elasticity, gets quite normal position. Cuts are sewn up and at position of a corpse in a coffin can be absolutely hidden, even if the neck skin will be not covered by a suit collar. It is necessary to do a plaster mask of the person before opening and soon after mors if in it there is a necessity. 5* 67 This method can be applied with success and for issle-dovanija tumours of organs of a mouth, for example, a cancer and so forth If it is necessary to investigate a neck behind, a back flap of a skin of a head, having turned a corpse prone and not making new additional cuts. Offered way we will much easier and easier execute, than a way on which cross-section continue on a back, and it is perpendicular, to it spend the second cut on an average line of a back to a vertex. Thus a skin from a neck from different directions for what it is necessary to turn a corpse that on one, on other side, kneading thus muscles and polluting a table. Independently V.I.Vitushinsky (1940) also under has developed a method of opening what is etodolac of the person. However it before to do cuts from mastoids in the slanting Direction by the top part of a neck to a median line Bodies where these cuts meet with usual a cut. It less conveniently also spoils a neck skin. Eyes at ' , and a line skins At level of eyes it turns out rough. A skin, being kept On centuries, prevents to approach to area of the nasolacrimal The channel, ' The author eliminates this obstacle a section of an orbital septum. From top to bottom the skin separates only to nose wings, and in the bottom part of the person to mouth angles. OPENING OF CAVITIES OF THE EAR For research of external acoustical passage a skin from a temporal bone forward and downwards, beginning from a cut made for opening of a skull the Dermal flap delay for an ear, and acoustical passage cross closely at a bone. It is considerably facilitated at a cut on Medvedev's method for research of the person. Now it is possible to examine cartilaginous (external) and osteal (internal) departments of external acoustical passage. The external cartilaginous department remains in connection with an auricle. For opened osteal, internal department and tympanic membrane research separate on a slice of bonds - 68 a gouge a forward wall of acoustical passage, rabo-thaw rather cautiously not to damage a tympanic membrane, and deleting a forceps slices of bones. Middle ear opening (that has the greatest value that is why and it is desirable in each case) about - Fig. 23. Opening of a bone of the basis of a skull. About, 6, v-meeto orbit openings; , d-cages of a trellised bone; in, zh-bosoms of the basic bone; and, a k-drum-type cavity of an ear. Exhaust from a skull cavity. For this purpose a gouge chop off a roof of a drum-type cavity (tegmen, tympa-ni) from a forward surface of a pyramid of a temporal bone.

Jan 10, 2009 at 11:08 o\clock

Allocating a spinal cord, its all time needs to

Allocating a spinal cord, its all time needs to be held for the firm cover grasped once in the beginning of cervical department, cautiously pulling its buy ultracet online left arm up and to a head, lifting the left arm above. To drop a spinal cord thus, to incurvate it, excessively to pull, concern with its instruments or fingers it is inadmissible, as rasping manipulations conduct to deformations and the mixtures of cerebral substance doing a brain unsuitable for microscopical research. At last, at an input in the channel a cross-section dissect a firm cerebral cover and roots of a horse tail. The taken brain cautiously, not incurvating, stack on the dish covered with the wetted towel, a back surface upwards and a cervical part to itself. Keeping a forceps a firm cover, cut its small bellied scissors on all extent and then two mouse-tooth forceps move apart in the parties, baring a back surface of a brain. Having turned thebaic a brain with a forward surface up, such open a firm cover on a forward surface. Now, fixing a brain for a firm cover, cut its one movement of the acute razor in a cross-section direction on a number of segments. Cuts should be spent in intervals

between roots that separate segments remained bound at their help with a firm cover. At wounds of a backbone and introduction in a spinal cord of splinters of bones to open a firm cover follows before spinal cord extraction, on a place. Having taken out a spinal cord, examine the channel, a periosteum of a back surface of bodies of vertebra, Condition of ligaments and so forth it is possible to open the channel and in front after extraction of all organs of a neck, ' a stomach. For this purpose a post-mortem knife dissect intervertebral cartilages of III lumbar vertebra, and a gouge - its handles. Then osteal forcepses tear off a body of III lumbar vertebra. Cartilages and handles of all other vertebra further cross, going on a direction 63 To a neck and osteal forcepses tear off them, baring, thus, the spinal channel This way is technically more difficult, and at it is more often damaged , but it has that advantage, that well opens intervertebral nerve ganglions which to be there and then issledo-vany, and spinal nerves can be taken together with a spinal cord on an appreciable extent And their communication with boundary sympathetic trunks is examined At last, in case of need it is possible to take all backbone without its opening that does not represent special work (For elimination of deformations of a body wedge instead of a backbone a strong wooden stick.) On the taken backbone it is possible to make opening the channel. For this purpose saw bodies of vertebra in ^ Talcum a direction, back handles-on the one hand Such about-at once open the channel and a spinal cord-sideways and find out a parity between a backbone and a spinal cord For spinal cord bracing in a corpse do a lumbar puncture, let out a spinal liquid And enter 1-0 % formalin solution. I.D.Tsyban (1952), then Ampere-second. (1955) have offered the updatings of opening the channel. The first suggests to Cut from bodies of vertebra a sphenoidal tape, doing longitudinal a backbone, on the right and at the left receding on 1 sm from a median line The second suggests to do face-to-face bodies of vertebra at level of an attachment of heads of ribs at forward cheap colchicine edges of handles of vertebra to VII cervical vertebra. Then * the sawn off part of a backbone from cervical vertebra which remain untouched. In that and in other case the spinal channel opens insufficiently, that is obviously shown on fig. 3 at Ampere-second , It zna-chitelno interferes with spinal cord extraction COMPLEX EXTRACTION HEAD AND THE SPINAL CORD Sometimes happens it is necessary to take head and backs ths a brain, not separating them from each other In this case at first make opening of a skull and start to take a brain. However take it not up to the end, and stop on a cut cerebellar . After that a brain stack on a place, and a corpse cautiously turn prone and open the channel. Spinal cord start to take with a horse tail to cervical department. Having allocated a spinal cord, it stack on a place. Then, having raised a brain, cross remained nerves and firm cerebral about - 64 in the field of an occipital aperture then, taking in a palm a brain, cautiously take out it and through an occipital aperture extend a spinal cord. l and in and 7 OPENING OF THE FACIAL PART OF THE SKULL OPENING OF THE PERSON Here it is necessary to arrive especially cautiously. The pathologist should not suppose any cuts of a face skin not to disfigure it. In view of danger of wound of a face skin at its opening and difficulty of approaches the facial part of a skull is investigated not completely and more often its opening is not made at all, for this reason rather important pathological processes remain not studied. For full research of wounds and illnesses of jaws, an antrum of Highmore, a lead and its vessels, nerves and so forth I offer and develop the simple method accessible in any situation and absolutely not not damaging face skin (Medvedev's method). To begin it is necessary from a cut of a skin of a head for skull opening. Spend him, as always, from a mastoid of one party behind an ear, through a cinciput, to a mastoid behind an ear of other party. Further spend a cross-section immediately from the top process (asgo-mion) the left scapula, through a breast in a cross-section direction, an arch turned by concavity to a neck, at level of the second intercostal spaces, and finish symmetrically on acromion the right scapula, than it and differs from cut (fig. 28 see). Now spend a cut from a mastoid behind an ear (as it is possible ) to 5 Pathoanatomical technicians 65 acromion scapulas from one and other party on neck slopes where this cut meets final points of a cross-section. This cut, so, is continuation a cut made for opening of a skull. Thus, the dermal flap having the trapezoid form (fig. 22) turns out appreciable size.

Jan 10, 2009 at 11:08 o\clock

Chapter 6 OPENING OF THE CHANNEL

Chapter 6 OPENING OF THE CHANNEL AND SPINAL CORD To open the channel it is better after skull opening, but before breast and stomach opening as At the devastated corpse this operation to make more difficultly, and before opening of the person not to crumple its skin. If necessity to open a spinal cord has arisen after opening of the person it is necessary order skelaxin to put the person in order and to sew up all cuts made at its opening as, turning a corpse, it is possible to crumple a facial flap and to disfigure the person For opening the channel behind a corpse put prone and under a thorax under-kladyvajut . 59 Rice 20-rachitome-double saw The prosector becomes to the right of a corpse, , . Takes of a usual position at a dissecting table. By a post-mortem knife does a midsection of an occipital flap of a skin and further spends a cut from an occipital hillock to the middle of a sacrum or to coccyx. This cut goes closely about acanthas from this or that party Fig. 21. -* forcepses From them. Further separates a skin with a hypodermic fat and muscles from acanthas and back handles of vertebra from both parties. After a denudation of their back handles saw a rachitome - double saw (rice 20) or have a bite coronoid rachitome (rice 21). Having established saw cloths on the distance corresponding to distance between internal and by the extremities of articulate processes of thoracal vertebra 1, put a saw on a backbone so that acanthas were

between saw cloths Now, holding a rachitome for the handle the right arm, and the left arm pressing it to bones, Movements saw handles of thoracal vertebra After that saw handles of cervical and Lumbar vertebra for what it is necessary a little bit more widely 1 This distance is on the average peer 2 sm cloths according to larger Width of Handles and the channel in cervical and lumbar departments Application of a double saw not always conveniently, as Its cloths should be established - strictly paral - * It is efficient, that mismatches anatomic relations Handles of vertebra. At pathological curvatures Backbone using it becomes impossible. Therefore it is much more convenient to use a rachitome ^ - coronoid forcepses (rice 21), perekusy - it each handle separately with one and with another The parties At last, it is possible to make and a usual sheet saw or to cross their gouge handles are cut, bitten or split by a gouge acanthas on all extent become mobile of what it is necessary to be convinced In the absence of mobility of the handle or again split , or break their cautious, but resolute blows of a hammer, putting them sideways on acanthas with that and on the other hand Thus in order to avoid occurrence of splashes from hammer blows it is necessary to cover acanthas with the dry towel folded double on length, And to beat a hammer on a towel on each side acanthas on the right and at the left After that a sheet saw saw an occipital bone from both parties, from a median line on 5 see conduct obliquely downwards - so that it has entered into edge of an occipital aperture (foramen occipitale magnum) the Back handle of an atlas should be had a bite osteal scissors or rachitome - coronoid forcepses. Now it is necessary ligaments between vertebra. For this purpose it is recommended to dissect them between III and IV lumbar vertebra, sticking between them a knife Further, having grasped the handle II and III lumbar vertebra the osteal forcepses tearing and strong movement up and to the left tear methocarbamol robaxin off acanthas together with handles in the form of a tape from lumbar Department to cervical and on border with an atlas cut off a knife As thus to tear it is necessary up and to the left, that it is impossible to recognise convenient, we apply other way, a small post-mortem knife we cross in pove - 61 River direction lig. nuchae and membrana atlanto-occipitalis posterior. The handle of I cervical vertebra is very narrow, and between it and an occipital bone there is a big space, as facilitates operation. It is necessary to mean, that membrana atlanto-occipitalis posterior on an average line with firm cerebral, a spinal cord cover. On all other extent dura mater spinalis unlike a firm cover of a brain leaky to bones. Having parted ligament between an atlas and an occipital bone on this way, we grasp osteal forcepses acanthas of cervical vertebra and it is broken them, making jerk up and to the right, that is much more convenient. Further, cutting a firm cerebral cover at back edge of an occipital aperture, we separate the cut part of an occipital bone then the channel on all extent appears opened. -After that examine an internal surface of the taken out handles, the channel and a spinal cord covered with a firm cerebral cover. Note position and the spinal cord form, colour of a firm cover, its surface, , a strain and so forth If the spinal liquid was not is taken earlier it is possible to take it now, punctures by a syringe needle a firm cover in a lumbar part. EXTRACTION AND SPINAL CORD OPENING Strong forceps cautiously grasp a firm cerebral cover at an occipital aperture, not concerning a brain. Holding a forceps in the left arm, cautiously delay a spinal cord for a cover that in one in other party, with a scalpel separating from a clivus, and cut nervous roots out of a firm cover as it is possible more close to intervertebral foramens. If cervical department of a spinal cord to delay in the parties more strongly it is possible to extend and spinal ganglions - intervertebral nerve ganglions. If they are necessary for investigating on all extent of a backbone a gouge chop off articulate processes of vertebra from both parties and open intervertebral foramens with ganglions laying in them. 62

Jan 10, 2009 at 11:07 o\clock

Through the right hemisphere

Through the right hemisphere one cut is made only; the line with a finger shows a direction of the second cut. The corpus collosum is cut in the field of columns and its right leg and cast away to the left. The worm of a cerebellum is dissect, its hemispheres are cast zanaflex online away in the parties thanks to what IV ventricle is opened. Through the left hemisphere of a cerebellum the first cut is made; black lines show a direction of the same cut of the right hemisphere and additional cuts of the left hemisphere of a cerebellum. Cross-section black lines correspond to places of a section of grey knots "the bases and to a brain part. in connection with visual hillocks by means of habenula (bridles). Write down its colour, size, measuring by a ruler; a kind on a cut; separate and weigh. Normally it of krasnovato-grey colour, is surrounded pia mater, at newborns consists of lobes. In its tissue there are calcareous kernels (cerebral sand), defined by touch. 55 7 Now grasp index and big fingers left the right leg of a crest falling to a back horn of the right lateral ventricle, dissect it from top to down and throw together with a corpus collosum, a crest and a vascular plexus to the left.

Thus completely open: a surface of the big grey knots, III ventricle and a surface . Examine and cautiously feel, finding out a consistence of these formations, and note a condition of III ventricle as it is told about the lateral After that it is possible to make face-to-face cuts the knife moistened with water through grey knots and to them white substance. For this purpose it is necessary to bring the left arm a palm up under the basis of a brain and over it to dissect a brain frontally on slices in the thickness of 0,5 sm, slightly raising a brain the left arm; thus slices easily are parted and become accessible to survey of a surface of cuts Now, having moved the left arm under the part of a brain and under a cerebellum and slightly raising them, a cut is dissected by a worm of a cerebellum but an average line - cerebellum hemispheres thus depart from each other in the parties and "IV ventricle opens. it also describe, as well as previous. It is necessary to do this cut especially cautiously not to cut a bottom of IV ventricle. For opening l - and in and a waterpipe also cautiously do a cut through . Dissect each hemisphere of a cerebellum half-and-half from a surface of a cut of a worm on an average branch arboris vitae. If necessary it is possible to spend the same additional cuts of each of half of cerebellum. At last, open a brain part with face-to-face (cross-section) cuts. For this purpose the left arm from below raise it above that cerebellum hemispheres have dispersed as much as possible in the parties and downwards. Cuts spend a scalpel, holding it as the writing feather, is possible cheap tegretol more abruptly These receptions it is possible to spend accurately cuts with legs of a brain, an oblong brain with 56 Bridges and through an initial part of a spinal cord, izvle-chennogo together with head. doing excessive damages. It is possible to open a part of a brain and from the brain basis. For this purpose result all ' in a starting position, that the way quite supposes. CL Rice 18 Cuts brain parts. /, 2, cut 3-lines, a-b-os a brainstem Having clasped arms both hemispheres of a brain, cautiously overturn its basis up and do face-to-face cuts through brain legs, the bridge and an oblong brain. In all time of opening of a brain carefully examine substance of a brain on cuts and describe a degree of wetness (moderated, strong, puffiness or dryness), (a hyperemia or an anaemia). At stagnation of blood it acts on a surface of a cut in the form of the points which are easily washed off (it they differ from hemorrhages). Further note colour of a cortex, knots and white substance, note a consistence - soft or is more dense. Note a condition of gyruses and sulcuses, a thickness of a cerebral cortex and a cerebellum. There can be protrusions or retractions, 4 hematomas, cysts, 57 Abscesses, tumours, tyromatoses and other changes. "For research brain parts horizontal cut is a little suitable, as at it the part is dissected under an acute angle to its longitudinal axis that breaks a segmentary order. Therefore for conservation of position of kernels and fascicles and the subsequent correct orientation a beam - Fig. 19. The Same, that on fig. 18, but a cut to do brain cuts perpendicularly to a longitudinal axis (fig. 18 and 19) a brainstem (oblong see, average and intermediate). It can be reached, doing three cuts preliminary fixed, but not deformed brain: I - through border the bridge and an oblong brain in a direction to fiss calcarinae; II - in parallel this cut behind corpora mammillaria through brain legs to the top third fiss parietooccipitale; III-also in parallel these cuts ahead and behind forward branches sulcuses through forward parts of visual hillocks The brain can be fixed and before skull opening, filling in it of 10 % formalin solution through carotids. It is possible to recommend this way especially 58 For children's corpses as the brain of children is extremely gentle also unstable easily breaks up. Pituitary body usually investigate separately. Having written down its configuration, the sizes and weight, make its opening that is recommended to do by two parallel cuts in a frontback direction sideways from a funnel. the cut through a funnel spoils an organ that for microscopical research its most valuable average part will be lost. a gland (glandula pinealis s. epiphisis cerebri) lays over lobbies under the platen of a corpus collosum at a back wall of III ventricle and it is bound to visual hillocks a leg or a bridle (habenula). It well opens at a horizontal cut of a brain on . At children it is larger, than at adults, and at women is larger, than at men. Its involution comes already at seven-year age. At its tissue often there are calcareous adjournment.

Jan 10, 2009 at 11:07 o\clock

Having brought the left arm under

Having brought the left arm under a cerebellum, open IV ventricle, cutting a worm in a direction. After that investigate a cerebellum, cutting its hemispheres it is horizontal through a gear kernel (nucleus dentatus cerebelli) on the top and bottom half and toradol medication leaving them in communication with each other. For additional research do face-to-face cuts of the top and bottom half of brain, a part and a cerebellum. It is possible to investigate a brain, making one vertical face-to-face cuts (without horizontal). Fig. 13. Face-to-face cuts of a brain ^ Fisher 1-7 (fat lines) brain-cuts;/-bulbus olfactorius,//-n opticus; III-a. oculomotorius; IV-n. trochlearis; V-n. trigemmus; VI-n. abducens, VII-n. iacia-lis, VIII-n. statoacusticus; IX-X-n. glossopharyngeus et vagus, XI-n accessorius; XII-n. hypoglossus 50 ON FISHER'S METHOD For this purpose it is recommended to do seven face-to-face cuts from the brain basis (fig. 13, 14, 15): Fig. 14. The second face-to-face cut on Fisher's method. /-nucleus caudatus;, 2 - capsula interna; 3-thalamus; 4-ventnculus tertUb; 5-corpus callosum. -7 Fig. 15. The third face-to-face cut on Fisher. /-nucleus caudatus; 2-thalamus opticus, 3-capsula interna; - (-.nucleus lenticularis. 4* 51 Immediately at back parts olfactory Bulbs; Immediately ahead of a decussation of the visual Nerves; Through bodies (corpora mammillaria);

Immediately at the bridge, ahead of it, Referring a knife a little back; Through the middle the bridge; 6} through a forward part of an oblong brain and 7) through the middle of olivas. ON METHOD It is necessary to separate preliminary a brain part together with a cerebellum. For this purpose stack a brain on a little table the basis up. The left arm slightly raise a part of a brain with a cerebellum and spend a cut through both legs of a brain. Having separated a part, stack a brain the basis from top to bottom so that occipital shares have been turned to the left, and frontal-to the right, and spend-six parallel face-to-face cuts through both-hemispheres: In parallel to a sulcus on 5 sm ahead It; Through the back extremities of frontal gyruses; Through forward central gyruses; Through back central gyruses; Through both parietal, shares; 6) ahead of an occipitoparietal sulcus. a brain part investigate thus together With a cerebellum cross-sections from the party the bridge and an oblong brain. ON METHOD Having laid a-brain on a little table hemispheres up and occipital shares to itself, both arms put on a surface of hemispheres, cautiously move apart hemispheres. Thus there is visible a corpus collosum. Still slightly having removed and to the left the left hemisphere by the left arm, a post-mortem knife do a cut 52 Medial surface of a hemisphere on the left side of a corpus collosum on with gyrus frontalis. A cut conduct through a corpus collosum obliquely, from top to down and a little and get into a cavity of the left Fig. 16. Brain opening on (beginning). The first cut opening a cavity of a left ventricle. The dashed line shows a direction of the subsequent cuts. Lateral ventricle. Having continued this cut to front from itself through the frontal. A share, open a forward horn of a left ventricle of a brain, and having continued it through an occipital share to itself open a back horn (fig. 16). After baclofen 10mg that still remove the left hemisphere to the left and examine all left lateral ventricle and write down: its size (approximately); contents, which in norm - a transparent, colourless liquid 53 In insignificant quantity, in its pathological cases can be much, for example at an edema, it can be muddy and dense at a purulent inflammation, - at a hemorrhagic inflammation or it can be blood at a hemorrhage. Then, having removed contained by an easy stream of water, examine a ventricle surface, i.e. An ependyma, which in norm smooth, wet, shining, soft. In pathological cases can be granular, dense, with hemorrhages and so forth Having examined and having described a brain left ventricle, spend New cut - continuing and deepening the previous In frontal and occipital shares. In its average part Spend on the bottom wall of a ventricle a little from grey knots obliquely under an angle 45 °, dissecting The left hemisphere and down to its surface, Leaving untouched a soft cerebral cover (Fig. 17). This cut short separates the big piece of a brain which have the prismatic form and falling off and to the left. Now on the middle of a surface of a cut of this piece spend still a longitudinal section also reaching a soft cerebral cover, not crossing it. It is possible to spend still if it is necessary, 2 and such 3 cuts through the parts which have separated after the previous cuts. As open also a right ventricle, spend the same cuts of the right hemisphere. For this purpose conveniently-turn brain frontal lobes to itself, and occipital shares from itself. Having finished right ventricle opening, again result a brain in former position - occipital shares in itself. Having grasped index and big fingers of the left arm a corpus collosum, slightly raise its and right arm from the right lateral ventricle vvo-djat a knife in an interventricular foramen (foramen Monroi) and from it dissect a corpus collosum and crest columns. Dissect corpus collosum together with a crest throw back , the vascular plexus (tela et plexus chorioidei) thus opens. Describe its condition: degree , a degree of wetness (puffiness), pus and so forth and, having grasped it is 54 in a forward part, also throw back it , crossing the veins going from the big grey knots. Now the gland (glandula pinealis) became visible . It lays over lobbies a hillock - Fig., 17. Brain opening on (the subsequent cut). Through the left hemisphere two cuts are already made; the line with a finger shows a direction of the third cut.

Jan 10, 2009 at 11:06 o\clock

Adnations with a cerebral cortex is better

Adnations with a cerebral cortex is better define at putting off of soft covers from gyruses of a brain a forceps, preliminary having made an incision them. Further note a brain consistence, a condition of its gyruses ( or a thinning) and sulcuses (delection or their expansion and so forth) Then move apart hemispheres and examine a corpus collosum. Having made buy orlistat xenical corpus collosum cuts over lateral ventricles, collect a cerebrospinal liquid in the substituted vessel or a puncture of a corpus collosum a syringe needle receive a liquid for bacteriological research by rules of bacteriological technics. In order to avoid a designation skulls under a forehead skin (after cleaning of a corpse) it is possible to arrive, as is shown in fig. 9. BRAIN EXTRACTION Having advanced index and average fingers of the left arm between frontal lobes of a brain and a firm cover, cautiously take away frontal lobes of a brain from the skull basis together with olfactory tracts and bulbs.

There is enough having rejected frontal lobes of a brain from the skull basis, cut as it is possible more close to a bone both optic nerve and carotids, then third cranial nerves and a funnel of an appendage of a brain (pituitary body). If a pituitary body wish to take out together with a brain a scalpel cut a firm cover covering it at a place of its attachment to a backrest and a Turkish saddle and the fine vessels feeding a pituitary body. The brain thus gradually departs from the skull basis, and becomes visible cerebellar (tentorium cerebelli). It cut off from both parties a scalpel from the top sides temporal bones, adhering as it is possible more close to a bone not to wound a cerebellum. Further from both parties cut nerves: trochleariform, trigeminal, taking away, facial, acoustical, jazykoglo-exact, wandering with additional () and sublingual. After a section cerebellar the brain itself, owing to force of own gravity, deviates back, can cause rupture its parts. 46 For preventions of this rupture it is necessary to support a brain a palm of the left arm behind and from below. Now cut a spinal cord together with arteries, entering a scalpel as it is possible more deeply through an occipital aperture in the channel. The spinal cord is better to cross a myelotom (fig. 10), holding it as the writing feather, thus turns out strictly a spinal cord cross-section. After that the brain usually freely falls out on a left arm of the prosector supporting it. If the cerebellum does not leave a back cranial fossa it cautiously allocate with fingers of the right arm. Fig. 10. The Peak myelotom. The taken out brain put on a dish the basis up. Now examine a firm cerebral cover of the basis of a skull. Open its venous sine: cross-section, sigmoid, the cavernous, top and bottom petrous. Take an appendage of a brain (pituitary body) if it has not been taken together with a brain. For this purpose cautiously a scalpel cut round it a firm cover, a gouge force down a dorsum sellae and, having grasped a forceps maxalt 10 mg a firm cover the left arm, reject it in one and other party and separate a scalpel. For research of the additional pituitary body laying between a mucosa of a dome of a nasopharynx and the basic bone, and gipofi-zarnogo a course sometimes remaining in the form of islets of epithelial cells, recommend to cut a narrow saw a part of the basis of a skull, grasping all body of the basic bone together with a nasopharynx mucosa. The taken bone fix formalin, decalcify and after that investigate For survey of bones of the basis of a skull separate a firm cerebral cover, having grasped it for edges fingers or a strong forceps. Examine a surface of bones, seams, cracks, gas-serov the knot of a trigeminal nerve laying on a lobby on - 47 a temporal bone, knots jazykoglotOjA-nbgo of a nerve Laying in a jugular foramen, a vagus nerve with the additional. Chapter 5 BRAIN OPENING The surface of hemispheres has been already investigated on a place. Now investigate the-brain basis, a configuration of its parts, soft cerebral covers of the basis of a brain, noting their transparency or , , an exsudate which happens gelatinous as at a tubercular basal meningitis with , serous or purulent as at an epidemic lepto-meningitis and so forth Attentively examine area , olfactory tracts, sulcuses, and also an artery: sulcuses, circulus arte-riosus Willisii, a. basilaris, a. vertebralis and their branches. Now ^ put the basis from top to bottom and measure by its ruler in three directions: (length), face-to-face (width) and vertical (thickness) also weigh. After that a brain open, for what use various methods. Thus it is necessary to pursue three aims: 1) research possibility-full, 2) possibility of conservation of a brain as museum preparation and 3) possibility of the subsequent histological research. It is recommended to fix for detailed and exact research a brain immediately after extraction in 10 % formalin solution. For full bracing 8-10 days, but already are necessary and in a day it can be opened with smaller risk it to damage. The most simple, accessible under any circumstances, not spoiling a preparation and allowing in detail to investigate a brain the way of its horizontal cut is. 48 ON METHOD For this purpose a brain put on a little table the basis from top to bottom both frontal lobes to the right and cerebral knife (fig. 11) or amputating, preliminary smochen. - . 11 cerebral knife . Fig. 12. A kind of a surface of the bottom part of a brain at a cut on a method water (that the substance of a brain did not stick to a dry knife), spend a horizontal cut through both hemispheres of a brain on two fingers over a table. Cut it is necessary to conduct an iodine a corpus collosum immediately over a worm of a cerebellum. 4 Pathoanatomical technicians 49 This cut does not break brain topography, opens lateral and III ventricles and dissects the central ganglions (fig. 12).

Jan 10, 2009 at 11:06 o\clock

This cut contrary to a rule to cut from

This cut contrary to a rule to cut from left to right and to itself Here it is necessary to cut from right to left, and in the left part of a head - and from itself, holding a knife blade is horizontal If to cut from left to right the left arm of the prosector keeping a head for a forehead will stir, and movement of the right arm will be referred from itself Therefore here a cut better african hoodia to conduct from right to left Having reached to a left-hand side" "heads of a corpse - the prosector does by the left foot a step to the left with a half-turn to the right and to those gives full access to the right arm and a knife Movement of the right arm will be thus referred to itself, instead of from itself, that will give confidence to movement 41 If this reception is not possible, resort to the help of a knife, delaying a flap on the person of a corpse the left arm. In the same way separate a back flap, delaying it downwards and back to a nape, to a denudation of an occipital hillock. Forward flap reject on the person of a corpse, and back on a back surface of a neck. Temporal muscles are thus bared and remains untouched. For unit of temporal muscles a knife enter between a bone and a muscle at its basis, an edge from top to bottom, and an edge to itself. Fig. 5.

A sheet saw. For this purpose it is better to use an amputating knife (it already and more long), holding its handle in a fist turned by the big finger up. Slightly turning a knife blade to a bone, cut off muscles from scales of a temporal bone and turn on them to an ear. Now the prosector becomes the saline party of a head of a corpse. Having grasped strongly forward flap of a skin in the left arm and it fixing a head, it makes skulls an arc or sheet saw (fig. 5), holding it in the right arm. this goes on 1-2 sm you edges of orbits, on each side goes symmetrically through scales of temporal bones and further through an occipital bone to an occipital hillock, crossing it. begin in frontal area and conduct it to the right and to the left, turning - the left arm a head kept for a forward flap. At last, strongly having turned a head in that and in other party, saw an occipital bone and an occipital hillock where both directions should be bridged. It is recommended to adhere strictly to the specified position to saw a skull, standing to the right of a corpse. 42 In the latter case to fix a head it is necessary the left arm, but for a naked skull, that never gives to reliable bracing, and the saw can slide off a spherical surface of a skull and wound the left arm. Rice 6. A craniotome. Rice 7. A cross-section gouge. That at bones of a skull not to damage cerebral covers or even a brain, saw only an external plate of bones (lamina externa) to diploe, thus the arm feels resistance reduction under a saw. Then, having entered in alli weight loss a craniotome (fig. 6) or a gouge (Fig. 7), easy blows of a hammer on them split Internal plate of cranial bones (lamina interna). If all is made correctly, a cranial cover the mobile. Rice 8. A hammer with a hook. Now a head of a corpse result in former position (The person up) and, having moved apart an edge gouge a forehead Ache bones, enter into the formed cleft a handle hook Hammer (fig. 8) or any another also tear off skulls from a firm cerebral cover. Usually it It is possible without special effort. If resistance of a roof of a skull is too great, as, for example, at all children of early age (happens 43 And at adults owing to vicious adnations), to apply force does not follow, as it is possible to break off a brain. In this case a cranial cover take out together with a firm cerebral cover, dissecting its scissors on a course skulls and then cutting off the big crescent process from a crest of a trellised bone scissors Having taken out a cranial roof, examine it and note a thickness of bones, a condition of surfaces, grooves from vessels and a fossa o granulations, seams, at children and fontanels; surveying a roof on light, note most places and other features. Further examine a firm cerebral cover and note its strain, , colour, shine, humidity, granulations. After that with a cut a scalpel open a longitudinal venous sine (sinus sagittalis superior) and note its contents. If the firm cerebral cover is taken out together with a skull roof a sine open from within at the basis of a crescent process on the right or at the left After survey take out a firm cerebral cover. For this purpose it grasp a gear forceps pleated in the field of frontal lobes of a brain and scissors cut through in it a small aperture with that and on the other hand. Entering into the made aperture bellied small scissors, cut a firm cerebral cover on edge skulls on the right and at the left, all time delaying its scissors from a brain not to damage a brain. For survey of an internal surface of its firm cover turn on consistently: the right half on the left hemisphere, and then the left half on the right hemisphere. Now the firm cerebral cover appears bound to a skull only the big crescent process attached in front to to a crest of a trellised bone, and behind - to cerebellar . For putting off of a firm cover move apart fingers brain frontal lobes, grasp the left arm or a forceps the big crescent process and cut it from a crest of a trellised bone steeply put scissors. If now to grasp a first line of a firm cover and to pull it to itself and from top to bottom, it will easily separate from 44 Brain and at conservation of communication with a cerebellum osta-netsja to hang in occipital area. Quite often granulations considerably sprout a firm cover and show resistance at its unit; then dissect a knife; as arrive and with veins of a soft cerebral cover; running into a longitudinal sine, Fig. 9. the skulls, keeping an integrity of frontal bone Rum is designated circular ; a continuous line - , with an integrity of a frontal bone V If there are strong adnations of a firm cover with soft it round these adnations cut off nozhnitsa., and parts remain on a soft cover. As arrive and in case of defects in a firm cover, and edges keep them in connection with a soft cover. Now examine soft cerebral covers, noting them, transparency degree, on-_ , an edema, hemorrhages, applyings, the pus sometimes covering a brain like "cap" as it is observed at a purulent cerebrospinal meningitis. 45