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It may form a single or double hare-lip, or complicated, or it may involve the soft parts, or the hard (bony) and soft parts at the same time. It is double hair-lip in about one-tenth of the cases, and when double it is frequently complicated with cleft palate. The best time is between the third and sixth month, especially when it is a simple case. In some cases of double hair-lip, when the child cannot take the breast and has to be fed, early operation should be done if the child is strong. Fluids pass freely into the nose, and unless the child is carefully fed by hand it will soon die, as it is unable to suck. In the less severe forms the child soon learns to swallow properly, but when he learns to speak he cannot articulate properly and his voice is nasal. The end of one-half of the cleft palate is seized with an instrument and the edge freely pared with a thin bladed sharp knife; same with the other half. The patient is fed on liquid food for three or four days, and afterwards on soft food until the stitches are removed. They are removed about the sixth or eighth day, and the wound should be completely healed. The treatment should be begun, under the instructions of a physician, and continued from infancy and many a good foot can be obtained. It usually shows itself soon after the child begins to walk, but may not do so until puberty,-rarely later. It is due in the child to rickets; in the latter form, it is caused by an occupation that requires continued standing, by a person of feeble development of the muscles and ligaments. It may affect one or both knees, may be so slight as to escape detection, except upon a very careful examination, or so severe as to separate the feet very widely and render walking difficult and wobbling. If not severe it may often get better spontaneously as the rickets condition improves and the general strength increases. This result is common in the cases occurring later, from standing if the general condition improves. The quicker the treatment is begun, the quicker will be the recovery and the deformity will be less. If the rickets is still active, and the bones are soft and yielding, standing and walking should be forbidden, the limb should be straightened by manipulation and the correct position secured and maintained by an outside splint and bandage. The disease begins in early childhood; the cause is rickets, and the deformity is the direct result of the weight of the body and muscular action. Children should not be allowed to walk so early, especially those of slow development. The foot may be drawn outward, abducted, (Talipes Valgus); or, two may be combined, extended, and drawn inward (Equino Varus).
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To reduce blood loss and facili sometimes be rewarded by preservation of part or all of tate orderly microdissection, preoperative embolization the lower nerve branches. Large glomus jugulare tumor with retrograde spread into the sigmoid sinus and distal involvement of the lumen of the jugular vein. Within it are the jugular vein, the carotid artery, the styloid process, the third division of the trigem inal nerve, the eustachian tube, the pterygoid muscles and their associated bony plates, and a rather impres sive venous plexus. Laterally, the infratemporal fossa is defended by the mandible (condyle and ramus) and Figure 66–10. Medially, it is bounded by the lar foramen, leaving the descending facial nerve in situ. Tumors involv the removal of jugular foramen tumors can often be ing the deeper regions include trigeminal schwannomas accomplished with preservation of the auditory appara in the vicinity of the foramen ovale and penetrating tus. Resection of the middle ear and ear canal with clo malignant neoplasms such as those from the deep lobe sure of the meatus is necessary under two circum of the parotid gland and ear. The most common tumor stances: (1) extensive destruction of the ear canal and involving the deep aspect of the infratemporal fossa is (2) substantial involvement of the carotid genu (Figure nasopharyngeal carcinoma. Intradural penetration of jugular foramen Lesions involving the lateral portion of the infratempo tumors will be discussed with transjugular craniotomy. More anteriorly situated lesions jugular foramen: glomus jugulare mimic and surgical chal are approached preauricularly, often with access gained lenge. Com to expose Meckel cave and the cavernous sinus from this prehensive microsurgical anatomy of the jugular foramen and perspective. Ear canal closure is carried out with a meticulous three-layer technique to withstand cerebrospinal fluid pressure, if necessary. In one commonly size, shape, anatomic location, and pathologic type of used system of nomenclature, the various depths of tumor, as well as status of hearing (Figure 66–14). Thus, when the fundus of the canal is cusses vestibular schwannomas (see Chapter 56, Vestibular involved, direct exposure of the deepest portion of the Disorders). Neurophysiologic monitoring of the lower cranial nerves in jugular foramen surgery. Overview of posterior fossa approaches to the cerebellopontine angle: retrosigmoidal, retrolabyrinthine, translaby rinthine, and transcochlear. The translabyrinthine approach is primarily used for vestibular schwannomas, although it has some role in posterior fossa meningioma surgery as well. The primary advantage of the middle fossa approach is its superior ability to preserve hearing. Overview of the retrosigmoidal ap advantage is the inconvenient location of the facial nerve proach from an axial perspective. Note the removal of on the superior surface of the tumor that must be manip the posterior lip of the internal auditory canal. Although still used routinely as a hear roma surgery via middle cranial fossa approach.
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Because these While running forward in the floor of the orbit, the are postganglionic neurons that reach the pterygopalatine infraorbital nerve lies in the roof of the maxillary sinus and fossa, they do not synapse in the pterygopalatine ganglion. Once it reaches the face, the goid canal is the greater superficial petrosal nerve, which is infraorbital nerve carries sensation from an area of skin composed of preganglionic parasympathetic neurons. It canal and forward into the pterygoid canal to reach the then branches into the zygomaticofacial and zygomati pterygopalatine fossa (Figure 1–13). There, the pregangli cotemporal nerves, which pierce through the zygo onic parasympathetic neurons synapse in the pterygopal matic bone, turning forward onto the skin of the face atine ganglion. The postganglionic parasympathetic neu and backward onto the temple, respectively, from rons then join branches of the maxillary division of the where they carry sensation. Some postganglionic parasympathetic the posterior superior alveolar nerve courses laterally neurons travel on the zygomatic branch of the maxillary through the pterygomaxillary fissure and, on reaching division of the trigeminal nerve as it courses up the lateral the infratemporal fossa, pierces the back of the maxilla wall of the orbit. When the zygomatic nerve leaves the orbit and carries sensation from the roots of the upper by piercing through the zygomatic bone, the postganglionic molars. It communicates with the tempo branch of the ophthalmic division of the trigeminal nerve ral fossa above and with the pterygopalatine fossa medial to reach the lacrimal gland, to which they are secretomotor. The maxillary artery gives off several branches here, before passing into the pterygo palatine fossa. The infratemporal fossa lies between the mandible later Muscles ally and the lateral pterygoid plate of the sphenoid bone medially. The maxilla lies in front and the petrous part of the muscles of mastication associated with this region the temporal bone behind. It is bounded above by the are the temporalis, masseter, lateral pterygoid, and base of the skull and extends down to the level of the medial pterygoid muscles (Figure 1–14). The temporalis muscle arises from the temporal bone and passes medial to the zygomatic arch to attach to the coro Temporomandibular Joint noid process of the mandible. Its anterior fibers elevate the mandible, and its posterior fibers retract the mandible. The capsule of the joint is attached to the neck of the man the masseter muscle arises from the lower border of the dible below and the margins of the mandibular fossa above. The lateral pterygoid muscle arises from both the lateral the joint contains a fibrocartilaginous, intracapsular aspect of the lateral pterygoid plate and the sphenoid bone articular disc that divides the joint into upper and lower above, attaching to the neck of the mandible and the artic synovial cavities. Its contraction produced by the protraction and retraction of the man protracts the mandible along with the articular disc. Additional details of mandible is produced primarily by the lateral pterygoid the chorda tympani and the lingual nerve are described muscle, assisted by the medial pterygoid and masseter in the sections on the salivary glands and the mouth. Elevation of the mandible (clenching the teeth) is the inferior alveolar nerve courses into the mandibular produced by the anterior fibers of the temporalis, the canal and carries sensation from the roots of the lower masseter, and the medial pterygoid muscles.
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Qn-Hr-xpS=f and his family are particularly well known residents of Deir el-Medina owing to Qn-Hr-xpS=f ‘s long-held status as scribe and the unusual preservation of his large collection of papyri. They are published primarily by Gardiner (1935) in association with the British Museum and were clearly written in multiple hands spanning several decades in the Ramesside period, suggesting that these records were maintained and augmented by multiple generations. The majority of the papyri recovered in this collection include some kind of preventative or reactive medical text (see Table 3. Those papyri in this corpus without a medical function are generally fragmentary. In general, very few medical ostraca have been identified in Egypt,63 perhaps due to the length of medical texts which often involve multiple treatments for the same illness. This preference for papyri makes the medical texts even more elusive at Deir el-Medina, as the majority of preserved texts we have come from ostraca. Second, despite the fact that no member of the family of Qn-Hr-xpS=f was identified as part of a medical profession, the family still owned texts specifically medical in nature. The texts even include a passage mentioning that the treatments are specifically for the use of a swnw, physician (P. This may either suggest that there was a special interest in medical papyri within this family, or, as is more likely, that medical texts could be privately owned by individuals with levels of literacy that were high enough to understand them. Edwin Smith) in conjunction with the use of specific medical terminology in these texts serves to relegate them to only the most literate and makes them more exclusive. What motivated this control over medical knowledge through private ownership and specialized terminology? As demonstrated in the next chapter, medical services were paid, and therefore 63 Only four ostraca are translated in the Grundriss (Grapow et al. Secrecy and control of the medical texts therefore could have reduced the number of people with this specialized knowledge. Deir el-Medina scribes like Qn-Hr-XpS=f would have been ideally situated to use medical knowledge as a commodity. On the one hand, they had access to the literacy necessary to understand and compile medical texts— knowledge usually reserved only for the elites. On the other, as members of a community defined as a royal labor force, they would have wanted to seek out opportunities to enhance their financial and social position. Therefore, they had both the skills and motivation necessary to develop and maintain these medical texts. Out of the 10 medical ostraca identified by Stuhr (2011),64 nine date to the New Kingdom and at least six of these were recovered from Deir el-Medina (Table 3. This begs the question: why separate individual treatments onto ostraca in the first place, if it was indeed more economical to place a series of treatments on papyri? I suggest that these ostraca were specifically created in order to transfer knowledge between scribes, as lists for procuring ingredients, and as a means to augment an existing medical papyrus. Therefore, while medical papyri were developed and maintained as rubrics for general treatment for non-specific cases, the presence of medical ostraca attest to the individualized medical care provided at Deir el-Medina.
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These results suggest that lifestyle, race/ethnicity and socio-economic status affect symptoms in this Cross-cultural vasomotor symptom reporting age group (Gold et al. Age at menopause of Japanese Anthropological research has consistently shown that the preva American women was significantly later than that of Hispanic, lence of vasomotor symptom reporting, notably hot flushes and non-Hispanic White, African-, or Chinese-American women night sweats, is not distributed equally either between or among (Gold et al. Beyene car Relative to non-Hispanic Caucasians, African-American, ried out research among rural Mayans living in the Yucatan, Japanese-American and Chinese-American women had lower Mexico, where women have numerous pregnancies and extended odds of experiencing mood symptoms including feeling blue, cycles of amenorrhoea associated with prolonged lactation and nervous or irritable (Bromberger et al. African-Ameri malnutrition and found no reporting of either hot flushes or cold can women had amore positive attitude towards menopause sweats. In contrast, Greek peasant women, whom she also stu than Hispanic or non-Hispanic White women, and Japanese died, reported symptoms similar to those commonly reported and Chinese-Americans expressed the most negative attitudes across northern Europe (Beyene, 1986). Compared with non-Hispanic White Findings from research carried out in India (Flint, 1975), women, Chinese and Japanese-American women were less Indonesia (Flint and Samil, 1990; Boulet et al. Consumption of the soy isoflavone genistein was reporting should be understood as ‘a form of communication’ on not associated with vasomotor symptoms in any ethnic group the part of women, and speculate that vasomotor distress may be (Gold et al. The assumption in making such interpretations is that Japanese living in Japan (Kimira et al. Nevertheless, when subjective reporting does not coincide with the findings 500 Culture and symptom reporting at menopause anticipated by the researchers then women are, in effect, misre nopausal Japanese-Americans had avasomotor symptom rate of presenting their symptom experience. These examples illustrate the over half of the respondents in Malaysia and Philippines difficulties and limitations of comparing symptom rates and reported hot flushes (Boulet et al. In Nigeria (Okonofua identifying relevant factors without first controlling for methodo et al. One third to one half of reporting requires data on factors influencing the occurrence and women surveyed in countries in the Arab world reported them experience of hot flushes. Areview of literature published in the last 4 and race/ethnicity may also be associated with hot flushes years found population rates of hot flushes ranging from 15. Some of the factors that have been found to posi versus 1month versus since age 40 (Chim et al. While these studies have identified factors that their actual menopausal status (something that is particularly may influence vasomotor symptoms, the direction and extent of difficult to establish in ethnic groups in which multi-parity is the effect may vary between populations and individuals. For example, arecent detailed analysis of aJapanese called for before firm conclusions can be drawn on the basis of non-clinical population reported rates of hot flushes of 24. Sensitivity the latter rate is similar to the hot flush prevalence observed in to the complexity of linguistic expressions (Zeserson, 2001) and an Australian population in late perimenopausal and early translation of bodily terms across languages is often absent. This late perimenopausal women may differ significantly in their is problematic because such women often show different symp hormone levels (Santoro, 2002), and thus separation of these tom reporting (Gold et al. Very groups in analyses may be important in identifying women who often women are asked to recall what may have happened 5or are most likely to experience vasomotor symptoms.
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