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Rheology (a time period invented by Bingham and formally adopted in 1929) may be outlined as the examine of the flow and deformation properties of matter. Historically the importance of rheology in pharmacy was merely as a way of characterizing and classifying fluids and semisolids. For instance, all pharmacopoeias have included a viscosity standard to control substances corresponding to liquid paraffin. As a consequence, a proper understanding of the rheological properties of pharmaceutical materials is important for the preparation, growth, analysis and efficiency of pharmaceutical dosage forms. This article describes rheological behaviour and techniques of measurement and can type a foundation for the applied research described in later chapters. Newtonian fluids Viscosity coefficients for Newtonian fluids Dynamic viscosity the definition of viscosity was placed on a quantitative basis by Newton. He was the primary to notice that the speed of circulate is immediately associated to the applied stress : the fixed of proportionality is the coefficient of dynamic viscosity, extra usually referred to simply because the viscosity. A velocity gradient will therefore exist and this can be calculated by dividing the speed of the upper layer in m s-1 by the peak of the cube in metres. The resultant gradient, which is effectively the rate of flow however is often referred to as the speed of shear or shear price, and its unit is reciprocal seconds (s-1). The applied stress, often known as the shear stress, is derived by dividing the utilized drive by the realm of the upper layer, and its unit is N m-2. For a colloidal dispersion, the equation derived by Einstein could additionally be used Dynamic viscosity at 20 �C (mPa s) zero. The values of the viscosity of water and some examples of different fluids of pharmaceutical interest are given in Table 6. Viscosity is inversely related to temperature (which ought to always be quoted alongside every measurement); in this case the values given are those measured at 20 �C. The kinematic viscosity can be used and could additionally be defined because the dynamic viscosity divided by the density of the fluid v= (6. The cgs unit was the stoke (1 St = 10-4 m2 s-1), which together with the centistoke (cS), should be found in the literature. When the dispersed phase is a excessive molecular mass polymer, then a colloidal resolution will outcome and, supplied reasonable concentrations are used, Eq. However, it does endure from the apparent drawback that the idea is made that each one polymeric molecules form spheres in resolution. Its value offers a sign of the interaction between the polymer molecule and the solvent, such that a positive slope is produced for a polymer that interacts weakly with the solvent, and the slope turns into less constructive as the interaction will increase. A change in the value of the Huggins fixed can be utilized to consider the interplay of drug molecules in resolution with polymers. The intercept produced on extrapolation of the line to the ordinate will yield the constant k1 (Eqn 6. However, as soon as these constants have been determined, viscosity measurements present a quick and exact methodology for the viscosity-average molecular mass determination of pharmaceutical polymers similar to dextrans, that are used as plasma extenders. Furthermore, the values of the two constants present a sign of the form of the molecule in solution: spherical molecules yield values of = 0, whereas extended rods have values higher than 1. The velocity, which might be nearly zero at the surface, increases with growing distance from the surface until the bulk of the fluid is reached and the rate becomes constant. The region over which such differences in velocity are observed is referred to as the boundary layer, which arises as a end result of the intermolecular forces between the liquid molecules and people of the surface result in a discount of motion of the layer adjacent to the wall to zero. Its depth depends on the viscosity of the fluid and the speed of circulate within the bulk fluid. High viscosity and a low circulate fee will end in a thick boundary layer, which can become thinner as both the viscosity falls or the flow rate or temperature is increased. This sort of flow is described as streamline or laminar flow, and the liquid is taken into account to circulate as a sequence of concentric cylinders in a way analogous to an extending telescope. If the pace of the fluid is elevated, a critical velocity is reached at which the thread begins to waver and then to break up, although no mixing happens. When the speed is increased to higher values, the dye instantaneously mixes with the fluid in the tube, as all order is lost and irregular motions are imposed on the overall movement of the fluid: such move is described as turbulent circulate. In this type of move, the movement of molecules is completely haphazard, although the average motion will be in the direction of move. Reynolds experiments indicated that the move situations have been affected by four elements: namely, the diameter of the pipe and the viscosity, density and velocity of the fluid. Furthermore, it was proven that these components might be mixed to give the following equation Re = Laminar, transitional and turbulent move the situations beneath which a fluid flows via a pipe, for example, can markedly have an effect on the character of the flow. At low move charges the dye formed a coherent thread which remained undisturbed on the centre of the tube and increased little or no in ud (6. Re is called the Reynolds number and if appropriate items are used, it goes to be dimensionless. Values of Reynolds number in a circular crosssection pipe have been decided that can be associated with a particular kind of flow. For instance, if the floor is smooth, then laminar move will not be disturbed and may exist at values of a Reynolds quantity larger than 2000. However, if the floor is tough or the channel tortuous, then circulate may nicely be turbulent at values less than 4000, and even as little as 2000. Nevertheless, the Reynolds number remains to be an important parameter and can be used to predict the type of move that will happen in a specific situation. In laminar move the fluid layers will act as a barrier to such transfer, and due to this fact mass transfer can happen solely by molecular diffusion, which is a a lot slower process. A range of capillary bores are available, and an applicable one should be chosen so that a flow time for the fluid of approximately 200 seconds is obtained; the wider-bore viscometers are thus to be used with fluids of higher viscosity. The viscometer is then clamped vertically in a constant-temperature water bathtub and allowed to reach the required temperature. The time for the meniscus to fall between marks E and F is then recorded, and determinations ought to be repeated till three readings all within zero. V W Determination of the circulate properties of simple fluids A big selection of instruments exists that can be used to determine the move properties of Newtonian fluids. However, solely a few of these are capable of offering knowledge that can be utilized to calculate viscosities in basic units. The fee of flow of the fluid by way of the capillary is measured beneath the influence of gravity or an externally applied pressure. Consequently, for a fluid of viscosity 1 mPa s, the maximum shear price is roughly 2 � 103 s-1 if the capillary has a diameter of zero. This instrument is a modification of the U-tube viscometer which avoids the necessity to fill the instrument with a precise quantity of fluid. It additionally addresses the truth that the strain head within the U-tube viscometer is frequently altering as the 2 menisci approach one another. The viscometer is clamped vertically in a constant-temperature water tub and allowed to attain the required temperature. Tube Z is closed and fluid is drawn into bulb C by the appliance of suction by way of tube W till the meniscus is simply above the mark E. Tube W is then closed and tube Z opened in order that liquid can drain away from the underside of the capillary. Tube W is then opened and the time the fluid takes to fall between marks E and F is recorded.

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The larger absorptive energy of the upper stomach or subphrenic space is because of its larger surface space and because respiratory movements aid absorption. Therapeutically, considerable volumes of fluid could be administered through the peritoneal route. Conversely, metabolites, like urea may be faraway from the blood by artificially circulating fluid through the peritoneal cavity. Healing energy and adhesions: the mesothelial cells of the peritoneum can remodel into fibroblasts which promote therapeutic of wounds. Storage of fats: Peritoneal folds are capable of storing large amounts of fats, particularly in obese individuals. Provides passage for nerves, vessels and lymphatics to and from the suspended viscera. Laparoscopy is the examination of the peritoneal cavity under direct vision utilizing an instrument called laparoscope. Greater omentum limits the unfold of infection by sealing off the location of ruptured vermiform appendix or gastric ulcer and tries to delay the onset of peritonitis. Inflammation of parietal peritoneum causes localized severe ache and rebound tenderness on removing the fingers. The midgut types the relaxation of the duodenum, the jejunum, the ileum, the appendix, the caecum, the ascending colon, and the right two-thirds of the transverse colon. The hindgut forms the left one-third of the transverse colon, the descending colon, the sigmoid colon, proximal part of the rectum. The anorectal canal varieties distal part of rectum and the upper a half of the anal canal up to the pectinate line. The belly a half of the foregut is suspended by mesenteries both ventrally and dorsally. The ventral mesogastrium turns into divided by the developing liver right into a ventral half and a dorsal half. The larger or caudal part of the dorsal mesogastrium turns into tremendously elongated and varieties the higher omentum. The spleen develops in relation to the cranial a half of the dorsal mesogastrium, and divides it into dorsal and ventral elements. The cranial most a part of the dorsal mesogastrium forms the gastrophrenic ligament. The midgut and hindgut have solely a dorsal mesentery, which forms the mesentery of jejunum and ileum, the mesoappendix, the transverse mesocolon and the sigmoid mesocolon. The part of the peritoneal cavity known as the lesser sac between the second and third layers will get obliterated, aside from about 2. Contents 1 the best and left gastroepiploic vessels anastomose with one another within the interval between the primary two layers of the higher omentum a little below the larger curvature of the stomach. Attachments the anterior two layers descend from the higher curvature of the stomach to a variable extent, and fold upon themselves to form the posterior two layers which ascend to the anterior surface of the head, and the anterior border of the physique of the pancreas. The folding of the omentum is such that the primary layer turns into the fourth layer and the second layer turns into the third layer. In its upper half, the fourth layer is partially fused to the anterior floor of the transverse colon and of 1 It is a storehouse of fats. Collections of macrophages kind small, dense patches, known as milky spots, that are seen to the bare eye. On this account, the higher omentum is also identified as the policeman of the stomach. The larger omentum forms a partition between the supracolic and infracolic compartments of the greater sac. This fold contains the ligamentum teres of the liver or the obliterated left umbilical vein in its free posterior border. Examine the posterior surface of the mirrored lower components of anterior belly wall. Identify the parietal peritoneum, adherent to the parieties or walls of the belly cavity. Trace it from the walls to kind various double-layered folds which unfold out to enclose the viscera as the visceral peritoneum. Cut through the anterior layers of the greater omentum 2�3 cm inferior to the arteries to open the decrease part of the omental bursa sufficiently to admit a hand. Pull the liver superiorly and lift its inferior margin anteriorly to expose the lesser omentum. Examine the right free margin of lesser omentum, containing the bile duct, correct hepatic artery and portal vein. This free margin types the anterior boundary of the opening into the lesser sac, i. Superior to opening into the lesser sac is the caudate strategy of liver and inferiorly is the first part of duodenum. Remove the anterior layer of peritoneum from the lesser omentum along the lesser curvature of the stomach. Trace the best gastric artery to the right hepatic artery and the vein to the portal vein. Follow the widespread hepatic duct to the porta hepatis and the bile duct till it passes posterior to the duodenum. Attachments Inferiorly, the lesser omentum is connected to the lesser curvature of the abdomen and to the upper border of the first 2 cm of the duodenum. Contents the right free margin of the lesser omentum accommodates: 1 the proper hepatic artery; 2 the portal vein; three the bile duct; four Lymph nodes and lymphatics; and 5 the hepatic plexus of nerves, all enclosed in a perivascular fibrous sheath. Border it is a fold of peritoneum which extends from the lesser curvature of the abdomen and the primary 2 cm of the duodenum to the liver. The portion of the lesser omentum between the stomach and the liver known as the hepatogastric ligament, and the portion between the duodenum and the liver known as the hepatoduodenal the hooked up border, or root of the mesentery, is 15 cm lengthy, and is directed obliquely downwards and to the best. It extends from the duodenojejunal flexure on the left facet of vertebra L2 to the upper a half of proper sacroiliac joint. It crosses the next structures: 1 the third part of the duodenum the place the superior mesenteric vessels enter into it 2 the belly aorta three the inferior vena cava four the right ureter 5 the proper psoas main. Distribution of Fat Fat is most abundant in the decrease part of the mesentery, extending from the basis to the intestinal border. The upper part of the mesentery contains much less fats, which tends to accumulate near the root. Near the intestinal border, it leaves oval or round fats free, translucent areas, or home windows. Cut by way of the proper layer of peritoneum of the mesentery along the line of its attachment to the posterior abdominal wall and strip it from the mesentery. Dissect the branches to the jejunum, ileum, caecum, appendix, ascending colon, right two-thirds of Section 2 Abdomen and Pelvis It is a small, triangular fold of peritoneum which suspends the vermiform appendix from the posterior floor of the lower end of the mesentery close to the ileocaecal junction. Usually the fold extends as a lot as the tip of the appendix, but typically it fails to attain the distal one-third or so. Remove the peritoneum and fats on the posterior belly wall between the mesentery and descending colon to expose the inferior mesenteric vessels and the autonomic nerves and lymph nodes associated with them. Trace the three taeniae on the exterior floor of the colon and cranial to the basis of the vermiform appendix.

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It develops from paramesonephric ducts or urogenital sinus and is thought to be homologous with the vagina of feminine. Lowermost a part of prostatic urethra is fastened by puboprostatic ligaments and is, therefore, immobile. Membranous Part ground with heterogenous mixture of sluggish and quick twitch type of bigger diameter. So gradual twitch fibres of sphincter are able to sustained contraction over long period of time and contribute to tone that closes the urethra and maintains urinary continence. Pubourethral part of levator ani, essential to resist surges of intra-abdominal pressure (on coughing or exercise). Descends with a slight ventral concavity from the prostate to bulb of penis, passing via the perineal membrane. Muscle coat consists of relatively skinny layer of bundles of easy muscle, which are continuous proximally with these of prostatic urethra and a distinguished outer layer of the circularly oriented striated muscle fibres (rhabdosphincter) which kind external urethral sphincter. External sphincter represents points of highest transurethral pressure within the regular, and contracted states. Intrinsic striated muscle is made from fibres of very small diameter, devoid of muscle spindles, physiologically being sluggish twitch kind, not like pelvic Anterior or spongiosus part lies in corpus spongiosum and is 16 cm lengthy when penis is flaccid. Part of anterior urethra which is surrounded by bulbospongiosus known as bulbar urethra and is extensive part of urethra. It is slender and slit-like when empty and has diameter of 6 mm when passing urine. External urethral orifice is the narrowest a part of urethra and is a sagittal slit, 6 mm lengthy, bounded on each side by a small labium. Epithelium of urethra, particularly in bulbar and distal penile segments, presents orifice of quite a few small glands and follicles situated within the submucous tissue known as urethral glands. It contains numerous small pit-like recesses, or lacunae of various size whose orifices are directed forwards. One lacuna larger than the rest is lacuna magna which is situated on the roof of navicular fossa. Arteries Section 1 Urethral artery arises from inner pudendal artery just under perineal membrane and travels through corpus spongiosum to attain glans penis. Veins 2 Anterior urethra dorsal vein of penis inner pudendal vein which drains into prostatic venous plexusinternal iliac veins. Lymphatic Drainage Each paraurethral duct runs down within the submucous tissue and ends in a small aperture on the lateral margins of exterior urethral orifice. Veins Prostatic plexus supplies the graceful muscle of prostate and prostatic urethra. Greater cavernous nerves are sympathetic to preprostatic sphincter throughout ejaculation. It begins at the inside urethral orifice of bladder, roughly reverse center of the pubic symphysis and runs anteroinferiorly behind the symphysis pubis, embedded in anterior wall of vagina. It crosses the perineal membrane and ends at external urethral orifice as an anteroposterior slit with rather distinguished margins situated instantly anterior to the opening of vagina and a pair of. Except throughout passage of urine, anterior and posterior walls of canal possess a ridge which is termed urethral crest. Many small mucous urethral glands and minute pit-like recess or lacunae open into urethra. On all sides, close to the decrease end of urethra, a selection of these glands are grouped and open into a duct, named paraurethral duct. Posteriorly as the perineal membrane and the membranous layer of superficial fascia are continuous with the fascia around superficial transverse perinei. So, extravasated urine goes anteriorly into the free connective tissue of scrotum and penis and then to anterior stomach wall. Sensory fibres in pelvic splanchnic nerves attain to 2nd�4th sacral segments of spinal cord. Muscle coat: Outer sheath of striated muscle/external urethral sphincter or distal sphincter mechanism along with easy muscle. Female external urethral sphincter is anatomically separate from the adjacent periurethral striated muscle of the anterior pelvic flooring, i. The sphincter varieties a sleeve which is thickest anteriorly within the middle one-third of urethra, and is relatively deficient posteriorly. The striated muscle extends into the anterior wall of each proximal and distal thirds of urethra, however is poor posteriorly. Muscle cells forming external urethral sphincter are all small diameter slow twitch fibres. A few circularly arranged muscle fibres happen within the outer aspect of non-striated muscle layer that are oblique or longitudinally oriented and these intermingle with striated muscle fibres forming inner elements of external urethral sphincter. Distally, urethral easy muscle terminates in subcutaneous adipose tissue round exterior urethral meatus. Smooth muscle of feminine urethra receives an in depth presumptive cholinergic nerve supply, however a few noradrenergic fibres. [newline]In the absence of an anatomical sphincter, competence of female bladder neck and proximal urethra is unlikely to be totally dependent on clean muscle exercise and might be related to help offered by ligamentous buildings which encompass them. Longitudinal orientation and the innervation of muscular tissues means that urethral smooth muscle in feminine is energetic during micturition and serves to shorten and widen urethral lumen. If that is uncared for, rhythmic reflex contractions of the detrusor muscle begin, which turn into more and more powerful as the quantity of urine increases. The voluntary holding of urine is due to contraction of the sphincter urethrae and of the perineal muscles, with coincident inhibition of the detrusor muscle. This is adopted by firm contraction of the detrusor and rest of the proximal urethral sphincter mechanism. Lastly, distal urethral sphincter mechanism relaxes, and the move of urine begins. In the male, the final drops of urine are expelled from the bulbar portion of the urethra by contraction of the bulbospongiosus. In such instances, a rubber tube called a catheter is handed into the bladder through the urethra. The condition is associated with ectopia vesicae and absence of infraumbilical part of anterior stomach wall. The lumen of allantois will get obliterated to form urachus connecting the apex of the bladder to the umbilicus. Trigone of bladder is fashioned by the absorption of mesonephric ducts and is mesodermal in origin. As the bladder has ruptured, a couple of blood vessels are injured, making the urine red. Urine would move in the pelvic cavity and behind ascending and descending colons into the paracolic gutters. When the patient is rolled to right aspect, urine escapes to proper facet and the note over the descending colon will get resonant. A complete description of the arterial provide of the human bladder, including variations and anomalies. This study, along with its companion article in regards to the male urethral sphincter anatomy, dispelled the long-standing errors surrounding a urogenital diaphragm and corrected the anatomy of the urethral sphincter. This paper considers the development of the cloacal area and its separation into enteric and urogenital components.

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The midbrain passes via the tentorial notch, and is expounded on each side to the parahippocampal gyri, the optic tracts, the posterior cerebral artery, the basal vein, the trochlear nerve, and the geniculate our bodies. The major subdivisions of midbrain are as follows: 1 the tectum is the half posterior to aqueduct. It is crossed by optic tract, basal vein, posterior cerebral and superior cerebellar arteries from the medial facet, of this oculomotor nerve and from lateral facet, trochlear nerve emerges. In the past, it has been thought of because the centre for auditory reflexes, but the out there evidence indicates that it helps in localizing the supply of sounds. White Matter Transverse Section of Midbrain on the Level of Superior Colliculi Grey Matter 1 the crus cerebri incorporates: a. Temporopontine, parietopontine and occipitopontine fibres within the lateral one-sixth. The lemnisci (medial, trigeminal, spinal and lateral) are arranged within the form of a band by which they lie within the order talked about (from medial to lateral side) like a necklace. The medial longitudinal bundle lies in close relation to the trochlear nucleus (somatic efferent column). It decussates within the superior medullary velum, and emerges lateral to the frenulum veli. Nucleus of oculomotor nerve with EdingerWestphal nucleus within the ventromedial half. It controls reflex movements of the eyes, and of the head and neck in response to visual stimuli. The pretectal nucleus is an important a half of the pathway for light reflex and the consensual reflex. Its lesion causes Argyll Robertson pupil in which the light reflex is misplaced but lodging reflex stays intact. It receives afferents from the superior cerebellar peduncle, globus pallidus, subthalamic nucleus and cerebral cortex. It gives efferents to the spinal wire (rubrospinal tract), reticular formation, thalamus, olivary nucleus, subthalamic nucleus, and so forth. The similar lemnisci as seen in the lower half apart from the lateral lemniscus which has terminated within the inferior colliculus. The decussation of the tectospinal and tectobulbar tracts varieties the dorsal tegmental decussation. The decussation of the rubrospinal tracts forms the ventral tegmental decussation. These fibres attain up to interstitial nucleus of Cajal at the upper finish of aqueduct. Tremors and twitching of reverse facet as a outcome of damage to purple nucleus and superior cerebellar peduncle. Features include weakness of upward gaze and vertical nystagmus because of lesion of superior colliculus. The fibres of light reflex take following course: Retina optic nerve optic chiasma optic tractsome fibres to pretectal nucleus of each side Edinger-Westphal nucleus3rd nerve nucleus and 3rd nerve ciliary ganglion short ciliary nerves pupil constricts. A person affected by syphilis complains of lack of ability to see in response to gentle thrown within the eyes, whereas he can learn and see nearby things: � Where is the lesion Ans: In such cases, the light reflex is misplaced, whereas lodging reflex is retained. Such a 1�10 From Medical Council of India, Competency based Undergraduate Curriculum for the Indian Medical Graduate, 2018;1:44�80. Draw a labelled diagram of transverse part of medulla oblongata on the stage of sensory decussation. Temporopontine, parietopontine and occipitopontine fibres in lateral one-sixth half d. The anterior side of the cerebellum is marked by a wide and deep notch in which the pons and medulla are lodged. It is limited in entrance by the fissura prima (on the superior surface), and by the posterolateral fissure (on the inferior surface). Where each the superior and inferior surfaces of the cerebellum are drawn in a single aircraft. The upper part of the diagram, above the horizontal fissure, represents the superior surface; and the lower half, under the horizontal fissure represents the inferior surface. It is made up of the anterior lobe (except lingula), and the pyramid and uvula of the inferior vermis. It is made up of the posterior/middle lobe (the largest part of the cerebellum) except the pyramid and uvula of the inferior vermis. It is primarily involved with the regulation of nice actions of the physique (Table 6. Lateral Zone Connected with affiliation areas of the mind and is involved in planning, programming and coordination of muscular activities of the whole physique. It is completed through dentato-rubro-thalamo-cortical tract, descending corticospinal tracts. Concerned with management of muscles of distal parts of limbs like hands and feet by way of rubrospinal tract. Planning and programming of purposeful and rapid actions including their length and termination � Acts as a suggestions centre between cerebral cortex and peripheral motor movements Spinocerebellum Dorsal spinocerebellar Ventral spinocerebellar Cuneocerebellar tract Reticulocerebellar Trigeminocerebellar Pontocerebellar tract Olivocerebellar Cerebelloreticular Cerebello-olivary Neocerebellum Dentatothalamic Dentatorubral Table 6. Inferior cerebellar peduncle (connects cerebellum to medulla oblongata) Afferent tracts 1. Posterior spinocerebellar Cuneocerebellar (posterior external arcuate fibres) Olivocerebellar Parolivocerebellar Reticulocerebellar Vestibulocerebellar Anterior exterior arcuate fibres Striae medullaris Trigeminocerebellar 1. This is in marked contrast to cerebrum which controls the opposite half of the body. It controls and coordinates these by affecting agonists, antagonists and synergists. Spinocerebellum, vermis and intermediate areas receive afferents from motor cortex by way of corticopontocerebellar fibres. All sensory data of muscular tissues, joints, cutaneous, auditory and visual elements are relayed right here. It corrects and modifies ongoing movements via thalamocortical projections, reticulospinal and rubrospinal tracts. These sufferers present inattention, grammatical errors in speech and patchy reminiscence loss. Intention tremors (tremors solely during movements) tested by finger-nose and heel-knee checks. Adiadochokinesia which is incapability to perform fast and common alternating movements, like pronation and supination. Nystagmus is to and fro oscillatory movements of the eyeballs while trying to either facet. The cortex incorporates three layers: 1 Molecular layer: It consists of unmyelinated nerve fibres which are derived from the parallel fibres of axons of granule cells, axons of stellate and basket cells, sensory climbing fibres, dendrites of Purkinje and Golgi cells. Each fibre gives collateral branches to synapse with deep cerebellar nuclei and make monosynaptic contacts after coiling across the non-spinous a half of the dendritic tree of 1 Purkinje cell.

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The trigeminal nerve is hooked up to this surface at the junction of the pons with the peduncle. The nerve has two roots-a small motor root which lies medial to the much larger sensory root. The connected abducent, facial and vestibulocochlear nerves are at the lower border of the ventral surface on the junction of pons and medulla oblongata. Neuroblasts from the alar plate of the neural tube at this stage will produce the sensory nuclei of the medulla. In transverse sections, the pons is seen to be divisible into ventral and dorsal components. The ventral or basilar part is continuous inferiorly with the pyramids of the medulla, and on all sides with the cerebellum by way of the center cerebellar peduncle. The dorsal or tegmental part is a direct upward continuation of the medulla (excluding the pyramids). Grey Matter It is represented by the nuclei pontis that are scattered among longitudinal and transverse fibres. Some of these nuclei get displaced during improvement, and type the arcuate nucleus (see medulla) and the pontobulbar body. The ventral or anterior floor is convex in both instructions and is transversely striated. Tegmental Part/Dorsal Part partly to nuclei of the corpus trapezoideum, and to nuclei of the lateral lemniscus. White Matter However, the construction of the tegmental part differs in the higher and lower parts of the pons. The vestibular nuclei lie deep to the vestibular space in the flooring of the fourth ventricle, partly within the medulla and partly within the pons. They receive the fibres of the vestibular nerve, and provides efferents to the cerebellum (vestibulocerebellar), the medial longitudinal bundle, the spinal cord (vestibulospinal tract arising in the lateral vestibular nucleus) and the lateral lemniscus. The dorsal and ventral cochlear nuclei are located dorsal and ventral to the inferior cerebellar peduncle. They obtain the fibres of the cochlear nerve, and provides efferents largely to the superior olivary nucleus and 1 the trapezoid body or corpus trapezoideum is a transverse band of fibres lying simply behind the ventral a half of the pons. They first cross backwards and medially to reach the medial side of the abducent nucleus. This loop is responsible for producing an elevation, the facial colliculus, in the flooring of the fourth ventricle. The anterior spinothalamic tract carries details about crude touch and crude stress. The trigeminal lemniscus incorporates fibres arising in the spinal nucleus of the trigeminal nerve and travelling to the thalamus. It is formed by fibres arising in nuclei lying in close relation to the trapezoid physique (superior olivary nucleus and nucleus of trapezoid body). Hyperpyrexia as a end result of slicing off of the temperature regulating fibres from the hypothalamus. Ipsilateral facial paralysis and lack of taste in anterior two-thirds of tongue and hyperacusis because of injury to fibres of facial nerve. Absence of corneal reflex on the facet of lesion because of damage to nucleus of V nerve including its spinal tract. Cells of alar lamina migrate to kind the pontine nuclei, cochlear and vestibular nuclei, trigeminal sensory nucleus. Basal plate neuroblasts give rise to abducens nucleus, facial nucleus, motor nucleus of trigeminal and superior salivatory nucleus. Its cavity is named the cerebral aqueduct of Sylvius (French anatomist 1478�1555). These neurons migrate dorsally and type the rhombic lip which types the cerebellum. In its centre, the paleocerebellum develops, splitting the archicerebellar elements into two parts-the lingula and flocculonodular lobe. Lastly, the paleocerebellar half can additionally be cut up by the development of neocerebellum in its centre into two parts-the anterior lobe besides lingula and pyramid with uvula. Stellate cell and basket cell: Their cell our bodies are at right angles to the long axis of the folium. They receive enter from parallel fibres, climbing fibres and mossy fibres and output to granule cells. Sensory Fibres of Cerebellum the afferent connections of cerebellum are via mossy and climbing fibres. Mossy fibres represent all A 40-year-old female complained of incapability to work correctly together with her right hand. The tumour has disrupted these capabilities, giving rise to symptoms from which she is struggling. Which of the next regions of cerebellum is concerned with planning and programming muscular actions Archicerebellum and paleocerebellum management muscles of hand, finger, ft and toes d. It is a tent-shaped space located between the pons and upper part of medulla oblongata in front and cerebellum behind. So it lies dorsal to pons and upper part of medulla oblongata and ventral to cerebellum. Parts It is divisible into: 1 An higher triangular half formed by dorsal floor of pons. The intermediate half is extended laterally over the inferior cerebellar peduncle as the ground of lateral recess. This half is marked by transversely operating fibres which are fibres of stria medullaris. The sulcus limitans presents melancholy at the cranial end called superior fovea and in the path of caudal half known as inferior fovea. Deep to the colliculus is the genu of the facial nerve shaped by this nerve looping around the abducent nucleus. The colour is due to presence of pigmented neurons which constitute substantia ferruginea. The superior or cranial part of roof is formed by superior cerebellar peduncles and superior medullary velum. On approaching the inferior colliculi, they converge after which intermingle over the ventricles and form a half of the roof. The superior medullary velum which is made up of nervous tissue fills the angular interval between the 2 superior cerebellar peduncles. The caudal inferior a half of roof in most of its extent consists of an exceedingly thin sheet, totally devoid of nervous tissue and formed by the ventricular ependyma and double fold of pia mater or the tela choroidea of the fourth ventricle which covers it posteriorly.

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Other, more direct, efferent pathways exist from the amygdala, together with the ventral amygdalofugal pathway and direct connections with other cortical, subcortical and brainstem buildings. Direct electrical stimulation of the amygdala can produce intense behavioural, emotional and visceral responses. The olfactory cortex has further projections to the orbitofrontal cortex, the insula, the thalamus (dorsomedial nucleus) and other limbic buildings. Thalamus the septum the septum consists of the septum pellucidum and the septal space. The septum pellucidum is a thin membrane that lies between the anterior horns of the lateral ventricles, extending from the fornix inferiorly to the corpus callosum superiorly. The septal area is taken into account to be a part of the limbic system and consists of a group of paramedian nuclei positioned inferiorly to the podium of the corpus callosum and anteriorly to the lamina terminalis. The septal space receives afferent fibres from the amygdala, the hippocampus via the fornix, the hypothalamus and, via an ascending enter, the brainstem. The septal area can influence behaviour via connections to the hypothalamus and the brainstem. The medial forebrain bundle is a projection from the septal area into various hypothalamic nuclei and the midbrain tegmentum. The stria medullaris thalami receives contributions from the septal area that are steady alongside the lateral partitions of the third ventricle posteriorly and into the habenular nuclei. The habenular nuclei modulate brainstem perform by way of the fasciculus retroflexus. Function the thalamus is the largest a half of the diencephalon and has an essential integrative function for sensory and motor modalities. Other capabilities embody roles in consciousness, the sleep/wake cycle and reminiscence formation. The thalamus receives a quantity of inputs from the spinal cord, brainstem, cerebellum and basal ganglia and relays this to the related cortical areas in the cerebral hemispheres to permit acceptable processing. There is reciprocal innervation between the thalamus and cerebral cortex, which is referred to as corticothalamic and thalamocortical projections. The slim anterior end, the anterior tubercle, varieties the posterior margin of the interventricular foramen. The posterior finish tasks backwards and laterally over the midbrain because the pulvinar. This is much like the optic pathway, however the olfactory system bypasses the thalamus and enters immediately into cortical and subcortical structures. Specialized olfactory epithelium is located within the superior aspect of the nasal cavity. Olfactory nerve cells project their axons via the cribriform plate of the ethmoid bone to synapse with second-order mitral cells in the olfactory bulb. The olfactory bulb is positioned in the olfactory sulcus of the orbital surface of the frontal lobe and continues posteriorly as the olfactory tract. As it approaches the anterior perforated substance, at the degree of the optic chiasm, the tract becomes progressively flatter and triangular in form and is named the olfactory trigone. The olfactory tract divides into two buildings, the medial and lateral olfactory striae. The medial olfactory stria passes to the septal space and the contralateral olfactory bulb. A skinny sheet of white matter incompletely covers the thalamus on the dorsal floor, because the stratum zonale, and on the lateral floor as the exterior medullary lamina. Within the interior medullary lamina are further nuclei termed intralaminar nuclei. The arched higher floor of the thalamus is related medially to the stria medullaris thalami, a fibre bundle passing from the septal space to the habenula. The superolateral surface of the thalamus varieties the floor of the lateral ventricle and is closely related to the stria terminalis (a fibre bundle originating from the amygdala), the thalamostriate vein and the caudate. Between the internal capsule and exterior medullary lamina lies a skinny sheet of gray matter generally identified as the reticular nucleus of the thalamus. Nuclei As described above, every thalamus could be anatomically divided into lateral, medial and anterior nuclear plenty. Other nuclei embody the lateral and medial geniculate nuclei, intralaminar nuclei and reticular nucleus of the thalamus. The ventrobasal nucleus consists of the ventroposterior, ventrolateral and ventroanterior nuclei. The ventroposterior nuclear complicated is of explicit importance for receiving sensory information. The ventral posterior medial nucleus receives the trigeminothalamic tract, conveying sensory data from the orofacial structures. The ventral posterior lateral nucleus receives the dorsal column and spinothalamic pathways. The ventrolateral and ventroanterior nuclei receive motor information from the basal ganglia and cerebellum and project this to the motor cortex. It receives fibres from the mammillothalamic tract and tasks to the cingulate cortex. The medial mass consists primarily of the dorsomedial nucleus and is concerned in emotional responses. It connects the hypothalamus, olfactory cortex and amygdala with the prefrontal cortex. The medial geniculate nucleus is a relay station in the auditory pathway, receiving fibres from the lateral lemniscus; its efferents type the auditory radiation, which passes to the transverse temporal gyrus (primary auditory cortex). The lateral geniculate nucleus receives fibres from the optic tract and its efferents kind the optic radiation that passes to the striate cortex in the occipital lobe. The reticular nucleus is a thin layer of inhibitory neurons veiled over the lateral floor of the thalamus. Thalamocortical and corticothalamic neurons cross by way of the reticular nucleus, thus permitting modulation of thalamocortical activity. This is achieved via the regulation of the autonomic nervous system, orchestrating the majority of the endocrine system through the pituitary gland and controlling thermoregulation, starvation and thirst. At its anterior side is the optic chiasm and behind this is an elevation, the tuber cinereum, which supplies rise to the infundibulum (pituitary stalk). Two small elevations, the mammillary bodies, lie behind the tuber cinereum and separate it from the posterior perforated substance and the cerebral peduncles. The hypothalamic sulcus on the lateral wall of the third ventricle is a groove that separates the thalamus from the hypothalamus. The anterior columns of the fornix fan out into the hypothalamus, dividing each side into medial and lateral elements. The medial elements are composed of the preoptic, supraoptic and paraventricular nuclei. The supraoptic and paraventricular nuclei project to the neurohypophysis to launch antidiuretic hormone and oxytocin into the circulation. Afferent fibres enter the hypothalamus by way of the fornix (hippocampus), stria terminalis (amygdala), anterior limb of the interior capsule (cerebral cortex), medial forebrain bundle (septal area) and dorsal longitudinal fasciculus (multiple brainstem structures). It is considerably spherical in form and is connected to the hypothalamus by the infundibulum.

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Short branches come up both from the marginal artery or from the long branches, and the majority of them directly sink into the bowel wall on the mesocolic border. The short and lengthy branches together thus provide the mesocolic area of the wall with plentiful blood provide. Subserous coat of long branches is intimately related to appendices epiploicae, to which they contribute branches. During removing of those appendages, care should be taken not to pull on them to find a way to avoid traction on the subjacent vessel. Mucosa may herniate in these situations causing diverticulosis, with related dangers of diverticulitis, fibrosis and stricture. Paracolic nodes, on the medial side of the ascending and descending colon and close to the mesocolic border of the transverse and sigmoid colon. In carcinoma of the colon, the associated paracolic and intermediate lymph nodes have to be eliminated. Their elimination is possible solely after the ligature of the principle department of the superior or inferior mesenteric artery along which the involved lymph nodes lie. It is critical, therefore, to take away a big phase of the bowel than is actually required by the extent of the disease, so as to keep away from gangrene on account of interference with the blood supply. It is all the time sensible to take away the entire portion of the bowel provided by the ligated vessel. The midgut territory receives its sympathetic provide from the coeliac and superior mesenteric ganglia (T11 to L1), and its parasympathetic provide from the vagus. Both kinds of nerves are distributed to the gut by way of the superior mesenteric plexus. The hindgut territory receives its sympathetic supply from the lumbar sympathetic chain (L1, 2), and its parasympathetic supply from the pelvic splanchnic nerve (nervi erigentes), both through the superior hypogastric and inferior mesenteric plexuses. The ultimate distribution of nerves within the intestine is much like that in the wall of the small intestine. The parasympathetic nerves are motor to the big intestine and inhibitory to the internal anal sphincter. Pain impulses from the intestine up to the descending colon journey by way of the sympathetic nerves, and from the sigmoid colon and rectum through the pelvic splanchnic nerves. It is situated in the proper iliac fossa, above the lateral half of inguinal ligament. Vessels and Nerves � Large intestine could be immediately considered by a procedure called colonoscopy. The arterial supply of the caecum is derived from the caecal branches of the ileocolic artery. The nerve provide is similar as that of the midgut (T11 to L1; parasympathetic, vagus). Control and Mechanism the decrease finish of the ileum opens on the posteromedial side of the caecocolic junction. Section 1 the valve is actively closed by sympathetic nerves, which cause tonic contraction of the ileocaecal sphincter. Incise the lateral wall of the caecum and locate the ileocaecal orifice and its related valve. The appendix may lie in front of the ileum (preileal) or behind the ileum (postileal). Although the base of the appendix is fastened, the tip can level in any path, as described under. The positions are often 1 the appendicular orifice is located on the posteromedial facet of the caecum 2 cm beneath the ileocaecal orifice. It runs behind the terminal a part of the ileum and enters the mesoappendix at a brief distance from its base. Here it offers a recurrent branch which anastomoses with a department of the posterior caecal artery. The major artery runs towards the tip of the appendix mendacity at first close to to and then in the free border of the mesoappendix. Blood from the appendix is drained by the appendicular, ileocolic and superior mesenteric veins, to the portal vein. Lumen of Appendix Sympathetic nerves are derived from T9 and T10 segments through the coeliac plexus. Referred ache of appendix is felt at umbilicus, just like that of small gut and testis. Lymphatic Drainage It is type of small and may be partially or fully obliterated after mid-adult life. Peritoneal Relations Most of the lymphatics pass directly to the ileocolic nodes, but a couple of of them cross not directly via the appendicular nodes situated in the mesoappendix. Abdomen and Pelvis the operation for elimination of the appendix known as appendicectomy. Some anatomical facts related to the analysis and therapy of appendicitis are as follows: � Pain brought on by appendicitis is first felt within the region of the umbilicus. Note the reality that each the appendix and the umbilicus are innervated by section T10 of the spinal twine; appendix by sympathetic fibres and umbilicus by somatic fibres. This is brought on by involvement of the parietal peritoneum of the region (remember that parietal peritoneum is sensitive to ache, however visceral peritoneum is not): Appendicitis is widespread as a outcome of: i. The level lies on the junction of the lateral one-third and the medial two-thirds of the line becoming a member of the umbilicus to the proper anterior superior iliac spine. It is because of passage of contaminated lymph to the subpyloric nodes which trigger irritation of pylorus. The flexure lies on the lower a part of the left kidney and diaphragm, behind the stomach, and beneath the anterior end of the spleen. The flexure is attached to the eleventh rib (in the midaxillary line) by a horizontal fold of peritoneum, called the phrenicocolic ligament. This ligament helps the spleen and forms a partial upper limit of the left paracolic gutter. Section 2 Abdomen and Pelvis Transverse colon is about 50 cm long and prolong across the abdomen from the right colic flexure to the left colic flexure. The differences between proper two-thirds and left one-third of transverse colon are tabulated in Table 20. Descending colon is about 25 cm long and extends from the left colic flexure to the sigmoid colon. It is suspended by the sigmoid mesocolon and is covered by coils of small intestine. Duodenum is supplied both by branches of coeliac axis (artery of foregut) and by branches of superior mesenteric artery (artery of midgut). Muscularis Externa Outer longitudinal coat is thickened at three locations to type taenia coli.

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The deep slip divides into two components which embrace the flexor tendons, and blend with the fibrous flexor sheaths and with the deep transverse metatarsal ligaments. From the margins of the aponeurosis, lateral and medial vertical intermuscular septa move deeply, and divide the only real into three compartments. Thinner transverse septa come up from the vertical septa and divide the muscular tissues of the solely real into four layers. Functions 1 Lower Limb the deep fascia overlaying the only real is thick within the centre and thin at the sides. The plantar aponeurosis differs from the palmar aponeurosis in giving off an extra course of to the nice toe, which restricts the actions of the latter. Deep Transverse Metatarsal Ligaments these are four short, flat bands which connect the plantar ligaments of the adjoining metatarsophalangeal joints. They are related dorsally to the interossei, and ventrally to the lumbricals and the digital vessels and nerves. Muscles of Second Layer Section the contents of second layer are the tendons of the flexor digitorum longus, and of the flexor hallucis longus; and the flexor digitorum accessorius and lumbrical muscle tissue. Identify and detach the abductor digiti minimi and identify the lateral head of the flexor digitorum accessorius till its insertion into the tendon of flexor digitorum longus. Trace the long flexor tendons via the fibrous flexor sheath into the bottom of distal phalanges of toes. Cut by way of both the lengthy flexor tendons (flexor hallucis longus and flexor digitorum longus) and flexor digitorum accessorius the place all of the three are united to each other. Reflect the ends proximally and distally to reveal the muscles of third layer of sole. Medial and lateral intermuscular septa Insertion the muscle ends in four tendons for the lateral 4 toes. Opposite the bottom of the proximal phalanx, every tendon divides into two slips that are inserted into the margins of the middle phalanx. Note that the insertion is similar to that of the flexor digitorum superficialis of the hand the tendon fuses with the medial portion of the tendon of the flexor hallucis brevis. It is inserted into the medial facet of the base of the proximal phalanx of the nice toe 2. Abductor hallucis this muscle lies along the medial border of foot, and covers the origin of the plantar vessels and nerves 3. Medial tubercle of calcaneum Flexor retinaculum Deep fascia overlaying it Medial intermuscular septum a. Deep fascia covering it the tendon fuses with the tendon of the flexor digiti minimi brevis. Abductor digiti minimi Nerve supply Medial plantar nerve Medial plantar nerve Main trunk of lateral plantar nerve Actions Flexion of the toes on the proximal interphalangeal joints and metatarsophalangeal joints Abduction of the great toe away from the second toe Abduction of the little toe Lower Limb Table 10. Flexor digitorum longus Nerve supply Tibial nerve Actions Plantar flexion of lateral four toes Plantar flexion of ankle Maintains medial longitudinal arch 1. Flexor digitorum accessorius Main trunk of lateral plantar nerve the first muscle by the medial plantar nerve; and the opposite three by the deep branch of lateral plantar nerve Tibial nerve 1 Section 3. Medial head is large and fleshy; it arises from the medial concave floor of the calcaneum b. The two heads unite at an acute angle They come up from the tendons of the flexor digitorum longus. The first lumbrical is unipennate, and the others are bipennate First lumbrical arises from medial side of 1st tendon of flexor digitorum longus Second lumbrical arises from adjacent sides of 1st and 2nd tendons of flexor digitorum longus Third lumbrical arises from adjoining sides of 2nd and third tendons of flexor digitorum longus Fourth lumbrical arises from adjoining sides of third and 4th tendons of flexor digitorum longus Lower three-fourths of the posterior surface of fibula besides lowest 2. Each is inserted to the plantar surface of distal phalanx of second to fifth digit the muscle fibres are inserted into the lateral side of the tendon of the flexor digitorum longus three. Muscles of the Fourth Layer the structures current in the fourth layer of the sole are the interosseous muscles, and the tendons of the tibialis posterior and of the peroneus longus (Tables 10. Interosseous Muscles of the Foot these are small muscular tissues positioned between the metatarsal bones. On slicing the deep transverse metatarsal ligament on both sides of second toe, tendons of interossei muscles are recognised. Identify and look at the attachment of tendon of tibialis posterior on the medial facet of foot. Trace the course of tendon of peroneus longus by way of the groove in the cuboid bone throughout the sole to its insertions into lateral sides of base of first metatarsal and medial cuneiform bone. The lateral limb, from the medial a part of the plantar surface of the cuboid bone, behind the groove for the peroneus longus and from the adjacent side of the lateral cuneiform bone b. The medial limb is a direct continuation of the tendon of tibialis posterior into the foot Insertion the muscle splits into medial and lateral elements, every of which ends in a tendon. Each tendon is inserted into the corresponding facet of the bottom of the proximal phalanx of the nice toe 2. The oblique head is massive, and arises from the bases of the second, third, and fourth metatarsals, from the sheath of the tendon of the peroneus longus b. The transverse head is small, and arises from the deep metatarsal ligament, and the plantar ligaments of the metatarsophalangeal joints of the third, fourth and fifth toes (transverse head has no bony origin) On the lateral aspect of the base of the proximal phalanx of the massive toe, in frequent with the lateral tendon of the flexor hallucis brevis three. Sheath of the tendon of the peroneus longus Into the lateral aspect of the bottom of the proximal phalanx of the little toe Table 10. Adductor hallucis Nerve provide Medial plantar nerve Deep branch of lateral plantar nerve, which terminates on this muscle Superficial department of lateral plantar nerve Actions Flexes the proximal phalanx at the metatarsophalangeal joint of the great toe 1. Maintains transverse arches of the foot Flexes the proximal phalanx on the metatarsophalangeal joint of the little toe three. Peroneus longus Origin Bases and medial sides of third, fourth and fifth metatarsals Insertion Medial sides of bases of proximal phalanges and dorsal digital/extensor expansions of third, 4th and 5th toes Section 1 Adjacent sides of metatarsal bones Bases of proximal phalanges and dorsal digital enlargement of toes; first on medial facet of 2nd toe; second on lateral aspect of 2nd toe; third on lateral facet of 3rd toe and fourth on lateral aspect of 4th toe Tuberosity of navicular (see Table 9. Third by lateral plantar (superficial branch) First, second, third by lateral plantar (deep branch), fourth dorsal interosseous by superficial branch of lateral plantar Tibial nerve Superficial peroneal nerve Actions Adductors of third, fourth and fifth toes towards the axis. Flexor of metatarsophalangeal and extensor of interphalangeal joints of third, fourth and fifth toes Abductors of toes from axis of second toe. Third and fourth for abduction of third and 4th toes Plantar flexor of ankle (see Table 9. Peroneus longus After learning the muscles of the third layer, detach them from their origins in the direction of their insertions. The posterior tibial artery divides into the medial and lateral plantar arteries somewhat larger than the division of tibial nerve. As a result, the arteries are closer to the margins of the only than the corresponding nerves. This arch lies between the third and 1 the chief arteries of the sole are the medial and lateral plantar arteries. It passes forwards between abductor hallucis and flexor digitorum brevis and divides into its branches. Branches muscles-flexor digiti minimi brevis, the third plantar and fourth dorsal interossei, and the pores and skin on the lateral facet of the little toe. The medial department communicates with the medial plantar nerve, and supplies the skin lining the fourth interdigital cleft. The deep branch provides 9 muscular tissues, together with the second, third and fourth lumbricals; first, second and third dorsal interossei; first and second plantar interossei and adductor hallucis. Here lateral plantar artery varieties a plantar arch across the only which gives numerous branches.

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Usually, the irregular artery passes lateral to the femoral canal in contact with the femoral vein and is secure in an operation to enlarge the femoral ring. Sometimes, however, the irregular obturator artery may lie alongside the medial margin of the femoral ring, i. The authentic axis artery within the uppermost part of the limb is represented by the inferior gluteal artery. Relations of Femoral Artery in Femoral Triangle Anterior: Skin, superficial fascia, deep fascia and the anterior wall of the femoral sheath. [newline]However, the vein progressively crosses to the lateral side to lie posterior to the artery. It is immediately behind the artery on the apex of the femoral triangle, and lateral to the decrease finish of the artery. Branches in the Femoral Triangle the femoral artery offers off three superficial and three deep branches within the femoral triangle. Superficial epigastric for pores and skin and fasciae of lower a part of anterior abdominal wall. Profunda Femoris Artery the ascending branch runs deep to the tensor fasciae latae, gives branches to the hip joint and the greater trochanter, and anastomoses with the superior gluteal artery. The transverse branch pierces the vastus lateralis and takes part within the cruciate anastomosis on the back of the thigh just under the greater trochanter. The descending branch runs down alongside the anterior border of the vastus lateralis, accompanied by the nerve to that muscle. Deep External Pudendal Artery this branch of the femoral artery passes deep to the spermatic twine, or the round ligament of the uterus, and provides the scrotum or the labium majus. Muscular Branches Numerous muscular branches come up from the femoral and profunda femoris artery, or its branches, to provide the muscular tissues of the thigh. It arises from the lateral aspect of the femoral artery about four cm under the inguinal ligament. Continuing downwards, it passes first between the adductor longus and the adductor brevis, and then between the adductor longus and the adductor magnus. Its terminal part pierces the adductor magnus to anastomose with higher muscular branches of the popliteal artery. The medial circumflex femoral artery leaves the femoral triangle by passing posteriorly, between the pectineus and the psoas main muscle tissue. It gives an acetabular, branch and divides into an ascending and transverse branches. In the thigh, it lies within the groove between the iliacus and the psoas major, exterior the femoral sheath, and lateral to the femoral artery. The articularis genu is equipped by a department from the nerve to vastus intermedius. The nerve to the vastus medialis contains quite a few proprioceptive fibres from the knee joint, accounting for the thickness of the nerve. Continuous lines symbolize anterior division and dotted lines symbolize posterior division. It passes obliquely downwards and medially, behind the femoral sheath, to attain the anterior surface of the muscle. In addition to these, some muscle tissue belonging to different areas are additionally encountered on the front of the thigh. The iliacus and psoas major muscles, which form a part of the floor of the femoral triangle, have their origin inside the stomach. The pectineus and adductor longus, additionally seen in relation to the femoral triangle, are muscles of the medial compartment of the thigh. In the higher lateral nook of the front of the thigh, we see the tensor fasciae latae. These are the rectus femoris, the vastus lateralis, the vastus medialis, and the vastus intermedius. It runs roughly vertically on the entrance of the thigh superficial to the vasti. They pull the synovial membrane upwards throughout extension of the knee, thus preventing damage to it. Iliacus and Psoas Major Iliacus and psoas major muscular tissues type the lateral a half of the ground of the femoral triangle. They are categorized as muscle tissue of the iliac area, and in addition among the muscle tissue of the posterior abdominal wall. Since the greater parts of their fleshy bellies lie within the posterior belly wall, they will be described intimately in the part on the stomach. However, on account of their principal action on the hip joint, the following points could also be famous. The psoas is provided by the branches from the nerve roots, whereas the iliacus is supplied by the femoral nerve. The origin and insertions of the parts of the quadriceps femoris are given in Table 3. The articularis genu consists of some muscular slips that come up from the anterior surface of the shaft of the femur, a number of centimetres above the patellar articular margin. Articularis genu Upper three-fourths of the anterior and lateral surfaces of the shaft of femur Anterior floor of femur Suprapatellar bursa/synovial membrane of knee joint *The patella is a sesamoid bone within the tendon of the quadriceps femoris. The ligamentum patellae is the actual tendon of the quadriceps femoris, which is inserted into the higher a half of tibial tuberosity Table 3. Sartorius Nerve supply Femoral nerve Actions Abductor and lateral rotator of thigh Flexor of leg at knee joint these actions are involved in assuming the place during which a tailor work, i. Flexor of hip joint Extends knee joint, helps in standing, walking and running Extends knee joint, prevents lateral displacement of patella. Extends knee joint Pulls the synovial membrane upwards throughout extension of the knee, thus stopping injury to it D. Extent the canal extends from the apex of the femoral triangle, above; to the tendinous opening within the adductor magnus, below. Within the canal it provides off muscular branches and a descending genicular department. The descending genicular artery is the last branch of the femoral artery arising simply above the hiatus magnus. It divides right into a superficial saphenous branch that accompanies the saphenous nerve, and a deep muscular department that enters the vastus medialis and reaches the knee. The femoral vein lies posterior to the femoral artery within the upper part, and lateral to the artery within the lower a half of the canal. Note the boundaries and contents of the canal � the medial wall or roof is formed by a strong fibrous membrane joining the anterolateral and posteromedial partitions. The subsartorial plexus of nerves lies on the fibrous roof of the canal beneath cover of the sartorius. The plexus is formed by branches from the medial cutaneous nerve of the thigh, the saphenous nerve, and the anterior division of the obturator nerve. On lifting the center one-third of sartorius, a half of deep fascia stretching between vastus medialis and adductor muscular tissues is exposed. Ans: the swelling is the femoral hernia which seems at saphenous opening when she coughs because of raised intra-abdominal strain. The femoral hernia is extra frequent in females as a end result of bigger pelvis, larger femoral canal and smaller femoral vessels.

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Scale-up of powder mixing the extent of mixing achieved at a small laboratory scale throughout improvement work could not necessarily be mirrored when the identical formulation is combined at a full production scale, even when the same mixer design is used for both. Often, mixing efficiency and the extent of blending are improved on scale-up owing to elevated shear forces. This is more likely to be helpful generally, although when mixing lubricants care is needed to avoid overlubrication, which may, for instance, lead to soft tablets and delayed disintegration and dissolution. Problems associated with a deficiency of some of the parts of a formulation, which have been encountered at a production scale however not in growth work, have been traced to adsorption of a minor constituent. Drug particle traits may change when the drug is manufactured on a large scale. This in flip might affect the motion of the particles in the mixer and the interaction with other components and therefore the tendency to combine and segregate. The optimum mixing time and conditions should therefore be established and validated at a production scale so that the suitable degree of blending is obtained without segregation, overlubrication or harm to part particles. Flow pattern Mixing of miscible liquids and suspensions Vortex Vertical baffle Mobile liquids with a low viscosity are easily combined with one another. Similarly, solid particles are readily suspended in mobile liquids, although the particles are more probably to settle rapidly when mixing is discontinued. Viscous liquids are more difficult to stir and mix but they scale back the sedimentation fee of suspended particles (discussed further in Chapter 26). The impeller has four flat blades surrounded by perforated inner and outer diffuser rings. One disadvantage is the absence of an axial element, however a different head with the perforations pointing upwards can be fitted if this is desired. As the liquid is compelled by way of the small orifices of the diffuser rings at high velocity, giant shear forces are produced. When mixing immiscible liquids, if the orifices are sufficiently small and velocity sufficiently excessive, the shear forces produced allow the generation of droplets of the dispersed part that are small enough to produce steady dispersions (water-in-oil or oil-in-water dispersions). Turbine mixers of this type (homogenizers) are subsequently typically fitted to vessels used for the large-scale manufacturing of emulsions and creams. These liquids are greatest handled as semisolids and dealt with in the same gear as used for such materials (see later). Mixers for semisolids Planetary mixers this type of mixer is commonly discovered within the domestic kitchen. Double planetary mixers that transfer materials by rotating two identical blades (either rectangular or helical) on their very own axes as they orbit on a standard axis are often used for mixing highly viscous semisolid supplies. As the blades repeatedly advance along the periphery of the mixer vessel, they remove materials from the partitions and transport it in the direction of the inside. Advances in powder mixing and segregation in relation to pharmaceutical processing. Granules are aggregated groups of small particles or particular person bigger particles which may have overall dimensions higher than 1000 �m. Powders exist as a dosage type in their own proper, but the largest pharmaceutical use of powders is to produce tablets and capsules. Together with mixing and compaction properties, the flowability of a powder is of important importance within the manufacturing of pharmaceutical dosage types. Some of the explanations for producing free-flowing pharmaceutical powders embody: � uniform circulate from bulk storage containers or hoppers into the feed mechanisms of tableting or capsule-filling equipment, allowing uniform particle packing and a continuing volume-to-mass ratio so as to preserve pill weight uniformity; � reproducible filling of tablet dies and capsule dosators to enhance weight uniformity and allow tablets to be produced with extra consistent physicomechanical properties; � uneven powder circulate may end up in excess entrapped air within powders, which in some high-speed tableting circumstances could promote capping or lamination; and � uneven powder flow may result from excess nice particles in a powder, which will increase particle� die-wall friction, causing lubrication problems, and elevated mud contamination risks throughout powder switch. There are many industrial processes that require powders to be moved from one location to another, and this is achieved by many various methods, such as gravity feeding, mechanically assisted feeding, pneumatic switch, fluidization in gases and liquids and hydraulic transfer. In every of these examples, powders are required to circulate and, as with different operations described earlier, the effectivity with which they achieve this depends on each process design and particle properties. Adhesive and cohesive forces acting between particles in a powder bed are composed primarily from short-range nonspecific van der Waals forces, which increase as particle size decreases and differ with adjustments in relative humidity. Other attractive forces contributing to interparticulate adhesion and cohesion could additionally be produced by surface tension forces between adsorbed liquid layers on the particle surfaces and by electrostatic forces arising from contact or frictional charging. These could have quick duration but improve adhesion and cohesion by way of enhancing interparticulate contacts and hence increasing the quantity of van der Waals interactions. Cohesion offers a useful methodology of characterizing the drag or frictional forces appearing inside a powder mattress to prevent powder circulate. An object, corresponding to a particle, will begin to slide underneath gravitational forces when the angle of inclination is large enough to overcome frictional forces. Conversely, an object in motion will cease sliding when the angle of inclination is below that required to overcome adhesion/ cohesion. This stability of forces causes a powder poured from a container onto a horizontal surface to form a heap. Initially the particles stack until the strategy angle for subsequent particles joining the stack is giant enough to overcome friction. They then slip and roll over one another until the gravitational forces stability with the interparticulate forces. This angle known as the angle of repose and is a attribute of the internal friction or cohesion of the particles. The value of angle of repose shall be excessive if a powder is cohesive and low if a powder is noncohesive. If the powder may be very cohesive, the heap may be characterized by multiple angle of repose. Initially, the interparticulate cohesion causes a really steep cone to type, but on the addition of further powder, this tall stack could abruptly collapse, inflicting air to be entrained between particles and partially fluidizing the bed, thus making it extra mobile. The resulting heap has two angles of repose: a large angle Particle properties Adhesion and cohesion the presence of molecular forces produces a bent for individual solid particles to stick with each other and to different surfaces. Powders having a particle dimension of lower than approximately 10 �m are often extremely adhesive/cohesive and resist flow under gravity. An necessary exception to this discount in flowability with decrease in size is when the very small particles turn out to be adhered/cohered to larger ones and the flowability of the powder as a complete turns into managed by the bigger particles. This phenomenon is necessary within the concept of ordered mixing (see Chapter 11) and is exploited within the formulation of dry powder inhalers (see Chapter 37). Powders with related particle sizes however dissimilar shapes can have markedly totally different move properties because of differences in interparticulate contact area. For example, a group of spheres has minimal interparticulate contact and usually optimum circulate properties, whereas a group of particle flakes or dendritic particles have a really excessive surface-to-volume ratio, a bigger space of contact and thus poorer circulate properties. Irregularly shaped particles might expertise mechanical interlocking along with adhesive and cohesive forces. By slight vibration of the bed, particles could be mobilized; if the vibration is stopped, the bed is once extra in static equilibrium however occupies a different spatial volume than earlier than. The change in bulk quantity has occurred by rearrangement of the packing geometry of the particles. In basic, such geometric rearrangements end in a transition from loosely packed particles to extra tightly packed ones, in order that the equilibrium steadiness moves from left to right in Eqs 12. Particle size results Because adhesion and cohesion are surface phenomena, particle measurement will affect the flowability of a powder. In basic, fine particles with a really high surface-to-mass ratio are extra adhesive/cohesive than coarser particles.

References

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