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Co-Director, Washington State University Elson S. Floyd College of Medicine

The straight sinus lies in the triangular interval where the lower edge of the posterior part of the falx cerebri joins the tentorium cerebelli antibiotic hair loss cheap phagocin 250 mg with amex. Anteriorly virus free screensavers order 100mg phagocin fast delivery, it receives the inferior sagittal sinus antibiotics for sinus infection cipro cheap phagocin 250mg without prescription, and a vein from the interior of the brain called the great cerebral vein (42. Posteriorly, the straight sinus ends by becoming continuous with the transverse sinus of the side opposite to that with which the superior sagittal sinus is continuous i. These are the superior sagittal sinus, the straight sinus and the right and left transverse sinuses (see below). The occipital sinus lies in the midline in relation to the floor of the posterior cranial fossa. Here the dura is raised into a fold called the falx cerebelli; and the sinus lies within this fold. Chapter 42 Blood Vessels of Head and Neck 857 Coronal section through the posterior cranial fossa (behind Coronal section through middle cranial fossa to show the foramen magnum) to show the position of some intracranial the position of some intracranial venous sinuses venous sinuses b. The anterior end of the occipital sinus bifurcates into two channels that pass round either side of the foramen magnum to join the corresponding sigmoid sinus. The right sinus is usually a continuation of the superior sagittal sinus and the left sinus is usually a continuation of the straight sinus, but this arrangement is sometimes reversed. Each sinus runs in a curve at first laterally and then forwards, along the line of attachment of the tentorium cerebelli. The sinus produces a transverse groove on the inner surface of the occipital bone, and on the posteroinferior angle of the parietal bone. Finally, it reaches the petrous part of the temporal bone where it becomes continuous with the sigmoid sinus. The right and left sigmoid sinuses are continuations of the corresponding transverse sinuses. It first runs downwards and medially in a deep groove on the mastoid part of the temporal bone, and then across the jugular process of the occipital bone. Finally, it runs forwards to reach the jugular foramen where it ends by becoming continuous with the upper end of the internal jugular vein. The upper part of the sinus is related anteriorly to the mastoid antrum from which it is separated only by a thin plate of bone. The right and left cavernous sinuses are so called because their cavities are traversed by delicate strands of tissue that appear to subdivide each sinus into a number of smaller spaces (or caverns). They are placed anteroposteriorly on either side of the body of the sphenoid bone. The artery is accompanied by the abducent nerve that lies below and lateral to it. From above downwards, these are the oculomotor nerve, the trochlear nerve, and the ophthalmic division of the trigeminal nerve. The maxillary division of the trigeminal nerve runs along the inferior angle of the sinus. Medially, the sinus is related above to the hypophysis cerebri, and below it is separated from the sphenoidal air sinus by a plate of bone. A pouch like extension of dura mater containing the trigeminal ganglion (trigeminal cave) projects into the posterior part of the sinus.

In paralysis the movement is weak on the affected side (due to paralysis of the sternocleidomastoid muscle) antibiotics diarrhea buy phagocin 100 mg visa. The neurons that give origin to these fibres are located in the hypoglossal nucleus that is shown in 43 antibiotic 3 day dose order phagocin 100mg with amex. The hypoglossal nerve emerges from the medulla by ten to fifteen rootlets that are attached in the vertical groove separating the pyramid from the olive (43 antimicrobial textiles 250 mg phagocin with amex. The hypoglossal nerve leaves the cranial cavity through the hypoglossal canal (or anterior condylar) canal. On emerging at the base of the skull the nerve lies deep (medial) to the internal jugular vein and internal carotid artery. It passes downwards to reach the interval between these vessels, and then runs vertically between them, up to the level of the angle of the mandible (43. Here the nerve passes forwards crossing the internal and external carotid arteries, and enters the submandibular region. In the submandibular region the hypoglossal nerve at first lies superficial to the hyoglossus muscle and then to the genioglossus. These supply all the intrinsic and extrinsic muscles of the tongue (except the palatoglossus that is supplied, along with other muscles of the palate, by the cranial accessory nerve) (also see below). In the initial part of its course the nerve passes laterally behind the internal carotid artery, the glossopharyngeal nerve and the vagus. The nerve then winds round the lateral side of the inferior ganglion of the vagus to reach the front of the nerve. Just before the nerve turns forwards (near the angle of the mandible) it lies deep to the posterior belly of the digastric muscle. Emerging from under this muscle the nerve loops round the inferior sterno-cleidomastoid branch of the occipital artery (43. As the nerve runs forwards in the neck it crosses the internal carotid artery, the external carotid artery and the loop formed by the lingual artery. The loop of the lingual artery is crossed just above the tip of the greater cornu of the hyoid bone. As the nerve runs forwards above the greater cornu of the hyoid bone it is crossed by the digastric tendon and the stylohyoid. As the hypoglossal nerve crosses the hyoglossus the lingual nerve, the submandibular duct and the deep part of the submandibular gland lie above it (43. The hypoglossal nerve itself supplies the muscles of the tongue (styloglossus, hyoglossus, genioglossus, and intrinsic muscles). A meningeal branch arises from the nerve as it passes through the hypoglossal canal. The fibres of this branch are probably derived from the upper cervical nerves and from the superior cervical sympathetic ganglion. The nerve gives a descending branch that forms the superior root of the ansa cervicalis. Branches from the hypoglossal nerve also supply the thyrohyoid and geniohyoid muscles (43. Like the fibres of the descending branch the fibres of these branches are also derived from the first cervical nerve. Functional Component the fibres of the hypoglossal nerve are classified as somatic efferent because the muscles of the tongue develop from somites (occipital somites). Protrusion of the tongue is produced by the pull of the right and left genioglossus muscles.

On the visceral surface antibiotic resistance markers in genetically modified plants discount phagocin 100 mg mastercard, the line of demarcation between these territories lies roughly along the fossa for the gall bladder antimicrobial 220 buy discount phagocin 500 mg on-line. On the posterior part of the liver antibiotic drugs buy 500mg phagocin otc, the line lies along the groove for the inferior vena cava. On the anterosuperior part of the diaphragmatic surface, the line is not marked by any surface feature. It can be represented roughly by a line joining the fundus of the gall bladder and the upper end of the inferior vena cava (red lines in 28. Note that the caudate and quadrate lobes lie in the territory drained by the left hepatic duct. Each lobe, thus defined is divisible into a number of segments based on the branching pattern of the hepatic ducts within the liver. On the visceral surface it corresponds to the quadrate lobe, and the caudate lobe. The medial and lateral parts of the left lobe are each divided into superior and inferior segments. It is important to remember, however, that there are no surface features to outline the segments, and that there is considerable individual variation in the size and relationship of individual segments to the surface of the liver. The subdivision is, therefore, not very useful to a surgeon wanting to remove a part of the liver. Further Consideration of Peritoneal Folds Attached to the Liver the Lesser Omentum 1. The lesser omentum consists of two layers of peritoneum that are continuous with the peritoneum lining the anterior and posterior surfaces of the stomach (28. It is attached by its lower edge to the lesser curvature of the stomach and to the proximal portion of the first part of the duodenum. This attachment is to the fissure for the ligamentum venosum and to the lips of the porta hepatis (28. Extending between the duodenum and the right extremity of the porta hepatis the lesser omentum has a free edge formed by continuity of the anterior and posterior layers. The structures that lie between the two layers of the omentum near its free edge are: i. Along the lesser curvature of the stomach, the right and left gastric arteries and veins lie within the omentum. The right margin of the omentum forms the anterior boundary of the aditus to the lesser sac. The anterior layer of peritoneum forming the omentum can be traced down to the front of the pylorus and the commencement of the duodenum. The caudate lobe is bounded on the left side by the fissure for the ligamentum venosum. The lesser omentum extends to the bottom of the fissure where its layers are reflected on to the walls of the fissure. In this way, a narrow recess of the cavity of the lesser sac comes to lie behind the caudate lobe. The peritoneum lining the posterior surface of the caudate lobe is reflected on to the diaphragm along the upper border of the lobe thus forming the upper limit of the superior recess of the lesser sac. The falciform ligament is attached on the anterior and superior parts of the diaphragmatic surface of the liver. Its lower part is attached anteriorly to the anterior abdominal wall, the attachment extending up to the level of the umbilicus and posteriorly it has a free edge formed by continuity of the two layers of peritoneum (right and left) that form it.

The flexor digiti minimi brevis is supplied by the digital branch for the lateral side of the fifth toe antibiotics for persistent uti buy phagocin with mastercard. This nerve also supplies the interosseous muscles that lie between the fourth and fifth metatarsal bones antibiotic 127 pill cheap phagocin online visa. The deep branch supplies all interossei except those lying between the fourth and fifth metatarsals k. pneumoniae antibiotic resistance discount 250 mg phagocin overnight delivery. It also supplies the 2nd, 3rd and 4th lumbrical muscles, and the adductor hallucis. The skin on the lateral side of the little toe and the contiguous sides of the fourth and fifth toes is supplied by the corresponding digital branches. Stroking the lateral side of the sole of the foot (and carrying the stroke towards the base of the great toe) results in reflex flexion of the toes. Sciatica Part 2 Lower Extremity Pressure on the lumbosacral nerve roots is often produced by prolapse of an intervertebral disc. Typically, the condition causes severe pain that begins in the gluteal region and radiates down the back of the thigh and leg to reach the foot (sciatica). Congenital deformities are frequently seen in the region of the ankle and foot, and are of various types. In the most common variety of deformity the foot shows marked plantar flexion (= equinus: like the foot of a horse), and inversion (= varus: inward bend). A flat footed person may have difficulty in walking long distances, or in running. This condition is often associated with neurological disorders (including poliomyelitis). In hallux valgus, there is lateral deviation of the big toe that may come to lie below, or above, the second toe. In hallux rigidus, there is pain and limitation of movement of the big toe at the metacarpophalangeal joint. The affected toe is hyperextended at the metacarpophalangeal joint, flexed at the proximal interphalangeal joint, and again hyperextended at the distal interphalangeal joint. Some other Clinical Conditions in the Foot Metatarsalgia is a condition in which there is pain in the forefoot on walking. The pain is usually located in the interspace between the 3rd and 4th toes and is caused by pressure on the digital nerve present here. The condition can be prevented by trimming the nail straight and making sure that it does not grow into soft tissue. Infection can be drained by an incision parallel to the medial border of the foot. This joint corresponds in structure to that of a secondary cartilaginous joint (See chapter 9). The sacrum articulates on each side with the corresponding ilium forming the right and left sacroiliac joints. The iliac and sacral surfaces are both shaped like the auricle (pinna) and are, therefore, called auricular surfaces. The surfaces are covered by cartilage, but because of the presence of a number of raised and depressed areas the joint allows little movement. The main bond of union between the sacrum and ilium is, however, the interosseous sacroiliac ligament that is attached to rough areas above and behind the auricular surfaces of the two bones. The posterior aspects of the sacrum and ilium are connected by a strong dorsal sacroiliac ligament which covers the interosseous ligament from behind. Two other ligaments that connect the sacrum to the hip bone are the sacrotuberous and the sacrospinous ligaments that have been encountered in the gluteal region (14. The lateral margin of the lower part of the sacrum and the upper part of the coccyx.

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