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Disorders of the cranial nerves usually produce clear abnormalities, apparent to both patient and doctor alike. The specialists who become involved in the management of patients with cranial nerve problems are neurologists, neurosurgeons, ophthalmologists (cranial nerves 2 4, 6), dentists (cranial nerve 5) and ENT surgeons (cranial nerves 1, 5, 7 10, 12). Cranial nerves 1, 2 and 11 are a little different from the others. Nerves 1 and 2 are highly specialized extensions of the brain, for smell and sight, in the anterior cranial fossa and suprasellar region. Nerve 11 largely originates from the cervical spinal cord, rises into the posterior fossa only to exit it again very quickly, to supply muscles of the neck and shoulder. It is useful to remember that the other cranial nerves (3 10 and 12; Fig. 8.1) can be damaged at three different points along their paths. The lesion may affect the nucleus of the cranial nerve within the brainstem, where its cell bodies lie. Alternatively, the lesion may damage the axons travelling to or from the nucleus but still within the brainstem. In both these situations there is commonly damage to nearby pathways running through the brainstem, so that in addition to the cranial nerve palsy, the patient will often have weakness, sensory loss or ataxia in the limbs. Finally the lesion may affect the nerve itself outside the brainstem as it passes to or from the structure which it supplies. This causes either an isolated cranial nerve palsy, or a cluster of palsies arising from adjacent nerves. Examples of these clusters include malfunction of 5, 7 and 8 caused by an acoustic neuroma in the cerebellopontine angle, or malfunction of 9, 10 and 11 due to malignancy in ltrating the skull base.

4. Start the DTEXT command again. Follow the prompts: Specify start point of text or [Justify/Style]: Right-click and choose Justify. Enter an option [Align/Fit/Center/Middle/Right/TL/TC/TR/ML/MC/MR/BL/ BC/BR]: Right-click and choose Middle. Specify middle point of text: Pick 3 in Figure 13.4. (This point doesn t have to be exact.) Specify rotation angle of text <45>: 0 Enter text: %%UMASTER BATH Enter text: 5. Save your drawing. It should look like Figure 13.5.

Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

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Now, in paint(), instead of drawing on the screen Graphics object, you can draw on this off-screen Graphics object:

Figure 26-11

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with advanced disease most often require laparotomy The surgery is typically performed via vertical skin incision This type of incision provides the best method of exposure to the upper abdomen that may be required for surgery involving the liver, diaphragm, or spleen The rst step in the operation is to get a sense of the extent of disease and obtain enough tissue to send for frozen section and make a diagnosis Can the patient be optimally cytoreduced This question may often dictate the radical nature of the operation For example, if the patient has extensive upper abdominal disease, such as parenchymal liver metastases or diaphragmatic disease, a rectosigmoid resection may not be indicated for cytoreduction unless the patient has symptoms of obstruction These patients may bene t equally from simple hysterectomy and bilateral salpingoophorectomy.

We have only recently become aware of the risks involved in climate change. In 1988, a decisive step was taken with the creation of the Intergovernmental Panel on Climate Change (IPCC), on the joint initiative of the World Meteorological Organisation (WMO) and the United Nations Environment Programme (UNEP). The rst IPCC report led in 1992 to the adoption of the climate convention, currently rati ed by 189 countries. The second report was published in 1996, before the signing of the Kyoto Protocol. The third report, published in 2001, led to the adoption of control measures and sanctions designed to ensure effective application of the Kyoto Protocol [19]. The fourth report, published in 2007, con rms and improves the main conclusions of the previous report. Over 2000 scientists from 154 countries participate in the IPCC studies. Wishing to reach a consensus of opinion, the IPCC has remained prudent

Figure 11.3 shows a typical locking profile of a transaction. The number of locks held bythe transaction grows up to a certain maximum. The transaction can release the lock for an object onlywhen it knows that it will no longer need the object and has acquired all the locks that it needs. It is desirable to release locks as early as possible so that concurrent transactions that need access to the object can acquire their lock. However, due to the complexity involved in deciding whether the it is safe to release a lock, transactions often retain locks to objects and only release them together at the end.

Let us try one more improvement--expanding the two-stage filter to a four-stage filter. Again, the gain magnitude is 0. 1 at 22.05 kHz and can be written

The omentum should be removed (infracolic or total), especially if it is in ltrated by tumor, as removal of the omentum will add to the tumor debulking and decrease postoperative ascites formation The pelvic and para-aortic lymph nodes should be assessed and removed if they are enlarged or if there is no evidence of gross disease 2 cm outside the pelvis (less than stage IIIC disease) The ultimate goal of cytoreductive surgery in advanced ovarian cancer is to remove all visible signs of tumor Multiple studies have evaluated optimal and suboptimal cytoreduction and consistently shown that optimal cytoreduction to at least less than 1 cm residual disease positively impacts survival44, 45 Conversely patient with suboptimal residual disease had a worse 5-year survival.

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