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Passion Flower Uses: Generalized anxiety disorder Interaction/toxicity: Concomitant use with barbiturates can increase drug- 4337 induced sleep time; can potentiate the effects of sedatives and tranquilizers deltasone 5mg with mastercard allergy medicine and cold medicine, including sedative effects of antihistamines order deltasone 40 mg fast delivery allergy testing vials for sale. Quassia Uses: Anorexia cheap 40 mg deltasone otc allergy medicine makes my heart race, indigestion order 10mg deltasone with amex allergy treatment using cold laser for drug withdrawal, fever, mouthwash, as an anthelmintic for thread worms, nematodes, and ascaris Interaction/toxicity: Stimulates gastric acid and might oppose effect of antacids and H2 antagonists. Excessive doses might have additive effects with anticoagulant therapy with Coumadin. Concomitant use of potassium- depleting diuretics or stimulant laxative abuse might increase risk of cardiac glycoside toxicity as a result of potassium loss. Red Clover Uses: Hot flashes Interaction/toxicity: Can increase the anticoagulant effects and bleeding risk because of its Coumarin content. May interfere with hormone replacement therapy or oral contraceptives, and may interfere with tamoxifen because of its potential estrogenic effects. Saw Palmetto Uses: Benign prostatic hypertrophy, antiandrogenic Interaction/toxicity: Potentiates birth control pills and estrogens. May decrease effects of warfarin, steroids, and possibly benzodiazepines and calcium channel blockers. Sweet Clover Uses: Chronic venous insufficiency, including leg pain and heaviness, night- time leg cramps, itching and swelling, for supportive treatment of thrombophlebitis, lymphatic congestion, postthrombotic syndromes, and hemorrhoids 4338 Interaction/toxicity: Use with hepatotoxic drugs might increase risk of hepatotoxicity. Concomitant use with anticoagulant and antiplatelet drugs may increase risk of bleeding. Turmeric Uses: Dyspepsia, jaundice, hepatitis, flatulence, abdominal bloating Interaction/toxicity: Concomitant use with anticoagulant and antiplatelet drugs may increase risk of bleeding. Valerian Uses: Sedative, anxiolytic Interaction/toxicity: Potentiates barbiturates and anesthetics. Vitamin E Uses: Vitamin E deficiency, heart disease Interaction/toxicity: Concomitant use with anticoagulant and antiplatelet drugs may increase risk of bleeding. Willow Bark Uses: Lower back pain, fever, rheumatic ailments, headache Interaction/toxicity: Enough salicylate is present in willow bark to cause drug interactions common to salicylates or aspirin. Can impair effectiveness of beta-adrenergic blockers, probenecid, and sulfinpyrazone. Beyond are general visceral afferent ibres from the the ganglion, the sensory branch of the thorax and abdomen (transmitting pain, trigeminal nerve carries the postganglionic, visceral distension, etc. For pelvic sensation similar ibres parasympathetic branches that pass down reach sacral segments S2,3,4, with their cell to the heart and then each vagus continues bodies in the dorsal root ganglia before they to supply parasympathetic ibres to thoracic enter the dorsal horn of the spinal cord. The the parasympathetics are special visceral preganglionic ibres synapse in peripheral afferents which detect taste and changes in ganglia so that the postganglionic ibres are the baro- and chemoreceptors in the carotid usually short. On the left, pre- connections are in the nucleus solitarius (see and postganglionic ibres pass superiorly summary table of cranial nerve nuclei and via the hypogastric nerves to the superior ibres). The sensation of taste originates in taste Taste buds are found as follows: buds in the mucosa of the tongue and 1 As single buds in the mucosa. The buds are surrounded 2 In fungiform papillae on the anterior by the endings of the gustatory nerves two-thirds of the tongue. Interrupted yellow lines indicate probable additional pathways for sympathetics (see p. It supplies mainly the kidney and upper ureter The greater splanchnic nerve (T5–9) with sympathetic and parasympathetic supplies the coeliac and aorticorenal ganglia ibres although the function of the latter and the suprarenal gland with preganglionic ibres is not clear. The superior mesenteric plexus around The lesser splanchnic nerve (T10,11) the superior mesenteric artery is a supplies the aorticorenal ganglion with downwards extension of the coeliac plexus. Its mixed sympathetic and parasympathetic The least splanchnic nerve (T12) supplies ibres are distributed on this artery. The abdominal aortic (intermesenteric) Each of the splanchnic nerves pierces plexus lies on the aorta between the the crura of the diaphragm to enter the superior and inferior mesenteric arteries. They each carry efferent and It is connected above to the coeliac ganglia afferent ibres. They are supplied by inferior mesenteric and superior hypogastric preganglionic sympathetic ibres from the plexuses. Postganglionic sympathetic input from the irst and second sympathetic ibres leave these ganglia and lumbar splanchnic nerves. The vagus nerves enter the abdomen via The coeliac plexus connects the coeliac the oesophageal opening and distribute ganglia across the midline; it surrounds to abdominal organs and the bowel as far the coeliac truck and extends down to as two-thirds along the transverse colon become the superior mesenteric plexus. The via the coeliac and superior mesenteric coeliac plexus also receives preganglionic plexuses. These preganglionic ibres synapse parasympathetic ibres from the vagus in small ganglia in the walls of the organs nerves. Many leave the plexus on branches surrounds the beginning of the inferior of the coeliac trunk to be distributed to the mesenteric artery and is supplied by the bowel and other organs such as liver and abdominal aortic plexus with additional spleen. Others pass downwards to reach preganglionic sympathetic input from the other plexuses before being distributed second and third lumbar splanchnic nerves. Parasympathetic ibres from the sacral The aorticorenal ganglia are partially outlow (S2,3,4) ascend via the left inferior detached parts of the coeliac ganglia, lying and superior hypogastric plexuses to be just inferiorly. They contribute to both the distributed with the sympathetic ibres on coeliac and renal plexuses. It has postganglionic The majority of sympathetic ibres reaching sympathetic contributions from the coeliac it are preganglionic to the medulla. There and aorticorenal ganglia and preganglionic is no parasympathetic supply to the contributions from the least splanchnic suprarenal gland. It has a few small ganglia for preganglionic ibres that leave the these preganglionic ibres to synapse. The The superior hypogastric plexus lies ibres are preganglionic and synapse in over and just below the bifurcation of the the walls of the organs they supply. It is supplied by ibres continuing are motor to large bowel beyond the left down from the abdominal aortic plexus third of the transverse colon, bladder and (postganglionic) and the third and fourth uterus. It supplies the iliac vessels via from the left inferior hypogastric plexus, the iliac plexuses and the ureter. It also has are those ibres mentioned above that pelvic parasympathetics (S2,3,4) ascending supply parasympathetics to the left large through it on the way to the inferior bowel beyond the distribution of the mesenteric artery to supply bowel from the vagus. The two inferior mesenteric artery, whilst others together make the pelvic plexus. They may run directly to the left colon via the are supplied by pre- and postganglionic retroperitoneum. They sympathetic or parasympathetic and also contain small ganglia for the synapses of at the postganglionic parasympathetic any remaining preganglionic sympathetic endings. All postganglionic sympathetic outlow from this plexus runs on arteries endings have either noradrenalin or to give vasomotor supply and motor ibres adrenalin as the neurotransmitter except to vas, seminal vesicles, prostate, anal and sweat glands which are cholinergic. The parasympathetic efferent (motor) The sacral splanchnics are sympathetic ibres, however, cause glandular secretion preganglionic ibres that leave the and intestinal peristalsis but are inhibitory sympathetic chain to supplement the pelvic to the pyloric and ileocaecal sphincters. S1 and S2 join the pelvic There are also speciic actions of penile/ plexus or hypogastric nerve on each side. S3 clitoral erection and contraction of the and S4 from each side form a plexus on the bladder and uterus.

This is a valuable tool to be able to track changes in maternal blood pressure through- out gestation and the effcacy of novel therapeutic agents in controlling hypertension order 40mg deltasone overnight delivery allergy testing elisa. Current technology is now suffciently developed to allow high fdelity blood pressure recordings over several months with little or no drift buy discount deltasone 40 mg on line allergy shots gain weight. More generally buy deltasone 40mg with mastercard xyzal allergy testing, radiotelemetry can also be applied by researchers working with other disease models seeking to predict the effectiveness and safety of new therapeutic compounds prior to clinical trials discount deltasone 40mg with mastercard allergy testing indianapolis. This results in the clinical features of pre- eclampsia, such as increased proteinuria and gestational hyperten- sion, which resolves upon delivery. Importantly we show here the workfow needed to record high-quality blood pressure data as well as the steps required to verify the clinical validity of the model. Figure 1 presents results that can be expected following stable and reliable telemetry recordings. It is thus important to monitor the changes in blood pressure during normal circadian rhythm, to be able to differentiate between intrinsic and pathogenic fuctua- tions in blood pressure. Five days following sFlt1 and sEng adeno- viral delivery, we observe that blood pressure begins to increase up to a maximum of 10–15% of baseline (Fig. There is also notable proteinuria, as evidenced by an increase in albumin/ creatinine ratio in the urine of the rats over pregnancy (Fig. Traffc in this area should be kept to a minimum, and preferably only investigators should be allowed access to this area. The room should have suffcient ventilation to maintain appropri- ate housing conditions, ambient temperature, moisture, and noise which should be monitored and should also have an automatic day/night switching system. House rats in flter-top cages or if possible individually venti- and Handling lated cages. However, following probe implantation, rats should be housed individually to avoid rats manipulating wound stitches or sutures. Rats should be kept on a 12 h day/night cycle, and when lights are off, investigators should be cautious not to use the room lighting so as not to disturb natural circadian rhythm. Rats should be allowed to acclimatize for 1 week in the experimen- tal holding area before surgery commences. By the end of the acclimatization period, rats should be 12–13 weeks of age, with a body weight of 260 g or more to maximize postsurgical recovery times. Ensure that the tip of the catheter (the pressure-sensing end) is suffciently gelled to improve recording fdelity, if probes have been explanted previously (see Note 1). Set the appropriate calibration values (provided by the manu- facturer on the original packaging of the probes) on the receiv- ers attached to each telemetry plate. Real-Time Blood Pressure Recording Using Radiotelemetry 329 Aorta Incision for Cellulose cannula patch Cannula Fig. After placing the cellulose patch over the incision point, both “legs” of the patch should be pressed down and sealed along the sides of the aorta 3. Transmitter probes are provided sterile from the manufacturer to Surgery (see Note 3). During this time, autoclave surgical instruments (including gauze, applicator sticks, and sterile drapes). After 10–12 h, remove probes from Cidex and wash probes thoroughly in running water for 2–3 min. Pre-warm heating pad, ensuring that dissecting microscope, light source, radio, shaver, and instruments are prepared on the bench. After noting a lack of tail pinch refex and righting response, move the rat onto the silicone breathing cone, making sure to change the isofurane to a level of 1. Carefully monitor the respiration rate of the rat (ideally this should be ~100 breaths per minute). Apply a petroleum-based ointment to the rat’s eyes to prevent damage to the cornea during the surgical procedure. Apply betadine over the shaved surface using sterile gauze, and wipe away with 70% ethanol (see Note 4). Place a sterile drape over the rat, precutting a window which will lie over the exposed abdominal area, approximately 5 cm × 5 cm. Ensure that hind limbs and other areas with unclipped fur are cov- ered to create a sterile feld. This will also assist with maintaining the rat’s core body temperature during the surgical procedure. Using sterile cotton-tipped applicator sticks, move the intes- tines, colon, kidney, spleen, and stomach aside to expose the descending aorta. The ideal positioning of the cannula is such that the aortic clip should be placed just below the left renal branch. This allows suffcient clearance for the aortic clip, sutures, and cannula incision. Use sterile gauze dipped in warm saline, wrap the internal organs, and tuck the gauze under the muscle on each side of the incision to hold them in place and reduce moisture loss. Place a self-retaining tissue retractor, ensuring the teeth are placed on the sterile gauze and not underlying organs to pre- vent damaging them. Using the curved blunt forceps, isolate the aorta by separating the connective tissue between the aorta and vena cava, directly below the left renal branch point (Fig. Pull through a ~20 cm silk suture, clamp with a hemostat, and pull upward to restrict the blood fow through the aorta. Pull through a ~20 cm silk suture, clamp with a hemostat, and pull downward to restrict the backfow of blood through the aorta. Prepare for aortic occlusion; ensure that your cannula, cannula holder, and bent 23-G syringe needle (see Note 6) are placed within reach. Real-Time Blood Pressure Recording Using Radiotelemetry 331 Silk suture Schwarz Aorta vessel Vena cava clip Fig. The clip should be placed as high as possible near the bifurcation of the vena cava to the renal artery 11. Make an incision on the aorta in the middle of the isolated aortic segment using the bent 23-G needle. While keeping the needle tip in place, slide the cannula of the telemetry probe underneath. Slowly advance the cannula while retracting the needle tip, pulling the needle upward if necessary. Once the Vetbond is completely dry, release the bottom hemostat and the Schwarz clip (see Note 8). Ensure the intestines fall back into place smoothly by flooding the abdominal cavity with 2 mL of saline with Tribactral. Carefully massage the organs back into place, making sure not to entangle the probe catheter in the rat’s organs.

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Pulmonary artery pressure was subsequently stable deltasone 40 mg line allergy symptoms dizzy, but wedge Our patient had advanced end­stage heart pressure went up deltasone 10mg generic allergy treatment pollen, indicating a reduction in failure complicated by renal failure due to pulmonary vascular resistance buy 20 mg deltasone free shipping allergy testing dermatologist. Pulmonary cardiorenal syndrome with an acute kidney saturation did increase with the nitroprusside deltasone 20 mg on line allergy testing los angeles, injury. With the degree of right­sided heart failure suggesting a signifcant improvement in forward and severe pulmonary hypertension, she initially fow with vasodilatation (see. However, she did tolerate a high dose of et al (2005) Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular nitroprusside suggesting she might beneft from assist device in patients with revascularized acute further aferload reduction. She continued on myocardial infarction complicated by cardiogenic elevated doses of both hydralazine and isosorbide shock. Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L In the interim, we considered short­term (2008) A randomized clinical trial to evaluate safety and efcacy of a percutaneous left ventricular assist solutions to allow time for improved hepatorenal device versus intra-aortic balloon pump for treatment function in the setting of cardiogenic shock. J Thorac Cardiovasc Surg 141(4): stable with improved renal and hepatic function (see 932–939. Cheng J, den Uil C, Hoeks S, van der Ent M, Jewbali L References et al (2009) Percutaneous left ventricular assist devices vs intra-aortic balloon pump counterpulsation for 1. At the frst decompensated cardiac myopathy, postcar- encounter for patients with cardiogenic shock, diotomy shock, and fulminant myocarditis. Moreover, these patients always restore hemodynamic instability and end-organ receive antiplatelet therapy before and afer percu- function and may improve outcomes following taneous coronary intervention or other causes. In this report, despite optimal medical therapy, bridge-to-deci- the 90-day mortality was 6. Tese patients ofen Considering these results, one-stage durable have simultaneous hepatic dysfunction. Patients with severe acute pulmonary injury, simultaneous in cardiogenic shock ofen show some degree of implantation of a temporary right ventricular biventricular dysfunction. Lorusso R, Centofanti P, Gelsomino S, Barili F, Di membrane oxygenator support for right ventricular Mauro M, Orlando P et al (2015) Venoarterial failure following implantable left ventricular assist extracorporeal membrane oxygenation for acute device placement. Eur J Cardiothorac Surg 49: fulminant myocarditis in adult patients: a 5-year multi- 73–77 institutional experience. J Am Coll Cardiol circulatory support for fulminant myocarditis 61(3):313–321 complicated by cardiogenic shock. Saito S, Matsumiya G, Sakaguchi T, Miyagawa S, Naka Y (2005) Left ventricular assist device Yoshikawa Y, Yamauchi T et al (2010) Risk factor implantation after acute anterior wall myocardial analysis of long-term support with left ventricular infarction and cardiogenic shock: a two-center study. Circ J 76:1631–1638 139:1316–1324 121 11 Bridge to Transplant and Destination Therapy Strategies in the United States Yasuhiro Shudo, Hanjay Wang, Andrew B. Decisions about candidacy heart transplantation and have no absolute for each strategy should be made collaboratively contraindications to transplant, but who have by an experienced heart failure team, including medical, social, or fnancial barriers to transplant both surgeons and cardiologists, and reassessed as candidacy at the time of evaluation) and bridge to dictated by the patient’s clinical course. A thorough listed for heart transplant at the time of device assessment of operative risk and potential implantation. Tus, for end- therapy, the overall operative risk combines stage heart failure patients with contraindications those associated with two surgeries instead of to heart transplantation, commonly including one. Tese operation would involve a redo sternotomy and patients also experience signifcant improvements repeat cardiopulmonary bypass, both of which in quality of life based on assessments such as the are associated with increased operative risk. As introduced are less ill and who have not yet developed sequelae previously, the prospectively randomized of end-stage cardiac insufciency. Te pump can generate Support fows up to 10 L/min, operating at pump speeds of 6,000 rpm to 15,000 rpm. Patient-specifc durability of the pump and also allow for a factors that should be considered include the reduction in the size and weight of the device. For right but in the absence of treatment, mortality within ventricular support, the right atrium and 6 months was 48%. With a total displaced volume is compatible with patients of almost any body of 50 mL and weight of 160 g, the HeartWare size. Using a transplanted patients surviving to hospital magnetically and hydrodynamically levitated discharge [21]. Te replacement biventricular support had survival- to- of mechanical bearings by the frictionless, transplantation rates of 41% and 55%, respectively. Te device consists of a 65 mL stroke eliminates any other abnormalities of the native volume pump placed in a paracorporeal position heart, including valve dysfunction and outside of the body on the abdomen anteriorly, arrhythmias. Te device weighs 200 g and is randomized study of 200 transplant-ineligible implanted into the pericardial space. A continuation 10 L/min and also features pump speed of this study more recently demonstrated modulation, allowing for antithrombotic cycling updated 1- and 2-year survival rates to be 73% to prevent thrombosis of the pump. Anand I, Maggioni A, Burton P et al (2006) The seattle decade, signifcant progress has been made with heart failure model: prediction of survival in heart regard to patient selection and management, failure. J Thorac challenge heart transplantation as the standard of Cardiovasc Surg 137(4):971–977 care for advanced heart failure. Mancini D, Lietz K (2010) Selection of cardiac management of chronic heart failure in the adult: a transplantation candidates in 2010. Circulation report of the American College of Cardiology/ 122(2):173–183 Review American Heart Association Task Force on Practice 16. N Engl J Med 370(1):33–40 with a continuous fow left ventricular assist device as a 20. Presented at the International Society for Recommendations for the use of mechanical Heart and Lung Transplantation 35th Annual Meeting circulatory support: device strategies and patient and Scientifc Sessions, 15–18 Apr, Nice 131 12 Mechanical Circulatory Support as Bridge to Recovery Michael Dandel and Stephan Schueler 12. Myocardial recovery in recurred in about one half of them during the patients who were successfully weaned from first 10 post-weaning years. In weaned patients “recovery” with freedom from future heart with nonischemic cardiomyopathy as the events. However, improvement in myocyte contraction and the few studies on reverse remodeling at cellular relaxation [6, 10, 12]. In a study (synthetic thrombin inhibitor) infusions (2 μg/kg/ which compared long-term outcomes of patients min started 1 h before of-pump trials) [22]. Before the which might interfere with possibly still ongoing frst of-pump trial, it is useful to perform stepwise recovery. Tus, if underwent assessments of cardiac recovery incomplete interruption of unloading already exclusively at rest [9, 22]. If the patient remains asymptomatic but adaptation to stress, the weaning results appeared. Te same the risk of myocardial exhaustion with negative group also uses cardiopulmonary exercise impact on an ongoing myocardial recovery process. However, in border- explant cardiac stability of ≥10 years can reach line cases, of-pump data on deformation velocity 90%. Exercise testing also appeared as well as on intraventricular synchrony and predictive for recovery.

The upper parathyroid glands (glandulae parathyroideae superiores) lie between the fibrous capsule of the thyroid gland and visceral fascia plate endocervicalis at the cricoid cartilage in the middle of the distance between the upper pole and the isthmus of the thyroid gland generic deltasone 40 mg otc allergy symptoms pressure behind eyes, adjacent to the rear surface of its shares cheap deltasone 40mg otc allergy treatment pollen. The lower parathyroid glands (glandulae parathyroideae inferiores) are located at the lower pole on the rear surface of the thyroid lobe between the fibrous capsule and visceral fascia plate endocervicalis in the area where entering the lower thyroid artery order 20mg deltasone mastercard allergy medicine injections. In order to preserve the parathyroid glands by removing the thyroid gland - should separate out the bottom part of the thyroid gland deltasone 10mg sale allergy symptoms 3 year old, while retaining all the “panicle” vessels— ramifications of the inferior thyroid artery (a. The medial surface of the gland adjacent to the sublingual, lingual and styloglossus. The upper edge of the iron in contact with the inner surface of the body of the mandible and the lower part is getting out of its lower edge. By the submandibular gland suitable arterial branches of the facial artery and venous branches diverging in the same vein. Afferent innervation of the prostate made fibers lingual nerve (of the mandibular nerve - the third branch of the trigeminal nerve, V pair of cranial nerves). Afferent innervation of the gland is carried out by the fibers of the lingual nerve (From the mandibular nerve - the third branch of the trigeminal nerve, V pair of cranial nerves). Sympathetic fibers pass to the gland of the plexus around the external carotid artery. The tissue between the platysma and 2nd cervical fascia neck branch of the facial nerve and the upper branch of n. Fascia surrounds iron freely without fusing with it and not giving in depth cancer processes. The upper part of the outer surface of the gland adjoins directly to the periosteum of the mandible; internal (deep) rests on the surface of the iron mm. Abscess does not tend to spread to surrounding tissues Figure 53 Typical localization of abscesses and abscesses of the neck a - sagittal section: 1 - retropharyngeal abscess; 2 - extradural abscess; 3 - abscess nuchal region; 4 - retrotrahealny presternal abscess abscess; 6 - interapneuroticum episternal abscess; 7 - abscesses previsceral space; 8 – abscess behind esophagus Pathotopography (Fig. Hyperal abscess (retropharyngeal abscess) is formed as a result of suppuration of the lymph nodes and pharyngeal pharynx space. Pathogens penetrate the lymphatic pathways from the nasal cavity, nasopharynx, auditory tube and middle ear. There are the following types of retropharyngeal abscesses: Figure 54 Patotopographic anatomy of the neck 1 – a. Epipharyngeal - located above the palate Mesopharyngeal - localized between the root of the tongue and the edge of the palatal curtain Hypopharyngeal - located below the root of the tongue Mixed - occupying several anatomical zones. The abscess is located in the pharyngeal space, which is located behind the pharynx. Limited to the rear of the prevertebral fascia, in front of theparapharyngeal fascia, from the sides to the pharyngeal-vertebral fascial spurs. At the top it starts from the base of the skull, below it passes into the cellulose located behind the esophagus (the back cerebral cell space of the neck), the latter passes into the fiber of the posterior mediastinum. With the formation of retropharyngeal abscesses, the purulent process can quickly spread along the course of loose fiber, into the posterior mediastinum with the development of a dangerous posterior mediastinitis. In the X-ray examination of the pharynx in the lateral projection, the inflammatory process in the pharyngeal space is characterized by the widening of its shadow; The pharyngeal abscess manifests itself in the form of a shadow in a certain area. Retro-tracheal abscess is an inflammatory process, localized between the trachea and esophagus. The abscess blends the trachea anteriorly, as a result, the narrowing of its lumen is observed. Purulent exudate compresses the recurrent guttural nerves, the lower thyroid arteries. Behind the esophagus abscess is most often located in a slotted retrovisceral space filled with loose fiber and spreading from the base of the skull to the posterior mediastinum up to the diaphragm. The abscess also squeezes the thoracic duct, right intercostal arteries, the terminal sections of the semi-unpaired and additional semi-unpaired veins. The epidural abscess develops more often in the middle chest and lower lumbar regions, where the epidural space is best expressed. The formation of an abscess leads to compression of the spinal roots, and then of the spinal cord. Pre-tracheal abscess is an accumulation of pus between the parietal and visceral sheets of the 4th fascia. With a massive inflammatory process, it is possible to squeeze the main neurovascular bundle of the neck surrounded by vagina carotica, which is formed by the parietal leaf of the 4th fascia. Figure 54 depicts the pathological tortuosity of the right internal carotid artery, the right external carotid artery, which arises as a result of stenosis of the right internal carotid artery. These vessels cross each other, as a result of which the right internal carotid artery shifts to the anterior region of the neck and partially covers the posterior abdomen of the digastric muscle; The right external carotid artery is displaced to the lateral processes of the cervical vertebrae, which is not observed in the norm, a. Carotis interna, departs from the common carotid artery at the level of the upper edge of the thyroid cartilage. It does not enter the cranial cavity through the sleep canal, but goes to the facial part of the skull, where it splits into terminal branches. In cases of absence of the internal carotid artery, the lack of blood supply to the brain is compensated by a much greater development of the corresponding arteries of the opposite hemisphere, as well as by the unusual development of vertebral arteries. Ectopia of the tissue of the thyroid gland is a condition in which tissues of the thyroid are located not only in the natural location of the gland, but also go beyond it. Figure 55 Ectopic and normal arrangement of the various types of goiter 1 - craw of the tongue; 2 - internal goiter; 3 - schitoyazychny goiter; 4 - cyst shchito-lingual duct; 5 - predgortanny goiter; 6 - normally located thyroid gland; 7 - intratracheal goiter; 8 - retrosternal goiter Language ectopic manifestations are the most common type of anomalies in 90% of cases of this condition. Such formations can be divided into the sublingual and sublingual or appear at the level of the hyoid bone. The tooth of the root of the tongue can develop both from dystopic and aberrant thyroid tissue. The root of the tongue is located mainly along the midline of the tongue in the region of the foramen caecum and rarely in the region of one of the halves of the tongue. The knot has a rounded shape, a smooth surface, a wide base, clear boundaries, located partly in the thickness of the tongue, unshifted. As a result of compression of the neighboring anatomical-topographical structures and formations, the goiter node can cause a change in the voice-the appearance, so-called, of the nasal voice, sensation of the foreign body in the pharynx, followed by the development of dysphagia or aphagia. The cyst of the shield-lingual duct is located on the neck along the median line in the pre- tracheal space of the neck, it can be either front from behind the hyoid bone, in most cases the cysts are connected to the hyoid bone. Less commonly, the arteries are squeezed, namely, the subclavian and internal mammary arteries. There is compression of the nervous tables, the recurrent nerve, sympathetic trunk, brachial plexus and diaphragmatic nerve can be squeezed. Intratracheal goiter is a goiter that forms in the uninfected thyroid duct, covered with the hyoid bone and thus located inside the tracheal wall. Goiter leads to a narrowing of the lumen of the trachea, thus causing respiratory failure. The node is usually located in the cervical region of the trachea at the back of the posterolateral wall, often on the left.