The worst for me was my phrenic nerve, which extends from the neck down to the diaphragm.
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The theory is that capsaicin irritates the phrenic nerve, which serves the diaphragm, the muscle that helps us breathe.
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Some doctors, when less invasive treatments have failed, have attempted to stimulate the vagus nerve directly with an electrical implant or used an injection of an anesthetic to block the phrenic nerve, which controls the diaphragm.
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" Over production that Scotty Hard says was intended to be "a kinda hype-banger," Mr. Dead spits: "Yo, there's nothing to fear, there's no time to panic/ It's another installment from your local schizo-pathic-psycho-phrenic/ Leaving your brain cells demented/ My lyrical damage that did it/ Your style's pathetic.
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The phrenic plexus accompanies the inferior phrenic artery to the diaphragm, some filaments passing to the suprarenal gland. It arises from the upper part of the celiac ganglion, and is larger on the right than on the left side. It receives one or two branches from the phrenic nerve. At the point of junction of the right phrenic plexus with the phrenic nerve is a small ganglion (ganglion phrenicum).
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The subclavian nerve can variably give rise to a branch which innervates the diaphragm called the accessory phrenic nerve. The accessory phrenic nerve may rather branch from the ansa cervicalis. This nerve usually joins with the phrenic nerve before innervating the diaphragm.
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Each (left and right) superior suprarenal artery is a branch of the inferior phrenic artery on that side of the body. The left and right phrenic arteries supply the diaphragm, and come off the aorta.
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The parietal pleura is supplied by the intercostal nerves and the phrenic nerve. The costal pleura is innervated by the intercostal nerves. The diaphragmatic portion of the parietal pleura overlies the diaphragm and is innervated by the phrenic nerve in its central portion and by the intercostal nerves in its peripheral portion. The mediastinal portion of the parietal pleura forms the lateral wall of the mediastinum and is innervated by the phrenic nerve.
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An external battery-operated transmitter sends radiofrequency energy to the receiver through an antenna, which is placed on the skin overlying the receiver. The receiver converts this energy into an electric current that is directed to the phrenic nerve in order to stimulate the nerve, thereby causing contraction of the diaphragm. The surgery can be performed via either a cervical or thoracic approach. Phrenic pacing provides ventilatory support for patients with chronic respiratory insufficiency whose diaphragm, lungs, and phrenic nerves have residual function.
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The symptoms are mainly those of peripheral neuritis with special implication of the phrenic and the pneumogastric nerves.
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After successful craniocaudal folding the septum transversum picks up innervation from the adjacent ventral rami of spinal nerves C3, C4 and C5, thus forming the precursor of the phrenic nerve. During the descent of the septum, the phrenic nerve is carried along and assumes its descending pathway. During embryonic development of the thoracic diaphragm, myoblast cells from the septum invade the other components of the diaphragm. They thus give rise to the motor and sensory innervation of the muscular diaphragm by the phrenic nerve.
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Position of the Phrenic Nerve (diagram) Spasm in the diaphragm leads to the muscle 'locking up' so that all breathing effort falls to the intercostal muscles. The resulting loss of movement causes the lungs to deflate gradually. This is easily diagnosed and treated (see Treatment below) by short-term interruption of the Phrenic nerve.
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The device is placed as an alternative to the traditional ventilator in patients with quadriplegia, central sleep apnea, diaphragm paralysis, and other respiration maladies, so long as the patient's respiratory system still has some residual function. The Mark IV Breathing Pacemaker is a phrenic nerve stimulator, also called a diaphragm pacemaker. Phrenic nerve stimulation is a technique whereby a nerve stimulator provides electrical stimulation of the phrenic nerve to cause diaphragmatic contraction. It consists of surgically implanted receivers and electrodes mated to an external transmitter by antennas worn over the implanted receivers.
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The pericardiacophrenic artery is a long slender branch of the internal thoracic artery. It accompanies the phrenic nerve, between the pleura and pericardium, to the diaphragm, to which it is distributed. It anastomoses with the musculophrenic and superior phrenic arteries. On their course through the thoracic cavity, the pericardiacophrenic arteries are located within and supply the fibrous pericardium.
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The basic principle behind a diaphragm pacing device (the U.S. Food and Drug Administration identifies the device as a "diaphragmatic/phrenic nerve stimulator") involves passing an electric current through electrodes that are attached internally. The diaphragm contracts, expanding the chest cavity, causing air to be sucked into the lungs (inspiration). When not stimulated, the diaphragm relaxes and air moves out of the lungs (expiration). According to the United States Medicare system, phrenic nerve stimulators are indicated for "selected patients with partial or complete respiratory insufficiency" and "can be effective only if the patient has an intact phrenic nerve and diaphragm".
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This electrode is connected to a radiofrequency receiver which is implanted just under the skin. An external transmitter sends radio signals to the device by an antenna which is worn over the receiver. For the cervical surgical technique, the phrenic nerve is approached via a small (~5 cm) incision slightly above, and midline to, the clavic. The phrenic nerve is then isolated under the scalenus anticus muscle.
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The action of breathing takes place because of nerve signals sent by the respiratory center in the brainstem, along the phrenic nerve from the cervical plexus to the diaphragm.
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The scalene muscles have an important relationship to other structures in the neck. The brachial plexus and subclavian artery pass between the anterior and middle scalenes. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as the muscle crosses over the first rib. The phrenic nerve is oriented vertically as it passes in front of the anterior scalene, while the subclavian vein is oriented horizontally as it passes in front of the anterior scalene muscle.
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However, advances in mechanical ventilation by the likes of George Poe in the early twentieth century ended up being initially favored over phrenic nerve stimulation. Harvard researchers Sarnoff et al. revisited diaphragm pacing via the phrenic nerve in 1948, publishing their experimental results on dogs. In a separate publication a few days before, the same group also revealed they had an opportunity to use the technique "on a five-year-old boy with complete respiratory paralysis following rupture of a cerebral aneurysm".
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It also separates the pleural cavity from the mediastinum. The parietal pleura is innervated by the intercostal nerves and the phrenic nerve. Between the membranes is a fluid-filled space called the pleural space.
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Diaphragmatic spasm is easily checked by pinching the phrenic nerve in the neck between the fingertips. Kittens with this type of FCKS will improve almost immediately, but may require repeated pinching to prevent the spasm from recurring.
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The superior phrenic arteries are small and arise from the lower part of the thoracic aorta; they are distributed to the posterior part of the upper surface of the diaphragm, and anastomose with the musculophrenic and pericardiacophrenic arteries.
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These neurons are intrinsic pacemakers. Post-I neurons display an initial burst of activity followed by decrease in activity at the end of inspiration. Aug-E neurons begin firing during the E2 phase and end before the phrenic nerve burst.
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The phrenic nerve is a nerve essential for our survival which arises from nerve roots C3, C4 and C5. It supplies the thoracic diaphragm, enabling breathing. If the spinal cord is transected above C3, then spontaneous breathing is not possible.
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The idea of stimulating the diaphragm through the phrenic nerve was first firmly postulated by German physician Christoph Wilhelm Hufeland, who in 1783 proposed that such a technique could be applied as a treatment for asphyxia. French neurologist Duchenne de Boulogne made a similar proposal in 1855, though neither of them tested it. It wasn't until a year later that Hugo Wilhelm von Ziemssen demonstrated diaphragm pacing on a 27-year-old woman asphyxiated on charcoal fumes by rhythmically faradizing her phrenic nerves, saving her life. Duchenne would later in 1872 declare the technique the "best means of imitating natural respiration".
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Diaphragm pacing is the rhythmic application of electrical impulses to the diaphragm. Historically, this has been accomplished through the electrical stimulation of a phrenic nerve by an implanted receiver/electrode, though today an alternative option of attaching percutaneous wires to the diaphragm exists.
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Pericardiacophrenic veins are the vena comitans of the pericardiacophrenic arteries. Pericardiacophrenic vessels accompany the phrenic nerve in the Middle Mediastinum of the Thorax. The artery is a branch of the internal thoracic artery. The vein drains into the internal thoracic(or brachiocephalic)vein.
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Common patient diagnoses for phrenic nerve pacing include patients with spinal cord injury, central sleep apnea, congenital central hypoventilation syndrome (i.e., Ondine's curse), and diaphragm paralysis. There are currently three commercially distributed diaphragm pacing devices: Synapse Biomedical, Inc.'s NeuRx (US), Avery Biomedical Devices, Inc.
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In the case of the Atrostim and Mark IV devices, several surgical techniques may be used. Surgery is typically performed by placing an electrode around the phrenic nerve, either in the neck (i.e., cervically; an older technique), or in the chest (i.e., thoracically; more modern).
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Another method, called extrapleural thoracoplasty, involved removal of portions of several ribs to collapse the chest wall. Phrenic nerve interruption was introduced to Glen Lake in 1924. This paralysis of the diaphragm reduced movement of the affected lung.Myers. p.142-143. The collapse era was followed by chemotherapy.
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Signals from the VRG are sent along the spinal cord to several nerves. These nerves include the intercostals, phrenic, and abdominals. These nerves lead to the specific muscles they control. The bulbospinal pathway descending from the VRG allows the respiratory centers to control muscle relaxation, which leads to exhalation.
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Holothurin is shown to have a blocking effect on nerves in desheathed bullfrog sciatic nerve and rat phrenic nerve preparations, and its potency can be compared to that of cocaine, procaine, and physostigmine. Unlike the other mentioned blocking agents, the disrupting effect of holothurin appears to be quite irreversible upon washing. In another experiment on frog sciatic nerve, holothurin A is shown to be capable of destroying electrical excitability of a node of Ranvier along with basophilic macromolecular material found in and near the cytoplasm of the node. In another experiment on rat phrenic nerve, the nerve-disrupting effect of holothurin A is found to be preventable when specific concentrations of physostigmine are present.
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As the nerves lose function, the muscles associated with those nerves begin to atrophy. In brachial plexus degeneration, atrophy may occur in the deltoid muscles. In phrenic nerve degeneration, the diaphragm may be affected. In this case, breathing can be impaired due to a lack of muscle control of the diaphragm.
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For the respiratory system, the LTF facilitated by intermittent hypoxia aids in increasing phrenic motor nerve output. This has been shown to help people with obstructive sleep apnea and COPD. The ability to increase muscle activity, specifically for walking, has also been demonstrated in both rats and humans after spinal cord injury.
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This is because the supraclavicular nerves have the same cervical nerves origin as the phrenic nerve, C3 and C4. The discovery of this is often attributed to a German gall bladder surgeon named Hans Kehr, but extensive studies into research he conducted during his life shows inconclusive evidence as to whether he actually discovered it.
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STP is the increase in ventilation after the acute hypoxic response and the eventual return of ventilation to its equilibrium after carotid sinus nerve stimulation, which causes a slowing in heart rate. This mechanism usually lasts between one and two minutes. STP is most apparent in tidal volume or the amplitude of phrenic neural output.
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The thoracic descending aorta gives rise to the intercostal and subcostal arteries, as well as to the superior and inferior left bronchial arteries and variable branches to the esophagus, mediastinum, and pericardium. Its lowest pair of branches are the superior phrenic arteries, which supply the diaphragm, and the subcostal arteries for the twelfth rib.
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Twiddler's syndrome is a malfunction of a pacemaker due to manipulation of the device and the subsequent dislodging of the leads from their intended location. As the leads move, they stop pacing the heart and can cause strange symptoms such as phrenic nerve stimulation resulting in abdominal pulsing or brachial plexus stimulation resulting in rhythmic arm twitching.
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The growing tumor can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or, characteristically, compression of a sympathetic ganglion (the stellate ganglion), resulting in a range of symptoms known as Horner's syndrome. Pancoast tumors are named for Henry Pancoast, an American radiologist, who described them in 1924 and 1932.
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Lymphatic vessels travel only away from the thymus, accompanying the arteries and veins. These drain into the brachiocephalic, tracheobronchial and parasternal lymph nodes. The nerves supplying the thymus arise from the vagus nerve and the cervical sympathetic chain. Branches from the phrenic nerves reach the capsule of the thymus, but do not enter into the thymus itself.
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Shortness of breath is often the only symptom in those with tachydysrhythmias. Panic attacks typically present with hyperventilation, sweating, and numbness. They are however a diagnosis of exclusion. Neurological conditions such as spinal cord injury, phrenic nerve injuries, Guillain–Barré syndrome, amyotrophic lateral sclerosis, multiple sclerosis and muscular dystrophy can all cause an individual to experience shortness of breath.
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The middle suprarenal arteries (middle capsular arteries; suprarenal arteries) are two small vessels which arise, one from either side of the abdominal aorta, opposite the superior mesenteric artery. They pass laterally and slightly upward, over the crura of the diaphragm, to the suprarenal glands, where they anastomose with suprarenal branches of the inferior phrenic and renal arteries.
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The kind of mental activity conducted in the Phren involves what 20th and 21 Century Western thinkers consider both feeling and thinking; scholars have remarked that Ancient Greeks located this activity in the torso as opposed to the head. Its Latinized form is "fren" and is found in English language words such as schizophrenia, phrenitis, phrenic nerve, phrenology, frenzy, frenetic.
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FCKS cannot be corrected surgically. Diaphragmatic spasm is easily tested for and treated by short term interruption of the Phrenic nerve. The nerve runs down the outside of the neck where the neck joins to the shoulder, within a bundle of muscles and tendons at this junction. The cluster can be pinched gently and held for a few seconds each time.
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Cervical spinal nerve 4, also called C4, is a spinal nerve of the cervical segment. It originates from the spinal cord above the 4th cervical vertebra (C4). It contributes nerve fibers to the phrenic nerve, the motor nerve to the thoracoabdominal diaphragm. It also provides motor nerves for the longus capitis, longus colli, anterior scalene, middle scalene, and levator scapulae muscles.
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STD is a temporary jump in respiratory frequency at the beginning of carotid chemo afferent stimulation or a temporary drop in respiratory frequency at the end of chemo afferent stimulation. This mechanism lasts from a span of several seconds to a few minutes. STP has only been found in the respiratory frequency of phrenic nerve stimulation, which produces contraction of the diaphragm.
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Diaphragm pacing, (and even earlier as electrophrenic respiration), is the rhythmic application of electrical impulses to the diaphragm to provide artificial ventilatory support for respiratory failure or sleep apnea. Historically, this has been accomplished through the electrical stimulation of a phrenic nerve by an implanted receiver/electrode, though today an alternative option of attaching percutaneous wires to the diaphragm exists.
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For the thoracic surgical technique, a small (~5 cm) incisions over the 2nd or 3rd intercostal space. The electrodes are placed around the phrenic nerves alongside the pericardium. Use of a thorascope allows for this technique to be performed in a minimally-invasive manner. In the case of the NeuRx device, a series of four incisions are made in the abdominal skin.
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The suprarenal plexus is formed by branches from the celiac plexus, from the celiac ganglion, and from the phrenic and greater splanchnic nerves, a ganglion being formed at the point of junction with the latter nerve. The plexus supplies the suprarenal gland, being distributed chiefly to its medullary portion; its branches are remarkable for their large size in comparison with that of the organ they supply.
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The esophageal arteries four or five in number, arise from the front of the aorta, and pass obliquely downward to the esophagus, forming a chain of anastomoses along that tube, anastomosing with the esophageal branches of the inferior thyroid arteries above, and with ascending branches from the left inferior phrenic and left gastric arteries below. These arteries supply the middle third of the esophagus.
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The visceral pleura receives its blood supply from the bronchial circulation, which also supplies the lungs. The parietal pleura receives its blood supply from the intercostal arteries, which also supply the overlying body wall. The costal and cervical portions and the periphery of the diaphragmatic portion of the parietal pleurae are innervated by the intercostal nerves. The mediastinal and central portions of the diaphragmatic pleurae are innervated by the phrenic nerves.
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The pneumotaxic center is responsible for limiting inspiration, providing an inspiratory off-switch (IOS). It limits the burst of action potentials in the phrenic nerve, effectively decreasing the tidal volume and regulating the respiratory rate. Absence of the center results in an increase in depth of respiration and a decrease in respiratory rate. The pneumotaxic center regulates the amount of air that can be taken into the body in each breath.
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Avery Biomedical Devices is a biomedical engineering and device company that invented and distributes the Mark IV Breathing Pacemaker, a Phrenic Nerve Pacing device used for patients in the United States. The device received full pre-market approval from the FDA in 1987, and is the only such device with this approval.U.S. Food and Drug Administration. "Premarket Approval (PMA)" A similar device developed in Finland is approved for use in Europe.
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Dr. Bill Dobelle (October 24, 1941 – October 5, 2004) was a biomedical researcher who developed experimental technologies that restored limited sight to blind patients, and also known for the impact he and his company had on the breathing pacemaker industry with the development of the only FDA approved device for phrenic nerve pacing. He was the former director of the Division of Artificial Organs at the Columbia-Presbyterian Medical Center.
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AMS 800 and ZSI 375 artificial urinary sphinctersOther types of organ dysfunction can occur in the systems of the body, including the gastrointestinal, respiratory, and urological systems. Implants are used in those and other locations to treat conditions such as gastroesophageal reflux disease, gastroparesis, respiratory failure, sleep apnea, urinary and fecal incontinence, and erectile dysfunction. Examples include the LINX, implantable gastric stimulator, diaphragmatic/phrenic nerve stimulator, neurostimulator, surgical mesh, artificial urinary sphincter and penile implant.
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Position of Phrenic nerve in a sleeping kitten. The nerve bifurcates and runs down both sides of the neck. Treatment is difficult to define given the number of different causes and the wealth of anecdotal information collected by and from cat breeders. Treatments have hitherto been based on the assumption that FCKS is caused by a muscular spasm, and their effectiveness is impossible to assess because some kittens will recover spontaneously without intervention.
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Although clinical signs of myelomalacia are observed within the onset (start) of paraplegia, sometimes they may become evident only in the post-operative period, or even days after the onset of paraplegia. Death from myelomalacia may occur as a result of respiratory paralysis when the ascending lesion (abnormal damaged tissue) reaches the motor nuclei of the phrenic nerves (nerves between the C3-C5 region of the spine) in the cervical (neck) region.
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The central tendon of the diaphragm is a thin but strong aponeurosis situated slightly anterior to the vault formed by the muscle, resulting in longer posterior muscle fibers. It is inferior to the fibrous pericardium, which fuses with the central tendon of the diaphragm via the pericardiacophrenic ligament. The caval opening (at the level of the T8 vertebra) passes through the central tendon. This transmits the inferior vena cava and right phrenic nerve.
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During the depression phase, the inspiratory burst changes from an augmenting bell-shaped burst to a decrementing burst, a primary feature of gasping. Neuronal discharge patterns are altered during the depressed synaptic inhibition, contributing to the reformation of the network. Many of the respiratory neurons in the ventrolateral medulla inactivate before phrenic and/or hypoglossal (XII) cessation. These neurons are inconsistent in their response with rhythmic bursts and become either de- or hyperpolarized.
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The cervical spinal nerve 5 (C5) is a spinal nerve of the cervical segment.American Medical Association Nervous System -- Groups of Nerves It originates from the spinal column from above the cervical vertebra 5 (C5). It contributes to the phrenic nerve, long thoracic nerve, and dorsal scapular nerve before joining cervical spinal nerve 6 to form the upper trunk, a trunk of the brachial plexus, which then forms the lateral cord, and finally the musculocutaneous nerve.
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Many drugs have been used, such as baclofen, chlorpromazine, metoclopramide, gabapentin, and various proton-pump inhibitors. Hiccups that are secondary to some other cause, like gastroesophageal reflux disease or esophageal webs, are dealt with by treating the underlying disorder. The phrenic nerve can be blocked temporarily with injection of 0.5% procaine, or permanently with bilateral phrenicotomy or other forms of surgical destruction. Even this rather drastic treatment does not cure some cases, however.
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Certain athletes also report a pain in the tip of their shoulder blade. This is believed to be because this is a referred site of pain for the diaphragm via the phrenic nerve. When the side stitch is on the right side, published advice is to try to exhale when the left foot lands. There are other theories regarding side stitches than simple stretching of the visceral ligaments due to repeated vertical translation and jolting.
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The most common, early complication of surgery is bleeding, the risk of which can be increased by prematurity, prolonged acidosis prior to surgery, and excessive tension on the anastamosis due to inadequate mobilization of the ascending and descending aorta. Other early complications include damage to the left recurrent laryngeal nerve and the phrenic nerve. Late complications include obstruction of the graft and obstruction of the left main bronchus (which passes underneath the aortic arch).
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HNA is an episodic disorder; it is characterized by episodes generally lasting 1–6 weeks. During an episode, the nerves of the brachial plexus are targeted by the body as antigens, and the body's immune system begins to degenerate the nerves of the brachial plexus. The exact order or location of the nerve degeneration cannot be predicted before an episode. Other areas of the nervous system that have been affected are the phrenic nerves and the recurrent laryngeal.
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Additionally, new surgical techniques such as a thoracoscopic approach began to appear in the late 1990s. In the mid-2000s, U.S. company Synapse Biomedical began researching a new diaphragm pacing system that wouldn't have to attach to the phrenic nerve but instead depended on "four electrodes implanted in the muscle of the diaphragm to electronically stimulate contraction". The marketed NeuRx device received several FDA approvals under a Humanitarian Device Exemption (HDE), one in 2008 and another in 2011.
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One advantage to having plexes is that damage to a single spinal nerve will not completely paralyze a limb. There are four main plexuses formed by the ventral rami: the cervical plexus contains ventral rami from spinal nerves C1-C4. Branches of the cervical plexus, which include the phrenic nerve, innervate muscles of the neck, the diaphragm, and the skin of the neck and upper chest. The brachial plexus contains ventral rami from spinal nerves C5-T1.
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The respiratory centres control respiration, by generating motor signals that are passed down the spinal cord, along the phrenic nerve to the diaphragm and other muscles of respiration. This is a mixed nerve that carries sensory information back to the centres. There are four respiratory centres, three with a more clearly defined function, and an apneustic centre with a less clear function. In the medulla a dorsal respiratory group causes the desire to breathe in and receives sensory information directly from the body.
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1856 advertisement for the Tilden Company, maker of Tilden's Extract. Tilden's Extract was a 19th-century medicinal cannabis extract, first formulated by James Edward Smith of Edinburgh. In the United States, the Tilden Company of New Lebanon, New York, manufactured and sold the extract under its own name, advertising the drug as: > Phrenic, anæsthetic, anti-spasmodic and hypnotic. Unlike opium, it does not > constipate the bowels, lessen the appetite, create nausea, produce dryness > of the tongue, check pulmonary secretions or produce headache.
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The procedure begins when the surgeon makes an incision in the skin over the breastbone and divides the breastbone to expose the pericardium. During the surgery, the surgeon will grasp the pericardium, cut the top of this fibrous covering of the heart, drop it into the specimen bag, and re-cover the heart. The breastbone is then wired back together and the incision is closed, completing the procedure. When the portion of pericardium lying between the two phrenic nerves is excised it is called total pericardiectomy.
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The cystic plexus is the derivation of the hepatic plexus, which is the largest offshoot from the celiac plexus. Formed by branches from the celiac plexus, the right and left vagi and the right phrenic nerve, parasympathetic nerves are motor to the musculature of the gall bladder and bile ducts, but inhibitory to the sphincters. Sympathetic nerves derived from thoracic seven to nine segments are vasomotor and motor to sphincters. It supplies the gall bladder, common hepatic duct, cystic duct and upper part of the bile duct.
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Comparison between a normal costophrenic angle on the patient's right, and an obscured costophrenic angle (circled) on the patient's left, due to pneumonia with parapneumonic effusion. In anatomy, the costophrenic angles are the places where the diaphragm (-phrenic) meets the ribs (costo-). Each costophrenic angle can normally be seen as on chest x-ray as a sharply- pointed, downward indentation (dark) between each hemi-diaphragm (white) and the adjacent chest wall (white). A small portion of each lung normally reaches into the costophrenic angle.
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In most pinnipeds, there is a striated muscle sphincter at the level of the diaphragm around the posterior venacava, innervated by the right phrenic nerve, and located cranial to the large hepatic sinus and inferior vena cava, which is most developed in phocid seals. The function of this sphincter is considered to be regulation of venous return during brachycardia. Some whales also have a sphincter of the vena cava, and some cetaceans have smooth muscle sphincters around the intrahepatic parts of the portal vein. The precise function of these structures is not well understood.
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Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classic symptom of a ruptured spleen. May result from diaphragmatic or peridiaphragmatic lesions, renal calculi, splenic injury or ruptured ectopic pregnancy. Kehr's sign is a classic example of referred pain: irritation of the diaphragm is signaled by the phrenic nerve as pain in the area above the collarbone.
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The muscles of the face are usually spared, but in rare cases, the eye muscles may be weakened, leading to ophthalmoplegia. Respiratory difficulties can be caused by atrophy of the muscles between the ribs (intercostals), atrophy of the diaphragm muscle, and degeneration of the nerve that stimulates the diaphragm (phrenic nerve). This can prolong the time the wean a person off of a breathing machine (mechanical ventilation) by as much as 7 – 13 days. Deep tendon reflexes may be lost or diminished, and there may be bilateral symmetric flaccid paralysis of the arms and legs.
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Rate of diaphragmatic contraction ranges between 35 and 480 contractions per minute, with the average rate found to be 150. Studies show that possible causes include disruptions within the central or peripheral nervous systems, anxiety, nutritional disorder, and certain pharmaceuticals. No single treatment has proven effective, though blocking or crushing of the phrenic nerve can provide instantaneous relief when pharmacologic treatment has proven ineffective. Only about 50 people in the world have been diagnosed with diaphragmatic flutter. One case is Chaz Moore of Colorado Springs, Colorado, who was interviewed by CNN’s Dr. Sanjay Gupta.
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The hepatic plexus, the largest offset from the celiac plexus, receives filaments from the left vagus and right phrenic nerves. It accompanies the hepatic artery, ramifying upon its branches, and upon those of the portal vein in the substance of the liver. Branches from this plexus accompany all the divisions of the hepatic artery. A considerable plexus accompanies the gastroduodenal artery and is continued as the inferior gastric plexus on the right gastroepiploic artery along the greater curvature of the stomach, where it unites with offshoots from the lienal plexus.
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A three-phase model is the classical view of the respiratory CPG. The phases of the respiratory CPG are characterized by the rhythmic activity of: (1) the phrenic nerve during inspiration; (2) recurrent laryngeal nerve branches that innervate the thyroarytenoid muscle during the last stage of expiration; (3) the internal intercostal nerve branches that innervate the triangularis sterni muscle during the second stage of expiration. The rhythmicity of these nerves is classically viewed as originating from a single rhythm generator. In this model, phasing is produced by reciprocal synaptic inhibition between groups of sequentially active interneurons.
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The needle goes in about 3–4 cm and a single shot of local anesthetic is injected or a catheter is placed. The most common local anesthetics used at the site of the nerves are bupivicaine, mepivicaine, and chloroprocaine. There is a very high chance that the phrenic nerve, which innervates the diaphragm, will be blocked so this block should only be done on patients who have use of their accessory respiratory muscles. The block may not affect the C8 and T1 roots which supply part of the hand, so it is usually not done for hand surgeries.
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They revealed that MLA blocked neuromuscular transmission in skeletal muscle, but not smooth muscle, and had some ganglion-blocking action. Such properties are characteristic of an antagonist of acetylcholine exerting its effects at nicotinic, but not muscarinic sites. In the rat phrenic nerve-diaphragm preparation, for example, a 2 x 10−5M concentration of MLA produced a 50% decrease in response, and total inhibition was caused by a 3 x 10−5M concentration of the drug. In this preparation, MLA-treated muscle responded normally to direct electrical stimulation, but the inhibition of contractions was only partially antagonized by physostigmine.
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The accumulation of carbon dioxide in the lungs will eventually irritate and trigger impulses from the respiratory center part of the brain and the phrenic nerve. Rising levels of carbon dioxide signal the body to breathe and resume unconscious respiration. The lungs start to feel as if they are burning and the signals your body gets from your brain when your CO2 levels are too high, include strong, painful, and involuntary contractions or spasms of the diaphragm and the muscles in between your ribs. At some point the spasms become so frequent and unbearable that you can no longer hold your breath.
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If the cause of flattening is colic related to over-production of milk then this would not be cause for neutering. The only way to determine if the cause is digestive would be if the condition was alleviated by pinching the phrenic nerve and/or use of liquid paraffin to relieve colic, resulting in improvement in the condition. Line-breeding or inbreeding is highly inadvisable in any situation, and particularly so in lines where FCKS has appeared, given the possibility of inheritance of any underlying condition or breeding factor that may cause kittens to develop FCKS.
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Approximately 19 percent of all paralytic polio cases have both bulbar and spinal symptoms; this subtype is called respiratory or bulbospinal polio. Here, the virus affects the upper part of the cervical spinal cord (cervical vertebrae C3 through C5), and paralysis of the diaphragm occurs. The critical nerves affected are the phrenic nerve (which drives the diaphragm to inflate the lungs) and those that drive the muscles needed for swallowing. By destroying these nerves, this form of polio affects breathing, making it difficult or impossible for the patient to breathe without the support of a ventilator.
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This technology was commercialized as the Atrostim PNS system and became commercially available in Europe in 1990. By the early 1990s, long-term evaluations of the technology were being published, with some researchers such as Bach and O'Connor stating that phrenic nerve pacing is a valid option "for the properly screened patient but that expense, failure rate, morbidity and mortality remain excessive and that alternative methods of ventilatory support should be explored". Others such as Brouillette and Marzocchi suggested that advances in encapsulation and electrode technologies could improve system longevity and reduce damage to diaphragm muscle.
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As part of the pre-procedure work-up, every patient has a triple- phase CT scan within a month of the scheduled embolization. Triple-phase CT is essential for documenting the extent of disease, demonstrating arterial anatomy, evaluating the portal venous system, and looking for non-hepatic blood supply to the tumor. This study serves as the basis for a treatment plan. The extent and distribution of the tumors are laid out, arterial blood supply to the tumor is evident and any contribution from the extra hepatic vasculature such as the phrenic or internal mammary arteries, should be seen.
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This is immediately sensed by the carbon dioxide chemoreceptors on the brain stem. The respiratory centers respond to this information by causing the rate and depth of breathing to increase to such an extent that the partial pressures of carbon dioxide and oxygen in the arterial blood return almost immediately to the same levels as at rest. The respiratory centers communicate with the muscles of breathing via motor nerves, of which the phrenic nerves, which innervate the diaphragm, are probably the most important. Automatic breathing can be overridden to a limited extent by simple choice, or to facilitate swimming, speech, singing or other vocal training.
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Lenny's creative work has been supported by the Pennsylvania Council on the Arts, Independence Foundation, National Endowment for the Arts, Rockefeller Foundation's MAP Fund, William J. Cooper Foundation and Pew Center for Arts and Heritage. He was commissioned by Phrenic New Ballet to compose a new piece for choreographer Christine Cox's "Tabula Rasa," and by Kim Arrow for his "Quasimodo in the Outback". He was awarded the APPEX Fellowship in 1999, a six-week inter-cultural residency at UCLA where he collaborated and lived with 30 performing artists from throughout Asia. He also was awarded a three-month residency at Headlands Center for the Arts in Sausalito, CA in 1993.
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Since the suprascapular nerve provides sensory information to 70% of the joint capsule, blocking this nerve can help with post-operative shoulder pain. A nerve stimulator, ultrasound device, or a needle insertion that is 1 cm above the midpoint of the scapular spine can quickly block the suprascapular nerve. Furthermore, blocking the axillary nerve together with the suprascapular nerve can further anesthetize the shoulder joint. The benefit of the suprascapular nerve block is that it avoids blocking motor function to parts of the upper limb innervated by the more inferior roots of the brachial plexus (C8-T1), which thus prevents the phrenic nerve from being blocked.
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The respiratory center sends a signal along the phrenic nerve, excites the diaphragm muscle cells, leading to muscle contraction and descent of the diaphragm dome. As a result, the pressure in the airway drops, causing an inflow of air into the lungs. With NAVA, the electrical activity of the diaphragm (Edi) is captured, fed to the ventilator and used to assist the patient's breathing in synchrony with and in proportion to the patients own efforts, regardless of patient category or size. As the work of the ventilator and the diaphragm is controlled by the same signal, coupling between the diaphragm and the SERVO-i ventilator is synchronized simultaneously.
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If the upper cervical segment of the spinal cord is involved, all four limbs may be affected and there is risk of respiratory failure – the phrenic nerve which is formed by the cervical spinal nerves C3, C4, and C5 innervates the main muscle of respiration, the diaphragm. Lesions of the lower cervical region (C5–T1) will cause a combination of upper and lower motor neuron signs in the upper limbs, and exclusively upper motor neuron signs in the lower limbs. Cervical lesions account for about 20% of cases. A lesion of the thoracic segment (T1–12) will produce upper motor neuron signs in the lower limbs, presenting as a spastic paraparesis.
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The diaphragm divides the body cavity into the thoracic cavity and the abdominal cavity. It develops from four components: the septum transversum (central tendon), the pleuroperitoneal membranes, the dorsal mesentery of the esophagus, and muscular components from somites at cervical levels three to five (C3–5) of the body wall. Since the septum transversum is located initially opposite cervical segments of three to five, and since muscle cells for the diaphragm originate from somites at these segments, the phrenic nerve, which innervates the diaphragm, also arises from these segments of the spinal cord (C3, 4, and 5). The thoracic cavity is divided into the pericardial cavity and two pleural cavities for the lungs by the pleuropericardial membranes.
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At first, it passes downward and laterally across the scalenus anterior and phrenic nerve, being covered by the sternocleidomastoid muscle; it then crosses the subclavian artery and the brachial plexus, running behind and parallel with the clavicle and subclavius muscle and beneath the inferior belly of the omohyoid to the superior border of the scapula. It passes over the superior transverse scapular ligament in most of the cases while below it through the suprascapular notch in some cases.Chapter 8: THE SHOULDER AND AXILLAScapular Region The artery then enters the supraspinous fossa of the scapula. It travels close to the bone, running through the suprascapular canal underneath the supraspinatus muscle, to which it supplies branches.
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Reduced partial pressures of oxygen in the arteries due to intermittent hypoxia are sensed by and stimulate the carotid body, a chemoafferent receptor. The activated carotid body triggers the release of serotonin that attach to serotonin receptors on the surface of motoneurons, such as the phrenic motoneuron in the case of respiratory recovery. This signal transduction pathway then uses downstream molecules such as TrkB, BDNF, and PKA to increase the synaptic output of the involved motor neuron which in turn increases the motor output of the involved muscles and, thus, decreases functional impairment. As the amount of intermittent hypoxia changes the amount of serotonin release and, as a result, the amount of LTF, this process exhibits metaplasticity.
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RL is performed by an interventional radiologist in the angiography suite, in a fashion similar to radioembolization. The procedure is composed of two different portions, a planning phase and the actual radiation lobectomy, usually performed in two different sessions: # Planning phase: the patient undergoes planning angiography of the abdominal aorta and its major vessels. The interventional radiologist accesses the femoral artery via Seldinger technique and advances a wire and catheter to the level of the superior mesenteric artery and the celiac axis, injecting contrast in order to delineate the patient’s anatomy. Utilizing smaller catheters and wires, he does the same thing evaluating the common hepatic artery, gastroduodenal, proper hepatic, left hepatic, right hepatic and phrenic arteries.
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The redtail coral snake has a potentially deadly neurotoxic venom which produces a complete depolarizing muscle block. The venom acts by blocking the neuromuscular transmission of nerve muscle preparations, it acts in a post-synaptic way through the nicotinic acetylcholine receptor (nAChr), inhibiting the muscle contractions in phrenic nerve diaphragm. After the bite, local pain and paraesthesia appear in minutes, in severe cases, neurological manifestations appear in 30 minutes to 1–2 hours, such as progressive bilateral ptosis, dysarthria, progressive weakness in the muscles of the extremities, difficulties in walking, salivation, drowsiness, respiratory paralysis, flaccid quadriparesis and severe flaccid quadriplegia. The LD50 for 18-20 gram mice is 0.009 mg and 0.45 mg / kg, and 0.06 μg / g intraperitoneally.
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The physiological type occurs before 28 weeks after conception and tend to last five to ten minutes. These hiccups are part of fetal development and are associated with the myelination of the phrenic nerve, which primarily controls the thoracic diaphragm. The phylogeny hypothesis explains how the hiccup reflex might have evolved, and if there is not an explanation, it may explain hiccups as an evolutionary remnant, held-over from our amphibious ancestors. This hypothesis has been questioned because of the existence of the afferent loop of the reflex, the fact that it does not explain the reason for glottic closure, and because the very short contraction of the hiccup is unlikely to have a significant strengthening effect on the slow-twitch muscles of respiration.
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The details of the results vary between species and depend on the length of the dive and the diving capacity of the animals. There are large vena cava and hepatic sinuses in which blood can be temporarily stored during a dive, controlled by a sphincter of striated muscle anterior to the diaphragm, which is controlled by a branch of the phrenic nerve. This sphincter prevents engorgement of the heart by constriction of the arteries through which the blood is shifted to the central veins, creating an oxygen- rich reserve of blood in the vena cava, which is released into the circulation in proportion to cardiac output. Towards the end of a dive this reserve of venous blood may have a higher oxygen content than the arterial blood.
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The initial treatment was to pump air into the abdomen, and after that proved to be unsuccessful, they tried pumping air into her back to collapse the bad lung, which also failed. They next tried an operation called a phrenic which would permanently collapse her infected lung, again it failed to kill the TB. After attending a conference on tuberculosis, Dr. Meyers learned of a procedure that was new in the United States. This operation required the removal of ribs and the upper lobe of her more infected lung, followed by another operation to remove the rest of the lung. Madonna Swan was one of the first patients to undergo this new procedure and much was learned about the treatment of TB from her experiences.
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The physiological type occurs prior to twenty-eight weeks after conception and tend to last five to ten minutes. These hiccups are part of fetal development and are associated with the myelination of the phrenic nerve, which primarily controls the thoracic diaphragm. The phylogeny hypothesis explains how the hiccup reflex might have evolved, and if there is not an explanation it may explain hiccups as an evolutionary remnant, held over from our amphibious ancestors. This hypothesis has been questioned because of the existence of the afferent loop of the reflex, the fact that it does not explain the reason for glottic closure, and because the very short contraction of the hiccup is unlikely to have a significant strengthening effect on the slow-twitch muscles of respiration.
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When compared with MLA in the rat phrenic nerve-diaphragm assay, lycoctonine-18-O-benzoate was also about 10x less potent, and a similar reduction in potency was observed in an electrophysiological study involving frog extensor muscle. Even the absence of the methyl group from the methylsuccinimido- ring, as in the alkaloid lycaconitine, reduces the affinity for α7 receptors by a factor of about 20,> but in this case affinity for α4β2 receptors is not significantly changed in comparison with MLA. Another approach that has been explored in the attempt to elucidate structure-activity relationships in MLA has been to start with 2-(methylsuccinimido)-benzoic acid (the carboxylic acid produced when MLA is split at the C-18 ester group) and to esterify it with various alcohols and amino-alcohols that might be considered as "molecular fragments" of MLA.
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The hilum is the large triangular depression where the connection between the parietal pleura (covering the rib cage) and the visceral pleura (covering the lung) is made, and this marks the meeting point between the mediastinum and the pleural cavities. The root is formed by the bronchus, the pulmonary artery, the pulmonary veins, the bronchial arteries and veins, the pulmonary plexuses of nerves, lymphatic vessels, bronchial lymph nodes, and areolar tissue, all of which are enclosed by a reflection of the pleura. The root of the right lung lies behind the superior vena cava and part of the right atrium, and below the azygos vein. That of the left lung passes beneath the aortic arch and in front of the descending aorta; the phrenic nerve, pericardiacophrenic artery and vein, and the anterior pulmonary plexus, lie in front of each, and the vagus nerve and posterior pulmonary plexus lie behind.
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He has been active in the organization of general, laparoscopic and liver surgery at Van Yüzüncü Yıl University and Kırıkkale University. He has been pioneering in the development and implementation of international clinical protocols, laying the foundations of laparoscopic, transplantation, liver and bariatric-metabolic surgery in Azerbaijan. He has actively participated in establishment of laparoscopyc, transplantation centers and realization of the liver and kidney transplantation in prime hospitals in Azerbaijan such as, Central Clinic Hospital, M. Naghiyev Emergency and Medical Care Hospital, Central Customs Hospital and Azerbaijan Medical University Surgical Educational Hospital. He has broken grounds in healthcare industry in Azerbaijan by leading first stem cell transplantation, major liver resections, hepatectomy including (ALPPS) surgery, damage control surgery, laparostomy and mesh closure surgery, advanced laparoscopic operations such as, common bile duct exploration and resection, choledocho-duodenostomy, choledocho-yeyunostomy, fundoplication, liver, pancreas, gastric, bowel, colon resections, portal vein ligations, gasto-yeyunostomy, splenectomy, hysterectomy, cystectomy, renal operations and sympathectomy, thoracoscopic phrenic nervectomy (first time in the world) and first organ transplantation in Azerbaijan Medical University (2015).
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Her choreography has been performed by Ballet West, Staatsballett Berlin, Complexions Contemporary Ballet, Colorado Ballet, Cedar Lake Contemporary, BalletX among others. Her work has also been presented in national television commercials, The Kennedy Center, New York’s City Center Theater, the Helsinki International Ballet Competition and Vail International Dance Festival. Gates' works include: Barely Silent premiered at The Joyce Theatre in New York City on January 2007, commissioned for Complexions Contemporary Ballet; Minor Loop for The Washington Ballet in June 2006; Momentary Play premiered in New York for Cedar Lake Contemporary Ballet in October 2005, now and again, premiered at the Joyce Theater and created for New York City Ballet in 2005; Three at a Time for the Laguna Dance Theater in 2005; In the Arms of Morpheus for the now- disbanded Phrenic New Ballet in Philadelphia in 2004; Somewhere/In-Between, created for the now-disbanded Ballet Pacifica in 2003; Por Ti, choreographed for the American Ballet Theatre's summer workshop in 2003; and an original work for Pennsylvania Ballet dancers in 2000. Her more recent projects and collaborations include choreography for the Los Angeles Tourism and Convention Board "Discover Los Angeles" national commercial in 2017, which included students from the Glorya Kaufman School of Dance.
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