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For a full acoinnt Skechers of the whole aubjecl, «ee Killlker' Haadbueh der Oewobelehre det Meotcbea, 4th ed., ltUSS)It I alto nndcvrrolnod In what relation tlio nervefibre and branched or multipolar cell of tho cord aland to each other. MOM are Inclined to believe that the radiating prolongation of the cell are in

actual continuity with the axial filaments of nerve fibre, whether proceeding from nerve-root or from different part of the cord itaelf; and the direct observation of no eh continuity ha hocn affirmed by home, a by Schroeder Van der Kolk. Hut It I «tlll OUUldered by obtcrreni who hava given moat careful attention to till investigation that, although well continuity may lie regarded a of the greatest prolwbility, and although It may be considered at proved in tome other fstrt of the nervous system. especially in the lower animal, the actual passage of nsrve-fibre into the pieMMM of nerve-eell ha not Sketchers Shape UPS l«n proved at the remit of actual oli«rvation in the spinal cord of man or of mammal.H-"illj »J KrperiuimU.—Seeing the imperfect natnre of the knowledge of the minute stricture of the ipinal cord a obtained from mlcrostcopk observation. it may be proper to give here a short account of the more Important retail of phyaiolngtml experiment a to the course of the transmission of sensory Impression and motor influences through It, although It I at preeent difficult to reconcile them with the resalu of anatomical research For the most important information upon this subject. derived from vivisection, science i indebted to the rosearcbet of Brown- Htquftid and Schilf.When the wperlor or dorsal half of the cord a href="http://www.discountshapeup.com/">Skechers Shape UPS la divided in animal, •ciuatlon ttill continues in the bind limtw. Sensation likewise continue after division of the Inferior half of the c«ird. and even after the superior and inferior part of the cord have lieen divided at different levels In such a manner that the hinder extremity of the eord may lie supposed to communicate with tho Shape UPS brain by means of the central jcrey matter only. But sensation la abolished by piercing the interior of the oord with an Instrument, and to moving it a to divide a much a possible the Shape UP Skechers grey matter without Injuring the white matter. Moreover, tcction of the cord and IrriUllon of the cut surfaces pro-luce no |«ln. provided that the plane of sttUoo b »ufflc!nlly removed from the origin of nerve, a may 1 accomplished in the cervical region; but In the neighbourhood of nerve root there i groat sensibility.


the anterior Nrna.jiis of three com- pirtio.nu of the anterior coluana is which the luojitojinal filir«» of tbv curd am atiowa in Inureru aoction ; t, t, larc radiated and nuclmtol cell in tho grey lubiUnw of Hie aoUrwr eorno- with three, otbera with a grnaUr nualier of pr-msou uoanat ng fn« them : »o direct emuauntcali n U abswa between the»o proeeuai and tho nerre fibt«» of the roj.The fibre of

the jyfttrior rvoU on reaching the posterior cornu direre from each MW in a cureed manner, «o a» a href="http://www.discountshapeup.com/">Skechers Shape UPS to form in great part the substantia gelatinou. In front of thi there mar be teen, cut acra in lransrer»e Mction, a group of these fclor which turn longitudinally upwards and downward", and afterward pa forward, in part at least, to the anterior cornu, aud in part to reach by the posterior comaiuure the poilerior aud lateral column of the opposite «ide. Other fibre of »ho posterior root pat forward at once through the grey «ubstance to the anterior soil lateral colorant. Skechers Another »et of fibre alanl iirloelpally upward, but tome downwaril, In the poaterior column. and, interlacing with each other, moat probably enter tin) grey muter at different height. Some are loot to view in the posterior white colutnM, and it it uncertain whether or not they immediately ascend through tht»e cohimnt to the brain.Much ditcuuion luu taken place n to the cvsrwe of the fibres In the cord, and their ultimate destination. It la easily understood that by the examination of eecxlooa difficult to prepare, limited In extent, Shape UPS liable to undergo changrn in the preparation, and giving Tiows confined each to little more than a thin lamina, it i scarcely to be expected that the full hittory of many tortuous fibre can be awuratoly ascertained. Thus it remain" still nndecided whether Sketchers Shape UPS any of tho fibre of the oerveroott pa« Shape UP Skechers up all the way to the brain. Yolkmann concluded that none of them reached the brain, arguing from measurement of the ale nf the cord In different regions, that the cord coald not contain In iu upper region all thote nerve-fibrea which were traccable to it in the lower. Kolliker pointed ont the fallacy of thi coeduloQ In »o far a Volkmann had aol made proper allowance for the diminished »lxe of the fibre a they acod in the cord; bot although Volkmano's argument was thereby invalidated, It appear impossible to prove by microscopic observations that fibre of nerve-roots traced into the grey matter, and obeorred to emerge into the white matter, do not again re enter the grey, and terminate there.


Those two porta have a relation, ono to the othor, vory similar to that which subsists between the cranium and vertebral oolainn : thus, they are continuous structures ; at tho time of their first formation in tho footus they are nearly similar; tho earliest devolopcd distinction consists in the enlarge¬ment of the enoephalon ; and, moreover, tho spinal cord, like the vertebral oolatnn, continue

to present a structure nearly uniform throughout it extent, while tho enoephalon becomes gradually more and more complicated, tonnectire ii«uc it remarkably abaadant, and the MITE fibres particularly tmalL The connective tissue furuvi also a rriiiWuw (proa-sous reticularis), in which the longitudinal nerve fibres are imbedded. Sketchers Shape UPS In the grey matter the connective tiMiie Is atilt more abeodant, more especially in the immediate neighbourhood of the ceulral canal. Much di»;aloii has taken place aj to whether the smallest cell already described are really nervou or bdong to the connective tissue. In the present imperfect state of knowledge of the development of nervous clemenu, it might be nub to express a decided opinion On this ]fial; but it may be stated that, independent of nuclei are figured by Kdlliker in the reticulum, and aUo edit couUining attentat and dividing nuclei in the neighbourhood of tho central canal.Origin thr tftimtl nrr«.—The anterior an 1 posterior roots of the «pinal ncrrc are attached along the sldM of the o»nl in or near the anterior and posterior lateral groove, and opposite to the corresponding oornua of the Skechers grey matter; the poitwlor Shape UPS roott in a straight line, and the anterior roots scattered aomcwlul irregularly opou the surface (Fig. 315).The fibres of the 'inferior roo(j may be traced into and through the anterior eoroua. They then diverse In a href="http://www.discountshapeup.com/">Skechers Shape UPS different directions. The innermost fibres, after pasting through among the cells in the inner group of the anterior oornu, cro» in the white comaitMttro to the anterior column of the opposite side. Many filrca pass backwards in the oubitaiKC of the anterior corau where ume of them would Shape UP Skechers a; .pear (o form connection with fibre proceeding from other piru of the cord, and others to spread obliquely upwanis and downward; while those which are most external, pauaag through the outer group of cells, reach the lateral column. •;mlinc in the anterior (uraua ad th« nno tide tmrli the anterior cmnmlMOni, aM oo the other


UNDF.H tho Shape UP Skechers n»mo of Nenrology, it is intended a href="http://www.discountshapeup.com/">Skechers Shape UPS to includo the descriptive anatomy of tho various organs forming part of tho norvoua system.Tho norvous systom consist of two sots of part, ono of which i central, the other peripheral. To tho firnt set belong tho brain and pin.il eord, forming together tho ccrebro-spina] axis, and tho ganglia : to tho second set belong all tho nervu

distributed throughout tho body ; and along with theme may bo includod tho organ of tho senses, or those organ which contain tho terminations of tho aoveral nerves of special sensation, in con¬nection with certain apparatus or modifications of structure related to tho reoeptloo of imprcs'ions by each of these nerrc.Among tho periphoral nerves it is necosaary also to distinguish tho cere¬brospinal and tho sympathetic or ganglionic, which, though intimately connected with each othor at soiuo places, .ire yot so different in ihoir structure and modo of distribution as to require separate description.Tho description of thco aoveral parts of tho nervous system will bo bronght Skechers under tho following four sub-sections, vix. 1. Tho cerebrospinal Attn ; '2. Tho oerobro-spinal norves ami tho ganglia connecto«l with them ; 3. Tho sympathetic nervos and their ganglia ; 4, Tho organs of tho senses.I.—TIIE CEREBROSPINAL AXIS.Tho cerebrospinal oris is contained partly within tho cavity of tho cra¬nium, and partly within tho vertobral canal ; it is symmetrical in its form and structure throughout, consisting of a right and a left half, separated to a oortain oxtent by longitudinal lissures, and presonting in their plane of aniou various portions of whito and grey nervous substanoo, which crow from ono side to another, Sketchers Shape UPS and form tho cvmmittvra of the brain and spinal cord.Enclosed within tho skull and the vertebral canal, tho cerebrospinal axis is protected by tho bony walls Shape UPS of those two cavities ; it is also surrounded by three membranes, which alTonl it additional protection and support, and are subservient to its nutrition. These envelopes, which will be described hereafter, are, 1st, a dense fibrous membrane namod tho dura mater, which i» placed most superficially ; 2nd, a serous membrane culled tho arach¬noid ; and, 3rd, deepest of all, a highly vascuUr membrane namod the pia mater.The oerobro-spinal axis is divided by anatomist into tho eneephalon or enlarged upper mass plaoed within the cranium, and tho spinal cord con¬tained within tho vertebral canal.


For late presentation of distal radius fracture malu- nion.an osteotomy through the distal radius to realign the artic¬ular joint surface and correct any excessive dorsal angulation is necessary to correct the instability.11-" The surgical technique roust be modified to ibe number of planes of correction required.Dorsal angvdalion akmc, without his of radius height or ulnar inclination, requires d.irul open-wedge osteotomy with a wedge- shaped interposition iliac crest bone graft (see Chapter 15). The osteotomy is best performed at a href="http://www.discountshapeup.com/">Skechers Shape UPS tbe site of malunion to prevent an bend-in the dislal radius and to minimise the amount of angu lar cotrvction required Cats- must Isj taken to place tbe frift prox¬imal to the distal radioulnar joint. Either a btvorlscal dor».il-ba«d. intercalary graft or two wedge-shaped trkorticocancclloux grafts are cut from the Qiac crest. The surgical technique b to cu. Ihe graft through the inner and outer tables with a power saw to give the exact angular correction required. Triangular cortical Shape UPS wedges (inner and outer tables) and ibe dorsal cortical crest maintain

con¬tact between corticjl bone surfaces for correction of deformity and allow maximum cancellous banc suifsce area contact for osteosyn- Ihcsis (Fig. 2ts7).Techniques described by Fernandez are helpful. These involve careful preoperative measurement of the angulation of tlw distal Sketchers Shape UPS radius (dorsal and radial-ulnar) as well as live normal contralateral wrist. If the normal 22-degree ulnar inclination of'the radius articular surface has been last, then ihe nvorc radial of the two tri¬angular grafts is cut wilh greater angulation lo open lite radial side of the- osteotomy more than ihe ulnar side (Fig. 26.7). If. in addition to dorsal till and loss of Shape UP Skechers ulnar inclination, impaction hasshortened Ihe radius, then the triangular grafts .ire replaced by iivipe/.t AIHI grafts to displace the radial fragment distally to gisv neutral ulna variance IFig 26.$). Once the graft hoc been \ut. the defect (deficiency) in the distal radius can be corrected by a lam¬ina spreader or with an external fixation distraction system. Depending on the location of the osteotomy, the correction obtained wilh the opening-wedge graft can be maintained by cither a plate with screws (Figs. 2/.'M and 26-10) or a tension band wire iFig, 26.98). Dorsal osteotomies that Skechers are placed too far dis¬till;' may prevent the ute of plate and screw fixation owing to extensor tendon interference. Simple and effective fixation can be achiesed with dortal tension hand wiring that utet two parallel Kirschner wires (Fig. 26.9B).Author's Preferred Technique for Corrective OsteotomyIhe Kirschner wires are driven from the dittal radius distoll; and dorsally in a proximal and palmar direction through the bone graft to engage tbe palmar cortex of the radius (Fig, 26.9B). This, com¬bined with the dorsal tension band wire, prevents dorsal extrusion ol the bone graft. The distal w ire can go either around or through the distal portion of the radius at long at it avoidt the joint articu¬lar surface.


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