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The falciform ligament attaches the liver anteriorly to the diaphragm and the anterior abdominal wall above the umbilicus.
The coronary ligaments extend laterally to attach the liver to the diaphragm. Beginning at the suprahepatic inferior vena cava (IVC), the lateral extensions of the coronary ligaments form the triangular ligaments (right and left), which are also attached to the diaphragm.
The anatomical division of the liver into the eight classic Couinaud segments has no practical application in traumatic liver resection, where the resection planes are nonanatomical and are dictated by the extent of injury. However, the external anatomical landmarks may be useful in planning operative maneuvers.
The plane between the center of the gallbladder and IVC runs along the middle hepatic vein, and serves as the line of division between the right and left lobes.
The left lobe is divided by the falciform ligament into the medial and lateral segments.
Dissection along the falciform ligament should be performed carefully, so as to avoid injury to the portal venous supply to the medial segment of the left lobe inferiorly and the hepatic veins superiorly.
The retrohepatic IVC is approximately 8–10 cm long and is partially embedded into the liver parenchyma. In some cases, the IVC is completely encircled by the liver, further complicating exposure and repair.
There are three major hepatic veins (right, middle, and left), as well as multiple accessory veins. The first 1–2 cm of the major hepatic veins are extra-hepatic, with the remaining 8–10 cm intra-hepatic. In approximately 70% of patients, the middle hepatic vein joins the left hepatic vein before entering the IVC.
The common hepatic artery originates from the celiac artery. It is responsible for approximately 30% of the hepatic blood flow, but supplies 50% of the hepatic oxygenation. It branches into the left and right hepatic arteries at the liver hilum in the majority of patients. In a common anatomical variant, the right hepatic artery may arise from the superior mesenteric artery. Less frequently, the entire arterial supply may arise from the superior mesenteric artery. Alternatively, the left hepatic artery may arise from the left gastric artery in 15–20% of patients.
The portal vein provides approximately 70% of hepatic blood flow, and 50% of the hepatic oxygenation. It is formed by the confluence of the superior mesenteric vein and the splenic vein behind the head of the pancreas. The portal vein divides into right and left extrahepatic branches at the level of the liver parenchyma.
The porta hepatis contains the hepatic artery (medial), common bile duct (lateral), and portal vein (posterior, between the common bile duct and the hepatic artery).
The right hepatic duct is easier to expose after removal of the gallbladder.
The left hepatic duct, the left hepatic artery, and the left portal vein branch enter the undersurface of the liver near the falciform ligament.
The abdominal aorta bifurcates into the two common iliac arteries at the level of the fourth to fifth lumbar vertebrae (surface landmark is the umbilicus). The common iliac arteries are about 5–7 cm in length.
At the level of the sacroiliac joint, the common iliac arteries bifurcate to the external and the internal iliac arteries.
The external iliac artery runs along the medial border of the psoas muscle and goes underneath the inguinal ligament to become the common femoral artery. It gives two major branches: the inferior epigastric artery, just above the inguinal ligament, and the deep iliac circumflex artery, which arises from the lateral aspect of the external iliac artery opposite the inferior epigastric artery.
The internal iliac artery is a short and thick vessel, about 3–4 cm in length. It divides into the anterior and posterior branches at the sciatic foramen. These branches provide blood supply to the pelvic viscera, perineum, pelvic wall, and the buttocks.
The ureter crosses over the bifurcation of the common iliac artery.
The common iliac veins lie medially and posterior to the common iliac arteries. They join to form the inferior vena cava at the level of the fifth lumbar vertebra, posterior to the right common iliac artery.
In 1598, the first English convent to be founded since the dissolution of the monasteries was established in Brussels, followed by a further twenty-one foundations, which all self-identified as English institutions in Catholic Europe. Around four thousand women entered these religious houses over the following two centuries. This book highlights the significance of the English convents as part of, and contributors to, national and European Catholic culture. Covering the whole exile period and making extensive use of rarely consulted archive material, James E. Kelly situates the English Catholic experience within the wider context of the Catholic Reformation and Catholic Europe. He thus transforms our understanding of the convents, stressing that they were not isolated but were, in fact, an integral part of the transnational Church which transcended national boundaries. The original and immersive structure takes the reader through the experience of being a nun, from entry into the convent, to day-to-day life in enclosure, how the enterprise was funded, as well as their wider place within the Catholic world.
This book explores the mobilities of capital and labour in the contemporary global economy, with a particular focus on Asia. Using an analytical framework around three dimensions related to the forms, institutions, and spatialities of mobility, the chapters use a variety of sub-national, national and transnational sites within and beyond Asia to examine the interrelationships between mobilities of capital and labour at multiple levels of analyses. The book foregrounds the intricate and persistent linkages between the two mobilities, which have played an important role in capitalist development, but have hitherto mostly been analyzed as separate processes.
De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.
Psychiatric disorders are associated with increased risk of ischaemic heart disease (IHD) and stroke, but it is not known whether the associations or the role of sociodemographic factors have changed over time.
To investigate the association between psychiatric disorders and IHD and stroke, by time period and sociodemographic factors.
We used Scottish population-based records from 1991 to 2015 to create retrospective cohorts with a hospital record for psychiatric disorders of interest (schizophrenia, bipolar disorder or depression) or no record of hospital admission for mental illness. We estimated incidence and relative risks of IHD and stroke in people with versus without psychiatric disorders by calendar year, age, gender and area-based deprivation level.
In all cohorts, incidence of IHD (645 393 events) and stroke (276 073 events) decreased over time, but relative risks decreased for depression only. In 2015, at the mean age at event onset, relative risks were 2- to 2.5-fold higher in people with versus without a psychiatric disorder. Age at incidence of outcome differed by cohort, gender and socioeconomic status. Relative but not absolute risks were generally higher in women than men. Increasing deprivation conveys a greater absolute risk of IHD for people with bipolar disorder or depression.
Despite declines in absolute rates of IHD and stroke, relative risks remain high in those with versus without psychiatric disorders. Cardiovascular disease monitoring and prevention approaches may need to be tailored by psychiatric disorder and cardiovascular outcome, and be targeted, for example, by age and deprivation level.
This volume endeavors to explain the most important developments in philosophy since the end of the Second World War. Yet even when we restrict our focus primarily to those insights and movements that most profoundly shaped the English-speaking philosophical world (as we reluctantly found it necessary to do), it still remains the case that no one – and no one volume (not even a volume like ours, filled with more than fifty chapters from a diverse range of leading philosophers) – can tell this whole story. This is not only because there is no one single overarching story to tell, but also because the overlapping and sometimes conflicting stories that together constitute this complex history are still being written – here in this book, for example. Two of the reasons for the history of philosophy’s necessary incompleteness came to the fore of (what we risk calling) the general self-understanding of Western philosophy during this historical period. These interconnected philosophical reasons (or self-realizations) merit emphasis here, especially because they remain subtle undercurrents throughout the book.