Sign in anonymously Don't add me to the active users list. Published on Aug 20, No Downloads. Jo — R-Type [Awesome] Mar 13, at PM 2. Mar 13, at PM 3.
Porn star toes. Hardcore Jungle Oldskool
Housing the monstrous rounds is a monstrous long front 2 bottom magazine contains 26 rounds. Disclaimer Selectuve Hazard Alert is not a standard or regulation, and it creates no new legal obligations. The Base selective blow out changes are a different caliber around the new Chinese cases of 5. Start on. Bruce Smith April 20, General considerations Co-morbidities such as cardiac, respiratory and hepatic disease are common place in patients undergoing neck dissections in either Ethan nude elective or therapeutic sense. And chipping away at ice can damage the gutters or shingles. Others only serve one purpose. Spare Parts Online Store. If you are using an extension cord make sure it is rated for the wattage the heater draws.
RCR today said existing institutional shareholders took up 88 per cent of new shares available to them.
- Selectable detents allow switching between no detent ideal for loader operation  and mechanical detent for continuous hydraulic motor operation .
- Space, also known as the highest frontier - And by the same logic the seas and oceans could be called along with the dippiest mines as the lower frontier.
- For those of you who follow my blog you know I try to keep things fairly short.
- The neck dissection has remained a pivotal aspect of head and neck cancer management for over a century.
- Ever since the first pickup truck was built, owners have been trying to get more power and performance from their engines.
Tape That : a new series dedicated to dusting off the classic rave tape packs any raver over 25 had in their collection. Written by regular blog contributor Jamie S23 , the first in our series whisks us back 19 years to Dreamscape It was held on 28th May , a time where the acid house era was now lurking deep underground, jungle and hardcore breakbeats were fusing together and darkside vibes went hand in hand with uplifting pianos.
Returning to The Sanctuary in Milton Keynes and using an almost identical flyer to the very first Dreamscape design back in , Murray Beetson brought an unstoppable line-up to the sacred tin shed. The line up in the main arena consisted of: Ramos, Sy.
The mixed bag line-up was a sign of the times…. During the transitional period of underground music, attending an event like this would provide a broad education into music, one hour you would be listening to the likes of Dougal dropping hands in the air piano anthems, the next hour would see G. E Real RIP fusing techno with reggae and jungle. Take Conrad, for example; a modern day GQ in terms of his approach to mic duties in comparison.
Sure he has his lyrics, but it was his crowd control, his manner and professionalism that won over the crowd time and time again and probably why, to this day, he is still traveling the world with LTJ Bukem.
At the time of this event I was 14, way too young to legally enter a rave like this and in all fairness I probably had no chance — mainly because I still looked about 9. This tape pack was my musical education — the Ramos, Dougal and GE Real sets gave me a true insight to the ever changing hardcore scene.
Early production from Kane, Pascal, Andy C and Hype are combine for a excellent mixture of breakbeat, early jungle and hardcore. Moving onto another set from the pack that will always hold many memories for me: Dougal and Conrad. For those that want to get right into it I would skip the first 5 or so minutes where G.
Unlike other ways to control NOx, the DEF system allows the diesel engine to run at its optimum range in terms of fuel mixture; whereas, some systems require the engine to run richer, which can be harmful to diesel engines. It is important to identify this fascia since it not only protects the underlying neural structures but also provides a plane along which dissection is readily facilitated. In the example shown, the pin length is correct at 1 - 1. No child under age 13 should ever ride in the front seat of a car. Is cardiopulmonary exercise testing a useful test before esophagectomy? Also bullet firing leaves a distinctive bubble like trail reviling the shooter presence and location.
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Whereas the ansa cervicalis is frequently sacrificed the vagus, lingual, hypoglossal and marginal mandibular branch of the facial nerves should be identified and preserved.
Identification of the latter should be attempted early on in the neck dissection following flap elevation. If the nerve cannot be identified by visual inspection through the layers of the deep cervical fascia its integrity should be preserved by dividing the facial vessels approximately 1 cm below the lower border of the mandible and then retracting the divided ends upwards, so lifting the marginal mandibular branch of the nerve away from the surgical field.
The hypoglossal nerve can be identified crossing the external carotid artery and then emerging from underneath the posterior belly of digastric on the hyoglossus muscle - it is at risk of inadvertent damage at both sites. Transient neuropraxia to the phrenic nerve is often manifested sub-clinically in the post-operative period with changes on plain radiography but if a severe pulmonary problem exists, especially with concurrent pectoris major flat harvest, respiration may be compromised.
Bilateral phrenic nerve palsies may necessitate periods of prolonged mechanical ventilation. The brachial plexus lies between scalenus anterior and medius muscles as it crosses the posterior triangle.
It is not usually encountered other than in the extended radical neck dissection but knowledge of its location is important in preventing further readily avoidable complications. Intentional transection of the vagus nerve can result in intra-operative cardiac problems of which the anaesthetist needs to be forewarned.
Where possible integrity of the cranial nerves should be maintained unless this compromises tumour resection. Although it is well established that resection of the facial nerve in parotid malignancy provides similar survival benefit to preservation and post-operative radiotherapy, no similar data is available for other cranial nerves with relevance to neck dissection. Nerve resection therefore remains an individual decision and may well be influenced by other matters, e.
Drainage is used following neck dissection to prevent the collection of fluid and to aid healing. The placing of drainage should be carried out separately from the incision to reduce the risk of infection. Although there is some controversy whether active or passive drains should be used when neck dissections are carried in conjunction with free tissue transfer, the evidence suggests that active drainage should be employed in both free flap and non-free flap cases [ 28 ].
In addition to neural structures, vascular elements may also have to be sacrificed in certain clinically-determined circumstances. Major vessel involvement should be assessed pre-operatively with appropriate imagining, be it contrast-enhanced computed tomography, magnetic resonance imagining, magnetic resonance angiography, ultrasound, Doppler or conventional angiography.
Selective sacrifice of the common or internal carotid arteries during extensive cervical operative procedures or their compulsory ligation after exposure for haemorrhage post-operatively can produce some of the most serious complications in head and neck surgery. The highest morbidity occurs in those patients in whom ligation has been performed during a hypotensive episode such as one due to proceeding haemorrhage rather than those in whom selective ligation or excision is undertaken [ 29 ].
Balloon-test occlusion with hypotensive challenge offers a simple and reliable method of pre-operative risk assessment when internal carotid artery resection is planned for regional control of disease in advanced head and neck cancer [ 30 ].
However, this management option is still associated with a potential for neurological complication that must be weighed against the natural history of the disease and the risk and benefits of other treatment modalities. Increased morbidity and mortality has been demonstrated in patients undergoing simultaneous bilateral neck dissections [ 31 ].
Higher rates of infections and fistulae occur and complications such as facial oedema and swelling are commonplace, particularly if both IJVs are simultaneous transacted. This rise in ICP commonly requires aggressive treatment with hyperventilation, fluid restriction, steroids and mannotol. The ICP frequently returns to normal within 24 hours. There can be a significant rise in ICP in a staged second neck dissections even if the subsequent operation is undertaken many years after the initial surgery.
If both IJVs are to be transected then preservation of conduits in the external venous system should be attempted wherever possible, eg external jugular veins.
As in all cases of neck dissection where significant swelling may compromise the airway in the post-operative period the possibility of a prophylactic tracheostomy should be entertained.
Previous treatment of the neck, be it radiation, chemo-radiation or surgery can have a significant impact both in terms of practicalities and post-operative complications.
Previous radiation encourages fibrosis between tissue planes such that subsequent dissection can be a laborious process. There is no substitute to a painstaking approach and proactive haemostasis in such circumstances.
These problems are often compounded when previous neck surgery has taken place and is of particular issue if vascular access needs to be preserved to form the basis of recipient vessels for free tissue transfer. In such circumstances some of the more commonly used vessels, e. There is rarely a role for pre-operative arterial imaging but instead the surgeon should be wary of preserving vessels in and around the surgical field.
The transverse cervical artery and vein are useful recipient vessels since they are rarely irradiated, are of near constant calibre throughout their course and are not commonly affected by atheroclerosis.
In selected circumstances veins grafts may be advisable as an alternative to exposing the contra-lateral neck. In extreme circumstances one may resort to using the cephalic vein turned over the clavicle or the internal mammary system.
Neurological sequaelae of emergency ligation include hemiplegia, hemi-anaesthesia, aphasia and dysarthria. The incidence is increased following radiation and salary fistulae. Damage to the adventitial layer during surgery may be another contributory factor. If risk of exposure is anticipated vessels should be covered, e. This is particularly important in the post-irradiation subject. If impending blow out is suspected sentinel bleed endovascular techniques with stent-grafts may be indicated rather than open ligation although short-term complications still occur [ 34 ].
Over the past century the neck dissection has become the accepted face of head and neck oncology, be it performed in isolation or as integral element of a more major resection and reconstruction. Since it is carried out with such regularity in many units it has the potential to be considered as routine.
However in common with many procedures the appreciable potential morbidity and indeed morbidity should not be underestimated by junior and seniors surgeons alike. Whilst a meticulous, almost protocol-driven approach should be employed throughout, any one patient's needs can only be truly addressed by an individual approach. Despite the best planning complications can still occur but their impact can be minimised by a vigilant and proactive emphasis in the entire peri-operative period.
National Center for Biotechnology Information , U. Journal List Head Neck Oncol v. Head Neck Oncol. Published online Oct Cyrus J Kerawala 1 and Manolis Heliotos 2. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Cyrus J Kerawala: moc. Received May 2; Accepted Oct This article has been cited by other articles in PMC. Abstract Background The neck dissection has remained a pivotal aspect of head and neck cancer management for over a century.
Objectives This review will consider the potential complications of neck dissection and on the basis of the available evidence describe both their management and prevention. Conclusion Although the neck dissection continues to provide clinicians with a method of addressing cervical disease, its reliability and safety can only be assured if surgeons remain cognisant of the potential complications and aim to minimise such morbidity by appropriate management in the peri-operative period.
Introduction Since its original description by Crile in and subsequent popularisation by Hays Martin in the radical neck dissection RND remained the standard treatment for palpable or potential cervical metastasis from head and neck cancer for many decades [ 1 , 2 ]. General considerations Co-morbidities such as cardiac, respiratory and hepatic disease are common place in patients undergoing neck dissections in either an elective or therapeutic sense.
Pre-operative evaluation Reduced nutritional intake may be a direct result of symptoms from the index tumour such as dysphasia or odynophagia and in itself is an independent contributory factor to poor gastrointestinal function. Anaesthesia The importance of communication between the anaesthetic and surgical teams cannot be over emphasised.
Post-operative care Peri-operative cardiac complications can often be minimised by proactive management, e. Surgical technique Asepsis Although preparation of a surgical site prevents wound contamination by removing transient pathological bacteria and decreasing resident flora counts, good surgical technique with minimal tissue damage still has a role to play.
Incisions A variety of approaches exist for the approach to neck dissections that usually simply rely on surgeon preference, e. Flap elevation and closure Flaps should be elevated in the sub-platysmal plane in order to maximise their blood supply unless local disease dictates otherwise. Progression of neck dissection The sequence of the neck dissection is dictated by the type of procedure being undertaken, whether such surgery is being performed simultaneously with other ablative procedures, e.
Air embolus This is a rare event which can occur following injury to the IJV. Pneumothorax This may occur when working low in the neck particularly if the lung apex is high as may occur in over inflation secondary to inadvertent one-lung intubation. Chyle leak The thoracic duct arises from the cisternal chyli at the level of the second lumbar vertebra and rises into the neck between the aorta and the azygos vein.
Neural structures Reparative processes of transected cervical nerves may lead to neuromas in the early or late post-operative period. Drains Drainage is used following neck dissection to prevent the collection of fluid and to aid healing. Extended neck dissections In addition to neural structures, vascular elements may also have to be sacrificed in certain clinically-determined circumstances. Special considerations Bilateral neck dissection Increased morbidity and mortality has been demonstrated in patients undergoing simultaneous bilateral neck dissections [ 31 ].
The previously treated neck Previous treatment of the neck, be it radiation, chemo-radiation or surgery can have a significant impact both in terms of practicalities and post-operative complications. Conclusion Over the past century the neck dissection has become the accepted face of head and neck oncology, be it performed in isolation or as integral element of a more major resection and reconstruction.
Competing interests The authors declare that they have no competing interests. Authors' contributions CK Surgical technique Special considerations Conclusions MH Introduction General considerations and peri-operative evaluation Both authors read and approved the final manuscript.
References Crile G. Excision of cancer of the head and neck with special reference to the plan of dissection base of one hundred and thirty-two operations. Neck dissection. Preoperative radiation and radical neck dissection. Surg Clin N Amer.
Combined surgery and postoperative irradiation in the treatment of cervical lymph nodes. Arch Otolaryngol. Failure in the neck following multimodality treatment for advanced head and neck cancer. A syndrome resulting from radical neck dissection. Am J Surg. Functional neck dissection: an evaluation and review of cases.
Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck. T2 carcinoma of the tongue: the histopathologist's perspective. Br J Oral Maxillofac Surg. Prognostic impact of blood transfusion in patients undergoing primary surgery and free-flap reconstruction for oral squamous cell carcinoma. Acute perioperative normovolaemic haemodilution in major maxillofacial surgery. Prophylaxis for venous thromboembolism in head and neck surgery: the practice of otolaryngologists.
J Laryngol Otol. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Haemodynamic optimisation of the surgical patient revisited. Anaesthesia International. Is cardiopulmonary exercise testing a useful test before esophagectomy?
Ann Thorac Surg. Postoperative hypertension after radical neck dissection. Otolaryngol Head Neck Surg. Prolongation of the Q-T interval and sudden cardiac arrest following right radical neck dissection. Neck dissection and the clinical appearance of post-operative shoulder disability: the post-operative role of physiotherapy. Eur J Cancer Care Engl ; 17 —8. The efficacy of topical antibiotic prophylaxis for contaminated head and neck surgery.
Clin Otolaryngol. Chyle leaks: consensus on management? In both cases, checking the process parameters should eliminate the problem. In the example shown, shorts are seen on the Pin Grid Array device. Due to the close proximity and the number of pins, the solder separation is impeded from the base of the board. Shorting can occur due to poor fluxing, incorrect heat or wave separation.
Poor N2 quality can also cause shorts. All shorting can be decreased through good design rules with reduction in pad size and component lead length. A lead length from 1 - 1. Longer pins can cause more shorts. Most can only be fluxed by good design. Increasing the flux solids will improve the drainage on all joints.
In the example shown, the pin length is correct at 1 - 1. With smaller pads, less solder is retained on the board to short between pins. The most common cause for sunken joints is the hole to lead ratio. If the hole is large in comparison to the lead diameter, the solder literally drops in or out of the hole. Sunken solder joints can be caused by incorrect preheat or poor fluxing when seen on the topside of the board.
Bass Selective - Blow Out Pt 2&3 (, Stamped, Vinyl) | Discogs
Written by Ian McQuaid 23 May. Do U remember '92? This clutch of banging old-skool tunes will put a smile y on your face. This was a crazy, intense time for British music. New technology was coming out monthly, and producers were caught in an arms race to see who could squeeze the weirdest, freshest sounds from their gear.
Whether UK dance music has ever sounded as crazy as this since is open to debate. Bass Selective — Blow Out Part 2 The Moog — Rush Hour In terms of truly shameless drug anthems, this one takes the biscuit.
Half of the track consists of frantic synths and a hooligan MC shouting "make some noise" with barely discernable rhythm. Sound Entity — A2 A classic from the darkside era. Produced by Alex Reece — later famous for his Metalheadz classic Pulp Fiction — and Jack Smooth , a one man production factory who has worked on upwards of a thousand hardcore and drum'n'bass cuts, this EP is something of a rave holy grail.
Rachel Wallace — Tell Me Why A bittersweet hardcore ballad to broken hearts. In a parallel universe this would have been a huge hit. It has the simplicity and hookiness of a pop classic, combined with beats hard enough to carry a warehouse into euphoric bedlam. The original version of this ethereal banger was withdrawn from sale after occasional rave vocalist Seal launched a copyright claim.
A tiny snippet of his vocals singing "music takes you round and round" had been sampled, giving the track its name — and a plaintive, soulful sheen. Blame re-released the tune with the Seal vocal removed and it went on to become a huge hit, but the original still keeps a special place in the hearts of rave OGs.
Released in , it had a huge piano led breakdown that was cheesy enough for the happy hardcore massive, alongside hammering breakbeats hard enough to keep the junglists raving. It was set to become a huge chart success, only to have fame and fortune snatched away at the last minute — a Dutch producer called Paul Elstak ripped off the main sample after Jimmi J and Cru-L-T turned down his attempt to license 6 Days to his own label. Every single record released on the Production House label from to is a stone cold classic.
The label was set up by Phil Fearon , a former UK chart topper whose Brit soul with the band Galaxy had given him the funds to set up an independent production studio. Phil gathered a set of young musicians around him and allowed them to produce hardcore epics with no constraints. The result were long tracks of serious musical complexity — the closest rave had to a label making prog rock. Exodus from the Brothers Grimm is a three-part beast, opening with a sample taken from The Exorcist , dropping into a sub bass heavy mid-section, before finishing up with a hands-aloft dancehall singalong.
Ravers knew it as "The Sound Of Music", thanks to its pitched-up, discordant vocal sample. Anyone tuning into to garage pirate radio in the late 90s would stand a fair chance of hearing this hit getting wheeled up. Now listen to the acid house channel on Red Bull Radio. Want a hit of new music every Friday? Follow our 4pm Finish Spotify playlist.
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