Copertina del libro Arcipelago Gulag di Sozenicyn. Incentrato sull’universo concentrazionario dell’Unione Sovietica, esce per Mondadori nella. Arcipelago Gulag shared Il Sotterraneo del Retronauta’s post. October 17 ·. Image may contain: 1 person, smiling, text · Il Sotterraneo del Retronauta. Arcipelago Gulag. Winner Description: Author: Aleksandr Solzhenitsyn. Publisher : Mondadori. Winner Blurb: Life in Soviet prison camps as recounted by the.

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The Gulag Archipelago Russian: It was first published infollowed by an English translation the following year. It covers life in the gulagthe Soviet hulag labour camp system, through a narrative constructed from various sources including reports, interviews, statements, diaries, legal documents, and Solzhenitsyn’s own experience as a gulag prisoner. Following its publication, the book initially circulated in gukag underground publication in the Soviet Union until its appearance in the literary journal Novy Mir inin which a third of the work was published in three issues.

Structurally, the text comprises seven sections divided in most printed editions into three volumes: At one level, the Gulag Archipelago traces the history of the system of arcpelago labor camps that existed in the Soviet Union from to Solzhenitsyn begins with V.

Lenin ‘s original decrees which were made shortly after the October Revolution ; they established the legal and practical framework for a series of camps where political prisoners and ordinary criminals would be sentenced to forced labor.

Arcipelago Gulag 2°: : Books

Note 1 The book aricpelago describes and discusses the waves bulag purges and the assembling of show trials in the context of the development of the greater Gulag system; Solzhenitsyn gives particular attention to its purposive legal and bureaucratic development.

Khrushchev gave the speech at the 20th Congress of the Communist Party of the Soviet Uniondenouncing Stalin ‘s personality culthis autocratic power, and the surveillance that pervaded the Stalin era.

Although Khrushchev’s gylag was not published in the Soviet Union for a long time, it was a break with the most atrocious practices of the Gulag system. Despite the efforts by Solzhenitsyn and others to confront the legacy of the Gulag, the realities of the camps remained a taboo subject until the s.

File:Aleksandr Solzhenitsyn – Arcipelago Gulag (Архипелаг ГУЛаг) – I saggi Mondadori 1974.jpg

Solzhenitsyn was also aware that although many practices had been stopped, the basic structure of the system had survived and it could be revived and expanded by future leaders. While Khrushchev, the Communist Party, and the Soviet Union’s supporters in the West viewed the Gulag as a deviation of Stalin, Solzhenitsyn and many among the opposition tended to view it as a systemic fault of Soviet political culture — an inevitable outcome of the Bolshevik political project.

Along the way, Solzhenitsyn’s examination details the trivial and commonplace events of an average prisoner’s life, as well as specific and noteworthy events during the history of the Gulag system, including revolts and uprisings. Macbeth’s self-justifications were feeble — and his conscience devoured him. Yes, even Iago was a little lamb, too.

The imagination and spiritual strength of Shakespeare’s evildoers stopped short at a dozen corpses. Because they had no ideology.

Ideology — that is what gives evildoing its long-sought justification and gives the evildoer the necessary steadfastness and determination. That is the social theory which helps to make his acts seem good instead of bad in his own and others’ eyes That was how the agents of the Inquisition fortified their wills: Without evildoers there would have been no Archipelago. Solzhenitsyn draws on his own and fellow prisoners’ long experiences in the gulag as the basis for this non-fiction work.

Solzhenitsyn spent time as an inmate at a sharashka or scientific prison, an experience that he also used as the basis of the novel The First Circle. However, the ultimate integrity and authority of The Gulag Archipelago is rooted in the first-hand testimony of fellow prisoners.

The sheer volume of firsthand testimony and primary documentation that Solzhenitsyn managed to assemble in this work made all subsequent Soviet and KGB attempts to discredit the work useless. Much of the impact of the treatise stems from the closely detailed stories of interrogation routines, prison indignities and especially in section 3 camp massacres and inhuman practices.

Solzhenitsyn also poetically re-introduces his character of Ivan Denisovich towards the conclusion of the book. When questioned by the book’s author if he has faithfully recounted the story of the Gulag, Denisovich now apparently freed from the camps replies that “you [the author] have not even begun One chapter of the third volume of the book was written by a prisoner named Georg Tenno, whose exploits so amazed Solzhenitsyn to the extent that he offered to name Tenno as co-author of the book; Tenno declined.

However, never before had the general reading public been brought face to face with the horrors of the Gulag in this way. The controversy surrounding this text, in particular, was largely due to the way Solzhenitsyn definitively and painstakingly laid the theoretical, legal, and practical origins of the Gulag system at Lenin’s feet, not Stalin’s. According to Solzhenitsyn’s testimony, Stalin merely amplified a concentration camp system that was already in place.

This is significant, as many Western intellectuals viewed the Soviet concentration camp system as a “Stalinist aberration”. Solzhenitsyn documented the Soviet government’s reliance on the prison system for governance and labor, placing doubt on the entire moral standing of the Soviet system.

The government could not govern without the threat of imprisonment.

Arcipelago Gulag

The Soviet economy depended on the productivity and output of the forced labor camps, especially insofar as the development and construction of public works and infrastructure were concerned.

In Western Europethe book eventually contributed strongly to the need for a rethinking of the historical role of Vladimir Ilyich Ulyanov, Lenin. With The Gulag ArchipelagoLenin’s political and historical legacy became problematic, and those factions of Western communist parties who still based their economic and political ideology on Lenin were left with a heavy burden of proof against them.

Kennanthe influential U. In an interview with German weekly Die ZeitBritish historian Orlando Figes asserted that many gulag inmates he interviewed for his research identified so strongly with the book’s contents that they became unable to distinguish between their own experiences and what they read: After the KGB had confiscated Solzhenitsyn’s materials in Moscow, during —, the preparatory drafts of The Gulag Archipelago were turned into finished typescript, sometimes in hiding at his friends’ homes in the Moscow region and elsewhere.

Solzhenitsyn entrusted Susi with the original typed and proofread manuscript of the finished work, after copies had been made of it both on paper and on microfilm.

In the KGB seized one of only three existing copies of the text still on Soviet soil. This was achieved after interrogating Elizaveta Voronyanskayaone of Solzhenitsyn’s trusted typists [12] who knew where the typed copy was hidden; within days of her release by the KGB she hanged herself 3 August News of the nature of the work immediately caused a stir, and translations into many other languages followed within the next few months, sometimes produced in a race against time.

American Thomas Whitney produced the English version; the English and French translations of Volume I appeared in the spring and summer of Solzhenitsyn had wanted the manuscript to be published in Russia first, but knew this was impossible under conditions then extant.

The work had a profound effect internationally. Not only did it provoke energetic debate in the West; a mere six weeks after the work had left Parisian presses Solzhenitsyn himself was forced into exile.

Because possession of the manuscript incurred the risk of a long prison sentence for “anti-Soviet activities”, Solzhenitsyn never worked on the manuscript in complete form. Since he was under constant KGB surveillance, Solzhenitsyn worked on only parts of the manuscript at any one time, so as not to put the full book into jeopardy if he happened to be arrested.

For this reason, he secreted the various parts of the work throughout Moscow and the surrounding suburbs, in the care of trusted friends. Sometimes when he was purportedly visiting them on social calls he actually worked on the manuscript in their homes.

During much arcipelgao this time, Solzhenitsyn lived at the dacha of the world-famous cellist Mstislav Rostropovichand due to the reputation and standing of the musician, despite the elevated scrutiny of the Soviet authorities, Solzhenitsyn was reasonably safe from KGB searches there.

Solzhenitsyn did not think this series would be his defining work, ggulag he considered it journalism and history rather than high aripelago. Solzhenitsyn was aware that there was a wealth of material and perspectives that deserved to be continued in the future [ clarification tulag ]but he considered the book finished for his part. The royalties and sales income for the book were transferred to the Solzhenitsyn Aid Fund for aid to former camp prisoners, and this fund, which had to work in secret in its native country, managed to transfer substantial amounts of money to those ends in the s and s.

Natalya Reshetovskaya, Aleksandr Solzhenitsyn’s first wife, wrote in her memoirs that The Gulag Archipelago was based on “campfire folklore” arcpelago opposed to objective facts. She wrote that she was “perplexed” that the Western media had accepted The Gulag Archipelago as “the solemn, ultimate truth”, saying that its significance had been “overestimated and wrongly appraised”.

She said that her husband did not regard the work as “historical research, or scientific research”, and added that The Gulag Archipelago was a collection of “camp folklore”, containing “raw material” which her husband was planning to use in his future productions.

Wheatcroft asserts that it is essentially a “literary and political work”, and “never claimed to place the camps in a historical or social-scientific quantitative perspective”. The documentary covers events related to the writing and publication of The Gulag Archipelago. From Wikipedia, the arciipelago encyclopedia. A Soul in Exile. Check arcipelaho values in: A Century in his Life. Ist der Wurm nun aus dem Apfel Gefallen? A Study of His Western Reception.

Art of the Baltics: The New York Times. When Solzhenitsyn wrote and distributed his Gulag Archipelago it had enormous political significance and greatly increased popular understanding of part of the repression system.

Arcipelago Gulag | Awards & Grants

But this was a literary and political work; it never claimed to place the camps in a historical or social-scientific quantitative perspective, Solzhenitsyn cited a figure of 12—15 million in the camps. But this was a figure that he hurled at the authorities as a challenge for them to show that the scale of the camps was less than this. The press service the channel Rossiya K. Retrieved 23 August The Gulag Archipelago in Russian.

Archived from the original on 13 January Origins Of The Gulag: The Soviet Prison Camp System, — Works by Aleksandr Solzhenitsyn. Miniatures Prussian Nights One Day in the Life of Ivan Tulag The Gulag Archipelago Retrieved from ” https: Views Read Edit View history.

In other projects Wikimedia Commons Wikiquote.

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I’ve just set up GoodReader on my iPad2, and the PDF and TextEdit files that I set up with. GoodReader are all encrypted. How do I read them?. I password protected my folder on iPad Goodreader, but I still can access the We have just bought iPad GoodReader and encrypted the files. GoodReader, the document reader which achieved the rank of #2 best-selling iPad app in , now leverages the iOS’s ability to encrypt.

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Here you will find a brief description of GoodReader’s goodeeader with links to more detailed manuals. There are two types of viewing engines – the ones that we’ve written ourselves, and ebcrypted built-in device’s standard viewing engine. Our own engines provide great flexibility and many additional features not found in the built-in engine for example, opening very large files.

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GoodReader for iPad Adds AirPlay for Video, Encryption, Better PDF Annotations – MacStories

By putting such files into this folder, you will keep your backup size and time reasonable, plus you will save your wireless traffic, if you’re doing wireless backups. However, if a file is of a considerable value to you, and you’d like it to be backed up either to iTunes or to iCloud, move this file out of this folder.

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Password Protect Files and Folders In GoodReader

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GoodReader for iPad Adds AirPlay for Video, Encryption, Better PDF Annotations

This API encrypts files, to make sure that your data will be secure, even if your device gets lost or stolen. While this feature is designed to be as transparent and effortless as possible, there are some procedures that need to be performed to enforce data encryption. Also, some limitations apply, so please be sure to encrgpted the following section, if you want to use this feature.

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We do want to try a few things with individuals. When asked if the international players will be managed further this season, van Graan added: Munster’s training squad has had a youthful look to it this week.

As a result, van Graan has been keen to include as many academy players into his first pre-season in Limerick as possible and identified the likes of Gavin and Liam Coombes, Shane Daly, Jack Daly and Alex McHenry as players who have impressed him this summer.

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‘It’s a World Cup year’: Van Graan expects to see less of Munster’s internationals this season

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By Ryan Bailey Tuesday 14 Aug1: Van Graan speaking to the media in UL yesterday.

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Maybe you could write next articles referring to this article. I desire to read more things about it! Superbe fotografiile si articolul foarte bun.

Drumul prin Ranca a fost largit odata cu asfaltarea Transalpinei fata de anii trecuti, au mai fost facute si parcari. Ramane de vazut ce efect or sa aiba modificarile in sezon. Frank,Thanks for the information. I do try to have an open comments section within reason. Obviously there are letlst.

Taking apart Fatima’s claims can educate people on both the tactics and mindset of our enemies. We started with the normalization of deviance and ended with a look at bad ideas and why they tend to stick around. In between we talked about SOAP reporting and being nice. Some things in here I have not thought about before.

Thanks for makingsuch a cool post which is actually very well written will be referring many friends aboutthis. Being a math minded person, your perception was from a math perspective.

I Am A Cuban Sandwich | The Radio Theatre Project | Live Radio Theatre at The [email protected]

Would be interesting to know how many consumers see it as a math function and scratch their heads about its meaning. I imagine few if any would say the same of me. Please take that into consideration. I honestly believe this is very heavy handed. I understand that the extent of the injury played a huge role here, but where was this concern when Kobe suffered a concussion and a broken nose?

A little consistency from the league would be nice. I have got 1 recommendation for your blog site. It seems like at this time there are a handful of cascading stylesheet troubles while opening a number of web pages in google chrome and firefox. It is working fine in internet explorer.

Probably you can double check this. Ist trotzdem die Zustimmung Dritter erforderlich? Wat een leuke kussens maakte je Marion!! Je bent wel druk bezig! Is de slaapkamer al helemaal af? Mooi, die donkere muren. Ik ben benieuwd naar het totaalplaatje. Ik wens je een heel fijne tijd in Engeland.

You can test it by buying a pregnancy test and testing a few drops of the mixture. That was well after my time. When I was a kid, my first bike was something my Dad cobbled together from parts he probably found in the garbage.

It didn’t even have fenders. WOW, look at that view…just gorgeous! As is your roulade…so special made with homemade jam. This enables organizations to locate a large number of potential employees who have other commitments and cannot work set hours each week. ESPNReportOnNewtonInvestigation CamNewtonPlayerCard If you send a detailed policy on recruitment and employment that comprehensively covers subjects like work permits, travels, relocations, uniforms, work ethics, social activities, etc.


Path: /eico/b/. This is the BAMA archive. These manuals are available for download and free of charge. I am now accepting new manuals for inclusion in this. DESCRIPTION. Your new EICO Model Resistance-Capacitance-. Comparator Bridge, was designed to measure practically all resistances and capacitances. The article currently covers the EICO series, PACO C, Knight KG, Heathkit C-2 and C-3, etc. (More models will be added on an ongoing basis as I.

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Posted in Test Equipment on August 23rd, This article discusses repair and calibration information for a number of vintage capacitor testers that all use the same fundamental test circuit. More models will be added on an ongoing basis as I find the time.

All of these models are almost identical 590b functionality and circuitry. You get the entire set of 3 reference caps 1 of pf, 1 of 0. You NEED precision reference capacitors to achieve an accurate capacitor tester.

Extreme caution must be followed with any vintage capacitor tester because very high voltages are present during repair and while operating. They should only be used by knowledgeable technicians.

Eixo models use a balanced bridge that measures capacitance from 10mmf up to mf and resistance from 0. During component value testing, the magic eye tube serves as the null-indicator.

When the bridge is far from balanced, the target area of the magic eye tube glows completely closed green, and in fact overlaps. As the pointer dial approaches balance point, first the overlapping disappears and eventually the entire target area of the eye tube is completely open dark. The bridge is balanced when the maximum dark area is indicated, and you can then read the value of your component on the faceplate scale. Most models use the magic eye tube for both Leakage testing and component value testing.

Eico: eico model 950b bridge construction

Any technician who repairs vintage tube equipment such as tube amps, antique radios, vintage jukeboxes will find that a quality capacitor tester is a useful test instrument. Other values of precision capacitors are available by request. Heathkit C-3 dark color scheme.

Heathkit C-3 light color scheme. NRI Professional model This website discusses repair of electronic items.

Antique Radio Forums • View topic – Eico B resistance/capacitance/comparator bridge

90b Electrical voltages are present and represent a danger. Repairs should only be attempted by a qualified technician. We do not provide free personalized troubleshooting.

All content is the opinion of the author and not intended as advice.


This lesson linear series is a continuation of the Newbie Level Nihongo-Dojo series. You will follow the story of Haruya, a professional Japanese boxer, and. In this lesson series, you’ll review topics covered in Beginner Seasons 1 and 2 as well as learn new grammar topics and expressions. In this season, you’ll. This lesson series is a continuation of Beginner Season 4. You will hear about Haruya, the professional Japanese boxer and another young Japanese man.

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La Bella Figura has ratings and reviews. Michael Goldman said: While I learned that as an overthinker who flies by the seat of his pants when t. The journalist Beppe Severgnini offers a witty, insightful view of Italy, where red lights and tax laws are viewed as advisory only. La Bella Figura: A Field Guide to the Italian Mind. Beppe Severgnini, Author, Giles Watson, Translator. Broadway $ (p) ISBN.

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Your purchase helps support NPR programming. An offbeat odyssey into the heart of Italy and the Italian people captures the colorful character of the nation in a ten-day journey to thirty destinations that reveal Italy’s best, worst, and most authentic aspects. Now, he is turning his wisdom and wit toward his homeland, exploring the nuances of life in modern Italy. For instance, Severgnini says, traffic laws are interpreted a bit different in Italy.

A Beautiful Figure and ‘The Italian Mind’ : NPR

Book excerpts are provided by the publisher and may contain language some find offensive. Being Italian is a full-time job. We never forget who we are, and we figuda fun confusing anyone who is looking on. Don’t trust the quick smiles, bright eyes, and elegance of many Italians.

A Beautiful Figure and ‘The Italian Mind’

Be wary seevrgnini everyone’s poise. It offers instant attention and solace. But don’t take Italy at face value. Or, rather, take it at face value if you want to, but don’t complain later.

Follow the Author

One American traveler wrote, “Italy is the land of human nature. You’re going to need a map. So you’ll be staying for ten days? We’ll take a look at three locations on each day of your trip.

They’ll be classics, the sort of places that get talked about a lot, perhaps because they are so little known. We’ll start with an airport, since we’re here. Then I’ll try to explain the rules of the road, the anarchy of the office, why people talk on trains, and the theatrical nature of hotel life. We’ll sit in judgment at a restaurant and feel the sensory reassurance of a church. We’ll visit Italy’s televisual zoo and appreciate how important the beach hella.

We’ll experience the solitude of the soccer stadium, and realize how crowded the bedroom feels. We’ll note the vertical fixations of the apartment building, and the transverse democracy of the living room–or, rather, the eat-in kitchen. Ten days, thirty places.

We’ve got to start somewhere if we want to find our way into the Italian mind. First of all, let’s get one thing straight.

Your Italy and our Italia are not beella same thing. Italy is a soft drug peddled in predictable packages, such as hills in the sunset, olive groves, lemon trees, white wine, and raven-haired girls.

Italia, on the other hand, is a maze. It’s beppee, but complicated. In Italia, you can go round and round in circles for years. Which of course is great lla. As they struggle to find a way out, many newcomers fall back on the views of past visitors.

People like Goethe, Stendhal, Byron, and Twain always had an opinion about Italians, and couldn’t wait to get home and write it down. Those authors are still quoted today, as if nothing had changed. This is not true. Some things have changed in our Italy. The problem is bbeppe out what.

Almost all modern accounts of the country fall into one of two categories: The former have an inferiority severgnihi toward Italian home life, and usually feature one chapter on the importance of the family, and another on the excellence of Italian cooking.

The diaries take a supercilious attitude toward Italian public life. Inevitably, there is censure of Italian corruption, and a section on the Mafia. By and large, the chronicles of love affairs are penned by American women, who display love without interest in their descriptions of a heppe Eden, where the weather is good and the locals are charming. The diaries of disappointment tend to be produced by British men, who show interest without love.

They describe a bbeppe country populated by unreliable individuals and governed by a public administration from hell. Yet Italy is far from hellish. It’s got too much style. Neither is it heaven, of course, because it’s too unruly. Let’s just say that Italy is an offbeat purgatory, full of proud, tormented souls each of whom is convinced he or she has a hotline to the boss.

It’s the kind of place that can have you fuming and then purring in the space of a hundred meters, seergnini the course of ten minutes. Italy is the only workshop in the world that can turn out both Botticellis and Berlusconis. People who live in Italy say they want to get out, but those who do escape all want to come back.

As you seveegnini understand, this is not the sort of country that is easy to explain. Particularly when you pack a ssevergnini fantasies in your baggage, and Customs lets them through. Take this airport, for example. Whoever wrote that airports are nonplaces never visited Milan’s Malpensa or Linate, or Rome’s Fiumicino. Or, if they did pay a call, they must have been too busy avoiding people shouting into cell phones and not looking where they were going.

An airport in Italy figur violently Italian. It’s a zoo with air conditioning, where the animals don’t bite and only the odd comment is likely to be poisonous. You have to know how to interpret the seevergnini and signals. Italy is a place where things are always about to happen. Generally, those things are unpredictable.

For us, normality is an exception. Do you remember The Terminal? He’d have founded a political party, promoted a referendum, opened a restaurant, and organized a farmers’ market. Look at the childlike joy on the faces of the people as they stroll into the shops. Note how inventive they are at thinking up ways to pass the time.

Observe the deference to uniforms any uniform, from passing pilots to cleaning staff. Authority has been making Italians uneasy for centuries, so we have developed an arsenal of countermeasures, from flattery to indifference, familiarity, complicity, apparent hostility, and feigned admiration. Study the emerging faces as the automatic doors of international arrivals open. They reveal an almost imperceptible hint of relief at getting past Customs.

Obviously, almost all the arriving passengers have nothing to hide. There was a uniform, and now it’s gone. Note the relief giving way to affection as they retrieve their suitcases from the carousel. At the check-in desk, they weren’t sure they would ever see their suitcases again, and did all they could to pass them off as hand luggage. Listen to the couples quarreling, their accusations lent extra ferocity by the embarrassment of performing in public “Mario!

You said you had the passports! Admire the rituals of the families coming back from holiday. These spoken exchanges–Mom wants to know where their son is; Dad shouts to the son; the son answers Dad; Dad tells Mom, who has disappeared in the meantime–are the same ones that echo in a New York hotel or a street market in London.

Malpensa encapsulates the nation. Only a naive observer would mistake this for confusion. Actually, it’s performance art.

It’s improvisation by gifted actors. No one believes for one minute he or she is an extra. Everyone’s a star, no matter how modest the part. Federico Fellini would have made a good prime minister, if he’d wanted the job. It takes an outstanding director to govern the Italians. What else can you find out at an Italian airport? Well, Italians’ signature quality–our passion for beauty–is in danger of becoming our number-one defect. All too figurz, it prevents us from choosing what seevrgnini good.

Look at the cell-phone displays and the saleswomen perched on their stools. Many of them can’t tell a cell phone from a remote control, but all are indisputably attractive. Do you know why the phone companies hire them instead of using skilled staff? Because that’s what the public wants. People prefer good looks to good answers. There is a lesson to be learned.

We are prepared to give up a lot for the sake of beauty, even when it doesn’t come in a miniskirt. We judge books by their covers, politicians by their smiles, professionals by their offices, secretaries by their posture, table lamps by their design, cars by their styling, and people by their title. It’s no coincidence that one Italian in four is president of something.


El caso Dominique – Francoise Enviado por Centr Universitario del Sur . Salvar. El caso Dominique – Francoise para depois. salvar. El caso Dominique – Francoise Cargado por Centr Universitario del Sur. Copyright: © All Rights Reserved. Download as PDF or read online from. El caso Dominique – Françoise – Download as PDF File .pdf), Text File .txt) or view presentation slides online.

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Spo Pelayanan Histerektomi jFull description. Asoep Previa Full description. Plasenta Restan plasenta restanFull description. Plasenta Previa plasenta previa.

Akibat tidak adanya desidua basalis secara parsial atau total dan gangguan perkembangan lapisan fibrinoid membran Nitabuch. Pada plasenta akreta vili korialis menanamkan diri lebih dalam ke dinding rahim. Pada plasenta normal menanamkan diri sampai ke batas lapisan otot rahim.

Plasennta ini terjadi karena bertambahnya angka pelahiran caesar. American college of obstetricians and gynecologist memperkirakan bahwa plasenta akreta timbul sebagai komplikasi dalam 1 retenso kelahiran.

Dari ulasan Stafford dan Belfort melaporkan insiden sekitar 1 dari pada tahun an. Terdapat faktor resiko untuk plasenta akreta yang telah diketahui berkat penapisan MSAFP untuk defek tabung saraf dan aneuploidi.

Hung, dkk, menganalisis keluaran pada lebih dari perempuan yang ditapis untuk sindrom down pada 14 hingga 22 minggu gestasi. Perlengketan abnormal ini dapat mengenai semua lobuli plasenta plzsenta totalatau hanya melibatkan beberapa bagian lobuli plasenta akreta parsial dan semua atau sebagian lobulus tunggal dapat melekat abnormal plasenta akreta fokal.

Plasenta akreta dapat menyebabkan plasenta. Perdarahan antepartum dengan plasenta akreta lazim terjadi dan biasanya terjadi akibat plasenta previa yang terdapat bersamaan. Pada plasehta kasus, plasenta akreta tidak diidentifikasi rstensio persalinan kala III. Berbagai upaya dilakukan untuk mengidentifikasi secara lebih tepat pertumbuhan plasenta ke arah dalam sebelum terjadi partus. Lam dkk, menemukan bahwa sensitifitas sonografi hanya 33 persen untuk mendeteksi plasenta akreta.

Dengan pemetaan aliran warna menggunakan Doppler sonografik, Twickler dkk melaporkan bahwa terdapat dua faktor yang sangat prediktif untuk invasi miometrium: Kedua faktor ini memiliki sensitivitas persen dan nilai prediktif positif 78 persen. Hal tersebut mungkin mencerminkan invasi trofoblastik ke dalam miometrium dan jaringan sekitar. Pada plasenta akreta parsialis, masih dapat dilepaskan secara manual, tetapi plasenta akreta kompleta tidak boleh dilepaskan secara manual karena usaha ini dapat menimbulkan perforasi dinding rahim.

Keberhasilan pengobatan bergantung pada pemberian darah pengganti dengan segera dan hampir selalu histerektomi dini. Definisi 2,4,5,8,9 Histerektomi obstetrik adalah pengangkatan rahim atas indikasi obstetrik. Histerektomi adalah prosedur bedah mayor yang paling sering dilakukan retfnsio perempuan usia subur. Histerektomi mungkin merupakan operasi nomor tiga atau empat yang paling sering dilakukan di Amerika Serikat.

Prosedur ini dapat dilakukan secara abnormal atau vaginal, bergantung pada indikasi spesifik. Histerektomi vaginal lebih disukai karena tidak dilakukan insisi abdomen, lama rawat inap lebih singkat, dan pemulihan lebih cepat.

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Dahulu, histerektomi tidak jarang menyebabkan pasien dirawat di rumah sakit selama 10 — 14 hari. Saat ini,pasien biasanya hanya menginap 3 — 4 hari setelah histerektomi abdominal dan 2 — 3 hari setelah histerektomi vaginal.

Sejumlah batasan dilakukan untuk menjelaskan histerektomi dengan lebih akurat. Istilah histerektomi dan histerektomi total keduanya dapat dipakai bergantian, yang artinya pengangkatan uterus secara lengkap, termasuk serviks.

Histerektomi subtotal adalah pengangkatan korpus uteri saja. Histerektomi abdominal adalah pengangkatan korpus uteri dan serviks melalui insisi abdominal. Histerektomi vaginal adalah pengangkatan serviks dan korpus uteri melalui vagina. Histerektomi ekstrafasial adalah pengangkatan uterus dan serviks bersama — sama dengan lapisan fasia luar serviks fasia endopelvis. Histerektomi intrafasial adalah pengangkatan uterus dan serviks dari dalam fasia endopelvis serviks.

Indikasi dilakukan histerektomi terbagi atas: Perdarahan yang tidak dapat dikontrol dengan cara-cara yang ada, misalnya pada: Uterinae terputus – Plasenta inkreta dan perkreta – Hematoma yang luas pada rahim 3. Infeksi intrapartal berat, untuk ini biasanya dilakukan operasi Porro, yaitu uterus dengan isinya diangkat sekaligus bulat-bulat 4.

Uterus miomatosus yang besar 5. Kematian janin dalam rahim dan missed abortion dengan kelainan darah 6. Keganasan ginekologi – Serviks – Uterus – Ovarium – Tuba 7. Penyakit jinak ginekologi refrakter terhadap terapi lain – Leiomioma uteri – Adenomiosis bergejala – Endometriosis bergejala – Sindrom relaksasi panggul bergejala – Nyeri panggul pusat sehingga menimbulkan ketidakmampuan kronis – Penyakit radang pelvis berat atau Abses – Perdarahan uterus yang sulit diatasi 8.

Komplikasi obstetri – Perdarahan uterus yang tidak dapat dikendalikan – Kehamilan mola. Teknik Histerektomi 4,5,8,13, 1.

Histerektomi abdominal Pasien diletakkan pada posisi terlentang, dan dipasang kateter Folley dalam kandung kemih. Meskipun insisi kulit tergantung masalah alamiahnya, untuk kebanyakan keadaan jinak dapat dilakukan insisi melintang rendah pfannenstiel.

Untuk kasus — kasusu keganasan dengan komplikasi, insisi qskep garis tengah bagian bawah simfisis pubis hingga umbilikus memberikan pemaparan dan kemungkinan perluasan yang lebih baik. Paada insisi melintang, fasia diinsisi melintang, melengkung kearah lateral superior untuk menghindari daerah inguinal, muskulus piramidalis dipisahkan bersama dengan muskulus rektus. Kemudian masuk dengan selubung rektus posterior dan peritoneum dengan hati — hati.

Peritoneum biasanya diinsisi secara vertikal.

Sekum dan apendiks diperlihatkan dan abdomen atas ginjal, hati, kandung empedu, lambung dan usus kecil bagian proksimal, pankreas di aakep. Usus digeser hati — hati kebagian atas abdomen.

Dipermudah dengan meletakkan pasien pada posisi sedikit trendelenburg. Ligamentum rotundum diligasi dengan benang dan dipotong. Dengan pemisahan secara tajam dibuat insisi di memungkinkan sepanjang ligamentum ligamentum latum latum terpisah dan anterior, rongga retroperitoneal terbuka. Insisi ini tepat diatas lipatan uterovesika. Dengan diseksi tajam dan kemudian tumpul, kandung kemih dipisahkan dari serviks.

Pada saat ini, dengan diseksi tumpul tambahan secara minimal, pembuluh pelvis dan ureter dapat dikenali. Diseksi garis tengah diperluas ke vagina sampai labium anterior serviks teraba. Pada saat ini, retensi tumpul dilakukan ke lateral untuk mengangkat plaeenta dari pembuluh darah uterus. Jika akan dilakukan ooforektomi, peritoneum posterior diinsisi secara vertikal tepat tepat 1 cm di infundibulopelvis.

Begitu dipastikan lateral ligamentum ureter sudah bebas, ligamentum infundibulopelvis diligasi dua kali. Ovarium dibawa ke medial. Jika adneksa ingin dipertahankan, setiap ligamentum uteroovarii diklem dan diligasi pada tempat insersi uterus retrnsio bagian pedikel termasuk tuba retensioo dan peritoneum posterior diinsisi ke arah insersi ligamentum uterosakrum.

Pembuluh darah pelvis dikenali dn diisolasi pada ketinggian ostium interna. Arteri dan vena diklem dan diligasi dua kali. Ligamentum kardinale diklem biasanya dengan menyelipkan klem dari serviksdiinsisi dan diligasi pada beberapa bagian pada setiap sisi.

Sop Retensio Plasenta

Jika detensio ligamentum uterosakrum, ligamentum tersebut diklem, diligasi dan diinsisi. Pada saat ini serviks plaeenta diraba dan vagina dimasukkan biasanya melalui anterior dengan diseksi tajam. Dilakukan insisi melingkar dan spesimen diangkat. Ligamentum uterosakrum dan kardinale dijahit kesudut vagina untuk memastikan penopang vagina dan vagina ditutup dengan jahitan. Penutupan vagina dapat dari mukosa ke mukosa dengan menjahit vagina secara tertutup anterior ke posterior.

Atau lumen vagina dibiarkan terbuka biasanya untuk rehensio dengan jahitan sederhana di sekitaar vagina. Pada kedua kasus digunakan benang yang dapat diserap. Peritoneum pelvis seringkali ditutup, terapi penelitian dewasa ini menunjukan bahwa penutupan ini tidak selalu diperlukan. Setelah semua spons, jarum, dan alat — alat dihitung dan jumlahnya sudah benar, peritoneum parietal ditutup dan fasia diaproksimasi kembali dengan jahitan.

Jaringan subkutan ditutup dan kulit ditutup dengan jahitan atau klip. Kassa kering dipasang untuk mengakhiri tindakan. Reteniso ini dipermudah jika terjadi prolaps uteri. Pasien diletakkan pada posisi litotomi dorsal dan vagina serta pudendum dibersihkan dengan larutan antiseptik. Dipasang kain penutup steril, dan spekulum dimasukkan ke dalam vagina sebelah posterior.

Serviks dijepit dan mobilitas retensii lagi. Dibuat insisi melingkar pada fasia di sambungkan servikovaginal dan cul — de — sac dimasuki. Begitu dipastikan cul-de-sac sudah bebas, ligamentum uterosakrum dikenali, diklem, diinsisi dan diligasi. Pada saat ini, disarankan menjahit mukosa vagina bagian posterior ke peritoneum untuk menghentikan perdarahan dari daerah ini.

Jika anatomi memungkinkan, digunakan diseksi tajam dan tumpul dengan modifikasi untuk membebaskan kandung kemih dari serviks untuk menginsisi peritoneum anterior.

Jika sulit, satu atau lebih ligamentum kardinale dapat diklem, diinsisi dan diligasi. Begitu peritoneum anterior dimasuki, lakukan diseksi tumpul ke lateral untuk memisahkan ureter dari pembuluh darah uterus, sementara retraktor dibiarkan untuk meninggikan dan mempertahankan kandung kemih.

Pembuluh darah uterus dikenali, diklem, diligasi dan diinsisi secara bilateral. Setelah ligamentum latum diklem, diligasi, dan dinsisi secara bilateral, ligamentum uteroovarii, tuba fallopi dan ligamentum rotundum diklem, diinsisi dan diligasi pada satu pedikel.

Ovarium diamati dan diamankan hemostasis. Peritoneum ditutup dengan benang yang dapat lpasenta sehingga semua pedikel terletak ekstraperitoneal. Segmen terbawah ligamentum cardinale dan ligamentum uterosakrum dijahit ke sudut vagina superior dan biasanya ligamentum uterosakrum dijahit bersama — sama ke garis tengah.

Akhirnya ujung vagina ditutup dengan benang yang dapat diserap. Histerektomi vaginal dengan bantuan laparoskopi dewasa ini sudah mulai digunakan secara luas. Histerektomi dilengkapi dengan reseksi ligamentum uterosakrum dan bagian bawah ligamentum cardinale per vaginam.