एओर्तिक दिसेक्सन छगु मेदिकल इमर्जेन्सी ख। थ्व अवस्थाय् एओर्ताया छुं सतह बाया हि सतहतेगु दथुइ वनि। थ्व छगू मेदिकल इमर्जेन्सी ख। बांलाक्क उपचार याःसां थ्व अवस्थां याना मनु छकलं हे सी फु। दिसेक्सनं याना एओर्टा पूवंकः बाःसा (स्वंगु हे तहय् बायावंसा) छकलं यक्व हि बाहा वनी। एरोर्टिक दिसेक्सनं हि धों रप्चर (rupture) जुसा  ८०% मोर्टालिटी रेट दै नापं ५०% उसाँय् मदुपिं अस्पताल थ्यने न्ह्यः हे सी धुंकी। दिसेक्सन ६ से मि  थ्यंसा उसाँय् मदुमेसित आकस्मिक शल्यक्रिया यायेमा। थ्व शल्यक्रिया यायेत २० घौ तक्कया ई मा। उसाँय् मदुमेसियात वासः बिया ३न्हु तक्क कोमाय् तैगु या।

म्हसीका

दक्वं आर्तरीय् थें एओर्टा स्वंगु तह जाना दयाच्वंगु दै। त्युनिका इन्तिमा हियागु बाहा नापं प्रत्यक्ष स्वापूय् दयाच्वनि। थ्व सतह आपा कथं इन्दोथेलियल सेलं देकातगु दै। मेगु तह त्युनिका मिदिया ख। थ्व दथुयागु सतह स्मूथ मसल व इलास्तिक तिस्युं देकी। दक्ले पिनेया तह त्युनिका एद्भेन्तिसिया ख। थ्व तह कनेक्तिभ तिस्यु नं देकी।

एओर्तिक दिसेक्सनय् हि इन्तिमा तहं दुहां वया मिदियाय् थ्यनि। हियागु बाहां मिदियायात खुनाछ्वया अप्व हि मुंकिगु थाय् देकी। थन्यागु थाय् एओर्ताया हाकय् थी-थी हाकः तक्क दयाच्वने फु। थ्व कथं एओर्ताया हाकः बायावनेबिले नुगःया दिशाय्, नुगः विपरित दिशाय् वा निगु हे दिशाय् वने फु। इन्तिमाय् घा आपालं एओर्तिक भाल्भ स्वया १०० मि मि दुनेया दुरीय् दयाच्वनि।

एओर्तिक दिसेक्सनया मू खतरा एओर्ता मुइगु ख। एओर्ता मुया तच्वगु हि बाहा वना मनु सी फु।

बायेगु व्यवस्था

एओर्तिक दिसेक्सनया वर्णन यायेत थी-थी कथंया बायेज्या न्ह्यब्वगु खने दु। थन्यागु बायेज्याय् आपालं दिसेक्सनया एनाटोमी वा लक्षणया विकास जुया गुलि ई धुंका उसाँय् मदुम्ह अस्पताल थ्यन, उकिया आधारय् देकातःगु खने दु।

दिबेकी बायेगु व्यवस्था
थ्व व्यवस्थाया नां सर्जन व एओर्तिक दिसेक्सन ल्वेमि माइकल इ दिबेकीया नामे तःगु ख। थ्व व्यवस्थाय् एओर्तिक दिसेक्सनया एनातोमिकल देस्क्रिप्सन बी। थ्व व्यवस्थाय् दिसेक्सनया वर्गीकरण वास्तविक इन्तिमल घाःया थाय् व दिसेक्सनया मात्राया आधारय् याइ (थाय् एस्सेन्दिङ्ग एओर्ता, दिस्सेन्दिङ्ग एओर्ता वा निगु हे जुइफु)
प्रकार I - एस्सेक्दिङ्ग एओर्ताय् न्ह्यथनि, म्होय् नं एओर्तिक आर्क तक्क थ्यनि व आपालं आर्क स्वया नं तापाक्क वनि।
प्रकार II – एस्सेन्दिङ्ग एओर्ताय् न्ह्यथना थुकिलि हे सीमित जुइ।
प्रकार III – दिस्सेन्दिङ्ग एओर्ताय् न्ह्यथना म्हो अवस्थाय् सत्तिकः वनि।

स्ट्यानफर्द बायेगु व्यवस्था
एस्सेन्दिङ्ग एओर्ता सम्बन्धित दु/मदुया आधारय् २ गु पुचले विभाजित यानातगु दु, क्रमशः A व B।
A = प्रकार I व II दिबेकी
B = प्रकार III दिबेकी

प्याथोफिजियोलोजी
एओर्तिक दिसेक्सनया न्ह्यथनिगु झाका एओर्ताया इन्तिमा गुइगु ख। एओर्ताया उच्च रक्तचापं याना हि मिदियाय् गुयाच्वंगु थासं दुहां वनि। हि बाहां याना गुयावंगु घा झन तच्वया वनि। थ्व कथं तच्वना प्रोक्जिमल्ली (नुगः नापं) वा दिस्तल्ली (नुगः स्वया विपरित दिशाय् ) वा निगु हे दिशाय् वने फु। हि मिदियाय् दुहां वना स्युदोएन्युरिजम देकी। फल्स ल्युमेन व ट्रु ल्युमेनयात इन्तिमल तन्तुया छगू सतहं बाना तइ। थन्यागु तहयात इन्तिमल फ्ल्याप धाइ।

एओर्तिक दिसेक्सन आपा याना इन्तिमल टियरं न्ह्यथनि व थन्यागु टियर एसेन्दिङ्ग एओर्ता (६५%), एओर्तिक आर्क (१०%), वा दिसेन्दिङ्ग एओर्ताया लिगामेन्तम एओर्तिओसम् (२०%)य् आपालं खने दइ।

हि फल्स ल्युमेनं बाहा वनेबिले बाहां इन्तिमाय् सेकेन्डरी टियर देके फु। थन्यागु सेकेन्दरी टियरं याना हि ल्युमेनय् हानं दुहां वने फु।

इन्तिमल टियर छाय् जुइ धका बांलाक्क मस्युसां थुलि खं सी दु कि थन्यागु टियरय् मिदिया देकिगु कोल्याजेन व इल्यास्तिनया दिजेनेरेसन जुइ। थुकियात सिस्तिक मेदियल नेक्रोसिस धाइ व थन्यागु अवस्था आपालं मार्फान सिन्द्रम व एह्लर्स-दान्लोज सिन्द्रमय् खने दै।

थ्यं-मथ्यं १३% एओर्तिक दिसेक्सनय् इन्तिमल टियरया छुं निशान मलु। थन्यागु अवस्थाय् न्ह्यथनिगु कारक छगू इन्ट्राम्युरल हेमातोमा (मिदिया दुनेया हेमोरेजं याना) जुइगु धइगु विश्वास दु। थन्यागु अवस्थाय् ट्रु व फल्स ल्युमेनय् छुं नं स्पष्ट स्वापू मदइगुलिं थन्यागु अवस्थाय् एओर्तोग्राफी छ्य्‌ला डायग्नोज याये थाकु। इन्त्राम्युरल हेमातोमां याःगु एओर्तिक दिसेक्सनयात इन्तिमल टियरं याःगु एओर्तिक दिसेक्सनयात थें हे याना व्यवहार यायेमा।

कारक
एओर्तिक दिसेक्सन हाइपरतेन्सन व थी-थी कनेक्तिभ तन्तुया ल्वे नाप स्वापू दूगु ल्वे ख। थ्व ल्वे म्हो अवस्थाय् भास्कुलाइतिसनाप नं सम्बन्धित जु। नापं चेस्ट ट्रमाया लिच्वःया कथं नं थ्व ल्वे जुइफु। थ्व ल्वे दैपिं आपालं ल्वमिइ हाइपरतेन्सन दयाच्वनि।

थ्व ल्वे दकले अप्व ५०दँ निसें ७०दँया मनुइ खनेदु। थ्व ल्वे मिसा स्वया मिजंय् निच्वः अप्व खनेदु (लैंगिक अनुपात मिजं:मिसा=२:१) । ४०दँ स्वया म्हो दँया मिसाय् थ्व ल्वे मचा प्वाथय् दइ बिले (३गु त्राइमेस्तर व पोस्तपार्तम ईले) खनेदु।

थ्व ल्वचं कापिं मनुइ ७-१४% तक्क मनुइ बाइकस्पिद एओर्तिक भाल्भ दयाच्वनि। These individuals are prone to dissection in the ascending aorta.  The risk of dissection in individuals with bicuspid aortic valve is not associated with the degree of stenosis of the valve.

मार्फान सिन्द्रम is noted in 5-9% of individuals who suffer from aortic dissection.  In this subset, there is an increased incidence in young individuals.  Individuals with Marfan syndrome tend to have aneurysms of the aorta and are more prone to proximal dissections of the aorta.

Turner syndrome also increases the risk of aortic dissection, by aortic root dilatation.

Chest trauma leading to aortic dissection can be divided into two groups based on etiology:  blunt chest trauma (commonly seen in car accidents) and iatrogenic.  Iatrogenic causes include trauma during cardiac catheterization or due to an intra-aortic balloon pump.

Aortic dissection may be a late sequalae of cardiac surgery.  18% of individuals who present with an acute aortic dissection have a history of open heart surgery.  Individuals who have undergone aortic valve replacement for aortic insufficiency are at particularly high risk.  This is because aortic insufficiency causes increased blood flow in the ascending aorta.  This can cause dilatation and weakening of the walls of the ascending aorta.

लक्षण
About 96% of individuals with aortic dissection present with severe pain that had a sudden onset.  It may be described as tearing in nature, or stabbing or sharp in character.  17% of individuals will feel the pain migrate as the dissection extends down the aorta.  The location of pain is associated with the location of the dissection.  Anterior chest pain is associated with dissections involving the ascending aorta, while intrascapular (back) pain is associated with descending aortic dissections.  If the pain is pleuritic in nature, it may suggest acute pericarditis due to hemorrhage into the pericardial sac.

While the pain may be confused with the pain of a myocardial infarction (heart attack), aortic dissection is usually not associated with the other signs that suggest myocardial infarction, including heart failure, and ECG changes.  Also, individuals suffering from an aortic dissection usually do not present with diaphoresis (profuse sweating).

Individuals with aortic dissection who do not present with pain have chronic dissection.

Less common symptoms that may be seen in the setting of aortic dissection include congestive heart failure (7%), syncope (9%), cerebrovascular accident (3-6%), ischemic peripheral neuropathy, paraplegia, cardiac arrest, and sudden death.  If the individual had a syncopal episode, about half the time it is due to hemorrhage into the pericardium leading to pericardial tamponade.

Neurologic complications of aortic dissection (i.e., cerebrovascular accident (CVA) and paralysis) are due to involvement of one or more arteries supplying portions of the central nervous system.

If the aortic dissection involves the abdominal aorta, compromise of the branches of the abdominal aorta are possible.  In abdominal aortic dissections, compromise of one or both renal arteries occurs in 5-8% of cases, while mesenteric ischemia (ischemia of the large intestines) occurs 3-5% of the time.

ब्लड प्रेसर भिन्नता
While many patients with an aortic dissection have a history of hypertension, the blood pressure is quite variable at presentation with acute aortic dissection, and tends to be higher in individuals with a distal dissection.  In individuals with a proximal aortic dissection, 36% present with hypertension, while 25% present with hypotension.  In those that present with distal aortic dissections, 70% present with hypertension while 4% present with hypotension.

Severe hypotension at presentation is a grave prognostic indicator.  It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta.  Accurate measurement of the blood pressure is important.  Pseudohypotension (falsely low blood pressure measurement) may occur due to involvement of the brachiocephalic artery (supplying the right arm) or the left subclavian artery (supplying the left arm).

एओर्टिक इन्सफिसियन्सी
Aortic insufficiency (AI) occurs in 1/2 to 2/3 of ascending aortic dissections, and the murmur of aortic insufficiency is audible in about 32% of proximal dissections.  The intensity (loudness) of the murmur is dependent on the blood pressure and may be inaudible in the event of hypotension.

There are multiple etiologies for AI in the setting of ascending aortic dissection.  The dissection may dilate the annulus of the aortic valve, so that the leaflets of the valve cannot coapt.  Another mechanism is that the dissection may extend into the aortic root and detach the aortic valve leaflets.  The third mechanism is that if there was an extensive intimal tear, the intimal flap may prolapse into the LV outflow tract, causing intimal intussusception into the aortic valve preventing proper valve closure.

मायोकार्दियल इन्फार्क्सन
Myocardial infarction (heart attack) occurs in 1-2% of aortic dissections.  The etiology of the infarction is involvement of the coronary arteries (the arteries that supply the heart) in the dissection.  The right coronary artery is involved more commonly than the left coronary artery.  If the myocardial infarction is treated with thrombolytic therapy, the mortality increases to over 70%, mostly due to hemorrhage into the pericardial sac causing pericardial tamponade.

Because aortic dissection may present to the emergency room physician similar to a myocardial infarction, the physician must be careful to make the proper diagnosis prior to initiating treatment for myocardial infarction, since the treatment regimen for myocardial infarction can be lethal to an individual presenting with aortic dissection.

प्ल्युरल इफ्युजन
A pleural effusion (fluid collection in the space between the lungs and the chest wall or diaphragm) can be due to either blood from a transient rupture of the aorta or fluid due to an inflammatory reaction around the aorta. If a pleural effusion were to develop due to an aortic dissection, it is more commonly in the left hemithorax rather than the right hemithorax.

डायाग्नोसिस
Because of the varying symptoms and signs of aortic dissection depending on the initial intimal tear and the extent of the dissection, the proper diagnosis is sometimes difficult to make.

In an individual with chest pain radiating to the back, the differentials to consider include:
 Aortic dissection
 Myocardial infarction
 Acute aortic insufficiency
 Non-dissecting aortic aneurysm
 Pericarditis
 Musculoskeletal pain
 Mediastinal tumors

While taking a good history from the individual may be strongly suggestive of an aortic dissection, the diagnosis cannot always be made by history and physical signs alone.  Often the diagnosis is made by visualization of the intimal flap on a diagnositic imaging test.  Common tests used to diagnose an aortic dissection include a CAT scan of the chest with iodinated contrast material and a trans-esophageal echocardiogram.  Other tests that may be used include an aortogram or magnetic resonance angiogram (MRA) of the aorta.  Each of these test have varying pros and cons and they do not have equal sensitivities and specificities in the diagnosis of aortic dissection.

In general, the imaging technique chosen is based on the pre-test likelihood of the diagnosis, availability of the testing modality, patient stability, and the sensitivity and specificity of the test.

चेस्ट एक्स से
Widening of the mediastinum on an x-ray of the chest has moderate sensitivity (67%) in the setting of an ascending aortic dissection.  However, it has low specificity, as many other conditions can cause a widening of the mediastinum on chest x-ray.

The calcium sign is a finding on chest x-ray that suggests aortic dissection.  It is the separation of the intimal calcification from the outer aortic soft tissue border by 10 mm.

Pleural effusions may be seen on chest x-ray.  They are more commonly seen in descending aortic dissections.  If seen, they are typically in the left hemithorax.

Another findings are obliteration of the aortic knob, depression of the left mainstem bronchus, loss of the paratracheal stripe, and tracheal deviation.

About 12%-20% of individuals presenting with an aortic dissection have a "normal" chest x-ray.

इ सी जी
There are no specific electrocardiographic findings associated with aortic dissection.  About 1/3 of the time, the ECG will show signs of left ventricular hypertrophy, which is due to the long-standing hypertension seen in these individuals.  Another 1/3 of the time the ECG would be considered "normal".  If the ECG suggests cardiac ischemia in the setting
of aortic dissection, involvement of the coronary arteries should be suspected.

बायोकेमिकल मार्कर
While there are currently no blood tests that can accurately diagnose aortic dissection, research has been performed into the serial measurement of monoclonal antibodies to smooth muscle myosin heavy chains that appears to be both sensitive and specific for aortic dissection.  The sensitivity of this test is about 90% and the specificity is 97% within the first 12 hours of the beginning of the dissection, and this assay can accurately differentiate myocardial infarction from aortic dissection.  This test is not currently available for the diagnosis of aortic dissection in the clinical setting.

ट्रान्सइसोफेजियल इकोकार्डियोग्राफी
The transesophageal echocardiogram (TEE) is a relatively good test in the diagnosis of aortic dissection, with a sensitivity of up to 98% and a specificity of up to 97%.  It is a relatively non-invasive test, requiring the individual to swallow the echocardiography probe.  It is especially good in the evaluation of AI in the setting of ascending aortic dissection, and to determine whether the ostia (origins) of the coronary arteries are involved.  While many institutions give sedation during transesophageal echocardiography for added patient-comfort, it can be performed in cooperative individuals without the use of sedation.  Disadvantages of the TEE include the inability to visualize the distal ascending aorta (the beginning of the aortic arch), and the descending abdominal aorta that lies below the stomach.  A TEE may be technically difficult to perform in individuals with esophageal strictures or varices.

एओर्टोग्राम
An aortogram involves placement of a catheter in the aorta and injection of contrast material while taking x-rays of the aorta. The procedure is known as aortography. The diagnosis of aortic dissection can be made by visualization of the intimal flap and flow of contrast material in both the true lumen and the false lumen.

The aortogram was previously considered the gold standard test for the diagnosis of aortic dissection, with a sensitivity of up to 88% and a specificity of about 94%.  It is especially poor in the diagnosis of cases where the dissection is due to hemorrhage within the media without any initiating intimal tear.

The advantage of the aortogram in the diagnosis of aortic dissection is that it can delineate the extent of involvement of the aorta and branch vessels and can diagnose aortic insufficiency.

The disadvantages of the aortogram are that it is an invasive procedure and it requires the use of iodinated contrast material.

कम्प्युतेद तोमोग्राफी एन्जियोग्राफी

Computed tomography angiography is a fast non-invasive test that will give an accurate three-dimensional view of the aorta.  These images are produced by taking rapid thin cut slices of the chest and abdomen, and combining them in the computer to create cross-sectional slices.  In order to delineate the aorta to the accuracy necessary to make the proper diagnosis, an iodinated contrast material is injected into a peripheral vein. Contrast is injected and the scan performed using a Bolus Tracking method.  This is a type of scan timed to an injection, in order to capture the contrast as it enters the aorta.  The scan will then follow the contrast as it flows though the vessel.

It has a sensitivity of 96 - 100% and a specificity of 96 to 100%.  Disadvantages include the need for iodinated contrast material and the inability to diagnose the site of the intimal tear.

एम आर आइ

Magnetic resonance imaging (MRI) is currently the gold standard test for the detection and assessment of aortic dissection, with a sensitivity of 98% and a specificity of 98%.  An MRI examination of the aorta will produce a three-dimensional reconstruction of the aorta, allowing the physician to determine the location of the intimal tear, the involvement of branch vessels, and locate any secondary tears.  It is a non-invasive test, does not require the use of iodinated contrast material, and can detect and quantitate the degree of aortic insufficiency.

The disadvantage of the MRI scan in the face of aortic dissection is that it has limited availability and is often located only in the larger hospitals, and the scan is relatively time consuming.  Due to the high intensity of the magnetic waves used during MRI, an MRI scan is contraindicated in individuals with metallic implants.  In addition, many individuals experience claustrophobia while in the MRI scanning tube.

प्राकृतिक इतिहास
{| class="toccolours" align="right" cellpadding="4" cellspacing="0" style="margin: 0px 0px 1em 1em; clear:right;"
|-
! colspan="3" bgcolor="#ccccff" align="center" | Risk of death in untreated aortic dissection
|-
| colspan="3" |
|25% in first 24 hours
|50% in first week
|75% in first month
|90% in first year
|}

The risk of death is high in untreated aortic dissection.  While the risk is highest in the first 24 hours of the event, those that survive the initial event still have an elevated mortality compared to age- and sex-matched controls.

First Aid and Pre-Hospital Life Support
It is unlikely that a lay-person will recognize this condition. Call for help and arrange for immediate transport via emergency medical services to advanced medical care. In wilderness first aid, immediate evacuation is imperative, by MEDEVAC to an advanced medical facility if available.

Transport immediately to a facility capable of emergency cardiac surgery such as a trauma center is suggested, not a community hospital without a surgical service.  Supportive care including pain and blood pressure control should be provided en route to the medical center.

For Basic Life Support Providers (EMT-B or equivalent): Treat for shock by placing the patient in a modified Trendelenburg position and administering oxygen therapy. Despite chest pain, do not administer nitrates.

For Advanced Life Support Providers (EMT-I or EMT-P): Initiate the above BLS steps. Apply cardiac monitoring and establish intravenous therapy early. Titrate fluid to blood pressure, but do not use vasopressors. Record a diagnostic electrocardiogram to distinguish between aortic dissection and acute myocardial infarction. Do not administer thrombolytics. Analgesia should be accomplished with regard to the vasodilative effects of opioid analgesics such as morphine, fentanyl, and nalbuphine and should not be provided to a patient in decompensated shock.

Treatment
The risk of death due to aortic dissection is highest in the first few hours after the dissection begins, and decreases afterwards.  Because of this, the therapeutic strategies differ for treatment of an acute dissection compared to a chronic dissection.  An acute dissection is one in which the individual presents within the first two weeks.  If the individual has managed to survive this window period, his prognosis is improved.  About 66% of all dissections present in the acute phase.

In all individuals with aortic dissections, medication should be used to control high blood pressure, if present.

In the case of an acute dissection, once diagnosis has been confirmed, the choice of treatment depends on the location of the dissection.  For ascending aortic dissection, surgical management is superior to medical management.  On the other hand, in the case of an uncomplicated distal aortic dissections (including abdominal aortic dissections), medical management is preferred over surgical treatment

Individuals who present two weeks after the onset of the dissection are said to have chronic aortic dissections.  These individuals have been self-selected as survivors of the acute episode, and can be treated with medical therapy as long as they are stable.

Medical management is appropriate in individuals with an uncomplicated distal dissection, a stable dissection isolated to the aortic arch, and stable chronic dissections.  Patient selection for medical management is very important.  Stable individuals who present with an acute distal dissection (typically treated with medical management) still have an 8 percent 30 day mortality.

VIDEO - What is New in the Treatment of Type B Aortic Dissection?, Girma Tefera, MD, speaks at the University of Wisconsin School of Medicine and Public Health.

Medical management
The prime consideration in the medical management of aortic dissection is strict blood pressure control.  The target blood pressure should be a mean arterial pressure (MAP) of 60 to 75 mmHg.  Another factor is to reduce the shear-force dP/dt (force of ejection of blood from the left ventricle).

To reduce the shear stress, a vasodilator such as sodium nitroprusside should be used with a beta blocker, such as esmolol, propranolol, or labetalol.  The alpha-blocking properties of labetalol make it especially attractive in this situation.

Calcium channel blockers can be used in the treatment of aortic dissection, particularly if there is a contraindication to the use of beta blockers.  The calcium channel blockers typically used are verapamil and diltiazem, because of their combined vasodilator and negative inotropic effects.

If the individual has refractory hypertension (persistent hypertension on the maximum doses of three different classes of antihypertensive agents), involvement of the renal arteries in the aortic dissection plane should be considered.

Surgical management
Indications for the surgical treatment of aortic dissection include an acute proximal aortic dissection and an acute distal aortic dissection with one or more complications.  Complications include compromise of a vital organ, rupture or impending rupture of the aorta, retrograde dissection into the ascending aorta, and a history of Marfan's syndrome or Ehlers-Danlos Syndrome.

The objective in the surgical management of aortic dissection is to resect (remove) the most severely damaged segments of the aorta, and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and any secondary tears along the vessel).  While excision of the intimal tear may be performed, it does not significantly change mortality.

Some methods of repair are:
 Replacement of the damaged section with a tube graft (often made of dacron) when there is no damage to the aortic valve.
 Bentall procedure - Replacement of the damaged section of aorta and replacement of the aortic valve.
 David procedure - Replacement of the damaged section of aorta and reimplantation of the aortic valve.
 Insertion of a stent, combined with on-going medical management

A number of comorbid conditions increase the surgical risk of repair of an aortic dissection.  These include:
 Prolonged pre-op evaluation (increased length of time prior to surgery)
 Advanced age
 Comorbid disease states (e.g.: coronary artery disease)
 Aneurysm leakage
 Cardiac tamponade
 Shock
 Past history of myocardial infarction or CVA
 History of renal failure (either acute or chronic renal failure)

Long term follow-up
The long term follow-up in individuals who survive aortic dissection involves strict blood pressure control.  The relative risk of late rupture of an aortic aneurysm is 10 times higher in individuals who have uncontrolled hypertension, compared to individuals with a systolic pressure below 130 mmHg.

The risk of death is highest in the first two years after the acute event, and individuals should be followed closely during this time period.  29% of late deaths following surgery are due to rupture of either the dissecting aneurysm or another aneurysm.  In addition, there is a 17% to 25% incidence of new aneurysm formation.  This is typically due to dilatation of the residual false lumen.  These new aneurysms are more likely to rupture, due to their thinner walls.

Serial imaging of the aorta is suggested, with MRI being the preferred imaging technique.

Famous victims
Deaths
King George II of Great Britain
Liese Prokop, Austrian Interior Minister and Olympic silver medallist
Lucille Ball, actress and entertainer
Flo Hyman, volleyball player
Jonathan Larson, composer of Rent
John Ritter, actor
Richard Biggs, actor
Mike Wieringo, American comic book artist
Jim Murray, American Sportswriter Los Angeles Times 1961-1998

Survivors
Dr. Michael E. DeBakey, who devised the surgery to correct aortic dissection (as well as other cardiovascular and vascular techniques).  Dr. DeBakey was also noteworthy for being the oldest patient ever to receive his own operation: he was 97 at the time of his surgery on February 9 and 10 of 2006.  He survived and, though he worked with physical therapists to walk on his own again after suffering muscle deconditioning from prolonged physical inactivity during recovery, retained all of his mental faculties and was back to working nearly a full day until his death of natural causes on July 11, 2008. (See  published 25 December, 2006, in the New York Times).
Daniel Dennett, philosopher
Gérard Houllier, former manager of Liverpool Football Club, now manages Olympic Lyonnais
Jose Miguel Arroyo, spouse of Philippine President Gloria Macapagal-Arroyo

See also
Aortic aneurysm
Connective tissue disease
Ehlers-Danlos Syndrome
Hypertension
Marfan syndrome
Traumatic aortic rupture
Bicuspid aortic valve

References

पिनेया स्वापू
एओर्तिक दिसेक्सन
एओर्तिक दिसेक्सनया बायेज्या
अमेरिकन हार्ट असोसियसन
एओर्तिकदिसेक्सन॰कम्

कार्दियोलोजी
मेदिकल इमर्जेन्सी
भास्कुलर सर्जरी
मृत्युया कारक
ल्वे

एओर्तिक दिसेक्सन


Philibert Berthelier (c. 1465August 23, 1519), often known just as Berthelier, was a Genevan patriot, an uncompromising enemy of the Duke of Savoy in his ambition to control Geneva.

Rebellion against the Duke of Savoy
In 1513, the Duke of Savoy nominated his cousin as bishop of Geneva, and Berthelier called for a rebellion, but later made a political compromise with the Bishop of Geneva when accepting nomination as commander of the Castle of Penay. However, in June 1515, he rose in open rebellion, and in 1517 even fled to Fribourg in order to secretly promote a cooperation between the republican factions in both cities. In February 1518 he returned to Geneva after being given safe conduct by the bishop of that city, and in October of the same year began a series of secret meetings with members of the republican faction in the city (known as Huguenots) for the purpose of overthrowing Savoy rule. In order to prevent any rebellion, the bishop of Geneva decided to move his residence into that city from Pignerol, where he resided most of the time, and on April 20, 1519, moved into Geneva. Berthelier was offered by his friends to flee to Fribourg another time, but refused.

Trial and execution
Berthelier was arrested by the bishop's soldiers on August 23, 1519, and was tried for treason against the Duke of Savoy. For the purpose of the trial, the bishop circumvented the laws of the land that required trial by the Grand Council established in 1457 and appointed a former dentist named Jean Desbois as a special judge. After a summary trial held on the same day, Berthelier was found guilty and was sentenced to death by beheading. The sentence was carried out on the same day.

Legacy
In the grounds of the church that stands beside the Domaine de Chateauvieux in the village of Peney, overlooking the Rhone near Geneva, there is a small plaque erected in 1986 to commemorate the 450th anniversary of the Reformation. This refers to the Castle of Peney as the 'ancient fief of Philibert Berthelier'. After the Reformation was declared Peney Castle was a stronghold of Catholicism and was destroyed by the Genevans in 1536. On the site now stands the Domaine de Chateauvieux, a luxury hotel and restaurant which has a brief historical account of the castle in English.

Berthelier had a son by the same name, who was an opponent of Jean Calvin. As a prominent Libertine Philibert Berthelier was secretary to the Council of the Two Hundred, and known for his sexual promiscuity was excommunicated by the consistory of the Church of Geneva in 1551

References

1460s births
1519 deaths

Philibert Berthelier (Geneva patriot)


Mangalavanam is an ecologically sensitive area situated at the centre of the Indian city of Kochi, covering about 2.74 hectares. It also houses a shallow tidal lake connected with Kochi backwaters by a canal. It is situated behind the Kerala High Court building. It is a nesting ground for a large variety of migratory birds and supports many types of mangroves. The Managalavanam is often regarded as the "green lung of Kochi", considering its role in keeping the city's air pollution under check. The area is a roosting place for many kinds of resident and migratory birds.

Recently the high-rise buildings surrounding the area are curtailing the movement of birds in the sanctuary. The buildings close to the sanctuary interrupt proper orientation, take-off and landings of the birds. They also cause hurdles in the regular movements of the nesting birds in transporting nesting materials. It is also likely to hinder the movement of birds while bringing food materials to the chicks and fledglings. The administrative control of the sanctuary is with the Assistant Conservator of Forest and  Wildlife Warden Mangalavanam Bird Sanctuary of Nature Study Centre Kalady and then to the Range Officer Research Range Kodanad.

Flora and fauna
The true mangrove and mangrove associate species that exist in the sanctuary are Avicennia officinalis, Rhizophora mucronata, Acanthus ilicifolius and Acrostichum aureum— Although not threatened species according to IUCN Red List, they are of vital importance in estuarine ecosystems.

Mangalavanam is primarily a bird refuge. A bird survey conducted in May 2006 found that there were 194 birds belonging to 32 species. The total number of bird species recorded so far from the area is 72. Some of the birds found are common redshank, common greenshank, brahminy kite, white-breasted waterhen and marsh sandpiper.

In a recent study revealed six species of mammals Indian flying-fox, painted bat, three-striped palm squirrel/dusky palm squirrel, house rat/black rat, bandicota, and Eurasian otter. Two species of amphibians, Limnonectes limnocharis and Duttaphrynus melanostictus, and seven species of fishes Anabas testudineus, Striped panchax, Malabar swamp eel, Orange chromide, Blackline rasbora, Etroplus suratensis and Sarotherodon mossambica are found here.

During a study conducted in 2006, 17 species of butterflies were recorded in this area. 51 species of spiders belonging to 40 genera and 16 families were recorded here. This represented 27% of the total families reported from India.

References

Gallery

Bird sanctuaries of Kerala
Protected areas of Kerala
2004 establishments in Kerala
Tourist attractions in Kochi
Geography of Kochi
Protected areas established in 2004

Mangalavanam Bird Sanctuary


A narrator is a person who tells a story to an audience. Narrators occur in face-to-face story-telling, and in literary works, movies, and plays. They can be fictional, or they can be real people. When the narrator is also a character within the story, he or she is sometimes known as the viewpoint character. The narrator is one of three parts in any story-telling. The others are the author and the audience; in literature, the latter is the reader.

The author and the audience both live in the real world. It is the author's function to create the universe, people, and events within the story. It is the audience's function to understand and interpret the story. The narrator only exists within the world of the story and presents it in a way the audience can grasp. In non-fiction the narrator and the author may be the same person, since the real world and the world of the story may be the same.

Related pages
 Unreliable narrator
 Narrative

Literary terms

Narrator


Dragons' Den is a reality television series that has aired in over 20 countries. The show originated in Japan as Manē no Tora ("Tiger of Money"), first airing in 2001. It has aired in countries such as the United Kingdom, Australia, New Zealand, and Canada. Small companies and investors pitch their ideas to a group of investors known as the "dragons" in exchange for a percentage of their company and the rights to their product. They also have an amount of money they want to get from the dragons. If they do not get at least the amount they are looking for, they get nothing. In the United States, the show is known as Shark Tank, and the investors are known as the "sharks." The format is owned by Sony Pictures Television International.

In the British version the dragons are Touker Suleyman, Deborah Meaden, Sara Davies and Peter Jones. The programme has been produced by BBC Manchester since its inception and was first broadcast on BBC Two on 4 January 2005, and since 2021, it has been broadcast on BBC One.

References

Reality television series

Dragons' Den


The Aka, also known as Hrusso, are an ethnic group of Indian state Arunachal Pradesh. They are found in various areas of Arunachal Pradesh including the Thrizino Bhalukpong,  Buragaon, Jamiri, Palizi, Khuppi area in West Kameng. Their language belongs to the Tibeto-Burman family.

Lifestyle

For the convenience of administration, the Aka people elects a chief, who often acts the role of the village headman. Polygamy is widely practiced in their patrilineal society, and cross-cousin marriages are accepted. Like most tribes, the Aka have an elementary caste system, the aristocrat Kutsun and the commoner Kevatsum.

The Aka practice shifting cultivation and rear domestic animals such as the Mithun. Temporary huts, accommodated by young boys, are built near the field to guard the crops from the animals. The staple food of Akas is maize and millet. They plant leaves, pulses, potato and rice. Drinks locally made from fermented maize and millet include Lao pani, Mingri and the Aarah.

The Aka live in elongated houses made from bamboo, wood and cane leaves. Raised on platforms about 6 feet above the ground, the Aka house are further sub-divided into three sections. The granary is built away from the main house.

Culture

The Aka share strong cultural affinities with the Miji, and intermarriage with the Miji is prevalent. Centuries of Vaishnava and intermittent Tibetan influence from the Sherdukpen has shaped the Aka culture into its modern form. Handicrafts, basket weaving and wood carving are the principal arts among the Aka tribe. Intermittent Tibetan contacts is evidenced by the fact that the Aka and Mishmis are known as "Khakhra" (meaning barbarians) to the Tibetans.

One of the most notable features of Aka arts is the Chinese design of the Jana flower, which can be often found on many of the indigenous haversacks. It is a known legend that the Jana flower represents the commemorate an ancient Tibetan king, who was believed to have led his entire life through daily reincarnations. It was also believed that he lived in an open giant palace that grew the Jana flowers every time the sun sets.

Indigenous festivals under the guidance of a village Chieftains such as those of the four-day Nechido festival, held in November involves the affiliation with the natural world and community.

Dual language

Among the Aka live a second group of people, with their own language, the Koro. They are culturally integrated with the Aka, but have somehow maintained their separate, only distantly related Tibeto-Burman language. Koro has more similarities with the Tani language group, in easternmost Tibet. There are thought to be 800 to 1200 remaining speakers of Koro, and 4,000 to 6,000 speakers of Aka.

Costume

The Aka costume deeply reflects its indigenous culture. While both male and female keep long hair, there are distinctions in the dress within the Aka. These restrictions involve the use of the Assamese silk and the Tibetan knobbed hat, which are worn among the aristocrats.

Generally, most men wear a silky Assamese toga, while the women wear a long, dark-red garment that covers the entire body. Indigenous lingchong cream manufactured from the pine-resin serves as the cosmetics for the Aka women. However, the interesting cane cap reaching three inches high inserted with two bird-feathers serves the highlight of the Aka costume.

Silver ornaments play another important role in the female Aka costume. Vase-shaped earrings and for the richer ones, a fillet of silver chain is worn around the head. The rich Aka women wear a pretty filet of silver chain-work round the head. Jade beads are also made into necklaces.

Face tattooing is another notable feature among some Aka. Especially in the case of the women, they tattoo their faces in a straight line from the forehead to the chin.

Religion

The Aka are mainly Animists–who are described to follow a variant of the Nyezi-No religion, which means Sky and Earth. Occasional contacts with the Assamese and neighbouring Buddhist tribes and Tibetans have seen Hindu and Buddhist influence imbibed beliefs and culture. However, centuries of Buddhist and Hindu influences have greatly shaped the religious rites of their religion. For instance, veneration of the Assamese Hindu God, Hori Deo came as a result of the imprisonment of a local Aka king, Tagi Raja. Superstitions and magic play an important role in their belief system. Shizhou proved to be the most popular form of magic ritual among the Aka, and anybody who is angry may resort to conducting Shizhou rituals on their foe.

The rituals of Shizhou involve slaughtering a dog, draining the blood from its head, and either sprinkling a few drops of the blood onto the enemy undetected, throwing them into his house, or burning them in his hearth. If the ritual succeeds, the enemy is supposed to lose their life.

References

External links

 Web India The Aka
 Ethnologue profile

Tribes of Arunachal Pradesh
Ethnic groups in Northeast India
Ethnic groups in India

Hruso people


Suit is a term with various meanings:

 A lawsuit, an action brought before a court, as to recover a right or redress a grievance.
 Suit (clothing), a combination of clothing, such as a jacket and matching trousers,
 Environmental suit, a piece of clothing used for a particular activity or in a particular environment, for example a space suit or diving suit.
 Jumpsuit, catsuit, wetsuit, or swimsuit, a one-piece outfit.
 Suit (cards), one of four categories into which a deck of cards is divided.
 Slang for a professional, The Establishment, management or government employee, because they wear a suit (clothing).  Used pejoratively by  Beats, artists, and hackers to refer to anyone in a position of authority.
 Suit (album), the name of one of rapper Nelly's 2004 albums.
 Suits, the third album by Fish.
Suit (comic), a fictional character in the marvel universe, appearing first in the Venom series.

Suit


Everything2 or E2 is a website.  It lets people make pages about many different things, and some people use it as a diary.

E2 users create pages called nodes and add stuff in writeups.  Only logged-in users can create writeups.  Only the person who created the writeup or someone who the website owners (called "gods") choose can edit the writeup.  On the other hand, on Wikipedia, anyone can edit pages, but on Everything2 only those who can edit the writeup can edit pages.

Everything2 does not require a neutral point of view like Wikipedia does. So, it is possible to have more than one article (writeups) under the same title (node), each by different authors, and presenting different points of view.

Other websites
 Everything2 website
 Everything2.com article about Wikipedia

Websites
1998 establishments

Everything2


A sarabande (spelt sarabanda in Italian), is a dance that was popular in Baroque music in the 17th and early 18th centuries.

Composers of the Baroque period often composed a group of several dances.  This was called a suite.  There was usually an Allemande, a Courante, a Sarabande and a Gigue, in that order, and sometimes two Bourrées as well.

The sarabande was a slow, stately dance with 3 beats in a bar (3/4 time or Simple Triple). There was always a small stress (Tenuto) on the second beat of the bar. The note on the first beat would often be played quite short so that the second beat would feel heavy. Like the other dance movements in the suite, the Sarabande was in Binary form.

The sarabande seems to have come from Central America where it was known as "zarabanda".  Although it was mainly used in the Baroque Period, composers in the 20th Century such as Debussy, Satie, Howells and Britten sometimes wrote Sarabandes.

Perhaps the most famous Sarabande is one written by an unknown composer. The piece is called La folie espagnole. Many Baroque composers such as Monteverdi and Corelli and even some modern ones used this well-known tune.

Movies
The sarabande has been used a lot in movies, including one by Ingmar Bergman called Saraband (2003). It uses the sarabande from the 5th suite for solo cello by Bach.

Ballroom dances
Musical forms

Sarabande


Capitol Offense is an American rock band. It is most notable for its bassist, Mike Huckabee, who is the former Governor of Arkansas and former 2008 Republican candidate for President of the United States.

History

Early years (1996-2000)
The band was formed in July 1996 by newly elected governor Mike Huckabee and members of his executive staff: Chris Pyle (drums); DeWayne Hayes (lead guitar); and Mike Perkins (vocals), who all enjoyed classic rock. They drew their name from the fact that all of them work in the Capitol building, and because according to Huckabee, "in the course of our playing, we offend just about everybody." The band's first performance was at a Governor's staff Christmas party in 1996, where their setlist consisted of Chuck Berry's "Rock and Roll Music," Barrett Strong's "Money (That's What I Want)," and the Beatles' "Come Together." Thereafter, the band would often play at Governor's staff events. In 1999, the band gave a performance in the Governor's Conference Room, during a bill-signing ceremony in honor of Arkansas native Johnny Cash. The band was also a regular guest at the annual Hope Watermelon Festival in Huckabee's hometown of Hope, Arkansas.

Huckabee, by far the most famous member of the band, was drawn to music from very early on in his life. He has played guitar since he was a child and states unequivocally that "music was life changing for me."

Recent times (2001-present)
Huckabee's band played at Washington inaugural balls put on by the Free Republic in both 2001 and 2005. In recent years Capitol Offense has honed their sound to such an extent that they have opened for several high-profile artists, including The Charlie Daniels Band, Dionne Warwick, REO Speedwagon, Willie Nelson, Percy Sledge, 38 Special, and Grand Funk Railroad. During 2007, front man Huckabee took his musical act on the presidential stump with him, performing numerous times without Capitol Offense during his campaign in Iowa. At one stop, backed by two record store employees, he covered a Chuck Berry song, before answering questions from the crowd at the store.
During Huckabee's 2008 campaign, Boston's guitarist and songwriter Tom Scholz, a supporter of Democratic candidate Barack Obama wrote to Huckabee, requesting him to stop performing the Boston song "More than a Feeling" at public appearances. Huckabee was reported to have been regularly playing the song, sometimes with former Boston band member Barry Goudreau (who was a Huckabee supporter).

Style
Capitol Offense is a cover band that plays a mix of classic rock, Motown, country and blues.

Lineup
Capitol Offense's lineup is as follows:
Mike Huckabee - bass
Chris Pyle - drums (1996-2010)
DeWayne Hayes - lead guitar (1996–2003)
Mike Perkins - vocals (1996)
Grant Tennille - vocals (1997–1999)
Rick Calhoun - guitar, vocals
Aaron Black - vocals
Steve Pyle - vocals
Teri Cox - vocals
Marynell Branch - keyboard
Gordon Caffey - lead guitar, vocals
Alan Eidson - drums

References

Rock music groups from Arkansas
Musical groups established in 1996
Politics of Arkansas
Musical groups from Little Rock, Arkansas

Capitol Offense (band)


Kant is a ceety in the Chuy Valley o northren Kyrgyzstan, some 20 km frae Bishkek, the caipital o Kyrgyzstan.
It is the administrative centre o the Ysyk-Ata Destrict (umwhile Kant Destrict).

Etymology
The Kyrgyz wird for succar is "kant", an the ceety received its name when a succar plant wis biggit thare in the 1930s.  (It is an eften repeated myth that the toun wis named efter the German philosopher Immanuel Kant).

Economy
Kant is an industrial an service center. Amang notable local enterprises is the Abdysh Ata Brewery, whose products are weel kent throughout Kyrgyzstan.
During the Soviet era, Kant an its surroondin aurie war home tae a lairge nummer o ethnic Germans who haed been forcibly relocated tae Central Asia in 1941 frae the Volga region when the Volga German Autonomous Soviet Socialist Republic wis abolished. Most left for Germany during the 1990s efter the demise o the Soviet Union when the factories whaur thay haed worked shut doun.  Several ither nearby settlements, such as Luxemburg an Bergtal, still cairy thair German names, but retain anly very smaw remnants o thair Volga German an Roushie Mennonite founders.

Air base
The Kant Air Base near the ceety is nou host tae the Roushie Air Force's 5t Air Army's 999th Air Base, stationed in Kyrgyzstan in response tae the United States presence at Manas Air Base.

Sports
Recently, Kant became a caipital o fitbaa in Kyrgyzstan due tae its contreibution tae the development o fitbaa. Thare are mony new fitbaa grunds an pitches in Kant which are maintained in good condeetion throughout the year. Moreover, the Abdysh-Ata company recently installed a new artificial pitch on the Sportkompleks Abdysh-Ata - home o Abdish-Ata Kant, a local soccer team - which indicates Kant's commitment tae mak it possible for fitbaa tae thrive in Kyrgyzstan.

References

Populatit places in Chuy Province
German communities

Kant, Kyrgyzstan


The Sicilian Vespers (; ) was a successful rebellion on the island of Sicily that broke out at Easter 1282 against the rule of the French-born king Charles I of Anjou, who had ruled the Kingdom of Sicily since  1266. The revolt came after twenty years of Angevin rule over Sicily, whose policies were deeply unpopular among the Sicilian populace.

Sparked by an incident in Palermo, the revolt quickly spread to the majority of Sicily. Within six weeks, approximately 13,000 French men and women were slain by the rebels, and the government of Charles lost control of the island. Seeking support for the rebellion, the Sicilians offered the throne to Peter III of Aragon, who claimed the crown on behalf of his wife, Constance of Sicily. The Aragonese intervention in the rebellion led to an expansion of the conflict into the War of the Sicilian Vespers.

Background

The papacy versus the House of Hohenstaufen
The rising had its origin in the struggle of investiture between the pope and the Hohenstaufen Holy Roman Emperors for control of Italy, especially the Church's private demesne known as the Papal States. These lay between Hohenstaufen lands in northern Italy and the Hohenstaufen Kingdom of Sicily in the south; the Hohenstaufens also, at the time, ruled Germany.

In 1245 Pope Innocent IV excommunicated Frederick II and declared him deposed, and roused opposition against him in Germany and Italy. When Frederick died in 1250, his dominion was inherited by his son, Conrad IV of Germany. A period of turmoil followed Conrad's death in 1254, and the Kingdom of Sicily was seized by Manfred, King of Sicily, Frederick's illegitimate son, who reigned from 1258 to 1266.

Manfred had no involvement in German politics, where the interregnum lasted longer and there was no emperor until 1274. He first styled himself as vicar of his nephew Conradin, Conrad's son. However, following a false rumor that Conradin was dead, Manfred had himself crowned king. He wished for a reconciliation with the papacy, which may have explained his support for the landless Baldwin II, Latin Emperor. However, Pope Urban IV and later Pope Clement IV were not prepared to recognize Manfred as lawful ruler of Sicily and first excommunicated him, then sought to depose him by force of arms.

After abortive attempts to enlist England as the champion of the Papacy against Manfred, Urban IV settled on the later Charles I of Naples as his candidate for the Sicilian throne. Charles invaded Italy and defeated and killed Manfred in 1266 at the Battle of Benevento, becoming King of Sicily. In 1268 Conradin, who had meanwhile come of age, invaded Italy to press his claim to the throne, but he was defeated at the Battle of Tagliacozzo and executed afterwards. Charles was now undisputed master of the Kingdom of Sicily.

Charles of Anjou and Sicilian unrest
Charles regarded his Sicilian territories as a springboard for his Mediterranean ambitions, which included the overthrow of Michael VIII Palaiologos of the Byzantine Empire and the capture of Constantinople. Constantinople was captured during the Fourth Crusade and had been brought into the fold of the catholic religion for 57 years under the rule of the Latin Empire. With the Byzantine recapture of the city in 1261, Michael VIII Palaiologos continued to rebuild what was left of the economically strategic city as an important trade route to Europe.

Unrest simmered in Sicily because of its very subordinate role in Charles' empire—its nobles had no share in the government of their own island and were not compensated by lucrative posts abroad, as were Charles' French, Provençal and Neapolitan subjects; also, Charles spent the heavy taxes he imposed on wars outside Sicily, making Sicily somewhat of a donor economy to Charles' nascent empire. As Steven Runciman put it, "[The Sicilians] saw themselves now being ruled to enable an alien tyrant make conquests from which they would have no benefit"

The unrest was also fomented by Byzantine agents to thwart Charles' projected invasion and by King Peter III of Aragon, Manfred's son-in-law, who saw his wife Constance as rightful heir to the Sicilian throne.

The uprising

The event takes its name from an insurrection which began at the start of Vespers, the sunset prayer marking the beginning of the night vigil on Easter Monday, 30 March 1282, at the Church of the Holy Spirit just outside Palermo. Beginning on that night, thousands of Sicily's French inhabitants were massacred within six weeks. The events that started the uprising are not known for certain, but the various retellings have common elements.

According to Steven Runciman, the Sicilians at the church were engaged in holiday festivities and a group of French officials came by to join in and began to drink. A sergeant named Drouet dragged a young married woman from the crowd, pestering her with his advances. Her husband then attacked Drouet with a knife, killing him. When the other Frenchmen tried to avenge their comrade, the Sicilian crowd fell upon them, killing them all. At that moment all the church bells in Palermo began to ring for Vespers. Runciman describes the mood of the night:

According to Leonardo Bruni (1416), the Palermitans were holding a festival outside the city when the French came up to check for weapons, and on that pretext began to fondle the breasts of their women. This then began a riot. The French were attacked, first with rocks, then weapons, and all were killed. The news spread to other cities leading to revolt throughout Sicily. "By the time the furious anger at their insolence had drunk its fill of blood, the French had given up to the Sicilians not only their ill-gotten riches but their lives as well."

There is also a third version of the events that is quite close to Runciman's, varying only in the minor details. This story is part of the oral tradition on the island up to the present time. This oral tradition cannot be verified, but is of interest to sociologists. According to the legend, John of Procida was the mastermind behind the conspiracy. It seems that he was in contact with both Michael VIII Palaiologos and Peter III of Aragon. All three were later excommunicated by Pope Martin IV in 1282.

Immediate aftermath
After leaders were elected in Palermo, messengers spread word across the island for the rebels to strike before the French had time to organise resistance. In a fortnight the rebels gained control over most of the island, and within six weeks it was all under rebel control, except for Messina which was well fortified, and whose leading family, the Riso, remained faithful to Charles. But on 28 April it too broke into open revolt under the command of Captain of the People  and, most significantly, the islanders' first act was to set fire to Charles's fleet in the harbor. It is reported that upon hearing of the fleet's destruction, King Charles exclaimed "Lord God, since it has pleased You to ruin my fortune, let me only go down in small steps."

Charles' Vicar Herbert and his family were safely within castle Mategriffon, but after negotiations the rebels granted Herbert and his family safe conduct to leave the island upon a promise that they never return. After the restoration of order in the city, the townsmen announced themselves a free commune answerable only to the pope. They elected leaders, one of whom was Bartholomaeus of Neocastro who was prominent in the unfolding events and would later chronicle much of the revolt in Historia Sicula, an important if sometimes contradictory source of information for historians. Again significantly, the leaders' next act was to send word, via a Genoese merchant named Alafranco Cassano, to the Emperor Michael advising him that his nemesis Charles had been crippled. Only thereafter were ambassadors sent to Pope Martin IV pleading for each city on the island to be recognised as a free commune under the sole suzerainty of the Holy Church. The islanders were hoping for status similar to that enjoyed by Venice, Genoa, Pisa and other cities, which were free to form their own government but morally answerable only to the Pope, who would hold a vague and unstable suzerainty. However, the French pope was firmly in Charles' camp and he directed the Sicilians to recognize Charles as their rightful king. But Martin underestimated the Sicilians' hatred of the French, and especially of Charles, who ruled from Naples rather than Palermo, where he could have seen the suffering caused by his officials. Charles' island officials were far removed from his oversight; he did not see the avarice, the rape, theft and murder, nor did he see the high taxes levied against the meager possessions of the peasants, which kept them impoverished, but made no improvement in their lives.

Aragonese intervention

The pope refused the rebels' pleas to allow the status of free communes; therefore, the Sicilians sent their pleas to Peter III of Aragon married to Constance, daughter of Manfred, King of Sicily and granddaughter of the Hohenstaufen Holy Roman emperor, Frederick II. Of all that emperor's heirs, she was the only one not captive and was able to assert her rights. Peter III championed his wife's claim to the entirety of the Kingdom of Sicily.

Before the Vespers, Peter III constructed and outfitted a fleet for war. When the pope asked why he needed such a great war fleet, Peter stated that it would be used against the Saracens along the northern coast of Africa, because he had legitimate trade interests there and needed to protect them. So when Peter received a request for help from the Sicilians he was conveniently on the north coast of Africa in Tunis, just 200 miles across the sea from the island. At first, Peter feigned indifference to the request of the Sicilians and their plight, but after several days to allow a proper showing of deference made for the pope's consumption, he took advantage of the revolt. Peter ordered his fleet to sail for Sicily, landed at Trapani on 30 August 1282. While he marched towards Palermo, his fleet followed close by the coastal road. Peter III of Aragon's involvement changed the character of the uprising from a local revolt into a European War. When Peter arrived at Palermo on September 2, he was received initially by the populace with indifference, as merely one foreign king replacing another. However, when Pope Martin made plain his orders for the Sicilians to accept Charles, Peter promised the islanders that they would enjoy the ancient privileges they had had under the Norman king, William II of Sicily. Thus, he was accepted as a satisfactory second choice and crowned by acclamation at the cathedral in Palermo on September 4, thus becoming also Peter I of Sicily.

With the pope's blessing, the counterattack from Charles was not long in coming; his fleet from the Kingdom of Naples arrived and blockaded the port of Messina and made several attempts to land troops on the island, but all were repulsed.

The commentary of Michael Palaeologus
Years later, in his autobiography, Michael VIII wrote: "Should I dare to claim that I was God's instrument to bring freedom to the Sicilians, then I should only be stating the truth." But as Runciman (who? Add source) observes, with or without Byzantine gold, it was the proud people of Sicily alone who fought against their armed oppressor; and "However it may have been plotted and prepared, it was that one March evening of the Vespers at Palermo that brought down King Charles' empire."

Sources
Runciman, Steven, The Sicilian Vespers, Cambridge: Cambridge University Press, 1958, .
Lu rebellamentu di Sichilia, lu quale Hordinau e Fichi pari Misser Iohanni in Procita contra Re Carlu is still located in the Central Library in Palermo. Whether it is a contemporary narrative or not hinges on the interpretation of one word in the text. Runciman (p. 329) describes these words as "putirini", the first person plural, vs "putirisi" the impersonal tense.
The earliest narrative source for the Vespers is the Sicilian language Lu rebellamentu di Sichilia, written perhaps as early as 1287. It credits John of Procida with organising the overthrow of the French and portrays him in a positive light. Two later Tuscan Guelph histories, the Liber Jani de Procida et Palialoco and the Leggenda di Messer Gianni di Procida, possibly relying on the Rebellamentu or the Rebellamentus lost source, follow it in stressing John's involvement, but they portray him in a more critical light. The Liber, as its title suggests, emphasises John's negotiations with Michael VIII ("Palioloco").
Besides these there are two Florentine chronicles of importance. The Leggenda was once thought to be a source for the Nuova Cronica of Giovanni Villani, itself a source for the Vespers. Brunetto Latini, in his Tesoro, similarly adopts the Sicilian version of events, which includes the earliest version of the rape. The Tuscan Liber turns the rape story around, suggesting the Sicilian woman had pulled a knife on her French suitor when his friends came to aid him.
. A description of all prayer 'Offices' is given therein... Vespers, Matins, Laudes... etc.
Jordan, L'Allemagne et l'Italie, at pp. 219–221. This is the best source of the blasphemous and cunning character of Frederick II as king.
Bäthgen, Die Regentschaft Papst Innocenz III im Konigreich Sizilien describes Frederick's minority. See also Van Cleve, Markward of Anweiler; and Luchaire, Innocent III, vol. III; and Rome et l'Italie, pp. 153–204. Jordan, (supra) at pp. 272–74 discusses the origin of the Guelf and Ghibelline factions. See also, Hefele-Leclercq, Historie des Conciles vol VI, I, pp. 6–9.
Chalandon, Historie de la Domination Normande en Italia, vol. I, pp. 189–211, 327–54. These are excellent sources describing the Norman Conquest of Italy and Sicily by the Guiscard family. For their rule in Sicily, see vol. II, passim.

References in culture
Author Carlo Treviso's historical thriller novel, Siciliana (2022), depicts the harrowing events surrounding the Sicilian Vespers Revolt of 1282.
The Sicilian Vespers has been a commonly represented topic by Italian painters, for example, Francesco Hayez painted three works on the Sicilian Vespers, the first in 1821. Other painters include Morelli, Erulo Eroli, and Michele Rapisardi.
Felicia Hemans's tragedy, The Vespers of Palermo (1823), in which the hero, Raimond di Procida (son of the Count di Procida), supports the insurrection but refuses to take part in the murder of innocent French citizens, is based loosely on this uprising.
The German composer Peter Josef von Lindpaintner composed the opera Die Sizilianische Vesper, premiered in 1843 in Stuttgart and recorded in 2015 in its Italian version, Il vespro siciliano.
The present (but composed in 1847 and set to music in 1848) Italian National anthem, "Il Canto degli Italiani", popularly known as "Fratelli d'Italia" ("Brothers of Italy"): "Il suon d'ogni squilla / i vespri sonò" (with reference to the past uprisings of the Italian people against foreign rulers, occurring again in these years).
Reflecting the dual significance of the events to both France and Italy, Giuseppe Verdi's Les vêpres siciliennes (1855) was originally written for the Paris Opera to a libretto by Eugène Scribe but circulated more widely in its Italian version, I vespri siciliani.
A popular urban legend holds that the Mafia began with the Sicilian Vespers and the word Mafia itself is a backronym for "Morte Alla Francia Italia Anelia!" ("Death to the French is Italy's Cry!"). However, this is very unlikely as Sicilians did not consider themselves to be Italians in the 13th century. The first reference to the term Mafia dates from 1862. The claim that the Mafia originated as a secret society that had allegedly organised and led the uprising of 1282 was propagated by Mafiosi in the 19th and 20th centuries to promote the Mafia's self-image as the romantic and chivalrous defenders of ordinary Sicilians against foreign oppressors. This origins story came to be believed by Mafiosi themselves with for example the American Mafiosi Joseph Bonanno telling his friends and family when asked about the origin of the Mafia that it began with the Sicilian Vespers. The fact that many Sicilians considered the Piedmont-dominated Italian state that emerged after Italian unification in 1861 to be a sort of foreign occupation gave the Mafia a strong reason to promote this image to capitalise on the widespread resentment felt by people in the Mezzogiorno about the way that the Piedmontese monopolised power in the new state. Hence the story about Mafia as the leaders of the Sicilian Vespers was invented, with the implication that the Italian state was the latest in a series of foreign oppressors and it would be ignoble for Sicilians to co-operate with the Italian state against the Mafia.

19th-century Italian Paintings depicting Sicilian Vespers

Other uses of the term
In 1594, when the French King Henry IV was taking some tedious peace negotiations with the Spanish ambassador in France, bored with the unwillingness of the Spaniards to accept his terms, he stated that the King of Spain should behave with more humility, for if not, he could easily invade Spanish territories in Italy, stating that "My armies could move so fast that I would have breakfast in Milan and dine in Rome." Whereupon the Spanish ambassador replied "Now then, if that is so, Your Majesty would surely make it to Sicily in time for Vespers".
Having previously arranged the murder of mafia boss Joe Masseria on 15 April 1931 in order to consolidate organized crime in New York City under Salvatore Maranzano, mafia boss Lucky Luciano then ordered the murders of Maranzano and those capos of Maranzano and Masseria whom Luciano saw as threats. These murders allegedly occurred on September 10, 1931, which marked the end of the Castellammarese War in New York City and in mafia parlance is known as the Night of the Sicilian Vespers. This was later proved to be mostly a myth in mafia culture as no hard evidence exists that all these murders – outside of Maranzano and a few others – actually occurred.
Sicilian-born brothers David and Francis Rifugiato named their short-lived band "The Sicilian Vespers" after this event. They released one album on Profile Records in 1988.
Operation Sicilian Vespers (1992–98), an internal security operation involving the collaborative forces of the Italian Armed Forces and local police in the fight against the mafia in Sicily

Notes

References
Bruni, Leonardo. (1416), History of the Florentine People, Harvard, 2001, . Regarded as the first history book to be called "modern", and the first modern historian, it also happens to cover the events of this period.
Mendola, Louis. (2015), Sicily's Rebellion against King Charles, . Translation of Lu Rebellamentu di Sichilia.
Mott, Lawrence V. Sea power in the medieval Mediterranean: The Catalan-Aragonese fleet in the war of the Sicilian vespers (University Press of Florida, 2003).
Runciman, Steven. (1958),The Sicilian Vespers, . online
Colomer Pérez, Guifré, Memòries de la guerra de les Vespres (1282-1285). Controvèrsies ideològiques i conflictes polítics a la Mediterrània occidental, Tesi Doctoral URV, 2022 (català) http://hdl.handle.net/10803/675697

External links

Historia Sicula text
"Sicilian Vespers". In Encyclopædia Britannica Online.
The Catholic Encyclopedia.

Conflicts in 1282
1282 in Europe
1280s in the Byzantine Empire
13th-century rebellions
13th century in the Kingdom of Sicily
Genocide
Military history of Catalonia
Military history of the Kingdom of Sicily
War of the Sicilian Vespers
Sicilian rebellions
Massacres in Italy
Francophobia in Europe
Ethnic cleansing in Europe
Charles I of Anjou
History of Palermo
Shibboleths

Sicilian Vespers


The National Assembly is the name of both chambers of the Bahraini parliament.  This is in the Constitution of 2002.

It has 80 seats.  There are 40 elected members of the Council of Representatives (the lower house).  There are 40 royally-appointed members of the Consultative Council (the upper house).

It is chaired by the Speaker of the Consultative Council.  If that person is gone the chair is the Speaker of the Council of Representatives.

1973 establishments in Asia
Bahrain
Bahrain
Politics of Bahrain
History of Bahrain

National Assembly (Bahrain)


Jam is a condiment. It is usually made from pressed fruit, sugar, and sometimes pectin. Most jams are cooked. After making, jam is normally put into an airtight jar.

Usually a jam contains as much sugar as it contains fruit. The two parts are then cooked together to form a gel.

In the European Union, the jam directive (Council Directive 79/693/EEC, 24 July 1979) sets minimum standards for the amount of "fruit" in jam.  It also expanded the definition of fruit.  This was done to take several unusual kinds of jam made in the EU into account.  For this purpose, "fruit" is considered to include fruits that are not usually treated as fruits, such as tomatoes; fruits that are not normally made into jams, such as melons and watermelons; and vegetables that are sometimes made into jams, such as: rhubarb (the edible part of the stalks), carrots, sweet potatoes, cucumbers, and pumpkins.  This definition continues to apply in a later directive, Council Directive 2001/113/EC (20 December 2001).

According to Canadian food and drug regulation (CRC), jam and jam products must at least have 45% of the named fruit and 66% of water-soluble solids. In addition, it may contain added pectin, pectinous preparation, or acid ingredient. Also, reasonable amount of a Class II preservative, a pH adjusting agent, and an antifoaming agent is acceptable. However, the jam product shall not contain apple or rhubarb.

Marmalade is jam made from oranges and tends to have pulp and peels.

Jelly is different from jam as it is made from mostly juice instead of fruit.

Fruit butters are made from slow cooking fruit to a smooth consistency.

Joan Miró used blackberry jam as an art medium.

As a gel, jam is neither a solid or a liquid. It can contain chunks of fruit which are solids. Once opened and out of the fridge the gel becomes more like a liquid, and is able to decay.

References

Other websites
 National Center for Home Food Preservation - How do I...Jam & Jelly
 Council Directive 2001/113/EC (20 December 2001)

Spreads

Jam