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Management of Specific Wounds
7 Management of Specific Wounds Bite Wounds 174 Hygroma 234 Burns 183 Snakebite 239 Inhalation Injuries 195 Brown Recluse Spider Bites 240 Chemical Burns 196 Porcupine Quills 240 Electrical Injuries 197 Lower Extremity Shearing Wounds 243 Radiation Injuries 201 Plate 10: Pipe Insulation Protective Frostbite 204 Device: Elbow 248 Projectile Injuries 205 Plate 11: Pipe Insulation to Protect Explosive Munitions: Ballistic, the Greater Trochanter 250 Blast, and Thermal Injuries 227 Plate 12: Vacuum Drain Impalement Injuries 227 Management of Elbow Pressure Ulcers 228 Hygromas 252 Atlas of Small Animal Wound Management and Reconstructive Surgery, Fourth Edition. Michael M. Pavletic. © 2018 John Wiley & Sons, Inc. Published 2018 by John Wiley & Sons, Inc. Companion website: www.wiley.com/go/pavletic/atlas 173 174 Atlas of Small Animal Wound Management and Reconstructive Surgery BITE WOUNDS to the skin. Wounds may be covered by a thick hair coat and go unrecognized. The skin and underlying Introduction issues can be lacerated, stretched, crushed, and avulsed. Circulatory compromise from the division of vessels and compromise to collateral vascular channels can result in Bite wounds are among the most serious injuries seen in massive tissue necrosis. It may take several days before small animal practice, and can account for 10–15% of all the severity of tissue loss becomes evident. All bites veterinary trauma cases. The canine teeth are designed are considered contaminated wounds: the presence of for tissue penetration, the incisors for grasping, and the bacteria in the face of vascular compromise can precipi- molars/premolars for shearing tissue. The curved canine tate massive infection. teeth of large dogs are capable of deep penetration, whereas the smaller, straighter canine teeth of domestic cats can penetrate directly into tissues, leaving a rela- tively small cutaneous hole. -
Reconstructive
RECONSTRUCTIVE Muscle versus Nonmuscle Flaps in the Reconstruction of Chronic Osteomyelitis Defects Christopher J. Salgado, Background: Surgical treatment of chronic osteomyelitis requires aggressive M.D. debridement followed by wound coverage and obliteration of dead space with Samir Mardini, M.D. vascularized tissue. Controversy remains as to the effectiveness of different tissue Amir A. Jamali, M.D. types in achieving these goals and in the eradication of disease. Juan Ortiz, M.D. Methods: Chronic osteomyelitis was induced in 26 goat tibias using Staphylo- Raoul Gonzales, D.V.M., coccus aureus as an infecting inoculum. In a single stage, debridement followed Ph.D. by reconstruction using either a muscle flap (n ϭ 13) or a fasciocutaneous flap Hung-Chi Chen, M.D. (n ϭ 13) was performed. Flap donor sites were closed primarily and antibiotics El Paso, Texas; Kaohsiung, Taiwan; were given for 5 days postoperatively. Daily clinical evaluation for 1 year was and Sacramento, Calif. performed and monthly radiographs were obtained for 9 months and 1 year after the reconstruction. Results: Twenty-five flaps survived completely, and one nonmuscle flap under- went partial flap loss following a period of venous congestion. There were no postoperative complications in the muscle flap group. Two goats (15 percent) in the nonmuscle group developed superficial wounds in the immediate post- operative period that resolved with conservative management. No limbs had recurrent osteomyelitis wounds at 1 year of clinical follow-up examination. Radiographic evidence of osteomyelitis was present in two goats (15 percent) in the muscle group and one goat (8 percent) in the nonmuscle group. -
(TECA) Surgery
Audit of Total Ear Canal Ablation-Lateral Bulla Osteotomy Procedures Performed by One Surgeon Audit project lead: D G Bentley Subject/area of practice: Surgery/Dermatology Date: January 2nd 2018 Reasons for Audit: To determine how complication rate of this procedure, both short and long term, compare with that in recently published literature and to be sure this procedure should be still be offered in-house rather than being referred to a surgical specialist. Background Total Ear Canal Ablation-Lateral Bulla Osteotomy (TECA-LBO) procedures on dogs (and cats) have been performed by this surgeon since 1991 and since that time over 260 procedures have been performed. The surgeon also runs a dermatology service with special interest in ear disease and wishes to provide a complete service whereby cases that are beyond medical treatment can go to surgery without being referred to a specialist surgeon. Indications for TECA-LBO are “end stage otitis”, where there is chronic irreversible change to the ear canal, intractable ear infections particularly as a result of middle ear infection and changes in the vicinity of the tympanic membrane/lower horizontal ear canal, and tumours in the ear canal which cannot be dealt with either by Lateral Wall Resection or Vertical Canal Ablation. Also sometimes, due to financial reasons, a client may prefer surgery to lengthy courses of treatment, requiring several anaesthetics and ear flushings, with no guarantee of success at the outset. The surgeon first learnt the technique that was published in video format in the “In Practice” series around 1991. This involved the use of an osteotome to separate the ear canal from the bulla and also looking for the facial nerve and pulling it out of the way using penrose drain material. -
(12) Patent Application Publication (10) Pub. No.: US 2010/014.3507 A1 Gant Et Al
US 2010.0143507A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2010/014.3507 A1 Gant et al. (43) Pub. Date: Jun. 10, 2010 (54) CARBOXYLIC ACID INHIBITORS OF Publication Classification HISTONE DEACETYLASE, GABA (51) Int. Cl. TRANSAMINASE AND SODIUM CHANNEL A633/00 (2006.01) A 6LX 3/553 (2006.01) A 6LX 3/553 (2006.01) (75) Inventors: Thomas G. Gant, Carlsbad, CA A63L/352 (2006.01) (US); Sepehr Sarshar, Cardiff by A6II 3/19 (2006.01) the Sea, CA (US) C07C 53/128 (2006.01) A6IP 25/06 (2006.01) A6IP 25/08 (2006.01) Correspondence Address: A6IP 25/18 (2006.01) GLOBAL PATENT GROUP - APX (52) U.S. Cl. .................... 424/722:514/211.13: 514/221; 10411 Clayton Road, Suite 304 514/456; 514/557; 562/512 ST. LOUIS, MO 63131 (US) (57) ABSTRACT Assignee: AUSPEX The present invention relates to new carboxylic acid inhibi (73) tors of histone deacetylase, GABA transaminase, and/or PHARMACEUTICALS, INC., Sodium channel activity, pharmaceutical compositions Vista, CA (US) thereof, and methods of use thereof. (21) Appl. No.: 12/632,507 Formula I (22) Filed: Dec. 7, 2009 Related U.S. Application Data (60) Provisional application No. 61/121,024, filed on Dec. 9, 2008. US 2010/014.3507 A1 Jun. 10, 2010 CARBOXYLIC ACID INHIBITORS OF HISTONE DEACETYLASE, GABA TRANSAMNASE AND SODIUM CHANNEL 0001. This application claims the benefit of priority of Valproic acid U.S. provisional application No. 61/121,024, filed Dec. 9, 2008, the disclosure of which is hereby incorporated by ref 0004 Valproic acid is extensively metabolised via erence as if written herein in its entirety. -
Design, Synthesis, and Evaluation of Antiepileptic Compounds Based on Β-Alanine and Isatin
Design, Synthesis, and Evaluation of Antiepileptic Compounds Based on β-Alanine and Isatin by Robert Philip Colaguori A thesis submitted in conformity with the requirements for the degree of Master of Science Department of Pharmaceutical Sciences University of Toronto © Copyright by Robert Philip Colaguori, 2016 ii Design, Synthesis, and Evaluation of Antiepileptic Compounds Based on β-Alanine and Isatin Robert Philip Colaguori Master of Science Department of Pharmaceutical Sciences University of Toronto 2016 Abstract Epilepsy is the fourth-most common neurological disorder in the world. Approximately 70% of cases can be controlled with therapeutics, however 30% remain pharmacoresistant. There is no cure for the disorder, and patients affected are subsequently medicated for life. Thus, there is a need to develop compounds that can treat not only the symptoms, but also delay/prevent progression. Previous work resulted in the discovery of NC-2505, a substituted β-alanine with activity against chemically induced seizures. Several N- and α-substituted derivatives of this compound were synthesized and evaluated in the kindling model and 4-AP model of epilepsy. In the kindling model, RC1-080 and RC1-102 were able to decrease the mean seizure score from 5 to 3 in aged mice. RC1-085 decreased the interevent interval by a factor of 2 in the 4-AP model. Future studies are focused on the synthesis of further compounds to gain insight on structure necessary for activity. iii Acknowledgments First and foremost, I would like to thank my supervisor Dr. Donald Weaver for allowing me to join the lab as a graduate student and perform the work ultimately resulting in this thesis. -
228 April 2003 Category 1
Laparoscopica cantireflux Edward T Chory, MD Tracey A Ross, CST, MEd surgery astroesophageal Reflux The number of undiagnosed cases Disease (GERD) is a com- promises to be much higher based mon condition with a on the millions of heartburn suf- heavy economic impact. In ferers who take over-the- G a study published in the counter medications to treat May 2002 issue of Gastroenterol- their symptoms. GERD is also the ogy, researchers calculated that most expensive of the digestive GERD is one of the most preva- conditions with annual direct lent digestive diseases in America costs at $9.3 billion.1 with 19 million diagnosed cases.1 APRIL 2003 The Surgical Technologist 13 228 APRIL 2003 CATEGORY 1 Indirect costs, such as missed work and lower (painful swallowing), esophageal spasm, and productivity, would be almost impossible to more rarely GI bleeding (hematemesis or mele- measure accurately. However, companies and na). Tertiary symptoms are unrelated to the individuals are likely to feel the financial impact esophagus, such as reflux-induced asthma, in increased insurance premiums. For example, hoarseness and pharyngitis. Tertiary symptoms in 2002, the Wall Street Journal reported that the have increasingly been considered indications cost of proton pump inhibitors (PPIs) increased for antireflux surgery, and recent reports have General Motors’ health care budget for employ- documented excellent results, particularly for ees and retirees more than $55 million.2 reflux-induced asthma.11 With increasing experience in laparoscopic Traditionally, antireflux surgery was reserved antireflux surgery over the last 10 years, mor- for patients who did not respond to medical bidity has decreased, outcomes have improved therapy. -
Dihydro-3H-1,2,4-Triazole-3-Thione (TP-315)—A New Anticonvulsant Drug Candidate—On Living Organisms
International Journal of Molecular Sciences Article Effect of Chronic Administration of 5-(3-chlorophenyl)-4-Hexyl-2,4 -Dihydro-3H-1,2,4-Triazole-3-Thione (TP-315)—A New Anticonvulsant Drug Candidate—On Living Organisms Anna Makuch-Kocka 1,* , Marta Andres-Mach 2, Mirosław Zagaja 2, Anna Smiech´ 3 , Magdalena Pizo ´n 4 , Jolanta Flieger 4, Judyta Cielecka-Piontek 5 and Tomasz Plech 1 1 Department of Pharmacology, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland; [email protected] 2 Isobolographic Analysis Laboratory, Institute of Rural Health, 20-090 Lublin, Poland; [email protected] (M.A.-M.); [email protected] (M.Z.) 3 Sub-Department of Pathomorphology and Forensic Veterinary Medicine, Department and Clinic of Animal Internal Diseases, University of Life Sciences in Lublin, 20-612 Lublin, Poland; [email protected] 4 Department of Analytical Chemistry, Faculty of Pharmacy, Medical University of Lublin, 20-093 Lublin, Poland; [email protected] (M.P.); jolanta.fl[email protected] (J.F.) 5 Department of Pharmacognosy, Faculty of Pharmacy, Poznan University of Medical Sciences, 61-781 Pozna´n,Poland; [email protected] * Correspondence: [email protected] Citation: Makuch-Kocka, A.; Andres-Mach, M.; Zagaja, M.; Smiech,´ Abstract: About 70 million people suffer from epilepsy—a chronic neurodegenerative disease. In A.; Pizo´n,M.; Flieger, J.; most cases, the cause of the disease is unknown, but epilepsy can also develop as the result of a Cielecka-Piontek, J.; Plech, T. Effect of Chronic Administration of stroke, trauma to the brain, or the use of psychotropic substances. -
Management of Common Breast-Feeding Problems Joy Melnikow, Ml), MPH, and Joan M
Clinical Review Management of Common Breast-feeding Problems Joy Melnikow, Ml), MPH, and Joan M. Bedinghaus, MD Sacramento, California, and Cleveland, Ohio The benefits of breast-feeding have been well docu Poor weight gain in the infant is managed by more mented in the literature: it reduces morbidity from frequent nursing. Neonatal jaundice or infant gastro many illnesses and is considered the ideal nutrition for enteritis rarely requires discontinuation of breast-feed the newborn infant. This paper reviews common breast ing. feeding problems that family physicians may be called Although physicians frequently recommend that upon to manage: maternal problems, infant problems, women discontinue breast-feeding because of the ad and problems related to the need for maternal medica ministration of some maternal medications, maternal ill tion. ness can often be managed with medications that do not Ensuring proper position of the infant at the breast interfere with nursing. and attention to the let-down reflex is the recom Given proper advice and support, many mothers con mended method for prevention and treatment of nipple tinue to breast-feed even after returning to work. soreness. Prompt identification and treatment of blocked ducts, mastitis, and mondial infection of the Key words. Breast-feeding; hyperbilirubinemia; mastitis; nipple can prevent complications and allow uninter abscess, review literature. rupted nursing. ( / Fam Pract 1994; 39:56-64) Breast-feeding, which is recognized as the ideal nutrition offer little guidance -
Pharmaceutical Composition Comprising Brivaracetam and Lacosamide with Synergistic Anticonvulsant Effect
(19) TZZ __T (11) EP 2 992 891 A1 (12) EUROPEAN PATENT APPLICATION (43) Date of publication: (51) Int Cl.: 09.03.2016 Bulletin 2016/10 A61K 38/04 (2006.01) A61K 31/4015 (2006.01) A61P 25/08 (2006.01) (21) Application number: 15156237.8 (22) Date of filing: 15.06.2007 (84) Designated Contracting States: (71) Applicant: UCB Pharma GmbH AT BE BG CH CY CZ DE DK EE ES FI FR GB GR 40789 Monheim (DE) HU IE IS IT LI LT LU LV MC MT NL PL PT RO SE SI SK TR (72) Inventor: STOEHR, Thomas 2400 Mol (BE) (30) Priority: 15.06.2006 US 813967 P 12.10.2006 EP 06021470 (74) Representative: Dressen, Frank 12.10.2006 EP 06021469 UCB Pharma GmbH 22.11.2006 EP 06024241 Alfred-Nobel-Strasse 10 40789 Monheim (DE) (62) Document number(s) of the earlier application(s) in accordance with Art. 76 EPC: Remarks: 07764676.8 / 2 037 965 This application was filed on 24-02-2015 as a divisional application to the application mentioned under INID code 62. (54) PHARMACEUTICALCOMPOSITION COMPRISING BRIVARACETAM AND LACOSAMIDE WITH SYNERGISTIC ANTICONVULSANT EFFECT (57) The present invention is directed to a pharmaceutical composition comprising (a) lacosamide and (b) brivara- cetam for the prevention, alleviation or/and treatment of epileptic seizures. EP 2 992 891 A1 Printed by Jouve, 75001 PARIS (FR) EP 2 992 891 A1 Description [0001] The present application claims the priorities of US 60/813.967 of 15 June 2006, EP 06 021 470.7 of 12 October 2006, EP 06 021 469.9 of 12 October 2006, and EP 06 024 241.9 of 22 November 2006, which are included herein by 5 reference. -
Diazepam Therapy and CYP2C19 Genotype
NLM Citation: Dean L. Diazepam Therapy and CYP2C19 Genotype. 2016 Aug 25. In: Pratt VM, McLeod HL, Rubinstein WS, et al., editors. Medical Genetics Summaries [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2012-. Bookshelf URL: https://www.ncbi.nlm.nih.gov/books/ Diazepam Therapy and CYP2C19 Genotype Laura Dean, MD1 Created: August 25, 2016. Introduction Diazepam is a benzodiazepine with several clinical uses, including the management of anxiety, insomnia, muscle spasms, seizures, and alcohol withdrawal. The clinical response to benzodiazepines, such as diazepam, varies widely between individuals (1, 2). Diazepam is primarily metabolized by CY2C19 and CYP3A4 to the major active metabolite, desmethyldiazepam. Approximately 3% of Caucasians and 15 to 20% of Asians have reduced or absent CYP2C19 enzyme activity (“poor metabolizers”). In these individuals, standard doses of diazepam may lead to a higher exposure to diazepam. The FDA-approved drug label for diazepam states that “The marked inter-individual variability in the clearance of diazepam reported in the literature is probably attributable to variability of CYP2C19 (which is known to exhibit genetic polymorphism; about 3-5% of Caucasians have little or no activity and are “poor metabolizers”) and CYP3A4” (1). Drug: Diazepam Diazepam is used in the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. In acute alcohol withdrawal, diazepam may provide symptomatic relief from agitation, tremor, delirium tremens, and hallucinations. Diazepam is also useful as an adjunct treatment for the relief of acute skeletal muscle spasms, as well as spasticity caused by upper motor neuron disorders (3). There are currently 16 benzodiazepines licensed by the FDA. -
Answer Key Chapter 1
Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 1 of 101 Answer Key Chapter 1 Introduction to Clinical Coding 1.1: Self-Assessment Exercise 1. The patient is seen as an outpatient for a bilateral mammogram. CPT Code: 77055-50 Note that the description for code 77055 is for a unilateral (one side) mammogram. 77056 is the correct code for a bilateral mammogram. Use of modifier -50 for bilateral is not appropriate when CPT code descriptions differentiate between unilateral and bilateral. 2. Physician performs a closed manipulation of a medial malleolus fracture—left ankle. CPT Code: 27766-LT The code represents an open treatment of the fracture, but the physician performed a closed manipulation. Correct code: 27762-LT 3. Surgeon performs a cystourethroscopy with dilation of a urethral stricture. CPT Code: 52341 The documentation states that it was a urethral stricture, but the CPT code identifies treatment of ureteral stricture. Correct code: 52281 4. The operative report states that the physician performed Strabismus surgery, requiring resection of the medial rectus muscle. CPT Code: 67314 The CPT code selection is for resection of one vertical muscle, but the medial rectus muscle is horizontal. Correct code: 67311 5. The chiropractor documents that he performed osteopathic manipulation on the neck and back (lumbar/thoracic). CPT Code: 98925 Note in the paragraph before code 98925, the body regions are identified. The neck would be the cervical region; the thoracic and lumbar regions are identified separately. Therefore, three body regions are identified. Correct code: 98926 Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 2 of 101 6. -
31295005186035.Pdf (3.964Mb)
CYCLODEXTRINS AND MICELLES IN SEPARATIONS by TIMOTHY JOSEPH WARD, B.S. A DISSERTATION IN CHEMISTRY (ANALYTICAL) Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY Approved 1 /1 May, 1987 h'C^ ACKN0WLEDGMENT5 I give my deepest appreciation to Dr. Armstrong for his guidance and constant support. His encouragement helped me to grow as an independent researcher. I also thank the members of my committee for their constructive criticism. I would like to express my love and gratitude to Karen, for her companionship and help made the entire process easier and more enjoyable. I give thanks and praise to our Lord Jesus Christ through whom all things are possible. Finally, I want to dedicate this dissertation to my mother and father, who placed such a high value on education. Their love and encouragement sustained me through the years. 11 TABLE OF C0NTENT5 ACKN0WLEDGMENT5 i i LI5T0FTABLE5 vi LI5T0FFIGURES viii PREFACE Xi CHAPTER PART ONE CYCL0DEXTRIN5 IN SEPARATI0N5 \. INTRODUCTION 2 Traditíonal Methods for Resolving Enantiomers 2 Separation of Enantiomers by HPLC 4 Cyclodextrins 8 Structure and Physical Properties 11 Preparation of Bonded Phases 20 11. MATERIALS AND METHODS 29 Instrumentation 29 111 Chemicals 30 Methods 31 III. RESULTS AND DI5CU55I0N 34 Enantiomeric Separations 34 Dansy] Amino Acids 35 Crown Ethers 43 Drug Stereoisomers 54 Routine Separations 59 Mechanism of Separation 67 Parameters Which Affect Separation 80 IV. CONCLUSIONS 92 REFERENCES 94 APPENDIX 99 PART TWO MICELLESINSEPARATIONS V. MICELLES 101 Introduction 101 Micelle Structure and Properties 101 Micelles in Chromatography 102 iv VI.