What is normal blood pressure?

The blood pressure varies considerably during the course of the day and night. Physical and emotional stress, sadness or happiness cause it to rise or fall. During the night, the blood pressure is usually lower than during the day. The World Health Organization (WHO) recently set the boundary between normal and high blood pressure as 140/90 mmHg.

Intracoronal Attachments

Intracoronal attachments can be prefabricated as well as made in a laboratory. tNJey Dental International Bloom field. Conn Use of Ceka extracoronal attachments to retain a distal extension RPD. A to C, The female attachment is positioned in relation to the wax pattern by means of a mandrel in the dental surveyor. D, Substructures are cast directly onto the attachments. E, Anterior prosthesis assembled. Porcelain has been applied. F, Fixed splint and RPD at try-in. G, Male attachments in place....

Laterally Positioned Pedicle Graft

Free autogenous gingival graft. A, The location of the mucogingival junction is determined by moving the edge of a probe coronally. B, The recipient site is prepared. C, The graft is sutured to place. Some apical adjustment will be needed around the premolar before application of the surgical dressing. D, The healed graft. Compare the width of attached keratinized gingiva here with that in A. The defective restoration can be treated at this stage. or full thickness. The recipient bed...

Mummification

Mummification occurs in hot, dry environments. The body dehydrates and bacterial proliferation is minimal. The skin becomes dark, dried, and leathery. The process occurs readily in the fingers and toes in dry environments regardless of the temperature. Most mummified bodies are found in the summer months. It is also common for this process to occur in winter months if the environment is warm. It is possible for an entire body to mummify in a only a few days to weeks. Once a body is in this...

Stippling Gunshot

Handguns and rifles fire ammunition or cartridges composed of a primer, gunpowder or propellant, and a bullet or projectile. When the firing pin of a weapon strikes the primer, the resulting explosion ignites the gunpowder. Gunpowder, vaporized primer, and metal from a gun may be deposited on skin and or clothing of the victim. The presence and location of primer elements on the hands help to indicate who may have fired the weapon in question. Gunpowder comes out of the muzzle in two forms. 1....

The Relationship Between Substance Abuse And Psychopathology

While determining which disorder is primary in dually diagnosed populations can be useful in clinical research, it may provide little benefit in the clinical management of these patients. Patients with two disorders typically require treatment for both the exception is patients who present with temporary psychiatric symptoms caused by the substance use or its withdrawal. Meyer (1986) suggests considering six possible ways in which substance use and other psychopathology may be related 1....

Sequential Parallel and Integrated Treatment Models

There are three major models in which dually diagnosed patients are treated sequential, parallel, and integrated treatment. Each is discussed below. In sequential treatment, the more acute condition is treated first, followed by the less acute co-occurring disorder. The same staff may treat both disorders, or the less acute disorder may be treated after transfer to a different program or facility. For example, a manic patient with a cocaine use disorder needs mood stabilization before...

Localized Hair Loss

Traction e.g., corn-rows, ponytails Nonscarring Alopecia Intact Hair Follicles 3. Anagen effluvium following chemotherapy 4. Androgenetic alopecia AGA male or female pattern baldness 6. Infections fungal i.e., tinea capitis, kerion Scarring alopecia Loss of Hair Follicles 1. Discoid lupus erythematosus DLE 3. Infections fungal, bacterial, TB, leprosy N.B. If scalp biopsy performed e.g., scarring alopecia , ideally a 4-mm punch biopsy is taken of a...

Salivary Glands

Fig. 5.2 Grossly enlarged submandibular gland. This develops if an impacted calculus is ignored. A neoplasm of the submandibular gland is the differential diagnosis if the enlargement is persistent and there is no evidence of a calculus on radiograph. The nodular surface and the firm, nontender character on palpation of this gland are also suggestive of a neoplasm, commonly a pleomorphic adenoma or adenoid cystic carcinoma. calculus obstructing the submandibular duct causes painful and...

Reactive Lymphocytosis

Lymphatic cells show wide variability and transform easily. This is usually seen as enlarged nuclei, a moderately loose, coarse chromatin structure, and a marked widening of the basophilic cytoplasmic layer. Clinical findings, which include acute fever symptoms, enlarged lymph nodes, and sometimes exanthema, help to identify a lymphatic reactive state. Unlike the case in acute leukemias, erythrocyte and thrombocyte counts are not significantly reduced. Although the granulocyte count is...

Elevated Eosinophil and Basophil Counts

In accordance with their physiological role, an increase in eosinophils gt 400 1, i.e. for a leukocyte count of 6000, more than 8 in the differential blood analysis is usually due to parasitic attack p. 5 . In the Western hemisphere, parasitic infestations are investigated on the basis of stool samples and serology. Strongyloides stercoralis in particular causes strong, sometimes extreme, elevation of eosinophils may be up to 50 . However, eosinophilia of variable degree is also seen in ameba...

Hyperchromic Anemias

In patients with clear signs of anemia, e.g., a sickly pallor, atrophic lingual mucosa, and sometimes also neurological signs of bathyanesthesia loss of deep sensibility , even just a cursory examination of the blood smear may indicate the diagnosis. Marked poikilocytosis and anisocytosis are seen, and the large size of the erythrocytes is particularly conspicuous in comparison with the lymphocytes, whose diameter they exceed mega-locytes . These are the hallmarks of macrocytic, and, with...

Autopsy Findings

Autopsy findings in CO deaths are fairly characteristic. In Caucasians, the first impression one gets on viewing the body is that the person looks very healthy. The pink complexion is caused by coloration of the tissue by car-boxyhemoglobin, which has a characteristic cherry-red or bright-pink appearance that can be seen in the tissue. Cherry-red livor mortis suggests the diagnosis even before autopsying the individual. It must be realized, however, that this color can be simulated by prolonged...

Establishing System Linearity

The easiest way to establish the linearity of a flow cytometer is to analyze particles that fluoresce or scatter light with known relative intensities. Absolute intensities of the particles need not be known however, relative intensities must be known with an accuracy acceptable for the application for which the flow cytometer is being tested to run. The range of particle intensities is chosen to span the full histogram scale. By far the most common calibrators are fluorescent particles,...

Sudden Infant Death Syndrome Crib Death

A diagnosis of SIDS requires a complete autopsy and scene investigation. The diagnosis can only be made if both the scene and the autopsy are negative or unremarkable. There is no probable cause of death. There may be minor injuries to the external body by CPR and insects anthropophagia these must not be confused with injuries. figure 14.1 These spectacle hemorrhages raccoon's eyes were caused by blows to the side of the head. There do not have to be fractures of the skull to have spectacle...

Parallel Group Designs

A parallel group design is a complete randomized design in which each patient receives one and only one treatment in a random fashion. Basically there are two types of parallel group design for comparative clinical trials, namely, group comparison or parallel-group designs and matched pairs parallel designs. The simplest group comparison parallel group design is the two-group parallel design which compares two treatments e.g., a treatment group vs. a control group . Each treatment group...

Brix Acidity Correction

Before proceeding on the subject of fruit juice technology, it is essential to address the subject of Brix acidity correction. The regular Brix refractometer instrument used to determine Brix in sugar solutions is calibrated on the refractive indices of pure An acidity correction must be applied to refractometric Brix readings of juices. Single-Strength Juice Brix Values of Some Common Fruits Refractometric Brix Value Single-Strength Juice Mandarin tangerine Orange Passion fruit Peach (puree)...

The Brixacid Ratio

As mentioned previously, the juice of a ripe fruit has a dissolved solids content (Brix) characteristic of that particular fruit species. This is also the case for the acid content of a fruit juice. The levels of both of these items in the juice may vary in a narrow range depending on climatic and environmental conditions in which the fruit was grown as well as on the ripeness state of the fruit when harvested. As these two values of Brix and acidity are more or less distinctive for each fruit...

Treatment of Furcation Involvement

Diagnosis and treatment of furcation involvement of multirooted teeth is one of the more difficult Fig. 5-25. Normal relationship of the CEJ and the osseous crest. FromBaimaRF J Prosthet Dent 56 138, 1986. Fig. 5-25. Normal relationship of the CEJ and the osseous crest. FromBaimaRF J Prosthet Dent 56 138, 1986. problems encountered in the periodontal-restora-tive dentistry continuum. Familiarity with the furcation's anatomic and morphologic variations is essential when formulating a treatment...

Compartmental modeling

The pharmacokinetic profile of a drug is described by the processes of absorption, distribution, metabolism, and excretion. The disposition of a drug in the body may be further delineated by mathematical modelling. These models are based on the concept that the body may be viewed as a series of compartments in which the drug is distributed. If the compartmental concept is considered literally, then each tissue and organ becomes an individual compartment. However, in pharmacokinetic modelling,...

Atypical Urothelial Cells Indeterminate for Neoplasia

Unfortuntely, as in every other body site, cytologic samples from the urinary tract are not always readily placed into distinct categories. An atypical interpretation is appropriate when morphologic changes exceed those described as benign cellular changes, but lack clear signs of neoplasia Figs. 2.7, 2.15, 2.33 . This is generally encountered when dealing with a sample from a patient with a low grade lesion, especially those called low malignant potential LMP , or in the presence of severe...

Production of Sodium Hypochlorite

NaOCl is essentially produced by two methods chemical and electrochemical. Cl2 is made to react with a solution of NaOH. In this way, NaOCl, NaCl and water are produced according to the reaction This method produces solutions of high concentrations, but their purity and stability do not satisfy the quality characteristics that are necessary for their use in the food and medical sectors. We start with a solution obtained by dissolving NaCl, until obtaining concentrated brine. The solution is...

Sodium Hypochlorite And Cathether Hubs

Renal Data Systems USRDS 2004 Annual Data Report Atlas of End Stage Renal Disease in the United States Bethesda, MD, National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases, 2004. 2 Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni RL Haemodialysis vascular access problems in Canada results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Nephrol Dial Transplant 2006 21 721-728. 3 Maki DG Sources of infection with...

Electrolytic Chloroxidizer

Electrolytic chloroxidizer, otherwise known as Amuchina, is a chlorine-based solution with a 17 sodium chloride component and 0.057 sodium hypochlorite. ExSept is the 5 or 10 dilution of Amuchina. It is said to be effective against all spectrums of pathogens including Gram-positive, Gramnegative bacteria, viruses and spores. Amuchina is similar in molecular size and structure to water, and because it does not present with an electrical charge, the undissociated hypochlorous acid may easily...

Flow Chart For Hernia

Provides assurance and comfort to parents in giving care. COPYRIGHT 2005 by Thomson Delmar Learning. All Rights Reserved. COPYRIGHT 2005 by Thomson Delmar Learning. All Rights Reserved. COPYRIGHT 2005 by Thomson Delmar Learning. All Rights Reserved. STAT Ref Online Electronic Medical Library 5 5 2006 6 51 38 AM PST GMT -08 00 Delmar's Pediatric Nursing Care Plans - 3rd Ed. 2005 12 21 2006 6 00 48 PM PST GMT -08 00 123 amp docid 35 DELMAR'S PEDIATRIC NURSING...

Flow of Cerebrospinal Fluid

The cerebrospinal fluid CSF is an ultra-filtrate of plasma actively secreted into the cerebral ventricles by the choroid plexus, a highly vascularized and perfused lining of the ventricles. Average blood flow through the cerebral circulation is about 0.5 ml min g of brain tissue, and flow to the choroid plexus is about ten times higher. The choroid plexus supplies at least 75 of the CSF, which is also derived from the interstitial fluid ISF , which is produced by the endothelial cells of the...

Perivascular And Interstitial Dermatitis

B Perivascular and interstitial dermatitis without epidermal changes. C Lymphocytes and eosinophils perivascular and numerous neutrophils interstitial. Figure 1 A Urticae on the trunk. B Perivascular and interstitial dermatitis without epidermal changes. C Lymphocytes and eosinophils perivascular and numerous neutrophils interstitial. Figure 2 A Sharply demarcated purpuric erythema on the leg, a bulla Is seen in the uppermost part of the lesion. B Perivascular...

Transient Global Amnesia

Transient global amnesia was first described by Fisher and Adams in 1964 as a transient event in which there is altered behavior with prominent memory loss. Patients with this condition are typically Diagnostic Criteria for Olfactory Reference Syndrome A. A preoccupation with imagined body odor (including halitosis) persisting despite reassurance. B. At some point during the course of the disorder, the person recognizes that the preoccupation (obsession compulsion) is excessive or unreasonable....

Vasogenic Edema

Vasogenic edema is characterized by dysfunction of the blood-brain barrier, allowing an abnormal passage of proteins, electrolytes and water into the extracellular compartments. Fluid leaving the capillaries enlarges the extracellular space, predominantly in the white matter. Osmotic and hydrostatic gradients will also cause interstitial edema, increasing the extracellular space as water shifts from blood vessels and or ventricles. Intracellular components are rela tively preserved Fig. 4.14 ,...

Intradermal Nevus Fibrosis

Clark WH Jr, Elder DE, Guerry D IV, et al. A study of tumor progression the precursor lesions of superficial spreading and nodular melanoma. Human Pathol 1984 15 1147-1165. 2. Elder DE. The dysplastic nevus. Pathology 1985 17 291-297. 3. Barnhill RL, Roush GC, Duray PH. Correlation of histologic and cytoplasmic features with nuclear atypia in atypical dysplastic nevomelanocytic nevi. Hum Pathol 1990 21 51-58. 4. Piepkorn MW. An appraisal of the dysplastic nevus syndrome concept. Adv Dermatol...

Melanocytic Neoplasms Neoplasms

Location of melanocytes in the skin depth Superficial Intraepidermal Papillary dermis Upper half of reticular dermis Deep Lower half of reticular dermis Subcutaneous Fascial Disposition of melanocytes Intraepidermal Basilar melanocytes single cell pattern Normal numbers Increased frequency - With elongated rete lentiginous - Without elongated rete Pagetoid pattern Patchy perivascular, periadnexal, perineurial Wedge pattern deep apex of nests, fascicles of melanocytes extend into reticular...

Cellular Blue Nevus

INTRODUCTION Cellular blue nevus is a variant of the common blue nevus, but was first described as a variant of melanoma. Although these can be similar clinically to the common blue nevus, they tend to be larger, elevated, and have more pronounced celluarity composed of nonpigmented spindle-shaped melanocytes. They are most common in Asian populations, and rare in blacks. The cellular blue nevus is believed to represent a dermal arrest of embryonal migration of neural crest melanocytes that...

Intracranial Hypertension

The normal intracranial pressure ICP is 60-120 mmH2O, which corresponds to 5-15 mmHg. An ICP greater than 30 mmHg impairs cerebral blood flow an ICP greater than 50 mmHg for more than 30 minutes is fatal an ICP greater than 80 mmHg for any length of time can cause brain damage. Intracranial hypertension may be either acute developing in hours to days or chronic lasting for weeks or months . Its manifestations are progressively more severe as the ICP rises, but are not specific thus, the...

Basal Cell Carcinoma

Occurs in sites chronically exposed to the sun and increased in frequency from the third decade onward, although they have been reported in children and young adults. Most frequently on the face and scalp, rarely arises on the digits, the back of the hand, dorsum of the foot, or on the ears. Typically are solitary opalescent nodules with telangiectasia Fig. 18A or ulceration Fig. 18B . Common variant is the superficial type Fig. 18C , which often appears as a thin plaque. Morphea-form may...

Axial Reduction and Groove Placement The

Path of withdrawal of the restoration must be accurately determined before axial reduction. Mesiodis-tally it should parallel the long axis of the tooth buccolingually it should parallel the middle third or incisal two thirds of the facial surface. This will permit the preparation of proximal grooves of optimum length in an area of the tooth where sufficient bulk is present. 4. To enhance the retention and resistance form of the preparation, place a slightly exaggerated chamfer on the lingual...

Cavosurface Angle Amalgam

Good strength intermediate restoration Preparation delay Condensation Corrosion No bonding Thermal expansion Setting contraction Bonding Highest strength Indirect procedure Delayed expansion Two-visit procedure Provisional needed Bonding can be achieved with 4-META products. Resin-modified formulations are less sensitive. Bonding can be achieved with 4-META products. Resin-modified formulations are less sensitive. infection control, and optimum visibility. Placement follows techniques developed...

Clinical Attachment Level

Documenting the level of attachment helps the clinician determine the amount of periodontal destruction that has occurred and is essential when rendering a diagnosis of periodontitis loss of connective tissue attachment 1617 This measurement also provides the clinician with more detailed and accurate information regarding the prognosis of an individual tooth. The clinical attachment level CAL or AL is determined by measuring the distance between the apical extent of the probing depth and a...

Ligature Strangulation

In ligature strangulation, the pressure on the neck is applied by a constricting band that is tightened by a force other than the body weight. Virtually all cases of ligature strangulation are homicides. In the authors' experience, ligature strangulation is the most common method of homicidal asphyxia, though the incidence of manual strangulation follows fairly closely. In a study of 133 homicides caused by asphyxia, ligature strangulation accounted for 48 of the deaths manual strangulation for...

Deaths from Choke or Carotid Holds

Neck holds are used by law enforcement agencies to subdue violent individuals. Rarely, one will encounter a death alleged to have occurred due to application of either a choke hold or a carotid sleeper hold.38-41 These terms are often used interchangeably, but, in fact, refer to two different holds whose purpose is to produce transient cerebral ischemia and unconsciousness. Neither involves use of a mechanical implement. Rather, the arm and forearm are used to compress the neck, producing...

Carbon Monoxide Poisoning Caused Liver Disease

Sudden death in association with liver disease is uncommon. Rarely, individuals will die of massive hepatic necrosis caused by fulminating hepatitis. One should always worry in such cases that the hepatitis is of a toxic nature such as that caused by an overdose of acetaminophen. In children, Reye's syndrome can cause relatively rapid death, but the condition is usually diagnosed prior to death. Another cause of massive hepatic necrosis is ingestion of poisonous mushrooms. Amanita phalloides is...

Instructions For Scoring The Quality Of Life Scale

This form of the Quality of Life Scale QOLS has 16 items rather than the 15 found in the original Flanagan version. Item 16, Independence, doing for yourself' was added after a qualitative study indicated that the instrument had content validity in chronic illness groups but that it needed an item that reflected the importance to these people of remaining independent and able to care for themselves. The instrument is scored by summing the items to make a total score. Subjects should be...

Coopwonca Charts

The Dartmouth Primary Care Cooperative Information Project COOP chart system has been developed and refined for over a decade for the purpose of making a brief, practical and valid method to assess the functional status of adults and adolescents. The system was developed by the Dartmouth COOP Project, a network of community medical practices that cooperate on primary care research activities. The charts are similar to Snellen charts, which are used medically to measure visual acuity quickly in...

Frontal Lobe Lesions

The frontal lobe includes the motor cortex areas 4, 6, 8, 44 , the prefrontal cortex areas 9-12 and 45-47 , and the cingulate gyrus p. 144 . It is responsible for the planning, monitoring, and performance of motor, cognitive, and emotional functions executive functions . Frontal lobe syndromes may be due to either cortical or subcortical damage and thus cannot be reliably localized without neuroimaging. The typical syndromes listed here are useful for classification but do not imply a specific...

Surgical Treatment of Puborectalis Hypertrophy

Defecation is a complicated procedure in which pelvic floor muscles actively participate in the process. Rectal distention evokes the desire to defecate and induces relaxation of the anal sphincter. Under conducive circumstances, the act of defecation is completed by adoption of a suitable posture, contraction of the diaphragm and abdominal muscles to increase the intraabdominal pressure, and relaxation of the two striated muscle of the puborectalis and external anal sphincter. Puborectalis...

Ionization and Lipophilicity

Molecules are most lipophilic when they are unionized, and their lipophilicity decreases rapidly when they are ionized. This has an important implication for the absorption and transport of drugs as a result of their permeability by passive diffusion through membranes and lipid bilayers. Figure 14 shows the lipophilicity expressed as octanol water partition of three ionizable drugs as a function of pH. Significant variations in lipophilicity occur over the physiological pH range. The pH of...

Defining Multiple Substance Use Diagnostic Approaches

Changes in Diagnostic Criteria from DSM-III to DSM-IV-TR Polysubstance dependence originated in the DSM nomenclature only in 1987, with the introduction of the third revised edition of the Diagnostic Manual of Mental Disorders (DSM-III-R American Psychiatric Association, 1987). Prior to this, in DSM-III (American Psychiatric Association, 1980, p. 179), there was the diagnostic category of mixed substance abuse, in which criteria for diagnosing substance abuse were met, but either the substances...

Circumstances Surrounding Death

Identifications may be impossible to make based on the few remains discovered at the scene however, the circumstances in which the remains are discovered may allow an identification to be made. For example, if only a few pieces of a body are located in a burned-out house, an identification cannot be made based on any scientific testing. But, if the owner of the house was last seen in the house, or if there is no other reason to believe the remains are those of someone else, a pre- FIGURE 2.2...

General Discussion

Multiple incised and or stab wounds of the neck, face, and extremities so-called defense wounds are usually caused by an assailant. Multiple incised wounds of varying depths on the neck or wrists suggest a suicide. Superficially incised wounds adjacent to a major incised wound are referred to as hesitation marks and are characteristic of self-inflicted injuries. A body sustaining tens or hundreds of stab and incised wounds is characteristic of a situation known as overkill which usually occurs...

Blunt Head Trauma

Blunt trauma to the scalp and face can produce contusions, lacerations, and abrasions. However, there may be no external signs of trauma to the head if a person has a full head of hair. Obvious external injuries are not necessary for a death to be caused by head trauma. Occasionally, the weapon leaves a characteristic identifying pattern on the scalp. Unfortunately, this is the exception rather than the rule. Battle's sign a bluish discoloration of the skin behind the ear that occurs from blood...

Acute Leukemias

Acute leukemias are described in this place for morphological reasons, because they involve a predominance of mononuclear cells p. 63 . Although or perhaps because the term leukemia is relatively imprecise, an overview seems required Table 13 . The cellular phenomenon common to the different forms of leukemia is the rapidly progressive reduction in numbers of mature granulocytes, thrombocytes, and erythrocytes. Simultaneously, the leukocyte count usually increases due to the occurrence of...

Oral Candidiasis Thrush

Monilla, or oral candidiasis thrush , is one of the fungal infections of the pharynx. Extensive white areas cover the entire oropharynx, and are not confined to the tonsil. They are either continuous Fig. 4.56a or punctate Fig. 4.56b . A swab shows Candida albicans and confirms the diagnosis. The condition responds to antifungal mouth washes or lozenges containing nystatin or amphotericin. It is commoner in neonates, and may complicate treatment with broad spectrum antibiotics. Oral candidiasis...

Stab Wounds by Anatomical Location

Most fatal stab wounds are located in the left chest region. Among a number of explanations is that most people are right handed and, when facing a victim, will tend to stab the left chest. In addition, if the intention is to kill someone, one would stab in the left chest where the heart is thought to be. Most fatal stab wounds of the chest involve injury to the heart or aorta. Deaths due solely to a stab wound of the lung are less common. Fatal stab wounds of the right chest usually involve...

Trigeminal Innervation

The trigeminal nerve is primarily sensory, and covers a large area of the skin of the face, dura mater, major in-tracranial blood vessels, the teeth, and the oronasal mucosa. The nerve also supplies the masticatory muscles with both sensory afferents and motor efferents. The three main divisions of the trigeminal sensory nuclei are the principal, mesen-cephalic, and spinal nuclei. The trigemi-nal sensory gasserian ganglion lies near the apex of the petrous temporal bone and gives rise to three...

Saddle Or Ridge Lap Pontic

The saddle pontic has a concave fitting surface that overlaps the residual ridge buccolingually, simulating the contours and emergence profile of the missing tooth on both sides of the residual ridge. How ever, saddle or ridge lap designs should be avoided because the concave gingival surface of the pontic is not accessible to cleaning with dental floss, which will lead to plaque accumulation Fig. 20-12 . This design deficiency has been shown to result in tissue inflammation' Fig. 20-13 ....

Dangers in Current Techniques Supcroxol HeatLigh I Technique

The prospect of a treatment posing danger to a patient or to the oral environment is of particular concern when embarking on an elective procedure. The corrosive nature of super-oxol and its potential deleterious effects on various tissues are a definite drawback to the superoxol heat light bleaching system. The tooth, which is more intimately and deliberately exposed to the bleaching agent than any other tissue, is the most at risk. The concerns about chemical and thermal intrusions on the...

Ovate Pontic

The ovate pontic is the most esthetically appealing pontic design. Its convex tissue surface resides in a soft tissue . depression or hollow in the residual ridge, which makes it appear that a tooth is literally emerging from the gingiva Fig. 20-19 . Careful treatment planning is necessary for successful results. Socket-preservation techniques, which have already been described, should be performed at the time of extraction to create the tissue recess from which the ovate pontic form will...

Dentogingival Junction

At the base of the gingival sulcus crevice is the epithelium-tooth interface, also known as the den-togingival junction DGJ . This structural relationship between hard and soft tissues is unique in the body. At the ultrastructural level, it is made up of hemidesmosomes and a basal lamina, which anchor the epithelial cells to the enamel and cemental surfaces4-11 The depth of the sulcus varies in healthy individuals, averaging 1.8 mm.12 In general, the shallower it is, the more likely the gingiva...

Osseous Resection with Apically Positioned

Chronic inflammatory periodontitis results in the loss of osseous tissue, destruction of osseous architecture, and creation of an intrabony lesion. The osseous tissue has no predictable or simple pattern of loss the resorption may take the form of craters, hemiseptal defects, or well-like troughlike shapes. Craters in the interproximal areas Fig. 5-24 are the most common type of lesion. The objective of osseous resection is to shape the bone to form even contours. This is accomplished by...

Pinledge Preparations

A pinledge Fig. 10-34 is occasionally used as a single restoration, generally to reestablish anterior guidance, in which case only the lingual surface is prepared. More commonly, however, it is used as a retainer for a fixed partial denture Fig. 10-35 or to splint periodontally compromised teeth Fig. 10-36 . In these cases, one or more of the proximal surfaces are included in the preparation design to accommodate the required connector s . Retention and resistance are provided primarily by pins...

Subgingival Margin Preparation

The development of good axial contours. This will enable the junction between the restoration and the tooth to be smooth and free of any ledges or abrupt changes in direction. Under most circumstances a crown should duplicate the contours and profile of the original tooth unless the restoration is needed to correct a malformed or malpositioned tooth . If an error is made, a slightly undercontoured flat restoration is better because it is easier to keep free of plaque however, increasing...

Saliva Control

Depending on the location of the preparations in the dental arch, several techniques can be used to create the necessary dry field of operation Fig. 14-1 . In areas where only supragingival margins are present, Fig. 14-1. Saliva control for impression making. When correctly placed, maxillary cotton rolls block salivary flow from the parotid gland. A, The evacuator removes saliva from the floor of the mouth, keeping the prepared tooth dry while the flange displaces the tongue medially. B,...

Supragingival Margin And Large Gingival Embrasure

Data from jepsen A Acta Odontol Scat id 21 35, 1963. Data from jepsen A Acta Odontol Scat id 21 35, 1963. Fig. 3-23. A, Because of the conical shape of most roots, the actual area of support A diminishes more than might be expected from the height of the bone H . In addition, the center of rotation R moves apically and the lever arm L increases, magnifying the forces on the supportive structure. B, A fixed partial denture replacing a maxitlary first molar. The first premolar is an abutment...

Metal Ceramic Crowns

Should be approximately 1 mm wide and should extend well into the proximal embrasures when viewed from the incisal occlusal side Fig. 9-8 . Where access permits, establishing this shoulder from the proximal gingival crest toward the middle of the facial wall is preferred. This will minimize placement of the initial shoulder preparation too close to the epithelial attachment. If the margin is established from facial to proximal, a tendency exists to bury the instrument and encroach on the...

Substantia Nigra

The motor system controls the timing, direction, amplitude, and force of movement through the coordinated opposing actions of agonist and antagonist muscles. It also keeps the body in a stable position through postural and righting reflexes. Reflex movements are involuntary, stereotyped responses to stimuli. Rhythmic movements have both reflex and voluntary components. Voluntary movements are performed at will. Withdrawing a foot from a noxious stimulus or spreading the arms when falling are...

Rl81a85434 2007

Visit the Informa Web site at www.informa.com and the Informa Healthcare Web site at www.informahealthcare.com This book is dedicated to the memory of my Dad, George H. Grant, D.D.S. who died on June 8, 2006 at noon and to my husband, Barry D. Kels, M.D., J.D. They are both gentle yet strong, demonstrate an absolute love of life and family, and my greatest supporters. In their arms, I have learned what it means to feel safe and secure. My Dad was the first man in my life that I loved with every...

Spinal Extradural Cysts

Spontaneous spinal nerve root diverticula and cysts Tarlov cysts Posttraumatic or postoperative meningeal diverticula Spinal ganglion cysts and spinal synovial cysts These cysts arise as an evagination or herniation of the arachnoid that gradually enlarges. Its neck eventually closes, creating a cyst that no longer communicates with the CSF space. The cysts are located exclusively or primarily in the thoracic spine in 86 of cases, and less frequently in the cervical region 2.5 and lumbosacral...

How Does MS Affect the Nervous System

In contrast to many diseases that affect a single part of the human body, MS affects two different body systems the immune system and the nervous system. The immune system is not a distinct organ like the brain or liver. Instead, it is composed of many different types of molecules and cells known as white blood cells that travel through the bloodstream. The immune cells use chemical messages to protect the body from attack by bacteria, viruses, and cancers. MS is believed to be an autoimmune...

Soldering Flux And Antiflux

This substance is applied to a metal surface to remove oxides or prevent their formation. When the oxides are removed, the solder is free to wet and spread over the clean metal surface. Borax glass Na2B4O7 is frequently used with gold alloys because of its affinity for copper oxides. An often-cited soldering flux formula'-' is borax glass 55 parts , boric acid 35 parts , and silica 10 parts . These ingredients are fused together and then ground into a powder. Fluxes are...

Administrative Interim Analysis

A nominal level 0.289 for each of four tests does not have a size of 5 . Suppose that there is a ranking among the K endpoints. The individual hypotheses for the important primary endpoints are tested at the 5 level as usual. However, for other endpoints with less relevance, individual tests can be performed at a higher nominal significance level to improve the power of the IUT procedure. But the resulting IUT procedure does not have an experimentwise false positive rate of 5 . In general, if...

Structure And Components Of A Protocol

As indicated in Section 1.4, the minimum requirements for the protocol of a clinical trial are provided in Section 312.23 of 21 CFR. In addition, Table 1.4.2 provides an example for format and contents of a protocol for a well-controlled clinical trial. A protocol cover sheet suggested by the FDA provides a tabular summary of information and characteristics for the trial. On the other hand, a protocol synopsis with a length of one to two pages can depict a narrative summarized description of a...

Syrup Making The Heart of the Process

This chapter deals with the subject of the syrup-making stage in soft drink manufacture. It, therefore, ostensibly deals only Syrup-to-water proportioning is 11. .en- i-i mainly used in the carbonated soft with those final beverage-filling operations in which prepre- , . , . , pared concentrated syrup of the product is blended, at the filling machine, with treated water in a prescribed water-to-syrup ratio. This blending operation is effected by a piece of equipment called a syrup proportioner...

Statistical Modeling In Pharmaceutical Research And Development

Andr a de Gaetano, Simona Panunzi, Benoit Beck, and Bruno Boulanger 3.2 Descriptive versus Mechanistic Modeling 3.3 Statistical Parameter Estimation 3.7 Population Modeling References The new major challenge that the pharmaceutical industry is facing in the discovery and development of new drugs is to reduce costs and time needed from discovery to market, while at the same time raising standards of quality. If the pharmaceutical industry cannot find a solution to reduce both costs and time,...

Red Cell Autoantibodies

A classification of red cell autoantibodies is shown in Figure 22.1. Red cell autoantibodies are arbitrarily divided into cold and warm antibodies, but the distinction is not absolute. Cold antibodies are antibodies which preferentially agglutinate red cells at low temperatures. They characteristically agglutinate red cells at 4 C and at room temperature 22 C , but tend not to cause agglutination at 37 C. Warm antibodies on the other hand tend to be inactive at room temperature but do cause...

Platelets Indications and Dosing

Blood platelets are currently manufactured in one of two ways. Whole blood donors may donate a unit of blood from which a platelet concentrate is manufactured. In this process, the unit of blood is subjected to two centrifugational steps. The first step is called a soft spin, which makes platelet rich plasma and a concentrated (packed) red cell. The platelet rich plasma is expressed from the bag and then subjected to a second centrifugation called a hard spin, after which the platelets are...

Mutually Protected Occlusion

During the early 1960s, an occlusal scheme called mutually protected occlusion was advocated by Stuart and Stallard, 4 based on earlier work by D'Amico.35 In this arrangement, centric relation coincides with the maximum intereuspation position. The six anterior maxillary teeth, together with the six anterior mandibular teeth, guide excursive movements of the mandible, and no posterior occlusal contacts occur during any lateral or protrusive excursions. The relationship of the anterior teeth, or...

Umbilical Cord No Twist

The umbilical cord is the lifeline of the fetus. Complete cord occlusion often leads to fetal demise while intermittent obstruction has been associated with intrauterine brain damage. Cord compression and vasospasm are important factors in fetal distress. Careful umbilical cord examination often reveals significant lesions which may be associated with these processes. The umbilical cord forms in the region of the body stalk where the embryo is attached to the chorion. This area contains the...

Inverted Follicular Keratosis

INTRODUCTION Inverted follicular keratosis is a benign skin lesion that is common on the face and less frequently on the eyelids. It occurs in older individuals from the fifth decade on, and is considerably more common in males. It is frequently mistaken for a malignant tumor. These lesions arise from the infundibular epithelium of the hair follicle and therefore are related to epidermoid cysts. Inverted follicular keratosis may be an irritated form of seborrheic keratosis or verruca vulgaris....

Dermatologic Physical Examination

The four components of the dermatologic physical examination are 1 primary lesions, 2 secondary lesions, 3 distribution, and 4 configuration. Because primary and secondary lesions are rather constant with most dermatitides, they should be relied on heavily to lead to the correct diagnosis. The two other basic components of the physical exam, distribution and configuration, are used for support and confirmation. Some skin disorders lack a distinct distribution or configuration. Occasionally,...

Activated Carbon

. Ac tivated carbon in granular or powdered form provides a type of physico-chemical filtration. Activated carbon removes discoloration, dyes, colors, phosphates, chlorine, chloramines, antimony, arsenic, chromium, hydrogen peroxide, potassium permanganate, some of the heavy metals, and many other toxins in varying degrees. It also removes many fish medications at the end of therapy. It is ideal for prefiltration of the tap water to remove most of the residual toxins left after municipal water...

Treatment of Combined Colonic Inertia and Obstructed Defecation

Transit studies and anorectal physiology tests can subdivide severely constipated patients into three groups colonic inertia causing slow transit, obstructed defecation, and a combination of both. Patients with obstructed defecation may have mechanical outlet obstruction related to the presence of anatomic abnormalities such as a rectocele, or functional outlet obstruction. The principles of treating slow-transit constipation or obstructed defecation alone are generally agreed upon. The optimal...

Pneumothorax

Pneumothorax occurs when air enters the pleural space and Ppl falls to zero p. 108 , which can lead to collapse of the affected lung due to elastic recoil and respiratory failure B . The contralateral lung is also impaired because a portion of the inspired air travels back and forth between the healthy and collapsed lung and is not available for gas exchange. Closed pneumothorax, i.e., the leakage of air from the alveolar space into the pleural space, can occur spontaneously e.g., lung rupture...

Blood Buffer System

The pH of any buffer system is determined by the concentration ratio of the buffer pairs and the pKa of the system p. 378 . The pH of a bicarbonate solution is the concentration ratio of bicarbonate and dissolved carbon dioxide HCO3- CO2 , as defined in the Henderson-Hasselbalch equation A1 . Given HCO3 24mmol L and CO2 1.2mmol l, HCO3- CO2 24 1.2 20. Given log20 1.3 and pKa 6.1, a pH of 7.4 is derived when these values are set into the equation A2 . If HCO 3 drops to 10 and CO2 decreases to...

Concentration Estimation By Hydrometer

A hydrometer is used to determine the density or specific gravity of a liquid using the principles of buoyancy. Buoyancy results from the upthrust on any object immersed or partially immersed in a liquid. Upthrust is developed as a consequence of the weight of the displaced liquid. At the point of partial immersion at which this upthrust just equals the weight of the hydrometer, the hydrometer will float. The liquid level can be measured against a scale etched on the hydrometer. The density is...

Urothelial Cells

Benign Urothelial Cells catheterized urine Clusters of benign urothelial cells are admixed with squamous cells. Several acute inflammatory cells are seen in the background. The urothelial cells are seen in two main clusters, one cluster of which is smaller than the second. Cytoplasmic vacuolization and variability in nuclear size and shape is observed. Although the cytoplasm appears to be homogeneous, the nuclear cytoplasmic ratio is not increased. In catheterized specimens, these...

Ionizable Groups

This section reviews the most common ionizable groups, and the structural factors that influence pKa values. 5.16.2.1 The Number of Ionizable Drugs To evaluate their ionization properties, compounds can be divided into several classes. Some compounds are neutral nonionizable they will not be discussed in this chapter. Most ionizable compounds are acids or bases with one, two or more ionizable groups. Another class includes ampholytes and zwitterions, which are molecules with at least one acidic...

Is Remission of Kidney Failure Possible

There has been a lot of talk recently about remission of chronic renal failure. A decrease in the loss of protein in the urine, in the absence of kidney failure, or when the kidney disease is acute, certainly does occur. But a small scarred kidney is not going to grow back into a normal one, no matter what. There is no such thing as remission of chronic renal failure. However, arresting the progression of the disease is a real possibility, as shown by a number of publications and by several...

Modified Barthel Index

Notes in parenthesis are to facilitate application 1. The patient is unable to attend to personal hygiene and is dependent in all aspects. Patient is totally dependent on assistance to brush teeth denture, comb hair, wash hands, wash face, shave and or apply make-up. 2. Assistance is required in all steps of personal hygiene. Patient may complete one or two of the above activities. Generally requires assistant to provide more effort than self for each of the activities, loosen dentures, shave...

Causes of anemia

Iron deficiency (hypochromic, microcytic) the most common cause of anemia in the US. Look for low iron ferritin level, elevated total iron-binding capacity (TIBC also known as transferrin), and lowTIBC saturation. Rarely patients have a.craving for ice or dirt (pica) or Plummer-Vinson syndrome (esophageal web producing dysphagia, iron deficiency anemia, and glossitis). In a patient over 40, rule out colon cancer as a cause of chronic blood loss.

Websites of Interest

American Academy of Dermatology (AAD) http www.aad.org Dermanities http www.dermanities.com Dermatology Information System (DermIS) http dermis. multimedica.de Dermatology Nurses Association (DNA) http dna.inurse.com Dermatology Physician Assistants http home.pacifier.com jomonroe Dermatology Times http www.dermatologytimes.com dermatologytimes DermMD www.gizmodoc.com dermmd Electronic Textbook of Dermatology http www.teleme dicine.org stamford.htm E-medicine dermatology www.emedicine.com derm...

Clinical Development Plan

A clinical development plan (CDP) is a description of clinical studies that will be carried out in order to assess the safety and effectiveness of the drug. A clinical development plan typically includes a development rationale, listing of trial characteristics, timeline, cost, and resource requirements. A good and flexible clinical development plan hence is extremely crucial and important to the success and unbiased assessment of a potential pharmaceutical entity. Although a typical CDP is...

Benign Lichenoid Keratosis

Synonym Lichen planus-like keratosis. Chest, back, neck, upper extremities of adults over 40 Light brown to red, may notice brown at periphery Often associated with or arising in a solar lentigo Fig. 12C Variety of histologic subtypes including atypical and bullous Atrophic to hyperplastic epidermis Compact ortho- and parakeratosis Lichenoid, predominantly mononuclear cell infiltrate, obscures dermal-epidermal junction Fig. 12D Scattered necrotic keratinocytes May have mild keratinocytic atypia...