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http://projects.csail.mit.edu/courseware/?term=ap-world-history-compare-and-contrast-essay-prompts ap world history compare and contrast essay prompts They also are less likely to develop hand oa but more likely to develop knee oa. Pathophysiology oa is characterized by damage to diarthrodial joints and joint structures (figure 58–1). The pathophysiology is multifactorial and typified by progressive destruction of joint cartilage, erratic new bone formation, thickening of subchondral bone and the joint capsule, bony remodeling, development of osteophytes, variable degrees of mild synovitis, and other changes. 5 the earliest stages of oa are characterized by increasing water content and softening of cartilage in weight-bearing joints. As the disease progresses, proteoglycan content of cartilage declines, and eventually, cartilage becomes hypocellular. Protease enzymes proliferate before changes in cartilage, suggesting that catabolic proteinases play an important role in the initiation and progression of oa. Subchondral bone undergoes metabolic changes, including increased bone turnover, that appear to be precursors to tissue destruction. The normally contiguous bony surface becomes fissured. Persistent use of the joint eventually results in loss of cartilage, permitting bone-to-bone contact that ultimately promotes thickening and eburnation of exposed bone. Microfractures may appear in subchondral bone, and osteonecrosis may develop beneath the surface especially in individuals with advanced disease. New bone is formed haphazardly, leading to the formation of osteophytes that extend into the joint capsule and ligament attachments and may encroach on the joint space. Progressive loss of joint cartilage, subchondral damage, narrowing of joint spaces, and changes in the underlying bone and soft tissues may culminate in deformed, painful joints. 889 890  section 11  |  bone and joint disorders regular normal subchondral bone texture normal, thick, smooth articular cartilage irregular thickening and remodeling of subchondral bone with sclerosis and cysts thickening, distortion, and fibrosis of the capsule smooth joint margin fibrillation, loss of volume, and degradation of articular cartilage normal, single-cell– layered synovium modest, patchy, chronic synovitis thin, even capsule osteophytosis and soft tissue growth at joint margin classification oa can be classified as primary (idiopathic) or secondary. Primary oa is the predominant form and occurs in the absence of a known precipitating event. Primary oa may assume a localized, generalized, or erosive pattern. Localized oa is distinguished from generalized disease by the number of sites involved. Erosive disease is characterized by an erosive pattern of bone destruction and marked proliferation of interphalangeal joints of the hands. Secondary oa results from congenital or developmental disorders or inflammatory, metabolic, or endocrine diseases. Risk factors oa develops when systemic factors and biomechanical vulnerabilities combine. Systemic factors include age, gender, genetic predisposition, and nutritional status.

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a one page essay B. Technique. Bladder taps are done with a 5- to 10-ml syringe attached to a 22- or 23-gauge needle or to a 23-gauge butterfly needle. Before the tap, one should try to determine that the baby has not recently urinated. Ultrasonographic guidance is useful. One technique is as follows. 1. The pubic bone is located by touch. 2. The needle is placed in the midline, just superior to the pubic bone. 3. The needle is inserted and aimed at the infant's coccyx. 4. If the needle goes in >3 em and no urine is obtained, one should assume that the bladder is empty and wait before attempting again. 854 i common neonatal procedures v. Lumbar puncture a. Technique 1. The infant should be placed in the lateral decubitus position or in the sitting position with legs straightened. The assistant should hold the infant firmly at the shoulders and buttocks so that the lower part of the spine is curved. Neck flexion should be avoided so as not to compromise the airway. 2. A sterile field is prepared and draped with towels. Chlorhexidine should not be used to sterilize the skin prior to an lp as it is specifically not intended to be introduced into the central nervous system. 3. A 22- to 24-gauge spinal needle with a stylet should be used. Use of a nonstyleted needle, such as a 25-gauge butterfly needle, may introduce skin into the subarachnoid space and is to be avoided. 4. The needle is inserted in the midline into the space between the fourth and fifth lumbar spinous processes.

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http://projects.csail.mit.edu/courseware/?term=free-response-essay free response essay Later that evening she was ound to have developed hypotension and tachycardia. Right lower quadrant abdominal pain, lessened i she exed that knee, developed later at which time the in-house on-call physician was noti ed to evaluate the patient. Most hospitalizations involve one or more procedures, but the principal procedure is the one identi ed and per ormed or de nitive treatment. In 2010, the total number o inpatient procedures per ormed was 51.4 million, most commonly or maternal, cardiovascular or musculoskeletal disorders. While rates are dependent on age, estimated number o procedures per ormed in 2010 are as ollows. Cardiac catheterization, 1.0 million (insertion o coronary artery stent, 454,000. Coronary artery bypass gra , 395,000. And balloon angioplasty o coronary artery or coronary atherectomy, 500,000). Cesarean section, 1.3 million. Upper gi endoscopy, 1.1 million. Total knee replacement, 719,000. And total hip replacement, 332,000.64,65 see table 51-6. Diagnostic cardiac catheterization xt and percutaneous transluminal intervention66 what is the purpose of cardiac catheterization and how is it performed?. Originally developed as a diagnostic procedure that provided hemodynamic in ormation and de ned coronary anatomy, percutaneous coronary angiography has become a methodology that acilitates therapeutic interventions (percutaneous coronary intervention, pci, either angioplasty or placement o a coronary stent). Diagnostic catheterization and pci are done through skin puncture under local anesthesia. Preexisting anticoagulation is held until the international normalized ratio (inr) reaches 1.5 or the direct-acting oral anticoagulants 861 int er nal medic ine and neur ology table 51-6. Number o stays, stays per 10,000 population, and percentage change in rate o the most frequent all-listed procedures or hospital stays by age, 1997 and 2010 num all li d css p o du of s ay wi p o du t ou and in s ay wi p o du p 10,000 po ula ion (r a ) p n ag c ang in r a 1997 2010 1997 2010 1997–2010 all stays (with and without procedures) 34,681 39,008 1272 1261 –1% all stays with any procedure 21,257 24,740 780 800 3% percentage of all stays with procedure 61% 63% blood transfusion 1098 2815 40 91 126% prophylactic vaccinations and inoculations 567 1837 21 59 185% respiratory intubation and mechanical ventilation 919 1638 34 53 57% repair of current obstetric laceration 1137 1292 42 42 0% diagnostic cardiac catheterization. Coronary arteriography 1461 1283 54 41 –23% caesarean section 800 1278 29 41 41% upper gastrointestinal endoscopy. Biopsy 1105 1206 41 39 –4% circumcision 1164 1150 43 37 –13% artificial rupture of membranes to assist delivery 853 917 31 30 –5% fetal monitoring 1002 875 37 28 –23% diagnostic ultrasound of heart (echocardiogram) 632 858 23 28 20% hemodialysis 473 850 17 27 58% arthroplasty knee 329 730 12 24 96% enteral and parenteral nutrition 277 613 10 20 95% percutaneous transluminal coronary angioplasty 581 562 21 18 –15% laminectomy. Excision intervertebral disc 425 532 16 17 10% colonoscopy and biopsy 531 528 19 17 –12% spinal fusion 202 492 7 16 115% incision of pleura. Thoracentesis. Chest drainage 349 475 13 15 20% hip replacement. Total and partial 291 456 11 15 38% adapted with permission from pfuntner a, wier lm, stocks c. Most frequent procedures performed in u.S. Hospitals, 2010. Statistical brief #149. February, 2013. Have been metabolized, but periprocedural use o anticoagulants (heparin) and antiplatelet drugs (aspirin and an adp receptor antagonist) is necessary. A er a needle is placed into the artery, a guide wire is inserted and guided to the heart. T e needle is withdrawn and replaced with a exible catheter or sheath through which a catheter is threaded over the guide wire and guided into the heart or coronary artery where hemodynamic measurements are made, angiography per ormed, or angioplasty/stent placement per ormed. T e common emoral artery was the 862 c h apt er 51 most requent access site, but associated vascular complications have led to an increasing pre erence or the radial artery.

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http://www.cs.odu.edu/~iat/papers/?autumn=england-homework-help england homework help B. Decreased k clearance due to renal failure, oliguria, hyponatremia, and congenital adrenal hyperplasia. 280 i fluid and electrolyte management c. Miscellaneous associations, including dehydration, birth weight < 1,500 g (see viii.A.2.), blood transfusion, inadvertent excess (kcl) administration, cld with kcl supplementation, and exchange transfusion. D. Up to 50% of vlbw infants born before 25 weeks' gestation manifest serum k levels >6 meq/l in the first 48 hours of life (see viii.A.2.). The most common cause of sudden unexpected hyperkalemia in the neonatal intensive care unit (nicu) is medication error. 2. Diagnosis. Obtain serum and urine electrolytes, serum ph, and ca concentrations. The hyper.Kalemic infant may be asymptomatic or may present with a spectrum of signs, including bradyarrhythmias or tachyarrhythmias, cardiovascular instability or collapse. The ecg findings progress with increasing serum k from peaked t waves (increased rate of repolarization), flattened p waves and increasing pr interval (suppression of atrial conductivity), to qrs widening and slurring (conduction delay in ventricular conduction tissue, as well as in the myocardium itself), and finally, supraventricular/ventricular tachycardia, bradycardia, or ventricular fibrillation. The ecg findings may be the first indication of hyperkalemia (see chap. 41). Once hyperkalemia is diagnosed, remove all sources of exogenous k (change all iv solutions and analyze for k content, check all feedings for k content), rehydrate the patient if necessary, and eliminate arrhythmiapromoting factors. The pharmacologic therapy of neonatal hyperkalemia consists of three components. A. Goal i. Stabilization of conducting tissues. This can be accomplished by na orca ion administration. Ca gluconate (io%) givm carefully at i to 2 mijkg iv (over 0.5-i hour) may be the most useful in the nicu. Treatment with hypertonic nacl solution is not done routinely. However, if the patient is both hyperkalemic and hyponatremic, ns infusion may be beneficial. Use of antiarrhythmic agents such as lidocaine and bretylium should be considered for refractory ventricular tachycardia (see chap. 41). B. Goal 2. Dilution and intracellular shifting of k. Increased serum k in the setting of dehydration should respond to fluid resuscitation. Alkalemia will promote intracellular k-for-hydrogen-ion exchange.

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essay writing services recommendations Na bicarbonate i to 2 meq/ kg/hour iv may be used, although the resultant ph change may not be sufficient to markedly shift k ions. Na treatment as described in goal 1 may be effective. In order to reduce risk of ivh, avoid rapid na bicarbonate administration, especially in infants bom before 34 weeki gestation and jouiif than 3 days. Respiratory alkalosis may be produced in an intubated infant by hyperventilation, although the risk of hypocarbia-diminishing cerebral perfusion may make this option more suited to emergency situations. Theoretically, every 0.1 ph unit increase leads to a decrease of 0.6 meq/l in serum k. Insulin enhances intracellular k uptake by direct stimulation of the membrane-bound na-k atpase.

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