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Someday, I'd like to see what's down every road. I'd like to travel across Every highway and every byway. I'd like to explore Every mountain pass and every sandy trail. I'd like to follow Every straight route and every winding path. Someday, I'd like to understand From where all things come, And to what all things are destined. Someday, Even though I sure of my lesson-- That we are all hoping to the same place-- I'd like to take the time To travel and explore and follow So that I can really see and understand What's down every road. Mattie J. T. Stepanek, August 2001 From Hope Through Heartsongs Reprinted with permission by Hyperion Books.
Adjusted hazard ratio 2.8; p 0.001 for UFH; hazard ratio 3.3; p 0.001 for ENOX ; . Males were also at higher risk for re-exploration hazard ratio 1.4; p 0.07 ; . For those requiring re-exploration, the interval between surgery and first re-exploration was prolonged 4 days ; among those receiving ENOX 37.5%, odds ratio 36.7; p 0.001 ; and UFH 20.0%, odds ratio 14.7; p 0.01 ; compared with none 1.8% ; . Prolonged times with ENOX had a greater proportion of prolonged times than UFH odds ratio 2.5; p 0.09 ; . Conclusions. Early postoperative use of ENOX and UFH is associated with a significant increase in reexploration for postoperative bleeding, often at a significantly delayed time period after the initial surgery. This delay was especially common with ENOX suggesting the need for prospective studies. Ann Thorac Surg 2005; 80: 518 ; 2005 by The Society of Thoracic Surgeons.
Patients. Patients receiving marrow or blood stem cell autografts effectively depleted of malignant cells using anti-B cell monoclonal antibodies may achieve prolonged remissions.39, 40 In a recent update of the Dana-Farber results, 41 Freedman et al reported 153 patients with recurrent low-grade lymphoma who underwent purged autologous transplantation. Patients were required to have chemotherapy-sensitive, low-bulk disease. At the time of harvest 30% of patients were in complete remission. Disease-free and overall survival was 42% and 66% at 8 years, with significantly better disease-free survival in patients receiving marrow that was PCR negative for bcl2-rearranged cells. However, whether purging improves clinical outcome is controversial, and its efficacy has never been confirmed in a randomized trial.42 In most studies, there is a continuing risk of relapse following purged autologous transplants with no clear plateau in disease-free survival.43 In addition, there has been a high rate of secondary myelodysplasia in long-term survivors after autotransplants in this disease.44-47 Allogeneic Myeloablative Bone Marrow Transplantation High-dose chemoradiotherapy with allogeneic BMT has generally been reserved for far advanced patients with low-grade lymphoma. Van Besien et al reported encouraging results with extended disease-free survival in 12 of heavily pretreated patients.48, 49 Other groups have also reported a high percentage of long-term remissions.50-53 Relapse rates after allogeneic transplants have been substantially lower than with purged autologous transplants.54, 55 Verdonck et al published a study of 28 patients with advanced low-grade lymphoma, comparing results of allogeneic transplants to autologous transplants.55 The patients had previously received two to five conventional chemotherapy regimens. All 10 allogeneic BMT patients achieved complete remission, three patients had treatment-related deaths, and seven patients were alive in remission at a median follow-up of 41 months. Of 18 autologous transplant recipients, none died of treatmentrelated complications, but only three patients are alive and disease-free. The probability of disease progression among allogeneic transplants was 0% versus 83% for autologous recipients P .002 ; , and progression-free survival at 2 years was 68% and 22% respectively P 0.049 ; . The continuing risk of relapse after purged autologous transplants suggests that the high-dose preparative regimen does not completely eradicate the malignancy in most patients. The lower relapse rate with allogeneic transplants is likely due to an immune mediated GVL effect. Van Besien for the International Bone Marrow Transplant Registry recently analyzed results of allogeneic BMT from HLA-identical sibling donors in 113 patients 174.
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Pamela M. Marcus, Ph.D., M.S., Epidemiologist, Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda Bill Radaj, American Marketing Manager, CT, G. E. Medical Systems Denise Aberle, M.D. Chairman, Department of Radiological Sciences, U.C.L.A. Los Angeles.
ALAT, alanine aminotransferase; ASAT, aspartate aminotransferase; GGT, -glutamyl transpeptidase; PTT, partial thromboplastin time; TRAb, TSH receptor antibodies; n.m., not measured. TABLE 3. Serologic tests on admission to our hospital.
Gulf Coast Veterinary Specialists, Houston, Texas, USA Arthroscopic assisted fracture repair presents one of the most technically demanding aspects of small animal arthroscopy. All cases are unique and few are routine. Proper case selection is imperative, and cases that are truly good candidates are infrequent, further complicating the learning curve. Sound orthopedic principles should not be abandoned simply to achieve an "arthroscopic repair". Orthopedic techniques must be capable of withstanding the anticipated increased stress placed on a repair proformed by minimally invasive technique in already inherently poorly compliant postoperative patient. Conversely, in properly selected cases, arthroscopy may allow better visualization of the intrarticular reduction and minimize soft tissue disruption to promote healing while preserving joint range of motion. In general and in most cases, arthroscopic assisted fracture repair utilizes familiar portals to visualize the problem and determine if arthroscopic repair is possible. Patients and owners should always be prepared for open techniques if success is not considered likely. In most cases, precisely placed accessory portals, usually verified with needle placement initially, are necessary. Rigid cannula systems are particularly useful for establishment of unfamiliar portals in swollen tissues that may have unreliable landmarks. These same cannulas are often useful in assisting and maintaining reduction while small K-wires are placed through their lumens. Cannulated screw systems can also be utilized over the K-wires to allow precise lag screw placement if additional fixation is needed. Eyed Steinman pins are useful for pin and tension band techniques for smaller avulsion fragments, particularly when dealing with cruciate ligament avulsion. The list of arthroscopic assisted applications will no doubt grow as arthroscopy continues to gain popularity and innovative surgeons continue to share ideas. Arthroscopy has been successfully utilized to manage avulsion fractures of the origin and insertion of the cranial cruciate ligament, the origin of the posterior cruciate ligament, minimally displaced supracondylar femoral fractures, supraglenoid tubercle fractures, lateral condylar fractures of the humerus, and incomplete ossification of the humeral condyl. Some smaller fractures such as foveal avulsion fractures of the femoral head if non-luxated, non-dysplastic ; , and small avulsion fractures of the supraglenoid tubercle, hock, and carpus can be managed by simple arthroscopic removal of the fragments if repair is not possible or considered necessary. Arthroscopic assisted fracture repair is in its infancy. Working together, open-minded surgeons will no doubt find additional applications provided they understand the limitations of arthroscopy and work within framework of sound orthopedic priciples and bilberry.
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In interpretation caused by pharmacokinetic differences between species, the concentration of an antibiotic should be measured in the blood and lung to ensure that the levels are similar to those likely to be achieved in man. Bacterial viable counts in the blood and lung must be measured as well as animal survival, because death may be due to factors other than infection. For example, bacterial toxin production may cause death, so that whilst an antibiotic can be effective in decreasing bacterial numbers it might not influence mortality. Pneumolysin is an important intracellular toxin of the pneumococcus which is released during cell lysis induced by Mactam antibiotics Feldman et al., 1991 ; . It follows that the more extensively a model has been studied, and the more widely it has been used in different laboratories, the more useful it becomes. Many animal models have been described, but few have been studied in sufficient detail to permit comparison of data between laboratories. A new animal model should only be developed when there are problems with an existing model, or when new techniques become available, and clear benefits of the new model can be demonstrated. For example, most animal models used to study Pneumocystis carinii pneumonia rely on steroid-induced immonosuppression to activate latent P. carinii infections in rats. These models are often limited by the unknown baselines of P. carinii infection, the long time required for development of heavy infections, and the frequency of secondary infections that render many of the animals unusable. Recently, a new rat model has been described using subcutaneous methyl prednisolone and intratracheal instillation of P. carinii. This new.
The Artifice of Truth It is often imagined that the assertion of truths is the general function of language--and that error and deceit are no more than derivative possibilities arising from the general function of truthfulness. One often hears indignant exclamations to the effect that the notions of falsity and deception only make sense in relation to possible knowledge of what is really true. Let us imagine, 9 with a greater sensitivity and bioflavonoids.
The embryonic age, calculated from the menstrual history, is seldom of use O'Rahilly and Mller, 1987 ; . Allowance should be made for considerable variability in both the follicular and luteal phases of the menstrual cycle, with the date of ovulation only estimated at midcycle. The age of very early human embryos those of the first 34 weeks, post-ovulation ; has been estimated chiefly by comparison of their development with that of the monkey conceptuses of known post-ovulatory ages Rock and Hertig, 1944 ; . Coital history has not always been noted but where the information is available the post-ovulatory age is easier to identify.
All growth rates included in the review of turnover are at constant exchange rates CER ; unless otherwise stated. The sterling growth rates may be found in the tables of pharmaceutical turnover by therapeutic area on page 32 and by geographic region on page 33. Total pharmaceutical turnover in 2006 was 20, 078 million compared with 18, 661 million in 2005, an increase of 9% CER. Within the Group's portfolio, turnover of new products first launched in a major market within the last five years accounted for 27% 2005 24% ; of total turnover and grew by 20% to 5, 333 million 2005 4, 478 million ; . Turnover of the more established, franchise products amounted to 11, 709 million 2005 10, 933 million ; , representing 58% of total turnover, and increased 9% compared with last year. Turnover of older products, now less actively promoted, was 3, 036 million 2005 3, 250 million ; , representing 15% of total turnover, and declined by 5%. In sterling terms total pharmaceutical turnover increased 8%, 1% less than CER due principally to the strength of Sterling against major International currencies and biperiden.
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Routine in-vitro fertilization IVF ; . For this reason, clinicians have tried to find more convenient forms of GnRHa administration whilst maintaining the main advantage of this medication, i.e. pituitary desensitization and subsequent ovarian quiescence. The existence of long-acting GnRHa preparations has encouraged several groups to employ this approach, reducing administration of the drug to a single daily subcutaneous injection. The results published so far have shown reduced implantation Devreker et al., 1996 ; and pregnancy rates, as well as increased miscarriages Gonen et al., 1991; Devreker et al., 1996 ; , when long-acting GnRHa have been compared to shortacting preparations in routine IVF. As the implantation rate is related to both embryo quality and appropriate endometrium environment, it is assumed that long-acting forms may alter the oocyte and the resulting embryo, the endocrine milieu of the endometrium, or both Gonen et al., 1991; Devreker et al., 1996 ; . It has been suggested that the more pronounced inhibition of ovarian function during the follicular phase due to the administration of long-acting forms may affect both oocyte quality and the function of the corpus luteum Devreker et al., 1996 ; . However, there is also evidence that the inadvertent administration of GnRHa prior to an IVF cycle is not detrimental for the fetus and may potentially enhance corpus luteum function, resulting in an unexpected treatment for infertility Smitz et al., 1991; Balasch et al., 1993 ; . None of the authors mentioned above has mentioned the effects of GnRHa on the endometrium. However, high-affinity binding sites for the GnRH receptor have been detected in proliferative human endometria by reverse transcription polymerase chain reaction using oligonucleotide primers synthesized according to the receptor's sequence Imai et al., 1994 ; . Thus, there is also a possible role for GnRHa on the endometrium itself. In previous studies, we tested the hypothesis of whether the use of GnRHa may affect endometrial receptivity employing the oocyte donation model Remohi et al., 1994 ; . In this in-vivo situation, the quality of the embryos is determined by the source of the oocytes, while the endocrine environment can be modulated with exogenous steroids. We learned that short-acting GnRHa were not detrimental for implantation Remohi et al., 1994 ; . Current informa tion concerning IVF cycles, however, suggests that long-acting preparations may be detrimental for implantation Gonen et al., 1991; Devreker et al., 1996 ; . Thus, a prospective study was carried out employing two long- and one short-acting analogues, which are all in current clinical use, in order to address the issue of a potential direct effect of the GnRHa on the endometrium and its impact on implantation employing the ovum donation model. Two long-acting forms were used and bisacodyl.
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In 1974-75, Moynihan was Ambassador to the United Nations, with his Republican host Leonard Garment at the UN as an aide. Garment's gangster friend Max Fisher got Garment this UN post, and Garment told Moynihan to accept the ambassadorship. Garment and Norman Podhoretz taught Moynihan the doctrine of rightwing Zionism, using as a guide the British Arab Bureau's Bernard Lewis, who claimed that the Arab view of the matter was merely a product of Soviet propaganda.
This program is intended to ensure that the life-extending benefits of bidil will be available to each and every black patient with heart failure and bleomycin.
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Subsequent retrospective data analysis, however, suggested an improvement in mortality in black patients on combination treatment, whereas white patients showed no benefit over placebo or showed greater benefit from enalapril compared to the combination treatment 9 ; . After consideration of these data, the FDA indicated that a persuasive clinical study limited to black HF patients could serve as the basis for approval of BiDil. This third study, the A-HeFT African-American Heart Failure Trial ; , was designed to confirm the response of combination treatment added to standard therapy in black HF patients 10 ; . The trial was terminated early owing to the statistically lower mortality rate in patients receiving the isosorbide dinitrate hydralazine combination compared with placebo 11 ; . Race is presumed to be a surrogate for the true basis of these observations. Disparate observations in drug response between black and white populations with HF may be due in part to biological, environmental, and or sociocultural factors subsumed under the variable of race. In order to identify the variables responsible for efficacy of BiDil in blacks, factors from each of these categories will need to be characterized in patients who do and do not respond to BiDil in different populations. Differences in gene allele frequency among ethnic groups have been known for decades. In genes implicated in heart disease, for example, frequencies of gene variants in paraoxonase 1 12 ; , angiotensin-converting enzyme 13 ; , and the adenosine triphosphate-binding cassette reporter 1 14 ; have been found to differ significantly between blacks and whites. Given that BiDil works by enhancing production and stability of nitric oxide, it has been hypothesized that reduced nitric oxide bioactivity seen in blacks may account for the improved response to BiDil 15, 16 ; . The frequency of several genetic variants in the endothelial nitric oxide synthase gene have been shown to vary between black and white populations, however, the clinical significance of this finding is unclear 17 ; . For example, the G894T variant has and boniva.
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Clonidine was given at 0.8 mg kg because previous studies have shown that moxonidine has approximately 1 10 the antihypertensive potency of clonidine when given to SHR Armah et al., 1988 ; . Oral moxonidine markedly increased plasma glucose and decreased insulin, with a prolonged time course extending up to 12 Fig. 4 ; . Clonidine elicited nearly identical effects at 1 10 the moxonidine dose. Thus, oral dosing with 2AR agonists is capable of inducing significant hyperglycemia. Acute Metabolic Response to 2AR and I1R Agonists in SHR. To determine whether these responses to imidazoline and nonimidazoline 2AR agonists were specific for the insulin-resistant SHROB animal, the experiments with orally administered agents were repeated in lean SHR littermates. As shown in Fig. 5, the rise in blood glucose showed a reduced overall amplitude, but was highly significant. Plasma insulin is by necessity plotted on a different scale for SHR than for SHROB. Insulin fell to nearly undetectable levels after either moxonidine or clonidine. The time course of the glucose and insulin responses was similar in SHR and SHROB, suggesting comparable pharmacokinetics. In both genotypes, not all groups had returned to baseline by 12 h postinjection. Because responses to oral and i.p. routes were similar, and because larger responses were observed in SHROB rats, further investigations were carried out with i.p. administration to SHROB. Effects of Selective Receptor Blockade. Selective antagonists were used to further test the receptor mechanisms responsible for the acute effects of i.p. moxonidine in SHROB. The selective 2AR antagonist rauwolscine 7.5 mg kg ; , the mixed I1R and 2AR antagonist efaroxan 0.6 mg kg ; , or the selective I1R antagonist AGN 192403 10 mg kg ; Munk et al., 1996; Schafer et al., 2002 ; was given with moxonidine 0.5 mg kg ; . Coadministration of moxonidine with either of the and bidil
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