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By V. Samuel. West Virginia University. 2018.

Another male patient classified as an unstable (acute on chronic) with its onset at the age of 12 years and 3 months developed chondrolysis discount albenza 400 mg without a prescription. Narrowing of the joint space became reversed following 2-year relief of body weight with a pogo-stick brace generic 400mg albenza free shipping. A patient who complained of coxalgia was noted to have arthrotic changes generic albenza 400mg otc. A reoperation was performed on a patient who incurred breakage of a plate postoperatively and two patients who had postoperative loosening and rotation of a plate because of bone fragility. Discussion The aim of treatment of slipped capital femoral epiphysis is to stabilize the slipping region, improve congruity of the hip joint, and maintain hip joint function through life without causing any complication. Treatment methods are classified as follows: in situ pinning aimed at stabilization of the slipped epiphysis without correction, various osteotomy procedures involving corrections at sites other than the deformed region, and open reduction, consisting of closed manipulation for correction at the slippage site and subcapital femoral neck osteotomy. The in situ pinning method is performed to stabilize the slipped epiphysis, expect- ing postoperative remodeling to improve congruity of the hip joint. Various reduc- tion procedures are designed to improve hip joint congruity by aiming for anatomical reduction, whereupon the slippage region becomes stabilized. The in situ pinning method has been described to be safest and noticeably effective even in severe cases, according to the American Academy of Orthopaedic Surgeons (AAOS) overview of the varieties of treatment methods for slipped capital femoral epiphysis, but the overview includes fairly outdated reports and can hardly find categorical acceptance. Rab conducted a study using three-dimensional models and showed that formation of articulation of the metaphysis with the acetabular shelf occurred in 1 of 6 of cases with a PTA of 30°, in 1 of 3 of cases with a PTA of 60°, and in 1 of 2 of cases with a PTA of 90°, and that this might cause arthrosis. It follows that it is too risky to have improvement in hip joint congruity totally depend on remodeling. Manual reduction is commonly used when the physeal stability is rated as unstable, and it reportedly entails a rather reduced risk of avascular necrosis of the femoral head if performed with tender care. Nevertheless, it cannot be ruled out that closed manipulations may possibly cause injury to nutrient arteries in the case where epiph- yseal excursion is decreased; the incidence of avascular necrosis of the femoral head was reported to be 14% by Peterson et al. While it has been described that, if physeal stability is stable, the risk of avascular necrosis of the femoral head can be reduced by concomitant application of subcapital femoral neck osteotomy in the open reduction of the epiphysis, the inci- dence of the necrosis is 4. Open reduction involves complicated operative procedures and has the drawback of exposing the joint cartilage to air upon deployment of the articular capsule. Intertrochanteric osteotomy entails problems such as development of deformity and reduction in leg length because the surgical correction is made at a site distant from the deformed area. However, its operative technique poses no problem in regard to avascular necrosis of the femoral head and has the advantage of providing an early closure of the growth plate and of no deployment of the articular capsule. Factors that affect long-term results in cases of slipped capital femoral epiphysis include type of disorder, severity, any complications, and treatment methods. Loder Corrective Imhäuser Intertrochanteric Osteotomy for SCFE 45 et al. They also reported that none devel- oped avascular necrosis of the femoral head among the “stable” cases while it occurred in 47% of “unstable” cases. That is, to achieve the best therapeutic results, it is necessary to perform treatment without causing complications in stable, mild cases. It may be said to stand to reason that the Imhäuser treatment system ensures a stable physeal stability of the affected hip joint by pinning in mild cases, whereas in more severe cases the physeal stability of the joint is rendered stable by traction and then the PTA is reduced to 30° or less by osteotomy to lessen the severity to mild. In the present study, limitation of range of motion completely resolved in all patients following treatment, and none had necrosis of the femoral head postoperatively. However, the apparent neck–shaft angle was 150° on average at the time of this inves- tigation, thus indicating a tendency toward coxa valga (Fig. Further investigation is necessary, therefore, to investi- gate osteotomy angle, especially with respect to anterotation and valgus. C Good congruity of the hip joint was obtained at the final visit (18 years and 11 months old), and neck–shaft angle was 155° 46 S. The treatment scheme is under reconsideration with regard to preoperative duration of traction, based also on the recent medical care situation. Intertrochanteric osteotomy in the Imhäuser treatment system is considered a useful procedure because it is relatively simple in technique and involves no develop- ment of avascular necrosis of the femoral head. Indeed, there are problems peculiar to this treatment method that remain to be solved, as has been disclosed by the present study; further long-term follow-up for treated joints is needed. Loder RT, Aronsson DD, Dobbs MB, et al (2001) Slipped capital femoral epiphysis. Loder RT, Richards ABS, Shapiro PS, et al (1993) Acute slipped capital femoral epiphy- sis: the importance of physeal stability.

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The extraction of tin and lead from their ores has been possible for thousands of years generic 400mg albenza amex. In the past century purchase albenza 400mg visa, carbon-containing molecules have become increasingly important for the development of new sub- stances order albenza 400mg line, including plastics, other new materials and health products. Organic chemistry was originally the study of compounds connected with life, but, more than a century and a half ago, Wöhler showed it was pos- sible to make an organic compound (urea, which may be extracted from urine) from inorganic (that is, not living) compounds. What had seemed a precise distinction between living and non-living compounds became hazy. The subject may now be defined as the study of molecules which contain carbon atoms, although the precise boundaries of the area are not clear, as the overlaps with biology, with materials science, with inorganic chemistry, and with physics can all be debated and boundaries drawn and re-drawn. However, it is clear that understanding of organic chemistry advanced tremendously in the closing century of the second millennium Increasing knowledge of the properties of molecules has made it pos- sible to synthesise very complicated compounds. Organic synthesis is engineering on an atomic scale, and requires delicate operations to be per- formed on objects which are too small to see. It also requires techniques of mass production, because single molecules are usually not useful by them- selves. A car factory may produce tens of thousands of cars each year, but 43 44 J. GOODMAN this is very small scale compared to the job of a synthetic chemist. A pint of beer contains approximately 1025 (ten million million million million) molecules. If you were to pour a pint of beer into the sea, wait for the waves to mix it well all around the world, and then take a pint of sea water from any part of any ocean, that pint would probably contain a thousand mole- cules from the original pint. A successful synthesis of a new molecule would not make hundreds or thousands of copies of the molecules, but mil- lions of millions of millions. In order to make a complex molecule, it is necessary to have methods which join simpler molecules together, and also techniques to make small changes to different bits of the molecule, once the framework has been con- structed. There is an enormous variety of reagents which can be used to transform one arrangement of atoms into another. The line drawings at the top show the same molecules as the ball and stick representations below. In the lower version, hydrogen atoms are white, carbon atoms are dark grey, and oxygen atoms are speckled. In the more concise representation at the top, hydrogen atoms attached to carbon are omitted, and the carbon–oxygen double bond in the ketone is drawn with a double line. The lower diagram shows the two hydrogens which must be removed to turn the alcohol into the ketone. One of these is on the oxygen, and the other on the central carbon atom. Many reagents are available which will transform an alcohol into a ketone, removing these two hydrogens and turning the carbon–oxygen single bond into a double bond. It is a problem if the same transformation is used to make a more complicated molecule, such as PM-toxin (Figure 3. This molecule, which is produced by the fungal pathogen Phyllosticta maydis, has been the cause of major epidemics of leaf blight disease in the United States. The top representation is much more concise, but does not give information about the shape of the molecule. The lower illustration shows how the atoms are arranged in space as well as how they are connected to each other. This molecule has four alcohol groups (an oxygen joined to a carbon atom and a hydrogen atom by single bonds). Changing one of these to a ketone (an oxygen joined to a carbon by a double bond) without affecting the others will be difficult, as all the reagents which can do this are likely to act on the whole molecule, not just on a specific part of it. A synthesis could not finish by oxidising just some of the alcohols to ketones, because the reagent would not know which alcohols should be oxidised and which should not. How is it possible to selectively make ketones in the presence of alcohols? More generally, how can a trans- formation be made to act on only a part of a molecule? Selective reagents could be developed, so that it is possible to change some alcohols into ketones without affecting others in the same molecule.

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X When developing questions buy discount albenza 400mg on-line, make sure they are open rather than closed cheap albenza 400mg with mastercard. X Become familiar with your schedule so that you do not have to keep referring to it during the interview buy albenza 400 mg mastercard. Don’t rush straight into the interview unless the interviewee pushes to do so. Accept a cup of tea, if offered, and make polite conversation to help put both of you at ease. X Think about your appearance and the expectations of the person you’re about to interview. If the interviewee is a smartly turned out business person who expects to be interviewed by a professional looking researcher, make sure you try to fulfil those expectations with your appearance and behaviour. Maintain appropriate eye-contact and smile in a natural, unforced manner. Remember that the eyes and smile account for more than 50% of the total communication in a greeting situation. If you es- tablish rapid and clear eye-contact, you’ll be more ea- sily trusted. X During the interview, firm eye contact with little move- ment indicates that you’re interested in what is being said. On the other hand, if your eyes wander all over the place and only briefly make contact with the eyes of the interviewee, low self-esteem, deceit or boredom HOW TO CONDUCT INTERVIEWS / 71 can be indicated. Conversely, watch the eyes of your interviewees which will tell you a lot about how the interview is progressing. Try not to sit directly opposite them – at an angle is better, but not by their side as you will have to keep turning your heads which will be un- comfortable in a long interview. By watching the eye movements and body language of the interviewees, and by listening to what they’re saying, you’ll soon know when you’ve established rapport. If, however, you notice the interviewees becoming uncomfortable in any way, respect their feelings and move on to a more general topic. Sometimes you might need to offer to turn off the recorder or stop taking notes if you touch upon a particularly sensitive issue. Negotiate a length of time for the interviews and stick to it, unless the interviewees are happy to continue. Make sure you thank them for their help and leave a contact number in case they wish to speak to you at a later date. You might find it useful to send a transcript to the inter- viewees – it is good for them to have a record of what has been said and they might wish to add further information. Do not disclose information to third parties unless you have received permission to do so (see Chapter 13). ASKING QUESTIONS AND PROBING FOR INFORMATION As the interview progresses, ask questions, listen carefully 72 / PRACTICAL RESEARCH METHODS to responses and probe for more information. When you probe, you need to think about obtaining clar- ification, elaboration, explanation and understanding. There are several ways to probe for more detail, as the fol- lowing list illustrates. PROBING FOR MORE DETAIL X That’s interesting; can you explain that in more de- tail? You’ll find that most people are uncomfortable during silences and will elaborate on what they’ve said rather than experience discomfort. Also, you may find it helpful to summarise what people have said as a way of finding out if you have understood them and to determine whether they wish to add any further information. Another useful tactic is to repeat the last few words a per- son has said, turning it into a question. The following piece of dialogue from an interview illustrates how these techniques can be used so that the researcher does not in- fluence what is being said. HOW TO CONDUCT INTERVIEWS / 73 Janet: ‘Well, often I find it really difficult because I just don’t think the information’s available. I wer- en’t exactly naughty at school, I just didn’t really bother, you know, I didn’t really like it that much, if I’m honest with you. SUMMARY X Practise with the recording equipment before the inter- view takes place.

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It was an alky- The first drug to treat widespread bacteria was devel- lating compound generic albenza 400 mg fast delivery, derived from the chemical warfare agent oped in the mid-1930s by the German physician-chemist nitrogen mustard albenza 400 mg overnight delivery, which binds with chemical groups in the Gerhard Domagk buy 400 mg albenza with visa. In 1932, he discovered that a dye named cell’s DNA, keeping it from reproducing. Alkylating com- prontosil killed streptococcus bacteria, and it was quickly used pounds are still important in cancer treatment. One of In the next twenty years, scientists developed a series of the first patients cured with it was Domagk’s own daughter. In useful antineoplastic (anti-cancer) drugs, and, in 1954, the 1936, the Swiss biochemist Daniele Bovet, working at the forerunner of the National Cancer Institute was established in Pasteur Institute in Paris, showed that only a part of prontosil Bethesda, MD. Leading the research efforts were the so-called was active, a sulfonamide radical long known to chemists. The first widely used anti-sense drugs, which affect specific genes within cells. They are also used after cervix, nose and throat, kidney, lung, and prostate cancers. Since many of the drugs have severe side effects, their ger the body’s immune system to produce more cells that will value must always be weighed against the serious short-and react to and kill cancer cells. One approach involves isolating long-term effects, particularly in children, whose bodies are white blood cells that will kill cancer and then to find certain still growing and developing. A “vac- gen, estrogen, and progestins, scientists also use the hormone cine gene gun” has also been developed to inject DNA directly somatostatin, which inhibits production of growth hormone into the tumor cell. Unlike most vaccines, which have been primarily tai- action of the body’s own hormones. An example is Tamoxifen, lored for specific patients and cancers, the RNA cancer vac- used against breast cancer. Normally the body’s own estrogen cine is designed to treat a broad number of cancers in many causes growth of breast tissues, including the cancer. As research into cancer treatment continues, new can- Forms of the B-vitamin folic acid were found to be use- cer-fighting drugs will continue to become part of the medical ful in disrupting cancer cell metabolism by the American sci- armamentarium. Many of these drugs will come from the bur- entist Sidney Farber (1903–1973) in 1948. Today they are geoning biotechnology industry and promise to have fewer used on leukemia, breast cancer, and other cancers. Plant alkaloids have long been used as medicines, such See also Antibiotic resistance, tests for; Antiviral drugs; as colchicine from the autumn crocus. Cancer therapy drugs include vincristine and vinblastine, derived from the pink peri- Bacteria and bacterial infection; Blood borne infections; Cell winkle by American Irving S. They prevent cycle and cell division; Germ theory of disease; History of mitosis (division) in cancer cells. VP-16 and VM-16 are microbiology; History of public health; Immunization derived from the roots and rhizomes of the may apple or man- drake plant, and are used to treat various cancers. Taxol, which is derived from the bark of several species of yew trees, was CHICKEN POX • see ANTIBIOTICS discovered in 1978, and is used for treatment of ovarian and breast cancer. Another class of naturally occurring substances are CChitin HITIN anthracyclines, which scientists consider to be extremely use- ful against breast, lung, thyroid, stomach, and other cancers. Chitin is a polymer, a repeating arrangement of a chemical Certain antibiotics are also effective against cancer cells structure. Chitin is found in the supporting structures of many by binding to DNA and inhibiting RNA and protein synthesis. Of relevance to microbiology, chitin is present in Actinomycin D, derived from Streptomyces, was discovered fungal species such as mushrooms, where it can comprise by Selman Waksman and first used in 1965 by American from 5% to 20% of the weight of the organism. It is now used against cancer of The backbone of chitin is a six-member carbon ring that female reproductive organs, brain tumors, and other cancers. This A form of the metal platinum called cisplatin stops can- structure is very similar to that of cellulose. Newer groups of chitin is known as acetamide, whereas cellulose has treatments that are biological or based on proteins or genetic material and can target specific cells are also being developed.

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