Mark Corson

Pseudomonas and other non- 13th week: fermentative Gram negative bacilli Lecture: 25 buy minomycin 100 mg lowest price. Rickettsiae Practical: Bacterial respiratory tract diseases Practical: Urinary tract infections minomycin 50 mg fast delivery. Mycology I infections and food poisoning Practical: Central nervous system diseases caused by bacteria 12th week: Lecture: 23 buy minomycin 50 mg free shipping. Missed practice may be made up in the practice with another group only in the same week. A list of questions and the examination rules will be announced in the Department at the beginning of the 2nd semester. Year, Semester: 3rd year/1st semester Number of teaching hours: Lecture: 30 Practical: 45 1st week: Practical: Introduction Lecture: -Introduction to anatomical pathology. Foreign body granuloma 3rd week: 8th week: Lecture: - Abnormal glycogen and protein Lecture: - Diagnostic immunohistochemistry. Bile stasis in the liver due to extrahepatic bile duct 10th week: obstruction Lecture: - Opportunistic infections. Systemic effects of neoplasia (cachexia, 5th week: immunosupression, paraneoplastic syndromes). Myelofibrosis Practical: Repeating practice 14th week: Lecture: - Malignant lymphomas. Requirements Validation of Semester in Pathology: Missing two practicals (histopathology and gross pathology together) is tolerable. Intracurricular replacement of histopathological and/or gross pathological classes is possible on the same week. In case of failure student can repeat these parts of the exam during the exam period. An acceptable result in the practical exam is mandatory to apply for the oral part. During the theoretical exam 3 titles are to be worked out and presented orally and one photo about a slide (with different magnifications) has to be described and diagnosed also orally. During the theoretical exam 3 titles are to be worked out (one from the material of the 1st semester, and two from the material of the 2nd semester). One photo about a slide (with different magnifications) has to be described and diagnosed (from the whole year). At least a (2) level of gross pathological examination and recognition of the histopathological alteration achieved in the course of a previous unsuccessful examination is acceptable without repeating for the next (B or C chance) examination. Cancer registries 6th week: Lecture: Role of viruses in the malignant 13th week: transformation. Lecture: Prevention strategies in cancer 7th week: Lecture: Chemical carcinogenesis. Carcinogenic Requirements Conditions of signing the Lecture book at the end of the semester. Although attendance at lectures is not compulsory, it is highly recommended, since the material covered in the lectures will be examined. The department will refuse to sign the Lecture book if the student fails the test. If the student fails the written test, they can retake it on the date prearranged with the department. One of the main objective is to provide sufficient theoretical background to the basic principles of carcinogenesis, cellular and molecular biology of cancer, the effect of lifestyle, social factors and nutrition on tumorigenesis. In order to highlight the importance of the various environmental factors in the development and progression of cancer, detailed information is given in the following areas: the health effect of various chemicals and occupational exposures, health hazard of ionizing and nonionizing radiation and the role of viruses in malignant transformation. The genetic background of various cancers will be discussed based on molecular epidemiological data. The course provides sufficient background to pathobiochemical alterations associated with tumor growth and tumor metastasis, characteristics of benign and malignant tumors and malignant cell populations. Seminar: Instrumental order on the big instrumental table and on the Sonnenburg table. Seminar: Cutting, hemostatic, grasping- Wound closure with different suturing techniques retracting, special and suturing instruments. Lecture: Surgical suture materials, sutures, Seminar: Blood sampling, intramuscular and knotting techniques. Conventional hand suturing Practical: Blood sampling, intramuscular and techniques (interrupted, continuous sutures on intravenous injection on phantom models. Special knotting and suturing Repeat: Vein preparation, cannulation on techniques on surgical training model. Seminar: Conicotomy and tracheostomy - Seminar: Demonstration of steps of the venous video-demonstration. Wound closure with different suturing Vein preparation, cannulation on phantom model, techniques on biopreparate model. Wound closure with preparation, cannulation on phantom model, different suture techniques on surgical training preparation of infusion set. Practical: Repeat: Vein preparation, cannulation Seminar: Paramedian laparotomy - video- on phantom models, preparation of infusion set. Vein preparation, cannulation on phantom model, preparation of 13th week: infusion set. Lecture: Basic techniques of the intestinal Seminar: Different types of catheters and wound anastomosis.

Patients with a malignant pleural effusion are treated Alternatively generic 100mg minomycin with amex, the diagnosis can be established by culture symptomatically for the most part because the presence of the pleural fluid minomycin 50 mg amex, needle biopsy of the pleura buy minomycin 50mg line, or thora- of the effusion indicates disseminated disease and most coscopy. In with the instillation of a sclerosing agent such as 500 mg many series, no diagnosis is established for ∼20% of exuda- of doxycycline. The importance of these Mesothelioma effusions is that one should not be too aggressive in try- Malignant mesotheliomas are primary tumors that arise ing to establish a diagnosis for the undiagnosed effusion, from the mesothelial cells that line the pleural cavities; particularly if the patient is improving clinically. The most common cause is Kaposi’s sarcoma followed Transudative Pleural Effusions by parapneumonic effusion. Peritoneal dialysis Chylothorax Exudative Pleural Effusions A chylothorax occurs when the thoracic duct is dis- 1. Metastatic disease bypass surgery rupted and chyle accumulates in the pleural space. Post–cardiac injury sclerotherapy syndrome chest tube drainage because this will lead to malnutrition g. Pericardial disease When a diagnostic thoracentesis reveals bloody pleural erythematosus 20. If the hematocrit is more than half of that in the lymphadenopathy peripheral blood, the patient is considered to have a e. Churg-Strauss syndrome tube thoracostomy, which allows continuous quantifica- tion of bleeding. If the bleeding emanates from a lacera- tion of the pleura, apposition of the two pleural surfaces is likely to stop the bleeding. If the pleural hemorrhage The diagnosis of an asbestos pleural effusion is one of exceeds 200 mL/h, consideration should be given to tho- exclusion. Several drugs can cause pleural effusion; the associated fluid is usually eosinophilic. Pleural Miscellaneous Causes of Pleural Effusion effusions commonly occur after coronary artery bypass There are many other causes of pleural effusion surgery. Key features of some of these conditions typically left sided and bloody with large numbers of are as follows: If the pleural fluid amylase level is ele- eosinophils and respond to one or two therapeutic tho- vated, the diagnosis of esophageal rupture or pancreatic racenteses. If the patient is febrile, has predominantly are typically left sided and clear yellow with predomi- polymorphonuclear cells in the pleural fluid, and has no nantly small lymphocytes and tend to recur. Other pulmonary parenchymal abnormalities, an intraabdomi- medical manipulations that induce pleural effusions nal abscess should be considered. Most can be managed with supplemental oxy- Pneumothorax is the presence of gas in the pleural space. Whereas a primary sponta- neous pneumothorax occurs in the absence of underlying Tension Pneumothorax lung disease, a secondary pneumothorax occurs in its presence. A traumatic pneumothorax results from penetrating or non- This condition usually occurs during mechanical ventila- penetrating chest injuries. The positive pleural pressure is pneumothorax in which the pressure in the pleural space life threatening both because ventilation is severely com- is positive throughout the respiratory cycle. Difficulty in ventilation during resuscitation or high Primary spontaneous pneumothoraces are usually caused peak inspiratory pressures during mechanical ventilation by rupture of apical pleural blebs, small cystic spaces that strongly suggests the diagnosis. Primary physical examination showing an enlarged hemithorax spontaneous pneumothoraces occur almost exclusively in with no breath sounds, hyperresonance to percussion, and smokers, which suggests that these patients have subclini- shift of the mediastinum to the contralateral side. Approximately 50% of patients with an pneumothorax must be treated as a medical emergency. If initial primary spontaneous pneumothorax will have a the tension in the pleural space is not relieved, the patient recurrence. The initial recommended treatment for pri- is likely to die from inadequate cardiac output or marked mary spontaneous pneumothorax is simple aspiration. A large-bore needle should be inserted into the lung does not expand with aspiration or if the patient the pleural space through the second anterior intercostal has a recurrent pneumothorax, thoracoscopy with stapling space. If large amounts of gas escape from the needle after of blebs and pleural abrasion is indicated. The needle should be or thoracotomy with pleural abrasion is almost 100% left in place until a thoracostomy tube can be inserted. It is obstructive pulmonary disease, but pneumothoraces have separated into three compartments. Pneu- extends from the sternum anteriorly to the pericardium and mothorax in patients with lung disease is more life threat- brachiocephalic vessels posteriorly. It contains the thymus ening than it is in normal individuals because of the lack gland, the anterior mediastinal lymph nodes, and the inter- of pulmonary reserve in these patients. The middle mediastinum lies with secondary pneumothorax should be treated with between the anterior and posterior mediastina and contains tube thoracostomy. Most of them should also be treated the heart; the ascending and transverse arches of the aorta; with thoracoscopy or thoracotomy with the stapling of the venae cavae; the brachiocephalic arteries and veins; the blebs and pleural abrasion. If the patient is not a good phrenic nerves; the trachea, main bronchi, and their con- operative candidate or refuses surgery, then pleurodesis tiguous lymph nodes; and the pulmonary arteries and veins. It contains the descending thoracic aorta, esophagus, thoracic Traumatic Pneumothorax duct, azygos and hemiazygos veins, and the posterior group of mediastinal lymph nodes. Traumatic pneumothoraces can result from both pene- trating and nonpenetrating chest trauma. If a hemopneumothorax The first step in evaluating a mediastinal mass is to place is present, one chest tube should be placed in the superior it in one of the three mediastinal compartments because part of the hemithorax to evacuate the air, and another each has different characteristic lesions. The most com- should be placed in the inferior part of the hemithorax mon lesions in the anterior mediastinum are thymomas, 220 lymphomas, teratomatous neoplasms, and thyroid masses. Those with fibrosing mediastinitis usually have signs vascular masses, lymph node enlargement from metastases of compression of some mediastinal structure such as the or granulomatous disease, and pleuropericardial and bron- superior vena cava or large airways, phrenic or recurrent chogenic cysts.

The reduction in morbidity as well as mortality from this disease is reflected in the following recommendations proven 50mg minomycin. Because the therapy is considered relatively innocuous generic minomycin 50 mg fast delivery, little attention was paid to other patient factors safe 50 mg minomycin, such as well being, for these recommendations. These recommendations may not be appropriate for patients who suffer from unrelated diseases that may limit lifespan to less than 10 years or patients who find medication use onerous. In addition, patients who must make choices regarding medications because of cost should be made aware that the medications used to treat this condition are expensive and should be strongly encouraged to manage the condition with lifestyle modifications initially and perhaps offered extra time to do so. The Encounter Chief Complaint: Typically the condition is detected through screening of asymptomatic individuals either in the community or in the office setting. The complaint is typically regarding the evaluation or follow- up of hyperlipidemia although it may be that the initiation of treatment occurs with an incidental finding the patient has multiple risk factors or the level is markedly elevated. A complaint of University of South Alabama, Department of Family Medicine June 30, 2008 94 chest pain that is assessed as non-cardiac will often generate a serum lipid profile that may indicate the patient is at an elevated risk of cardiac disease. History of Present Illness (new evaluation): Patient should be encouraged to identify what concerns exist. Patient should then be queried regarding major risk factors for cardiovascular disease. Inquire about changes in status, focusing on possible development of cardiac disease. Consider review of Risk Factors approximately every 12 to 24 months, more frequently if poor control. General – Look for evidence of tobacco use, general body habitus looking for truncal obesity, acanthosis nigricans. Attention to acute complaints with particular attention to worrisome symptoms that are consistent with end- organ damage (see following table) University of South Alabama, Department of Family Medicine June 30, 2008 102 Post-visit assessment Concern Periodicity Normal lipids (lipids at Progression Recheck 5 years. Lipids above target but not Progression Follow-up every 6-12 months until at treatment threshold in reduced or until decision is made to low risk patient. Lipids above target but not Progression Follow-up every 6 weeks to 3 months at treatment threshold in until reduced. Lipids above target but not Progression, Follow-up every 3 - 6 months until at treatment threshold in development of reduced. Strongly consider medication low risk patient with a cardiac disease therapy if unable to reach goal. Controlled lipids Monitor for side Office visit every 3 – 6 months, lipids effects, annually, additional labs on medication progression change or periodically, monitor and control other risk factors and co- morbidities as needed. University of South Alabama, Department of Family Medicine June 30, 2008 103 Supplemental materials On-line resource outlining a series on encounters with patients with chronic illnesses www. Pediatric hypertension is a growing problem (associated with obesity and genetic factors) and should be identified and managed appropriately. In that population hypertension is th identified as blood pressure > 95 percentile on 3 separate occasions) General Approach to the patient: Goals of the care process 1. Identify patients at risk of developing hypertension and implement risk factor modification strategies to prevent hypertension from manifesting 2. Identify patients who have developed clinical hypertension prior to development of end-organ damage a. Offer counseling to reduce or eliminate concomitant risk factors such as tobacco abuse or obesity 3. Initiate treatment using medication known to be effective in combinations known to be effective 4. Monitor for reduction in and maintenance of blood pressure at physiologic levels that are associated with elimination of end-organ damage 5. It is a disease of rising prevalence with 50 million Americans potentially in need of treatment. It is the most common diagnosis given to patients over 65 following an office visit. Unfortunately estimates are that 30% of the population is unaware that they suffer from hypertension, 40% of those who have a diagnosis of hypertension are not being treated and of those that are being treated 66% are not controlled. Hypertension as a finding increases with patient age, patient weight, and a patient diet that is high in sodium and low in fresh fruits and vegetables. In addition in clinical trials, antihypertensive therapy has been associated with reductions in stroke incidence (averaging 35–40 percent); myocardial 3 infarction (averaging 20–25 percent); and heart failure (averaging >50 percent). They focused on Patient-oriented outcomes that included not only mortality but also other outcomes that affect patients’ lives and well-being, such as sexual function, ability to maintain family and social roles, ability to work, and ability to carry out daily living activities. The Encounter Chief Complaint: Typically the condition is detected through screening of asymptomatic individuals either in the community or in the office setting. The complaint is typically regarding the evaluation or follow- up of hypertension although it may be that the initiation of treatment occurs with an incidental finding if it is Stage 2 or greater. A complaint of headache, epistaxis, (not harbingers of hypertension) will often generate a blood pressure reading that may indicate pre-hypertension or hypertension. History of Present Illness (new evaluation): Patient should be encouraged to identify what concerns exist. Patient should then be queried regarding major risk factors for cardiovascular disease. General – Look for evidence of tobacco use, general body habitus looking for striae, moon facies. Observe for neurologic asymmetry suggestive of cerebrovascular damage, determine whether cuff size was correct. The lower without symptoms, the better Lifestyle modifications much more important for long-term, especially in patients on medication For stage 1, a thiazide-type diuretic is a safe, inexpensive first choice For stage 2, dual drug therapy often needed. Many combinations include a thiazide diuretic and are good first choices Pay attention to compelling indications Pay attention to additional risk factors and focus on reduction or elimination In the face of resistance, think non-adherence Self-monitoring can be helpful. This entails monitoring in home, office, or other settings such as drug stores where blood pressure cuffs are maintained.

La fabricación puede tener lugar a comienzos de gramo superior; cuando las fracciones de kilogramo son un año utilizando materias primas que se estaban de menos de 500 gramos buy generic minomycin 50mg, se redondean al kilogramo empleando ya a finales del año anterior discount 50 mg minomycin. Sin embargo minomycin 100mg fast delivery, ciertas deadas al gramo superior; cuando las fracciones de tasas de rendimiento requieren investigación por parte gramo son de menos de 500 miligramos, se redondean de la Junta; al gramo inferior. El guión largo (—) significa que la cantidad es a la Junta y no necesariamente los totales mundiales nula. Por las razones indicadas en los apartados b) signo “=” significa una cantidad (nula) o inferior a la y c) supra, los totales son a veces mayores o menores unidad de medida considerada. Los nombres de tasas de rendimiento de la fabricación varían de un año los territorios no metropolitanos aparecen en bastardilla. Le signe “"” signifie que le and provides a record of the receipt of reports required by the Board. Le signe “=” signifie que Those reports include the quarterly statistics of imports and exports la Convention de 1961 et le Protocole de 1972 s’appliquent au of narcotic drugs (form A), the annual estimates of requirements of territoire respectif. Le signe “"” signifie également que le pays ou narcotic drugs, manufacture of synthetic drugs, opium production territoire concerné a présenté le rapport prévu. Par “1961”, on and cultivation of opium poppy for purposes other than opium entend la Convention de 1961 sous sa forme originale et l’abréviation production (form B) and the annual statistics of production, “1961/72” indique qu’il s’agit de la Convention de 1961 telle que manufacture, consumption, stocks and seizures of narcotic drugs modifiée par le Protocole de 1972. The table permits an assessment of the rate of accession to the 1961 Convention and of the way in which the parties are fulfilling their obligations by furnishing to the Board the required information. Failure by a country or territory to provide mandatory reports to the Board may indicate problems in the implementation of the provisions of the 1961 Convention in that country or territory. Notas: Countries (and territories to which the 1961 Convention could apply) are divided into three groups: parties to the 1961 Convention En el cuadro de la segunda parte se indica, respecto de cada país as amended by the 1972 Protocol; parties to the 1961 Convention y territorio no metropolitano, el estado de la adhesión a la Conven- in its original form only; and non-parties to the 1961 Convention. The sign “=” indicates that the 1961 Convention and requeridos por la Junta que se han recibido de cada uno de ellos. The sign “"” is Esos informes incluyen las estadísticas trimestrales de importaciones also used to indicate that the respective country or territory furnished y exportaciones de estupefacientes (formulario A), las previsiones the relevant report. The 1961 Convention in its original form is indi- anuales relativas a las necesidades de estupefacientes, la fabricación cated as “1961”; and “1961/72” is used to indicate the 1961 Con- de estupefacientes sintéticos, la producción de opio y el cultivo de vention as amended by the 1972 Protocol. Countries and territories la adormidera con fines distintos de la producción de opio (formu- that provided all the required reports (i. El cuadro permite hacer una apreciación del índice de adhe- Notes: siones a la Convención de 1961 y de la forma en que las partes están cumpliendo sus obligaciones suministrando a la Junta la Le tableau de la deuxième partie indique, pour chaque pays et información requerida. El hecho de que un país o territorio no pre- territoire non métropolitain, l’état d’adhésion à la Convention unique sente a la Junta los informes que está obligado a enviar puede ser sur les stupéfiants de 1961 et à cette convention telle que modifiée indicio de problemas en la aplicación de las disposiciones de la par le Protocole de 1972 et rend compte de la réception des rapports Convención de 1961 en ese país o territorio. Ces rapports comprennent les statistiques trimestrielles des importations et des exportations de stupéfiants Los países (y los territorios a los que se podría aplicar la Con- (formulaire A), les évaluations annuelles des besoins en stupéfiants, vención de 1961) están divididos en tres grupos: partes en la Con- de la fabrication des stupéfiants synthétiques, de la production vención de 1961 enmendada por el Protocolo de 1972; partes en d’opium et de la culture du pavot à opium destiné à d’autres fins la Convención de 1961 en su forma original solamente; y no partes que la production d’opium (formulaire B) et les statistiques annuelles en la Convención de 1961. El signo “"” indica que el país es parte de la production, de la fabrication, de la consommation, des stocks en el instrumento pertinente. El signo “=” indica que la Convención et des saisies de stupéfiants (formulaire C). El signo “"” se utiliza también para indicar que el país o territorio Le tableau permet d’évaluer le taux d’adhésion à la Convention de que se trata suministró el informe pertinente. La Convención de de 1961 et la manière dont les parties s’acquittent de leurs obliga- 1961 en su forma original viene indicada como “1961”; y la fórmula tions en fournissant à l’Organe les informations requises. Le manque- “1961/72” se utiliza para indicar la Convención de 1961 enmendada ment d’un pays ou territoire à son obligation de faire rapport à por el Protocolo de 1972. Los países y territorios que han suminis- l’Organe peut être révélateur de problèmes dans l’application de la trado todos los informes requeridos (o sea, los formularios A y C Convention unique dans le pays ou territoire concerné. The total of the estimates for the last two years, as Part three contains two tables relating to estimated world reflected in the table, are provisional and are liable to be amended requirements of narcotic drugs: table A and table B. It is important to note that the totals of the last two years are comparable only with the data displayed in Table A column A of the previous years. Table A shows, for each country and territory, the provisional total of the estimates (liable to be amended in the light of supplementary Notes: estimates/adjustments to stocks) for each drug for the relevant year. The table serves three purposes: (a) the authorities of the countries La troisième partie contient deux tableaux relatifs aux évaluations and territories that have furnished estimates are informed in this des besoins mondiaux en stupéfiants, le tableau A et le tableau B. Ce tableau a trois objectifs: Estimates furnished by Governments for concentrate of poppy a) les pays et territoires qui ont fourni des évaluations sont ainsi straw relate to three different types: concentrate of poppy straw informés que celles-ci ont été confirmées par l’Organe et ont désor- that contains morphine as the main alkaloid (concentrate of poppy mais valeur légale; b) la publication des évaluations permet aux parties straw (M)); concentrate of poppy straw that contains thebaine as à la Convention de 1961 de se rendre compte de la manière dont the main alkaloid (concentrate of poppy straw (T)); and concentrate elles s’acquittent de leurs obligations contractuelles réciroques; et c) le of poppy straw that contains oripavine as the main alkaloid (concen- total des évaluations permet aux parties de déterminer la quantité trate of poppy straw (O)). The different types of concentrate of poppy maximale de stupéfiants qu’un pays ou territoire peut obtenir en vertu straw may also contain, in addition to their main alkaloid, the other de la Convention de 1961 par importation ou fabrication. On the basis Les évaluations concernant le concentré de paille de pavot of information received, the Board calculates the total quantity of fournies par les gouvernements portent sur trois types différents de each alkaloid required by a given country or territory in concentrate concentré: celui dont le principal alcaloïde est la morphine (M), celui of poppy straw. Those totals are the maximum quantity of each of dont le principal alcaloïde est la thébaïne (T) et celui dont le principal the alkaloids contained in concentrate of poppy straw that may be alcaloïde est l’oripavine (O). En plus de leur alcaloïde principal, les acquired by that country or territory, regardless of the types of différents types de concentré de paille de pavot peuvent également concentrate of poppy straw used. Sur la base des informations reçues, l’Organe calcule la The updating of table A is carried out by means of monthly quantité totale de chaque alcaloïde nécessaire à chaque pays ou supplements. In order to assist exporting countries in checking the territoire sous forme de concentré de paille de pavot. Ces totaux totals of the estimates, the monthly supplements reflect the latest correspondent à la quantité maximale de chacun des alcaloïdes con- status of all estimates, not just the amended data submitted by tenus dans le concentré de paille de pavot pouvant être acquise par Governments. Consequently, each supplement replaces the preced- chaque pays ou territoire, quels que soient les types de concentré ing one and the published table A in its entirety. Their reading in French Le tableau A est mis à jour au moyen de suppléments mensu- and Spanish may be facilitated by consulting the indexes of countries els. Pour aider les pays exportateurs à vérifier les totaux des évalu- and territories and of drugs appearing on pages 9-23 of this publica- ations, les suppléments mensuels ne fournissent pas uniquement les tion. En vue d’accélérer la communication des suppléments aux autorités nationales compétentes, ceux-ci sont Table B publiés uniquement en anglais. Les lecteurs francophones et his- Table B presents the world totals of estimates for six years.