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The 65-year-old with pancreatic adenocarcinoma in the head of pancreas was taken to surgery diabetes symptoms teenager order glimepiride 1mg with mastercard. It was explained to the patient and his family that the surgery would likely not be curative diabetic hamburger recipes buy cheap glimepiride 4 mg line, but rather palliative in that the cancer was already too far advanced for removal diabetes diet while pregnant order glimepiride 4 mg without a prescription. During the surgery ablation of the autonomic innervation that carries pain in this region is also performed to provide pain relief diabetes type 1 lada order 3 mg glimepiride with visa. The surgeon will inject 50% ethanol to kill nerve cells at which of the following locations She recently learned to do back flips on the balance beam, when her foot slipped off and she landed with her perineum striking the beam. She developed a massive subcutaneous hematoma filling her perineum that posteriorly formed a straight horizontal line just anterior to her anus, and anteriorly extended onto the anterior abdominal wall about half way up to her umbilicus and above the inguinal ligament. Ischioanal fossa Superficial perineal space Deep perineal space Femoral sheath Inguinal canal 498 Anatomy, Histology, and Cell Biology 381. A slender 53-year-old woman who smokes a pack of cigarettes each day comes to your office complaining of a pulsating sensation in her abdomen with generalized abdominal and back pain. You order an abdominal Doppler ultrasound, which shows a large, high abdominal aortic aneurysm above renal arteries of about 8 cm in diameter. She is admitted to the hospital immediately for repair of her aortic aneurysm because it is life threatening, but you warn her that one of the complications of such surgical repair includes paraplegia. During the procedure the vascular surgeon must completely clamp off the abdominal aorta for about an hour while repairing the aneurysm. Which of the following would explain to the patient why there is a risk of paraplegia Stopping the blood within the abdominal aorta causes the muscle of the lower limbs to die b. Stopping the blood within the abdominal aorta causes the peripheral nerves of the lower limb to die c. Stopping the blood within the abdominal aorta causes loss of blood flow to the major radicular artery (of Adamkiewicz), which causes the motor components in the spinal cord for the lower limb to die d. Stopping the blood within the abdominal aorta causes microemboli within the lower limb to form during the surgery and those microemboli then pass through the lung and left side of the heart into the brain where they selectively lodge in the motor cortex that controls the lower limbs. Stopping the blood within the abdominal aorta causes excessive perfusion of the brain during the surgery, which selectively causes bleeding stroke within the motor cortex that controls the lower limbs 382. The lateral umbilical fold serves as the demarcation for whether an inguinal hernia is direct or indirect. The lateral umbilical fold on each side of the inner surface of the anterior abdominal wall is created by which of the following underlying structures Falx inguinalis Inferior epigastric artery Lateral border of the rectus sheath Obliterated umbilical artery Urachus Abdomen 499 383. A 19-year-old teenager is brought to the emergency room after a single-car accident just 20 minutes earlier in which she lost control of her car on black ice and hit a retaining column of an overpass at about 45 miles per hour. She was wearing a seat belt but looks pale, has tachycardia and positional hypotension, is extremely nauseated, and is lying in the fetal position due to increasingly severe abdominal pain. Lacerated kidney Ruptured spleen Ruptured gallbladder Diverticulitis Hemorrhoids 384. A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce an initial localized peritonitis or abscess formation in which of the following Greater sac Left subhepatic and hepatorenal spaces (pouch of Morison) Omental bursa Right subphrenic space Right subhepatic space 385. Using abdominal percussion you determine that her liver extends 5 cm below the right costal margin at the midclavicular line. You call in a gastroenterologist because you suspect that the bright red blood is most likely the result of which of the following Hemorrhoids Colon cancer Duodenal ulcer Gastric ulcer Esophageal varices 500 Anatomy, Histology, and Cell Biology 386. The lesser sac (omental bursa) is directly continuous with which of the following recesses or spaces

A second carrier diabetes insipidus of pregnancy cheap 1mg glimepiride visa, Asiana Airlines diabetes type 2 definition buy discount glimepiride 3 mg on-line, was established in 1988 to serve three domestic cities diabetic muffins discount glimepiride 2 mg visa. Telecommunications Communications services improved dramatically in the 1980s with the assistance of foreign partners and as a result of the development of the electronics industry diabetes mellitus feline buy glimepiride without a prescription. Radio, and in more recent years television, reached virtually every resident (see the Media, ch. The Japanese established a radio station in Seoul in 1927; radio sets in the country. Transistor radios and television sets have made their way to the most remote rural areas. Television sets, now massproduced in South Korea, became far less expensive; most city peo- number of rural families owned or had access Ownership of television sets grew from 25,000 sets when broadcasting was initiated in 1961 to an estimated 8. Financing this persistent, although not unexpected, gap between domestic and imported resources was a principal concern for economic planners. In the 1950s and 1960s, much of the trade deficit was financed by foreign aid funds, but in the last two decades, borrowing from and investment in international capital markets have almost completely substituted for economic aid. It also freed South Korea from the burden of heavy international debts during the initial phase of growth and enabled the government to allocate credit in accordance with planning goals (see the Post-War Economy, ch. Before 1965 the United States was the largest single aid contributor, but thereafter Japan and other international sponsors played an increasingly important role. Apart from grant assistance, other forms of aid were offered; after 1 963 South Korea received foreign capital mainly in the form of loans at concessionary rates of interest. According to government ery from the 183 South Korea: A Country Study sources, between 1964 and 1974 such loans averaged about 6. Other data suggested a figure; it much higher government were concessional, at least through the early 1970s. The aid component of these loans was only a fraction of their to the seemed that most loans - total value. United States assistance ended in the early 1970s, from which time South Korea had to meet its need for capital investment on that the United States decided to phase out -. The government and private industry received funds through commercial banks, the World Bank (see Glossary), and other foreign government agencies. The fact that South Korea was so dependent on foreign trade made it very vulnerable to international market fluctuations. For example, a dramatic rise in domestic demand for automobiles in 1 989 more than compensated for a sharp drop in exports. In 1962 the Foreign Capital Inducement Act established tax holidays, equal treatment with domestic firms, and guarantees of profit remittances and withdrawal of principal. Despite the 184 the Economy provisions of the act, there was little foreign investment activity until after the establishment of diplomatic relations between South Korea and Japan in 1965. Seoul had to mobilize both external and internal sources when it launched its First Five- Year Economic Development Plan in 1962. The Foreign Capital Inducement Act was amended in 1966 to encourage a greater inflow of foreign capital to make up for insufficient domestic savings. But until the early 1980s, South Korea relied heavily on borrowing and maintained a somewhat restrictive policy towards foreign direct investment. Donald S Macdonald has pointed out that under the liberalizaon foreign direct investment were eased in 1984 and 1985. An automatic approval system was introduced under which all projects meeting certain requirements were to be immediately and automatically approved by the Ministry of Finance. In 1984 there were 339 items, or 34 percent of the 999 items on the Korean Standard introduction - - Industrial Classification, on the negative list. In December 1987, Seoul announced a policy to liberalize the domestic capital market by 1992. Japan invested mainly in hotels and tourism, followed by the electric and electronics sector. In the 1970s, South Koreans invested in trading, manufacturing, forestry, and construction industries. By the early 1980s, a sharp reduction in Middle East led to a decline in South Korean investment there.

In addition to prominent abdominal veins diabetes mellitus type 2 in pregnancy order 1mg glimepiride visa, portal hypertension may also cause esophageal varices and hemorrhoids diabetes mellitus definition cdc trusted glimepiride 4 mg. While both the gall bladder and appendix are on the right side of the abdomen diabetic zucchini dessert recipes purchase glimepiride online from canada, both cholecystitis (answer d) and appendicitis (answer c) should result in abdominal pain diabetes in dogs blood test generic glimepiride 2mg with visa, which is absent in this patient. An abdominal aortic aneurysm (answer e) would normally appear in the midline and pulsate. Which of the following is a characteristic of the female (compared with the male) pelvis A young couple comes to your urology office because of inability to conceive a wanted child after 1 year of unprotected sex. The wife had already undergone a gynecological workup, including testing for 3 months showing a normal ovulation profile as confirmed by an ovulatory kit. The husband has a brother, who has two children, one of whom has confirmed cystic fibrosis. The gubernaculum is a continuous mesenchymal condensation extending from the caudal pole of each gonad through the inguinal canal to the labioscrotal swelling, inferiorly. Canal of Nuck Ligament of the ovary or proper ligament of the ovary Round ligament of the uterus Round ligament of the uterus and the ligament of the ovary or proper ligament of the ovary. Parts of some human skeletal remains are brought to you as coroner of a rural community. The pelvis is complete, yet the individual bones of the pelvis, the ilium, ischium, and pubis have just started to fuse together. On the basis of this information, you guess the remains are of which of the following Following vaginal childbirth, a woman experienced urinary incontinence, particularly when coughing. Puborectalis muscle Obturator internus muscle Pubococcygeus muscle Superficial transverse perineal muscle Piriformis muscle Pelvis 533 419. When one touches the upper medial thigh or scrotum of most young males, the testicles are pulled upwards towards the external inguinal ring. The efferent limb of the cremasteric reflex is provided by which of the following Femoral branch of the genitofemoral nerve Genital branch of the genitofemoral nerve Ilioinguinal nerve Pudendal nerve Temperature differential between core body temperature and scrotal temperature 420. A 36-year-old man complained to his primary care physician of occasional dull, throbbing pain associated with the right testis and scrotum. The physician remarked that in all probability the patient had this condition since adolescence and should not be bothered by it. The patient was emphatic that the condition had arisen within the last few months and sought a second opinion from an urologist. Factors that the urologist considered include which of the following in regard to varicocele of the pampiniform plexus on the right side It is very uncommon It occurs about as often as that on the left side It may be the result of testicular torsion It may be associated with a long, redundant mesorchium 534 Anatomy, Histology, and Cell Biology 421. While she has never had them before, she states that she thinks she has kidney stones. The pain started in her mid back about a week ago and then subsided and now the pain has decreased somewhat and also extends down into her labia majora. At the junction of the renal pelvis with the ureters As the ureters cross the cranial edge of the greater pelvis As the ureters cross the external iliac artery at the pelvic brim As the ureters pass through the wall of the bladder a, b, and c a, c, and d 422. You deliver a full-term baby boy who is healthy and receives an Apgar score of 9 out of 10. You do note that his scrotum is rather large compared to his penis and when he cries and strains, the scrotum gets even bigger. A 6-year-old boy badly bruised his perineum on the horizontal bar of his bicycle as he was learning to ride a bike.

To pioneer pilots blood sugar tester monitor buy 2 mg glimepiride with mastercard, flying airplanes was a way of life diabetes in dogs and death purchase glimepiride without a prescription, something they did because they loved it diabetes insipidus zentrum order generic glimepiride on-line. Aviation was a gusher that returned unimaginable profits diabetes test amazon buy glimepiride 3mg low price, at least percentagewise, on the amount invested. From the moment the Post Office proved that an airmail service was feasible, certain wellheeled gentlemen were using their influence with pow erful congressmen to have it transferred to private contractors. To get some idea of just how lucrative a government mail contract could be, consider the following example. In 1926, the year Congress authorized private bidding for mail contracts, one Charles Deeds, son of a powerfully connected East Coast financier, invested a mere $253 in the stock of Frederick B. The initial stock issue was closely held, available only to insiders with the right connections. Acting through their association, they hired former Superintendent of the Air Mail Carl F. Egge to head a pilotowned corporation created for the specific purpose of bidding on a contract. They naturally resented being exploited by people who never flew, who never risked their own necks. And there were shenanigans going on after 1926 that the pilots found very distasteful. In 1928 Bullock was one of several pilots who approached the owner of Northwest, a Minneapolis banker named Lilly, for a raise. By that time [1928], it was a pretty big business and it was making 25 percent per year on the original investment, right through when the only revenue was mostly mail. He was a hot air kind of guy, but he had a lot of guts and he knew every politician in the country. Behncke al ways painted a picture of how rough it was in those days, and it was rough. Rube Wagner agrees about the combination of political and public re lations pressures that Behncke brought to bear. A pilot who played it too safe, who canceled flights too often because of weather or some other consideration, could get fired. Airline operators had a hardnosed attitude about schedule completion in those days and tended to regard overly conservative pilots as "slackers. Unless airlines, like railroads, ran on schedule, no one would take them seriously. The pilots were skeptical about entering a competition with the railroads for the sensible reason that it could get them killed. Any serious effort to compete with the railroads in the area of schedule reliability, the pilots knew, would fall most heavily upon them and would put pressure on them to take risks. More bluntly, the pilots worried less about being taken seriously by business moguls of the 1920s than about being taken advantage of by them. Some pilots were overly timid, reluctant to adopt the new instrument flying techniques as they began to appear during the late 1920s and early 1930s. They were slow to abandon the oldfashioned contactflying techniques that had seen them through so many flights before. On the other hand, some operators were too ready to adopt new flying techniques and equipment that later turned out to have seri ous flaws. Although conflict between pilots and their superiors over when and how to fly is an old story, going back almost to the beginning of regular airmail flying, the pace of technological change in the late 1920s and early 1930s ag gravated the situation. By the early 1930s, the operators preferred to promote commercial aviation as an industry that had arrived, that was fully developed, mature, and no longer experimental. The pilots knew better and preferred a more conservative image, 17 F Flying the Line one that portrayed the industry as it really was, essentially a taxsupported pub lic service. Because it was still heavily dependent upon the government airmail subsidy, the pilots insisted that airline service should be seen as a regulated public utility, with safety dominant over every other consideration. This conflict of assumptions and image set the stage for a battle over safety that continues to this day. In theory, airline owners agreed with their pilots that safety was the para mount goal; in practice, it was a different story.

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