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He is on the editorial board of the Journal of Biomechanics and Clinical Biomechanics purchase feldene 20 mg free shipping. He was President of the Section of Bioengineering of the Royal Academy of Medicine in Ireland from 1998 to 2000 feldene 20mg on-line. Scientific inter- ests include computer simulation of tissue differentiation and bone remod- elling purchase 20 mg feldene mastercard, and the design of medical devices. He studied medicine and biophysics at the Russian Medical University, Moscow, and obtained his PhD at the Berlin Charité. In 1992, Peter joined the Physiology Department at Oxford to continue his studies on the effects of mechanical stimulation on heart rate and rhythm. His work uses a variety of techniques, ranging from experiments on single cells and tissues to analytical models of cardiac mechano-electrical interactions. An unusual facet of his work is devoted to the investigation of the role of connective tissue in the regulation of electrophysiological behaviour of the heart. Peter likes to travel, preferably with his growing family, and enjoys water sports and landscape photogra- phy. His favourite – and by far most regular – recreational activity, though, is cooking. Contributor biographies 193 Denis Noble Denis Noble, 64, is the British Heart Foundation Burdon Sanderson Professor of Cardiovascular Physiology at the University of Oxford and a Fellow of Balliol College. In the early 1960s, he developed the first ‘ionic’ cell models of cardiac excitation and rhythm generation and has been at the forefront of computational biology ever since. As the Secretary-General of the International Union of Physiological Sciences, he has been pivotal to the initiation of a world-wide effort to describe human physiology by analytical models – the Physiome Project. In 1998 he was honoured by the Queen for his services to Science with a CBE. Denis Noble enjoys playing classical guitar, communicating with people all over the world in their mother-tongue, and converting the preparation of a meal into a gastro- nomic celebration. Winslow Raimond L Winslow, 45, is Associate Professor of Biomedical Engineering, with joint appointment in the Department of Computer Science, at the Johns Hopkins University School of Medicine and Whiting School of Engineering. He is co-Director of the Center for Computational Medicine and Biology, Associate Director of the Whitaker Biomedical Engineering Institute at Johns Hopkins University, and a member of the Institute for Molecular Cardiobiology. His work is aimed at understanding the origins of cardiac arrhythmias through the use of biophysically detailed computer models. These models span levels of analysis ranging from that of individ- ual ion channels, to cells, tissue, and whole heart. Contributor biographies 195 Peter Hunter Peter Hunter, 52, is a NZ Royal Society James Cook Fellow and Chair of the Physiome Commission of the International Union of Physiological Sciences. He founded the Biomedical Engineering Group at Auckland University which, in close collaboration with the Auckland Physiology Department, uses a combination of mathematical modelling techniques and experimental measurements to reveal the relationship between the electrical, mechanical and biochemical properties of cardiac muscle cells and the performance of the intact heart. A similar approach is also being used by the Auckland group to analyse gas transport, soft tissue mechan- ics and blood flow in the lungs with the aim of producing an anatomically detailed, biophysically based coupled heart–lung model for use in drug dis- covery and the clinical diagnosis and treatment of cardiopulmonary disease. Kolston Born in Wellington, New Zealand, Paul Kolston studied at Canterbury University (NZ) where he graduated in 1985 with first class honours in Electrical and Electronic Engineering. He obtained his PhD there in 1989, although he spent one year of his PhD studies at the Delft University of Technology, The Netherlands. After a one-year post-doctoral position at 196 CONTRIBUTOR BIOGRAPHIES the University Hospital Utrecht, The Netherlands, he moved to Bristol University (UK). In 1995 Paul was awarded a Royal Society University Research Fellowship, which he transferred to Keele University in 1999. Paul’s favourite scientific interest is computer modelling of biological systems; his favourite recrea- tional pursuit is body-surfing. Walsh Born in Oldham, Greater Manchester, Vincent Walsh graduated in Psychology from the University of Sheffield and studied at UMIST for his PhD in Visual Neuroscience. His early interests were in the brain mecha- nisms for the construction and perception of form and colour. He currently holds a Royal Society University Research Fellowship in the Department of Experimental Psychology, Oxford, where his work is now concentrated on perceptual learning and mechanisms of brain plasticity. His recent initiatives using magnetic stimulation have been the first series of experi- ments to use the technique to study cognitive processes. It took several years to establish these health regions and to organise services and on 5 July 1948 the new NHS began.

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Management and treatment of cardiac arrest in trauma patients follows the principles detailed in earlier chapters order feldene 20mg. The primary arrhythmia in adult traumatic cardiac arrest is pulseless electrical activity (PEA) buy 20mg feldene amex, and specific causes should be sought and treated buy 20mg feldene with amex. Paediatric traumatic arrests are usually due to hypoxia or neurological injury, but, in either case, adequate ventilation is particularly important in the management of these patients. Receiving the patient Management of the trauma patient in hospital should begin It is important that a well organised trauma team receives the patient with a clear and concise handover from the ambulance crew, who should give a summary of the incident, the mechanism of injury, the clinical condition of the patient on scene, suspected injuries, and any treatment given in the pre-hospital setting. During this handover, it is imperative that the receiving team remain silent and listen to these important details. Trauma team It is important that a well organised trauma team should receive the patient. Ideally this will comprise a team leader, an “airway” doctor, and two “circulation” doctors, each doctor being paired with a member of the nursing team. An additional nurse may be designated to care for relatives; a radiographer forms the final team member. Primary survey Airway and cervical spine stabilisation Airway Some degree of airway obstruction is the rule rather than the The airway is at risk from blood, tissue debris, swelling, vomit, exception in patients with major trauma and is present in as and mechanical disruption 63 ABC of Resuscitation many as 85% of patients who have “survivable” injuries but nevertheless die after major trauma. The aim of airway management is to allow both adequate oxygenation to prevent tissue hypoxia and adequate ventilation to prevent hypercapnia. The airway is at risk from: G Blood G Tissue debris G Swelling G Vomit G Mechanical disruption. Loss of consciousness diminishes the protective upper airway reflexes (cough and gag), endangering the airway further through aspiration and its sequelae. If the patient is able to talk it means that the airway is patent and breathing and the circulation is adequate to perfuse the brain with oxygenated blood. Signs of airway obstruction include: G Stridor (may be absent in complete obstruction) Jaw thrust opens the airway while maintaining cervical spine alignment G Cyanosis G Tracheal tug G “See-saw” respiration G Inadequate chest wall movement. Oxygen Aim to give 100% oxygen to all patients by delivering 15l/min through an integrated mask and reservoir bag. Lower concentrations of oxygen should not be given to trauma patients with chronic obstructive pulmonary disease even though they may rely on hypoxic drive. However, respiratory deterioration in these patients will necessitate intubation. Basic airway manoeuvres Manoeuvres to open the airway differ from those used in the management of primary cardiac arrest. The standard head tilt and chin lift results in significant extension of the cervical spine and is inappropriate when cervical spine injury is suspected. These are: G Jaw thrust—the rescuer’s fingers are placed along the angle of the jaw with the thumbs placed on the maxilla. The jaw is then lifted, drawing it anteriorly, thus opening the airway G Chin lift—this achieves the same as a jaw thrust by lifting the tip of the jaw anteriorly. Airway adjuncts If basic airway manoeuvres fail to clear the airway, consider the use of adjuncts, such as an oropharyngeal (Guedel) or nasopharyngeal airway. The oropharyngeal airway is inserted into the mouth inverted and then rotated 180 before being inserted fully over the tongue. The nasopharyngeal airway is inserted backwards into the nostril as far as the proximal flange, using a safety pin to prevent it slipping into the nostril. It should be used with caution in patients with suspected basal skull fracture. Blood, saliva, and vomit frequently contribute to airway obstruction and must be removed promptly. Be prepared to roll the patient and tip them head down if they vomit, taking particular care of those who cannot protect their airway—for example, those who are unconscious or those on a spinal board.

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For the opposite side buy generic feldene 20 mg, we performed prophylactic pinning; this was done when the case was diagnosed as preslippage on radiogram and the patient was obese or had an endocrine abnormality buy feldene 20 mg otc. For the radiographic estimation discount feldene 20 mg mastercard, we measured the posterior tilt angle (PTA) before and after CO and at the final examination to clarify actual performance and mainte- nance of correction. Duration until union of osteotomy site and duration until physeal closure after surgery were also investigated. An original plate for corrective osteotomy (CO) in the treatment of slipped capital femoral epiphysis (SCFE). The original plate is made from titanium and has 40° flexion and 15° internal rotation (Nagoya U. Accommodating to the original plate provides correction of posterior tilting deformity. Varus deformity can be corrected by the blade insert angle; however, normally the blade is inserted into the axis of the femur vertically normal with the convexity of the anterior margin of the femoral head running into a concavity, which was the anterior border of the neck; in type B, the anterior outline of the head and neck appeared as a straight line; and in type C, the profile was convex, the anterior margin of the femoral head being posterior to the anterior margin of the neck. Types A and B were defined as being remodeled and type C represented failure of remodeling. We also estimated changes in osteoarthritis from the radiogram at the time of final examination according to Boyer’s classification: grade 0, no degenerative changes; grade I, no more than one subchondral cyst or one osteophyte, no bone sclerosis, and the joint space of normal width; grade II, one or a few subchondral cysts as well as osteophytes, minimum subchondral sclerosis, and slight joint space nar- rowing; and grade III, multiple subchondral cysts and osteophytes, with joint space narrowing. As for the clinical results, we investigated pain, limping, range of hip motion, and leg length discrepancy (LLD) at the final examination. The presence of avascular necrosis and chondrolysis were also investigated as complications. Results Average PTA was 47° before the surgery, 12° after the surgery, and 9° at the final examination. A 35° correction was obtained on average by the surgery and was main- tained after surgery to bone maturity. According to Jones’s classification, we classified 10 cases of type A, 5 cases of type B, and 5 cases of type C, and 15 of 20 cases were remodeled. Again, according to Boyer’s classifications, we found 1 case of grade II with slight joint space narrowing, and this case had the complication of chondrolysis. There was 1 case of chondrolysis; however, no case developed to avascular necrosis of the femoral head. One case showed slight pain at the final examination, and five cases showed slight limping. Also, five cases showed limitation of internal rotation of more than 20°, and average LLD was 1. Case Presentation A 12-year-old boy with hip pain on the right side presented to our hospital. Corrective osteot- omy using the original plate without physeal fixation was performed, and PTA improved to 12°. Proximal femoral physeal closure on the right side was recognized without further slippage 18 months after the operation. A 12-year-old boy with SCFE on the right side treated by CO with an original plate. According to Jones’s classification, his right hip was remodeled (type A), and according to Boyer’s classification it was grouped into grade I with a few osteophytes (Fig. Discussion Location of proximal femoral osteotomies for SCFE was classified in three categories: subcapital, base of neck, and intertrochanteric. The rate of complications such as chondrolysis or avascular necrosis is more or less directly related to the proximity of 38 T. On the other hand, the greater the distance between the corrective osteotomy and the apex of deformity, the more severe the secondary com- pensating deformity will be, and the greater the difficulty of further reconstructive procedures, such as total joint arthroplasty. We always try to correct deformity at the intertrochanteric area because of lesser concern about complications.

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