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This drug is a potassium channel activator: a) Nifedipine b) Saralasin c) Diazoxide d) Losartan 016. This drug is contraindicated in patients with bronchial asthma: a) Propranolol b) Clonidine c) Enalapril d) Nifedipine 018. This drug is converted to an active metabolite after absorption: a) Labetalol b) Clonidine c) Enalapril d) Nifedipine 019. This drug routinely produces some tachycardia: a) Propranolol b) Clonidine c) Enalapril d) Nifedipine 020. The reason of beta-blockers administration for hypertension treatment is: a) Peripheral vasodilatation b) Diminishing of blood volume c) Decreasing of heart work d) Depression of vasomotor center 024. Choose the group of antihypertensive drugs which diminishes the metabolism of bradykinin: 85 a) Ganglioblockers b) Alfa-adrenoblockers c) Angiotensin-converting enzyme inhibitors d) Diuretics 026. Hydralazine (a vasodilator) can produce: a) Seizures, extrapyramidal disturbances b) Tachycardia, lupus erhythromatosis c) Acute hepatitis d) Aplastic anemia 027. The reason of diuretics administration for hypertension treatment is: a) Block the adrenergic transmission b) Diminishing of blood volume and amount of Na+ ions in the vessels endothelium c) Depression of rennin-angiotensin-aldosterone system d) Depression of the vasomotor center 029. Tick the diuretic agent ­ aldosterone antagonist: a) Furosemide b) Spironolactone c) Dichlothiazide d) Captopril 030. The main principle of shock treatment is: a) To increase the arterial pressure b) To increase the peripheral vascular resistance c) To increase the cardiac output d) To improve the peripheral blood flow 002. Pick out the drug which increases cardiac output: a) Noradrenalin b) Methyldopa c) Phenylephrine d) Angiotensinamide 003. Tick the synthetic vasoconstrictor having an adrenomimic effect: a) Noradrenalin b) Adrenalin c) Phenylephrine d) Angiotensinamide 004. Indicate the vasoconstrictor of endogenous origin: a) Ephedrine b) Phenylephrine c) Xylomethazoline d) Angiotensinamide 005. General unwanted effects of vasoconstrictors is: a) Increase of arterial pressure b) Increase of cardiac output c) Decrease of peripheral blood flow d) Increase of blood volume 86 007. For increasing blood pressure in case of low cardiac output the following agents must be used: a) Ganglioblockers b) Vasoconstrictors c) Positive inotropic drugs d) Diuretics 008. Tick the positive inotropic drug of glycoside structure: a) Dopamine b) Digoxin c) Dobutamine d) Adrenalin 009. Tick the positive inotropic drug of non-glycoside structure: a) Digitoxin b) Digoxin c) Dobutamine d) Strophanthin 010. Dopamine at low doses influences mainly: a) Alfa-adrenoreceptors (leads to peripheral vasoconstriction) b) Dopamine receptors (leads to vasodilation of renal and mesenterial vessels) c) Beta-1 adrenoreceptors (leads to enhanced cardiac output) d) All of the above 011. Dopamine at medium doses influences mainly: a) Alfa-adrenoreceptors (leads to peripheral vasoconstriction) b) Dopamine receptors (leads to vasodilation of renal and mesenterial vessels) c) Beta-1 adrenoreceptors (leads to enhanced cardiac output) d) All of the above 012. Tick the group of drugs for treatment of shock with hypovolaemia (reduced circulating blood volume): a) Positive inotropic drugs b) Vasoconstrictors c) Plasmoexpanders d) Analeptics and tonics 014. Tick the group of drugs for chronic hypotension treatment: a) Positive inotropic drugs b) Vasoconstrictors c) Plasmoexpanders d) Analeptics and tonics 015. Tick the drug influencing the blood flow which is related to antiplatelet agents: a) Heparin b) Aspirin c) Pyracetam d) Tanakan 017. Which of the following drugs is related to anticoagulants and may be useful in disorders of cerebral circulation? Indicate the drugs which are Ca-channel blockers influencing the brain blood flow: a) Aminalon, Picamilon b) Nimodipine, Cinnarizine c) Heparin, Warfarin d) Vinpocetine, Nicergoline 019. Indicate the drug - Vinca minor alcaloid: a) Nicergoline b) Warfarin c) Cinnarizine d) Vinpocetine 021.

Saphenous vein flow and diameter are documented and compared to their pre-operative findings spasms youtube 30 gr rumalaya gel overnight delivery. After ligation of the sapheno-femoral junction spasms from alcohol discount rumalaya gel 30 gr overnight delivery, there is a short-term retrograde flow during calf diastole spasms knee buy rumalaya gel 30 gr low price. This is caused by drainage of the venous tributaries via the saphenous trunk and then into the deep veins spasms after urinating generic 30 gr rumalaya gel otc. It is obvious that the fascia has been opened and the saphenous fascia is not visible. The "scar cloud" (arrow) reaches the small saphenous vein where the muscle fascia was not opened. Left above, right at the level of the scar where the saphenous fascia is interrupted, but the muscle fascia remains intact. Left, empty fascial eye above the scar; centre, scar tissue where both fascias were opened; right, small saphenous vein in the fascial compartment distal from the scar. He suffered with pains in the groin region with the appearance of new reticular varices in the outer thigh. A very small sapheno-femoral junction venous tributary is seen with high-velocity reflux in the region of the scar. This fills the anterior accessory saphenous vein which is dilated with very slow flow (see accompanying online material) Copyright: [Author] a b. The non-resorbable suture can be recognised as two white points indicated by arrows. Suture material can obscure the colour signal with their sound shadow (see accompanying online material) Copyright: [Author] through a distal perforating vein. In cases of persisting great saphenous vein reflux, retrograde flow may be similar to or less than that documented prior to the operation. In this case a new perforating vein 13 Ultrasound After Venous Intervention 251. Longitudinal view through the groin showing the common femoral vein with the interruption point (arrowed) in the front wall. The front wall of the vein is smooth indicating a flush ligation (online material: image with flow) Copyright: [Author] or venous tributary re-entry point must be found, and treatment of the sapheno-femoral junction may be indicated. In general, venous tributaries and saphenous veins must be examined for superficial thrombosis. That means possible discomfort and a longer time until the final cosmetic result is achieved. After ligation or crossectomy of the saphenofemoral junction, post-operative flow in the groin must be monitored with special care and the absence or presence of a stump must be clarified. The problem of a refluxing venous tributary at the sapheno-femoral junction which was not identified pre-operatively has already been discussed in Sect. The great saphenous vein receives a minimal antegrade flow from a competent venous tributary of the sapheno-femoral junction. A single ligation has been performed directly below the junction of the superficial epigastric vein with the great saphenous vein at a distance of approx. The epigastric vein is pathological with continuous drainage into the great saphenous vein (see online material and c. A minimal drainage of the venous tributaries of the sapheno-femoral junction into the great saphenous vein is desirable as it prevents thrombus forming in the saphenous vein. If pre-operative reflux exists in the venous tributaries of the sapheno-femoral junction, this paves the way for a groin recurrence. This occurs through newly formed anastomoses 8 weeks after operation with the development of a long-term pathological reflux from the sapheno-femoral junction venous tributaries into the distal great saphenous vein. As in conventional sapheno-femoral junction ligation operations, a stump or a venous tributary can lead to recurrence. In post-operative duplex ultrasound evaluations, the venous flow of remaining venous tributaries must be examined. Recanalisation and recurrent reflux are seen at this point (see accompanying online material) Copyright: [Author] point must be sought. If the venous tributaries are only dilated but not refluxive, it may be concluded that the walls lack tone. Older valvuloplasty implants returned a strong echo making it impossible to take direct measurements in the confluence area. The new implants, available since 2007, are almost ultrasound neutral and allow haemodynamic measurements to be taken.

Part Four: Other sweeteners: this part contains information on less well established sweeteners that do not conform in all respects to what may be considered to be standard sweetening properties muscle relaxant migraine buy rumalaya gel 30gr with mastercard. Some sweeteners described in this part exhibit some interesting nutritional and technological functionalities muscle relaxant ibuprofen purchase 30 gr rumalaya gel free shipping. Part Five: Bulking agents/multi-functional ingredients: this part deals with speciality carbohydrates that have been developed as bulking agents muscle relaxers not working order rumalaya gel 30 gr overnight delivery, allowing greater flexibility when replacing sugar in formulations and complementing the use of high-intensity sweeteners spasms spinal cord injury rumalaya gel 30gr lowest price, polyols and other sweeteners, including sugar. These materials have important physiological benefits which are related, on the whole, to their soluble dietary fibre properties. They are all, by definition, calorie reduced and in some cases they can even replace or partially replace fat in applications. Their chemistry allows for other technological benefits in formulations, and so they can therefore be considered truly multifunctional. The summary tables at the end of each chapter and the extensive references are meant to inspire those who wish to learn more. All the contributors deserve sincere thanks for their efforts and commitment in preparing chapters for this book. Knowledge will enable good choices, and further research and understanding of the literature will confirm or deny how good our choices are, and where improvements are possible. Choice is not simply a matter of which is the healthier or healthiest; technological properties and economics of sugars and sweeteners impact on which of them can be used suitably in a particular food. A wide range of potential influence on health is offered by sugars and sweeteners when selected appropriately, as will be evident in detail from other chapters. Of particular relevance here is their impact on the glycaemic response and control. Reducing post-prandial glycaemia and insulinaemia with sugars8 and sweeteners,7 together with other low-glycaemic carbohydrates,9 fibre, protein, lower energy intake and exercise,10 can each potentially lower the prevalence or risk of developing metabolic diseases associated with high-glycaemic carbohydrate nutrition including metabolic syndrome, diabetes (and associated complications), heart disease, hypertension, stroke and certain cancers. Attributes of sugars and sweeteners affecting health via the glycaemic response are nutritional and need to be seen 4 Sweeteners and Sugar Alternatives in Food Technology in the context of the whole diet. It is appropriate therefore to consider the glycaemic aspect of diet and health from ancient to the present and future times so far as these can be ascertained, explained and envisaged. Successful genes were in existence for both herbivorous and carnivorous diets prior to humankind; however no early diet appears to have been high glycaemic. Those not having adapted contribute to the prevalent diabetes and other conditions mentioned that are currently experienced, which is far higher than in either hunter-gatherers or rudimentary horticulturalists or simple agriculturalists or pastoralists. Generally, we may assume diets to partly reflect the foods that can be found or are made available to eat. Based on the history of foods in Europe,28 with calculations by the present author (unpublished). Cumulative average glycaemic load/100 g food 20 Glycaemic Responses and Toleration 5 optimal health. Such an inventory is provided by Toussaint-Samat28 from which an assessment of the development in the glycaemia character of contemporary diets has been made taking account of the protein, fat, fibre and sources of carbohydrate. The picture cannot be accurate but what is clear is a progressive increase in the glycaemic load, with a markedly rapid increase in this load following industrialisation. We cannot be sure of the prevalence of disease in Europe throughout the whole of this timescale, but we would not likely dispute that the prevalence of obesity and metabolic disease is as high now as ever. Whereas very-low-glycaemic carbohydrate foods such as chana dahl were used in ancient India for a condition now recognised as diabetes,32 nineteenth century recommendations in Western cultures were for starvation diets, which were of course non-glycaemic. The drawback of such is obvious and in 1921 high-fat (70%) low-carbohydrate (20%) diets were recommended,33 which by definition would be low glycaemic. The adverse influence of higher glycaemia may also have been overlooked due to the apparent benefits of the non-digestible carbohydrate in the high-carbohydrate foods. Indeed, the Institute of Medicine has recently recommended high-fibre diets to combat coronary heart disease,45 and this builds upon the dietary fibre hypothesis that proposed higher prevalence of diabetes, heart disease and other conditions associate with diets deficient of fibre. In part this is because carbohydrate 6 Sweeteners and Sugar Alternatives in Food Technology supplies energy, but also because carbohydrate counters the insulin-desensitising influence of both mobilised body fat and dietary fat. It is noteworthy that the increasing carbohydrate content of diets throughout European history, which partly explains the higher-glycaemic load. Excess of carbohydrate prevents the use of fat stores and encourages dietary fat to be stored. In general, elevating the consumption of mono- and polyunsaturated (bar trans) fats is considered beneficial in respect of diabetes, coronary heart disease and a variety of conditions55­58 and is consistent with early diets. Proponents of the Mediterranean diet (high in mono- and polyunsaturated fats) would hold that use of carbohydrate for the purpose of limiting fat intake is unsound.

In the first few years it is common for nails to be fragile with transverse lamellar changes at the free edge (Figure 4 spasms before falling asleep generic 30gr rumalaya gel free shipping. In a survey of 160 schoolchildren spasms right upper quadrant buy generic rumalaya gel 30 gr, the most common features seen in 5- to 7-year-old children were herringbone nails spasms post stroke rumalaya gel 30 gr free shipping, nail-biting fingers spasms baby discount 30 gr rumalaya gel free shipping, lamellar nail dystrophy, koilonychias, malalignment, and nail thickening in the toes. Nail Surface, Direction, Thickness, and Consistency Variations 41 Triangular Worn-Down Nail Syndrome Worn-down nail syndrome has first been described as the bidet nail syndrome, in women affected by a unilateral nail disorder characterized by a triangular defect of the fingernails with its base at the free edge of the nail. However, it may involve both hands, as in the following case: an 8-year-old girl with triangular thinning of the distal shiny nail plate of all the fingers with the base distally located and accompanied by a pink erythema of the distal nail bed. Dermoscopy of the nail showed erythema of the nail bed with dilated capillaries and pinpoint hemorrhages of the thinned areas. Worn-down nail syndrome may be included in the group of disorders observed in childhood, such as onychotillomania, onychophagia, and trichotillomania. Downloaded by [Chulalongkorn University (Faculty of Engineering)] at Elkonyxis the nail appears punched out at the lunula and subsequently the disorder moves distally with the growth of the nail. It has been observed in syphilis, psoriasis, reactive arthritis, reflex sympathetic dystrophy, histiocytosis X, post-trauma, and graft-versus-host disease. It has been diagnosed with etretinate, isotretinoin, alitretinoin, and penicillamine. Nail Direction Variations Claw-Like Nail One or both little toenails are often rounded like a claw. There was a deformity in the distal tuft of the index phalanx with a Y-shaped configuration on the lateral view16 (Figure 4. Malalignment of the Nail Plate Inherited, congenital malalignment of the great toenail which is often misdiagnosed is not an uncommon condition (see Chapter 15). It consists of a lateral deviation of the long axis of nail growth relative to the distal phalanx (see Chapter 17). Malalignment of the nail plate may occur after experiencing a trauma in the matrix area or following a lateral longitudinal nail biopsy wider than 3 mm in adolescence. Triangular Nail of Hallux in Newborn Downloaded by [Chulalongkorn University (Faculty of Engineering)] at It is probably a mild variant of congenital malalignment, where the apparent hypertrophy of the nail folds seems to be secondary due to the lack of pressure of the nail plate on the subungual tissue17 (Figure 4. Onychogryphosis (Onychogryposis) In this disorder, the nail is severely distorted, thickened, opaque, brownish, spiraled, and not attached to the nail bed. Nail keratin is produced by the nail matrix at uneven rates, with the faster-growing side determining the direction of the deformity. In rare cases, it may be produced by acute trauma, and is rarely inherited as an autosomal dominant trait. A congenital type of onychogryphosis was described on the left fifth finger as a thickened nail plate with gross hyperkeratosis, increased curvature, growing in an upward direction with a "leaning tower" appearance. Parrot Beak Nails Parrot beak nails refers to a peculiar, symmetrical overcurvature of the free edge of some fingernails, simulating the beak of a parrot. If the patient trims the affected nails close to the line of separation from the nail bed, no abnormality would be noted clinically. Parrot beak nails can occur as a primary nail dermatosis or secondary to finger pulp atrophy. Up-slanting Nails (Upturned Nails, Ski Jump Nails) Downloaded by [Chulalongkorn University (Faculty of Engineering)] at the variation in nail contour (small: brachyonychy and concave) and in nail direction (returned small nails) may be observed in children or adolescent with lower-limb lymphedema. Lymphedema in adults is classically divided into two forms, primary and secondary, essentially after cancer treatment. Pediatric lymphedema may be a part of syndromic form, with or without gene implication (Turner, Noonan, Hennekam syndromes and Waldmann disease)22 (Table 4. Classically, lymphedema involves one limb or two limbs under the knee (foot, ankle, and calf). Lymphedema affects commonly the nail anatomy23 with small hyperplastic concave nails and increased insertion angle. In adolescents, primary lymphedema of the lower limbs is associated with the up-slanting toenails and soft upturned small nails in children. In Mosaic Turner syndrome, although an intermediate mean fingernail angle is noted, no clear correlation between mean fingernail angle and severity of other manifestations has been shown.