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Some formulations and compatibility problems with dimenhydrinate Gravol. Early gonadectomy is advised to: Bilateral exploration is done routinely by most experienced pediatric surgeons. Large defects with phrenic nerve displacement may need a thoracic approach. The remaining patients all completed the study. Only reliable chances of cure is surgical excision although half are unresectable at dx.

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Critical Care Compendium

Surgical results are generally excellent. A few deaths have resulted from cardiovascular and respiratory compromise due to visceral herniation causing mediastinal and pulmonary compression. First described in , Morgagni Hernias MH are rare congenital diaphragmatic defects close to the anterior midline between the costal and sternal origin of the diaphragm.

Almost always asymptomatic, typically present in older children or adults with minimal gastrointestinal symptoms or as incidental finding during routine chest radiography mass or air-fluid levels. Infants may develop respiratory symptoms tachypnea, dyspnea and cyanosis with distress. Cardiac tamponade due to protrusion into the pericardial cavity has been reported. US and CT-Scan can demonstrate the defect. Trans-abdominal subcostal approach is preferred with reduction of the defect and suturing of the diaphragm to undersurface of sternum and posterior rectus sheath.

Large defects with phrenic nerve displacement may need a thoracic approach. Results after surgery rely on associated conditions. Two types of esophageal hernia recognized are the hiatal and paraesophageal hernia. Diagnosis is made radiologically always and in a number of patients endoscopically. The hiatal hernia HH refers to herniation of the stomach to the chest through the esophageal hiatus.

The lower esophageal sphincter also moves. It can consist of a small transitory epiphrenic loculation minor up to an upside-down intrathoracic stomach major. HH generally develops due to a congenital, traumatic or iatrogenic factor.

Most disappear by the age of two years, but all forms of HH can lead to peptic esophagitis from Gastroesophageal reflux. Repair of HH is determined by the pathology of its associated reflux causing failure to thrive, esophagitis, stricture, respiratory symptoms or the presence of the stomach in the thoracic cavity.

In the paraesophageal hernia PH variety the stomach migrates to the chest and the lower esophageal sphincter stays in its normal anatomic position. PH is a frequent problem after antireflux operations in patients without posterior crural repair. Small PH can be observed. With an increase in size or appearance of symptoms reflux, gastric obstruction, bleeding, infarction or perforation the PH should be repaired.

The incidence of PH has increased with the advent of the laparoscopic fundoplication. A hernia is defined as a protrusion of a portion of an organ or tissue through an abnormal opening. For groin inguinal or femoral hernias, this protrusion is into a hernial sac. Whether or not the mere presence of a hernial sac or processus vaginalis constitutes a hernia is debated.

Inguinal hernias in children are almost exclusively indirect type. Those rare instances of direct inguinal hernia are caused by previous surgery and floor disruption.

An indirect inguinal hernia protrudes through the internal inguinal ring, within the cremaster fascia, extending down the spermatic cord for varying distances.

The direct hernia protrudes through the posterior wall of the inguinal canal, i. The embryology of indirect inguinal hernia is as follows: During the third month of gestation, the processus vaginalis extends down toward the scrotum and follows the chorda gubernaculum that extends from the testicle or the retroperitoneum to the scrotum.

During the seventh month, the testicle descend into the scrotum, where the processus vaginalis forms a covering for the testicle and the serous sac in which it resides. At about the time of birth, the portion of the processus vaginalis between the testicle and the abdominal cavity obliterates, leaving a peritoneal cavity separate from the tunica vaginalis that surrounds the testicle.

The typical patient with an inguinal hernia has an intermittent lump or bulge in the groin, scrotum, or labia noted at times of increased intra-abdominal pressure. A communicating hydrocele is always associated with a hernia. This hydrocele fluctuates in size and is usually larger in ambulatory patients at the end of the day.

If a loop of bowel becomes entrapped incarcerated in a hernia, the patient develops pain followed by signs of intestinal obstruction. If not reduced, compromised blood supply strangulation leads to perforation and peritonitis.

Most incarcerated hernias in children can be reduced. Associated to these episodes of incarceration are chances of: Symptomatic hernia can complicate the clinical course of babies at NICU ill with hyaline membrane, sepsis, NEC and other conditions needing ventilatory support.

Repair should be undertaken before hospital discharge to avoid complications. Postconceptual age sum of intra- and extrauterine life has been cited as the factor having greatest impact on post-op complications. These observation makes imperative that preemies with post conceptual age of less than 45 weeks be carefully monitored in-hospital for at least 24 hours after surgical repair of their hernias.

Outpatient repair is safer for those prematures above the 60 wk. The very low birth weight infant with symptomatic hernia can benefit from epidural anesthesia. At times, the indirect inguinal hernia will extend into the scrotum and can be reduced by external, gentle pressure. Occasionally, the hernia will present as a bulge in the soft tissue overlying the internal ring.

It is sometimes difficult to demonstrate and the physician must rely on the patient's history of an intermittent bulge in the groin seen with crying, coughing or straining. Elective herniorrhaphy at a near convenient time is treatment of choice. Since risk of incarceration is high in children, repair should be undertaken shortly after diagnosis. Simple high ligation of the sac is all that is required. Pediatric patients are allowed to return to full activity immediately after hernia repair.

Bilateral exploration is done routinely by most experienced pediatric surgeons. Recently the use of groin laparoscopy through the hernial sac permits visualization of the contralateral side. Testicular feminization syndrome TFS is a genetic form of male pseudohermaphroditism patient who is genetically 46 XY but has deficient masculinization of external genitalia caused by complete or partial resistance of end organs to the peripheral effects of androgens.

This androgenic insensitivity is caused by a mutation of the gene for androgenic receptor inherited as an X-linked recessive trait. In the complete form the external genitalia appear to be female with a rudimentary vagina, absent uterus and ovaries. The incomplete form may represent undervirilized infertile men. This patients will never menstruate or bear children. Early gonadectomy is advised to: Vaginal reconstruction is planned when the patient wishes to be sexually active.

These children develop into very normal appearing females that are sterile since no female organs are present. A hydrocele is a collection of fluid in the space surrounding the testicle between the layers of the tunica vaginalis.

Hydroceles can be scrotal, of the cord, abdominal, or a combination of the above. A hydrocele of the cord is the fluid-filled remnant of the processus vaginalis separated from the tunica vaginalis. A communicating hydrocele is one that communicates with the peritoneal cavity by way of a narrow opening into a hernial sac.

Hydroceles are common in infants. Some are associated with an inguinal hernia. They are often bilateral, and like hernias, are more common on the right than the left. Most hydroceles will resolved spontaneously by years of age. After this time, elective repair can be performed at any time.

Operation is done through the groin and search made for an associated hernia. Aspiration of a hydrocele should never be attempted. As a therapeutic measure it is ineffective, and as a diagnostic tool it is a catastrophe if a loop of bowel is entrapped. A possible exception to this is the postoperative recurrent hydrocele. The undescended testis is a term we use to describe all instances in which the testis cannot be manually manipulated into the scrotum. The testes form from the medial portion of the urogenital ridge extending from the diaphragm into the pelvis.

In arrested descent, they may be found from the kidneys to the internal inguinal ring. Rapid descent through the internal inguinal ring commences at approximately week 28, the left testis preceding the right.

Adequate amounts of male hormones are necessary for descent. The highest levels of male hormones in the maternal circulation have been demonstrated at week Thus, it appears that failure of descent may be related to inadequate male hormone levels or to failure of the end-organ to respond.

The undescended testes may be found from the hilum of the kidney to the external inguinal ring. The undescended testis found in 0.

Testes that can be manually brought to the scrotum are retractile and need no further treatment. Parents should know the objectives, indications and limitations of an orchiopexy: To improve spermatogenesis producing an adequate number of spermatozoids surgery should be done before the age of two.

Electron microscopy has confirmed an arrest in spermatogenesis reduced number of spermatogonias and tubular diameter in undescended testis after the first two years of life. Other reasons to pex are: The management is surgical; hormonal Human Chorionic Gonadotropin treatment has brought conflicting results except bilateral cases.

Surgery is limited by the length of the testicular artery. Palpable testes have a better prognosis than non-palpable. Laparoscopy can be of help in non-palpable testis avoiding exploration of the absent testis. Viens, MS University of Toronto. An umbilical hernia is a small defect in the abdominal fascial wall in which fluid or abdominal contents protrude through the umbilical ring.

The presence of a bulge within the umbilicus is readily palpable and becomes more apparent when the infant cries or during defecation. The actual size of the umbilical hernia is measured by physical examination of the defect in the rectus abdominis muscle, and not by the size of the umbilical bulge.

The size of the fascial defect can vary from the width of a fingertip to several centimetres. Embryologically, the cause of an umbilical hernia is related to the incomplete contraction of the umbilical ring.

The herniation of the umbilicus is a result of the growing alimentary tract that is unable to fit within the abdominal cavity. Umbilical hernias are more prevalent in females than in males and are more often seen in patients with African heritage. The increased frequency of umbilical hernias has also been attributed to premature babies, twins and infants with long umbilical cords. There is also a frequent association with disorders of mucopolysaccharide metabolism, especially Hurler's Syndrome gargoylism.

Most umbilical hernias are asymptomatic; the decision to repair the umbilical hernia in the first years of life is largely cosmetic and is often performed because of parental request, not because of pain or dysfunction.

In the past, some parents use to tape a coin over the umbilical bulge, however, manual compression does not have an effect on the fascial defect. Treatment of umbilical hernia is observation. However, surgical repair is recommended if the hernia has not closed by the age of five. The incidence of incarceration trapped intestinal loop is rare, even in larger defects. Females should especially have their umbilical hernia corrected before pregnancy because of the associated increased intra-abdominal pressure that could lead to complications.

The procedure is simple and incidence of complication such as infection is extremely rare. The repair is usually done as outpatient surgery under general anesthetic. Inguinal and umbilical hernia repair in infants and children. Surg Clinics of North Am 73 3: Swenson's Pediatric Surgery - 5th edition.

The developing human - 4th edition. Philadelphia, WB Saunders, pp. Some observations on umbilical hernias in infants. The comparative incidence of umbilical hernias in colored and white infants. J Natl Med Assoc The three most common abdominal wall defect in newborns are umbilical hernia, gastroschisis and omphalocele. Omphalocele is a milder form of primary abdominoschisis since during the embryonic folding process the outgrowth at the umbilical ring is insufficient shortage in apoptotic cell death.

Defect may have liver, spleen, stomach, and bowel in the sac while the abdominal cavity remains underdeveloped in size. The sac is composed of chorium, Wharton's jelly and peritoneum. The defect is centrally localized and measures cm in diameter.

A small defect of less than 2 cm with bowel inside is referred as a hernia of the umbilical cord. Epigastric localized omphalocele are associated with sternal and intracardiac defects i. Cardiac, neurogenic, genitourinary, skeletal and chromosomal changes and syndromes are the cornerstones of mortality. Cesarean section is warranted in large omphaloceles to avoid liver damage and dystocia. After initial stabilization management requires consideration of the size of defect, prematurity and associated anomalies.

Primary closure with correction of the malrotation should be attempted whenever possible. Antibiotics and nutritional support are mandatory. Manage control centers around sepsis, respiratory status, liver and bowel dysfunction from increased intraabdominal pressure. The protruding gut is foreshortened, matted, thickened and covered with a peel.

The IA might be the result of pressure on the bowel from the edge of the defect pinching effect or an intrauterine vascular accident. Rarely, the orifice may be extremely narrow leading to gangrene or complete midgut atresia. In either case the morbidity and mortality of the child is duplicated with the presence of an IA.

Alternatives depend on the type of closure of the abdominal defect and the severity of the affected bowel. With primary fascial closure and good-looking bowel primary anastomosis is justified. Angry looking dilated bowel prompts for proximal diversion, but the higher the enterostomy the greater the problems of fluid losses, electrolyte imbalances, skin excoriation, sepsis and malnutrition.

Closure of the defect and resection with anastomosis two to four weeks later brings good results. Success or failure is related to the length of remaining bowel more than the specific method used. Initially do an Apt test to determine if blood comes from fetal origin or maternal origin blood swallowed by the fetus. If this coagulation profile is normal the possibilities are either stress gastritis or ulcer disease. If the coagulation profile is abnormal then consider hematologic disease of the newborn and manage with vitamin K.

The apt test is performed by mixing 1 part of vomitus with 5 part H2O, centrifuge the mixture and remove 5 ml pink. If the coagulation profile is abnormal give Vit K for hematologic disorder of newborn. If it's normal do a rectal exam.

A fissure could be the cause, if negative then consider either malrotation or Necrotizing enterocolitis. The stress includes prematurity, sepsis, hypoxia, hypothermia, and jaundice. These babies frequently have umbilical artery, vein catheters, have received exchange transfusions or early feeds with hyperosmolar formulas.

The intestinal mucosal cells are highly sensitive to ischemia and mucosal damage leads to bacterial invasion of the intestinal wall. Gas-forming organisms produce pneumatosis intestinalis air in the bowel wall readily seen on abdominal films.

Full-thickness necrosis leads to perforation, free air and abscess formation. These usually premature infants develop increased gastric residuals, abdominal distension, bloody stools, acidosis and dropping platelet count.

The abdominal wall becomes reddened and edematous. There may be persistent masses and signs of peritonitis. Perforation leads to further hypoxia, acidosis and temperature instability. The acid-base status is monitored for worsening acidosis and hypoxia.

The white blood cell count may be high, low or normal and is not generally of help. Serial abdominal films are obtained to look for evidence of free abdominal air, a worsening picture of pneumatosis intestinalis, or free portal air.

Therapy consist initially of stopping feeds, instituting nasogastric suctioning and beginning broad-spectrum antibiotics ampicillin and gentamycin. Persistent or worsening clinical condition and sepsis or free air on abdominal films require urgent surgical intervention.

Attempts to preserve as much viable bowel as possible are mandatory to prevent resultant short gut syndrome. Complicated NEC is the most common neonatal surgical emergency of modern times, has diverse etiologies, significant mortality and affects mostly premature babies. Consist of a right lower quadrant incision and placement of a drainage penrose or catheter under local anesthesia with subsequent irrigation performed bedside at the NICU.

Initially used as a temporizing measure before formal laparotomy, some patient went to improvement without the need for further surgery almost one-third. They either had an immature fetal type healing process or a focal perforation not associated to NEC? Some suggestion made are: PPD should be an adjunct to preop stabilization, before placing drain be sure pt has NEC by X-rays, persistent metabolic acidosis means uncontrolled peritoneal sepsis, do not place drain in pts with inflammatory mass or rapid development of intraperitoneal fluid, the longer the drainage the higher the need for laparotomy.

In the initial evaluation a history should be obtained for bleeding disorders, skin lesions, and aspirin or steroid ingestion. The physical exam for presence of enlarged liver, spleen, masses, ascites, or evidence of trauma or portal hypertension.

Labs such as bleeding studies and endoscopy, contrast studies if bleeding stops. Common causes of Upper GI bleeding are: Esophagus a Varices- usually presents as severe upper gastrointestinal bleeding in a year old who has previously been healthy except for problems in the neonatal period.

This is a result of extrahepatic portal obstruction portal vein thrombosis most commonly , with resulting varices. The bleeding may occur after a period of upper respiratory symptoms and coughing. Management is initially conservative with sedation and bedrest; surgery ir rarely needed. Treatment consist of antacids, frequent small feeds, occasionally medications and if not rapidly improved, then surgical intervention with a fundoplication of the stomach.

This was thought to be uncommon in children because it was not looked for by endoscopy. It probably occurs more often than previously thought. Treatment initially is conservative and, if persistent, oversewing of the tear through an incision in the stomach will be successful. They bleed when there is ectopic gastric mucosa present.

Total excision is curative. Occasionally requires surgical intervention with local repair or ligation of hepatic vessels. Anal fissure is the most common cause of rectal bleeding in the first two years of life. Outstretching of the anal mucocutaneous junction caused by passage of large hard stools during defecation produces a superficial tear of the mucosa in the posterior midline. Pain with the next bowel movement leads to constipation, hardened stools that continue to produce cyclic problems.

Large fissures with surrounding bruising should warn against child abuse. Crohn's disease and leukemic infiltration are other conditions to rule-out. The diagnosis is made after inspection of the anal canal. Chronic fissures are associated with hypertrophy of the anal papilla or a distal skin tag. Management is directed toward the associated constipation with stool softeners and anal dilatations, warm perineal baths to relax the internal muscle spasm, and topical analgesics for pain control.

If medical therapy fails excision of the fissure with lateral sphincterotomy is performed. Meckel's diverticulum MD , the pathologic structure resulting from persistence of the embryonic vitelline duct yolk stalk , is the most prevalent congenital anomaly of the GI tract. MD can be the cause of: Diagnosis depends on clinical presentation.

Rectal bleeding from MD is painless, minimal, recurrent, and can be identified using 99mTc- pertechnetate scan; contrasts studies are unreliable. Persistent bleeding requires arteriography or laparotomy if the scan is negative. Obstruction secondary to intussusception, herniation or volvulus presents with findings of fulminant, acute small bowel obstruction, is diagnosed by clinical findings and contrast enema studies. The MD is seldom diagnosed preop. Diverticulitis or perforation is clinically indistinguishable from appendicitis.

Mucosal polyps or fecal umbilical discharge can be caused by MD. Overall, complications of Meckel's are managed by simple diverticulectomy or resection with anastomosis. Laparoscopy can confirm the diagnosis and allow resection of symptomatic cases.

Removal of asymptomatic Meckel's identified incidentally should be considered if upon palpation there is questionable heterotopic gastric or pancreatic mucosa thick and firm consistency present. Histology features a cluster of mucoid lobes surrounded by flattened mucussecreting glandular cells mucous retention polyp , no malignant potential.

Commonly seen in children age with a peak at age As a rule only one polyp is present, but occasionally there are two or three almost always confined to the rectal area within the reach of the finger. Most common complaint is bright painless rectal bleeding.

Occasionally the polyp may prolapse through the rectum. Diagnosis is by barium enema, rectal exam, or endoscopy. Removal by endoscopy is the treatment of choice. Rarely colotomy and excision are required. Wilms tumor WT is the most common intra-abdominal malignant tumor in children affecting more than children annually in the USA.

It has a peak incidence at 3. WT present as a large abdominal or flank mass with abdominal pain, asymptomatic hematuria, and occasionally fever. Other presentations include malaise, weight loss, anemia, left varicocele obstructed left renal vein , and hypertension. Initial evaluation consists of: The presence of a solid, intrarenal mass causing intrinsic distortion of the calyceal collecting system is virtually diagnostic of Wilms tumor.

Doppler sonography of the renal vein and inferior vena cava can exclude venous tumor involvement. Metastasis occurs most commonly to lungs and occasionally to liver.

Operation is both for treatment and staging to determine further therapy. Following NWTSG recommendation's primary nephrectomy is done for all but the largest unilateral tumors and further adjuvant therapy is based on the surgical and pathological findings. Important surgical caveats consist of using a generous transverse incision, performing a radical nephrectomy, exploring the contralateral kidney, avoiding tumor spillage, and sampling suspicious lymph nodes.

Nodes are biopsied to determine extent of disease. Stage I- tumor limited to kidney and completely resected. Stage II- tumor extends beyond the kidney but is completely excised. Stage III- residual non-hematogenous tumor confined to the abdomen.

Stage IV- hematogenous metastasis. Stage V- bilateral tumors. Further treatment with chemotherapy or radiotherapy depends on staging and histology favorable vs.

Non-favorable histologic characteristics are: Prognosis is poor for those children with lymph nodes, lung and liver metastasis. They tend to occur in younger patients. Routine abdominal ultrasound screening every six months up to the age of eight years is recommended for children at high risk for developing WT such as the above-mentioned syndromes. It was originally thought that WT developed after the two-hit mutational model developed for retinoblastoma: When the first mutation occurs before the union the sperm and egg constitutional or germline mutation the tumor is heritable and individuals are at risk for multiple tumors.

Nonhereditary WT develops as the result of two-postzygotic mutations somatic in a single cell. The two-event hypothesis predicts that susceptible individuals such as familial cases, those with multifocal disease and those with a congenital anomaly have a lower median age at diagnosis than sporadic cases.

It is now believed that several genes' mutations are involved in the overall WT pathogenesis. Loss of whole portions of a chromosome is called loss of heterozygosity LOH , a mechanism believed to inactivate a tumor-suppressor gene.

Children with the WAGR association shows a deletion in the short arm of chromosome 11 band 13 11p13 but a normal 11p15 region.

Up to a third of sporadic WT have changes in the distal part of chromosome 11, a region that includes band p The region of the deletion has been named the WT1 gene, a tumor suppressor gene that also forms a complex with another known tumor-suppressor, p WT1 gene express a regulated transcription factor of the zinc-finger family proteins restricted to the genitourinary system, spleen, dorsal mesentery of the intestines, muscles, central nervous system CNS and mesothelium. The important association of WT1 mutation and WAGR syndrome with intralobar nephrogenic rests immediately suggest that WT1 expression be necessary for the normal differentiation of nephroblasts.

Inactivation of WT1 only affects organs that express this gene such as the kidney and specific cells of the gonads Sertoli cells of the testis and granulosa cells of the ovary. WT1 has been shown to cause the Denys-Drash syndrome.

Most of the mutations described in DDS patients are dominant missense mutations. A small subset of BWS has a 11p15 duplication or deletion. The region 11p15 has been designated WT2 gene and is telomeric of WT1. This might prove that two independent loci may be involved in tumor formation. A gene for a familial form FWT1 of the tumor has also been identified in chromosome 17q.

There also might be a gene predisposing to Wilms tumor at chromosome 7p, where constitutional translocations have been described. Mutation in p53 is associated with tumor progression, anaplasia and poor prognosis. Most WT are probably caused by somatic mutations in one or more of the increasing number of WT genes identified.

A few chromosomal regions have seen identified for its role in tumor progression. LOH at chromosome 16q and chromosome 1p has been implicated in progression to a more malignant or aggressive type Wilms' tumor with adverse outcome.

These children have a relapse rate three times higher and a mortality rate twelve times higher than WT without LOH at chromosome 1p. Patients with WT and a diploid DNA content indicating low proliferation have been found to have an excellent prognosis. Butterfly species diversity from Vikram university campus Madhya Pradesh Dynamics of stochastic sis epidemic model with vertical transmission.

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Effect of gamma rays on seed germination, plant survival and quantitative Phytochemical screening for secondary metabolites in two medicinally Studies on the spent waste of i coffee and ii tea for extraction of Exigency analysis of state road transport system in India. Assay of exfoliated and associated nuclear anomalies as biomarker in Moisture sorption characteristics and storage regime of defatted grape Toxicity of cadmium on the oxygen consumption and gill histology estuarine Clinical evaluation of terminalia arjuna on wound healing in caprine.

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Entomophagy among the bodos of udalguri district, btad, assam, india. Anti-microbial activity and phytochemical assay of busikad Researches and issues in teacher education. Performance evaluation of different growth regulators on propagation of Ethnobotany, phytochemistry and pharmacological evaluation of vernonia A comparative clinical study of palasha ksharasutra and apamarga Evaluation of popular functional christologies among the ndia christians A survey of some ethno-medicinal plants used by the tribes of melghat in Groundwater governance in andhra pradesh- possibility to move towards A review of intestinal helminthiasis in ethiopian school children and the Physiological quality of landrace seeds from rural community settlements The effect of cement stabilization on the physical and mechanical Pathophysiology of metastatic tumors of oral cavity: Study on removal of phenol using adsorption process.

Seasonal toxicological profile of three puffer fishes collected along Internal controls impact on the effective management of devolved revenue Evaluation of colour fastness to washing studied on Himalayan nettle, Mycoflora associated with farmer stored seeds of chickpea and pigeon pea Quantification of lycopene extracted from watermelon and tomato varieties Matrix representation of double layered complete fuzzy graph.

Districtwise distribution of households by source of drinking water in Overcoming material overflow using flexible lot size for kanban system. Pilates and physiotherapy in acute Lowback ache and sciatica — An evidence ICT in the service of enginering, weather and climate: Exploration of sediment derived streptomyces sp.

Combined probationary training programme for the new entrants in state Non-human primates as research models in the field of periodontics: Evaluation and analysis of yield, performance and adoption of blackgram The myth of tribal backwardness: Land rights in tribals.

Assay on osmotic fragility and antioxidant potential of the methanolic Brain tumor features generation from mri t2-weighted grayscale images Study of physico-chemical parameters of anjaneri pond near Nashik M.

Study of the elementary surgical procedures and instruments with Kantha embroidery-a woman-centric path towards empowerment for artisans Effect of planting time on yield and quality of strawberry cv chandler in Composite boards from agro waste residue of grass and Bamboo. Perception of future employees towards a world class organization. Role of host plants for white sandal santalum album L.

Aphrodisiac activity of aqueous and hydroethanolic extracts of the stem A cross country analysis of inflation rate among brics nations: Pro-poor tourism and its seeming upshots on a locality — An exploratory On weakly regular ternary. Dynamic fuzzy expert system for multi objective criteria for selection of Characterization of active compound and extracts of aerva lanata using Study on the impact of innovations in banking sector.

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A study of physico chemical and biological characteristics of sabarmati Comparative study of lactobacillus species in dental caries active subjects. A study to assess the level of stress regarding demonetization of rs. Study of antibacterial activity of medicinal plants on oral microflora and Lead poisoning from cars exhausts among primary school children in Sudan.

Benefits, challenges and selection of cloud erp systems used in smes. Exploring anticancer activity of topically applied quinine sulfate on Impact of selected yogic practices on antioxidant activity in middle aged Fed-batch and cstr studies for l-methionine production by c.

Declining level and quality assessment of ground water with a special Concept of shayyamutra in present scenario. Determination of the hygienic and physico-chemical quality of Raw milk Reduction of nox emissions in a diesel engine using selective catalytic Carbenicillin inactivation of aminoglycosides in patients with severe renal failure.

Carbenicillin-gentamicin interaction in acute renal failure. Bodey GP, Feld R. Am J Med Sci. Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. Are carbenicillin and gentamicin synergists or antagonists? Electrolyte content of common intravenous solutions and antibiotics. Stability of citrated caffeine injectable solution in glass vials. Turco SJ, Hasan I. Comparison of features of Kefzol and Ancef. Stennett DJ, Simonson W.

Stability of mandol in parenteral fluids, frozen solutions and admixtures containing other drugs. Presented at 13th annual ASHP midyear clinical meeting. Thrombophlebitic potential of intravenous cytotoxic agents. Irritant properties of diazepam. Irritant properties of diazepam—reply. Precipitation of diazepam from intravenous preparationsi. Kortilla K, Sothman A.

Polyethylene glycol as a solvent for diazepam: Acta Pharmacol Toxicol Copenh. Diazepam metabolism in normal man I. Serum concentrations and clinical effects after intravenous, intramuscular and oral administration. The influence of the route of administration on the clinical action of diazepam.

Dilution of diazepam in intravenous fluids. Continuous infusion of diazepam in infants with severe recurrent convulsions. Khalid MS, Schultz H. Treatment and management of emergency status epilepticus.

Diseases of the central nervous system—epilepsy. Diazepam Calmpose in eclampsia: Active management of severe pre-eclampsia. Intravenous diazepam in the treatment of prolonged seizure activity.

Tehrani JB, Cavanaugh A. Diazepam infusion in the treatment of tetanus. Safety of diazepam infusion questioned. Investigational drug information—daunorubicin hydrochloride and streptozotocin. The lipid phase in TPN. Photodegradation and hydrolysis of furosemide and furosemide esters in aqueous solutions. Stability of gentamicin in plastic syringes.

Gentamicin sulfate injection repackaging in syringes. Personal communication, August 21, Sohn C, Cupit GC. Concentration of heparin in heparin-locks. Okuno T, Nelson CA. Anticoagulant activity of heparin in intravenous fluids.

Brown J, Stead K. Anti-human lymphocyte globulin-heparin precipitate. Raab WP, Windisch J. Antagonism of neomycin by heparin. Further observations on the anaphylactoid activity of neomycin. A case for prodrugs: Adv Drug Del Rev. Dupuis LL, Wong B.

Stability of propafenone hydrochloride in i. Am J Health-Syst Pharm. Compatibility and stability of propafenone hydrochloride with five critical-care medications. Effect of storage temperature on stability of commercial insulin preparations.

Treatment of diabetic coma with continuous low-dose infusion of insulin. Treatment of severe diabetes mellitus by insulin infusion. Semple PF, White C. Continuous intravenous infusion of small doses of insulin in treatment of diabetic ketoacidosis. Routine use of low-dose intravenous insulin infusion in severe hyperglycaemia.

Continuous low-dose infusion of insulin in the treatment of diabetic ketoacidosis in children. Low-dose intravenous insulin infusion versus subcutaneous insulin injection: A controlled comparative study of diabetic ketoacidosis. Insulin adsorption to an inline membrane filter. Kristofferson J, Skobba TJ.

Adsorption of insulin to infusion equipment. Clinical significance of insulin adsorption by polyvinyl chloride infusion systems. Availability of insulin from parenteral nutrient solutions.

Availability of insulin from continuous low-dose insulin infusions. Direct addition of small doses of insulin to intravenous infusion in severe uncontrolled diabetes. Peterson L, Caldwell J. Insulin adsorbance to polyvinyl chloride surfaces with implications for constant-infusion therapy. A trial of total dose infusion iron therapy as an outpatient procedure in rural Iranian villages a three month follow-up. Biological activity of dilute isoproterenol solution stored for long periods in plastic bags.

Epperson E, Nedich RL. Mannitol crystallization in plastic containers. Thermal and photolytic decomposition of methotrexate in aqueous solutions. Muller HJ, Berg J. Stabilitatsstudie zu tramadolhydrochlorid im PVC-infusionbeutel. Oxidation of methyldopate hydrochloride in alkaline media. Vitamin A delivery in total parenteral nutrition solution. Stability of oxytetracycline in solutions and injections.

Colding H, Anderson GE. Stability of antibiotics and amino acids in two synthetic L-amino acid solutions commonly used for total parenteral nutrition in children. Maintenance of therapeutic phenytoin plasma levels via intramuscular administration. Sellers EM, Kalant H. Alcohol intoxication and withdrawal. Formulation of caffeine injection for i. Woo E, Greenblatt DJ. Choosing the right phenytoin dosage. Bighley LD, Wille J. Mixing of additives in glass and plastic intravenous fluid containers.

Schondelmeyer S, Gatlin L. Sistare F, Greene R. Phenytoin in IV fluids: Woodside W, King JA. Addition of potassium to non-rigid plastic intravenous infusion containers: Hyperkalemia after administration of potassium from nonrigid parenteral-fluid containers. Reconstitution of sodium nitroprusside. Martin T, Patel JA. Determination of sodium nitroprusside in aqueous solution. Spectrophotometric determination of sodium nitroprusside and its photodegradation products.

Stability of injection solutions of vitamin B 1. Photodegradation of vitamin K 1 and vitamin K 2 injections in preservation and in intravenous admixtures. Stability of methotrexate in an intravenous fluid. Aust J Hosp Pharm. Stability of intravenous additive preparations; studies on hydralazine as an additive. Mixing chlorpromazine and morphine.

Stability of refrigerated and frozen solutions of tropisetron in either polyvinylchloride or polyolefin infusion bags. J Clin Pharm Ther. Conversion of cefamandole nafate to cefamandole sodium. Production of carbon dioxide gas after reconstitution of cefamandole nafate. Stability of frozen solutions of cefamandole nafate.

Am J Hosp Pharm,. Buckles J, Walters V. Stability of amitriptyline hydrochloride in aqueous solution. Decomposition of amitriptyline hydrochloride in aqueous solution: Factors influencing decomposition rate of amitriptyline hydrochloride in aqueous solution. Potential pH incompatibility of pharmacological and isotopic adjuncts to arteriography. The effect of additives on the physical properties of a phospholipid-stabilized soybean oil emulsion.

J Clin Hosp Pharm. Stability of caffeine citrate injection in intravenous admixtures and parenteral nutrition solutions. Formulation of three nitrosoureas for intravenous use. Cancer Chemother Rep 3. Stability of imipramine hydrochloride solutions. Estudio de la estabilidad in vitro de la ranitidine i. Effect of phototherapy light, sodium bisulfite, and pH on vitamin stability in total parenteral nutrition admixtures. J Parenter Enteral Nutr. Leucovorin calcium administration and preparation.

Tavoloni N, Guarino AM. Photolytic degradation of adriamycin. Stability of intravenous fat emulsions. A review of two safety factors in the use of paraldehyde. J R Coll Gen Pract. Search for drug interactions between the antitumor agent DTIC and other cytotoxic agents.

Stability of imipenem and cilastatin sodium in total parenteral nutrient solution. Kuehnle C, Moore TD. Sodium chloride residue provides potential for drug incompatibilities. Investigational drug information—ifosfamide and semustine.

A new light on the photo-decomposition of the antitumour drug DTIC. The lack of inactivation of tobramycin by cefazolin, cefamandole, and moxalactam in vitro. Stability of tobramycin in combination with selected new beta-lactam antibiotics. Kinetics and mechanisms of the autoxidation of ketorolac tromethamine in aqueous solution. Freeze thaw stability of ceftazidime. Br J Parenter Ther. Br J Intensive Care. Losses of calcitrol to peritoneal dialysis bags and tubing.

Potency and stability of extemporaneous nitroglycerin infusions. In vitro and in vivo interactions of recent cephalosporins with gentamicin and amikacin. Long-term stability of 5-fluorouracil and folinic acid admixtures. Stability of nitroglycerin injection determined by gas chromatography.

Potency and stability of extemporaneously prepared nitroglycerin intravenous solutions editorial. Loss of nitroglycerin from plastic intravenous bags. Loss of nitroglycerin from intravenous infusion sets.

Stability of nitroglycerin solutions in Viaflex plastic containers. Interaction of platinol cisplatin and the metal aluminum. Bristol Laboratories; Jul. Deerfield IL; Apr. Stability of antimicrobial agents in peritoneal dialysate. Incompatibilities with cimetidine hydrochloride injection. Stability of five antibiotics in plastic intravenous solution containers of dextrose and sodium chloride. Stability and compatibility of antitumor agents in glass and plastic containers.

Bretylium tosylate intravenous admixture compatibility. Dopamine, lidocaine, procainamide and nitroglycerin. Colvin M, Hartner J. Stability of carmustine in the presence of sodium bicarbonate. Incompatibilities with parenteral anticancer drugs. Stability of cefamandole nafate and cefoxitin sodium solutions. Stability of anthracycline antitumor agents in four infusion fluids.

A rational approach to intravenous additives. Incompatibility between carbenicillin injection and promethazine injection. Pharmacological incompatibility of contrast media with various drugs and agents.

Stability of corticosteroids in aqueous solutions. Stability of antibiotics frozen and stored in disposable hypodermic syringes. Effect of inline filtration on the potency of low-dose drugs. Stability of five liquid drug products after unit dose repackaging. Interactions between drugs and polyvinyl chloride infusion bags. Zatz L, Sethia P. Folic acid and calcium gluconate. Compatibility of amphotericin B with certain large-volume parenterals. Compatibility of amphotericin B with drugs used to reduce adverse reactions.

Stability in common large-volume parenteral solutions. Cimetidine hydrochloride compatibility with preoperative medications.

Stability of procainamide in 0. Stability of procainamide hydrochloride in dextrose solutions. Jeglum EL, Winter E. Nafcillin sodium incompatibility with acidic solutions. Compatibility of verapamil hydrochloride injection in commonly used large-volume parenterals. Cimetidine hydrochloride compatibility I: Chemical aspects and room temperature stability in intravenous infusion fluids.

Cimetidine hydrochloride compatibility II: Room temperature stability in intravenous infusion fluids. Cimetidine hydrochloride compatibility III: Room temperature stability in drug admixtures. Visual compatibility of dobutamine with seven parenteral drug products. Stability of trimethoprim-sulfamethoxazole injection in two infusion fluids. Activity of antibiotic admixtures subjected to different freeze-thaw treatments. Effect of freezing and microwave thawing on the stability of six antibiotic admixtures in plastic bags.

Boddapati S, Yang K. Physiochemical properties of aminophylline-dextrose injection admixtures. Effect of freezing on particle formation in three antibiotic injections. Compatibility of netilmicin sulfate injection with commonly used intravenous injections and additives. Effects of cold and freezing temperatures on pharmaceutical dosage forms.

Hardin TC, Clibon U. Stability of 5-fluorouracil in a crystalline amino acid solution. Stability of pyridoxine hydrochloride in infusion solution under practical circumstances in wards. Dony J, Devleeschouwer MJ. Etude de la degradation photochimique de macrolides en presence de riboflavine. Compatibility of perphenazine and butorphanol admixtures. Retention of drugs during inline filtration of parenteral solutions.

Cimetidine and parenteral nutrition. Cutie MR, Waranis R. Compatibility of hydromorphone hydrochloride in large-volume parenterals. Growth of bacteria and fungi in parenteral nutrition solutions containing albumin. Interactions between aminoglycoside antibiotics and carbenicillin or ticarcillin. Pickering LK, Gearhart P. Effect of time and concentration upon interaction between gentamicin, tobramycin, netilmicin, or amikacin and carbenicillin or ticarcillin. Animal model distinguishing in vitro from in vivo carbenicillin-aminoglycoside interactions.

Titratable acidities of crystalline amino acid admixtures. Frozen storage and microwave thawing of parenteral nutrition solutions in plastic containers. Photoreaction involving essential amino acid injection. Some aspects of the stability of parenteral nutrition solutions. Amino acid stability in a mixed parenteral nutrition solution.

Stability of amino acids and the availability of acid in total parenteral nutrition solutions containing hydrochloric acid. Rusho WJ, Standish R. A comparison of crystalline amino acid solutions for total parenteral nutrition. Guidelines for essential trace element preparations for parenteral use. A statement by an expert panel.

Chromium deficiency during total parenteral nutrition. Skeletal changes of copper deficiency in infants receiving prolonged total parenteral nutrition. Moran DM, Russo J. Zinc deficiency dermatitis accompanying parenteral nutrition supplemented with trace elements. Zinc, copper, and parenteral nutrition in cancer. Zinc in total parenteral nutrition: Trace elements and total parenteral nutrition. What goes into parenteral nutrition solutions?.

J Postgrad Pharm Hosp Ed. Parenteral nutrition of adults with a milliosmolar solution via peripheral veins. Am J Clin Nutr. Medications not to be refrigerated. Dilution of oral and intravenous aminophylline preparations. Pharmacy-initiated intravenous infusion guidelines. Compatibility of the cephalosporin, cefamandole nafate, with injections. Tipple M, Shadomy S. Availability of active amphotericin B after filtration through membrane filters.

A review of complications of amphotericin B therapy: Activity of amphotericin B after filtration. Comparative stabilities of ampicillin and hetacillin in aqueous solutions. Relative stability of hetacillin and ampicillin in solution.

Studies on the stability and compatibility of drugs in infusion fluids 6. Factors affecting the stability of ampicillin.

Compatibility of azathioprine sodium with intravenous fluids. Interactions between drugs and intravenous delivery systems. Compatibility of calcium chloride and calcium gluconate with sodium phosphate in a mixed TPN solution.

Calcium and phosphorus compatibility in parenteral nutrition solutions for neonates. Central venous catheter occlusion caused by body-heat-mediated calcium phosphate precipitation. Guidelines for phenytoin infusions. Stewart P, Lourwood D. Guidelines for the administration of a phenytoin loading dose via IVPB. An evaluation of the stability and safety of phenytoin infusion.

NY State J Pharm. Kradjan WA, Burger R. In vivo inactivation of gentamicin by carbenicillin and ticarcillin.

Young LS, Decker G. Inactivation of gentamicin by carbenicillin in the urinary tract. In vitro inactivation of gentamicin, tobramycin, and netilmicin by carbenicillin, azlocillin, or mezlocillin.

Inactivation of netilmicin by carbenicillin. Degradation of carmustine in aqueous media. Cardi V, Willcox GS.

Reconstituting cefamandole and protecting from light. Kaiser GV, Gorman M. Cefamandole—a review of chemistry and microbiology. Hydrolysis of cefamandole nafate to cefamandole in vivo. Bioavailability and pain study of cefamandole nafate. Formylation of glucose by cefamandole nafate at alkaline pH. Stability of cefazolin sodium admixtures in plastic bags after thawing by microwave radiation.

An evaluation of cefazolin sodium injection in an IV piggyback bottle. Effect of microwave radiation on the stability of frozen cefoxitin sodium solution in plastic bags. The stability of preservative-free morphine in plastic syringes. Stability and sterility of cimetidine admixtures frozen in minibags.

Error —More on cisplatin storage. Some quantitative data on cis-dichlorodiammineplatinum II species in solution. Cis-platin stability in aqueous parenteral vehicles. J Parenter Drug Assoc. Physical compatibility and chemical stability of cisplatin in various diluents and in large-volume parenteral solutions.

Cisplatin current status and new developments. Plasma diazepam levels after single dose oral and intramuscular administration. Thrombophlebitis with diazepam used intravenously. Dam M, Christiansen J. Additional conclusions on diazepam injectable precipitate: Raymond G, Huber JW. Identification of injectable Valium precipitate. Solubility characteristics of diazepam in aqueous admixture solutions: Factors affecting diazepam infusion: Adsorption of diazepam to plastic tubing.

Compatibility of diazepam with intravenous fluid containers and administration sets. Cloyd JC, Vezeau C. Availability of diazepam from plastic containers. Dasta JF, Brier K.

Loss of diazepam to drug delivery systems. A four-stage approach to new-drug development. Chemical incompatibility of Renografin 76 and protamine sulfate.

Stability of refrigerated and frozen solutions of doxorubicin hydrochloride. Possible incompatibility of doxorubicin hydrochloride with aluminum. Comparative study of the ability of four aminoglycoside assay techniques to detect the inactivation of aminoglycosides by beta-lactam antibiotics. Diagn Microbiol Infect Dis. Study of intravenous emulsion compatibility: Comment on intravenous emulsion compatibility. Rational use of intravenous fat emulsions.

Current status of intralipid and other fat emulsions. Fat emulsion in parenteral nutrition. American Medical Association; Use of Intralipid in neonates and infants. Effect of microwave radiation on redissolving precipitated matter in fluorouracil injection.

Driessen O, deVos D. Adsorption of fluorouracil on glass surfaces. Stability of furosemide in aqueous systems. Gentamicin and ticarcillin serum levels. Louis RH, et al.

Subcutaneous infusions for control of cancer symptoms. J Pain Symptom Manag. Combined infusions of morphine and ketamine for postoperative pain in elderly patients. The pharmaceutical stability of deferoxamine mesylate. Downie G, McRae N. Leaching of plasticizers by fat emulsion from polyvinyl chloride. Heparin stability in dextrose solutions [proceedings]. Bowie HM, Haylor V. Stability of heparin in sodium chloride solution.

Stability of diluted heparin sodium stored in plastic syringes. Standardization of heparin-lock maintenance solution. More on heparin lock. Frequently asked questions about insulin.