Despite recent support for outpatient treatment centers contributed minimally discount silagra 100 mg online, especially in the of pediatric pyelonephritis (13) purchase silagra 100 mg online, these data indicate Medicaid population cheap 100 mg silagra. From 1996 onward 100 mg silagra with visa, the hospitalization rate centers more often than did children with commercial was at least 2. The female-to-male That children with Medicaid visited emergency ratio was at least 5:1 for each year analyzed. Urinary tract infections listed as primary diagnosis among children having commercial health insurance (left) and Medicaid (right) by visit setting and gender. The female-to- counts were low for this diagnosis in children, these male ratio for physicians offce visits by commercially counts and rates were derived by frst collapsing data insured children rose from 4. Circumcision is not a covered diagnosis in children, these counts and rates were service, and families insured through Medicaid may derived by frst collapsing data from the even years in not be able to afford to pay for it out-of-pocket; the 19942000 and then dividing by 4. In the offce setting, adolescents Isolated orchitis is extremely rare in the had lower visit rates than did either infants or older prepubertal male and in most cases is due to the children, regardless of insurance status (Tables 4 and extension of acute epididymitis into epididymo- 5). Most cases occur in adolescents and present 222 223 Urologic Diseases in America Urinary Tract Infection in Children Table 6. The primary differential diagnosis is usage in adolescents may represent an appropriate torsion of the testis or appendix testis. Nonbacterial epididymitis can also result from vasal refux of urine causing an infammatory response. Caution should be used in Despite shorter length of stay for all groups interpreting this trend, because these costs are not analyzed between 1999 and 2001 (Table 12), nominal adjusted for infation. Hence, comprehensive estimates case mix between teaching and nonteaching facilities. Nonetheless, the data suggest that inpatient costs 226 227 Urologic Diseases in America Urinary Tract Infection in Children Table 11. Indirect Cost nosocomial infections though proper catheter Because children do not contribute direct management and to prevent resistance through more economic support in most families, the impact of selective use of antimicrobials are increasing. However, an ill child usually means continuing debate over the roles of both routine work loss for parents and, as such, may generate newborn circumcision and sibling screening for refux substantial indirect costs. Such practices as proper hygiene, good voiding habits, and relief of constipation are the primary methods for preventing uncomplicated infections. Efforts to reduce 226 227 Urologic Diseases in America Urinary Tract Infection in Children Table 12. To ensure proper access to care for all children, investigation is needed into who is and who is not receiving appropriate evaluation. Enhanced awareness of the morbidity and cost of this complication should lead to more judicious use of catheters and improved protocols for their management. National trends in mean length of stay (days) for children hospitalized with urinary tract infection listed as primary diagnosis 1. Length of Stay Parental reporting of smelly urine and urinary tract 1994 1996 1998 2000 infection. Imaging studies after a frst Race/ethnicity febrile urinary tract infection in young children. Urinary tract infection at Hospital Type the age extremes: pediatrics and geriatrics. Newborn circumcision decreases incidence and costs of urinary tract infections during the frst year of life. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. However, they do not readily also the result of infection with a sexually transmitted allow for analyses restricted to cases seen exclusively organism (4). Although Trichomonas pathogens, because this condition is rarely managed vaginalis infection commonly presents as a vaginitis, it by urologists. There were too few visits for syphilis cPrevalence is the total number of cases in the population. Our analyses of all datasets included with long-term sequelae managed by urologists. This may refect differences prevalent cases with chronic manifestations that may in sexual behavior or more effcient transmission from involve extended therapy. There are no herpes are minimum estimates of contacts with health signifcantdifferencesinprevalenceamonggeographic care providers; thus, patient visits for initial episodes regions of the United States. In 1998, the rates seen but because of the increasing incidence, this cost has among male and female Medicare benefciaries were been predicted to rise to $2. Note that Medicare offces per year for genital herpes rose from fewer benefciaries under age 65 include the disabled and than 10,000 in 19661970 to more than 150,000 in persons with end-stage renal disease and are distinct 19952001. The highest rates were seen among women (426 of analysis is the individual patient. However, the datasets we analyzed are rates of patients diagnosed with genital herpes from useful for describing trends in care-seeking behavior 240 241 Urologic Diseases in America Sexually Transmitted Diseases Table 4. A much higher rate of symptomatic, are more likely to prompt medical care visits was observed among women enrollees (88 per and to represent incident infections. Another recent 4044 198 92 (79104) study has underscored the diffculty of using drug 4554 287 61 (5468) claims for acyclovir as a way to estimate the burden 5564 105 29 (2435) of symptomatic genital herpes (11). Overall, the best estimates aThe number of medical visits includes both inpatient visits and of the prevalence of genital warts are based on outpatient visits; however, most medical visits were outpatient visits. Approximately Rate per 100,000 enrollees who were continuously enrolled in a health plan throughout 1999. In MarketScan data, rates of inpatient $1,692 in costs per 1,000 person-years) and men 25 and outpatient visits for genital herpes varied by to 29 years of age (5. Risk factors for developing enrollees in the West to 61 to 72 per 100,000 in the genital warts have been diffcult to assess because other regions. However, urologists and other clinicians who engage in procedures directed at ameliorating genital 244 245 Urologic Diseases in America Sexually Transmitted Diseases Table 9. Therefore, for any warts, of which 207 (66%) were men and 280 (89%) population in a given dataset, the total numbers of resided in urban areas. In 2000, there was a weighted frequency of 315 persons under 65 years of age (16 per 100,000). Counts for 1992 refect the relative lack of specifcity in coding for that year as compared to subsequent years. The highest rates <10 61 25 (1931) were seen among those 20 to 24 years of age (520 1014 92 53 (4264) per 100,000). Rates varied by geographical region, 1519 390 209 (188229) from 127 per 100,000 in the West to 201 per 100,000 2024 597 520 (478562) in the Northeast. A difference was also seen between 2529 458 466 (424509) urban (186 per 100,000) and rural (144 per 100,000) 3034 498 349 (318380) residents. As with genital herpes, the highest rates information on genital warts will require an in-depth of genital warts in 2001 were seen among women (90 understanding of the coding practices of offce-based cases per 100,000 unique outpatients), persons 25 to 34 clinicians with respect to diagnoses and procedures. However, unlike genital women made the majority of outpatient visits for herpes, no consistent trend was seen when comparing genital warts. For example, genital warts in outpatient visits and 18 inpatient visits for genital women are more likely to come to medical attention warts accompanied by a claim for services associated than genital warts in men, if only because women 248 249 Urologic Diseases in America Sexually Transmitted Diseases periodically seek Pap smears. In 2001, a total trachomatis also causes asymptomatic infection that of 783,242 cases (278 per 100,000 population) were can result in serious and costly sequelae if acute reported to the Centers for Disease Control and infection is not treated promptly and properly. These included cases with and Congenitally exposed infants may develop neonatal without symptoms or signs detected during medical inclusion conjunctivitis and pneumonitis syndromes. Forty percent Over the past two decades, there has been a dramatic of the cases of chlamydia were reported among increase in the use of various measures for diagnostic persons 15 to 19 years of age. Chlamydial infection is common through 1998 were too sparse to permit meaningful among all races and ethnic groups, but prevalence interpretation (Table 14). For example, Medicare is generally higher among women than among men hospital outpatient visit rates decreased from 2. Of these tests, rather than a higher underlying incidence of 767 visits, 558 were by women and 209 were by disease. The higher rates observed among women screening guidelines (22), 19% of those 16 to 20 years and persons under 25 years of age may be due in part of age and 16% of those 21 to 26 years of age received to higher rates of screening of younger asymptomatic screening in managed care organizations that reported women during family planning and prenatal care. However, a marked family planning clinics) screen higher percentages of difference was seen between urban (38 per 100,000) women. Inclusion of screening costs for patients with and rural (24 per 100,000) residents. Neisseria species, including those normally in the In the 767 medical visits coded as being for fora of the oro- and nasopharynx, have a similar chlamydial infection in the 1999 MarketScan data, 178 appearance. Culture testing has been the standard drug claims were fled for a recommended or alternate against which all other tests for N.
Phase three commences when the animals have reached and maintained their corresponding body weight reduction for a couple days or weeks and are well within their zone of metabolic disease management purchase silagra 100mg otc. Brain does not usually metabolize ketone bodies for energy unless circulating glucose levels are reduced best buy for silagra, which is correlated with reduced body weight (Owen et al order cheap silagra on line. Specifically buy generic silagra canada, elevated blood glucose levels have been shown to have detrimental effects on disease phenotype and symptomatology (Fabry et al. Similarly, with respect to the ketogenic diet, more is not better, as consumption of excessive amounts of the ketogenic diet will maintain high blood glucose levels and thus result in no disease management (Seyfried et al. Supplementation of vitamins and minerals should also not be a 145 problem as long as their consumption does not change any biochemical or physiological biomarkers (e. Animal data need to be interpreted with caution, as restricted regimens in these animal cases may simply represent a transition from overeating to a healthier diet. Potentially, new dietary formulations can be designed with nutritional and caloric compositions more appropriate for managing neurodegenerative and other types of diseases in humans. This could also involve the use of low glycemic diets, which are effective in maintaining low circulating glucose levels and are easier to implement than some ketogenic diets (Kossoff et al. Upon re-feeding, R-fed mice consumed almost twice as much food compared to their restricted food intake (data not shown), and gradually their body weights matched those of the unrestricted fed mice. Relationship of Circulating Plasma Metabolites in the Management of Neurodegenerative and Neurological Diseases. These values are within normal physiological ranges of glucose and ketones under fasting conditions in mice. Despite these intriguing observations, it is not yet clear what is the exact mechanism(s) for the neuroprotective effect of these diets. The gad1 and gad2 genes are responsible for coding these two isoforms, respectively. Brain tissues were further dissected and separated in left and right cortex, left and right hippocampus, left and right cerebellum, and left and right brain stem. The relative expression of each gene analyzed was normalized to the expression of -actin. Western Blot Analysis One half of the cerebral cortex or the hippocampus tissue from each dietary group were homogenized in either 500 ml or 200 ml of ice-cold 1X Lysis buffer (Cell Signaling), respectively. Lysates were transferred 0 to Eppendorf tubes, mixed for 1 hr at 4 C, and then centrifuged at 8,100 x g for 20 min. The specific ratio of the indicated protein to -actin was analyzed by scanning densitometry (FluorChem 8900 Software). Furthermore, we sought to determine whether our system is able to detect accurately even the smallest changes on protein expression levels. Interestingly, reports of altered gene expression in epilepsy are inconsistent, probably due to discrepancies from the experimental models used. Finally, previous findings have shown inflammation to be linked with seizure activity and vice versa (Jankowsky and Patterson, 2001; Peltola et al. For positive and negative controls, fasted brain (F), or Tumor (T) were used respectively. The results in this thesis showed that colorie restricted diets had a positive influence 308/y on the anxiety behavior and motor characteristics in Mecp2 mice. These findings indicate that 201 calorically restricted diets may be of clinical importance in improving various aspects of the behavior in individuals with Rett. Although comparisons of a variety of age-related changes have been made between energy-restricted and unrestricted animals in an effort to identify the specific physiological and biochemical processes that may mediate the improvement of the disease phenotype, many studies fail to provide a standardized regimen for diet implementation. This thesis sought to address some of the issues of diet implementation in disease management and to provide guidelines for data interpretation. The points raised in this thesis will help facilitate data analysis across various disease animal models and studies, as well as provide insight on the mechanism(s) by which restricted diet therapies might manage neurological and neurodegenerative diseases. Moreover, these diet implementation guidelines, on a standard calorically restricted paradigm for disease animal models, should maximize the therapeutic efficacy of these diets while facilitating cross-study comparisons and data interpretation. We suggest that the transition from glucose to ketone bodies as a major energy fuel for the brain produces multiple changes in gene-linked metabolic networks. It is these changes that gradually adjust neurotransmitter pools and membrane excitability to restore the physiological balance of excitation and inhibition (Greene et al. In addition, ketone body metabolism could increase membrane ionic pump activity (Kaur and Kaur, 1990; Veech et al. Increased pump activity could increase membrane potential in neurons while also increasing neurotransmitter uptake in glia (Greene et al. Perspectives on the Metabolic Management of Epilepsy Through a Dietary Reduction of Glucose and Elevation of Ketone Bodies. A dietary reduction in blood glucose levels will increase ketone utilization for energy. This is expected to shift the neural environment from excitation to inhibition through multiple integrated systems. Implementation of calorically restricted diets for the management of neurological and neurodegenerative disease in murine models (in preparation). Although, in epileptic mice several genetic alterations have been shown to be epileptogenic, no specific mutation relating to glutamatergic function has yet been linked to human epilepsy (Chapman, 1998). Although, this region of chromosome 9 had not been previously associated with seizures in other animal epilepsy models and no epilepsy locus has been mapped on human chromosome 11, which is syntenic to the region on mouse chromosome 9 containing El-N (Todorova et al. Sequencing reactions were performed at 96C for 20 s, 50C for 20 s, and 60C for 240 s based on a 32 cycle reaction. This caused a C->A transition, but resulted 214 in no amino acid change (Table 1). It is 215 not yet clear if this later discrepancy represents an error in the already published GenBank GluR4 sequence or a population genetic variation among B6 mouse strains. However, we cannot exclude the possibility that GluR4 expression might be influenced by different seizure testing environments (Naka et al. At pH 7, the formation of acetoacetate can also be determined from the + above reaction without modifications. Increasing the pH above 7 (lowering [H ]) the formation of acetoacetate can still be determined by shifting the equilibrium to the right. Molecular Devices SpectraMax M2 or M5 microplate reader with a 340 nm excitation filter (wavelength). Eppendorff repeater Plus pipette (2-20 l volume), plus regular p20, p200, and p1000 pipettors. If acetoacetate remains in the rxn it can drive reaction backwards thus interfering 222 with the accurate estimation of -hydroxybutyrate. The acetoacetate is removed in a shift base reaction (see below) and the proton is captured by the high pH. To run assay for a whole half size plate take 150 l from enzyme stock and add 240 l of ddH2O (a 2. Collection and Perchloric acid Treatment of blood (This step is optional since assay can be done on plasma or serum alone too) 1. Centrifuge sample for 2 minutes at ~12,000 rpm on table centrifuge (or maximum speed). Let partially neutralized solution sit on ice for 15 minutes (longer incubation will result in complete neutralizationup to 1-2 hrs) with top open. Notes: If you do not neutralize your sample with a base, the perchloric acid will degrade your -hydroxybutyrate, thus making the above reaction go slower. Centrifuge solution at about 12,000 rpm for 4 minutes and then aspirate supernatant to new tube for usage in the assay. Cocktail Reagent Buffer: (sufficient for a full half size microplate at 50 l of cocktail/well) Amount Concentration in Reagent Concentration in (ml) cocktail (mM) well (mM) 0. Cocktail should be stored at room temperature after it is prepared and while waiting to run assay. Prepare a standard stock solution of -hydroxybutyrate at a concentration of o 165 mM in ddH2O. Notes: To prepare a 165 mM stock standard solution of -hydroxybutyrate, dissolve 0.
Screening for asymptomatic internal carotid artery stenosis and aneurysm of the abdominal aorta: comparing the yield between patients with manifest atherosclerosis and patients with risk factors for atherosclerosis only buy silagra in united states online. Prevalence of risk factors buy silagra toronto, coronary and systemic atherosclerosis in abdominal aortic aneurysm: comparison with high cardiovascular risk population purchase cheap silagra on-line. Incidental Abdominal Aneurysms: A Retrospective Study of 13 115 Patients Who Underwent a Computed Tomography Scan 100mg silagra with amex. Materials and methods The study has a prospective character and was conducted over a period of 5 years, between 2006 and 2011 on a batch of 196 patients admitted to the Cardiology Ward of the Constantin Opris County Emergency Hospital of Baia Mare or investigated within Ambulatory Cardiology clinics. The subjects were followed by performing cardiology clinical reassessment every 6 months during the study. The patients in the study group were monitored regarding all-cause and cardiovascular mortality rate. Validation of those events was performed by studying the hospital discharge papers and death certificates, confirmed by telephone calls with the treating physicians or specialists if the adverse events occurred in another hospital unit. Survival data were described by presenting the number of deaths, censored data and the survival percentage at different points in time and the quantiles of survival associated with 95% confidence intervals, respectively graphically by the Kaplan-Meier survival curves. Comparisons between groups regarding the survival data were made using the log-rank test. We calculated the hazard ratio for different explanatory variables to assess their association with the survival rate, using Cox regression analysis. Results We studied the presence of carotid artery intima-media thickness through vascular ultrasound at this level. We considered the average carotid intima thickening at levels higher than or equal to 1 mm. If focal atherosclerotic plaques were present, they were included in the calculation. Aortic stenosis is commonly associated with posterior mitral annular calcification. In our study posterior mitral annular calcification occurred in 140 patients, accounting for 71. The probability of survival in the presence of posterior annular calcification Of 196 patients 140 had posterior annular calcification and of these 51 died. The probability of survival in the presence of posterior annular calcification Absence of mitral annular Time Mitral annular calcification Survival rate % calcification 12 82. The evolution of the probability of survival related to the carotid intima-media thickness index is shown in Chart 2. The probability of survival related to the presence of carotid intima-media thickening associated with posterior mitral annular calcification. There is a great variability in the duration of the latency period and the disease progression. Posterior mitral annular calcification is seen in patients who develop significant atherosclerosis and is more frequently found in the elderly. Several ultrasound studies demonstrate an important association between Medimond. The presence of posterior mitral annular calcification should be considered as an important clinical parameter. Individuals with posterior mitral annular calcification have a higher prevalence and risk of ischemic heart disease, stroke and cardiovascular mortality. It is no less true that patients with a rapid development of valvulopathy have a poorer prognosis. Up to the present no methods have been available for risk stratification and appropriate individual management of these patients. It is estimated that half of the cardiovascular events, including sudden cardiac death appear in asymptomatic individuals; therefore screening has a major importance both for the deceleration of myocardial ischemia and for the estimation of cardiovascular risk. Also, the survival rate of patients who have carotid artery intima-media thickening associated with posterior mitral annular calcification is significantly reduced. Association of mitral annulus calcification, aortic valve calcification with carotide intima media thickness. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. An early sign of this pathogenesis is the development of endothelial dysfunction, which is accompanied by impairment of vessel relaxation and responsiveness. A key factor in the multi-step development of atherosclerosis is the expression of cellular adhesion molecules, which are active in the recruitment and adhesion of leukocytes to endothelial cells and transmigration of leukocytes into the subendothelial space of vessels, leading to the development of atherosclerotic plaque. They are transmembrane glycoproteins that mediate cell-cell and cell-extracellular matrix interactions [1-4] and intracellular signalling pathways. Their basic structure consists of an extra-cellular component with binding domains that interact with other adhesion molecules or components of the extracellular matrix, a hydrophobic transmembrane component and an intracytoplasmic component, which mediates interactions with the cell. This accumulation involves several steps (known as the leukocyte adhesion cascade) and cell types including T and B cells, monocytes and macrophages, dendritic cells, and natural killer cells. Capture of the leukocytes involves tethering, rolling, firm adhesion and transmigration into the subintimal space. Unique combinations of endothelial adhesion molecules and chemokines direct tissue-specific migration of leukocytes and control the various steps in the cascade. Each of these studies was limited to mature adults and the possibility of significant progression toward cardiovascular disease. Progression of coronary artery calcification and both carotid artery stenosis and intima media thickness were measured as indicators of subclinical disease. Dietary patterns have been associated with cellular adhesion markers in cross-sectional studies. Our current objective was to study prospective associations of three dietary patterns with cellular adhesion molecules. Multivariable linear regression models predicted year 15 cellular adhesion molecules from averaged (year 0/7) dietary patterns. Wagner, Prominent Role of P-Selectin in the Development of Advanced Atherosclerosis in ApoE-Deficient Mice. We decided to investigate the impact of ambulatory blood pressure monitoring on patient management. Our retrospective study included 633 studies on 364 patients over the span of over 18 years. The study sample was 62% male and 38% female and ranged from 18 to 96 years of age. In patients who had more than one test, the shortest span between tests was 7 months. Tests were classified as normal (exhibiting satisfactory distribution of blood pressure with minimal deviation), as abnormal high (three or more readings over 140 mmHg, or as abnormal low (three or more readings below 80 mmHg). We also analysed the distribution of blood pressure abnormalities throughout the twenty-four hours recording by the time of day of their occurrence and the subsequent effect on physician recommendations. In conclusion, 24-hours ambulatory blood pressure monitoring is a very valuable tool in assessing uncertainties of blood pressure control. Introduction Blood pressure control requires the optimization of blood pressure at any time of day or night. In-office and clinical measurements may not reflect a patients true blood pressure profile. We opted to use twenty-four hour ambulatory blood pressure monitoring to determine a patients out-of-office blood pressure readings. Instances of abnormally high blood pressure readings in clinical settings, also known as white-coat hypertension, can be separated from true chronic hypertension. The monitor records the blood pressure every hour over a period of twenty-four hours. Results are obtained and discussed immediately with the patient following the test conclusion. In a normal test, the patient is reassured and encouraged to adhere to current management. There is insufficient evidence to suggest that the percent of abnormal blood pressure readings detected differs across the different reasons for initiating the test. The distribution of blood pressure abnormalities by the time of day of their occurrence.
According to the Hungarian surgical belief buy silagra overnight delivery, Victor Fischer (an ingenious designer of surgical instruments) was the inventor of the first surgical stapler that was used by Hmr Htl 100mg silagra mastercard. In 1912 generic silagra 50mg free shipping, Ramstedt described a new technique to save the life of the infants suffering from spastic hypertrophic pyloric stenosis order generic silagra online. His electrosurgical unit let the high frequency alternating current pass through the body allowing it to cut or coagulate (electrocautery). With the support of the Charite in Berlin, they opened the Institute of Medical Cinematography. They put a camera above the operating table which was electrically directed and could make films from operations. He was the first who performed a pulmonectomy in a patient who was suffering from bronchiectasia. In order to prevent injuries of the lung while getting through the thoracic wall, Veres used his own new, special, spring- loaded needle to create safely an artificial pneumothorax which was a technique for treatment of the tuberculosis at that time. The instrument (Veres-needle) is spreaded world-wide in creating pneumoperitonuem during laparoscopy. In the Johns Hopkins Hospital, he performed the first successful operation on a cyanotic infant (blue- baby), who had a syndrome of tetralogy of Fallot. The transplanted kidney functioned well at the begining, but they had to reoperate the patient 10 months later, when they found a shrunken and pale kidney graft. This produced an ambivalent opinion in the public: You are dead when your doctor says you are. In 1966, the French Medical Academy for the first time used the irreversible injury to the brain as a factor to establish (determine) the death instead of the cardiac standstill. The donor heart came from a 24-year-old woman, who had been killed in a road accident. Washkansky survived the operation and lived for eighteen (18) days when he died due to a severe infection. Erich Mhe (1938-2005) performed the first laparoscopic cholecystectomy in Bblingen. That time, the German surgical society degradated the method as the keyhole surgery. Friedrich-Wilhelm Mohr (1951- ) using the Da Vinci surgical robot performed the first robotically assisted cardiac bypass in the Leipzig Heart Centre (Germany). In New York Jacques Marescaux used the Zeus robot to perform a laparoscopic cholecystectomy on a 68 year old woman in Strasbourg (France). The human use of the technique promises the reduction of postoperative pain (no pain surgery), the decrease in possibilty for adhesion, and the elimination of postoperative abdominal hernias. Operating theatre Operation All such diagnostic or therapeutic interventions, in which we disrupt the body integrity or reconstruct the continuity of the tissues are called operations. Layout and equipments of the operating room We talk about two types of operating theatres: septic and aseptic ones. In the aseptic operating theatre the danger of bacterial infection does not usually exist (e. The essence of it is: always to prepare the surgical area for the patient in a way that we do not put him (or her) in a danger of infection. Before entering into the operating room, you should change your dresses in the dressing (or locker) room (of the operating complex) and wear the surgical cap and the face mask. The patients are brought into the operating theatre with the help of a specifically used transporting chair or bed- after passing through a separate locker room (of the operating complex). The operating theatre is a 50-70 m room, which does not usually have any windows. The operating complex must be architecturally separated from the wards and the intensive care unit. The operating complex consists of: locker rooms (dressing rooms), scrub-up area, preparing rooms, and opearting theatres. It is equipped with central and portable vacuum system, as well as pipes for gases. Only those people whose presence is absolutely neccessary should stay in the operating room. Activity causing superfluous air flow (talking, laughing, and walking around) should be avoided. Entry into the operating theatre is allowed only in operating room attire and shoes worn exclusively in the operating room. This complete change to the garments used in the operating theatre should also apply for the patient placed in the holding area (i. Movement into the operating room out of the holding area is allowed only in a cap and mask covering the hair, mouth and nose. General rules of asepsis concering the personnal attire Taking part in an operation is permitted only after surgical hand washing and scrubbing. Surgical team members in sterile attire should keep well within the sterile area; the sterile area is limited by isolation. Scrubbed team members should always face each other, and never show their backs to each other. Non-scrubbed personnel should not come close to the sterile field or the scrubbed sterile person, they should not reach over sterile surfaces, and they should handle only non-sterile instruments. Behaviours and movements in the sterile operating room The personnel is always keeping in mind the rules of asepsis while moving: they face each other and the sterile territory (e. Sterile hands must not touch the cap, the mask or the nonsterile parts of the gown. You must not stretch out your hand to attempt to catch falling instruments and you are not allowed to pick them up. Do not take any instrument from the instrument stand; ask the scrub nurse to give it to you. General rules of the aseptic opereating room Only sterile instruments can be used to perform a sterile operation. The sterile instrument will stay so if only the sterile person touch it (or if it comes in contact with only a sterile object). If a sterile instrument comes in contact with an instrument of doubtful sterility, it will loss its sterility. In a wider sense, the asepsis means such an 14 ideal state when the instruments, the skin, and the surgical territory do not contain microorganisms. Antisepsis Includes all those procedures and techniques designed to eliminate contamination (bacterial, viral, fungal) present on objects and skin by means of sterilization and disinfection. Because skin surfaces and so the operating field and the surgeons hands can not be considered sterile, in these cases we can not talk about the superficial sterilization. In a wider sense, antisepsis includes all those prophylactic procedures designed to ensure surgical asepsis. A careful scrub and preparation of the operative site (cleansing and removal of hair) is necessary. In septic and high-risk patients, there is a need for perioperative antibiotic prophylaxis. Hypothermia and general anesthesia both induce vasodilatation, and thus the core temperature will decrease. Hand washing is mandatory and the use of sterile gloves is compulsory while handling wound dressings and changing bandages during the postoperative period. Sterilization, disinfection Sterilization This involves the removal of viable microorganisms (including latent and resting forms such as spores) which can be achieved by different physical and chemical means and methods. Important methods which are used frequently: autoclaves, gas sterilization by ethylene oxide, cold sterilization, and irradiation. Disinfection This is the reduction of the number of viable microorganisms by destroying or inactivating them. Surgical hand scrub and surgical area disinfectioning are considered as disinfectining procedures. Scrubbing Changing the clothes Entry into the operating theater is allowed only in operating room attire and shoes worn exclusively in the operating room. Surgical cap, face mask The surgical team members should wear surgical caps and face masks before entry into the operating room. Srubbing, surgical hand disinfection Surgical hand scrub should be done before any operation and sterile intervention.