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As it becomes severe generic amoxicillin 250 mg free shipping symptoms tuberculosis, your get oxygen 500mg amoxicillin visa treatment 4 hiv, blood pressure drops effective 500 mg amoxicillin medicine 5513, damaging the among other heart generic amoxicillin 250 mg visa medications 44334 white oblong. A level over 10% emia levels over 10) cause problems, but the 16 can be mechanism isnt clear, fatal. Jaundice When the bilirubin levels reach 2, you The bilirubin 5% may start to see a yellowish tint in the poisons your whites of the eyes. How tumors could cause this is considered a mystery, but I find maleic anhydride is the culprit. Hypothrombo- If you dont have enough platelets, you Heart failure, 1% cytemia cant stop bleeding internally or exter- among other nally. Of course classical thinking is that cancer is responsible for all the symptoms described above, so the cause of death in all these cases is cancer. My evidence suggests the op- posite: there are two separate battles, tumors, and the toxins re- sponsible for them. I have seen many people conquer their tu- mors, only to succumb to some aspect of toxicity. Not for a moment am I suggesting I can give you a medical school course in one chapter, but I want to emphasize that there are many things you can learn from your X-ray that dont need great expertise to un- derstand! Because they are precious, your doctor is justifiably reluctant to give them to you, even on loan. Tape your negatives to a window that lets in bright light to give you good visibility. Some scans include a diagram to show you where in the body the pictures were taken. If you have numerous nega- tives choose a few that show the problem most clearly; they may have already been marked by the radiologist. It is not necessary to learn the names of ana- tomical parts to recognize that they are not normal! On the left view of lungs side, marked L on the nega- tive, a slanting edge marks the heart. Frames taken very close together (a few millimeters) will be able to spot things that are only a few mm in size. The dark areas are the lungs, white specks are the tracheoles with their lymph nodes. Pres- sure due to fluid buildup, edema, is the usual cause of displace- ment of the centerline. The tumor itself is identifiable as an extra dense region that is not shaped as normal brain tissue should be; the shape is compared to the opposite side that is normal and healthy. Ultrasound uses sound waves instead of radiation, is also non-invasive, and in- expensive. Although they may be of equal size in your body, one might be placed higher than the other so a cross section may make them appear dissimilar. If the frames are closely spaced, a nodule can be found that may be missed on an ultrasound. If the prostate becomes enlarged, it pushes against the bladder, indenting it with a cookie bite like ap- pearance. The prostate gland should have a smooth external edge and a homogeneous internal ap- pearance. The radiologist calculates its weight from its dimensions, often given on the ultrasound. Pictures taken at dif- ferent angles will give different lengths and widths; such variations should be taken into consideration. A bone scan views all the bones in your body, from the skull to your toes in one small picture. An injection of radioactive techne- tium (an element) is given first, al- lowed to find its way to the bones (three hours) followed by imaging of your radiating bones! The regions where the technetium has accumulated will show up as intensely white hot spots. These hot spots are cancerous bone lesions, to be distinguished by the radiologist from mere inflammatory or benign lesions. You will be able to identify some of the hot spots yourself by matching them with your pain locations. There will alwaysor at least for yearsbe a region of low bone density at these locations. For this reason, a follow up X- ray or bone scan can never be expected to appear totally normal. But the hot spots will be gone and former lesions that were small can disappear, leaving only the evidence of former severe bone lesions. Use your orientation to understand the scans in the case histories that come next. The more of these you look at, the easier it is to see things that should or should not be there. They were not selected because they were all successful, indeed, some of the earliest ones were hampered by our lack of understanding. These true stories were selected simply on the basis of having confirming before-and-after evi- dence of what the treatment did for them. Naturally the names have been changed to ones randomly selected from a telephone book to protect the privacy of the patient. But each one taught a new lesson, sometimes at great cost, and for that reason the knowledge in this book is priceless. She was in pain from top to toe, especially at the back of her head and neck and the bottom of her spine. Her daughter, who came with her, could easily see the downward trend; her mother could only sit and had dropped below 90 lb. She felt a lump in her abdomen that she could not explain and her bowels had not moved for days. When a tissue slide is included in the circuit, only problems at this tissue are detected. Other testing we did included isopropyl alcohol (Negative: cancer suf- ferers always test positive to this, but Katherine had already stopped using all items on the isopropyl alcohol list); lead and vanadium (Negative); asbestos (Positive: she must stop using her dryer); arsenic (Positive: she must clear all pesticide from her home); fiberglass (Negative). Staphylococcus could certainly be hiding in a cavitation and we would do a careful inspection. Katherine was to start taking the kidney herbs, kill parasites regularly, zap daily, and take two teas she could make herself at home. She would also take 1 tablespoon of moose elm (also called slippery elm) made into a cup of half and half. All this could have overwhelmed Katherine, but her daughter took on the tasks eagerly. She had begun to have bowel action the previous day; the alginate had found its way through. But albumin, her precious liver protein, was too low and iron was frighteningly low (35! Note: instructions in the current 21 Day Program can be dif- ferent from those given a few years ago. These two would eventually replace her heart medicine by supplying what the heart really needed.

These concepts empha size the utility of antioxidants in the prophylaxis and treatment of periodontal disease and therefore justify the search of new antioxidant preparations for this purpose order 250mg amoxicillin amex medicine you can give dogs. In some cases cheap 500 mg amoxicillin medications drugs prescription drugs, however purchase amoxicillin 500mg with visa medicine 6 times a day, the inflammation occurs regardless of these fac tors cheap amoxicillin 250mg without a prescription treatment viral pneumonia, suggesting the existence of other stimulating immune. Although its magnitude is relatively low, its impact on affected patients and their costs in health systems is high. There is a considerable variation in the incidence and mortality rates around the world. Squamous cell cancer of the posterior lateral border of the tongue in a 28-year-old woman. In a very general overview, the balance between tu mor suppressor genes and those genes that induce cell cycle is altered. Allowing cells to es cape cell cycle control and developing an unpredictable biological behavior. Subsequently, the cells express molecules that allow them to acquire an invasive phenotype, a phenomen on known as epithelial-mesenchymal transition. Free radicals are products of the oxidation-reduction systems of the cell and its participation in cellular metabolic functions is essential for cell survival. The involvement of free radicals in cancer development has been studied for 3 decades, and there is sufficient evidence that implicates theirs in the multistage theory of carcinogenesis. It should be added that oxidative protein damage participates in facilitating the development of cancer. The results agree that there is an imbalance between the high amount of free radicals and insufficient antioxidant system activity. Added to this, some researchers have observed that high levels of lipid-peroxidation combined with low levels of thiols and anti oxidant status, correlate with poor survival rate in patients with oral cancer [16]. It is considered that the smoke from cigarettes have 4000 chemicals, 40 of which have carcinogenic potential. It has been shown that ciga rette smoke contains pro-oxidants that are capable of initiating the process of lipid-peroxida tion and deplete levels of antioxidants from the diet [17,18]. In contrast, there is epidemiological evidence that demonstrates the protective effect of diet on some populations [19-21]. For example in Greece, which has the lowest rates of oral can cer among European countries,its population is exposed to latent risk factors such as alcohol intake and smoking; micronutrients consume such as riboflavin, magnesium and iron corre lated inversely with oral cancer [19]. Consequently, several authors have proposed the ingestion of diverse exogenous antioxi dants; supporting in those epidemiological studies, where the diet offers protection for the development of cancer, and taking into account that the endogenous antioxidant systems have been overwhelmed by oxidative stress. For example, vitamin C is one of the most extensively evaluated antioxidants in oral cancer alternative co-therapies. Low or even undetectable levels of vitamin C correlate with the presence of oral cancer [17, 22]; in contrast, is one of the micronutrients that have a consis tent inverse correlation in different studies [23]. Vitamin C acts as a scavenger of free radicals and impedes the detrimental chain reactions triggered by the free radicals. The l-glutamine is administered in the diet as a complementary ther apy; the proposal is that restores glutathione cascade system [15]. Even more,when them are administered together during the cycles of radiotherapy [25]. Author details Mario Nava-Villalba, German Gonzlez-Prez, Maribel Lian-Fernndez and2 3 Torres-Carmona Marco4 *Address all correspondence to: marionava23@gmail. AutonomousUniversity of Quertaro, Quer taro, Mxico 3 Dentistry Department, School of Medicine. AutonomousUniversity of Quertaro, Quer taro, Mxico 4 Dentistry Department, School of Medicine. Periodontitis in individuals with diabetes treated in the public health system of Belo Horizonte, Bra zil. The effect of intensive oral hygiene care on gingivitis and periodontal de struction in Type 2 diabetic patients. Relationship of oxidative stress with periodontal disease in older adults with type 2 diabetes mellitus. Por phyromonasgingivalis Peptidoglycans induce excessive activation of the innate im mune system in silkworm slrvae. Oral cancer prevention and control- The approach of the World Health Organization. Evaluation of oxi dative stress and nitric oxide levels in patients with oral cavity cancer. Oxidative stress in lymphocytes, neutrophils, and serum of oral cavity cancer patients: modulatory ar ray of l-glutamine. Lipid peroxidation, total antioxidant status, and total thiol levels predict overall sur vival in patients with oral squamous cell carcinoma. Status of serum vitamin C level and peroxidation in smokers and non-smokers with oral can cer. Erythrocyte malonilaldheyde and antioxidant status in oral squamous cell carcinoma patients and tobacco chew ers/smokers. Diet in the etiology of oral and pharyngeal cancer among women from the southern United States. Ef fect of oral antioxidant supplementation on lipid peroxidation during radiotherapy in head and neck malignancies. Introduction Aging is an extremely complex and multifactorial process that proceeds to the gradual dete rioration in functions. Traditionally researchers focused primarily on understanding how physiological functions decline with the increasing age; almost no research was dedicated to investigation of causes or methods of aging intervention. If scientists would discover a drug for healing all major chronic degenerative diseases, the average lifetime would be increased for just 12 years. Defects formed in human body as a consequence of the aging process start to arise very ear ly in life, probably in utero. In the early years, both the fraction of affected cells and the aver age burden of damage per affected cell are low [1]. The signs of aging start to appear after maturity, when optimal health, strength and appearance are at the peak. Aging theories Scientists estimated that the allelic variation or mutations in up to 7,000 relevant genes might modulate their expression patterns and/or induce senescence in an aging person, even in the absence of aging specific genes [4, 5]. As these are complex processes they may result from different mechanisms and causes. Consequently, there are many theories trying to ex plain the aging process, each from its own perspective, and none of the theories can explain all details of aging. The aging theories are not mutually exclusive, especially, when oxida tive stress is considered [6]. Mild oxidative stress is the result of normal metabolism; the resulting biomolecular damage cannot be totally repaired or removed by cellular degradation systems, like lysosomes, pro teasomes, and cytosolic and mitochondrial proteases. Since extensive research on the relation between polymorphisms likely to accelerate/decelerate the common mechanisms of aging and resistance to the oxidative stress has been neglected in almost all scientific stud ies, the data do not allow us to conclude that the oxidative theory supports the theory of programmed aging so far [7]. However, the most recent studies support the idea that oxida tive stress is a significant marker of senescence in different species. Resistance to oxidative stress is a common trait of long-lived genetic variations in mammals and lower organisms [5, 12]. Free radical theory, oxidative stress theory and mitochondrial theory of aging Denham Harman was first to propose the free radical theory of aging in the 1950s, and ex tended the idea to implicate mitochondrial production of reactive oxygen species in 1970s, [13]. According to this theory, enhanced and unopposed metabolism-driven oxidative stress has a major role in diverse chronic age-related diseases [13, 14, 7]. Harman first proposed that normal aging results from random deleterious damage to tissues by free radicals [14] and subsequently focused on mitochon dria as generators of free radicals [13]. Halliwell and Gutteridge later suggested to rename this free radical theory of aging as the oxidative damage theory of aging [22], since aging and diseases are caused not only by free radicals, but also by other reactive oxygen and ni trogen species. Increases in mitochondrial energy production at the cellular level might have beneficial and/or deleterious effects [23].

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Biochemical indices are also affected by drugs that alter nutritional status of some nutrients discount amoxicillin 500mg overnight delivery medicine norco, particularly folic acid buy 500 mg amoxicillin amex medications equivalent to asmanex inhaler, the fat-soluble vitamins buy amoxicillin 500mg without a prescription medicine you can take while pregnant, and calcium generic amoxicillin 500 mg overnight delivery xerostomia medications that cause. Enteral or parenteral nutrition may be required if a patient is unable to maintain weight or if a patient has significant intestinal dysfunction (41). Skin fibrosis of the fingers may make it difficult to eat and write or to handle objects in shopping or cooking. Raynauds phenomenon involves vasoconstriction with resulting symptoms of cold hands and feet and changes in skin color on the fingers and toes (25). The patients with moderate to severe Raynauds phenomenon had greater difficulty in performing activities that involved hand use (i. Reduced grip may increase difficulty in preparing food and fibrosis in the face may limit movement of the lips and mouth (25). Hand disability may result from tight skin (43), swelling, hand contractures (25) or ulcerations (25,43); eating dysfunction seems to be the most closely associated hand disability (43). Fecal incontinence (25,41) or urgency (41) may be a sign or symptom of dysfunction in the lower gut. Estimates of its prevalence are unknown (45), but it is estimated to be up to 10 cases per 1 million people (46). The disease manifests with proximal muscle weakness developing in a few weeks or months (4547). The muscle weakness is symmetrical and the pelvis and shoulder muscles are most commonly affected in these patients, but the neck muscles, primarily the flexor muscles, can also become weak and this is found in about 50% of the patients (46). Degraded muscle fibers may be replaced with fibrous connective tissue, fat, or simply atrophy (46). The stiffness and muscle weakness also make it difficult to take anthropometric measurements in some patients. The patients neck flexor muscles may be so weak that raising the head to stand erect for a standing height is not possible. Nausea may compromise an individuals desire to eat, further compromising nutritional status. Corticosteroids may also contribute to further muscle wasting, weakness and loss (46). Immunosuppressive drugs, particularly azathioprine and methotrexate, may be prescribed if the corticosteroids do not sufficiently improve muscle strength (4547). Side effects of these drugs often compromise nutritional status when the patient experiences anorexia, nausea, diarrhea, and altered taste. Patients may show signs and symptoms of hypoxemia and dyspnea (46), which may decrease food intake owing to shortness of breath. Dysphagia is common in patients with weakened esophageal and pharyngeal muscles, and may increase risk of aspiration (4547). It is important for dysphagia to be documented in the medical chart and for corrective actions to be taken. Pelvic muscle loss may result in difficulties in toileting and rising from a sitting position. The major nutritional assessment challenges are anthropometricobtaining sound estimates of fatness status and stature. During flares the individual may be unable to eat at all or may only be able to eat very small amounts of food. Systemic lupus erythematosus is a disease that is much more common in women then men. Dietary and nutritional assessments are similar in most respects to other rheumatic disease. The unique feature of assessment in systemic lupus erythematosus is the need for very careful assessment of kidney function because the disease affects the kidneys and may eventually lead to kidney failure. Careful consideration of a patients nutritional status using basic principles of assessment, and addressing problem areas, can contribute to a patients overall well-being. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, 2000. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. A practical approach to nutrition in the patient with juvenile rheumatoid arthritis. You are what you eat: healthy food choices, nutrition, and the child with juvenile rheumatoid arthritis. The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation. Measurement of health status, functional status, and quality of life in children with juvenile idiopathic arthritis: clinical science for the pediatrician. Rheumatoid cachexia: cytokine-driven hyperme- tabolism accompanying reduced body cell mass in chronic inflammation. Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. Systemic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Measuring disease activity and functional status in patients with scleroderma and Raynauds phenomenon. Gout Assessment Question- naire: initial results of reliability, validity and responsiveness. The content and properties of a revised and expanded arthritis impact measurement scales health status questionnaire. Bundy Summary Heterogeneity in clinical presentation and variability in disease course of rheumatic diseases pose a significant problem in describing the epidemiology of these conditions. Unlike cardiovascular disease, diabetes mellitus, and many cancers, the heterogeneity in clinical presentation and variability in disease course of rheumatic diseases pose a significant problem in describing the epidemiology of these conditions. This chapter presents an overview of some of the important issues in rheumatic disease epidemiology and it provides a summary of epidemiologic features of major rheumatic diseases. It is broadly defined as the study of the distribution and determinants of health-related events or conditions in populations (2). The goal of the epidemiologist is to identify risk factors From: Nutrition and Health: Nutrition and Rheumatic Disease Edited by: L. Primordial prevention, a relatively new concept coined by Strasser (4), includes efforts directed to the general population that prevent the emergence of disease risk factors. These can include changes in social or environmental conditions that favor the development of disease risk factors. Because many diseases share the same risk factors, primordial prevention efforts can have a wide impact on multiple diseases. Primary prevention protects health by eliminating or modifying risk factors in susceptible people. Using antibiotics to treat strep throat is an example of a primary prevention of rheumatic heart disease. Secondary prevention refers to early detection of a disease for prompt intervention and treatment to minimize disability. This type of prevention could include early detection of repetitive strain injuries to prevent further tissue damage. Finally, tertiary prevention is actions to prevent or minimize the impact of long-term complications and disability of a disease. Hip replacement to reduce pain and provide improved mobility from degenerative joint disease is an example of a tertiary prevention effort. Primary Epidemiological Study Designs In working toward the ultimate goal of preventing disease, epidemiologists use a variety of study methods to understand the frequency of disease, uncover risk factors, and design interventions to modify disease risk factors. These study designs, some of which are shown in Table 2, have various strengths and limitations.

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On examination 2months later in another hospital she was found to have a high 1cm vesicovaginal fistula purchase amoxicillin 500mg free shipping treatment anemia, which was Hypertension and diabetes are more difficult to treat discount amoxicillin 500 mg otc treatment quinsy, contiguous with the cervix cheap amoxicillin 500 mg with visa medicine 8162, which was torn and ragged best 500 mg amoxicillin treatment xdr tb. Preferably insert the suture at 14wks, when the danger of an early miscarriage is passed. Insert a #2 monofilament nylon (or special cerclage suture) superiorly in the outer surface of the cervix, near the level of the internal os, about 3mm under the surface of the cervix staying more or less at the same depth in the cervix for 90-120 and then let your needle come out. Continue to reinsert the sutures in the cervix near the place where your previous insertion exited the cervix at regular intervals as shown, so as to encircle it. Then tighten the suture round the cervix and knot in such a way that when it is tightened it would still be easy to insert scissors between the knot and the cervix. This is so that, later at 37wks or when in labour, you can cut on one side of the knot. Make a drawing to show where the knot is to facilitate removal when it is time Fig. A, the position of the Review every 2wks, and insert a speculum or examine suture. Partly from Bonney V, Gynaecological Surgery, Baillre Tindall, 2nd ed 1974 with kind permission. Remove the suture immediately if: (4) Local vaginal or possibly intra-uterine infection. Very occasionally implantation is in the abdominal cavity (2) You have explained precisely what you are going to do, (20. Trouble occurs either because the and that the suture must be removed at 37wks, tube ruptures, or because the gestation aborts through the or when labour starts. The periods are usually a few days to a few months late, and she may rightly think she is pregnant. Or, she may not think she is pregnant because: (1) the tube may rupture before she has missed a period. If the period of amenorrhoea is short, before the symptoms start, gestation is likely to be in the isthmus, and the effects of rupture worse. An acute rupture presents as a sudden severe lower abdominal pain, with signs of hypovolaemia. Peripheral shutdown, tachycardia and drop in blood pressure ensue as shock progresses. D, the uterine the onset of the pain, as the decidua are shed if the bleeding part of the tube. A subacute rupture typically presents with a history of 3-7days of weakness, anaemia and abdominal swelling, The common sites (20-3A,B) are the distal of the tube. The lower abdomen may be tender, Here, the results may be: with rebound tenderness and guarding, but these signs are (1);an acute or subacute rupture 6-10wks after the last often minimal. Blood irritating the diaphragm may cause period, referred pain at the tip of the shoulder. The presentation may (2) a tubal miscarriage, in which the foetus is expelled into be with diarrhoea and vomiting in up to 40% of cases. Instead, chronic bleeding may continue slowly urgent; you should perhaps cross-match blood first. A chronic ectopic gestation presents as lower abdominal In the uterine part of the tube (20-3D), it ruptures early. Both close to the internal os (20-3G), The diagnosis is usually easy when there has been massive resulting in placenta praevia, and in the cervix (20-3H) bleeding in the abdominal cavity but it can be very difficult, it leads to antepartum vaginal haemorrhage. If an ectopic gestation survives to 20wks Remember that any woman with a menstrual irregularity without causing serious symptoms, it is probably in one of (a period or more missed or periods which have been lighter the less common sites, perhaps in an angle. Patients with an ectopic gestation form 5 groups: Anaemia, dizziness, shoulder pain, and a tender mass are all (1). Those who have had a massive bleed into the abdominal extras which encourage the diagnosis, but are not necessary cavity. A few of these A -ve sensitive urine pregnancy test excludes an ectopic chronic ectopic gestations (20. The gestation attaches itself to an area in the abdomen or ultrasound, you may be better off performing a laparoscopy sometimes inside the broad ligament where there is enough or mini-laparotomy as an ectopic gestation is potentially room even to grow to term! Those presenting early because they think they are salpingitis or appendicitis in the absence of an pregnant, often symptomless, where an ultrasound finds the intra-uterine gestation, you will have correctly intervened uterus empty while there is a pregnancy seen elsewhere, even if for the wrong reasons! Look for general signs of blood loss loses blood fast without having an infusion of fluid will die, (shock and anaemia), and for signs of bleeding within the if she does so, not from lack of red blood cells but from lack abdomen. This is the basis of hypovolaemic tenderness and guarding are variable, and may be absent. If there is a large tender mass in the lower abdomen, If then she arrives in shock and is operated immediately and bleeding has been confined there by adhesions. With volume just gone home: you may make bleeding get worse or even replacement but continuous bleeding, the cause of death is re-start! A few days after a severe bleed, however, you may find an Also because the blood in her abdomen is now partly diluted Hb as low as 3g/dl. In case of <1-15l (the younger she is, usually the stronger) she does doubt, run 200ml of normal saline via a giving set and not really need to be (auto) transfused unless she was cannula into the abdomen. If possible these patients (with infusions If clear fluid runs back in the system you can exclude a running) should be operated immediately and perhaps ruptured ectopic gestation. If the patient is stable at the end of the operation and has enough circulating volume and you are certain you have stopped the bleeding, then a blood transfusion is often not needed. However, the first signs of problems are oxygen hunger: cardiac failure typified by crepitations Ketamine is ideal for anaesthesia. Do not use thiopentone over the lung bases, an impossibility to lie horizontally, for induction: the blood pressure might crash! Check the Hb: if <5g/dl, transfuse The Hb being 6g/dl by now, the nurse there even more strongly refused to give anaesthesia. The patient was now transported to the provincial hospital 1 unit of red cells if available. Neither surgeon nor Remember transfusions are often just giving you an extra anaesthetist wanted to intervene, so she was now referred to a Central margin of safety. The message is clear: dont think others in more sophisticated surroundings can do better with a patient who is much worse. In those cases bleeding can be often stopped immediately Since one ectopic gestation is followed in 30% of cases by even without access to a fully equipped theatre. This fluid might actually kill the patient as a result of inducing cardiac failure. Stop any bleeding (suction curetting with 6mm Karman curette without anaesthesia or twisting off a pedunculated fibroid. As soon as you open the abdomen while the patient is in Do not be too enthusiastic to restore the blood pressure Trendelenburg position (otherwise the blood will spill over and is not available for auto-transfusion) lift out the uterus if possible, find the above 90mmHg systolic, because you might promote more ruptured Fallopian tube and if it is still bleeding significantly, grasp the bleeding. Your first priority is to stop the bleeding: mesosalpinx between your finger and thumb, so as to compress and resuscitation is to prepare the patient as best you can in the later clamp the vessels and stop the bleeding. There will be blood in to insert the needle of a blood letting system as used by the abdominal cavity, which should not spill out and be lost blood banks, through the abdominal wall into the pool of for auto-transfusion. Find the ruptured Fallopian tube, and if it is still actively bleeding, grasp its broad ligament between your finger and thumb, so as to compress the vessels in it (20-4). Apply long curved haemostats across the tubes on either side of the ectopic gestation (20-5) so that the points meet and you leave no part of the broad ligament unclamped. You can put the distal clamp either over the distal tube (20-5X) or over the remaining broad ligament (20-5Y) which will result in removal of the distal tube. If you leave the fimbria, it may prove possible later to reconstruct the tube, provided there is >4cm of it remaining, if the patient becomes infertile. On the other hand, it is possible that a zygote fertilized in the contralateral tube might be trapped in the distal part of the amputated tube, resulting in another ectopic gestation. Suck out and discard the last drops of blood, so you can see where to place ligatures at the right place.

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