Search This Blog

Translate

خلفيات وصور / wallpapers and pictures images / fond d'écran photos galerie / fondos de pantalla en i

Buscar este blog

PopAds.net - The Best Popunder Adnetwork

12/27/23

download Handbook of Pharmaceutical Excipients pdf

Handbook of pharmaceutical excipients.pdf - 25.3 MB

download pdf





download pdf

Pharmaceutical dosage forms contain both pharmacologically active compounds and excipients added to aid the formulation and manufacture of the subsequent dosage form for administration to patients. Indeed, the properties of the final dosage form (i.e. its bioavailability and stability) are, for the most part, highly dependent on the excipients chosen, their concentration and interaction with both the active compound and each other. No longer can excipients be regarded simply as inert or inactive ingredients, and a detailed knowledge not only of the physical and chemical properties but also of the safety, handling and regulatory status of these materials is essential for formulators throughout the world. In addition, the growth of novel forms of delivery has resulted in an increase in the number of the excipients being used and suppliers of excipients have developed novel excipient mixtures and new physical forms to improve their properties. The Handbook of Pharmaceutical Excipients has been conceived as a systematic, comprehensive resource of information on all of these topics The first edition of the Handbook was published in 1986 and contained 145 monographs. This was followed by the second edition in 1994 containing 203 monographs, the third edition in 2000 containing 210 monographs and the fourth edition in 2003 containing 249 monographs. Since 2000, the data has also been available on CD-ROM, updated annually, and from 2004 online. This new printed edition with its companion CDROM, Pharmaceutical Excipients 5, contains 300 monographs compiled by over 120 experts in pharmaceutical formulation or excipient manufacture from Australia, Europe, India and the USA. All the monographs have been reviewed and revised in the light of current knowledge. There has been a greater emphasis on including published data from primary sources although some data from laboratory projects included in previous editions have been retained where relevant. Variations in test methodology can have significant effects on the data generated (especially in the case of the compactability of an excipient), and thus cause confusion. As a consequence, the editors have been more selective in including data relating to the physical properties of an excipient. However, comparative data that show differences between either source or batch of a specific excipient have been retained as this was considered relevant to the behavior of a material in practice. The Suppliers Directory (Appendix I) has also been completely updated with many more international suppliers included. In a systematic and uniform manner, the Handbook of Pharmaceutical Excipients collects essential data on the physical properties of excipients such as: boiling point, bulk and tap density, compression characteristics, hygroscopicity, flowability, melting point, moisture content, moisture-absorption isotherms, particle size distribution, rheology, specific surface area, and solubility. Scanning electron microphotographs (SEMs) are also included for many of the excipients. The Handbook contains information from various international sources and personal observation and comments from monograph authors, steering committee members, and the editors. All of the monographs in the Handbook are thoroughly cross-referenced and indexed so that excipients may be identified by either a chemical, a nonproprietary, or a trade name. Most monographs list related substances to help the formulator to develop a list of possible materials for use in a new dosage form or product. Related substances are not directly substitutable for each other but, in general, they are excipients that have been used for similar purposes in various dosage forms. The Handbook of Pharmaceutical Excipients is a comprehensive, uniform guide to the uses, properties, and safety of pharmaceutical excipients, and is an essential reference source for those involved in the development, production, control, or regulation of pharmaceutical preparations. Since many pharmaceutical excipients are also used in other applications, the Handbook of Pharmaceutical Excipients will also be of value to persons with an interest in the formulation or production of confectionery, cosmetics, and food products.


download pdf


Contents

International Steering Committee ix

Editorial Staff ix

Contributors x

About the Editors xii

New Monographs xiii

Related Substances xiv

Preface xvi

Arrangement xvii

Acknowledgments xix

Notice to Readers xix

Bibliography xx

Abbreviations xx

Units of Measurement xxii

Monographs

Acacia 1

Acesulfame Potassium 4

Acetic Acid, Glacial 6

Acetone 8

Acetyltributyl Citrate 10

Acetyltriethyl Citrate 12

Agar 14

Albumin 16

Alcohol 18

Alginic Acid 21

Aliphatic Polyesters 24

Alitame 28

Almond Oil 30

Alpha Tocopherol 32

Aluminum Hydroxide Adjuvant 36

Aluminum Oxide 38

Aluminum Phosphate Adjuvant 40

Aluminum Stearate 42

Ammonia Solution 44

Ammonium Alginate 46

download pdf

Ascorbic Acid 48

Ascorbyl Palmitate 51

Aspartame 53

Attapulgite 56

Bentonite 58

Benzalkonium Chloride 61

Benzethonium Chloride 64

Benzoic Acid 66

Benzyl Alcohol 69

Benzyl Benzoate 72

Boric Acid 74

Bronopol 76

Butylated Hydroxyanisole 79

Butylated Hydroxytoluene 81

Butylparaben 83

Calcium Alginate 86

Calcium Carbonate 89

Calcium Phosphate, Dibasic Anhydrous 93

Calcium Phosphate, Dibasic Dihydrate 96

Calcium Phosphate, Tribasic 100

Calcium Stearate 102

Calcium Sulfate 105

Canola Oil 108

Carbomer 111

Carbon Dioxide 116

Carboxymethylcellulose Calcium 118

Carboxymethylcellulose Sodium 120

Carrageenan 124

Castor Oil 128

Castor Oil, Hydrogenated 130

Cellulose, Microcrystalline 132

Cellulose, Powdered 136

Cellulose, Silicified Microcrystalline 139

Cellulose Acetate 142

Cellulose Acetate Phthalate 145

Ceratonia 148

Cetostearyl Alcohol 150

Cetrimide 152

Cetyl Alcohol 155

Cetylpyridinium Chloride 157

Chitosan 159

Chlorhexidine 163

Chlorobutanol 168

Chlorocresol 171

Chlorodifluoroethane (HCFC) 174

Chlorofluorocarbons (CFC) 176

Chloroxylenol 180

Cholesterol 182

Citric Acid Monohydrate 185

Colloidal Silicon Dioxide 188

Coloring Agents 192

Copovidone 201

Corn Oil 204

Cottonseed Oil 206

Cresol 208

Croscarmellose Sodium 211

Crospovidone 214

Cyclodextrins 217

Cyclomethicone 222

Denatonium Benzoate 224

Dextrates 226

Dextrin 228

Dextrose 231

Dibutyl Phthalate 234

Dibutyl Sebacate 236

Diethanolamine 238

Diethyl Phthalate 240

Difluoroethane (HFC) 242

Dimethicone 244

Dimethyl Ether 246

Dimethyl Phthalate 248

Dimethyl Sulfoxide 250

Dimethylacetamide 253

Disodium Edetate 255

Docusate Sodium 257

Edetic Acid 260

Erythorbic Acid 264

Erythritol 266

Ethyl Acetate 268

Ethyl Lactate 270

Ethyl Maltol 272

Ethyl Oleate 274

Ethyl Vanillin 276

Ethylcellulose 278

Ethylene Glycol Palmitostearate 283

Ethylene Vinyl Acetate 285

Ethylparaben 287

Fructose 290

Fumaric Acid 293

Gelatin 295

Glucose, Liquid 299

Glycerin 301

Glyceryl Behenate 304

Glyceryl Monooleate 306

Glyceryl Monostearate 308

Glyceryl Palmitostearate 311

Glycofurol 313

Guar Gum 315

Hectorite 318

Heptafluoropropane (HFC) 321

Hexetidine 323

Hydrocarbons (HC) 325

Hydrochloric Acid 328

Hydroxyethyl Cellulose 330

Hydroxyethylmethyl Cellulose 334

Hydroxypropyl Cellulose 336

Hydroxypropyl Cellulose, Low-substituted 341

Hydroxypropyl Starch 344

Hypromellose 346

Hypromellose Acetate Succinate 350

Hypromellose Phthalate 354

Imidurea 359

Inulin 362

Iron Oxides 364

Isomalt 366

Isopropyl Alcohol 371

Isopropyl Myristate 374

Isopropyl Palmitate 376

Kaolin 378

Lactic Acid 381

Lactitol 383

Lactose, Anhydrous 385

Lactose, Monohydrate 389

Lactose, Spray-Dried 396

Lanolin 399

vi Contents

Lanolin Alcohols 402

Lanolin, Hydrous 404

Lauric Acid 406

Lecithin 409

Leucine 412

Linoleic Acid 414

Macrogol 15 Hydroxystearate 416

Magnesium Aluminum Silicate 418

Magnesium Carbonate 422

Magnesium Oxide 426

Magnesium Silicate 428

Magnesium Stearate 430

Magnesium Trisilicate 434

Malic Acid 436

Maltitol 438

Maltitol Solution 440

Maltodextrin 442

Maltol 445

Maltose 447

Mannitol 449

Medium-chain Triglycerides 454

Meglumine 457

Menthol 459

Methylcellulose 462

Methylparaben 466

Mineral Oil 471

Mineral Oil, Light 474

Mineral Oil and Lanolin Alcohols 476

Monoethanolamine 478

Monosodium Glutamate 480

Monothioglycerol 482

Myristic Acid 484

Neohesperidin Dihydrochalcone 486

Nitrogen 488

Nitrous Oxide 490

Octyldodecanol 492

Oleic Acid 494

Oleyl Alcohol 496

Olive Oil 498

Palmitic Acid 501

Paraffin 503

Peanut Oil 505

Pectin 507

Petrolatum 509

Petrolatum and Lanolin Alcohols 512

Phenol 514

Phenoxyethanol 517

Phenylethyl Alcohol 519

Phenylmercuric Acetate 521

Phenylmercuric Borate 524

Phenylmercuric Nitrate 526

Phosphoric Acid 530

Polacrilin Potassium 532

Poloxamer 535

Polycarbophil 539

Polydextrose 542

Polyethylene Glycol 545

Polyethylene Oxide 551

Polymethacrylates 553

Poly(methyl vinyl ether/maleic anhydride) 561

Polyoxyethylene Alkyl Ethers 564

Polyoxyethylene Castor Oil Derivatives 572

Polyoxyethylene Sorbitan Fatty Acid Esters 580

Polyoxyethylene Stearates 585

Polyvinyl Acetate Phthalate 589

Polyvinyl Alcohol 592

Potassium Alginate 594

Potassium Benzoate 596

Potassium Bicarbonate 598

Potassium Chloride 600

Potassium Citrate 603

Potassium Hydroxide 605

Potassium Metabisulfite 607

Potassium Sorbate 609

Povidone 611

Propionic Acid 617

Propyl Gallate 619

Propylene Carbonate 622

Propylene Glycol 624

Propylene Glycol Alginate 627

Propylparaben 629

2-Pyrrolidone 633

Raffinose 635

Saccharin 638

Saccharin Sodium 641

Saponite 644

Sesame Oil 646

Shellac 649

Contents vii

Simethicone 652

Sodium Acetate 654

Sodium Alginate 656

Sodium Ascorbate 659

Sodium Benzoate 662

Sodium Bicarbonate 665

Sodium Borate 669

Sodium Chloride 671

Sodium Citrate Dihydrate 675

Sodium Cyclamate 678

Sodium Hyaluronate 681

Sodium Hydroxide 683

Sodium Lactate 685

Sodium Lauryl Sulfate 687

Sodium Metabisulfite 690

Sodium Phosphate, Dibasic 693

Sodium Phosphate, Monobasic 696

Sodium Propionate 699

Sodium Starch Glycolate 701

Sodium Stearyl Fumarate 705

Sodium Sulfite 708

Sorbic Acid 710

Sorbitan Esters (Sorbitan Fatty Acid Esters) 713

Sorbitol 718

Soybean Oil 722

Starch 725

Starch, Pregelatinized 731

Starch, Sterilizable Maize 734

Stearic Acid 737

Stearyl Alcohol 740

Sucralose 742

Sucrose 744

Sugar, Compressible 748

Sugar, Confectioner’s 750

Sugar Spheres 752

Sulfobutylether b-Cyclodextrin 754

Sulfuric Acid 758

Sunflower Oil 760

Suppository Bases, Hard Fat 762

Talc 767

Tartaric Acid 770

Tetrafluoroethane (HFC) 772

Thaumatin 775

Thimerosal 777

Thymol 780

Titanium Dioxide 782

Tragacanth 785

Trehalose 788

Triacetin 790

Tributyl Citrate 792

Triethanolamine 794

Triethyl Citrate 796

Vanillin 798

Vegetable Oil, Hydrogenated 800

Water 802

Wax, Anionic Emulsifying 807

Wax, Carnauba 809

Wax, Cetyl Esters 811

Wax, Microcrystalline 813

Wax, Nonionic Emulsifying 815

Wax, White 817

Wax, Yellow 819

Xanthan Gum 821

Xylitol 824

Zein 828

Zinc Acetate 830

Zinc Stearate 832

Appendix I: Suppliers’ Directory 835

Appendix II: List of Excipient ‘E’ Numbers 882

Appendix III: List of Excipient ‘EINECS’ Numbers 884

Appendix IV: List of Excipient Molecular Weights 886

Index 889

viii Contents

International Steering Committee

Gregory E Amidon

Pharmacia Corporation

Kalamazoo, MI, USA

Graham Buckton

University of London

London, UK

Colin G Cable

Western General Hospital

Edinburgh, UK

Brian A Carlin

FMC Biopolymer

Princeton, NJ, USA

Walter Cook

AstraZeneca

Loughborough, UK

Henk J de Jong

Servier International Research Institute

Courbevoie, France

Stephen Edge

DMV International

Veghel, The Netherlands

Roger T Guest

GlaxoSmithKline

Ware, Hertfordshire, UK

Bruno Hancock

Pfizer Inc

Groton, CT, USA

Stephen W Hoag

University of Maryland at Baltimore

Baltimore, MD, USA

Arthur H Kibbe

Wilkes University

Wilkes-Barre, PA, USA

William J Lambert

Eisai Inc

Research Triangle Park, NC, USA

M Jayne Lawrence

King’s College, University of London

London, UK

John MacLaine

Boots Contract Manufacturing

Nottingham, UK

Colin P McCoy

Queens University Belfast

Belfast, UK

R Christian Moreton

Idenix Pharmaceuticals

Cambridge, MA, USA

Sandeep Nema

Pfizer Inc

Chesterfield, MO, USA

Siaˆ n C Owen

Royal Pharmaceutical Society of Great

Britain

London, UK

Anthony Palmieri III

University of Florida

Gainesville, FL, USA

Raymond C Rowe

Intelligensys Ltd

Billingham, UK

Shirish A Shah

Watson Pharmaceuticals

Corona, CA, USA

Bob Sherwood

JRS Pharma

Patterson, NY, USA

Paul J Sheskey

The Dow Chemical Co

Midland, MI, USA

Kamalinder K Singh

SNDT Women’s University

Mumbai, India

Paul J Weller

Royal Pharmaceutical Society of Great

Britain

London, UK

Tim Wood

GlaxoSmithKline

Ware, Hertfordshire, UK

Mukund Yelvigi

Wyeth Research

Pearl River, NY, USA

Editorial Staff

Editorial Staff of the Pharmaceutical Press:

Laurent Y Galichet

Louise ME McIndoe

Siaˆn C Owen

Paul J Weller

Contributors

O AbuBaker

Pfizer Inc

Ann Arbor, MI, USA

KS Alexander

University of Toledo

Toledo, OH, USA

LV Allen

International Journal of Pharmaceutical

Compounding

Edmond, OK, USA

GE Amidon

Pharmacia Corporation

Kalamazoo, Michigan, USA

GP Andrews

The Queen’s University of Belfast

Belfast, UK

NA Armstrong

Harpenden, Hertfordshire, UK

ME Aulton

De Montford University

Leicester, UK

S Behn

AstraZeneca

Macclesfield, UK

M Bond

Danisco Sweeteners Ltd

Redhill, Surrey, UK

CG Cable

Western General Hospital

Edinburgh, UK

E Cahill

AstraZeneca

Macclesfield, UK

W Camarco

ISP Corp

Wayne, NJ, USA

WG Chambliss

University of Mississippi

University, MS, USA

RK Chang

Shire Laboratory

Rockville, MD, USA

R Chen

Pfizer Inc

Groton, CT, USA

JH Chu

Pfizer Inc

Groton, CT, USA

JH Collett

University of Manchester

Manchester, UK

JT Colvin

Pfizer Inc

Groton, CT, USA

W Cook

AstraZeneca

Loughborough, UK

DQM Craig

The University of East Anglia

Norwich, UK

TC Dahl

Gilead Sciences

Foster City, CA, USA

A Day

AstraZeneca

Loughborough, UK

HJ de Jong

Servier International Research Institute

Courbevoie, France

SP Denyer

University of Cardiff

Cardiff, UK

X Duriez

Roquette Fre`res

Lestrem, France

S Edge

DMV International

Veghel, The Netherlands

K Fowler

Schering-Plough Healthcare Products

Memphis, TN, USA

SO Freers

Grain Processing Corporation

Muscatine, IA, USA

B Fritzsching

Palatinit GmbH

Mannheim, Germany

G Frunzi

Bristol-Myers Squibb

New Brunswick, NJ, USA

LY Galichet

Royal Pharmaceutical Society of Great

Britain

London, UK

SR Goskonda

Sunnyvale, CA, USA

JL Gray

The Queen’s University of Belfast

Belfast, UK

RT Guest

GlaxoSmithKline

Ware, Hertfordshire, UK

RR Gupta

SNDT Women’s University

Mumbai, India

VK Gupta

Tyco HealthCare Mallinckrodt

St Louis, MO, USA

G Haest

Cargill Cerestar BVBA

Mechelen, Belgium

BC Hancock

Pfizer Inc

Groton, CT, USA

RJ Harwood

Bensalem, PA, USA

S Hem

Purdue University

West Lafayette, IN, USA

L Hendricks

Rhodia Inc

Cranbury, NJ, USA

SE Hepburn

Bristol Royal Infirmary

Bristol, UK

NA Hodges

University of Brighton

Brighton, UK

JT Irwin

Perrigo Corporation

MI, USA

BR Jasti

University of the Pacific

Stockton, CA, USA

R Johnson

AstraZeneca

Loughborough, UK

DS Jones

The Queen’s University of Belfast

Belfast, UK

AS Kearney

GlaxoSmithKline

King-of-Prussia, PA, USA

SW Kennedy

Morflex Inc

Greensboro, NC, USA

VL Kett

The Queen’s University of Belfast

Belfast, UK

AH Kibbe

Wilkes University

Wilkes-Barre, PA, USA

V King

Rhodia Inc

Cranbury, NJ, USA

PB Klepak

Reheis Inc

Berkley Heights, NJ, USA

JJ Koleng

University of Texas at Austin

Austin, TX, USA

K Kussendrager

DMV International

Veghel, The Netherlands

WJ Lambert

Eisai Inc

Research Triangle Park, NC, USA

BA Langdon

Pfizer Inc

Groton, CT, USA

MJ Lawrence

King’s College, University of London

London, UK

JC Lee

Cellegy

San Jose´, CA, USA

MG Lee

Medicines and Healthcare products

Regulatory Agency

London, UK

X Li

University of the Pacific

Stockton, CA, USA

EB Lindblad

Brenntag Biosector

Frederikssund, Denmark

O Luhn

Palatinit GmbH

Mannheim, Germany

PE Luner

Pfizer Inc

Groton, CT, USA

HJ Mawhinney

The Queen’s University of Belfast

Belfast, UK

CP McCoy

The Queen’s University of Belfast

Belfast, UK

OS McGarvey

The Queen’s University of Belfast

Belfast, UK

JW McGinity

University of Texas at Austin

Austin, TX, USA

LME McIndoe

Royal Pharmaceutical Society of Great

Britain

London, UK

LA Miller

Pfizer Inc

Groton, CT, USA

RW Miller

Bristol-Myers Squibb

New Brunswick, NJ, USA

J-P Mittwollen

BASF Aktiengesellschaft

Ludwigshafen, Germany

RC Moreton

Idenix Pharmaceuticals

Cambridge, MA, USA

G Mosher

CyDex Inc

Lenexa, KS, USA

C Mroz

Colorcon Ltd

Dartford, Kent, UK

MP Mullarney

Pfizer Inc

Groton, CT, USA

S Murdande

Pfizer Inc

Groton, CT, USA

RA Nash

St John’s University

Jamaica, NY, USA

S Nema

Pfizer Inc

Chesterfield, MO, USA

SC Owen

Royal Pharmaceutical Society of Great

Britain

London, UK

A Palmieri

University of Florida

Gainesville, FL, USA

D Parsons

ConvaTec Ltd

Clwyd, UK

Y Peng

University of Tennessee

Memphis, TN, USA

JD Pipkin

CyDex Inc

Lenexa, KS, USA

D Pipkorn

Pfizer Inc

Ann Arbor, MI, USA

JC Price

University of Georgia

Athens, GA, USA

MA Repka

University of Mississippi

University, MS, USA

B Sarsfield

Bristol-Myers Squibb

New Brunswick, NJ, USA

T Schmeller

BASF Aktiengesellschaft

Ludwigshafen, Germany

A Schoch

Palatinit GmbH

Mannheim, Germany

CJ Sciarra

Sciarra Laboratories Inc

Hicksville, NY, USA

Contributors xi

JJ Sciarra

Sciarra Laboratories Inc

Hicksville, NY, USA

SA Shah

Watson Pharmaceuticals

Corona, CA, USA

RM Shanker

Pfizer Inc

Groton, CT, USA

PJ Sheskey

The Dow Chemical Co

Midland, MI, USA

AJ Shukla

University of Tennessee

Memphis, TN, USA

KK Singh

SNDT Women’s University

Mumbai, India

R Steer

AstraZeneca

Loughborough, UK

JT Stewart

University of Georgia

Athens, GA, USA

Y Sun

University of Tennessee

Memphis, TN, USA

AK Taylor

Baton Rouge, LA, USA

MS Tesconi

Wyeth Research

Pearl River, NY, USA

D Thassu

UCB Pharma Inc

Rochester, NY, USA

BF Truitt

Pfizer Inc

Groton, CT, USA

CK Tye

Pfizer Inc

Kalamazoo, MI, USA

HM Unvala

Bayer Corporation

Myerstown, PA, USA

KD Vaughan

Boots Healthcare International

Nottingham, UK

H Wang

Pfizer Inc

Groton, CT, USA

PJ Weller

Royal Pharmaceutical Society of Great

Britain

London, UK

AJ Winfield

Aberdeen, UK

AW Wood

GlaxoSmithKline

Research Triangle Park, NC, USA

M Yelvigi

Wyeth Research

Pearl River, NY, USA

PM Young

University of Sydney

Sydney, Australia

About the Editors

Raymond C Rowe

BPharm, PhD, DSc, FRPharmS, CChem, FRSC, CPhys, MInstP

Raymond Rowe has been involved in the Handbook of

Pharmaceutical Excipients since the first edition was published

in 1986, initially as an author then as a Steering Committee

member. In addition to his position as Chief Scientist at

Intelligensys, UK, he is also Professor of Industrial Pharmaceutics at the School of Pharmacy, University of Bradford, UK. He

was formerly Senior Principal Scientist at AstraZeneca, UK. In

1998 he was awarded the Chiroscience Industrial Achievement

Award, and in 1999 he was the British Pharmaceutical

Conference Science Chairman. He has contributed to over

350 publications in the pharmaceutical sciences including a

book and eight patents.

Paul J Sheskey

BSc, RPh

Paul Sheskey has been involved in the Handbook of Pharmaceutical Excipients as an author and member of the Steering

Committee since the third edition. He is a Technical Service

Leader in the Water Soluble Polymers, Pharmaceutical R&D

Group at The Dow Chemical Company in Midland, Michigan,

USA. Paul received his BSc degree in pharmacy from Ferris

State University. Previously, he has worked as a research

pharmacist in the area of solid dosage form development at the

Perrigo Company and the Upjohn (Pharmacia) Company. Paul

has authored numerous journal articles in the area of

pharmaceutical technology. He is a member of the AAPS,

Controlled Release Society, and the Institute for Briquetting and

Agglomeration.

Siaˆn C Owen

BSc, MA

Siaˆn Owen has been involved with the Handbook of

Pharmaceutical Excipients since the fourth edition, as a

contributor and Steering Committee member. Siaˆn received

her BSc degree in pharmacology from the University of

Sunderland, and her MA in biotechnological law and ethics

from the University of Sheffield.

xii Contributors

New Monographs

The following new monographs have been added to the Handbook of Pharmaceutical Excipients, 5th edition.

Acetone

Agar

Aluminum Hydroxide Adjuvant

Aluminum Oxide

Aluminum Phosphate Adjuvant

Ammonium Alginate

Aluminum Stearate

Boric Acid

Calcium Alginate

Cetylpyridinium Chloride

Copovidone

Dimethylacetamide

Disodium Edetate

Erythorbic Acid

Erythritol

Ethyl Lactate

Ethylene Vinyl Acetate

Hectorite

Hydroxypropyl Starch

Hypromellose Acetate Succinate

Inulin

Iron Oxides

Isomalt

Lactose, Anhydrous

Lactose, Monohydrate

Lactose, Spray-Dried

Lauric Acid

Leucine

Linoleic Acid

Macrogol 15 Hydroxystearate

Myristic Acid

Neohesperidin Dihydrochalcone

Octyldodecanol

Oleyl Alcohol

Palmitic Acid

Pectin

Polycarbophil

Poly(methylvinyl ether/maleic anhydride)

Potassium Alginate

2-Pyrrolidone

Raffinose

Saponite

Sodium Acetate

Sodium Borate

Sodium Hyaluronate

Sodium Lactate

Sodium Sulfite

Sulfobutylether b-Cyclodextrin

Thaumatin

Thymol

Zinc Acetate

Related Substances

Acetic acid

Activated attapulgite

Aleuritic acid

d-Alpha tocopherol

d-Alpha tocopheryl acetate

dl-Alpha tocopheryl acetate

d-Alpha tocopheryl acid succinate

dl-Alpha tocopheryl acid succinate

Aluminum distearate

Aluminum monostearate

Amylopectin

a-Amylose

Anhydrous citric acid

Anhydrous sodium citrate

Anhydrous sodium propionate

Artificial vinegar

Bacteriostatic water for injection

Bentonite magma

Beta tocopherol

Beta-carotene

n-Butyl lactate

Butylparaben sodium

Calcium ascorbate

Calcium cyclamate

Calcium polycarbophil

Calcium propionate

Calcium silicate

Calcium sorbate

Calcium sulfate hemihydrate

Capric acid

Carbon dioxide-free water

Cationic emulsifying wax

Ceratonia extract

Cetylpyridinium bromide

Chlorhexidine acetate

Chlorhexidine gluconate

Chlorhexidine hydrochloride

Chlorodifluoromethane

Chlorophenoxyethanol

Corn syrup solids

m-Cresol

o-Cresol

p-Cresol

Crude olive-pomace oil

Cyclamic acid

De-aerated water

Dehydrated alcohol

Delta tocopherol

Denatured alcohol

Dextrose anhydrous

Diazolidinyl urea

Dibasic potassium phosphate

Diethylene glycol monopalmitostearate

Dilute acetic acid

Dilute alcohol

Dilute ammonia solution

Dilute hydrochloric acid

Dilute phosphoric acid

Dilute sulfuric acid

Dimethyl-b-cyclodextrin

Dioctyl phthalate

Dipotassium edetate

Docusate calcium

Docusate potassium

Dodecyl gallate

Dodecyltrimethylammonium bromide

Edetate calcium disodium

Eglumine

Ethyl gallate

Ethylene glycol monopalmitate

Ethylene glycol monostearate

Ethyl linoleate

Ethylparaben potassium

Ethylparaben sodium

Extra virgin olive oil

Fine virgin olive oil

Fuming sulfuric acid

Gamma tocopherol

Hard water

Hesperidin

Hexadecyltrimethylammonium bromide

High-fructose syrup

Hyaluronic acid

Hydrogenated lanolin

Hydrogenated vegetable oil, type II

2-Hydroxyethyl-b-cyclodextrin

2-Hydroxypropyl-b-cyclodextrin

3-Hydroxypropyl-b-cyclodextrin

Indigo carmine

Invert sugar

Isotrehalose

Lampante virgin olive oil

Lanolin alcohols ointment

DL-Leucine

Liquefied phenol

Liquid fructose

Magnesium carbonate anhydrous

Magnesium carbonate hydroxide

Magnesium lauryl sulfate

Magnesium metasilicate

Magnesium orthosilicate

Magnesium trisilicate anhydrous

D-Malic acid

L-Malic acid

d-Menthol

l-Menthol

Methyl lactate

Methyl linoleate

Methyl methacrylate

Methyl oleate

Methylparaben potassium

Methylparaben sodium

N-Methylpyrrolidone

Microcrystalline cellulose and carboxymethylcellulose sodium

Microcrystalline cellulose and carrageenan

Microcrystalline cellulose and guar gum

Modified lanolin

Monobasic potassium phosphate

Montmorillonite

Myristyl alcohol

Neotrehalose

Normal magnesium carbonate

Octyl gallate

Oleyl oleate

Olive-pomace oil

Palmitin

Pharmaceutical glaze

Phenoxypropanol

Polacrilin

Poly(methyl methacrylate)

Potassium bisulfite

Potassium myristate

Potassium propionate

Powdered fructose

Propan-1-ol

(S)-Propylene carbonate

Propylparaben potassium

Propylparaben sodium

Purified bentonite

Purified stearic acid

Quaternium 18-hectorite

Rapeseed oil

Refined almond oil

Refined olive-pomace oil

Saccharin ammonium

Saccharin calcium

Self-emulsifying glyceryl monostearate

Shellolic acid

Sodium bisulfite

Sodium borate anhydrous

Sodium edetate

Sodium erythorbate

Sodium laurate

Sodium myristate

Sodium palmitate

Sodium sorbate

Sodium sulfite heptahydrate

Soft water

Sorbitol solution 70%

Spermaceti wax

Stearalkonium hectorite

Sterile water for inhalation

Sterile water for injection

Sterile water for irrigation

Sunset yellow FCF

Synthetic paraffin

DL-()-Tartaric acid

Tartrazine

Theobroma oil

Tocopherols excipient

Tribasic sodium phosphate

Trimethyl-b-cyclodextrin

Trimethyltetradecylammonium bromide

Trisodium edetate

Virgin olive oil

Water for injection

White petrolatum

Zinc propionate

Related Substances xv

Preface

Pharmaceutical dosage forms contain both pharmacologically

active compounds and excipients added to aid the formulation

and manufacture of the subsequent dosage form for administration to patients. Indeed, the properties of the final dosage

form (i.e. its bioavailability and stability) are, for the most part,

highly dependent on the excipients chosen, their concentration

and interaction with both the active compound and each other.

No longer can excipients be regarded simply as inert or inactive

ingredients, and a detailed knowledge not only of the physical

and chemical properties but also of the safety, handling and

regulatory status of these materials is essential for formulators

throughout the world. In addition, the growth of novel forms of

delivery has resulted in an increase in the number of the

excipients being used and suppliers of excipients have developed novel excipient mixtures and new physical forms to

improve their properties. The Handbook of Pharmaceutical

Excipients has been conceived as a systematic, comprehensive

resource of information on all of these topics

The first edition of the Handbook was published in 1986 and

contained 145 monographs. This was followed by the second

edition in 1994 containing 203 monographs, the third edition

in 2000 containing 210 monographs and the fourth edition in

2003 containing 249 monographs. Since 2000, the data has

also been available on CD-ROM, updated annually, and from

2004 online. This new printed edition with its companion CDROM, Pharmaceutical Excipients 5, contains 300 monographs

compiled by over 120 experts in pharmaceutical formulation or

excipient manufacture from Australia, Europe, India and the

USA. All the monographs have been reviewed and revised in the

light of current knowledge. There has been a greater emphasis

on including published data from primary sources although

some data from laboratory projects included in previous

editions have been retained where relevant. Variations in test

methodology can have significant effects on the data generated

(especially in the case of the compactability of an excipient),

and thus cause confusion. As a consequence, the editors have

been more selective in including data relating to the physical

properties of an excipient. However, comparative data that

show differences between either source or batch of a specific

excipient have been retained as this was considered relevant to

the behavior of a material in practice. The Suppliers Directory

(Appendix I) has also been completely updated with many more

international suppliers included.

In a systematic and uniform manner, the Handbook of

Pharmaceutical Excipients collects essential data on the

physical properties of excipients such as: boiling point, bulk

and tap density, compression characteristics, hygroscopicity,

flowability, melting point, moisture content, moisture-absorption isotherms, particle size distribution, rheology, specific

surface area, and solubility. Scanning electron microphotographs (SEMs) are also included for many of the excipients. The

Handbook contains information from various international

sources and personal observation and comments from monograph authors, steering committee members, and the editors.

All of the monographs in the Handbook are thoroughly

cross-referenced and indexed so that excipients may be

identified by either a chemical, a nonproprietary, or a trade

name. Most monographs list related substances to help the

formulator to develop a list of possible materials for use in a

new dosage form or product. Related substances are not

directly substitutable for each other but, in general, they are

excipients that have been used for similar purposes in various

dosage forms.

The Handbook of Pharmaceutical Excipients is a comprehensive, uniform guide to the uses, properties, and safety of

pharmaceutical excipients, and is an essential reference source

for those involved in the development, production, control, or

regulation of pharmaceutical preparations. Since many pharmaceutical excipients are also used in other applications, the

Handbook of Pharmaceutical Excipients will also be of value to

persons with an interest in the formulation or production of

confectionery, cosmetics, and food products.

Arrangement

The information consists of monographs that are divided into

22 sections to enable the reader to find the information of

interest easily. Although it was originally intended that each

monograph contain only information about a single excipient,

it rapidly became clear that some substances or groups of

substances should be discussed together. This gave rise to such

monographs as ‘Coloring Agents’ and ‘Hydrocarbons’. In

addition, some materials have more than one monograph

depending on the physical characteristics of the material, e.g.

Starch versus Pregelatinized Starch. Regardless of the complexity of the monograph they are all divided into 22 sections as

follows:

1 Nonproprietary Names

2 Synonyms

3 Chemical Name and CAS Registry Number

4 Empirical Formula and Molecular Weight

5 Structural Formula

6 Functional Category

7 Applications in Pharmaceutical Formulation or

Technology

8 Description

9 Pharmacopeial Specifications

10 Typical Properties

11 Stability and Storage Conditions

12 Incompatibilities

13 Method of Manufacture

14 Safety

15 Handling Precautions

16 Regulatory Status

17 Related Substances

18 Comments

19 Specific References

20 General References

21 Authors

22 Date of Revision

Descriptions of the sections appear below with information

from an example monograph if needed.

Section 1, Nonproprietary Names, lists the excipient names

used in the current British Pharmacopoeia, European Pharmacopeia, Japanese Pharmacopeia, and the United States Pharmacopeia/National Formulary.

Section 2, Synonyms, lists other names for the excipient,

including trade names used by suppliers (shown in italics).

The inclusion of one supplier’s trade name and the absence of

others should in no way be interpreted as an endorsement of

one supplier’s product over the other. The large number of

suppliers internationally makes it impossible to include all the

trade names.

Section 3, Chemical Name and CAS Registry Number, indicates the unique Chemical Abstract Services number for an

excipient along with the chemical name, e.g., Acacia [9000-

01-5].

Sections 4 and 5, Empirical Formula and Molecular Weight

and Structural Formula, are self-explanatory. Many excipients

are not pure chemical substances, in which case their composition is described either here or in Section 8.

Section 6, Functional Category, lists the function(s) that an

excipient is generally thought to perform, e.g., diluent, emulsifying agent, etc.

Section 7, Applications in Pharmaceutical Formulation or Technology, describes the various applications of the excipient.

Section 8, Description, includes details of the physical appearance of the excipient, e.g., white or yellow flakes, etc.

Section 9, Pharmacopeial Specifications, briefly presents the

compendial standards for the excipient. Information included

is obtained from the British Pharmacopoeia (BP), European

Pharmacopeia (PhEur), Japanese Pharmacopeia (JP), and the

United States Pharmacopeia/National Formulary (USP/

USPNF). Information from the JP, USP and USPNF are

included if the substance is in those compendia. Information

from the PhEur is also included. If the excipient is not in the

PhEur but is included in the BP, information is included from

the BP. Pharmacopeias are continually updated with most

now being produced as annual editions. However, although

efforts were made to include up-to-date information at the

time of publication of this edition, the reader is advised to

consult the most current pharmacopeias or supplements.

Section 10, Typical Properties, describes the physical properties of the excipient which are not shown in Section 9. All

data are for measurements made at 208C unless otherwise

indicated. Where the solubility of the excipient is described in

words, the following terms describe the solubility ranges:

Very soluble 1 part in less than 1

Freely soluble 1 part in 1–10

Soluble 1 part in 10–30

Sparingly soluble 1 part in 30–100

Slightly soluble 1 part in 100–1000

Very slightly soluble 1 part in 1000–10 000

Practically insoluble 1 part in more than 10 000

or insoluble

Where practical, data typical of the excipient or comparative

data representative of different grades or sources of a material

are included, the data being obtained from either the primary or

the manufacturers’ literature. In previous editions of the

Handbook a laboratory project was undertaken to determine

data for a variety of excipients and in some instances this data

has been retained. For a description of the specific methods

used to generate the data readers should consult the appropriate previous edition(s) of the Handbook.

Section 11, Stability and Storage Conditions, describes the

conditions under which the bulk material as received from

the supplier should be stored. In addition some monographs

report on storage and stability of the dosage forms that contain the excipient.

Section 12, Incompatibilities, describes the reported incompatibilities for the excipient either with other excipients or with

active ingredients. If an incompatibility is not listed it does

not mean it does not occur but simply that it has not been

reported or is not well known. Every formulation should be

tested for incompatibilities prior to use in a commercial product.

Section 13, Method of Manufacture, describes the common

methods of manufacture and additional processes that are

used to give the excipient its physical characteristics. In some

cases the possibility of impurities will be indicated in the

method of manufacture.

Section 14, Safety, describes briefly the types of formulations

in which the excipient has been used and presents relevant

data concerning possible hazards and adverse reactions that

have been reported. Relevant animal toxicity data are also

shown.

Section 15, Handling Precautions, indicates possible hazards

associated with handling the excipient and makes recommendations for suitable containment and protection methods. A

familiarity with current good laboratory practice (GLP) and

current good manufacturing practice (GMP) and standard

chemical handling procedures is assumed.

Section 16, Regulatory Status, describes the accepted uses in

foods and licensed pharmaceuticals where known. However,

the status of excipients varies from one nation to another,

and appropriate regulatory bodies should be consulted for

guidance.

Section 17, Related Substances, lists excipients similar to the

excipient discussed in the monograph.

Section 18, Comments, includes additional information and

observations relevant to the excipient. Where appropriate, the

different grades of the excipient available are discussed. Comments are the opinion of the listed author(s) unless referenced

or indicated otherwise.

Section 19, Specific References, is a list of references cited

within the monograph.

Section 20, General References, lists references which have

general information about this type of excipient or the types

of dosage forms made with these excipients.

Section 21, Authors, lists the current authors of the monograph in alphabetical order. Authors of previous versions of

the monograph are shown in previous printed editions of the

text.

Section 22, Date of Revision, indicates the date on which

changes were last made to the text of the monograph.

xviii Arrangement

Acknowledgments

A publication containing so much detail could not be produced

without the help of a large number of pharmaceutical scientists

based world-wide. The voluntary support of over 120 authors

has been acknowledged as in previous editions, but the current

editors would like to thank them all personally for their

contribution. Grateful thanks also go to the members of the

International Steering Committee who advised the editors and

publishers on all aspects of the Handbook project. Steering

Committee members also diligently reviewed all of the

monographs before their publication. Many authors and

Steering Committee members have been involved in previous

editions of the Handbook. For others, this was their first edition

although not, we hope, their last. Walter Chambliss and John

Hogan retired from the International Steering Committee

during the preparation of this edition and we extend our

thanks for their support over many years. Thanks are also

extended to excipient manufacturers and suppliers who

provided helpful information on their products.

Thanks are also gratefully extended to the staff of the

Pharmaceutical Press and American Pharmacists Association

who were involved in the production of the Handbook: Eric

Connor, Tamsin Cousins, Simon Dunton, Laurent Galichet,

Julian Graubart, Louise McIndoe, Karl Parsons, Paul Weller,

and John Wilson. Once again, the diligent copy-editing and

challenging questions asked by Len Cegielka helped the authors

and editors, we hope, to express their thoughts clearly,

concisely, and accurately.

Raymond C Rowe, Paul J Sheskey and Siaˆ n C Owen

August 2005

Notice to Readers

The Handbook of Pharmaceutical Excipients is a reference

work containing a compilation of information on the uses and

properties of pharmaceutical excipients, and the reader is

assumed to possess the necessary knowledge to interpret the

information that the Handbook contains. The Handbook of

Pharmaceutical Excipients has no official status and there is no

intent, implied or otherwise, that any of the information

presented should constitute standards for the substances. The

inclusion of an excipient, or a description of its use in a

particular application, is not intended as an endorsement of

that excipient or application. Similarly, reports of incompatibilities or adverse reactions to an excipient, in a particular

application, may not necessarily prevent its use in other

applications. Formulators should perform suitable experimental studies to satisfy themselves and regulatory bodies that a

formulation is efficacious and safe to use.

While considerable efforts were made to ensure the accuracy

of the information presented in the Handbook, neither the

publishers nor the compilers can accept liability for any errors

or omissions. In particular, the inclusion of a supplier within the

Suppliers Directory is not intended as an endorsement of that

supplier or its products and, similarly, the unintentional

omission of a supplier or product from the directory is not

intended to reflect adversely on that supplier or its product.

Although diligent effort was made to use as recent

compendial information as possible, compendia are frequently

revised and the reader is urged to consult current compendia, or

supplements, for up-to-date information, particularly as efforts

are currently in progress to harmonize standards for excipients.

Data presented for a particular excipient may not be

representative of other batches or samples.

Relevant data and constructive criticism are welcome and

may be used to assist in the preparation of any future editions

or electronic versions of the Handbook. The reader is asked to

send any comments to the Editor, Handbook of Pharmaceutical

Excipients, Royal Pharmaceutical Society of Great Britain, 1

Lambeth High Street, London SE1 7JN, UK, or Editor,

Handbook of Pharmaceutical Excipients, American Pharmacists Association, 2215 Constitution Avenue, NW, Washington,

DC 20037-2985, USA.

Bibliography

A selection of publications and websites which contain useful information on pharmaceutical excipients is listed below:

Ash M, Ash I. Handbook of Pharmaceutical Additives, 2nd

edn. Endicott, NY: Synapse Information Resources, 2002.

Aulton ME, ed. Pharmaceutics: the Science of Dosage Form

Design, 2nd edn. Edinburgh: Churchill Livingstone, 2002.

Banker GS, Rhodes CT, eds. Modern Pharmaceutics, 4th edn.

New York: Marcel Dekker, 2002.

British Pharmacopoeia 2004. London: The Stationery Office,

2004.

Bugay DE, Findlay WP. Pharmaceutical Excipients Characterization by IR, Raman, and NMR Spectroscopy. New York:

Marcel Dekker, 1999.

European Pharmacopoeia, 5th edn. and supplements. Strasbourg: Council of Europe, 2005.

Florence AT, Salole EG, eds. Formulation Factors in Adverse

Reactions. London: Butterworth, 1990.

Food and Drug Administration. Inactive Ingredient Guide.

http://www.accessdata.fda.gov/scripts/cder/iig/index.cfm

(accessed 11 July 2005).

Food Chemicals Codex, 4th edn. Washington, DC: National

Academy Press, 1996.

Health and Safety Executive. EH40/2002: Occupational

Exposure Limits 2002. Sudbury: Health and Safety Executive, 2001.

Health Canada. Canadian List of Acceptable Non-medicinal

Ingredients. http://www.hc-sc.gc.ca/hpfb-dgpsa/nhpd-dpsn/

nmi_list1_e.html (accessed 11 July 2005)

Hoepfner E, Reng A, Schmidt PC, eds. Fiedler Encyclopedia of

Excipients for Pharmaceuticals, Cosmetics and Related

Areas. Aulendorf, Germany: Editio Cantor, 2002.

Japan Pharmaceutical Excipients Council. Japanese Pharmaceutical Excipients 2004. Tokyo: Yakuji Nippo, 2004.

Japanese Pharmacopeia, 14th edn. and supplement. Tokyo:

Yakuji Nippo, 2001.

Kemper FH, Luepke N-P, Umbach W, eds. Blue List Cosmetic

Ingredients. Aulendorf, Germany: Editio Cantor, 2000.

Lewis RJ, ed. Sax’s Dangerous Properties of Industrial

Materials, 11th edn. New York: John Wiley, 2004.

Lund W, ed. The Pharmaceutical Codex: Principles and

Practice of Pharmaceutics, 12th edn. London: Pharmaceutical Press, 1994.

National Library of Medicine. TOXNET.

http://toxnet.nlm.nih.gov (accessed 11 July 2005)

O’Neil MJ, Smith A, Heckelman PE, eds.The Merck Index: an

Encyclopedia of Chemicals, Drugs, and Biologicals, 13th

edn. Whitehouse Station, NJ: Merck, 2001.

Smolinske SC. Handbook of Food, Drug and Cosmetic

Excipients. Boca Raton, FL: CRC Press, 1992.

Swarbrick J, Boylan JC, eds. Encyclopedia of Pharmaceutical

Technology, 2nd edn. New York: Marcel Dekker, 2002.

Sweetman SC, ed. Martindale: the Complete Drug Reference,

34rd edn. London: Pharmaceutical Press, 2005.

United States Pharmacopeia 28 and National Formulary 23.

and supplement. Rockville, MD: United States Pharmacopeial Convention, 2005.

University of the Sciences in Philadelphia. Remington: the

Science and Practice of Pharmacy, 21st edn. Baltimore:

Lippincott Williams and Wilkins, 2005.

Weiner M, Bernstein IL. Adverse Reactions to Drug Formulation Agents: a Handbook of Excipients. New York: Marcel

Dekker, 1989.

Weiner ML, Kotkoskie LA, eds. Excipient Toxicity and Safety.

New York: Marcel Dekker, 2000.

Abbreviations

Some units, terms, and symbols are not included in this list as they are defined in the text. Common abbreviations have been omitted.

The titles of journals are abbreviated according to the general style of the Index Medicus.

 approximately.

Ad Addendum.

ADI acceptable daily intake.

approx approximately.

atm atmosphere.

BAN British Approved Name.

bp boiling point.

BP British Pharmacopoeia.

BS British Standard (specification).

BSI British Standards Institution.

cal calorie(s).

CAS Chemical Abstract Service.

CFC chlorofluorocarbon.

cm centimeter(s).

cm2 square centimeter(s).

cm3 cubic centimeter(s).

cmc critical micelle concentration.

CNS central nervous system.

cP centipoise(s).

cSt centistoke(s).

CTFA Cosmetic, Toiletry, and Fragrance Association.

D&C designation applied in USA to dyes permitted for use

in drugs and cosmetics.

DoH Department of Health (UK).

download General Surgical Emergencies pdf


download pdf

 Preface

 Many textbooks are available dealing with the details of emergency surgical conditions. Not many are available dealing exclusively with the emergency conditions, especially those related to surgery. Not that every patient coming to the casualty at odd hours with an acute symptom has a life-threatening emergency, but it becomes necessary to comfort the patient at the first instant, followed by a quick diagnosis of the clinical condition. It is also imperative that the impending emergency should be identified by the clinician, so that a catastrophe is avoided. The classical example of such confusing situation is the acute pancreatitis. This can present with a variety of symptoms which will not give a lead towards diagnosis, but the whole clinical picture establishes after some time, and takes the patient through a very tough morbid situation, and may also end in death. This concise book has been designed in such a way that the common emergency conditions are detailed to the extent so that surgical students or the casualty doctors or young surgeons may not miss the diagnosis. It cannot replace the many well-established textbooks, but it gives sufficient information for a clinician to manage the emergency. Color photographs are useful add-ons to these chapters, which will make the reader remember the information for a long time. Every new doctor who is resident in the casualty and the intensive care unit will face with a variety of clinical problems, and I hope the handbook will come handy. I also hope that I have hit the required details at the right level for the young surgeons. S


download pdf



I sincerely thank Professor SM Balaji, Professor J Cornelius, Dr Gayathri, Dr M Kanagavel, Dr Kirthana Rao, Professor N Mohan, Dr R Narasimhan, Professor MG Rajamanickam, Professor R Rajaraman, Professor N Sekar, Dr K Sridhar, Professor V Srinivasan, Dr V Thulasiraman, Dr Usha Dorairajan, Professor PS Venkatesh Rao and Dr S Vijayaraghavan, who contributed their clinical photographs, from their personal collections. My special thanks to my friends Dr Mani Veeraraghavan for the endoscopy photographs and Dr V Ganesan for the ultrasound photographs. Most of the CT and MRI pictures were procured from Bharat Scans, Chennai, Tamil Nadu, India, and I sincerely thank Dr R Emmanuel for providing them. My special thanks to my daughters Dr Bhavna for going through the script and making corrections, and Dr Kirthana for drawing the diagrams. My very special thanks goes to my wife Kalpana for the tolerance during the preparation of this manual.


Contents

 SECTION ONE: INTRODUCTION 1. Introduction 3 SECTION TWO: ASSESSMENT 2. Assessment of Surgical Emergencies 7  Make the Patient Lie Down Comfortably 7  Elicit a Quick History 8 • Make a Thorough Clinical Examination 8 • Come to a Quick Working Clinical Diagnosis 10 • Ask for Essential Meaningful Investigations 10 • Admit the Patient where Thought to be Required 11 • Put the Patient in Intensive Care Whenever Required 11 • Collect Investigation Reports at the Earliest 11 • Start Emergency Treatment 11 • Ask for Expert Opinions 12 SECTION THREE: CRITICAL CARE 3. Critically Ill Patient and Critical Care 15  Cardiac Support 15  Respiratory Support 15  Inotropic Support 16 4. Shock 17  Hypovolemic Shock 17 • Treatment of Hypovolemic Shock 18  Septic Shock 18 • Symptoms and Signs 18 • Pathogenesis  18 • Treatment 19  Anaphylactic Shock 19 • Incidence and Etiology 19 • Pathogenesis  19 • Symptoms and Signs 19 • Treatment 20  Cardiogenic Shock 20  Neurogenic Shock 20 • Pathogenesis  20 • Treatment 20 5. Acute Respiratory Distress Syndrome 21 • Incidence and Etiology 21 • Pathogenesis  21 • Clinical Presentation  21 • Relevant Investigations 21 • Treatment 22 SECTION FOUR: TRAUMA 6. Polytrauma 25  Introduction 25  Preparation 25 • Prehospital Communication  25 xiiGENERAL SURGICAL EMERGENCIES  Trauma Reception Team 26 • Receiving the Patient  27 • Primary Survey and Resuscitation  27 • Airway and Cervical Spine Control 27 • Breathing 28 • Circulation and Hemorrhage Control 29 • Recognition and Assessment of Hypovolemia 29 • Fluid Resuscitation 30 • Disability 30 • Exposure 30  Secondary Survey 30  Clinical Evaluation 31 • Eliciting History 31 • Physical Examination   31 • Scalp 31 • Neurological State 31 • Base of Skull 31 • Neck 32 • Eyes 32 • Face 32 • Thorax 32 • Abdomen 33 • Extremities 33  Definitive Care 33 7. Head Injuries 34  Brain Injury 34  Fractures of Skull 36 • Symptoms and Signs 36  CSF Fistulae 39  Scalp Injuries 39 8. Facial Injuries 41  Fractures of Midfacial Skeleton 41  Fractures of Mandible 42 • Clinical Presentation  43 • Relevant Investigations  45 • Treatment  45 9. Spine and Spinal Cord Injuries 46  Injuries to Bony and Ligamentous Spine 46 • Incidence and Etiology  46 • Symptoms   46 • Signs  47 • Relevant Investigations  47 • Treatment  48  Injuries of the Spinal Cord 48 • Incidence and Etiology  48 • Symptoms and Signs  48 • Relevant Investigations  49 • Treatment  49 10. Thoracic Injuries 50  Rib Fractures 50 • Incidence and Etiology 50 • Symptoms 50 • Signs 51 • Relevant Investigations 51 • Treatment 51  Flail Chest 53 • Incidence and Etiology 53 • Symptom  54 • Sign  54 • Relevant Investigations  54 • Treatment  54  Sternal Fracture 54 • Incidence and Etiology  54 • Symptom  54 • Sign 55 • Relevant Investigations 55 • Treatment 55  Pneumothorax 55 • Incidence and Etiology 55 xiii CONTENTS • Symptoms 56 • Signs 56 • Relevant Investigations 56 • Treatment 58  Surgical Emphysema 58 • Incidence and Etiology 58 • Pathogenesis  59 • Symptoms and Signs 59 • Relevant Investigations 59 • Treatment 59  Hemothorax 59 • Incidence and Etiology 59 • Symptoms 60 • Signs 60 • Relevant Investigations 60 • Treatment 61  Pulmonary Contusion/laceration 61 • Incidence and Etiology 61 • Symptoms and Signs 61 • Relevant Investigations 61 • Treatment 62  Injuries of Thoracic Aorta 62 • Incidence and Etiology 62 • Symptom 63 • Signs 63 • Relevant Investigations 63 • Treatment  64  Injuries of Myocardium 64 • Incidence and Etiology  64 • Symptoms   64 • Signs   64 • Relevant Investigations 65 • Treatment 65  Esophageal Injuries 65 • Incidence and Etiology 65 • Symptoms 65 • Signs 65 • Relevant Investigations 65 • Treatment 66  Diaphragmatic Injuries 66 • Incidence and Etiology 66 • Symptoms and Signs 67 • Relevant Investigations 67 • Treatment 67 11. Abdominal Injuries 68  Closed Injuries 68  Open Injuries 69 • Symptoms and Signs 69  Injuries of Liver 69 • Incidence and Etiology 69 • Symptoms and Signs 70 • Relevant Investigations 70 • Treatment 70  Injuries of Spleen 72 • Incidence and Etiology 72 • Symptoms 72 • Signs 72 • Relevant Investigations 73 • Treatment  74  Injuries of Mesentery 74 • Incidence and Etiology  74 • Symptoms   74 • Sign 75 • Relevant Investigations 75 • Treatment 75  Injuries of Duodenum 75 • Incidence and Etiology 75 • Symptoms and Signs 75 • Relevant Investigations 75 • Treatment 76  Injuries of Small Intestine 76 • Incidence and Etiology 76 xivGENERAL SURGICAL EMERGENCIES • Clinical Presentation  76 • Relevant Investigations 76 • Treatment 77  Injuries of Large Intestine 77 • Incidence and Etiology 77 • Symptoms 77 • Signs 77 • Relevant Investigations 77 • Treatment 77  Abdominal Compartment Syndrome 78 • Incidence and Etiology 78 • Pathogenesis  78 • Symptom 78 • Signs 78 • Relevant Investigations 78 • Treatment 78 12. Urological Injuries 79  Renal Injuries 79 • Incidence and Etiology 79 • Symptom 79 • Signs 79 • Relevant Investigations 80 • Treatment 80  Ureteric Injuries 80 • Incidence and Etiology 80 • Symptom and Sign 81 • Relevant Investigation 82 • Treatment 82  Urinary Bladder Injuries 82 • Incidence and Etiology 82 • Symptoms 83 • Signs 83 • Relevant Investigations 83 • Treatment  84  Urethral Injuries 84 • Incidence and Etiology  84 • Symptom  84 • Sign  84 • Relevant Investigation  84 • Treatment 85 13. Male Genital Injuries 86  Injuries of Penile Skin 86 • Incidence and Etiology 86 • Symptom 86 • Sign 86 • Relevant Investigation 86 • Treatment 86  Foreign Bodies in Penile Urethra 87 • Incidence and Etiology 87 • Symptoms and Signs 87 • Relevant Investigation 88 • Treatment 88  Scrotal Laceration 88 • Incidence and Etiology 88 • Symptom 89 • Signs 89 • Relevant Investigation 89 • Treatment 89 14. Female Genital Injuries 90  Coital Injuries 90 • Incidence and Etiology 90 • Symptom 90 • Signs 90 • Relevant Investigations 90 • Treatment 90  Injuries during Childbirth 91 • Incidence and Etiology 91 • Clinical Presentation  91 • Relevant Investigations 91 • Treatment 91 15. Hand Injuries 92 • Incidence and Etiology 92 xvCONTENTS • Clinical Presentation  92 • Relevant Investigations 96 • Treatment 96 SECTION FIVE: ORGANS AND SYSTEMS 16. Oral Cavity 99  Acute Odontogenic Infections 99 • Incidence and Etiology 99 • Pathogenesis  99 • Symptoms and Signs 100 • Relevant Investigations 100 • Treatment 100 17. Head and Neck 101  Acute Suppurative Sialadenitis 101 • Incidence and Etiology 101 • Clinical Presentation  101 • Relevant Investigation 103 • Treatment 103  Ludwig’s Angina 103 • Incidence and Etiology 103 • Pathogenesis  103 • Symptoms 103 • Signs 103 • Relevant Investigation 103 • Treatment  104 18. Thorax 105  Acute Mediastinitis 105 • Incidence and Etiology 105 • Clinical Presentation  105 • Relevant Investigations 105 • Treatment 106  Acute Pleuritis 106 • Incidence and Etiology 106 • Symptom 106 • Sign 106 • Relevant Investigations 107 • Treatment 107  Pleural Effusion 107 • Incidence and Etiology 107 • Symptom 107 • Signs 107 • Relevant Investigations 108 • Treatment 109  Acute Empyema Thoracis 109 • Incidence and Etiology 109 • Symptom 110 • Signs 110 • Relevant Investigations 110 • Treatment 110  Spontaneous Pneumothorax 110 • Incidence and Etiology 110 • Symptom 110 • Sign 111 • Relevant Investigations 111 • Treatment 111  Foreign Bodies in the Respiratory Tract 112 • Incidence and Etiology 112 • Pathogenesis   112 • Symptoms 112 • Signs 112 • Relevant Investigations 112 • Treatment 113  Suppurative or Aspiration Pneumonia 113 • Incidence and Etiology 113 • Pathogenesis   113 • Symptoms   114 • Sign  114 • Relevant Investigation  114 • Treatment  114  Hospital Acquired Pneumonia 115 • Incidence and Etiology 115 xviGENERAL SURGICAL EMERGENCIES • Symptoms 115 • Signs 115 • Relevant Investigations 115 • Treatment 115  Acute Lung Abscess 115 • Incidence and Etiology 115 • Symptoms 116 • Sign 116 • Relevant Investigations 116 • Treatment 116  Pulmonary Embolism 116 • Incidence and Etiology 116 • Symptoms and Signs 116 • Relevant Investigations 117 • Treatment 117 19. Breast 118  Breast Hematoma 118 • Incidence and Etiology 118 • Symptoms 118 • Sign 118 • Relevant Investigations 118 • Treatment 118  Acute Breast Abscess 119 • Incidence and Etiology 119 • Symptoms 119 • Signs 119 • Relevant Investigations 119 • Treatment 119 20. Spine 120  Degenerative Diseases of Disk and Facet Joints 120 • Incidence and Etiology 120 • Symptoms and Signs 120 • Relevant Investigations 121 • Treatment 121  Spondylolisthesis 122 • Incidence and Etiology 122 • Symptom 122 • Signs 122 • Relevant Investigations 123 • Treatment 123 21. Gastroenterology 124  Acute Abdomen 124 • Introduction  124 • Pain  125 • Vomiting  128  Acute Upper Abdominal Pain 130 • Abdomen 131 • Relevant Investigations 133 • Treatment Plan  134  Acute Lower Abdominal Pain 134 • Treatment Plan  138  Acute Liver Abscess 138 • Incidence and Etiology 138 • Pathogenesis  138 • Symptoms 138 • Signs 139 • Differential Diagnosis 139 • Relevant Investigations 139 • Treatment  140  Acute Cholecystitis 140 • Incidence and Etiology  140 • Pathogenesis   140 • Complications  140 • Symptoms   140 • Signs   141 • Differential Diagnosis  141 • Relevant Investigations  141 • Treatment  142  Acute Cholangitis 143 • Incidence and Etiology  143 xvii CONTENTS • Pathogenesis  143 • Symptoms  143 • Signs  144 • Relevant Investigations  144 • Treatment  146  Primary Sclerosing Cholangitis 146 • Incidence and Etiology  146 • Clinical Presentation  146 • Relevant Investigations  146 • Treatment  147  Splenic Abscess 148 • Incidence and Etiology  148 • Pathogenesis  148 • Symptoms   148 • Sign  148 • Relevant Investigation  148 • Treatment  149  Acute Hemorrhagic Pancreatitis 149 • Incidence and Etiology  149 • Pathogenesis  150 • Symptoms 150 • Signs 150 • Relevant Investigations 151 • Treatment 153  Acute Appendicitis 154 • Incidence and Etiology  154 • Pathogenesis   154 • Symptoms  154 • Signs 155 • Relevant Investigations 157 • Treatment 159  Acute Mesenteric Lymphadenitis 159 • Incidence and Etiology 159 • Pathogenesis   159 • Symptoms 159 • Signs 159 • Relevant Investigations 159 • Treatment 160  Acute Colonic Diverticulitis 160 • Incidence and Etiology 160 • Pathogenesis  160 • Symptoms 161 • Signs 161 • Relevant Investigations 161 • Treatment 162  Acute Meckel’s Diverticulitis 162 • Incidence and Etiology 162 • Symptom 163 • Sign 163 • Differential Diagnosis 163 • Relevant Investigations 163 • Treatment  164  Acute Solitary Cecal Diverticulitis 164 • Incidence and Etiology  164 • Symptom   164 • Sign   164 • Relevant Investigations  164 • Treatment  164  Acute Ulcerative Colitis 164 • Incidence and Etiology  164 • Symptoms 165 • Signs 165 • Relevant Investigations 165 • Treatment 165  Acute Intestinal Obstruction 166 • Symptoms 166 • Signs 167 • Relevant Investigations 167 • Treatment 168  Gallstone Ileus 168 • Incidence and Etiology 168 • Symptoms 169 xviiiGENERAL SURGICAL EMERGENCIES • Signs 169 • Relevant Investigations 169 • Treatment 169  Acute Intussusception 170 • Incidence and Etiology 170 • Symptoms 171 • Signs 172 • Relevant Investigations 172 • Treatment 173  Swallowed Foreign Bodies 173 • Incidence and Etiology 173 • Symptoms 173 • Signs 173 • Relevant Investigations 173 • Treatment 173  Perforated Bowel Pathologies 174 • Differential Diagnosis 175 • Relevant Investigations 175 • Treatment 177  Intestinal Strictures 177 • Incidence and Etiology 177 • Symptoms 177 • Signs 177 • Relevant Investigations 177 • Treatment 177  Bands and Adhesions 178 • Incidence and Etiology 178 • Symptoms and Signs 178 • Relevant Investigations 178 • Treatment 178  Enteroliths/Food Bolus 179 • Incidence and Etiology 179 • Symptoms and Signs 179 • Relevant Investigations 179 • Treatment 179  Volvulus 179  Sigmoid Volvulus 179 • Incidence and Etiology 179 • Pathogenesis   179 • Symptoms 179 • Signs 180 • Relevant Investigations 180 • Treatment 180  Cecal Volvulus 180 • Incidence and Etiology 180 • Clinical Presentation  181 • Relevant Investigations 181 • Treatment 181  Midgut Volvulus 181 • Incidence and Etiology 181 • Symptom 181 • Signs 181 • Relevant Investigation 181 • Treatment 181  Gastric Volvulus 182 • Incidence and Etiology 182 • Symptoms 182 • Sign 182 • Relevant Investigation 182 • Treatment 182  Intestinal Obstruction due to Herniae (Internal and External) 182 • Incidence and Etiology 182 • Symptoms 183 • Sign 183 • Relevant Investigation 183 • Treatment 183  Paralytic Ileus 183 • Incidence and Etiology 183 • Symptoms   184 xix CONTENTS • Sign   184 • Relevant Investigations  184 • Treatment 185  Torsion of Mesenteric Cyst 185 • Incidence and Etiology 185 • Pathogenesis  186 • Symptom 186 • Signs 186 • Relevant Investigation 186 • Treatment 186  Torsion of Omentum 186 • Incidence and Etiology 186 • Pathogenesis   186 • Symptoms 187 • Signs 187 • Relevant Investigation 187 • Treatment 187  Colics 187 • Incidence and Etiology 187 • Clinical Features 188 • Symptoms 188 • Signs 189 • Differential Diagnosis by Clinical History and Examination 190 • Relevant Investigations 190 • Radiology 190 • Treatment Plan  190  Gastrointestinal Hemorrhage 190 • Definitions 190 • Types of Gastrointestinal Hemorrhages 191 • Hematemesis and Melena 192 • Melena 192 • Hematochezia 192 • Eliciting History 193 • Hematochezia 193 • Past History  194 • Family History  194 • Clinical Examination  194 • Abdomen 195 • Differential Diagnosis by Clinical History and Examination 195 • Relevant Investigations 196 • Treatment 198 • Surgical Treatment 198 22. Anorectum 199  Acute Anal Fissure 199 • Incidence and Etiology 199 • Pathogenesis  199 • Symptoms 199 • Signs 200 • Relevant Investigation 201 • Treatment 201  Anorectal Abscess 201 • Incidence and Etiology 201 • Pathogenesis   202 • Symptoms 202 • Signs 202 • Relevant Investigation 203 • Treatment 203  Hemorrhoids 203 • Incidence and Etiology 203 • Symptoms 203 • Signs   204 • Relevant Investigation 205 • Treatment 205  Perianal Hematoma 206 • Incidence and Etiology 206 • Pathogenesis   206 • Symptoms 206 • Sign 206 xxGENERAL SURGICAL EMERGENCIES • Relevant Investigation 207 • Treatment 207  Prolapse of Rectum 207 • Incidence and Etiology 207 • Pathogenesis  207 • Symptoms 207 • Signs 207 • Relevant Investigation 208 • Treatment 208 23. Vascular System 209  Acute Limb Ischemia 209 • Incidence and Etiology 209 • Symptoms 210 • Signs 210 • Relevant Investigations 211  Acute Intestinal Ischemia 211 • Incidence and Etiology 211 • Clinical Presentation  211 • Relevant Investigations 212 • Treatment 212  Leaking or Dissecting Aortic Aneurysm 212 • Incidence and Etiology 212 • Clinical Presentation  212 • Relevant Investigation 213 • Treatment 213 24. Urology 214  Acute Retention of Urine 214 • Definition  214 • Incidence and Etiology  214 • Symptoms  214 • Signs   214 • Relevant Investigations 215 • Treatment 215  Hematuria 215 • Definition 215 • Incidence and Etiology 215 • Symptoms 216 • Signs 216 • Relevant Investigations 216 • Treatment 217  Renal Colic 217 • Relevant Investigations 218 • Treatment 218  Ureteric Colic 218 • Symptom 218 • Relevant Investigations 218 • Treatment 219  Acute Urethritis 220 • Incidence and Etiology 220 • Symptoms 220 • Sign 220 • Relevant Investigations 220 • Treatment 220  Acute Prostatitis 221 • Incidence and Etiology 221 • Symptom 221 • Sign 221 • Relevant Investigation 221 • Treatment 221  Acute Prostatic Abscess 221 • Incidence and Etiology 221 • Symptom 221 • Sign 222 • Relevant Investigations 222 • Treatment 222 25. Male Genitalia 223  Acute Scrotal Pain 223 • Definition 223 • Causes of Acute Scrotal Pain  223 • Symptoms   224 • Past History  224 • Signs   224 xxi CONTENTS • On Palpation  225 • Differential Diagnosis by Clinical History and Examination 225 • Relevant Investigations 225 • Treatment 226  Torsion of Testis 226 • Incidence and Etiology 226 • Pathogenesis  226 • Symptoms 226 • Signs 227 • Relevant Investigation 227  Torsion of Appendages of Testis 228 • Incidence and Etiology 228 • Pathogenesis  228 • Symptom 228 • Signs 228 • Relevant Investigation 228 • Treatment 228  Acute Epididymo-orchitis 229 • Incidence and Etiology 229 • Pathogenesis  229 • Symptom 229 • Signs 229 • Relevant Investigations 229 • Treatment 229  Traumatic Orchitis 230 • Incidence and Etiology 230 • Clinical Presentation  230 • Relevant Investigation 230 • Treatment 230  Hematocele 230 • Definition 230 • Incidence and Etiology 230 • Symptoms 230 • Signs 231 • Relevant Investigation 231 • Treatment 231  Pyocele 231 • Definition 231 • Incidence and Etiology 232 • Symptom 232 • Signs 232 • Relevant Investigations 232 • Treatment 232  Idiopathic Scrotal Edema 232 • Incidence and Etiology 232 • Pathogenesis  232 • Symptom 232 • Signs 233 • Relevant Investigations 233 • Treatment 233  Acute Scrotal Abscess 233 • Incidence and Etiology 233 • Symptoms 233 • Sign 233 • Relevant Investigations 233 • Treatment  234  Fournier’s Gangrene 234 • Incidence and Etiology  234 • Symptoms 235 • Signs 235 • Relevant Investigation 235 • Treatment 235  Acute Filarial Scrotum 236 • Incidence and Etiology 236 • Clinical Presentation  236 • Relevant Investigation 236 • Treatment 236  Fracture Penis 237 • Incidence and Etiology 237 • Symptoms and Signs 237 xxiiGENERAL SURGICAL EMERGENCIES • Relevant Investigations 238 • Treatment 238  Paraphimosis 238 • Incidence and Etiology 238 • Symptoms 238 • Sign 238 • Relevant Investigation 238 • Treatment 238  Priapism 239 • Incidence and Etiology 239 • Clinical Presentation  240 • Relevant Investigation  240 • Treatment  240 26. Hernias 241  Complicated Hernias 241 • Definition  241 • Anatomy of the Hernial Sac  242 • Complications   242 • Symptoms  243 • Signs   244 • Relevant Investigations  244 • Treatment  244 27. Gynecology 245  Acute Torsion of Ovarian Cyst 245 • Incidence and Etiology  245 • Pathogenesis   245 • Symptom  245 • Signs  245 • Relevant Investigations  245 • Treatment  246  Acute Salpingitis 246 • Incidence and Etiology  246 • Pathogenesis   246 • Symptoms  246 • Signs   247 • Relevant Investigations  247 • Treatment  247  Rupture of Lutein Cyst 247 • Incidence and Etiology  247 • Clinical Presentation  247 • Relevant Investigations  247 • Treatment  247 28. Pediatrics 248  Acute Intussusception 248 • Incidence and Etiology  248 • Pathogenesis  248 • Symptoms   248 • Signs   249 • Relevant Investigations  249 • Treatment  249  Congenital Pyloric Stenosis 250 • Incidence and Etiology 250 • Pathogenesis   250 • Symptoms 250 • Signs 250 • Relevant Investigations 250 • Treatment 250  Necrotizing Enterocolitis 250 • Incidence and Etiology 250 • Pathogenesis   251 • Symptoms 251 • Signs 251 • Relevant Investigations 251 • Treatment 251  Tracheoesophageal Fistula 251 • Incidence and Etiology 251 • Pathogenesis   251 • Symptoms 252 • Signs 252 • Relevant Investigations 252 • Treatment 252 xxiii CONTENTS 29. Lymphatic System 253  Acute Lymphangitis 253 • Incidence and Etiology 253 • Clinical Presentation  253 • Relevant Investigations  254 • Treatment  254  Acute Viral and Bacterial Lymphadenitis 254 • Incidence and Etiology  254 • Symptoms  254 • Signs   254 • Relevant Investigations 255 • Treatment 255  Acute Filarial Lymphangitis and Lymphadenitis 255 • Incidence and Etiology 255 • Symptoms 255 • Signs 255 • Relevant Investigation 255 • Treatment 256 30. Skin and Subcutaneous Tissues 257  Hematoma 257 • Incidence and Etiology 257 • Symptom 257 • Sign 257 • Relevant Investigations 257 • Treatment 257  Erysipelas 258 • Incidence and Etiology 258 • Symptoms 258 • Investigations 259 • Treatment 259  Furuncle 259 • Incidence and Etiology 259 • Symptom 259 • Signs 260 • Relevant Investigations 260 • Treatment 260  Cellulitis 260 • Incidence and Etiology 260 • Pathogenesis   260 • Symptoms 261 • Signs 261 • Relevant Investigations 261 • Treatment 261  Acute Pyogenic Abscess 261 • Incidence and Etiology 261 • Symptoms 262 • Sign 262 • Relevant Investigations 262 • Treatment 262  Carbuncle 262 • Incidence and Etiology 262 • Symptom 263 • Signs 263 • Relevant Investigations 263 • Treatment 263  Burns 263 • Definition 263 • Pathogenesis   264 • Clinical Features  264 • Metabolic Effects of Burns 267  Physical Examination 268 • Preliminaries Before Examination  268  Inspection 271 • General Examination 272 • Systemic Examination 272 • Relevant Investigations 272 • Treatment 273  Necrotizing Fasciitis 274 • Incidence and Etiology  274 • Pathogenesis  274 xxivGENERAL SURGICAL EMERGENCIES • Symptom  274 • Sign  274 • Relevant Investigations  274 • Treatment  274 SECTION SIX: SPECIAL PROCEDURES AND SITUATIONS 31. Emergency Surgical Procedures 277  Pericardial Aspiration 277 • Materials Required 277 • Procedure  277 • Complications 278  Intubation of Trachea 279 • Materials Required 279 • Procedure  279 • Complication of Endotracheal Intubation 280  Percutaneous Tracheostomy 280 • Advantages of Tracheostomy 280 • Indications 280 • Contraindications 281 • Materials Needed for Percutaneous Tracheostomy 281 • Procedure  281 • Complications 282  Cricothyroidotomy/Minitracheostomy 282 • Indications 282 • Contraindications 283 • Materials Required 283 • Procedure  284 • Complications   284  Insertion of Chest Drains 284 • Indications   284 • Type of Drain 285 • Site of Drain 285 • Materials Required 286 • Procedures  286  Passing a Nasogastric Tube 287 • Indications 287 • Contraindications 289 • Materials Required 289 • Procedure 289  Peritoneal Tap 289 • Materials Required 289 • Procedure  291 32. Preparing the Patient for Emergency Surgery 292 • General Measures 292 • Investigations Support 292 • Situations which Need Special Attention 293 33. Antibiotics 294  Antibiotics and Emergency Surgery 294 • Which Emergency Surgical Procedure should have Antibiotic Prophylaxis ? 294 34. Death 296 • Breaking the News 296 Index 299

download Surgical_Anatomy_2013 pdf

Matary-Surgical_Anatomy_2013--AllTebFamily.com.pdf - 171.1 MB

 





This book provides an update for medical students who need to keep abreast of recent developments. I hope also it will be usefu! for those preparing for postgraduate examination. This book is designed to provide a concise summary of anatomy, which medical students and others can use as study guide by itself or with readings in current textbooks, monographs, and reviews. Summaries of relevant anatomical considerations are included in every chapter, taking into account that this book is written primarily for those who have some knowledge of anatomy and physiology. The author ts extremely grateful to all the contributors for high standard of the new chapters, and hopes that you, reader, will enjoy going through these pages as much as had. M. El-Mutury the the he

12/25/23

Cirugíaen la clínica de pequeños animales Errores y complicaciones en cirugía La cirugía en imágenes, paso a paso .pdf

descargar pdf




descargar pdf

Autores


Rodolfo Brühl Day, DVM (coord.)

Rodolfo Brühl Day es médico veterinario desde 1977 graduado por la Universidad de Buenos Aires

(Argentina) de la Facultad de Ciencias Veterinarias. Se graduó con honores (Magna cum Laude) y

recibió el premio al mejor expediente académico. Realizó una Residencia en Cirugía de pequeños

animales en el Veterinary Medical Teaching Hospital de la Universidad de California, Davis, en

1984. Fue nombrado Iniciador de la Especialidad (Charter Diplomate) del departamento de Cirugía

de pequeños animales de la Facultad de Ciencias Veterinarias de la Universidad de Buenos Aires

(1998). Además, es especialista en Docencia Universitaria con orientación en Ciencias Veterinarias y

Biológicas (2000) y diplomado del Colegio Latinoamericano de Oftalmólogos Veterinarios (2002).

Fue recientemente nombrado Especialista en Cirugía de Pequeños Animales por el Consejo Profesional de Médicos Veterinarios de la Argentina (2017).

A lo largo de su extensa carrera, ha sido docente en varias universidades (Universidad de Buenos Aires,

Facultad de Ciencias Veterinarias, Buenos Aires; University of California, Davis, School of Veterinary

Medicine, California, United States; y Ross University, School of Veterinary Medicine, Saint Kitts, West

Indies). Desde 2008 es Profesor de Cirugía de pequeños animales, Director del Departamento de Medicina y Cirugía de pequeños animales y Cirujano de la clínica universitaria (Small Animal Clinic) en la

St. George’s University-School of Veterinary Medicine (Grenada, Indias Occidentales).

El Dr. Brühl Day ha recibido numerosas becas, premios y distinciones, y ha participado en un gran

número de publicaciones como libros, revistas especializadas y materiales didácticos. Asimismo, ha

sido ponente en cursos y seminarios, y no ha dejado de formarse en cursos de formación continuada

a lo largo de toda su carrera.

María Elena Martínez, DVM

María Elena Martínez es médica veterinaria desde 1991, graduada por la Facultad de Ciencias

Veterinarias de la Universidad de Buenos Aires (FCV-UBA), Argentina. Como miembro del área

de Cirugía y Anestesiología de pequeños animales, ha sido docente y tutora en la FCV-UBA en esta

materia de 1998 a 2006. En 2002 obtuvo el Diploma como especialista en Cirugía de pequeños

animales otorgado por la Universidad de Buenos Aires. Fue directora del área de Cirugía de la diplomatura en Neurología veterinaria. Sus numerosas estancias en centros extranjeros como Estados

Unidos (University of Missouri), Brasil (Universidade do Estado de Santa Catarina), y Colombia

(Fundación Universitaria San Martín) le han permitido adquirir una gran experiencia en su especialidad. Es miembro de Neurolatinvet y socia fundadora de la Asociación de Neurología Veterinaria

Argentina (Neurovet).


.descargar pdf

Pablo Meyer, DVM

Pablo Meyer es médico veterinario desde 1986, graduado por la Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina. Desde 2003, es Diplomado en Cirugía de pequeños animales y docente

encargado de los cursos de Cirugía de la piel, heridas y reconstructiva y Cirugía torácica de la carrera de

Especialización en Cirugía de pequeños animales. Además, también desempeña su labor como cirujano en el

Servicio de Cirugía del Hospital Escuela de la Facultad de Ciencias Veterinarias de la Universidad de Buenos

Aires (HEMV-UBA) y como profesor de Oncología, además de ser disertante académico en Chile y Perú. Autor de distintos trabajos y publicaciones en revistas especializadas, el Dr. Meyer ha participado en congresos

sobre oncología y cirugía.

Colaborador


José Rodríguez Gómez, DVM, PhD

Licenciado en Medicina Veterinaria por la Universidad Complutense de Madrid (España). Tutor jefe del Departamento de Patología animal, Universidad de Zaragoza (España). Cirujano veterinario, Hospital Veterinario Valencia Sur (Valencia, España). Coautor de la colección Cirugía en la clínica de pequeños animales: la

cirugía en imágenes, paso a paso y editor de los vídeos de este volumen de la colección.

Tomás Guerrero, DVM, PhD, Dip. ECVS

Tomás Guerrero es médico veterinario desde 1993 graduado por la Universidad Nacional de La Plata, Buenos Aires, Argentina. En el año 2000 comenzó su especialización en Cirugía de pequeños animales en la Universidad de Zúrich, Suiza, donde completó un Internado y posteriormente una Residencia en Cirugía de pequeños animales. En 2003 obtuvo su grado de Doctor en Medicina Veterinaria por la Universidad de Zúrich

con la tesis doctoral Advancement of the tibial tuberosity for the treatment of cranial cruciate-deficient canine

stifle. Entre 2005 y 2011 trabajó como profesor asistente en la sección de Cirugía de la clínica de pequeños

animales de la Universidad de Zúrich, y en 2006 obtuvo su grado de diplomado por el Colegio Europeo de

Cirujanos Veterinarios (ECVS). En 2013 obtuvo la Venia Legendis en la Universidad de Zúrich. Desde 2011,

es profesor de Cirugía de pequeños animales la St. George’s University-School of Veterinary Medicine, en la

isla de Grenada, Indias Occidentales.

Es miembro Acknowledged de la Fundación AOVET, siendo actualmente el chair del AOVET Latin America

Regional Board.

El Dr. Guerrero ha sido colaborador de otras obras de la editorial SERVET como “Artrología Canina 3D.

Principales patologías ortopédicas y abordajes quirúrgicos” y “Patologías ortopédicas de la rodilla”.

“Lo peor no es cometer un error sino tratar de justificarlo,

en vez de aprovecharlo como aviso providencial de nuestra ligereza o ignorancia”

Santiago Ramón y Cajal

En la literatura veterinaria abundan los trabajos dedicados a probar o desacreditar tanto hipótesis, como teorías, métodos, diagnósticos y tratamientos, entre otros. Muy pocos, si acaso

alguno, se ha centrado exclusivamente en identificar, analizar y describir la corrección de algunos errores que, independientemente de su origen, se observan frecuentemente como consecuencia de intervenciones quirúrgicas practicadas en los animales de compañía.

En este sentido, la presente edición de “Errores y complicaciones en cirugía” viene a ocupar un

espacio donde los cirujanos veterinarios podrán encontrar la razón de algunos de sus fracasos

y, simultáneamente, los procedimientos indicados para corregirlos. Julio Verne advirtió: “La

ciencia se compone de errores que, a su vez, son los pasos hacia la verdad”. De ello depende

muchas veces la vida de un paciente.

Los autores han cubierto detalladamente ciertas carencias en la aplicación de principios de la

cirugía general y una variedad de errores y complicaciones surgidos de operaciones realizadas

en tórax, abdomen, huesos e, incluso, en procedimientos oncológicos. Todo ello expuesto con

evidente maestría descriptiva, apoyada en fotografías de altísima definición y dibujos claros y

precisos. La información relevante se destacada mediante cuadros con fondo de color y, ocasionalmente, se remite al lector a páginas de otros textos de esta colección.

En conclusión, es un libro de fácil lectura, cuidadosamente realizado y excelentemente ilustrado, cuyo contenido actualizado y de gran nivel será, sin duda, un referente de utilidad para

todo cirujano veterinario.

Michel de Montaigne aludió a los errores de los médicos diciendo: “Médicos, hombres de

suerte. Sus éxitos brillan al sol… y sus errores los cubre la tierra”, es obvio que los autores de

esta obra han hecho un gran esfuerzo para mitigar tan elevada opinión.

Prof. Dr. Eduardo J. Durante

Senior Associate Dean

Universidad de St. George, Facultad de Veterinaria

(Grenada, Indias Occidentales)

9

Prólogo / Prefacio

“El primer gran error en la cirugía es la operación innecesaria y el siguiente es la realización de un

procedimiento quirúrgico mayor por un cirujano no adecuadamente entrenado para realizarlo”

M. Thorek

El propósito de este nuevo libro de la serie de Cirugía en la clínica de pequeños animales es revisar aquellos errores quirúrgicos que tienen lugar en la práctica diaria. Algunos son involuntarios, mientras que otros son el resultado de la limitada

habilidad o entrenamiento adecuado, de la escasez de conocimientos, de la carencia de técnica quirúrgica correcta o del

instrumental necesario para realizar un determinado procedimiento. También, la falta de experiencia juega un rol importante

para llegar a obtener un resultado beneficioso para el paciente.

Los casos derivados pueden ser a veces demandantes, por ello cirujanos especializados en esta área, con años de experiencia

en la formación de profesionales y en la práctica privada explicarán los casos, paso a paso, cómo fueron diagnosticados y,

a posteriori, resueltos mediante la cirugía.

Enfrentarse al error de otro profesional puede tornarse en un dilema ético de vastas dimensiones no sabiendo cómo actuar

frente a los hechos antes de condenar el trabajo de un colega.

El propósito de este libro no es el de levantar dedos acusadores, sino hacer una revisión de aquellos errores y complicaciones

quirúrgicas que ocurren a diario en la práctica de la cirugía de pequeños animales.

Esperamos que sea un libro de consulta que si bien no brinda todas las soluciones, servirá para señalar las evidencias que

lleven a seguir prestando atención, estudiando, investigando y proveyendo, además, de un espacio idóneo para mejorar las

habilidades quirúrgicas y la conducta del equipo quirúrgico en la sala de operaciones.

Este libro sigue la línea de los otros volúmenes de la serie, desde un punto de vista tanto clínico como práctico. Se dirige a

cirujanos noveles, residentes, así como a cirujanos más experimentados porque siempre hay un lugar para el error si este no

se tiene en consideración.

Nadie está exento de que le ocurra un accidente, en mayor o menor grado. ¿A qué cazador no se le ha escapado alguna vez

la liebre? Es por ello por lo que entre la casuística descrita hay casos que nos pertenecen; porque la idea es que podamos

compartir sin vergüenza lo que funcionó mal, para evitar que algún otro colega tropiece en la misma piedra. A eso se le llama

adquirir destreza, hacerse apto.

Todo médico veterinario debe formarse, acreditar su adiestramiento y demostrarlo con hechos. No debe hacer lo que no sabe

ni debe efectuar una práctica en un lugar que no sea el adecuado.

Errar es humano, esconderlo es imperdonable, y fallar en aprender de ello es inexcusable.

Lo importante es saber reconocer qué pasó y cómo resolver el problema o la complicación; la responsabilidad de haber

causado daño al paciente que nos fue confiado es intransferible.

Aquel que solo presenta éxitos no está mostrando todo el espectro de su experiencia.

En conclusión, no es banal resaltar el aprendizaje a partir de los errores ni recalcar la importancia de planificar hasta el detalle más ínfimo de una intervención quirúrgica para que esta tenga el éxito que merece, beneficiando al paciente.

Rodolfo Brühl Day

12/24/23

download concise Book.pdf

concise Book.pdf - 51.0 MB

 Concise Book of Medical Laboratory Technology Methods and Interpretations Ramnik Sood MD (Path, Gold Medalist) Consultant Reem Medical and Diagnostic Center Healthcare Mena Limited Sharjah United Arab Emirates 2nd Edition




download  concise Book.pdf




Preface to the Second Edition I authored an exhaustive book entitled “Medical Laboratory Technology – Methods and Interpretations” that hit the stands in mid-eighties in the previous century and is now running in its 6th edition. This was the first such book in the subcontinent and was much appreciated and used by technologists and pathologists alike. The book has seen testimonies in courts and has been appreciated in the west too. However, in our subcontinent, I was requested by many technologists that they wanted a little younger sister of the book popularly known as MLT authored by me. And so was born the Concise Book of Medical Laboratory Technology: Methods and Interpretations. The book essentially covers everything presented in MLT-6 but in an abridged/shortened and easy-to-digest format. The book is presented in a flowing noninterrupted format and not in a cumbersome experiment-wise cascading flow. There is no break in the style that runs smoothly and is easier to absorb and assimilate. As experiments are a part of any course, more stress has been laid out in the book to understand the intricacies of relevant theories and even troubleshooting all experiments that you would conduct during the course of your study. As I have written multiple modules for many Universities in India, I did not have to think for too long to devise a style and format for this book. You will find everything from ESR to PCR and you will find foam test for bile pigments as also complete automation in urinalysis. You will find basic biochemistry as also detailed cytogenetics. So whatever be your course or query, you will find it within the covers of this short but sweet book now going into its second edition. The book is designed for you not to mug but to understand and elicit the answers from the book of all questions in your mind. I am aware that this book is used by most of your teachers and tutors too. Nothing wrong that you are holding now. It will help you all your life!


Preface to the First Edition

The first book on Medical Laboratory Technology from the house of Jaypee’s came out in 1985 and has been the best seller in its class till date. The title “Medical Laboratory Technology – Methods and Interpretations” has seen 6 editions. The latest one hit the stands in January this year and was released in two volumes. It is a four-color book and has over 1670 pages. The reader base of all editions of our vastly popular title “MLT” has been upcoming laboratorians, undergraduate and postgraduate medical students. It was requested by a few institutes to produce a little smaller version of the two-volume set that would be suitable for the upcoming Laboratory Technology students. So here it is! It is exhaustive yet precise and concise too. The book will help you to appreciate things as they appear in real life under the microscope and otherwise. All current technologies find a mention within the covers of this book. Gone are the days when we had to prepare reagents first thing in the morning (or the days usage); therefore, the current trend of consuming ready-to-use reagents/kits is followed here to make your job and understanding simpler. So, what is available in the market for all investigations, is what is presented here. The Tulip Group has very kindly given us the rights to reproduce the text related to all their kits and reagents in this book. Latest instruments are not forgotten too. Most important— Parasitology section is presented in ample detail as it is relevant to all the developing nations. Quality control/assurance is mentioned in appropriate details. Working is not enough. Working properly and producing nothing but the most accurate reports are the order of the day. This book will not fail you there. Follow the recommendations to the hilt and you would be running the most accurate laboratory available anywhere. Should problems arise! The book has “Troubleshooting” section for every possible test mentioned inside. If this happens – then what! If that happens – then what! You will find all answers. From ESR to PCR – you will find everything. The book is based on most syllabi as applicable to most institutes in India and elsewhere internationally. All necessary care has been taken to weed out any discrepancies/typographical errors at the time of going to press. However, if anything has remained inadvertently, the publishers/author do not take any responsibility for the same in any manner whatsoever. Learning can be enjoyable experience, flip a few pages to experience that




Chapter 1. Laboratory 1 Laboratory Set-up 3 Code of Conduct for Medical Laboratory Personnel 6 Accidents 6 Accidents in the Laboratory 10 Universal Work Precautions (Uwp) for Laboratory Personnel (Especially in Relation to Hiv Transmission) 15 Medicolegal Aspects of Clinical Practice 17 Laboratory Instruments 17 Chapter 2. Sterilization 29 Methods Commonly Used for Sterilization 29 Modern Day Disinfection 34 Chapter 3. SI Units 41 Liter 41 Gram 41 Mole (Mol) 41 International Unit (U) 42 Conversion Factors Between Conventional and System International Units (Siu) 42 Chapter 4. Fundamental Chemistry 52 Indicators 52 Solutes, Solvents and Solutions 52 Periodic Table of Elements 54 Chapter 5. Urine Analysis 56 Composition of Urine 56 Gross Examination of Urine 57 Chemical Examination of Urine 60 Multiple Reagent Strips for Urinalysis 71 Automation in Urinalysis 78 Special Urine Tests 82 Microscopy of the Urinary Sediment 92 Chapter 6. Renal Function and its Evaluation 104 Renal Physiology in Brief 104 Functions of the Kidney 104 Concentration: Dilution Tests 105 Phenol Red Test 105 Clearance Tests 106 Principles of Precise Tests of Renal Function 107 Maximal Tubular Capacity (Tm) 108 Contents Chapter 7. Stool Examination 112 Specimen Collection 112 Inspection of Feces 113 Chapter 8. Medical Parasitology 124 Medical Parasites 124 Intestinal Protozoa of Man 124 Laboratory Examination for Parasites 201 Chapter 9. Clinical Hematology 205 Ways of Obtaining Blood 205 Anticoagulants 206 Blood Collection System 208 Hemoglobin 210 Anemia 211 Hematocrit/Packed Cell Volume (Pcv) 212 Blood Cell Counts 213 Erythrocyte Indices 216 Complete Blood Count (Cbc) 217 Erythrocyte Sedimentation Rate (Esr) 220 Blood Film Examination 222 Rapid Diagnostics 225 Development of Blood Cells and Sites of Blood Formation 227 Morphological Types of Red Blood Cells 234 Qualitative Assessment of G6pd Deficiency 240 Examination of Fetal Hemoglobin 244 Laboratory Diagnosis of Disorders Related to Rbcs 248 Thalassemias (Reduced Synthesis Rate) 256 Normal White Cell Values and Physiological Variations 259 White Blood Cells 263 Quality Control in Hematology 270 Chapter 10. Clinical Hematology: Bleeding Disorders 272 Platelets, Coagulation and Bleeding Disorders: Laboratory Investigations 272 Laboratory Diagnosis of Platelet Disorders 272 Quality Assurance for Routine Hemostasis Laboratory 278 Buffered 3.2% Citrate Solution (Profact) 280 Prothrombin Time (Quick One-Stage Method) Liquiplastin® 283 Sensitive Thromboplastin Reagent for Prothrombin Time (Pt) Determination (Isi = 1.0) Uniplastin® 285 xii Concise Book of Medical Laboratory Technology: Methods and Interpretations Thromboplastin Reagent for Prothrombin Time (Pt) Determination, Lyoplastin® (Lyophilized Reagent, Isi = 1.0) 287 Aptt/Pttk Cephaloplastin Reagent for Partial Thromboplastin Time (Aptt) Determination Using Ellagic Acid as Activator Liquicelin-E® 293 Normal and Abnormal Control Plasmas for Coagulation Assays Plasmatrol H-I/Ii ® 296 Fibroscreen Thrombin Time Test for Qualitative Estimation of Fibrinogen Fibroscreen® 297 Fibrinogen Estimation-Quantitative Fibroquant, Reagent for Quantitative Estimation of Fibrinogen 299 Fibrinolytic Activity 301 Fdps A Qualitative and Semiquantitative Latex Slide Test for Detecting Cross Linked Fibrin Degradation Products in Human Plasma X-L Fdp 302 Laboratory Diagnosis of Coagulation Disorders 304 Automation in Coagulation Analysis 305 Troubleshooting 309 Prothrombin Time 310 Dptt/Pttk 312 Fibrinogen Estimation 314 Chapter 11. Blood Banking (Immunohematology) 317 Blood Group Antibodies 317 Anti-A, Anti-B, Anti-Ab Blood Grouping Antisera for Slide and Tube Tests 320 Anti-A, Anti-B, Anti-Ab Monoclonal }|Blood Grouping Antibodies for Slide and Tube Tests 321 Anti-A1 Lectin Dolichos Biflorus Lectin for Slide and Tube Tests 322 Anti-H Lectin Ulex Europaeus Lectin for Slide and Tube Tests 323 Physiological Saline Solution for Serological Applications (Sodium Chloride 0.9% W/V) 325 Bovine Serum Albumin 22% Solution for Serological Applications 325 Concentrated Iso-Osmotic Phosphate Buffered Saline for Serological Applications 327 Red Cell Preserving Solution for Serological Applications 328 Abo Grouping 329 Rh Blood Group System 331 Anti-D (Rho) Human (Igg) Polyclonal Blood Typing Antibodies for Slide and Modified Tube Tests 333 Anti-D (Rho) (Igm) Monoclonal Blood Typing Antibodies for Slide and Tube Tests 335 Anti-D (Rho) (Igg) Monoclonal Blood Typing Antibodies for Slide and Modified Tube Tests 336 Anti-D (Rho) (Igm + Igg) Monoclonal Blood Typing Antibodies for Slide and Tube Tests 338 Anti-human Igg Monospecific Coomb’s Reagent for Direct and Indirect Antiglobulin Test 353 Anti-human Globulin Reagent for Direct and Indirect Antiglobulin Tests 356 Preparing Coomb’s Control Cells Agtrol® 358 Low Ionic Salt Solution for Serological Applications 359 Stabilized, Activated Papain Enzyme Solution for Serological Applications 361 Blood Transfusion 363 Trouble Shooting 372 Chapter 12. Cerebrospinal and Other Body Fluids 382 Cerebrospinal Fluid 382 Synovial Fluid (Sf) 388 Pleural Fluid 389 Pericardial Fluid (Pf) 391 Peritoneal Fluid 392 Amniocentesis and Amniotic Fluid Analysis, Diagnostic 394 Chapter 13. Semen Analysis 398 Semen Analysis 398 Chapter 14. Sputum Examination 405 Sputum 405 Common Respiratory Disorders 406 Chapter 15. Pregnancy Tests 411 Bioassays 411 Immunologic Methods 412 Slide Test for Pregnancy 412 Slide Test for Pregnancy 414 Elisa Pregnancy Test 416 Dipstick Ict Pregnancy Test 416 Device Ict Pregnancy Test 417 Dipstick Ict, Urine/Serum Pregnancy Test 418 Device Ict Urine/Serum Pregnancy Test 419 Troubleshooting 421 Rapid Formats 423 Chapter 16. Examination of Gastrointestinal Contents 425 Normal Saliva—Constituents 425 Gastric Juice 425 Examination of Duodenal Contents 430 Composition of Bile 430 Pancreatic Function Tests 430 Sweat Electrolytes Pilocarpine Iontophoresis 432 Contents xiii Chapter 17. Diabetes Mellitus: Laboratory Diagnosis 434 Diabetes Mellitus 434 Glycosylated Hemoglobin Kit (Ion Exchange Resin Method) for the Quantitative Determination of Glycohemoglobin in Blood (for in Vitro Diagnostic use Only) 443 Rapid Diagnostics 448 Chapter 18. Liver Function Tests 454 Tests of Excretion by the Liver 454 Evaluation of Synthesis in Liver 457 Evaluation of Enzyme Activity 458 Suggested Liver Function Tests 458 Chapter 19. Clinical Chemistry 461 Colorimetry 461 Photometer 462 Clinical Chemistry 465 Total Proteins 478 Serum Albumin 479 Serum Cholesterol 481 Hdl Cholesterol 484 Blood Glucose 490 Uric Acid 492 Calcium 493 Phosphorus 497 Chloride 500 Serum Iron and Tibc 501 Trace Elements 503 Zinc 503 Zinc (Colorimetric Method) 503 Copper 504 Magnesium 506 Automation in Clinical Chemistry 508 Principles of Quality Assurance and Standards for Clinical Chemistry 514 Chapter 20. Enzymology 519 Alpha-amylase 519 Lipase 520 Phosphatases 522 Transaminases 530 Gamma-glutamyl Transpeptidase (Ggtp) Blood 536 Lactic Dehydrogenase 538 Automation in Clinical Chemistry: Random Access Autoanalyzer 546 Chapter 21. Blood Gases and Electrolytes 548 Blood Gases 548 Automation in Blood Gas Analysis 556 Avl Compact 2 Blood Gas Analyzer 557 Electrolyte Analysis by Flamephotometer 558 Rapid Diagnostics in Electrolyte Analysis 561 Chapter 22. Serology/Immunology 563 Basic Immunology 563 Technologies 568 Enzyme Immunoassay 572 Chemiluminescence: The Technology 585 Polymerase Chain Reaction 587 Ria 590 Liquid Handling Systems 591 Streptavidin-Biotin Systems 594 Representative Elisa/Clia Techniques 595 Examples of Detailed Elisa Methods 597 Tests for Syphilis 608 Modified Vdrl Reagent Trepolipin® 610 Toluidine Red Unheated Serum Test for Rapid Serodiagnosis of Syphilis Redgen® 613 Latex Slide Test for Vdrl Syphfinal 615 Rapid Plasma Reagin (Rpr) Card Test/Carbon Antigen for Syphilis Testing (Carbogen) 618 One-step Test for Syphilis: Dipstick Syphicheck® 621 One-step Test for Syphilis (Device) Syphicheck 622 Third Generation Double Antigen Sandwich Enzyme-linked Immunosorbent Assay (Elisa) for the Detection of Antibodies to Treponema Pallidum in Human Serum or Plasma Trepolisa 3.0 624 Tests for Typhoid/Enteric Fever Widal Antigen Set/Antigens for Tube Tests (Typhochek) 624 Widal Antigen Set/Antigens for Slide and Tube Tests (Tydal)® 627 Reduced Widal Antigen Set: O and H for Tube Tests (Vital Widal) 630 Positive Control for Widal Test 631 Rapid Test for Detection Igm Antibodies to S. typhi in Serum/Plasma/Whole Blood (Device) Enterocheck – Wb 632 Slide and Tube Test for Detection of Antibodies to Brucella Abortus/Melitensis Brucel A/M 635 Slide Screening Test for Brucella Antibodies (Brucel-Rb) ® 636 Brucellosis Positive Control 638 Rapid Test for Igm and Igg Antibodies to Dengue Virus: Dengue Fever (Denguecheck-Wb) (Device) 639 Test for Infectious Mononucleosis (Immutex) 643 Rapid Test for Igm Antibodies to Leptospira: Leptospirosis (Leptochek-Wb) (Device) 645 Rapid Test for Malaria Pan/Pv/Pf (Paramax-3®) (Device) 647 Slide Test for C-reactive Protein (Rhelax Crp) 650 Slide Test for Antistreptolysin O (Rhelax Aso®) 653 Slide Test for Rheumatoid Factors (Rhelax Rf) 656 Slide Test for Anti-deoxyribonucleoprotein (Rhelax Sle) 659 xiv Concise Book of Medical Laboratory Technology: Methods and Interpretations Australia Antigen Hbsag (Virutex Hbsag) 662 One-Step Test for Hbsag Virucheck Device 664 Hcv Flavicheck Device 665 Toxoplasma Infections 668 Rapid Immunoconcentration Test for Hiv-1 and Hiv-2 Antibodies Flow through Method Retroquick-Hiv 669 Rapid Test for Simultaneous/Differential Detection of total Antibodies to Hiv1 and Hiv-2 in Human Serum/Plasma Retroscreen 671 Tuberculosis 673 Rapid Test for Detection of Antibodies to Mycobacterium tuberculosis (Device) Serocheck-Mtb 676 Tb Igg, Iga, Igm Ab, Mfd Anda 678 Tumor Markers 679 Tumor Markers Standard Methodologies Available on Elisa and Clia, as on Ria too 683 Ca 15-3 (Carcinogenic Antigen 15-3) 683 Ca 19-9 (Carbohydrate Ag 19-9, Gicam Gastrointestinal Cancer Antigen) Blood Mfd: Can Ag, 683 Ca 242 Mfd: Can Ag, 684 Ca 125 (Cancer Antigen 125) Mfd: Monobind 684 Carcinoembryonic Antigen (Cea) Mfd: Monobind 685 Prostate-specific Antigen (Psa) Total Prostate Specific Antigen (Tpsa) Elisa, Mfd: Monobind 685 Prostatic Acid Phosphates (Pap), Blood Method: Biochemical Analysis 686 Elisa Troubleshooting Aspects 686 Technical Tips 690 Chapter 23. Diagnostic Immunology 693 Qualitative Determination of Plasma Proteins by Immunoprecipitation 693 Fundamental Quantitative Considerations 698 Turbidimetry 699 An Example of Turbidimetric Immunoassay 718 C-reactive Protein 720 Turbidimetric Immunoassay for Determination of C-reactive Protein 722 Turbidimetric Immunoassay for Ultrasensitive Determination of C-Reactive Protein 723 Turbidimetric Immunoassay for Determination of Antistreptolysin ‘O’ in Human Serum 724 Turbidimetric Immunoassay for Determination of Microalbuminuria 724 Immunoglobulins (Ig) 724 Turbidimetric Immunoassay for Estimation of Immunoglobulin Iga in Human Serum 725 Turbidimetric Immunoassay for Estimation of Immunoglobulin Igg in Human Serum 726 Turbidimetric Immunoassay for Estimation of Immunoglobulin Igm in Human Serum 726 Turbidimetric Immunoassay for Estimation of Complement C3 in Human Serum 726 Turbidimetric Immunoassay for Estimation of Complement C4 in Human Serum 727 Turbidimetric Immunoassay for Estimation of Antithrombin Iii in Human Serum 727 Quantitative Immunoturbidimetric Assay for Estimation of Fibrinogen 727 Turbidimetric Immunoassay for Estimation of Lipoprotein (A) in Human Serum 727 Quantitative Turbidimetric Immunoassay for Estimation of Apolipoprotein A-I 728 Quantitative Turbidimetric Immunoassay for Estimation of Apolipoprotein B 728 Automation in Turbidimetry 729 Chapter 24. The Endocrine System 731 Pituitary Gland 731 Anterior Lobe: Growth Hormone (Gh) 732 Method of Evaluation: StreptavidinBiotin Elisa 733 Corticotropin (Acth) 735 Other Anterior Pituitary Hormones 735 Intermediate Lobe (Pars Intermedia) 736 Posterior Pituitary (Neurohypophysis) 736 Disorders of the Pituitary System 738 Hypothalamus 738 Adrenal (Suprarenal) Gland 738 Mineralocorticoids 738 Glucocorticoids 739 Adrenal Medulla 742 Thyroid 742 Calcitonin 753 Parathyroid 754 Parathyroid Hormone (Intact) Elisa 756 Pancreas 757 Testes 758 Ovary 758 Pineal Gland 759 Hormones and Fertility 759 Male Fertility 760 Female Fertility 763 Algorithm for Evaluating Amenorrhea, Immunoassays for Lh, Fsh and Prl 768 Adrenal Cortex 775 Adrenal Medulla 777 Testes 779 Steroids 781 17-Β-Estradiol 781 Dheas (Dehydroepiandrosterone Sulfate) 782 ∆4-Androstenedione 782 Progesterone 782 17-Alpha-hydroxyprogesterone 783 Total Tri-iodothyronine (T3) 783 Cia™ Insulin (Chemiluminescence Immunoassay) 788 Contents xv Chapter 25. Histopathology 791 Preparation of Tissues 791 Routine Staining Procedures 794 Some Staining Techniques in Detail 799 Automation in Histopathology 805 Chapter 26. Cytology 808 Papanicolaou Method of Staining Smears (Modified) 808 Fnac (Fine-Needle Aspiration Cytology) 809 Smearing Techniques 812 Requirements for Laboratory Set Up 812 Immunoperoxidase Staining for Cyto and Histopathology 817 Automation in Cytology 818 Chapter 27. Microbiology and Bacteriology 819 Classification 819 Culture 825 Ready to Pour, Sterilized Pouched Media for Microbiological Applications Instaprep 828 Easybact 833 General Instructions for Microbiology 837 Gram-positive Cocci 837 Gram-negative Cocci 839 Anaerobic Spore Bearing Bacilli 840 Aerobic Spore Forming Bacilli 842 Gram-positive Bacilli 842 Mycobacteria 843 Overview of M. tuberculosis: Diagnostic Approach, Afb Staining, Culture and Sensitivity 845 Mucolytic, Disinfectant, Specimen Pretreatment and Buffering System for Afb Staining and Culture 848 Rapid Two Step Cold Afb Stain 851 Ready to use Lj Solid Medium for Mycobacterium tuberculosis Isolation 855 Combipack of Solid and Liquid Medium for Mycobacterium tuberculosis Isolation 857 Primary/Secondary Drug Containing Lowenstein-Jensen Media Panel Mtb Sensitivity Tests 861 In Determination of Adenosine Deaminase Activity in Serum, Plasma and Biological Fluids 863 Gram-negative Bacilli 865 Spirochetes 871 Gram Stainer 872 Quality Assurance in Bacteriology 872 Color Atlas—Media and Colonies 873 Chapter 28. Mycology 883 Intermediate Superficial Deep Mycoses 884 Deep or Systemic Mycoses 884 Fungi Usually Present as Contaminants but Which Rarely Cause Disease—Usually in Patients Chronically Ill from Other Diseases 885 Mycological Methods 885 Chapter 29. Diagnostic Skin Test 886 Technique of Skin Tests 886 Immunologic Basic for Skin Tests 886 Common Skin Tests 887 Immediate Reaction Type of Skin Tests 887 Delayed Reaction Type of Skin Tests 889 Chapter 30. Cytogenetics 891 Blood Lymphocyte Culture 891 Karyotyping 893 G and Q Bandings 894 Importance of Chromosomal Studies 894 Barr Body Analysis and Buccal Smear for Staining of Sex Chromatin Mass 895 Chapter 31. World’s Latest and Best Technologies by Roche 896 Business Areas 896 Revaluating Diagnostics 896 Testing Efficiency and Medical Value 896 Effective Management of Infectious Diseases 898 Cobas® Modular Platform 900 Your Benefit 900 Cobas® 8000 Modular Analyzer Series 901 Cobas® 8000 Modular Analyzer Series 902 Cobas® 6000 Analyzer Series 903 Cobas® 4000 Analyzer Series 906 Cobas C 311 Analyzer 906 Cobas E 411 Analyzer 906 Cobas C 111 Analyzer 907 Cobas Integra® 400 Plus 908 Cobas P 312 Pre-analytical System 910 Cobas P 512 Pre-analytical System 910 Cobas P 612 Pre-analytical System 911 Cobas P 501 and Cobas P 701 Modular® Pre-analytics Evo 912 Cobas® Connection Modules (Ccm) 913 Cobas® 8100 Automated Workflow Series 914 Cobas® It Solutions 916 Cobas® Middleware Solution 917 Cobas® Laboratory Information System 918 Cobas® Infinity It Solutions 920 Overview of Serum Work Area Tests 921 Ecl—Unique Immunoassay Technology 925 Technology for Homogeneous Immunoassay Detection 926 Elecsys® Hbsag Ii Quant 926 Elecsys® Hiv Combi Pt 4th Generation (Ag+Ab Test) 927 The Syphilis Assays 929 Elecsys® Syphilis Immunoassay 929 Elecsys® Torch Panel 930 Elecsys® Troponin T High Sensitive (Tnt Hs) 931 xvi Concise Book of Medical Laboratory Technology: Methods and Interpretations Key Benefit: Earlier Diagnosis of Ami 932 Elecsys® Nt-proPnB 932 Elecsys® Tumor Marker Portfolio 933 Elecsys® He4 935 Elecsys® Pro-grp 936 Elecsys® Calcitonin 937 Elecsys® Anti-Tshr 938 Elecsys® Tg Ii 939 Tina-Quant® Lipoprotein (A) Gen 2 Test 940 Tina-Quant® Immunoglobulin A and M Csf 941 Tina-Quant® Hemoglobin A1c 942 Tina-Quant® Cystatin C Gen 2 942 Elecsys® Preeclampsia 943 Elecsys® Vitamin D Total 945 Elecsys® Il-6, Pct and Tina-Quant® Crp 945 Elecsys® Tacrolimus and Cyclosporine 947 Hemostasis Testing 949 Multiplate® Analyzer 949 Urinalysis 951 Urinalysis From Roche 951 Combur-Test® Strip 951 Urisys 1100® Analyzer 952 Cobas U 411 Urine Analyzer 953 Cobas® 6500 Urine Analyzer Series* 954 Point-of-Care Testing 956 Cobas Poc it Solution 958 Cobas bge Link Software 960 Cobas B 121 System 961 Cobas B 221 System 962 Cobas B 123 Poc System 963 Accu-Chek® Inform Ii System 964 Accu-Chek® Safe-T-Pro Plus 965 Cobas H 232 Poc System 966 Roche Cardiac® Trop T Sensitive Test 967 Coaguchek® Xs System 968 Coaguchek Xs Plus System 969 Accutrend® Plus System 970 Reflotron® Plus System 971 Cobas B 101 System 972 Molecular Diagnostics 974 Solutions from Roche for Molecular Diagnostics 974 Cobas P 630 Instrument 977 Cobas® Ampliprep Instrument 978 Cobas® Taqman® Analyzer and Cobas® Taqman® 48 Analyzer 979 Cobas® Ampliprep/Cobas® Taqman® Hcv Qualitative and Quantitative Tests, V2.0 980 Cobas® Taqman® Mtb Test 981 Cobas P 480 Instrument 982 Cobas® 4800 System V2.0 983 The Cobas® Hpv Test 985 The Cobas® Oncology Tests 985 Cobas® Mrsa/Sa Test 987 Cobas® Cdiff Test 987 Cobas® Hsv 1 and 2 Test 988 Cobas S 201 System 988 Lightcycler® Systems 990 Lightcycler® 2.0 Instrument 991 Test Kits, Validated for Ivd 992 Lightcycler® Septifast Test 992 Lightcycler® Mrsa Advanced Test 993 Magna Pure Systems 993 Symphony System 996 Benchmark Special Stains 997 Primary Antibodies 999 Ihc Detection 1001 Breast Cancer Diagnostics 1002 Prostate Cancer Diagnostics 1003 Hematopathology 1004 Colorectal Diagnostics 1004 Lung Cancer Diagnostic Solutions 1005 Benchmark Ihc/Ish Platform 1007 Benchmark System Features 1007 Digital Pathology 1008 Vantage Workflow Solution 1009 Consultancy Services 1011 Sequencing Solutions 1013 Genome Sequencer Flx+ System 1013 Gs Junior System 1014 Nimblegen Sequence Capture 1015 Roche Dialog 1017 Appendix 1019 Index 1033

 


Biowavers

Biowavers are the exemptions that are granted by USFDA from conducting human

bioequivalence studies. Biowavers reduce the need for bioequivalence studies. They

are given when in vitro studies data provides sufficient estimate of a relative in vivo

performance of two products. These are given when API meets certain solubility and

permeability criteria.

BIOSTATISTICS IN PHARMACEUTICAL PRODUCT DEVELOPMENT

Statistics is the science which deals with collection, tabulation and classification of

numerical facts as the basis for explanation, description and comparison of the

phenomenon.

Biostatistics is the branch of statistics concerned with mathematical facts and data

related to biological events. Sir Francis Galton is the Father of biostatistics.

There are two types of biostatistics:

1. Inferential biostatistics: It is the methods of generalising a larger group. The

generalization is based on information about a sample. The sample is considered to

be similar to the population.

2. Descriptive biostatistics: These are used to explain the basic features of the data.

They also provide simple summaries of the data.

Application of Biostatistics

After the Kefauver Harris drug amendments, it is compulsory for the firms to prove

the safety of the drug with suitable statistical evidence. Statistics is involved in all

stages of drug development, i.e. from drug discovery to post-marketing processes.

DATA PRESENTATION FOR FDA SUBMISSIONS

The FDA accepts electronic submissions. The electronic submission's regulatory process

is divided into four steps:

1. Early planning and management of the project

2. Document Preparation

3. Dossier publishing

4. Dossier submission

During the planning stage applicants are recommended to use the following tools:

• Checklist • Glossary

• Template • Timeline table

MANAGEMENT OF CLINICAL STUDIES

The clinical trial management requires efficient management. Clinical trial consists of

a series of stages. Each of the stages requires effective management. The stages are as

follows:

1. Initiating 2. Planning 3. Executing

4. Monitoring and controlling 5. Analysis and reporting

Managing these five stages is the most effective way of managing clinical studies.

 


10. Quality and Related Concepts

11. Total Quality Management and Other Quality

Management Systems

12. ISO Series, NABL and GLP

Summary

4

Quality Management Systems

150 Industrial Pharmacy II

QUALITY

If we go with the dictionary meaning of quality, then quality means “standard of

something when compared with one that already exists, or degree of excellence of

something.”

Quality is something that motivates organisations not only to achieve the minimum

excellence mark but also to improve it continuously. Quality of any product depends

upon the stakeholders, i.e. their demands and expectations from the products. Here,

stakeholder means everyone who has an interest in the product directly or indirectly.

Customers comprise a large group of stakeholders. Other stakeholders are investors,

employees, suppliers, etc.

Quality of any product can be assured by three ways:

i. By setting guidelines which are compulsory for an organisation to follow.

ii. By setting up an effective quality control system in the organisation that will

maintain the ensured quality.

iii. By developing a culture in the organisation of improving the quality.

This unit deals with the same concept of quality and different quality management

systems developed for ensuring quality. Different ISO series have also been discussed

in this unit.

10.1 CONCEPT OF QUALITY

The quality in the pharmaceutical industry is a very important topic. The government

regulatory agencies, drug manufacturers, customers and other stakeholders all joined

together to give or to have a quality product. Every agency or stakeholders define

quality differently. Everyone has its meaning of quality.

According to ASQC (American Society for Quality Control) quality can be defined

as the totality of features and characteristics of a product that bears on its ability to

satisfy the stated or implied needs.

ISO, an international body for formulating standards, has defined quality as: “Degree

to which a set of inherent characteristics fulfils requirements”.

According to ICH quality is the degree to which a set of inherent properties of a

product, system or process fulfils requirements.

150

Quality and Related Concepts

10

Quality and Related Concepts 151

There are many ways to define quality like:

a. “It delivers the properties described on the label and is not contaminated”

b. “Fitness for intended use”

c. “Freedom from defects”

d. “Meeting or exceeding customer expectations”

We can summarise these definitions of quality as:

i. User-based: “In the eyes of beholder/what user expects.”

ii. Manufacturing-based: “Right at the first time”

iii. Product-based: “Precise as per specifications”

Dimensions of Quality

There are eight dimensions which decide either the product is a quality product or

not. These are as follows (Fig. 10.1):

i. Performance

ii. Features

iii. Reliability

iv. Conformance

v. Durability

vi. Serviceability

 


IND is not required:

• In case the drug is not intended for human subjects.

• In case the drug is intended for in vivo testing.

• When the drug is already approved and study is conducted within the approved

indication for use.

INVESTIGATOR'S BROCHURE (IB)

It is a compilation of the clinical and non-clinical data on the investigational product

that is relevant to the study of the product in human subjects. The main purpose of an

investigator's brochure is to provide information to the investigator. It also enables

the investigator to understand the trial and make benefit/risk assessment of the

investigational product by own. The investigational brochure is edited by a medically

qualified person.

NEW DRUG APPLICATION (NDA)

The application through which drug sponsors propose the approval of a new drug

product; for marketing in front of regulatory authority. It includes all clinical and

non-clinical data.

Review time frame: The FDA will review and issue an approval, approvable,

or non-approvable letter within 180 days of receipt of application. This period is

known as review-clock. In this period the application is reviewed by the FDA

thoroughly. During this period applicant may withdraw the application and resubmit

it later.

Filing time frame: After 60 days of receiving the application, the FDA will decide

whether the application may be filed or not. If the FDA filed the application, then

applicants will be notified otherwise the applicant will be allowed to discuss the reason

for non-filing of application with FDA.

CLINICAL RESEARCH/BE STUDIES

BE stands for bioequivalence. It is a relative term. It denotes that a drug substance in

two or more identical dosage forms reaches the systemic circulation at the same relative

rate and to the same relative extent.

Summary 147

Popular Posts

Popular Posts

Popular Posts

Popular Posts

Translate

Blog Archive

Blog Archive

Featured Post

  ABSTRACT Doxorubicin (Dox) is a highly potent chemotherapy drug. Despite its efficacy, Dox's clinical application is limited due to it...