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Remove as much of the soft decayed material as possible with a spoon-shaped instrument symptoms zoloft overdose buy thyroxine 200 mcg with amex. Have the patient bite several times to symptoms 9 days before period buy genuine thyroxine on-line compress the putty treatment of ringworm buy on line thyroxine, and to medicine journals impact factor thyroxine 100mcg without prescription avoid malocclusal problems with opposite teeth when dry. Remove surplus filling material by lightly rubbing the tooth with a moist cotton pellet. The pain should disappear in a few minutes and the putty will harden within 5-10 minutes. Instruct the patient that the procedure is temporary and a dentist must give definitive care. Although many types of extraction forceps are manufactured, the removal of any erupted tooth can usually be done with one of two instruments: the Maxillary Universal Forceps (150) or the Mandibular Universal Forceps (151). Break the attachment of the gingival tissue to the tooth by forcing a blunt instrument (Periosteal Elevator, Woodson Plastic Instrument, etc. Use the free hand to guide the beaks of the forceps under the gingival margin on the facial and lingual aspects of the tooth and to support the alveolar process. Apply pressure toward the root of the tooth to force the tips of the forceps as far down on the root as possible. To loosen teeth with more than one root (molars and upper first bicuspids): slowly rock the tooth with progressively increasing traction in a facial-lingual direction. Note the direction in which the tooth moves most easily and follow this path for delivery. After the extraction, compress the sides of the empty socket (this repositions the bone that has 5-25 5-26 been sprung by the extraction fold) and place a folded dampened sponge or 2 x 2 over the wound. Instruct the patient to maintain light biting pressure on this compress for 60 minutes. Suture a small drain or slice of surgical tubing in the wound to maintain drainage and leave for 2-3 days. Stabilize the tooth firmly with the fingers; remove the soft decay with a spoon-shaped instrument until an opening into the pulp chamber is made. Finger pressure on the gingiva near the root of the tooth should force pus out through the chamber opening. Disseminated gonorrhea presents with infectious arthritis, tenosynovitis, and a characteristic gunmetal blue skin lesion surrounded by a red halo, usually on the extremities (arthritis-dermatitis syndrome). Infant eye and lung infections are consequent to maternal genital infection with Chlamydia. A thick mucus discharge with pain on urination and genital ulcer should suggest Herpes simplex. Patient Education General: Evaluate and treat recent sexual contacts No Improvement/Deterioration: Always treat patient as if co-infected with chlamydia Medications: Avoid taking doxycycline with antacids, milk, iron pills or multivitamins. Prevention and Hygiene: Use barrier protection (latex condoms) or abstinence for duration of treatment. For recurrent urethritis after treatment of patient and partner, give metronidazole 2 gm po in single dose and erythromycin 500 mg po qid for 7 days (discuss Antabuse effect of metronidazole and do not use during pregnancy). Consult urology, gynecology, infectious disease or preventive medicine experts as needed. Granuloma inguinale (caused by gram-negative Calymmatobacterium granulomatis) causes beefy red granulomas that progress slowly but can cover the genitalia and heal slowly with scarring. Suppuration, scarring, systemic infection, chronic elephantiasis and rectal strictures have been seen in untreated infection. Syphilis is curable in all stages but treatment may yield a Jarisch-Herxheimer reaction with fever, rigors and intensification of the lesions 2-24 hours after initiating treatment. Chancroid is especially seen in Africa and Asia and is the most frequent cause of genital ulcer in the tropics. Granuloma inguinale is most often associated with exposure in India, Australia, South Pacific, Brazil and South Africa. Assessment: Diagnosing the cause of genital ulcer disease is mainly based on the clinical history and inspection. Differential Diagnosis Genital ulcers can have non-infectious etiology: fixed drug eruption (take medication history), Behcets syndrome (recurrent symptoms with oral ulcers, conjunctivitis and uveitis), traumatic injury, malignancy. Secondary syphilis (rash) can be confused with infectious exanthems, drug reaction, Erythema multiforme. Helpful clues for syphilis are sexual history, prior healed chancre, rash on palms and soles, and absence of any skin lesions that look like targets. Patient Education: Limit activity if possible during early week of antibiotics to decrease risk of strictures. Expect to see a treatment response by seven days but prolonged therapy is needed to avoid relapse. Treatment: Herpes simplex Primary: Acyclovir 400 mg q 8 hours x 10-14 days if initial episode, for 5 days if recurrence Alternative: Valacyclovir 1000 mg q 12 hours x 10 days (use 500 mg po qd for 5 days for recurrence), Famciclovir 250 mg po q 8 hours x 5-10 days (use 125 mg bid for 3-5 days for recurrence) 5-29 5-30 Patient Education: this virus can be sexually transmitted even in the absence of active lesions. Prevention and Hygiene: Health care workers should wear gloves to handle lesions to reduce risk of local inoculation to the hand (herpetic whitlow). It can be asymptomatic initially but manifestations can include Hutchinsons teeth, saddlenose, saber shins, deafness. Suspect this if the umbilical cord is swollen and demonstrates a red/white/blue pattern like a barber pole. Evacuation/Consultant Criteria: Evacuation is not usually required for any of these conditions in the acute phase. Consult urology, gynecology, infectious disease or preventive medicine experts as needed, particularly in chronic cases. Subjective: Symptoms Yellow-green discharge (may be frothy and malodorous but not usually fishy); vulvovaginal irritation and burning; dysuria. Using Basic Tools: Characteristic discharge not always present; vulva may be edematous and inflamed; redness of the cervix (strawberry cervix); tender vagina; no abdominal pain. Plan: Treatment Primary: Metronidazole 2 gm po X 1 or metronidazole 500 mg po bid x 7 days (95% cure rate) Note: Pregnancy: Oral therapy after the first trimester. If this is not available, consider vaginal clotrimazole or other antifungal (50% effective) if patient is very symptomatic, followed by oral metronidazole after the first trimester. In a mildly symptomatic patient in the first trimester of pregnancy, delay therapy until the 2nd trimester (after 12 weeks). Diet: As tolerated Medications: Refrain from alcohol and use of alcohol-containing products during treatment because of Antabuse-like effect (vomiting, anxiety, myalgia, etc. Subjective: Symptoms Gradual onset of bloody diarrhea with associated abdominal pain and tenderness. Assessment: Differential Diagnosis Diarrhea giardiasis, viral gastroenteritis, bacterial gastroenteritis, cryptosporidiosis, isosporiasis, E. Plan: Treatment: Metronidazole 750 mg tid x 10 days followed by paromomycin 30 mg/kg/d in 3 divided doses x 10 days. Patient Education General: Maintain adequate oral intake of fluids to avoid volume depletion. Medications: Metronidazole should not be used in the first trimester of pregnancy. Follow-up Actions Return evaluation: If diarrhea continues, consider other etiologies. The eggs hatch in the small intestine, penetrate the intestinal wall and travel by venous circulation to the lungs. Ascaris is also known as roundworm, and is large enough to easily see without magnification. Subjective: Symptoms Abdominal pain (obstruction of bowel or bile ducts [biliary colic] with worms); wheezing and coughing (pneumonitis [Loefflers syndrome]); occasional liver enlargement; fever. Worms (some larger than earthworm) pass from the anus, nose and mouth and are often brought for diagnosis. Plan: Treatment: Primary: Albendazole 400 mg once Alternative: Mebendazole 100 mg bid for one day. Activity: As tolerated Diet: As tolerated Medications: Occasional gastrointestinal side-effects Prevention and Hygiene: Hand washing No Improvement/Deterioration: Refer for evaluation Follow-up Actions Return evaluation: As needed Consultation Criteria: Failure to improve. It is typically a mild illness in healthy people but it can be fatal, particularly in immunocompromised patients (especially splenectomized patients).

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If the needle is properly in the vein medicine you can take while pregnant buy thyroxine 100mcg low price, blood will begin to medicine reactions discount 100 mcg thyroxine overnight delivery enter the syringe spontaneously medicine cabinets recessed thyroxine 75mcg overnight delivery. With the syringe and needle system medications 44334 white oblong purchase thyroxine cheap online, first cover the needle with its cap, remove it from the nozzle of the 52 Hematology syringe and gently expel the blood into a tube (with or without anticoagulant). With the vacutainer system, remove the tube from the vacutainer holder and if the tube is with added anticoagulant, gently invert several times. Do not let the patient go until the bleeding stops Advantages of Venous Blood By providing sufficient amount of blood it allows various tests to be repeated in case of accident or breakage or for the all-important checking of a doubtful result. It also frequently allows the performance of additional tests that may be suggested by the results of those already ordered or that may occur to the clinician as afterthoughts. Difference between peripheral and venous Blood Venous blood and peripheral blood are not quite the same, even if the latter is free flowing, and it is likely that free flowing blood obtained by skin puncture is more arteriolar in origin. The total leucocyte and neutrophil counts are higher by about 8% and the 54 Hematology monocyte count by 12%. Conversely, the platelet count appears to be higher by about 9% in venous than peripheral blood. Advantages of the Vacutainer Method of Venous Blood Collection It is an ideal means of collecting multiple samples with ease. The multiple sample needle used in the vacutainer method has a special adaptation that prevents blood from leaking out during exchange of tubes. Arterial punctures are technically more difficult to perform than venous punctures. What is the difference between samples collected from these two sources in terms of hematological parametersfi While clotted blood is desirable for certain laboratory investigations, most hematology procedures require an anticoagulated whole blood. Calcium is either precipitated as insoluble oxalate (crystals of which may be seen in oxalated blood) or bound in a non-ionized form. It exerts its effect by tightly binding (chelating) ionic calcium thus effectively blocking coagulation. This concentration does not appear to adversely affect any of the erythrocyte or leucocyte parameters. Heparin Heparin is an excellent natural anticoagulant extracted from mammalian liver or pancreas. Heparin prevents clotting by inactivating thrombin, thus preventing conversion of fibrinogen to fibrin. It is unsatisfactory for leucocyte and platelet and leucocyte counts as it causes cell clumping and also for blood film preparation since it causes a troublesome diffuse blue background in Wright-stained smears. Adequate mixing is necessary prior to film preparation if the blood has been standing for any appreciable period of time. It is essential that the slide used as a spreader have a smooth edge and should be narrower in breadth than the slide on which the film is prepared so that the edges of the film can be readily examined. If the edges of the spreader are rough, films with ragged tails will result and gross qualitative irregularity in the distribution of cells will be the rule. Spinner method 70 Hematology Blood films that combine the advantages of easy handling of the wedge slide and uniform distribution of cells of the coverglass preparation may be made with special types of centrifuges known as spinners. The spinner slide produces a uniform blood film, in which all cells are separated (a monolayer) and randomly distributed. This is of little practical significance, but it does result in slightly lower monocyte counts in wedge films. Desirable qualities of a thin blood film the availability of sufficient working area. Preparation of thick blood smears Thick blood smears are widely used in the diagnosis of blood parasites particularly malaria. What are the possible effects of using a blood sample that has been standing at room temperature for some time on blood cell morphologyfi Jenner (1880) found that the precipitate formed when eosin and methylene blue are mixed could 74 Hematology be dissolved in methyl alcohol to form a useful stain combining certain properties of both parent dye stuffs. Principle of staining Acidic dyes such as eosin unites with the basic components of the cell (cytoplasm) and hence the cytoplasm is said to be eosinophilic (acidic). Conversely, basic stains like methylene blue are attracted to and combine with the acidic parts of the cell (nucleic acid and nucleoproteins of the nucleus) and hence these structures are called basophilic. Romanowsky stains in common use 75 Hematology Modern Romanowsky stains in common. Wright stain In its preparation, the methylene blue is polychromed by heating with sodium carbonate. Place the air-dried smear film side up on a staining rack (two parallel glass rods kept 5cm apart). Without disturbing the slide, flood with distilled water and wash until the thinner parts of the film are pinkish red. Leishman Stain In its preparation, the methylene blue is polychromed by heating a 1 % solution with 0. It is commonly used in combination with Jenner or May Grunwald stains it constitutes panoptic staining". Panoptic staining Panoptic staining consists of a combination of a Romanowsky stain with another stain. This improves the staining of cytoplasmic granules and other bodies like nucleoli of blast cells. It is buffered to the correct pH and neither solution requires dilution when staining thick films. Thin film Fields staining technique Required Fields stain A Fields stain B, diluted 1 in 5 Buffered pH 7. Place the slide on a staining rack and cover the methanol-fixed thin film with approximately 0. Add immediately an equal volume of Fields stain A and mix with the diluted Fields stain B. Holding the slide with the dried thick film facing downwards, dip the slide into Fields stain A for 5 seconds. Wipe the back of the slide clean and place it upright in a draining rack for the film to air-dry. Describe the appearance of cells and cell components in Romanowskystained thin blood films. It is not recommended for routine red cell counts because the number of cells which can be counted within a reasonable time in the routine laboratory will be too few to ensure a precise result. Yet it is still necessary for the technologist to be able to use this method effectively and to know its limitations. Any cell counting procedure includes three steps: dilution of the blood, sampling the diluted suspension into a measured volume, and counting the cells in that volume. Counting Chambers the hemocytometer is a thick glass slide with inscribed platforms of known area and precisely controlled depth under the coverslip. In the center of the upper surface 87 Hematology there are ruled areas separated by moats/channels from the rest of the slide and two raised transverse bars one of which is present on each side of the ruled area. The ruled portion may be in the center of the chamber (single chamber) or there may be an upper and lower ruled portion (double chamber). The double chamber is to be recommended since it enables duplicate counts to be made rapidly. When an optically plane cover glass is rested on the raised bars there is a predetermined gap or chamber formed between its lower surface and the ruled area (fig. This is called the depth of the chamber and it varies with the type of the chamber. The counting chamber recommended for cell counts is a metallized surface (Bright-line) double cell Improved Neubauer ruled chamber. The width of the triple lines dividing the large squares is the same as the width of a small square. Two adjacent sides of the ruled area are bounded by triple lines, the other two by single lines.

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Validation of the Cumulative Illness Rating Scale in a geriatric residential population medications zoloft side effects buy cheap thyroxine. Assessing the impact of comorbid illnesses on death within 10 years in prostate cancer treatment candidates medicine 1900 thyroxine 50mcg without a prescription. Assessment of older people: self-maintaining and instrumental activities of daily living symptoms hypothyroidism buy thyroxine 25mcg without a prescription. All-cause 1- medications for migraines cheap thyroxine generic, 5-, and 10-year mortality in elderly people according to activities of daily living stage. Undernutrition in elderly patients with cancer: target for diagnosis and intervention. Cognitive impairment: an independent predictor of excess mortality: a cohort study. Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy. Bone-modifying agents in the treatment of bone metastases in patients with advanced genitourinary malignancies: a focus on zoledronic acid. Docetaxel-based chemotherapy in elderly patients (age 75 and older) with castration-resistant prostate cancer. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Do anxiety and distress increase during active surveillance for low risk prostate cancerfi Predictors of health-related quality of life and adjustment to prostate cancer during active surveillance. Long-term Distress After Radical Prostatectomy Versus Watchful Waiting in Prostate Cancer: A Longitudinal Study from the Scandinavian Prostate Cancer Group-4 Randomized Clinical Trial. A national study of adverse effects and global quality of life among candidates for curative treatment for prostate cancer. Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy. Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. A prospective study of transition from laparoscopic to robot-assisted radical prostatectomy: quality of life outcomes after 36-month follow-up. Nerve-sparing surgery significantly affects long-term continence after radical prostatectomy. Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. Long-term outcomes among localized prostate cancer survivors: healthrelated quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy. Health-related quality of life up to six years after (125)I brachytherapy for early-stage prostate cancer. Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: a randomized controlled trial in prostate cancer patients undergoing radiotherapy. Health-related quality of life for men with prostate cancer and evaluation of outcomes 12-24 months after treatment. Fatigue in prostate cancer patients treated with external beam radiotherapy: a prospective 5-year long-term patient-reported evaluation. Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer. Results of high intensity focused ultrasound treatment of prostate cancer: early Canadian experience at a single center. Quality of life and sexuality of men with prostate cancer 3 years after cryosurgery. A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer: quality of life outcomes. Quality of life in advanced prostate cancer: results of a randomized therapeutic trial. Cognitive and mood changes in men undergoing intermittent combined androgen blockade for non-metastatic prostate cancer. Quality of life of asymptomatic men with non-metastatic prostate cancer on androgen deprivation therapy. Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study. Bicalutamide monotherapy compared with castration in patients with nonmetastatic locally advanced prostate cancer: 6. Non-steroidal antiandrogens: a therapeutic option for patients with advanced prostate cancer who wish to retain sexual interest and function. Boccardo F, Rubagotti A, Barichello M, et al, for the Italian Prostate Cancer Project. Bicalutamide monotherapy versus flutamide plus goserelin in prostate cancer patients: results of an Italian Prostate Cancer Project study. Androgen deprivation therapy for prostate cancer: recommendations to improve patient and partner quality of life. Hot flashes during androgen deprivation therapy with luteinizing hormonereleasing hormone agonist combined with steroidal or nonsteroidal antiandrogen for prostate cancer. Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial. Two modes of acupuncture as a treatment for hot flushes in men with prostate cancer-a prospective multicenter study with long-term follow-up. Risk of clinical fractures after gonadotropin-releasing hormone agonist therapy for prostate cancer. Bicalutamide 150 mg maintains bone mineral density during monotherapy for localized or locally advanced prostate cancer. Bicalutamide monotherapy preserves bone mineral density, muscle strength and has significant health-related quality of life benefits for osteoporotic men with prostate cancer. Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer. Randomized controlled trial of annual zoledronic acid to prevent gonadotropin-releasing hormone agonist-induced bone loss in men with prostate cancer. Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment. Frequency of zoledronic acid to prevent further bone loss in osteoporotic patients undergoing androgen deprivation therapy for prostate cancer. Denosumab and bone-metastasis-free survival in men with castrationresistant prostate cancer: results of a phase 3, randomised, placebo-controlled trial. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Metabolic syndrome in men with prostate cancer undergoing longterm androgen-deprivation therapy. Changing patterns in competing causes of death in men with prostate cancer: a population based study. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of Veterans with prostate cancer. Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials.

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No clinical signs of toxicity or alterations in weight gain were seen in any of the species examined medicine ball exercises discount 50mcg thyroxine with amex. In dogs and monkeys medications xyzal 100mcg thyroxine, hematology and clinical chemistry results throughout the study and at termination were unremarkable symptoms at 4 weeks pregnant purchase thyroxine 75 mcg free shipping, as were the results of the gross and histopathologic examinations medicine of the people buy thyroxine 100mcg cheap. At 25 ppm, no significant differences from controls were seen in mouse liver levels E-7 of cytochromes. Mice exposed to 25 ppm showed no histopathologic changes, while histologic changes in mice at 100 ppm were restricted to positive fat stains and some cytoplasmic vacuolation in the liver. In rats at both exposure levels, the livers showed positive staining for increased fat, and the kidneys showed evidence of nonspecific tubular degenerative and regenerative changes. The only significant effect observed in rats was a slight redness of the conjunctiva 110 hours after each exposure. In dogs, compound-related effects were restricted to slight sedation throughout the exposure period and slight erythema lasting up to 10 hours after exposure. Comprehensive sets of tissues and organs in control and high-dose animals were histologically examined; tissues from the lower dose groups were examined to determine the no-observed-effect level. One male and one female rat from the 8,400 ppm exposure group died before the end of the study, but the cause of death was not discussed. Foreign-body pneumonia was present in 4/10 male and 6/10 female rats exposed to 8,400 ppm and in 1/10 female rats from the 4,200 ppm exposure group. The liver lipid/liver weight ratios for 8,400 ppm rats of both sexes and 4,200 ppm female rats were significantly lower than in controls. In mice, 4/10 males and 2/10 females exposed to 8,400 ppm died before the end of the study, and these deaths were considered treatment-related. Histologic changes in exposed mice consisted of hepatic centrilobular hydropic degeneration (of minimal to mild severity) in 3/10 males and 8/10 females at 8,400 ppm and in 9/10 females from the 4,200 ppm exposure group. The liver lipid/liver weight ratio for the high-dose female mice was significantly lower than in controls. The test material was dichloromethane (of unspecified purity) purchased from Dow Chemical Company. At approximately 100 days of age, the rats were mated 1 to 1 to produce the F1 generation. F1 rats (15/sex/dose level) received the same treatment as F0 for 90 days, at which time they were sacrificed and necropsied. Comprehensive sets of 24 tissues from 10 male and 10 female F1 rats from the control and 225 mg/kg-day groups were examined microscopically after embedding, sectioning, and staining. Reproductive parameters examined were fertility index, number of pups per litter, and pup survival. F1 rats also underwent hematology and clinical chemistry tests and urinalysis at 1, 2, and 3 months of the study and ophthalmoscopic examination at 3 months. There were no significant compound-related alterations in any of the endpoints monitored. Mating with unexposed females started 1 week after the last exposure and continued for 2 weeks. After the mating period, the males were sacrificed and the testes were examined microscopically. The authors reported that exposure to dichloromethane had no statistically significant effects on number of litters, implants/litter, live fetuses/litter, percent dead/litter, percent resorbed/litter, or fertility index. Examination of the testes showed no significant alterations compared with controls. Groups of F344 rats (30/sex/dose level) were exposed by inhalation in whole-body chambers to 0, 100, 500, or 1,500 ppm dichloromethane (99. After weaning, 30 randomly selected F1 pups/sex/dose level were exposed as the parental generation for 17 weeks and subsequently mated to produce the F2 generation. The results showed no statistically significant exposurerelated changes in reproductive performance indices (fertility, litter size), neonatal survival, E-9 growth rates, or histopathologic lesions in F1 (Table E-3) or F2 weanlings sacrificed at time of weaning. None of the values in Table E-3 were significantly different from control values using a p = 0. Exposure of the male mice to dichloromethane had no statistically significant effects on number of litters, implants/litter, live fetuses/litter, percent dead/litter, or percent resorbed/litter, and no significant alterations in the testes were noted. The fertility index was 95, 95, 80, and 80% in the control, 100, 150, and 200 ppm groups, respectively. Individual p-values for the comparison of each group with the control group were 0. The results for the combined 150 and 200 ppm groups were statistically different from the combined controls and 100 ppm group (Fishers exact test, one-sided p-value = 0. Gavage Studies and Culture Studies Narotsky and Kavlock (1995) evaluated developmental effects of dichloromethane (99. Dead pups or pups with no gross abnormalities were sacrificed and examined for soft tissue abnormalities. Maternal weight gain during pregnancy was significantly reduced in high-dose dams (by 33%, as estimated from Figure 5 of the paper); this group also exhibited rales and nasal congestion. At the end of the exposure, embryos were observed for development of yolk sac vasculature, crown-rump length, total embryonic protein content, and number of somite pairs. At sacrifice, E-11 uterine horns were excised and examined for fetal position and number of live, dead, or absorbed fetuses. The only effects seen on developing fetuses were changes in the incidence of minor skeletal variants. In rats, the incidence of lumbar ribs or spurs was significantly decreased compared with controls, whereas the incidence of delayed ossification of sternebrae was significantly greater than in controls. In mice, a significant number of litters contained pups with a single extra center of ossification in the sternum. Mean absolute liver weights of exposed dams of both species were significantly elevated compared with controls, but mean relative liver weights were not affected. Hardin and Manson (1980) conducted a study in female Long-Evans rats to determine whether exposure before and during gestation is more detrimental to reproductive outcome than exposure either before or during gestation alone. Livers were weighed, and uterine horns were examined for fetal position and number of live, dead, or absorbed fetuses. None of the groups showed significant alterations in the incidence of gross, external, skeletal, or soft-tissue anomalies. Assessed activities included head movement/pivoting when placed in a novel environment (4 days of age), limited crawling (10 days), movement in a photocell cage (15 days), use of running wheel (45108 days), and shock avoidance (4 months). Exposure during gestation (with or without pregestation exposure) caused altered rates of behavioral habituation to novel environments in the pups tested as early as 10 days of age; these altered rates were still present at 150 days of age. Growth, food and water consumption, wheel running activity, and avoidance learning were not significantly affected by exposure to dichloromethane. Groups of 60 male and 69 female newborns continued to be exposed after birth to 60 ppm dichloromethane 4 hours/day, 5 days/week for 7 weeks, followed by exposure 7 hours/day, 5 days/week for 97 weeks. Additional groups of 60 male and 70 female newborn were exposed after birth to 60 ppm dichloromethane 4 hours/day, 5 days/week for 7 weeks and then for 7 hours/day, 5 days/week for 8 weeks. At the end of exposure, animals were sacrificed and histologic examinations were performed on 20 tissue types. Also, there was no significant effect of exposure to dichloromethane on the percentage of animals with benign and malignant tumors and malignant tumors, the number of malignant tumors per 100 animals, or the percentage of animals with benign mammary tumors, malignant mammary tumors, leukemias, pheochromocytomas, and pheochromoblastomas. The results provide no evidence that gestational exposure to 100 ppm dichloromethane during early life stages of development increases the susceptibility of SpragueDawley rats to the potential carcinogenicity of dichloromethane, but further conclusions from these results are precluded because the study included only one exposure level that was below the maximum tolerated dose for adult Sprague-Dawley rats. Experiments comparing cancer responses from early-life exposures with adult exposures are not available for F344 rats or B6C3F1 mice, the strains of animals in which carcinogenic responses to dichloromethane have been observed. In the acute study, rats were dosed with 0, 101, 337, 1,012, or 1,889 mg/kg dichloromethane (8 rats per group). At 4 and 24 hours after the administered dose, rats were tested for the neurological parameters. Significant changes in the neuromuscular and sensorimotor parameters were observed and occurred mostly E-13 in rats administered with the highest dose. These significant changes were only observed at the 4-hour time point and not when measured at 24 hours. With the exception of the activity measurements, all other neurobehavioral parameters (neuromuscular, th sensorimotor, autonomic, excitability) were significantly affected from the 4 day through the entire 14-day exposure cycle. All of the waveform amplitudes returned to control levels when measured at the 1-hour time point for all doses tested. Response latencies were still different from controls when measured 5 hours after dosing, but the effect was less pronounced than at the 15-minute and 1-hour time points. The rats were sacrificed 2 hours after a single gavage dose of 0 or 534 mg/kg of undiluted dichloromethane.

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