X
|
STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
|
Jamie Kisgen, PharmD
The primary metabolites of epinephrine and norepinephrine are vanilylmandelic acid and 3-methoxy-4-hydroxyphenethyleneglycol sciatica pain treatment exercise purchase artane 2 mg visa. At high infusion rates of dopamine pain treatment hemorrhoids cheap artane 2 mg with amex, ventricular arrhythmias pain treatment for uti buy generic artane 2mg online, and hypertension may occur pain medication for dogs human cheap artane 2mg without a prescription. Gangrene of the extremities may occur in patients with profound shock given large doses of dopamine for long periods of time the pain treatment and wellness center purchase 2 mg artane with amex. Norepinephrine may cause dose-related hypertension (sometimes indicated by headache) myofascial pain treatment center reviews artane 2mg otc, reflex bradycardia, increased peripheral vascular resistance, and decreased cardiac output. Local necrosis may result from perivascular infiltration and angina, mesenteric ischemia, and peripheral ischemia. Epinephrine may cause dose-related restlessness, anxiety, tremor, cardiac arrhythmias, palpitation, hypertension, weakness, dizziness, and headache. A sharp rise in blood pressure from overdosage may cause cerebral hemorrhage and pulmonary edema. Chronic Toxicity (or Exposure) Human Mechanism of Toxicity Catecholamines are sympathomimetic drugs. These drugs increase heart rate and cardiac output and may produce cardiac arrhythmias. Administration of norepinephrine also results in increased peripheral vascular resistance. Both effects may cause serious Prolonged use and repeated injection of epinephrine may lead to tolerance and local necrosis. Prolonged use of norepinephrine may cause edema, hemorrhage, focal myocarditis, necrosis of the intestine, or hepatic and renal necrosis. Treatment is directed at ameliorating tachycardias, shock, cardiac arrhythmias, systemic hypertension, pulmonary edema, and lactic acidosis. In the case of severe toxicity, administration of a rapidly acting a-adrenergic blocking drug such as phentolamine may be considered. It has been demonstrated to protect wood from dry rot, fungi, molds, termites, and other pests that can threaten the integrity of wood products. At the end of the process, the excess treatment solution is pumped back to a storage tank for reuse. However, some of the chemical may migrate from treated wood into surrounding soil over time and may also be dislodged from the wood surface upon contact with skin. Interestingly, the leaching occurs more with newer structures and decreases with time. Since excessive exposure to arsenic can be hazardous to health, precautions should be taken to decrease exposure. One should wash hands thoroughly after contact with treated wood, especially prior to eating and drinking; and ensure that food does not come into direct contact with any treated wood. The eighth sample, which yielded the greatest amount of arsenic, was rough-sawn lumber, a material classified by the wood-treatment industry as not acceptable for playground equipment. No problems have ever been recorded that indicate that the preservative migrates into plants and causes any health effects. This decision will facilitate the transition in both the manufacturing and retail sectors to wood preservatives that do not contain arsenic, as well as other alternatives, such as naturally resistant woods and plastic alternatives. Further Reading Chirenje T, Ma L, Clark C, and Reeves M (2003) Cu, Cr and As distribution in soils adjacent to pressure-treated decks, fences and poles. Hingston J, Collins C, Murphy R, and Lester J (2001) Leaching of chromated copper arsenate wood preservatives: A review. Shuler C, Pellicane P, and Carruthers G (1995) Long-lasting safe pressure-treated wood. Cell Cycle491 Cell Cycle Alice M Sheridan, Vishal S Vaidya, and Harihara M Mehendale & 2005 Elsevier Inc. Cell cycle regulation also ensures that cell proliferation occurs only under defined conditions in response to growth factors and in the presence of a suitable environment. The cell cycle comprises four stages, which are called G1, S, G2, and M phases (Figure 1). M (for mitosis) is the stage in which the cell divides and G2 is the stage preceding M during which the cell prepares for cell division. Two major points of regulation are at the transitions between G1 and S and between G2 and M phases. The progression of cells through late G1/S requires the presence of growth factors. Cells that are not actively proliferating are said to be quiescent and are in G0 phase. The entry of cells from G0 into the cell cycle is also a closely regulated step and requires an extracellular stimulus or growth factor. We describe below the critical proteins that have been identified to date that regulate G1/S and G2/M transitions. We emphasize that the cell cycle paradigm is rapidly evolving and expanding and that this description is likely incomplete. Cyclins and Cyclin-Dependent Kinases Numerous proteins have been identified that stringently regulate the passage of cells at G1/S and G2/M phase transitions. Conserved serine/threonine kinases, called cyclin-dependent kinases (cdks), phosphorylate and activate specific regulatory proteins that drive cell cycle progression. Whereas the cdks are constitutively expressed throughout the cell cycle, the level of the cyclins varies throughout. Cyclin levels are controlled by both regulated synthesis and ubiquitin-mediated proteolysis. Formation of the heterodimers cyclin D/cdk4, cyclin D/cdk6, and cyclin E/cdk2 are necessary for entry into and progression through G1. The induction of cyclin D family members is provoked by an extracellular signal or growth factor and initiates the entry of quiescent cells from G0 into G1. Cyclin D/cdk heterodimers phosphorylate and inactivate retinoblastoma protein (pRb) causing the release and activation of the E2F family of transcription factors. This family of transcription factors drives transcription of genes necessary for the G1/S transition, including cyclin E. Cyclin E/cdk2 also phosphorylates pRb but unlike cyclin D heterodimers, its activity is mitogen-independent. Cyclins A and B form complexes with cdk1 (also called cdc2) and are called the mitotic cylins since these complexes regulate mitosis. Cell cycle progression is controlled by various positive and negative cell cycle regulatory proteins including cyclins (A, B, D, E); cyclin dependent kinases (cdk 1, 2, 4, 6); cdk inhibitors (p15, p16, p18, p19, p21, p27, p57), retinoblastoma (Rb) and p53. Re 492 Cell Cycle cyclin B to cdk1, the activated heterodimer phosphorylates proteins that are involved in mitosis. A third level of regulation is achieved by control of protein levels of cdk inhibitors. The Kip/Cip proteins include three structurally related proteins, p21, p27, and p57. Protein levels of p27 are highest in quiescent cells and induce G1 arrest in response to conditions that typically result in cell quiescence such as growth factor deprivation or contact inhibition. Retinoblastoma the retinoblastoma gene (Rb) was the first tumor suppressor to be identified. Rb mutations were first shown to be causal in familial and sporadic retinoblastoma, a rare tumor of the eye, but have since been associated with many other tumors including osteosarcoma, small cell lung cancer, and prostate and breast cancer. In addition, mutations in the upstream Rb signaling pathway that result in the functional inactivation of the Rb gene product, pRb, are found in virtually all malignancies. The primary role of pRb is the inhibition of transcription of genes that mediate passage across the G1/S transition. The binding characteristics of the homologs vary slightly as, whereas pRb binds preferentially to E2F1-4, p107 and p130 bind preferentially to E2F4 and E2F5. Hypophosphorylated pRb is active and binds to E2F family members thus sequestering E2F and inhibiting its transcriptional activity. Hyperphosphorylated pRb is inactive and releases E2F, which results in the transcription of genes that allow the cell to progress to S phase. There are 16 possible sites for cdk-mediated phosphorylation and data suggest that phosphorylation at each different site regulates a distinct pRb function. Cyclin D/cdk4/6 initiates phosphorylation in early G1 and cyclin E/cdk2 hyperphosphorylates pRb in late G1. A decrease in functional pRb results in the activation of p53-induced apoptosis, which appears to be mediated via the release of E2F1. Since mdm-2 initiates the degradation of p53, its inhibition results in an increase in p53 and a corresponding increase in apoptosis. Thus, a decrease 493 Cell Cycle in functional pRb, which could otherwise result in unchecked cell proliferation, triggers an apoptotic response. A decrease in functional pRb also creates a selection pressure for p53 mutations, since only cells that have mutated dysfunctional p53 survive. Not surprisingly, p53 mutations are often found to coexist with Rb mutations in malignant tumors. Of these proteins, the least is known about sensor proteins, although several candidate genes have been suggested. The effector proteins include kinase inhibitors such as p21, or cyclin/cdk heterodimers that are either activated or inhibited to cause cycle arrest. The result of p53 activation is cell type-specific and depends on the type and severity of injury. A decrease in the interaction between p53 and mdm-2 causes a decrease in ubiquitin-mediated proteolysis of p53 and a resulting increase in p53 protein levels. In addition to phosphorylation, the acetylation status of p53 also determines its stability. The protein product of 14-3-3 s sequesters cdc25C, which prevents the dephosphorylation of cdk1. Apoptosis, or programmed cell death is an evolutionarily conserved, energy-requiring mechanism by which unwanted or irreparably damaged cells are removed from the organism. Apoptosis is a fundamental component of both normal embryogenesis and adult homeostasis. Apoptosis is carried out by caspases, which are proteases that contain a cysteine nucleophile and cleave proteins whose sequence contains specific motifs that include an aspartic acid residue. Upstream or initiator caspases are activated by the binding of an extracellular ligand to a 494 Cell Cycle death receptor. Death receptors are members of the tumor necrosis superfamily and are characterized by an intracellular death domain. Upon binding of a ligand, the death receptor binds to intracellular adaptor proteins. Adapter proteins bind to initiator caspases 2, 8, 9, or 10, which provokes their autocleavage and activation. Cytochrome c release from mitochondria results in dimerization of an adaptor protein called Apaf-1 (apoptotic protease activating factor) which binds procaspase 9 resulting in its cleavage and activation. Importantly, no singular p53activated gene product has been conclusively shown to initiate apoptosis. It appears that many p53-induced proapoptotic genes need to be activated concurrently in order for apoptosis to occur. It is not clear which variables determine whether p53 induces cell cycle arrest or apoptosis. Certain cell types, such as T lymphocytes, are especially sensitive to apoptosis whereas fibroblasts are more likely to undergo cell cycle arrest. Whereas p53 induces arrest or senescence in normal cells, p53 activation usually causes apoptosis in transformed cells. The reason for the enhanced sensitivity to p53-induced apoptosis in transformed cells may be related to the deregulation of E2F due to the inactivation of pRb. Other factors that may predispose the cell toward p53-induced apoptosis include alterations in the bax/bcl-2 ratio, concurrent absence of growth factors, a greater intensity of stress and higher protein levels of p53. Posttranslational modifications may also determine p53 promoter specificity, which may play a major role in determining whether p53 expression results in cell cycle arrest or apoptosis. Clinical Application the normal regulation of the cell cycle plays an important role in tissue repair and inflammation. All tissues may be stratified by proliferative capability into three categories including labile, quiescent or permanently nondividing cells. Labile cells are continuously dividing and include surface epithelial cells such as stratified squamous epithelial cells of the skin and columnar epithelial cells of the gastrointestinal tract. Quiescent cells are nondividing under normal circumstances but can be induced to reenter the cell cycle by exposure to growth factors. Quiescent cells include parenchymal cells of the liver, kidney, and pancreas and mesenchymal cells such as fibroblasts. The cytokine-induced reentry of quiescent cells into G1 phase is an important component of the inflammatory response, which has been well characterized in the kidney. Glomerular mesangial cells proliferate in many models of glomerular disease, including lupus nephritis and diabetes. The proliferation of mesangial cells occurs in response to cytokines such as platelet-derived growth factor and basic fibroblast growth factor. Inhibition of mesangial cell proliferation may abrogate the glomerulosclerosis or the glomerular scarring that occurs as a result of inflammation. Permanently nondividing cells have lost all capacity for proliferation and include nerve cells and cardiac muscle cells. The deregulation of the cell cycle resulting in unchecked cell proliferation is a hallmark of cancer.
January 1 joint and pain treatment center fresno buy artane 2 mg line, 2017 Florida Rules of Criminal Procedure the Florida Bar 32 the committee emphasizes that the right to appointed counsel is not enlarged by the application of these standards pain treatment non-pharmacological discount 2 mg artane otc. The court should appoint conflict counsel only if there is a conflict and the defendant otherwise qualifies for representation by the Public Defender back pain treatment kuala lumpur order artane 2 mg without a prescription. A defendant who is represented by retained counsel is not entitled to the appointment of a second lawyer at public expense merely because that defendant is unable to bear the cost of retaining two lawyers pediatric pain treatment guidelines buy 2 mg artane free shipping. The Steering Committee added minimum requirements for lead counsel in capital postconviction proceedings to ensure a requisite level of expertise in capital postconviction cases and to permit the State the opportunity to seek opt-in treatment pursuant to 28 U blue ridge pain treatment center artane 2mg low cost. The Supreme Court has exclusive jurisdiction under Article V treatment pain legs purchase artane 2 mg online, section 15 of the Florida Constitution to "regulate the admission of persons to the practice of law and the discipline of persons admitted. The Supreme Court has adopted minimum educational and experience requirements for attorneys in capital cases, see. Any claim of ineffective assistance of counsel will be controlled by Strickland v. The rule is not intended to apply to counsel of record in direct or collateral adult felony appeals. All sworn complaints charging the commission of a criminal offense shall be filed in the office of the clerk of the circuit court and delivered to the state attorney for further proceedings. The judge may take testimony under oath to determine if there is reasonable ground to believe the complaint is true. The judge may commit the offender to jail, may order the defendant to appear before the proper court to answer the charge in the complaint, or may discharge the defendant from custody or from any undertaking to appear. Committee Notes January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 34 1968 Adoption. Some doubt was expressed as to whether the terms of the statute incorporated in the rule are within the rulemaking power of the Supreme Court. Altered to incorporate the provision for testimony under oath formerly contained in rule 3. January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 35 (b) Amendment. No arrest warrant shall be dismissed nor shall any person in custody be discharged because of any defect as to form in the warrant; but the warrant may be amended by the judge to remedy such defect. Also, the rule does not incorporate that seldom used part of the statute that permits the magistrate to issue an arrest warrant upon affidavits made before the prosecuting attorney. Unless indicated otherwise, notice to appear means a written order issued by a law enforcement officer in lieu of physical arrest requiring a person accused of violating the law to appear in a designated court or governmental office at a specified date and time. The officer shall deliver 1 copy of the notice to appear to the arrested person and the person, to secure release, shall give a written promise to appear in court by signing the 3 remaining copies: 1 to be retained by the officer and 2 to be filed with the clerk of the court. These 2 copies shall be sworn to by the arresting officer before a notary public or a deputy clerk. If notice to appear is January 1, 2017 Florida Rules of Criminal Procedure 37 the Florida Bar issued under subdivision (b), the notice shall be issued immediately upon arrest. If notice to appear is issued under subdivision (c), the notice shall be issued immediately on completion of the investigation. The arresting officer or other duly authorized official then shall release from custody the person arrested. With the sworn notice to appear, the arresting officer shall file with the clerk a list of witnesses and their addresses and a list of tangible evidence in the cause. One copy shall be retained by the officer and 2 copies shall be filed with the clerk of the court. The clerk shall deliver 1 copy of the notice to appear and schedule of witnesses and evidence filed therewith to the state attorney. If notice to appear is issued, it shall contain the: (1) (2) (3) applicable; (4) (5) counts of each offense; time and place that the accused is to appear in court; name and address of the accused; date of offense; offense(s) charged - by statute and municipal ordinance if (6) name and address of the trial court having jurisdiction to try the offense(s) charged; (7) (8) (9) name of the arresting officer; name(s) of any other person(s) charged at the same time; and signature of the accused. January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 38 (h) Failure to Appear. If a person signs a written notice to appear and fails to respond to the notice to appear, a warrant of arrest shall be issued under rule 3. Nothing contained herein shall prevent the operation of a traffic violations bureau, the issuance of citations for traffic violations, or any procedure under chapter 316, Florida Statutes. Rules and regulations of procedure governing the exercise of authority to issue notices to appear shall be established by the chief judge of the circuit. The accused at such appearance may elect to waive the right to counsel and trial and enter a plea of guilty or nolo contendere by executing the waiver form contained on the notice to appear, and the court may enter judgment and sentence in the cause. When the court sets a trial date by the court, the clerk shall, without further praecipe, issue witness subpoenas to the law enforcement officer who executed the notice to appear and to the witnesses whose names and addresses appear on the list filed by the officer, requiring their attendance at trial. Social Security # at (location) in County, Florida, committed the following offense(s): (2): State Statute Municipal Ord. Please contact [identify applicable court personnel by name, address, and telephone number] at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711. Signature of Defendant I swear the above and reverse and attached statements are true and correct to the best of my knowledge and belief. Your failure to answer this summons in the manner subscribed will result in a warrant being issued on a separate and additional charge. I hereby enter my plea of Guilty [] or Nolo Contendere [], and waive my right to prosecute appeal or error proceedings. I plead Guilty [] or Nolo Contendere [] to the charge, being fully aware that my signature to this plea will have the same effect as a judgment of this court. Testimony: Address: Business: I certify that the foregoing is a complete list of witnesses and evidence known to me. The elimination of subdivision (k) will entitle individuals charged with criminal violations to the same discovery, without regard to the nature of the charging instrument. As amended, persons charged by way of a notice to appear can obtain the same discovery as persons charged by way of either an information or an indictment. In this regard the committee also has January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 44 proposed amendments to rule 3. Except when previously released in a lawful manner, every arrested person shall be taken before a judicial officer, either in person or by electronic audiovisual device in the discretion of the court, within 24 hours of arrest. In the case of a child in the custody of juvenile authorities, against whom an information or indictment has been filed, the child shall be taken for a first appearance hearing within 24 hours of the filing of the information or indictment. The chief judge of the circuit for each county within the circuit shall designate 1 or more judicial officers from the circuit court, or county court, to be available for the first appearance and proceedings. The state attorney or an assistant state attorney and public defender or an assistant public defender shall attend the first appearance proceeding either in person or by other electronic means. First appearance hearings shall be held with adequate notice to the public defender and state attorney. If the defendant has retained counsel or ex-presses a desire to and is financially able, the attendance of the public defender or assistant public defender is not required at the first appearance, and the judge shall follow the procedure outlined in subdivision (c)(2). The judge shall also adequately advise the defendant that: (1) the defendant is not required to say anything, and that anything the defendant says may be used against him or her; (2) if unrepresented, that the defendant has a right to counsel, and, if financially unable to afford counsel, that counsel will be appointed; and (3) the defendant has a right to communicate with counsel, family, or friends, and if necessary, will be provided reasonable means to do so. January 1, 2017 Florida Rules of Criminal Procedure 45 the Florida Bar (c) Counsel for Defendant. If practicable, the judge should determine prior to the first appearance whether the defendant is financially able to afford counsel and whether the defendant desires representation. When the judge determines that the defendant is entitled to court-appointed counsel and desires counsel, the judge shall immediately appoint counsel. This determination must be made and, if required, counsel appointed no later than the time of the first appearance and before any other proceedings at the first appearance. If necessary, counsel may be appointed for the limited purpose of representing the defendant only at first appearance or at subsequent proceedings before the judge. When the defendant has employed counsel or is financially able and desires to employ counsel to represent him or her at first appearance, the judge shall allow the defendant a reasonable time to send for counsel and shall, if necessary, postpone the first appearance hearing for that purpose. The judge shall also, on request of the defendant, require an officer to communicate a message to such counsel as the defendant may name. The officer shall, with diligence and without cost to the defendant if the counsel is within the county, perform the duty. If the postponement will likely result in the continued incarceration of the defendant beyond a 24-hour period, at the request of the defendant the judge may appoint counsel to represent the defendant for the first appearance hearing. No further steps in the proceedings should be taken until the defendant and counsel have had an adequate opportunity to confer, unless the defendant has intelligently waived the right to be represented by counsel. The waiver, containing an explanation of the right to counsel, shall be in writing and signed and dated by the defendant. This written waiver of counsel shall, in addition, contain a statement that it is limited to first appearance only and shall in no way be construed to be a waiver of counsel for subsequent proceedings. January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 46 (d) Pretrial Release. The judicial officer shall proceed to determine conditions of release pursuant to rule 3. For a defendant who has been arrested for violation of his or her probation or community control by committing a new violation of law, the judicial officer: (1) May order the offender to be taken before the court that granted the probation or community control if the offender admits the violation; (2) If the offender does not admit the violation at first appearance hearing, the judicial officer may commit and order the offender to be brought before the court that granted probation or community control, or may release the offender with or without bail to await further hearing, notwithstanding section 907. In determining whether to require or set the amount of bail, the judicial officer may consider whether the offender is more likely than not to receive a prison sanction for the violation. Unless charged with a capital offense or an offense punishable by life imprisonment and the proof of guilt is evident or the presumption is great, every person charged with a crime or violation of municipal or county ordinance shall be entitled to pretrial release on reasonable conditions. As a condition of pretrial release, whether such release is by surety bail bond or recognizance bond or in some other form, the defendant shall refrain from any contact of any type with the victim, except through pretrial discovery pursuant to the Florida Rules of Criminal Procedure and shall comply with all conditions of pretrial release as ordered by the court. Upon motion by the defendant when bail is set, or upon later motion properly noticed pursuant to law, the court may modify the condition precluding victim contact if good cause is shown and the interests of justice so require. The victim shall be permitted to be heard at any proceeding in which such modification is considered, and the state attorney shall notify the January 1, 2017 Florida Rules of Criminal Procedure 47 the Florida Bar victim of the provisions of this subsection and of the pendency of any such proceeding. If no conditions of release can reasonably protect the community from risk of physical harm to persons, assure the presence of the accused at trial, or assure the integrity of the judicial process, the accused may be detained. For the purpose of this rule, bail is defined as any of the forms of release stated below. Except as otherwise provided by this rule, there is a presumption in favor of release on nonmonetary conditions for any person who is granted pretrial release. The judicial officer shall impose the first of the following conditions of release that will reasonably protect the community from risk of physical harm to persons, assure the presence of the accused at trial, or assure the integrity of the judicial process; or, if no single condition gives that assurance, shall impose any combination of the following conditions: (A) (B) specified by the judge; personal recognizance of the defendant; execution of an unsecured appearance bond in an amount (C) placement of restrictions on the travel, association, or place of abode of the defendant during the period of release; (D) placement of the defendant in the custody of a designated person or organization agreeing to supervise the defendant; (E) execution of a bail bond with sufficient solvent sureties, or the deposit of cash in lieu thereof; provided, however, that any criminal defendant who is required to meet monetary bail or bail with any monetary component may satisfy the bail by providing an appearance bond; or January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 48 (F) any other condition deemed reasonably necessary to assure appearance as required, including a condition requiring that the person return to custody after specified hours. Any judge setting or granting monetary bond shall set a separate and specific bail amount for each charge or offense. Failure to comply with the provisions of this subdivision may result in the revocation or modification of bail. However, no defendant shall be compelled to provide information regarding his or her criminal record. No judge or a court of equal or inferior jurisdiction may modify or set a condition of release, unless the judge: (A) required; January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 50 imposed the conditions of bail or set the amount of bond (B) to be tried; (C) defendant; or is the chief judge of the circuit in which the defendant is has been assigned to preside over the criminal trial of the (D) is the first appearance judge and was authorized by the judge initially setting or denying bail to modify or set conditions of release. If application is made to the supreme court or district court of appeal, notice and a copy of such application shall be given to the attorney general and the state attorney. January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 51 (f) Revocation of Bail. The court in its discretion for good cause, any time after a defendant who is at large on bail appears for trial, may commit the defendant to the custody of the proper official to abide by the judgment, sentence, and any further order of the court. The order for the commitment of the defendant shall recite generally the facts on which it is based and shall direct that the defendant be arrested by any official authorized to make arrests and that the defendant be committed to the official in whose custody he or she would be if he or she had not been given bail, to be detained by such official until legally discharged. The defendant shall be arrested pursuant to such order on a certified copy thereof, in any county, in the same manner as on a warrant of arrest. If the order provided for is made because of the failure of the defendant to appear for judgment, the defendant shall be committed. If the order is made for any other cause, the court may determine the conditions of release, if any. If the defendant applies to be admitted to bail after recommitment, the court that recommitted the defendant shall determine conditions of release, if any, subject to the limitations of (b) above. If the defendant offers bail after recommitment, each surety shall possess the qualifications and sufficiency and the bail shall be furnished in all respects in the manner prescribed for admission to bail before recommitment. January 1, 2017 Florida Rules of Criminal Procedure 52 the Florida Bar (j) Issuance of Capias; Bail Specified. On the filing of either an indictment or information charging the commission of a crime, if the person named therein is not in custody or at large on bail for the offense charged, the judge shall issue or shall direct the clerk to issue, either immediately or when so directed by the prosecuting attorney, a capias for the arrest of the person. If the person named in the indictment or information is a child and the child has been served with a promise to appear under the Florida Rules of Juvenile Procedure, capias need not be issued. When a complaint is filed charging the commission of a misdemeanor only and the judge deems that process should issue as a result, or when an indictment or information on which the defendant is to be tried charging the commission of a misdemeanor only, and the person named in it is not in custody or at large on bail for the offense charged, the judge shall direct the clerk to issue a summons instead of a capias unless the judge has reasonable ground to believe that the person will not appear in response to a summons, in which event an arrest warrant or a capias shall be issued with the amount of bail endorsed on it. The summons shall state substantially the nature of the offense and shall command the person against whom the complaint was made to appear before the judge issuing the summons or the judge having jurisdiction of the offense at a time and place stated in it. On the filing of an indictment or information or complaint charging a corporation with the commission of a crime, whether felony or misdemeanor, the judge shall direct the clerk to issue or shall issue a summons to secure its appearance to answer the charge. If, after being summoned, the corporation does not appear, a plea of not guilty shall be entered and trial and judgment shall follow without further process. January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 53 (b) (c) (d) (e) (f) (g) (h) (i) (j) Same as section 903. The options are the same as those available under the federal rules without the presumption in favor of release on personal recognizance or unsecured appearance. It also sets forth the specific factors the judge should take into account in making this determination. January 1, 2017 Florida Rules of Criminal Procedure the Florida Bar 54 1983 Amendment. A person arrested for an offense for which detention may be ordered under section 907. The state may file with the judicial officer at first appearance a motion seeking pretrial detention, signed by the state attorney or an assistant, setting forth with particularity the grounds and the essential facts on which pretrial detention is sought and certifying that the state attorney has received testimony under oath supporting the grounds and the essential facts alleged in the motion. If no such motion is filed, the judicial officer may inquire whether the state intends to file a motion for pretrial detention, and if so, grant the state no more than three days to file a motion under this subdivision.
Today pain neck treatment cheap 2mg artane free shipping, however phoenix pain treatment center order artane 2mg without prescription, toxicology is getting a facelift with the help of recent computer-based approaches cape fear pain treatment center buy artane 2mg. These technologies may also result in the identification of useful biomarkers midwest pain treatment center fremont ohio artane 2mg cheap, adverse effect treatment for shingles nerve pain generic artane 2mg amex, and mode of action of the low dose range treatment for shingles pain mayo clinic discount 2mg artane free shipping. Cross-Species Extrapolation One of the major challenges in regulatory toxicology is the prediction of toxicity of a chemical across the species; presently, the effects in humans are predicted from animal studies. The concept of extrapolation is based on the knowledge that all the species arise from common evolutionary ancestors. However, it is 660 Coniine toxicology is expected to increase the accuracy or precision of risk assessment based on science. It is designed to increase the capacity to prioritize, screen, and evaluate chemicals by enhancing the predictive understanding of toxicities. Success will be measured by the ability to improve risk assessments by understanding the potential of chemicals to affect molecular and biochemical pathways of concern. Computational methods will not assure 100% accuracy in the prediction of toxicity, and they will not eliminate the need for testing, but these methods will dramatically slash the time, choice, and expense of testing chemicals and make regulatory decision-making quicker and science-based. See also: Bioinformatics; Risk Assessment, Human Health; Safety Testing, Clinical Studies; Toxicity Testing, Validation. Mechanism of Toxicity Coniine acts on the autonomic ganglia to produce initial stimulation of skeletal muscle followed by neuromuscular blockade. Certain small birds (skylarks, chaffinches, and robins) are not susceptible to coniine poisoning. Coniine toxicity has been reported in cows, goats, horses, pigs, sheep, ewes, rabbits, and chickens. Human Exposure Routes and Pathways the most common route of coniine exposure is by ingestion, although there are reports of dermal and eye irritations upon direct contact. Toxic doses of the plant extract are difficult to determine due to differing concentrations of eight piperidinic alkaloids in the plant. Plants in their second year have an alkaloid content of B1% in all parts of the plant. The principal manifestations of coniine poisoning are nausea and vomiting, salivation, fever, and gradually increasing muscular weakness followed by paralysis with respiratory failure. Intragastric administration of activated charcoal is recommended to reduce absorption in the gastrointestinal tract. Ammonia Introduction There are products that we use everyday and products that we use only occasionally. Among both categories, there are products that are very tempting for children by the nature of the way the look, smell, sound, feel, or simply because they can be reached. According to the Federal Hazardous Substances Act of 1960, labeling of hazardous products must contain instructions for special handling and storage, as well as warning statements for accidental exposure prevention and treatment. Several common household products are briefly discussed here for their most common toxicological concerns. Ammonia is a respiratory irritant when inhaled, and large doses may affect the nervous and circulatory system with rapid heart beat, weak pulse, bluish lips and fingers, restlessness, and temporary blindness. Dermal contact can cause severe irritation, burning, and even permanent blindness. Antifreeze Specific Categories and Concerns Air Fresheners/Deodorizers Consumption of small amounts of antifreeze can be deadly. Gastric treatment and dialysis may be immediately necessary for survival depending on the dose, and long-term kidney and brain damage are possible. Accidental exposures, depending on the amount, may lead to eye, nose, throat and skin irritation, as well as nausea, nosebleeds, headaches, dizziness, memory loss, and shortness of breath. This is a respiratory irritant and can cause burning from inhalation, ingestion, or dermal contact. Contact with other chemicals can 662 Consumer Products lead to chlorine fumes, and when mixed with ammonia can result in formation of a nonodorous deadly methane gas. The extent of damage will depend on the amount consumed and how rapidly it is diluted and neutralized. Accidental ingestion should be followed by immediate consumption of milk or water to dilute, and vomiting should not be induced due to the burning potential. Long-term damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible, some of which may continue to occur for weeks after exposure. Detergents vomiting should not be induced, but milk or water should be given to dilute poisonous ingestions. Ingestion may lead to respiratory irritation, severe abdominal pain, vomiting, hypotension, and dangerous change in blood pH. Ingestion should be followed by immediate consumption of milk or water if possible, then immediate medical attention. Extensive damage to the mouth, throat, eyes, lungs, esophagus, nose, and stomach are possible, and depending on the severity of the damage, death could occur up to 1 month after ingestion. For eye contact, rinsing should be done only with water and/or an eye doctor should be seen if symptoms persist or the eyelids cannot be opened. Dermal and ocular exposures should be immediately rinsed, and vomiting should not be induced. Inhalants Common household disinfectants contain sodium hypochlorite, phenols, or ammonia. Drain Cleaners Drain cleaners may contain sodium or potassium hydroxide (lye), hydrochloric acid, or trichloroethane. Hydrochloric acid is a corrosive irritant, causes damage to the kidneys, liver, and digestive system. Trichloroethane is a skin and eye irritant, causes central nervous system depression, and liver and kidney damage when ingested. Dyes Household dyes for cloth are typically nontoxic mixtures of pigments, salts, and mild soaps. Some contain small amounts of corrosive alkali detergent that can only be hazardous if consumed in large quantity. Fertilizers and Household Plant Foods Plant fertilizers are mildly toxic in small doses, and may lead to gastrointestinal upset and or skin irritation. Larger doses can be more harmful, especially to children, and may cause severe burns, therefore, Inhalant abuse is a drug abuse problem. They range from high volatility, minimal viscosity substances such as methane, butane, benzene and petroleum ether to minimal volatility, high viscosity products such as lubricating oil, mineral oils and asphalt. The inhalation of these substances, especially those with high and intermediate volatility, can rapidly displace alveolar gas, causing difficulty in breathing. Continued inhalation however may lead to increased symptoms of intoxication, confusion, hallucination, and aggressive behavior. As most of the harmful effects of inhalant abuse are not felt immediately, chronic abuse of inhalants is associated with a variety of medical problems with a real risk of death. Consumer Products 663 Table 1 Common targets for consumer product inhalation abuse Products Adhesive/glues Aerosol propellants Anesthetics and analgesics Commercial dry cleaning and degreasing agents Domestic spot removers and dry cleaners Fire extinguishers Cleaning solutions Fuel gases Nail varnish and nail varnish remover Paint and paint thinners Typewriter correction fluid Industrial solvents Lighter fluids Major volatile compounds Acetone, ethyl acetate, butanone, toluene, cyclohexane, trichloroethylene, nhexane, xylene Liquid petroleum gas, dimethyl ether, fluorocarbon Nitrous oxide, cyclopropane, diethyl ether, halothane, enflurane, isoflurane Dichloromethane, methanol, trichloroethane, toluene Dichloromethane, trichloromethane, tetrachloroethylene Bromochlorodifluoromethane Trichloroethylene, petroleum products, carbon tetrachloride Liquid petroleum gas, propane, butane Acetone and esters Acetone, butanone, esters, hexane, toluene, trichloroethylene, xylenes Trichlorethane n-Hexane Naphtha, aliphatic hydrocarbons Source: Razak Lajis, pharmacist at the National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia. Table 2 the health hazards of some solvents used in substances that are inhaled Solvent Acetone Chloroform Health hazard summaries Vapors mildly irritating to eyes and respiratory tract. Ataxia and seizures have been reported Vapors slightly irritating to eyes and respiratory tract. Mild to moderate systemic toxicity include headache, nausea, vomiting, confusion, and drunkenness. Greater exposure may cause unconsciousness and death Acute exposure results in euphoria, excitement, dizziness, headache, nervousness, ataxia, convulsion, and coma. The symptoms of acute inhalation may include nausea, euphoria, ataxia, dizziness, agitation, and lethargy. Severe exposure will lead to respiratory arrest, seizures, and coma Dizziness, excitement, flushing of the face, drowsiness, incoordination, tremor, confusion, respiratory depression, and coma n-Hexane Toluene Trichloroethane Xylene Taken in smaller doses, they can cause euphoria, delusions, and hallucinations. Chronic abuse of certain substances such as toluene-containing products can produce severe organ damage involving the liver, kidneys, and brain. Glues containing n-hexane and toluene (see Table 2 for a list of health hazards posed by solvents used in substances that are inhaled) have been associated with the development of muscle weakness and atrophy. Three major clinical presentations are common with people who sniff toluenecontaining glues. They will experience muscle weakness, gastrointestinal complaints, and neuropsychiatric disorders. Some of the signs and symptoms of acute intoxication are breathing difficulties, chest pain and discomfort, eye irritation, double vision, ringing ears, diarrhea, and muscle and joint pain. After prolonged inhalation or rapid inhalation of highly concentrated vapor, the sniffer may experience a phase of excitement followed by loss of consciousness and coma. Inks and Dyes Artistic inks and dyes, as well as those used in textiles are generally nontoxic, though occasionally irritating or allergenic to some. They are known to have high contents of heavy metals, such as cobalt, lead, mercury, and others, many of which are common skin irritants, and some of which are carcinogens and reproductive toxicants therefore large and frequent 664 Consumer Products ingestions should be avoided. Dermal and ocular contact should be followed by rinsing with water to prevent irritation. Eye irritation and staining of skin and other mucous membranes is generally reversible. Pesticides Typical household pesticides can be moderately toxic with inhalation, but are generally nontoxic for human dermal contact or low-level ingestion (carbon, sulfur, potassium nitrate). Revenge Rodent Smoke Bombs, for example, contain a variety of volatile gases and solids that will become airborne and respirable upon ignition. After igniting, cartridge produces foul-smelling smoky mixture of gases (including carbon monoxide, carbon dioxide, and nitrogen) and solids (including potassium carbonate, potassium sulfate, sulfides, and uncombined carbon). If inhaled, and person has poison symptoms (headache, nausea, dizziness, and weakness), the victim should be transferred to fresh air. Pesticide residues are common to many types of food as they protect against molds, fungi, and insects. While allowed pesticides residues already have low in toxicity, rinsing/washing fresh produce in cold water is recommended. Eye and skin irritation may be mild with quick recovery, and small ingestions and inhalation are nonirritating. Fungicides Common household fungicides, such as Scotts Lawn Fungus Control and Ortho Multi Purpose Fungicide Daconil 2787 Plant Disease Control generally contain carbamates that are moderately toxic, cause skin and eye irritation upon exposure, may be harmful if swallowed, and with prolonged or excessive inhalation may cause respiratory tract irritation. These are generally not highly toxic to humans; however, inhalation may cause asphyxiation. Industrial insecticides occasionally found in households, garages, and greenhouses may contain more toxic organophosphates, carbamates, and paradichlorobenzenes. Exposure to these compounds may result in breathing difficulty, gastrointestinal upset, multiple nervous system effects such as weakness, sweating, convulsions, and other treatable symptoms. Some multipurpose landscaping/yard insecticides, such as Ortho Bug B Gon Multi Purpose Insect Killer Ready may contain permethrin at 2. In most mammals, there is generally a rapid metabolic breakdown of pyrethroids by the liver; therefore, no signs of toxicity are likely to occur. Permethrin is detoxicified by ester hydrolysis or oxidation, followed by hepatic hydroxylation and conjugation to either glucuronides or sulfates. Because cats are generally deficient in metabolizing substances through hepatic glucuronidation, they are limited in their ability to metabolize permethrin quickly. The clinical signs of permethrin toxicosis in cats may include muscle tremors, hyperexcitability, depression, ataxia, vomiting, seizures, anorexia, and death. Treatment of permethrin toxicosis in a cat consists of tremor and/or seizure control, dermal decontamination, and supportive care. Other household garden insecticides, such as Ortho Bug B Gon Ready Spray contain dizainon, a common pesticide that is relatively non-toxic when inhaled or ingested in small accidental amounts, though are moderately irritating to the eyes and skin. Larger ingestions can cause cholinesterase inhibition with symptoms occurring within 12 h. Effects may include headache, dizziness, weakness, nausea, vomiting, diarrhea, pupil constriction, blurred vision, excessive salivation or nasal discharge, profuse sweating, and abdominal cramps. Incontinence, unconsciousness, convulsions and breathing difficulties are indicative of severe poisoning. As these products are sold at diluted concentrations, the active compound is generally mildly irritating to mucous membranes and if it gets into the eyes, can be immediately relieved by rinsing with water. Few have reported skin irritation with frequent use, especially those with other skin ailments such as psoriasis or severe acne. Oven Cleaners Flea powders may contain carbaryl, dichlorophene, chlordane, and other chlorinated hydrocarbons. Dichlorophene is a skin irritant and may cause damage to the liver, kidneys, spleen, and central nervous system. Chlordane and other chlorinated hydrocarbons are biocumulative, and may damage the eyes, lungs, liver, kidneys, and skin. Mineral Spirits Oven cleaners contain corrosive alkalis that can cause burning of the skin and respiratory tract if inhaled. Large doses may lead to breathing difficulty, pain in throat, nose, eyes, ears, lips, and tongue, abdominal pain, vomiting, blood in vomit and stool, hypotension, collapse, skin irritation, burns, and necrosis (holes) in skin and underlying tissue, and severe changes in blood pH.
Order artane 2 mg on line. Prancing Jewels of Meridian MS.
Example 69: I (a) Hydrocephalus (b) Tuberculousmeningitis Codetosequelaeoftuberculousmeningitis(B90 pain treatment and research purchase artane 2 mg with visa. Example 70: I (a) Hypostaticpneumonia (b) Hemiplegia (c) Cerebrovascularaccident(l0years) Codetosequelaeofcerebrovascularaccident(I69 pain management for osteosarcoma in dogs artane 2 mg free shipping. Example 71: I (a) Chronicnephritis (b) Scarletfever Codetosequelaeofotherspecifiedinfectiousandparasitic diseases(B94 midwest pain treatment center ohio buy artane 2mg with mastercard. There are two types ofcombination: "withmentionof"meansthattheotherconditionmayappearanywhereon thecertificate; "when reported as the originating antecedent cause of" means that the other condition must appear in a correct causal relationship or be otherwise indicatedasbeing"dueto"theoriginatingantecedentcause pain treatment in acute pancreatitis order 2mg artane free shipping. A46 Streptococcalsepsis Other sepsis Erysipelas Codetothesediseaseswhentheyfollowasuperficialinjury(any conditioninS00 period pain treatment uk buy 2 mg artane fast delivery,S10 pain treatment sickle cell buy discount artane 2 mg on line,S20,S30,S40,S50,S60,S70,S80,S90, T00,T09. C97 Malignantneoplasmsofindependent(primary)multiplesites Not to be used for underlying cause mortality coding. When multiple but independent malignant neoplasms are reported on thedeathcertificate,selecttheunderlyingcausebyapplyingthe SelectionandModificationRulesinthenormalway. Conductiveandsensorineuralhearingloss Other hearing loss Not to be used if the antecedent condition is known. Postprocedural disorders of ear and mastoid process, not elsewhereclassified Not to be used for underlying cause mortality coding. Whenmultiplevalvulardiseasesofnonrheumaticoriginarereportedonthesamedeathcertificate,the underlyingcauseshouldbeselectedbyapplyingtheGeneral Principle or Rules 1, 2, or 3 in the normal way. For mortality the occurrence of myocardial infarction is assumed and assignment made to I21. If no other cause of maternal mortality is reported, code to Complication of labouranddelivery,unspecified(O75. This does not apply if the only other cause of perinatal mortality reportedisrespiratoryfailureofnewborn(P28. If no other perinatal cause is reported, code to condition originating in the perinatalperiod,unspecified(P96. When a disease of bone density is reported on the same line or as the originating antecedent cause of a fracture, the fracture should be considered pathological, code M80. Whentheselectedcauseislistedinthefirstcolumnandappearsonthecertificate as a cause of one of the diseases listed in the third column, code as indicated in the fourth column. Each country will need to amplify the rules,dependinguponthecompletenessandqualityofmedicalcertification. The information in this section will help in formulating such additional instructions. TheassumptionofaninterveningcauseinPartIispermissibleinacceptinga sequence as reported, but it must not be used to modify the coding. Example 1: I (a) Cerebralhaemorrhage (b) Chronicnephritis Codetochronicnephritis(N03. Itisnecessarytoassume hypertensionasaconditioninterveningbetweencerebral haemorrhage and the underlying cause, chronic nephritis. Example 2: I (a) Mentalretardation (b) Prematureseparationofplacenta Code to premature separation of placenta affecting fetus or newborn(P02. Itisnecessarytoassumebirthtrauma,anoxia orhypoxiaasaconditioninterveningbetweenmentalretardation and the underlying cause, premature separation of placenta. The purpose of these lists is to produce the most useful mortality statistics possible. Thefollowinginstructionsalwaysapply,therefore,whetherthe relationship is considered medically correct or not. This would apply in the interpretation of "highly improbable" relationships(seeabove)andinModificationRuleF(sequelae). Categories O95 (Obstetric death of unspecified cause), O96 (Death from any obstetriccauseoccurringmorethan42daysbutlessthanoneyearafterdelivery) andO97(Deathfromsequelaeofdirectobstetriccauses)classifyobstetricdeaths accordingtothetimeelapsedbetweentheobstetriceventandthedeathofthe woman. Category O95 is to be used when a woman dies during pregnancy, labour, delivery,orthepuerperiumandtheonlyinformationprovidedis"maternal"or "obstetric"death. CategoryO96isusedtoclassifydeathsfromdirectorindirectobstetric causes that occur more than 42 days but less than a year after termination of thepregnancy. CategoryO97isusedtoclassifydeathsfromanydirectobstetric cause which occur one year or more after termination of the pregnancy. In many cases, these sequelae include conditions present one year or more after the onset of the disease or injury (seealsoSequelaebelow). Conditionsreportedas sequelaeorresidualeffectsofagivendiseaseorinjuryshouldbeclassifiedtothe appropriatesequelacategory,irrespectiveoftheintervalbetweentheonsetofthe disease or injury and death. For certain conditions, deaths occurring one year or more after the onset of the disease or injury are assumed to be due to a sequela or residualeffectofthecondition,eventhoughnosequelaisexplicitlymentioned. Ifthere is no sequelae category for the underlying condition, code to the underlying condition itself. If there is a mention of an abnormal reaction of the patient, without mention of misadventureatthetimeoftheprocedure,codetoO74,O75. Code late complications and functional complications to the appropriate system chapter. Example 1: I (a) Pulmonaryembolism (b) Appendectomy Codetounspecifieddiseaseofappendix(K38. Example 2: I (a) Accidentalpunctureofaorta (b) Laparotomy Codetounintentionalpunctureduringsurgicaloperation(Y60. Example 4: I (a) Amnioticfluidembolism (b) Caesareansection Code to other complication of obstetric surgery and procedures (O75. Using the Alphabetic Index Theentry"Neoplasm"intheVolume3AlphabeticalIndexgivesguidance notes,listingofsites,anduptofivecodesdependingonthebehaviourofthe neoplasm. The entry for the morphological type will either state a code to use, or direct youtothecorrectentryunderthemainterm"Neoplasm". However,donot codehaemangiomatosis,whichisspecificallyindexedtoadifferentcategory,in the same way as haemangioma. Adeathshouldbe assigned to a malignant neoplasm only if the selection rules, strictly applied, lead to the selection of the neoplasm as the underlying cause of death. Itisnotanobviousconsequenceof hepatocellular carcinoma, which should not be selected as the underlying cause of death. Example 2: I (a) (b) (c) (d) Renalfailure Nephropathy Diabetesmellitus Malignantneoplasmofbreast Codetodiabeteswithrenalcomplications(E14. Example 4: I (a) Metastaticinvolvementofchestwall (b) Carcinomainsituofbreast Codetomalignantcarcinomaofthebreast(C50. If they are reported as the cause of metastases or secondary tumours, they should be considered malignant and coded as malignant neoplasms. Example 5: I (a) Secondarymalignantneoplasmoflung (b) Polypofstomach Codetoprimarymalignantneoplasmofstomach(C16. Since the polyp is reported as the cause of secondary spread it is consideredmalignant. Primary site indicated (a) A neoplasm specified as primary Ifonemalignantneoplasmisspecifiedasprimary,andotherneoplasmsare mentioned but not described as primary, then consider these other neoplasms assecondary. UsetheGeneralPrincipletoselecttransitional cell carcinoma of bladder as the temporary underlying cause of death. Sinceatransitionalcellcarcinomaisnot a consequence of an osteosarcoma, Rule 3 does not apply. Example 8: I(a)Secondariesinlung,pleurabrainandliver (b)Carcinomaofbreast A carcinoma of breast may cause secondaries in pleura, brain, andliver. Rule 3 applies, and malignant neoplasm of kidney(C64)isselectedasunderlyingcauseofdeath. First, apply Rule 2 to select the secondary neoplasm in lymph nodes as the temporary underlying cause. Example 11: I (a) Cancerofliverandlung (b) Chronichepatitis Codetounspecifiedmalignantneoplasmofliver(C22. Example 12: I (a) Canceroflung (b) Cancerofliver (c) Prolongedexposuretovinylchloride Codetounspecifiedmalignantneoplasmofliver(C22. Example 13: I (a) Cancerofchestwall (b) Canceroflung (c) Smoking Codetomalignantneoplasmofbronchusorlung,unspecified (C34. Example 14: I (a) Mesotheliomasofpleuraandlymphnodes (b) Prolongedinhalationofasbestosdust Codetomesotheliomaofpleura(C45. Exposuretoasbestos increases the risk of pleural mesothelioma, which is considered primary. Exposure to asbestos increases the risk of cancer in the mediastinum, and theliverneoplasmisconsideredsecondary. Example 16: I (a) Generalizedmetastaticspread (b) Pseudomucinousadenocarcinoma SelectpseudomucinousadenocarcinomausingtheGeneral Principle. Also,stated duration may refer to the date of diagnosis rather than the duration of the disease. In this case, the different durations do not necessarily indicate that the malignant neoplasm of throat is a metastatic spread from the breast malignancy, since the patient mayhavedevelopedtwoindependentprimarymalignancies. Example 19: I (a) Secondarycarcinomaofliver (b) Primarysiteunknown Thecertificatestatesthattheprimarysiteisunknown. Example 21: I (a) Generalizedmetastasess (b) Melanoma (c) Primarysiteunknown Codetomalignantmelanomaofunspecifiedsite(C43. Ifnoclarificationcanbeobtained,theselectionrules should be applied in the usual way. Example 22: I (a) Cancerofstomach (b) Cancerofbreast Stomachisnotonthelistofcommonsitesofmetastases(see Section4. Example 25: I (a) Hypemephroma (b) Oatcellcarcinoma Hypernephroma and oat cell carcinoma are different morphologies. UsetheGeneralPrincipletoselect malignant melanoma of colon, and code to malignant neoplasm ofcolon(C18. Example 27: I (a) Acutelymphocyticleukaemia (b) Non-Hodgkinlymphoma Anon-Hodgkinlymphomamaydevelopintoanacute lymphocytic leukaemia. Example 28: I (a) Acuteandchroniclymphocyticleukaemia Theacutelymphocyticleukaemia,mentionedfirstonlineI (a),isselectedasthetemporaryunderlyingcauseaccordingto Rule2. Rule 3 also applies, and chronic lymphocyticleukaemia(C911)isselectedastheunderlying cause of death. Amalignantneoplasmofaparticularsiteortissueshould not be accepted as due to a neoplasm of another site or type of tissue. Apply the selectionrulesintheusualway,ifasite-specificmorphologyisreportedwitha malignant neoplasm of another site. Example 29: I (a) Hodgkinlymphoma (b) Carcinomaofbladder Two different morphological types are mentioned, which indicates the presence of two different primary neoplasms, Hodgkin lymphoma and bladder carcinoma. Aprimarymalignantneoplasmofliver should not be accepted as due to cancer of breast, since both the hepatoma and the breast cancer are considered primary. Donotusethecodesforoverlapping lesions if a malignant neoplasm has spread from one part of an organ or organ system to another part of the same organ or organ system. Example 32: I (a) Malignantneoplasmofrectosigmoidcolon Code to C19, malignant neoplasm of rectosigmoid junction. Example 33: I (a) Malignantneoplasmofcolonandgallbladder Thereisnostatementthatthe"colonandgallbladder"refers toanoverlappingneoplasm. List of common sites of metastases Althoughmalignantcellscanmetastasizeanywhereinthebody,certainsitesare more common than others and must be treated differently. Common sites of metastases Bone Brain Diaphragm Ill-definedsites(sitesclassifiabletoC76) Liver Lung(seespecialinstructions) Lymphnodes(seespecialinstructions) Mediastinum Meninges Peritoneum Pleura Retroperitoneum Spinalcord B. Common sites of metastases: how to use list (a) A common site of metastases reported with other sites Ifseveralsitesarereportedonthedeathcertificateandtheprimarysiteisnot indicated, consider neoplasms of sites in Table 3 as secondary, and those not in Table 3 as primary.
