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By D. Ben. East Texas Baptist University.

Since contact occurs at points identifiable in both the femoral and tibial articulating surfaces buy lotrisone 10mg otc, we can write at each contact point: zc = f(xc, yc) (7. Satisfying these equations at some given point will ensure that it is a contact point. Thus, in the two-point contact version of the model, Eqs. The geometric condition of compatibility of rigid bodies requires that a single tangent plane exists to both femoral and tibial surfaces at each contact point. This condition also implies that the normals to the femoral and tibial surfaces at each contact point are always colinear, and their cross product must vanish. In order to express the geometric compatibility condition in a mathematical form, the position vector of the contact point in the femoral coordinate system (Eq. Cross product of these two tangent vectors is then employed to determine the unit vector normal to the femoral surface,nˆ f , at the contact point. Thus, for each contact point, two independent scalar equations are written generating four scalar equations to represent the geometric compatibility conditions in the two-point contact situation and two scalar equations to represent the geometric compatibility conditions in the one-point contact situation. Ligamentous Forces In this analysis, external loads are applied, and ligamentous and contact forces are then determined. The model includes 12 nonlinear spring elements that represent the different ligamentous structures and the capsular tissue posterior to the knee joint. Four elements represent the respective anterior and posterior fiber bundles of the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL); three elements represent the anterior, deep, and oblique fiber bundles of the medial collateral ligament (MCL); one element represents the lateral collateral ligament (LCL); and four elements represent the medial, lateral, and oblique fiber bundles of the posterior part of the capsule (CAP). The coordinates of the femoral and tibial insertion sites of the different © 2001 by CRC Press LLC ligamentous structures were specified according to the data available in the literature. The spring elements representing the ligamentous structures were thus assumed to be line elements extending from the femoral origin to the tibial insertion.

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Skin hyperpigmentation and cervical lym- phadenopathy are noted discount 10mg lotrisone with amex. A small bowel biopsy shows villous atrophy and macrophages with sickleform particles. Which of the following therapies is indicated for this patient? Cholestyramine Key Concept/Objective: To be able to recognize Whipple disease The patient has clinical and laboratory findings consistent with the diagnosis of Whipple disease. This is a rare multisystem disease caused by infection with Tropheryma whippelii. Classically, the disease begins in a middle-aged man with a nondeforming arthritis that usually starts years before the onset of the intestinal symptoms. Arthralgias, diarrhea, abdominal pain, and weight loss are the cardinal manifestations of Whipple disease. Other complaints include fever, abdominal distention, lymphadenopathy, hyperpigmentation of the skin, and steatorrhea. The diagnosis rests on identifying the classic PAS-positive macrophages, which contain sickleform particles. The histologic lesion shows distended villi filled with the foamy, PAS-positive macrophages. A flat, villous surface can be seen in extreme cases. For treatment of Whipple disease, TMP- SMX is given for 1 year. Prednisone has no role in the treatment of Whipple disease. Cholestyramine is a resin that binds bile acids and can be used in cases of diarrhea related to bile acid malabsorption. He developed unilateral left upper and lower extremity edema 1 year ago. On review of systems, abdominal swelling and occasional diarrhea are noted.

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He is critically ill and requires endotra- cheal intubation by the resident in the emergency department 10 mg lotrisone with amex. The patient is then transferred to the medical intensive care unit. The patient is started on a third-generation cephalosporin. Lumbar punc- ture shows purulent fluid with gram-negative cocci in pairs. You are asked to give recommendations regarding the use of prophylactic antibiotics for Neisseria meningitidis in people who have been near the patient. Which of the following people should receive prophylactic antibiotics? The patients who were seen in the emergency department on the same day B. The resident who performed the endotracheal intubation in the emergency department C. The paramedics who brought the patient to the emergency department D. The persons who attended the restaurant where the patient had lunch the previous day Key Concept/Objective: To know the indications for postexposure prophylaxis in persons in con- tact with a patient with N. The risk of invasive disease in family members of persons with invasive meningococcal disease is increased by a factor of 400 to 800. Prophylaxis is recommended for close contacts of infected persons. The likelihood of contracting invasive disease from close contacts is highest in the first few days after exposure. Prophylaxis should therefore be administered within 24 hours after identification of the index case; it is unlikely to be of value if given 14 days or longer after onset of illness in the index case.

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