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To treat as allegorical; to understand in an allegorical sense; as medications excessive sweating buy cheap lactulose 200 ml on-line, when a passage in a writer may understood literally or figuratively treatment narcissistic personality disorder buy lactulose with visa, he who gives it a figurative sense is said to allegorize it medications made from plants generic 100 ml lactulose. Thu Feb 11 12:10:05 2016 380 Defn: One who allegorizes medicine lodge kansas order 100ml lactulose overnight delivery, or turns things into allegory; an allegorist. A figurative sentence or discourse, in which the principal subject is described by another subject resembling it in its properties and circumstances. The real subject is thus kept out of view, and we are left to collect the intentions of the writer or speaker by the resemblance of the secondary to the primary subject. In the allegory quoted above the properties of the vine and the relation of the branches are transferred to the person of Christ and His apostles and disciples. Allelomorphs which under certain circumstances are themselves compound are called hypallelomorphs. As we know that the several unit characters are of such a nature that any one of them is capable of independently displacing or being displaced by one or more alternative characters taken singly, we may recognize this fact by naming such characters allelomorphs. To lighten or lessen (physical or mental troubles); to mitigate, or make easier to be endured; as, to alleviate sorrow, pain, care, etc. The calamity of the want of the sense of hearing is much alleviated by giving the use of letters. These words have in common the idea of relief from some painful state; and being all figurative, they differ in their application, according to the image under which this idea is presented. To alleviate the distresses of life; to mitigate the fierceness of passion or the violence of grief; to assuage angry feeling; to allay wounded sensibility. A narrow passage; especially a walk or passage in a garden or websters 1913 gutenberg(2009). The state of being allied; the act of allying or uniting; a union or connection of interests between families, states, parties, etc. The alliance resembling that of families or states; union by in qualities; affinity. The act of tying together or attaching by some bond, or the state of being attached. Note: the rule is named from the method of connecting together the terms by certain ligature-like signs. Alligation is of two kinds, medial and alternate; medial teaching the method of finding the price or quality of a mixture of several simple ingredients whose prices and qualities are known; alternate, teaching the amount of each of several simple ingredients whose prices or qualities are known, which will be required to make a mixture of given price or quality. It has a shorter and broader snout than the crocodile, and the large teeth of the lower jaw shut into pits in the upper jaw, which has no marginal notches. Besides the common species of the southern United States, there are allied species in South America. Unlike the common snapping turtle, to which the name is sometimes erroneously applied, it has a scaly head and many small scales beneath the tail. Note: the recurrence of the same letter in accented parts of words is also called alliteration. In a somer seson whan soft was the sonne, I shope me in shroudes as I a shepe were. The allocation of the particular portions of Palestine to its successive inhabitants. The admission of an item in an account, or an allowance made upon an account; - a term used in the English exchequer. A slip of paper attached to a bill of exchange for receiving websters 1913 gutenberg(2009). That which is allotted; a share, part, or portion granted or distributed; that which is assigned by lot, or by the act of God; anything set apart for a special use or to a distinct party. Cottage allotment, an allotment of a small portion of land to a country laborer for garden cultivation. Note: Thus, carbon occurs crystallized in octahedrons and other related forms, in a state of extreme hardness, in the diamond; it occurs in hexagonal forms, and of little hardness, in black lead; and again occurs in a third form, with entire softness, in lampblack and charcoal. In some cases, one of these is peculiarly an active state, and the other a passive one. Thus, ozone is an active state of oxygen, and is distinct from ordinary oxygen, which is the element in its passive state. To grant, give, admit, accord, afford, or yield; to let one have; as, to allow a servant his liberty; to allow a free passage; to allow one day for rest. To own or acknowledge; to accept as true; to concede; to accede to an opinion; as, to allow a right; to allow a claim; to allow the truth of a proposition.

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Recognized systemic toxic mechanisms in mammals include a corrosive effect on the gastrointestinal tract (particularly from high concentrations of the free acid) medicine 79 cheap 100ml lactulose fast delivery, cardiomyopathy and vascular injury leading to shock medicine in french order lactulose 100ml free shipping, and central nervous system injury treatment improvement protocol purchase discount lactulose online, causing convulsions and respiratory depression medicine recall buy lactulose 100 ml mastercard. A single case has been reported of a lethal poisoning in a previously healthy 21-year-old man who died after ingestion of 7-8 grams of endothall. In this patient, hemorrhage and edema were noted in the gastrointestinal tract and lungs. Decontaminate the skin with soap and water as outlined in the Chapter 3, General Principles. Irrigate exposed eyes with copious amounts of clean water or saline for at least 15 minutes. If irritation persists after irrigation, obtain specialized medical treatment in a healthcare facility. If ingested, consider gastrointestinal decontamination as outlined in Chapter 3, but use treatment procedures appropriate for ingestions of corrosives (strong acids and alkalis). Due to the corrosive nature of this agent, gastric lavage is usually contraindicated, because of the risk of esophageal perforation. Treat severe systemic endothall poisoning in an intensive care unit setting with appropriate supportive care, including respiratory support, intravenous fluids, cardiac monitoring and renal function support as necessary. Examine the urine for protein and cells and for "smoky" phenolic excretion products. Metaldehyde Toxicology Metaldehyde is a 4-unit cyclic polymer of acetaldehyde long used to kill slugs and snails, which are attracted to it without the use of bait. Occasional poisonings of animals and children have resulted from ingestion of pellets intended as molluscicide, and tablets designed as a combustible fuel ("meta-fuel") have also been responsible for human poisonings. Both acetaldehyde and metaldehyde produced similar effects in dogs; however, acetaldehyde was not detected in the plasma or urine of the metaldehyde-poisoned dogs. ConfirmationofPoisoning Metaldehyde can be measured in the serum, although there are very few reports of levels among poisoned humans. Saito described a method to measure metaldehyde in serum using headspace solid-phase microextraction and gas chromatography-mass spectrometry. Treat severe systemic metaldehyde poisoning in an intensive care unit setting with appropriate supportive care, including respiratory support, intravenous fluids, cardiac monitoring and renal function support as necessary. Early and aggressive treatment of all of the above may be life saving following a massive ingestion. Order liver function tests and urine sediment examination to assess liver and kidney injury in poisoned patients. Sodium Chlorate Sodium chlorate is used in agriculture as a defoliant, nonselective contact herbicide and semi-permanent soil sterilant. Because of its explosive nature, it must be formulated with a water-soluble, fire-retardant material such as sodium metaborate, soda ash, magnesium chloride or urea. Toxicology Sodium chlorate is irritating to skin, eyes and mucous membranes of the upper respiratory tract. Even though gastrointestinal absorption is alsoinefficient,severepoisoning,sometimesfatal,followsingestionofatoxicdose, saidtobeabout20gramsintheadulthuman. The principal mechanisms of toxicity are hemolysis, coagulation disturbances methemoglobin formation, cardiac arrhythmia (partly secondary to hyperkalemia) and renal tubular injury. Plasma and urine are dark brown from presence of free hemoglobin and methemoglobin. Chlorate not only forms methemoglobin, it also destroys erythrocytes and the enzymatic systems in the process. However, chlorate will denature the glucose-6-phosphate dehydrogenase, which will in turn render methylene blue ineffective. Dark brown-to-black staining of the plasma and urine indicates the action of a strong oxidizing agent on hemoglobin. Treat severe systemic sodium chlorate poisoning in an intensive care unit setting, withappropriatesupportivecareincludingrespiratorysupport,intravenousfluids, cardiac monitoring and renal function support as necessary. The widely used insecticide synergist piperonyl butoxide acts by inhibiting the enzymatic degradation of pyrethrins, rotenone, N-methyl carbamates, organophosphates and possibly some other insecticides. Their presence in pesticide products to which humans are exposed does not change the basic approach to management of poisoning with the focus of treatment based on the active ingredient involved.

This has the added advantage of protecting the airway from aspiration of regurgitated gastric contents treatment kidney cancer symptoms order lactulose us. Give calcium gluconate (10% solution) slowly medicine 219 buy lactulose master card, intravenously to relieve hypocalcemia medications adhd order 100 ml lactulose overnight delivery. Because of the severity of toxicity from this poison medicine 72 purchase lactulose cheap online, patients should be treated in an intensive care unit setting if available. If seen within an hour of ingestion and the patient is conscious and not convulsing, consider gastrointestinal decontamination with charcoal. If seizures have already begun, they should be controlled prior to attempting decontamination. Inclusionofsodiumbicarbonateintheinfusionfluidcounteractsmetabolicacidosis generated by convulsions caused by strychnine. Because of the mechanism of crimidine toxicity, pyridoxine (vitamin B6) has been suggested for seizures due to this convulsant, though there are no humans reports of its use. Bromethalin is widely used and is available in the form of bait stations and loose pellets. Toxicology Red squill is an ancient rodenticide, consisting of the inner portions of a small cabbage plant grown in eastern Mediterranean countries. For several reasons, mammals other than rodents are unlikely to be poisoned: (1) red squill is an intense nauseant, so animals that vomit (rodentsdonot)areunlikelytoretainthepoison;(2)theglycosideisnotefficiently absorbed from the gut; and (3) absorbed glycoside is rapidly excreted. Injection of the glycosides leads to effects typical of digitalis: alterations in cardiac impulse conduction and arrhythmias. Although it is registered for use as a rodenticide, most toxic exposures from vitamin D result from over supplementation or ingestion of multivitamins. Symptoms and signs of vitamin D-induced hypercalcemia in humans are fatigue, weakness, headache and nausea. Symptoms mirror what may be found in animal poisonings (dog and cat), which include mental status changes, stupor, coma, and cerebral edema. Treatment for bromethalin poisoning is supportive as outlined in the Chapter 3, General Principles. Confirmation of Poisoning Cholecalciferol intoxication is indicated by an elevated concentration of calcium (chieflytheunboundfraction)intheserum. Therearenogenerallyavailabletestsfor the other rodenticides or their biotransformation products. Treatment of Red Squill Toxicosis Red squill is unlikely to cause poisoning unless ingested at substantial dosage. Miscellaneous Rodenticides Treatment of Cholecalciferol Toxicosis Cholecalciferol at high dosage may cause severe poisoning and death. Human poisonings from its use as a rodenticide have not been reported, but vitamin D overdosage has occurred under clinical circumstances. Treatment is directed at limiting gastrointestinal absorption, accelerating excretion and counteracting the hypercalcemic effect. If cholecalciferol has been ingested within an hour prior to treatment consider gastric decontamination as outlined in Chapter 3, General Principles. Repeated administration of charcoal at half or more the initial dosage every 2-4 hours may bebeneficial. Administer intravenous fluids (normal saline or 5% glucose) at moderate rates tosupportexcretorymechanismsandexcretion. Measure total and ionized calcium levels in the blood 24 hours after cholecalciferol ingestion to determine severity of toxic effect. Patients should be managed in an intensive care unit setting with nephrological consultation if possible. Consider using prednisone and similar glucocorticoids to reduce elevated blood calcium levels. Although prednisone and glucocorticoids have not been tested in cholecalciferoloverdosage,itispossiblethattheywouldbebeneficial. It is a logical antidote for cholecalciferol actions, but has only very limited use in human poisoning.

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This information should be carefully studied and mastered symptoms enlarged spleen lactulose 200 ml otc, as it can be applied for understanding 4 Anomalies with a left-to-right shunt in children 97 more complex anomalies that also have a communication between the two sides of the circulation medicine ok to take during pregnancy buy lactulose 100 ml low cost. Overall schedule 8 medicines cheap lactulose 200 ml on line, a ventricular septal defect is a component in half of all patients with a cardiac malformation medicine effects buy lactulose in india. Less frequently they are found either above the crista supraventricularis or in the muscular portion of the septum. Small defects in the muscular ventricular septum create characteristic murmurs in neonates and young infants as pulmonary resistance falls. It is the most common cardiac "defect" (reported in as many as 5% of neonates, as detected by echocardiography). Most small muscular defects close spontaneously within the first few months of life. When the size of the defect approaches the size of the aortic annulus, flow is governed by the relative pulmonary and systemic vascular resistances. When the defect is smaller, blood flows from the left to the right ventricle because of the higher left ventricular systolic pressure. Because two physiologic mechanisms influence the shunt, the clinical findings, natural history, and operative considerations for the two different sizes (large and small) of ventricular septal defects will be considered separately. Large ventricular septal defect In patients whose ventricular septal defect approaches the diameter of the aortic annulus, the resistance to outflow from the heart is determined primarily by the caliber of the arterioles of the systemic and pulmonary vascular beds. Since the systemic arterioles have a thick muscular coat and narrow lumen and the pulmonary arterioles have a thin coat and wide lumen, the systemic resistance is greater than the pulmonary resistance. In an individual with a normal heart, the difference in systemic and pulmonary resistances is reflected by systemic arterial pressure in the region of 110/70 mmHg and by pulmonary arterial pressure of 25/10 mmHg. Because the pulmonary and systemic blood flows are identical in a normal person, the resistance in the pulmonary arteriolar bed is therefore a fraction of that in the systemic vasculature. Since the flow through a large defect is governed by resistances, any condition that increases resistance to left ventricular outflow, such as coarctation of the aorta or aortic stenosis, increases the magnitude of the left-to-right shunt, whereas any abnormality that obstructs right ventricular outflow, such as coexistent pulmonary stenosis, as in tetralogy of Fallot, or pulmonary arteriolar disease, decreases the magnitude of the left-to-right shunt. If the resistance to right ventricular outflow 4 Anomalies with a left-to-right shunt in children 99 exceeds the resistance to left ventricular outflow, the shunt is in a right-to-left direction. Prior to birth, the pulmonary vascular resistance is elevated and is greater than the systemic vascular resistance. In a neonate, the pulmonary arterioles are thick walled and histologically resemble systemic arterioles. The elevation of pulmonary vascular resistance before birth is supported by observations of the fetal circulation: the right ventricular output enters the pulmonary artery, the major portion flows into the aorta through the ductus arteriosus, and only a small portion enters the gasless high-resistance lungs. The systemic vascular bed has relatively low resistance because of the highly vascular placenta. The proportions of flow in utero to each vascular bed depend on the relative resistances. Immediately after birth, the lungs expand, the pulmonary vascular resistance decreases, and as the placenta is disconnected from the systemic circuit, the systemic resistance nearly doubles. Thus, the pulmonary vascular resistance falls, almost reaching adult levels by the time the child is about 8 weeks of age. Although this sequence occurs in every individual, this decrease in pulmonary vascular resistance has profound effects on patients with a ventricular septal defect. In those with a large ventricular septal defect, the medial layer does not undergo regression either as quickly or to the extent of an normal individual. Therefore, at any age the pulmonary vascular resistance is higher than normal yet lower than the systemic resistance. In patients with a large isolated ventricular septal defect, the systolic pressures in both ventricles and both great vessels are the same, with the right-sided systolic pressures elevated to the same levels as those normally present on the left side of the heart. Because the aortic systolic pressure is regulated at a constant level by baroreceptors, the pulmonary artery pressure (P) is also relatively fixed. At birth, flow through the defect is limited, but as the neonate and then young infant grows, the pulmonary blood flow progressively increases. Large ventricular septal defects place two major hemodynamic loads upon the ventricles: increased pressure load on the right ventricle and increased volume load on the left ventricle. In a large defect, the right ventricle develops a level of systolic pressure equal to that of the left ventricle.

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An apology mostly respects the conduct of individuals toward each other as equals; it is a voluntary act produced by feelings of decorum treatment scabies generic lactulose 100 ml line, or a desire for the good opinion of others medicine 1700s lactulose 100 ml. Defn: Sung or addressed to one departing; valedictory; as medicine review generic 200ml lactulose with mastercard, apoplectic songs or hymns medicine technology generic lactulose 200ml with amex. Note: the term is now usually limited to cerebral apoplexy, or loss of consciousness due to effusion of blood or other lesion within the substance of the brain; but it is sometimes extended to denote an effusion of blood into the substance of any organ; as, apoplexy of the lung. One who has forsaken the faith, principles, or party, to which he before adhered; esp. Defn: Pertaining to , or characterized by, apostasy; faithless to moral allegiance; renegade. Specifically: One of the twelve disciples of Christ, specially chosen as his companions and witnesses, and sent forth to preach the gospel. He called unto him his disciples, and of them he chose twelve, whom also he named apostles. Note: the title of apostle is also applied to others, who, though not of the number of the Twelve, yet were equal with them in office and dignity; as, "Paul, called to be an apostle of Jesus Christ. The missionary who first plants the Christian faith in any part of the world; also, one who initiates any great moral reform, or first advocates any important belief; one who has extraordinary success as a missionary or reformer; as, Dionysius of Corinth is called the apostle of France, John Eliot the apostle to the Indians, Theobald Mathew the apostle of temperance. It certainly dates back to the beginning of the sixth century, and some assert that it can be found in the writings of Ambrose in the fourth century. Pertaining to an apostle, or to the apostles, their times, or their peculiar spirit; as, an apostolical mission; the apostolic age. According to the doctrines of the apostles; delivered or taught by the apostles; as, apostolic faith or practice. The churches of Rome, Alexandria, Antioch, and Jerusalem were called apostolic churches. They were Polycarp, Clement, Ignatius, and Hermas; to these Barnabas has sometimes been added. Peter, the prince of the apostles, and the only apostle who has successors in the apostolic office. In this way a passage in the Old Testament may have, or rather comprise, an apotelesmatic sense, i. Note: In England an apothecary is one of a privileged class of practitioners - a kind of sub-physician. One who sells drugs and makes up prescriptions is now commonly called in England a druggist or a pharmaceutical chemist. The pound and ounce are the same as in Troy weight; they differ only in the manner of subdivision. Defn: A short, pithy, and instructive saying; a terse remark, conveying some important truth; a sententious precept or maxim. A deposit formed in a liquid extract of a vegetable substance by exposure to the air. The act of elevating a mortal to the rank of, and placing him among, "the gods;" deification. Defn: To exalt to the dignity of a deity; to declare to be a god; to deify; to glorify. Defn: Of or pertaining to a chain of mountains in the United States, commonly called the Allegheny mountains. Note: the name Appalachian was given to the mountains by the Spaniards under De Soto, who derived it from the heighboring Indians. Whine, of its own nature, will not congeal and freeze, only it will lose the strength, and become appalled in extremity of cold. To depress or discourage with fear; to impress with fear in such a manner that the mind shrinks, or loses its firmness; to overcome with sudden terror or horror; to dismay; as, the sight appalled the websters 1913 gutenberg(2009). The portion of land assigned by a sovereign prince for the subsistence of his younger sons. Hence: A full collection or set of implements, or utensils, for a given duty, experimental or operative; any complex instrument or appliance, mechanical or chemical, for a specific action or websters 1913 gutenberg(2009).

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