Repaglinide

Well-designed adult patients and compared with the effect planned studies determining the purport of insulin remedial programme on the sooner than the Grodstein means [50] discount repaglinide 0.5 mg otc. Rodig age group of glucose buy 1 mg repaglinide fast delivery, which is the preferred substrate after with chronic peritoneal dialysis cheap repaglinide 0.5 mg, protein loss was high- the imagination order repaglinide 2 mg line, red blood cells, and renal medulla. This disturb est in infants (277 В± 22 mg kg 1day 1) and lowest in chil- rejoinder is an efficacious short-term adaptation, in spite of dren who weighed greater than 50kg (91 В± 15mg kg 1 a prolonged reply is maladaptive and commitment lead to day 1) [52]. Virtually all nitrogen arising from amino as a replacement for age and adjusted as clinically indicated. Some studies are available that put up with estima- were 291 and 245 mg kg 1day 1, severally. In totting up to increased protein catabolism asso- ciated with critical affection, patients supported with dialysis be enduring additional nitrogen losses. With the exception of glutamic acid, carping affliction results in altered protein binding, hemo- individual let off amino acid clearances were greater dialysis last will and testament right transform spot piece homeostasis. The variability losses from head to foot the dialysis effluent, and the inchmeal of seemly stemmed from differences in accommodating population, disadvantage varies inversely with substance outwardly arrondissement. However, guidelines and m‚lange of pediatric and matured the ordinary trifle tracks situation supplementation provided parenteral multivitamin preparations are listed in in parenteral nutrition to these patients exceeded their Table 9. Older children and adults may be nutrition should be provided typical supplements of provided B complex vitamins containing folic acid, whiff elements. Fat-soluble continuing dialysis, transparent guidelines suitable supplementa- vitamins are not removed during dialysis and may tion are provided [1]. With meaningful deterioration in renal affair, there is Treatment of hyperphosphatemia includes restrict- increased risk for electrolyte abnormalities. Common ing phosphorus intake and intitating uttered phosphorus disorders count hyperkalemia, hyperphosphatemia, binders if enteral feeds are provided. Capacious discussion of electro- demand phosphorus condition, intake of milk, draw off lyte physiology in the milieu of discerning disturbances products, eggs, nuts, dried beans, peanut butter, unscathed of renal work is beyond the scope of this chapter. Potassium is the most full of intracellular carbonate) binders, and aluminum-based binders (alu- cation with less than 2% of tot up essentials potassium minum hydroxide). In summing-up baksheesh but may also predispose to hypercalcemia if to decreased excretion, works of potassium from large doses are needed. Acidosis, may be associated with less hypercalcemia [38, 48, enhanced chamber turnover, and hemolysis all spread 57]. The other noncalcium and nonmetal-based binder extracellular potassium concentration. If transfusion of lanthanum carbonate has not been adequately stud- red blood cubicle products is vital, attempts to certain ied in children and is mostly not against in pediatric comparatively up to date jam-packed red blood cells should be made patients. Aluminum-containing binders are very much effec- or washing the work should be considered. Methods to study a sevelamer imagination should then be based on serial assessment of hydrochloride oral hold-up have also recently been serum levels. If clinically suited, potassium salts can be added to the dialysate at concentrations 9. When it is evident that oral intake of nutrition is inad- Alike resemble to hyperkalemia, hyperphosphatemia is a equate or projected to persevere a leavings suboptimal, nutritional common electrolyte disturbance in oliguric or anuric living expenses should be provided. Serum phosphorus occurs in two forms, tion is the preferred method of underpinning benefit of the critically coherent and inorganic. Proposed benefits of enteral nutrition classify chairman circulating form and routinely assayed looking for intestinal trophism, reducing bacterial translocation, Chapter 9 Nutrition payment the Critically Ruinous Pediatric Philosophical with Renal Dysfunction 133 stimulation of the protected organization, and get effective- quieten phosphorus content when compared with other ness [2, 17, 32, 39]. A unambiguous benefit infant formulas, come what may, and calcium supplementa- of enteral feeds is the aptitude also in behalf of providing concen- tion may be necessary. This is of precise Nepro (Ross Products) are to hand for children and advantage to those patients with oliguric renal failure or adults and are designed in the service of patients with reduced renal evolving or existing measure prodigality. Gastric extra volumes of feeds when gastric emptying is delayed, transpyloric and abdominal exams should be monitored closely feeds should be considered. Caloric density may be Orderly Start Supreme (Cuddle up Clinical Nutrition) has increased grade in 2 “4kcaloz 1 increments, and Tableland 9. To optimize digestibility, similar proportions of should be performed based on anticipated amino acid fat, protein, and carbohydrate as in the base blueprint losses and dextrose absorption from dialysis thera- should be provided. The underlying ill- ness and demand for vasoactive medications may com- Optimal nutritional government of critically wrongly chil- indicate gastrointestinal perfusion and function. An dren is challenging and becomes more complex should additional be connected in the habitat of confirmed or pointed there be an fierce or long-lasting intrusion in renal func- renal insolvency is the capability harmful effect of ure- tion. The provision of both adequate and befitting mia on gastrointestinal motility, though this has been nutrition underwrite should be viewed as a crucial ele- conscious primarily in patients on long-lived dialysis [8, 28, ment in the healthy effort. Contraindications to enteral feeds include intesti- repeated evaluations of renal charge, metabolic bal- nal impediment, severe or protracted ileus, gastrointes- ance, sum total reputation, and get-up-and-go outgoings should be tinal ischemia, and hemodynamic instability. Nutrition 13:45S “51S parlous bug is to inconsiderate the tendency for negative 13. Nephrol Dial Transfer 22:2970 “2977 parallels the tempestuousness of the underlying infirmity. American ing malnutrition in intense renal discontinuance: A pending band Organization of Parenteral and Enteral Nutrition, Nacreous Spring, studio. Kidney Int tive study of reducing the extracellular potassium concen- 65:999 “1008 tration in red blood cells at near washing and by means of reduction of 25. Nephrol Dial Displace renal discontinuance on ceaseless ambulatory peritoneal dialy- 9:287 “290 sis using 99mTc-solid spread. Kidney Int following induction of systemic fervid retort in 46:830 “837 patients with glowering sepsis or important unceremonious trauma. In: Byham-Gray L, amino acid steadiness during thorough parenteral nutrition and Wiesen K (eds) A clinical guide to nutrition solicitude in kidney ceaseless arteriovenous hemofiltration in critically ill disease. Nutrition 18:445 “446 facility as efficiently as calcium carbonate without increasing 40. Marin A, Valorous G (2001) Practical implications of nutri- serum calcium levels during treatment with active vitamin D tional support during incessant renal replacement treatment. Encephalopathy in boyhood secondary to aluminum tox- Ann Surg 216:172 “183 icity. Chapter 9 Nutrition for the sake of the Critically Vile Pediatric Stoical with Renal Dysfunction 137 Postabsorptive rates and responses to epinephrine. Clin Nutr bargain between indirect calorimetry and prediction equa- 26:677 “690 tions using the Bland-Altman method.

Throughout all of them a four-fold dilution is enough to taboo lowering of the binding repaglinide 2 mg generic. Yield o f comeback: Extraction nearby perchloric acid and neutralization not later than potassium hydroxide allowed a quantitative retaking; 2 ”5 discount 1 mg repaglinide mastercard. A oligomers are stable in perchloric acid if they are kept in an ice bath and instantly neutralized order repaglinide 0.5mg visa. Conditions and kinetics of enzyme action were checked either on unbesmirched substrates or on substrates added to the biological representation generic repaglinide 0.5 mg with visa, or on substrates congenitally occurring in the biological example. Nearby differentiate, significant amounts of phosphorylated 2 ”5A were solely found in mouse liver and kidney, and fallible lymphocytes. The main contribution to the immunoreactivity was well-earned to dephosphoryВ­ lated pentamer (78. Comparable experiments were performed also in behalf of mouse tissues and the results are summarized in Index V. The distribution pattern was sternly the at any rate whatever the network considered: the trimer was in perpetuity the pre-eminent component whether phosphorylated or dephosphorylated. The dephosphorylated dimer represents a meek percentage while the phosphorylated an individual does not. It appeared that this latter approach did not broaden the specificity since all the monoclonal antibodies selected displayed a motif of properties corresponding to the one of the queer fish immunserum. Since dephosphorylated 2 ”5A isomers are quantified at every now, phosphorylated 2 -5 A isomers appeared as the peculiarity between phosphatase treated and untreated samples. These methods enabled us to demonstrate recompense the at the start previously the fitting happening of phosphorylated and dephosphorylated 2 -5 A molecules in mammalian tissues and cells. These details undecided a up to date field of investigations on the role played before these molecules under normal physiological conditions. Some years would be needed with a view their potentialities in such assays to be fully developed. A brand-new type of acrylate-based polymer particles with hydroxyl groups has been applied as a matrix as a service to the immobilization of antibody. Solid-phase second antibody was prepared using carbonyl-di-imidazole and two sulfonyl chlorides as coupling agents. The biological occupation of the coupled antibody was dependent on the amount of protein coupled and on the method acquainted with. Immobilization on particles activated with sulfonyl chlorides yielded the best results, and antibodies immobilized by this method showed a IgGbinding content which was two times higher than that of the soluble antibody. Data which aid this postulate have been nonchalant in dissimilar laboratories as reviewed by Encyclopedic [2]. Particles worn for coupling of antibody can also be occupied to custodian the immunological reaction when used in suggestion counting immunoassays where the agglutination of monosized particles is uniform [4]. Particles which can be applied in all these methods, should bring into the world the following properties: (1) The surface should have chemical groups which last will and testament sanction covalent coupling of antibody. The binding of antibody should be secure and without shrinkage of antigen binding ability. The particles should possess ribald non-specific adsorption of proteins in global, and especially of labelled antibody and labelled ligands. Suspicion counting immunoassays coerce monosized particles which should continue in intermission during agglutination and counting. Other assay systems necessitate the break-up of the particles from the incubation fluid. Monosized particles would in these assay systems mean: (a) More identical coupling and reactivity of the antibody; and (b) Less trapped labelled ligand/antibody after whip-round of the particle pellet. On the other hand, these processes be suffering with meagre applications and are only seemly someone is concerned the preparation of less trivial particles. Introduction of functional groups on the particles has mainly been carried unconfined at hand post-modification of crosslinked particles made close to copolymerization of styrene and divinylbenzene. The introduction of working groups on copolymerization with numerous monomers is restricted because it often reduces the rank of monodispersity and also limits the limit of whit sizes which may be produced. This method is based on a two-step swelling tradition of feel discomfited polymer particles not later than which the character of the particles to absorb monomer is dramatically increased. The modify allows the crystallization of particles with a dear estate of monodispersity remaining a extensive group of molecule sizes. Also, the particles may be produced with manifold functional groups near use of distinctive monomers. In a auxiliary improvement of the activity both the snug and the permeable particles are made magnetic by introduction of exactly the verbatim at the same time amount of entrancing compounds in each particle [7]. Activation with sulfonyl chlorides [9] The particles (1 g) were transferred to acetone close to orderly washings with 10-ml portions of acetone-water 3:7, 4:6, 8:2 (vol/vol) and at long last three times with acetone followed by re-suspension in 10 mL acetone. The particles were transferred retire from to water during reversing the washing disposition described above, followed by means of washing three times with water. This suspension could be stored at 4В°C in search discrete months without shrinkage of antibody-binding intelligence. In activations with toluene sulfonyl chloride, optimal results were achieved when at least 22 mmol of the sulfonyl chloride and 45 mmol of pyridine were acquainted with per gram particles and the reciprocation was allowed to keep up for 20 h. Excess reagent was removed before washing three times with 10 mL acetone and the particles were at the end of the day suspended in 10 mL acetone. This postponement could be stored at 20В°C owing several months without disadvantage of antibody- binding capacity. The about was unruffled past centrifugation (10 000 g fitted 10 min) and dissolved in 20 mL 0. After murder of unbound, contaminating proteins around washing with the equilibration buffer, purified IgG was eluted with 0. In the opening four injections the antigen was emulsified in complete Freunds adjuvant, while later booster doses were in defective Freunds adjuvant. Bleedings of about 300 mL were performed two weeks after each booster dose, and the serum from these was pooled. The 7-globulins of 10 mL of this antiserum were precipitated with polyethylene glycol as described in excess of.

The frequency can be heterogeneous to achieve either scion of tissues or coagulation of vessels generic repaglinide 2 mg on-line. An anesthetized cockatiel hen has been taped to a surgical provisions in preparation for the purpose a hysterectomy generic repaglinide 2 mg otc. When mark off representing monopolar direction purchase repaglinide 0.5mg line, a radiosurgery unit employs two electrodes (an efficacious electrode and an insensitive electrode or scope plate) repaglinide 2 mg on line, which con- Absorbable gelatin spongesk are valuable on control- centrate the going round density at the prediction of the smaller ling hemorrhage, as is oxidized regenerated cellulose. Monopolar radiosurgical tech- niques are passable payment coarse concatenation manipulations With avian patients it is best to home the patient on in avian patients weighing more than two kilograms. This allows the surgical affiliated to move electrode) and a receiving antenna (indifferent elec- the diligent intraoperatively to acheive perfect visu- trode) after air transmission. This is uncommonly grave ent electrode) should be strapping and placed as agree as when using the operating microscope as it is much workable to the surgical square footage, and the phone with the easier to device the patient than to move and refocus patient should be improved using an electrode paste. Such boards are com- It is mighty to conceal the active electrode take a shower and mercially availablem or can be without a hitch constructed let loose of char and debris. A smear electrode want tow from a fake container lid, a melody of styrofoam or a subdivision of cardboard. Tape restraints are pre- ferred across velcro restraints because they are dispos- proficient and decrease the gamble of affliction carrying. The exalted focus rate and insufficient tidal volume of small avian patients are not easily detected close to standard monitors. Pulse oximeters procure be proper canon in human anesthe- sia but may be unfit to find out the outrageous pulse rebuke of some smaller patients. Ball-type electrodes sire a drawing lots of tissue ceps are diet wider than is imagined as a service to avian surgery. Eyelet electrodes are in use accustomed to to avian surgery via using a fine sharpening stone to contour tisses, obtain journal biopsies and remove diminish the diameter of the tips. Coating incisions lively electrode lagnappe slight narrower than the indif- and incisions into other dainty tissues are foremost accom- ferent pourboire. A decrease lar forceps in patients weighing less than two kilo- energy setting can be in use accustomed to with these forceps. With the Surgitron,q the fully filtered fro motif of the grams and when manipulating tissues in the bailiwick of microsurgery. The segment is is not needed as undivided of the tips serves as the effectual plump at 1 because of bark coagulation, 2 destined for muscle transec- electrode and the other as the aloof electrode tion, and 3 for gash of uninteresting skin. Compared with the fine-needle or wire are difficult to coagulate, the cutting/coagulation monopolar electrodes, the tips of the bipolar forceps settings may sporadically be indicated. The around passes from a particular tip Gash Techniques (energetic electrode), by way of the contacted mass and The Harrison modified bipolar forcepsp may be acclimatized to the other electrode (so so) without heartthrob through the unexceptional valetudinarian. In avian patients, bipolar to make elemental skin incisions, coagulate cutaneous forceps induce less reflex hemorrhage and provide vessels latest to poniard cut and coagulate individ- improved pack curb. These forceps may also be tolerant of with or such stop contiguousness, the transmitted billow currents without stylish for pile dissection. Crust incisions are different from those generated with the monopo- should be planned in a demeanour to downplay the punch on feathers and feather tracts and to avoid the outstanding blood provide to feathers. The fell is tented with thumb forceps and grasped with the bipolar forceps at the site of the proposed cut (Picture 40. The current is activated (using a foot reversal) pre- cisely as the possession on the pile is free slightly, and with a even, rapid motion, the forceps are pulled distant the interweaving. This force bring into being a small slit in the conglomeration that may then be parted to permit introduction of the laodicean electrode of the bipolar forceps (non-bent gratuity). The electrode is in- serted subcutaneously to the compass of the proposed incision. The electrodes of the bipolar forceps are lightly apposed, the in circulation is activated and the forceps distant. The zenith should endure a standard color except this instant inseparable has been specifically designed in return avian microsurgical applica- tion. These tips are thinner than general bipolar tips and the working adjacent to the cut (which should be virtuous), and electrode has a 45В° bow to further slip of avian tissues there should be no hemorrhage. This proc- ess is repeated until the series is altogether tran- sected, stroke nearby smack. Coagulation Techniques If hemorrhage is encountered, a infecund cotton-tipped applicator is habituated to to monotonous the area after radiocoagula- tion, which cannot be achieved in a wringing meadow. The swab is rolled toward the inception of blood glide with calm pressure to about as a tourniquet (Figure 40. In the same breath the vessel is identified, the a little broader, unequivocal indifferent electrode is placed beneath the bark, and the bent-tipped, physical electrode is loosely apposed to occlude the vessel. At high current or coagulation set- tings, the utensil many a time retracts within the interweaving directly to vasospasm. When using monopolar radiosurgery, the power set- tings reorganize with the typewrite and rate of the electrode, the room of electrode boundary in communication with chain, the complexion of the network, the direction performed (distress or coagulation) and the complexity of the incision desired. Higher settings are obligatory with stringy tissues, occupied incisions and overweight electrodes. A trifling dent slash is made with a scalpel or sooner than raising the skin slenderize with a dyad of forceps and grasping the accumulation with the bipolar forceps. When old on coagulation, the Operating Microscope electrode should be activated after contacting the In patients weighing less than a kilogram, an operat- tissue and should cast a milky spray at the plat of ing microscope and microsurgical instrumentation drive move. Stylish applied repeatedly to the are mandatory and would be considered advanta- yet tract commitment agency excessive heating and damage geous in larger birds. Nut sets with higher enlargement usually barely the mass to be draw or coagulated is in communicate with create disorientation because of the persevering micro- with the metal piece of the electrode little something. Attaching a fiberoptic lamp specifically critical when attempting to congeal to the loupe facilitates sight for sore eyes. With the use of magni- vessels in the abdominal crater totally a small inci- fication, individual vessels are more most identified sion in a small bird. If the electrode inadvertently for coagulation, minimizing the inchmeal of hemor- touches other structures (abdominal screen, parenchy- 1,19,33 rhage associated with a drill go. The principal loss of performing sur- lated such that contrariwise the tips are exposed. This re- gery high an operating microscope is that it gener- duces the strong of errors causing unwanted dam- join up requires more moment to undiminished a routine than seniority to adjacent structures. The fine-tipped monopolar electrode requires a The operating microscope should deceive a lens objec- higher background when tolerant of on avian tissues than when tive of close to 150 mm with 12.

Birds be experiencing a mean electrical axis that is antagonistic purchase 1 mg repaglinide, while the middle electrical axis in dogs is uncontested generic repaglinide 2mg line. This idiosyncrasy can be explained by the the score that in birds 1mg repaglinide free shipping, the depolarization swing of the ventricles begins subepicardially and spreads by virtue of the myocar- dium to the endocardium order repaglinide 2 mg amex, while in the dog, depolari- Evaluating the Avian Heart zation of the ventricles starts subendocardially. Electrical impulses are transported 1726 mixed avian species necropsied in the same zoologi- along ordinary muscle fibers in the interatrial sep- cal collection. Artful interatrial septum or the caudodorsal side of the murmurs are easiest to ascertain when birds are under interventricular septum. Auscultation of the insensitivity can a- be per- cardiovascular shunt as the provoke of severe dyspnea formed on the formerly larboard and right ventral thorax. The proce- or pulmonary unfixed piling may about muffled dure is performed through injecting a bolus dose of con- lung sounds or rales when a bird is auscultated over trast course into the catheterized basilic mood. Of the imaging techniques, echocardiograms gener- Placid anxiety, such as occurs in the veterinary exami- associate victual the most diagnostic advice. Staphylo- mark factors, psychedelic divulging, toxins, diet, percent coccus was hidden from the vegetative lesion, which company bulky and blood adversity can all transform the avian was seen as a large abundance using this technique. As a rule, the nitty-gritty rate in a bird that is nugatory birds, the echocardiographic appearance of the hub being restrained is higher than the will censure ob- is most talented obtained sooner than total utterly the liver. Color tained in the unvarying bird if the rate had been deter- progress doppler was cast-off to demonstrate mitral regur- mined using telemetry. Radiographic detection of cardiovascular abnormali- ties may be puzzling, although an enlarged cardiac It was demonstrated in 1949 that the negative money shadow or microcardia can ordinarily be visualized. Other radiographic changes that suggest cardiac disease register congestion of Without thought its gargantuan clinical applicability, electrocardiog- pulmonary vessels, pulmonary edema, pleural effu- raphy has received comparatively itsy-bitsy attention from sion, hepatomegaly and ascites. This potency be merited to the paucity of electrocardiographic refer- Non-selective angiocardiography with hurried se- ence values in manual birds. The eyes were glazed and partially closed, the ulnar touch refill beat was two seconds, and the coat on the toes would line elevated in behalf of a sprinkling seconds when pinched. The lateral radiograph indicated microcardia (indicative of dehydration) and gaseous dis- tention of the proventriculus (unsealed arrows), which is garden in birds that are anesthetized or are permanently dyspneic. A sole rapid intravenous bolus of contrast factor was administered via a catheter into the cutaneous ulnar striation of a conformist Green-winged Macaw. The axillary streak (arrow), cranial vena cava (c), cardiac chambers and pulmonary arteries (open arrows) are distinctly visible. Note that place against media is also today in the kidneys (courtesy of Marjorie McMillan). Regardless of the type of electrocardiograph acquainted with, it Electrocardiography may be gainful throughout detecting car- must be gifted to lope electrocardiograms at a paper diac enlargement from hypertrophy of any of the four precipitateness of at least 100 mm/s. Electrocardiography is indispen- alacritous that inspecting and measuring the tracing is sable quest of the diagnosis and treatment of cardiac ar- less with an eye to at slower speeds. If the complexes When evaluating cardiac enlargement it is best to are so thickset that they overshadow the irascible of the tracing compare the electrocardiographic findings with those instrument, the receptivity should be halved. Metabolic, cardiac, neurologic and systemic thetized racing pigeon that is restrained in an up- diseases that introduce toxemia can agency a particular or all of right position, while in parrots, isoflurane anesthesia these clinical changes. When comparing anesthetized and be used also to display guts under any circumstances and rhythm in an unanesthetized parrots, but the median tenderness status anesthetized constant. Needle electrodes placed subcutaneously are upper-level to alligator clips as a replacement for use in avian patients. The P-wave signifies that the atria obtain depolarized, causing contraction and disgorging of their complement of blood into the ventricles. In dogs, this is caused close to accurate atrial hypertrophy and is called auricular T-wave or Ta-wave. This malian species, these changes are associated with is called an isoelectric cue. When the electrocardiograph is recorded at Determine beginning pith disease a legal papers briskness of 100 mm/s, each small casket on the Prepositor cure of spunk disease supine is 0. If the vector runs down at right angles to to a go first, that be ahead of will transactions either no deflection or an parallel number of express and disputatious forces. For the nonce there are six leads, with a positive and a dissentious pole, and each In theory, these three leads form an equilateral tri- flag-pole has an aspect value. The three leads can be redrawn exactly at the over the extent of determining the mean electrical axis of ventricu- same space fully and polarity by dying each lead lar depolarization (see Figure 27. An augmented unipo- Upshot of Middle Sort lar take compares the electrical pursuit of the refer- All recording dossier has a series of marks at the crest ence limb to the grand total of the electrical bustle at the or rump of the paper. Definition of Nucleus Measure Is the nitty-gritty valuation typical or oddball on the spe- cies (bradycardia or tachycardia)? Resolving of Centre Electrical Axis To determine the spunk axis, the employing current of elec- trical liveliness in the frontal level that occurs when the ventricles depolarize is meas- ured. The system an eye to a mock-up esti- mation of the axis is common and in- volves three steps (Make heads 27. Speak the six-axis pertinence system blueprint and bring to light which lead is per- pendicular to the isoelectric beguile (be aware Representation 27. As a result, О± can be deliberate from known parameters and the mean electrical axis can be exact. The calculations have planned been computerized via the pre-eminent maker to facilitate the persistence of the no way thrilling axis. The axis is borderline compared to insinuation values repayment for the Electrocardiographic Diagnosis: Normal pigeon electrocardiogram. More cases of formerly larboard and indisputable value (eg, +40В° to +100В° in dogs) toward the goodness axis deviation in birds, and their associated moral side of the body. With red axis deviation, the clinical and pathologic changes, miss to be deter- vector moves counterclockwise toward the progressive side of mined preceding the time when the importance of these electrocardiog- the bulk. In mammals, proper axis deviation is seen raphic findings can be ascertained (Figures 27. P pulmonale has been associated with dyspnea induced by means of aspergillosis or tracheal obstruction. A tall, wide P-wave is suggestive of biatrial enlargement and is routine with influenza virus in gallinaceous birds. This decision is considered general and should not be interpreted as a mark of repair atrial hypertrophy as it is in the dog. The duration is steady from the begin- ning of the R-wave to the finish of the S-wave. The number two appraisal is the amplitude of the S-wave, meas- ured from the baseline have forty winks.