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Local muscle flaps in the treatment of chronicosteomyelitis. X60.b.This higher magnification shows an areawhere the glandular epithelium ispseudostratified.The round nuclei adjacent to the connectivetissue (arrowheads)belong to the basal cells.Those nuclei thataremore elongate and furtherremoved from the baseofthe epithelium belong to the secretory cells.Notethetermi-nal bars(arrows)thatareevidentatthe apical region ofthesecells.Thered-stained siteswithin the denseconnectivetissue represent smooth muscle cells. How-ever, ancillary studies can be helpful in ruling out otherdisorders in the differential diagnosis and also helpenforce a clinical impression or presumptive diagnosis.Electrophysiologic studies, including an EEG (electro-encephalogram), may show changes in brain functionover time that are consistent with the neurodegeneration.However, EEG is not a common test in the evaluation ofCBD. This informationcan be used to detect the onset of secondary brain injuries that may be intervened uponand to set physiologic end points to guide goal-directed therapy and thereby create andmaintain an optimal physiologic environment for the comatose injured brain to heal (1). Inless severe cases, with modest decrease in Crs ,standard approaches should not cause harm pro-viding ventilator rates are limited to 30 breaths/min. Clearly, neither the patient nor the provider can change the insurance company’spolicies. Nicotinic acid appears to inhibit lipolysis in adiposetissue by decreasing hormone stimulated intracellular cAMPformation through this receptor.
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