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2013 SPRING/SUMMER COLLECTION CHARMS* Birthstones 2 SILVER JANUARY BIRTHSTONE BOY $5 CH3049 SILVER FEBRUARY BIRTHSTONE BOY $5 CH3050 SILVER MARCH BIRTHSTONE BOY $5 CH3051 SILVER APRIL BIRTHSTONE BOY $5 CH3052 SILVER MAY BIRTHSTONE BOY $5 CH3053 SILVER JUNE BIRTHSTONE BOY $5 CH3054 SILVER JULY BIRTHSTONE BOY $5 CH3055 SILVER AUGUST BIRTHSTONE BOY $5 CH3056 SILVER SEPTEMBER BIRTHSTONE BOY $5 CH3057 SILVER OCTOBER BIRTHSTONE BOY $5 CH3058 *Enlarged to show detail 2013 SPRING/SUMMER COLLECTION CHARMS* Birthstones 3 SILVER NOVEMBER BIRTHSTONE BOY $5 CH3059 SILVER DECEMBER BIRTHSTONE BOY $5 CH3060 SILVER JANUARY BIRTHSTONE GIRL $5 CH3061 SILVER FEBRUARY BIRTHSTONE GIRL $5 CH3062 SILVER MARCH BIRTHSTONE GIRL $5 CH3063 SILVER APRIL BIRTHSTONE GIRL $5 CH3064 SILVER MAY BIRTHSTONE GIRL $5 CH3065 SILVER JUNE BIRTHSTONE GIRL $5 CH3066 SILVER JULY BIRTHSTONE GIRL $5 CH3067 SILVER AUGUST BIRTHSTONE GIRL $5 CH3068 *Enlarged to show detail 2013 SPRING/SUMMER COLLECTION CHARMS* Gold Crystal Initials Birthstones 4 SILVER SEPTEMBER BIRTHSTONE GIRL $5 CH3069 SILVER OCTOBER BIRTHSTONE GIRL $5 CH3070 GOLD INITIAL A WITH CRYSTALS $5 CH8027 GOLD INITIAL B WITH CRYSTALS $5 CH8028 GOLD INITIAL C WITH CRYSTALS $5 CH8029 SILVER NOVEMBER BIRTHSTONE GIRL $5 CH3071 SILVER DECEMBER BIRTHSTONE GIRL $5 CH3072 GOLD INITIAL D WITH CRYSTALS $5 CH8030 GOLD INITIAL E WITH CRYSTALS $5 CH8031 GOLD INITIAL F WITH CRYSTALS $5 CH8032 *Enlarged to show detail 2013 SPRING/SUMMER COLLECTION CHARMS* Gold Crystal Initials 5 GOLD INITIAL G WITH CRYSTALS $5 CH8033 GOLD INITIAL H WITH CRYSTALS $5 CH8034 GOLD INITIAL I WITH CRYSTALS $5 CH8035 GOLD INITIAL J WITH CRYSTALS $5 CH8036 GOLD INITIAL K WITH CRYSTALS $5 CH8037 GOLD INITIAL L WITH CRYSTALS $5 CH8038 GOLD INITIAL M WITH CRYSTALS $5 CH8039 GOLD INITIAL N WITH CRYSTALS $5 CH8040 GOLD INITIAL O WITH CRYSTALS $5 CH8041 GOLD INITIAL P WITH CRYSTALS $5 CH8042 *Enlarged to show detail
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92182 Drawings Included In Calpulli Center 4th Floor Drawing # Drawing Title Revision # Drawing Date Set Architectural A51.0 PROJECT SITE PLAN 0 05/06/2016 Conforming Set 05/06/16 D1.0 FOURTH FLOOR DEMO PLAN 0 05/06/2016 Conforming Set 05/06/16 A1.1 ENLARGED FOURTH FLOOR PLAN 0 05/06/2016 Conforming Set 05/06/16 A1.0 ACCESSIBILITY REQUIREMENTS:
however, they are insufficient for obese patients (who typically have enlarged, fatty livers) due to decreased intra-abdominal space and increased stress concentrations at the tissue-retractor interface (sometimes causing perforations in the tissue, as shown in Figure 2).
However, they are insufficient for obese patients (who typically have enlarged, fatty livers) due to decreased intra-abdominal space and increased stress concentrations at the tissue-retractor interface (sometimes causing perforations in the tissue, as shown in Figure 2).
Alterations Anesthetic Implications Weight gain/breast engorgement Hinders laryngoscopy Swollen mucosa Easy bleeding with manipulation Upper airway obstruction Use of smaller caliber endotracheal tubes Renal Changes with Pregnancy Anesthetic Implications MAC decreased Overdosage hazard Decreased FRC Faster induction with insoluble agents Increased VE Speeds induction with soluble agents Greater risk of Hypoxemia Alterations Decreased FRC Anesthetic Implications Less O2 reserve Increased O2 consumption Mucosal engorgement of the Respiratory Tract Rapid airway obstruction Elevated progesterone levels o decreased gastric motility o decreased food absorption o lower esophageal sphincter tone at term Placental secretion of gastrin o higher gastric acidity (Gastric pH ≤ 2.5) o increased gastric acid volume Enlarged uterus o increased intragastric pressure o gastroesophageal angle flattens Clinical Significance • Increased danger of vomiting and aspiration • Acid Aspiration Pneumonia(Mendelson’s Syndrome) • All parturients are considered to have a full stomach regardless of the number of hours after last food intake • No solid food should be given to parturients and that liquids be restricted to a small amount of ice chips Medical Measures for a Full Stomach • Histamine2-blocking agents o (cimetidine, ranitidine, decrease acidity and volume • Hematologic Changes with Pregnancy Clotting factors rise by 50-250% Hemoglobin decreases by 20% Platelet count lowered by 20% Iron and folate anemias Plasma flow and GFR increases by 50% Decreased threshold for glucose and amino acids Gastrointestinal Changes with Pregnancy Modified responses to anesthetics Alterations Dilutional anemia Platelet count – 20% ↓ The following factors are increased:
With atypia – enlarged, hyperchromatic, hyperplastic and pleomorphic nuclei - Glands Stroma Gland Distribution - Increased number of glands with pseudostratified columnar lining epithelium, varying in sizes, some can be cystically dilated Absence of thick walled blood vessels Cellular stroma Uneven distribution of glands Can be compared to endometrial polyp or proliferative endometrium Can be described as an endometrium exhibiting a swiss cheese pattern The glands may be near each other, but they should not be back to back or fused – this is adenocarcinoma already 4 Main Categories: