Group Vi Modern Medical Care

8/8/2019 Group Vi Modern Medical Care

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Facultad De Medicina HumanaEscuela Profesional De Medicina Humana

Medical EnglishCURSE : Medical English

TEACHER : Dra. Rosa Gonzles Llontop

CONTENT : Modern Medical Care

GROUP VI :ALCOSER ARCILA ALONSO

DE LA CRUZ RUIZ LENIN

MENDOZA MEGO BORIS

LUMBRE YUPTON CESAR

QUEVEDO MORI ARTURO

REGALADO ROCHA WILINTON

CYCLE : 2010-I

Lambayeque, Per

September 2010


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CURRENT MEDICINE

In the twentieth century, medicine has undergone a radical transformation,

especially in regard to the ability of professional action of this science, which

today can cure diseases that once were fatal, creating a very life expectancy

large. These developments are reflected in the methods of diagnosis, medical

and surgical therapy, and even in preventive medicine.

Among the most sophisticated diagnostic elements are the modern techniques

of reconstruction of three-dimensional models of the body (traditional CT,

ultrasound, computed tomography and magnetic resonance imaging), and

direct views from inside the body (arthroscopy, endoscopic surgery, cardiac

surgery remote control, etc.).. Examination by analytical chemistry and image

can now know every corner and reactions of the human body.

Advances in surgery are also spectacular. The use of the microscope, the laser

beam as a dissector, transplantation techniques, which have enabled

thousands of lives saved due to the introduction of entire organs (heart, kidney,

liver ...) in hospice-techniques endoscopic surgery, the many interventions

guided fine on small areas of the brain, and even the current trials of robotic

surgery and controlled by computer without almost anything involving t he

intervention of human hands, added all at best sutures, hemostasis systems ,

cutting and dissection, have created a very satisfactory picture surgery.

One of the most significant surgical fields is the reference to the heart and great

vessels. The valve expansion techniques (intravenous today), recanalization of

coronary and other open heart achievements, unimaginable until recently, have

made possible the continuation of the lives of many patients.

Unfortunately, these advances in medicine do not occur equally in all countries

of the world, so that there is still a general advance in all branches of medical

care, some sectors of the population have better access, and therefore are

much better protected than others, especially the marginalized and poo r

countries. Pending, and in the twenty -first century, which are pending bothmedicine and political leaders that structure the social and economic dynamics

of the world.

But medicine still has to face many challenges, among which are cancer, the

treatment of many mental illnesses like Parkinson's and Alzheimer's disease,

and many infectious diseases such as hepatitis and AIDS (Acquired

Immunodeficiency Syndrome).


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Although science has made major achievements in combating infectious

diseases, there are others for which there is no known effective method of

combat.

In the case of AIDS, for example, although drug therapy has increasingly better

results, has long been trying to find a vaccine to curb this scourge of our times.

The hepatitis B virus (HBV), in addition to producing liver disease, causes a

common form of cancer, and is the most important human carcinogen, after

snuff. In this sense, the progress of molecular biology of HBV has found

interesting medical applications, among which are prevention o f infection

through vaccination. They have high hopes for new vaccines created through

genetic engineering, for the eradication of such diseases.

Cancer, for its part, is very different methods depending on the type, but today

is still looking for a system of immunotherapy, ie a treatment to increase the

potential innate immune system, which is the main natural defense the body

against viruses and other foreign invaders, including organ transplantation, to

eliminate cancer cells. And in any case, immunotherapy is a good complement

to existing treatments.

Thanks to modern techniques of biochemistry and molecular genetics has

opened a huge field of future possibilities for control of hereditary diseases.

There is a global project, the genome project, coor dinated by numerous

institutions and aims to get the complete human genome. The maps obtainedwill be of great value in research on gene and chromosome organization, as

well as the identification of genes involved in certain genetic diseases.

Medical developments promise better health in the future, through the use of

new therapies, genetic manipulation, construction of artificial organs, the use of

drug design and implementation of other ingenious techniques to restore organ

function. Likewise, counter many more infectious agents. However, all this

knowledge must be applied to enable a better quality of life, and we must take

into account ethical issues that every case entails


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CLI ICALLABORATORY

A medical laboratory or clinical laboratory is a laboratory where tests are

one on clinical specimens in order to get information about the health of a

patient as pertaining to the diagnosis, treatment, and prevention of disease.

I. HEMATOLOGICAL TESTS

A. COMPLETE BLOOD COUNT

Also known as: CBC; Hemogram; CBC with differential.

The CBC is used as a broad screening test to check for such disorders as

anemia, infection, and many other diseases. It is actually a panel of tests that

examines different parts of the blood and includes the following:

White blood cell (WBC) count is a count of the actual number of white

blood cells per volume of blood. Both increases and decreases can be

significant.

White blood cell differential looks at the types of white blood cells

present. There are five different types of white blood cells, each with its

own function in protecting us from infection. The differential classifies a

person's white blood cells into each type: neutrophils (also known as

segs, PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophi ls,

and basophils.

Red blood cell (RBC) count is a count of the actual number of red

blood cells per volume of blood. Both increases and decreases can point

to abnormal conditions.

Hemoglobin measures the amount of oxygen-carrying protein in the

blood.

Hematocrit measures the percentage of red blood cells in a given

volume of whole blood.


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The platelet count is the number of platelets in a given volume of blood.

Both increases and decreases can point to abnormal conditions of

excess bleeding or clotting. Mean platelet volume (MPV) is a machine-

calculated measurement of the average size of your platelets. New

platelets are larger, and an increased MPV occurs when increased

numbers of platelets are being produced. MPV gives your doctor

information about platelet production in your bone marrow.

Mean corpuscular volume (MCV) is a measurement of the average size

of your RBCs. The MCV is elevated when your RBCs are larger than

normal (macrocytic), for example in anemia caused by vitamin B12

deficiency. When the MCV is decreased, your RBCs are smaller than

normal (microcytic) as is seen in iron deficiency anemia or thalassemias.

Red cell distribution width (RDW) is a calculation of the variation in the

size of your RBCs. In some anemias, such as pernicious anemia, the

amount of variation (anisocytosis) in RBC size (along with variation in

shape poikilocytosis) causes an increase in the RDW.

What does the test result mean?

White Blood Cell: May be increased with infections, inflammation, cancer,

leukemia; decreased with some medications (such as methotrexate), some

autoimmune conditions, some severe infections, bone marrow failure, and

congenital marrow aplasia (marrow doesn't develop normally).

Red Blood Cell: Decreased with anemia; increased when too many made

and with fluid loss due to diarrhea, dehydration burns.

Platelet: Decreased or increased with conditions that affect platelet

production; decreased when greater numbers used, as with bleeding;

decreased with some inherited disorders (such as Wiskott-Aldrich, Bernard-

Soulier), with Systemic lupus erythematosus, pernicious anemia,

hypersplenism (spleen takes too many out of circulation), leukemia, and

chemotherapy.


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II. Microbiological tests

A.Antibiogram

An antibiogram is the result of a

laboratory testing for the sensitivity of

an isolated bacterial strain to different

antibiotics. It is by definition an in vitro-

sensitivity.

In clinical practice, antibiotics are most

frequently prescribed on the basis ofgeneral guidelines and knowledge about sensitivity: e.g. uncomplicated urinary

tract infections can be treated with a first generation quinolone, etc. This is

because Escherichia coliis the most likely causative pathogen, and it is known

to be sensitive to quinolone treatment. Infections that are not acquired in the

hospital, are called "community acquired" infections.

However, many bacteria are known to be resistant to several classes of

antibiotics, and treatment is not so straight-forward. This is especially the case

in vulnerable patients, such as patients in the intensive care unit. When these

patients develop a "hospital-acquired" (or "nosocomial") pneumonia, more

hardy bacteria like Pseudomonas aeruginosa are potentially involved.

Treatment is then generally started on the basis of surveillance data about the

local pathogens probably involved. This first treatment, based on statistical

information about former patients, and aimed at a large group of potent ially

involved microbes, is called "empirical treatment".

Before starting this treatment, the physician will collect a sample from a

suspected contaminated compartment: a blood sample when bacteria possibly

have invaded the bloodstream, a sputum sample in the case of ventilator

associated pneumonia, and a urine sample in the case of a urinary tract

infection. These samples are transferred to the microbiology lab, which looks at


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the sample under the microscope, and tries to culture the bacteria. This can

help in the diagnosis.

Once a culture is established, there are two possible ways to get an

antibiogram:

y a semi-quantitative way based on diffusion (Kirby-Bauer method); small

discs containing different antibiotics, or impregnated paper discs, are

dropped in different zones of the culture on an agar plate, which is a

nutrient-rich environment in which bacteria can grow. The antibiotic will

diffuse in the area surrounding each tablet, and a disc of bacterial lysis will

become visible. Since the concentration of the antibiotic was the highest at

the centre, and the lowest at the edge of this zone, the diameter is

suggestive for the Minimum Inhibitory Concentration, or MIC, (conversion of

the diameter in millimeter to the MIC, in g/ml, is based on known linear

regression curves).

y a quantitative way based on dilution: a dilution series of antibiotics is

established (this is a series of reaction vials with progressively lower

concentrations of antibiotic substance). The last vial in which no bacteria

grow contains the antibiotic at the Minimal Inhibiting Concentration.

Once the MIC is calculated, it can be compared to known values for a given

bacterium and antibiotic: e.g. a MIC > 0 , 06 g/ml may be interpreted as a

penicillin-resistant Streptococcus pneumoniae. Such information may be useful

to the clinician, who can change the empirical treatment, to a more custom-

tailored treatment that is directed only at the causative bacterium.


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B. BLOOD CULTURE

Blood culture is a microbiological culture of

blood. It is employed to detect infections that

are spreading through the bloodstream (such

as bacteremia, septicemia amongst others).

This is possible because the bloodstream is

usually a sterile environment.

Method

A minimum of 10 ml of blood is taken through venipuncture and injected into

two or more "blood bottles" with specific media for aerobic and anaerobic

organisms.

The blood is collected using clean technique. This requires that both the tops of

the culture bottles and the venepuncture site of the patient are cleaned prior to

collection with alcohol swabs containing 2% chlorhexidine and 7 0% isopropyl

alcohol.

To maximise the diagnostic yield of blood cultures multiple sets of cultures

(each set consisting of aerobic & anaerobic vials filled with 3-10 mL) may be

ordered by medical staff.

Ordering multiple sets of cultures increases the pro bability of discovering a

pathogenic organism in the blood and reduces the probability of having a

positive culture due to skin contaminants.

After inoculating the culture vials, they are sent to the clinical pathology

microbiology department. Here the bot tles are entered into a blood culture

machine, which incubate the specimens at body temperature. The blood culture


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instrument reports positive blood cultures (cultures with bacteria present, thus

indicating the patient is "bacteremic"). Most cultures are monitored for 5 days

after which negative vials are removed.

If a vial is positive, a microbiologist will perform a Gram Stain on the blood for a

rapid, general ID of the bacteria, which they will report to the attending

physician of the bacteremic patient. The blood is also subcultured or "subbed"

onto agar plates to isolate the pathogenic organism for culture and suceptability

testing, which takes up to 3 days. This culture & sensitivity (C&S) process

identifies the species of bacteria. Antibiotic sensitivities are then assessed on

the bacterial isolate to inform clinicians on appropriate antibiotics for treatment.

Some guidelines for infective endocarditis recommend taking up to 6 sets of

blood for culture (around 60 ml).

C. VDRL(the venereal disease research laboratory test)

Is a blood test for syphilis and was developed by the former Venereal Disease

Research Laboratory, now the Treponemal Pathogenesis and Immunology

Branch, of the United States Public Health Service. The VDRL type test was

invented before World War I, with its first iteration being that developed by

August Paul von Wasserman with the aid of Albert Neisser in 1906.

The VDRL test, as it is largely still done today, was developed in 1946 by

Harris, Rosenberg, and Riedel.


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III. INMUNOLOGIC TESTS

A. URINALYSIS (OR "UA")

Is an array of tests performed on urine and one

of the most common methods of medical

diagnosis. A part of a urinalysis can be performed

by using urine dipsticks, in which the test results

can be read as color changes.

A urine sample is about to be examined under a phase -contrast microscope using a

Neubauer counting chamber. The urine is under the cover slide, in the upper segment

formed by the H-shaped grooves.

The numbers and types of cells and/or material such as urinary casts can yield

a great detail of information a nd may suggest a specific diagnosis.

y Hematuria - associated with kidney stones, infections, tumors and other

conditions

y Pyuria - associated with urinary infections

y eosinophiluria - associated with allergic interstitial nephritis , atheroembolic

disease

y Red blood cell casts - associated with glomerulonephritis, vasculitis, malignant

hypertension

y White blood cell casts - associated with acute interstitial nephritis , exudative

glomerulonephritis , severe pyelonephritis

y (heme) granular casts - associated with acute tubular necrosis

y crystalluria -- associated with acute urate nephropathy (or "Acute uric acid

nephropathy", AUAN)

y calcium oxalatin - associated with ethylene glycol toxicity


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B.ANTIBODIES

(also known as immunoglobulins , abbreviated Ig) are gamma globulin

proteins that are found in blood or other bodily fluids of vertebrates, and

are used by the immune system to identify and neutralize foreign objects,such as bacteria and viruses. They are typically made of basic structural

unitseach with two large heavy chains and two small light chainsto

form, for example, monomers with one unit, dimers with two units or

pentamers with five units. Antibodies are produced by a kind of white

blood cell called a plasma cell. There are several different types of

antibody heavy chains, and several different kinds of antibodies, which

are grouped into different isotypes based on which heavy chain they

possess. Five different antibody isotypes are known in mammals, which

perform different roles, and help direct the appropriate immune response

for each different type of foreign object they encounter. [2]

y Though the general structure of all antibodies is very similar, a small

region at the tip of the protein is extremely variable, allowing millions of

antibodies with slightly different tip structures, or antigen binding sites, to

exist. This region is known as the hypervariable region. Each of these

variants can bind to a different target, known as an antigen.[3]

This hugediversity of antibodies allows the immune system to recognize an equally

wide variety of antigens. The unique part of the antigen recognized by an

antibody is called the epitope. These epitopes bind with their antibody in

a highly specific interaction, called induced fit, that allows antibodies to

identify and bind only their unique antigen in the midst of the mi llions of

different molecules that make up an organism. Recognition of an antigen

by an antibody tags it for attack by other parts of the immune system.

Antibodies can also neutralize targets directly by, for example, binding to

a part of a pathogen that it needs to cause an infection.


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IV. BIOCHEMICAL TEST

A. ELECTROLYTE

Is any substance containing free ions that make the substance electrically

conductive. The most typical electrolyte is an ionic solution, but molten

electrolytes and solid electrolytes are also possible.

y Electrolytes commonly exist as solutions of acids, bases or salts.

Furthermore, some gases may act as electrolytes under conditions of

high temperature or low pressure. Electrolyte solutions can also resultfrom the dissolution of some biological (e.g., DNA, polypeptides) and

synthetic polymers (e.g., polys tyrene sulfonate), termed polyelectrolytes,

which contain charged functional group.

y Electrolyte solutions are normally formed when a salt is placed into a

solvent such as water and the individual components dissociate due to

the thermodynamic interactions between solvent and solute molecules, in

a process called solvation. For example, when table salt, NaCl, is placed

in water, the salt (a solid) dissolves into its component ions, according tothe dissociation reaction NaCl(s) Na

+(aq) + Cl

(aq)

y It is also possible for substances to react with water when they are added

to it, producing ions, e.g., carbon dioxide gas dissolves in water to

produce a solution which contains hydronium, carbonate, and hydrogen

carbonate ions.

y An electrolyte in a solution may be described as concentrated if it has a

high concentration of ions, or dilute if it has a low concentration. If a high

proportion of the solute dissociates to form free ions, the electrolyte is

strong; if most of the solute does not dissociate, the electrolyte is weak.

The properties of electrolytes may be exploited using electrolysis to

extract constituent elements and compounds contained within the

solution.


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B. HORMONE (from Greek - "impetus")

Is a chemical released by a cell in one part of the body, that sends out

messages that affect cells in other parts of the organism. Only a small

amount of hormone is required to alter cell metabolism. It is essentially

a chemical messenger that transports a signal from one cell to another.

All multicellular organisms produce hormones; plant hormones are also

called phytohormones. Hormones in animals are often transported in

the blood. Cells respond to a hormone when they express a specific

receptor for that hormone. The hormone binds to the receptor protein,

resulting in the activation of a signal transduction mechanism that

ultimately leads to cell type-specific responses.

y Endocrine hormone molecules are secreted (released) directly into the

bloodstream, while exocrine hormones (or ectohormones) are secreted

directly into a duct, and from the duct they either flow into the

bloodstream or they flow from cell to cell by diffusion in a process known

as paracrine signalling.

C. BIOCHEMICAL PROFILE

A panel of tests, usually selected for their ability in the particular species to

evaluate the functional capacity of several critical organ systems and general

health. The 'profile' may literally be the results plotted on individual, parallel

numerical scales, producing a pattern similar to a bar grap .


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RADIOLOGY

1. EFI ITION

Radiology is the branch or specialty of medicine that utilizes imaging

technologies like x-rays, CT scans, and MRIs to diagnose and treat diseases.

Radiologists are physicians that utilize an array of imaging technologies (such

as ultrasound, computed tomography (CT), nuclear medicine, positron emission

tomography (PET) and magnetic resonance imaging (MRI)) to diagnose or treat

diseases. Interventional radiology is the performance of (usually minimally

invasive) medical procedures with the guidance of imaging technologies. Theacquisition of medical imaging is usually carried out by the radiographer or

radiologic technologist.

2. PROJECTION (PLAIN)RADIOGRAPHY

MADURA FOOT X-RAY

Radiographs (or roentgenographs, named after the discoverer of x-rays,

Wilhelm Conrad Rntgen) are produced by the transmission of x-rays through a

patient to a capture device then converted into an image for diagnosis. The

original and still common imaging produces silver impregnated films. In Film -

Screen radiography an x-ray tube generates a beam of x-rays which is aimed at

the patient. The x-rays which pass through the patient are filtered to reduce

scatter and noise and then strike an undeveloped film, held tight to a screen of


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dissection (tearing of the aortic wall), appendicitis, diverticulitis, and obstructing

kidney stones. Continuing improvements in CT technology including faster

scanning times and improved resolution have dramat ically increased the

accuracy and usefulness of CT scanning and consequently increased utilization

in medical diagnosis.

The first commercially viable CT scanner was invented by Sir Godfrey

Hounsfield at EMI Central Research Labs, Great Britain in 1972. EMI owned the

distribution rights to The Beatles music and it was their profits which funded the

research.[4] Sir Hounsfield and Alan McLeod McCormick shared the Nobel Prize

for Medicine in 1979 for the invention of CT scanning. The first CT scanner in

North America was installed at the Mayo Clinic in Rochester, MN in 1972.

4. LTRASOUND

Medical ultrasonography uses ultrasound (high-frequency sound waves) to

visualize soft tissue structures in the body in real time. No ionizing radiation is

involved, but the quality of the images obtained using ultrasound is highly

dependent on the skill of the person (ultrasonographer) performing the exam.

Ultrasound is also limited by its inability to image through air (lungs, bowel

loops) or bone. The use of ultrasound in medical imaging has developed mostly

within the last 30 years. The first ultrasound images were static and two

dimensional (2D), but with modern-day ultrasonography 3D reconstructions can

be observed in real-time; effectively becoming 4D.

Because ultrasound does not utilize ionizing radiation, unlike radiography, CT

scans, and nuclear medicine imaging techniques, it is generally considered

safer. For this reason, this modality plays a vital role in obstetrical imaging.Fetal anatomic development can be thoroughly evaluated allowing early

diagnosis of many fetal anomalies. Growth can be assessed over time,

important in patients with chronic disease or gestation -induced disease, and in

multiple gestations (twins, triplets etc.). Color -Flow Doppler Ultrasound

measures the severity of peripheral vascular disease and is used by Cardiology


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magnetic fields (3 teslas), shortening exam times, wider, shorter magnet bores

and more open magnet designs, have brought some relief for claustrophobic

patients. However, in magnets of equal field strength there is often a trade -off

between image quality and open design. MRI has great benefit in imaging the

brain, spine, and musculoskeletal system. The modality is currently

contraindicated for patients with pacemakers, cochlear implants, some

indwelling medication pumps, certain types of cerebral aneurysm clips, metal

fragments in the eyes and some metallic hardware due to the powerful

magnetic fields and strong fluctuating radio signals the body is exposed to.

Areas of potential advancement include functional imaging, cardiovascular MRI,

as well as MR image guided therapy.

Ultrasound

The Ultrasound uses sound waves of high frequency to look at organs and

structures within the body. Health professionals use them to see the heart,

blood vessels, kidneys, liver and other organs. During pregnancy, doctors use

ultrasound tests to examine the fetus. Unlike X-rays, ultrasound involves no

radiation exposure.

During the scan, a special technician or doctor moves a device called a

transducer over a body part. The probe sends sound waves that bounce off

tissues inside the body. The transducer also captures the waves that bounce

back. The images are created by these sound waves


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Radiation Therapy

Also called: Brachytherapy, Radiotherapy

Radiation is a form of energy released in particles or waves. In high doses,

radiation destroys cells or keeps them from multiplying.


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Radiation therapy is a cancer treatment. Its goal is to kill cancer cells and shrink

tumors. Unlike cancer cells, most of your normal cells recover from radiation

therapy. Doctors try to protect normal cells by limiting the radiation dosage and

spreading treatment out over time. When they use radiation machines, they

shield as much of your body as possible while targeting the cancer.

The radiation for cancer treatment comes externally, from special machines, or

internally, from radioactive substances that a doctor places in your body.

Sometimes radiation is used with other treatments, like surgery or

chemotherapy.

Diagnostic Imaging

Diagnostic imaging refers to technologies that doctors use to look inside your

body for clues about a medical condition. A variety of machines and techniques

can create pictures of the structures and activities inside your body. The

technology your doctor uses will depend on your symptoms and the part of your

body being examined. X-rays, CT scans, nuclear medicine scans, MRI scans

and ultrasound are all types of diagnostic imaging.

Many imaging tests are painless and easy. Some require you to stay still for a

long time inside a machine, though. This can be uncomfortable. Certain tests

involve radiation, but these are generally considered safe because the dosage

is very low.


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For some imaging tests, a tiny camera attached to a long, thin tube is inserted

in your body. This tool is called a scope. The doctor moves it through a body

passageway or opening to see inside a particular organ, such as your heart,

lungs or colon. These procedures often require anesthesia.

OPHTHALMOLOGY

It is born of the need to realize and complement examinations of support to the

ophthalmological diagnosis, as well as in the prevention of visual deficiencies

and in the necessary cases, in the treatment and the visual rehabilitation. His

performance is realized to level of primary care in hospitable sectors and from

the first aids to state and private levels, being this the principal filter in the

affections of the field of vision.

y CORNEAL TOPOGRAPHER: is a non-invasive medical imaging

technique for mapping the surface curvature of the cornea

y PUPILOMETER: It measures the size pupillary

y ORA (OCULAR RESPONSE ANALYZER): It measures the resistance ofthe cornea and the elasticity

OTORHINOLARYNGOLOGY

They can develop in:

- The clinic doing auditory examinations, of balance and of the nasal

function for the support to the medical diagnosis, as control of medical -

surgical treatments;

- The production and execution of programs of precocious inquiry of

auditory alterations, in neonates with Emission Otoacsticas and school

children with sifted telephone earpieces;

- The precocious detection of deafnesss induced by noise with the

production and execution of programs of prevention of the deafness;


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- The auditory rehabilitation with headphones or implants cochleares

- The treatment of the patients with dizziness by means of the vestibular

rehabilitation and the maneuvers of reinstatement of particles:

o Accomplishment of examinations ORL in evaluations doctor legal.

o Other services destined for the teaching, investigation and

extension in related topics to ORL.

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