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Only a couple of allergen molecules, interacting with cell-bound IgE, lead to the release of many mediator molecules, leading to a significant biologic amplification of the allergen� IgE antibody reaction. Binding of antibody to the cell floor results in complement activation, which signals white blood cell influx and tissue injury. In addition, cytotoxic killer lymphocytes, with Fc receptors for IgG, can bind to the tissue-bound IgG, resulting in antibody-dependent cellular cytotoxicity. These complexes activate the complement system, which outcomes in the inflow of inflammatory white blood cells, leading to tissue damage. Clinical examples embody serum sickness (after overseas proteins or drugs), lupus erythematosus, and glomerulonephritis after common infections. Cloning and sequence determination of the gene for the human immunoglobulin epsilon chain expressed in a myeloma cell line. Participation of the N-terminal region of Cepsilon3 within the binding of human IgE to its excessive affinity receptor FcR1. Immunoglobulin E: position in asthma and allergic illness: lessons learned from the clinic. IgE enhances mouse mast cell Fc(epsilon)R1 expression in vitro and in vivo: evidence for a novel amplification mechanism in IgE-dependent reactions. Distribution of gamma E-forming cells in lymphoid tissues of the human and monkey. The metabolism of IgE: studies in normal individuals and in a patient with IgE myeloma. The quantitation of IgE antibody particular for ragweed antigen E on the basophil floor in patients with ragweed pollenosis. Interleukin-4 causes isotype switching to IgE in T cell-stimulated clonal B cell cultures. A T-cell activity that enhances polyclonal IgE production and its inhibition by interferon-. Role of T-cells and T-cell derived cytokines within the pathogenesis of allergic illnesses. Structure and expression of germline epsilon transcripts in human B cells induced by interleukin-4 to switch to IgE production. Distribution of IgE in a community inhabitants pattern: correlation with age, intercourse, allergen pores and skin take a look at reactivity. Mediation of native homeostasis and irritation by leukotrienes and other mast-cell dependent compounds. Expulsion of Nippostrongylus brasiliensis from the gut of rats: collaboration between humoral and cellular components of the immune response. Th1 and Th2 cells: different patterns of lymphokine secretion result in different useful properties. Mechanisms of persistent airway inflammation in asthma: a task for T cells and T-cell products. Delayed anaphylaxis, angioedema, or urticaria after consumption of purple meat in patients with IgE antibodies particular for galactose-alpha-1,3-galactose. Serum IgE concentrations in atopic dermatitis: reationship to severity of disease and presence of atopic respiratory illness. The evaluation of immunologic and clinical adjustments occurring throughout corticosteroid remedy for allergic bronchopulmonary aspergillosis. Measurement of the absolute levels of IgE antibodies in patients with ragweed hay fever: impact of immunotherapy on seasonal changes and relationship to IgG antibodies. A stable section radioimmunoassay for the quantitation of human reaginic antibody towards ragweed antigens. Measurement of IgE on human basophils: relation to serum IgE and anti-IgE induced histamine release. Limiting concentrations of human basophilbound IgE antibody required for histamine release.

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The merchandise of all components and their quantities in the original formula are added together individually. Dividing the sum of merchandise by the sum of quantities in the authentic method provides a quotient, which represents the energy. For instance, to calculate the power of the ultimate mixture when 12 g of a 10% w/v sucrose solution is mixed with 24 g of a 40% w/v sucrose answer, one would write the alligation medial methodology as indicated in Table 5. For example, to calculate the strength of the ultimate combination when 12 g of a 10% w/v sucrose Table 5. The variety of elements required for the lower- and higher-concentration preparations to make the target-concentration preparation is obtained by developing a matrix and doing the calculation as shown in Table 5. Thus, subtracting the goal focus from the decrease concentration provides the goal amount of the higher-concentration preparation, and subtracting Table 5. Thus, the whole amount of the targetconcentration preparation that would be ready may be obtained by adding collectively the goal amounts of higher- and lower-concentration preparations needed. If the required amount of the target-concentration preparation is different than the quantity obtained by the formulation, the principles of proportion, discussed earlier, can be used to calculate the quantities needed for the required complete amount of the target-concentration preparation. For example, to prepare 200 mL of a 12% w/v sucrose resolution using a 40% w/v and one other 5% w/v sucrose resolution, one would write the alligation matrix as shown in Table 5. Thus, combining 7 mL of 40% w/v solution with 28 mL of 5% w/v resolution would give 7 + 28 = 35 mL of 12% w/v answer. To make 200 mL of 12% w/v answer, one would use the ideas of proportion as follows: For the amount of 40% w/v solution, 7 mL x mL = 35 mL 200 mL Hence, x = 7 � 200 = 40 mL 35 For the amount of 5% w/v answer, 28 mL x mL = 35 mL 200 mL Hence, x = 28 � 200 = one hundred sixty mL 35 Alternatively, a conversion factor might be derived for the calculation: = Conversion factor 200 mL = 5. Therefore, the amount of the 5% w/v solution required = 200 - 40 = a hundred and sixty mL or 28 � 5. The legal guidelines of proportion can be used, as described earlier, to calculate particular portions of starting options that might be needed to prepare a desired quantity of the final resolution. The alligation alternate methodology for more than two components can use any pairing of upper (than the desired) energy ingredient(s) with lower (than the desired) strength ingredient(s). The alligation methods are relevant to all types of preparations, together with powders. In addition, the alligation technique may additionally be used for calculating the required quantities for dilution of a preparation with the solvent or diluent alone by making the focus of the lower-concentration preparation zero. If uninterrupted circulate of solvent is allowed, it will result within the equalization of concentration across the membrane. The pressure of solvent involved in this phenomenon is termed Pharmacy math and statistics 103 osmotic stress. A resolution containing a nonpermeable solute creates a strain for the inward flow of solvent across the semipermeable membrane. Thus, osmotic strain may also be outlined because the pressure that should be utilized to an answer to prevent the inward flow of solvent throughout a semipermeable membrane. Tonicity is the osmotic pressure of two options separated by a semipermeable membrane. Tonicities of options are sometimes represented close to that of regular body fluids. Thus, options that exert decrease osmotic pressure than the physique fluids are termed hypotonic, whereas solutions that exert larger osmotic stress than the body fluids are termed hypertonic. Hypotonic options have lower and hypertonic solutions have higher impermeable solute concentration than the body fluids. Two options which have the same osmotic strain are termed isosmotic, while a solution that has the same osmotic pressure as a reference physique fluid is termed isotonic. To define the osmotic amount and concentration of a solute without referring to another resolution, the ideas of osmole, osmolarity, and osmolality are introduced. An osmole is the quantity of a substance that represents the variety of moles of particles that it varieties in a solution. Similar to the idea of molarity, osmolarity (abbreviation: Osmol) is defined because the osmoles of solute per liter of resolution. Therefore, 1 Osmol of glucose solution represents 186 g (molecular weight) of glucose dissolved in 1 L of answer. Similar to the idea of molality, osmolality is outlined because the osmoles of solute per kg of solvent.

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Cloning and pharmacological characterization of a fourth histamine receptor (H4) expressed in bone marrow. Molecular cloning and characterization of a novel sort of histamine receptor preferentially expressed on leukocytes. Histamine receptors: particular ligand, receptor biochemistry, and signal transduction. Histamine H4 receptor mediates eosinophil chemotaxis with cell shape change and adhesion molecule upregulation. Histamine H4 receptor antagonism diminishes existing airway irritation and dysfunction via modulation of Th2 cytokines. Clinical manifestations of the discharge of histamine and different inflammatory mediators. A potent and selective histamine H4 receptor antagonist with anti-inflammatory properties. Platelets within the immune response: revisiting platelet-activating think about anaphylaxis. Platelet activating factor as a mediator and therapeutic method in bronchial bronchial asthma. Platelet activating factor: a potent chemotactic and chemokinetic issue for eosinophils. Effect of platelet activating factor on pulmonary perform and bronchial responsiveness in man. Basal platelet-activating issue acetylhydrolase: prognostic marker of severe Hymenoptera venom anaphylaxis. Antiallergic effects of anti-interleukin-33 are related to suppression of immunoglobulin light chain and inducible nitric oxide synthase. Selective inducible nitric oxide synthase inhibition has no effect on allergen problem in bronchial asthma. The bronchoconstrictor effects of inhaled prostaglandin D2 in regular and asthmatic males. A prostaglandin J2 metabolite binds peroxisome proliferator112 activated receptor gamma and promotes adipocyte differentiation. IgE-dependent activation of cytokine promed mouse cultured mast cells induces a delayed part of prostaglandin D2 generation by way of prostaglandin endoperoxidase synthase 2. Cutaneous immunosurveillance and regulation of irritation by group 2 innate lymphoid cells. Thymic stromal lymphopoietin controls prostaglandin D2 era in patients with aspirin-exacerbated respiratory disease. Mast cells and eicosanoid mediators: a system of reciprocal paracrine and autocrine regulation. Crystal structure of a human membrane protein concerned in cysteinyl leukotriene biosynthesis. Molecular cloning and characterization of a second human cysteinyl leukotriene receptor: discovery of a subtype selective agonist. Additional functions for the cysteinyl leukotrienes recognized by way of research of inflammatory processes in null strains. Targeted gene disruption reveals the role of cysteinyl leukotrienes 1 receptor in the enhanced vascular permeability of mice undergoing acute inflammatory responses. Directed vascular expression of human cysteinyl leukotriene 2 receptor modulates endothelial permeability and systemic blood stress. Leukotrienes and cyclooxygenase products mediate anaphylactic venoconstriction in ovalbumin sensitized rat livers. Honeybee venom secretory phospholipase A2 induces leukotriene manufacturing however not histamine launch from human basophils. Phospholipase D2 acts as an important adaptor protein in the activation of Syk in antigen-stimulated mast cells. Assessment of receptor-dependent activation of phosphatidylcholine hydrolysis by each phospholipase D and phospholipase C.

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Submicron measurement particles are absorbed through transcytosis by each enterocytes and M cells, which are epithelial cells of the mucosa-associated lymphoid tissues. For systemic motion of drugs, the oral route has been the popular route of administration. Several nonoral routes of drug supply have been utilized to present sufficient drug concentrations within the systemic circulation, in addition to localized drug therapy. These embody the rectal, vaginal, and the transdermal routes of drug administration. More importantly, rectal drug administration has the benefit of minimizing or avoiding hepatic first-pass metabolism. The rectal bioavailability of lidocaine in human is 65%, as compared to an oral bioavailability of 30%. Moreover, rectal administration ought to 340 Pharmaceutical Dosage Forms and Drug Delivery be avoided in immunosuppressed sufferers in whom even minimal trauma might lead to the formation of an abscess. Most steroids are readily absorbed by vaginal epithelium, resulting in their larger bioavailability compared to their oral administration because of a decreased first-pass metabolism. For medicine with excessive membrane permeability, vaginal absorption is decided by permeability of the aqueous diffusion layer, whereas for medicine with low membrane permeability, such as testosterone and hydrocortisone, vaginal absorption is decided by membrane permeability. Contraceptive creams comprise spermicidal agents and are used just prior to sexual intercourse. Among the factors influencing percutaneous absorption are the physicochemical properties of the drug, including its molecular weight, solubility, partition coefficient, nature of the automobile, and condition of the skin. In basic, patches are composed of three key compartments: (1) a protective seal that forms the external floor and protects it from damage, (2) a compartment that holds the treatment itself and has an adhesive backing to maintain the entire patch on the pores and skin surface, and (3) a release liner that protects the adhesive layer throughout storage and is removed simply previous to software. Most patches belong to one of two general types-the reservoir system and the matrix system. Drug transport from the patch to the pores and skin is channelized and controlled via a rate-limiting surface layer. The matrix system, on the opposite hand, incorporates the drug uniformly across the patch in a polymer matrix. Diffusion of the drug by way of the polymer matrix and the bioadhesive properties of the polymer determines the rate of drug absorption. Marketed transdermal patches are exemplified by Estraderm (estradiol), Testoderm (testosterone), Alora (estradiol), Androderm (testosterone), Organ-specific drug supply 341 and Transderm-Scop (scopolamine). In addition, occlusive dressings can be found, which have low water vapor permeability. These dressings assist stop water loss from the skin floor, resulting in increased hydration of the stratum corneum. The sublingual mucosa is comparatively permeable, and is suitable for delivery of low molecular weight lipophilic medicine when a speedy onset of action with rare dosing is required. Thus, the buccal mucosa is appropriate for sustained delivery of much less permeable molecules, and perhaps peptide drugs. One of the main disadvantages related to buccal drug delivery is the low flux that results in low drug bioavailability. Glyceryl trinitrate has been found fairly efficient when administered via this route. The main 342 Pharmaceutical Dosage Forms and Drug Delivery advantages of nasal administration embody the fast absorption, rapid onset of action, and avoidance of hepatic and intestinal first-pass results. Permeation by way of the epithelial cell lining may utilize either the lipoidal pathway or an aqueous pore pathway. Temporal barrier: Dosage forms for nasal absorption should deposit and remain in the nasal cavity lengthy sufficient to permit effective absorption. Therefore, protein and peptide medicine which would possibly be delicate to such enzymes could get degraded through the process of drug absorption. Commonly used dosage forms administered via this route are nasal sprays and drops.

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Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder. Erosion of Amplatzer septal occluder system after closure of secundum atrial septal defects: evaluation of registry of issues and proposals to reduce future danger. Echocardiographic predictors of cardiac erosion after Amplatzer septal occluder placement. Morphological variations of secundum-type atrial septal defects: feasibility for percutaneous closure using Amplatzer septal occluders. Usefulness of anatomic parameters derived from two-dimensional echocardiography for estimating magnitude of left to right shunt in sufferers with atrial septal defect. Improvement in train capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Atrial septal defect with proper to left shunt regardless of regular pulmonary artery pressure. Orthodeoxia-platypnea as a end result of intracardiac shunting-relief with transcatheter double umbrella closure. Prevalence of patent foramen ovale and its contribution to hypoxemia in patients with obstructive sleep apnea. Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea. The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea. Patent foramen ovale closure in obstructive sleep apnea improves blood stress and cardiovascular perform. An increased frequency of patent foramen ovale in patients with transient international amnesia. Isolated left ventricular non-compaction as a reason for thrombo-embolic stroke: a case report and evaluation. Migraine headache incapacity and health-related quality-of-life: a population-based casecontrol examine from England. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler research. Shunt-associated migraine responds favorably to atrial septal restore: a case-control research. Effect on migraine of closure of cardiac right-to-left shunts to stop recurrence of decompression illness or stroke or for haemodynamic reasons. Platypnea-orthodeoxia: medical profile, diagnostic workup, administration, and report of seven instances. Interatrial right-to-left shunting developing after pulmonary resection in the absence of elevated right-sided heart pressures. Atrial right-to-left shunting inflicting severe hypoxaemia despite normal right-sided pressures. Platypnea-orthodeoxia: an unusual indication for surgical closure of a patent foramen ovale. A large number of sufferers with varied situations (3) have now been handled worldwide, enabling us to assess the efficacy and danger of the technique, and long-term outcomes make us higher able to choose probably the most applicable candidates for therapy utilizing this methodology. The catheter is advanced over the guide wire into the superior vena cava and the information wire is eliminated. The Brockenbrough needle is connected to a stress line, which is repeatedly flushed, and is inserted into the dilator simply contained in the distal end underneath fluoroscopic guidance. When the needle reaches the desired place inside the catheter the flush is stopped and strain is constantly monitored. Then, underneath continuous fluoroscopic and pressure monitoring, each catheter and needle are withdrawn downwards and rotated counterclockwise till contact with the septum is felt. Before puncturing the interatrial septum, the next parameters should be checked: proper atrial strain tracing, appropriate place, and tactile contact with the septum. The dilator ought to be advanced solely when assurance is obtained that the needle has crossed the septum. When both the needle and the catheter have crossed the septum, the needle is withdrawn while making use of a counterclockwise rotation to the proximal part to orientate the catheter in course of the mitral valve. Approaches the retrograde method with out transseptal catheterization (5) has been used with good outcomes, but its use is now very limited. Transseptal catheterization is the first step of the process and some of the crucial (6).

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Hydrophilic colloids are used for formation of o/w emulsions for the rationale that movies are hydrophilic. These materials adsorb at the oil�water interface and form multilayer films across the dispersed droplets of oil in an o/w emulsion. They stabilize emulsions by the formation of multilayer films that are strong and resist coalescence. Finely divided stable particles which may be predominantly wetted by water type o/w emulsions, whereas those which are predominantly wetted by oil form w/o emulsions. The two phases of the emulsion are assembled separately, by dissolving and mixing of the ingredients to type applicable solutions. Then, phases are combined by slow addition of the dispersed phase into the continuous phase with steady mixing. An optimum quantity of blending shear and time are determined based on the rate of change of the size distribution of the dispersed phase with mixing. The sequence of addition of formulation elements to the emulsion may be critical for the steadiness of the emulsion. Emulsions 419 In addition, volatile ingredients, corresponding to flavors, and thermosensitive elements must be added last, after the emulsion has been formed, to minimize loss during processing. Self-emulsifying and self-microemulsifying drug delivery methods are manufactured as nonaqueous preconcentrates by easy mixing to dissolve all components. The resulting formulations can then be packaged in single or multidose containers for distribution. Four major phenomena are related to the bodily instability of emulsions: (1) flocculation, (2) creaming, (3) coalescence, and (4) breaking. Creaming involves visually evident separation of two layers that differ primarily within the number density of the dispersed section, and, thus, show optical differences. These processes happen because of the density differences in the two phases and can be reversed by shaking. Creaming is undesirable as a end result of a creamed emulsion increases the chance of coalescence because of the closer proximity of the globules within the cream and because of the nonuniformity of the creamed emulsion. Coalescence is the process by which emulsified globules merge with one another to kind bigger globules. Coalescence is an irreversible process because the movie that surrounds the person globules is destroyed. It results in progressive improve within the measurement of the dispersed part, in the end resulting in breaking of the emulsion. The proportion of the amount of emulsion occupied by creamed layer is an indicative of the stability of an emulsion. Flocculation, which finally ends up in weak interactions between dispersed-phase droplets, can stabilize an emulsion by rising the length of time it takes for creaming and the proportion of the creamed section. In addition, rising the mechanical power of the interfacial barrier, such as by nearer packing of the interfacial surfactant monolayer, reduces the propensity toward coalescence. Increasing the viscosity of the continual section helps to stabilize the dispersed phase and minimizes coalescence. For example, at greater than ~74% of oil in an o/w emulsion, the oil globules typically coalesce and breaking happens. Phase inversion can happen by the addition of an electrolyte or by altering the part quantity ratio. Addition of monovalent cations promotes the formation of o/w emulsions, whereas the addition of divalent cations increases the propensity toward the formation of w/o emulsions. For instance, an o/w emulsion stabilized with sodium stearate could be inverted to a w/o emulsion by adding calcium chloride to type calcium stearate. Nevertheless, separation of the reacting species in the oily and aqueous phases can minimize reactivity and enhance stability of a drug in an emulsion. In addition to the well being risks of microbial development, microorganisms in an emulsion can cause physical separation of the phases. Preservatives must be added in adequate concentrations in the formulations to resist microbial growth. The preservative ought to be concentrated within the aqueous section as a result of bacterial growth will normally occur there. The oil and water partition coefficient of the preservatives ought to be considered to calculate the concentration of the surfactant in the aqueous section, which must be above the antimicrobial focus. The parabens (methylparaben, propylparaben, and butylparaben) are the generally used preservatives in emulsions.

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Nevertheless, with cautious affected person choice, prasugrel can function an acceptable different to clopidogrel, particularly in patients at high danger of ischaemic events however at low danger of bleeding, and these that current with stent thrombosis while on clopidogrel. Patients had been randomized to receive prasugrel (60 mg loading and 10 mg maintenance) or clopidogrel (300 mg loading and seventy five mg maintenance) for 6�15 months. The research medication was administered at any time between randomization and 1 h after leaving the cardiac catheterization laboratory. However, sufferers receiving prasugrel had considerably higher rates of lifethreatening bleeding (1. Although absolutely the danger of bleeding was small, no extra in deadly bleeding has ever been reported in any of the twin antiplatelet remedy trials. The research also Ticagrelor Ticagrelor is a reversible direct-acting antagonist of the adenosine diphosphate receptor P2Y12. All patients received aspirin seventy five or a hundred mg every day (with loading with 325 mg for patients who had not previously acquired aspirin). Additionally, there was no significant difference within the rate of life-threatening or fatal bleeding (6. Bivalirudin leads to prolongation of each the activated prothrombin time and the activated clotting time. It is administered intravenously and eradicated by both the kidneys and the liver. All patients got aspirin, 75�325 mg/day indefinitely, and clopidogrel 75 mg/day for 1 12 months. Subgroup evaluation showed no interaction between the primary study endpoints and numerous demographic and treatment variables. Fondaparinux Fondaparinux binds particularly to antithrombin and subsequently serves as a selective factor Xa inhibitor. It has no effect on the activated prothrombin time or the activated clotting time. It is excreted by the kidneys and is subsequently contraindicated in sufferers with a creatinine clearance less than 30 ml/min. This randomized, doubleblind, multicentre examine randomized 20,078 patients to fondaparinux 2. Similarly, the charges of major bleeding and mortality had been lower in the fondaparinux group at 30 days (1. There was additionally a significant improve in the incidence of intracranial haemorrhage with both rivaroxaban doses in comparison with placebo (0. However, there was no significant distinction within the rates of fatal bleeding with rivaroxaban as compared with placebo (0. The trial was terminated prematurely after recruitment of 7392 sufferers because of a rise in major bleeding occasions with apixaban and not using a important reduction in the recurrent ischaemic occasions. In these with multivessel disease, surgical revascularization remains the optimum remedy possibility. The antagonistic results of anaemia upon the cardiovascular system embrace elevated heart rate and cardiac output, compensatory left ventricular hypertrophy, and a mismatch between oxygen demand and delivery. Anaemia may even exacerbate any discount in the delivery of oxygen to anywhere within the body because the oxygen supply equation has haemoglobin in it. Furthermore, there was a dose�response effect, with decrease survival charges in those sufferers with a greater degree of anaemia. This has been attributed to elevated blood viscosity resulting in elevated coronary vascular resistance and decreased coronary bloodflow, which in turn predispose to thrombosis and elevated cardiac workload (76). The subsequent 20 years is more probably to see an additional revolution with regard to developments in stent know-how and potential growth of novel antiinflammatory therapies. The present strategy of optimum medical therapy and early invasive investigation and revascularization is well established. These include: the apparent lack of profit for this aggressive technique in women. However, a variety of the proposed mechanisms embrace decreased collateral circulation resulting in elevated infarct measurement, microvascular dysfunction, greater incidence of no-reflow, greater free fatty acid concentration, insulin resistance, and impaired myocardial glucose utilization.

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Mine-Boss, 63 years: For example, water and hydrophilic molecules choose stronger hydrogen bonding, dipole�dipole interactions, and electrostatic interactions, whereas lipids and hydrophobic molecules choose weaker van der Waals interactions. In copolymers, the monomeric items could additionally be distributed randomly (random copolymer), in an alternating fashion (alternating copolymer), or in blocks (block copolymer). Cardiac catheterization is no longer mandated but can be utilized to confirm the echo findings by measuring chamber pressures, oxygen saturation, and shunt calculation.

Hector, 32 years: These fashions are a fancy array of equations that are solved simultaneously utilizing a computing software, such as the commercially obtainable GastroPlus or Simcyp, to establish pharmacokinetic properties. It can be insensitive, has high interoperator variability, can result in scar formation, and is therefore not recommended. Predictors of main problems during diagnostic cardiac catheterization recognized in a multivariate evaluation of 58,332 procedures are proven in Tables 9.

Will, 28 years: Variation in carotid endarterectomy mortality in the Medicare inhabitants: trial hospitals, volume, and affected person characteristics. Therefore, the whole mass of functional myocardium supplied by a given stenosis in an infarct-related artery will are most likely to decrease (61). Furthermore, a review of up to date randomized trials utilizing the Cochrane Database has reached similar conclusions (24).

Tukash, 34 years: Intravascular ultrasound predictors of restenosis after percutaneous transcatheter coronary revascularization. However, there was no significant difference within the charges of deadly bleeding with rivaroxaban as compared with placebo (0. Outcomes related to drug-eluting and bare-metal stents: a collaborative network metaanalysis.

Agenak, 60 years: No statistically vital differences have been seen within the primary endpoint between the 2 therapies. Thus, during drug discovery, relative potencies of various compounds are in contrast on a molar foundation. The tonic equivalence of two substances represents their quantities that might produce the same osmotic pressure.

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• Hadway P, et al: Total glans resurfacing for premalignant lesions of the penis: initial outcome data, BJU Int 98(3):532n536, 2006.