Reference no: EM133021107
What is the appropriate code to report for this case study? A 60 year old male with a history of cigarette and alcohol abuse presents with weight loss, dysphagia and pain. A 3-cm tumor is identified in the base of the tongue adjacent to the faucial arch of tonsil. Neck nodes are clinically negative and a positron emission tomography scan shows no metastasis. Following external beam radiation with concurrent chemotherapy, a brachytherapy boost procedure is schedules.
Description or procedure: After induction of general anesthesia with nasotracheal intubation, the patient is positioned and stabilized, affording comfortable intramural access and exposure of the neck and face. Visual and bimanual examination is performed to asses residual tumor volume and residual chemo/radiation reaction. Wax protection is fashioned for the remaining teeth. Shave, scrub and drape are preformed. The relationship to the tumor to normal structures including the hyoid bine, mandible, and carotid arteries is determined, and the projection are drawn on the skin. The proposed catheter entrance sites are marked, and an appropriate number of catheters , fixing buttons, and silk ties are selected and assembled. The oral cavity and oropharynx are suctioned and rinsed,. Initial skin punctures are made according to the location drawn sub mentally, with 17-gauge 30-degree bevel needles, and advanced along a trajectory aiming for the selected exit point within the oropharynx, through the muscle. A double-glovedfinger monitors the position of the tumor, the target position for the catheter, and the needle tip. An alternate series of advances and palpations are performed until the needle tip is in the dissed position just beneath the mucosa of the base of the tongue. The finger is withdrawn and the needle advanced until it exits from the tongue into the oropharynx. A 26-gauge surgical steel wire is inserted into the external portion of the needle and advanced until it can be palpated internally. Its tip is then brought out through the oral cavity with the proximal end clamped to prevent it from being lost into the needle. The leader portion of the catheter tube, button, and silk tie is then threaded over the wire. A tonsil clamp is applied to the leader and wire. The assembly is then pulled from the submittal region until the leader portion of the catheter is visible; the button end of the tube is pulled into te oral cavity and down onto the dorsal surface of the tongue. The silk tie is brought out through the oral cavity and set aside. The external portion of the catheter is eld in position by placing a hemispherical color-coded button on the leader and bringing rounder end snugly to the skin. The process is repeated for each of the 25 needles according to the implant volume. Strict spacing is assessed visually on the skin and by palpation within the oropharynx and oral cavity. catheters are removed and replaced as necessary to ensure the geometry. Frequent irrigation and suctioning are preformed to maintain a clean, dry field. The excess catheter and leader projecting beyond the fixing buttons are cut to desired length and discarded. The inner catheter ribbons (for stabilizing the catheter during insertion) are individually removed with wire strippers and discarded. The silk ties are gathered outside the oral cavity and tied together with another silk tie. The group is then pulled through a Penrose-tyoe drain and externally secured with tape. The face and neck are cleansed and the exit sites of the catheter are painted with triple antibiotic ointment.
From HBR: Breaking Bad (rules): Argentina Default, 2015, provide an explanation of the following:
What caused the breakdown of Argentina's economy and society?
What are the reasons for fixing Argentina's exchange rate in the first place?
Who are the winners and losers of the 2002 devaluation?
Why do economists and Kirchner so often disagree? Who is right?
Why is there so much inflation in 2014? Why are they running out of foreign reserves?
What type of exchange rate did Argentina have at time of 2001 crisis? What benefits and costs does such a system have? Would a Gold Standard system help in preventing such a crisis?
What is the Friedman Trilemma (or Mundell-Fleming Trilemma)? Does China's exchange rate system consistent with the Trilemma? What about Hong Kong? Should Hong Kong dollar peg against Chinese currency Yuan instead of US$?
What caused the Crisis in Argentina?
Who benefited from the crisis?
What was Nestor Kirchner's strategy? Did it make sense according to economic principles? What were the results of his strategy?
What was Cristina Kirchner's strategy? Did it work?
Do you think that Argentina is able to break the bad rules?