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237 STROMA REMODELLING FOLLOWING HEALING OF AN IRREGULAR SURFACE INDUCED BY PTK PANAGIOTOPOULOS M, GAN L, Dept. Ophth., Linkoping Univ. Purpose : To study the histopathology of the remodelling process in the stroma after excimer laser induced corneal injuries. Materials and methods: 7 New Zealand White rabbits received in the right eye a transepithelial phtoablation and an additional laser ablation to a preset depth of 60 m and 25 m respectively.On the denuded stroma an electron microscopy specimen grid was placed and another 25 m ablation was applied to produce surface irregularities.DTAF was then applied for 45 sec and washed away.Another 7 eyes of 7 rabbits were ablated the same way but without using the grid obtaining a plano ablation. All the rabbits were sacrificed at weekly intervals after treatment.The harvested corneas from both eyes were further processed for hematoxylin-eosin as well as for microscopic examination under a fluorescence microscope. Results: The corneal wounds were covered by epithelium in the first week.The 25m x25m x25m stromal irregularities were clearly discernible up to 3 weeks after treatment during which time they melted and disappeared.A homogeneous zone was formed where keratocytes fibroblasts layed down an initially disorganised stroma.This was sharply visible under a fluorescence microscope as a dark area between the DTAF fluorescent stroma and autofluorescent epithelium.Very little activity was seen in the plano ablated wound. Conclusions: As the irregularities are flattened and the homogenous zone becomes repopulated with keratocytes forming ECM, the cornea regains its previous architecture in both groups but at a very dissimilar way and speed seems that the more irregular the treated surface is, the more aggressive and disorganised the healing response appears. 238 LASEK VERSUS PRK: VISUAL OUTCOMES AT 6 MONTH RIGAL-SASTOURNE JC, REDA K, LEDUC C, RENARD JP, MAURIN JF Hopital Val de Grace Purpose: Laser epithelial keratomileusis is a new technique where a vital epithelial flap is created. We performed this study to compare the visual outcomes of LASEK and PRK for correction of moderate myopia. Methods: Prospective analysis of 60 eyes that underwent refractive surgery using the Bausch and Lomb Technolas 217 excimer laser. We performed PRK in 22 eyes and LASEK in 38 eyes with spherical equivalent refraction less than-5D. Epithelial flap was created using 20% ethanol for 30 seconds. We compared the visual outcomes of PRK and LASEK patients at 5 days, 1 month and 6 months. Results: All eyes with 6 months post operative follow up were available for analysis. The range of refractive error was -0.75 to -5 D, mean myopia -2.8 + - 1.2D. No eye lost 2 lines of BCVA or more in both group. 94% LASEK eyes were operated without complications. At 6 monthspost op, mean refraction was emmetropia + -0.5 D in 95% LASEK eyes. The comparison of LASEK and PRK visual outcomes appears to indicate that LASEK is associated with little pain, little haze and rapid recovery than PRK. Conclusion: LASEK for treatment of moderate myopia is an effective, predictable and safe procedure. The visual outcomes are significantly better in LASEK patients at 5 days and 1 month. Long term follow up is needed to assess stability.
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Assurance NCQA ; evaluates and reports on the quality of the nation's MCOs. One of its measures, the Health Plan Employer Data and Information Set HEDIS ; , will soon account for 25% of an MCO's NCQA accreditation. HEDIS measures the following women's health indicators: chlamydia screening, management of menopause, breast cancer screening, cervical cancer screening, prenatal care in the first trimester, and check-ups after delivery see Table 1, left ; . Future HEDIS measures are likely to include osteoporosis and family planning counseling. Opportunities for Managed Care Pharmacy Women's health care is also important to managed care pharmacy. In terms of finances only, women represent 62% of prescription drug use and 58% of total prescription costs. 11 Approximately 70% of all prescriptions for antidepressants and antianxiety agents and 80% for migraine drugs are filled for women. 11 Several other classes of medications e.g., gastrointestinal drugs, pain medications, antihistamines ; are more commonly filled for women. In the past decade, a dramatic 75% increase in pharmaceutical industry research on areas of women's health has led to a full pipeline of drugs to help meet the special health needs of women.12 U.S. pharmaceutical companies are developing 348 new medicines directed at women's health needs see Table 2, page 265 ; . Many are for diseases that disproportionately afflict women, but for some gender-based research is being conducted. With all these medications in the pipeline, managed care will face the challenge of improving care while managing costs. The significant opportunities to improve the care of women are illustrated by the wide variation of care in HEDIS measures, especially chlamydia screening see Table 1 ; . Smoking rates are declining more slowly for women, and obesity and physical inactivity are more prevalent in women than men. Recently, the Centers for Disease Control and Prevention revealed that clinicians are missing opportunities for.
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DISCLOSURE: Antonio Raimondi, None. CURRENT PRACTICE OF TRACHEOTOMY IN EUROPE: A POSTAL SURVEY IN THE NETHERLANDS Denise P. Veelo MD Marleen E. Graat Peter E. Spronk PhD Marcus J. Schultz PhD * Academic Medical Center, Amsterdam, Netherlands PURPOSE: Tracheotomy is increasingly performed in critically ill patients requiring prolonged respiratory support, weaning and frequent broncho-pulmonary toilet. METHODS: To ascertain current practice of tracheotomy in critically ill patients a simple questionnaire was sent to intensive care units ICUs ; throughout the Netherlands. Questionnaires were sent to the lead clinicians of ICUs with 5 beds. RESULTS: From the number of units responding n 28, 43.1% ; , the majority n 17, 60.7% ; practiced percutaneous tracheotomy as opposed to open surgical tracheotomy. In the majority of hospitals tracheotomy was performed by the intensivist n 19, 67.9% ; , followed by the surgeon n 15; 53.6% ; , and the ENT-physician n 9, 32.1% ; . Tracheotomies were mainly performed in the ICU n 20; 71.4% ; , than in the operation room, and more tracheotomies were performed by a team i.e., for each tracheotomy procedure more than one physician was present, n 22, 78.6% ; than by a single physician n 2, 7.1% ; . In the majority of ICUs no antimicrobial prophylaxis was given before tracheotomy n 23; 82.1% ; . Reasons for tracheotomy were polyneuropathy n 13; 46.4% ; , prolonged mechanical ventilation 14 days ; n 22; 78.6% ; , and low GCS n 18; 64.3% ; . Although it was the policy to perform the.
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Year Ended December 31, 2006 BALANCE SHEET DATA Amounts in accordance with IFRS: Cash, cash equivalents and current marketable securities . Inventories . Other current assets . Non-current assets . Assets related to discontinuing operations . Trade accounts payable . Other current liabilities . Non-current liabilities . Liabilities related to discontinuing operations . 2005 2004 2003 Exchange Rates The following table shows, for the years and dates indicated, certain information concerning the rate of exchange of US dollar per Swiss franc based on exchange rate information found on Reuters Market System. The exchange rate in effect on January 25, 2007, as found on Reuters Market System, was CHF 1.00 $0.80. Year ended December 31, 2002 . 2003 . 2004 . 2005 . 2006 . Period End 0.71 0.80 0.88 . Average 1 ; 0.65 0.75 0.81 . Low 0.58 0.70 0.76 High 0.72 0.81 0.88 Risk Factors Our business faces significant risks and uncertainties. You should carefully consider all of the information set forth in this annual report on Form 20-F and in our other filings with the SEC before deciding to invest in any Novartis securities, including the following risk factors faced by us and our industry. Our business, financial condition or results of operations could be materially adversely affected by any of these risks as well as other risks and uncertainties not currently known to us or which we presently deem immaterial. Risks Facing Our Business Our business is significantly affected by ongoing pricing pressures. Our business and the healthcare industry in general are significantly affected by ongoing pricing pressures. These pricing pressures include government-imposed industry-wide price reductions, mandatory reference prices, an increase in parallel imports, the shifting of the payment burden to patients through higher co-payments, mandatory substitution of generic drugs and growing pressure on physicians to reduce the prescribing of patented prescription medicines. We expect these efforts to continue as governments, healthcare providers, insurance companies and other stakeholders step up initiatives to reduce the overall cost of healthcare to patients, restrict the prescribing of new medicines, increase the use of generics and impose overall price cuts. These initiatives do not only affect the results of our Pharmaceuticals Division, but also have an increasing impact on the prices which we are able to charge for the generic drugs marketed by our Sandoz Division. This is particularly true in Germany, our second largest market for generic products, where various measures were introduced to require generic manufacturers to lower their prices. Similar effects are also being felt on Sandoz's business in other markets, particularly in Europe. We expect that these and other challenges will continue to put pressure on our revenues, and therefore could have an adverse effect on our business, financial condition or results of operations. For more information on the pricing controls and on our challenging business environment see ``Item 4.B Business Overview--Pharmaceuticals--Price Controls'' and ``Item 5.A Operating Results-- Factors affecting results of operations--Challenging Business Environment and Ongoing Pricing Pressures''. Our Pharmaceuticals Division faces intense competition from lower-cost generic products. Our Pharmaceuticals Division faces increasing competition from lower-cost generic products. Our Pharmaceuticals Division's products are generally protected by patent rights which are expected to provide us with exclusive marketing rights in various countries. However, those patent rights are of varying strengths and durations. Loss of market exclusivity and the introduction of a generic version of the same or a similar medicine typically results in a significant and sharp reduction in net sales for the relevant product, given that generic manufacturers typically offer their versions of the same medicine at sharply lower prices. In 2007, there is a significant risk that generic competition will emerge for our Top 20 product Trileptal and that US generic competition will emerge for our Top 20 product Lamisil, which already faces generic competition outside the US. Lamisil's US patent will expire in June 2007. In 2006, Lam9sil accounted for $574 million in annual sales in the US, or 1.6% of our net sales from continuing operations 3.9% of the sales in the US ; . Similarly, patent protection for Trileptal's active ingredient has expired in the US and other major countries. In 2006, Trileptal accounted for $549 million in sales in the US, or 1.5% of our net sales from continuing operations 3.8% of our sales in the US ; . In addition to Lamisil, three other products that are still among our Top 20 products have already encountered generic competition in some markets: Neoral, Sandostatin SC and Voltaren. As a result, revenue from these products has declined, and may decline significantly further in the future. A number of our other top-selling products, including the anti-hypertension drugs Diovan and Lotrel as well as the 6.
Nabumetone . nadolol 17 nafcillin sodium . naloxone hcl . naltrexone hydrochloride . NAMENDA . naproxen . NARDIL . NASONEX 28 NATACYN 27 NATAFOLIC-OB .30 NATRECOR 19 NAVANE 11 nefazodone hcl . neomycin sulfate . neostigmine methylsulfate 13 NIASPAN 18 NIFEDIAC CC .17 NILANDRON 10 NIPENT . NITRO-BID .19 nitrofurantoin . NITROPRESS 19 norethindrone acetate 23 nortriptyline hcl . NORVASC 17 NORVIR 12 NOVOLOG 14 NOVOSEVEN 15 nystatin . nystatin w triamcinolone . labetalol hcl 18 LACRISERT 27 lactulose 21 LAMICTAL . LAMISIL . LANTUS 14 LARIAM 10 leucovorin calcium . LEUKERAN . LEVITRA 22 levobunolol hcl 27 LEVOXYL 24 LEVULAN 20 LEXAPRO . LEXIVA 12 lidocaine hcl . lindane 10 LIPITOR 18 lisinopril 16 lisinopril-hctz .16 lithium carbonate 13 lithium citrate 13 LIVOSTIN 26 loperamide 21 34 Index by Drug Name and lansoprazole.
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PRESENTATIONS OF ORIGINAL PAPERS: "From the Groin to the Finger, a Case of Ectopic Acanthosis Nigricans, " American Academy of Dermatology Annual Meeting, February 2003, San Francisco, California. "Pigmented Pilomatricoma, " American Academy of Dermatology Annual Meeting, March 2004, Washington DC. RESEARCH: 2006-present: A Randomized, Double-Blind, Placebo-Controlled, Dose Ranging Study to Assess the Immunogenicity and Safety of "study drug" Application in Healthy Adults. August 1995-Winter 1997 Position: Clinical Research Coordinator, Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio Coordinated several phase II and III trials involving Saquinavir, Delavirdine, AmBisome and Lamisil. Principal Investigators: John R. Graybill MD; Kay Sharkey MD; Jean Smith MD.
Most children with cerebral palsy are healthy, and can expect a normal life span. A very small group of children with extremely severe cerebral palsy and associated conditions such as epilepsy may be at risk of reduced life expectancy for example, they may develop recurrent chest infections or have a prolonged seizure.
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