Microsoft word - preoperative_instructions.doc

I have scheduled you to have a growth excised in the office. Excision is the medical term for removal of a lesion from your skin. The wound is closedwith stitches (deep ones that dissolve in 2 months) and superficial ones that are removed in 7-14 days. The goals of the procedure are complete removal of the growth and a good cosmetic result. Unless otherwise instructed takeall of your regularly prescribed medications and eat normally. After the procedure most patients may resume their normal activities; sometimesthere are temporary restrictions on sports, exercising, lifting and other Some tips on planning your procedure
Unless you have been told the procedure should be done ASAP don't  Near a major event (e.g. wedding, presentation, exam)  You cannot swim or go into a hot tub with a stitched wound In most instances I will recommend that vigorous exercise be discontinuedespecially when there is a risk of sutures coming out and the wound falling Anesthesia
We inject anesthesia that numbs the skin around the growth by affecting local nerves. There is no significant absorption of the anesthetic so you arefully awake for the procedure. The discomfort of the injection is similar to having blood drawn and lasts for 10-20 seconds. Once the skin is numb (about 2-5 minutes) you will have no further pain from the procedure. In thevast majority of cases you will be able to drive yourself home, but it is always wise to have a family member or friend with you for moral support.
1. You faint or pass out easily. If you do it's very important to eat 2 2. You have had difficulty with bleeding during prior surgical procedures.
3. You have a pacemaker.
4. You have an internal defibrillator device.
5. You are taking aspirin.
6. You are taking Coumadin or warfarin.
7. You are taking arthritis medications, anti-inflammatory drugs (e.g.
Motrin), persantine (dipyridamole), plavix.
8. You are taking vitamin E.
9. You require oral antibiotics before dental cleanings, have artificial joints or artificial joints or artificial heart valves.
There is always minor bleeding at the time of surgery which is very easilycontrolled. In rare instances there is delayed bleeding and the wound swells and is painful (hematoma). In my experience the following minimizeexcessive bleeding at the time of surgery: 1. No alcoholic beverages for 2 days prior to the procedure (including 2. Aspirin. Please avoid taking aspirin for 14 days prior to your procedure unless on a doctor's orders. If a doctor has recommended aspirin for you, ask your doctor if it can be temporarily stopped and inform us of the decision before the surgery date. Many things contain aspirin (e.g.
Alka Seltzer) so read labels carefully. One aspirin can decrease your ability to clot (thin your blood) for 2 weeks! 3. Motrin, Ibuprofen and other so-called nonsteroidal anti-inflammatory drugs should be discontinued for 5 days.
How come so much tissue needed to be removed?
In order to close an excised wound evenly as a thin line, the optimal lengthto width ratio is 3:1. Picture trying to close a circle from side to side; you get two loops of tissue at either end and these need to be removed in order for the wound to heal in a straight line. If you have a mole that is 6 mm wide(1/4 inch) and I excise it with margins of 2 mm (1/12 inch), this makes the actual excision width 10 mm (5/12 inch). The length (3:1 length to widthratio) of the excision is 30 mm (1 and ¼ inches).
When cut skin heals it always forms a scar. Every effort will be made to
minimize the appearance of the scar but certain locations (e.g. chest, around a joint) are a higher risk for thicker or spread scars. If you form keloids ordon't heal well, please let me know.
Postoperative care
We will give you detailed instructions after surgery is completed. If the wound is in an area that you cannot reach please arrange for a familymember or friend to do the wound care for you. You will not be able to bathe or shower the area for 24 hours. You will need Telfa (non-stick) pads,Vaseline and adhesive tape for the postoperative care.
Postoperative pain in most cases is mild, lasts less than 24 hours and can be
controlled with Tylenol. In some instances I will prescribe a narcotic for oneor two nights. Aspirin and Motrin should be avoided for 3 days.
Questions or Concerns and Advice
Surgical procedures can be intimidating so if you have questions or need
reassurance contact us! Our goal is to make your experience as smooth aspossible. Using a Walkman during the procedure is a helpful relaxation


Microsoft word - tc037_keep_banking_secrecy.doc

KEEP BANKING SECRECY AND PRESERVE GLOBALIZATION Avoid undermining democracy and competition IMD Chemin de Bellerive 23 PO Box 915, CH-1001 Lausanne Switzerland Tel: +41 21 618 01 11 Fax: +41 21 618 07 07 http://www.imd.chKEEP BANKING SECRECY | Avoid undermining democracy and competition Keep banking secrecy and preserve globalization Global leaders at the G20 Summit in

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2012 Publications Brennan DJ, O'Connor DP, Laursen H, McGee SF, McCarthy S, Zagozdzon R, Rexhepaj E, Culhane AC, Martin FM, Duffy MJ, Landberg G, Ryden L, Hewitt SM, Kuhar MJ, Bernards R, Millikan RC, Crown JP, Jirström K, Gallagher WM. The cocaine- and amphetamine-regulated transcript mediates ligand-independent activation of ERα, and is an independent prognostic factor in node-negative

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