By Darren Shan
Time appeared to collapse... there has been a pointy stabbing sensation in my stomach... Steve crowed, "Now i've got you! Now you're gonna die!"
Dead if he loses - damned if he wins. The time has eventually come for Darren to stand his archenemy, Steve Leopard. one among them will die. the opposite turns into the Lord of the Shadows - and spoil the world.
Is the long run written, or can Darren trick future?
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Additional info for Sons of Destiny (The Saga of Darren Shan, Book 12)
Initial residual urine volume (after the patient has performed free uroﬂowmetry). —Normal residual = less than 50 ml. Whether pain or resistance to catheterization is noted (may suggest urethral stenosis). The ﬁrst desire to void, when patient ﬁrst notes that she would look for a toilet. —Normal FDV = 150–200 ml. Normal desire, when patient would normally stop work and go to toilet. —Normal desire usually = 350–400 ml. Maximum cystometric capacity, when patient would not tolerate any more ﬂuid.
In a teaching unit, only one medical student should “watch” the procedure. Actually we ask the student to position the lamp, type in data on the computer, help the patient off the couch, so they do not “watch” the patient but are actively involved. Patients do not like to feel like a goldﬁsh in a bowl, especially when they are being asked to leak. Before starting to ﬁll, the nurse or doctor also explains the concepts of First Desire to Void, Strong Desire to Void, and Maximum Cystometric Capacity (see below).
4. The peak ﬂow rate is poor, the average ﬂow rate is poor, but there is no evidence of abdominal straining. The detrusor contraction is intrinsically weak, but this needs to be proven by voiding cystometry. Less common voiding abnormalities are described in the section on voiding cystometry (detrusor hyperactivity with impaired contractility, DHIC, seen in the elderly with mild neurological dysfunction, and detrusor sphincter dyssynergia, seen only in neuropathic disease such as multiple sclerosis).