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MEDICAL ANIMATION TRANSCRIPT: Drug metabolism is the chemical conversion of drugs into water soluble compounds that can be excreted by the body. Drug metabolism mainly takes place in the liver, while excretion mainly takes place in the kidneys. Following drug administration, drugs must pass through tightly packed cells, crossing cell membranes to reach their sites of action. Usually drugs are lipophilic or fat soluble compounds, and cell membranes are composed of phospholipids, so drugs are able to cross them. However, for excretion by the kidneys, it's necessary to convert drugs to water soluble or hydrophilic compounds. Drugs are usually administered orally or parenterally. Parenteral drugs bypass the digestive tract. Parental routes include injection, transdermal patches, lotions, inhalants, and suppositories. If injected, the drugs reach general circulation quickly and have an immediate effect. If taken orally, drugs must pass through the cells of the gastrointestinal tract. Drugs cross through cells of the GI tract and travel to the liver via the hepatic portal vein. The liver has a chance to metabolize some of the drug before it goes into general circulation, this is called the first pass effect. In the liver, drugs enter hepatic cells where a series of enzymes in smooth endoplasmic reticulum metabolize them. Drugs move through the phospholipid membrane of endoplasmic reticulum. Hepatic microsomal enzymes such as p450 convert drugs from lipophilic to hydrophilic compounds. Repeated use of certain drugs increases the amount of metabolic enzymes and increases drug metabolism. This is called enzyme induction. Conversely, certain drugs compete to bind to metabolic enzymes thereby decreasing drug metabolism. This is called enzyme inhibition. Once metabolized, these hydrophilic metabolites leave the cell ready for excretion by the kidney. A drug's duration and intensity of effect are largely determined by metabolic rate. Increased metabolic rate will decrease drug duration and intensity by facilitating excretion. Decreased metabolic rate increases drug duration and intensity. A few of the factors affecting metabolic rate are the first pass effect, liver disease such as cirrhosis, neonates in the elderly have decreased liver function, compromised blood flow to the liver will lower metabolic rate, variation in amount and type of hepatic enzymes, poor diet and nutrition can affect normal liver function, and higher circulating drug levels due to dosage or patient's weight take longer to metabolize. ♪ [music] ♪
"[I] have come to rely upon the Doe Report and your great staff of
illustrators for all my medical malpractice cases. … Please know
that I enthusiastically recommend you to all my colleagues.
Frank Rothermel
Bernhardt & Rothermel
"Medical illustrations are essential during trial for any medical malpractice case. The people at MLA have the uncanny ability of creating medical illustrations that simplify the most complex of medical concepts and human anatomy to a lay audience. The exhibits of MLA allow experts to easily describe complex concepts and human anatomy in a manner that could
not be done otherwise.
In addition, their custom illustrations show in great detail the extent of
injuries suffered and the devastating effects they have had on the client's
anatomy. These custom illustration can show, side by side, the body before
and after a catastrophic injury. The effect of this juxtaposition is
unmatched by any testimony that can be adduced at the time of trial.
Even jurors after trial have commented on the ease with which they grasp
medical concepts and anatomy once the MLA exhibits were introduced and
used by my experts. Even judges who have "seen it all" are thoroughly
impressed by the detail and sophistication of the illustrations.
"This past year, your company prepared three medical illustrations for our cases; two in which we received six figure awards; one in which we received a substantial seven figure award. I believe in large part, the amounts obtained were due to the vivid illustrations of my clients' injuries and the impact on the finder of fact."
Donald W. Marcari Marcari Russotto & Spencer, P.C. Chesapeake, VA
"Thank you for the wonderful illustrations. The case resulted in a defense verdict last Friday. I know [our medical expert witness] presented some challenges for you and I appreciate how you were able to work with him."
Robert F. Donnelly
Goodman Allen & Filetti, PLLC
Richmond, VA
Medical Legal Art creates medical demonstrative evidence (medical
illustrations, drawings, pictures, graphics, charts, medical animations,
anatomical models, and interactive presentations) for use during legal
proceedings, including research, demand letters, client conferences,
depositions, arbitrations, mediations, settlement conferences, mock jury
trials and for use in the courtroom. We do not provide legal or medical
advice. If you have legal questions, you should find a lawyer with whom you
can discuss your case issues. If you have medical questions, you should seek the advice of a healthcare provider.