A study of the feasibility of channel maintenance and beach restoration was undertaken by consultants, Dr. William Cleary and Dr. Paul Hosier. In May of 1994, Drs. Cleary and Hosier provided an extensive report to the Board of Directors detailing the environmental consequences of undertaking a beach renourishing project. The report outlined a three-phase process for maintaining the island. Phase I included channel dredging from Middle Sound Channel with relocation of the dredged sand to the southern ocean side of the island. This sand relocation would reestablish the beach width to 1990 conditions. Phase II called for channel maintenance and shoreline nourishment for the northern portion of the island. The sand source for beach replenishment in Phase II would come from the dredging of nearby Rich's Inlet. Phase III proposed continued channel maintenance of the Middle Sound Channel and dune reconstruction in order to further fight erosion.

111 Is the use of amlodipine or furosemide recommended to normalize blood pressure in a case of hypertensive heart failure? If so, which is most effective?

112 How can diabetes cause endothelial dysfunction? What are the roles of ACE inhibitors in the kinin-kallikrein system? What are the mechanisms by which a decrease in the level of nitric oxide causes endothelial dysfunction?

113 Can sublingual nifedipine be given to a patient with malignant hypertension/accelerated hypertension? It seems to be a controversial issue with some favouring it and some against it.

114 Is the diagnosis of malignant hypertension based only on the basis of the retinopathy (even in the presence of a normotensive state)? Labetalol, parenterally, is suggested as a treatment for malignant hypertension. What other more readily available preparations (besides sodium nitroprusside) are recommended in addition to this drug? Parental labetalol is not available in Pakistan!

115 Patients at medium risk of DVT and pulmonary embolism are usually given specific prophylaxis with low-dose heparin at a dose of 5000 units subcutaneously every 8-12 hours until the patient is ambulatory. Is the first dose given immediately after, say, extensive varicose vein surgery of small and great saphenous veins?

116 'Anticoagulants are not necessary, as embolism does not occur from superficial thrombophlebitis' (K&C 7e, p. 809). Why?

117 Can we use enoxaparin for deep vein thrombosis (DVT) prophylaxis in the immediate postoperative period and in a case of cerebral haemorrhage? Wouldn't it increase the risk of haemorrhage in either case?

118 Can external jugular vein thrombosis cause tingling numbness over the earlobe and adjoining part of the lower face?

119 For how long does a patient have to stay in bed to be labelled as bedridden and to merit low-molecular-weight heparin (LMWH) as prophylaxis for deep vein thrombosis?

120 Is an inferior vena cava filter an alternative treatment for a patient with a history of recurrent deep vein thrombosis on lifelong anticoagulation with warfarin?