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1. Keratinizing type occurs in older women; associated with other vulvar dystrophies such as lichen sclerosis but not with HPV; usually unifocal 2. Warty or basaloid type found in younger women; associated with HPV, VIN, and cigarette smoking; usually multifocal 1. Direct extension: to the vagina, urethra, or anus 2. Lymphatic dissemination: occurs via the superficial inguinal nodes into the deep inguinal and femoral nodes and finally into the pelvic lymphatics 3. Hematogenous dissemination: rare; occurs mostly in patients who also have lymphatic dissemination; spreads to lung, liver, and bone Lymphatic spread occurs in 30% of vulvar cancers and its likelihood increases with the size of the lesion and the depth of invasion The FIGO system is used to stage vulvar cancer and is based on both the microscopic evaluation of the removed tumor as well as of the regional lymph nodes. See Table 5-3. In general, treatment needs to be individualized using the most conservative treatment that will lead to cure of the disease. The possible modalities are listed below: 1. Groin node dissection with either wide local excision or radical vulvectomy is the mainstay of treatment 2. Adjuvant radiation therapy can be added postoperative in patients with either positive inguinal nodes or close/positive surgical margins or preoperatively in patients with advanced disease

Brunner, G W, Computer and Physical Modeling of Bridge Scour, ASCE Compendium of Papers on Stream Stability and Scour at Highway Bridges, 1998 Dumas, C and J Krolack, A Geotechnical Perspective: Design and Construction of Highway Bridge Foundation for Scour, Proceedings of First International Conference on Scour of Foundations, Texas A&M University, November 2002 Ettema, R, Flume Experiments on Abutment Scour, Hydroscience and Engineering, University of Iowa, Volume 1, Proceedings of First International Conference on Scour of Foundations, Texas A&M University, November 2002 Fotherby, L M, Alternatives to Riprap for Protection Against Local Scour at Bridge Piers, Transportation Research Record, Vol 1420, TRB, National Research Council, Washington, DC, 1993 Gao, D, Lilian Posada and Carl Nordin, Pier Scour Equations Used in China, ASCE Compendium of Papers on Stream Stability and Scour at Highway Bridges, 1998 Guidelines for Bridge Maintenance and Rehabilitation, by Secretary, US.

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Most scanning software works by default in Buffered Memory mode. Disk file transfer is not supported. Native and Buffered Memory modes are supported.

Prominent nouns in the narrative are customer, meter, bill, reading, and rate. For each o f these nouns, the narrative describes associated attributes. Figure 6.1 shows a preliminary E R D with entity types for nouns and associated attributes. Note that collections o f things are not attributes. For example, the fact that a customer has a collection o f meters will be shown as a relationship, rather than as an attribute o f the Customer entity type. In addition, references between these entity types will be shown as relationships rather than as attrib utes. For example, the fact that a reading contains a meter number will be recorded as a relationship. The narrative specifically mentions uniqueness o f customer number, meter number, reading number, bill number, and rate number. The bill number, reading number, and meter number s e e m to be stable and single purpose as they are imprinted on physical objects.

Department of Interior, Washington, DC Khan, Mohiuddin A, J Zarriello and S A Baig, Stream Instability Study for New Jersey Bridges, Proceedings of First International Conference on Foundation Engineering, Texas A&M University Klaassen, G J and K Vermeer, Con uence Scour in Large Braided Rivers with Fine Bed Material, Proceedings of International Conference on Fluvial Hydraulics, Budapest, (1988) Kosicki, A and H Johanesson, The Challenges of Scour Prediction, Proceedings of First International Conference on Scour of Foundations, Texas A&M University, November 2002 Kumar, Virender, K Raju and N Vittal, Reduction of Local Scour Around Bridge Piers Using Slots and Collars, Journal of Hydraulic Engineering, Vol 125, No12, Federal Highway Administration, Washington, DC, 1999 Lagasse, P F, P L Thompson and S A Sabol, Guarding Against Scour, Civil Engineering, 65(6), 1995, 56 59.

J. Christian Gerdes Assistant Professor of Mechanical Engineering, Design Division, Stanford University, Palo Alto, California (chap. 11) Cecil O. Huey, Jr. Professor of Mechanical Engineering Clemson University, Clemson, South Carolina (chap. 5) Harold A. Rothbart Dean Emeritus, College of Science and Engineering, Fairleigh Dickinson University, Teaneck, New Jersey (chaps. 1, 2, 3, 4, 6, 8, 9, 10, 12, 14) Carlos Santiago Lopez-Caj n Professor de la Faculted, Departamento de Ingenieria, Universidad Aut noma de Quer taro, Quer taro, Mexico (chap. 7) Dermin Tsay Professor, Department of Mechanical Engineering, National Sun Yat Sen University, Kaohsiung, Taiwan (chap. 5)

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