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his chapter focuses on sales contracts and special processes, with specific tips on their use and configuration in mySAP ERP Numerous business relationships relate to contracts or agreements with customers and the represented business, based upon material, price, and quantity over a fixed period of time Contracts facilitate planning on behalf of the business and guarantee a fixed price agreement with the customer In SAP the term contracts is represented as quantity contracts, value contracts, service contracts, and group master contracts It is advisable to use a different number range for contracts (see Number Ranges in s 3 and 10) as this ensures an easier time searching for documents and referencing contracts later The area in the IMG for configuration of the contracts process is the same as the standard sales document types unless specifically stated Thus, to configure the contract document type, use the following menu path

finding diagnostically The condition is relatively uncommon, with the most frequent causes being amyloidosis In Africa, endomyocardial fibrosis, a specific entity in which there is severe fibrosis of the endocardium, often with eosinophilia (L ffler s syndrome), is seen Other causes of restrictive cardiomyopathy are infiltrative cardiomyopathies (eg, hemochromatosis, carcinoid syndrome) and connective tissue diseases (eg, scleroderma) Amyloidosis results from deposition of various proteins within the myocardium Primary amyloidosis is caused by deposition of immunoglobulin light chains (AL) by monoclonal plasma cells, often as a consequence of multiple myeloma The heart may be the only organ involved at times Systemic amyloidosis is due to production of AA light chains Familial amyloidosis results from production of a carrier protein called transthyretin Systemic amyloidosis may affect any organ but is particularly associated with significant pulmonary and renal involvement and with a peripheral neuropathy (that often results in orthostatic hypotension)

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Restrictive cardiomyopathy must be distinguished from constrictive pericarditis (Table 10 12) The key feature is that ventricular interaction is accentuated with respiration in constrictive pericarditis, and that interaction is absent in restrictive cardiomyopathy Pulmonary pressure is invariably elevated in restrictive cardiomyopathy and is normal in uncomplicated constrictive pericarditis

Conduction disturbances are frequently present Low voltage on the ECG combined with ventricular hypertrophy revealed by echocardiography are suggestive Cardiac MRI presents a distinctive pattern in amyloidosis and is a useful screening test The echocardiogram reveals a small thickened LV with bright myocardium, rapid early diastolic filling revealed by Doppler, and biatrial enlargement Atrial septal thickening may be evident Rectal, abdominal fat, or gingival biopsies can confirm systemic involvement, but myocardial involvement may still be present if these are negative, and requires biopsy for confirmation Demonstration of tissue infiltration on biopsy specimens using special stains followed by immunohistochemical studies and genetic testing is essential to define which specific protein is involved

Right heart failure tends to dominate over left heart failure Pulmonary hypertension present Amyloidosis is the most common cause Echocardiography is key to diagnosis MRI and cardiac catheterization are helpful Myocardial biopsy can confirm

Unfortunately, little useful therapy is available for either the causative conditions or the restrictive cardiomyopathy itself Diuretics can help, but excessive diuresis can produce worsening symptoms As with most patients with severe right heart failure, loop diuretics, thiazides, and aldosterone antagonists are all useful Digoxin may precipitate arrhythmias and generally should not be used -Blockers help slow heart rates and improve filling Corticosteroids may be helpful in sarcoidosis but relieve conduction abnormalities more often than heart failure In amyloidosis, the therapeutic strategy depends on the characterization of the type of

Restrictive cardiomyopathy is characterized by impaired diastolic filling with preserved contractile function The diastolic filling pattern in restrictive cardiomyopathy reveals that early diastolic filling is accentuated (rapid E wave on the echocardiogram/Doppler) The LV systolic function may be mildly depressed and the atria are generally enlarged; if present, hypertrophy of the interatrial septum is a helpful additional

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Sales Documents | Sales Document Header | Define Sales Document Types [VOV8]

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