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By M. Dawson. University of Rhode Island.

Rather purchase diovan 80 mg with amex arteria digitalis palmaris communis, in participating in alternative therapies order diovan 80mg with visa arteria definicion, they were actively seeking relief from problems for which they found little or no redress in other quarters. However, the people who took part in this research rarely identified ideological issues as reasons for their decisions to first seek out alternatives. While these informants made reference throughout their interviews to a variety of ideological components of the alternative model of health and healing they espouse, including a belief in the value of a holistic approach to health care or therapies that allow them to take control of health and healing, these beliefs were almost never voiced in conjunction with the accounts they gave of why they first turned to alternative therapies. Furthermore, while dissatisfaction with allopathic medicine was mentioned by informants as concomitant with their initial participation in alternative forms of health care, it proves problematic to attempt to explain an individual’s use of these therapies solely through a dissatisfaction with allopathic medicine. Control That alternative therapies allow individuals a greater degree of control over their health and health care is often specified as a motivating factor in people’s participation in these therapies (Furnham and Beard 1995). For example, in talking about her encounters with her naturopath, Grace said, “She encouraged me to take control. For instance, Trudy was one of the two who indicated that her interest in holism predated her initial foray into alternative approaches to health and healing: I had a bladder infection and I knew that there was more to it. I realised that there was a lot more to it in terms of the whole psychology. I could understand that my body was responding to my own thinking and I was responding to my environment with my thinking. I came from a family of alcoholics, so I was also looking for my healing, so I got involved with the Wellness Centre. Again, it was only through their experiences with these therapies, and in interaction with alternative practitioners, that the vast majority of these informants came to espouse alternative ideologies, including a belief in holism. For example, it was long after he first participated in alternative therapies that Greg began learning about alternative ideology from his practitioners: “They [practitioners] try and I listen and it’s kind of, well it’s [their] show and I’m not going to tell [them] how to conduct the symphony. However, these informants did identify dissatisfaction with allopathic medicine as something concomitant with their decisions to turn to alternative health care. Why People Turn to Alternative Therapies | 45 Dissatisfaction Many authors argue that people turn to alternative therapies because they have recognized the limitations of Western medicine and/or are, in general, dissatisfied with allopathic approaches to health care (Fulder 1996)7. Similarly, almost all of the people who participated in this study associated disillusionment with biomedicine with their first experiences of alternative therapies. In Hanna’s words: “I found traditional [allopathic] therapy wasn’t helping me at all. For some a profoundly negative experience with biomedicine led them to look for alternatives. Below, Lindsay and Hanna describe incidents of what they saw as medical negligence, something which led them to turn away from allopathic approaches. I had a really bad infection and what he found out was that I was retaining about five hundred CCs of urine. He said that I was probably going to end up living on antibiotics for the rest of my life because every time I turned around I’d get a bladder infection. And Hanna told me, Well the car accident, the therapy was making it worse. I kept going to my family doctor and saying, ‘It’s not just in the muscles; I think it’s the nerves. All I kept having was one x-ray after x-ray and, well, there were no bones injured. She wouldn’t believe me until I said there was something drastically wrong behind the left eye. For most other informants, however, a sense of dissatisfaction with allopathic medicine was more all-encompassing and tended to be focussed on discontent with medical professionals on the one hand and/or dissatisfaction with medical therapy on the other. Several told me that their sense of dissatisfaction with Western medicine was related to what they saw as arrogant or uncaring attitudes displayed by physicians (Taylor 1984). He gave me three strips of, they reminded me of clarinet reeds actually. He said: ‘Just take them home, take them in the bathroom, urinate on them and if they go green you’re, no red, no green.

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The various antiviral agents are designed to thwart the AAppert generic diovan 80 mg without prescription blood pressure 5 year old boy, Nicolas FrançoisPPERT safe 80mg diovan blood pressure medication drug classes, NICOLAS FRANÇOIS (1750-1841) replication of whatever virus they are directed against. One French chef means to achieve this is by blocking the virus from comman- Nicolas Appert gave rise to the food canning industry. Born in deering the host cell’s nuclear replication machinery in order Châlons-sur-Marne, France, around 1750, young Appert to have its genetic material replicated along with the host’s worked at his father’s inn and for a noble family as a chef and genetic material. By 1780 he had set up a confectionery shop in vention of replication will prevent the numbers of viruses from increasing, giving the host’s immune system time to deal Paris, France. Appert became interested in food preservation when the The incorporation of the nucleotide building blocks into French government offered a 12,000-franc prize in 1795 to the deoxyribonucleic acid (DNA) can be blocked using the drug person who could find a way to keep provisions for idoxuridine or trifluridine. Both drugs replace the nucleoside Napoleon’s armies from spoiling in transit and storage. After thymidine, and its incorporation produces a nonfunctional years of experimentation Appert devised a method of putting DNA. So, food in glass bottles that were then loosely corked and this antiviral drug is also an anti-host drug. Vidarabine is immersed in boiling water for lengths of time that varied with another drug that acts in a similar fashion. The drug is incor- the particular food; after boiling, the corks were sealed down porated into DNA in place of adenine. In an age before bacteriology, Appert did not other DNA building blocks. But, because the virus utilizes known as appertization—preserved the food. Appert later set the host’s genetic machinery, stopping the viral replication up his first bottling plant at Massy, south of Paris, in 1804. The French navy successfully used Appert’s products in Another tact for antiviral drugs is to block a viral 1807, and in 1809 Appert was awarded the 12,000-franc prize. This approach has been successfully covery, which he did in his 1810 work The Art of Preserving exploited by the drug acyclovir. The drug is converted in the Animal and Vegetable Substances for Several Years, which host cell to a compound that can out compete another com- gave specific directions for canning over fifty different foods. Appert, who also invented Arenaviruses contain ribonucleic acid (RNA) as their the bouillon cube, was financially ruined in 1814 when his genetic material. The viral genome consists of two strands of plant was destroyed during the Napoleonic wars. Little is known about the actual replication of new viral components or about the assembly of these components to produce the new virus ARCHAEA particles. It is known that the new virus exits the host by “bud- Archaea ding” off from the surface of the host cell. When the budding Genes that code for vital cellular functions are highly con- occurs some of the lipid constituent from the membrane of the served through evolutionary time, and because even these host forms the envelope that surrounds the virus. American microbiologist Carl Woese and his col- only known exception is an arenavirus called the Tacaribe leagues obtained sequences of the genes coding for RNA in the virus, which is resident in Artibeus bats. The association subunit of the ribosome from different organisms to argue that between an arenavirus type and a particular species of rodent life on Earth is comprised of three primary groups, or is specific. These domains are the Eukarya (which include one species of mouse or rat. A hallmark of arenaviruses is that While Archae are microorganisms, they are no more the infections in these rodent hosts tend not to adversely related to bacteria than to eukaryotes. In contrast to the rodent hosts, the human illness organization of their genetic material bears more similarity to can be compromising. Most arenavirus infections produce relatively mild The three domains are thought to have diverged from symptoms that are reminiscent of the flu, or produce no symp- one another from an extinct or as yet undiscovered ancestral toms whatsoever. The archae and eukarya may have branched off from a phocytic choriomeningitis virus, usually produces symptoms common ancestral line more recently than the divergence of that are mild and are often mistaken for gastrointestinal upset. However, this view remains However, some infections with the same virus produce a controversial and provisional. They inhabit environments which are too the different outcomes of an infection with the virus is yet to harsh for other microbes. These viruses include the Lassa virus (the furous springs of Yellowstone National Park.

Smillie’s academic and professional career was finally capped by his presidency of the International Society of the Knee from 1981 to 1983 purchase diovan 160 mg overnight delivery blood pressure on leg. He had many interests outside medicine: he raced exotic cars at Brooklands in the 1930s cheap 160 mg diovan overnight delivery arrhythmia in dogs, and his serious interests included philately and pho- tography. His pervasive interests were farming, fishing and stalking—he published A Guide to the Stalking of Red Deer in Scotland in 1983. Ian Smillie was a complex character; some- times defensive, always enthusiastic, lacing his discussion and instruction with humor. He could Robert William SMITH be cutting in debate, but equally generous in praise when this was deserved. On one occasion, 1807–1873 an arch-rival attacked his techniques and the knives that he had designed, saying “The only use Robert William Smith spent his entire life in for which I can recommend Mr. He waited for it is in surgical pathology that he made his great- what seemed an age, then continued—“The best est contributions. X can make of these knives surgical literature by its association with a frac- is to sharpen pencils”. Treatise on the Pathology, Diagnosis and Treat- His contribution to knee surgery was immense ment of Neuroma, containing an extensive review and surgeons everywhere will miss him, as will of the literature as well as his own observations. In Boston, in addition to and on stone” by the Irish illustrator Connelly, are being instructor in orthopedic surgery at Harvard for the most part life-size. The monograph itself Medical School (1930–1935) and clinical pro- is unusual, being an elephant folio measuring 48 fessor of orthopedic surgery (1935–1946), he ¥ 70cm, and is said to be the largest book ever became chief of the orthopedic service at the published in Ireland up to that time. This Scandinavian–American mixture had the strongest anglophile leanings, and these were further developed by his contact with British orthopedic surgeons, in particular Sir Robert Jones in the latter half of the First World War, and subsequently. From very early days in his medical career, Smith-Petersen was a pioneer. In the course of his Moynihan Lecture in 1947, he himself told the story of the original planning and execution of the anterior approach to the hip joint in 1917, stimu- lated in the first place by Dr. Subsequently, this approach was developed into the acetabuloplasty operation, which he described in 1936 for the relief of pain and restoration of function in cases of malum coxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabu- lum and coxa plana. SMITH-PETERSEN ment in the form of Vitallium mold arthroplasty, 1886–1953 with preliminary trials of several materials, including glass (1923), viscoloid (1925), Pyrex Dr. Smith- virtue of his skill and thought, with reference to Petersen put into his work on arthroplasty of the hip joint surgery in particular, but throughout his hip provoked worldwide interest and progress, professional career his strong personality, mixed and it is to be noted that a long period of research with a great sense of humility and kindness, preceded his final operative technique. Not only was he the “surgical joint dates back to 1930-1931, when he intro- master,” but the friend and confidant of all who duced the use of the three-flanged nail for inter- had the privilege to come into contact with him. At that Although he was somewhat shy and sensitive as time, he wrote: “A great responsibility rests on the an individual, his powers of concentration and surgeon who introduces a new method of treat- real deep thinking made him a great leader and ment. The desire to have a new idea published is teacher in the art and science of orthopedic so great that the originator is often led astray, and surgery. His great aim, both in theory (Harvard) in 1914, and was awarded an Honorary and practice, was to be constructive, and thus we 310 Who’s Who in Orthopedics find him developing many procedures for the English-speaking orthopedic surgeons in London relief of pain and restoration of function in the and the provinces. Fortunately, he had a chance deformed joints of the unfortunate sufferers from of seeing most of his friends and was able to visit chronic arthritis. In 1946, he worked out on paper to the last detail, before was honored with the award of Commander of being put into effect most successfully and the Royal Norwegian Order of Saint Olaf, and dramatically. In honorary member of the Norwegian Surgical this respect he was much influenced by his early Association. Smith-Petersen undoubtedly was seen at his American Orthopedic Association, and held the best when dealing with patients, either on a ward office of president of the American Academy of round or in his office. During the Second vidual one, and with his quiet smile and sly wink World War, he was consultant in orthopedic he captivated both patients and pupils alike. He was also a man has ever portrayed the essential spirit of the member of the International Society of Orthope- doctor–patient relationship better. On social occa- dic Surgeons, and an associate member of the sions, he loved to be surrounded by the younger French Academy of Orthopedic Surgery. Smith-Petersen died on June 16, 1953 in a Scandinavian manner, and provoking both at the age of 67, after a short illness.

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Higher doses have been used cheap diovan 80 mg visa hypertension quality improvement, with the most frequent side effect being paresthesias cheap diovan 80mg prehypertension uk. Systemic corticosteroids have been found in some patients to be helpful, especially when the PPTC is associated with systemic inflammatory disease, like sarcoidosis. Some patients have been found to be responsive to other diuretics, especially furose- mide. Lumbar Puncture Serial lumbar punctures are performed to lower the pressure. This approach may work by creating a number of holes in the dura of the spinal canal allowing enough cerebrospinal fluid egress to normalize the intracranial pressure. This method is dif- ficult to accomplish in children over a long period of time for practical reasons, but can be used over a short period of time until more definitive therapies can be arranged. Surgical Treatment of PPTC Surgical treatment is not often needed for PPTC, possibly because there are frequent associations, which can be corrected with rapid normalization of the pressure. How- ever, the physician must be prepared to intervene when there is optic neuropathy, very high pressure, or documented progression of optic nerve damage. Unfortu- nately, there is insufficient published evidence to clearly recommend one over the other procedure. Repeat eye examinations are required to monitor the outcome of either surgical drainage procedure. Lumboperitoneal Shunt Lumboperitoneal shunting involves the placement of a silicone tube from the lumbar subarachnoid space to the peritoneal cavity. These have long been used by neurosur- geons for PPTC, though not always successfully. This approach leads to a rapid resolution of the PPTC, but the tubes can obstruct, become infected, and are 242 Repka associated with the development of a Chiari malformation. Failure to drain is com- mon and blockage leads to a rapid increase in pressure, which can cause catastrophic damage to the optic nerve. Ongoing ophthalmologic observation is recommended especially when there is a recurrence of symptoms. Optic Nerve Sheath Fenestration This treatment has been reported in many adults for the relief of pseudotumor cere- bri, but has only been performed in a small number of children. An incision in the dural sheath of optic nerve is made from an orbital approach under general anesthe- sia. Fenestration has been shown to relieve papilledema of the operated nerve and sometimes even the contralateral nerve. If the contralateral eye does not show evidence of improvement, a second procedure will be needed for this eye. PROGNOSIS Most children with PPTC have a self-limited course, resolving once the causative problem has been corrected. However, the clinician should be vigilant for older chil- dren and teens, who may have more chronic elevation of intracranial pressure or lack an obvious association. Permanent damage to the optic nerves is found in about one- fourth of affected pediatric patients. There does not seem to be any age difference in the occurrence of this unfavorable outcome. SUMMARY Pediatric pseudotumor cerebri is an uncommon neurologic disease of childhood. Obesity is less common in the childhood form of the disease and there is often an asso- ciated condition. Management requires collaboration of neurology, ophthalmology, and pediatrics in evaluating and monitoring the patients. The sooner the increased pressure is reduced, the less likely there will be permanent visual impairment. Idiopathic intracranial hypertension (pseudotumor cerebri) in pediatric patients. Lumboperitoneal shunting: a retrospective study in the pediatric population. Idiopathic intracranial hypertension in prepu- bertal pediatric patients: characteristics, treatment, and outcome.

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Transient hyperhidrosis contralateral to a large cerebral infarct in the absence of autonomic dysfunction has also been described purchase 160 mg diovan fast delivery arteria umbilical. Regional syndromes of hyperhidrosis (hands 80 mg diovan heart attack while running, feet, axillae) are also described. Symptoms may be helped (but not abol- ished) by low dose anticholinergic drugs, clonidine or propantheline. For focal syndromes, botulinum toxin injections or sympathectomy may be helpful. BMJ 2000; 320: 1221- 1222 - 159 - H Hyperkinesia Labar DR, Mohr JP, Nichols FT, Tatemichi TK. Neurology 1988; 38: 1679-1682 Naumann M, Flachenecker P, Brocker EB, Toyka KV, Reiners K. Lancet 1997; 349: 252 Cross References Anhidrosis; Diaphoresis; Holmes-adie pupil, Holmes-adie syndrome Hyperkinesia Hyperkinesia indicates an involuntary movement disorder character- ized by excessive amplitude of movement, such as ballism, or chorea, or the speech disorders occurring with them. Cross References Ballism, ballismus; Chorea, choreoathetosis; Dysarthria Hypermetamorphosis Hypermetamorphosis is an overattention to external stimuli. Patients with hypermetamorphosis may explore compulsively and touch every- thing in their environment. This is one element of the environmental dependency syndrome and may be associated with other forms of uti- lization behavior, imitation behavior (echolalia, echopraxia) and frontal release signs, such as the grasp reflex. It occurs with severe frontal lobe damage and may be observed following recovery from her- pes simplex encephalitis and in frontal lobe dementias including Pick’s disease. Bitemporal lobectomy may also result in hypermetamorpho- sis, as a feature of the Klüver-Bucy syndrome. Cross References Attention; Echolalia; Echopraxia; Frontal release signs; Grasp reflex; imitation behavior; Klüver-bucy syndrome; Utilization behavior Hypermetria - see DYSMETRIA Hypermnesia - see EIDETIC MEMORY; SYNESTHESIA Hyperorality Hyperorality is a neurobehavioral abnormality consisting of drinking more than usual, eating excessively, eating anything in sight, and put- ting objects inappropriately into the mouth. It is one element of the Klüver-Bucy syndrome, along with hypersexuality. Cross References Klüver-bucy syndrome Hyperpathia Hyperpathia is an unpleasant sensation, often a burning pain, associ- ated with elevated threshold for cutaneous sensory stimuli, such as light touch or hot and cold stimuli, especially repetitive stimuli. Clinical features of hyperpathia may - 160 - Hyperreflexia H include summation (pain perception increases with repeated stimula- tion) and aftersensations (pain continues after stimulation has ceased). The term thus overlaps to some extent with hyperalgesia (although the initial stimulus need not be painful itself) and dysesthesia. There is an accompanying diminution of sensibility due to raising of the sen- sory threshold (cf. Hyperpathia is a feature of thalamic lesions, and hence tends to involve the whole of one side of the body following a unilateral lesion, such as a cerebral hemorrhage or thrombosis. Generalized hyperpathia may also be seen in variant Creutzfeldt-Jakob disease, in which poste- rior thalamic (pulvinar) lesions are said to be a characteristic neurora- diological finding. Cross References Allodynia; Dysesthesia; Hyperalgesia Hyperphagia Hyperphagia is increased or excessive eating. Binge eating, particularly of sweet things, is one of the neurobehavioral disturbances seen in cer- tain of the frontotemporal dementias. Hyperphagia may be one fea- ture of a more general tendency to put things in the mouth (hyperorality), for example in the Klüver-Bucy syndrome. Cross References Hyperorality; Klüver-bucy syndrome Hyperphoria Hyperphoria is a variety of heterophoria in which there is a latent upward deviation of the visual axis of one eye. Using the cover-uncover test, this may be observed clinically as the downward movement of the eye as it is uncovered. Cross References Cover tests; Heterophoria; Hypophoria Hyperpilaphesie The name given to the augmentation of tactile faculties in response to other sensory deprivation, for example touch sensation in the blind. Hyperpronation - see CHOREA, CHOREOATHETOSIS; DECEREBRATE RIGIDITY Hyperreflexia Hyperreflexia is an exaggerated briskness of the tendon reflexes. This may be physiological in an anxious patient (reflexes often denoted ++), or pathological in the context of corticospinal pathway pathology (upper motor neurone syndrome, often denoted +++). It is sometimes difficult to distinguish normally brisk reflexes from pathologically brisk reflexes.

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