By V. Denpok. Wingate University.
These figures have been primarily based on 92 discount extra super levitra 100 mg overnight delivery,93 retrospectively collected single case reports and case series 100 mg extra super levitra overnight delivery, and practitioner 91 quality extra super levitra 100mg,94 surveys extra super levitra 100 mg on line. There has been one retrospective cohort study that examined the incidence of 89 cerebrovascular accidents after manipulation. It covered the period 1978–88, and the experience of 99% of the practicing chiropractors in Denmark. Over 10 years, five arterial dissection cases and one fatality were identified, representing approximately one serious complication for every 1 million cervical manipulations. The only case-control 95 study published to date on this topic is that by Rothwell and associates. They concluded that no temporal relationship existed between spinal manipulation and stroke for patients over the age of 45 years. Under the age of 45 years there was a five-fold increased likelihood that a patient would have visited a chiropractor in the past week or received three or more treatments within the past month before the vertebral artery occlusion or dissection, when compared to controls. A positive association was noted between cervical manipulation and vertebrobasilar artery stroke in 1. Assuming that patients are likely to receive 8–14 chiropractic 6 treatments during the course of care, this number approaches the one in 500000 to 1 million manipulations noted from the various surveys. It is important to note that in only nine cases out of 582 with vertebrobasilar arterial strokes in the province of Ontario could any temporal association be found between chiropractic treatment and stroke. Furthermore, the results of this study yielded the statistical anomaly that the odds ratio for stroke was actually significantly less than in controls for patients who received manipulation 8–30 days before the stroke. Finally, this study also did not consider the potential confounding effect of patients seeking chiropractic treatment for acute neck pain associated with an evolving dissection of the vertebral artery. All of these issues will require detailed, prospective investigation if true understanding of risk is to be determined. The RAND study estimated the rates of serious complications as 5–10 in 10 million for vertebrobasilar reactions, 3–6 in 10 million for major impairment, fewer than three fatalities per 10 million manipulations, and about 1 per 100 million complications 96 involving cauda equina following lumbar manipulation. If these numbers hold up to Chiropractic 53 further scrutiny, spinal manipulation would be among the safest treatments available for spinal disorders. SUMMARY Since the end of the 19th century, chiropractic has moved from a profession that was ostracized and marginalized to a position where integration into the mainstream health- care system is not only possible, but is actually in process. This has been largely due to the development of a defined and regulated chiropractic educational process, licensure, insurance recognition and a growing body of clinical research that supports the use of chiropractic treatment for some conditions. These privileges have come about primarily through a strong public demand for chiropractic and a commitment on the part of chiropractic academic institutions to outcomesbased research to evaluate clinical claims. The exact role of chiropractors in the treatment of disorders outside the classic realm of the musculoskeletal system, however, remains controversial. Although there is a reasonable body of controlled clinical research to support a role for chiropractors in the treatment of low back pain, neck pain and certain types of headache, it is not yet easy to identify the patient most likely to respond to manipulative treatment. The exact mechanism by which manipulation obtains its success is not well understood, although this is an arena of increased study. The issue of claims for effectiveness based on anecdotal experience and case reports remains a source of contention between chiropractors and medical practitioners. These issues are slowly being addressed and it can be expected that the future will bring greater clarity in our understanding of the role of chiropractic, if any, in the care of patients with disorders beyond the musculoskeletal system. It can be anticipated that patients will continue to seek the care of chiropractors in ever-greater numbers. Improvement in understanding of the role of chiropractors and other alternative and complementary practices should therefore be considered to be in the best interest of the significant fraction of patients who combine these treatments with more conventional medical care. Trends in alternative medicine use in the United States, 1990–1997: results of a followup national survey. Chiropractic Health Care: a National Study of Cost of Education, Service, Utilization, Number of Practicing Doctors of Chiropractic and Other Key Policy Issues. Washington, DC: The Foundation for the Advancement of Chiropractic Tenets and Science, 1980 6. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Rockville, MD: US Department of Health and Human Services, Agency for Health Care Policy and Research, 1994 8. Scientific approach to the assessment and management of activity related spinal disorders.
The spinal cord may protrude through an opening in the vertebrae of the spinal column Ultrasound—An imaging technique that uses (myelomeningocele) order 100 mg extra super levitra amex. Children who survive infancy have sound waves to help visualize internal structures profound mental retardation and may experience in the body order extra super levitra 100mg fast delivery. GALE ENCYCLOPEDIA OF GENETIC DISORDERS 891 ably prominent heels buy generic extra super levitra 100mg, “rocker-bottom foot trusted 100 mg extra super levitra,” and miss- ing ribs. Genital malformations are common in individ- uals affected with Patau syndrome and include undescended testicles (cryptorchidism), an abnormally developed scrotum, and ambiguous genitalia in males, or an abnormally formed uterus (bicornuate uterus) in females. In nearly all cases, affected infants have respiratory difficulties and heart defects, including atrial and ventric- ular septal defects (holes between chambers of the heart); malformed ducts that cause abnormal direction of blood flow (patent ductus arteriosus); holes in the valves of the lungs and the heart (pulmonary and aortic valves); and misplacement of the heart in the right, rather than the left side of the chest (dextrocardia). The kidneys and gas- trointestinal system may also be affected with cysts sim- ilar to those seen in polycystic kidney disease. Partial trisomy of the distal segment of chromosome 13 generally results in less severe, but still serious, symp- toms and a distinctive facial appearance including a short upturned nose, a longer than usual area between the nose and upper lip (philtrum), bushy eyebrows, and tumors made up of blood capillaries on the forehead (frontal cap- illary hemangiomata). Partial trisomy of the proximal segment of chromosome 13 is much less likely to be fatal and has been associated with a variety of facial features including a large nose, a short upper lip, and a receding jaw. A severe complication that may result in infants with Patau syndrome is synopthamia, in which the eyes are fused Beyond one month of age, other symptoms that are together in the center of the face. The eyes are sometimes set close together (hypotelorism) or even fused into a single struc- Diagnosis ture. Incomplete development of any structures in the eye Patau syndrome is detectable during pregnancy (coloboma) or failure of the retina to develop properly through the use of ultrasound imaging, amniocentesis, (retinal dysplasia) will also produce vision problems. The ears are generally mal- involves the separation and isolation of the chromo- formed and low-set. Frequently, a child with trisomy 13 somes present in cells taken from an individual. Other physical cells are generally extracted from cells found in a blood characteristics include loose folds of skin at the back of sample. The 22 non-sex linked chromosomes are iden- the neck, extra fingers or toes (polydactyly), perma- tified by size, from largest to smallest, as chromosomes nently flexed (closed) fingers (camptodactyly), notice- 1 through 22. The sex determining chromosomes are 892 GALE ENCYCLOPEDIA OF GENETIC DISORDERS also identified. ORGANIZATIONS Treatment and management Rainbows Down Under—A Trisomy 18 and Trisomy 13 Some infants born with Patau syndrome have severe Resource. Structural WEBSITES abnormalities such as cleft lip and cleft palate can be cor- Pediatric Database (PEDBASE) Homepage. Johnson Since the translocation form of Patau syndrome is genetically transmitted, genetic counseling for the par- ents should be part of the management of the disease. Prognosis IPatent ductus arteriosus Approximately 45% of infants with trisomy 13 die within their first month of life; up to 70% in the first six Definition months; and over 70% by one year of age. Survival to Patent ductus arteriosus (PDA) is a heart abnormal- adulthood is very rare. Only one adult is known to have ity that occurs when the ductus arteriosus (the temporary survived to age 33. Description They may also be able to understand words and phrases, The ductus arteriosus is a temporary fetal blood ves- follow simple commands, use a few words or signs, and sel that connects the aorta and the pulmonary artery recognize and interact with others. The ductus arteriosus should be present and open before birth while the fetus is developing in the Resources uterus. Since oxygen and nutrients are received from the BOOKS placenta and the umbilical cord instead of the lungs, the Gardner, R. Chromosome ductus arteriosus acts as a “short cut” that allows blood to Abnormalities and Genetic Counseling. PERIODICALS Closure of the ductus arteriosus usually occurs at birth as Baty, Bonnie J. If the ductus arteriosus closes Growth, Physical Assessment, Medical Histories, correctly, the blood pumped from the heart goes to the Survival, and Recurrence Risk. As noted, the size of the PDA determines how much Aorta—The main artery located above the heart harder the heart has to work and how much bigger the which pumps oxygenated blood out into the body. If the PDA is large, the bottom left side of Many congenital heart defects affect the aorta. As the heart responds to the increased demands for more oxygenated blood by pump- Ductus arteriosus—The temporary channel or ing harder, the pulmonary artery has to change in size and blood vessel between the aorta and pulmonary shape in order to adapt to the increased amount and force artery in the fetus.
In the analysis of neuronal activity buy extra super levitra 100 mg with visa, we essentially disregarded the first adaptation phase in the Early Force condition and in Early Washout cheap 100 mg extra super levitra with visa, and we focused on movements that had comparable kinematics buy 100 mg extra super levitra visa. Hence buy extra super levitra 100 mg cheap, this experimental design allowed for dissociating the neuronal activity related to the movement kinematics (the same in the three conditions) from that related to the movement dynamics (the same in the Baseline and Washout, but different in the Force condition). Most importantly, the experimental design allowed us to dissociate the neuronal correlates of motor performance from plastic changes associated with motor learning. For this dissociation, we compared the activity of neurons recorded in the Washout with that recorded in the Baseline. Indeed, the performance of the monkey (kinematics and dynamics) was essentially identical in the two conditions. The only difference was that in the Washout the monkeys had previously adapted and learned a new dynamic. Hence, changes in the activity in the Washout compared to the Baseline were associated with that learning experience. In particular, we recorded and analyzed the activity of 162 individual neurons in a movement-related time window (from 200 msec before the movement onset to the end of movement). As first described by Georgopoulos and colleagues,14 we found that a large proportion of neurons in M1 were directionally tuned in the Baseline; their activity differed for movements in different directions. Surprisingly, however, we found that some of the neurons that were initially not tuned in the Baseline acquired a new directional tuning in the Force condition following adaptation to the force field. In some cases, these “tune-in” cells maintained their newly acquired directional tuning in the Wash- out following readaptation to the unperturbed conditions. Conversely, other neurons that were initially tuned lost their directional tuning following adaptation (“tune- out” neurons). The presence of these two groups of cells is an indication of what seems to be an intrinsic property of cells in M1: to be shaped by experience and to undergo plastic changes in a relatively short period of time. A further analysis, however, revealed another variety of plastic changes associated with motor learning. Specifically, neurons that were directionally tuned throughout the three conditions (Baseline, Force, and Washout) generally changed their preferred direction (PD) as the monkey adapted to the perturbation and readapted to the unperturbed conditions in the washout. Interestingly, in some cases, the final PD in the Washout was different from that originally recorded in the Baseline. In conclusion, these data strongly suggest that M1 plays a prime role in motor learning. They show a surprisingly high degree of plasticity in M1, an area that seems crucial for motor control (for instance, lesions to M1 dramatically disrupt movement genera- tion). Moreover, they show that plastic changes can be induced by a relatively brief exposure to new forces. But how can the same population of neurons effectively support motor performance (after all, movements in the Washout are as good as in the Baseline) and at the same time be flexible enough to support motor learning? A closer inspection of the changes of PD recorded for individual neurons and for the entire population offers a glimpse into this fascinating question. Specifically, when monkeys adapt to a curl force field, the PD of muscles shifts in the direction of the external force (CW or CCW, depending on the force field). The reason for this shift is that the internal forces exerted by muscles sum with the external force field in the Force condition. As a result, the monkey maximally activates any given muscle in the Force condition to execute movements in a direction (the new PD) different from the direction that elicited maximal muscle activation in the Baseline (the old PD). Most importantly, the PD shifts for all the muscles in the same direction, namely the direction of the external force field, independently of the original PD. We verified these predictions empirically by recording in our monkeys the EMG of five muscles of the upper arm (pectorals, deltoid, triceps, biceps, and brachioradialis). We found that the PD of all muscles shifted in the direction of the external force, on average by 19. These changes of PD observed for the muscle EMG offer a framework for interpreting the activity of neurons. For each neuron in M1 directionally tuned in both conditions, we computed the shift of PD in the Force as compared to the Baseline.
In the United States order 100 mg extra super levitra visa, Lyme disease accounts for more than 90% of all reported vector-borne illnesses cheap extra super levitra 100mg with visa. It Side effects is a significant public health problem and continues to be diagnosed in increasing numbers buy extra super levitra 100 mg with mastercard. The Centers for Dis- There are no specific side effects discount extra super levitra 100 mg otc, but individual ag- ease Control and Prevention (CDC) attributes this in- gravations may occur. In addition, some epidemiologists be- lieve that the actual incidence of Lyme disease in the When taking any homeopathic remedy, it is advised United States may be 5–10 times greater than that report- to avoid peppermint products, coffee, or alcohol. The reasons for this difference include products may cause the remedy to be ineffective. Controversy clouds the true incidence of Lyme dis- ease because no test is definitively diagnostic for the dis- Resources ease, and many of its symptoms mimic those of so many BOOKS other diseases. It is caused by an in- fection transmitted by the bite of ticks carrying the Borrelia burgdorferi bacterium. The disease is also found in Scandi- be removed before the 24 hours or more of continuous navia, continental Europe, the countries of the former feeding needed to transmit Bb. Soviet Union, Japan, and China; in addition, it is possi- ble that it has spread to Australia. Causes & symptoms The risk for acquiring Lyme disease varies, depend- Lyme disease is a collection of effects caused by Bb. A Once Bb gains entry to the body through a tick bite, it tick passes through three stages of development—larva, can move through the bloodstream quickly. Only 12 nymph, and adult—each of which is dependent on a live hours after entering the bloodstream, Bb can be found in host for food. In the United States, Bb is borne by ticks cerebrospinal fluid (which means it can affect the ner- of several species in the genus Ixodes, which usually vous system). Treating Lyme disease early and thorough- feed on the white-footed mouse and deer (and are often ly is important because Bb can hide for long periods called deer ticks). In the summer, the larval ticks hatch within the body in a clinically latent state. That ability from eggs laid in the ground and feed by attaching them- explains why symptoms can recur in cycles and can flare selves to small animals and birds. It is the next stage—the tant to note, however, that not everyone exposed to Bb nymph—that causes most cases of Lyme disease. Nymphs are very active from spring through early sum- mer, at the height of outdoor activity for most people. Lyme disease is usually described in terms of length Because they are still quite small (less than 2 mm in of infection (time since the person was bitten by a tick length), they are difficult to spot, giving them ample op- infected with Bb) and whether Bb is localized or dissem- portunity to transmit Bb while feeding. Although far inated (spread through the body by fluids and cells carry- more adult ticks than nymphs carry Bb, the adult ticks ing Bb). Furthermore, when and how symptoms of Lyme 1252 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 The first sign of lyme disease is usually an itchy rash around the site of the tick bite. Late disseminated disease and chronic Lyme People who experience recurrent bouts of symptoms disease over time are said to have chronic Lyme disease. Weeks, months, or even years after an untreated tick bite, symptoms can appear in several forms, including: Early localized Lyme disease • fatigue, forgetfulness, confusion, mood swings, irri- The most recognizable indicator of Lyme disease tability, numbness is a rash around the site of the tick bite. Often, the tick • neurologic problems, such as pain (unexplained and not exposure has not been recognized. The rash—erythema usually one-sided but may be on both sides), and a mim- migrans (EM)—generally develops within 3–30 days icking of the inflammation of brain membranes known and usually begins as a round, red patch that expands. The rash may look like a bruise on and other musculoskeletal complaints individuals with dark skin. Of those who develop Less common effects of Lyme disease are heart ab- Lyme disease, about 50% notice the rash; about 50% normalities (such as irregular rhythm or cardiac block) notice flu-like symptoms, including fatigue, and eye abnormalities (such as swelling of the cornea, headache, chills and fever, muscle and joint pain, and tissue, or eye muscles and nerves). However, a rash at the site can also be an allergic reaction to the tick saliva rather Diagnosis than an indicator of Lyme disease, particularly if the rash appears in less than 3 days and disappears only A clear diagnosis of Lyme disease can be difficult, days later. Sharp, intense pain may be ease may mimic other conditions, including chronic fa- relieved by applying an ice pack to the affected area.