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    Zone 1 includes the area between the shoulder of the glenoid compo- nent and the glenoid itself cheap 160mg diovan with visa. It would not be surprising that a radiolucent zone would appear in the area as the hard subchondral surface does not permit interdigitation with the cement order 40 mg diovan mastercard. It was considered to be grade 2 when it was in contact with the lower screw discount 80mg diovan with amex, grade 3 when it was over the lower screw and grade 4 when it extended under the baseplate. Classification of bone defection of the scapular notch in patients with inverse shoulder arthroplasty. Based on the location, the defects were cate- gorized as central, peripheral (anterior or posterior), or combined (cen- tral and peripheral) deficiencies. Based on the severity, deficiencies were classified as mild if they involved less than one third of the glenoid rim or surface, moderate if they involved between one third and two thirds, and severe if the involved more than two thirds. Mild and moderate deficiencies are often suitable for component reimplantation with or without bone grafting of glenoid. Severe central or combined deficiencies often preclude implantation of new component 18. Finally, the location of the heterotopic bone formation was recorded as proximal or distal to the head of the humeral component. Classification of heterotopic bone formation following total shoulder arthro- plasty. The authors consider a hundred-point scoring system, combined with the ability to assess individual parameters with numerical values, to be the best method of functional assessment of the shoulder. The first subjective pa- rameter assesses the most severe degree of pain experienced during ac- tivities of normal daily living (Table 10). The other subjective parameter assessed is the ability of the individu- al to carry out daily activities in relation to work, recreation, and ability to sleep (Table 11). The ability of the patient to perform everyday activ- ities in terms of the position of the arm in relation to the trunk is also evaluated. Twenty points may be allocated for activities of daily living, as shown in Table 11. Scoring for individual parameters Parameter Score Pain 15 Activities of daily living 20 Range of motion 40 Power 25 Total 100 200 19 Scores Table 10. Scoring for pain experienced during normal daily activity Pain experienced Score None 15 Mild 10 Moderate 5 Severe 0 Table 11. Scoring for activities of daily living Activity Score Activity level Full work 4 Full recreation/sport 4 Unaffected sleep 2 Positioning Up to waist 2 Up to xiphoid 4 Up to neck 6 Up to top of head 8 Above head 10 Total 20a a Only one of the five positions is found in each patient. The maximum points attain- able by a normal individual in this section can only be 20 activities outside work and two to unaffected sleep. The patient is asked to say what percentage of work and recreation has to be abolished as a result of the shoulder problems. One must be sure that sleep disturbance is caused by the shoulder and not by other problems, before reducing the allocated points. The other 10 points allocated to activities of daily living are given for the ability to perform tasks at a variety of levels, ranging from below waist to above head level. This is not the assessment of pure motion; it is the assessment of the ability of the hand to work at the levels de- scribed. Since the shoulder at rest will allow below-waist activities to be undertaken without much shoulder function, such activ- ities get only 2 points. Increasing point for activities above the level are allocated as shown in Table 11. The objective assessment rates the patient on painless active motion in the planes of pure forward and lateral elevation (Table 12), as well as composite functional external and internal rotation (Tables 13 and 14). Finally the shoulder power is included in the assessment, and is mea- sured as abduction power at 908 (or less if the patient is unable to ab- duction to that level). He used a tensiometer to measure isometric power of the shoulder at 908 of lateral elevation.

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    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) cheap diovan 80 mg visa, they are difficult to spot discount 160 mg diovan free shipping, giving them ample op- infected with Bb) and whether Bb is localized or dissem- portunity to transmit Bb while feeding order 160mg diovan overnight delivery. 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. The patient may treat Lyme disease by visual- other diseases with many symptoms involving multiple izing Bb as looking like ticks swimming in the blood- body systems. Differential diagnosis (distinguishing stream being killed by the flame of a candle. Lyme disease from other diseases) is based on clinical evaluation with laboratory tests used for clarification, • Probiotics. A two-test approach is common to con- ficial microbes either by ingestion or through a sup- firm the results. Probiotics can restore a healthy balance of results (false-positive and false-negative), laboratory bacteria to the body in cases where long-term antibi- tests alone cannot establish the diagnosis. Yo- gurt or Lactobacillus acidophilus preparations may Doctors generally know which disease-causing or- be ingested. The most helpful piece of information is whether a tick bite or rash • Supplements. Use calcium and magnesium for aches, was noticed and whether it happened locally or while chlorophyll to aide healing, vitamin C for bacterial in- traveling. Doctors may not consider Lyme disease if it is fection and inflammation, bioflavonoids for joint in- rare locally, but will take it into account if a patient men- flammation and to boost the immune system, diges- tions vacationing in an area where the disease is com- tive enzyme for digestive problems, vitamin B com- monly found. Treatment While antibiotics are essential in treating Lyme dis- Allopathic treatment ease, many alternative therapies may minimize symp- toms, improve the immune response, and help treat late For most patients, oral antibiotics (doxycycline or disseminated or chronic disease. The doctor may guidelines include drinking plenty of fluids and eating have to adjust the treatment regimen or change medica- cooked whole grains and fresh vegetables. Antibiotics can sugar, fat, refined carbohydrates, and dairy products kill Bb only while it is active, rather than while it is dor- should be reduced. When symptoms indicate nervous system involve- Lyme disease include: ment or a severe episode of Lyme disease, intravenous antibiotic (ceftriaxone) may be given for 14–30 days. Formulae used to treat systemic bac- Some physicians consider intravenous ceftriaxone the terial infections include Wu Wei Xiao Du Yin (Five-In- best therapy for any late manifestation of disease, but gredient Decoction to Eliminate Toxin), Yin Hua Jie Du treatments for late Lyme disease are still controversial Tang (Honeysuckle Decoction to Relieve Toxicity), and as of 2003. Inflammation at the site of infection may be treated externally with Yu Lu San (Jade Dew Extract) or Expected results Jin Huang San (Golden Yellow Powder). Specific Chi- nese herbs and treatments can be used for specific If aggressive antibiotic therapy is given early, and symptoms.

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    Resting state fluctuations generic 40mg diovan with visa, pharmacological manipulations order diovan 40mg online, and analyses of functional or effective connectivities were not covered or were barely touched upon order 80 mg diovan overnight delivery, though they offer interesting prospects. Yet, in addition to providing some sort of overview, we hope this chapter can help achieve a better assessment of the strengths and limitations of magnetic resonance as a tool in the neurosciences in general and in the study of Copyright © 2005 CRC Press LLC motor control in particular. Sensorimotor function is associated with a distributed neural substrate, and the fact that fMRI readily covers the entire brain is helpful in this respect. Highly focalized research techniques are hypothesis-driven, at least in terms of the location they target, and this impairs the potential for new discoveries. In that sense, even if fuzzy, a picture of activity in the entire brain may help to generate and then test novel hypotheses, apart from offering plausibility controls for ongoing studies. Furthermore, the fact that the contrast agent exploited in the BOLD contrast is endogenous and thus permanently present permits a true neurophysio- logical recording that can go beyond evoked responses. In other words, fMRI hits hard biological limits, not technical ones, even though technical difficulties are abundant and not yet always fully mastered. Studies in the visual system with fMRI have established that dedicated acquisition and analysis techniques can resolve much smaller functional cortical units than in the currently available motor studies discussed here. Many of the topics discussed in the previous sections illustrated that one of the major shortcomings of functional neuroimaging studies still lies in the uncertainties of anatomical labeling. Each brain is different, but previous neuroimaging techniques required normalizing the data into a common standard stereotactic space so as to perform averaging of voxel-based signals from roughly homologous brain areas across subjects. These group analyses then had sufficient statistical power and the advantage of ensuring some degree of generality in terms of volume coverage and intersubject variability. Even if a spatial normalizing technique incorporates nonlinear algorithms that warp one gyrification pattern rather well into another, the correspon- dence of actual brain areas becomes blurred by these procedures, and accordingly probabilistic atlases are the closest one can get to reality in this setting. In the previous sections, it has become obvious that such maps can indeed be helpful in tentatively assigning fMRI responses to certain areas, but often enough, even prob- abilistic statements leave painful uncertainties as to which areas we are obtaining effects from. The set of neuroanatomical criteria range from cyto- and myeloarchitectonic features to densities and laminar distributions of receptors and other neurochemical markers. However, these conclu- sions were based on relating functional findings from one or several brains to a database formed from many other and thus different brains. The desideratum at this Copyright © 2005 CRC Press LLC stage is to map areas in individual subjects, namely those subjects in whom we can also obtain physiological observations, thus avoiding the limitations introduced by intersubject variability. Whether this will be achieved by morphological or functional criteria is not yet clear, but in any case this will need to be done in a noninvasive fashion and will thus require imaging techniques. More- over, some finger muscles, because of tendon interconnections and incompletely subdivided muscle bellies, exert tension simultaneously on multiple digits. Conse- quently, each digit does not move independently of the others, and additional muscle contractions must be used to stabilize against unintended motion. This biological control of a complex peripheral apparatus initially may appear unnecessarily com- plicated compared to the independent control of digits in a robotic hand, but can be understood as the result of concurrent evolution of the peripheral neuromuscular apparatus and its descending control from the motor cortex. What began as intercon- nected bony rays supporting a fin evolved into a hand with digits capable of relatively independent motion. During this evolution, the pressures of natural selection con- currently influenced both the peripheral musculoskeletal apparatus and the central mechanisms for its neural control. The resulting biological hand, which has reached its most sophisticated form in primates, especially humans, nevertheless retains many structural and functional features of the ancestral appendage. To understand how the motor cortex participates in controlling finger movements, we must appreciate cer- tain aspects of how the peripheral apparatus of a biological hand works. Here, we will consider first the motion of the fingers themselves, then the functional organi- zation of the muscles that move the fingers, and then how M1 controls finger movements. Because M1 plays a particularly crucial role in controlling fine, indi- viduated finger movements, we will focus on features that affect the independence of finger movements. Further along the phylogenetic scale, mammals such as rats and cats can be observed to mold the digits of the forepaw to grasp objects.

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    Your doctor will want to know if you or anyone in your family has had any of these conditions: pregnancy purchase 160mg diovan mastercard, tuberculosis buy diovan 160mg visa, nervous system disease order diovan 160 mg visa, breast cancer, benign cystic disease, alcoholism, liver disease. Your doctor will do a physical examination including the fol- lowing: thorough breast exam, checking lymph nodes under your arms, and, in males, checking testes for size and firmness. BREAST PROBLEMS 27 WHAT CAN CAUSE BREAST PROBLEMS, AND WHAT IS TYPICAL FOR EACH CAUSE? BREAST ENLARGEMENT CAUSE WHAT IS IT YPICAL SYMPTOMS Puberty Period of becoming Enlargement of one or both sexually mature, or breasts, common and capable of reproducing normal in male and female adolescents Long-term use Use of spironolactone Breast enlargement in adult of certain (Aldactone), digoxin men medications (Lanoxin), diphenyl- hydantoin (Dilantin), cimetidine (Tagamet) Liver disease Includes hepatitis and Breast enlargement in adult cirrhosis (scarring of the men, jaundice (skin taking liver) on a yellowish appear- ance), alcoholism, small and soft testicles Testicular An abnormal growth of Breast enlargement in adult cancer cells in the testicles men, firm mass in the testicles LUMPS OR MASSES CAUSE WHAT IS IT YPICAL SYMPTOMS Cystic mastitis Fluid-filled sacs in the Lumps in the breast, usual- breast ly becoming painful before each menstrual period Cancer An abnormal growth of Family history of breast cells in the breast cancer, lump with an ill- defined border, sometimes with dimpling of the over- lying skin 28 BREAST PROBLEMS WHAT CAN CAUSE BREAST PROBLEMS, AND WHAT IS TYPICAL FOR EACH CAUSE? What can make it worse: dust, chest injury, lying down, exertion, breathing in a particular substance, prolonged inactivity, recent sur- gery, certain times of year, allergies, emotional stress. Your Doctor Visit What your doctor will ask you about: anxiety, confusion, light- headedness, lethargy, fever, chills, night sweats, blueness or numb- ness in lips or fingers, cough, coughing up sputum or blood, wheez- ing, noisy breathing, swelling, weight change, the influence of being upright on your ability to breathe, chest pain, ankle swelling, previ- ous chest X-rays, electrocardiograms, tests of lung function, allergy skin tests. Your doctor will want to know if you or anyone in your family has had any of these conditions: heart disease, high blood pres- sure, obesity, pneumonia, chest surgery, anemia, tuberculosis, AIDS, allergies to drugs, eczema, hay fever, lung failure, chronic lung dis- eases such as bronchitis, emphysema, or fibrosis. Your doctor will want to know if you smoke cigarettes and, if so, how many and for how long. Your doctor may also ask where you have lived and if you have worked in certain professions linked to breathing problems, such as mining, stone carving, painting, and quarry work. Your doctor will do a physical examination including the fol- lowing: blood pressure, pulse, breathing rate, weight, temperature, listening to your chest and heart with a stethoscope, thorough neck exam, checking your arms and legs for swelling or discoloration, pushing on your abdomen, thorough skin exam. CAUSE WHAT IS IT YPICAL SYMPTOMS Asthma Recurrent attacks of Attacks typically occur wheezing, coughing, and after exposure to certain shortness of breath triggers, such as pollen, brought on by certain respiratory infections, triggers animals Anemia (See Low blood count Easy fatigue, dizziness that chapter on occurs in certain positions, Weakness. What can make it worse: dust, injury, exertion, breathing in a cer- tain substance, particular times of the year, allergies, stress. Healthy infants can experience “rattling” or noisy breathing until up to 5 months of age, while their respiratory systems develop. Your Doctor Visit What your doctor will ask you about your child: anxiety, change in voice, drooling, sore throat, trouble swallowing, decreased eating, cough, coughing up sputum, wheezing, blueness of lips or fingers, fever, chills, weight loss, chest pain, ankle swelling, confusion, lethar- gy. The doctor will also want to know if there is a history of exposure to dust or whether the child has inhaled a foreign body, how long the breathing problem has gone on, and whether the child has ever had a chest X-ray, and if so, what it showed. Your doctor will want to know if the child is taking any med- ications, including: steroids, asthma medications, antihistamines, decongestants, allergy shots, antibiotics, inhalants, beta-blocking agents. WHAT CAN CAUSE BREATHING PROBLEMS IN CHILDREN, AND WHAT IS TYPICAL FOR EACH CAUSE? CAUSE WHAT IS IT YPICAL SYMPTOMS Asthma Recurrent attacks of Attacks typically caused by wheezing, coughing, and exposure to certain trig- shortness of breath gers, nighttime cough brought on by certain triggers Bronchiolitis Infection of some of the Fever, rapid breathing, tiny branches of the lungs wheezing, flaring nostrils, more common in infants less than 6 months old Croup Infection in the voicebox Barking cough, wheezing, fever, hoarseness, typically appears after a cold, more common in children between 6 months and 3 years old Epiglottitis Infection or inflammation Vibrating sound during of the flap in the back of breathing, muffled speak- the throat that blocks air ing, sore throat, trouble passages during swallowing, fever, drool- swallowing ing, most common in chil- dren between 3 and 7 years old Hyperventilation Rapid, shallow breathing Sudden onset of breathing trouble, anxiety, chest pain (adolescents), light-headed- ness, tingling around the mouth, numbness in hands, more common in children older than 6 years Pneumonia Infection of the lungs Coughing up sputum, high fever, rapid breathing BREATHING PROBLEMS (CHILD) 35 WHAT CAN CAUSE BREATHING PROBLEMS IN CHILDREN, AND WHAT IS TYPICAL FOR EACH CAUSE? Bruising and Bleeding Tendencies What it feels like: being quick to bruise after minor injury, sponta- neous bleeding, or bleeding for long periods of time after a cut. Your Doctor Visit What your doctor will ask you about: fever, chills, headache, swollen lymph nodes, joint swelling, dark or bloody urine, black and tar-like bowel movements, jaundice (skin taking on a yellowish appearance), skin rashes, infections. Your doctor will want to know if you or anyone in your family has had any of these conditions: liver disease, valvular heart dis- ease, hemophilia, systemic lupus erythematosus, tendency toward easy bruising or excess bleeding at the time of birth or later, particu- larly during surgeries or dental work. Your doctor will do a physical examination including the fol- lowing: temperature, listening to your heart with a stethoscope, pushing on your abdomen, checking joints for swelling, thorough skin exam, checking lymph nodes to see if they are enlarged. If you are going to have elective or nonelective surgery, be sure to tell your surgeon about your bruising or bleeding tendency. BRUISING AND BLEEDING TENDENCIES 37 WHAT CAN CAUSE A TENDENCY TO BRUISE OR BLEED EXCESSIVELY, AND WHAT IS TYPICAL FOR EACH CAUSE? CAUSE EXAMPLES TYPICAL SYMPTOMS Lack or poor Hereditary disease Large superficial bruises, function of sub- (hemophilia), medication spontaneous bleeding stances in the use (warfarin and other blood that en- anticoagulants), liver able it to clot disease Lack or poor Medication use (diuretics Small, superficial bruises, function of and steroids), leukemia, prolonged bleeding, spot- blood particles diseases of the blood sized bleeding into the called platelets, vessels, infections skin or fragile blood (bacterial infections of vessels the heart, Rocky Mountain spotted fever) Burns What it feels like: pain, blistering, and charred skin caused by injury from electricity, fire, or chemicals. Your Doctor Visit What your doctor will ask you about: pain, blistering, trouble breathing, loss of consciousness. If the burn was electrical, the doc- tor will ask where the source touched you, and what the source was.

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