Copyright © Walter Egan. All Rights Reserved.
Come celebrate the Spring Equinox and Walter Egan and William Adair’s exhibitions at Gypsy Sally’s on Thursday March 20th from 6:00 to 9:00 p.m.
Walter Egan will perform an acoustic set of his songs as well as songs by the musical artists depicted in his exhibition of paintings, Martyrs of Rock.
The exhibition and performance are FREE and open to the public.
Egan and Adair’s exhibitions will continue through March 29th at Gypsy Sally’s in Georgetown.
“Walter Egan is known worldwide for his hit single “Magnet and Steel.” Egan’s song, with Stevie Nicks singing background vocals, has been featured in movies such as Boogie Nights, Deuce Bigalow, Overnight Delivery, The Night We Never Met, and This is 40, among others. I’ve heard “Magnet and Steel” in elevators as muzak. Another song of Walter’s, “Hot Summer Nights,” served as the inspiration for Eminem’s hit record, “We Made You,” a top- 10 single. His song “Hearts on Fire” was recorded by Gram Parsons, the champion of the music genre known as Americana. A member of the bands Spirit, Burrito Deluxe, and the Brooklyn Cowboys, Egan has performed with everyone from Jackson Browne to Wanda Jackson. His music has been heard by millions of people and his accomplishments as a musician, performer and recording artist are known far and wide.
While Egan is well known as a musical artist, most people don’t know that Egan is also a visual artist who has developed a unique style. He earned a degree from Georgetown University in Fine Art in 1970. Since that time, Egan has continued to develop his raw, personal and powerfully enigmatic painting style. Egan’s paintings are a testament to his parallel talents as a visual artist. In this series of paintings, he pays homage to many of the musicians who have inspired him. These portraits, from Ricky Nelson, to Jimi Hendrix, to Amy Winehouse, reveal Egan’s sensitivity as a painter and his intimate connection with his subjects.” – Chris Murray
From the exhibition catalogue for Walter Egan’s Martyrs of Rock.
Copyright © William Adair. All Rights Reserved.
The I Threes, Bob Marley, and Junior Marvin. Copyright © David Burnett. All Rights Reserved.
This weekend Bob Marley’s long-time guitarist extraordinaire Junior Marvin is going to perform with his band the entire “Uprising” and “Exodus” albums from start to finish at the amazing club The Hamilton Live in Washington, DC.
Junior Marvin was by Bob Marley’s side both on stage and in the recording studio from the time of the “Exodus” album to Marley’s untimely passing. Junior, who was born in Jamaica and grew up in London, was known as the “British Jimi Hendrix” when he got a call on Valentine’s day 1977 from Bob Marley asking him to join his band.
This is a rare opportunity to see Junior Marvin perform both albums, “Uprising” on Friday, February 28th and “Exodus” on Saturday, March 1st.
This photo of Junior Marvin performing with Bob Marley is featured in award-winning photographer David Burnett’s book Soul Rebel. Burnett’s photographs are available through Govinda Gallery.
Donovan’s ‘aide-de-camp’ Chris Murray, Howard Stern, and Donovan. The Howard Stern Show studios, February 5th, 2014. Copyright © Sebastian Leitch. All Rights Reserved.
Donovan’s recent appearance on the Howard Stern Show February 5th was one to remember. Howard Stern has been doing the best interviews of important musical artists of anyone in the media. His recent interviews with Paul McCartney, Lady Gaga, Rod Stewart, and Graham Nash have been extraordinary. Donovan’s interview was the latest and one of the greatest.
Stern has a great love and knowledge of rock music and you can appreciate that in his in-depth and insightful approach to these significant interviews. Donovan’s interview went for an hour and twenty minutes live on-air without interruption. It was fascinating to hear Donovan trace the roots of rock and roll to the ballad form that came out of the earlier Irish and English traditions that were then transplanted to America and out of which developed folk, country, and blues music. Donovan told many wonderful stories including his time in India with the Beatles and played portions of a number of his extraordinary hit songs from Catch the Wind to Hurdy Gurdy Man.
The team at the Howard Stern Show was wonderful including executive producer Gary Dell’Abate, Steve Brandano, Will Murray, the great Fred Norris and Robin Quivers, as well as Ronnie ‘the Limo Driver’ and Scott the engineer. It was wonderful to meet Howard after the interview. He could not have been more charming and appreciative of Donovan’s visit. We love Howard Stern.
A few days later Allan Kozinn in the New York Times wrote about Donovan’s induction into the Songwriter’s Hall of Fame. It is a great honor for Donovan and one that is well deserved.
The New York Times
February 11, 2014
by Allan Kozinn
“The Songwriters Hall of Fame is expected to announce on Tuesday that its 2014 class of inductees will include Donovan, Ray Davies, Graham Gouldman, Mark James and Jim Weatherly. They will be formally inducted in a ceremony in New York on June 12.
The hall, which was founded in 1969, and has a gallery with video exhibits and interactive displays at the Grammy Museum in Los Angeles, regards its mission as honoring established songwriters and nurturing young ones. It offers educational programs, including master classes, workshops and scholarships.
Though the hall’s more than 400 inductees include songwriters that go back to the 19th century, as well as a hefty representation of Tin Pan Alley composers, this year’s crop is drawn from melodists who came to prominence between the mid-1960s and early 1970s, but who represent several styles.
Donovan, a versatile folk singer whose first hits were Dylanesque pieces like “Catch the Wind” and “Colors,” went on to write late-60s pop classics (“Season of the Witch,” “Sunshine Superman”), epics of early psychedelia (“Mellow Yellow,” “Hurdy Gurdy Man,” “Atlantis”) and in recent years, country-tinged ballads (“Blue Jean Angel,” “Shadows of Blue”)…”
Tom Zito, Washington Post Music Critic, Chris Murray, Govinda Gallery Director, and Walter Egan, in the ‘greenroom’ backstage at The Cellar Door, Georgetown, 1977. Copyright © Govinda Gallery Archive. All Rights Reserved.
Walter Egan is celebrating his exhibition of paintings, Martyrs of Rock, with a reception tomorrow night at Gypsy Sally’s in Georgetown from 7:00 to 10:00 p.m. and Egan will perform at 9:30 p.m.
This photograph was taken at Georgetown’s legendary music venue The Cellar Door while Egan was performing there in 1977. Govinda Gallery and The Cellar Door were both on 34th street and Gypsy Sally’s is on 34th Street today.
Tomorrow, February 5th, 2014, Donovan will be featured on the Howard Stern show at 7:00 a.m. for an hour long in-depth interview. If you have Sirius Radio don’t miss this exclusive interview! Donovan’s Sapphographs are available through Govinda Gallery.
Jack Duganne, Chris Murray, Douglas Kirkland, and Mac Holbert at Nash Editions with Marilyn Monroe proofs, Manhattan Beach, California, 1992. Copyright © Govinda Gallery Archive. All Rights Reserved.
Photographer Douglas Kirkland’s extraordinary career was recently honored at Photo LA. Kirkland has had a very significant impact on Govinda Gallery and our photography program.
Douglas Kirkland and Chris Murray at the Light Years opening at Govinda Gallery in April of 1990. Copyright © Chester Simpson. All Rights Reserved.
It was my great honor to host Kirkland’s first two exhibitions at Govinda Gallery, Light Years in the spring of 1990 and Icons in the fall of 1993. Light Years launched Kirkland’s book of the same name and that exhibition featured portraits of Dustin Hoffman, Ann Margaret, Catherine Deneuve, Marilyn Monroe, Elizabeth Taylor, and many more.
Kirkland’s second exhibition at Govinda Gallery, Icons, was the first exhibit anywhere that exclusively featured pigment prints. Not only is Douglas Kirkland a great photographer, he is also a pioneer of the pigment printing methods that have now been embraced by photographers and artists worldwide.
After Kirkland’s Light Years exhibition I was enthusiastic to publish a portfolio of Kirkland’s unforgettable Marilyn Monroe photographs. Govinda Gallery has published photographic portfolios for a number of artists and I knew that a portfolio of Kirkland’s Marilyn Monroe photographs would be well regarded.
Kirkland’s photographs of Marilyn Monroe were so sensitive and beautiful that traditional photographic printing methods did not do those compelling images justice. Kirkland had met musical artist and photographer Graham Nash at a party and told me that Nash was soon opening up a fine art print making studio featuring a new method of making prints. He suggested we consider this new process for our portfolio project. I flew to Los Angeles and met up with Kirkland and we went to visit Nash Editions in Manhattan Beach, which had not yet opened for business.
Douglas Kirkland with the first Marilyn Monroe proof at Nash Editions, Manhattan Beach, California, 1992. Copyright © Govinda Gallery Archive. All Rights Reserved.
We met with Mac Holbert and Jack Duganne, the master printers who first worked at Nash Editions and we produced proofs of Kirkland’s photos of Marilyn Monroe. They were so beautiful that with great enthusiasm we had the portfolios printed at Nash Editions in 1992. That portfolio was the first job at Nash Editions, the studio that pioneered pigment printing. Graham Nash had started printing his own photos there and the studio had experimented with a number of artists as they started to get their machines running. But the portfolio of Douglas Kirkland’s Marilyn Monroe photographs that Govinda Gallery published was the first paid and complete project to come out of Nash Editions.
Mac Holbert of Nash Editions, Manhattan Beach, California, 1992. Copyright © Govinda Gallery Archive. All Rights Reserved.
Jack Duganne operating the printer at Nash Editions, 1992. Copyright © Govinda Gallery Archive. All Rights Reserved.
If you happen to be in Washington, DC visit the National Portrait Gallery and see Douglas Kirkland’s photo of John Travolta taken during the time of Saturday Night Fever as part of the Dancing the Dream exhibition that continues through July 13, 2014. Dancing the Dream was curated by Amy Henderson. I co-curated the Elvis at 21: Photographs by Alfred Wertheimer exhibition with the National Portrait Gallery’s Amy Henderson and Warren Perry. That exhibition has toured museums throughout the United States and is currently at the National Portrait Gallery in Australia through March 10th, 2014.
Douglas Kirkland, Jack Duganne, and Francoise Kirkland at Nash Editions, 1992. Copyright © Govinda Gallery Archive. All Rights Reserved.
Congratulations Douglas on being honored at Photo LA and to Francoise Kirkland, his muse, wife, and partner. Douglas Kirkland’s photographs are available through Govinda Gallery.
Dr. John’s New Year’s Eve set list from the Hamilton Live.
I was definitely in the ‘right place at the right time’ at the Hamilton Live for their New Year’s Eve celebration with Dr. John and the ‘Queen of Rockabilly’ Wanda Jackson. There wasn’t an empty seat in the house when Elvis’ friend and fellow performer Wanda Jackson took the stage. Wanda warmed up the crowed with her distinctive voice and her charming ways.
After her performance the one-and-only Dr. John sat at his keyboards and started his set with his great ‘gris-gris’ spirit. The Hamilton Live started rocking and didn’t stop until seventeen songs later. Dr. John took an encore with his classic song Such A Nite, and it really was such a night of awesome music!
I had the privilege of going backstage with Dr. John’s long time friend Tony Wheelock to meet Dr. John. I spoke with Donovan a day or two before the show and told him I was going to see Dr. John at the Hamilton and he asked me to give him his regards if I had the chance. Dr. John was so happy to hear from Donovan and told me “I remember my times so fondly performing with Donovan at festivals over the years”.
Dr. John by William Coupon.
William Coupon’s photos are available through Govinda Gallery.
Boardroom Heroes, Trash Bar, NYC, 2013. Copyright © Vivienne Foster. All Rights Reserved.
“WASHINGTON – Swinging mics, mid-song strums and tattooed arms. A new collection of photographs is doing more than documenting the area’s modern rock scene, it’s illustrating the fading relationship between musicians and photographers.
“4″ x 6″ East Coast Rock & Roll Photography 2013” is a pop-up exhibition at the new K Street music venue Gypsy Sally’s, organized by the Govinda Gallery and curated by local photographer Vivienne Foster.
The exhibit features photographs of East Coast rock-and-roll bands, through the lenses of six young photographers.
“Govinda Gallery is known for having shown the greatest music photographs, from Elvis right up through punk rock. But what this exhibit highlights are photographers who are shooting bands today,” says Chris Murray, director of Govinda Gallery.
But the exhibit goes beyond snapshots and portraits, it shows the audience what is often no longer available to photographers: access.
“Rarely do photographers get the kind of access that they did in the old days, when, for instance, Al Wertheimer could follow Elvis Presley or Astrid Kirchherr could be with the Beatles … but this show is wonderful because the bands are young, many of them are just signed to labels,” Murray says.
“This show reminds me a little bit of the wonderful link that photography and music had from the ‘60s and ‘70s and ‘80s and ‘90s, when the ‘golden age,’ if you will, of photography and rock-and-roll took place … I love that this show demonstrates the access and the availability that the bands allowed these young photographers to have and it really captures that energy.”
The exhibit also captures each band’s story — and what happens once the curtain closes.
“It tells the story about the journey that a young band takes, in getting gigs, performing, developing a following and that effort and that journey for a young rock band,” says Murray, who adds his favorite part is the energy and spontaneity both the musicians and the photographers bring to their art.
“For me it’s exciting, after working for a long time with legendary photographers, photographing legendary bands, here we get a chance to see photographers photographing bands, some of which may become legendary.”
Govinda Gallery will host a reception for the photographers on Thursday, Dec. 19 from 7 to 11 p.m. at Gypsy Sally’s, 3401 K Street NW. In addition to showcasing the photographs, the reception, which is free and open to the public, will also feature performances from three local bands: The Sniffs, Collapser and Boardroom Heroes.
By Rachel Nania
“4″ x 6″ East Coast Rock & Roll Photography 2013″ continues through Jan. 4, 2014.
WTOP’s Neal Augenstein contributed to this report.”
© 2013 WTOP. All Rights Reserved.
John Waters, 2012, and David Murray, 1992. Copyright © Greg Gorman. All Rights Reserved.
Last night I went to the Birchmere in Alexandria, Virginia to see John Waters’ stand-up Christmas show. It’s becoming a holiday tradition for me as this is the fifth year in a row that I’ve gone to his funny, clever, illuminating, and naughty Christmas stand-up routine at the Birchmere.
There was a terrific story in the New York Times last week about John Waters’ Christmas cards. The photo of Waters’ accompanying the story was taken by the great photographer Greg Gorman. Greg also photographed Govinda Gallery manager David Murray over 20 years ago, while David was visiting LA in the spring of ’92 when he was 10 years old. David went with me to the show at the Birchmere last night with his wife Ashley and Govinda artist Carlotta Hester and I introduced him to John backstage after his show. I brought a print of Gorman’s photo of David from 1992 with me and showed it to John, which he enjoyed seeing very much.
Greg Gorman’s photos are available through Govinda Gallery.
Sound and Vision: Monumental Rock and Roll Photography, organized by the Columbus Museum and Govinda Gallery, has traveled to the lovely Cedarhurst Center for the Arts in MT. Vernon Illinois. The exhibition at the Cedarhurst continues through December 31st. Sound and Vision has drawn great audiences throughout it’s tour with its extraordinary photographs of rock and roll musicians.
Mick Jagger, London, 1968. © Baron Wolman
four classes: incisors, canines, premolars (PM; a new class for permanent teeth), and molars. Based on location, the two permanent front teeth in each quadrant are incisors (I), followed by one canine (C), then two premolars (PM), and finally three molars (M). The dental formula for the human permanent dentition is as follows: I 2 C 1 PM 2 M 3 = 8 upper and 8 lower teeth 2 1 2 3 on either side, 32 teeth in all The classes of permanent teeth containing more than one tooth per quadrant (namely, incisors, premolars, and molars) are subdivided into types within each class. Each type can be identified by location within the quadrant. As in the primary dentition, the permanent incisor closest to the midline between the right and the levitra with food
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Buccal Ridge Prominence: The buccal ridge is more prominent on the maxillary first premolar than on the mandibular first premolar. Crown Proportions: From the occlusal view, maxillary premolars are more oblong or rectangular (considerably wider faciolingually than mesiodistally), whereas mandibular premolars are closer to equal dimension faciolingually as mesiodistally (Fig. 4-4). This difference may be even more apparent when comparing 12 levitra canada order levitra faq
When studying the proximal views of mandibular first and second premolars, refer to Figure 4-16. 1. CROWN SHAPE OF MANDIBULAR PREMOLARS FROM THE PROXIMAL VIEWS Mandibular premolars are shaped like a rhomboid from the proximal view (Appendix 6b). A rhomboid is a foursided figure with opposite sides parallel to one another, like a parallelogram. As on all mandibular posterior teeth, the crowns of the mandibular first premolars tilt noticeably toward the lingual surface at the cervix (much more than any other premolar). This tilt places the tip of the buccal cusp almost over the mid-root axis line (obvious on all mandibular first premolars in Fig. 4-16). As was also seen from the lingual aspect, the lingual cusp of the mandibular first premolar is considerably shorter than the buccal cusp by more than one third of the total crown length.Z Since it is so short, it is considered a nonfunctioning cusp (Appendix 6p). The lingual cusp tip is so lingually positioned that it is usually aligned vertically with the lingual outline of the cervical portion of the root. The short lingual cusp also Maxillary first premolar Maxillary second premolar precio levitra 20 mg
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This section is included in this chapter to provide the reader with an appreciation of the variation that can occur compared to the average (ideal) molars that have been discussed thus far in this chapter. Also, it should provide the reader with insight into the variations of teeth from ethnic populations that differ from persons in central Ohio in the 1970s whose teeth data served as the basis for many of the statements made in this book. Variation in the Number of Cusps: As mentioned earlier, nearly a fifth of mandibular first molars have only four cusps.G This four-cusp type of mandibular first molar does not taper as much from buccal to lingual as a four-cusp mandibular second molar (occlusal aspect), but it often tapers from distal to mesial, which is unusual. Mandibular first, second, and most frequently, third molars may have an extra cusp on the buccal surface of the mesiobuccal cusp, about in the middle third of the crown (Fig. 5-35). Studies show this is common in the Pima Indians of Arizona12,13 and in Indian (Asian) populations.14,15 Some mandibular first molars have a sixth cusp, which is named tuberculum sextum (too BUR kyoo lum SEKS tum) when located on the distal marginal ridge between the distal cusp and distolingual cusp; it is named tuberculum intermedium (too BUR kyoo lum in Chapter 6 | Primary (and Mixed) Dentition levitra 10mg schmelztabletten
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Chapter 8 | Application of Root and Pulp Morphology Related to Endodontic Therapy cialis senza ricetta in farmacia
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Canine-protected articulation. When the mandible moves to the patient’s right side (in the direction of the red arrow), the overlap of canines results in the separation (disocclusion) of his posterior teeth on the right side. This is the patient’s working side since the mandibular buccal cusps are lining up directly under the maxillary buccal cusps (as during chewing or working). E. CHANGING TOOTH LOCATION TO TREAT MALOCCLUSION cialis avec paypal
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prepared method and the Leaf Gauge-Leaf Wafer System. RGO 1992;40(5):356–360. Woelfel JB. New device for deprogramming and recording centric jaw relation: the sliding guiding inclined gauge. Advanced Prosthodontics Worldwide, Proceedings of the World Congress on Prosthodontics, Hiroshima, Japan, September 21–23, 1991:218–219. Woelfel JB. A new device for mandibular deprogramming and recording centric relation: the sliding guiding inclined gauge. Protesi occlusionone ATM a cura di Giorgio Vogel FDI 1991. Milan, Italy: Monduzzi Editore III, 1991: 35–40. Woelfel JB. Sliding and guiding the mandible into the retruded arc without pushing. Compend Contin Educ Dent 1991(Sept);12(9):614–624. Woelfel JB. An easy practical method for centric registration. Jpn J Gnathol 1994;15(3):125–131. Tsolka P, Woelfel JB, Man WK, et al. A laboratory assessment of recording reliability and analysis of the K6 diagnostic system. J Craniomandib Disord Facial Oral Pain 1992;6:273–280. Donegan SJ, Carr AB, Christensen LV, et al. An electromyographic study of aspects of “deprogramming” of human jaw muscles. J Oral Rehabil 1990;17:509–518. Carr AB, Donegan SJ, Christensen LV, et al. An electrognathographic study of aspects of “deprogramming” human jaw muscles. J Oral Rehabil 1991;18:143–148. Christensen LV, Carr AB, Donegan SJ, Ziebert GJ. Observation on the motor control of brief teeth clenching in man. J Oral Rehabil 1991;18(1):15–29. Kruger L, Michel F. A single neuron analysis of buccal cavity representation in the sensory trigeminal complex of the cat. Arch Oral Biol 1962;7:491–503. Kawamura Y, Nishiyama T. Projection of dental afferent impulses to the trigeminal nuclei of the cat. Jpn J Physiol 1966;16:584–597. Jerge CR. Comments on the innervation of the teeth. Dent Clin North Am 1965(3);117–127. cialis and heart attack cialis canadian drugs
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Attrition results from prolonged bruxism or grinding of the teeth. A. The anterior teeth have been worn down almost to the gingival sulcus. B. The permanent mandibular incisors are worn down to a level where the pulp chamber had been at one time many years previously. (Note the darker circular and oval areas of exposed secondary or reparative dentin visible on the incisal ridges.) cialis sale on line
Part 2 | Application of Tooth Anatomy in Dental Practice 365 il cialis fa male types of cialis
• Blocks of carving wax (34 × 17 × 17 mm for molars or 32 × 12 × 12 mm for other teeth) • Boley gauge (Vernier caliper) • Millimeter ruler OPENINGS—TERMS USED TO DESCRIBE HOLES IN BONES AND/OR TEETH Aperture: an opening; compare a camera lens aperture Foramen [fo RAY men] (plural: foramina [fo RAM i nah]): a small hole through bone or tooth for passage of nerves and vessels Foramen ovale [o VAL ee]: a specific oval or eggshaped foramen Foramen rotundum: a specific round foramen; recall the Capitol’s rotundum or dome is round when viewed from above Meatus [me A tus]: a natural passage or opening in the body TERMS USED TO DESCRIBE RELATIVE LOCATION— Figure 14-1 will be helpful in understanding terms with an asterisk (*). Anterior*: toward the front of the body Buccal [BUCK al]: related to or near the cheek; the buccal nerve innervates the cheek; the buccinator muscle is within the cheek; the buccal surface of a tooth is the side toward the cheek Cervix: of the neck or neck-like; compare a cervical vertebrae in the neck External: toward the outside of the body; seen from the outside Facial*: toward the face; seen when viewing the face side Inferior* or the prefix infra: located below or beneath; lower than Lateral*: pertaining to, or situated at, the side Medial*: the surface toward, or closest to, the midline (median) plane of the body; do not confuse medial with mesial Median plane*: a longitudinal plane that divides the body into relatively equal right and left halves Midsagittal plane* [mid SAJ i t’l]: same as median plane Posterior*: toward the rear of the mouth or body Retro (prefix): back or behind Sub (prefix): under or beneath; compare to infra Superficial: closer to the surface Superior* or the prefix supra: located above or over; higher or upper GENERAL TERMS RELATED TO BONES Acoustic [ah KOOS tik]: referring to sounds or hearing; near the ear Cervical [SER vi kal]: related to the neck; like cervical vertebrae Condyle [KON dile]: an articular prominence of a bone resembling a knuckle cialis 100mg tablets cialis cancer prostate
FIGURE 14-11. Temporomandibular joint, photomicrograph of the lateral aspect: The anterior of the skull (the face) is toward the right of the picture. The white area across the top is the space of the brain case. Notice the thicker fibrous covering (shaded red) and underlying compact bone on the functional part of the posterior inferior articular eminence and superior anterior part of the mandibular condyle. Also, notice the arrows indicating the contours of the concave articular fossa, and convex articular eminence, of the temporal bone. (Courtesy of Professor Rudy Melfi.) cialis comprar no brasil cialis 20 mg side effects
filling the space between incongruous articulating surfaces of the convex condyle and concave-convex articular fossa and articular eminence.12 The disc cushions the articulating bones of the joint at the areas of contact (like a shock absorber). The cushioning and lubrication reduce physical wear and strain on joint surfaces. As the mandible moves forward, the discs move forward with the mandible due, in part, to the thickened borders of each disc, which conforms to the shape of the condyles, and because the muscles that pull the mandible forward (lateral pterygoids) are attached to the neck of each condyles (in the pterygoid fovea) as well as to the discs. When the thicker peripheral portions of the discs become flattened or the center of the disc thickens, the disc fails to move synchronously with the condyle, resulting in a popping or grating noise (crepitus), which is quite an annoying yet a fairly common occurrence. The frequency of this occurrence is presented in Table 14-1. With an elastic posterior attachment, the joint is at about the same level as the occlusal plane at birth with relatively no ramus height (Fig. 14-25). During growth, the articular fossa deepens, the articular eminence becomes prominent, the condyle becomes rounded, and the shape of the disc changes to conform to the change in shape of the fossa and condyle. There is also a lengthening of the ramus. The condyle contains cartilage beneath its surface, and the condyloid process and ramus lengthen until a person is 20 to 25 years old. As a result of growth in the condyle area, the body of the mandible is lowered from the skull, and the occlusal plane is located about 1 in. below the level of the condyles in an adult. cialis ship canada pedir cialis
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The anesthetic syringe needle penetrates through the oral mucosa at the height of the maxillary vestibular fornix (near the buccal frenum) adjacent to the maxillary premolars until the needle tip reaches the estimated level of the root tips. This injection location should reduce sensation to the maxillary premolars and adjacent first molar by infiltrating through the maxilla to block the MSA nerve and the adjacent branches of the PSA nerve. precio cialis andorra super cialis canada
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BREKHUS (1931 ) studied a group of students at the university of Minnesota and reported the following caries susceptibility incidence of the teeth Upper and lower first molar : 95 % Upper and lower second molars : 75 % Upper second bicuspids : 45% Upper first bicuspid :35% Lower second bicuspids : 35% Upper central and lateral incisor : 30 % Upper cuspids and lower first bicuspids : 10% Lower central and lateral incisors : 3 % Lower cuspids : 3% Pits and fissures cialis normal dosage acquisto cialis in italia
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Damage to the main trunk of the radial nerve results in a wrist drop due to paralysis of all the wrist extensors (Fig. 144). Damage to the posterior interosseous nerve, however, leaves extensor carpi radialis longus intact, as it is supplied from the radial nerve above its division; this muscle alone is sufﬁciently powerful to maintain extension of the wrist. The disability produced by a wrist drop is inability to grip ﬁrmly, since, unless the ﬂexor muscles are stretched by extending the wrist, they act at a mechanical disadvantage. Try yourself to grip strongly with the wrist ﬂexed and realize how, by operative fusion of the wrist joint in extension, the weakness produced by a radial nerve paralysis would be overcome. Nerve overlap means that division of the radial nerve produces only a small area of anaesthesia of the dorsum of the hand between the 1st and 2nd metacarpals. prices for cialis 10mg cialis generico 5mg
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Fig. 198◊Diagram of the lymph drainage of the tongue. Note two points. (i) The anterior part of the tongue tends to drain to the nodes farthest down the deep cervical chain, whereas the posterior part drains to the upper chain. (ii) The anterior two-thirds of the tongue drain unilaterally, the posterior one-third bilaterally. 1◊◊The right subclavian artery is grafted end-to-side into the right pulmonary artery to short-circuit the pulmonary stenosis of the tetralogy of Fallot (Blalock’s operation) (see Fig. 33). It is important to note, therefore, that variations occur in the origins of the right subclavian artery, which may arise directly from the aortic arch either as its ﬁrst or as its last branch. In the latter case, the right subclavian artery passes behind the trachea and oesophagus in the course to the neck; this vessel may then compress the oesophagus and produce difﬁculty in swallowing (dysphagia lusoria). Occasionally, the left subclavian artery has a common origin with the left carotid from the aortic arch. 2◊◊An aneurysm of the subclavian artery is not rare; it never involves the thoracic part of the subclavian and its site of election is the third part of the artery. The close relation of the subclavian artery to the brachial plexus accounts for the pain, weakness and numbness in the arm which accompany this lesion. Oedema of the arm may result in compression of the subclavian vein. 3◊◊A cervical rib may elevate the subclavian artery and render it unduly palpable; under these circumstances it may closely simulate an aneurysm and, in fact, there may be aneurysmal dilation of the artery distal to the edge of the cervical rib. Vascular changes in the arm associated with a cervical rib are probably due to peripheral emboli thrown off from thrombi forming on the walls of the compressed subclavian artery. cialis upotreba
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1◊◊The sense of smell is not highly developed in man and is easily disturbed by conditions affecting the nasal mucosa generally (e.g. the common cold). However, unilateral anosmia may be an important sign in the diagnosis of frontal lobe tumours. Tumours in the region of the uncus may give rise to the so-called ‘uncinate’ type of ﬁt, characterized by olfactory hallucinations associated with impairment of consciousness and involuntary chewing movements. 2◊◊Bilateral anosmia due to interruption of the 1st nerve is common after head injuries, particularly in association with anterior cranial fossa fractures, when leakage of C.S.F. through the cribriform plate may present as rhinorrhoea. and malleus, exits via the ﬁssure between the tympanic and petrous parts of the temporal bone to enter the infratemporal fossa where it joins the lingual nerve. Hence its taste ﬁbres reach the anterior two-thirds of the tongue and its secretomotor ﬁbres are conveyed to the submandibular ganglion, thence to the submandibular and sublingual salivary glands. On emerging from the stylomastoid foramen, the nerve supplies the stylohyoid and the posterior belly of digastric muscle. It then enters the parotid gland where it divides into ﬁve divisions for the supply of the facial muscles: the temporal, zygomatic, buccal, mandibular, and cervical branches (see Figs 208, 209, 264). buy generic cialis in usa thai cialis
The object of the presentation is to briefly and concisely (usually in a few minutes) describe your patient’s reason for being in the hospital to all members of the team who do not know the patient and the story. Unlike the write-up, which contains all the data you obtained, the presentation may include only the pertinent positive and negative evidence of a disease and its course in the patient. It is hard to get a feel for what is pertinent until you have seen and done a few presentations yourself. Practice is important. Try never to read from your write-up, as this often produces dull and lengthy presentations. Most attendings will allow you to carry note cards, but this method can also lead to trouble unless content is carefully edited. Presentations are given in the same order as a write-up: identification, chief complaint, history of the present illness, past medical history, family history, psychosocial history, review of systems, physical examination, laboratory and x-ray data, clinical impression, and plan. Only pertinent positives and negatives from the review of systems should be given. These and truly relevant items from other parts of the interview often can be added to the history of the present illness. Finally, the length and content of the presentation vary greatly according to the wishes of the attending and the resident, but you will learn quickly what they do and do not want. acquistare cialis senza ricetta
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FIGURE 13–11 Demonstration of the preferred sites and technique of performing a heelstick in an infant. (Reprinted, with permission, from: Gomella TL [ed]: Neonatology: Basic Management, On-Call Problems, Diseases, Drugs, 4th ed. Appleton & Lange, Norwalk CT, 1998.) Procedure cialis discount coupons
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628 58. Anderson IB, Mullen WH, Meeker JE, et al. Pennyroyal toxicity: measurement of toxic metabolite levels in two cases and review of the literature. Ann Intern Med 1996; 124: 726–34 59. Blumenthal M, King P. The agony of the ecstasy. Herbal high products get media attention. HerbalGram 1996; 37:20–49 60. Slifman NR, Obermeyer WR, Aloi BK, et al. Contamination of botanical dietary supplements by Digitalis lanata. N Engl J Med 1998; 339:806–11 61. Woolf GM, Petrovic LM, Rojter SE, et al. Acute hepatitis associated with the Chinese herbal product Jin Bu Huan. Ann Intern Med 1994; 121:729–35 62. Anderson LA. Concern regarding herbal toxicities: case reports and counseling tips. Ann Pharmacother 1996; 30:79–80 63. Horowitz RS, Feldhaus K, Dart RC, et al. The clinical spectrum of Jin Bu Huan toxicity. Arch Intern Med 1996; 156:899–903 64. Hsu CK, Leo P, Shastry D, et al. Anticholinergic poisoning associated with herbal tea. Arch Intern Med 1995; 155:2245–8 65. Frasca T, Brett AS, Yoo SD. Mandrake toxicity. A case of mistaken identity. Arch Intern Med 1997; 157:2007–9 66. Abt AB, Oh JY, Huntington RA, Burkhart KK. Chinese herbal medicine induced acute renal failure. Arch Intern Med 1995; 155: 211–12 67. Nelson L, Shih R, Hoffman R. Aplastic anemia induced by an adulterated herbal medication. J Toxicol Clin Toxicol 1995; 33:467–70 68. Schaumburg HH, Berger A. Alopecia and sensory polyneuropathy from thallium in a Chinese herbal medication. J Am Med Assoc 1992; 268:3430–1 69. Espinosa EO, Mann MJ, Bleasdell B. Arsenic and mercury in traditional Chinese herbal balls. N Engl J Med 1995; 333:803–4 70. Huxtable RJ. The harmful potential of herbal and other plant products. Drug Safety 1990; 5 (Suppl 1): 126–36 71. Piscitelli SC, Burstein AH, Chaitt MPH, et al. Indinavir concentrations and St John’s wort. Lancet 2000; 355:547–8 72. D’Arcy PF. Adverse reactions and interactions with herbal medicines. Part 2—Drug interactions. Adverse Drug Reactions Tox Rev 1993; 12: 147–62 73. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: a Guide for Health-Care Professionals. London: The Pharmaceutical Press, 1996 74. Griffen JP, D’Arcy PF. A Manual of Adverse Drug Interactions. Amsterdam: Elsevier Science, 1997:537–48 75. Miller LG. Herbal medicinals. Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998; 158:2200–11 76. Fugh-Berman A. Herb-drug interactions. Lancet 2000; 355:134–8 77. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs—a systematic review. Drugs 2001; 61:2163–75 78. Barnes J, Anderson LA, Phillipson, J.D. Herbal therapeutics. (10) Herbal interactions. Pharm J 2003; 270:118–21 79. Gold JL, Laxer DA, Dergal, JM, et al. Herbal-drug therapy interactions: a focus on dementia. Curr Opin Clin Nutr Metab Care 2001; 4:29–34 80. Brown R. Potential interactions of herbal medicines with antipsychotics, antidepressants and hypnotics. Eur J Herbal Med 1997; 3: 25–8 81. Heck AM. Potential interactions between alternative therapies and warfarin. Am J Health-Syst Pharm 2000; 57:1221–30 82. Cohen RJ, Ek K, Pan CK. Complementary and alternative medicine (CAM) use by older adults: a comparison of self-report and physician chart documentation. J Gerontol Ser A Biol Sci Med 2002; 57:M223–7 cialis fertility
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responsible for false-positive interpretations of certain neurological signs and symptoms. Furthermore, certain common patterns of somatic dysfunction mimic the symptoms of common neurological disorders and create altered neurological findings that are misconstrued as supporting the neurological diagnosis. An understanding of somatic dysfunction expands the differential diagnosis required before making the diagnosis of the neurological disorder and expands the therapeutic armamentarium in treating patients complaining of certain symptom complexes. Lumbosacral radiculopathy and sciatica Lumbosacral radiculopathy and sciatica are often overdiagnosed or misdiagnosed. In part, this is because several regional somatic structures are capable of mimicking classic pain referral patterns and altering the interpretation of the neuromuscular tests commonly used in the diagnosis of these two entities. Therefore, in the absence of ‘red flags’ and before What side-effects alert the clinician to modify OMT? cialis pharmacy reviews
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gadolinium-enhanced lesions152. However, given the unpredictable course of the disease, it is difficult to differentiate placebo effect clearly from natural history in the published multiple sclerosis trials. Epilepsy Significant improvements in frequency of seizures, usually defined as a reduction by more than 50%, are not uncommon in placebo arms of anticonvulsant trials153,154. However, as with multiple sclerosis, the disease course is relatively unpredictable and no trials have directly evaluated the placebo effect with a natural history control. Most current anticonvulsant trials are add-on or comparison trials, so further data on placebo effect may be limited. There have been some proposals to initiate short-term placebocontrolled trials155. in which case it may be possible to estimate the placebo effect, provided a long enough pretreatment assessment was obtained for accurate estimation of baseline seizure frequency. Placebos have been used in epilepsy to induce psychogenic seizures, a relatively common problem in epilepsy referral centers. Patients with nonepileptic seizures of psychogenic origin may have their typical spells induced by saline injection, tilt table maneuver, or simple suggestion, but a high false-positive rate may preclude its routine clinical use156–158. Aging and dementia There are few data on the placebo effect related to aging. This is a very important area because of the changing demographics in the USA with the increasing percentage of seniors, and because seniors are the largest consumers of drugs. From a practical perspective there have been many placebo-controlled trials of memory-enhancing agents in older subjects. In some of the Alzheimer’s disease trials there has been an improvement in performance during the first 1–2 months of a clinical trial159 that has not been further evaluated. This shortterm improvement is perhaps related to learning effect, but some of the outcome measures are not sensitive to learning effects and the learning effect would be expected to carry over into succeeding test sessions. Thus, the short-term improvements may be related to placebo or expectancy effects. Often trials have an openlabel extension. In some of these trials, the short-term improvement during the openlabel extension was greater than the improvement seen during the initial double-blind period of the study, again suggesting that placebo effects may impact some outcome measures in studies on Alzheimer’s disease. Additionally, many patients with Alzheimer’s disease in clinical trials who have received placebo fare better than those comparable patients reported from prior natural history control data. Although this may also be related to placebo effect, there are other explanations as well, including subject selection and Hawthorne effects related to attention and cognitive stimulation associated with participating in the study. cialis achat forum
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clear. The studies suggest some improvement in cognitive function in subjects with probable Alzheimer’s disease of mild to moderate severity and probably in vascular dementia. The effect of Ginkgo biloba extract in possible or severe Alzheimer’s disease, and other dementias is not known. The best dosing of Ginkgo biloba extract is not known. The studies reviewed here used a daily dose of 120 or 240 mg mostly divided three times daily, but also into two daily doses. It is not known whether the higher dose is better, or whether an even higher dose that has not been previously evaluated may be even better. Notably, many animal studies have used a dose of up to 50–150 mg/kg daily. It is not known whether twice daily dosing which would improve compliance is as good as the three times daily dosing used in most studies. The active ingredient or ingredients in Ginkgo biloba extract are not known. Is it one of the ginkgolides or is it the flavonoid component? If this were known, a more effective extract could possibly be developed. There are no data comparing efficacy of the various Ginkgo biloba extract preparations to clarify whether there are differences related to the specific process of extracting the ginkgo from the raw leaf. It is not known whether there is a low incidence of significant complications, e.g. bleeding. If this is an issue, the relative contraindications, such as use of other antiplatelet agents or history of gastrointestinal bleeding, could be defined. Lastly, as with all botanicals, issues related to standardization are not straightforward (see Chapter 2). The precise chemical constitution of the drug may vary with age of the tree and season, and the current standardization to flavonoid and terpenoid totals may not reflect the most relevant active ingredient or ingredients67. Additionally, as with all botanicals, the standardization stated on the label may not reflect the actual content68–70 (Table 2). Summary There is an effect of Ginkgo biloba extract on cognitive performance in Alzheimer’s disease, although the effect is fairly modest. Recent cialis ohne rezept aus deutschland how long before to take cialis
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PA I N I N T H E C L I N I C A L S E T T I N G One of the greatest puzzles in our understanding of pain is why some injuries lead to pain that continues for months or years, whereas other acute pains come and go as expected. The concept that chronic pain is multifactorial in origin has evolved to explain this. The endogenous mechanisms that modulate and control pain may be genetically determined. The balance between the extent of tissue injury and the body’s defence system against it determines whether acute pain can be controlled or will lead to chronicity. In this transition, psychosocial factors may act as a catalyst and then maintain chronic pain. These factors need to be understood when attempting to prevent acute pain becoming chronic. cialis women taking buy cialis pills online
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Larrey described refrigeration anaesthesia during the French retreat from Moscow (1812), but in modern anaesthetic practice, the use of cold to achieve conduction block is largely limited to transient, topical anaesthesia (e.g. ethyl chloride spray). The application of heat may be used to produce permanent nerve block (e.g. radio-frequency lesions of the trigeminal ganglion in the treatment of trigeminal neuralgia). Pressure neural blockade is usually inadvertent (poor positioning on the operating table), but remarkably effective. It provides a portion of the analgesia observed with the use of intravenous regional anaesthesia (Bier’s block). Pharmacologic nerve block may be temporary (using local anaesthetics or other agents, e.g. pethidine) or permanent (using neurolytic chemicals). cialis ad music
Figure 37.2 The gall bladder meridian represents a referral pattern from a TP in the trapezius muscle. The dark grey shaded areas show the more frequent pain referral pattern of a TP. The light grey shows areas of less frequent pain referral. From Acupuncture – A Scientiﬁc Appraisal by Ernst and White. Reprinted by permission of Elsevier Ltd and Dr Michael Cummings. cialis wirkungseintritt best cialis dose
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However, recent evidence in clinical practice indicates underestimation of the amount of time it takes to recover brain functions from concussion. Accordingly, the alteration of brain potentials associated with postural movement clearly observed within 30 days post-injury could potentially be considered within the scope of existing grading scales and retum-to-play criteria. will cialis work on women
Sullivan, H.G., Martinez, J., Becker, D.P., Miller, J.D., Griffith, R., & Wist, A.O. (1976). Fluid-percussion model of mechanical brain injury in the cat. Journal of Neurosurgery, 45, 520-534. Dixon, C.E., Lyeth, B.C., Povlishock, J.T., Findling, R.L., Hamm, R.J., Marmarou, A., Young, H.F., & Hayes, R.L. (1987). A fluid percussion model of experimental brain injury in the rat. Journal of Neurosurgery, 67, 110-119. Metz, B. (1971). Acetylcholine and experimental brain injury. Journal of Neurosurgery, 35, 523-528. Bornstein, M.B. (1946). Presence and action of acetylcholine in experimental brain trauma. Journal of Neurophysiology, 9, 349-366. Ruge, D. (1954). The use of cholinergic blocking agents in the treatment of craniocerebral injuries. Journal of Neurosurgery, 11,11-S3. Sachs, E. (1957). Acetylcholine and serotonin in the spinal fluid. Journal of Neurosurgery, 14, 22-27. Tower, D.B., & McEachern, D. (1948). Acetylcholine and neuronal activity in craniocerebral trauma. Journal of Clinical Investigation, 27, 558-559. Tower, D.B. & McEachern, D. (1949). Acetylcholine and neuronal activity; cholinesterase patterns and acetylcholine in cerebrospinal fluids of patients with craniocerebral trauma. Canadian Journal of Research, 27, 105-119. Ward, A.A. (1950). Atropine in the treatment of closed head injury. Journal of Neurosurgery, 7, 398-402. Symonds, C.P. (1935). Disturbance of cerebral function in concussion. Lancet 1, 486-488. Kooi, K.A. (1971). Fundamentals of Electroencephalography. New York: Harper & Row. Brown, G.W., & Brown, M.L. (1954). Cardiovascular responses to experimental cerebral concussion in the rhesus monkey. Archive of Neurology and Psychiatry, 71, 707-713. Clare, A. (1976). Psychiatry in Dissent. London: Tavistock. Belenky, G.L., & Holaday, J.W. (1979). The opiate antagonist naloxone modifies the effects of electroconvulsive shock (ECS) on respiration, blood pressure and heart rate. Brain Research, 777,414-417. Urea, G., Yitzhaky, J., & Frenk, H. (1981). Different opioid systems may participate in postelectroconvulsive shock (ECS) analgesia and catalepsy. Brain Research, 219, 385-396. Duret, H. (1920). Commotions graves, mortelles, sans lesions (commotions pures) et lesions cerebrales etendues sans commotion dans les traumatismes dranio-cerebraux. Revolutionary Neurology, 27, 888-900. Gurdjian, E.S., Lissner, H.R., Webster, J.E., Latimer, F.R., & Haddad, B.F. (1954). Studies on experimental concussion: relation of physiologic effect to time duration of intracranial pressure increase at impact. Neurology 4, 674-681. Krems, A.D., Schoepfle, G.M., & Erlanger, J. (1942). Nerve concussion. Proceedings of Society: Experimental Biology and Medicine, 49, 73-75. Walker, A.E. (1994). The physiological basis of concussion: 50 years later. Journal of Neurosurgery, 81, 493-494. Ingvar, D.H., Brun, A., Johansson, L., & Samuelsson, S.M. (1978). Survival after severe cerebral anoxia with destruction of the cerebral cortex: the apallic syndrome. Annals New York Academy of Science, 315, 184-214. Gloor, P. (1978). Generalized epilepsy with bilateral synchronous spike and wave discharge: new findings concerning its physiological mechanisms. Electroencephalography and Clinical Neurophysiology, Supplement, 34, 245-249. Pincus, J.H., Tucker, G.J. (1985). Behavioral Neurology, 3rd Edition. New York: Oxford University Press. Engel, J. (1989). Seizures and Epilepsy. Philadelphia: F.A. Davis. Schacter, D.L., & Crovitz, H.F. (1977). Memory function after closed head injury: a review of the quantitative research. Cortex 13, 150-176. Biomechanics of Concussion cialis 5 mg cheap
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The study of impact biomechanics is leading researchers and clinicians to a better understanding of the mechanisms and forces that cause injury to the brain during sport-related activities. Technological advancements in research have allowed us to better predict the effects of linear and rotational Reaction Time (RT) cialis and flushing
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Department of Psychology, The Pennsylvania State University; firstname.lastname@example.org Abstract: This chapter provides a review of the limited information that is available regarding the impact of motivation on the neuropsychological assessment of sports-related concussion. We first outline what is known about the impact of motivation on assessment by identifying how the impact that differential motivation on baseline and post-concussion evaluations may obscure the true cognitive deficits of concussion. Next, we provide a review of two studies which provide some direct empirical evidence for differential motivation in baseline and post-concussion testing. This is followed by a review of possible causative factors associated with poor baseline motivation including: personality style, lack of education, and active misrepresentation. Next, the possible methods for identification of athletes with poor motivation on testing are presented. This includes both the use of objective measures of motivation and the identification of testing patterns consistent with poor motivation. Finally, the chapter concludes with the identification that more empirical research on each of the covered topics is necessary. Concussion; Mild Traumatic Brain Injury; Motivation; Effort; Sports. cialis flushing
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METHOD Research Design concussed controls (Iverson, Lovell & Collins, 2003). The lower ORs in the current study can be attributed to the within concussion comparison groups of PTA versus no PTA. The findings in the current study lend support to the growing body of evidence (e.g., Collins et al., 2004; Lovell & Collins, 2003) indicating that ImPACT is a valid measure for assessing concussion outcomes. The findings also support the notion that PTA may be a valid indicator of post-concussion neurocognitive impairment and symptoms (Collins, Iverson, Lovell, McKeag, and Norwig, et al., 2003). The findings can be viewed in reverse, suggesting that on-field evaluations employing empirically-based signs and symptoms such as PTA are valid in predicting neurocognitive symptoms and impairment. best site to buy cialis online
of the pathology of MTBL As all brain injuries differ in their mechanism, location, severity and symptomology, it is to be expected that EEG abnormalities post injury will differ between subjects. There is no special pathognomonic location and there is no special biological process that would produce pathognomonic changes in the EEG (Nuwer, 2005). Korn et al. illustrate this statement in a study published in 2005. EEG recordings and LORETA analysis demonstrated the sensitivity of LORETA to detect the varying sources of cortical damage post concussion. The EEG recordings taken in the MTBI population showed typical post injury findings of increased delta and decreased alpha power. The revolutionary findings for the study of MTBI came when LORETA was applied to the recorded EEG. Whereas controls displayed generators of delta rhythm in consistent voxels representing distinct cortical regions, MTBI subjects displayed increased intervoxel variability for delta generators, where the generators of maximal activity varied from patient to patient (Korn et al., 2005). These locations of abnormality were also compared to single photon emission computed tomography (SPECT), which is an invasive procedure compared to the noninvasive EEG. The location of abnormality given by the invasive SPECT procedure localized the source of the abnormal activity at or closely related (at the same cortical lobe) to the pathologic region observed in LORETA (Korn et al., 2005). Although all MTBI subject's abnormal rhythms were located in differing anatomical locations, as is to be expected based on the above discussion, the dysfunctional areas were generally found to originate in peripheral cortical regions compared to the mid-line restricted symmetric source that characterized the normal group (Korn et al., 2005). This is probably due to the proximity of the brain to the skull and the resulting impact at injury. These findings suggest that in concussed individuals the focal cortical abnormal generators that differ in location between patients, are related to the location of cerebral injury rather than to a single common pathologic generator or a general diffused cortical slowing (as one would expect in the case of a general stress-dependent mechanism, white matter lesion or lesion of a deep structure such as the thalamus or brain stem) (Korn et al., 2005). Based on their findings Korn et al. suggest several lines of evidence that support the view that cortical dysfunction, as reflected by EEG findings, may underlie PCS. First, three patients presenting with transient attacks of paraesthesia, suggestive of partial epilepsy, had a focal abnormal EEG localized to contralateral parietal cortex. Second, the correlation between EEG aberrations and reduced regional cerebral blood flow (rCBF) perfusion and blood-brain barrier (BBB) permeability suggests an association between the functional and anatomic lesions. Third, in eight patients with persistent PCS, EEG abnormalities were related anatomically to the SPECT findings and in one patient in whom the clinical syndrome was resolved, recovery was associated with parallel resolution of both EEG aberrations and SPECT findings (Korn et al., 2005). cialis best way to take cialis online pharmacy uk
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as well, indicating that this is her fifth concussion in the past 2 years of rugby. All of the concussions have been minor and associated with a headache and visual problems for a few days. However, each time she returned back to practice and did not tell anybody. She had recurrent injury on three consecutive days in practice three weeks prior to this incident but did not report these as well. Since that time, she has had a headache, dizziness, and nausea that have progressed in severity leading up to this most recent injury. She states now that she has head pain any time she has any type of physical activity and has worsening headache and mild dizziness. She has difficulty concentrating, still has emotional outbursts, and still has periods of amnesia. These worsen with activity. She also recalls that four years ago she had evaluation for headaches by her primary care physician and her hometown emergency department following a fall where she hit her head, that included an MRI of her brain. She was told she had a "structural abnormality" that needed to be followed but she was afraid to do so and has had no further evaluation. She has had a history of headaches with extreme activity over the past decade of her life. The athlete was held from all activity and formal neuropsychological testing was performed. She also had a repeat MRI performed given her history, which revealed an Arnold Chiari Malformation (the cerebellar tonsils protruding out of the foramen magnum). The athlete was disqualified from further contact sports at that point. She ultimately has had a surgical decompression by neurosurgical specialists and resolution of her symptoms. One of the specific injuries of concern is the cumulative effect of concussion. The current misconception is that multiple head injuries are unlikely in athletics. However, a recent study conducted among Ohio and Pennsylvania High School football players showed that over 34% of participant had experienced multiple concussions (Langburt, 2001). Multiple brain injuries are likely to lead to cumulative neurological and cognitive deficits. In a study of amateur athletes, those who had suffered three or more concussions were 7.7 times more likely to exhibit drops in memory functioning (Iverson et al., 2004). If multiple head injuries are experienced within a short period of time, the effects could be fatal (MMWR, 1997). One sport in which we have observed the direct consequences of head trauma is boxing. This is a sport in which athletes are extremely susceptible to constant blows to the head. A study by Ravdin et al. (2003) was conducted to test the cognitive functioning of boxers. They found that boxers who fought in 12 or more bouts showed a significant decrease in cognitive functioning as a result of the number of blows suffered in competition. This suggests that there are cumulative effects related to multiple concussions (Ravdin et al., 2003). Another study was conducted among high school football players examining the symptoms of concussion in relation to concussion history (Collins et al., 2003). Specifically, this study was focused on symptoms such as loss of consciousness, anterograde amnesia, retrograde amnesia and confusion. It was shown that athletes who had suffered three or more concussions were 9.3 times more likely to exhibit these symptoms when suffering another concussion (Collins et al., 2003). DeRoss et al. (2002) conducted a study on rats in which differences were found between rats with 1 injury versus those with multiple head injuries. 85% of the rats showed impairments in spatial recognition and deviations from baseline scores but motor control was not affected (DeRoss, 2002). In the following text, the results of combined EEG, balance and psychological testing of injured athletes are presented and discussed. the best way to take cialis
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Traditionally, the emotion of fear has been excluded from research related to general orthopedic and other injuries, including traumatic brain injuries, and has not been highly considered among injured athletes. One of the reasons is that athletes are generally perceived as "warrior type" individuals that do not harbor emotions such as fear. Athletes usually attempt to hide their fear because they feel coaches view fear as a weakness (Feigley, 1988). Both, the coaches viewing fear as a weakness and the athletes hiding their fear, are dangerous attitudes, considering that athletes The chapter begins with an integrated outline that numbers the major sections of the chapter and lists the concepts that support each section. cost of cialis pills
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Phosphate, PO 1 g/d for 2 d, then 500 mg/d for 2 to 3 wk Hydrochloride, IM 200 to 250 mg/d for 10 to 12 d Asymptomatic carriers, PO 650 mg/d Symptomatic intestinal amebiasis, PO 650 mg three times daily after meals for 20 d; repeat after 2 to 3 wk if necessary Amebiasis, PO 500 to 750 mg three times daily for 5–10 d Giardiasis, PO 250 mg three times daily for 7 d Trichomoniasis, PO 250 mg three times daily for 7 d, 1 g twice daily for 1 d, or 2 g in a single dose. Repeat after 4 to 6 wk, if necessary. Gardnerella vaginalis vaginitis, PO 500 mg twice daily for 7 d PO 250–500 mg q6h, up to 14 d cialis dose forum
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SC 0.5 mL; booster dose of 0.5 mL every 10 y if in endemic areas Darbepoetin alfa (Aranesp), epoetin alfa (Epogen), ﬁlgrastim (Neupogen, Neulasta), oprelvekin (Neumega), and the interferons are often self-administered or given by a caregiver to chronically ill clients. The home care nurse may need to teach clients or caregivers accurate drug preparation and injection techniques, as well as proper disposal of needles and syringes. Assistance may also be needed in obtaining appropriate laboratory tests (eg, CBC, platelet count, tests of renal or hepatic function) to monitor clients’ responses to the medications. Other interventions depend on the drug being taken. For example, epoetin alfa is not effective unless sufﬁcient iron is present, and most clients need an iron supplement. When an iron preparation is prescribed, the home care nurse may need to emphasize the importance of taking it. With ﬁlgrastim, the nurse may need to help the client and family with techniques to reduce exposure to infection. cialis pharmacie canada tadalafil generic cialis 20 mg
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washing techniques by clients and all others in contact with clients. Use sterile technique for all injections, IV site care, wound dressing changes, and any other invasive diagnostic or therapeutic measures. Screen staff and visitors for signs and symptoms of infection; if infection is noted, do not allow contact with the client. Report fever and other manifestations of infection immediately. Allow clients to participate in decision making when possible and appropriate. Use isolation techniques according to institutional policies, usually after transplantation or when the neutrophil count is below 500/mm3. Assist clients to maintain adequate nutrition, rest and sleep, and exercise. Enzyme-inducing drugs stimulate hepatic metabolism of cyclosporine, thereby reducing blood levels. If concurrent administration is necessary, monitor cyclosporine blood levels to avoid subtherapeutic levels and decreased effectiveness. buy cialis no rx online pharmacy cialis uk
Assessment 1. A selective, short-acting, inhaled beta2-adrenergic agonist (eg, albuterol) is the initial drug of choice for acute bronchospasm. 2. Because aerosol products act directly on the airways, drugs given by inhalation can usually be given in smaller doses and produce fewer adverse effects than oral or parenteral drugs. 3. Ipratropium, the anticholinergic bronchodilator, is most useful in the long-term management of COPD. It is ineffective in relieving acute bronchospasm by itself, but it adds to the bronchodilating effects of adrenergic drugs. 4. Theophylline is used less often than formerly and is now considered a second-line drug. When used, it is usually given orally in an extended-release formulation for chronic disorders, such as COPD. IV aminophylline is no longer used to treat acute asthma attacks. 5. Cromolyn and nedocromil are used prophylactically; they are ineffective in acute bronchospasm. 6. Because inﬂammation has been established as a major component of asthma, an inhaled corticosteroid is being do you need a prescription for viagra canada pastillas similares al viagra
Answer: Only short-acting beta-adrenergic bronchodilators should be used for acute dyspnea. Alupent, not Atrovent, is indicated. When patients have more than one inhaler, they should be taught which inhaler to use in emergency situations. The canister should be a different color (many manufacturers consider this) or clearly marked with tape, so that quick identiﬁcation can occur in an emergency. Additional teaching may be indicated for the nurse and the patient regarding the action of each inhaler. Antihistamines viagra with caffeine peut on acheter du viagra sans ordonnance
As the heart fails, the low cardiac output and inadequately ﬁlled arteries activate the neurohormonal system by several feedback mechanisms. One mechanism is increased sympathetic activity and circulating catecholamines (neurohormones), which increases the force of myocardial contraction, increases heart rate, and causes vasoconstriction. The effects of the baroreceptors in the aortic arch and carotid sinus that normally inhibit undue sympathetic stimulation are blunted in clients with HF, and the effects of the high levels of circulating catecholamines are intensiﬁed. Endothelin, a neurohormone secreted primarily by endothelial cells, is the most potent endogenous vasoconstrictor and may exert direct toxic effects on the heart and result in myocardial cell proliferation. Another mechanism is activation of the renin–angiotensin– aldosterone system. Renin is an enzyme produced in the kidney in response to impaired blood ﬂow and tissue perfusion. When released into the bloodstream, renin stimulates the production of angiotensin II, a powerful vasoconstrictor. Arterial vasoconstriction impairs cardiac function by increasing the resistance (afterload) against which the ventricle ejects blood. This raises ﬁlling pressures inside the heart, increases stretch and stress on the myocardial wall, and predisposes to subendocardial ischemia. In addition, clients with severe HF have constricted arterioles in cerebral, myocardial, renal, hepatic, and mesenteric vascular beds. This results in increased organ hypoperfusion and dysfunction. Venous vasoconstriction limits venous capacitance, resulting in venous congestion and increased diastolic ventricular ﬁlling pressures (preload). Angiotensin II also promotes sodium and water retention by stimulating aldosterone release from the adrenal cortex and the release of vasopressin (antidiuretic hormone) from the posterior pituitary gland. All of these mechanisms combine to increase blood volume and pressure in the heart chambers, stretch muscle ﬁbers, and produce dilation, hypertrophy, and changes in the shape of the heart (a process called cardiac or ventricular remodeling) that make it contract less efﬁciently. Overall, the compensatory mechanisms increase preload (amount of venous blood returning to the heart), workload of the heart, afterload (amount antithrombotic measures such as compression stockings/ devices or heparin therapy should be prescribed to prevent deep vein thrombosis. 6. Administer oxygen, if needed, to relieve dyspnea, improve oxygen delivery, reduce the work of breathing, and decrease constriction of pulmonary blood vessels (which is a compensatory measure in clients with hypoxemia). where to buy generic viagra in australia old men and viagra
Digoxin is widely used and a frequent cause of adverse effects in older adults. Reduced dosages are usually required because of decreased liver or kidney function, decreased lean body weight, and advanced cardiovascular disease. All of these characteristics are common in older adults. Impaired renal function leads to slower drug excretion and increased risk of accumulation. Dosage must be reduced by approximately 50% with renal failure or concurrent administration of amiodarone, quinidine, nifedipine, or verapamil. These drugs increase serum digoxin levels and increase risks of toxicity if dosage is not reduced. The most commonly recommended dose is 0.125 mg daily. Antacids decrease absorption of oral digoxin and should not be given at the same time. private prescription for viagra
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The goal of adrenergic drug therapy in hypotension and shock is to restore and maintain adequate tissue perfusion, especially to vital organs. 1. Describe factors that control blood pressure. 2. Deﬁne/describe hypertension. 3. Identify clients at risk for development of hypertension and its sequelae. 4. Discuss nonpharmacologic measures to control hypertension. 5. Review the effects of alpha-adrenergic blockers, beta-adrenergic blockers, calcium channel blockers, and diuretics in hypertension. 6. Discuss angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in half of a viagra pill
Clients who maintain control of their blood pressure for 1 year or so may be candidates for reduced dosages or reduced numbers of drugs. Any such adjustments must be gradual and carefully supervised by a health care provider. Expected beneﬁts include fewer adverse effects and greater compliance. viagra francais viagra de venta libre en argentina
clients to meet because it requires rather stringent lifestyle restrictions and may require two or more antihypertensive drugs. Older adults may be especially susceptible to the adverse effects of antihypertensive drugs because their homeostatic mechanisms are less efﬁcient. For example, if hypotension occurs, the mechanisms that raise blood pressure are less efﬁcient and syncope may occur. In addition, renal and liver function may be reduced, making accumulation of drugs more likely. Initial drug doses should be approximately half of the recommended doses for younger adults, and increases should be smaller and spaced at longer intervals. Lower drug doses (eg, hydrochlorothiazide 12.5 mg daily) are often effective and reduce risks of adverse effects. Blood pressure should be reduced slowly to facilitate adequate blood ﬂow through arteriosclerotic vessels. Rapid lowering of blood pressure may produce cerebral insufﬁciency (syncope, transient ischemic attacks, stroke). A further incentive for successful management of hypertension in older clients is the beneﬁt of reducing the incidence of dementia with antihypertensives. If blood pressure control is achieved and maintained for approximately 6 to 12 months, drug dosage should be gradually reduced, if possible. Danaparoid (Orgaran) Enoxaparin (Lovenox) substitut au viagra
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Drugs at a Glance: Antidiarrheal Drugs Routes and Dosage Ranges Generic/Trade Name Loperamide (Imodium) Characteristics A derivative of meperidine; decreases intestinal motility As effective as diphenoxylate, with fewer adverse effects in recommended doses. High doses may produce morphine-like effects. Safety not established for children <2 y of age. Naloxone (Narcan) is the antidote for overdose. Clinical Indications Symptomatic treatment of acute or chronic diarrhea Adults PO 4 mg initially, then 2 mg after each loose stool to a maximal daily dose of 16 mg. For chronic diarrhea, dosage should be reduced to the lowest effective amount (average 4–8 mg daily). Children 2–5 y, 13–20 kg: PO 1 mg 3 times daily; 6–8 y, 20–30 kg: PO 2 mg twice daily; 8–12 y, >30 kg: PO 2 mg 3 times daily how works viagra on men
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Alkylating Agents Alkylating agents include nitrogen mustard derivatives, nitrosoureas, and platinum compounds. Nitrogen mustard derivatives (eg, cyclophosphamide) interfere with cell division and the structure of DNA during all phases of the malignant cell cycle. As a result, they have a broad spectrum of activity. They are most effective in hematologic malignancies but also are used to treat breast, lung, and ovarian tumors. All of these drugs cause signiﬁcant myelosuppression (bone marrow depression). Nitrosoureas also interfere with DNA replication and RNA synthesis and may inhibit essential enzymatic reactions of cancer cells. They are cell cycle nonspeciﬁc and have been used in clients with gastrointestinal (GI), lung, and brain tumors. They are highly lipid soluble and therefore enter the brain and cerebrospinal ﬂuid more readily than other antineoplastic drugs. They cause delayed bone marrow depression, with maximum leukopenia and thrombocytopenia occurring 5 to 6 weeks after drug administration. As a result, the drugs are given less often than other drugs, and complete blood counts (CBCs) are needed weekly for at least 6 weeks after a dose. Platinum compounds are cell cycle–nonspeciﬁc agents that inhibit DNA, RNA, and protein synthesis. Cisplatin is widely used to treat both hematologic and solid cancers. Adverse effects include severe nausea and vomiting, nephrotoxicity, and ototoxicity. Carboplatin is most often used to treat endometrial and ovarian carcinomas and it produces bone marrow depression as a major adverse effect. Oxaliplatin (Eloxatin) was viagra how old to buy
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BETA BLOCKERS 1. Give medications only when clearly indicated, weighing anticipated beneﬁts to the mother against the risk of harm to the fetus. 2. When drug therapy is required, the choice of drug should be based on the stage of pregnancy and available drug information (see Boxes 67–1 and 67–2). During the ﬁrst trimester, for example, an older drug that has not been associated with teratogenic effects is usually preferred over a newer drug of unknown teratogenicity. 3. Any drugs used during pregnancy should be given in the lowest effective doses and for the shortest effective time. discount viagra coupon
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Figure 1–7A shows the rhythmical EMG activity elicited from a subject with a clinically complete thoracic SCI. If considered in parallel to the spinal transected cat experiments in Experimental Case Studies 1–2, this rhythmic activity suggests the possiblity that spinal automaticity in humans can be driven by locomotor-related sensory inputs that are recognized by CPGs. Repetitive step training of a subject with a complete SCI may lead to greater amplitude of the elicited EMG bursts and improved organization, as shown in Figure 1–7B. This training-induced change supports the potential for activity-dependent plasticity in the motor pools and their motor units and functional stepping despite partial disconnection from supraspinal influences. Thus, the lumbosacral spinal cord in humans recognizes patterned afferent input related to the step cycle and produces basic locomotor 380. de Leon R, Hodgson J, Roy R, Edgerton V. Retention of hindlimb stepping ability in adult spinal cats after the cessation of step training. J Neurophysiol 1999; 81:85–94. 381. Tillakaratne N. Increased expression of glutamate decarboxylase (GAD67) in feline lumbar spinal cord after complete thoracic spinal cord injury. J Neurosci Res 2000; 60:219–230. 382. Bouyer L, Whelan P, Pearson K, Rossignol S. Adaptive locomotor plasticity in chronic spinal cats after ankle extensors neurectomy. J Neurosci 2001; 21: 3531–3541. 383. Merzenich M, Recanzone G, Jenkins W, Grajski K. Adaptive mechanisms in cortical networks underlying cortical contributions to learning and nondeclarative memory. Cold Spring Harbor Symposia on Quantitative Biology: 1990 Cold Spring Harbor Laboratory Press, 1990:873–887. 384. Lashley K. Temporal variation in the function of the gyrus precentralis in primates. Am J Physiol 1923; 65:585–602. 385. Nudo R, Jenkins W, Merzenich M, Prejean T, Grenda R. Neurophysiological correlates of hand preference in primary motor cortex of adult squirrel monkeys. J Neurosci 1992; 12:2918–2947. 386. Kano M, Ino K, Kano M. Functional reorganization of adult cat somatosensory cortex is dependent on NMDA receptors. Neuroreport 1991; 2:77–80. 387. Dykes R, Metherate R. Sensory cortical reorganization following peripheral nerve injury. In: Finger S, Levere T, Almli C, Stein D, eds. Brain Injury and Recovery. New York: Plenum Press, 1988:215– 234. 388. Jenkins W, Merzenich M, Ochs M. Functional re- how 2 use viagra indian brands of viagra
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tient can be quite similar to the lesioned animal’s combination of the use of an alternate strategy, within the limitations of residual sensorimotor networks, and training-induced plasticity. A more obvious compensatory behavior is to use the unaffected upper extremity for tasks, rather than incorporating the hemiparetic hand. peut on acheter viagra sans ordonnance
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stimulation evoked larger motor responses in the abdominal muscles rostral to a thoracic spinal cord lesion and from a greater number of scalp positions than were evoked in the abdominal groups of normal subjects.133 This finding suggests that the cortical motor map had expanded after the injury. The investigators could not exclude a change at the level of the affected spinal motoneurons, such as an increase in their excitatory response to a descending volley or to sprouting of corticospinal axons. Another group of paraplegic subjects had PET studies with 15O-H2O as their hands moved a joystick in different directions. The investigators found enhanced bilateral activity in the thalamus and cerebellum and expansion of the hand region medially toward the activity-deprived leg representation.134 Magnetoencephalography showed that 20 of 24 tetraplegic subjects and 9 of 20 paraplegic subjects, including all 5 who could move their toes, had a posterior displacement of the evoked motor potential, suggesting plasticity-related somatosensory cortex adaptation to deafferentation and deefferentation.135 Cortical representations were mapped using fMRI with self-paced tongue and wrist movements in patients with motor complete cervical lesions graded ASIA A or B (see Table 10–1). The cortical activation for the tongue shifted medially and superiorly about 13 mm, compared to healthy subjects.136 Indeed, the focus of maximum activation shifted more as the level of the lesion moved higher in the patients. No shift was found, surprisingly, for the wrist representation. The findings are consistent with other studies revealing that a disconnected, but available cortical representation may come to cofunction with neighboring active cortex, either by physiologic unmasking of latent synapses or growth of new dendritic connections. TRAUMATIC BRAIN INJURY Activation paradigms after mild to moderate TBI may provide insights into the effects and management of a postconcussion syndrome, focal brain injuries, and diffuse axonal injury. Twelve subjects who had a mild TBI 1 month before testing were compared to controls in the auditory n-back task (see Experimental Case Study 3–1) for assessing working memory (see Chapter 1).137 The subjects described more is viagra a prescription drug in canada
ing. In subjects with dysphagia after recent strokes in a range of anatomical distributions, pharyngeal stimulation, compared to not stimulating with the catheter electrode in place, had a larger effect on the excitability of the normal hemisphere representation by TMS and led to reduced pharyngeal transit time and aspiration score. Higher stimulation rates at 20 Hz inhibited swallowing. Further trials that compare sensory stimulation combined with task-oriented skills learning to either one alone will be of great interest to rehabilitationists. viagra guidelines
THE TEAM APPROACH The Rehabilitation Milieu PHYSICIANS Responsibilities Interventions NURSES Responsibilities Interventions PHYSICAL THERAPISTS Responsibilities Interventions for Skilled Action OCCUPATIONAL THERAPISTS Responsibilities Interventions for Personal Independence SPEECH AND LANGUAGE THERAPISTS Responsibilities Interventions for Dysarthria and Aphasia NEUROPSYCHOLOGISTS SOCIAL WORKERS RECREATIONAL THERAPISTS OTHER TEAM MEMBERS SUMMARY The goals of neurologic rehabilitation, to help patients become as functional as possible across interacting impairments, disabilities, and personal needs, require a team of professionals who partner in inpatient and outpatient settings. I will refer to the team of rehabilitation specialists, such as nurses, physical therapists, physicians, and others, as rehabilitation clinicians or rehabilitationists, to best convey their equality at the patient’s bedside. Together, they practice the experiential art and science of the possible. Rehabilitationists provide what many programs call intensive and comprehensive neurologic rehabilitation. These loosely defined price of pfizer viagra in india
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262. Bodner R, Lynch T, Lewis L, Kahn D. Serotonin syndrome. Neurology 1995; 45:219–223. 263. Morin C, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia. JAMA 1999; 281:991–999. 264. Webster J, Bell K, Hussey J, Natale T, Lakshminarayanan S. Sleep apnea in adults with traumatic brain injury: A preliminary investigation. Arch Phys Med Rehabil 2001; 82:316–321. 265. Burns S, Little J, Hussey J, Lyman P, Lakshminarayanan S. Sleep apnea syndrome in chronic spinal cord injury: Associated factors and treatment. Arch Phys Med Rehabil 2000; 81:1334–1339. 266. Partinen M, Palomaki H. Snoring and cerebral infarction. Lancet 1985; 1:1325–1326. 267. Bassetti C, Aldrich M, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial strokes. A prospective study of 39 patients. Stroke 1997; 28:1765–1772. 268. Mohsenin V, Valor R. Sleep apnea in patients with hemispheric stroke. Arch Phys Med Rehabil 1995; 76:71–76. 269. Good D, Henkle J, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke. Stroke 1996; 27:252–259. 270. Sandberg O, Franklin K, Bucht G, Eriksson S, Gustafson Y. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: A randomized treatment study. Eur Respir J 2001; 18:630–634. 271. Vestergaard K, Andersen G, Gottrup H, Kristensen B, Jensen T. Lamotrigine for central poststroke pain. Neurology 2001; 56:184–190. 272. Leijon G, Boivie J. Central poststroke pain—a controlled trial of amitriptyline and carbamazepine. Pain 1989; 36:27–36. 273. Swiddall P, Molloy A, Walker S, Rutkowski S. The efficacy of intrathecal morphine and clonidine in the treatment of pain after spinal cord injury. Anesth Analg 2000; 91:1–6. 274. Attal N, Brasseur G, Dupuy M, Guirimand F, Parker F, Bouhassira D. Intravenous lidocaine in central pain. Neurology 2000; 54:564–574. best price for viagra in uk
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341. Nicholas M, Helm-Estabrooks N, Ward-Lonergan J, Morgan A. Evolution of severe aphasia in the first two years post onset. Arch Phys Med Rehabil 1993; 74:830–836. 342. Lendrem W, Lincoln N. Spontaneous recovery of language in patients with aphasia between 4 and 35 weeks after stroke. J Neurol Neurosurg Psychiatry 1985; 48:733–738. 343. Kertesz A, McCabe P. Recovery patterns and prognosis in aphasia. Brain 1977; 100:1–18. 344. Enderby P, Wood V, Wade D, Langton-Hewer R. Aphasia after stroke: A detailed study of recovery in the first 3 months. Int Rehabil Med 1987; 8:162–165. 345. Holland A, Greenhouse J, Fromm D, Swindel C. Predictors of language restitution following stroke: A multivariate analysis. J Speech Hear Res 1989; 32: 232–238. 346. Kertesz A. What do we learn from recovery from aphasia. In: Waxman S, ed. Functional Recovery in Neurological Disease. New York: Raven Press, 1988:277–292. 347. Shewan C, Kertesz A. Effects of speech and language treatment on recovery from aphasia. Brain Lang 1984; 23:272–299. 348. Naeser M, Gaddie A, Palumbo C, Stiassny-Eder D. Late recovery of auditory comprehension in global aphasia. Arch Neurol 1990; 47:425–432. 349. Naeser M, Helm-Estabrooks N, Haas G, Auerbach S, Srinivasan M. Relationship between lesion extent in ‘Wernicke’s’ area on computed tomographic scan and predicting recovery of comprehension in Wernicke’s aphasia. Arch Neurol 1987; 44:73–82. 350. Alexander M, Naeser M, Palumbo C. Broca’s area aphasias. Neurology 1990; 40:353–362. 351. Naeser M, Baker E, Palumbo C, Nicholas M, Alexander M, Samaraweera R, Prete M, Hodge S, Weissman T. Lesion site patterns in severe, nonverbal aphasia to predict outcome with a computer-assisted treatment program. Arch Neurol 1998; 55:1438–1448. 352. Hillis A, Woityk R, Tuffiash E, Beauchamp N, Jacobs M, Barker P, Selnes O. Hypoperfusion of Wernicke’s area predicts severity of semantic deficit in acute stroke. Ann Neurol 2001; 50:561–566. 353. Musso M, Weiller C, Kiebel S. Training-induced brain plasticity in aphasia. Brain 1999; 122:1781– 1790. 354. Mimura M, Kato M, Kato M, Sano Y, Kojima T, Naeser M, Kashima H. Prospective and retrospective studies of recovery in aphasia. Brain 1998; 121:2083– 2094. 355. Rosen H, Petersen S, Linenweber B, Snyder A, White D, Chapman L, Dromerick A, Fiez J, Corbetta M. Neural correlates of recovery from aphasia after damage to left inferior frontal cortex. Neurology 2000; 55:1883–1894. 356. Heiss W-D, Kessler J, Karbe H, Fink G, Pawlik G. Cerebral glucose metabolism as a predictor of recovery from aphasia in ischemic stroke. Arch Neurol 1993; 50:958–964. 357. Karbe H, Kessler J, Herholz K, Fink G, Heiss W. Long-term prognosis of poststroke aphasia studied with positron emission tomography. Arch Neurol 1995; 52:186–190. 358. Robey R. A meta-analysis of clinical outcomes in the treatment of aphasia. J Speech Lang Hear Res 1998; 41:172–187. how long viagra lasts
502. Figure 10–1. Standard neurologic classification of spinal cord injury. (Source: American Spinal Cord Injury Association.) old men on viagra where can you buy viagra in dublin
the British National Spinal Cord Injuries Center at Stoke Mandeville Hospital under Sir Ludwig Guttmann. From 1973 to 1986, the American hospitals in the Model Systems Program found a 66% decrease in the risk of dying within 2 years of a traumatic SCI.46 These investigators also reported a significant decline in the percentage of patients who required rehospitalization and the number of days hospitalized in the second year after SCI. The decline in mortality was also reflected in finding that, after adjusting for important covariants, the risk of dying during the first year after SCI was reduced by 67% in 1993–1998 compared to 1973–1977.47 Respiratory (28%) and cardiac (32%) causes of death led sepsis (8%), digestive (7%), and urinary (4%) causes in the 1st year. Respiratory (22%) and cardiac (20%) complications are still the most frequent cause of death in the 2nd year. Frankel and ASIA scales may not detect all of the change. No patient with complete paralysis below the lesion 1 year after SCI subsequently developed any useful motor function. deutsche viagra
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After the period of spinal shock from an acute SCI, a sequence of minimal reflex activity is often followed by flexor spasms, then flexor and extensor spasms, and then mostly extensor activity. Among 27 patients with a thoracic cord transection verified by laminectomy, however, 5 subjects with levels between T-3 and T-8 had flaccid, areflexic paralysis with marked muscular atrophy 2 years after injury.204 Most other subjects had extensor spasms elicited by stretch of the iliopsoas. Flexor responses typically followed plantar and genital stimuli. Medication for spasticity is often given to patients whose flexor withdrawal and extensor spasms cause pain, interrupt sleep, and interfere with ADLs such as wheelchair transfers or driving. Of 466 patients entered into the Model Systems, 26% were discharged on an antispasticity agent an average of 105 days after injury and 46% used medication by the 1-year followup.205 Further analysis of this cohort revealed that spasticity was related to the time from onset of injury and most prominent with cervical and upper thoracic SCI (90% in the University of Michigan subcohort and 57% in the national cohort at follow-up). Patients with Frankel grades A and D were less likely to have been treated than those with grades B and C. The data did not relate the use of antispasticity medication to any positive or negative effects on mobility. This clinical report and others,206,207 however, add to the impression that spasticity is most prominent after incomplete, 21 65 13 7 1 6 viagra discount coupon viagra prescription private
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Neuromuscular techniques include broad contact compression (compression, pressure, pressing), petrissage (kneading), stripping (stripping massage, deep stroking massage), and speciﬁc compression (focal compression, ischemic compression, digital compression, digital pressure, direct pressure, static friction, and deep touch). These techniques affect both superﬁcial and deeper tissues, such as muscle. Broad contact compression has been shown to increase blood and lymph ﬂow.6 It may increase or decrease muscle resting tension and have a stimulating or sedative effect, depending on the rate and pressure of strokes. Hence, it is commonly used in sports massage. In petrissage, the tissue is repetitively compressed, dragged, lifted, and released against underlying structures. These strokes relieve anxiety, improve immune function, and positively alter allergic responses. In addition, petrissage has been shown to increase mobility of connective tissue and extensibility of muscle, reduce muscle tension, enhance muscle performance, and increase joint motion.7 These effects may be caused by cutaneovisceral reﬂexes and mechanical compression. In stripping, slow, gliding strokes are applied from one attachment of muscle to the other. It may be used to reduce the activity of myofascial trigger points (points on the surface of the body that are sensitive to touch and cause pain that travels or spreads when palpated). In addition to affecting trigger points, stripping may have the same effects as petrissage. Strokes performed in the direction of the natural ﬂow result in emptying of veins and lymphatics. For this effect to occur, the muscles must be totally relaxed and the effects of gravity must be employed (e.g., limb elevation, recumbent position). It is important for proximal muscles to be relaxed while working on distal areas. If the pressure exerted is excessive, the arterial blood ﬂow that occurs in the opposite direction of veins and lymphatics may be impeded. Heavy pressure may also result in a protective reﬂex contraction of muscles. In speciﬁc compression, pressure is applied to a speciﬁc muscle, tendon, or connective tissue in a expiry date of viagra
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taste, and smell. Many depressions and grooves can be seen on the inside surface of the cranial cavity. These grooves are for venous sinus and for meningeal arteries. The joint between the ﬁrst vertebra and the occipital bone allows head movement. The important landmarks of the skull are shown in Figures 3.7–3.15. the sternal angle. The body articulates with the costal cartilages of ribs 2–7 at the costal notches. The most inferior part of the sternum is the xiphoid process, to which the diaphragm and the rectus abdominus muscles are attached. The sternal angle is an important landmark because the second costal cartilage is attached to the sternum at this point. The ribs and intercostal spaces below this point can easily be counted from here. It also indicates the location where the trachea divides into the two primary bronchi. The sounds made by the closing of the aortic and pulmonary valves (second heart sound) are best heard in the second intercostal spaces. is viagra now generic order cheap generic viagra
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Temporal bone per surface of the tibia. Numerous ligaments, cartilages, and tendons help stabilize this joint. The articulating surface is deepened by the presence of two halfmoon–shaped ﬁbrocartilage disks—the medial and lateral meniscus—located on the tibia (Figure 3.46E). The menisci also serve as shock absorbers, spreading the stress on the joint over a larger joint surface and helping lubricate the joint and reduce friction. can i drink alcohol with viagra
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tion of slow ﬁber. The proportion of fast and slow ﬁbers in each muscle is determined genetically. However, it is possible for ﬁbers to change from slow or fast to intermediate type by physical conditioning. For example, if a muscle with more fast ﬁbers is used repeatedly for events that require endurance, the fast ﬁbers may adapt by changing to intermediate ﬁbers. viagra wanita anwendung viagra 100mg
Temporalis Masseter Buccinator Platysma Mentalis Depressor ang. oris Depressor lab. inf. Insertion Origin Media pterygoid Mylohyoid Flexor hallucis longus Extensor hallucis longus cheap viagra women buying generic viagra safe
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Bipolar Neurons These neurons have two processes extending from either end of the cell body, the dendrite and the axon (see Figure 5.4). This type of neuron is rare and is found in the retina of the eye. Unipolar Neurons The cell body in this type lies to one side, with a single process leading off from one side of the body. This process divides at once into two processes: the axon and the dendrite. Sensory neurons are of this type. Multipolar Neurons The Massage Connection: Anatomy and Physiology how long before intercourse to take viagra
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Because the olfactory mucosa is easily accessible and yet so close to the brain, aromatherapy has a great potential to directly affect the functioning of the nervous system. Because of the wide nervous connections, emotions, memories, and moods, the autonomic system via the hypothalamus and many other functions can be impacted. However, there is a great need for research in this fascinating area. do you need prescription viagra canada medicine like viagra
4. On the diagram of the transverse section of the spinal cord, color the gray mater light brown; the white mater yellow; and the central canal blue. Label the spinal nerve; spinal ganglion; posterior root of spinal nerve; anterior horn; central canal; lateral horn; posterior median sulcus; anterior median ﬁssure; posterior horn; posterior funiculus; anterior funiculus; and lateral funiculus. propranolol e viagra
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At the beginning of the menstrual cycle, the uterine cavity has only the remnants of the deep layer of the endometrium. From the ﬁfth to the fourteenth days, the endometrium rapidly increases in thickness, and the uterine glands lengthen. This phase of the cycle is referred to as the proliferative phase. After ovulation, the endometrium becomes highly vascularized. The glands coil and secrete a clear ﬂuid. Hence, this phase (from the fourteenth to twenty-eighth days) is known as the secretory phase. If the ovum is not fertilized, the endometrium becomes thinner and areas of cell death (necrosis) begin to appear in the endometrium. Blood vessels go into spasm and some bleeding is seen. The inner lining of the endometrium sloughs off and this collection of dead cells, together with the blood, is the menstrual ﬂow. Normal Menstruation Normally, the menstrual blood contains 75% arterial and 25% venous blood. It contains tissue debris from the endometrial lining together with prostaglandin and ﬁbrinolysin (an enzyme that prevents clotting); therefore, clots are not seen in the menstrual ﬂow (unless the ﬂow has been excessive). Usually, menstruation lasts from 3–5 days (range, 1–8 days). The volume of blood can range from slight spotting to 80 mL (2.7 oz). Flows greater than that are considered abnormal. Functionally, the uterus restores the endometrium from the previous menstruation during the proliferative phase and prepares to embed the fertilized ovum during the secretory phase. The length of the secretory phase is remarkably constant at 14 days from the day of ovulation to the beginning of the next menstrual cycle. This is used to determine the day of ovulation in females. For example, if an individual has regular cycles of 32 days duration, the day of ovulation is likely to be on day 18 of the cycle (i.e., 32 Ϫ 14 ϭ 18). At times, especially the ﬁrst year after menarche (ﬁrst menstrual period) and the last few years of menopause (the time when menstrual cycles cease), ovulation does not occur in every cycle. These are known as anovulatory cycles. viagra drug reactions
At times, the placenta may grow close to the cervical opening. As pregnancy progresses or when the cervix dilates late in pregnancy, severe bleeding may occur. This condition is known as placenta praevia. prescription free generic viagra
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Bilirubin is carried in the blood from the macrophages in the spleen, liver, or red bone marrow to the liver, where it enters the liver cells and is converted into another form of bilirubin—conjugated bilirubin. Conjugated bilirubin is secreted by the liver cells into bile. (Bile is the yellow secretion formed by the liver, stored in the gall bladder, and secreted into the intestines when fat needs to be digested). As part of bile, bilirubin reaches the large intestine where it is converted by the bacteria in the intestine to urobilinogen. Some urobilinogen is reabsorbed into the blood and converted to the yellowish pigment urobilin. Urobilin is then excreted from the body in urine. The rest of the urobilinogen is excreted in the feces in the form of a brown pigment known as stercobilin. It is stercobilin that gives feces the characteristic color. As can be observed, bilirubin is transported to many regions before it is excreted (see Figure 8.3). From the macrophages in the spleen, it goes via the blood to the liver; as part of bile to the gallbladder, bile ducts, and intestines. Any problems along this route can result in excessive blood levels of bilirubin. When the levels of bilirubin increase in the blood, it wirkung von viagra auf frauen
One might wonder how this has any direct bearing on massage therapy. The basis of blood typing is an apt example of the basic concepts of immunity and how immunity is developed in an individual. The immune mechanisms involved in ﬁghting off infection, recognizing foreign cells (as in transplantation), and beneﬁts of immunization follow the same principles. buy viagra online united states viagra 30 minutes
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The outline of the heart can be visualized by connecting the following points that can be located on the body surface. Parietal pericardium viagra in johannesburg
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On completion of this chapter, the reader should be able to: • Identify the ﬂuid compartments of the body and the volume of ﬂuid in each compartment. • Describe the role of different factors that affect the movement of ﬂuid between the ﬂuid compartments. • Deﬁne edema. • Describe the formation and ﬂow of lymph. • Describe the factors that affect the rate of lymph production and removal. • Identify the structures that belong to the lymphatic system. • List the functions of the lymphatic system. • Describe the direction of lymph movement in different parts of the body. • Describe the structure of a lymph node. • Identify the major groups of lymph nodes and the regions they drain. • Describe the effects of massage on the lymphatic system. • Describe the speciﬁc techniques that are effective in reducing edema. On completion of this chapter, the reader should be able to: • Deﬁne immunity. • Differentiate between speciﬁc and nonspeciﬁc immunity. • Differentiate between active and passive immunity. • Deﬁne innate, humoral, and cellular immunity. • Describe the role of lymphocytes in immunity. • Identify the locations where lymphocytes are manufactured. • Deﬁne antigen and antibody. • Describe how antibodies work. • Explain the basis of immunization. • List the diseases against which immunization is available. • Explain how the disease AIDS affects immunity. • Deﬁne the term autoimmune disease. • List examples of autoimmune diseases. • Deﬁne allergy. • Explain the mechanism of allergy. • Deﬁne anaphylaxis and describe how it occurs. • Describe the changes that occur in the lymphatic system and immunity with aging. • Describe the effects of massage on immunity. where to buy cheap viagra in australia
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not have a nucleus. Ninety-ﬁve percent of intracellular protein in these cells is hemoglobin. The cell is small, about 7.4 µ, and shaped like a biconcave disk, with a narrow central part. This structure helps the cell squeeze through the tiny capillaries without rupturing (see Figure 10.13). Unique Properties of Hemoglobin The hemoglobin molecule is made up of four globular protein chains, two alpha and two beta chains (FigBeta polypeptide chains Iron atom O2 viagra italien viagra use video
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1. Salvo SG. Massage Therapy. Principles & Practice. Philadelphia: W.B. Saunders, 1999. 2. Wade JF. Respiratory Nursing Care. 2nd Ed. St. Louis: C.V. Mosby, 1977. 3. Hernandez-Reif M, Field T, Krasnegor J, Martinez E. Cystic ﬁbrosis symptoms are reduced with massage therapy intervention. J Pediatr Psychol 1999:24,183–189. 4. Miller, Frank B. Encyclopedia Dictionary of Medicine, Nursing & Allied Health. 6 Ed. W.B. Saunders, 1997. 5. Lawless J. The Complete Illustrated Guide to Aromatherapy. Shaftesbury: Element Books, 1997. 6. Premkumar K. Pathology A to Z. A Handbook for Massage Therapists. 2nd Ed. Calgary: VanPub books, 1999. 7. Field T, Henteleff T, Hernandez-Reif M, et al. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr 1998:132,854–858. Please refer to page •• (arterial supply to the abdomen and pelvis) and page •• (portal circulation). precio de viagra pfizer
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Psoas major m. 12th rib Laboratory analysis of urine, is a simple but important test that provides information about the state of blood and possible kidney dysfunction. Much information can be obtained by observing the change in color of the test strips that can be dipped into the sample. The urine pH and concentration of glucose, ketones, bilirubin, proteins, and hemoglobin are some characteristics that can be tested in this way. viagra refractory viagra and caffeine
Urinary tract infections are common. Infection of the bladder (cystitis) and urethra (urethritis) are considered lower urinary tract infections, and infection of the kidney (pyelonephritis) is considered an upper urinary tract infection. The infection is usually a result of the ascent of organisms from the perineal region. Incontinence, retention of urine, obstruction to urine ﬂow, catheterization, and reduced immunity are a few conditions that predispose to UTI. Back pain, dysuria, frequency, urgency, hematuria, and cloudy urine are some common symptoms of UTI. Urine output may be altered by applying pressure with the thumb for a few minutes on the kidney, ureter and bladder area of the foot.5 what was the original purpose of viagra