By P. Copper. Michigan State University.

He stressed the importance of the phenomena of sugges- tion in what he then called by the name of critical sleep generic mentax 15 mg online. He had a pre- sentiment that Mesmerian magnetism was non-existent, and he at- tempted to set forth the techniques of what would come to be called hypnosis. He refined a method that consists, for the subject, in staring at a shining point and concentrating on it; he stressed the major role played by suggestibility. Little by little, he provided the foundations of what he called neuro-hypnotism, and later hypnotism. The rupture between Braid and the Mesmerians was complete, after they attacked him in the Mesmerian newspaper Zoist, to which Braid responded by publishing La Physiologie de fascination et critique de la critique [Physiology of fascina- tion and a critique of criticism]. Little by little, Braid’s works entered the canons of mainstream medicine and hypnosis enjoyed wide acceptance, gaining further recog- nition with Charcot and the Medical School at Salpêtrière. The first is a theoretical discussion of hypnosis, and the second is the conviction that animal magnetism does not exist and that the phenomena that had been ascribed to it are, instead, the result of a hysterical tendency in the patient. In 1925, the physicist d’Arsonval, member of the French Academy of Sciences, published a report entitled L’Influence des ondes astrals sur les oscillations des cellules vivantes. He conducted experi- ments in partnership with the engineer, Lakhouski, who was perfecting an ultra-short wave apparatus, used with limited success on cancerous tumors. But Lakhouski and d’Arsonval got bogged down in murky theories, trying to describe a universal energy that would explain ani- mal magnetism, dowsing, telepathy, homeopathy and the whole ensem- ble of manifestations of "planetary energy". From Kirlian to Rocard In 1950 Kirlian, a Russian electrician, gave the finishing touches to a process that enabled him to photograph objects with an electric cur- rent running through them. Photographs of plants and hands show them surrounded by a kind of halo — pataphysicians see this as the expression of the organism’s health, and pataphysicists see it as the revelation of the aura. The Soviets, more materialist than that, saw it as the electrical print of "bioplasm". But in 1960, animal and human magnetism seemed to regain its 118 Waves and Magnets lost credit. Professor Yves Rocard, pioneer in radio astronomy, famous nuclear physicist, professor of physics at the elite Advanced Teacher’s College, proclaimed loud and clear his conviction that human magnetic phenomena exist. Initially intrigued by the work of a waterfinder (dowser), Rocard sought a logical explanation for this empirical prac- tice.

In a randomized Outpatient centers provide a large proportion of reha- trial buy mentax 15 mg line, such patients had improved function, fewer nursing bilitation services. These centers may be found in physi- home placements, and a trend toward reduced mortality cians’ offices, private physical (and occupational) therapy when compared to older patients cared for in traditional practices, Certified Outpatient Rehabilitation Facilities hospital units. Their advantages are (1) although there is controversy whether they offer benefits access to a wider variety of practitioners and technology, over traditional rehabilitation units. Geriatric rehabilita- (2) the stimulation for patients of being around other tion has been shown to be effective,43,44 and age need not people (a disadvantage to some patients with cognitive be a deterrent to providing rehabilitation. In a prospec- deficits), and (3) their ability to serve more patients with tive evaluation of factors that may predict rehabilitation fewer practitioners. The potential negative effects of status and social supports were strong predictors, as acute hospitalization have been well documented. Many elderly patients have difficulties with activities of The nursing home is another important site for daily living, and the hospital environment itself may providing rehabilitation. With the advent of ity requiring physical, occupational, and speech therapy, prospective payment, patients are being discharged Medicare reimbursement is available. When possi- Medicare reimbursement have led to an increase in the ble, patients should be kept out of their beds, walked to number of nursing homes providing rehabilitation serv- the bathroom or diagnostic studies, and encouraged to ices. Such facilities may be free- be able to use the nursing home as a primary site of reha- standing or affiliated with an acute hospital. This requirement is waived for receive Medicare reimbursement, patients must undergo HMOs, so direct admission to a nursing home can be 264 K. Patients were Grooming 0 = needs help with personal care matched according to seven groups of patient character- 5 = independent face/hair/teeth/shaving (implements istics: basic demographics; social support measures; pre- provided) morbid functional status, using the ADL index; acute Toilet use 0 = dependent medical or surgical characteristics; conditions at admis- 5 = needs some help, but can do some things alone sion to rehabilitation, derived from nursing staff or 10 = independent (on and off, dressing, wiping) patient record; functional status at rehabilitation admis- Feeding 0 = unable sion, using the number of ADL dependencies and the 5 = needs help cutting, etc. Enhanced 0 = unable, no sitting balance 5 = major help (one or two people, physical), can sit outcomes were found for elderly patients with stroke 10 = minor help (verbal or physical) who were treated in rehabilitation hospitals, but not for 15 = independent patients with hip fracture. Rehabilitation-oriented Mobility (on level surfaces) nursing homes were more effective than traditional 0 = immobile or <50 yards nursing homes in returning patients with stroke to the 5 = wheelchair independent, including corners, >50 community, despite comparable functional outcomes. Once that idea is entertained, a number of 10 = independent (including buttons, zips, laces) features must be considered.

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Retrospective analysis of our failures disclosed that an unsuccessful outcome was much more unlikely in the presence of calcified herni- ated discs generic mentax 15mg fast delivery, herniations associated with stenosis of the spinal canal, and large extruded herniations. Pathological analysis of tissue of surgically herniated disk re- moved after unsuccessful treatment with oxygen–ozone shows dehydration of the fibrillary matrix without evidence of the chondroid metaplasia. References 357 Tissue Structure Alterations In vivo experimental studies on swine intervertebral discs and in vitro tests on human discs with intradiscal administration of an O2–O3 mixture (at a concentration of 27 g/mL) demonstrated dehydration of the fibril- lary matrix of the nucleus pulposus that disclosed the collagen mesh/ network and regressive events of fragmentation and vacuole formation. Neuroangiogenesis was sometimes present, with mild hyperplasia of the chondrocytes in the matrix periphery. Such changes are thought to be due to the decomposition of ozone accompanied by the release of free radi- cals that act directly on the disc matrix or indirectly via proteolytic en- zymes (Figure 19. Complications and Risks No early or late neurological or infectious complications have been re- ported following O2–O3 injection. The results are virtually the same as those of other percutaneous techniques (75–80% success rate). The similar success rate and the low costs of the O2–O3 therapy make it our method of choice in the percu- taneous treatment of small herniated lumbar disc. Conclusion In our experience, intradiscal O2–O3 treatment of selected herniated lumbar disc has revolutionized the percutaneous approach to nerve root disease by making it safer, cheaper, and easier than treatments currently in use. In addition, O2–O3 therapy does not exclude subse- quent surgery, should patients fail to respond. Oxygen–ozone treatment has the advantage of being feasible in vir- tually all patients with root syndromes. The contraindications of chemo- nucleolysis or nucleoaspiration, which are determined by discography, are a less critical issue with ozone. On the basis of our results and the assessment of our failures, we recommend careful selection of patients. Accurate diagnosis of the lesion and the spinal level to be treated, along with accurate technical execution under CT, are key factors in ensuring the successful outcome of percutaneous treatment for this common condition.

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This is true especially in neonates and infants 15 mg mentax mastercard, where neurologic deficits may be subtle and difficult to ascertain. In this regard, MRI (with T1W, T2W, FLAIR, as well as DWI) may be superior to CT in the early identification of ischemic lesions and exclusion of stroke mimics (extrapolated from adult data). Diagnostic performance for patients presenting with acute neurological deficits Sensitivity Specificity Reference Evidence Acute intraparenchymal hemorrhage (<6 hours) CT 100%* 100%* * MRI 100% 100% 61 Strong Acute subarachnoid hemorrhage (<12 hours) CT 98–100% 16,17 Moderate MRI (FLAIR) 92–100% 100% 28–30 Limited Acute ischemic infarction (<6 hours) CT 61% 65% 9 Moderate MRI 91% 95% 9 Moderate * Although the exact sensitivity or specificity of CT for detecting intraparenchymal hemor- rhage is unknown (limited evidence), it serves as the gold standard for detection in compari- son to other modalities. Acute Imaging Protocols Based on the Evidence Head CT: indicated for all patients presenting with acute focal deficits Noncontrast examination Sequential or spiral CT with 5-mm slice thickness from the skull base to the vertex Head MR: indicated if stroke is in doubt Axial DWI (EPI) with ADC map, GRE, or ep T2*, FLAIR, T1W Optional sequences (insufficient evidence for routine clinical practice): MRA of the circle of Willis (3D TOF technique) PWI (EPI FLASH, 12 slices per measurement for 40 measurements, with 10- to 15-sec injection delay, injection rate of 5cc/sec with single or double bolus of gadolinium, followed by a 20-cc saline flush) Axial T1W postcontrast Areas of Future Research • Use of neuroimaging to select patients for acute therapies: Imaging the ischemic penumbra to extend the empirically determined therapeutic windows for certain individuals Predict individuals at high risk for hemorrhagic conversion As more therapies are made available, neuroimaging has the potential to help determine which modality might be most efficacious (e. What is the role of imaging in patients with headache and subarachnoid hemorrhage suspected of having an intracranial aneurysm? What is the recommended neuroimaging examination in adults with headache and known primary neoplasm suspected of having brain metastases? What is the sensitivity and specificity of computed tomography and magnetic resonance imaging? Key Points In adults, benign headache disorders usually start before the age of 65 years. Although most headaches in children are benign in nature, a small percentage is caused by serious diseases, such as brain neoplasm. Computed tomography (CT) imaging remains the initial test of choice for (1) new-onset headache in adults and (2) headache suggestive of subarachnoid hemorrhage (limited evidence). Neuroimaging is recommended in adults with nonacute headache and unexplained abnormal neurologic examination (moderate evidence). The sensitivity of these two examinations drops signifi- cantly for aneurysms less than 5mm (moderate evidence).

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This also happens in the ancillary medical professions (physical therapy order mentax 15mg with amex, nursing, etc. Although the authorities are paying increasing attention to the phenomenon of cult infiltration into the medical profession, they dis- play a lukewarm optimism in noting that such incidents are fortunately not very frequent but that conclusive examples do exist. In addition, they emphasize that many doctors, for want of information (and a criti- cal mind), allow themselves to be misled by the advertisements of pseudo-scientific treatments disseminated by cults, of which they are liable to become followers without even realizing it. But the extension of such practices, and of "cult solicitation" by doctors, generally imply that doctors are actively involved in the activi- ties of various cults, whether in "healing" groups or in various other cult-like movements. There is a whole continuum ranging from movements whose prin- ciple stated objective is therapeutic (and who generally reject all tradi- tional medicine) and certain movements that preach miracle cures as an adjunct to their general theory. The preferred prey targeted by these movements are people who suffer from incurable pathologies and, for the cults with psychoanalytical or psychological overtones, people who are avid for the potential of personal development. Doctors’ participation includes prescribing and using "medicaments" and other esoteric products or techniques, whose value is, of course, enhanced by the medical "imprimatur" which is thus con- ferred upon them — and this prescription goes hand in hand with the systematic rejection of traditional medicine. Sometimes this conduct is driven by idealistic motivations, but more often purely mercantile con- 219 Healing or Stealing? The collusion between cult practices and medical practices are usually hidden voluntarily; and the same holds true for the "consulting" doctors to whom potential followers are addressed for a "second opin- ion" and often the prescription of a "method" dispensed by the cult. Some doctors who "sympathize" with these movements have been ac- cused (rightly) of actively, if discreetly, supporting harmful cult prac- tices when they have been publicly exposed and attacked. Several practitioners have been convicted for having proselytized on behalf of one cult or another. They strongly de- nounce the relationships between certain "soft" or alternative medi- cines and cults, relationships that are very clear in some cases. Alterna- tive medicines and pseudo-medicines are often preached and used in- side cults, and there is considerable danger in the fact that alternative and pseudo-scientific therapies are promoted by associations or groups known to serve as "screens" for cults.