For many years antiinflammatory influence of glucocorticoids spoke stabilisation of lysosomic membranes, but lately a number of researchers was confirmed with these data. Representations about influence of corticosteroids on synthesis of Prostaglandinums have been reconsidered also. Earlier believed, that Prednisolonum and similar preparations do not buy cipro cheap render appreciable action on a metabolism of Prostaglandinums (unlike obvious effect of nonsteroid antiinflammatory preparations at the expense of enzyme inhibition ). It has been found out Later, that actually appointment of corticosteroids leads to reduction of synthesis of Prostaglandinums, but is perfect other by. It has appeared, that, not influencing on , they oppress activity of enzyme , releasing arachidonic acid from difficult complexes in cellular membranes. As Prostaglandinums are synthesised from arachidonic acid, reduction of formation by last under the influence of corticosteroids results finally and in reduction of formation of Prostaglandinums, limiting to that intensity of inflammatory process.
Immunodepressive action of glucocorticoids is realised by different ways. Most obvious of them is lytic action on lymphoid system, especially on T-limfotsity, responsible first of all for cellular immune reactions. According to it the last are braked most distinctly (including allergic reactions of the slowed down type and immunity). Besides immediate overwhelming influence on T-limfotsity, reduction of quantity of circulating monocytes and inhibition of their function as normally functioning monocytes play an essential "secondary" role in development of cellular immune reactions matter. Though V-limfotsity are less sensitive to lytic and according to braking influence of glucocorticoids, these preparations in certain degree oppress also humoral immune reactions - synthesis of immunoglobulins and concrete antibodies. It is necessary to consider oppression of ability of monocytes to metabolize antigens and to transfer them in adequate form V-limfotsitam.
Clinically obvious suppression of immune reactions by glucocorticoids can depend not only on actually immunodepressive action, but also from normalisation of capillary permeability (difficulty of contact of antigens with antibodies, an obstacle to passage of immune complexes through the basic membrane of vessels), and also from the nonspecific antiinflammatory effect shown in relation to any types of an inflammation (including to immune) irrespective of the processes which have caused it.
Extremely fast medical action of glucocorticoids at acute immune crises (for example, an autoimmune hemolysis, an autoimmune thrombocytopenia etc.) gives the basis to believe, that these preparations interfere also with reaction of an antigen with an antibody, but concrete mechanisms of such influence while are unknown.
At rheumatic diseases glucocorticoids apply almost exclusively in the form of tablets. Prednisolonum is issued in tablets on 5 mg, and also on 1 and 2,5 mg, Prednisonum - on 1 and 5 mg, Methylprednisolonum - on 2-4 and 16 mg, Triamcinolonum (Kenacortum, Polcortolonum) - on 1-2 and buy rimonabant cheap 4 mg, () - on 6 and 12 mg, dexamethasone - on 0,5, 0,75 and 2 mg, betamethasone - on 0,5 mg, - on 2 mg, Cortisonum - on 25 mg. On antiinflammatory medical effect of Prednisolonum of 5 mg are roughly equivalent 5 mg of Prednisonum, 4 mg of Methylprednisolonum or Triamcinolonum, mg , 0,75 mg of dexamethasone or betamethasone, 2 mg , 25 mg of Cortisonum or Hidrocortizonum.
If it is impossible to enter these preparations inside, they can be used in (thus a dose enlarge by 25-50 %). Practically unique glucocorticoid which could be applied to long parenteral treatment, Hidrocortizonum is, but it considerably concedes to Prednisolonum and other modern preparations on shipping. Other glucocorticoids existing in the form of injection forms (Prednisolonum, Methylprednisolonum, dexamethasone), at intramuscular and the more so intravenous introduction are metabolized much faster in this connection their action quickly and in most cases is not enough for carrying out of long treatment. For reception of equivalent medical effect it should to enter doses, in 2-4 times big, than at appointment inside, and to use frequent injections. For last years successful attempts of creation of the parenteral prolonged preparations (in particular, , or Kenalogum), used, however, not for active "overwhelming" treatment, and basically as agents of supporting or local (intraarticulate) therapy are undertaken by corticosteroids.
среда, 19 ноября 2008 г.
Prednisolonum
Prednisolonum quickly (but more slowly, than a hydrocortisone) is metabolized in a liver and in a kind is deduced with urine. The period of semipurification of plasma makes about an hour, and through 2 3 the preparation practically disappears from blood. However metabolic effects order ultram cheap in tissues remain within many hours. Some preparations are capable to influence concentration of Prednisolonum and other corticosteroids. In particular, phenobarbital and rifampicin intensify a metabolism of these hormones and by that reduce their medical action. The risk of a hyperglycaemia of potassium loss is enlarged by it at simultaneous appointment of Prednisolonum and Hypothiazidum (and other diuretics of this group). It is especially important, that simultaneous application and Acidum acetylsalicylicum so lowers level of last in blood, that its concentration appears below therapeutic [Hart F., 1978].
Physiological effects are surveyed basically as antiinsulinic and include regulation of an albuminous, carbohydrate, lipide and nucleic exchange. Influence on proteometabolism mainly catabolic, shown in the raised disintegration of fibers and the enlarged allocation of nitric products. At the same time the glycogen maintenance in a liver is enlarged, and its synthesis raises at the expense of use of products of an albuminous and lipide exchange (). As initial products amino acids from bones, skins, muscles and the connecting tissue, mobilised both owing to the raised catabolism of fiber, and in connection with oppression of its synthesis are used. Rising of level of amino acids arising thus stimulates secretion of the glucagon also promoting in blood. are necessary for mobilisation of fat acids as they do possible activation of a cellular lipase by substances - catecholamins and peptides. Synthesis of nucleic acids in the majority of tissues of a body is oppressed, but synthesis (just as synthesis of fiber and of some enzymes) is stimulated in a liver.
Specific influence on a cell sensitive to its effects begins with interaction of a steroid and specific fiber - the steroid receptor which is in a cytoplasma. Then the complex a steroid - a receptor is transported to a kernel where co-operates with a chromatin (apparently, from DNA). The RNK-INTERMEDIARY, inducing in a cytoplasma synthesis of specific fiber which mediates concrete physiological effects is as a result synthesised specific. Influence of surveyed hormones on structural fibers and a fatty tissue variously in different parts of a body. So, even pharmacological doses can essentially reduce the fiber maintenance in an osteal matrix of vertebra, but influence long bones a little; the vpxl cheap combination of the enlarged adiposity on an abdominal wall and between scapulas with reduction of a fatty tissue of extremities is quite often observed.
support enough of extracellular water, interfering with its entering in cells. They suppress secretion by a pituitary body of an antidiuretic hormone and raise rate of a glomerular filtration, that in a combination to direct influence on canaliculuses enlarges a clearance of free water. They also oppress secretion , development of a somatotropic hormone by a pituitary body and with a liver.
Glucocorticoids make certain impact on mentality of the person. Appreciable emotional disorders are observed both at their excess in an organism, and at insufficiency.
Antiinflammatory action of glucocorticoids depends substantially on their normalising influence on a hyperpermeability of capillaries. Steroids support normal reaction of vessels of a microcirculatory bed to vasoconstrictive stimulus, interfering with that to influence of mediators of the inflammation dilating these vessels and raising their permeability. They oppress also migration of neutrophils in the inflammation centre that contacts inhibition of endothelial attachment of leucocytes in the inflamed area and their subsequent emigration. This effect explain, in particular, antagonism with the factor limiting migration of leucocytes which is developed by lymphocytes and macrophages. Braking influence on a chemotaxis of neutrophils and their ability to a phagocytosis though the total of neutrophils in peripheric blood at corticosteroid therapy is enlarged at the expense of stimulation of their exit from an osteal brain Is supposed also. Corticosteroids interfere with accumulation in the centres of an inflammation of monocytes as in connection with retardation of remission of mature monocytes from an osteal brain, and owing to reduction of their mobility, and bactericidal activity. Activity of fibroblasts that can lead to restriction of sclerotic processes chokes also.
Physiological effects are surveyed basically as antiinsulinic and include regulation of an albuminous, carbohydrate, lipide and nucleic exchange. Influence on proteometabolism mainly catabolic, shown in the raised disintegration of fibers and the enlarged allocation of nitric products. At the same time the glycogen maintenance in a liver is enlarged, and its synthesis raises at the expense of use of products of an albuminous and lipide exchange (). As initial products amino acids from bones, skins, muscles and the connecting tissue, mobilised both owing to the raised catabolism of fiber, and in connection with oppression of its synthesis are used. Rising of level of amino acids arising thus stimulates secretion of the glucagon also promoting in blood. are necessary for mobilisation of fat acids as they do possible activation of a cellular lipase by substances - catecholamins and peptides. Synthesis of nucleic acids in the majority of tissues of a body is oppressed, but synthesis (just as synthesis of fiber and of some enzymes) is stimulated in a liver.
Specific influence on a cell sensitive to its effects begins with interaction of a steroid and specific fiber - the steroid receptor which is in a cytoplasma. Then the complex a steroid - a receptor is transported to a kernel where co-operates with a chromatin (apparently, from DNA). The RNK-INTERMEDIARY, inducing in a cytoplasma synthesis of specific fiber which mediates concrete physiological effects is as a result synthesised specific. Influence of surveyed hormones on structural fibers and a fatty tissue variously in different parts of a body. So, even pharmacological doses can essentially reduce the fiber maintenance in an osteal matrix of vertebra, but influence long bones a little; the vpxl cheap combination of the enlarged adiposity on an abdominal wall and between scapulas with reduction of a fatty tissue of extremities is quite often observed.
support enough of extracellular water, interfering with its entering in cells. They suppress secretion by a pituitary body of an antidiuretic hormone and raise rate of a glomerular filtration, that in a combination to direct influence on canaliculuses enlarges a clearance of free water. They also oppress secretion , development of a somatotropic hormone by a pituitary body and with a liver.
Glucocorticoids make certain impact on mentality of the person. Appreciable emotional disorders are observed both at their excess in an organism, and at insufficiency.
Antiinflammatory action of glucocorticoids depends substantially on their normalising influence on a hyperpermeability of capillaries. Steroids support normal reaction of vessels of a microcirculatory bed to vasoconstrictive stimulus, interfering with that to influence of mediators of the inflammation dilating these vessels and raising their permeability. They oppress also migration of neutrophils in the inflammation centre that contacts inhibition of endothelial attachment of leucocytes in the inflamed area and their subsequent emigration. This effect explain, in particular, antagonism with the factor limiting migration of leucocytes which is developed by lymphocytes and macrophages. Braking influence on a chemotaxis of neutrophils and their ability to a phagocytosis though the total of neutrophils in peripheric blood at corticosteroid therapy is enlarged at the expense of stimulation of their exit from an osteal brain Is supposed also. Corticosteroids interfere with accumulation in the centres of an inflammation of monocytes as in connection with retardation of remission of mature monocytes from an osteal brain, and owing to reduction of their mobility, and bactericidal activity. Activity of fibroblasts that can lead to restriction of sclerotic processes chokes also.
понедельник, 17 ноября 2008 г.
Scarlatina. Before
Scarlatina. Before introduction in wide practice of an antibioticotherapia at a scarlatina complication in the form of infectious allergic arthritis was often enough observed. Besides, at serious buy cipro online septic forms of a scarlatina there were purulent streptococcal arthritises. Sometimes serous arthritises were combined with other late (metatonsillar) complications, more often with a myocarditis and a nephritis. It is necessary to mean, that after a scarlatina, as well as after streptococcal quinsy, the rheumatic disease also proceeding with a lesion of joints can develop. Differential diagnostics of a rheumatic arthritis will be separately surveyed. Thus, at a scarlatina it is possible to allocate 3 versions of arthritises: infectious-allergic, rheumatic, purulent (septic). Now early appointment of Penicillinum reliably warns development of all variants of an arthritis. However in the absence of an antibioticotherapia (appointment preparations, even in a combination to «antirheumatic agents» and so forth) they can develop.
From three versions of scarlatinal arthritises the easiest and short-term is an infectious-allergic arthritis. It appears in the end of 2nd or in the beginning of 3rd week of illness when already there pass all implications of the acute period of a scarlatina (is normalised the body temperature, the eruption disappears and so forth), can remain only enlarged lymph nodes and a skin ecdysis in exanthema places. Large joints are amazed, they swell up a little, movements in them painful and are moderately limited. At a puncture the serous exudate can be received. The arthritis proceeds rather not for long and passes without any residual phenomena. Unlike a rheumatic arthritis at it there are no other implications of rheumatic disease. The septic arthritis is purulent. It is one of the secondary hematogenic centres of a sepsis who always proceeds in the form of serious disease. From other kinds of a sepsis (staphylococcal, caused rods and so forth) It differs that gives in to a penicillin therapy (streptococcuses have high sensitivity to antibiotics groups), that can have differentsialno-diagnostic value.
Purulent arthritises at a typhoid, paratyphoids, generalised forms of a salmonellosis and a listerosis have much in common in the mechanism of occurrence and local disturbances. Arthritises are purulent complications of the given illnesses, develop in the height period, more often on 2nd week from the disease beginning. Large joints (knee, coxofemoral, talocrural, ulnar, humeral) are amazed, as a rule. Purulent process grasps articulate a cartilage, blasting it, and further can pass to subchondral sites of a bone with formation abscesses. The purulent arthritis can serve as the centre from which the sepsis further develops. Patients complain of strong pains in the amazed joint, the pain amplifies at attempt to make movement in a joint. Joint contours smoothed, the skin over it is stretched, , hot to the touch. At a joint cavity puncture it is possible to receive pus at which crops it is possible to allocate a microbe-infecting agent. At a blood analysis become perceptible a leukocytosis and ESR rising that is uncharacteristic for an uncomplicated typhoid, paratyphoids and other salmonelloses. For differential diagnostics other implications of illness matter also. The typhoid, paratyphoids and generalised forms of a salmonellosis become complicated a purulent arthritis in the period of height of illness when it is available all characteristic symptoms - rozeolezno-papuleznaja an eruption, liver and lien augmentation, a high fever, etc. Only on the basis of clinical semiology to differentiate this group of arthritises it is impossible. Specification of the nosological form is spent on the basis of originator allocation (from blood, pus, than excrements), is more rare . In the absence of laboratory acknowledgement at the given clinical semiology the typhoid diagnosis (clinically), complicated by a purulent arthritis is established.
At purulent arthritises, besides a lesion of joints, the eruption condensed on the person, in the field of large joints becomes buy rimonabant now perceptible erythematic or , the generalised lymphadenopathy, an acute tonsillitis, mononuclear character of peripheric blood (without atypical ), that allows to differentiate arthritises from . For diagnosis acknowledgement originator allocation is used (from blood, pus, a spinal liquid), are less informative researches (an agglutination test, ).
The sepsis of a various aetiology (staphylococcal, pneumococcal, , pyocyanic, etc.) is often accompanied by development of purulent arthritises. Usually they are the secondary centres, but can be and primary. One joint is in most cases amazed, round it the expressed tumescence is formed, in inflammatory process are involved cartilaginous, osteal and surrounding tissues. The arthritis or arthritises appear against the hardest septic process and consequently character of a lesion of joints does not cause doubts in such patients. At carrying out of differential diagnostics of the most important decoding of an aetiology of a sepsis that is carried out by microbe-originator allocation is.
From three versions of scarlatinal arthritises the easiest and short-term is an infectious-allergic arthritis. It appears in the end of 2nd or in the beginning of 3rd week of illness when already there pass all implications of the acute period of a scarlatina (is normalised the body temperature, the eruption disappears and so forth), can remain only enlarged lymph nodes and a skin ecdysis in exanthema places. Large joints are amazed, they swell up a little, movements in them painful and are moderately limited. At a puncture the serous exudate can be received. The arthritis proceeds rather not for long and passes without any residual phenomena. Unlike a rheumatic arthritis at it there are no other implications of rheumatic disease. The septic arthritis is purulent. It is one of the secondary hematogenic centres of a sepsis who always proceeds in the form of serious disease. From other kinds of a sepsis (staphylococcal, caused rods and so forth) It differs that gives in to a penicillin therapy (streptococcuses have high sensitivity to antibiotics groups), that can have differentsialno-diagnostic value.
Purulent arthritises at a typhoid, paratyphoids, generalised forms of a salmonellosis and a listerosis have much in common in the mechanism of occurrence and local disturbances. Arthritises are purulent complications of the given illnesses, develop in the height period, more often on 2nd week from the disease beginning. Large joints (knee, coxofemoral, talocrural, ulnar, humeral) are amazed, as a rule. Purulent process grasps articulate a cartilage, blasting it, and further can pass to subchondral sites of a bone with formation abscesses. The purulent arthritis can serve as the centre from which the sepsis further develops. Patients complain of strong pains in the amazed joint, the pain amplifies at attempt to make movement in a joint. Joint contours smoothed, the skin over it is stretched, , hot to the touch. At a joint cavity puncture it is possible to receive pus at which crops it is possible to allocate a microbe-infecting agent. At a blood analysis become perceptible a leukocytosis and ESR rising that is uncharacteristic for an uncomplicated typhoid, paratyphoids and other salmonelloses. For differential diagnostics other implications of illness matter also. The typhoid, paratyphoids and generalised forms of a salmonellosis become complicated a purulent arthritis in the period of height of illness when it is available all characteristic symptoms - rozeolezno-papuleznaja an eruption, liver and lien augmentation, a high fever, etc. Only on the basis of clinical semiology to differentiate this group of arthritises it is impossible. Specification of the nosological form is spent on the basis of originator allocation (from blood, pus, than excrements), is more rare . In the absence of laboratory acknowledgement at the given clinical semiology the typhoid diagnosis (clinically), complicated by a purulent arthritis is established.
At purulent arthritises, besides a lesion of joints, the eruption condensed on the person, in the field of large joints becomes buy rimonabant now perceptible erythematic or , the generalised lymphadenopathy, an acute tonsillitis, mononuclear character of peripheric blood (without atypical ), that allows to differentiate arthritises from . For diagnosis acknowledgement originator allocation is used (from blood, pus, a spinal liquid), are less informative researches (an agglutination test, ).
The sepsis of a various aetiology (staphylococcal, pneumococcal, , pyocyanic, etc.) is often accompanied by development of purulent arthritises. Usually they are the secondary centres, but can be and primary. One joint is in most cases amazed, round it the expressed tumescence is formed, in inflammatory process are involved cartilaginous, osteal and surrounding tissues. The arthritis or arthritises appear against the hardest septic process and consequently character of a lesion of joints does not cause doubts in such patients. At carrying out of differential diagnostics of the most important decoding of an aetiology of a sepsis that is carried out by microbe-originator allocation is.
For specific
For specific acknowledgement of the diagnosis use allocation from excrements or are more often applied methods (an agglutination test, , etc.) with which help increase of an antiserum capacity during illness is registered.
The rubella also can become complicated order ultram 1mg arthritises. They are more often observed at adult men. The tumescence and morbidity of joints appear soon after a deflorescence and keep during 5... 10 days. Arthritises at a rubella after themselves do not leave Any consequences. Are amazed both fine joints of brushes of arms, and larger joints, but changes of the last are observed less often. Differential diagnostics of difficulties usually does not cause, as arthritises arise at the demonstrative forms of a rubella proceeding with characteristic by an exanthema, a hyperadenosis, especially and occipital, and differ a fast involution without residual changes. Any special diagnostic receptions for decoding of character of arthritises thus it is not required. In doubtful cases specific laboratory methods can be used. Antiserum capacity increase is usually taped, is diagnostically significant - in 4 times and more.
The epidemic parotitis also becomes complicated arthritises though and is more rare, than a rubella. Rather is more often they develop at adult men. There are arthritises through 1... 2 after sialadens. Large joints (radiocarpal, humeral, knee and talocrural) are amazed more often. Joints swell up, become painful at a palpation, in them there can be a serous exudate. Duration of arthritises more often 1... 2 , only at some patients they are tightened to 1... 3 months of Any consequences after parotitis arthritises do not remain.
Differential diagnostics in typical cases of difficulties does not cause, as the clinical semiology of an epidemic parotitis - and morbidity sialadens, symptom , frequent rising of activity of an amylase of urine, presence of complications typical for a parotitis (adult men in 50 % of cases have an orchitis) is rather characteristic. The epidemiological anamnesis - contact to the patient, absence of inoculations and disease by a parotitis in the past Matters. In doubtful cases it is spent research with didymous Serums ( and with specific diagnosticums).
Pseudotuberculosis. At palindromias, and they develop at half of patients, often there are arthritises (in 20... 30 % of cases). Some patients can have some relapses. The general duration of the complicated pseudotuberculosis makes 1... 2 , less often illness is tightened to 3 months Arthritises appear on 3rd week of illness is more often. They are accompanied by a new wave of a fever, often there is an exanthema, but any more
("scarlatiniform"), as in an illness initial stage, and in the form of a nodulose erythema with localisation of elements on anticnemions. Arthritises have infectious-allergic (but not purulent) character and pass without any residual phenomena.
Recognition of the pseudotuberculous nature of arthritises does not represent difficulties as they are preceded by the basic (first) wave of illness which has the characteristic developed semiology in vpxl 1mg the height period. The erased and atypical forms of a pseudotuberculosis do not become complicated arthritises. At abdominal forms of a pseudotuberculosis relapses and consequently also arthritises, arise in 2 times more often, than in the cases proceeding without a lesion of organs of digestion. In the period of height of a pseudotuberculosis often there is a punctate rash, a dermahemia of the person and a neck («a hood symptom»), a tumescence and a dermahemia of palms and feet. Mesadenitis signs are often taped. The second wave of a fever appears after short remission, on its background there are arthritises. Thus, differential diagnostics of pseudotuberculous arthritises can mainly be based on clinical data. In doubtful cases use specific laboratory methods, in particular allocation of the originator from excrements, revealing of specific antibodies by means of serological tests (, with pseudotuberculous., etc.). However at a capture of Serum (first) in occurrence of an arthritis of increase of an antiserum capacity to tap any more it is not possible.
The rubella also can become complicated order ultram 1mg arthritises. They are more often observed at adult men. The tumescence and morbidity of joints appear soon after a deflorescence and keep during 5... 10 days. Arthritises at a rubella after themselves do not leave Any consequences. Are amazed both fine joints of brushes of arms, and larger joints, but changes of the last are observed less often. Differential diagnostics of difficulties usually does not cause, as arthritises arise at the demonstrative forms of a rubella proceeding with characteristic by an exanthema, a hyperadenosis, especially and occipital, and differ a fast involution without residual changes. Any special diagnostic receptions for decoding of character of arthritises thus it is not required. In doubtful cases specific laboratory methods can be used. Antiserum capacity increase is usually taped, is diagnostically significant - in 4 times and more.
The epidemic parotitis also becomes complicated arthritises though and is more rare, than a rubella. Rather is more often they develop at adult men. There are arthritises through 1... 2 after sialadens. Large joints (radiocarpal, humeral, knee and talocrural) are amazed more often. Joints swell up, become painful at a palpation, in them there can be a serous exudate. Duration of arthritises more often 1... 2 , only at some patients they are tightened to 1... 3 months of Any consequences after parotitis arthritises do not remain.
Differential diagnostics in typical cases of difficulties does not cause, as the clinical semiology of an epidemic parotitis - and morbidity sialadens, symptom , frequent rising of activity of an amylase of urine, presence of complications typical for a parotitis (adult men in 50 % of cases have an orchitis) is rather characteristic. The epidemiological anamnesis - contact to the patient, absence of inoculations and disease by a parotitis in the past Matters. In doubtful cases it is spent research with didymous Serums ( and with specific diagnosticums).
Pseudotuberculosis. At palindromias, and they develop at half of patients, often there are arthritises (in 20... 30 % of cases). Some patients can have some relapses. The general duration of the complicated pseudotuberculosis makes 1... 2 , less often illness is tightened to 3 months Arthritises appear on 3rd week of illness is more often. They are accompanied by a new wave of a fever, often there is an exanthema, but any more
("scarlatiniform"), as in an illness initial stage, and in the form of a nodulose erythema with localisation of elements on anticnemions. Arthritises have infectious-allergic (but not purulent) character and pass without any residual phenomena.
Recognition of the pseudotuberculous nature of arthritises does not represent difficulties as they are preceded by the basic (first) wave of illness which has the characteristic developed semiology in vpxl 1mg the height period. The erased and atypical forms of a pseudotuberculosis do not become complicated arthritises. At abdominal forms of a pseudotuberculosis relapses and consequently also arthritises, arise in 2 times more often, than in the cases proceeding without a lesion of organs of digestion. In the period of height of a pseudotuberculosis often there is a punctate rash, a dermahemia of the person and a neck («a hood symptom»), a tumescence and a dermahemia of palms and feet. Mesadenitis signs are often taped. The second wave of a fever appears after short remission, on its background there are arthritises. Thus, differential diagnostics of pseudotuberculous arthritises can mainly be based on clinical data. In doubtful cases use specific laboratory methods, in particular allocation of the originator from excrements, revealing of specific antibodies by means of serological tests (, with pseudotuberculous., etc.). However at a capture of Serum (first) in occurrence of an arthritis of increase of an antiserum capacity to tap any more it is not possible.
среда, 12 ноября 2008 г.
eception Эрбена
Reception Эрбена consists in the following: investigated it is offered to sit down on hunkers and strongly to incline a head forward, it is desirable before contact of a chin with knees. In norm there is a retardation of pulse within 6 - 12 blows in a minute. Larger retardation is regarded as prevalence of excitability of system of a vagus nerve.
Clinical methods of research of sosudisto-warm reflexes, besides here resulted, it is described much; we do not stop buy cipro on their treating.
The greatest diffusion have received an oculocardiac reflex and ортоклиностатическая assay. Their practical value, on a level with other functional assays of heart, basically, consists that with their help we can establish presence of hypererethism, mobility and instability of a vegetative innervation, in particular, concerning sosudisto-warm system.
Finishing the given chapter, we will stop on treating of value of research and an estimation of a condition of a vegetative innervation in practice of neurologic work.
Research of local, zone disorders of a vegetative dermal innervation (vascular, pilomotor, потовых, etc.) is a valuable additional method in the decision of problems of topical diagnostics at lesions of peripheric nervous system, segmentary and conduction lesions of a spinal cord, cerebral focal processes, etc., not speaking about exclusive value of these researches at diseases of "actually visceral nervous devices, for example ganglions buy rimonabant of a boundary sympathetic trunk, etc.
Presence of asymmetries of the vegetative innervation which are falling outside the limits physiological fluctuations, can, at small expression of other symptoms, help with recognition initial (or residual) forms of cortical or diencephalic lesions.
The establishment of pathological mobility (lability), instability and hypererethism of a vegetative innervation matters in an objective estimation of neurotic conditions, and also in questions of special selection for some trades.
Detailed research of changes of a vegetative innervation in zones "reflected" (реперкуссивных) the phenomena at diseases of internal organs can help with recognition of illness and define area for application of reflex therapy.
Spinal, or cerebrospinal, the liquid is in a close parity with covers and vascular plexuses of ventricles.
Covers head and a spinal cord represent as though a case which covers a brain, and consist of three leaves: firm (dura mater, pachymeninx), web (arachnoidea) and soft (pia mater, leptomeninx).
The firm cerebral cover consists of two leaves. The external leaf densely adjoins to skull and backbone bones and is their periosteum. The internal leaf, or actually firm cerebral cover, represents a dense fibrous plate. In a skull cavity both leaf adjoin to each other (in a place of their divergence sine are formed), in the intraspinal channel between them there is the quaggy fatty tissue rich with a venous network (epidural space).
The web cover covers an internal surface of a firm cover and a number of plates and тяжей is bridged to the deepest leaf - a soft cerebral cover.
The soft cerebral cover densely adjoins and grows together with a surface head and a spinal cord. The space between web and soft cerebral covers is called as subarachnoidal, or subarachnoid; in it is and the most part of a cerebrospinal liquid (fig. 77) circulates.
Places (for example, over cerebral gyruses) where the substance of a brain settles down close to a bone, the subarachnoid space is absent: both leaves, both a web and soft cover, adjoin to each other.
Small щелевидные spaces are in excavations between cerebral gyruses. On the brain basis there are big cavities where clumps of a cerebrospinal liquid are appreciable enough. Such cavities are called as tanks. The most powerful are: big, settling down under a cerebellum and. Over an oblong brain, the basic, laying on the basis of a brain, etc. In the field of a spinal cord the subarachnoid space is great enough and surrounds all spinal cord. Below, since II lumbar vertebra where the spinal cord comes to an end and roots of a horse tail are located, the subarachnoidal spinal space extends, forming the so-called final tank.
Clinical methods of research of sosudisto-warm reflexes, besides here resulted, it is described much; we do not stop buy cipro on their treating.
The greatest diffusion have received an oculocardiac reflex and ортоклиностатическая assay. Their practical value, on a level with other functional assays of heart, basically, consists that with their help we can establish presence of hypererethism, mobility and instability of a vegetative innervation, in particular, concerning sosudisto-warm system.
Finishing the given chapter, we will stop on treating of value of research and an estimation of a condition of a vegetative innervation in practice of neurologic work.
Research of local, zone disorders of a vegetative dermal innervation (vascular, pilomotor, потовых, etc.) is a valuable additional method in the decision of problems of topical diagnostics at lesions of peripheric nervous system, segmentary and conduction lesions of a spinal cord, cerebral focal processes, etc., not speaking about exclusive value of these researches at diseases of "actually visceral nervous devices, for example ganglions buy rimonabant of a boundary sympathetic trunk, etc.
Presence of asymmetries of the vegetative innervation which are falling outside the limits physiological fluctuations, can, at small expression of other symptoms, help with recognition initial (or residual) forms of cortical or diencephalic lesions.
The establishment of pathological mobility (lability), instability and hypererethism of a vegetative innervation matters in an objective estimation of neurotic conditions, and also in questions of special selection for some trades.
Detailed research of changes of a vegetative innervation in zones "reflected" (реперкуссивных) the phenomena at diseases of internal organs can help with recognition of illness and define area for application of reflex therapy.
Spinal, or cerebrospinal, the liquid is in a close parity with covers and vascular plexuses of ventricles.
Covers head and a spinal cord represent as though a case which covers a brain, and consist of three leaves: firm (dura mater, pachymeninx), web (arachnoidea) and soft (pia mater, leptomeninx).
The firm cerebral cover consists of two leaves. The external leaf densely adjoins to skull and backbone bones and is their periosteum. The internal leaf, or actually firm cerebral cover, represents a dense fibrous plate. In a skull cavity both leaf adjoin to each other (in a place of their divergence sine are formed), in the intraspinal channel between them there is the quaggy fatty tissue rich with a venous network (epidural space).
The web cover covers an internal surface of a firm cover and a number of plates and тяжей is bridged to the deepest leaf - a soft cerebral cover.
The soft cerebral cover densely adjoins and grows together with a surface head and a spinal cord. The space between web and soft cerebral covers is called as subarachnoidal, or subarachnoid; in it is and the most part of a cerebrospinal liquid (fig. 77) circulates.
Places (for example, over cerebral gyruses) where the substance of a brain settles down close to a bone, the subarachnoid space is absent: both leaves, both a web and soft cover, adjoin to each other.
Small щелевидные spaces are in excavations between cerebral gyruses. On the brain basis there are big cavities where clumps of a cerebrospinal liquid are appreciable enough. Such cavities are called as tanks. The most powerful are: big, settling down under a cerebellum and. Over an oblong brain, the basic, laying on the basis of a brain, etc. In the field of a spinal cord the subarachnoid space is great enough and surrounds all spinal cord. Below, since II lumbar vertebra where the spinal cord comes to an end and roots of a horse tail are located, the subarachnoidal spinal space extends, forming the so-called final tank.
Detailed statement
Detailed statement of some methods of research and an estimation of their clinical value are resulted in the special monographies devoted to the description of a visceral (vegetative) innervation and their disturbances (G.I.Markelov, I.I.Rusetsky, N.S.Chetverikov, etc.).
The wide circulation in clinical practice suffices has received research of cardiovascular reflexes. We will stop on treating of some of them.
The Oculocardiac reflex order ultram (phenomenon Даньини - Ашнера) causes as follows. Investigated lays on a back, in free position; after a while at it сосчитывается pulse. After that the investigating makes pressure, it is better on both eyeglobes simultaneously big and index arm fingers (or index and average). Pressure is recommended to be made not on the forward chamber, and on lateral departments of an eyeball, and it should be intensive enough, but not painful for investigated. Through 20 - 30 seconds, not stopping pressure, consider pulse within 20 or 30 seconds. After recalculation for a minute the pulse rate before and after pressure is compared. In norm there is a pulse retardation on some blows in a minute (to 10 blows). Larger retardation is regarded as vagotonic effect, absence of retardation or paradoxical acceleration - as synpaticotonic.
At described reception other reflex phenomena are quite often observed also: falling of a blood pressure, change of breath, an intestinal peristalsis, etc., going as rising of a tonus of system of a vagus nerve. A reflex arch of a reflex: trigeminal - wandering nerves. Other name of a reflex more widely characterising its implications, - глазовисцеральный is offered. In practice are more often limited to the account of changes of a pulse rate. With a view of dosage of a put boring (pressure upon an eyeball) special apparatus - the compressors which have not received, however, the general recognition have been offered.
Ortoklinostatichesky assay consists as a matter of fact of two receptions.
The orthostatic reflex arises at transition investigated of horizontal position (laying) in vertical (standing) and is expressed in norm in pulse increase, usually on 10 - 12 blows in a minute (pulse consider before assay and a first minute after position change). The clinostatic reflex turns out at transition from vertical position in horizontal; the return phenomenon is observed: pulse in norm is slowed down on 10 - 12 blows in a minute. The big degree of increase (at orthostatic assay) and retardations (at clinostatic) should be regarded as an indicator of hypererethism of nervously-muscular devices of heart; attempts to use results ортоклиностатической assays vpxl for more exact estimation of a sympathicotonia or a vagotonia to us seem insufficiently proved.
The cervical reflex causes pressing by the big finger investigating (or index and average fingers together) on area to front from a grudino-kljuchichno-papillary muscle, at level of its top third, below a mandible angle - to sensation of a pulsation of a carotid. In norm there is a pulse retardation on 6 - 12 blows in a minute. The big degree of retardation and joining of changes of breath, an intestinal peristalsis, etc. is regarded as implication of the raised tonus of system of a vagus nerve.
Epigastric (солнечноузловой) the reflex causes at position investigated on a back with as much as possible relaxed musculation of a prelum abdominale; the hemodynamometry and pulse is made. Investigating presses fingers on area between a xiphoid process and a belly-button, strengthening gradually pressure to sensation of a clear pulsation of an abdominal aorta. Result is retardation of pulse and blood pressure dropping; sharp degree of these reflex phenomena is regarded as an indicator of hypererethism of parasympathetic department. However quite often simultaneously there are reflexes and a sympathetic order: expansion of pupils, etc., that speaks presence in a solar plexus both sympathetic, and a parasympathetic innervation. Besides, the method of influence (pressing of an abdominal aorta) can cause circulatory disorders and widespread vascular reflexes.
Coming back to the cervical reflex surveyed above (in their various updatings it is described a little), it is necessary to note, as here it is impossible to speak about influence only on a vagus nerve; in essence there is a mechanical boring (pressing) of a vago-sympathetic nervously-vascular cervical fascicle and a carotid zone.
The wide circulation in clinical practice suffices has received research of cardiovascular reflexes. We will stop on treating of some of them.
The Oculocardiac reflex order ultram (phenomenon Даньини - Ашнера) causes as follows. Investigated lays on a back, in free position; after a while at it сосчитывается pulse. After that the investigating makes pressure, it is better on both eyeglobes simultaneously big and index arm fingers (or index and average). Pressure is recommended to be made not on the forward chamber, and on lateral departments of an eyeball, and it should be intensive enough, but not painful for investigated. Through 20 - 30 seconds, not stopping pressure, consider pulse within 20 or 30 seconds. After recalculation for a minute the pulse rate before and after pressure is compared. In norm there is a pulse retardation on some blows in a minute (to 10 blows). Larger retardation is regarded as vagotonic effect, absence of retardation or paradoxical acceleration - as synpaticotonic.
At described reception other reflex phenomena are quite often observed also: falling of a blood pressure, change of breath, an intestinal peristalsis, etc., going as rising of a tonus of system of a vagus nerve. A reflex arch of a reflex: trigeminal - wandering nerves. Other name of a reflex more widely characterising its implications, - глазовисцеральный is offered. In practice are more often limited to the account of changes of a pulse rate. With a view of dosage of a put boring (pressure upon an eyeball) special apparatus - the compressors which have not received, however, the general recognition have been offered.
Ortoklinostatichesky assay consists as a matter of fact of two receptions.
The orthostatic reflex arises at transition investigated of horizontal position (laying) in vertical (standing) and is expressed in norm in pulse increase, usually on 10 - 12 blows in a minute (pulse consider before assay and a first minute after position change). The clinostatic reflex turns out at transition from vertical position in horizontal; the return phenomenon is observed: pulse in norm is slowed down on 10 - 12 blows in a minute. The big degree of increase (at orthostatic assay) and retardations (at clinostatic) should be regarded as an indicator of hypererethism of nervously-muscular devices of heart; attempts to use results ортоклиностатической assays vpxl for more exact estimation of a sympathicotonia or a vagotonia to us seem insufficiently proved.
The cervical reflex causes pressing by the big finger investigating (or index and average fingers together) on area to front from a grudino-kljuchichno-papillary muscle, at level of its top third, below a mandible angle - to sensation of a pulsation of a carotid. In norm there is a pulse retardation on 6 - 12 blows in a minute. The big degree of retardation and joining of changes of breath, an intestinal peristalsis, etc. is regarded as implication of the raised tonus of system of a vagus nerve.
Epigastric (солнечноузловой) the reflex causes at position investigated on a back with as much as possible relaxed musculation of a prelum abdominale; the hemodynamometry and pulse is made. Investigating presses fingers on area between a xiphoid process and a belly-button, strengthening gradually pressure to sensation of a clear pulsation of an abdominal aorta. Result is retardation of pulse and blood pressure dropping; sharp degree of these reflex phenomena is regarded as an indicator of hypererethism of parasympathetic department. However quite often simultaneously there are reflexes and a sympathetic order: expansion of pupils, etc., that speaks presence in a solar plexus both sympathetic, and a parasympathetic innervation. Besides, the method of influence (pressing of an abdominal aorta) can cause circulatory disorders and widespread vascular reflexes.
Coming back to the cervical reflex surveyed above (in their various updatings it is described a little), it is necessary to note, as here it is impossible to speak about influence only on a vagus nerve; in essence there is a mechanical boring (pressing) of a vago-sympathetic nervously-vascular cervical fascicle and a carotid zone.
суббота, 8 ноября 2008 г.
of the named kinds
of the named kinds of sensitivity occurs on an opposite side as fibers of the second neurones of painful and temperature feeling buy cipro mg to their introduction into a lateral column are exposed to a decussation in forward grey soldering.
VIII. The Lesion of half, a spinal cord gives on the centre party: disturbance of sustavno-muscular feeling in the presence of the central paralysis from top to bottom from lesion level, on the opposite party - conduction painful and temperature anaesthesia (fig. 5). This symptom-complex wears the name broun-sekarovskogo a paralysis or a syndrome.
Fig. 5. Sensitivity disorders at броунсекаровском a paralysis.
And - a cut line through the right half of spinal cord. Cross-section lines designate area of conduction painful and temperature anaesthesia on the party opposite to the centre; over it - a narrow girdle of a hyperesthesia. On the lesion party - the central paralysis, loss of sustavno-muscular and tactile sensitivity; over it very narrow corbel of dermal anaesthesia (on Bekhterev).
IX. The Lesion of all diameter of the spinal cord, causing a break of all sensitive conductors from located below body segments, gives a picture of anaesthesia of all kinds of sensitivity of conduction type from both parties, from top to bottom from lesion level. The bilaterial central paralysis with emiction disorders is simultaneously observed.
X. The Lesion of a medial loop (lemniscus medialis) in a cerebral trunk (fig. 2) after full merge tractus spino-thalamicus and bulbo-thalamicus (in the bridge, in brain legs) causes loss of all kinds of sensitivity on an opposite side of a body and sensitive атаксию in opposite extremities at the expense of loss of sustavno-muscular feeling (a hemianaesthesia and a hemiataxia).
Fibers for various kinds of sensitivity in a medial loop are located in such a manner that most medially there are conductors of sustavno-muscular feeling, кнаружи from them - tactile, still латеральное - temperature and, at last, painful feeling. Therefore at an incomplete lesion of a medial loop those or other kinds of sensitivity on a body opposite side can mainly drop out. Especially probably it at a lesion of an oblong brain where tractus spino-thalamicus and bulbo-thalamicus have not merged yet and go separately. The law of an eccentric locating of longer ways is applicable and concerning a medial loop: conductors from underlaying segments (the bottom extremities) are ventro-lateralno from the overlying.
XI. The Lesion of a visual hillock - thalami optici - causes, as well as a lesion of a medial loop, a hemianaesthesia of all kinds of sensitivity and a hemiataxia on an opposite side; besides, at the buy rimonabant mg expense of a lesion of the subcortical visual centres (corpus geniculatum laterale) there is also a hemianopsia of opposite fields of vision, i.e. «A syndrome of three геми»: a hemianaesthesia, a hemiataxia and a hemianopsia.
Quite often at a lesion of a visual hillock there are original thalamic pains in an opposite half of body - hemialgias: the excruciating and extremely unpleasant feeling of a cold or a burning sensation which can be hardly described the patient is felt and badly localised by it; the vagueness, иррадиация pains is observed. These pains usually badly give in to therapeutic influences. At sensitivity research on a half of body opposite to the centre the hyperpathia is found out thus usually. Sometimes these pains are stronger in rest and decrease at movements.
XII. The Lesion of sensitive ways in an internal capsule where in a back third of back hip (fig. 55, VII} pass Volonum of the third neurones of sensitivity (tractus thalamo-corticales) causes also «a syndrome of three геми»: a hemianaesthesia, a hemiataxia and a hemianopsia. Often processes in an internal capsule are more diffusive, and then at the expense of a lesion пирамидных ways the hemiplegia is observed also on an opposite side and the central type, i.e. « Syndrome of three геми »other character: a hemiplegia, a hemianaesthesia and a hemianopsia. If at a lesion of a back hip of an internal capsule in process it is involved simultaneously
VIII. The Lesion of half, a spinal cord gives on the centre party: disturbance of sustavno-muscular feeling in the presence of the central paralysis from top to bottom from lesion level, on the opposite party - conduction painful and temperature anaesthesia (fig. 5). This symptom-complex wears the name broun-sekarovskogo a paralysis or a syndrome.
Fig. 5. Sensitivity disorders at броунсекаровском a paralysis.
And - a cut line through the right half of spinal cord. Cross-section lines designate area of conduction painful and temperature anaesthesia on the party opposite to the centre; over it - a narrow girdle of a hyperesthesia. On the lesion party - the central paralysis, loss of sustavno-muscular and tactile sensitivity; over it very narrow corbel of dermal anaesthesia (on Bekhterev).
IX. The Lesion of all diameter of the spinal cord, causing a break of all sensitive conductors from located below body segments, gives a picture of anaesthesia of all kinds of sensitivity of conduction type from both parties, from top to bottom from lesion level. The bilaterial central paralysis with emiction disorders is simultaneously observed.
X. The Lesion of a medial loop (lemniscus medialis) in a cerebral trunk (fig. 2) after full merge tractus spino-thalamicus and bulbo-thalamicus (in the bridge, in brain legs) causes loss of all kinds of sensitivity on an opposite side of a body and sensitive атаксию in opposite extremities at the expense of loss of sustavno-muscular feeling (a hemianaesthesia and a hemiataxia).
Fibers for various kinds of sensitivity in a medial loop are located in such a manner that most medially there are conductors of sustavno-muscular feeling, кнаружи from them - tactile, still латеральное - temperature and, at last, painful feeling. Therefore at an incomplete lesion of a medial loop those or other kinds of sensitivity on a body opposite side can mainly drop out. Especially probably it at a lesion of an oblong brain where tractus spino-thalamicus and bulbo-thalamicus have not merged yet and go separately. The law of an eccentric locating of longer ways is applicable and concerning a medial loop: conductors from underlaying segments (the bottom extremities) are ventro-lateralno from the overlying.
XI. The Lesion of a visual hillock - thalami optici - causes, as well as a lesion of a medial loop, a hemianaesthesia of all kinds of sensitivity and a hemiataxia on an opposite side; besides, at the buy rimonabant mg expense of a lesion of the subcortical visual centres (corpus geniculatum laterale) there is also a hemianopsia of opposite fields of vision, i.e. «A syndrome of three геми»: a hemianaesthesia, a hemiataxia and a hemianopsia.
Quite often at a lesion of a visual hillock there are original thalamic pains in an opposite half of body - hemialgias: the excruciating and extremely unpleasant feeling of a cold or a burning sensation which can be hardly described the patient is felt and badly localised by it; the vagueness, иррадиация pains is observed. These pains usually badly give in to therapeutic influences. At sensitivity research on a half of body opposite to the centre the hyperpathia is found out thus usually. Sometimes these pains are stronger in rest and decrease at movements.
XII. The Lesion of sensitive ways in an internal capsule where in a back third of back hip (fig. 55, VII} pass Volonum of the third neurones of sensitivity (tractus thalamo-corticales) causes also «a syndrome of three геми»: a hemianaesthesia, a hemiataxia and a hemianopsia. Often processes in an internal capsule are more diffusive, and then at the expense of a lesion пирамидных ways the hemiplegia is observed also on an opposite side and the central type, i.e. « Syndrome of three геми »other character: a hemiplegia, a hemianaesthesia and a hemianopsia. If at a lesion of a back hip of an internal capsule in process it is involved simultaneously
THE SYNDROMES OF SENSITIVE
THE SYNDROMES OF SENSITIVE DISORDERS ARISING AT THE LESION OF VARIOUS DEPARTMENTS OF SENSITIVE SYSTEM
In the presence of sensitive order ultram 400mg disorders it is necessary to find out: 1) in what limits (in what territory) sensitivity is upset; 2) its what kinds are broken; 3) whether exist, besides disturbances of dermal sensitivity, a pain or paresthesia.
Fig. 4. The scheme of distribution of dermal sensitivity according to nerves and spinal cord segments.
1. The lesion (full) of a trunk of a peripheric nerve is characterised by disturbance of all kinds of sensitivity in the field of a dermal innervation of the given nerve as fibers of all kinds of sensitivity pass in a peripheric nerve together. Zones of a dermal innervation of each nerve are presented on fig. 4. The lesion of the admixed or sensitive nerve is accompanied usually by pains or paresthesias.
II. The Lesion of trunks of plexuses (cervical, humeral, lumbar and крестцового) causes anesthesias or hypesthesias of all kinds of sensitivity of extremities in territory, иннервируемой sensitive fibers of those nerves, which start with the amazed trunk (or trunks) a plexus. Presence of pains is Here too characteristic.
III. The Lesion of a back sensitive root of a spinal cord gives also loss or dropping of all kinds of sensitivity, but zones of sensitive disorders wear fished, namely segmentary character: circular on a trunk and poloskovo-longitudinal on extremities (fig. 4 see). The lesion of roots also is accompanied by pains. At simultaneous involving in process of an intervertebral ganglion (a ganglionitis or a ganglioneuritis) the rash herpes zoster in the field of corresponding segments is possible.
IV. The Lesion of a back horn of a spinal cord causes the same segmentary disorders of sensitivity, as well as a lesion of a back root, but, unlike a root lesion, split, or dissociated, disorders here are observed. It is necessary to recollect, that at an input of a back sensitive root in a spinal cord only fibers painful and a thermoesthesia enter a back horn; fibers of tactile and sustavno-muscular feeling pass it, entering immediately in structure vpxl 400mg of white conductors of a back column (fig. 1 see). Therefore at a lesion of a back horn ways for carrying out from the given segment of painful and temperature feeling are exposed to a break only. As a result there is a painful and temperature anaesthesia at safety in the same territory of tactile sensitivity (dissociation). Was considered, that unlike a lesion of a back root, at a lesion of a back horn of a pain are not so characteristic; However and at a lesion of back horns quite often rather intensive painful sensations are observed.
V. The Lesion of forward grey soldering of a spinal cord where there is a decussation of fibers of painful and temperature feeling, also causes the dissociated disorders (abaissement painful and a thermoesthesia at safety tactile); sites of anesthesias have segmentary character; they двухсторонни also are symmetric (type of "butterfly").
Unlike lesions of back roots, back horns and the forward grey soldering, anesthesias giving segmentary distribution, a lesion of white conductors of the central nervous system gives conduction disorder of sensitivity.
VI. The Lesion of a back column of a spinal cord where there pass Gaulle's fascicles and Бурдаха (fig. 1 see), causes loss of sustavno-muscular and vibratory feeling on the party of a lesion of conduction type, i.e. From lesion level up to the end from top to bottom; can arise as well disorders of tactile feeling. As a result of disturbance of feeling of position comes sensitive атаксия about which it has been told above. Lesions of back columns of a spinal cord are caused quite often by hyperpathia occurrence at drawing painful and temperature a boring.
VII. The Lesion of a lateral column of a spinal cord causes painful and temperature anaesthesia of conduction type at the expense of a lesion passing here tractus spino-thalamicus (fig. 1 see). Abaissement
In the presence of sensitive order ultram 400mg disorders it is necessary to find out: 1) in what limits (in what territory) sensitivity is upset; 2) its what kinds are broken; 3) whether exist, besides disturbances of dermal sensitivity, a pain or paresthesia.
Fig. 4. The scheme of distribution of dermal sensitivity according to nerves and spinal cord segments.
1. The lesion (full) of a trunk of a peripheric nerve is characterised by disturbance of all kinds of sensitivity in the field of a dermal innervation of the given nerve as fibers of all kinds of sensitivity pass in a peripheric nerve together. Zones of a dermal innervation of each nerve are presented on fig. 4. The lesion of the admixed or sensitive nerve is accompanied usually by pains or paresthesias.
II. The Lesion of trunks of plexuses (cervical, humeral, lumbar and крестцового) causes anesthesias or hypesthesias of all kinds of sensitivity of extremities in territory, иннервируемой sensitive fibers of those nerves, which start with the amazed trunk (or trunks) a plexus. Presence of pains is Here too characteristic.
III. The Lesion of a back sensitive root of a spinal cord gives also loss or dropping of all kinds of sensitivity, but zones of sensitive disorders wear fished, namely segmentary character: circular on a trunk and poloskovo-longitudinal on extremities (fig. 4 see). The lesion of roots also is accompanied by pains. At simultaneous involving in process of an intervertebral ganglion (a ganglionitis or a ganglioneuritis) the rash herpes zoster in the field of corresponding segments is possible.
IV. The Lesion of a back horn of a spinal cord causes the same segmentary disorders of sensitivity, as well as a lesion of a back root, but, unlike a root lesion, split, or dissociated, disorders here are observed. It is necessary to recollect, that at an input of a back sensitive root in a spinal cord only fibers painful and a thermoesthesia enter a back horn; fibers of tactile and sustavno-muscular feeling pass it, entering immediately in structure vpxl 400mg of white conductors of a back column (fig. 1 see). Therefore at a lesion of a back horn ways for carrying out from the given segment of painful and temperature feeling are exposed to a break only. As a result there is a painful and temperature anaesthesia at safety in the same territory of tactile sensitivity (dissociation). Was considered, that unlike a lesion of a back root, at a lesion of a back horn of a pain are not so characteristic; However and at a lesion of back horns quite often rather intensive painful sensations are observed.
V. The Lesion of forward grey soldering of a spinal cord where there is a decussation of fibers of painful and temperature feeling, also causes the dissociated disorders (abaissement painful and a thermoesthesia at safety tactile); sites of anesthesias have segmentary character; they двухсторонни also are symmetric (type of "butterfly").
Unlike lesions of back roots, back horns and the forward grey soldering, anesthesias giving segmentary distribution, a lesion of white conductors of the central nervous system gives conduction disorder of sensitivity.
VI. The Lesion of a back column of a spinal cord where there pass Gaulle's fascicles and Бурдаха (fig. 1 see), causes loss of sustavno-muscular and vibratory feeling on the party of a lesion of conduction type, i.e. From lesion level up to the end from top to bottom; can arise as well disorders of tactile feeling. As a result of disturbance of feeling of position comes sensitive атаксия about which it has been told above. Lesions of back columns of a spinal cord are caused quite often by hyperpathia occurrence at drawing painful and temperature a boring.
VII. The Lesion of a lateral column of a spinal cord causes painful and temperature anaesthesia of conduction type at the expense of a lesion passing here tractus spino-thalamicus (fig. 1 see). Abaissement
четверг, 6 ноября 2008 г.
The Latin term “placebo”
The Latin term “placebo” means to "like", “to give pleasure”. In medicine represents the indifferent substance used at a scientific estimation of action of medicines (under the pretext of a new preparation). The favorable effect плацебо is bound to psychological action on the patient. In clinical practice sometimes prescribe the patient with superficial disturbances of the mentality, wrongly considering, that symptoms of their illness have an organic basis. Плацебо it is possible to prescribe and the incurable patient for rising of their mood. The doctor should understand, that its relation to order ultram 200mg treatment influences result: the enthusiasm and belief in success can strengthen therapeutic effect, scepticism, on the contrary, to weaken. The patient reacting to introduction , name . The persons reacting on , are inclined to trust in miracles, are socially active, are less ambitious and are self-confident, acutely feel the individuality and more , than not reacting on . To are sensitive about 35 % of patients with organic diseases and 40 % of patients with functional disorders.
Value of impression which is made on the patient by the doctor, well-known from history, by G.A.Zaharina's experience (1829-1897). This outstanding doctor used the following situation during consultations of well-founded patients. After survey the professor in loneliness in the special blacked out room considered the diagnosis and treatment. At this time in the house the full silence should remain. The impression of such consultation on the patient and its relatives was favorably reflected in results of treatment and allowed Grigory Antonovichu to achieve amazing successes.
Efficiency of new medicines usually compare with in comparable groups of patients on a sex, age, duration and gravity of disease. Treatment in both groups spend simultaneously double blind method. Thus not only the patient, but also the attending physician do not know, whether the patient the examinee receives a preparation or (the full information the third party has only). The double blind method allows to exclude influence of bias on results of treatment as the doctor not only cannot have psychological influence on the patient, but also insufficiently objectively estimate effect of therapy. Application not always is necessary, and sometimes and unethically, for example, when patients is inadmissible to deprive of effective treatment. At a tuberculosis sick groups of comparison receive most effective of already applied preparations. Use in controllable clinical tests always puts ethical problems before the doctor. Modern demands to carrying out of clinical tests - Good Clinical Practice (GCP) - include obligatory observance of ethical standards which besides the decision of ethical committee on test carrying out concerns and the informed consent of the patient. However the last as show some researches, can affect result of test. If at application the aggravation of symptoms becomes perceptible, the patient should be deduced from research or to translate on active treatment within the limits of the same test.
Platsebo-reactions are used for a long time in medicine. When the doctor or someone from relatives shows attention and care of the patient, to that becomes frequent better. This influence, undoubtedly, keeps the value and now, despite the big achievements of medicine though quite often frames deceptive impressions and illusions about efficiency of some new methods of treatment. The fast improvement coming at sick virus infection under the influence of an antibiotic can be an example of such illusions. The probability of effect always should be considered, when there is no full confidence of accuracy of the diagnosis. Such situation meets almost at half of patients in the general practice. So, in group of patients, at which convincing data for certain disease at the moment of the reference it is not taped, application in 80 % of cases has led to improvement.
In the majority of the developed countries after the Second World War the augmentation of number of persons with various mental disturbances and the painful implications bound to them is noted. At them the effect any treatment is often enough observed. There was even a term buy vpxl 200mg “temporarily dependent sick - patients for whom the fact of an occurring with the doctor and its survey is important, and also the prescription of any therapy. When parts of such patients it has been declared, that they do not demand treatment, the effect as a whole did not differ from that at patients by whom symptomatic therapy was spent. Apparently, at many such patients application can be more safe and even effective, than appointment of active agents. However more often doctors are not inclined to use , regarding such treatment as charlatanism.
The platsebo-effect can be called any contact of the doctor to the patient. The trust of the patient to the doctor depends not only on its words, but also from appearance, a dialogue manner, and also others in effect few the studied factors. Different people possess various ability to dialogue. Some consider, that on character and trustful doctors cure softer better, than categorical and sharp. The effect usually is absent at conservative people, suspicious and mistrustful. The most expressed effect observe at an injection way of introduction. It depends on appearance and colour of tablets. At research of analgetic effect of tablets depending on their colour it decreased in the following sequence: red, blue, green, yellow. As well as active medicines, can cause subjective collateral reactions - delicacy, a headache, dryness in a mouth, constipations, an impotency.
Research of the importance of so-called "positive" and "negative" consultations at patients with a functional pathology is carried out. In the first case to the patient said, that it does not have serious disease and in the near future to it it becomes better; in the second informed, that character of illness is not absolutely clear. In both groups one patient prescribed , to another a drug intake did not recommend. Recover came is much more often and faster in the first group of patients; in both groups there were no differences in effect of treatment between sick, receiving and not receiving any preparation. The conclusion is drawn, that in daily practice the platsebo-effect meets often enough and in many respects depends on the person of the doctor.
Value of impression which is made on the patient by the doctor, well-known from history, by G.A.Zaharina's experience (1829-1897). This outstanding doctor used the following situation during consultations of well-founded patients. After survey the professor in loneliness in the special blacked out room considered the diagnosis and treatment. At this time in the house the full silence should remain. The impression of such consultation on the patient and its relatives was favorably reflected in results of treatment and allowed Grigory Antonovichu to achieve amazing successes.
Efficiency of new medicines usually compare with in comparable groups of patients on a sex, age, duration and gravity of disease. Treatment in both groups spend simultaneously double blind method. Thus not only the patient, but also the attending physician do not know, whether the patient the examinee receives a preparation or (the full information the third party has only). The double blind method allows to exclude influence of bias on results of treatment as the doctor not only cannot have psychological influence on the patient, but also insufficiently objectively estimate effect of therapy. Application not always is necessary, and sometimes and unethically, for example, when patients is inadmissible to deprive of effective treatment. At a tuberculosis sick groups of comparison receive most effective of already applied preparations. Use in controllable clinical tests always puts ethical problems before the doctor. Modern demands to carrying out of clinical tests - Good Clinical Practice (GCP) - include obligatory observance of ethical standards which besides the decision of ethical committee on test carrying out concerns and the informed consent of the patient. However the last as show some researches, can affect result of test. If at application the aggravation of symptoms becomes perceptible, the patient should be deduced from research or to translate on active treatment within the limits of the same test.
Platsebo-reactions are used for a long time in medicine. When the doctor or someone from relatives shows attention and care of the patient, to that becomes frequent better. This influence, undoubtedly, keeps the value and now, despite the big achievements of medicine though quite often frames deceptive impressions and illusions about efficiency of some new methods of treatment. The fast improvement coming at sick virus infection under the influence of an antibiotic can be an example of such illusions. The probability of effect always should be considered, when there is no full confidence of accuracy of the diagnosis. Such situation meets almost at half of patients in the general practice. So, in group of patients, at which convincing data for certain disease at the moment of the reference it is not taped, application in 80 % of cases has led to improvement.
In the majority of the developed countries after the Second World War the augmentation of number of persons with various mental disturbances and the painful implications bound to them is noted. At them the effect any treatment is often enough observed. There was even a term buy vpxl 200mg “temporarily dependent sick - patients for whom the fact of an occurring with the doctor and its survey is important, and also the prescription of any therapy. When parts of such patients it has been declared, that they do not demand treatment, the effect as a whole did not differ from that at patients by whom symptomatic therapy was spent. Apparently, at many such patients application can be more safe and even effective, than appointment of active agents. However more often doctors are not inclined to use , regarding such treatment as charlatanism.
The platsebo-effect can be called any contact of the doctor to the patient. The trust of the patient to the doctor depends not only on its words, but also from appearance, a dialogue manner, and also others in effect few the studied factors. Different people possess various ability to dialogue. Some consider, that on character and trustful doctors cure softer better, than categorical and sharp. The effect usually is absent at conservative people, suspicious and mistrustful. The most expressed effect observe at an injection way of introduction. It depends on appearance and colour of tablets. At research of analgetic effect of tablets depending on their colour it decreased in the following sequence: red, blue, green, yellow. As well as active medicines, can cause subjective collateral reactions - delicacy, a headache, dryness in a mouth, constipations, an impotency.
Research of the importance of so-called "positive" and "negative" consultations at patients with a functional pathology is carried out. In the first case to the patient said, that it does not have serious disease and in the near future to it it becomes better; in the second informed, that character of illness is not absolutely clear. In both groups one patient prescribed , to another a drug intake did not recommend. Recover came is much more often and faster in the first group of patients; in both groups there were no differences in effect of treatment between sick, receiving and not receiving any preparation. The conclusion is drawn, that in daily practice the platsebo-effect meets often enough and in many respects depends on the person of the doctor.
вторник, 4 ноября 2008 г.
This stream of the published news
This stream of the published news, some of which were inexact, and
Some simply mismatched true, have caused to doctor Dik-Read ultram online 100mg
It is much more harm, than it is possible to present only. On December, 19th, 1948, in
Day when he has left England, millions inhabitants of Brighton have read the false
Heading "": "to the Doctor refuse in homing".
News has flown about all world, acquiring hearings and gossips, and on March, 26th, 1949
In "" details have appeared in time:
"The doctor about Harley - the persona non grata in Southern Africa
To the British accoucheur, doctor Grantli Dik-Read who has relieved all women from
Pains at sorts, it is given up in reception by the South African Medical Council.
Council has made this decision at meeting of Committee and later has confirmed it on
Open session. To make comments on this decision officials of Council
Have refused. "
The charges which have been put forward by Council against doctor Grantli, consisted that
He has addressed for advertising to a secular press, and, besides, was the person with
"Bad character" so, at all did not approach to be
Registered in Southern Africa as the doctor. Doctor Dik-Read has employed the lawyer for
Appeal preparations. While proceeding, it proceeded
Remained out-of-pocket to existence, to it have forbidden to practise. Though in it
It is a high time it overcame calls of hundred the women begging it to visit of them
Labours. Its house even was watched by spies, whether it accepts patients secretly.
Eventually, Medical Council suited the special commission, that
To familiarise with the appeal which A.Izrail should represent, one of
The most outstanding lawyers of Southern Africa:
"... Exhaustive proofs, that doctor Grantli Dik-Read are presented you
Is the famous expert in the field of obstetrics... It is correct or not
Its method, not to me and not to you to judge. The given statement does not concern it
Question. I speak to you about it simply because I know, that in Council is
People who wish to present doctor Grantli Dik-ri-yes as the person,
Nothing made in medicine. They have shown it on an occurring
Executive committee. I will not speak and about a moral aspect of the such
Acts...
With documents we have put numerous letters-responses of leaders to a folder
Experts-gynecologists about a method of doctor Dik-Read. There and the letter
The Lord Chancellor from England, and doctor Tomsa, the head of obstetric unit
University in , letters from Medicine School in Boston, letters from Canada
And many other things places where works of doctor Grantli Dik-Read are widely known and
On advantage are estimated, where it concern with the big respect, because
Understand importance of its works for obstetrics development. vpxl 300mg
So really in this country its work consider such unnecessary, that with contempt
Wave away from its desire to work here?
... the chairman, I think, that I will not violate the truth, if
I will tell, that on Executive Council to doctor Grantli Dik-Read have arranged
Formulated interrogation though on it Council did not have any right. However the doctor
Has answered all questions put before it and has answered directly. Unless already it
One does not prove, that its charge in bad character mismatches
To true? "
After perusal of the text of the appeal voting has begun. From nineteen
The person only one has refrained, eighteen has voted against
Permissions to doctor Grantli Dik-Read to practise in Southern Africa! Remained
Only one way to address for the help - the appeal in the Supreme Court Southern
Africa. Has as a result taken place three hearings of business and, at last, on June, 23rd 1941
Year the Supreme Court has decided, that to Grantli Dik-Read should be given out
The certificate on registration without any delay.
In the meantime plans of building of new hospital have been thrown for a long time. But all
Possibility to practise in has been given doctor Dik-Read
In small, but well equipped hospital, nuns
Dominican Award. Nuns have invited to come, promising all
Support. He has answered them: "I think, we will not have problems with patients.
More likely, we will have a problem how to extend, to satisfy all
Wishing to get to our hospital ". Its predictions have come true.
Some simply mismatched true, have caused to doctor Dik-Read ultram online 100mg
It is much more harm, than it is possible to present only. On December, 19th, 1948, in
Day when he has left England, millions inhabitants of Brighton have read the false
Heading "": "to the Doctor refuse in homing".
News has flown about all world, acquiring hearings and gossips, and on March, 26th, 1949
In "" details have appeared in time:
"The doctor about Harley - the persona non grata in Southern Africa
To the British accoucheur, doctor Grantli Dik-Read who has relieved all women from
Pains at sorts, it is given up in reception by the South African Medical Council.
Council has made this decision at meeting of Committee and later has confirmed it on
Open session. To make comments on this decision officials of Council
Have refused. "
The charges which have been put forward by Council against doctor Grantli, consisted that
He has addressed for advertising to a secular press, and, besides, was the person with
"Bad character" so, at all did not approach to be
Registered in Southern Africa as the doctor. Doctor Dik-Read has employed the lawyer for
Appeal preparations. While proceeding, it proceeded
Remained out-of-pocket to existence, to it have forbidden to practise. Though in it
It is a high time it overcame calls of hundred the women begging it to visit of them
Labours. Its house even was watched by spies, whether it accepts patients secretly.
Eventually, Medical Council suited the special commission, that
To familiarise with the appeal which A.Izrail should represent, one of
The most outstanding lawyers of Southern Africa:
"... Exhaustive proofs, that doctor Grantli Dik-Read are presented you
Is the famous expert in the field of obstetrics... It is correct or not
Its method, not to me and not to you to judge. The given statement does not concern it
Question. I speak to you about it simply because I know, that in Council is
People who wish to present doctor Grantli Dik-ri-yes as the person,
Nothing made in medicine. They have shown it on an occurring
Executive committee. I will not speak and about a moral aspect of the such
Acts...
With documents we have put numerous letters-responses of leaders to a folder
Experts-gynecologists about a method of doctor Dik-Read. There and the letter
The Lord Chancellor from England, and doctor Tomsa, the head of obstetric unit
University in , letters from Medicine School in Boston, letters from Canada
And many other things places where works of doctor Grantli Dik-Read are widely known and
On advantage are estimated, where it concern with the big respect, because
Understand importance of its works for obstetrics development. vpxl 300mg
So really in this country its work consider such unnecessary, that with contempt
Wave away from its desire to work here?
... the chairman, I think, that I will not violate the truth, if
I will tell, that on Executive Council to doctor Grantli Dik-Read have arranged
Formulated interrogation though on it Council did not have any right. However the doctor
Has answered all questions put before it and has answered directly. Unless already it
One does not prove, that its charge in bad character mismatches
To true? "
After perusal of the text of the appeal voting has begun. From nineteen
The person only one has refrained, eighteen has voted against
Permissions to doctor Grantli Dik-Read to practise in Southern Africa! Remained
Only one way to address for the help - the appeal in the Supreme Court Southern
Africa. Has as a result taken place three hearings of business and, at last, on June, 23rd 1941
Year the Supreme Court has decided, that to Grantli Dik-Read should be given out
The certificate on registration without any delay.
In the meantime plans of building of new hospital have been thrown for a long time. But all
Possibility to practise in has been given doctor Dik-Read
In small, but well equipped hospital, nuns
Dominican Award. Nuns have invited to come, promising all
Support. He has answered them: "I think, we will not have problems with patients.
More likely, we will have a problem how to extend, to satisfy all
Wishing to get to our hospital ". Its predictions have come true.
понедельник, 3 ноября 2008 г.
Caisson disease.
The clinic, Caisson disease develops owing to penetration of nitrogen of tissues into blood at transition from under the raised pressure (2-5 ) to the normal. Passing from tissues in vascular system, nitrogen causes a gas vascular embolism. Arising emboluses, merging, can have foamy structure. In other cases gas blisters frame conditions for ultram 100mg formation of an occlusive thrombus from formulated elements of blood. Thus, the caisson disease proceeds or in the form of an aeroembolism, or an aerothrombosis.
Illness can be acute and chronic. Acute forms of a caisson disease are caused by an aeroembolism, chronic - an aerothrombosis. Chronic forms can be primary and secondary. Initially-chronic forms arise slowly, pass the long latent period and are caused by an aerothrombosis. The osteoarthrosis and a myocardial dystrophy concern them. Again-chronic forms are caused by an aeroembolism before which elimination in a nervous tissue there were deep irreversible pathological changes.
There is a certain dependence of gravity of a current of symptoms on the sizes and quantity of gas emboluses. In this connection among acute forms of a caisson disease it is necessary to distinguish easy, moderately severe, serious and lethal. Easy forms are characterised by convertibility after elimination of blockade of a circulation and influence of emboluses. It is necessary to carry the aeroembolisms which elimination is accompanied by the insignificant residual phenomena to moderately severe forms. Serious forms develop at insufficiently timely elimination of embolic action of gas or at massive aeroembolisms. They come to an end with the expressed defect of functions of organs. In case of massive flooding by aeroemboluses serious forms of a caisson disease can become lethal. Lethal forms of a caisson disease are observed at full blockade of a pulmonary circulation, acute insufficiency of work of heart or circulation disturbance in an oblong brain.
From the moment of the termination of decompression (transition from under the raised pressure to normal) and before occurrence of the first symptoms of a caisson disease passes usually not less a half an hour. Than above pressure and degree of a saturation of an organism (saturation by gas) and the more shortly decompression, the will come a gas embolism more likely. If saturation degree is low, for development of a gas embolism more long time is necessary, and disease will be expressed in easier form. vpxl 200mg
Osteoarthralgias concern easy forms, a neuralgia and dermal lesions (an itch, and a skin emphysema).
The basic symptom of an osteoarthralgia is the pain which is localised in bones and joints of extremities. Quite often pains are preceded by paresthesias. Intensity of pains can have alternating character. Sometimes pains are accompanied by cramps and fibrillar twitchings in extremities, a tumescence with exudate presence in joints. At a palpation the crepitation is taped. Rise in temperature can be observed.
Illness can be acute and chronic. Acute forms of a caisson disease are caused by an aeroembolism, chronic - an aerothrombosis. Chronic forms can be primary and secondary. Initially-chronic forms arise slowly, pass the long latent period and are caused by an aerothrombosis. The osteoarthrosis and a myocardial dystrophy concern them. Again-chronic forms are caused by an aeroembolism before which elimination in a nervous tissue there were deep irreversible pathological changes.
There is a certain dependence of gravity of a current of symptoms on the sizes and quantity of gas emboluses. In this connection among acute forms of a caisson disease it is necessary to distinguish easy, moderately severe, serious and lethal. Easy forms are characterised by convertibility after elimination of blockade of a circulation and influence of emboluses. It is necessary to carry the aeroembolisms which elimination is accompanied by the insignificant residual phenomena to moderately severe forms. Serious forms develop at insufficiently timely elimination of embolic action of gas or at massive aeroembolisms. They come to an end with the expressed defect of functions of organs. In case of massive flooding by aeroemboluses serious forms of a caisson disease can become lethal. Lethal forms of a caisson disease are observed at full blockade of a pulmonary circulation, acute insufficiency of work of heart or circulation disturbance in an oblong brain.
From the moment of the termination of decompression (transition from under the raised pressure to normal) and before occurrence of the first symptoms of a caisson disease passes usually not less a half an hour. Than above pressure and degree of a saturation of an organism (saturation by gas) and the more shortly decompression, the will come a gas embolism more likely. If saturation degree is low, for development of a gas embolism more long time is necessary, and disease will be expressed in easier form. vpxl 200mg
Osteoarthralgias concern easy forms, a neuralgia and dermal lesions (an itch, and a skin emphysema).
The basic symptom of an osteoarthralgia is the pain which is localised in bones and joints of extremities. Quite often pains are preceded by paresthesias. Intensity of pains can have alternating character. Sometimes pains are accompanied by cramps and fibrillar twitchings in extremities, a tumescence with exudate presence in joints. At a palpation the crepitation is taped. Rise in temperature can be observed.
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