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Are these people physically injured generic tolterodine 4 mg mastercard symptoms zinc deficiency adults, psychologically traumatised buy tolterodine 4 mg low price treatment quinsy, or ‘on the make’? In the Karlsborg ea (1997) series of 39 patients there are 6 cases of whiplash in females for every 4 cases in males cheap tolterodine 2mg online medications 3 times a day. Moderate to severe pain was reported by 27% of whiplash sufferers at 1 year and by slightly more (30%) at 3 years generic 4mg tolterodine amex treatment hpv. Accident-associated and post-accident psychosocial variables predicted pain severity at 12 months. Whilst whiplash was especially associated with compensation seeking, the authors suggested that this was explained by ‘the high proportion of innocent victims, the physical symptoms and the ease of legal definition’. This research was based on case notes and self-reports at follow-up, and response rates declined over the follow-up period. Like Cassidy ea (2000), Thomas (2002) emphasises the potential of litigation (as distinct from no fault compensation) to worsen and prolong suffering and reduce functioning. Electrical stimulation of this part of the brain can evoke illusions of elevation, rotation, lightness, flying, and limb shortening or movement. Fibrosis may also occur on the soles of the feet (plantar fibromatosis), knuckle pads, and penis (Peyronie’s disease). Trace elements Trace elements occur in living tissues in extremely small quantities. The association between trace elements and mental illness is circumstantial at present. Reducing the amount of aluminium in the water for dialysis prevents this encephalopathy. Contamination of water by huge 3173 quantities of aluminium may have led to some brain damage. Exposure in the workplace (welders, etc) may lead to tremor, impaired balance, reduced recall memory, and slowing of cognition. Cyanocobalmin (B12) deficiency (most often due to pernicious anaemia with antibodies again parietal cells and intrinsic factor) may cause 3174 anaemia, eye problems, spinal cord degeneration , neurasthenia, depression, paranoid psychosis with 3171 May have nodules or skin and knuckle pad thickening. However, some cases of B12 deficiency, especially older subjects, may have normal B12 levels but elevated methylmalonic acid 3176 and homocysteine levels. Always think of B12 deficiency in vegans or in the patient with reduced peripheral vibration sense. Successful treatment is now available with chelating agents such as penicillamine. The commonest psychiatric complications are non- specific affective or behaviour disorders, but schizophreniform or bipolar psychoses can also occur. Menkes’ kinky hair syndrome is a rare sex-linked recessive disorder associated with copper malabsorption. Infants fail to grow, have intellectually disability, brittle hair, anaemia, neutropaenia, and bone lesions. Manganese: Manganese is an essential trace element and is plentiful in the environment. A high manganese level has been associated with psychosis (‘manganese madness’ ) and 3179 Parkinsonism , e. Some cases may walk with their heels in the air and with their elbows flexed (cock-walk). The patient must be removed from sources of contamination although improvement is not guaranteed. This may present in the adult with delirium and seizures, often with associated hypertension. Chronic encephalopathy is characterised by headache, trembling, impaired memory and concentration, poor hearing, and episodic hemianopia and aphasia. Children are particularly badly affected and may develop coma, pareses, papilloedema, meningism, and compression of medullary centres, and those who survive may be brain damaged or blind. Alternatively, the oral chelating agent meso-2,3-dimercaptosuccinic acid may be used. Lead poisoning (plumbism) Sources of lead range from lead toys (common in the author’s childhood), retained bullets (especially in a joint space or a pseudocyst), and illegal whiskey (use of old car radiator) Lethargy Blue line on gum margins (lead sulphide deposition) Lead lines on x-rays of long bones in children Abdominal discomfort or pain, vomiting, constipation 3175 ‘megaloblastic madness’. They may be more sensitive indicators of tissue B12 deficiency than B12 levels themselves. Folic acid and B12 act as co-factors in re-methylation of homocysteine to methionine, deficiency of either vitamin causing increased homocysteine levels. Kim ea (2008) suggest that low B12, low folate and raised homocysteine levels may increase risk for late-life depression. Uptake of fluorodopa is normal in manganese-induced Parkinsonism but reduced in paralysis agitans. Hopes of replacing lithium with rubidium were upset by suggestions of neurotoxicity. Vitamin C converts this to the tetravalent ion, vanadyl (methylene blue has the same effect). Selenium: This is commonly found in skin applications and can cause tremor and loss of appetite if absorbed transcutaneously over a long period of time. Depletion might be a cause of depression and other negative mood states, such as anxiety, confusion and hostility. Well recognised symptoms of zinc deficiency include depression and perverted taste and smell. Low zinc levels are associated with poor nutrition and high phytate levels in bread. Zinc deficiency may also occur in malabsorption states, regional enteritis, hepatic failure, kidney disease, certain drugs (e. High zinc levels have been found in multiple sclerosis and in neural tube defects. Zinc (as acetate or sulphate) is used as a copper depleting agent in Wilson’s disease. Zince supplements given to pregnant poor Bangladeshi women did not confer benefit on their infants’ mental development (Hamadani ea, 2002) although it does seem to reduce mortality in infants from infectious diseases. Electrolytes and acid-base balance disorders Hyponatraemia: symptoms include nausea, vomiting, abdominal pain, anorexia, weakness, dizziness, headache, blurring of vision, sweating, malaise, lassitude, apathy, muscle cramps and twitching, delirium, coma, and hypotension. Patients with psychogenic polydipsia and those with eating disorders who drink water to produce a full feeling are at risk of hyponatraemia. Low sodium (< 125 mmol/L) or a rapid fall in sodium level can lead to agitated delirium whereas more chronic hyponatraemia may be associated with poor attention and falls in older patients. Central pontine myelinolysis is a rare disorder of cerebral white matter and has multiple causes; rapid correction of hyponatraemia (common in beer drinkers, especially when replacing vomited fluids with hypotonic fluids) may be a factor in the aetiology (although not invariably so), the condition presenting a day to a week later. A low sodium diet may be useful in reducing blood pressure in patients with multiple risk factors for the metabolic syndrome. Hypernatraemia: either too much water is lost or too little water is taken in; older people at are highest risk; there can be xerostomia, weight loss, grey complexion, lethargy, confusional state/delirium, and muscular hypertonicity; seizures and central pontine myelinolysis may follow over vigorous rehydration; shrinking of the brain may bleeding from veins; cerebral sinus thrombosis is a known complication; hypernatraemia may occur with anabolic steroid abuse or in diabetes insipidus. Hypokalaemia: this may occur in hepatic cirrhosis, metabolic alkalosis, vomiting, or laxative/diuretic/anabolic steroid abuse; there is reduced intake of potassium, a movement of potassium into cells, or excess potassium loss. Hyperkalaemia: this is chiefly a problem with kidney failure; clinical features include fatigue, muscle weakness (flaccidity in extreme cases), lethargy, confusion and cardiac arrhythmias (bradycardia due to heart block, ventricular fibrillation/asystole). Calcium: High serum calcium (hyperparathyroidism, cancer) causes depression, anxiety, and delirium; low serum calcium (diet low in calcium or vitamin D, hypoparathyroidism, rhabdomyolysis, kidney/liver disease, anticonvulsant drugs, thyroid/parathyroid surgery) can cause cramps, tetany, and seizures.
There was a signiﬁcant further ad- vance of her renal disease buy cheap tolterodine 4mg on-line treatment diarrhea, necessitating the initiation of haemodialysis (a kidney machine) two years later discount tolterodine 2mg visa treatment kidney infection, and a living tolterodine 2mg with mastercard symptoms pulmonary embolism, related donor renal transplant (from her mother) was subsequently performed buy generic tolterodine 4mg line medicine 66 296 white round pill. After the transplant, Mrs A remained well and maintained good kidney function on a combination of anti-rejection drugs, steroids and blood pressure tablets. At age 26, a reversal- of-sterilization operation was performed because she had become so distressed by her childlessness, but hysterosalpingography (a test to check for fallopian tubal patency) two years later, when pregnancy had not occurred, showed that both tubes had once again become blocked. Mrs A’s pregnancy test was positive 13 days after embryo transfer, and an ultrasound scan performed at eight weeks’ gestation showed a viable twin pregnancy. Throughout the treatment cycle and during pregnancy, the patient’s anti- rejection drugs (azathioprine and prednisolone) were continued at mainte- nance doses. The pregnancy was complicated at 20 weeks’ gestation by a right deep vein thrombosis, affecting the femoral and external iliac veins, and anti-coagulation with heparin and warfarin was required. Spontaneous rupture of the mem- branes, leading to premature delivery, occurred at 29 weeks’ gestation; the twins were delivered vaginallyand in good condition three hours later. After delivery of her babies, Mrs A remained well and her renal graft continued to function normally, with no change in immunosuppressive or antihypertensive (blood pressure) medication required. Risks to the mother, the fetus and the neonate Severe pre-eclampsia and eclampsia can result in irreversible damage to the maternal kidney, particularly due to acute renal cortical necrosis. Women who have recurrent pre-eclampsia in several pregnancies or blood pressures that remain elevated in the period following delivery (the puerperium), especially if they have pre-existing renal disease and/or hypertension, have a higher incidence of later cardiovascular disorders and a reduced life expect- ancy (Chesley, Annitto and Cosgrove, 1989). Pregnancy is recognized to be a privileged immunological state, and therefore episodes of rejection during pregnancy might be expected to be lower than for non-pregnant transplant recipients. Nevertheless, rejection episodes occur in nine per cent of pregnant women, occasionally in women who have had years of stable renal function- ing prior to conception. More rarely, rejection episodes occur in the puer- perium, when they may represent a rebound eVect from the altered im- munosuppressiveness of pregancy. Immunosuppressive (anti-rejection) drugs are theoretically toxic to the developing fetus; however, maternal health and graft function require im- munosuppression to be maintained. A large French study of women with pre-existing renal damage reported a prematurity rate of 17 per cent and a spontaneous abortion rate (miscarriage) of 20 per cent, as compared to 164 G. Severe pre-eclampsia can present as a progressive condition, tending to occur with greater virulence in successive pregnancies (Campbell and MacGillivrey, 1985). This, after all, had been the rationale behind the original decision to sterilize the patient after the death of her second baby, precipitated by pre-eclampsia and extreme prematurity. The successfully functioning trans- planted kidney had been donated by the patient’s mother and therefore, as an organ, was 30 years older than the patient herself. An editorial review (Davison and Redman, 1997) reported that 35 per cent of all conceptions in renal transplant patients failed to progress beyond the Wrst trimester because of therapeutic (approximately 20 per cent) and spon- taneous (approximately 14 per cent) abortions. Problems occur some time after delivery in 11 per cent of all women with transplants, unless the pregnancy was complicated prior to 28 weeks’ gestation, in which case remote problems can occur in 24 per cent of pregnancies. However, of the conceptions that continue beyond the Wrst trimester, 94 per cent end success- fully, in spite of a 30 per cent chance of developing hypertension, pre-eclampsia, or both. The hormone drug regime involves supra-physiological levels of oestradiol, which are associated with a higher risk of thrombotic (blood-clotting) episodes than in normal pregnancy. Arguments that could be advanced against oVering fertility treatment to renal transplant recipients, such as whether it is in the best interests of the patient to be helped to achieve a state as a result of which she may suVer chronic ill health or even early death, have also been advanced against permitting ‘old’, i. In both instances, one could argue that as long as the risks associated with fertility treatment and pregnancy were thoroughly explained to and accepted by the woman (and her partner), then to refuse treatment on the sole ground that her health may deteriorate is unacceptably paternalistic on the part of the clinicians involved. Mrs A stated that if she had not agreed to the sterilization (which she claimed she had been placed under undue pressure to accept at the time she was diagnosed with renal failure), then she would not only have been able to, but deWnitely would have tried to, achieve a further pregnancy, as she did after the reversal of sterilization was performed. Lockwood authorities as encouraging fertility units to feel justiWed in refusing treatment to women with signiWcant health problems (or to post-menopausal women) as it would, so they claim, not be in the ‘interests of the child’ to be born to a mother with reduced life expectancy due to chronic ill health or comparative- ly advanced age. Apart from the obvious rejoinders that society happily countenances men becoming fathers at an age when their life expectancy is reduced, and the medical profession’s heroic eVorts to assist women with serious health problems who become pregnant spontaneously, it is unques- tionably in the interests of the child. After all, the child will only be born if his transplanted mother is oVered fertility treatment and she should be oVered such treatment, even if he loses his mother at an early age or has to deal with the consequences of her ill health, as otherwise he won’t exist! The supposed stigma of illegitimacy is now vastly reduced to the point of being negligible, as are other historical reasons, such as those cited by PfeVer (1993), namely the stigmas of adultery and masturbation. Other reasons for secrecy, such as protecting patient conWdentiality and the more controversial claim that secrecy beneWts the doctor, I will not explore. Widdows examination of the procedure – including doctors’ practices of making social decisions about access and donors, which they are not qualiWed to make (Haimes, 1993). In addition, recent ad- vances in genetics have strengthened claims that knowing one’s genetic parentage is an important part of understanding one’s own identity (at least medically). Two main reasons given for keeping the donor anonymous are: Wrst, a practical reason, that anonymity is necessary to ensure that there are willing donors; and second, that anonymity ensures that donors have the ‘correct attitude’. First, the supposition that if donor anonymity were removed, then donors would no longer be willing to donate sperm can now be tested against the evidence which is emerging in countries where anonymity has been removed. At Wrst sight such evidence appears to suggest that both donors and potential parents were uncomfortable with the removal of donor anonymity – donors were less The ethics of secrecy in donor insemination 169 willing to donate and parents were choosing to go to countries which continued the practice of donor anonymity. A further possibility is that this increase in couples seeking treat- ment outside Sweden is an indicator not of dissatisfaction among donors with the removal of anonymity, but of the dissatisfaction of medical advisors, who adopted the practice of ‘advising and referring couples to have treatment outside Sweden’ (Daniels and Lalos, 1995: p. However, Daniels and Lalos do note that their view is contested by Bygdeman (cited in Daniels and Lalos, 1995), who argues that both the decline in donors and the trend for couples to seek treatment abroad was a direct reaction to the fact that their anonymity would no longer be protected. However, Daniels and Lalos conclude that ‘despite this limitation, it is clear that the number of available donors is increasing’ (Daniels and Lalos, 1995: p. To support this conclusion they cite statistics from the University Hospital of Northern Sweden, which had collected donor Wgures both before and after the introduction of the law. These Wgures show that the number of donors pre- and post-legislation remained static, and later (co- inciding with high-proWle recruitment campaigns) the number of donors began steadily to increase, thus supporting their claim that despite the removal of anonymity donor numbers are increasing. Widdows primarily by money, whereas donors recruited after the change in legislation tended to be older, married men, who were motivated altruistically by a desire to assist infertile couples (Daniels and Lalos, 1995). In one sense the predictions were correct, in that the donors who donated before the passing of the law (of those anonymous donors to whom the predictors had access) did cease to donate once anonymity was removed. Hence only the second reason for insisting on anonymity remains, namely, that anonymity ensures that donors should have the ‘correct’ attitude to the procedure. In such a framework it was in the interest of all parties to keep their involvement secret, and anonymity safeguarded secrecy for both the donor and the parents. Accordingly, the correct attitude of the donor was held to be detachment – the donor should not wish to know anything about, or have any contact with, his potential progeny (Pennings, 1997). Although the level of expenses is intended to be below the level of induce- ment, for many young men (characteristically students) the expenses are suYcient to function as inducement to donate (Daniels and Lalos, 1995; Lui et al. Indeed, it could be argued that this perception is the one intended, as paying expenses encourages the sense of conducting a transaction, which lowers any possibility of the donor feeling any entitlement to future information or contact with any possible children. Instead of attracting donors who wish to have no contact with the oVspring their sperm are used to create, donors are attracted who do not feel that anonymity is important, and therefore are willing for their donor-oVspring to know who they are, and perhaps even to be contacted by them. The conclusion which must be drawn is that those who support the continuing practice of donor anonymity do not fear that there would be no men willing to donate, but rather that these donors would be the ‘wrong’ type of donor. In particular, instead of enforcing the pretence of a ‘normal’ family – by which is meant the traditional (and many would argue outdated) model of father and mother and genetically related children – the change makes openness possible. This is linked to the wider topic of the importance of heredity and genetic relatedness; however, due to the remit of this chapter, this issue will not be discussed in detail, but should be noted as a signiWcant topic in the debate. Historically, the claim that secrecy is in the best interest of the child was a strong argument in that secrecy protected the child from the stigma of illegitimacy. The ethics of secrecy in donor insemination 173 First, the suggestion that keeping the mode of conception secret has a positive eVect on the child by preventing any questioning about identity has recently been heavily criticized.
Ensure that the wa- 22 ter temperature remains constant by adding more hot water after ca order tolterodine 2mg online xanax medications for anxiety. After 10 minutes of treatment trusted 2 mg tolterodine medicine bow wyoming, rinse the feet with clear buy 4mg tolterodine overnight delivery medicine 319 pill, lukewarm water tolterodine 2mg treatment zap, 24 paying careful attention to the ankles and areas between toes. Pour boiling water into a bowl 14 15 and add the lemon, cut surface facing downwards. Fold a diaper cloth to width of patient’s neck, then wrap in the dish 19 towel and dip in the hot lemon water until completely soaked. In that case, the wrap should be left on until it becomes too warm 26 and has lost its cooling effects. The water tempe- 17 rature should be 1–2 °C less than the patient’s body temperature. Pour 1 liter 18 of boiling water onto 3 tablespoons of peppermint leaf and steep for 5 minutes. Wet dressings soaked in Ringer’s solution provide the calcium needed 10 for granulation tissue development and maintain the moist wound environ- 11 ment needed for wound cleanliness for more than 12 hours. Draw into an ear syringe bulb, apply to 28 Tender-Wet compresses, and allow to soak for 3 minutes. Sorbalgon dressings 11 have a high absorption capacity: they absorb wound exudate at a rate of 12 approx. Germs and detritus are taken up into 13 the fibers and kept inside the gel upon transformation. Use the forceps to insert the Sorbalgon dressing 34 into the wound and wet with Ringer–calendula solution. The hydroactive dressing is 36 applied with the sticky side facing the cleansed wound surface. The dressing 37 should extend at least 2–3 cm beyond the edges of the wound to ensure secure 38 adhesion on the dry surrounding skin. The effects of topical heartsease prepara- 6 tions can be enhanced by drinking heartsease tea (prepared as specified below, 7 1 cup, 3 times daily). When finished, wrap the flannel sheet 27 or elastic bandage around the cabbage leaves and cover cloth. Pack the wound with pureed cabbage leaves or with thinly sliced (1– 30 2 mm) cabbage leaves, ensuring that the cabbage leaves do not extend over 31 the edges of the wound. If profuse amounts of exudate are secreted 33 from the wound, it should be cleaned with Ringer’s solution and the dress- 34 ing should be changed frequently. In wound treatment, the frequency of dressing 37 changes is determined by the amount of exudate secreted from the wound. Ephedra Aerial parts/root 23 Equisetum arvense Horsetail Sterile green stems 24 Eryngium planum Plains eryngo Root 25 Eschscholtzia californica California poppy Aerial parts 26 Eucalyptus globulus Eucalyptus Leaves/eucalyptus oil 27 Euphrasia stricta Eyebright Aerial parts 28 Filipendula ulmaria Meadowsweet Flowers 29 Foeniculum vulgare Fennel Fruit (seeds) 30 Frangula alnus Frangula (alder buckthorn) Bark (frangula bark) 31 Frangula purshiana Cascara sagrada Bark (cascara bark) 32 Fumaria officinalis Fumitory Flowering aerial parts 33 Galega officinalis Goat’s rue Aerial parts 34 Gelsemium sempervirens Gelsemium Rhizome 35 (Yellow jasmine) 36 Gentiana lutea Gentian Root 37 Ginkgo biloba Ginkgo Leaves 38 Glycyrrhiza glabra Licorice Root 39 Graminis flos Grass flowers, hay flowers Flower parts and glume 40 Gratiola officinalis Hedge hyssop, gratiola Aerial parts 41 Hamamelis virginiana Witch hazel Bark/leaves 42 Harpagophytum Devil’s claw Root 43 procumbens 44 Hedera helix English ivy Leaves 45 Herniaria glabra Rupturewort Aerial parts 46 Humulus lupulus Hops Cones (strobiles) 47 Hyoscyamus niger Henbane Leaves 48 Hypericum perforatum St. Pine tree Needles (pine) needle oil/ 42 twigs/turpentine 43 Piper methysticum Kava, Kava-kava, Rhizome 44 pepper plant 45 Plantago arenaria Psyllium Seeds 46 Plantago lanceolata English plantain (ribwort) Aerial parts/leaves 47 Plantago ovata Indian plantain (blond Husks 48 psyllium, isphagula) 49 Podophyllum peltatum Mayapple Rhizome (resin) 50 (American mandrake) 26. Poplar (cottonwood) Buds 5 Potentilla anserina Silverweed (goosewort) Flowering aerial parts 6 Potentilla erecta Cinquefoil (Tormentil) Rhizome 7 Primula elatior Oxlip Flowers/root 8 Primula veris Primula (primrose) Flowers/root 9 Quercus robur Oak Bark from twigs and shoots 10 Raphanus sativus Radish Root 11 Rhamnus cathartica Buckthorn Fruit (berries) 12 Rheum palmatum Chinese rhubarb Root 13 Ribes nigrum Black currant Fruit (berries) 14 Rosa canina Dog rose Fruit (rose hips) 15 Rosmarinus officinalis Rosemary Leafy shoots with flowers 16 Rubus fructicosus Blackberry Leaves 17 Rubus idaeus Raspberry Leaves 18 Ruscus aculeatus Butcher’s broom Rhizome 19 Salvia officinalis Sage Leaves 20 Sambucus nigra European elder Flowers 21 Saponaria officinalis Soapwort (bouncing bet) Root 22 Secale cornutum Ergot Fungus (ergot) 23 Senna alexandrina Senna Leaves/fruit (pods) 24 Serenoa repens Saw palmetto Fruit (berries) 25 (Sabal serrulata) 26 Silybum marianum Milk thistle, Fruit 27 Marian thistle 28 Sinapis alba White mustard Seeds 29 Solanum dulcamara Bittersweet, Stems 30 bitter nightshade 31 Solidago virgaurea European goldenrod Flowering aerial parts 32 Symphytum officinale Comfrey Root 33 Syzygium aromaticum Clove Flower buds 34 Taraxacum officinale Dandelion Root and aerial parts 35 Thuja occidentalis Thuja, Arbor vitae, tree of Twig tips and young shoots 36 life, Northern white cedar 37 Thymus vulgaris Thyme Leaves and flowers 38 Tilia cordata Linden Flowers 39 (small-leaved lime) 40 Tilia platyphyllos Linden Flowers 41 (large-leaved lime) 42 Trigonella foenum- Fenugreek Seed 43 graecum 44 Tropaeolum majus Nasturium, Indian cress Aerial parts including 45 leaves, flowers and seeds 46 Tussilago farfara Coltsfoot Leaves 47 Urginea maritima Red squill Bulb 48 Urtica dioica L. Betulae folium 25 Bitter nightshade See Bittersweet 26 Bitter orange Citrus × aurantium Aurantii pericarpium 27 Bittersweet Solanum dulcamara Dulcamarae stipites 28 (bitter nightshade) 29 Black cohosh Actaea racemosa Cimicifugae rhizoma 30 Black currant Ribes nigrum Ribis nigri fructus 31 Black mustard Brassica nigra Sinapis nigrae semen 32 Blackberry Rubus fruticosus Rubi fructicosi folium 33 Blessed thistle Cnicus benedictus Cnici benedicti herba 34 Blond psyllium See Indian plantain 35 Bog bean (buckbean) Menyanthes trifoliata Menyanthidis folium 36 Boldo Peumus boldus Boldo folium 37 Buckbean See Bogbean 38 Buckthorn Rhamnus cathartica Rhamni cathartici fructus 39 Buckthorn, alder See Frangula 40 Bugleweed See European bugleweed, 41 Virginia bugleweed 42 Burdock See Great burdock 43 Burnet saxifrage Pimpinella saxifraga Pimpinellae radix 44 Butcher’s broom Ruscus aculeatus Rusci aculeati rhizoma 45 Butterbur See Purple butterbur 46 Calamus (sweetflag) Acorus calamus Calami rhizoma 47 Calendula See Marigold 48 California poppy Eschscholtzia californica Eschscholtziae herba 49 Camphor Cinnamomum camphora Cinnamomi cortex 50 26. Ephedrae herba, 47 Ephedrae radix 48 Ergot Secale cornutum Secale cornutum 49 Eucalyptus Eucalyptus globulus Eucalypti folium, 50 Eucalypti aetheroleum 26. Pini picea, Pini turiones 22 Pineapple Ananas comosus Bromelain 23 Plaintain See Indian plaintain, 24 English plaintain 25 Plains eryngo Eryngium planum Eryngi radix 26 Poppy See California poppy 27 Primrose See Evening primrose, 28 Primula 29 Primula Primula veris Primulae flos cum calyci- 30 bus, Primulae radix 31 Psyllium Plantago arenaria Psyllii semen 32 Psyllium, blond See Indian plaintain 33 Pumpkin Cucurbita pepo Cucurbitae semen 34 Purple butterbur Petasites hybridus Petasitidis rhizoma 35 Purple echinacea Echinacea purpurea Echinaceae purpureae 36 herba 37 Radish Raphanus sativus Raphani sativi radix 38 Ramson See Bear paw garlic 39 Raspberry Rubus idaeus Rubi foliae 40 Red Beet Beta vulgaris var. Betae succus 41 conditiva 42 Red cinchona Cinchona pubescens Cinchonae cortex 43 Red squill Urginea maritima Scillae bulbus 44 Rhatany Krameria lappacea Ratanhiae radix 45 Rhubarb See Chinese rhubarb 46 Ribwort See English plantain 47 Rose See Dog rose 48 Rosemary Rosmarinus officinalis Rosmarini folium 49 Round-leaved sundew Drosera rotundifolia Droserae herba 50 26. The study has been approved by the local ethics com- Hong Kong, Hong Kong- China, The Hong Kong Polytechnic Uni- mittee n°2011/37, registered on clinical trial. No signifcant difference between groups was observed for the primary Introduction/Background: Children with developmental coordina- criterion (median 41. The number of unexpected medi- peripheral neuromuscular defcits that may affect their balance cal events was the same in the two groups. This study compared the effectiveness of a novel func- sion of this study is congruent to that of previous studies. Material and Methods: This was a single-blinded randomized controlled intervention trial. Secondary outcomes included the knee muscle peak force and the time taken to reach the peak force 1Guangdong Provincial Work Injury Rehabilitation Hospital, De- which were evaluated using hand-held dynamometer. The assessments were Salpétrière Hospital, Neurology, Paris, France performed at baseline, 4-week and 8-week treatment. All tension orthosis on walking training, can signifcantly improve the of subjects admitted can not walk for more than 100 m because of recovery of stroke patients with lower extremity motor function, it pain. Four subjects had right ischialgia, while the rest was on left is recommended further application in clinic. Introduction/Background: Stroke is the common and disabling global health-care problem. Motor functional abilities of Shenzhen, China hemiparetic upper limb were assessed by Fugl-Meyer assessment. Among them Moderate impairment Electric Acupuncture Therapy if there was no good effect at the was found 86. The outcomes were evaluated at 1 week, 1 month, ventional therapy has a fruitful impact on post stroke hemiparetic 3 months and 6 months. There was still few practitioners who has real- ized that the biomechanical abnormalities can associated with an Ischialgia. Material and Methods: A preliminary study on 7 subjects by convinient random sampling. Conclusion: Conclusion: Combi- Introduction/Background: Shoulder pain is a common musculo- nation of pressure controlled intrarticular hydraulic distention and skeletal condition. Patients are traditionally treated with one-to-one community based stretching exercise method of treatment of adhe- physiotherapy. There are no outcome studies of exercise classes sive capsulitis of shoulder was one of the most cost-effective and for people with non-specifc shoulder pain. The corre- lation of somatic (non-musculoskeletal) symptoms to outcomes in shoulder pain has not been studied. To compare the outcomes of a shoulder exercise class with and without a postural exercise component. Alamino Felix de Moraes2, baseline, 6 weeks and 6 months by the primary investigator (blind- W. Con- in the treatment of disabling pain due to severe primary knee os- clusion: A 6 week exercise class was effective in improving pain teoarthritis. Objective physical function at the untreated side were not statistically sig- was to assess its effectiveness by prospective cohort study. Intervention: supra-spinatus nerve block, followed by intra-articular instillation of 15 to 20 ml of saline 10 mixed with 5 ml of 2% xylocaine and 2 ml of methyl-prednisolone acetate; so that intra-articular pressure was around 100 mm of Hg. The same was to be done at home and continue three times daily; to be repeated 15 to 20 times per session. The frst method measures it at the femoral trochlear area with 1 Graduate School of Medicine - The University of Tokyo, Depart- the ultrasound transducer placed immediately above the patellar 2 and perpendicular to the long axis of the extremity (Yoon, 2008). The primary objective of this thetic, Tokyo, Japan, National Rehabilitation Center for Disabled Children, Department of Orthopedics, Tokyo, Japan, 5Shizuoka study is to compare articular cartilage thickness using longitudi- nal and transverse techniques in patients with knee osteoarthritis. Children’s Hospital, Department of Pediatric Orthopedics, Shi- Material and Methods: A systematic knee sonographic examina- zuoka, Japan tion was performed in patients with knee osteoarthritis by Altman’s classifcation of idiopathic osteoarthritis. Longitudinal-sagittal Introduction/Background: Treatment for congenital tibial defcien- scanning in the medial and lateral knee joint space was performed cy has not been established. There is a 23 affected limbs who visited our Limb Malformation Clinic, fve signifcant correlation in the cartilage thickness between both scan- with seven limbs underwent amputation after fve years of age, for ning techniques at the lateral left (r=0.