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By G. Jens. Elmira College. 2018.

Introduction 11 of their own subject lady era 100mg amex, medical authors such as Galen – who wrote a trea- tise advocating the view that the best doctor is effective lady era 100 mg, or should be, at the same time a philosopher – and the so-called Anonymus Londiniensis (the first-century ce author of a medico-doxographical work preserved on pa- pyrus) treated Plato’s views on the human body and on the origins of diseases as expounded in the Timaeus on a par with the doctrines of ma- jor Greek medical writers; and Aristotle and Theophrastus continued to be regarded as authorities in medicine by medical writers of later antiq- uity such as Oribasius and Caelius Aurelianus. Conversely, as we shall see in chapter 6, a philosopher such as Aristotle commented favourably on the contributions by ‘the more distinguished doctors’ to the area of ‘natural philosophy’. And in the doxographical tradition of ‘Aetius’,¨ in the context of ‘physics’ or ‘natural philosophy’, a number of medi- cal writers such as Diocles, Herophilus, Erasistratus and Asclepiades are cited alongside ‘philosophers’ such as Plato, Aristotle and the Stoics for their views on such topics as change, the soul, the location of the ruling part of the soul (see chapter 4), dreams, respiration, monstrosities, fertility and sterility, twins and triplets, the status of the embryo, mules, seventh-month children, embryonic development, and the causes of old age, disease and fever. It is no co- incidence that Aristotle’s comments on the overlap between ‘students of nature’ and ‘doctors’ are made in his own Parva naturalia, a series of works on a range of psycho-physiological topics – sense-perception, memory, sleep, dreams, longevity, youth and old age, respiration, life and death, health and disease – that became the common ground of medical writers and philosophers alike. And, not surprisingly, Aristotle makes similar re- marks in his zoological works concerning questions of anatomy, such as the parts of the body and structures like the vascular system, and embryology, especially the question of the origins of life, the mechanisms of repro- duction and the ways in which inherited features are passed on from one generation to another, the question of the male and female contribution to the reproductive process, the origin of the semen, questions of fertility and infertility (see chapter 9), stages of embryonic development, the way the embryo is nourished, twins and triplets, and suchlike. This whole area was referred to in later antiquity as ‘the nature of man’, particularly man’s physical make-up, ranging from the lowest, most basic level of ‘principles’ 19 See Runia (1999). We perceive this ‘agenda’ in texts as early as the Hippocratic works On Fleshes, On the Nature of Man and On Regimen, or in such later works as Nemesius’ On the Nature of Man, Vindicianus’ On the Nature of the Human Race and in the treatise On the Seed, preserved in a Brussels manuscript and attributed to Vindicianus, and there are similar points of overlap in the doxographical tradition. Even a philosopher like Plato, who seems to have had very little reason to be interested in mundane matters like disease or bodily waste products, deals at surprising length and in very considerable detail with the human body and what may go wrong with it, using an elaborate clas- sification of bodily fluids and types of disease (physical as well as mental) according to their physiological causes. Plato was of course not a doctor, but he was clearly aware of the medical doctrines of his time and took them sufficiently seriously to incorporate them into this account of the nature of the world and the human body as set out in the Timaeus. Yet interaction was not confined to matters of content, but also took place in the field of methodology and epistemology. As early as the Hip- pocratic medical writers, one finds conceptualisations and terminologi- cal distinctions relating to such notions as ‘nature’ (phusis), ‘cause’ (aitia, prophasis), ‘sign’ (semeion¯ ), ‘indication’ (tekmerion¯ ), ‘proof’ (pistis), ‘faculty’ (dunamis), or theoretical reflection on epistemological issues such as causal explanation, observation, analogy and experimentation. This is continued in fourth-century medicine, with writers such as Diocles of Carystus and Mnesitheus of Athens, in whose works we find striking examples of the use of definition, explanation, division and classification according to genus and species relations, and theoretical reflection on the modalities and the ap- propriateness of these epistemological procedures, on the requirements that have to be fulfilled in order to make them work. In Hellenistic medicine, authors such as Herophilus and Erasistratus made important theoretical points about causation, teleological versus mechanical explanation, and horror vacui, and in the ‘sectarian’ debates between Empiricists, Dogma- tists and Methodists major theoretical issues were raised about the nature of knowledge and science. Subsequently, in the Imperial period, we can observe the application and further development of logic and philosophy of science in writers such as Galen (chapter 10) and Caelius Aurelianus (chapter 11). And again, it is by no means the case that the medical writers Introduction 13 were exclusively on the receiving end: theories about causation or inference from signs constitute good examples of areas in which major theoretical and conceptual distinctions were first formulated in medical discourse and subsequently incorporated in philosophical discussions. To the Greek thinkers, areas such as those mentioned above represented aspects of natural and human reality just as interesting and significant as the movements of the celestial bodies, the origins of earth- quakes or the growth of plants and trees, and at least equally revealing of the underlying universal principles of stability and change. Nor were their interests in the medical area limited to theoretical study or the pursuit of knowledge for its own sake without extending to ‘clinical’ or ‘therapeutic’ practice. Some are known to have put their ideas into practice, such as Empedocles, who seems to have been engaged in considerable therapeutic activity, or Democritus, who is reported to have carried out anatomical research on a significant scale, or, to take a later example, Sextus Empiricus, who combined his authorship of philosophical writings on Scepticism with medical practice. Such connections between theory and practical application, and such combinations of apparently separate activities, may still strike us as re- markable. Nevertheless we should bear in mind, first, that especially in the period up to about 400 bce (the time in which most of the better-known Hippocratic writings are believed to have been produced), ‘philosophy’ was hardly ever pursued entirely for its own sake and was deemed of considerable practical relevance, be it in the field of ethics and politics, in the techni- cal mastery of natural things and processes, or in the provision of health and healing. Secondly, the idea of a ‘division of labour’ which, sometimes implicitly, underlies such a sense of surprise is in fact anachronistic. We may rightly feel hesitant to call people such as Empedocles, Democritus, Pythagoras and Alcmaeon ‘doctors’, but this is largely because that term conjures up associations with a type of professional organisation and spe- cialisation that developed only later, but which are inappropriate to the actual practice of the care for the human body in the archaic and classical period. The evidence for ‘specialisation’ in this period is scanty, for doctors 20 See, e. As we get to the Hellenistic and Imperial periods, the evidence of specialisation is stronger, but this still did not prevent more ambitious thinkers such as Galen or John Philoponus from crossing boundaries and being engaged in a number of distinct intellectual activities such as logic, linguistics and grammar, medicine and meteorology. It is no exaggeration to say that the history of ancient medicine would have been very different without the tremendous impact of Aristotelian science and philosophy of science throughout antiquity, the Middle Ages and the early modern period. Aristotle, and Aristotelianism, made and facilitated major discoveries in the field of comparative anatomy, physiology, embryology, pathology, therapeutics and pharmacology. They provided a comprehensive and consistent theoretical framework for re- search and understanding of the human body, its structure, workings and failings and its reactions to foods, drinks, drugs and the environment. They further provided fruitful methods and concepts by means of which medical knowledge could be acquired, interpreted, systematised and com- municated to scientific communities and wider audiences.

Earwax is helpful in normal ear infection discount 100 mg lady era with mastercard, external Infection of the skin cov- amounts buy lady era 100mg otc. The absence of earwax may result in dry, ering the outer ear canal that leads in to the ear itchy ears, and in infection. Most whites and blacks have inflammation, meningitis, encephalitis, and inflam- the wet type, and most Asians and Native Americans mation around the heart. Ebola virus underdeveloped countries, and it is a serious prob- epidemics have occurred mainly in Sudan and lem even in developed countries. The initial symptoms are fever and headache, antispasmodic medication, notably magnesium sul- followed by vomiting and diarrhea, muscle pain, fate. Ebola virus is ecogenetics The interaction of genetics with the highly contagious and is transmitted by contact with environment. The incubation period ranges from 2 to 21 is needed to process the amino acid phenylalanine, days. Echocardiography can measure cardiac output, and ectoderm The outermost of the three primary it is a sensitive test for detecting inflammation germ cell layers (the other two being the mesoderm around the heart (pericarditis). Echolalia is a feature of schizophre- inner ear, the nerves, the brain, and the spinal cord. See also echopraxia; ectodermal structures retain their ability to differ- schizophrenia; Tourette syndrome. For example, some cells in the brain (ectoderm) can become bone marrow echopraxia The involuntary imitation of the (mesoderm). The “echo” part of the name is an plasia is most common; because it is an X-linked acronym for enteric cytopathic human orphan trait, it mainly affects males. The term ectodermal dysplasia refers to the known that echoviruses can cause a number of dif- abnormal development (dysplasia) of structures ferent diseases, including rashes, diarrhea, respira- derived from one of the germ cell layers in the tory infections (such as the common cold, sore embryo (ectoderm). Also example, a lumpectomy is the surgical removal of a known as atopic dermatitis. Eczema is a very com- lump, a tonsillectomy is the removal of the tonsils, mon skin problem that may start in infancy, later in and an appendectomy is removal of the appendix. There are numerous types of eczema, including atopic dermatitis, contact eczema, seborrheic ectopic In the wrong place, out of place. For eczema, nummular eczema, neurodermatitis, stasis example, an ectopic kidney is a kidney that is not in dermatitis, and dyshidrotic eczema. Usually, ectopic pregnancies contact with a substance that the immune system occur because a fertilized egg settles and grows in a recognizes as foreign, such as poison ivy or certain Fallopian tube. Also known as occur in other locations, such as the ovary, cervix, allergic contact dermatitis. An ectopic pregnancy is usu- ally due to the inability of a fertilized egg to make its eczema, contact A localized reaction that way through a Fallopian tube into the uterus. A major concern with ectopic pregnancy characterized by clear, deep blisters that itch and is internal bleeding. The pain, which is usually sharp and stabbing, is often one-sided and may occur in the pelvis, eczema, nummular Coin-shaped patches of abdomen, or even the shoulder or neck (due to irritated skin that may be crusted, scaling, and blood from a ruptured ectopic pregnancy building extremely itchy. Nummular eczema appears most up under the diaphragm and the pain being commonly on the arms, back, buttocks, and lower “referred” up to the shoulder or neck). Ultrasound can also help edema The swelling of soft tissues as a result of determine whether a pregnancy is ectopic, as can excess fluid accumulation. Edema is often most culdocentesis, the insertion of a needle through the prominent in the lower legs and feet toward the end vagina into the space behind the uterus to see of the day because fluid pools while people maintain whether there is blood there from a ruptured an upright position. Treatment includes surgery, often by laparoscopy, to remove the ill-fated pregnancy. A edema, hereditary angioneurotic Localized ruptured Fallopian tube usually has to be removed. The outlook for future pregnancies normally prevents activation of a cascade of proteins depends on the extent of the surgery. Patients can develop recurrent attacks of swollen tissues, eczema An inflammatory reaction of the skin in pain in the abdomen, and swelling of the voice box which there are tiny blister-like raised areas in the (larynx) that can compromise breathing. The diag- early stage followed by reddening, swelling, bumps, nosis is confirmed when abnormally low levels of C1 crusting, and thickening and scaling. The most common symp- Treatment options include antihistamines and male toms of pleural effusion are chest pain and painful steroids (androgens).

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Anterior open bite may occur in autosomal dominant amelogenesis imperfecta as well as in other inheritance patterns buy lady era 100mg without a prescription. The mechanism producing the sometimes associated anterior open bite has not yet been elucidated cheap lady era 100mg mastercard. Aetiology The enamelin gene on chromosome 4 has been shown to be mutated in some families with autosomal dominant amelogenesis imperfecta. Other genes involved in normal enamel formation have been implicated in autosomal dominant amelogenesis imperfecta. Autosomal recessive amelogenesis imperfecta Autosomal recessive conditions are typically seen when there is parental consanguinity, so that that the parents may be first cousins (Fig. There may be cultural reasons for this or, alternatively, consanguinity may be seen in isolated communities with little outside contact and where there is consequently a limited gene pool. In other recessive conditions, such as cystic fibrosis, these restrictions do not apply and the relative prevalence of the condition is related to the frequency of gene carriers in the population. Where the parents are close relatives, both carrier adults will be unaffected but there will be a one in four chance of offspring inheriting two copies of the mutant gene. Autosomal recessive mutations causing amelogenesis imperfecta seem to be uncommon apart from Polynesia, where, presumably, the mutation is relatively common. A gene on chromosome 2 has been linked to autosomal recessive amelogenesis imperfecta associated with ocular defects. X-linked amelogenesis imperfecta X-linked amelogenesis imperfecta is characterized by a difference in the appearance of the teeth of affected males and females. The majority of families studied to date have an alteration in the amelogenin gene on the short arm of the X chromosome. Affected males cannot pass on the condition to their sons (by virtue of passing on their Y chromosome to their sons) but their daughters (to whom they necessarily pass on their X chromosome) will all inherit the mutant gene. Such daughters will always show some dental features although these might be subtle in some cases. The enamel in both sexes may be hypoplastic, hypomineralized, or show elements of both features. The appearance seen will be the result of the exact nature of the change in the amelogenin gene and the sex of the patient. Males, by virtue of having a single X chromosome, will be more severely and uniformly affected. The enamel may be thin (hypoplastic⎯reduced in quantity) or discoloured (with affected mineralisation) or a combination of both (Fig. Females within the same family who inherit the affected gene will show a vertical pattern of markings of the enamel, either vertical ridges and grooves (the equivalent of the male, uniform hypoplasia), with or without discolouration or loss of translucency of the enamel (where the mineralization is affected) (Fig. Aetiology The amelogenin gene, which encodes the enamel protein amelogenin, is located on the short arm of the X chromosome. Mutations in the gene are responsible for most cases of X-linked amelogenesis imperfecta but there also appears to be another gene on the long arm of the X chromosome which is responsible for similar clinical appearances in another family. Genetic enamel defects associated with generalized disorders Widespread enamel defects can be seen in a number of conditions with extraoral manifestations. These include conditions such as epidermolysis bullosa, tuberous sclerosis, oculo-dento-osseus dysplasia, as well as the amelogenesis imperfecta associated with tricho-dento-osseous syndrome. The exact genomic relationship between these and other conditions and amelogenesis imperfecta remains to be established in most cases. Key Points Amelogenesis imperfecta • Inheritance, • Autosomal dominant, • Autosomal recessive, • X-linked, • Apparently sporadic. Phenotype Hypoplastic +/- hypomineralization (hypocalcification to hypomaturity) Pure hypoplasia or hypomineralization are probably rare Profound hypomineralization leads to teeth so soft that they are reduced in size although this is, in fact, a later change. Molar-incisor hypoplasia In recent years reports have been published of children with mineralization defects of the first permanent molars and, sometimes, the permanent incisors. The defects in the incisors⎯which are usually less severe and most likely to show isolated mottling⎯will likewise be irregularly distributed.

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M edi­ cal imaging techniques have made an important contribution to the diagnosis o f carcinoma of the breast and the evaluation o f local buy 100 mg lady era with amex, regional and distant métastasés lady era 100mg mastercard. The primary purpose ofscreening asymptomatic women forbreastcancer isto diagnose breast cancer at an early stage and thus reduce the mortality. Accurate staginginbreastcancer, including tumour sizingand theassessment of nodal and distant métastasés, is required to plan surgery and post-operative therapy. Mammography remains theprocedure ofchoice inscreeningasymptomatic women, butrecentlyextensiveresearchhasfocusedon tumour specificradiolabelled agentswhich arelocalizedintumour tissuesand improve thespecificityoftheloco- regional detection of breast cancer [1-3]. Recently, significant progress in tumour detection has been made after introduction of different radiolabelled monoclonal antibodiesappliedtoinvivotumourdiagnostics. Medical imaging tech­ niques have made an important contribution to the diagnosis of carcinoma of the breastandtheevaluationoflocal,regionaland distantmétastasés [7-9]. The first group included 18 pre-operative females whose physical examination, abnormal mammogram and ultrasonogram were diagnosed asbreastcancer, and threepatients after surgery. The second group consistedof24 breastcancerpatientsforwhom whole body bone scintigraphy was unable to determine the exact localization of metastatic involvement in the skull, thorax and pelvis. Planar images (1024 X 256 matrix, 300 000 counts) ofthe chest were obtained in the anterior view. The tumour/heart (T/H), tumour/symmetric region (T/S) and lymph node/ symmetric lymph node (N/S) ratio were computed as follows: average tumour counts/average heart, or symmetric area counts. Sixty-fourframes, 30 s/frame, were recorded during 360° rotation, with an acquisition matrix of 64 X 64 or 128 X 128 pixels depending on the limited counting statistics. Increased uptake of the tracer was visualized clearly in the left axilla in all the projections. Planar scinti­ graphy showed an area with increased radiolabelled antibody only inthe breast. Thirty-five patients have been studied, divided into the following groups: those with planocellular lung carcinoma — 16 patients; with adenocarcinoma — 4 patients; with small cell carcinoma — 5 patients; with pulmonary echinococcosis — 8 patients; and lung cysts — 2 patients. All these patients underwent preliminary examination with X rays, computer assisted tomography and fibrobronchoscopy, with biopsy and histological verification. Negative findings were recorded in three patients treated with chemotherapy, which exerts an inhibitory effect on the accumulation of radiopharmaceuticals. Its accumulation in viable myocardium correlates with regional myocardial perfusion and itisproportional to the regional blood flow as well [1]. Recently, therehas been some increaseinthevolume ofpublications on itsapplica­ tion outside the field of cardiology, i. They were dividedaccord­ ing to theirdiagnosis and histological findings, as follows: — Group I. Patients with primary lung cancer: planocellular carcinoma — 16 patients; adenocarcinoma — 4 patients; small cell carcinoma — 5 patients. Control of patients with: pulmonary echinococcosis — 8 patients; pulmonary cysts — 2 patients. Figure 1presentstheexaminationresultsforafemale, 55 yearsofage, who was complainingforsixmonths ofchestpain,cough, shortnessofbreathduring exertion, fatigue, and loss ofweight and appetite. An intensive accumulation was found in the upperpulmonary fieldofherleftlung (Fig. In the sagittal, coronal and transversal scans, increased tracer uptake was visualized. These two patients have undergone preliminary treatmentwith chemotherapy and radiotherapy. Ten patient controls— withpulmonary echinococcosis(eightpatients)andpulmonary cysts(two patients) — were alsoexamined. Inthesecases,theindexofinclusiondecreaseswithvaluesthataretypical of those in the control group. Both chemotherapy and radiotherapy inhibit radio­ pharmaceutical uptake in the focus of the malignant tumour.

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