Free Medical eBooks-Lectures- Medical Videos -pdf-journal-askep

The Insider Encyclopedia on How to Build Muscle and Might

2010-10-24T05:20:00.000-07:00

The Insider Encyclopedia on How to Build Muscle and Might

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Central Nervous System Diseases and Inflammation

2010-04-20T23:38:00.000-07:00

By Thomas E. Lane, Monica Carson, Conni Bergmann, Tony Wyss-Coray
Publisher: Springer,2007-12-14
Pages: 318
ISBN-10 / ASIN: 0387738932

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Blueprints in Neurology

2010-04-20T23:31:00.000-07:00

Blueprints series
Blackwell publishing

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Color Atlas of Peripheral Nerve Pathology PDF

2010-04-20T23:30:00.000-07:00

By Shin J. Oh
ISBN-10: 0849316766
ISBN-13: 978-0849316760
CRC Press: 2002

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Clinical Neuroradiology: A Case-Based Approach pdf

2010-04-20T23:20:00.000-07:00

By Gasser M. Hathout
Publisher: Cambridge University Press,2008
ISBN: 0521600545

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Essential Radiological Anatomy for the MRCS

2010-04-20T23:16:00.000-07:00

By S. Currie, S. Kennish and K. Flood
e-ISBN-13: 978-0-511-59552-3
ISBN-13: 978-0-521-72808-9
Cambridge University Press ,1st ed. 2009

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ABC of Rheumatology PDF

2010-04-20T23:15:00.000-07:00

4th edition, 2010
By Ade Adebajo
ISBN 978-1-4051-7068-0
Blackwell Publishing Ltd
BMJ Books

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Surgical Treatment of Hip Arthritis By William J. Hozack, Javav Parvizi, and Benjamin Bender

2010-04-15T21:02:00.000-07:00

Reconstruction, Replacement, and Revision
By William J. Hozack, Javav Parvizi, and Benjamin Bender
ISBN-10: 1416058982
ISBN-13: 978-1416058984
Saunders, 2010

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Essential Clinical Anatomy By Keith L. Moore, Anne M.R. Agur

2010-04-15T20:40:00.000-07:00

By Keith L. Moore, Anne M.R. Agur
3rd edition
Lippincott, 2006

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Orthopaedic Medicine: A Practical Approach ebook PDF

2010-04-15T09:18:00.000-07:00

Orthopaedic Medicine: A Practical Approach-2nd edition, 2005
By Monica Kesson, Elaine Atkins
ISBN-10: 0750655631
ISBN-13: 978-0750655637
Butterworth-Heinemann

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Little Black Book of Gastroenterology-ebook free

2010-04-15T09:16:00.000-07:00

Little Black Book of Gastroenterology -2nd edition
By David W. Hay
ISBN: 978-0-7637-3457-2
Jones and Bartlett Publishers

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Emergencies in Primary Care

2010-03-05T07:39:00.000-08:00

1st Edition, 2007
ISBN-10: 0198570686
ISBN-13: 978-0198570684
Oxford University Press

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Clinical Imaging: An Atlas of Differential Diagnosis

2010-03-05T07:32:00.000-08:00

5th Edition
By Ronald L. Eisenberg
ISBN-10: 0781788609
ISBN-13: 978-0781788601
Lippincott Williams and Wilkins

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Multidetector CT in Neuroimaging: An Atlas and Practical Guide

2010-03-05T07:13:00.000-08:00

By Evelyn M. Teasdale, Susan Aitken

Publisher: Clinical Publishing Services, 2009

ISBN: 1904392687

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Pharmacokinetics and Pharmacodynamics of Abused Drugs

2010-01-27T10:49:00.000-08:00

Pharmacokinetics and Pharmacodynamics of Abused Drugs

Title: Pharmacokinetics and Pharmacodynamics of Abused Drugs
Product Details

* Hardcover: 208 pages
* Publisher: CRC (2007-10-09)
* ISBN-10: 1420054589
* ISBN-13: 9781420054583

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Connexin Methods and Protocols (Methods in Molecular Biology)

2010-01-27T10:48:00.000-08:00

Connexin Methods and Protocols (Methods in Molecular Biology)

Title: Connexin Methods and Protocols (Methods in Molecular Biology)
Product Details

* Hardcover: 491 pages
* Publisher: Humana Press (2001-01-15)
* ISBN-10: 0896036588
* ISBN-13: 9780896036581

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Mackie Shilstone - The Fat-Burning Bible

2010-01-27T10:45:00.000-08:00

Mackie Shilstone - The Fat-Burning Bible

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The Insider Encyclopedia on How to Build Muscle and Might

2010-01-27T10:43:00.000-08:00

The Insider Encyclopedia on How to Build Muscle and Might

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The Chronic Pain Management Sourcebook pdf

2010-01-03T23:51:00.000-08:00

* Publisher: McGraw-Hill
* Number Of Pages: 368
* Publication Date: 1999-08-01
* ISBN-10 / ASIN: 0737301015
* ISBN-13 / EAN: 9780737301014
* Binding: Paperback

Product Description:
(Lowell House) Text discussing treatment, physical conditioning, nutrition, social support, stress, drugs, surgery, cancer pain, and more. For consumers. Softcover.
Amazon.com Review:
There are few things as debilitating to the body and soul as chronic pain. "The physical and emotional suffering that accompanies chronic pain tries the body and the mind, and tests the limits of the spirit and the self," writes David Drumm. "You may feel helpless and alone, crying out for relief in the night." This book is an empowering tool for taking action to help yourself, managing your attitude as well as your pain, and discovering how you can live life as fully and joyously as your condition allows.

Nutrition and Pregnancy : A Complete Guide from Preconception to Postdelivery ebook

2010-01-03T23:45:00.000-08:00

* Publisher: McGraw-Hill
* Number Of Pages: 288
* Publication Date: 1998-11-01
* ISBN-10 / ASIN: 0737300183
* ISBN-13 / EAN: 9780737300185
* Binding: Paperback

Product Description:
Eating wholesome foods as part of a well-balanced diet is one of the most precious gifts a pregnant mother can give to her unborn baby. By maintaining good nutrition before, during, and after pregnancy, a mother will help her child begin life with a healthy advantage. Nutrition and Pregnancy provides information on a pregnant woman's increased demand for calories, nutrients, and wholesome foods and how to ensure the delivery of a healthy, well-nourished baby.

The Sinus Sourcebook ebook

2010-01-03T23:44:00.000-08:00

* Publisher: Lowell House
* Number Of Pages: 191
* Publication Date: 1998-05
* ISBN-10 / ASIN: 1565656431
* ISBN-13 / EAN: 9781565656437
* Binding: Hardcover

Product Description:
Every year, millions of people go into their doctors' offices complaining of "sinus trouble, " but does this necessarily mean they have sinusitis? The Sinus Sourcebook clears up the confusion around the disease and thoroughly explains the treatments available for a wide range of sinus maladies.

The Allergy Sourcebook: Everything You Need to Know

2010-01-03T23:40:00.000-08:00

* Publisher: NTC Business Books
* Number Of Pages: 269
* Publication Date: 1998-03
* ISBN-10 / ASIN: 1565658647
* ISBN-13 / EAN: 9781565658646
* Binding: Paperback

Product Description:

Recipient of the WellnessBooks.com Reviewer's Choice award, The Allergy Sourcebook contains the most up-to-date information available on the many types, triggers, and symptoms of allergies, as well as treatments. This revised edition also includes an extensive listing of organizations, products, and other resources to help the more than 50 million allergy sufferers in the United States live allergy-free.

ebook Basic Biostatistics for Geneticists and Epidemiologists: A Practical Approach

2010-01-03T23:39:00.001-08:00

* Publisher: Wiley
* Number Of Pages: 384
* Publication Date: 2008-12-31
* ISBN-10 / ASIN: 0470024895
* ISBN-13 / EAN: 9780470024898
* Binding: Hardcover

Product Description:

Anyone who attempts to read genetics or epidemiology research literature needs to understand the essentials of biostatistics. This book, a revised new edition of the successful Essentials of Biostatistics has been written to provide such an understanding to those who have little or no statistical background and who need to keep abreast of new findings in this fast moving field. Unlike many other elementary books on biostatistics, the main focus of this book is to explain basic concepts needed to understand statistical procedures.

Case Files: Neuroscience (Case Files) reviews

2010-01-03T23:36:00.000-08:00

* Publisher: McGraw-Hill Medical
* Number Of Pages: 408
* Publication Date: 2008-08-15
* ISBN-10 / ASIN: 0071489215
* ISBN-13 / EAN: 9780071489218
* Binding: Paperback

Product Description:
REAL LIFE CLINICAL CASES FOR THE BASIC SCIENCES AND USMLE STEP 1
You need exposure to clinical cases to pass course exams and ace the USMLE Step 1. Case Files: Neuroscience presents 50 real-life clinical cases illustrating essential concepts in microbiology. Each case includes and easy-to-understand discussion correlated to key basic science concepts, definitions of key terms, neuroscience pearls, and USMLE-style review questions. This interactive system helps you learn instead of memorize.

Hematology in Practice PDF

2010-01-03T23:30:00.000-08:00

Hematology in Practice

348 pages
Publisher: F A Davis Co,January 2007
ISBN-10: 0803615264
ISBN-13: 9780803615267

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Respiratory Physiology: The Essentials pdf

2010-01-03T13:16:00.000-08:00

Respiratory Physiology: The Essentials

By John B. West
8th Ed, 2008
192 pages
Publisher: Lippincott Williams & Wilkins; (January 1, 2008)
ISBN-10: 0781772060

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Ebook Interpretation of Pulmonary Function Test pdf

2010-01-03T13:15:00.000-08:00

Interpretation of Pulmonary Function Test

272 pages
Publisher: Lippincott Williams & Wilkins; Third Edition edition (July 1, 2008)
ISBN-10: 0781778824
ISBN-13: 978-0781778824

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ebook Dengue Fever and Other Hemorrhagic Viruses pdf

2010-01-03T13:09:00.000-08:00

Dengue Fever and Other Hemorrhagic Viruses

By Tirtha Chakraborty, Ph.D.
ISBN-13: 978-0-7910-8506-6
ISBN-10: 0-7910-8506-6
Infobase Publishing 2008

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Ebook Musculoskeletal Examination pdf

2010-01-03T13:07:00.000-08:00

Musculoskeletal Examination

By Jeffrey M. Gross, Joseph Fetto, and Elaine Rosen
ISBN 0-632-04558-2

Blackwell Science, Inc.

2nd ed, 2002

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Transfusion Microbiology pdf ebook

2010-01-03T12:49:00.000-08:00

Transfusion Microbiology

By John A. J. Barbara, Fiona A. M. Regan, and Marcela Contreras
ISBN-13 978-0-521-45393-6
ISBN-13 978-0-511-42298-0
Cambridge University Press

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Case Files: Neuroscience (Case Files)

2010-01-03T12:46:00.000-08:00

Mammography Examination (Lange Q&a)

2010-01-03T12:42:00.000-08:00

Mammography Examination (Lange Q&a)

* Publisher: McGraw-Hill Medical
* Number Of Pages: 174
* Publication Date: 2008-08-13
* ISBN-10 / ASIN: 0071548351
* ISBN-13 / EAN: 9780071548359
* Binding: Paperback

Product Description:
Everthing you need to ace the ARRT Mammography Exam in one complete study package!
Two complete practice tests plus easy-to-read summaries of all the must-know concepts for the most thorough exam prep available anywhere!
* Two practice tests in the book and on CD-ROM ensure that the real test is not your first test
* Questions on CD-ROM familiarizes you with the online testing experience
* ARRT-format questions prepare you for what you'll see on exam day
* Easy-to-read review of exam essentials boils down what you really must know
* Written by an experienced Radiography instructor who knows exactly what it takes to pass
* 400 exam-style questions in the book and on CD-ROM with answers and explanations

Contemporary Targeted Therapies in Rheumatology

2009-12-19T03:57:00.001-08:00

Publisher: Informa Healthcare
Number Of Pages: 636
Publication Date: 2007-10-24
ISBN-10 / ASIN: 1841844845
ISBN-13 / EAN: 9781841844848
Binding: Hardcover

Product Description:
Targeted Therapies in Rheumatology established itself as an excellent reference for all those needing to know about the clinical implications of new drugs and developments for patients suffering from rheumatoid arthritis. This volume takes up the further developments that have occurred in several of the drug therapies covered in the first volume, as well as looking at the latest areas of promising research. Targeted therapies of rheumatic diseases have become a reality and have completely changed patient care as well as patient expectations.

Atlas of Mesotherapy in Skin Rejuvenation

2009-12-19T03:41:00.000-08:00

Publisher: Informa HealthCare
Number Of Pages: 128
Publication Date: 2007-10-24
ISBN-10 / ASIN: 0415419948
ISBN-13 / EAN: 9780415419949
Binding: Hardcover

Product Description:

The injection of a combination of vitamins and medications into the middle layer of the skin has been practised in continental Europe for some fifty years now, but because the literature has hitherto not been published in English the topic is still surrounded by a great deal of ignorance and prejudice. This atlas from a renowned authorship will document in detail what is involved in the practical techniques of mesotherapy and will be of extreme interest to all practitioners of cosmetic dermatology.

Contemporary Targeted Therapies in Rheumatology

2009-12-19T03:40:00.001-08:00

Publisher: Informa Healthcare
Number Of Pages: 636
Publication Date: 2007-10-24
ISBN-10 / ASIN: 1841844845
ISBN-13 / EAN: 9781841844848
Binding: Hardcover

Product Description:

Targeted Therapies in Rheumatology established itself as an excellent reference for all those needing to know about the clinical implications of new drugs and developments for patients suffering from rheumatoid arthritis. This volume takes up the further developments that have occurred in several of the drug therapies covered in the first volume, as well as looking at the latest areas of promising research. Targeted therapies of rheumatic diseases have become a reality and have completely changed patient care as well as patient expectations.

CARA PASANG EKG-how to install EKG

2009-11-25T01:43:00.000-08:00

ekg instalation pictures

Cardiology Explained

2009-11-25T01:32:00.000-08:00

Ashley and Niebauer
Cardiology Explained
2003 - Remedica, 243 pp
ISBN 9781901346220

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Atlas of Kidney Diseases/Table of Contents

2009-11-25T00:59:00.000-08:00

Robert W. Schrier
Department of Medicine, University of Colorado School of Medicine Denver
1999
1000 pp

DOWNLOD HERE

EBOOK TUBERCULOSIS 2007 PDF

2009-11-25T00:53:00.000-08:00

Textbook on Tuberculosis

The winners of the Amedeo Tuberculosis Award are Juan Carlos Palomino, Sylvia Cardoso Leão, Viviana Ritacco, and 37 other clinicians and researchers from 12 countries. Tuberculosis 2007 was published on May 29^th, 2007.

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FROM : http://amedeochallenge.org

EBOOK INFLUENZA REPORT 2006 PDF

2009-11-25T00:44:00.000-08:00

Influenza Report, a medical textbook on influenza and its treatment (PDF, 225 pp,

free download.

source: http://www.influenzareport.com/

Clinical Neurology, Seventh Edition (LANGE Clinical Medicine)

2009-11-24T19:58:00.000-08:00

Clinical Neurology, Seventh Edition (LANGE Clinical Medicine)

Product Description

A comprehensive overview of basic and clinical neurology using a symptom-oriented approach

A Doody's Core Title ESSENTIAL PURCHASE!

"The book is presented as a teaching tool for students and practitioners. The focus of the book and its easy readability will appeal to a full spectrum of healthcare providers....This edition of the classic book has been updated and revised to make it even more clinically relevant. A quick overview of each topic is provided to be translated into advanced patient therapy. Besides its quality, focus, and easy readability, the book is light and convenient to hold, read, and access at a moment's notice. 3 Stars."--Doody's Review Service

No other book makes the link between basic neuroscience and current approaches in diagnosis and treatment easier to understand than ClinicalNeurology. Distinguished by its practice-oriented approach to neurology based on the patients' presenting symptoms, this classic has been updated and revised to make it even more clinically-relevant and enjoyable to read.

Features:

Essential concepts are presented within the framework of problems encountered in a clinical setting for greater relevance to real-world practice

Chapter outlines provide a quick overview of each topic

Treatment protocols reflect the most recent advances in the field

Advances in molecular biology and genetics are incorporated throughout to enhance understanding of neurologic disease
A step-by-step description of the neurologic examination
More than 200 tables and figures
About the Author
Roger P. Simon, MD
Robert Stone Dow Chair of Neurology
Director of Neurobiology Research
Legacy Health Systems
Portland, OR
David A. Greenberg, MD, PhD
Professor and Vice-President for Special Research Programs
Buck Institute for Age Research
Novato, CA
Michael J. Aminoff, MD, DSc, FRCP
Professor and Executive Vice-Chair
Department of Neurology
School of Medicine
University of Califo

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Mayo Clinic Cardiology: Concise Textbook, Third Edition

2009-11-24T19:53:00.000-08:00

Mayo Clinic Cardiology: Concise Textbook, Third Edition

For busy clinicians, residents, and fellows continually challenged with a rapidly expanding body of cardiology information, this expertly conceived Third Edition of a best-selling textbook provides a contemporary succinct distillation of the current status of cardiovascular knowledge and disease. From specific diseases to particular signs, symptoms, and patient concerns, including pregnancy and heart disease and cardiac emergency, this easily readable textbook guides the reader through all the essential information required to skillfully approach professional board examinations and practice state-of-the-art clinical patient care.

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Haematology at a Glance

2009-11-24T19:50:00.000-08:00

Haematology at a Glance

Following the familiar, easy-to-use at a Glance format, and in full-colour, Haematology at a Glance is an accessible introduction and revision text for medical students. Fully revised and updated to reflect changes to the content and assessment methods used by medical schools, this at a Glance provides a user-friendly overview of haematology to encapsulate all that the student needs to know.

This new edition of Haematology at a Glance:

Contains full-colour artwork throughout, making the subject easy to understand
Presents schematic diagrams on the left page and concise explanations on the right
Has been rearranged to provide more structured and logical coverage of the topics
Includes more explanation of the basics of haematology science and the latest clinical treatments
Features expanded chapters on Lymphoma and Myeloproliferative disorders - incorporating new advances in knowledge and practice
Contains self-assessment case studies and MCQs

This book is an invaluable resource for all undergraduates in medicine, immunology, and pharmacy, as well as for junior doctors, nurses and clinical nurse specialists and pharmacists who all need an introduction to haematology.

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MRI at a Glance

2009-11-24T19:46:00.000-08:00

MRI at a Glance

MRI at a Glance provides concise, easily accessible information on MRI physics and is an invaluable revision aid. All topics are included from magnetism to safety, K space to pulse sequences, image contrast to artefacts. The second edition has been fully revised and updated with brand new information on data acquisition and pulse sequences. The book is now in full colour throughout and follows the familiar, easy-to-useat a Glance format with each topic presented as a double-page spread with key facts accompanied by clear diagrams encapsulating essential knowledge.

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Jawetz, Melnick, & Adelberg's Medical Microbiology

2009-11-23T01:12:00.000-08:00

Jawetz, Melnick, & Adelberg's Medical Microbiology

The science of microbiology, Cell structure, Classification of bacteria, The growth and survival and death of microorganisms, Cultivation of microorganisms, Microbial metabolism, Microbial genetics, Immunology, Pathogenesis of bacterial infection, Antimicrobial chemotherapy, Normal microbial flora of the human body Spore-forming gram-positive bacilli: bacillus & clostridium species, Non-spore-forming gram-positive bacilli, corynebacterium, propionibacterium, listeria, erysipelothrix, actinomycetes, The staphylococci, The streptococci, Enteric gram-negative rods (enterobacteriaceae), Pseudomonads, acinetobacters, uncommon gram-negative bacteria, Vibrios, campylobacters, helicobacter, Haemophilus, bordetella, brucella, francisella, Yersinia & pasteurella, The neisseriae, Infections caused by anaerobic bacteria, Legionellae, bartonella, unusual bacterial pathogens, Mycobacteria, Spirochetes & other spiral microorganisms, Mycoplasmas & cell wall-defective bacteria, Rickettsia & ehrlichia, Chlamydiae, General properties of viruses, Pathogenesis & control of viral diseases, Parvoviruses, Adenoviruses, Herpesviruses, Poxviruses, Hepatitis viruses, Picornaviruses (enterovirus & rhinovirus groups), Reoviruses, rotaviruses, & caliciviruses, Arthropod-borne & rodent-borne viral diseases, Orthomyxoviruses (influenza viruses), Paramyxoviruses & rubella virus, Coronaviruses, Rabies, slow virus infections, prion diseases, Human cancer viruses, AIDS & lentiviruses, Medical mycology, Medical parasitology, Principles of diagnostic medical microbiology

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MICROBIOLOGY IMMUNOLOGY NOTES: (Basic Medical Science Notes)

2009-11-23T01:10:00.000-08:00

MICROBIOLOGY IMMUNOLOGY NOTES: (Basic Medical Science Notes)

Paperback: 203.0 pages
Publisher: S. H. Kaplan Educational Center, (January 1, 1993)
Language: English
ASIN: B000CDUH12

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Microbiology & Immunology: Board Review Series

2009-11-23T01:07:00.000-08:00

Microbiology & Immunology: Board Review Series

Product Description
Univ. of Minnesota, Duluth. Designed for students preparing for USMLE Step 1 and course exams. Previous edition:
Paperback: 302 pages
Publisher: Lippincott Williams & Wilkins; Fourth Edition edition (December 15, 2001)
Language: English
ISBN-10: 0781727707
ISBN-13: 978-0781727709
Product Dimensions: 9.9 x 7 x 0.5 inches

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Medical Microbiology

2009-11-23T01:01:00.000-08:00

Mims et al continue their proud tradition of delivering important and often complex material in a simple and informative style. Replete with new and colourful diagrams, impressively detailed images and totally new chapters this book is well formed for integration into the modernmedical course. The new'Key Facts' boxes at the end of each chapter, concisely sum-up the preceeding information, and the MCQ-style questions test your knowledge. Undoubtedly it is a superb resource and a phenomenally written textbook. I can strongly recommendMedical Microbiology 3E as a vital resource to medical learning, and a generally interesting text about basic microbiology and immunological concepts. Mims appears to have an assured position onMedical Student bookshelves the world over.

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Harrison's Principles of Internal Medicine, 17th Edition

2009-11-23T00:52:00.000-08:00

Harrison's Principles of Internal Medicine, 17th Edition

by Anthony S. Fauci (Author), Eugene Braunwald (Author), Dennis L. Kasper (Author), Stephen L. Hauser (Author), Dan L. Longo (Author), J. Larry Jameson (Author), Joseph Loscalzo (Author)

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Thyroid Cytopathology: An Atlas and Text

2009-11-23T00:48:00.000-08:00

Thyroid Cytopathology: A Text and Atlas (9780781768832): Sudha R Kini: Books

ISBN: 0781768837
ISBN-13: 9780781768832

Written by a leading expert in thyroid biopsy interpretation, this text/atlas is the most comprehensive reference on thyroid pathology. It contains over 1,700 full-color photomicrographs depicting the full range of findings seen on fine needle aspiration biopsies. The illustrations show the wide spectrum of cytologic features for each disease entity, including unusual as well as typical patterns. Particular attention is given to diagnostic pitfalls, overlapping patterns, and differential diagnosis. The book also includes chapters on basic concepts of cytopathology, fine-needle aspiration biopsy techniques, cytopreparation, ancillary diagnostic techniques, liquid-based cytologic preparations, and the application of needle biopsy findings to management decisions. The fully searchable online text and a full-color image bank are available on a companion Website. (www.kinisolution.com)

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Ophthalmology Clinical Signs and Differential Diagnosis

2009-11-23T00:43:00.001-08:00

product details 
Publisher: Mosby; 1 edition (January 15, 1999) 
Language: English 
ISBN-10: 0723431213 
ISBN-13: 978-0723431213LOR= "Blue"]
Book Description:

World-renowned author Jack J. Kanski and co-author Ken K. Nischal provide a new, complete, visual catalog of clinical ophthalmologic signs uniquely organized by anatomical site. This reference is an essential, first of its kind tool in ophthalmology specifically geared toward differential diagnosis. Pertinent information is succinctly provided for each disorder including diagnostic signs, ocular and systemic associations, causes, and other indicators relating to patient history and confirmation of diagnosis. More than 1,500 high-quality, color photographs and nearly 50 angiograms throughout allow you to compare directly with patient symptoms as they appear in clinical practice. This reference is a desk-side companion every ophthalmologist and optometrist will use repeatedly to match and verify diagnosis, and a valuable review tool for trainees.

PDF, 45.7 MB

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dr_hero

Ophthalmology: Expert Consult -Yanoff-3rd Ed

2009-11-23T00:41:00.000-08:00

Publisher: Mosby
Number Of Pages: 1552
ISBN-10 / ASIN: 0323043321
ISBN-13 / EAN: 9780323043328

Product Description:

Based on valuable customer feedback, Doctors Yanoff and Duker have streamlined their best-selling reference, Ophthalmology, to zero in on just the clinical answers you need in day-to-day practice. They’ve removed most of the basic science and anatomy information from the printed book and put it on the companion web site where it is easily accessible along with the entire contents of the book. This new edition presents unparalleled guidance on nearly every ophthalmic condition and procedure including the latest advances in the field, such as optical coherence tomography (OCT), the ocular surface, new pharmacologic therapies, updated oculoplastic surgical techniques, the latest in refractive surgery, and so much more. And, as an Expert Consult title, this meticulously updated 3rd edition comes with access to the complete contents online, fully searchable, plus additional basic science information.

Provides access to the complete contents online, fully searchable, plus additional basic science information, and a downloadable image library for use in electronic presentations.
Discusses every aspect of clinical ophthalmology for complete coverage in a single volume.
Uses 2250 full-color illustrations that depict a wide range of ophthalmic techniques and disorders.

Presents a more streamlined format to the printed text to help you focus on the clinically actionable information you need everyday.
Discusses hot topics such OCT, the ocular surface, glaucoma testing, refractive surgery, advances in molecular biology and genetics, neuro-ophthalmology, and retinal studies to keep you absolutely current.
Provides enhanced coverage of cataracts, including advances in phacoemulsification and surgical complications.
Helps you make optimal use of the newest drug therapies, including Anti-VEGF treatment for wet ARMD and bevacizumab treatment for complications of diabetes.
Offers authoritative guidance on the newest treatment options for cornea disorders, including evolving ocular surface reconstruction techniques and new cornea procedures such as DSEK.
Incorporates new chapters on increasingly popular aesthetic oculoplastic surgical techniques to help you meet today’s demands.

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No pass

Lecture Notes: Clinical Medicine ebook

2009-11-23T00:39:00.000-08:00

"This book is excellent, no nonsense, to the point, what you need to know is this. If only all books were as easy to learn from."
Sphincter, Liverpool Medical School Gazette

"The Lecture Notes series gets better and better and this is no exception [...] It is a joy to use and I would use it in preference to other 'baby' final year revision texts on the market [...] There is a small and illuminating chapter on the eye, and how to successfully focus an opthalmoscope. Surely, that in itself is worth the cover price."
GKT Gazette, December 2004

"The logical, well laid-out approach taken by this book really does facilitate learning. Thoroughly recommended."
University of Wales College of Medicine Student Gazette

"It is a useful refresher of information that is, or perhaps should be, deep down there somewhere.The book is positively crammed with information."
2nd Opinion

"It will be a good base for revision for any organized dudes out there, but it will also be a good oh-my-god-the-exams-is-in-half-an-hour last minute revision textbook. So yeah, I totally recommend it, but only for 3rd/4th years."
2nd Year Medical Student, Liverpool Medical School
Sphincter, December 2003

"...this book tackles the vast subject that is clinical medicine in a matter of fact, easy to learn way. It does exactly what it says on the tin: a no-nonsense overview of clinical medicine, perfect in the run up to finals."
Oxford Medical School Gazette, vol. 54 (1)

"This book more than lives up to the other popular books in the same 'lecture notes' series with its clear, concise, no-nonsense format [...] ideal for revision."
North Wing, Sheffield Medics Magazine, Winter 2004

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Oxford Handbook of Acute Medicine

2009-11-23T00:37:00.000-08:00

Oxford Handbook of Acute Medicine

Review

`Review from previous edition Reviews from the printed edition: Overall, I think the authors have done a tremendous job, and it certainly will make life on the wards a bit easier for clinicians. The book reads very well, and manages to include an admirable amount of detail, whilst remaining comprehensible. Well done!' Shreelatta Datta, Pre-registration House Officer

`It's pretty impressive. There has been quite a lot of re-writing and touching up. The style remains excellent, very clear and to the point, and comparing it to the current edition, I think the second edition is much more so. In all, I think the manuscript is excellent, and faultless. The authors have worked hard on an already good text to update it, and make it very saleable, and appealing to readers. Well done. I look forward to seeing it in print.' James Dawson, House Officer

`This pocket-sized book contains an absolute wealth of information on acute medical problems and is very comprehensive in the breadth of its coverage.' Hospital Doctor, February 2005

`The Oxford Handbook series have done it again, another great book to add to this ever growing collection . . . I would have thought juniormedical staff would benefit most from this book but GPs and their registrars would also appreciate some of the wisdom. Even more seniormedical staff would also want to own a copy and best of all is the price. This book truly represents superb value for money and even if this book gets a bit dog eared after a few months use, or worse gets lost or pinched (surely not), it will not break the bank to get another one . . . Certainly this book ranks up there with a BNF, a stethoscope, and a bleep that juniormedical staff need to go about their daily duties. As for other practitioners both hospital and non hospital based, this is also a very useful book to keep them up to date with what goes on in acute medicine.' Dr Harry Brown on the Univadis website

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Manual of Laboratory and Diagnostic Tests, Eighth Edition

2009-11-23T00:33:00.001-08:00

Manual of Laboratory and Diagnostic Tests, Eighth Edition, for PDA: Powered by Skyscape, Inc. (9780781790222): Frances Talaska Fischbach, Marshall B Dunning: Books

The new Eighth Edition of this best-selling clinical reference is now available in PDA format, for quick, easy point-of-care access. This handheld reference covers the full range of current laboratory and diagnostic tests and studies and describes each test in detail, with step-by-step instructions on correct procedure and tips for accurate interpretation. Platform: Palm OS, Windows CE, and Pocket PC handheld devices Also Available for iPhone/IPod touch

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High-Yield Microbiology and Infectious Diseases

2009-11-23T00:32:00.000-08:00

this new edition extracts the most important information on microbiology and infectious diseases and presents it in a concise, succinct fashion to prepare students for the USMLE. The book also serves as an excellent course review, with illustrations, review questions, and high-yield case study sections. This edition features 70 new images. High-Yield(TM) means exactly that...readers reap maximum benefits from very focused study.

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ACR BI-RADS American College Of Radiology

2009-11-23T00:29:00.000-08:00

Mammographiebefundung nach BI-RADS. Illustrierte Anleitung zur einheitlichen Befunderstellung von Mammographie, Mammasonographie, MR Mammographie (9783131369727): unknown: Books

The richly illustrated BI-RADS® Atlas provides guidance on BI-RADS through the use of illustrated cases, sample reports, statistical definitions, and explanations for performing the mammography audit. This comprehensive guide provides standardized breast imaging terminology; a report organization; assessment structure; and a classification system for mammography, ultrasound, and MR of the breast. The BI-RADS Atlas includes the fourth edition of the mammography lexicon and audit system.

The BI-RADS® Atlas is designed to serve as a comprehensive guide providing standarized breast imaging terminology, a report organization, assessment structure and a classification system for mammography, ultrasound and MRI of the breast. The report organization assists radiologists in providing a succinct review of mammographic, ultrasound and MRI findings. Results are then communicated to the referring physician in a clear fashion with a final assessment that indicates a specific course of action. Results are compiled in a standardized manner that permits the maintenance and collection analysis of demographic, mammographic and outcome data. Through a medical audit and outcome monitoring, the system provides important peer review and quality assurance data to improve the quality of patient care. The BI-RADS® Atlas also includes the 2003 revisions to the assessment categories, to lexicon terminology, and statistical definitions for the performance of amammography audit.

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Atlas of Clinical Diagnosis

2009-11-23T00:26:00.000-08:00

Atlas of Clinical Diagnosis (9780702026683): M. Azfal Mir: Books

the author feels there is still a place for bedside medicine and this book is proof...

The book is fully indexed so it is easy to find what you are looking for, by either looking here or in the contents. You could easily while away an hour idly leafing through the book, picking up numerous snippets by which to impress your colleagues." Dr JM Sager, Medix-UK, July 2003

over 1200 full colour, high quality photos of pathologies...a good book, well laid out and written." Medical Student, GKT Gazette, February 2004 --This text refers to an out of print or unavailable edition of this title.

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Interpretation of Diagnostic Tests

2009-11-23T00:23:00.000-08:00

"What tests do I order, and what do the results mean?" Interpretation of Diagnostic Tests, Eighth Edition provides the answers--quickly and clearly--for a vast range of adult and pediatric conditions. Arranged by organ system, the book summarizes the available tests for most diseases, explains what the results mean, and discusses differential diagnoses. This thoroughly updated edition includes additional tests based on molecular biology, new data on the use of genetic tests, and many new diagnostic laboratory tests in chemistry. Imaging tests are included where they play a key role in diagnosis. The section on chemical and microbiological terrorism has been expanded. Readers can search for information in the way that best suits their needs--by index, table of contents, test results, or specific disease. Also included are extensive tables of normal and panic values, tables comparing test results in similar diseases, and an appendix of conversion factors between conventional and SI units.

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Lippincott Professional Guides: Anatomy & Physiology

2009-11-23T00:19:00.000-08:00

Pocket quick reference for students and nurses. Features a body-system arrangement; overview of terms, cell and tissue types, chemical make-up of the body; illustrations, and tips on remembering complex points. Previous edition: c1998. Wire-spiral binding. DNLM: Anatomy--Handbooks.

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Gray's Anatomy: The Anatomical Basis of Clinical Practice, Expert Consult - Online and Print

2009-11-23T00:12:00.000-08:00

In short, the 40th edition of Gray's Anatomy is not only the most complete textbook of anatomy on the market but is possibly the most complete anatomical atlas available." -JAMA, May 6, 2009--Vol 301, No. 17, pp. 1829-1830.
"I am not aware of any book currently in print in any language that contains as much anatomical information as the 40th edition. it should be in the library of anyone who has the need for a comprehensive anatomical reference book. It may seem costly, but, per pound, it really is a bargain. Many books on the market offer much, much less but cost much more." -JAMA, May 6, 2009--Vol 301, No. 17, pp. 1829-1830.
"One of the most valuable aspects of Gray's is the way it integrates structure at all levels, from the subcellular through the regional." -JAMA, May 6, 2009--Vol 301, No. 17, pp. 1829-1830.
"[Gray's Anatomy] is to medical textbooks what Webster's is to dictionaries." -American Medical News, Posted Jan. 12, 2009 at amednews.com

"Each section has been reorganized by an editor, expert in the field, assisted by a group of contributors, and scrutinized by a panel of international reviewers. Anatomists, embryologists, cell biologists, surgeons, radiologists and other clinicians have brought their extensive experience to update the text and artwork. Moreover, essential and recent references are given at the end of each chapter of the different sections. The result is a well-documented and clinically-oriented state-of-the-art volume...The presentation of the book is practical and attractive...To sum up, this new 150th anniversary edition of Gray's Anatomy, which is the first one in full-colour, is quite simply a magnificent work."

Surgical and Radiologic Anatomy, November 2008
"The all-important tradition of improvement with age is most emphatically maintained by the newest edition of Gray's Anatomy . . . New and important ground has been broken . . . The authors have increasingly taken on the task of accommodating the new uses to which anatomy is being put in clinical situations, such as minimally invasive surgery, endoscopy, arthroscopy, microsurgery, and the entire expanding field of imaging, including three-dimensional studies . . . Beautifully produced and medically invaluable." - Scientific American, review of the 39th edition
Gray's Anatomy has been around since 1858. In 2008, Elsevier can be proud of the first class presentation of this updated, fabulous book. It has been completely re-imagined with re-organised contents and 1800 images now in full-colour, in addition to more than 120 new imaging studies. For those who need a detailed anatomy reference, this book is the business and it's the only one you'll ever need.

3D Clinic Professional (ISO)

2009-11-23T00:08:00.000-08:00

3DClinic Professional is a sophisticated educational tool designed specifically for use by doctors in communicating with patients in the clinical setting. Containing more than 100 distinct pieces of interactive media accessed via a simple and easy to navigate menu structure, 3D Clinic Professional replaces traditional analogue media (such as medical illustration books and skeleton models) used by doctor to converse with patient. With the unique advantage of draw-on-screen, type-on-screen, print, email and save-to-disk functionality, is not only designed to improve patient compliance, but also lower malpractice risk.
The unique selling point of 3DClinic Professional is our ability to facilitate a better patient outcome via a healthcare professional's communication of 3D interactive imagery. It is the intent of 3DClinic to take a competitive position throughout the world in any market segment where a healthcare professional, teacher, parent or other individual wishes to achieve an improved educational outcome in the area of anatomy, medicine and health via communication of 3D interactive imagery. The core value of our first product developed for use in general practice is a better patient outcome.
Our product is not designed to be additive to GP's current workflow practices, rather, simply replace the use by doctor of analogue media he/she would traditionally use to educate patients about their condition.
The software features:
• Simple menu structure for ease of navigation
• Health topics that provide a 3D interactive journey from a healthy to unhealthy state.
• A 3D library of anatomical images of the human body
• Draw and Type features that enable you to 'personalize' imagery for your patient
• Ability to Print, Email (for referrals) & Save these images for future reference
• Links to patient education materials provided by recognized professional associations

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The ECG In Practice

2009-11-23T00:06:00.000-08:00

This clinically-orientated book shows how the electrocardiogram is used to aid the diagnosis of patients with cardiovascular disease. Each chapter begins with a brief consideration of the history and examination of the patient to assist the doctor plan how to use the ECG in the most intelligent and profitable way. The text explains the variations in the patterns of ECGs which are seen in both healthy people as well as those with cardiac problems, and illustrates the abnormalities with a comprehensive range of examples.

A new page size and text design gives a much clearer presentation of the ECGs, allowing full traces to be presented on one page

A new chapter on electrophysiology and electrical devices responds to the increasing occurrence of pacemakers and implanted defibrillators in patients

The "What to do" sections at the end of chapters have been fully updated

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Medical Journal Review : ALLERGY

2009-11-22T23:47:00.000-08:00

Exploring the association between severe respiratory syncytial virus (RSV) infection and asthma (A).
Does RSV cause A, or do those infants who later develop A have a genotype that both predisposes them to A and makes them more susceptible to severe RSV infection? That question is explored in this population-based study of hospitalization data from all Danish twins born alive between 1994 and 2000 (8280 twin pairs). The diagnosis of RSV infection was based on hospital diagnosis and/or RSV identification by ELISA. Presence of A was assessed by hospital discharge diagnosis and parental questionnaire. Among the children with RSV infections, 50% were hospitalized before the age of 6 mo and 75% before 12 mo. 95% had been hospitalized before 24 mo. Twins hospitalized for RSV were more likely to have A. The data were subjected to statistical analysis and direction of causation (DOC) modeling. Monozygotic twins showed a higher correlation for A than dizygotic twins, suggesting a genetic component in disease susceptibility; but for RSV there was no such correlation, meaning that environmental factors play a larger role. When data were fitted to a DOC model, it was found that the best fit occurred for RSV infection resulting from the underlying susceptibility to A rather than vice-versa.
Editor’s comment: These data support the concept that RSV is associated with but does not cause A implying unknown genetic factors are involved.
Thomsen SF et al., Am J Resp Crit Care Med 2009; 179:1091-1097. Also see editorial by Kuehni and Silverman, pp. 1079-80 (Abstract not available online)
Urine concentrations of cysteinyl leukotrienes (CysLTs) in children with obstructive sleep-disordered breathing (SDB).
Adenotonsillar tissue from children (C) with SDB shows high levels of CysLTs and their receptors that may contribute to this disorder. C with SDB were compared to C with no evidence of SDB but with a history of recurrent tonsillitis. Subjects with asthma, respiratory tract infection or chronic inflammatory disorders were excluded along with those using antihistamines or intranasal corticosteroids. An obstructive apnea-hypopnea index (OAHI) was determined by overnight polysomnography and tonsillar size graded. Morning urine samples were assayed for CysLTs. A total of 92 C were enrolled and results were evaluated according to OAHI. C with OAHI ≥5 episodes/hr had significantly higher urine CysLT levels than those with mild or no SDB. Higher BMIs and larger tonsils were also predictors of SDB. These data support the hypothesis that SDB is associated with inflammation as well as anatomical factors, but whether the SDB is more severe because of the increased CysLTs or severe SDB causes an increase in CysLTs cannot be determined.
Editor’s comment: This study suggests that there is a link between SDB and inflammation.
Kaditis AG et al., Chest 2009; 135:1496-1501.
Venom immunotherapy (VIT) reduces large local reactions (LLRs) to insect stings.
LLRs to Hymenoptera occur in 10% of adults and have significant effects on QOL, often requiring oral corticosteroids. This 4 yr controlled pilot study was performed to determine the effectiveness of VIT in reducing the severity of LLRs. Enrollees had a history of LLRs and skin sensitivity to venom. Those with previous sting anaphylaxis were excluded. A baseline sting challenge was performed at entry and only those with skin induration of at least 16 cm were included. 19 subjects (there were 10 untreated controls) achieved a maintenance dose in 7 weeks. Sting challenges were administered and patients recorded the size of induration at 1, 12, 24, and 48 hr after the sting. No additional medications (e.g., antihistamines) were allowed until 48 hr after the sting. The size and duration of LLRs decreased significantly with increasing time of VIT. Patient satisfaction was >90%.
Editor’s comment: Several studies now indicate that VIT is effective to treat LLRs induced by Hymenoptera stings.
Golden DBK et al., J Allergy Clin Immunol 2009; 123:1371-1375.
Overweight and changes in weight status during childhood in relation to asthma (A) symptoms at 8 years.
A symptoms in relation to body mass index (BMI) were assessed at 3, 6 and 8 yrs in a group of 3756 children in a birth cohort. Yearly questionnaires were returned by parents reporting the child’s weight and height and whether they had A symptoms- wheeze and/or dyspnea and/or a prescription for inhaled corticosteroids in the previous year. At age 8, a subgroup of children gave a blood sample analyzed for a panel of specific IgE. Bronchial hyperresponsiveness (BHR) also was determined. A high BMI at an earlier age was not associated with dyspnea in children who were at normal weight at 8 yr. Eight year-old children who had A symptoms and BHR were significantly more likely to have had a high BMI at 6-7 yr but not at earlier ages. IgE levels did not correlate with BMI.
Editor’s comment: High BMIs in children at certain ages may be associated with the onset of asthma and BHR.
Scholtens S, et al., J Allergy Clin Immunol 2009; 123:1312-1318. Also see editorial by Schwartzstein and Gold, pp. 1319-20.
Work group report: oral food challenge (OFC) testing.
This document is a comprehensive, practical guide to administering an OFC. The criteria for deciding when to conduct an OFC and the risk/benefit analysis are discussed with guidelines for skin-prick and serum IgE testing. The different types of OFC—open, single-blind, placebo-controlled and double-blind are described. An open OFC may be done for simple screening while the more rigorous DBPC is primarily for research. An OFC procedure form and flow sheet are included.
Editor’s comment: This is a practical and highly useful document about OFC.
Nowak-Wegrzyn et al., J Allergy Clin Immunol 2009; 123 (suppl):S365-383.
Reparative capacity of airway epithelium impacts deposition and remodeling of extracellular matrix (ECM).
Defective repair of damaged epithelium is linked to fibrosis and remodeling in chronic lung disease. This mouse-model study focuses on the interactions between epithelial repair systems and the regulation of ECM deposition and fibrosis. Epithelial lesions were produced by intraperitoneal injection of naphthalene and mice were examined from 0 (control) to 6 days afterwards. In repair-competent mice exposed to naphthalene, a specific phenotypic signature was seen representing airway repair, cell proliferation and ECM regulation. The ECM protein, tenascin C (Tnc), was transiently up-regulated in naphthalene-challenged wild type mice but returned to normal following epithelial repair. In mice deficient in epithelial repair cells, however, lung damage led to a significant and sustained increase in Tnc and uncontrolled matrix deposition. Lack of repair of damaged epithelium led to an accumulation of Tnc protein in the sub-epithelial mesenchyme of airways and alveoli.
Editor’s comment: This study sheds additional light on the possible role of epithelial repair cells and Tnc in airway remodeling.
Snyder JC et al., Am J Resp Cell Mol Biol 2009; 40:633-642.
T-bet expression is regulated by EGR1-mediated signaling in activated T cells.
T-bet is a transcription factor that polarizes T cell development along the Th1 pathway and suppresses Th2-type cytokine production and stimulates expression of IFN-gamma and the IL-12 receptor. Regulation of T-bet production by early growth response gene 1 (EGR1) was studied in this report using human B and T cell lines and T cells isolated from mice. EGR1 binds to the gene promoter for T-bet in T cells and activates its expression, while depletion of EGR1 in T cells prevents induction of T-bet. Naïve CD4+ T cells, isolated from mice and activated by antigen-presenting cells under Th0, Th1 or Th2 conditions, shows concomitant expression of EGR1 and T-bet in Th0 and Th1 cells but not Th2.
Editor’s comment: EGR1 appears to be a key upstream regulator of T-bet expression.
Shin H-J et al., Clin Immunol 2009; 131:385-394.
Increases in urinary 9α,11β-prostaglandin F2 indicate mast cell activation in wine-induced asthma.
Wine-sensitive individuals can experience asthmatic symptoms after wine consumption. 8 participants with self-reported wine sensitivity were tested with high- and low-sulfite wines given double-blind. As primary outcome, urinary 9α,11β-prostaglandin F₂ (a metabolite of prostaglandin D₂, PGD2) was measured before and after consumption. With high-sulfite wines versus low-sulfite wines, the 9α,11β-prostaglandin F₂ level increased 1.6- and 1.5-fold, respectively, demonstrating that sulfites probably are not linked to the asthmatic symptoms of wine consumption. PGD2 is elevated as a result of mast cell activation and urinary 9α,11β-prostaglandin F₂ is currently the most sensitive indicator of degranulation. It is more likely that IgE-indpendent activation of mast cells occurs based on clinical characteristics of these subjects.
Editor’s comment: The reasons why wine may exacerbate asthma remain a mystery.
Misso NLA et al., Int Arch Allergy Immunol 2009; 149:127-132.
Desensitization in interferon-β1α (IFN-b) allergy: a case report.
IFN-b is the standard Rx for relapsing-remitting multiple sclerosis (MS), but an immune response to the drug can occur preventing treatment. A 41-year-old female with MS diagnosed 15 months earlier presented with urticaria and angioedema after s.c. IFN-b. Urticaria and pruritus, not associated with the injection site, appeared after the first month of Rx and grew progressively worse until periorbital and perioral angioedema developed and the IFN-b was stopped. The urticaria cleared immediately with no relapse. Skin-prick and intradermal tests with IFN-b were positive for 1:1 and =1:1000 dilutions, respectively. A desensitization schedule with incremental alternating s.c. IFN-b injections every 30 min over a period of 4 days was performed. Desensitization was successful and the patient resumed IFN-b Rx 3X/wk with no adverse effects.
Editor’s comment: This is a quick and simple desensitization procedure for immediate hypersensitivity to IFN-b.
Kalpaklioglu AF et al., Int Arch Allergy Immunol 2009; 149:178-180.
Inhibition of non-neuronal α7-nicotinic acid receptor for lung cancer treatment.
Non-small cell lung cancer (NSCLC) tumorigenesis appears to involve nicotinic acetylcholine receptors (nAChRs). The effect of blocking the α7-nAChR with alpha-cobratoxin (α-CbT) was investigated on various human lung tumor cells and in nonobese diabetic/severe combined immunodeficient (NOD/SCID) mice engrafted with NSCLC cells. The proliferation of tumor cells in vitro was inhibited by α-CbT compared to normal bronchial epithelial cells and the degree of inhibition was proportional to the density of α7-nAChRs on the tumor cells. For the in vivo evaluation of α7-nAChR inhibition, NSCLC cells were injected into the lungs of NOD/SCID mice, allowed to grow for 7 days, after which they were treated with vehicle control, cisplatin (lung cancer chemotherapeutic agent) or α-CbT (i.v. injection 3 times/wk for 3 wks). The endpoint was length of survival from time of injection of the cells. Cisplatin improved survival 16% relative to controls, while treatment with α-CbT resulted in survival, 80% higher than cisplatin and 93% than controls. Assays on tumor cells from α-CbT-treated mice showed >80% apoptosis.
Editor’s comment: This treatment offers promise as a way to slow the progression of NSCLC.
Paleari L, et al., Am J Resp Crit Care Med 2009; 179:1141-1150. Also see editorial by ER Spindel, pp. 1081-82 (Abstract not available online)
Bronchial airway epithelial cell damage following exposure to cigarette smoke (CS) includes disassembly of tight junction (TJ) components mediated by the extracellular signal-regulated kinase 1/2 (ERK1/2) pathway.
CS is a mixture of many chemicals that have a variety of effects on airway epithelial cells, including changes in signaling pathways, such as those involving epidermal growth factor receptor (EGFR) and ERK1/2. CS condensate (CSC) was prepared by collecting CS particulates on a filter and dissolving the filtrate in cell culture medium. Cultured normal human bronchial epithelial cell lines were incubated with various concentrations of CSC and the effects on TJs, cytotoxicity, DNA integrity and ERK1/2 signaling were measured. CSC caused disassembly of tight junctions in a time- and dose-dependent manner. Decreased cell proliferation was seen only at the highest dose of CSC (20%) but apoptosis was seen at 10% and 20% CSC. Preincubation of cells with EGFR inhibitor blocked CSC activation of the ERK1/2 pathway and prevented both DNA fragmentation and disassembly of TJs.
Editor’s comment: This in vitro evidence of ERK1/2 involvement in TJ damage warrants further study in animal models.
Petecchia L et al., Chest 2009; 135:1502-1512.
Acid-suppressive medication use and the risk for hospital-acquired pneumonia.
Use of proton pump inhibitors (PPIs) or histamine-2 (H2) receptor blockers for controlling acid reflux has increased and are being given routinely to many hospital inpatients. All patients ≥18 yr of age admitted to a large metropolitan hospital with a stay of 3 or more days were eligible for inclusion in this prospective cohort study. Admission to ICU was excluded. The primary outcome scored was a discharge diagnosis of pneumonia and the final cohort included 63,878 subjects. Use of acid-suppressing drugs (82% PPIs, 23% H2 blockers, and some both) was ordered for 52% of the patients and use of PPIs (but not H2 blockers) was associated with a 30% increase in the odds of having pneumonia while in the hospital.
Editor’s comment: Proton pump inhibitors may increase the risk for both inpatient and outpatient pneumonia.
Herzig SJ et al., JAMA, 2009; 301(20):2120-2128.

Cannabis (drug)

2009-11-22T23:46:00.000-08:00

Cannabis (drug)

By Various

"Marijuana" redirects here. For other uses, see Marijuana (disambiguation).
For the plant genus, see Cannabis. For other uses of cannabis, see Industrial and Personal Uses of Cannabis.
Cannabis, also known as marijuana, marihuana, and ganja (from Sanskrit: गांजा gañjā, meaning "hemp"), among many other namesa[›], refers to any number of preparations of the Cannabis plant intended for use as a psychoactive drug. The most common form of cannabis used as a drug is the dried herbal form.

The typical herbal form of cannabis consists of the flowers and subtending leaves and stalks of mature pistillate or female plants. The resinous form of the drug is known as hashish (or merely as 'hash').

The major psychoactive chemical compound in cannabis is Δ9-tetrahydrocannabinol (commonly abbreviated as THC). At least 66 other cannabinoids are also present in cannabis, including cannabidiol (CBD), cannabinol (CBN) and tetrahydrocannabivarin (THCV) among many others, which are believed in influence the effects of THC alone.

Cannabis use has been found to have occurred as long ago as the third millennium B.C. In modern times, the drug has been used for recreational, religious or spiritual, and medicinal purposes. The United Nations (UN) estimated that in 2004 about 4% of the world's adult population (162 million people) use cannabis annually, and about 0.6% (22.5 million) use it on a daily basis. The possession, use, or sale of cannabis preparations containing psychoactive cannabinoids became illegal in most parts of the world in the early twentieth century. Since then, some countries have intensified the enforcement of cannabis prohibition, while others have reduced it.

Contents

1 History
2 Forms
2.1 Cannabis (herbal form)
2.2 Hashish
2.3 Hash oil
2.4 Kief
2.5 Resin
3 Potency
4 Routes of administration
5 Effects
5.1 Classification
5.2 Medical use
5.3 Long-term effects
5.4 Adulterants
6 Gateway drug theory
7 Legal status
8 Price
9 Truth serum
10 Breeding and cultivation
11 See also
12 Notes
13 References
14 Further reading
15 External links
History

The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years in Taiwan. Má (Pinyin pronunciation), the Chinese expression for hemp, is a pictograph of two plants under a shelter.
Cannabis is indigenous to Central and South Asia. Evidence of the inhalation of cannabis smoke can be found as far back as the 3rd millennium B.C., as indicated by charred cannabis seeds found in a ritual brazier at an ancient burial site in present day Romania. Cannabis is also known to have been used by the ancient Hindus of India and Nepal thousands of years ago. The herb was called ganjika in Sanskrit (गांजा/গাঁজা ganja in modern Indic languages). The ancient drug soma, mentioned in the Vedas as a sacred intoxicating hallucinogen, was sometimes associated with cannabis.

Cannabis was also known to the ancient Assyrians, who discovered its psychoactive properties through the Aryans. Using it in some religious ceremonies, they called it qunubu (meaning "way to produce smoke"), a probable origin of the modern word "cannabis". Cannabis was also introduced by the Aryans to the Scythians and Thracians/Dacians, whose shamans (the kapnobatai—"those who walk on smoke/clouds") burned cannabis flowers to induce a state of trance. Members of the cult of Dionysus, believed to have originated in Thrace (Bulgaria, Greece and Turkey), are also thought to have inhaled cannabis smoke. In 2003, a leather basket filled with cannabis leaf fragments and seeds was found next to a 2,500- to 2,800-year-old mummified shaman in the northwestern Xinjiang Uygur Autonomous Region of China.

Cannabis sativa from Vienna Dioscurides, 512 A.D.
Cannabis has an ancient history of ritual use and is found in pharmacological cults around the world. Hemp seeds discovered by archaeologists at Pazyryk suggest early ceremonial practices like eating by the Scythians occurred during the 5th to 2nd century B.C., confirming previous historical reports by Herodotus. One writer has claimed that cannabis was used as a religious sacrament by ancient Jews and early Christians due to the similarity between the Hebrew word "qannabbos" ("cannabis") and the Hebrew phrase "qené bósem" ("aromatic cane"). It was used by Muslims in various Sufi orders as early as the Mamluk period, for example by the Qalandars.

A study published in the South African Journal of Science showed that "pipes dug up from the garden of Shakespeare's home in Stratford upon Avon contain traces of cannabis." The chemical analysis was carried out after researchers hypothesized that the "noted weed" mentioned in Sonnet 76 and the "journey in my head" from Sonnet 27 could be references to cannabis and the use thereof.

Cannabis was criminalized in the United States in 1937 due to Marihuana Tax Act of 1937. Several theories try to explain why it is illegal in most Western societies. Jack Herer, a cannabis legalization activist and writer, argues that the economic interests of the paper and chemical industry were a driving force to make it illegal. Another explanation is that beneficial effects of hemp would lower the profit of pharmaceutical companies which therefore have a vital interest to keep cannabis illegal. Those economic theories were criticized for not taking social aspect into account. The illegalization was rather a result of racism directed to associate American immigrants of Mexican and African descent with cannabis abuse.

Forms

Cannabis (herbal form)

Dried Cannabis flowers in its herbal form; commonly known as marijuana.
The terms cannabis or marijuana generally refer to the dried flowers and subtending leaves and stems of the female cannabis plant. This is the most widely consumed form, containing 3% to 22% THC. In contrast, cannabis strains used to produce industrial hemp contain less than 1% THC and are thus not valued for recreational use.

Hashish

Hashish.
Main article: Hashish
Hashish (also spelled hasheesh) or hash is a concentrated resin produced from the flowers of the female cannabis plant. Hash is more potent than marijuana and can be smoked or chewed. It varies in color from black to golden brown depending upon purity.

Hash oil

Main article: Hash oil
Hash oil, or honey oil, is an essential oil extracted from the cannabis plant through the use of various solvents. It has a high proportion of cannabinoids (ranging from 40-90%). This oil is also used in the process of making a variety of cannabis foods.

Kief

Main article: Kief
Kief is a powder made from trichomes removed from the leaves and flowers of cannabis plants. Kief can also be compressed to produce one form of hashish, or consumed in powder form.

Resin

Resin collected from a pipe.
Main article: Cannabis (hashish) rosin
Because of THC's adhesive properties, resin builds up inside the paraphernalia when cannabis is smoked. It has tar-like properties but still contains THC as well as other cannabinoids. This resin still has all the psychoactive properties of cannabis but is more difficult to smoke due to the discomfort caused to the throat and lungs. Cannabis users typically only smoke resin when cannabis is unavailable. Glass may be water-steamed at a low temperature prior to scraping in order to make the resin easier to remove.

Potency

According to the United Nations Office on Drugs and Crime (UNODC), "the amount of THC present in a cannabis sample is generally used as a measure of cannabis potency." The three main forms of cannabis products are the herb (marijuana), resin (hashish), and oil (hash oil). The UNODC states that marijuana often contains 5% THC content, resin "can contain up to 20% THC content", and that "Cannabis oil may contain more than 60% THC content."

A scientific study published in 2000 in the Journal of Forensic Sciences (JFS) found that the potency (THC content) of confiscated cannabis in the United States (US) rose from "approximately 3.3% in 1983 and 1984", to "4.47% in 1997". It also concluded that "other major cannabinoids (i.e., CBD, CBN, and CBC)" (other chemicals in cannabis) "showed no significant change in their concentration over the years".. More recent research undertaken at the University of Mississippi's Potency Monitoring Project has found that average THC levels in cannabis samples between 1975 and 2007 have increased from 4% in 1983 to 9.6% in 2007.

Australia's National Cannabis Prevention and Information Centre (NCPIC) states that the buds (flowers) of the female cannabis plant contain the highest concentration of THC, followed by the leaves. The stalks and seeds have "much lower THC levels". The UN states that the leaves can contain ten times less THC than the buds, and the stalks one hundred times less THC.

Routes of administration

A Volcano vaporizer. The balloon (top), after filling with vapors, may be removed and inhaled from.

Cannabis joints are potentially the most harmful method of consumption. Burning temperature can reach 700°C (1292°F).

A narrow, screened single-toke utensil, such as the midwakh (shown here) or kiseru, provides small, low-temperature servings, protecting against health damage.
Main article: Cannabis consumption
Cannabis is consumed in many different ways, most of which involve inhaling smoke.

The most commonly used include screened bowls, bubblers (small pipes with water chambers), bongs, one-hitters, chillums, paper-wrapped joints and tobacco-leaf-wrapped blunts. Local methods differ by the preparation of the cannabis plant before use, the parts of the cannabis plant which are used, and the treatment of the smoke before inhalation.

A vaporizer heats herbal cannabis to 365–410 °F (185–210 °C), which causes the active ingredients to evaporate into a gas without burning the plant material (the boiling point of THC is 392°F (200°C) at 0.02mmHg pressure, and somewhat higher at standard atmospheric pressure). A lower proportion of toxic chemicals are released than by smoking, although this may vary depending on the design of the vaporizer and the temperature at which it is set. This method of consuming cannabis produces markedly different effects than smoking due to the flash points of different cannabinoids; for example, CBN has a flash point of 212.7°C and would normally be present in smoke but might not be present in vapor.

As an alternative to smoking, cannabis may be consumed orally. However, the cannabis or its extract must be sufficiently heated or dehydrated to cause decarboxylation of its most abundant cannabinoid, tetrahydrocannabinolic acid (THCA), into psychoactive THC.

Cannabinoids can be leached from cannabis plant matter using high-proof spirits (often grain alcohol) to create a tincture, often referred to as Green Dragon.

Cannabis can also be consumed as a tea. THC is lipophilic and only slightly water soluble (with a solubility of 2.8 mg per liter), so tea is made by first adding a saturated fat to hot water (i.e. cream or any milk except skim) with a small amount of cannabis, green or black tea leaves and honey or sugar, steeped for approximately 5 minutes.

Effects

Main short-term physical effects of cannabis.
Main article: Effects of cannabis
Cannabis has psychoactive and physiological effects when consumed. The minimum amount of THC required to have a perceptible psychoactive effect is about 10 micrograms per kilogram of body weight. Aside from a subjective change in perception, the most common short-term physical and neurological effects include increased heart rate, lowered blood pressure, impairment of short-term episodic memory, working memory, psychomotor coordination, and concentration. Long-term effects are less clear.

Classification

Main article: Effects of cannabis#Psychoactive effects
While many drugs clearly fall into the category of either stimulant, depressant, or hallucinogen, cannabis exhibits a mix of all properties, perhaps leaning the most towards hallucinogen or psychedelic properties, though with other effects quite pronounced as well. Though THC is typically considered the primary active component of the cannabis plant, various scientific studies have suggested that certain other cannabinoids like CBD may also play a significant role in its psychoactive effects.

Medical use

Main article: Medical cannabis
Although the extent of the medicinal value of cannabis has been debated, it does have several well-documented beneficial effects. Among these are: the amelioration of nausea and vomiting, stimulation of hunger in chemotherapy and AIDS patients, lowered intraocular eye pressure (shown to be effective for treating glaucoma), as well as general analgesic effects (pain reliever).b[›]

Less confirmed individual studies also have been conducted indicating cannabis to be beneficial to a gamut of conditions running from multiple sclerosis to depression. Synthesized cannabinoids are also sold as prescription drugs, including Marinol (dronabinol in the United States and Germany) and Cesamet (nabilone in Canada, Mexico, The United States and The United Kingdom).b[›]

Currently, the U.S. Food and Drug Administration (FDA) has not approved smoked marijuana for any condition or disease in the United States. Regardless, thirteen states have legalized cannabis for medical use. Canada, Spain, The Netherlands and Austria have also legalized cannabis for medicinal use.

Long-term effects

Main article: Effects of cannabis#Long-term effects
The smoking of cannabis is the most harmful method of consumption, as the inhalation of smoke from organic materials can cause various health problems.

By comparison, studies on the vaporization of cannabis found that subjects were "only 40% as likely to report respiratory symptoms as users who do not vaporize, even when age, sex, cigarette use, and amount of cannabis consumed are controlled." Another study found vaporizers to be "a safe and effective cannabinoid delivery system."

Cannabis is ranked one of the least harmful drugs by a study published in the UK medical journal, The Lancet.
While a study in New Zealand of 79 lung-cancer patients suggested daily cannabis smokers have a 5.7 times higher risk of lung cancer than non-users, another study of 2252 people in Los Angeles failed to find a correlation between the smoking of cannabis and lung, head or neck cancers. These effects have been attributed to the well documented anti-tumoral properties of cannabinoids, specifically tetrahydrocannabinol (THC) and cannabidiol. Some studies have also found that moderate cannabis use may protect against head and neck cancers, as well as lung cancer. Some studies have shown that cannabidiol may also be useful in treating breast cancer.

Cannabis use has been assessed by several studies to be correlated with the development of anxiety, psychosis, and depression. Indeed, a 2007 meta-analysis estimated that cannabis use is statistically associated, in a dose-dependent manner, to an increased risk in the development of psychotic disorders, including schizophrenia. However, it is important to note that no causal mechanism has been proven, and the meaning of the correlation and its direction is a subject of debate that has not been resolved in the scientific community. Some studies assess that the causality is more likely to involve a path from cannabis use to psychotic symptoms rather than a path from psychotic symptoms to cannabis use, while others assess the opposite direction of the causality, or hold cannabis to only form parts of a "causal constellation", while not inflicting mental health problems that would not have occurred in the absence of the cannabis use.

Though cannabis use has at times been associated with stroke, there is no firmly established link, and potential mechanisms are unknown. Similarly, there is no established relationship between cannabis use and heart disease, including exacerbation of cases of existing heart disease. Though some fMRI studies have shown changes in neurological function in long term heavy cannabis users, no long term behavioral effects after abstinence have been linked to these changes.

Adulterants

Adulterants in cannabis are less common than in other drugs of abuse. Chalk (in the Netherlands) and glass particles (in the UK) have been used at times to make cannabis appear to be higher quality. Increasing the weight of hashish products in Germany with lead caused lead intoxication in at least 29 users. In the Netherlands two chemical analogs of Sildenafil (Viagra) were found in adulterated marijuana.

Gateway drug theory

Further information: Gateway drug theory
Some claim that trying cannabis increases the probability that users will eventually use "harder" drugs. This hypothesis has been one of the central pillars of anti-cannabis drug policy in the United States, though the validity and implications of these hypotheses are highly debated. Studies have shown that tobacco smoking is a better predictor of concurrent illicit hard drug use than smoking cannabis.

No widely accepted study has ever demonstrated a cause-and-effect relationship between the use of cannabis and the later use of harder drugs like heroin and cocaine. However, the prevalence of tobacco cigarette advertising and the practice of mixing tobacco and cannabis together in a single large joint, common in Europe, are believed to be a factor in promoting nicotine dependency among young persons investigating cannabis.

A 2005 comprehensive review of the literature on the cannabis gateway hypothesis found that pre-existing traits may predispose users to addiction in general, the availability of multiple drugs in a given setting confounds predictive patterns in their usage, and drug sub-cultures are more influential than cannabis itself. The study called for further research on "social context, individual characteristics, and drug effects" to discover the actual relationships between cannabis and the use of other drugs.

A new user of cannabis who feels there is a difference between anti-drug information and their own experiences will apply this distrust to public information about other, more powerful drugs. Some studies state that while there is no proof for this gateway hypothesis, young cannabis users should still be considered as a risk group for intervention programs. Other findings indicate that hard drug users are likely to be "poly-drug" users, and that interventions must address the use of multiple drugs instead of a single hard drug.

Another gateway hypothesis is that while cannabis is not as harmful or addictive as other drugs, a gateway effect may be detected as a result of the "common factors" involved with using any illegal drug. Because of its illegal status, cannabis users are more likely to be in situations which allow them to become acquainted with people who use and sell other illegal drugs. By this argument, some studies have shown that alcohol and tobacco may be regarded as gateway drugs. However, a more parsimonious explanation could be that cannabis is simply more readily available (and at an earlier age) than illegal hard drugs, and alcohol/tobacco are in turn easier to obtain earlier than cannabis (though the reverse may be true in some areas), thus leading to the "gateway sequence" in those people who are most likely to experiment with any drug offered.

Legal status

Cannabis propaganda sheet from 1935.
Main article: Legality of cannabis
See also: Drug prohibition, Drug liberalization, and AB 390
Since the beginning of the 20th century, most countries have enacted laws against the cultivation, possession, or transfer of cannabis for recreational use. These laws have impacted adversely on the cannabis plant's cultivation for non-recreational purposes, but there are many regions where, under certain circumstances, handling of cannabis is legal or licensed. Many jurisdictions have lessened the penalties for possession of small quantities of cannabis, so that it is punished by confiscation and sometimes a fine, rather than imprisonment, focusing more on those who traffic the drug on the black market.

In some areas where cannabis use has been historically tolerated, some new restrictions have been put in place, such as the closing of cannabis coffee shops near the borders of the Netherlands, closing of coffee shops near secondary schools in the Netherlands and crackdowns on "Pusher Street" in Christiania, Copenhagen in 2004.

Some jurisdictions use free voluntary treatment programs and/or mandatory treatment programs for frequent known users. Simple possession can carry long prison terms in some countries, particularly in East Asia, where the sale of cannabis may lead to a sentence of life in prison or even execution.

Price

The price or street value of cannabis varies strongly by region and area. In addition, some dealers may sell potent buds at a higher price.

In the United States, cannabis is overall the #4 value crop, and is #1 or #2 in many states including California, New York and Florida, averaging $3,000/lb. It is believed to generate an estimated $36 billion market. Most of the money is spent not on growing and producing but on smuggling the supply to buyers. The United Nations Office on Drugs and Crime claims in its 2008 World Drug Report that typical U.S. retail prices are 10-15 dollars per gram (approximately $290 to $430 per ounce). Street prices in North America are known to range at about $150 to $250 per ounce.

The European Monitoring Centre for Drugs and Drug Addiction reports that typical retail prices in Europe for cannabis varies from 2€ to 14€ per gram, with a majority of European countries reporting prices in the range 4–10€. In the United Kingdom, a cannabis plant has an approximate street value of £300.

Truth serum

Cannabis was used as a truth serum by the Office of Strategic Services (OSS), a US government intelligence agency formed during World War II. In the early 1940s, it was the most effective truth drug developed at the OSS labs at St. Elizabeths Hospital; it caused a subject "to be loquacious and free in his impartation of information."

In May 1943, Major George Hunter White, head of OSS counter-intelligence operations in the US, arranged a meeting with Augusto Del Gracio, an enforcer for gangster Lucky Luciano. Del Gracio was given cigarettes spiked with THC concentrate from cannabis, and subsequently talked openly about Luciano's heroin operation. On a second occasion the dosage was increased such that Del Gracio passed out for two hours.

Breeding and cultivation

Maturing female Cannabis plant
Main article: Cannabis cultivation
It is often claimed by growers and breeders of herbal cannabis that advances in breeding and cultivation techniques have increased the potency of cannabis since the late 1960s and early '70s, when THC was first discovered and understood. However, potent seedless marijuana such as "Thai sticks" were already available at that time. Sinsemilla (Spanish for "without seed") is the dried, seedless inflorescences of female cannabis plants. Because THC production drops off once pollination occurs, the male plants (which produce little THC themselves) are eliminated before they shed pollen to prevent pollination. Advanced cultivation techniques such as hydroponics, cloning, high-intensity artificial lighting, and the sea of green method are frequently employed as a response (in part) to prohibition enforcement efforts that make outdoor cultivation more risky. These intensive horticultural techniques have made it possible to grow strains with fewer seeds and higher potency. It is often cited that the average levels of THC in cannabis sold in United States rose dramatically between the 1970s and 2000, but such statements are likely skewed because of undue weight given to much more expensive and potent, but less prevalent samples.

"Skunk" cannabis is a potent strain of cannabis, grown through selective breeding and usually hydroponics, which is a cross-breed of Cannabis sativa and C. indica. Skunk cannabis potency ranges usually from 6% to 15% and rarely as high as 20%. The average THC level in coffee shops in the Netherlands is about 18–19%.

In revisions to cannabis rescheduling in the UK, the government has rescheduled cannabis back from C to B. One of the purported reasons is the appearance of high potency cannabis.

A Dutch double-blind, randomized, placebo-controlled, cross-over study examining male volunteers aged 18–45 years with a self-reported history of regular cannabis use concluded that smoking of cannabis with high THC levels (marijuana with 9–23% THC), as currently sold in coffee shops in the Netherlands, may lead to higher THC blood-serum concentrations. This is reflected by an increase of the occurrence of impaired psychomotor skills, particularly among younger or inexperienced cannabis smokers, who do not adapt their smoking style to the higher THC content. High THC concentrations in cannabis was associated with a dose-related increase of physical effects (such as increase of heart rate, and decrease of blood pressure) and psychomotor effects (such as reacting more slowly, being less concentrated, making more mistakes during performance testing, having less motor control, and experiencing drowsiness). It was also observed during the study that the effects from a single joint at times lasted for more than eight hours. Reaction times remained impaired five hours after smoking, when the THC serum concentrations were significantly reduced, but still present. The researchers suggested that THC may accumulate in blood-serum when cannabis is smoked several times per day.

Another study showed that consumption of 15 mg of Δ9-THC resulted in no impairment to learning whatsoever occurring over a three-trial selective reminding task after two hours. In several tasks, Δ9-THC increased both speed and error rates, reflecting “riskier” speed–accuracy trade-offs.

See also

Cannabis plant
Bhang
Cannabinoids
Cannabidiol (CBD)
Cannabinol (CBN)
Tetrahydrocannabinol (THC)
Tetrahydrocannabivarin (THCV)
Cannabis strains
Hash or hashish
Hash oil or honey oil
Hemp oil
Kief
Sinsemilla
Cannabis health
Medical Cannabis
Cannabis legality
1937 Marihuana Tax Act
Cannabis political parties
Global Marijuana March
International Opium Convention
Legal and medical status of cannabis
Legality of cannabis by country
Marijuana Control, Regulation, and Education Act
Marijuana Policy Project
National Organization for the Reform of Marijuana Laws
List of drugs illegal in the United Kingdom
Cannabis use demographics
Adult lifetime cannabis use by country
Annual cannabis use by country
Notes

^ a: Weed, pot, buddha or bud, Mary Jane, grass, herb, dope, schwag, and reefer, are among the many other nicknames for marijuana or cannabis as a drug.
^ b: Sources for this section (as well as far more information) can be found in the Medical cannabis article.

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^ "Cannabis bigger cancer risk than cigarettes: study". Thomson Reuters. http://www.reuters.com/article/healthNews/idUSHKG10478820080129.
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^ "Study Finds No Cancer-Marijuana Connection". Washington Post. [2006-5-26]. http://www.washingtonpost.com/wp-dyn/content/article/2006/05/25/AR2006052501729_pf.html.
^ "Marijuana compound may stop spread of breast cancer". Fox News. 2007-11-19. http://www.foxnews.com/story/0,2933,312132,00.html.
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^ Patton GC, Coffey C, Carlin JB, Degenhardt L, Lynskey M, Hall W (November 2002). "Cannabis Use and Mental Health in Young People: Cohort Study.". British Medical Journal 325 (7374): 1195–1198. doi:10.1136/bmj.325.7374.1195. PMID 12446533.
^ Moore THM, Zammit S, Lingford-Hughes A et al. (2007). "Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review". Lancet 370 (9584): 319–328. doi:10.1016/S0140-6736(07)61162-3. PMID 17662880.
^ Fergusson DM, Horwood LJ, Ridder EM (March 2005). "Tests of Causal Linkages Between Cannabis Use and Psychotic Symptoms.". Addiction 100 (3): 354–366. doi:10.1111/j.1360-0443.2005.01001.x. PMID 15733249.
^ Hall, Wayne; Degenhardt, Lousia; Teesson, Maree. "Cannabis Use and Psychotic Disorders: An Update". Office of Public Policy and Ethics, Institute for Molecular Bioscience University of Queensland Australia, and National Drug and Alcohol Research Centre University of New South Wales Australia published in Drug and Alcohol Review (December 2004). Vol 23 Issue 4. pp. 433–443.
^ Arseneault, Louise; Cannon, Mary; Wiitton, John; Murray, Robin M. "Causal Association Between Cannabis and Psychosis: Examination of the Evidence". Institute of Psychiatry published in British Journal of Psychiatry (2004). #184, pp. 110–117.
^ Halpin SF, Yeoman L, Dundas DD (October 1991). "Radiographic examination of the lumbar spine in a community hospital: an audit of current practice". BMJ (Clinical Research Ed.) 303 (6806): 813–815. doi:10.1136/bmj.303.6806.813. PMID 1932970.
^ Mukamal KJ, Maclure M, Muller JE, Mittleman MA (March 2008). "An exploratory prospective study of marijuana use and mortality following acute myocardial infarction". American Heart Journal 155 (3): 465–70. doi:10.1016/j.ahj.2007.10.049. PMID 18294478. PMC 2276621. http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)01044-7.
^ Gonzalez R (September 2007). "Acute and Non-Acute Effects of Cannabis on Brain Functioning and Neuropsychological Performance.". Neuropsychology Review 17 (3): 347–61. doi:10.1007/s11065-007-9036-8. PMID 17680367.
^ "Electronenmicroscopisch onderzoek van vervuilde wietmonsters". http://www.rivm.nl/bibliotheek/digitaaldepot/BriefrapportWiet.pdf.
^ "Department of Health, Social Services and Public Safety - Contamination of herbal or 'skunk-type' cannabis with glass beads". http://www.dhsspsni.gov.uk/hss_md_3-2007.pdf.
^ "Department of Health, Social Services and Public Safety - Update on seizures of cannabis contaminated with glass particles". http://www.dhsspsni.gov.uk/hss_md_11-2007__update.pdf.
^ Busse F, Omidi L, Timper K, et al. (April 2008). "Lead poisoning due to adulterated marijuana". N. Engl. J. Med. 358 (15): 1641–2. doi:10.1056/NEJMc0707784. PMID 18403778.
^ Venhuis BJ, de Kaste D (November 2008). "Sildenafil analogs used for adulterating marijuana". Forensic Sci. Int. 182 (1-3): e23–4. doi:10.1016/j.forsciint.2008.09.002. PMID 18945564.
^ Lundin, Leigh (2009-03-01). "The Great Smoke-Out". Criminal Brief. http://www.criminalbrief.com/?p=5445.
^ a b "RAND study casts doubt on claims that marijuana acts as "gateway" to the use of cocaine and heroin". RAND Corporation. 2002-12-02. http://www.rand.org/news/press.02/gateway.html.
^ a b Torabi MR, Bailey WJ, Majd-Jabbari M (1993). "Cigarette Smoking as a Predictor of Alcohol and Other Drug Use by Children and Adolescents: Evidence of the "Gateway Drug Effect".". The Journal of School Health 63 (7): 302–306. doi:10.1111/j.1746-1561.1993.tb06150.x. PMID 8246462.
^ Australian Government Department of Health: National Cannabis Strategy Consultation Paper, p. 4. "Cannabis has been described as a 'Trojan Horse' for nicotine addiction, given the usual method of mixing Cannabis with tobacco when preparing marijuana for administration."
^ Hall WD, Lynskey M (January 2005). "Is Cannabis A Gateway Drug? Testing Hypotheses About the Relationship Between Cannabis Use and the Use of Other Illicit Drugs.". Drug and Alcohol Review 24 (1): 39–48. doi:10.1080/09595230500126698. PMID 16191720. http://www.informaworld.com/openurl?genre=article&doi=10.1080/09595230500126698&magic=pubmed||1B69BA326FFE69C3F0A8F227DF8201D0.
^ Saitz, Richard (2003-02-18). "Is marijuana a gateway drug?". Journal Watch. http://general-medicine.jwatch.org/cgi/content/full/2003/218/1.
^ Degenhardt, Louisa et al. (2007). "Who are the new amphetamine users? A 10-year prospective study of young Australians". http://www.blackwell-synergy.com/doi/abs/10.1111/j.1360-0443.2007.01906.x.
^ Morral AR, McCaffrey DF, Paddock SM (2002). "Reassessing the marijuana gateway effect". Addiction 97 (12): 1493–504. doi:10.1046/j.1360-0443.2002.00280.x. PMID 12472629. http://www3.interscience.wiley.com/journal/118957921/abstract.
^ "Marijuana Policy Project- FAQ". http://www.mpp.org/about/faq.html.
^ Many Dutch coffee shops close as liberal policies change, Exaptica, 27/11/2007.
^ EMCDDA Cannabis reader: Global issues and local experiences, Perspectives on Cannabis controversies, treatment and regulation in Europe, 2008, p. 157.
^ 43 Amsterdam coffee shops to close door, Radio Netherlands, Friday 21 November 2008.
^ http://www.unodc.org/pdf/WDR_2005/volume_2_chap7_cannabis.pdf
^ http://norml.org/index.cfm?Group_ID=4444
^ http://norml.org/index.cfm?Group_ID=4414
^ "Marijuana Called Top U.S. Cash Crop". 2008 ABCNews Internet Ventures. http://abcnews.go.com/business/story?id=2735017&page=1.
^ United Nations Office on Drugs and Crime (2008) (PDF). World drug report. United Nations Publications. p. 264. ISBN 978-92-1-148229-4. http://www.unodc.org/documents/wdr/WDR_2008/WDR_2008_eng_web.pdf.
^ European Monitoring Centre for Drugs and Drug Addiction (2008) (PDF). Annual report: the state of the drugs problem in Europe. Luxembourg: Office for Official Publications of the European Communities. p. 38. ISBN 978-92-9168-324-6. http://www.emcdda.europa.eu/attachements.cfm/att_64227_EN_EMCDDA_AR08_en.pdf.
^ http://www.southyorks.police.uk/news/newssyp/dearnesaferneighbourhoodteamsntrecoverscannabisstreetvalueapproximately£9000
^ a b Cockburn, Alexander; Jeffrey St. Clair (1998). Whiteout: The CIA, Drugs and the Press. Verso. pp. 117–118. ISBN 1859841392. http://books.google.co.uk/books?id=s5qIj_h_PtkC&printsec=frontcover#PPA118,M1.
^ Daniel Forbes (November 19, 2002). "The Myth of Potent Pot". Slate.com. http://www.slate.com/id/2074151.
^ "World Drug Report 2006". United Nations Office on Drugs and Crime. http://www.unodc.org/unodc/en/data-and-analysis/WDR-2006.html. Ch. 2.3.
^ BBC: Cannabis laws to be strengthened. May 2008 20:55 UK.
^ Tj. T. Mensinga et al.. "A Double-Blind, Randomized, Placebo-Controlled, Cross-Over Study on the Pharmacokinetics and Effects of Cannabis." (PDF). RIVM. http://www.rivm.nl/bibliotheek/rapporten/267002002.pdf.
^ Curran H.V., et al. (2002). "Cognitive and subjective dose-response effects". NCBI. http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=12373420&dopt=AbstractCurranCurran.
^ "Marijuana Dictionary". http://www.marijuanadictionary.com/.
Further reading

Martin Booth (2005). Cannabis: A History. Macmillan Publishers & Random House, Inc. pp. 448. ISBN (10): 0-312-42494-9, (13): 978-0-312-42494-7. http://books.google.com/books?id=O7AoY6ljSygC&printsec=frontcover.
External links

Wiktionary Appendix of Cannabis Slang
Marijuana Policy Project
National Organization for the Reform of Marijuana Laws
Comprehensive Cannabis FAQs and Marijuana Information
The Union: The Business Behind Getting High
Scannabis.com - Cannabis News and Reports
National Cannabis Prevention and Information Centre
Tobacco and Marijuana Market Impact Index - National Trends
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Stimulants
Amphetamine · Arecoline (Areca) · Betel · Caffeine (Coffee, Tea) · Cathinone (Khat) · Cocaine (Coca) · Ephedrine (Ephedra) · Methamphetamine · Methylphenidate · Nicotine (Tobacco) · Theobromine (Cocoa)

Culture and Related Topics
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Treating Menopause Naturally

2009-11-22T23:43:00.000-08:00

By Dr. R.J. Peters

The hormones used in HRT (Hormone Replacement Therapy) aren't even the right ones. A very common drug, PremPro, is a combination of Premarin (horse estrogen) and Provera (completely artificial progesterone). However, studies done in Britain, and reported in the medical journal, The Lancet, August 9, 2003, showed that women using HRT had a 66% higher risk of developing breast cancer than women who did not use HRT.

A similar study, done earlier in the U.S., was reported in the Journal of the American Medical Association, on July 17, 2002, with the same findings, forcing the study to end earlier than planned.

Why treat one of life's natural processes with artificial substances? The medical community, after realizing the dangers, changed gears just a bit and began treating the uncomfortable symptoms of menopause with a different approach: tranquilizers and mood elevators... Zoloft, Paxil, Prozac... like the whole thing was just "in her head."

However, distraught women still demand relief, and doctors feel pressed to continue using dangerous drugs, as if symptoms are the result of a drug deficiency. We can take vitamins to cure problems that arise from a vitamin deficiency, but no amount of fake estrogen is going to "cure" menopause. In fact, the dangers are real, and the risks have been documented.

A far better approach is the natural one. Normalizing the body leads to a normal (and often faster) progression of this important time in a woman's life, and stands a better chance of resulting in a healthy and active period during the "golden years," where older and middle aged women don't have to feel old, tired or sick. And they don't have to risk dying earlier from breast cancer, heart disease or stroke.

A more normal and natural approach includes proper diet, exercise, and the use of certain supplements - including many herbs - which can be helpful in achieving a balanced body. Balance is the key.

Dr. R.J. Peters has an extensive background in health care and, though retired, still tries to spread the word about natural health care. Visit http://alternativehealthquestions.blogspot.com for

HGV - Hearts, Guts and Veins - Honey, Garlic and Vinegar

2009-11-22T23:42:00.000-08:00

By Bruce Caine

Am I the only one that immediately thinks of 'Heavy Goods Vehicles' when I see the letters HGV? It's quite appropriate in a way as lorry drivers normally suffer more than most from weight problems - I had a number of truckers as patients and my advice was always the same: make time for exercise, eat more salads and cut out fried food in those road side cafés!

In fact, regardless of occupation, obesity and related cardiovascular conditions are the biggest killers in the western world!

Honey, Garlic and Vinegar capsules (HGV)!!!

Many doctors, nutritionists and homeopaths are excited about the enormously positive impact of this new weight loss product. It has also been specifically designed to naturally improve the health of the cardiovascular system, the intestines, bowel and generally to promote overall well being.

In addition to the experts' comments, are all the messages I received from our readers telling us just how quick acting and effective HGV really is (feel free to look at the readers' reviews section opposite). HGV genuinely doubles weight loss for the vast majority of people that use it as part of their daily dietary regime!!!

Funnily enough, in many medical circles (HGV) is known as 'Hearts, Guts and Veins' - an incredibly apt nick name!

So why Hearts, Guts and Veins?

When we are younger, losing weight is usually all about our own self image.

Our desire to appeal and look our best does not diminish with age. However, the fatal reality of a poor diet and weight problems become more and more frightening as we realise that our 'luck' will not last forever!

HEART- With excessive weight your heart suffers! It's a muscle and therefore has a limit on the workload that it can carry. Imagine every five years you keep adding an extra ten pounds of weight - at some point the heart is going to breakdown = Heart Attack!!!

GUTS - Extra weight almost always equals a poor diet. Our system is designed for a balanced diet of meat, vegetables and fruit. If your diet consists mainly of junk and fatty foods, excessive amounts of red meat and you do not include fruit and vegetables, then not only are you damaging your heart, you are also damaging your intestines and bowel. Cramps, regular bouts of gastro enteritis, constipation and diarrhoea, severe and constant haemorrhoids are all key symptoms of the intestines and bowel breaking down - this all increases the risk of stomach and bowel cancer.

VEINS - If the blood cannot pump normally into the heart because of clogged arteries, usually due to high cholesterol levels, it stops = Heart Attack!!!

These are the reasons why HGV is proving to be so effective and successful. It safely accelerates weight loss and helps you to maintain a healthy weight. It does this by ensuring improved circulation, healthy cardiovascular function and comfortable bladder and bowel activity!

Remakably, HGV capsules have also been proven to be highly effective in preventing and treating arthritis, bronchitis, prostatitis, psoriasis, rheumatism, and a variety of other conditions that are listed, just click below ....

Why is this combination recommended?

Important studies from respected universities around the world prove its a 'super way to fight just about any affliction'.

A study at the University of Illinois (USA) discovered that men aged between 18 and 68 could increase the antioxidant levels in their blood after drinking a couple of ounces of honey everyday for five weeks

A daily dose of garlic has proved to be a powerful fat destroyer and weight reducer, according to Dr. Raymond Fish of London's famous Obesity Research Center.

The prestigious British Medical journal, The Lancet, reported that cholesterol levels plunged on average from 237.4 to 221.4 after volunteers consumed 50 grams of garlic. The study proved the dangers associated with high fat foods can be neutralized by adding garlic to your diet.

"I have seen many arthritis patients start to loosen up at once", says Dr. Jack Soltanoff, a nutrition expert from New York praising the benefits of vinegar.

The benefits ofHGV can be summed up in a very simple way

HGV

Burns extra fat, Reduces production and storage of extra fat
Eliminates natural cravings for high fat foods
EFFECTS

Doubles weight loss as part of a calorie controlled diet
Lowers Cholesterol
Reduces high blood pressure
Increases energy and vitality
Promotes healthy bladder and bowel
Leads to better circulation
Significant reduction in depression
That's all for now - it's very hot here today so I'm going for a quick swim!

Keep smiling and stay healthy

Dr Bruce Caine is a Sixty Five year old retired GP, who is quietly losing his boyish good looks, but with dignity. I retired just over a year ago and the first six months were great - moving to Spain and doing all the things we've always wanted to do. But now, the truth is - I've started to miss being in practice and being involved with people. So, that's why I started The People's Doctor - a weekly newsletter all about general health matters. To learn more about Honey, Garlic and Vinegar Capsules visit my home page at http://www.thepeoplesdoctor.co.uk

Latest News on Food Dyes and ADHD

2009-11-22T23:41:00.000-08:00

By Robert William Locke

Diet and food dye ADHD have been in the news a lot recently. Sugar has just been absolved in a recent debunking of the myth that sugar can cause hyperactivity. However the problem of food dye ADHD remains in that it is well known that kids after eating foods and snacks with lots of bright colours and additives seem to get a 'hyperactive high'. A recent study (published in the medical journal 'The Lancet') shows that some very common food dyes and the preservative sodium benzoate which is found in lots of food that kids eat can lead to increased hyperactivity.

The foods to mainly watch out for are: soda pop, salad dressings and fruit juices. It makes sense anyway (whether you have an ADHD kid or not) to limit these foods for the whole family as this will lead to healthier eating. There is also the fact that especially with girls that they should be accustomed to healthy eating which will help them later on in life. Why ? Although the number of girls who suffer from ADHD is less (1 for every 3 boys), there is a much greater risk that girls will develop eating disorders as ADHD will cause impulsive eating. Girls are overall 10 times more likely than boys to develop an eating disorder.

In the US, no formal warnings have been issued for food dyes ADHD. In Britain, the Food Standards Agency has warned parents to limit the number of food dyes and additives in general if they notice that their consumption leads to behavioural problems such as ADHD.

In the Lancet study organised by the University of Southampton, kids were divided into three groups and given various fruit juices with more or less of additives and food dyes added- eg. Sodium benzoate which is found in lots of kids' drinks. After three weeks, parents and carers were able to measure restlessness, hyperactivity and impulsive behaviour using standardised tests. They had no idea which kids were on the additive free drinks. After the results were assembled it was found that the kids who were on the additive free drinks showed much fewer ADHD symptoms such as fidgeting and interrupting than the kids who were on the additive hyped and food dye drinks.

So, a sensible diet which puts the emphasis on whole foods, fruit and vegetables rather than processed foods is going to produce healthier children (and adults!).There will be no need to worry about food dye ADHD. And what about ADHD medication?

The recent Monitoring the Future Survey found that of the 50,000 students surveyed in the teens classes at high school a high proportion were abusing prescription drugs such as Ritalin (ADHD drug) as well as tranquillizers and cough mixtures. The alarming fact is that 80% of these kids get them from medicine cabinets at home! So why run the risk when you can treat your ADHD child with safe alternative ADHD therapy which will not turn them into potential drug users. The link below will give you lots of information.

Robert Locke writes extensively on ADHD. Discover a safe effective ADHD Alternative Therapy.

Historical Vignette - The Sad Case of Ignaz Semmelweiz, Part I

2009-11-22T23:40:00.000-08:00

By Paul D Maher

In Vienna in the summer of 1846 a young Hungarian physician by the name of Ignaz Semmelweis had just been appointed to the post of assistant professor of Obstetrics at the Vienna General Hospital. There the young doctor found an appalling situation. His hospital ran two obstetric clinics which provided free perinatal care to the poor of the city. However, the clinic he was in charge of had a maternal mortality rate nearly 3 times that of the other hospital clinic and one which often exceeded 10% in any given month. Mind you this was not an infant mortality of 10%, rather one in ten mothers who entered this hospital to deliver a baby did not leave alive. It was so bad, the poor and the prostitutes of Vienna would often look to give birth on the street on the way to the hospital, in order to retain their child care benefits but not subject themselves to the potential health horrors of his clinic.

To Semmelweis' dismay, these "street births" as they were called did not suffer from the same risk of "child bed" or puerperal fever, the main cause of maternal death in his clinic, as those who were actually admitted to the clinic.

Being a contentious physician he sought the answer to this mystery stating the situation, "made me so miserable that life seemed worthless". One by one he eliminated various possible causes to account for the deaths of so many expectant mothers in his clinic, overcrowding, climate, medical technique and so forth were all examined and dismissed. The only difference he noted was that his clinic was used to instruct medical students while the clinic with much lower mortality was used to teach midwives. The mystery continued until somewhat later in 1847 when a good friend, Jakob Kolletchka, was pricked by a student's scalpel during an anatomy lesson with a cadaver. Over the ensuing days Kolletchka went on to suffer and die of an illness which very closely resembled the childbed fever so prevalent in the Vienna hospital. As Semmelweis stated,

"Day and night I was haunted by the image of Kolletschka's disease and was forced to recognize, ever more decisively, that the disease from which Kolletschka died was identical to that from which so many maternity patients died."
Puerperal fever in modern terminology would be recognized as a type of sepsis, an infection by bacteria seeded in the bloodstream. It began, as might be expected, with a high fever which usually came on quite suddenly and was accompanied by violent shaking chills. The infection was sometimes fought off and recovered from, however, if not, a condition of overwhelming sepsis ensued. The abdomen would often become unbearably tender to the touch. Only improving with a sometimes false sense of recovery when the abdominal tissue had become so gangrenous and necrotic as to be less painful. Over days or weeks, the bacteria and their toxins would attack every major organ system in the body. Even in modern times such a situation of overwhelming sepsis will quite often lead to death from multi organ system failure, the shutdown of kidneys, liver, lungs and/or endocrine system from the overwhelming infection. Without antibiotics the situation was generally a death sentence. And child bed fever sentenced women to die with a vengeance. Author Irving Louden in his "The Tragedy of Childbed Fever" estimates that in Europe of the 18th and 19th centuries, out of 1000 women in childbirth, 6-9 would contract the disease and 2-3 die of it. This background endemic rate was often punctuated by epidemic outbreaks where maternal mortality could exceed 50%. It was an ever present part of the fabric of society and described by a medical practitioner of the day as a "sort of desecration" that the relief and joy of successful childbearing would be followed so cruelly some days later by the onset of the disease.

Following the death of his friend, Kolletchka, Semmelweis observed that many of the medical students serving his clinic would go straight from their anatomy lessons with the cadavers to the maternity ward. Midwives, however, were not instructed in anatomy through the dissection of cadavers. In 1847, one year after being put in charge of the clinic, Semmelweis instituted a policy that we would only consider commonsense today, that of antiseptic handwashing before each delivery. The results he achieved using a solution of chlorinated lime as an antiseptic were dramatic to say the least. In April of 1847 the maternal mortality rate was 18.7%, hand washing was instituted in the middle of May. In June the mortality rate was 2.2%, in 1848, there would be two months with a zero death rate.

Perhaps at least, or even more, astonishing then the results Semmelweis achieved with his antiseptic approach was the response of the medical community of his time to his findings. Unfortunately his findings did not fit the prevailing wisdom of the day, which prescribed disease to an imbalance of humors often best treated through blood letting. Indeed, nearly a century before Semmelweis, noted Scottish obstetrician, Alexander Gordon, had correctly concluded that puerperal fever was spread by physicians and midwives, and that it had some relation to skin infections. In fact the staphylococcal and streptococcal bacteria responsible for the deadly childbed fever could sometimes be seen as a mild dermatological infection on the skin, a condition known as erysipelas. Despite his clear headed analysis of the etiology of the disease, Gordon then unfortunately concluded that puerperal fever should thus be treated by aggressive bloodletting; over a pint for an initial measure.

Semmelweis' findings were publicized initially by his students who wrote the heads of respected maternity clinics throughout Europe with news of their success. They detailed their findings in the well known English Medical journal the Lancet as well as other medical journals throughout Europe. A few individuals recognized the significance of the findings, Ferdinand Von Hebra who edited a prominent Austrian medical journal and would establish the modern discipline of dermatology, commented publicly in his journal that Semmelweis' findings had a significance comparable to that of Edward Jenner's work in developing the small pox vaccine. For the most part however, tragically, Semmelweis' findings were not merely dismissed they were ridiculed.

In time, of course, Semmelweis would go on to be called the "father of antisepsis" and the "savior of mothers". However, his research was still some decades before Louis Pasteur's groundbreaking microbiological work would lead to the "germ theory" of disease. The idea that minuscule infectious cadaveric particles on the hands could account for disease was rejected as irrational by some and offensive by others. As Charles Meigs the respected Philadelphia Obstetrician commented at the time, "Physicians are gentleman... and gentleman's hands are clean". Other noted medical authorities of the day likewise criticized the findings with vehemence and declared them unscientific.

The ensuing controversy with all of its political uproar soon cost Semmelweis his position in Vienna and he was forced to take an unpaid honorary position as head of Obstetrics at a small hospital in Pest, Hungary. There he again initiated his antiseptic regime, subsequently only eight patients would die of childbed fever in his clinic in the next five years. Eventually, he was able to obtain a more respectable position as professor of obstetrics at the University of Pest. Once again maternal mortality declined dramatically. Despite this and despite finally publishing himself at this time his findings he was dismissed by the obstetrical community of Europe, his ideas described by one respected obstetrician as "naive" and the "Koran of puerperal theology".

Over time Semmelweis' railings against the established medical doctrine grew more strident, he became obsessed with puerperal fever, and increasingly depressed at the rejection of his work. His behavior also began to become erratic and inappropriate. It is unclear to what extent his rapid decline was a result of stress from the rejection of his ideas. Some speculate that he was evincing signs of the neurologic sequela of tertiary syphilis, acquired either from a prostitute he was reported to have been frequently seen with or as an occupational hazard, often seen at that time, from his work. Be that as it may, as his condition worsened his friend and former professor, Ferdinand von Hebra, arranged, without Semmelweis' knowledge, to have him involuntarily committed to an insane asylum. When Semmelweis realized, too late, what was occurring he attempted to resist his commitment. In the process he was severely beaten by the hospital guards. In a painfully ironic twist of fate, he died two weeks later when an infection from his wounds seeded his blood leading to overwhelming sepsis, the same condition, from which he protected so many of his patients. Ignaz Semmelweiz was 46 years old.

A physician who spent nearly ten years at the US Food and Drug Administration, Dr. Maher, has authored peer-reviewed articles for the medical literature, authored a chapter on the genomics of rare diseases for a text book of rare disease therapy and writes on his website on neglected questions of medical importance as well as pointing out historical medical fallacies. You may find more of his work at The Skeptic's Health Journal Club,

Historical Vignette - The Sad Case of Ignaz Semmelweiz, Part I

2009-11-22T23:38:00.000-08:00

Is Colloidal Silver A Treatment For Bronchitis?

2009-11-22T23:30:00.000-08:00

By Wyatt McKinney

What is Bronchitis?

Bronchitis is defined as an inflammation of the bronchi. Bronchi are airways in the respiratory tract that bring air into the lungs. This inflammation is typically caused by viruses or bacteria, but it may also be caused by inhaled irritants, such as cigarette smoke or harmful chemicals.

Most cases of bronchitis cases involve a viral pathogen. The inflammation is usually the result of the mucus lining of the airways becoming swollen due to irritation. Anyone may contract bronchitis, but people with weak immune systems, such as children and the elderly, are particularly vulnerable.

What are the Symptoms?

Coughing up phlegm or spit, difficulty breathing, and wheezing are all common bronchitis symptoms. Patients typically seek treatment for bronchitis once the coughing becomes uncomfortable or painful. If the inflammation is particularly severe, fatigue, fever, or chest pains may arise. In rare cases, gastrointestinal bronchitis symptoms may arise.

How can you Prevent Bronchitis?

A vaccine for a Haemophilus influenza, which commonly causes bronchitis, was developed in 1985. However, since the vaccine only boosts immunity for six months, it is typically only administered to those most at risk.

Anyone who wants to limit their risk of bronchitis should stop or not start smoking. Even secondhand smoke may lead to bronchitis. Workers who are often exposed to dust or irritating chemicals should wear a dusk mask to prevent inhalation. Everyone who wants to decrease their risk should also limit their exposure to air and traffic pollution.

How is Bronchitis Treated?

There is no medical cure for bronchitis. Typically doctors will treat the symptoms to alleviate the pain and discomfort, and wait from the body to naturally correct the inflammation. Far too often, doctors will prescribe antibiotics. However, for the large majority of cases of bronchitis, this is inadvisable.

Most bronchitis cases are the result of a virus, and antibiotics are only designed to treat bacterial infections. Many doctors are aware that antibiotics are ineffective for bronchitis, but prescribe them anyway because they feel pressured by the patient to treat something besides the symptoms.

A study from 2002 titled Azithromycin for acute bronchitis published in the medical journal The Lancet referred to this pressure from patients, concluding that Many patients with acute bronchitis require their physicians to 'do something.' And that it should not include the defensive use of ineffective antibiotics."

Immunologists have long warned that over prescription of antibiotics will only lead to stronger and more resistant bacterial strains. Unnecessary prescription of any medicine can be harmful, and patients who take antibiotics may suffer side effects such as vomiting, headache, and rash.

Since the immune system is the best (and in most cases, the only) way to fight the infection that causes bronchitis, patients might benefit from taking supplements that support and boost the immune system.

Many have claimed good results with taking colloidal silver for bronchitis. Colloidal silver can be taken orally or through a nebulizer.

If you would like to take colloidal silver for the treatment of bronchitis, it may be interesting to note that some patients have reported the best results with true colloidal silver versus inferior products that are mostly ionic solutions.

HEALTH INSURANCE PROGRAM

2009-08-15T01:56:00.000-07:00

Health financing in the Administration (HCFA) of the U.S. Department of Health and Human Services administers Medicare, the nation's largest health insurance program. Medicare (Title XVIII of the Act Social Security) covers those who are 65 years and older citizens or permanent residents the United States, some people with disabilities, and people with End-stage kidney disease. If you reach age 65 and still working, you may end with health insurance through Medicare, also through company-sponsored health plan. In this case, your employer-sponsored group health plan insurance is the primary (pay first) and the Medicare secondary insurance (to pay after the primary insurance to pay).

Fast for details

HCFA, which administers Medicaid and Medicare provide toll-free telephone number for information about health plan benefits, rights and options. This also provides information about the quality of managed care plans, Medigap insurance, and Medicare Options

Internet And blog marketing

2009-05-15T18:32:00.000-07:00

talking about the blog world and we need to know about SEO, SEO advertise on blogsis important because it affects the position we are in the blog search engine like google, yahoo, Msn and others. SEO is a natural way to get a good trafic directly from the search engine. so it makes trafic SEO blog that we naturally from the search engine.

blog advertising can also bring trafic good for the blog we can exchange or through the review of links with others. blog marketingor we can buy links from other people. because with, purchase link mendatpatkan we can influence many things that we like to blog PR (page Rank) of google, blg the increased traffic and also we may also akan Alexa mebaik.

Exercise and Arthritis Pain Relief

2009-05-02T11:34:00.001-07:00

by Julieanne van Zyl

Exercise is one good form of Arthritis Help. One in three Americans undergo a form of arthritis or chronic joint pain. Without treatment or therapies the pain and discomfort can lead to functional loss and disability. Although, there are ways to manage the discomfort. One of these ways that is cost-effective and can be done by everyone is Arthritis exercises.

The amount and the form that an arthritis exercise schedule will take depends on the joints that are involved in the arthritis, the sum of pain and inflammation, the x-ray changes, how stable the joints are and whether or not there has been a joint replacement.

Before beginning an arthritis exercise schedule you must talk to your medical practitioner who can help you determine what exercises will be beneficial to your joint health and which may inadvertently cause more harm. A skilled medical practitioner or physical therapist can tailor make a schedule to fit the needs of the specific person.

Studies show that people with chronic joint pain are assisted by an arthritis exercise program. The programs appear to reduce the joint pain, stiffness and increase the flexibility, strength and endurance. They also help patients with weight reduction and a enhanced sense of well being. Weight reduction is imperative to patients with chronic joint pain and loss of mobility since the more weight the joint must support and cushion the more damage is performed to the joint.

Although arthritis exercise is a imperative piece it is just one part of a comprehensive rehabilitative plan for people with arthritis. The plan also includes rest, relaxation, proper nutrition, medications and use of the joints correctly to conserve energy and decrease functional loss of mobility.

There are three specific kinds of exercise that are appropriate in an arthritis exercise schedule. Range of motion exercises are exercise in which the joint is moved through the range it already has to maintain it or move toward more flexibility. Strengthening, such as weight training, will keep or boost muscle strength that supports the joints that are affected. And aerobics or endurance exercises will enhance cardiovascular fitness, maintain weight, and improve overall function. Today most health clubs and community centers offer programs for people with limited mobility.

When you start a program consult your plans with the medical practitioner, talk to a physical therapist or qualified trainer. There are several methods that can aid to reduce the initial discomfort of beginning an arthritis exercise program. For example you may apply heat to sore joints or start the exercise with heat applied to the joints to increase circulation and warm the joints. You should stretch and warm up with range of motion exercises. Always start exercises slowly but especially with strength training use low weights and short aerobic exercises.

Exercises should be done at specific intervals. This means that a range of motion exercises can be done day to day and should be done at least every other day to enhance and Retain your range. Strengthening exercises should be performed every other day or three times per week to take complete advantage of the muscle build up without overtaxing muscles and joints. Endurance exercises can be done for 20 -30 minutes three times a week unless you have sever pain/swelling in your joints.

When you exercise if you acknowledge pain that lasts more than 1 hour it is too strenuous. If you experience persistent fatigue, boosted weakness, decreased range of motion, continued pain or increased joint swelling - stop and talk to your medical practitioner.

Arthritis exercise regimes are an integral part of a comprehensive rehabilitation program for individuals who suffer from arthritis and chronic joint pain. Using this method will decrease your pain and increase flexibility and mobility. Exercise can contribute to an arthritis remedy, and can certainly go a long way in providing arthritis pain relief.

surce : http://www.xtremeus.co.cc/fitness/exercise/exercise-and-arthritis-pain-relief/

Teeth Whitening For A Dazzling Smile

2009-05-02T11:30:00.000-07:00

by Oliver Yoderelli

There are few people today who don’t want a dazzling smile. And that means one thing: whiter, brighter teeth.

Teeth whitening has become a big business, with more people than ever before spending lots of money to fulfill their desire for a great smile. With the host of treatment options available today, that smile may only be one teeth whitening procedure away.

There are not many of us who maintain white, bright teeth as we age. For most of us, discoloration is an inevitable consequence of getting older. But it doesn’t have to stay that way, especially since there are all kinds of effective teeth whitening options available today.

The surface of our teeth typically become stained because of what we eat and drink over the years. Things like coffee, red wine, soda, and tea are all major contributors to the discoloration that we see. Smoking, of course, is another major factor.

Discoloration is not confined to just the surface of your teeth. When the enamel on the surface of a tooth develops cracks, the dentin below the surface can become yellow. Also, if certain antibiotics are taken during the years that your teeth are forming, discoloration can occur as well.

One popular method of teeth whitening today is tray bleaching. We will look at this method and how it works in the rest of this article.

In tray bleaching, a tray is custom fitted to your mouth’s unique shape and then a whitening compound is put in the tray. The tray is then placed inside your mouth over your teeth, which applies the whitening chemical to your teeth.

Typically, peroxides such as carbamide peroxide or hydrogen peroxide are used as bleaching agents. As they decompose inside the patient’s mouth, oxygen is released which then penetrates the teeth’s surface, providing whitening to the dentin below as well as to the surface.

About four weeks is needed to complete the tray bleaching procedure. The first thing your dentist will do is make an impression of the inside of your mouth and create a tray that is custom fitted to it. Once the tray is ready and treatment begins, you will use it at home for 3-4 weeks, applying the whitening agent for about half an hour each day.

Teeth bleaching is one popular teeth whitening option. Your dentist will be able to help you decide if it is the right choice for you.

source: http://www.xtremeus.co.cc/health/beauty/teeth-whitening-for-a-dazzling-smile/comment-page-1/#comment-1034

Choosing a Fertility Specialist or Clinic

2009-05-02T11:26:00.000-07:00

by Andre Caring

The best fertility doctors are experts in their field with a successful track record as well as the ability to empathize with their patients during this emotionally-charged experience. Some of the things to keep in mind when selecting a fertility specialist include: his or her training, expertise, track record, and code of ethics.

While some Obstetrician/Gynecologists (OB/GYNs) can treat some forms of infertility, many do not have the necessary training or experience to offer couples the most cutting-edge fertility treatments available. Therefore, consulting with a Reproductive Endocrinologist may be a better option. These physicians have not only completed an OB/GYN residency, but have also received an additional 2-3 years of specialized training in treating infertility. If a Reproductive Endocrinologist has the words “board certified” after his or her name, it signifies that he or she has passed additional written and oral certification exams. In some cases, men experiencing infertility may need to consult with an Andrologist, a doctor specifically trained in male infertility issues.

It is a good idea to confirm whether certain tests and procedures are provided by a specific Reproductive Endocrinologist. Additionally, couples should ask whether the tests and procedures can be carried out in the doctor’s office or if they will need to see another specialist.

Couples should always feel they have access to their doctor, even if they are being treated in a group practice or by a large infertility treatment center. While 24/7 access to a provider is unrealistic, there should be protocols in place that allow couples to receive a timely response to their inquiries. It’s also a good idea to find out how their “on call” policy works in case of an emergency.

Success rates can be a good indicator of a fertility specialist’s expertise; however, couples need to make certain they are looking at the success rates for their specific fertility condition, their chosen course of treatment, and their age. Care should be taken not to over-rely on the statistics, however, since the numbers can be overly optimistic that a couple will be able to fill their crib after the treatment.

Couples should also reconcile their own feelings with their endocrinologist’s with regards to such topics as age limits for fertility treatment, the number of embryos to be implanted during in-vitro fertilization, and what happens to any embryos that are not implanted. Should the couple find themselves feeling uncomfortable with the doctor’s responses to these types of questions, they may wish to switch to a provider who more closely shares their views

source : http://www.xtremeus.co.cc/health/choosing-a-fertility-specialist-or-clinic/

Cost of Nose Surgery

2009-05-02T11:25:00.000-07:00

by Ray Sparks

As with any other plastic surgery procedure, prospective patients tend to be concerned about cost when it comes to the rhinoplasty procedure. The cost of such a procedure can vary depending on a variety of factors, including the region in which it is performed and by which particular surgeon. A major mistake many people make in selecting their surgeon is that they focus far too heavily on cost. With plastic surgery, you really do what you get for and hence, it is best to avoid plastic surgeons which quote you a very low price.

You need to take a holistic viewpoint when hunting for a surgeon and consider not only the cost, but also the surgeon’s track record, facility, educational background, etc. etc. There are many resources available for people to track down a qualified surgeon. Many internet sites feature online directories that can find plastic surgeons that perform this procedure within your local vicinity. Research is key when trying to maximize your invest in a rhinoplasty procedure, and as such, you should take your time when researching for a surgeon and consider as many candidates as possible in your selection process.

In the large majority of cases, the price of a rhinoplasty falls between a specific range. This range starts off at about four thousand and climbs to the fifteen thousand dollar range. These figures mostly account for the price of the surgical work. The other fees which are reflected in the price, but make up a much smaller portion of it include anesthesiologist fees as well as facilities use, etc. etc.

Research has indicated that most people pay over four thousand dollars towards their procedure. This amount reflects not only the surgical fee, but that for facilities use as well as anesthesia. If you find a doctor that charges a substantially lower price than the one mentioned above, you are strongly advised to bit more investigative work on his track record. Such suspicious price tags warrant a deeper look to protect yourself and others from a botched or otherwise unsuccessful rhinoplasty.

Traditional rhinoplasty procedures require the administration of anesthesia. Variants of the full-blown procedure might require the use of less potent anesthesia. In either case, an anesthesiologist must be present to administer the medication. Some surgeons have anesthesiologists on hand, while others simply call them in when necessary. Anesthesia fees typically run about several hundred dollars for this procedure.

It is very important that patients communicate any drug allergies they have so their anesthesiologist can act accordingly. Omissions on paperwork provided by the surgeon can bring about dangerous situations, as such, you should be as forthcoming as possible.

Facilities use compromises a portion of the overall cost a rhinoplasty, and refers to the use of equipment, staff, and supplies. This is during both the pre-operational and post-op stage. Any overhead is also taken into account. Rhinoplasty procedures that are performed within a hospital generally cost more than those performed in a private plastic surgery practice.

All in all, the cost of a rhinoplasty procedure is not very exorbitant in comparison to the other procedure offered in the cosmetic surgery field. However, the results can be well worth while for a large number of individuals. The best piece of advice is to be realistic in appraising a doctor’s candidacy given the price he is offering and his experience. Don’t fall victim to a surgeon who is offering very low prices to simply lure you in. Show good judgment and you will be satisfied with the outcome of your rhinoplasty.

source: http://www.xtremeus.co.cc/health/cost-of-nose-surgery/

Dental health insurance vs dental plans

2009-05-02T11:24:00.000-07:00

by Alec Parkurson

Co-published by: Dental Jet. The choice of the right dental health insurance will save one a lot of troubles and money: the included advantages count benefits such as the choice possibility of a favorite doctor, discounts on all procedures, a very simple approval process and many others. People who need to sign for some form of dental health insurance are usually aware of how intricate coverage aspects can get and how large the number of forms to fill actually is. Plenty of carriers pretend to provide the best dental insurance plan, but very few people can actually make the difference between the many offers available with various providers.

There is a difference between dental health insurance and dental plans. If we consider a health plan, the contractor has an agreement with a dental insurance company. Depending on the contract, the stipulations may differ, yet there are some common points such as the low amount of paperwork, the discounts or the quick approval.

Dental health insurance on the other hand is a lot more difficult to get: there are numerous forms to fill, you may be required to prove that there are no pre-existing conditions that could affect your dental health in the immediate future and you’ll have to wait for quite a while before the discounts are granted.

Both dental health insurance and dental plans cover the same type of processes with the mention that the insurance does not cover cosmetic interventions. The truth is that more and more people choose to join a dental plan because they don’t have to wait for reimbursement and most of the time all they need is the policy or membership card and number. The discount is granted immediately and all the paperwork falls in the responsibility of the dentist. There may be a cost difference to pay to the doctor if the treatments you require are supplementary or above the insurance coverage level.

Before you sign any contract with an insurance company, it is ideal to get information on dental health insurance in general so that you have some background knowledge for it. There is a huge number of people out there who cannot afford to pay a monthly fee to a dental health insurance company, and therefore, they could suffer more when it comes to oral health procedures.

Some employees get dental health insurance coverage as part of the wage and the bonuses granted by the employer; however, the time necessary for reimbursements as well as the only partial coverage is often a source of discontent.

source: http://www.xtremeus.co.cc/health/dental-health-insurance-vs-dental-plans/

2 Foods That Help Improve Skin Elasticity In Aging Skin

2009-05-02T11:22:00.000-07:00

by Peter Albertonach

Is it possible that foods that you eat can help aging skin and help improve your skin elasticity as you age?

Unfortunately though improving aging skin and preventing loss of skin elasticity isn’t as easy as simply eating a couple of foods.

But there’s no doubt at all that your general diet is extremely important to your overall skin health. Eating a good diet is extremely important to maintaining skin health into older age.

You see lots of good advice about eating the right diet, and much of it is the same advice for maintaining good health. You need to eat less fat, especially saturated animal fat, eat more fresh fruit and vegetables and you need to lower your intake of salt and sugar, and eat this type of diet permanently. This is good for your body, and your skin.

But there are some who spend their time looking for the magic bullet food that, if you eat it, will result in big improvements in skin elasticity and skin health. There are some foods that foods that help improve skin elasticity in aging skin, but it’s not quite as easy as that.

Here’s 2 examples of foods that help improve skin elasticity in aging skin

1. Omega 3 you’re probably familiar with. It’s a good fat found in oily fish and in some other foods and it’s recommended for heart health and has some other benefits for the body too. But you may be unaware that omega 3 fats are also very good for your skin.

A diet high in omega 3 fats is well worth it, for your overall health as well as your skin health. However it is quite difficult to ensure adequate levels of omega 3 in your diet unless you regularly eat large quantities of oily fish. In some cultures this happens all the time. But in ours the right types of fish isn’t a huge part of our diet, and is very expensive.

2. Phytessence Wakame. Now unlike omega 3 there is a good chance that you’ve never heard of phytessence wakame. Its a seaweed and is found around the coast of Japan, and is cultivated by the Japanese. It is a large part of the Japanese diet, both fresh and dried, and has been for centuries.

It’s true that Japanese women have wonderful skin. Probably the worlds best skin, right into old age. And science has set about finding out why, and the scientists have traced it back to the phytessence wakame they eat.

There’s a whole stack of reasons why phytessence wakame is good for your skin. I’ve written about it on my website and won’t reproduce it here or it will be too long, but it’s science has discovered a wide range of ingredients in phytessence wakame that improve skin elasticity and skin health.

There’s many more foods that contain ingredients that are beneficial to your skin, but you might see what were getting at here.

Its extremely difficult to put together a diet that will really make a lot of difference to your skin purely from what you eat. Certainly theres no doubt that eating a healthy diet is extremely good for your skin, but just trying to eat foods that help improve skin elasticity in aging skin and offer other skin care benefits is very difficult.

And often the active ingredients in these foods can be as good for your skin or even better when applied directly to your skin rather than eaten as well.

So if finding foods and eating them isn’t the best way to improve skin elasticity what is the best way?

The best way to improve skin health and skin elasticity using natural ingredients like those I’ve talked about is to use natural skincare products that have these ingredients in them already.

Most big brand skin care products tend to contain chemical ingredients manufactured in a lab, usually as these are much cheaper than natural ingredients. But its quite possible to get skin care products with the ingredients mentioned above, and lots more.That way you dont need to try and find seaweed to eat, or spend your time eating oily fish. Its really way too hard trying to combat skin wrinkles or loss of skin elasticity by eating specific foods. Certainly focus on eating a healty diet, but everyone ought to do that anyway.

Science has found many natural ingredients in foods and other places that are extremely important to good skin health, and improving skin elasticity, and put them in high quality natural skin care products.

I write more about these products on my website.

http://www.xtremeus.co.cc/health/2-foods-that-help-improve-skin-elasticity-in-aging-skin/

Should You See A Chiropractor For Sports Injuries?

2009-05-02T11:14:00.000-07:00

by Philip Vincent

Time and time again both amateur and professional athletes are relegated to the sidelines because of injuries that could have been prevented. Sometimes these injuries do not respond to normal treatment, and sometimes athletes continue to train or play through the pain as a way of showing the world or their coaches how tough and dedicated they are to their sport.

It can be exactly this type of behavior that may result in further injury and can make whatever small problem they have harder to fix in the long term. Pain medications may only mask the symptoms of the injury, but just like playing through the pain, unless something is done to take care of the cause of the problem, permanent damage can result if the injury becomes overused or overstressed.

As much as any healthcare field, chiropractic is perfect for sports injuries as it can provide a tailored approach to solving the problem. Chiropractic cannot fix a broken ankle, but in with the addition of some complementary therapies, chiropractic can address the source of the problem. For example, addressing posture or balance that may have lead to the broken ankle in the first place.

In this way, chiropractic is more of a preventative health process, and as any athlete or sports player knows, it is far better to prevent an injury in the first place than it is to work on an injury once it has already occurred.

More and more athletes, especially professional, have been stepping forward to publicly proclaim the benefits they’ve experienced under chiropractic care. From golfers to basketball players to football players, they all seem to have something to gain by keeping their spines in alignment. Even better, chiropractic can improve your game. There is a huge amount of pressure to get athletes to perform at higher and higher levels of intensity.

This can sometimes cause some to lose sight of what the game is really about and turn to harmful and illegal steroids or performance enhancing drugs. Forget about that, though. With chiropractic, that stuff is all unnecessary. Chiropractic is perfect for the athlete who wants to live up to his or her full physical potential.

By adjusting ones body before the game, a so-called pre-game tune up as it were, the athlete will be better balanced, have better blood flow, less stress and more energy. The San Francisco 49ers team swore by chiropractics in the 1980s citing it as one of the reasons they managed to win 4 superbowls during that decade.

Working along with other sports therapy techniques, chiropractic is a great treatment for anything from sprains and strains to “tennis elbow” and bursitis. The best part is that it doesn’t use any drugs, chemicals, or surgery to achieve its results.

http://www.xtremeus.co.cc/health/alternative-medicine/should-you-see-a-chiropractor-for-sports-injuries/

Antioxidants for damage control

2009-05-02T11:13:00.000-07:00

by Paul Mair

There are more than 1500 recognised antioxidants and related phyto-chemicals in everyday common foods that do an uncommonly good job of combating free radicals in the body - those substances released internally during the process of oxidation and formed externally by environmental forces such as radiation, X-rays, drugs, pesticides, air and water pollutants, hydrocarbons, food additives, alcohol, smoking - you name it. Free radicals damage living cells and contribute to a continuing roll call of complaints, including interference with DNA programming, premature aging, heart disease, AIDS, arthritis, cancer, cataracts, allergies and diabetes.

Here’s how the antioxidant force can be with you when you eat. Perhaps the most celebrated of the free radical foes are the carotenoids (named for the carrots in which they were first isolated), of which there are approximately 40, including alpha and beta-carotene (found in carrots, apricots and sweet potatoes) and lutein (found in spinach, celery and kale). The carotenoids are especially potent in blocking cancer, fighting allergies and slowing the aging process. The most powerful members of the antioxidant family are probably the pycnogenols (also known as flavonoids) which are 20 times more potent than Vitamin C and 50 times more active than Vitamin E. Pycnogenols protect against capillary damage, bruising and improve your overall immunity to heart disease and cancer.

Best sources:

onions, green peppers, red wine, green tea and selected herbs. Beyond what it does for the common cold and flu, the vitamin-antioxidant ascorbic acid (vitamin C) can slow the onset of Parkinson’s disease, reduce the risk of hardening of the arteries by increasing the amount of protective high density lipoprotein (HDL) cholesterol in your bloodstream, help prevent cataracts by guarding the eyes against oxidation, help lower blood pressure, and protect against a wide spectrum of cancers.

Vitamin E (tocopherol) is a fat-soluble vitamin-antioxidant and important immune system stimulant that helps alleviate fatigue and provides tissue oxygen to accelerate the healing of wounds, burns and skin disorders such as acne and eczema. In partnership with the mineral selenium, it neutralizes free radicals that accelerate cellular and cerebral aging and raise the risk of cancer.

20 ANTIOXIDANTS - 40 FOOD SOURCES

Of the 20 nutrients critical in the prevention of cancer, half are antioxidants. And what’s true for cancer is true for heart disease and most other degenerative diseases. If your health’s on hold your body’s not equipped to fight back because its inadequately supplied with these food-based free radical scavengers. What do you need on a meal-to-meal basis to protect yourself ? Take a look.

YOUR HERBAL ANTIOXIDANT ARSENAL

Good herbal antioxidants to sip, sniff or cook with include alfalfa, rose-hips, peppermint, nettles, hawthorn, goldenseal and fenugreek, cumin, capsicum (red pepper), cinnamon and basil (all available as teas and tinctures).

FREE RADICALS’ BIGGEST FOE

Along with other major antioxidants such as vitamins A and C, selenium, and vitamin E, beta-carotene snuffs out free radicals, which cause the cellular changes that lead to degenerative diseases such as rheumatoid arthritis, diabetes, cardiovascular ailments, and cancer. Beta-carotene is the most celebrated and certainly the most visible (it’s the plant pigment that makes pink grapefruit pink and oranges orange) of all the antioxidants, but it is only one of the 30 to 50 of the carotene complex, including alpha carotene, gamma carotene, lycopene, lutein, and capsanthin, known to contain vitamin A. While all of the carotenes have the ability to partially convert on command into vitamin A (depending on the health of your thyroid and the presence of zinc and protein in your system) none are as readily found in common foods as beta-carotene.

source: http://www.xtremeus.co.cc/health/antioxidants-for-damage-control/

Healthy Ways of Anti Aging

2009-05-02T11:12:00.000-07:00

by Monika - p

Now a days it is very important to stay fit and young for a longer time. There are several natural anti aging procedures to stay young for a longer time. One may say that it is possible only by cosmetic surgery. These are very simple yet very effective. Let us list the most important ones.

Milk and milk products may help you restore the collagen levels in the skin at faster rate. In general our body requires 500 -600 mg of calcium every day which is fulfilled by this intake.

Posture is of great importance in life. Our body is hurt by every bad postures, sedentary jobs and unhealthy diet. Thus one of the anti aging secrets is to detox every week. For detoxication, engulf detoxication capsules and drinks. This helps to shed off the toxins and promotes cell regeneration.

There are certain diet regimes to be followed: 1. Reduce fat intake 2. Reduce alcohol intake 3. Reduce sugar intake 4. Reduce starches (pasta, breads, rice)

Avoid caffeine, alcohol, cigarettes and other drugs. These types of drugs will age you quickly. A high intake of caffeine, alcohol and nicotine inhibits the absorption of of calcium into bone and speeds up the process of bone loss. Smoking generally triggers the early menopause and may even lead to cancer of lungs, blood, skin and colon. Any intoxification can make you feel older than your age as they kill the collagen content of the skin cells.

Anti-aging supplements like Resveratrol Ultra are very helpful to slow down the ageing process of the skin. Along with this you can apply products like Dermapril which would help you have a glowing skin without any laugh marks or wrinkles.

source: http://www.xtremeus.co.cc/health/healthy-ways-of-anti-aging/

Six Factors to look at when getting a LTCi Quote

2009-05-02T11:10:00.000-07:00

by Storm Castle

If you want to get a long term care insurance quote, it is essential that you know some of the factors involved. This particular article will give you six essential factors to take into consideration. If you want an ltci quote, there is so much information you will want to know about so that you can make an informed decision. This information is based upon factors such as what type of benefits you want to receive when using your policy.

A long term care insurance quote is contingent upon many factors and following are some of the points to consider. Your age and what type of benefits will cause your quote to vary.

Long-term care is contingent upon what benefits you want to receive. Looking at whether you may receive in-home services, nursing home care or community based services will help your quote vary.

Your age is going to determine the cost of the policy. If you are younger and buying a policy, you will almost certainly receive a lower premium.

Different costs for quotes can be based upon what company you request a quote for. You should ask your employer if they offer ltci.

The type of policy you choose will cause different quotes. You can choose a policy which will pay a maximum daily, weekly or monthly limit or one which pays up to a certain dollar amount.

You can also choose when your benefits can be used age-wise. The older you are the more expensive.

You will want to think about what kind of daily benefits you will receive. Your quote will be higher when you want higher daily benefits.

This article should have opened your eyes to a greater degree to what to expect when receiving a long term care insurance quote. You want to have as much information out and on the table when talking about this because it is important to know what to expect with your policy.

source: http://www.xtremeus.co.cc/health/six-factors-to-look-at-when-getting-a-ltci-quote/

Long Term Care Insurance Quote: Six Important Factors to Consider

2009-05-02T11:08:00.000-07:00

by Terry Stanfield

Long term care insurance quotes can be very complex but this article will give you six important points to consider. When you buy your policy and the type of policy you choose will allow the quote to change.

When you are thinking about long-term care, you need to think about what types of benefits you will want. You can receive in-home service, nursing home care, or community based services to give you an idea.

One factor in the cost of your policy is your age. Getting your policy at a younger age allows the premium to be lower.

The types of companies you approach for an ltci quote can help determine a different cost in your quote. You may be able to receive this quote through your employer.

Your quote can be contingent upon how you want benefits to be paid out. Some policies allow you to spend a certain maximum in whatever way you want while others offer a maximum based upon a daily, weekly, or monthly time frame.

You can also choose when your benefits can be used age-wise.

You will want to think about what kind of daily benefits you will receive. Your quote will be higher when you want higher daily benefits.

Hopefully this has given you good information regarding long term care insurance quotes. More information is always better so that you have an idea what to expect and you can have thought through what you want out of your policy.

source: http://www.xtremeus.co.cc/health/long-term-care-insurance-quote-six-important-factors-to-consider/

Concussions Cause Short Term Memory Loss

2009-05-02T11:06:00.000-07:00

by Arthur Arturien

Memory loss and concussions are from injuries to the head. Concussions should not be mistaken for other cerebral injuries such as bleeding under the skull or inter cranial. Concussions are simply diagnosed closed head injuries.

CONCUSSION TYPES: they can range from severe concussions to the head that lead to blackouts to milder cases that entail no loss of consciousness.

CAUSES: An impact of outer force applied to the skull can push the brain into a deep state of trauma. A major fall, car accident, or any other event that has a headlong collision with a foreign object are the most common causes.

SYMPTOMS: Vomiting, nausea, and unconsciousness are the first signs of a concussion. The victims vision may also blur. Because of all this confusion and disarray happens. When the victim is traumatized there is a lso a period of short term memory loss. The victim may even ask the same question over and over again even if it has been answered due to an experience known as persevering.

MEDICAL HELP, IS IT ALWAYS NECESSARY? Not always, say doctors. But it is still advisable that a medical professional is consulted in the event of such an accident. After that, it is the doctor’s prerogative whether to advise simple bed rest and homecare, see the patient individually or to recommend immediate hospitalization.

SITUATIONS THAT DO NOT REQUIRE ICU: When a person impacts something hard like tile or bathtub floor, and the patient remains conscious and only suffers mild nausea and dizziness and no loss of vision. The worst they may suffer from is a headache for a couple days. Even if memory loss occurs it is no reason to panic.

SITUATIONS THAT REQUIRE THE AMBULANCE: memory loss from concussions can be irreversible if they are not take care of quickly. Special cases where an ambulance is needed are when the victim remains unconscious for over 2 minutes. The victim falls from a great height. The victim has severe physical weakness and bouts of vomiting.

source: http://www.xtremeus.co.cc/health/concussions-cause-short-term-memory-loss/

Pre eklampsia

2009-03-13T07:26:00.000-07:00

Pre eklampsia
A.PENGERTIAN
Pre eklampsia adalah sekumpulan gejala yang timbul pada wanita hamil, bersalin dan nifas yang terdiri dari hipertensi, edema dan protein uria tetapi tidak menunjukkan tanda-tanda kelainan vaskuler atau hipertensi sebelumnya, sedangkan gejalanya biasanya muncul setelah kehamilan berumur 28 minggu atau lebih ( Rustam Muctar, 1998 ).

B.PATOFISIOLOGI
Pada pre eklampsia terdapat penurunan plasma dalam sirkulasi dan terjadi peningkatan hematokrit. Perubahan ini menyebabkan penurunan perfusi ke organ , termasuk ke utero plasental fatal unit. Vasospasme merupakan dasar dari timbulnya proses pre eklampsia. Konstriksi vaskuler menyebabkan resistensi aliran darah dan timbulnya hipertensi arterial. Vasospasme dapat diakibatkan karena adanya peningkatan sensitifitas dari sirculating pressors. Pre eklampsia yang berat dapat mengakibatkan kerusakan organ tubuh yang lain. Gangguan perfusi plasenta dapat sebagai pemicu timbulnya gangguan pertumbuhan plasenta sehinga dapat berakibat terjadinya Intra Uterin Growth Retardation.

II.KONSEP DASAR ASKEP
A.PENGKAJIAN
Data yang dikaji pada ibu dengan pre eklampsia adalah :
1.Data subyektif :
Umur biasanya sering terjadi pada primi gravida , < 20 tahun atau > 35 tahun
Riwayat kesehatan ibu sekarang : terjadi peningkatan tensi, oedema, pusing, nyeri epigastrium, mual muntah, penglihatan kabur
Riwayat kesehatan ibu sebelumnya : penyakit ginjal, anemia, vaskuler esensial, hipertensi kronik, DM
Riwayat kehamilan : riwayat kehamilan ganda, mola hidatidosa, hidramnion serta riwayat kehamilan dengan pre eklamsia atau eklamsia sebelumnya
Pola nutrisi : jenis makanan yang dikonsumsi baik makanan pokok maupun selingan
Psiko sosial spiritual : Emosi yang tidak stabil dapat menyebabkan kecemasan, oleh karenanya perlu kesiapan moril untuk menghadapi resikonya

2.Data Obyektif :
Inspeksi : edema yang tidak hilang dalam kurun waktu 24 jam
Palpasi : untuk mengetahui TFU, letak janin, lokasi edema
Auskultasi : mendengarkan DJJ untuk mengetahui adanya fetal distress
Perkusi : untuk mengetahui refleks patella sebagai syarat pemberian SM ( jika refleks + )
Pemeriksaan penunjang ;
Tanda vital yang diukur dalam posisi terbaring atau tidur, diukur 2 kali dengan interval 6 jam
Laboratorium : protein uri dengan kateter atau midstream ( biasanya meningkat hingga 0,3 gr/lt atau +1 hingga +2 pada skala kualitatif ), kadar hematokrit menurun, BJ urine meningkat, serum kreatini meningkat, uric acid biasanya > 7 mg/100 ml
Berat badan : peningkatannya lebih dari 1 kg/minggu
Tingkat kesadaran ; penurunan GCS sebagai tanda adanya kelainan pada otak
USG ; untuk mengetahui keadaan janin
NST : untuk mengetahui kesejahteraan janin

B.MASALAH KEPERAWATAN
a.Resiko tinggi terjadinya kejang pada ibu berhubungan dengan …………

Ruptur uteri

2009-03-13T07:25:00.000-07:00

Ruptur uteri
A.PENGERTIAN
Ruptur Uteri adalah robekan atau diskontinuita dinding rahim akibat dilampauinya daya regang miomentrium. ( buku acuan nasional pelayanan kesehatan maternal dan neonatal )
Rupture uteri adalah robeknya dinding uterus pada saat kehamilan atau dalam persalinan dengan atau tanpa robeknya perioneum visceral.
( Obstetri dan Ginekologi )
B.ETIOLOGI
1.riwayat pembedahan terhadap fundus atau korpus uterus
2.induksi dengan oksitosin yang sembarangan atau persalinan yang lama
3.presentasi abnormal ( terutama terjadi penipisan pada segmen bawah uterus ).
( Helen, 2001 )

C.TANDA dan GEJALA
Tanda dan gejala ruptur uteri dapat terjadi secara dramatis atau tenang.
Dramatis
Nyeri tajam, yang sangat pada abdomen bawah saat kontraksi hebat memuncak
Penghentian kontraksi uterus disertai hilangnya rasa nyeri
Perdarahan vagina ( dalam jumlah sedikit atau hemoragi )
Terdapat tanda dan gejala syok, denyut nadi meningkat, tekanan darah menurun dan nafas pendek ( sesak )
Temuan pada palpasi abdomen tidak sama dengan temuan terdahulu
Bagian presentasi dapat digerakkan diatas rongga panggul
Janin dapat tereposisi atau terelokasi secara dramatis dalam abdomen ibu
Bagian janin lebih mudah dipalpasi
Gerakan janin dapat menjadi kuat dan kemudian menurun menjadi tidak ada gerakan dan DJJ sama sekali atau DJJ masih didengar
Lingkar uterus dan kepadatannya ( kontraksi ) dapat dirasakan disamping janin ( janin seperti berada diluar uterus ).

Tenang
Kemungkinan terjadi muntah
Nyeri tekan meningkat diseluruh abdomen
Nyeri berat pada suprapubis
Kontraksi uterus hipotonik
Perkembangan persalinan menurun
Perasaan ingin pingsan
Hematuri ( kadang-kadang kencing darah )
Perdarahan vagina ( kadang-kadang )
Tanda-tanda syok progresif
Kontraksi dapat berlanjut tanpa menimbulkan efek pada servik atau kontraksi mungkin tidak dirasakan
DJJ mungkin akan hilang

D.KLASIFIKASI
Ruptur uteri dapat dibagi menurut beberapa cara :
1.Menurut waktu terjadinya
a)R. u. Gravidarum
Waktu sedang hamil
Sering lokasinya pada korpus
b)R. u. Durante Partum
Waktu melahirkan anak
Ini yang terbanyak
2.Menurut lokasinya
a)Korpus uteri, ini biasanya terjadi pada rahim yang sudah pernah mengalami operasi seperti seksio sesarea klasik ( korporal ), miemoktomi
b)Segmen bawah rahim ( SBR ), ini biasanya terjadi pada partus yang sulit dan lama tidak maju, SBR tambah lama tambah regang dan tipis dan akhirnya terjadilah ruptur uteri yang sebenarnya
c)Serviks uteri ini biasanya terjadi pada waktu melakukan ekstraksi forsipal atau versi dan ekstraksi sedang pembukaan belum lengkap
d)Kolpoporeksis, robekan-robekan di antara serviks dan vagina
3.Menurut robeknya peritoneum
a). R. u. Kompleta : robekan pada dinding uterus berikut peritoneumnya ( perimetrium ) ; dalam hal ini terjadi hubungan langsung antara rongga perut dan rongga uterus dengan bahaya peritonitis
b)R. u. Inkompleta : robekan otot rahim tanpa ikut robek peritoneumnya. Perdarahan terjadi subperitoneal dan bisa meluas ke lig.latum
4.Menurut etiologinya
a)Ruptur uteri spontanea
Menurut etiologinya dibagi 2 :
1)Karena dinding rahim yang lemah dan cacat
bekas seksio sesarea
bekas miomectomia
bekas perforasi waktu keratase……….

KANKER SERVIKS

2009-03-13T07:22:00.000-07:00

A. PENGERTIAN
Kanker serviks adalah penyakit akibat tumor ganas pada daerah mulut rahim sebagai akibat dari adanya pertumbuhan jaringan yang tidak terkontrol dan merusak jaringan normal di sekitarnya (FKUI, 1990; FKKP, 1997).

B. ETIOLOGI
Penyebab kanker serviks belum jelas diketahui namun ada beberapa faktor resiko dan predisposisi yang menonjol, antara lain :
1. Umur pertama kali melakukan hubungan seksual
Penelitian menunjukkan bahwa semakin muda wanita melakukan hubungan seksual semakin besar mendapat kanker serviks. Kawin pada usia 20 tahun dianggap masih terlalu muda

2. Jumlah kehamilan dan partus
Kanker serviks terbanyak dijumpai pada wanita yang sering partus. Semakin sering partus semakin besar kemungkinan resiko mendapat karsinoma serviks.

3. Jumlah perkawinan
Wanita yang sering melakukan hubungan seksual dan berganti-ganti pasangan mempunyai faktor resiko yang besar terhadap kankers serviks ini.

4. Infeksi virus
Infeksi virus herpes simpleks (HSV-2) dan virus papiloma atau virus kondiloma akuminata diduga sebagai factor penyebab kanker serviks

5. Sosial Ekonomi
Karsinoma serviks banyak dijumpai pada golongan sosial ekonomi rendah mungkin faktor sosial ekonomi erat kaitannya dengan gizi, imunitas dan kebersihan perseorangan. Pada golongan sosial ekonomi rendah umumnya kuantitas dan kualitas makanan kurang hal ini mempengaruhi imunitas tubuh.
6. Hygiene dan sirkumsisi
Diduga adanya pengaruh mudah terjadinya kankers serviks pada wanita yang pasangannya belum disirkumsisi. Hal ini karena pada pria non sirkum hygiene penis tidak terawat sehingga banyak kumpulan-kumpulan smegma.

7. Merokok dan AKDR (alat kontrasepsi dalam rahim)
Merokok akan merangsang terbentuknya sel kanker, sedangkan pemakaian AKDR akan berpengaruh terhadap serviks yaitu bermula dari adanya erosi diserviks yang kemudian menjadi infeksi yang berupa radang yang terus menerus, hal ini dapat sebagai pencetus terbentuknya kanker serviks.

C. Klasifikasi pertumbuhan sel akan kankers serviks

Mikroskopis
1. Displasia
Displasia ringan terjadi pada sepertiga bagaian basal epidermis. Displasia berat terjadi pada dua pertiga epidermihampir tidak dapat dibedakan dengan karsinoma insitu.

2. Stadium karsinoma insitu
Pada karsinoma insitu perubahan sel epitel terjadi pada seluruh lapisan epidermis menjadi karsinoma sel skuamosa. Karsinoma insitu yang tumbuh didaerah ektoserviks, peralihan sel skuamosa kolumnar dan sel cadangan endoserviks.

3. Stadium karsinoma mikroinvasif.
Pada karksinoma mikroinvasif, disamping perubahan derajat pertumbuhan sel meningkat juga sel tumor menembus membrana basalis dan invasi pada stoma sejauh tidak lebih 5 mm dari membrana basalis, biasanya tumor ini asimtomatik dan hanya ditemukan pada skrining kanker.

4. Stadium karsinoma invasif
Pada karsinoma invasif perubahan derajat pertumbuhan sel menonjol besar dan bentuk sel bervariasi. Petumbuhan invasif muncul diarea bibir posterior atau anterior serviks dan meluas ketiga jurusan yaitu jurusan forniks posterior atau anterior, jurusan parametrium dan korpus uteri.

5. Bentuk kelainan dalam pertumbuhan karsinoma serviks
Pertumbuhan eksofilik, berbentuk bunga kool, tumbuh kearah vagina dan dapat mengisi setengah dari vagina tanpa infiltrasi kedalam vagina, bentuk pertumbuhan ini mudah nekrosis dan perdarahan.

Pertumbuhan endofilik, biasanya lesi berbentuk ulkus dan tumbuh progesif meluas ke forniks, posterior dan anterior ke korpus uteri dan parametrium.

Pertumbuhan nodul, biasanya dijumpai pada endoserviks yang lambatlaun lesi berubah bentuk menjadi ulkus.

Markroskopis
1. Stadium preklinis
Tidak dapat dibedakan dengan servisitis kronik biasa
2. Stadium permulaan
Sering tampak sebagian lesi sekitar osteum externum
3. Stadium setengah lanjut
Telah mengenai sebagian besar atau seluruh bibir porsio
4. Stadium lanjut
Terjadi pengrusakan dari jaringan serviks, sehingga tampaknya seperti ulkus dengan jaringan yang rapuh dan mudah berdarah.

I. D. GEJALA KLINIS
1. Perdarahan
Sifatnya bisa intermenstruit atau perdarahan kontak, kadang-kadang perdarahan baru terjadi pada stadium selanjutnya. Pada jenis intraservikal perdarahan terjadi lambat.
2. Biasanya menyerupai air, kadang-kadang timbulnya sebeluma ada perdarahan. Pada stadium lebih lanjut perdarahan dan keputihan lebih banyak disertai infeksi sehingga cairan yang keluar berbau.

E. Pemeriksaan diagnostik
1. Sitologi/Pap Smear
Keuntungan, murah dapat memeriksa bagian-bagian yang tidak terlihat.
Kelemahan, tidak dapat menentukan dengan tepat lokalisasi.
2. Schillentest
Epitel karsinoma serviks tidak mengandung glycogen karena tidak mengikat yodium. Kalau porsio diberi yodium maka epitel karsinoma yang normal akan berwarna coklat tua, sedang yang terkena karsinoma tidak berwarna.

3. Koloskopi
Memeriksa dengan menggunakan alat untuk melihat serviks dengan lampu dan dibesarkan 10-40 kali.
Keuntungan ; dapat melihat jelas daerah yang bersangkutan sehingga mudah untuk melakukan biopsy.
Kelemahan ; hanya dapat memeiksa daerah yang terlihat saja yaitu porsio, sedang kelianan pada skuamosa columnar junction dan intra servikal tidak terlihat.

4. Kolpomikroskopi
Melihat hapusan vagina (Pap Smear) dengan pembesaran sampai 200 kali

5. Biopsi
Dengan biopsi dapat ditemukan atau ditentukan jenis karsinomanya.

6. Konisasi
Dengan cara mengangkat jaringan yang berisi selaput lendir serviks dan epitel gepeng dan kelenjarnya. Konisasi dilakukan bila hasil sitologi meragukan dan pada serviks tidak tampak kelainan-kelainan yang jelas.

II. F. KLASIFIKASI KLINIS
• Stage 0:Ca.Pre invasif
• Stage I: Ca. Terbatas pada serviks
• Stage Ia ; Disertai invasi dari stroma yang hanya diketahui secara histopatologis
• Stage Ib : Semua kasus lainnya dari stage I
• Stage II : Sudah menjalar keluar serviks tapi belum sampai kepanggul telah mengenai dinding vagina. Tapi tidak melebihi dua pertiga bagian proksimal
• Stage III : Sudah sampai dinding panggul dan sepertiga bagian bawah vagina
• Stage IIIB : Sudah mengenai organ-organ lain.

G. Terapi

1. Irradiasi
• Dapat dipakai untuk semua stadium
• Dapat dipakai untuk wanita gemuk tua dan pada medical risk
• Tidak menyebabkan kematian seperti operasi.

2. Dosis
Penyinaran ditujukan pada jaringan karsinoma yang terletak diserviks

3. Komplikasi irradiasi
• Kerentanan kandungan kencing
• Diarrhea
• Perdarahan rectal
• Fistula vesico atau rectovaginalis

4. Operasi
• Operasi Wentheim dan limfatektomi untuk stadium I dan II
• Operasi Schauta, histerektomi vagina yang radikal

5. Kombinasi
• Irradiasi dan pembedahan
Tidak dilakukan sebagai hal yang rutin, sebab radiasi menyebabkan bertambahnya vaskularisasi, odema. Sehingga tindakan operasi berikutnya dapat mengalami kesukaran dan sering menyebabkan fistula, disamping itu juga menambah penyebaran kesistem limfe dan peredaran darah.

6. Cytostatika : Bleomycin, terapi terhadap karsinoma serviks yang radio resisten. 5 % dari karsinoma serviks adalah resisten terhadap radioterapi, diangap resisten bila 8-10 minggu post terapi keadaan masih tetap sama.

Asuhan Keperawatan Ibu Dengan Myoma Uteri

2009-03-13T07:18:00.000-07:00

A. Pengertian

Myoma Uteri adalah : neoplasma jinak yang berasal dari otot uterus yang disebut juga dengan Leiomyoma Uteri atau Uterine Fibroid.

Myoma Uteri umumnya terjadi pada usia lebih dari 35 tahun. Dikenal ada dua tempat asal myoma uteri yaitu pada serviks uteri (2 %) dan pada korpus uteri (97%), belum pernah ditemukan myoma uteri terjadi sebelum menarche

B. Etiologi

Walaupun myoma uteri ditemukan terjadi tanpa penyebab yang pasti, namun dari hasil penelitian Miller dan Lipschlutz dikatakan bahwa myoma uteri terjadi tergantung pada sel-sel otot imatur yang terdapat pada “Cell Nest” yang selanjutnya dapat dirangsang terus menerus oleh hormon estrogen.

C. Lokalisasi Mioma Uteri

1. Mioma intramural ; Apabila tumor itu dalam pertumbuhannya tetap tinggal dalam dinding uterus.

2. Mioma Submukosum ; Mioma yang tumbuh ke arah kavum uteri dan menonjol dalam kavum itu.

3. Mioma Subserosum ; Mioma yang tumbuh ke arah luar dan menonjol pada permukaan uterus.

D. Komplikasi

1. Pertumbuhan leimiosarkoma.

Mioma dicurigai sebagai sarcoma bila selama beberapa tahun tidak membesar, sekonyong – konyong menjadi besar apabila hal itu terjadi sesudah menopause

2. Torsi (putaran tangkai)

Ada kalanya tangkai pada mioma uteri subserosum mengalami putaran. Kalau proses ini terjadi mendadak, tumor akan mengalami gangguan sirkulasi akut dengan nekrosis jaringan dan akan tampak gambaran klinik dari abdomenakut.

3. Nekrosis dan Infeksi

Pada myoma subserosum yang menjadi polip, ujung tumor, kadang-kadang dapat melalui kanalis servikalis dan dilahirkan dari vagina, dalam hal ini kemungkinan gangguan situasi dengan akibat nekrosis dan infeksi sekunder.

A. Pemeriksaan Diagnostik

1. Pemeriksaan Darah Lengkap : Hb: turun, Albumin : turun, Lekosit : turun / meningkat, Eritrosit : turun

2. USG : terlihat massa pada daerah uterus.

3. Vaginal Toucher : didapatkan perdarahan pervaginam, teraba massa, konsistensi dan ukurannya.

4. Sitologi : menentukan tingkat keganasan dari sel-sel neoplasma tersebut.,

5. Rontgen : untuk mengetahui kelainan yang mungkin ada yang dapat menghambat tindakan operasi.

6. ECG : Mendeteksi kelainan yang mungkin terjadi, yang dapat mempengaruhi tindakan operasi.

B. Cara Penanganan Mioma Uteri

Indikasi mioma uteri yang diangkat adalah mioma uteri subserosum bertangkai. Pada mioma uteri yang masih kecil khususnya pada penderita yang mendekati masa menopause tidak diperlukan pengobatan, cukup dilakukan pemeriksaan pelvic secara rutin tiap tiga bulan atau enam bulan. Adapun cara penanganan pada myoma uteri yang perlu diangkat adalah dengan pengobatan operatif diantaranya yaitu dengan histerektomi dan umumnya dilakukan histerektomi total abdominal. Tindakan histerektomi total tersebut dikenal dengan nama Total Abdominal Histerektomy and Bilateral Salphingo Oophorectomy (TAH-BSO). TAH–BSO adalah suatu tindakan pembedahan untuk mengangkat uterus, serviks, kedua tuba falofii dan ovarium dengan melakukan insisi pada dinding, perut pada malignan neoplasmatic desease, leymyoma dan chronic endrometriosis (Tucker, Susan Martin, 1998).

C. Diagnosa Keperawatan

1. Gangguan eliminasi urin (retensio) berhubungan dengan penekanan oleh massa jaringan neoplasm pada daerah sekitarnnya, gangguan sensorik / motorik.
2. Gangguan rasa nyaman (nyeri) berhubungan dengan kerusakan jaringan otot
3. Ganguan konsep diri berhubungan dengan kekawatiran tentang ketidakmampuan memiliki anak, perubahan dalam masalah kewanitaan, akibat pada hubungan seksual.
4. Resiko tinggi syok hipovolemik berhubungan dengan terjadinya perdarahan yang berulang-ulang.
5. Kurang pengetahuan tentang kondisi, prognosis dan kebutuhan pengobatan berhubungan dengan salah interpretasi informasi, tidak mengenal sumber informasi.

RENCANA KEPERAWATAN

Dx 1

Gangguan rasa nyaman (nyeri) berhubungan dengan kerusakan jaringan otot dan system saraf akibat penyempitan kanalis servikalis oleh myoma

Tujuan

Klien dapat mengontrol nyerinya dengan criteria hasil mampu mengidentifikasi cara mengurangi nyeri, mengungkapkan keinginan untuk mengontrol nyerinya.

Intervensi dan Rasional

1. Observasi adanya nyeri dan tingkat nyeri.

Memudahkan tindakan keperawatan

2. Ajarkan dan catat tipe nyeri serta tindakah untuk mengatasi nyeri

Meningkatkan persepsi klien terhadap nyeri yang dialaminya.

3. Ajarkan teknik relaksasi

Meningkatkan kenyamanan klien

4. Anjurkan untuk menggunakan kompres hangat

Membantu mengurangi nyeri dan meningkatkan kenyamanan klien

5. Kolaborasi pemberian analgesik

Mengurangi nyeri

Dx 2

Gangguan eliminasi urine (retensio) berhubungan dengan penekanan oleh massa jaringan neoplasma pada daerah sekitarnnya, gangguan sensorik / motorik.

Tujuan

Pola eliminasi urine ibu kembali normal dengan criteria hasil ibu memahami terjadinya retensi urine, bersedia melakukan tindakan untuk mengurangi atau menghilangkan retensi urine.

Intervensi dan Rasional

1. Catat pola miksi dan monitor pengeluaran urine

Melihat perubahan pola eliminasi klien

2. Lakukan palpasi pada kandung kemih, observasi adanya ketidaknyamanan dan rasa nyeri.

Menentukan tingkat nyeri yang dirasakan oleh klien

3. Anjurkan klien untuk merangsang miksi dengan pemberian air hangat, mengatur posisi, mengalirkan air keran.

Mencegah terjadinya retensi urine

Daftar Pustaka

Bagian Obstetri & Ginekologi FK. Unpad. 1993. Ginekologi. Elstar. Bandung

Carpenito, Lynda Juall, 2000. Buku Saku Diagnosa Keperawatan. Edisi 8. EGC. Jakarta

Galle, Danielle. Charette, Jane.2000. Rencana Asuhan Keperawatan Onkologi. EGC. Jakarta

Hartono, Poedjo. 2000. Kanker Serviks/Leher Rahim & Masalah Skrining di Indonesia. Kursus Pra kongres KOGI XI Denpasar. Mimbar Vol.5 No.2 Mei 2001

Saifidin, Abdul Bari,dkk. 2001. Buku Acuan Nasional Pelayanan Kesehatan Maternal dan Neonatal. Yayasan Bina Pustaka Sarwono Prawirohardjo & JNKKR-POGI. Jakarta

Medical Billing Assistant

2009-03-13T06:18:00.000-07:00

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Diagnosis Keperawatan

2009-03-04T04:55:00.000-08:00

PENGERTIAN

Diagnosis Keperawatan merupakan keputusan klinik tentang respon individu, keluarga dan masyarakat tentang masalah kesehatan aktual atau potensial, dimana berdasarkan pendidikan dan pengalamannya, perawat secara akontabilitas dapat mengidentifikasi dan memberikan intervensi secara pasti untuk menjaga, menurunkan, membatasi, mencegah dan merubah status kesehatan klien (Carpenito, 2000; Gordon, 1976 & NANDA).

Diagnosis keperawatan ditetapkan berdasarkan analisis dan interpretasi data yang diperoleh dari pengkajian keperawatan klien. Diagnosis keperawatan memberikan gambaran tentang masalah atau status kesehatan klien yang nyata (aktual) dan kemungkinan akan terjadi, dimana pemecahannya dapat dilakukan dalam batas wewenang perawat.

KOMPONEN DIAGNOSIS KEPERAWATAN

Rumusan diagnosis keperawatan mengandung tiga komponen utama, yaitu :

1. Problem (P/masalah), merupakan gambaran keadaan klien dimana tindakan keperawatan dapat diberikan. Masalah adalah kesenjangan atau penyimpangan dari keadaan normal yang seharusnya tidak terjadi.

Tujuan : menjelaskan status kesehatan klien atau masalah kesehatan klien secara jelas dan sesingkat mungkin. Diagnosis keperawatan disusun dengan menggunakan standart yang telah disepakati (NANDA, Doengoes, Carpenito, Gordon, dll), supaya :

1. Perawat dapat berkomunikasi dengan istilah yang dimengerti secara umum
2. Memfasilitasi dan mengakses diagnosa keperawatan
3. Sebagai metode untuk mengidentifikasi perbedaan masalah keperawatan dengan masalah medis
4. Meningkatkan kerjasama perawat dalam mendefinisikan diagnosis dari data pengkajian dan intervensi keperawatan, sehingga dapat meningkatkan mutu asuhan keperawatan.

2. Etiologi (E/penyebab), keadaan ini menunjukkan penyebab keadaan atau masalah kesehatan yang memberikan arah terhadap terapi keperawatan. Penyebabnya meliputi : perilaku, lingkungan, interaksi antara perilaku dan lingkungan.

Unsur-unsur dalam identifikasi etiologi :

1. Patofisiologi penyakit : adalah semua proses penyakit, akut atau kronis yang dapat menyebabkan / mendukung masalah.
2. Situasional : personal dan lingkungan (kurang pengetahuan, isolasi sosial, dll)
3. Medikasi (berhubungan dengan program pengobatan/perawatan) : keterbatasan institusi atau rumah sakit, sehingga tidak mampu memberikan perawatan.
4. Maturasional :

Adolesent : ketergantungan dalam kelompok

Young Adult : menikah, hamil, menjadi orang tua

Dewasa : tekanan karier, tanda-tanda pubertas.

3. Sign & symptom (S/tanda & gejala), adalah ciri, tanda atau gejala, yang merupakan informasi yang diperlukan untuk merumuskan diagnosis keperawatan.

Jadi rumus diagnosis keperawatan adalah : PE / PES.

PERSYARATAN PENYUSUNAN DIAGNOSIS KEPERAWATAN

1. Perumusan harus jelas dan singkat dari respon klien terhadap situasi atau keadaan yang dihadapi

2. Spesifi dan akurat (pasti)

3. Dapat merupakan pernyataan dari penyebab

4. Memberikan arahan pada asuhan keperawatan

5. Dapat dilaksanakan oleh perawat

6. Mencerminan keadaan kesehatan klien.

HAL-HAL YANG PERLU DIPERHATIKAN DALAM MENENTUKAN DIAGNOSIS KEPERAWATAN

1. Berorientasi kepada klien, keluarga dan masyarakat

2. Bersifat aktual atau potensial

3. Dapat diatasi dengan intervensi keperawatan

4. Menyatakan masalah kesehatan individu, keluarga dan masyarakat, serta faktor-faktor penyebab timbulnya masalah tersebut.

ALASAN PENULISAN DIAGNOSA KEPERAWATAN

1. Memberikan asuhan keperawatan secara komprehensif

2. Memberikan kesatuan bahasa dalam profesi keperawatan

3. Meningkatkan komunikasi antar sejawat dan profesi kesehatan lainnya

4. Membantu merumuskan hasil yang diharapkan / tujuan yang tepat dalam menjamin mutu asuhan keperawatan, sehingga pemilihan intervensi lebih akurat dan menjadi pedoman dalam melakukan evaluasi

5. Menciptakan standar praktik keperawatan

6. Memberikan dasar peningkatan kualitas pelayanan keperawatan.

PROSES PENYUSUNAN DIAGNOSIS KEPERAWATAN

1. Klasifikasi & Analisis Data

Pengelompokkan data adalah mengelompokkan data-data klien atau keadaan tertentu dimana klien mengalami permasalahan kesehatan atau keperawatan berdasarkan kriteria permasalahannya. Pengelmpkkan data dapat disusun berdasarkan pola respon manusia (taksonomi NANDA) dan/atau pola fungsi kesehatan (Gordon, 1982);

Respon Manusia (Taksonomi NANDA II) :

1. Pertukaran
2. Komunikasi
3. Berhubungan
4. Nilai-nilai
5. Pilihan
6. Bergerak
7. Penafsiran
8. Pengetahuan
9. Perasaan

Pola Fungsi Kesehatan (Gordon, 1982) :

1. Persepsi kesehatan : pola penatalaksanaan kesehatan
2. Nutrisi : pola metabolisme
3. Pola eliminasi
4. Aktivitas : pola latihan
5. Tidur : pola istirahat
6. Kognitif : pola perseptual
7. Persepsi diri : pola konsep diri
8. Peran : pola hubungan
9. Seksualitas : pola reproduktif
10. Koping : pola toleransi stress
11. Nilai : pola keyakinan

2. Mengindentifikasi masalah klien

Masalah klien merupakan keadaan atau situasi dimana klien perlu bantuan untuk mempertahankan atau meningkatkan status kesehatannya, atau meninggal dengan damai, yang dapat dilakukan oleh perawat sesuai dengan kemampuan dan wewenang yang dimilikinya

Identifikasi masalah klien dibagi menjadi : pasien tidak bermasalah, pasien yang kemungkinan mempunyai masalah, pasien yang mempunyai masalah potensial sehingga kemungkinan besar mempunyai masalah dan pasien yang mempunyai masalah aktual.

1. Menentukan kelebihan klien

Apabila klien memenuhi standar kriteria kesehatan, perawat kemudian menyimpulkan bahwa klien memiliki kelebihan dalam hal tertentu. Kelebihan tersebut dapat digunakan untuk meningkatkan atau membantu memecahkan masalah yang klien hadapi.

1. Menentukan masalah klien

Jika klien tidak memenuhi standar kriteria, maka klien tersebut mengalami keterbatasan dalam aspek kesehatannya dan memerlukan pertolongan.

1. Menentukan masalah yang pernah dialami oleh klien

Pada tahap ini, penting untuk menentukan masalah potensial klien. Misalnya ditemukan adanya tanda-tanda infeksi pada luka klien, tetapi dari hasil test laboratorium, tidak menunjukkan adanya suatu kelainan. Sesuai dengan teori, maka akan timbul adanya infeksi. Perawat kemudian menyimpulkan bahwa daya tahan tubuh klien tidak mampu melawan infeksi.

1. Penentuan keputusan

- Tidak ada masalah, tetapi perlu peningkatan status dan fungsi (kesejahteraan) : tidak ada indikasi respon keperawatan, meningkatnya status kesehatan dan kebiasaan, serta danya inisiatif promosi kesehatan untuk memastikan ada atau tidaknya masalah yang diduga.

- Masalah kemungkinan (possible problem) : pola mengumpulkan data yang lengkap untuk memastikan ada atau tidaknya masalah yang diduga

- Masalah aktual, resiko, atau sindrom : tidak mampu merawat karena klien menolak masalah dan pengobatan, mulai untuk mendesain perencanaan, pelaksanaan, dan evaluasi untuk mencegah, menurunkan, atau menyelesaikan masalah.

- Masalah kolaboratif : konsultasikan dengan tenaga kesehatan profesional yang ompeten dan bekerja secara kolaboratif pada masalah tersebut. Masalah kolaboratif adalah komplikasi fisiologis yang diakibatkan dari patofisiologi, berhubungan dengan pengobatan dan situasi yang lain. Tugas perawat adalah memonitor, untuk mendeteksi status klien dan kolaboratif dengan tenaga medis guna pengobatan yang tepat.

3. Memvalidasi diagnosis keperawatan

Adalah menghubungkan dengan klasifikasi gejala dan tanda-tanda yang kemudian merujuk kepada kelengkapan dan ketepatan data. Untuk kelengkapan dan ketepatan data, kerja sama dengan klien sangat penting untuk saling percaya, sehingga mendapatkan data yang tepat.

Pada tahap ini, perawat memvalidasi data yang ada secara akurat, yang dilakukan bersama klien/keluarga dan/atau masyarakat. Validasi tersebut dilaksanakan dengan mengajukan pertanyaan atau pernyataan yang reflektif kepada klien/keluarga tentang kejelasan interpretasi data. Begitu diagnosis keperawatan disusun, maka harus dilakukan validasi.

4. Menyusun diagnosis keperawatan sesuai dengan prioritasnya

Setelah perawat mengelompokkan, mengidentifikasi, dan memvalidasi data-data yang signifikan, maka tugas perawat pada tahap ini adalah merumuskan suatu diagnosis keperawatan. Diagnosa keperawatan dapat bersifat aktual, resiko, sindrom, kemungkinan dan wellness.

Menyusun diagnosis keperawatan hendaknya diurutkan menurut kebutuhan yang berlandaskabn hirarki Maslow (kecuali untuk kasus kegawat daruratan — menggunakan prioritas berdasarkan “yang mengancam jiwa”) :

1. Berdasarkan Hirarki Maslow : fisiologis, aman-nyaman-keselamatan, mencintai dan memiliki, harga diri dan aktualisasi diri
2. Griffith-Kenney Christensen : ancaman kehidupan dan kesehatan, sumber daya dan dana yang tersedia, peran serta klien, dan prinsip ilmiah dan praktik keperawatan.

KATEGORI DIAGNOSIS KEPERAWATAN

1. Diagnosis Keperawatan Aktual

Diagnosis keperawatan aktual (NANDA) adalah diagnosis yang menyajikan keadaan klinis yang telah divalidasikan melalui batasan karakteristik mayor yang diidentifikasi. Diagnosis keperawatan mempunyai empat komponen : label, definisi, batasan karakteristik, dan faktor yang berhubungan.

Label merupakan deskripsi tentang definisi diagnosis dan batasan karakteristik. Definisi menekankan pada kejelasan, arti yang tepat untuk diagnosa. Batasan karakteristik adalah karakteristik yang mengacu pada petunjuk klinis, tanda subjektif dan objektif. Batasan ini juga mengacu pada gejala yang ada dalam kelompok dan mengacu pada diagnosis keperawatan, yang teridiri dari batasan mayor dan minor. Faktor yang berhubungan merupakan etiologi atau faktor penunjang. Faktor ini dapat mempengaruhi perubahan status kesehatan. Faktor yang berhubungan terdiri dari empat komponen : patofisiologi, tindakan yang berhubungan, situasional, dan maturasional.

Contoh diagnosis keperawatan aktual : Intoleransi aktivitas berhubungan dengan penurunan transport oksigen, sekunder terhadap tirah baring lama, ditandai dengan nafas pendek, frekuensi nafas 30 x/mnt, nadi 62/mnt-lemah, pucat, sianosis.

2. Diagnosis Keperawatan Resiko

Diagnosis keperawatan resiko adalah keputusan klinis tentang individu, keluarga atau komunitas yang sangat rentan untuk mengalami masalah dibanding individu atau kelompok lain pada situasi yang sama atau hampir sama.

Validasi untuk menunjang diagnosis resiko adalah faktor resiko yang memperlihatkan keadaan dimana kerentanan meningkat terhadap klien atau kelompok dan tidak menggunakan batasan karakteristik. Penulisan rumusan diagnosis ini adalag : PE (problem & etiologi).

Contoh : Resiko penularan TB paru berhubungan dengan kurangnya pengetahuan tentang resiko penularan TB Paru, ditandai dengan keluarga klien sering menanyakan penyakit klien itu apa dan tidak ada upaya dari keluarga untuk menghindari resiko penularan (membiarkan klien batuk dihadapannya tanpa menutup mulut dan hidung).

3. Diagnosis Keperawatan Kemungkinan

Merupakan pernyataan tentang masalah yang diduga masih memerlukan data tambahan dengan harapan masih diperlukan untuk memastikan adanya tanda dan gejala utama adanya faktor resiko.

Contoh : Kemungkinan gangguan konsep diri : gambaran diri berhubungan dengan tindakan mastektomi.

4. Diagnosis Keperawatan Sejahtera

Diagnosis keperawatan sejahtera adalah ketentuan klinis mengenai individu, kelompok, atau masyarakat dalam transisi dari tingkat kesehatan khusus ke tingkat kesehatan yang lebih baik. Cara pembuatan diagnsosis ini adalah dengan menggabungkan pernyataan fungsi positif dalam masing-masing pola kesehatan fungsional sebagai alat pengkajian yang disahkan. Dalam menentukan diagnosis keperawatan sejahtera, menunjukkan terjadinya peningkatan fungsi kesehatan menjadi fungsi yang positif.

Sebagai contoh, pasangan muda yang kemudian menjadi orangtua telah melaprkan fungsi positif dalam peran pola hubungan. Perawat dapat memakai informasi dan lahirnya bayi baru sebagai tambahan dalam unit keluarga, untuk membantu keluarga mempertahankan pola hubungan yang efektif.

Contoh : perilaku mencari bantuan kesehatan berhubungan dengan kurang pengetahuan tentang peran sebagai orangtua baru.

5. Diagnosis Keperawatan Sindrom

Diagnosis keperawatan sindrom merupakan diagnosis keperawatan yang terdiri dari sekelompok diagnosis keperawatan aktual atau resiko, yang diduga akan muncul karena suatu kejadian atau situasi tertentu.

Contoh : sindrom kurang perawatan diri berhubungan dengan kelemahan fisik.

MASALAH KOLABORATIF

Masalah kolaboratif adalah masalah yang nyata atau resiko yang mungkin terjadi akibat komplikasi dari penyakit atau dari pemeriksaan atau akibat pengobatan, yang mana masalah tersebut hanya bisa dicegah, diatasi, atau dikurangi dengan tindakan keperawatan yang bersifat kolaboratif. Label yang digunakan adalah : Potensial Komplikasi (PK).

MENCEGAH KESALAHAN DALAM MEMBUAT DIAGNOSIS KEPERAWATAN

1. Tidak menggunakan istilah medis. Jika harus, hanya sebatas memperjelas, dengan diberi pernyataan `sekunder terhadap`.

Ex : mastektomi b.d kanker

2. Tidak merumuskan diagnosis keperawatan sebagai suatu diagnosa medis

Ex : Resiko pneumonia

3. Jangan merumuskan diagnosis keperawatan sebagai suatu intervensi keperawatan

Ex : Menggunakan pispot sesering mungkin b.d dorongan ingin berkemih

4. Jangan menggunakan istilah yang tidak jelas. Gunakan istilah / pernyataan yang lebih spesifik.

Ex : Tidak efektifnya bersihan jalan nafas b.d kesulitan bernafas

5. Jangan menulis diagnosis keperawatan yang mengulangi instruksi dokter

Ex : Instruksi untuk puasa

6. Jangan merumuskan dua masalah pada saat yang sama

Ex : Nyeri dan takut b.d prosedur operasi

7. Jangan menghubungkan masalah dengan situasi yang tidak dapat diubah

Ex : Resiko cedera b.d kebutaan

8. Jangan menuliskan etiologi atau tanda/gejala untuk masalah

Ex : Kongesti paru b.d tirah baring lama

9. Jangan membuat asumsi

Ex : Resiko perubahan peran b.d tidak berpengalaman menjadi ibu baru.

10. Jangan menulis pernyataan yang tidak bijaksana secara hukum

Ex : Kerusakan integritas kulit b.d posisi klien tidak diubah setiap 2 jam.

DOKUMENTASI DIAGNOSIS KEPERAWATAN

1. Gunakan format PES untuk semua masalah aktual dan PE untuk masalah resiko

2. Catat diagnosis keperawtaan resiko ke dalam format diagnosis keperawatan

3. Gunakan istilah diagnosis keperawatan yang ada dalam NANDA ( terbaru : 2007 – 2008 )

4. Mulai pernyataan diagnosis keperawatan dengan mengidentifikasi informasi tentang data untuk diagnosis keperawatan

5. Masukkan pernyataan diagnosis keperawatan ke dalam daftar masalah

6. Hubungkan setiap diagnosis keperawatan ketika menemuan masalah perawatan

7. Gunakan diagnosis keperawatan sebagai pedoman untuk pengkajian, perencanaan, intervensi dan evaluasi.

Tujuan Dokumentasi Diagnosis Keperawatan :

1. Mengkomunikasikan masalah klien pada tim kesehatan

2. Mendemonstrasikan tanggung jawab dalam identifikasi masalah klien

3. Mengidentifikasi masalah utama untuk perkembangan intervensi keperawatan.

Operating Department Practice A–Z

2009-01-19T08:57:00.002-08:00

Second Edition
By Tom Williams and Brian Smith
Cambridge University Press 2008
ISBN-13 978-0-511-38659-6
ISBN-13 978-0-521-71021-3

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Pharmacology for the Health Care Professions

2009-01-19T08:57:00.001-08:00

By Christine Thorp
2008 by John Wiley & Sons, Ltd
ISBN 978-0-470-51018-6
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Clinical Nephrology

2009-01-19T08:55:00.000-08:00

By Woo Keng Thye

Paperback: 360 pages

Publisher: Singapore University Press; 2nd edition (February 2003)

ISBN-10: 981238085X

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Clinical Problems in General Medicine and Surgery

2009-01-19T08:54:00.000-08:00

Clinical Problems in General Medicine and Surgery

By Peter Devitt, Juliet Barker, Jon Mitchell, Christian Hamilton-Craig

400 pages

Publisher: Churchill Livingstone; 2 edition (September 8, 2003)

ISBN-10: 0443073236

ISBN-13: 978-0443073236

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The ASCRS Textbook of Colon and Rectal Surgery

2009-01-19T08:53:00.002-08:00

By Bruce G. Wolff, James W. Fleshman, David E. Beck, John H. Pemberton
Publisher: Springer
816 pages
Publication Date: 2006-10
ISBN / ASIN: 0387248463
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MCQs for the FRCR Part 1

2009-01-19T08:53:00.001-08:00

By Monica Khanna and Leon Menezes
166 pages
Publisher: Greenwich Medical Media; 1 edition (August 9, 2004)
Cambridge University Press
ISBN-10: 1841102148
ISBN-13: 978-1841102146

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Current Medical Diagnosis and Treatment 2009

2009-01-19T08:49:00.002-08:00

By Stephen J. McPhee and Maxine A. Papadakis
1728 pages
Publisher: McGraw-Hill Professional; 48 edition (October 2, 2008)
ISBN-10: 0071591249
ISBN-13: 978-0071591249
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Oxford Textbook of Clinical Nephrology

2009-01-19T08:49:00.001-08:00

By Alexander Davison, J. Stewart Cameron, Jean Pierre Grunfeld, and Claudio Ponticelli

3048 pages
Publisher: Oxford University Press, USA; 3 edition (April 24, 2008)
ISBN-10: 0198508247
ISBN-13: 978-0198508243

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The Abnormal Menstrual Cycle

2009-01-19T08:48:00.001-08:00

Edited by Margaret Rees, Sally Hope, Veronica Ravnikar
ISBN 0-203-62375-4
ISBN 1-84214-212-7

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