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Penn – British clinical pharmacologist order zithromax 500mg otc, London Petrarch – The medical herbalist is at fault for clinging to Italian poet and scholar outworn historical authority and for not assessing his drugs in terms of today’s knowledge buy zithromax 100 mg with amex, and the It is by poultices purchase 100 mg zithromax with amex, not by words, that pain is ended, orthodox physician is at fault for a cynical although pain is by words both eased and scepticism with regard to any healing discipline diminished. Fruits of Solitude Maxim  Satyricon  Samuel Pepys – Heinrich von Pfolspeundt th English diarist century German war surgeon Thanks be to God, since my leaving drinking of wine, I do find myself much better and do mind A wound should be bound with clean white my business better, and do spend less money, and bandages, else there be harmful effects. Diary  January () Buch der Bundth-Erntznei    ·  Thomas Phaer ? Médecine, Paris The Book of Children Every illness has its natural course, with which it behoves the doctor to become acquainted. Contemporary British journalist Letter to Fanny Burney,  November () Behind many of the most agonising dilemmas in modern medicine, behind the emotional and bitter Walter B. Harvester Press () Many people are better off with grave handicaps than with trifling ones. The grave handicaps Medical ethics are a bargain that has to be struck release copious energies. Raven Press, New York () Medicine is an art, and attends to the nature and Ludwig Pick – constitution of the patient, and has principles of German pathologist, Berlin, and describer of action and reason in each case. Niemann–Pick disease Gorgias Love is an acute psychosis that may always be This is the great error of our day in the treatment given a good prognosis. D Dear Soul, do not strive for immortal life, but exhaust the resources of the feasible. Pythian Ode Attributed    ·     Sir Harry Platt – There is alas no law against incompetency; no Professor of Orthopaedics, Manchester, and President striking example is made. They learn by our bodily Royal College of Surgeons of England jeopardy and make experiments until the death of the patients, and the doctor is the only person not A physician should not be a servant of any punished for murder. Journal of Medicine  January () Historia Naturalis ‘Greek Physicians’ If you cannot make a diagnosis at least make a There is nothing encourageth a woman sooner to decision. Attributed Historia Naturalis ‘Greek Physicians’ Amid the sufferings of life on earth, suicide is God’s best gift to man. It is being explored by psychiatry but is in danger of being neglected by Plutarch C. Greek essayist Republic Medicine, to produce health, has to examine Future generations, paying tribute to the disease. Moralia ‘Advice about Keeping Well’ ’Tis a portentous sign When a man sweats, Of all drinks, wine is the most profitable of and at the time shivers. Historia Naturalis ‘Greek Physicians’ Attributed ()    ·    Michael Polanyi – Sir Percivall Pott – Hungarian chemist and social philosopher Surgeon, St. Bartholomews Hospital, London Genius seems to consist in the power of applying Surgery has undergone many great the originality of youth to the experience of transformations during the past fifty years, and maturity. Polish proverbs Chirurgical Observations () A beggar does not hate another beggar as much as one doctor hates another. When the mischief seems to be of such nature as that gangrene and mortification are most likely to Every Czech is a musician; every Italian a doctor; ensue, no time can be spared... Johnson, London () The doctor demands his fees whether he has killed the illness or the patient. As fine and as fast as he can; Austrian-born British philosopher Though I am no judge of such matters, I’m sure he’s a talented man. It is not his possession of knowledge of irrefutable Poems of Life and Manners ‘The Talented Man’ truth that makes the man of science, but his persistent and recklessly critical quest for truth. Of which you need not read one letter; The worse the scrawl, the dose the better, Drunkenness turns a man out of himself, and For if you knew but what you take, leaves a beast in his room. By professional patriotism amongst medical men I mean that sort of regard for the honour of the He that is uneasy at every little pain is never profession and that sense of responsibility for its without some ache. Introduction to Abraham Flexner’s Medical Education in the Meddlesome midwifery is bad. Happiness is beneficial for the body, but it is grief that develops the powers of the mind. Scratching is bad because it begins with pleasure They err habitually on the side of optimism as to and ends with pain. If it is capable of deceiving the doctor, The best smell is bread, the savour salt, the best how should it fail to deceive the patient? Le Côté de Guermantes Pt  The best surgeon is he that has been well hacked Everything great in the world comes from himself. The choleric drinks, the melancholic eats, the Le Côté de Guermantes Pt  phlegmatic sleeps. Illness is the doctor to whom we pay most heed; to The eye is bigger than the belly. We are usually the best men when in the worst All would live long but none would be old. A man has often more trouble to digest food than We are born crying, live complaining, and die to get it. Putnam – As long as our brain is a mystery, the universe, the reflection of the structure of the brain, will also be No argument is needed to show what a mystery. Charlas de Cafe Boston Medical and Surgical Journal :  () It is best to attenuate the virulence of our ‘The man’ is above all else, the mind of the man, adversaries with the chloroform of courtesy and and not only the mind as an organ of conscious flattery, much as bacteriologists disarm a thought but the mind as an organ of bodily pathogen by converting it into a vaccine. Like an earthquake, true senility announces itself Boston Medical and Surgical Journal :  () by trembling and stammering. Charlas de Cafe Françis Quarles – That which enters the mind through reason can English poet be corrected. Statistical evidence shows that the greater the François Rabelais – intellectual freedom, and the higher the general average of intelligence in a community, the French physician and satirist greater is also the number of suicides. Jacques Le Clercq) Louis-Antoine Ranvier – Without health life is not life; it is unlivable. French professor of histology Without health, life spells but languor and an It is necessary in a word to make histology image of death. Ravdin – bowels are working and what sort of food he Professor of Surgery, University of Pennsylvania eats... I may venture to add one more question: In the surgery of the future the individualist will what occupation does he follow? Wright) of that broader field of experimental pathology to which all the medical sciences belong. Dr Virginia Ramirez de Barquero Annals of Surgery :  () Costa Rica health official We trust the drug companies.

The end of the colon that leads to the a wide opening to the skin and is capped with a rectum is closed off and becomes dormant (known blackened mass of skin debris buy discount zithromax 250 mg. Usually a colostomy is per- formed because of infection generic zithromax 100 mg free shipping, blockage 100mg zithromax overnight delivery, cancer, or in comedo. The common colostomy, transverse A colostomy in which the bile duct is formed by the junction of the cystic duct, exterior opening (stoma) is located on the upper from the gallbladder, and the common hepatic duct, abdomen. A complication is communication disorder A disorder of the so named because it complicates the situation. Treatment includes speech therapy and other inter- ventions, as appropriate, for the underlying condi- compound microscope A microscope that con- tion. See also aphasia; apraxia of speech; sists of two microscopes in series, the first serving articulation disorder; autism; cluttering; speech as the ocular lens (close to the eye) and the second disorder; stuttering. For example, if a person has both Crohn’s disease and stomach compress Cloth or another material applied ulcers, these are comorbid conditions. It may also be method of providing experimental treatments, gen- impregnated with medication or an herbal remedy. An example of a complementary therapy is using aromatherapy to computerized axial tomography scan See help lessen a patient’s discomfort following surgery. Complementary medicine is traditionally not taught or used in Western medical schools or hospitals. The term of practices and systems of health care that, for a conception has also been used to imply the implan- variety of cultural, social, economic, or scientific tation of the blastocyst, the formation of a viable reasons, have not been adopted by mainstream zygote, and the onset of pregnancy. A brain concussion can cause immedi- fetuses insensitive (unresponsive) to androgens ate but temporary impairment of brain functions, (male hormones). Instead, they are born looking such as thinking, vision, equilibrium, and con- externally like normal girls. After a person has had a concussion, he short blind-pouch vagina and no uterus, fallopian or she is at increased risk for recurrence. There are testes in the abdomen Moreover, after a person has several concussions, or the inguinal canal. The complete androgen less of a blow can cause injury, and the person can insensitivity syndrome is usually detected at puberty require more time to recover. The gene for the syndrome is on the X chromo- the body for either improved performance, as in some and codes for the androgen receptor (also called the dihydrotestosterone receptor). Named after the Russian physiologist Ivan Petrovich complete syndactyly See syndactyly, complete. Pavlov, who conditioned dogs to respond in what proved to be a predictable manner by giving them rewards. Cone cells absorb light and are essential for material that collects semen and thereby prevents distinguishing colors. When not specified, the term condom usually congenital A condition that is present at birth, refers to a male condom. It collects semen, pre- congenital clasped thumbs with mental retar- venting the semen from reaching the cervix, and dation See adducted thumbs. It also provides some protection against sexually transmitted dis- congenital defect A birth defect. See also barrier congenital dislocation of the hip See congen- method; birth control. A condom can be used only heart malformation, congenital cardiovascular dis- once. There are three major types of congenital hip dislocation One of the most condyloma, each of which is sexually transmitted: condyloma acuminatum (warts around the vulva), common birth defects, characterized by an abnor- mal formation of the hip joint in which the ball at condyloma latum (a form of secondary syphilis), and condyloma subcutaneum (also known as mol- the top of the thighbone (the head of the femur) is not stable within the socket (acetabulum). If the harness is not effective, the hip may be positioned into place under anesthesia condyloma latum A form of the secondary stage (closed reduction) and maintained with a body cast of syphilis, characterized by wartlike growths (spica). Congenital malformation can be genetic, it can result from exposure of the fetus to a malforming agent (such http://www. Examples include heart defects, conjunctivitis, allergic Inflammation of the cleft lip and palate, spina bifida, limb defects, and whites of the eyes (the conjunctivae), with itching, Down syndrome. The lids may droop only mone aldosterone by a tumor in the outer portion slightly, or they may cover the pupils and restrict or (cortex) of the adrenal gland. Moderate or severe ptosis calls terone results in low potassium levels for treatment to permit normal vision development. The basic tenets of connectionism are that keep up with the demands on it, with failure of the signals are processed by elementary units (in this heart to pump blood with normal efficiency. When case, neurons), processing units are connected in this occurs, the heart is unable to provide adequate parallel to other processing units, and connections blood flow to other organs, such as the brain, liver, between processing units are weighted. The resent the strengths of connection (either excitatory symptoms can include shortness of breath (dysp- or inhibitory) between two units. Lupus such as prolonged alcohol exposure; heart valve is a connective tissue disease. Conor and Bruch disease See typhus, African conization Surgery to remove a cone-shaped tick. Conization may be used to diagnose or treat a cervi- consanguinity Close blood relationship, some- times used to denote human inbreeding. Everyone carries rare recessive coats the inner surfaces of the eyelids (palpebral genes that, in the company of other genes of the conjunctiva) and the outer surface of the eye (ocu- same type, are capable of causing autosomal reces- lar, or bulbar, conjunctiva). First cousins share a set of grandpar- conjunctiva is called conjunctivitis (pinkeye). It can be a result marriage between first cousins (not to mention of infection or irritation of the eye, or it can be closer relatives) is generally discouraged, and in many areas of the world is illegal. For example, certain medications lies where a recessive genetic disorder is known or are contraindicated during pregnancy because of suspected to be present, genetic testing and coun- the danger they pose to the fetus, and the use of seling are advised, even if the level of consanguinity aspirin is contraindicated in small children because is very low (as, for example, in marriages between of the danger of Reye’s syndrome. Constipation is the opposite of diarrhea and is commonly caused by irritable contralateral Of or pertaining to the other side. Paradoxically, constipation can also be example, a stroke involving the right side of the brain caused by overuse of laxatives. A high-fiber diet can frequently relieve consti- control In research, the group of participants pation. If the diet is not helpful, medical evaluation that does not receive the treatment under investiga- is warranted. In lab research that does not use live partic- continuous positive airway pressure A treat- ipants (in vitro research rather than in vivo ment for sleep apnea that involves wearing over the research), control procedures serve the same pur- face a breathing mask that forces air through the pose as a control group.

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The technique may form the basis of a diagnostic tool that could be used in the clinic and also help in the search for cancer drugs that reduce chromosomal instability purchase 500 mg zithromax fast delivery. It has broad implications in advancing both cancer biology research and clinical can- cer management discount zithromax 500 mg amex, including the detection cheap zithromax 100mg, diagnosis and monitoring of cancer (Sequist et al. Variability between indi- viduals in the pharmacokinetics of anticancer chemotherapeutic agents has an impact on therapeutic efficacy and safety. Since most anticancer agents are trans- formed by enzymes, a better knowledge of the biotransformation pathways of cyclophosphamide, ifosfamide, tamoxifen, docetaxel, paclitaxel, and irinotecan could help improve treatment outcome. Furthermore, a better understanding of the metabolism of anticancer agents through phenotyping and genotyping approaches will facilitate the prediction of interactions between drugs. More clinical evidence is needed on the metabolic transformation and drug interactions with these agents to improve cancer therapeutics. As such, NanoFlares are the first genetic- based approach for detecting, isolating, and characterizing live cancer cells from blood and may provide new opportunities for cancer diagnosis, prognosis, and personalized therapy. Pathway-Based Analysis of Cancer Conversion of Gene-Level Information into Pathway-Level Information Gene-level information obtained by gene expression studies needs to be converted into pathway-level level information to generate biologically relevant representa- tion of each tumor sample. An algorithm, Pathifier, infers pathway deregulation scores for each tumor sample on the basis of expression data in a context-specific manner for every particular dataset and type of cancer that is being investigated (Drier et al. By introducing a series of oncogenes into otherwise normal cells and comparing gene expression patterns in normal cells versus cells harboring oncogenes, it can be shown that each cellular signaling pathway is associ- ated with a unique gene expression signature. When evaluated in several large col- lections of human cancers, these gene expression signatures identify patterns of pathway deregulation in tumors and clinically relevant associations with disease Universal Free E-Book Store Impact of Molecular Diagnostics on the Management of Cancer 213 outcomes. Combining signature-based predictions across several pathways identifies coordinated patterns of pathway deregulation that distinguish between specific can- cers and tumor subtypes. The majority of adenocarcinomas of the lung are found to be deregulated for the oncogene Ras, while only a tiny minority of squamous cell carcinomas exhibited Ras deregulation. Hence, deregulation of the Ras pathway is an important signature of adenocarcinomas but not of squamous cell carcinoma. Clustering tumors based on pathway signatures further defines prognosis in respective patient subsets, demonstrating that patterns of oncogenic pathway dereg- ulation underlie the development of the oncogenic phenotype and reflect the biology and outcome of specific cancers. Predictions of pathway deregulation in cancer cell lines are also shown to predict the sensitivity to therapeutic agents that target com- ponents of the pathway. Linking pathway deregulation with sensitivity to therapeu- tics that target components of the pathway provides an opportunity to make use of these oncogenic pathway signatures to guide the use of personalized cancer thera- pies. If the Ras and Myc pathways are activated in a tumor, physicians could choose drugs that target only Myc and Ras. Because tumors arise from multiple defective genes and their malfunctioning proteins, treatments must target multiple genes and their pathways. The likelihood that someone will be cured by a single drug is low, and the new approach can guide physicians as to which combination of drugs will most likely produce the best outcome. The next step in the research is to validate the new method in samples from can- cer patients who have been treated with one of the pathway-specific drugs to deter- mine if the pathway predictors are able to select those patients most likely to respond to the drug. A positive result would then form the basis for a clinical study that would evaluate the effectiveness of the pathway prediction to guide the most effec- tive use of therapeutics. This test could be used for frequent screening for cancer and replacing traditionally invasive methods with a simple blood test. It could also help determine whether a cancer treatment is effective and thus enable personalized chemotherapy. Universal Free E-Book Store 214 10 Personalized Therapy of Cancer Role of Molecular Imaging in Personalized Therapy of Cancer In oncology, if cancer cells are removed from their microenvironment, their pattern of gene expression changes because the behavior of tumor cells is inextricably linked to their environments. Therefore, noninvasive, quantitative means of detect- ing gene and protein activity are essential. In vivo optical imaging technologies have matured to the point where they are indispensable laboratory tools for small animal imaging. Human applications are being explored and the future for clinical optical imaging tech- niques looks bright. Merging these molecular imaging techniques with minimally or noninvasive image-guided therapeutic delivery techniques is an important goal in the fight against cancer. In investigational and clinical oncology there is a need for imaging technologies that will indicate response to therapy prior to clinical evidence of response. This may be useful for assessing response to traditional cytotoxic agents where tumor shrinkage occurs early. In contrast to this, molecularly targeted agents tend to induce arrest of cancer cell growth and development, but not neces- sarily significant tumor shrinkage in the short term. Thus there is a need for func- tional or molecular imaging methods that would give information about what is happening in the tumor at the molecular level. One example of this approach is an attempt to find an explanation for poor performance of some antiangiogenesis drugs in clinical trials despite abundant preclinical evidence that the drugs should work. Noninvasive molecular imaging is needed to identify patients that are suitable for a particular targeted therapy, and to determine if the drug is reaching its target and in sufficient quantities to block the target. The molecularly targeted approaches enable the therapy to be individually tailored to a given patient’s tumor and metabolism. Application of this technique in patients with malignant Universal Free E-Book Store Impact of Molecular Diagnostics on the Management of Cancer 215 brain tumors showed changes in the diffusion map if chemotherapy or radiation therapy was having any effect. Speeding up this process can save patients from often- uncomfortable treatments that may be a waste of time. There are plans to test the technique with breast cancer as well as head and neck cancer. Radiolabeled annexin V may provide an early indication of the success or failure of anticancer therapy on a patient-by-patient basis as an in vivo marker of tumor cell killing. Abnormal tryptophan metabolism catalyzed by indoleamine 2,3-dioxygenase may play a prominent role in tumor immunoresistance in many tumor types, includ- ing lung tumors. Physiologic and quantitative imaging techniques may serve as enabling tools that could potentially transform many existing challenges into opportunities for advancement of the field (Tandon and Farahani 2011). Systemic delivery of this protein-corrole complex results in tumor accumulation, which can be visualized in vivo owing to intensely red corrole fluorescence. Targeted delivery in vivo leads to tumor cell death while normal tissue is spared in contrast with the effects of doxorubicin, which can elicit cardiac damage during therapy and required direct intratumoral injection to yield similar levels of tumor shrinkage compared with the systemically delivered corrole (Agadjanian et al.

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Another student in your class buy discount zithromax 100mg line, Poindexter purchase 500mg zithromax with amex, conducted a survey of college students about their favorite beverage zithromax 100 mg discount. Based on what the sample said, he concluded that most college students prefer carrot juice to other beverages! In each of the following experiments, identify the independent variable, the condi- tions of the independent variable, and the dependent variable: (a) Studying whether scores on a final exam are influenced by background music that is soft, loud, or absent. List the scales of measurement, starting with the scale that provides the most pre- cise information about the amount of a variable present and ending with the scale that provides the least precise information. Using the terms sample, population, variable, statistics, and parameter, summarize the steps a researcher follows, starting with a hypothesis and ending with a conclusion about a nature. In question 21, why is each relationship a telltale sign that a law of nature is at work? Qualitative Continuous, Type of or Discrete, or Measurement Variable Quantitative Dichotomous Scale Gender ________ ________ ________ Academic major ________ ________ ________ Number of minutes before ________ ________ ________ and after an event Restaurant ratings ________ ________ ________ (best, next best, etc. Your goals in this chapter are to learn ■ What simple frequency, relative frequency, cumulative frequency, and percentile are. Recall that descriptive statistics tell us the obvious things we would ask about the relationship and scores in a sample. Before we examine the relationship between two variables, however, we first summarize the scores from each variable alone. Then, two important things that we always wish to know are: Which scores occurred, and how often did each occur? The way to answer this is to organize the scores into tables and graphs based on what are called frequency distributions. In this chapter, you’ll see how to create various kinds of frequency distributions and how to use a frequency distribution to derive additional in- formation about the scores. Before we get to that, however, here are some terms and symbols you’ll encounter in this chapter. Descriptive statistics help us to “boil down” the raw scores into an interpretable, “digestible” form. There are several ways to do this, but the starting point is to count the number of times each score occurred. The number of times a score occurs is the score’s frequency, symbolized by the lowercase f. A distribution is the general name that researchers have for any organized set of data. As you’ll see, there are several ways to create a frequency distribution, so we will combine the term frequency (and f ) with other terms and symbols. Note that N is not the number of different scores, so even if all 43 scores in a sample are the same score, N still equals 43. First, it answers our question about the different scores that occurred in our data and it does this in an organized manner. You’ll also see that we have names for some commonly occurring distributions so that we can easily communicate and envision a picture of even very large sets of data. As the saying goes, “A picture is worth a thousand words,” and nowhere is this more appropriate than when trying to make sense out of data. Second, the procedures discussed here are im- portant because they are the building blocks for other descriptive and inferential statis- tics. A simple frequency distribution shows the number of times each score occurs in a set of data. If three participants scored 6, then the Simple Frequency frequency of 6 (its f ) is 3. Creating a simple frequency distribution involves counting Distribution Table the frequency of every score in the data. The left-hand column identi- fies each score, and the right- hand column contains the Presenting Simple Frequency in a Table frequency with which the score occurred. See 15 4 what happens, though, when we arrange them into the simple frequency table shown in 14 6 13 4 Table 3. Thus, the highest score is 17, the lowest score is 10, and although no one obtained a score of 16, we still include it. Opposite each score in the f column is the score’s frequency: In this sample there is one 17, zero 16s, four 15s, and so on. For ex- ample, the score of 13 has an f of 4, and the score of 14 has an f of 6, so their combined frequency is 10. You can see this by adding together the fre- quencies in the f column: The 1 person scoring 17 plus the 4 people scoring 15 and so on adds up to the 18 people in the sample. Such a distribution is also called a regular frequency distribution or a plain old frequency distribution. Graphing a Simple Frequency Distribution When researchers talk of a frequency distribution, they often imply a graph. Essen- tially, it shows the relationship between each score and the frequency with which it oc- curs. Recall that a variable will involve one of four types of measurement scales—nominal, ordinal, interval, or ratio. The type of scale involved determines whether we graph a frequency distribution as a bar graph, a histogram, or a polygon. Simple Frequency Distributions 39 Bar Graphs Recall that in nominal data each score identifies a category, and in or- dinal data each score indicates rank order. A frequency distribution of nominal or ordi- nal scores is graphed by creating a bar graph. In a bar graph, a vertical bar is centered over each score on the X axis, and adjacent bars do not touch. Say that the up- per graph is from a survey in which we counted the number of participants in each cat- egory of the nominal variable of political party affiliation. The X axis is labeled using the “scores” of political party, and because this is a nominal variable, they can be arranged in any order. In the frequency table, we see that six people were Republicans, so we draw a bar at a height (frequency) of 6 and so on. Say that the lower graph is from a survey in which we counted the number of partic- ipants having different military ranks (an ordinal variable). Political affiliation Ordinal Variable of 8 Military Rank 7 Party f 6 General 3 5 Colonel 8 f 4 Lieutenant 4 Sergeant 5 3 2 1 0 Sgt.

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God] sees both the future and the present well discount zithromax 100mg fast delivery, even in people whose reasoning faculty is disengaged; this is why melancholics have clear dreams generic zithromax 100mg, for it seems that the principle works more strongly when reason is disengaged’ (toÓto [i generic 250 mg zithromax amex. However, he does not seem to have noticed that the relationship between Eudemian Ethics and On Dreams is the same as between On Divination in Sleep and On Dreams. His explanation is that this contradiction may have something to do with the fact that Aristotle later, in the Parva naturalia, denies that dreams could be of divine origin, something Aristotle considered possible in the Eudemian Ethics, which may well be earlier. In my opinion this explanation is not correct, as On Divination in Sleep also says that melancholics have clear dreams. Aristotle on melancholy 149 Aristotle distinguishes between two types of lack of self-control: on the one hand recklessness (propeteia), and on the other hand weakness (astheneia). According to Aristotle the difference is that the weak person thinks and deliberates, yet does not persist with the conclusions of his deliberations, whereas the reckless person does not think or deliberate at all. As examples of the reckless type of lack of self-control Aristotle mentions ‘the irritable’ (hoi oxeis ) and ‘the melancholics’ (hoi melancholikoi) in lines 25ff. In the case of the former (hoi oxeis) this is due to their speed (tachutes¯ ), in the case of the latter (hoi melancholikoi) it is due to their intensity (sphodrotes¯ ), that is, their inclination to follow their imagination (t¼ ˆkolouqhtikoª e²nai t¦€ fantas©a€). The argument that melancholics lack rational thought corresponds to statements of the same nature in the Parva naturalia (in particular On Divination in Sleep) and the Eudemian Ethics. The ‘intensity’37 that Aristotle mentions as explanation here was mentioned in On Divination in Sleep, where it was called typical for their strong imagination; in the next sentence it is specified in the sense of their inclination ‘to follow imagination’ (cf. The relationship between imagination and passion is not made explicit in the text of the Nicomachean Ethics, but it consists in the fact that phantasia presents the perceived object as something to be pursued or avoided (and therefore it can produce pleasure or pain). This typology of lack of self-control returns in 1151 a 1–5, where the reckless are simply called hoi ekstatikoi, ‘those who are prone to get beside themselves’. In this text ho melancholikos is therefore prototypical 37 The translation by Dirlmeier (1956) 157, ‘ein unheimlich brodelndes Temperament’ is entirely unfounded. This corresponds to 1151 a 1–5;40 yet the next sentence is confusing, for Aristotle continues by saying that those who lack self-control out of habit (ethismos) are easier to cure than those who lack self-control by nature (ton¯ phusikon¯ ). Yet that would imply that melancholy is not a natural predisposition (as the remark on the melancholike¯ phusis in Div. But this text may in fact refer to a subcategory of the reckless type in which melancholics are to be regarded as ‘reckless by nature’. In 1154 a 26 he asks the question why physical pleasure seems more desirable than other pleasures. The first reason he gives is that it drives away pain (lupe¯) and functions, as it were, as a cure against it. The second reason (1154 b 3) is that because of its intensity (sphodra) it is pursued by people who are unable to enjoy any other pleasure and who perceive even their normal state (in which there is neither pleasure nor pain) as painful. This incorrect interpretation may also be the reason why melancholics are said to belong to the weakness category by the author of Mag. However, this offers no explanation for the prototypical use of hoi melan- cholikoi to refer to both the reckless type in Eth. As the authenticity of the Magna moralia is still disputed (see for the latest debate the works of Cooper (1973) 327–49 and Rowe (1975) 160–72), I will not go into this complication here (for the possible origin of the contradiction see n. Aristotle on melancholy 151 For people constantly feel pleasure in their youth because they are growing; con- versely, melancholics by nature constantly need to be cured (tŸn fÅsin ˆeª «atre©av d”ontai), for the ‘mixture’ of their bodies keeps them in a constant state of stim- ulation (t¼ säma dakn»menon diatele± tŸn krŽsin) and they are always subject to intense desires (kaª ˆeª –n sfodrŽ€ ½r”xei e«s©n). According to Aristotle the pain is driven out by pleasure, once it has gained sufficient strength, and therefore these people are undisciplined and bad (akolastoi kai phauloi) in the way they act. This is again a context in which the influence of the body on people’s moral behaviour is discussed (hence the remark about lack of discipline). Aristotle speaks about people who even perceive the normal state as painful due to their nature (dia ten¯ phusin), their physiological constitution. They might be said to be permanently ill,44 for their bodies are permanently ‘bitten’ (daknomenon)as a result of their ‘mixture’ (krasis). The word krasis, which plays an important part in Greek medicine and physiology,45 clearly refers to a physiological state. As Aristotle makes no mention of a mixture of humours anywhere else, but does mention a particular mixture of heat and cold as the basis for a healthy physical constitution,46 it is appropriate to think of a mixture of qualities. In this theory, melancholics are characterised by a mixture of heat and cold (either too cold or too hot) that is permanently out of balance, something which Aristotle clearly regards as a sign of disease. Further details about this physiological basis can be found in the only passage entirely devoted to bile (chole¯), in Part. According to Aristotle, bile is a residue (perittoma¯ ) without purpose (oÉc ™nek† tinov), and although nature sometimes makes good use of residues, this does not imply that we should expect everything to have a purpose. After all, there are many things that are necessarily by-products of things that do serve a purpose, but are themselves without purpose. On bile as a perittoma¯ Aristotle says a few lines further on (677 a 25): ‘when the blood is not entirely pure, bile will be generated as a residue, for residue is the opposite of food’. Bile appears to be a ‘purifying secretion’ (apokatharma), which is con- firmed by the saying in antiquity that people live longer if they do not have bile. Ogle (1910) is correct in translating chole¯as ‘gall bladder’ and whether it should not be understood as ‘bile’ until later. This characterisation returns several times in Aristotle’s writings on biology: Part. The chapter in Parts of Animals clearly states that the residues are themselves without purpose, but that nature sometimes uses them for a good purpose. This characterisation of yellow and black bile and phlegm54 as perittomata¯ plays a pivotal part in the question whether Aristotle adopted the Hippo- cratic theory of the four humours. However, there is no indication that these fluids in any combination form a kind of humoral system similar to the theory of the four humours in On the Nature of Man; the only place where three are mentioned together (viz. This itself shows that it is unlikely that Aristotle assigned them a role as important bodily fluids on which hu- man health depends. In addition, it should be pointed out that the notion of perittoma¯ does not appear in the Hippocratic Corpus and was probably not introduced into Greek medicine until the second half of the fourth century bce (perhaps by Aristotle himself, or by one of his students), after 52 Louis (1956) 189 n. Aristotle uses the Hippocratic typology phlegmatodes – cholodes¯ ¯ ¯ ¯ once, though not in a biological context (and in a passage of dubious authenticity: Metaph. We may conclude that the texts do not give detailed information on the physiological basis of Aristotle’s use of the term hoi melancholikoi.

It is common for infected women to • Varicella zoster virus (chickenpox) have no symptoms buy zithromax 500 mg amex. Also zithromax 250mg with amex, an chimera 1 An imaginary monster made up of infant can acquire the disease during passage incongruous parts purchase zithromax 100mg otc. Chlamydia is one of the reasons new- may be due to the fusion of two embryos at a very borns are routinely treated with antibiotic eyedrops. More commonly today, the Chlamydia can also cause inflammation of the ure- formation of a chimera is due to transplantation, thra, epididymis, and rectum in men. A chronic such as when bone marrow from one person is form of arthritis, called reactive arthritis, can used to reconstitute the bone marrow of an irradi- develop after chlamydia infection. Chloroform was once neering techniques are used to enclose therapeutic administered by inhalation to produce anesthesia, properties from one cell in another type of cell for given to relieve pain, and used as a remedy for delivery. There are two dinates all of the body’s functions and that disease choanae, one on either side of the nose. Chocolate is rich in flavinoids, compounds misalignment and nerve pressure can cause prob- that act as antioxidants. Flavinoids may also lower lems not only in the local area, but also at some dis- blood pressure and improve blood flow by opening tance from it. Thus, chocolate may have health ben- effective for muscle spasms of the back and neck, efits, provided it is consumed in moderation. Not all chiropractors cholangitis, primary sclerosing See primary are alike in their practice. With modern sanitation, cholera is no longer as common as it cholesterol, lowering with niacin Niacin, also once was, but epidemics still occur whenever peo- known as nicotinic acid, is a water-soluble B vitamin ple must live in crowded and unsanitary conditions, that improves levels of all lipoproteins when given in such as in refugee camps. A common and troublesome side effect of niacin is flushing, or hot flashes, which is a result of cholescintigraphy A diagnostic test in which a the widening of blood vessels. Most patients develop two-dimensional picture of a radiation source in the a tolerance for flushing, and in some patients it can biliary system is obtained through the use of be decreased by taking the drug during or after radioisotopes. The test is used to examine the biliary meals or by the use of aspirin or other similar med- system and diagnose obstruction of the bile ducts ications prescribed by a physician. Cholesterol has a reputation for being of peptic ulcers have been seen in some patients associated with an increased risk for heart and who use niacin. However, cholesterol is essen- liver problems, gout, and high blood sugar; risk of tial to the formation of bile acids, vitamin D, prog- these complications increases as the dose of niacin esterone, estrogens (estradiol, estrone, estriol), increases. This can ability and function of the membranes that surround lead to inflammation of the gallbladder (cholecysti- cells. Chondrocalcinosis can be associated with the diet, most cholesterol is made in the liver and degenerative arthritis, pseudogout, hemochromato- other tissues. The treatment of elevated cholesterol sis, hyperparathyroidism, diabetes, hypomagne- involves not only diet but also weight loss, regular semia, and Wilson’s disease. Large chorioangiomas can cause complications, including excess amniotic chondroplasia The formation of cartilage by fluid (polyhydramnios), maternal and fetal clotting specialized cells called chondrocytes. Chondrosarcoma act as shunts between arteries and veins (arteriove- can be primary or secondary. Primary chondrosar- nous shunts), leading to progressive heart failure of coma forms in bone and is a disease in children. Secondary chondrosarcoma arises from a preexist- ing benign defect of cartilage (such as an osteo- choriocarcinoma A highly malignant tumor that chondroma or enchondroma), usually after age 40. The prognosis for women with metastatic chorda tendinea A thread-like band of fibrous choriocarcinoma has improved with the advent of tissue that attaches on one end to the edge of the tri- multidrug chemotherapy. The chorion develops villi (vascular (the seventh cranial nerve) that serves the taste finger-like projections) and develops into the pla- buds in the front of the tongue, runs through the centa. The chorda tympani is part of one of three cranial chorionic gonadotropin, human See human nerves involved in taste. The term eye behind the retina, either in its entirety (multifo- chorea is derived from the Greek word choreia, cal choroiditis) or in patches (focal choroiditis). The two chromatids are at first joined together by a centromere, and then they separate, with each chro- chorioamnionitis Inflammation of the chorion matid becoming a chromosome. Chorioamnionitis usually is associated with a chromatography, gas An automated technique bacterial infection. This may be due to bacteria for separating mixtures of substances in which the ascending from the mother’s genital tract into the mixture to be analyzed is vaporized and carried by http://www. Metaphase chromosomes are often chosen which objects appear abnormally colored to the for karyotyping and chromosome analysis. These arms are for analysis via resolution chromosome banding separated from each other only by the centromere, when it is important to detect minute details. The 3 chromosome, sex The X or Y chromosome in billion base pairs in the human genome are organ- humans. Generally the nucleus of a human cell contains two sets of chro- chromosome, X The sex chromosome found mosomes—one set given by each parent. Each set twice in normal females and once, along with a Y has 23 single chromosomes: 22 autosomes and an chromosome, in normal males. Once thought to be a genetic wasteland, the Y chro- mosome is now known to contain at least 20 genes. Humans have five pairs of acrocentric male fitness genes that are active only in the testis chromosomes. Down syndrome is due to an extra and that are thought to be responsible for the for- acrocentric chromosome (chromosome 21). Other genes on the Y chromosome have counterparts on the X chromosome, are active chromosome, autosomal Any chromosome in many body tissues, and play crucial “housekeep- other than a sex chromosome (X or Y chromo- ing” roles within cells. In humans, the normal abnormal in that it has two centromeres rather than chromosome complement consists of 46 chromo- one. Because the centromere is essential for chro- somes, including the 2 sex chromosomes. This causes the chromosome to form a bridge and then chromosome disorder An abnormal condition break and be unstable. For example, Down syndrome is a chromo- chromosome, marker An abnormal chromo- some disorder caused by the presence of an extra some that is distinctive in appearance but not fully copy of chromosome 21, and Turner syndrome is identified. A marker chromosome is not necessarily most often due to the presence of only a single sex a marker for a specific disease or abnormality, but chromosome: one X chromosome.

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The diagnosis of leukaemia can be suspected on seeing blast cells on the blood smear confirmed on bone marrow biopsy cheap zithromax 100 mg on line, which will show replacement by leukaemic lymphoblasts discount zithromax 100 mg line. The treatment varies with the clinical risk features; children under 2 3 years and over 10 years with an initial white blood cell count of over 100 buy zithromax 500mg visa,000/mm and central nervous system involvement (leukaemic cells in the cerebrospinal fluid) have the worst prognosis. Key Points Childhood leukaemia: • 75% is acute lymphocytic leukaemia; • peak incidence at 4 years of age; • dentists can help early diagnosis, alerted by mucosal haemorrhage, and mouth and throat infections. Dental management of leukaemia In common with other medically compromising conditions, children with leukaemia are categorized as having a high risk of dental caries. Unless there is a dental emergency no elective operative dental treatment should be carried out until the child is in remission. The drug regimen used to induce remission has numerous side-effects, including nausea and vomiting, reversible alopecia (hair loss), neuropathy, and, most importantly from a dental point of view, oral ulceration (mucositis). It can be extremely difficult to carry out normal mouth care for children at this stage and many have difficulty with toothbrushing due to acute nausea. Swabbing the mouth with chlorhexidine mouthwash and the routine use of antifungal agents are essential. Local anaesthesia preparations such as 5% lignocaine (lidocaine) ointment, 20% flavoured benzocaine, or benzydamine hydrochloride (Difflam) applied before mealtimes can help to reduce the pain from ulceration or mucositis. If invasive procedures are planned then current haematological information is required to assess bleeding risks. Prophylactic antibiotic therapy to prevent postoperative infection should be considered. Children who are immunosuppressed are also at risk of fungal and viral infections. Fungal infections should be treated aggressively with amphotericin B, nystatin, or fluconazole, and herpetic infections with topical and/or systemic acyclovir. Regional block anaesthesia may be contraindicated due to the risk of deep haemorrhage. A typical protocol might include: While in hospital (paediatric dentistry specialist): • Relief of mucositis: Difflam mouthwash, topical anaesthesia, antibiotic pastilles, ice chips. Key Points • Oral side-effects of chemotherapy: ⎯mucositis, oral ulceration; ⎯infection (leucopenia); ⎯haemorrhage (thrombocytopenia). This oral presentation and type of leukaemia is less common than the lymphocytic type shown in Fig. For example, the relatively short eustachian tube in infants and young children allows easy access to ascending infections from the pharynx. Cystic fibrosis largely affects Caucasians, whereas lung infections and infarctions associated with sickle-cell disease occur almost exclusively in Black children. Seasonal variation in the incidence of respiratory tract infections and asthma are quite marked and certain infections have a well-defined geographical distribution. The frequency of bronchitis may not be very different between socio- economic groups, but the severity may reflect differences in nutritional status and perhaps the availability of medical care. It is associated with hyperreactivity of the airways to a variety of stimuli and a high degree of reversibility of the obstructive process. Prevalence data are conflicting, but at least 10% of children will, at some time, have signs and symptoms compatible with a diagnosis of asthma. Before puberty approximately twice as many boys as girls will suffer from asthma, thereafter, the sex incidence is similar. About half the children who are affected will be virtually free of symptoms by the time they become adults. The aetiology is poorly understood but it is a complex disorder involving immunological, infectious, biochemical, genetic, and psychological factors. Acute episodes of coughing and wheezing are often precipitated by exposure to allergens and irritants, such as cold air or noxious fumes and emotional stress. Drug therapy is now the mainstay of treatment both prophylactically and during acute exacerbations. Dental management of asthma Dental treatment itself can cause emotional stress, which may precipitate an attack. Routine dental care with local anaesthesia is not usually a problem; if in doubt, invite the child to take a puff of their inhaler before commencing. Steroid inhalers for asthma do not generally cause adrenal suppression and insufficiency. However, there is recent evidence that some of the newer generation of steroid inhalers may cause suppression. General anaesthesia for severe asthmatics usually requires in-patient hospital admission. Key Points Of relevence to the dental management of asthma: • Erosion due to ⎯reflux; ⎯increase consumption of acidic beverages. Thick viscid mucus is produced, particularly in the lungs, which leads to chronic obstruction and infection of the airways and to malabsorption. It is the most common genetic condition in Caucasians, with approximately 5% of the population being carriers and 1 in 2000 of live births affected. The clinical manifestations of the condition are variable and some patients remain asymptomatic for long periods. Coughing is the most constant symptom of pulmonary involvement and this may lead to recurrent respiratory infections and bronchiolitis. Lung disease progresses leading to exercise intolerance and shortness of breath (Fig. More than 85% of affected children show evidence of malabsorption due to exocrine pancreatic insufficiency. Symptoms include frequent, bulky, greasy stools and a failure to thrive despite a large food intake. Dental management of cystic fibrosis There are reports of decreased caries prevalence attributable not only to the long term use of antibiotics and pancreatic enzyme supplements but also to increased salivary buffering. Nevertheless, these children suffer from delayed dental development; more commonly have enamel opacities and are more prone to calculus. Moreover, they need to have a very high calorific intake and may have frequent refined carbohydrate snacks. As such, children with cystic fibrosis are an important priority group for dental health education and care. A significant proportion of affected children also have cirrhosis of the liver, with resultant clotting defects and a liability to haemorrhage following surgical procedures.