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Con- Republic of Korea trusted 300mg oxcarbazepine, 3Soonchunhyang University cheap 150mg oxcarbazepine fast delivery, Division of Mo- clusion: As for the shoulder complex motion with natural trunk lecular Cancer Research in Soonchunhyang Medical Research In- motion in healthy males, w-Sinus was found to be approximately stitute, Cheonan, Republic of Korea 1. For future evaluation of compensatory trunk Introduction/Background: Diabetic skin is known to have defcient motion in shoulder motion of patient, this value could be used as wound healing properties, but little is known of its intrinsic biome- reference-value for normal range. We hypothesize that diabetic skin has inferior biomechanical properties at baseline, rendering it more prone to injury. Results: At ment of Rehabilitation-, Hengyang, China, 2West China Hospital- baseline, human diabetic skin was biomechanically inferior com- Sichuan University, Department of Rehabilitation, Chengdu, China pared to nondiabetic skin, with excessive distensibility (p<0. Material and Methods: Sixty female Sprague-Dawley trix were signifcantly higher in diabetic skin (p<0. In the frst batch, the rats were randomly divided into three involved in collagen metabolism were detected only in the diabetic groups (n=10): sham-operated (Sham-0 group), ovariectomized skin. Although it is a well- ate School of Medicine, Internal Medicine and Rehabilitation Sci- known swallowing exercise, its physiological mechanism is not ence, Sendai, Japan fully understood. This demonstrates the need for further study of evidence of renal damage was alleviated in response to exercise. Material and Methods: Prospective, Introduction/Background: People with stroke usually have defcits longitudinal and descriptive study from Mar to Jul 2014 in a Cardiac in locomotion skills because of hemiparetic disabilities. Research has shown that gaiting training could improve calisthenic program which lasted 4 weeks (12 sessions mínimum). Thus, the purpose of this study was to inves- Eventually, the stress test was performed again. Results: 5 patients tigate if the gait training had an effect on balance ability of stroke where included. Material and Methods: 21 stroke patients participated in the frst exercise test where from 3. At the end of minutes per day, three times a week for six weeks, and the control the program, the 5 where class Ib. This training effect obtained in this study 2 1 may have helped the patients stood stably. Introduction/Background: Retaining gait ability is critically impor- tant for patients with severe hemiplegia after stroke. Kob- tients from gait training because the motion of knee joint is quite ayashi2 different between these orthosis. Material and Methods: A 50-year old, male patient with se- vere hemiplegia on the left side was transferred to our convalescent Introduction/Background: Local cryotherapy is effective for the rehabilitation hospital at day 52. Conclusion: This case suggests that gait train- score) at pre-operatively and 28 days after surgery and the walk- ing with transitional settings of knee-joint motion may facilitate ing speed at pre-operatively 2weeks and 1month after surgery. There is effect of re- and total hemoglobin in the muscle were measured before and after sistance exercise to disuse atrophy in increasing the soleus muscle the 15-minutes intervention, together with the temperature at the skin fber diameter of Rattus novergicus. The local blood circu- lation and tissue temperature were followed until 30 minutes after the intervention and collected at the interval of 5 minutes. Exclusion criteria were previous stroke, preceding epilepsy, severe cognitive impairments, seri- 898 ous cardiac or orthopedic problems, or metallic implants. Results: The intervention 1 2 2 2 was completed for all 4 patients with right hemiplegia. During immobi- lization, protein synthesis and the amount of myofbrils fbers de- creases. First group received elec- 1Hyogo College of Medicine Hospital, Rehabilitation, Nishinomi- trical stimulation with frequency of 2 Hz, 2 × 3 hours/day with ya, Japan, 2Ssayama Medical Center Hyogo College of Medicine, 2-hours rest in between. Second group was given resistance ex- Rehabilitation, Sasayama, Japan, 3Hyogo College of Medicine, ercise, i. Third group was given the frst groups treatments as well as the second groups treatments. Introduction/Background: An important goal for stroke patients is In the end, soleus muscle was taken-turned into histopathology the recovery of gait performance, because almost all stroke patients preparation,stained with Hematoxylin eosin. In the Japanese guidelines for stroke soleus muscle fbers were measured using micrometer 400 × mag- rehabilitation, the effect of rehabilitation with functional electrical nifcation. Material and Methods: Study participants were stroke patients with recent stroke onset within 6 months or more. Staff results are best summarized as follows: ogy- and Biotechnology -Faculty of Sciences-, Kenitra, Morocco “The patients and family … have expressed the class has many pos- Introduction/Background: Brain vulnerability to infammation is itive … and lasting effects - more relaxed, sleep better, feel more high during the early postnatal age and perinatal infection could connected with themselves or their loved ones, less pain, and more result in long-lasting neuropsychiatric disorders, including autism motivated. In overall patient experience while providing low cost self-help skills the present study, we have assessed the effcacy of an extract of with the potential for long-term carry over. Material and Methods: the program has expanded to all units in the frst rehab hospital, and To counteract hippocampal microglia activation and depressive- to three more rehab hospitals in the same healthcare system. Moreover, we and Engineering, Taoyuan, Taiwan, Taipei Veterans General Hos- demonstrate for the frst time, that Thymelaea lythroides, similarly pital, Physical Medicine and Rehabilitation Department, Taipei, J Rehabil Med Suppl 55 Poster Abstracts 263 Taiwan, 3National Central University, Department of Computer (p>0. Conclusion: The rehabilitation therapies could modify the disability after stroke.

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The risk of cancer of the esophagus is throleukemia 300 mg oxcarbazepine amex, the body produces large numbers of increased by long-term irritation of the esophagus oxcarbazepine 300 mg with mastercard, abnormal, immature red blood cells. Very small tumors in the esoph- erythromycin An antibiotic that is commonly agus usually do not cause symptoms. Erythromycin grows, the most common symptom is difficulty in prevents bacteria from producing proteins and swallowing. There may be a feeling of fullness, pres- interferes with bacterial growth and multiplication. Cancer of the esophagus can also cause indigestion, heartburn, vomiting, and frequent choking on food. Treatment includes chemother- esophagogastroduodenoscopy See endoscopy, apy and sometimes surgery. In an adult, the esophagus obstruction of the esophagus occurs when food is about 25 centimeters (10 inches) long. Attempts to relieve the obstruction by induc- Glands in the lining of the esophagus produce ing vomiting at home are usually unsuccessful. Endoscopy is usually used to retrieve the obstruc- esotropia A condition in which a person is tion and relieve the condition. When linoleic acid is loon is then inflated, thereby opening the narrowing obtained in the diet, it can be converted to both caused by the stricture. Linoleic acid is inserting tapered dilators of different sizes through the commonly found in cold-pressed oils, especially mouth and into the esophagus to dilate the stricture. However, arachnoidic acid may lower the digestive juices secreted by the stomach cells. Ulcer pain may not correlate with the presence or essential oil An oil derived from a natural sub- severity of ulceration. Diagnosis is made through bar- stance, usually either for its healing properties or as ium X-ray or endoscopy. Treatment includes the-counter or “holistic” remedies, are based on or using antibiotics to eradicate H. Eugenics is from a helps control and guide sexual development, includ- Greek word meaning “normal genes. It Albert Einstein’s sperm to conceive a child by artifi- also influences the course of ovulation in the monthly cial insemination would represent an attempt at menstrual cycle, lactation after pregnancy, aspects of positive eugenics. It is changes naturally over the female lifespan, reaching important to note that no experiment in eugenics adult levels with the onset of puberty (menarche) and has ever been shown to result in measurable decreasing in middle age until the onset of improvements in human health. Estrogen deficiency can lead to lack of menstruation (amenorrhea), persistent difficulties eukaryote An organism that consists of one or associated with menopause (such as mood swings more cells with a nucleus and other well-developed and vaginal dryness), and osteoporosis in older age. Eukaryotes include all organisms In cases of estrogen deficiency, natural and synthetic except bacteria, viruses, and blue-green algae, estrogen preparations may be prescribed. In humans, the euploid number of chromosomes is 46; with the notable exception of estrogen-associated blood clots See estro- the unfertilized egg and sperm, in which it is 23. Eustachian tube The tube that runs from the estrogen-associated hypercoagulability middle ear to the pharynx. The function of the Hyper-coagulable blood (a supranormal tendency Eustachian tube is to protect, aerate, and drain the for blood to clot) occurs as an occasional but seri- middle ear and mastoid. The blood clots mits the gas pressure in the middle ear cavity to in this situation are dose-related; that is, they occur adjust to external air pressure. All descending in an airplane, the Eustachian tube estrogen therapy preparations carry this risk. Eustachian tube can lead to the development of mid- dle ear infection (otitis media). The Eustachian tube measures only 17 to 18 mm, and it is horizontal at etiology The study of causes, as in the causes of a birth. In medicine, exacer- opening in an adult is significantly below the tym- bation may refer to an increase in the severity of a panic opening, found in the middle ear near the disease or its signs and symptoms. The shorter length and the horizontal ori- exacerbation of asthma might occur as a serious entation of the Eustachian tube in infancy protects effect of air pollution, leading to shortness of breath. The Eustachian tube in the adult is opened by two muscles, the tensor palati exam, rectal See digital rectal exam. Also known contrast, a rash on the inside of the body (for exam- as otopharyngeal tube because it connects the ear to ple, inside the mouth) is called enanthem. For example, a scalpel evening primrose oil A natural source of essen- or laser beam may be used to excise a tumor. Exclamation grate clinical expertise with the research evidence point hair is a key diagnostic finding in a disorder and patient values. An exercise treadmill permits the detection of unique and essential: There is not an extra copy of abnormal heart rhythms (arrhythmias) and pro- that gene with which evolution can tinker, and vides a screening test for the presence of narrowed changes in the gene are likely to be lethal.

The results of this test will enable physicians to individualize treatment of their patients by discerning whether a patient has a genetic basis for lactose intolerance or if their symptoms are related to another disease or disorder discount 300mg oxcarbazepine visa. Personalized Geriatrics Geriatrics discount oxcarbazepine 150mg on-line, the branch of medicine dealing with disorders of elderly, is a recognized sub-specialty. There is no separate chapter on geriatrics in this book as many of the diseases described in various chapters of this book occur at various ages from infancy to old age although some occur more commonly in the elderly. This section will point out some issues that should be taken in consideration in personalized management of the elderly patients. Prevalence of both therapeutic failures and adverse drug reactions are signifi- cantly higher in older subjects. This might be due to higher incidence of polyphar- macy and multiple co-existing diseases. There are alterations in metabolism and pharmacokinetics due to impairment of renal and hepatic functions that are common in the elderly. Chronological vs Biological Age In conventional medicine, most of the physiological parameters and laboratory val- ues are based on chronological age of the patient. An elderly patient undergoing pulmonary or cardiovascular investigation that slight impairment of performance is Universal Free E-Book Store Personalized Management of Skin Disorders 569 still within the norm for his or age whereas prior to illness, the performance might have been >50 % as compared to average persons of his age. People age at different rates depending on several factors including genetic, environmental and life style. A physical active 70-year old may have been performing at the level of a 50-year old prior to onset of disease. In spite of slight impairment of function, his performance may still be within the normal range for his chronological age but may indicate early disease. This factor may be overlooked by the physician but a personalized approach takes this into consideration as a person is his or her own control even within the span of time. Pharmacogenetics and Adverse Drug Reactions Prevalence of both therapeutic failures and adverse drug reactions are significantly higher in older than in younger subjects. This might be due to higher use of poly- pharmacy and multiple co-existing diseases in the elderly. There are alterations in metabolism and pharma- cokinetics due to impairment of renal and hepatic functions that are common in the elderly. Pharmacogenetics of drug metabolizing enzymes, drug transporters and receptors should not be overlooked. Personalized Management of Skin Disorders There is an overlap between cosmetics, skin care and therapy of skin disorders. Everything from ancient herbs to sheep placentas has been used to make skin care products. The test and the sample are sent to a laboratory to be analyzed and the customized skin creams are generated based on the results. Another issue is privacy because the swabs taken at the shops contain a complete set of an individual’s genetic information including genes relevant to several diseases. Universal Free E-Book Store 570 18 Personalized Approaches to Miscellaneous Problems in Healthcare Lab 21 says they’ll keep all genetic information private, and their Web site claims the genetic samples are destroyed immediately after the analysis is complete. Tests are designed to assess genetic risks for certain skin disorders due to nutritional deficiencies and provide a basis for recommending for- mulations that have been specifically designed to compensate for these deficiencies. Management of Hair Loss Based on Genetic Testing Androgenetic alopecia occurs with increasing phenotypic expression based on advancing age, approximately 65 % men and 50 % of women will be affected by the age of 60. Clinical diagnosis relies largely on the development of a hair loss pattern, and visible areas of thinning or baldness, which is not apparent until approximately 50 % of hair are lost in a given area. Therefore, a screening test for androgenetic alopecia which identifies patients at higher risk for developing it can offer the opportunity for early medical intervention prior to visible signs of hair loss. An association between male pattern baldness and the androgen receptor gene has been confirmed (Levy-Nissenbaum et al. Personalized Preventive Medicine Genomics and genetics are vital for the development of preventive medicine. Current practice of preventive healthcare involves general advice applicable to pop- ulation at large, e. Integration of new genetic information into epidemiologic studies can help clarify causal relations between both life-style and genetic factors and risks of disease. An example is pre- vention of atherosclerosis where multiple factors interplay in the etiology. Since atherosclerosis involves arterial inflammation, a polymorphism in the 5- lipoxygenase gene promoter could relate to atherosclerosis in humans and that this effect could interact with the dietary intake of competing 5-lipoxygenase substrates. Universal Free E-Book Store Female Sexual Dysfunction 571 Inflammatory mediators, leukotrienes, are generated from arachidonic acid (polyunsaturated n-6 fatty acid) by the enzyme 5-lipoxygenase. Variant 5-lipoxy- genase genotypes have been found in persons with increased atherosclerosis sug- gesting that dietary n-6 polyunsaturated fatty acids promote, whereas marine n-3 fatty acids inhibit, leukotriene-mediated inflammation that leads to atherosclerosis in these persons.

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The early symptoms of pellagra include an- orexia buy 600 mg oxcarbazepine, irritability order oxcarbazepine 150mg visa, abdominal pain and vomiting, and glossitis. Hypertonic dextrose stimulates a much higher insulin level than normal feeding, which is evident on hospital day 9 in this scenario. Hyperinsulinemia stimulates antinatriuretic and antidiuretic hormone, which leads to sodium and fluid retention as well as increased intracellular transport of potassium, magnesium, and phosphorus. It is not uncommon to see an increase in weight and a low urine sodium in patients with normal renal function. Reducing the overall glucose content will also abate the need for higher insulin level. It is not useful clinically for estimating nutritional adequacy because it is a median re- quirement for a group; 50% of the individuals in a group fall below the requirement and 50% fall above it. Data on the tolerable upper limit of a vitamin are usually inadequate to establish a value for upper limit of tolerability. The absence of a published tolerable upper limit does not imply that the risks are nonexistent. Serum cortisol and 24-h urine free cortisol are generally elevated without the expected clinical consequences of hypercortisolism. Patients with the nonpurging subtype tend to be heavier and are less prone to electrolyte disturbances. Patients with the purging subtype are more emotionally labile and tend to have other problems with impulse control such as illicit drug abuse. Hypochromic anemia can be seen in a number of vitamin deficiency/excess disorders, including zinc toxicity and cop- per deficiency. Mortality amongst vitamin A–deficient children is substantially higher when infected with diar- rhea, dysentery, measles, malaria, or respiratory disease. Autoim- mune neutropenia may account for the repeated bouts of infection, but the constellation of Bitot’s spots and recurrent infection argues against this as the cause. Vitamin B1 (thiamine) deficiency causes beri-beri, which is associated with high output cardiac failure or peripheral neuropathy. During the first day of a fast, most energy needs are met by consumption of liver glycogen. During longer fasting, resting energy ex- penditure will decrease by up to 25% (provided there is no ongoing inflammation). In the presence of water intake and no inflammation, a normal individual may fast for months. A well-nourished individual can tolerate ~7 days of starvation while experienc- ing a systemic response to inflammation. The hiker in this scenario has starved for 6 days and, except for mild acute renal failure, he has compensated well for his starvation. Greater than 10% weight loss in 6 months represents significant protein-calorie malnu- trition. Effective pre- ventive measures include elevating the head of the bed to 30°, nurse-directed algorithms for formula advancement, combining enteral and parenteral feeding, and using post- ligament of Treitz feeding. Recent studies have suggested that constant suction above the endotracheal cuff may reduce ventilator-associated pneumonia. The presence of electrolyte disturbances confers an in- creased morbidity for both disorders. However, many pa- tients have persistent difficulties with weight maintenance, depression, and eating distur- bances. Approximately 5% of patients die per decade, usually due to the physical effects of chronic starvation or from suicide. Virtually all of the physiologic derangements asso- ciated with anorexia nervosa will improve with weight gain. Psychological health also improves with successful treat- ment, although these patients remain at risk for depression, recurrence, and development of bulimia nervosa. Which of the following statements regarding incidence studies are notable for an elevated alkaline phosphatase. A chemical toxin produced by Aspergillus species, Which of the following malignancies is most likely? Nonalcoholic steatohepatitis is not associated with an increased risk for hepatocellular carcinogen. The risk of developing hepatocellular carcinoma in individuals with hepatitis C infection is 50%. Variegate porphyria 55 Copyright © 2008, 2005, 2001, 1998, 1994, 1991, 1987 by The McGraw-Hill Companies, Inc.

The latter would be considered only in scenarios where anti- coagulation is not possible purchase 150 mg oxcarbazepine free shipping. Women with gestational diabetes are at increased risk of preeclampsia proven oxcarbazepine 150 mg, delivering infants large for gestational age, and birth lacerations. Not performing diabetes screening during preg- nancy should be considered only in low-risk patients (age <25, no obesity, no history of gestational or other diabetes, no diabetes in first-degree relatives). The history and physical exami- nation should focus on detecting symptoms or signs of occult cardiac or pulmonary disease. Preoperative laboratory testing should be carried out for specific conditions based on the clinical examination. There is no proven role for chest radiograph in this context provided that the cardiopulmonary history and physical examination are within nor- mal limits. A patient with none of the risk factors has a <1% chance of a postoperative major cardiac event. Patients with three of the criteria have a 10% chance of having a cardiac event in the perioperative or intraoperative period. This is therefore considered an appropriate cut-off point for noninvasive cardiac imag- ing/stress testing to occur. While their positive predictive value is poor, they have excellent negative predictive value for identifying patients at risk for perioperative myocardial infarction or death. The pa- tient is on adequate medical therapy for his ischemic cardiomyopathy but nevertheless had a very high-risk stress test. He should proceed to cardiac catheterization for either endovascular stenting or referral to bypass surgery. Stepwise clinical evaluation: [1] Emergency surgery; [2] Prior coronary revasculariza- tion; [3] Prior coronary evaluation; [4] Clinical assessment; [5] Revised cardiac risk index; [6] Risk modi- fication strategies. Axial stiffness, stooped posture, shuffling gait, and pill- rolling tremor are distinctive. Other progressive neurologic disorders such as those listed above may present with Parkinsonian features. The atypical Parkinsonian syndromes can be difficult to differentiate from Parkinson’s disease. However, the presence of a pill- rolling tremor is specific for Parkinson’s disease. However, unlike patients with inner ear dysfunction, these symptoms are usually not associated 32 I. Frontal gait disorder or gait apraxia is common in the elderly and has a variety of causes. Typical features include a wide base of support, short strides, shuffling, and difficulty with starts and turns. The most common cause of frontal gait is subcortical small-vessel cerebrovascular disease. Patients with Par- kinsonian syndromes have a shuffling gait, with difficulty initiating and turning en bloc. Patients have a narrow base and look down; their gait is regular with path deviation. The narrow-based gait with no difficulty initiating gait and normal strength is consistent with sensory ataxia. Classically this was caused by tabes dorsalis, although vitamin B12 deficiency is a treatable disease that may present with this form of neurop- athy and gait disorder. This suspicion is even greater in the context of a macrocytic anemia, a finding that is consistent with vitamin B12 deficiency. Further signs of im- paired proprioception, such as decreased ability to sense joint position, are even more suggestive of the diagnosis. Cerebrovascular disease may present with a frontal gait disorder that is charac- terized by a wide-based, slow, shuffling gait. Parkinson’s disease also causes a shuffling gait with difficulty initiating and turning en bloc. Amyotrophic lateral sclerosis does not cause a sensory or proprioceptive neuropathy but will alter gait due to muscle weakness. Though two-point discrimination is a common screening technique for cortical sensory deficits, each of the above techniques is a quick and helpful alternative to evaluate for a cortical sensory deficit. Two-point discrimination is best tested with a set of calipers that simultaneously touch the skin. Normally, one can distinguish 3-mm separation of points on the pads of the fingers. Touch localization is performed by having the patient close his or her eyes and identify the site of the examiner touching the patient lightly (with finger or cotton swab). As the response is only abnormal when light is shone in her left eye, this implies an afferent defect in that eye mediated by retinal or optic nerve damage.

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Potassium-sparing diuretics are used to avoid potassium depletion order oxcarbazepine 300mg online, especially when adminis- tered with cardiac glycosides 150 mg oxcarbazepine for sale. Propranolol (Inderal) (1) Propranolol antagonizes catecholamine action at both b1- and b2-receptors. Nadolol (Corgard), timolol (Blocadren), carteolol (Cartrol), pindolol (Visken), penbutolol (Levatol) (1) These drugs are similar in action to propranolol and block both b1- and b2- adrenoceptors. Metoprolol (Lopressor), atenolol (Tenormin), acebutolol (Sectral), bisprolol (Zebeta) (1) These drugs are relatively selective for b1-adrenoceptors. The effectiveness of these drugs diminishes in some patients because of tolerance. Phentolamine is administered parenterally; phenoxybenzamine is administered orally. Labetalol is useful for treating hypertensive emergencies and in the treatment of hyperten- sion of pheochromocytoma. Carvedilol has a significantly greater ratio of b to a antagonist activity than labetalol. When combined with a b-adrenoceptor antagonist, these agents may lower blood pressure to a greater extent than when either class of drug is administered separately. Centrally acting sympathomimetic agents reduce peripheral resistance, inhibit cardiac func- tion, and increase pooling in capacitance venules. Methyldopa (Aldomet) (1) Methyldopa has an active metabolite, a-methylnorepinephrine, a potent false neurotransmitter. Guanabenz acetate (Wytensin) (1) Guanabenz acetate activates central a2-adrenoceptors and inhibits sympathetic outflow from the brain, which results in reduced blood pressure. Reserpine (1) Reserpine eliminates norepinephrine release in response to nerve impulse by prevent- ing vesicular uptake. It depletes norepinephrine from sympathetic nerve terminals in the periphery and in the adrenal medulla. Mental depression, sometimes severe, may result, especially with high doses; use of reserpine is contraindicated in patients with a history of depression. Vasodilators relax smooth muscle and lower total peripheral resistance, thereby lowering blood pressure. This effect is probably mediated by increasing K+ efflux and decreasing Ca2+ influx, and increasing the production of nitric oxide. Minoxidil acts to increase K+ efflux, which hyperpolarizes cells and reduces the activity of L-type (voltage-sensitive) cal- cium channels. The accumula- tion of cyanide and risk of toxicity are minimized by concomitant administration of sodium thiosulfate or hydroxocobalamin. Administered by infusion, it is a useful drug in the control of emergency hypertension. Drugs used to treat pulmonary hypertension (1) Ambrisentan (Letaris) is a selective endothelin A receptor antagonist used to treat pul- mory hypertension. Drugs used to treat erectile dysfunction (1) Drugs in this class include sildenafil citrate (Viagra, Revatio), tadalafil (Cialis), and var- denafil hydrochloride (Levitra). Chapter 4 Drugs Acting on the Cardiovascular System 91 (2) Viagra was originally developed as an antianginal and antihypertensive agent but proved very effective in treating erectile dysfunction. The most serious adverse effects are cardiovascular: arrhythmias, heart block, cardiac arrest, stroke, and hypotension. Dietary or pharmacologic reduction of elevated plasma cholesterol levels can reduce the risk of atherosclerosis and subsequent cardiovascular disease. The exact factors linking elevated cho- lesterol levels to heart disease are not yet known. The association between cardiovascular disease and elevated plasma triglycerides is less dra- matic, but it is becoming more recognized. Cholesterol is a nonpolar, poorly water-soluble substance, transported in the plasma in par- ticles that have a hydrophobic core of cholesteryl esters and triglycerides surrounded by a coat of phospholipids, free cholesterol (nonesterified), and one or more apoproteins. Diseases of plasma lipids can be manifest as an elevation in triglycerides or as an elevation in cholesterol. In several of the complex or combined hyperlipoproteinemias, both triglyc- erides and cholesterol can be elevated. These drugs include lovastatin (mevinolin) (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), and fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor). Inhibitors of cholesterol biosynthesis are effective in reducing choles- terol levels in familial and nonfamilial hypercholesterolemias. These drugs may also interfere with in- tracellular localization of certain oncogenes and thereby reduce the incidence of some cancers. Mechanism (1) Nicotinic acid can exert cholesterol- and triglyceride-lowering effects at high concentra- tions (nicotinamide cannot do this).

Aristotle himself was the son of a distinguished court physician and had a keen interest in medicine and biology purchase 600 mg oxcarbazepine with amex, which was further developed by the members of his school cheap oxcarbazepine 150 mg overnight delivery. Aristotle and his followers were well aware of earlier and contemporary medical thought (Hippocratic Corpus, Diocles of Carystus) and readily acknowledged the extent to which doctors con- tributed to the study of nature. This attitude was reflected in the reception of medical ideas in their own research and in the interest they took in the historical development of medicine. It was further reflected in the extent to which developments in Hellenistic and Imperial medicine (especially the Alexandrian anatomists and Galen) were incorporated in the later history of Aristotelianism and in the interpretation of Aristotle’s works in late anti- quity. Aristotelianism in turn exercised a powerful influence on Hellenistic and Galenic medicine and its subsequent reception in the Middle Ages and early modern period. Introduction 15 Yet although all the above may seem uncontroversial, the relationship between Aristotelianism and medicine has long been a neglected area in scholarship on ancient medicine. The medical background of Aristotle’s biological and physiological theories has long been underestimated by a majority of Aristotelian scholars – and if it was considered at all, it tended to be subject to gross simplification. These attitudes appear to have been based on what I regard as a misun- derstanding of the Aristotelian view on the status of medicine as a science and its relationship to biology and physics, and on the erroneous belief that no independent medical research took place within the Aristotelian school. Aristotle’s distinction between theoretical and practical sciences is sometimes believed to imply that, while doctors were primarily concerned with practical application, philosophers only took a theoretical interest in medical subjects. It is true that Aristotle was one of the first to spell out the differences between medicine and natural philosophy; but, as I argue in chapters 6 and 9, it is often ignored that the point of the passages in which he does so is to stress the substantial overlap that existed between the two areas. And Aristotle is making this point in the context of a theoretical, physicist account of psycho-physical functions, where he is wearing the hat of the phusikos, the ‘student of nature’; but this seems not to have prevented him from dealing with more specialised medical topics in different, more ‘practical’ contexts. That such more practical, specialised treatments existed is suggested by the fact that in the indirect tradition Aristotle is credited with several writings on medical themes and with a number of doctrines on rather specialised medical topics. And as I argue in chapter 9, one of those medical works may well be identical to the text that survives in the form of book 10 of his History of Animals. Such a project would first of all have to cover the reception, transformation and further development of medical knowledge in the works of Aristotle and the early Peripatetic school. This would comprise a study of Aristotle’s views on the status of medicine, his characterisation of medicine and medical practice, and his use and further development of medical knowledge in the areas of anatomy, physiology and embryology; and it would also have to comprise the (largely neglected) medical works of the early Peripatos, such as the medical sections of the Problemata and the treatise On Breath, as well as the works of Theophrastus and Strato on human physiology, pathology and embryology. It would further have to examine the development of medical thought in the Peripatetic school in the Hellenistic period and the reception of Aristotelian thought in the major Hellenistic medical systems of Praxago- ras, Herophilus, Erasistratus and the Empiricists. Thirdly, it would have to cover the more striking aspects of Galen’s Aristotelianism, such as the role of Aristotelian terminology, methodology, philosophy of science, and tele- ological explanation in Galen’s work; and finally, it would have to consider the impact of developments in medicine after Aristotle – for example the Alexandrian discoveries of the nervous system and of the cognitive function of the brain, or the medical theories of Galen – on later Aristotelian thought and on the interpretation of Aristotle’s biological, physiological and psy- chological writings in late antiquity by the ancient commentators, such as Alexander of Aphrodisias, Themistius, Simplicius and John Philoponus, or by authors such as Nemesius of Emesa and Meletius of Sardes. This is a very rich and challenging field, in which there still is an enormous amount of work to do, especially when artificial boundaries between medicine and philosophy are crossed and interaction between the two domains is con- sidered afresh. It is concerned with what I claim to be an Aristotelian discussion 24 In addition to older studies by Flashar (1962) and (1966) and Marenghi (1961), see the more recent titles by King, Manetti, Oser-Grote, Roselli, Fortenbaugh and Repici listed in the bibliography. Introduction 17 of the question of sterility, a good example of the common ground that connected ‘doctors’ and ‘philosophers’, in which thinkers like Anaxagoras, Empedocles, Democritus and Aristotle himself were pursuing very much the same questions as medical writers like the author of the Hippocratic embryological treatise On Generation/On the Nature of the Child/On Diseases 4 or Diocles, and their methods and theoretical concepts were very similar. But Aristotle’s medical and physiological interests are also reflected in non-medical contexts, in particular in the fields of ethics and of psycho- physiological human functions such as perception, memory, thinking, imagination, dreaming and desire. In the case of Aristotle’s theory of sleep and dreams, too, there was a medical tradition preceding him, which he explicitly acknowledges; but as we will see in chapter 6, his willingness to accommodate the phenomena observed both by himself and by doctors and other thinkers before him brings him into difficulties with his own theoretical presuppositions. A similar picture is provided by the psychology and pathology of rational thinking (ch. And, moving to the domain of ethics, there is a very in- triguing chapter in the Eudemian Ethics, in which Aristotle tries to give an explanation for the phenomenon of ‘good fortune’ (eutuchia), a kind of luck which makes specific types of people successful in areas in which they have no particular rational competence (ch. Aristotle tackles here a phe- nomenon which, just like epilepsy in On the Sacred Disease, was sometimes attributed to divine intervention but which Aristotle tries to relate to the human soul and especially to that part of the soul that is in some sort of intuitive, instinctive way connected with the human phusis – the peculiar psycho-physical make-up of an individual. Thus we find a ‘naturalisation’ very similar to what we get in his discussion of On Divination in Sleep (see chapter 6). Yet at the same time, and again similar to what we find in On the Sacred Disease, the divine aspect of the phenomenon does not completely disappear: eutuchia is divine and natural at the same time. This is a remarkable move for Aristotle to make, and it can be better understood against the background of the arguments of the medical writers. Moreover, 18 Medicine and Philosophy in Classical Antiquity the phenomenon Aristotle describes has a somewhat peculiar, ambivalent status: eutuchia is natural yet not fully normal, and although it leads to success, it is not a desirable state to be in or to rely on – and as such it is comparable to the ‘exceptional performances’ (the peritton) of the melan- cholic discussed in chapter 5. We touch here on yet another major theme that has been fundamental to the development of European thought and in which ancient medicine has played a crucial role: the close link be- tween genius and madness, which both find their origin in the darker, less controllable sides of human nature. The fact that many of these writers and their works have, in the later tradition, been associated with Hippocrates and placed under the rubric of medicine, easily makes one forget that these thinkers may have had rather different conceptions of the disciplines or contexts in which they were working. Thus the authors of such Hippocratic works as On the Nature of Man, On Fleshes, On the Nature of the Child, On Places in Man and On Regimen as well as the Pythagorean writer Alcmaeon of Croton emphatically put their investigations of the human body in a physicist and cosmological framework. Some of them may have had very little ‘clinical’ or therapeutic interest, while for others the human body and its reactions to disease and treatment were just one of several areas of study. Thus it has repeatedly been claimed (though this view has been disputed) that the Hippocratic works On the Art of Medicine and On Breaths were not written by doctors or medical people at all, but by ‘sophists’ writing on technai (‘disciplines’, fields of systematic study with practical application) for whom medicine was just one of several intellectual pursuits. Be that as it may, the authors of On Regimen and On Fleshes, for instance, certainly display interests and methods that correspond very neatly to the agendas of people such as Anaxagoras and Heraclitus, and the difference is of degree rather than kind.

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