Mark Corson

By M. Hurit. University of Wisconsin-Whitewater. 2018.

Japanese Journal of Allergology gait performance in patients with Parkinson’s disease 15 mg mentax mastercard. Physiotherapy Yurtkuran M purchase mentax 15mg without a prescription, Alp A mentax 15 mg amex, Yurtkuran M et al 2007 A modified 87(6):285–288 yoga-based exercise program in hemodialysis patients: Wikstrom S, Gunnarsson T, Nordin C 2003 Tactile a randomized controlled study. Available online International Journal of Neuroscience 113:787–793 ScienceDirect 22 August 2006 Wilson A 2002 Effective management of Zernike W, Henderson A 1999 Evaluation of a musculoskeletal injury. International Journal Physiological Therapeutics 29(4):267–274 of Epidemiology 19:1037–1044 Zhu S, Wang N, Wang D et al 1998 A clinical Zwart J 1997 Neck mobility in different headache investigation on massage for prevention and treatment disorders. The modern field of hydro- Expectorant effects 522 therapy is sometimes referred to as medical hydrology. Diaphoretic effects 523 Balneology or balneotherapy is a branch of the science Diuretic effects 523 that studies baths and their therapeutic uses. Crenology Peptogenic effects 523 or crenotherapy is the science and use of waters from Reflex effects of external hydrotherapy mineral springs (Boyle & Saine 1988a). Today, we use the application 523 terms hydrotherapy and medical hydrology interchange- ably, with medical hydrotherapy indicating all uses of Circulation-reflex effects 524 water therapeutically (Bender 2006). Selected clinical hydrotherapy research 524 Hydrotherapy systematic review 525 Hydrotherapy, immune function and the History of hydrotherapy in relation common cold 526 to naturopathy Hydrotherapy and fibromyalgia 526 Medical hydrology has a rich history. Water was used for Aquatic therapy and fibromyalgia 526 healing in Biblical records and by the ancient Greeks and Hydrotherapy and cardiovascular health 526 Romans. In his tract on the use of fluids he laid down rules for the treatment of acute and 516 Naturopathic Physical Medicine chronic diseases by water, which were followed by the influenced both Simon Baruch and John Harvey hydropaths in the 19th century and which, together Kellogg (Boyle & Saine 1988b). Trall wrote over 25 Asclepiades popularized balneology throughout books and published the Hydropathic Encyclopedia in Rome. He relied on diet, massage, exercise and baths 1853 which influenced the entire hydropathic medical for his marvelous cures and to build his medical repu- profession in America. Asclepiades was the philosophical founder of Dr Henry Foster founded Clifton Springs Water the school from which sprang Cornelius Celsus and Cure Sanitarium in 1850 in Clifton Springs, New York. Cornelius Celsus, He had been trained as a physician at Case Western called the Latin Hippocrates, prescribed water freely in Cleveland and had previously worked at New in acute and chronic disease. Coelius Aurelianus was Grafenburg Sanitarium in Utica, New York, where he the originator of the abdominal compress for hypo- was also involved in the Water-Cure Reporter. Galen was an able and judicious advocate combined allopathy (which was botanical medicine of cold-water baths, and advised cold effusions upon then), homeopathy, hydropathy, hygienic reforms, the head while the body was immersed in warm water dietary therapy, mental therapy, and pastoral and (Baruch 1892). The charter Clifton Springs Hospital, still exists today, and was firmly legitimized the populist herbal health move- the first place to offer pastoral and spiritual care on a ment in the Western world. It was frequently referred full-time basis with a chaplain available full time; the to by the early 20th century naturopathic profession first place to have an open-floor psychiatric ward as the common law that legalized naturopathic prac- (where the term sanitarium became associated with tice in the United States. This was the first female Vincent Priessnitz (1829), a Silesian peasant, did physician to work in a hospital setting. She spent 6 more to popularize hydropathy than any other years working with Dr Foster as his right-hand person single person. He is recognized as the progenitor until, at the bequest of her brother, she came to run of the 19th century nature cure and modern naturo- her father’s water cure sanitarium in Castile, New pathic movement. Anthony at Clifton Springs known as a careful observer and a good judge of and was instrumental in providing the first donation human nature, and his mechanical skill enabled to the women’s rights movement. She wrote three him to invent various technical modifications of books and was considered by Spitler in Basic Natu- hydrotherapy, many of which are still in use today ropathy (1948) as one of the pillars of naturopathy and (Priessnitz 1843). Many of these evangelists/ that hydrotherapy was most effective when used ministers were traveling preachers at night and itiner- with fresh air, simple foods, water, sunlight, dress, ant doctors during the day, curing both the body and exercise, sleep, rest, social influence and mental and the soul. Wilhelm Winternitz was a Viennese physician who He was the first one to prepare, box and sell dry wrote over 200 articles and books on hydrotherapy cereal to be used, which he called granula. The and trained hundreds of doctors and nurses in his sanitarium was eventually purchased by the famous techniques and treated thousands of patients. His naturopath and founder of physcultopathy, Bernarr scientific hydrotherapy techniques and approaches Macfadden. Chapter 11 • Naturopathic Hydrotherapy 517 Simon Baruch is considered by some as the ‘Father leges as a relevant approach to whole-body constitu- of Scientific Hydrotherapy’ and considered himself a tional naturopathic physical medicine clinical practice. He taught, practiced and conducted Constitutional hydrotherapy will be described in research on hydrotherapy in New York, practicing at more detail later in this chapter as a representa- Saratoga Springs. He wrote The Principles and Practice tive example of the evolution of a modern clinical of Hydrotherapy (1898) and An Epitome of Hydrotherapy naturopathic method that employs a constitutional (1920). Physiological responses to The ‘nature cure’ was born from the larger ‘wasser hydrotherapy application kur’ or ‘water cure’ movements of the 19th century. Water ‘naturepathy’ in the Water Cure Journal published in also has unique physical properties which render it a the 1850s. Understanding water and leaders of naturopathy, including Benedict Lust and its physical characteristics is necessary to effectively Henry Lindlahr. He systematically combined various electro- therapy treatments with a refined approach to hydro- 3. Dr Carroll was first treated and then trained applying mechanical stimuli by the New Orleans physician Dr Ledoux, who had 4. Dr Carroll also nutritive changes such as improved collaborated with Dr Lindlahr when living in the assimilation and elimination (Abbott 1915a). He was encouraged to move to the It is generally conceded that it is the action of the Western United States and establish a school. Carroll did establish a very large clinical prac- the therapeutic effect when it is applied to the body. While the school nite and specific results are to be obtained from it of practice centered about clinical ‘constitutional (Boyle & Saine 1988d). Combining electrophysiotherapy with Thermic impressions the Kneipp understanding of hydrotherapy, a new Whenever a substance whose temperature differs clinical approach to hydrotherapy evolved.

The patient’s symptoms depend on whether or not both kidneys are involved discount mentax 15 mg free shipping, the degree of obstruction buy cheap mentax 15 mg, and the time course of the blockage order mentax 15 mg otc. Intrinsic renal failure is caused by disorders that injure the renal glomeruli or tubules directly. Does the patient have signs or symptoms of a systemic disease, such as heart failure or cirrhosis, that could cause prerenal failure? Does the patient have symptoms of a disease, such as lupus, that could cause a glomerulonephritis? Is the patient receiving an antibiotic and now has allergic inter- stitial nephritis? In addition to the history and physical examination, urinalysis and measurement of urinary electrolytes are helpful in making the diagnosis. In prerenal failure, urinal- ysis usually reveals a high specific gravity and normal microscopic findings. Individuals with postrenal failure typically are unable to concentrate the urine, so the urine osmolality is equal to the serum osmolality (isosthenuria) and the specific gravity is 1. The microscopic findings vary depending on the cause of the obstruction: hematuria (crystals or stones), leukocytes (prostatic hypertro- phy), or normal (extrinsic ureteral compression from a tumor). Tubulointerstitial nephritis classically produces urine that is isosthenuric (the tubules are unable to concentrate the urine), with mild proteinuria, and on microscopy, reveals leukocytes, white cell casts, and urinary eosinophils. Normally, the excreted sodium represents the dietary intake of sodium, maintaining sodium homeostasis. Furthermore, because the patient has either true volume depletion or “effective” volume depletion, serum aldosterone will stimulate the kidneys to retain sodium, and the urinary sodium will be low (<20 mEq/L). Diuretic medications, which interfere with sodium reab- sorption, are often used in congestive heart failure or nephrotic syndrome. Early in the course of postobstructive renal failure caused by ureteral obstruction, the afferent arteriole typically undergoes intense vasoconstric- tion, with consequent, low urinary sodium levels (Table 17–3). Because of the risk of fatal cardiac arrhythmias, severe hyperkalemia is considered an emergency, best treated acutely medically and not with dialysis. Although it will not lower the serum potassium level, the calcium will oppose the membrane effects of the high potassium concentration on the heart, allowing time for other methods to lower the potassium level. One of the most effective methods for treating hyperkalemia is administration of intravenous insulin (usually 10 units), along with 50 to 100 mL of 50% glucose solution to pre- vent hypoglycemia. Potassium also can be driven intracellularly with a beta-agonist, such as albuterol by nebulizer. In the presence of a severe metabolic acidosis, adminis- tration of intravenous sodium bicarbonate also promotes intracellular diffusion of potassium, albeit less effectively. All three therapies have only a transient effect on serum potassium levels, because the total body potassium balance is unchanged, and the potassium eventually leaks back out of the cells. Definitive treatment of hyperkalemia, removal of potassium from the body, is accomplished by one of three methods: (1) administration of a loop diuretic such as furosemide to increase uri- nary flow and excretion of potassium, or, if the patient does not make sufficient urine, (2) administration of sodium polystyrene sulfonate (Kayexalate), a cationic exchange resin that lowers potassium by exchanging sodium for potassium in the colon, or, finally, (3) emergency dialysis. On physical examination, she has normal jugular venous pressure, is normotensive without orthostasis, and has a benign abdom- inal examination. His physical examination is significant for an elevated jugular venous pressure, clear lung fields, and harsh systolic and diastolic sounds heard over the precordium. His urine output has fallen to 300 mL over 24 hours, and his serum creatinine has risen from 1. Which of the following laboratory values would be most consistent with a prerenal etiology of his renal insufficiency? Renal ultrasound is the next appropriate step to assess for hydronephrosis and to evaluate for bilateral ureteral obstructions, which are common sites of metastases of cervical cancer. Use of loop diuretics may increase her urine output somewhat but does not help to diagnose the cause of her renal fail- ure or to improve her outcome. Further imaging may be necessary after the ultrasound, but use of intravenous contrast at this point may actually worsen her renal failure. The patient has uremia, hyperkalemia, and (likely) uremic peri- carditis, which may progress to life-threatening cardiac tamponade unless the underlying renal failure is treated with dialysis. As for the other treatments, insulin plus glucose would treat hyperkalemia, and bicarbonate would help with both metabolic acidosis and hyper- kalemia, but in this patient, his potassium and bicarbonate levels are only mildly abnormal and are not immediately life-threatening. Supporting information would be a low central venous pressure read- ing (normal central venous pressure is 4-8 mm Hg). The gentamicin level of 4 μg/mL is elevated (normal <2 μg/mL) and may predispose to kidney damage. Clinical Pearls ➤ The two main causes of renal failure in hospitalized patients are prerenal azotemia and acute tubular necrosis. Other indica- tions include hyperkalemia, metabolic acidosis, severe hyperphos- phatemia,and volume overload when refractory to medical management. This page intentionally left blank Case 18 A 27-year-old woman presents to the emergency room complaining of retrosternal chest pain for the past 2 days. The pain is constant, not associated with exertion, worsens when she takes a deep breath, and is relieved by sitting up and leaning forward. Her neck veins are not dis- tended; her chest is clear to auscultation and is mildly tender to palpa- tion. Her heart rhythm is regular, with a harsh leathery sound over the apex heard during systole and diastole. Chest X-ray is read as normal, with a normal cardiac silhouette and no pulmonary infiltrates or effusions. She has no radiographic evidence of a large pericardial effusion and no clinical signs of cardiac tampon- ade. Considerations In patients with chest pain, one of the primary diagnostic considerations is always myocardial ischemia or infarction. Most patients with acute pericarditis seek medical attention because of chest pain.

In depend on examination findings discount 15mg mentax mastercard, and only one of the study with higher reliability cheap 15 mg mentax free shipping, the simulated leg- those on palpation discount mentax 15mg with visa. In the study with useful in predicting the efficacy of manipulation, they the poor reliability, the simulated leg-length differ- do not assist the practitioner in answering the ques- ences were 0. Aside from the differences already highlighted, this In contrast, Fritz et al (2004) have identified six vari- scenario provides good rationale for the use of multi- ables that predict non-response (negative outcome) to ple assessment methodologies in order to provide a manipulation in treatment of patients with low back comprehensive and accurate picture. Longer than 3 weeks’ duration of symptoms adjust for simulated leg-length discrepancy or uneven 2. No hypomobility on spinous process explanation as to why Gibbon’s study was apparently springing unfruitful. Reduced hip rotation range crest heights and shifts in the frontal plane, they may 5. A negative Gaenslen sign (pain provocation test with the patient supine, one hip taken Are there indicators that can suggest into full flexion and the other into successful palpation outcomes? The test is Is the focus on inter-examiner reliability the best way positive if pain is reported in the sacroiliac joint to evaluate the usefulness or otherwise of palpation (and/or thigh) on the side of the and assessment prior to treatment? Gemmell & Miller (2005) note that, in recent years, there has been a trend away from inter-examiner reli- Using such protocols would seem to offer useful ability studies towards a focus on outcome-based information as to who is more likely and who is less investigations (Borge et al 2001, Flynn et al 2002). For example, Flynn et al (2002) were able to identify However, as in the case of the positive predictors patients with low back pain that was more likely than above, they do not assist the practitioner in making a not to respond to manipulation. Duration of symptoms less than 16 days Such predictive methods should not result in 2. Hypomobility on lumbar spinous springing be applied with confidence once skills have been 5. Chapter 5 • Assessment and Palpation: Accuracy and Reliability Issues 117 The opinions of experts regarding the above three essential elements, as well as a deeper understanding of the problem that is As mentioned earlier, a team of experts were assem- inclusive of the patient’s perspective. While this model bled in 2002 to evaluate the problems highlighted of diagnosis is rapid, if employed too early there is a by studies that showed poor palpation outcomes chance that the pattern recognition model may be (Bullock-Saxton et al 2002). Poor inter-observer the conclusions drawn by the authors are confined to reliability of palpatory findings should not be consid- the limits of the study. Much research has been pub- ered as necessarily devaluing the use of palpation as lished that throws a negative light on clinical practice a diagnostic tool. This has resulted different ways to different palpatory cues, formulat- in ramifications that go far beyond clinical practice to ing their own manipulative prescription based upon stakeholders in the health care system whose agenda individual experience. I am not yet convinced that there Poor research design, use of inappropriate statistical is sufficient evidence in the current literature to methods and unsubstantiated conclusions have pre- condemn the use of some commonly taught palpation vented musculoskeletal medicine from drawing sub- techniques. Even where diagnosis is not predicated upon the use of palpatory cues, palpation is still criti- • Context specific, i. The authors would contend that highly refined pal- Conversely, experts in clinical practice tend to use a patory skills are essential for the development of the pattern recognition/inductive reasoning model that psychomotor skills necessary to perform manual has superseded the hypothetical deductive approach. From this, practitioners formed a motion will be constant from moment to moment for provisional diagnosis to explain their patient’s com- that individual. New diagnostic tests came 2000) in the pelvic girdle has shown that the stiffness to us in the 1980s with big hopes for the definitive value, directly related to range of motion (Buyruk answers to pain and suffering. The appropri- is under (at that moment) and therefore what the ately trained manual therapist, skilled in identifying available range of motion should be. To be • force closure (myofascial activation and meaningful in developing a treatment plan, these relaxation tests) methods all require subjective information from the • motor control (sequencing or timing of muscle patient and then subjective interpretation on the part activation) of the examiner. Such interpretation is clearly influ- • influence of the emotional state on resting enced by the level of experience and training of the muscle tone. The Nobel prize-winning Chapter 5 • Assessment and Palpation: Accuracy and Reliability Issues 119 microbiologist Rene Dubos said, ‘the measurable develop the sensitivity to detect differences in texture, drives out the useful’. To abandon a tool because it movement and muscle activity, in a stepwise fashion, is hard to measure does not make much sense when starting with simple tasks and gradually progressing we are in a field where over 85% of our patients are to more difficult tasks. There is some recent evidence labeled as having a ‘non-specific disorder’ (Bigos et al which suggests that starting with non-biological 1994, Erhard & Delitto 1994). If we were able to iden- materials may be an effective starting point for stu- tify, specifically, what was wrong with most back pain dents to be able to detect levels of stiffness in isolation patients with non-palpation tools and thereby deter- from the other nuances of biological tissue (Nicholson mine the most appropriate treatment, then it would et al 1997). However, in our field, we’re what I call the Three Essential Questions of Diagnosis just beginning to crawl. While we strive to establish (Murphy 2000): proof as our goal for creating a ‘best practice’ scenario, • Does this patient have a potentially serious or we are a long way from being able to reasonably life-threatening condition? The patient examination is too complex to measure with a gold standard instru- a multilevel process that begins when the practitioner ment, like seeing with photography or hearing with first lays eyes on the patient and continues through tape recorders, this does not make palpation useless. Perhaps, instead of of individual clinical tests that are available to us, abandoning the palpation of our patients, we should some of which have been demonstrated to be reliable perform a thorough physical examination using a and valid, some of which have been demonstrated to battery of tests so that the heterogeneity of our patient have relatively poor reliability and validity, and most population will not lead us to falsely conclude that of which have not yet been evaluated for reliability there is nothing mechanically wrong. By being aware of the literature in the Erhard & Delitto (1994) concluded that: area of reliability and validity, we may then apply a • a collection of palpation tests was more valid ‘levels of evidence’ approach to the examination. That than any one test by itself is, we can go through the examination process and • classification by a combination of palpation arrive at a working diagnosis, the ‘diagnostic hypoth- findings and other physical examination tests esis’. Those aspects of the hypothesis that are based has predictive validity for assigning patients on tests that are known to be reliable and valid will into different meaningful conservative care be given greater emphasis and the level of evidence treatment groups for these will be high. Those aspects that are based on tests of questionable reliability and validity will be • non-specific back pain patients represent a given less emphasis. Have the student first study (and be taught tissue texture changes during joint and learn) that muscle’s attachments, structure and func- myofascial palpation of other tissues. First, I chronic low-back pain behaviour and muscle function check the muscle myself to make sure I know what is examination of the flexion–relaxation response. If they are 15:92–95 having trouble finding it, it is easy for me to see why based on what I see them doing and what their palpa- Aprill C, Bogduk N 1992 High-intensity zone: a tion of that muscle feels like, compared to what it felt diagnostic sign of painful lumbar disc on magnetic resonance imaging. Another approach that is less demanding of teaching Beal M 1989 Louisa Burns Memorial Lecture: time is to have the students work in teams of three and Perception through palpation. Journal of the American have them take turns being paired examiners of the Osteopathic Association 89:1334–1352 subject.

The report continues: [N]evertheless buy mentax 15mg with mastercard, although to possess the same genome in no way leads two individuals to own the same psyche proven mentax 15mg, reproductive cloning would still inaugurate a fundamental upheaval of the relationship between genetic identity and personal identity in its 156 F mentax 15 mg on-line. The uniqueness of each human being, which upholds human autonomy and dignity, is immediately expressed by the unique appearance of body and countenance which is the result of the singularity of each genome. The autonomous human being (who may be deWned as one who is ‘submitted to his or her own laws’) may allegedly be threatened in this very quality by facing his or her relatively identical clones. Can we not argue instead that the best way to counteract discrimination is to accept diVerence as a valuable addition to the rich tapestry of life rather than fear its conse- quences? Indeed if dignity has to be deWned in any essential manner, as it must be if enshrined in international declarations, it is the unique quality of all human beings, also recognized in their diVerences, even if there is a degree of sameness, which gives us dignity. This is obviously absurd, and we have therefore to conclude that even if normal sexual reproduction were a necessary condition for human liberty, it is far from being a suYcient one. It seems reasonable to suppose that the constraints im- posed by the father’s sexual identity would somehow aVect the cloned child; would this be a reduction of the child’s liberty? Ethical issues in embryo interventions and cloning 157 Perhaps feminist psychoanalytical arguments can help us understand the problem of identity – for example, the work of Julia Kristeva (1991) and Luce Irigaray (see Whitford, 1991). Kristeva argues that we cannot respect and accept strangers if we have not accepted our own portion of strangeness, in other words, the stranger within ourselves (Kristeva, 1991). The implication for cloning is that the parent(s) seeking reproductive cloning cannot accept that strangeness carried in the matrix of the gestating mother. In the same analytical vein, one could argue that the fantasy of immortality, or the desire for genetic perpetuation at any cost by those who cannot procreate, seems a more narcissistic venture than the often unconscious choice of a reproductive partner. In a similarly psychoanalytical fashion, Irigaray begins from the Lacanian account of the mirror stage in identity development, but adds a feminist twist. For men, ego formation depends on coming to see the world as a mirror, on which the male projects his own ego; women are part of the mirror, so that they never see reXections of themselves (Whitford, 1991: p. The implication for cloning, after the manner of both Kristeva and Irigaray, is that deeper psychoanalytical forces are at work in popular revulsion at the idea. Because the identity of the subject is shaky, and subjectivity itself something to be constructed rather than a given, cloning poses a threat to our personal identity which we Wnd diYcult to tolerate. Another psychoanalytical question concerns the child thus conceived, rather than the parent – how will the child cope with building his or her sexual identity? Therapeutic cloning (or other applications of cloning technology which do not involve the creation of genetically identical individuals) has led to much less dismay. The European Commission Group of Advisors on the Ethical Implications of Biotechnology (1997) report reiterates in its summary that: As far as the human applications are concerned, it distinguishes between reproductive and non-reproductive (research), and also nuclear and replacement and embryo splitting limited to the in vitro phase, i. The European report stresses that therapeutic cloning should aim either to throw light on the causes of human disease or to contribute to the alleviation of suVering. All raise questions about what respect is owed to the embryo, its moral status, as well as about human rights, including the right to reproduce and the right to a family life. Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine: Bioethics Convention. Currently only 1 in 50 women of child-bearing age becomes pregnant following a renal transplant, and it may be that many more would welcome the chance of biological parenthood if their fertility problems could be overcome. However, some reviews (Sturgiss and Davison, 1992; Davison, 1994) have suggested that pregnancy in the graft recipient, unlike the rare pregnancy in patients undergoing dialysis, is usually likely to lead to a live birth, and that pregnancy may have little or no adverse eVect on either renal function or blood pressure in the transplant recipient. The current medical consensus is that if, prior to conception, renal function is well preserved, and if the patient does not develop high blood pressure, only a minority of transplant recipients will experience a deterioration of their renal function attributable to pregnancy (Lindheimer and Katz, 1992). It is inevitable that the rapid return to good health enjoyed by the majority of women following successful renal transplantation should encourage them to consider conception. Lockwood was due to severe, recurrent pre-eclampsia, a potentially life-threatening condition of late pregnancy causing raised blood pressure and renal compli- cations, which can progress to cause Wts and cerebro-vascular accidents (strokes). Sterilization by tubal ligation was offered and accepted under these circumstances, in view of the anticipated further deterioration of her renal function with any subsequent pregnancy. There was a significant further ad- vance of her renal disease, necessitating the initiation of haemodialysis (a kidney machine) two years later, and a living, related donor renal transplant (from her mother) was subsequently performed. After the transplant, Mrs A remained well and maintained good kidney function on a combination of anti-rejection drugs, steroids and blood pressure tablets. At age 26, a reversal- of-sterilization operation was performed because she had become so distressed by her childlessness, but hysterosalpingography (a test to check for fallopian tubal patency) two years later, when pregnancy had not occurred, showed that both tubes had once again become blocked. Mrs A’s pregnancy test was positive 13 days after embryo transfer, and an ultrasound scan performed at eight weeks’ gestation showed a viable twin pregnancy. Throughout the treatment cycle and during pregnancy, the patient’s anti- rejection drugs (azathioprine and prednisolone) were continued at mainte- nance doses. The pregnancy was complicated at 20 weeks’ gestation by a right deep vein thrombosis, affecting the femoral and external iliac veins, and anti-coagulation with heparin and warfarin was required. Spontaneous rupture of the mem- branes, leading to premature delivery, occurred at 29 weeks’ gestation; the twins were delivered vaginallyand in good condition three hours later. After delivery of her babies, Mrs A remained well and her renal graft continued to function normally, with no change in immunosuppressive or antihypertensive (blood pressure) medication required. Risks to the mother, the fetus and the neonate Severe pre-eclampsia and eclampsia can result in irreversible damage to the maternal kidney, particularly due to acute renal cortical necrosis. Women who have recurrent pre-eclampsia in several pregnancies or blood pressures that remain elevated in the period following delivery (the puerperium), especially if they have pre-existing renal disease and/or hypertension, have a higher incidence of later cardiovascular disorders and a reduced life expect- ancy (Chesley, Annitto and Cosgrove, 1989). Pregnancy is recognized to be a privileged immunological state, and therefore episodes of rejection during pregnancy might be expected to be lower than for non-pregnant transplant recipients. Nevertheless, rejection episodes occur in nine per cent of pregnant women, occasionally in women who have had years of stable renal function- ing prior to conception. More rarely, rejection episodes occur in the puer- perium, when they may represent a rebound eVect from the altered im- munosuppressiveness of pregancy. Immunosuppressive (anti-rejection) drugs are theoretically toxic to the developing fetus; however, maternal health and graft function require im- munosuppression to be maintained. A large French study of women with pre-existing renal damage reported a prematurity rate of 17 per cent and a spontaneous abortion rate (miscarriage) of 20 per cent, as compared to 164 G.

Peter Koenig buy cheap mentax 15mg, “The Placebo Effect in Patent Medicine mentax 15mg mastercard,” Psychology Today generic 15mg mentax, April 1973, 60. Much of the Club’s methodology is based on the work of Jay Forrester, principally his book World Dynamics (Cam­ bridge: Wright-Alien Press, 1971). Garrett Hardin, “The Tragedy of the Commons,” Science, 162 (De­ cember 13, 1968), 1243-1248. Horn, “Smoking and Death Rates: Report on Forty-four Months of Follow-Up of 186,763 Men,” Journal of the American Medical Association, 166 (1958), 1294-1308. Stocks, “On the Relations Between Atmospheric Pollution in Urban and Rural Localities and Mortality from Cancer, Bronchitis, and Pneumonia, with Particular Reference to 3, 4-Benayprene, Beryl- liu, Molybdenum, Vanadium, and Arsenic,” British Journal of Cancer, 14 (1960), 397-418. Rene Laennec pointed out the relationship between fossil-fuel use in industrial production and the contaminants that caused emphysema in 1819. Surgeon General, The Health Consequences of Smoking, A Public Health Service Review, 1967 (Washington, D. The Seventh Annual Public Health Service Report to the Congress on the Consequences of Cigarette Smoking, reported in the New York Times, January 18, 1973. Calhoun, “Population Density and Social Pathology,” Scientific American, 206 (1962), 136. Andervont, “Influences of Environment on Mammary Cancer in Mice,” The Jour­ nal of the National Cancer Institute, 4 (1964), 579-581. For more mixed results, see also a survey of research on crowding, Psychology Today, April 1974. Anticaglia and Alexander Cohen, “Extra-Auditory Effects of Noise as a Health Hazard,” American Industrial Hygiene Association, 31 (1970), 277. See, for example, Harvey Schroeder, “Metals in the Air,” Environ­ ment, 13, 8 (October 1971), 18. Committee on Environmental Hazards of the American Academy of Pediatricians, “Acute and Chronic Childhood Lead Poisoning,” Pediatrics, 47, 5 (May 1971). See also Committee of Public Health, “Air Pollution and Health,” The New York Academy of Medicine Bulletin, 42, 7 (July 1966). Rennie, Mental Health in the Metropolis: Midtown Manhattan Study (New York: McGraw-Hill, 1962). The study did not investigate matched institutional and noninstitutional popula­ tions. The inference, rather, rests on a comparison of the num ber of persons under treatm ent for diagnosed mental illness and the nonin­ stitutionalized population studied. Langner, “Urban Life and Mental Health,” American Journal of Psychiatry, 113 (1957), 831; Leo Srole, Thomas S. Rennie, “Mental Disorders in a Metropolis,” Public Health Report, 72 (1957), 580; and E. Marches, “Mental Health Morbidity in a Suburban Community,” Journal of Clinical Psychology, 24, 1 (1968). Brian Cooper, John Fry, and Graham Kalton, “A Longitudinal Study of Psychiatric Morbidity in a General Practice Population,” British Journal of Preventive and Social Medicine, 23 (1969), 210. In other words, the size of the catch depends upon the size of the mesh of the net that is used; mental institutions Rnd the least, community services find more, and direct interviews find the most. Indeed, the over-enthusiastic psychiatric diagnostician can find evi­ dence of psychiatric ill-health in most hum an beings; such findings perhaps tell us more about the observer than about those observed” (P- 177). Some of the works to which I have reference are Imperial Animal by Tiger and Robin Fox (New York: Holt, Rinehart and Winston, 1971); The Naked Ape by Morris (New York: McGraw-Hill, 1967); African Genesis by Ardry (New York: Atheneum, 1967); and On Aggression by Lorenz (New York: Harcourt Brace Jovanovich, 1966). Konrad Lorenz, Civilized Man’s Eight Deadly Sins (New York: Harcourt Brace Jovanovich, 1974). Dohrenwend, Social Status and Psychological Disorder: A Causal Inquiry (New York: Wiley-Interscience, 1969). Skinner’s thesis is most cogently presented in Beyond Freedom and Dignity (New York: Knopf, 1971). Klerman, “Psychotropic Drugs as Therapeutic Agents,” Hastings Center Studies, 2, 1 (January 1974). Robert Coles, “The Case of Michael Wechsler,” New York Review of Books, May 18, 1972. See, for example, Thomas Szasz, The Manufacture of Madness (New York: H arper & Row, 1970), and R. The study is reported in Society, 9, 10 (September/October 1972), and was done by E. Weiner, "The Next Thirty-Three Years: A Framework for Speculation,” in Daniel Bell (ed. Much of the material in this section has been culled from a paper prepared by Robert Sinsheimer, Ph. For a discussion of amniocentisis see Amitai Etzioni, Genetic Fix: New Opportunities and Dangers for You, Your Child and the Nation (New York: Macmillan, 1973). It is not clear whether the study controlled for other quality variables in the sample hospitals. Anne Somers, “Health Care and the Political System,” paper pre­ sented to the National Center for Health Service Research and De­ velopment Conference on Technology and Health Care Systems in the 1900s, Rockville, Maryland, January 19, 1972. This section is derived from a m onograph, “T he Pursuit of Well- Being,” co-authored Harvey W heeler and R. Carlson, prepared for the Center for the Study of Democratic Institutions, February 1973. See Abraham Maslow, Toward a Psychologyof Being (New York: Van Nostrand, 1962); and Frank Goble, The Third Force(New York: Grossman Publishers, 1970). See, for example, Barry Commoner, "Workplace Burden,” Environ­ ment, July/August 1973.