Mark Corson

By F. Goran. Emory University.

However buy discount isoptin 120mg, according to Samules’ opinion buy isoptin 120mg on-line, there is no reason to fear about the “dispersal” of tumor if distant points are used cheap isoptin 240mg line, instead of inserting the acupuncture needles in the vicinity of the tumor. Kitade and Ohyabu (2000) evaluated the analgesic effects of acupuncture on postoperative pain by comparing the patients who underwent routine tooth extraction alone with those who underwent tooth extraction in combination with acupuncture. When acupuncture was used in combination with tooth extraction, 3 of the 22 patients did not develop postoperative pain. In patients who underwent difficult wisdom- teeth extraction, acupuncture used in combination with local anesthesia was observed to decrease the postoperative pain. In addition, a series of studies were conducted to evaluate the efficacy of Chinese acupuncture in reducing postoperative oral surgery pain (Lao et al. The results of randomized, double-blinded, placebo-controlled trial on 39 healthy subjects showed that acupuncture is superior to the placebo in preventing postoperative dental pain. Besides, a systematic review was reported to assess the effectiveness of acupuncture in dental pain (Ernst and Pittler 1998). Sixteen controlled trials were included and the Jadad score was used 184 7 Acupuncture Analgesia in Clinical Practice to evaluate the methodological quality. The result demonstrated that acupuncture is effective in producing dental analgesia. However, optimal acupuncture technique and its relative efficacy when compared with the conservative methods of analgesia should be further investigated. In an earlier study, three amputees with acute or chronic phantom limb pain and phantom limb sensation were treated with western medical acupuncture, by needling the asymptomatic intact limb. Two of the three subjects reported complete relief from phantom limb pain, indicating that acupuncture was successful in treating phantom limb pain (Bradbrook 2004). Larger cohort studies should be carried out to provide more evidence on the efficacy of acupuncture in the treatment of phantom limb pain. The adverse effects of acupuncture are relatively lower than many drugs or other therapeutic procedures used for the same conditions for which acupuncture is used (Birch et al. However, a number of adverse effects, including systemic reactions and local reactions, have been reported. The systemic reaction includes tiredness, drowsiness, aggravation of preexisting symptom, itching in the punctured regions, dizziness or vertigo, feeling of faintness or nausea during treatment, headache, and chest pain, while local reaction includes bleeding on withdrawal of the needle, pain on the punctured region during or after needling, petechia or ecchymosis, subcutaneous hematoma, etc. These adverse effects are often transitorily associated with acupuncture treatment. Though acupuncture treatment is generally safe in most situations and the side effects are commonly minimum, some severe side effects have been reported. Although minor side effects have been observed, they are well-tolerated by patients. Furthermore, the serious side effects are rare and can be avoided if acupuncture is performed by well-trained 185 Acupuncture Therapy of Neurological Diseases: A Neurobiological View acupuncturists. This review has summarized the analgesic effects of acupuncture on several pain conditions. We have found good and promising evidence on the efficacy of acupuncture in treating most of the pain conditions described in this chapter. The endogenous pain modulating system is observed to be activated during the process of acupuncture analgesia, which might be the major mechanism underlying this process. Generally, a well-trained acupuncturist is recommended for administering acupuncture treatment to avoid unnecessary side effects, and proper acupuncture approaches are suggested to yield better analgesic effect. Furthermore, acupuncture combined with drugs is considered to be a good technique to enhance the analgesic effect, which has been well confirmed by our previous studies. However, we did observe some inconsistent results from different clinical trials, which might be owing to the methodological differences among the acupuncturists. For example, the intervention time, criteria for efficacy evaluation, time of observation of the therapeutic effect, statistical method, and control group are often different in various trials. Therefore, it is necessary to properly design the clinical trial, including the selection of proper control and the use of uniform acupuncture manipulation, to achieve convincing results. With the increasing evidence from numerous studies on the analgesic effect of acupuncture in the treatment of different kinds of acute and chronic pain, we believe that more and more people would be benefited from the use of acupuncture in pain relief, with the advantages of low costs, simple manipulation, and minimal adverse effects. Acknowledgements This work was supported by the National Natural Science Foundation (No. Diabetes Res Clin Pract 39: 115 121 186 7 Acupuncture Analgesia in Clinical Practice Ahonen E, Hakumaki M, Mahlamaki S, Partanen J, Riekkinen P, Sivenius J (1984) Effectiveness of acupuncture and physiotherapy on myogenic headache: A comparative study. J Altern Complement Med 10: 468 480 Bradbrook D (2004) Acupuncture treatment of phantom limb pain and phantom limb sensation in amputees. Clin J Pain 17: 296 305 Chen L (2006) Comparison of therapeutic effects between normal acupuncture and shallow needling with short needle on periarthritis of shoulder. J Tradit Chin Med 12: 119 Dana G (2003) Acupuncture for the management of cluster headaches. Med Acupunc 14: 14 15 Dang W, Yang J (1998) Clinical study on acupuncture treatment of stomach carcinoma pain. Br J Rheumatol 37: 1118 1122 de Wit R, van Dam F, Loonstra S, Zandbelt L, van Buuren A, van der Heijden K, Leenhouts G, Huijer Abu Saad H (2001) The Amsterdam Pain Management Index compared to eight frequently used outcome measures to evaluate the adequacy of pain treatment in cancer patients with chronic pain. Br Dent J 184: 443 447 Eshkevari L (2003) Acupuncture and pain: A review of the literature. Spine 30: 944 963 Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W (2002) Acupuncture for lateral elbow pain. Zhong Xi Yi Jie He Xue Bao (J Chin Integr Med) 3: 310 311 (in Chinese with English abstract) Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M, Natalis M, Senn E, Beyer A, Schops P (2001) Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain. Scand J Dent Res 85: 456 470 Kitade T, Ohyabu H (2000) Analgesic effects of acupuncture on pain after mandibular wisdom tooth extraction. Taehan Kanho Hakhoe Chi 33: 79 86 (in Korean with English abstract) Lin B (1991) Treatment of frontal headache with acupuncture on zhongwan A report of 110 cases.

If the system has only one service connection buy 240mg isoptin with amex, the repeat samples must be collected from the same sampling location over a four-day period or on the same day buy cheap isoptin 40 mg online. Waterborne Diseases ©6/1/2018 322 (866) 557-1746 Positive or Coliform Present Results What do you do when your sample is positive or coliform present? When you are notified of a positive test result you need to contact either the Drinking Water Program or your local county health department within 24 hours cheap isoptin 240mg fast delivery, or by the next business day after the results are reported to you. The Drinking Water Program contracts with many of the local health departments to provide assistance to water systems. Assistance After you have contacted an agency for assistance, you will be instructed as to the proper repeat sampling procedures and possible corrective measures for solving the problem. It is very important to initiate the repeat sampling immediately as the corrective measures will be based on those results. The recommended dose of 5% household bleach is 2 cups per 100 gallons of water in the well. If you plan to shock the entire system, calculate the total gallonage of storage and distribution. Conduct a cross connection program to identify all connections with non-potable water sources. Eliminate all of these connections or provide approved backflow prevention devices. Upgrade the wellhead area to meet current construction standards as set by your state environmental or health agency. If you continuously chlorinate, review your operation and be sure to maintain a detectable residual (0. This list provides some basic operation and maintenance procedures that could help eliminate potential bacteriological problems, check with your state drinking water section or health department for further instructions. Under normal circumstances when these standards are being met, the water is safe to drink with no threat to human health. The first is for total coliform; the second is an acute risk to health violation characterized by the confirmed presence of fecal coliform or E. Most of these sample bottles will come with the preservative already inside the bottle. Some bottles will come with a separate preservative (acid) for the field preservation. Slowly add the acid or other preservative to the water sample; not water to the acid or preservative. Waterborne Diseases ©6/1/2018 324 (866) 557-1746 Heterotrophic Plate Count, more detailed information in the next section (Check with your governmental environmental or health agency for more information. Pour Plate Method The colonies produced are relatively small and compact, showing less tendency to encroach on each other than those produced by surface growth. On the other hand, submerged colonies often are slower growing and are difficult to transfer. Spread Plate Method All colonies are on the agar surface where they can be distinguished readily from particles and bubbles. Colonies can be transferred quickly, and colony morphology easily can be discerned and compared to published descriptions. Membrane Filter Method This method permits testing large volumes of low-turbidity water and is the method of choice for low-count waters. Material: i ) Apparatus Glass rod Erlenmeyer flask Graduated Cylinder Pipette Petri dish Incubator ii ) Reagent and sample Reagent-grade water Nutrient agar Sample Procedure* 1. Boil mixture of nutrient agar and nutrient broth for 15 minutes, then cool for about 20 minutes. Count all colonies on selected plates promptly after incubation, consider only plates having 30 to 300 colonies in determining the plate count. Heterotrophic Plate Count (Spread Plate Method) (Check with your governmental environmental or health agency for more information. The Heterotrophic Plate Count provides a technique to quantify the bacteriological activity of a sample. The R2A agar provides a medium that will support a large variety of heterotrophic bacteria. After an incubation period, a bacteriological colony count provides an estimate of the concentration of heterotrophs in the sample of interest. Required Laboratory Equipment 100 x 15 Petri Dishes Turntable Glass Rods: Bend fire polished glass rod 45 degrees about 40 mm from one end. Quebec Colony Counter Hand Tally Counter Reagents 1) R2A Agar: Dissolve and dilute 0. Preparation of Spread Plates Immediately after agar sterilization, pour 15 mL of R2A agar into sterile 100 x 15 Petri dishes; let agar solidify. Pre-dry plates inverted so that there is a 2 to 3 g water loss overnight with the lids on. Use pre-dried plates immediately or store up to two weeks in sealed plastic bags at 4 degrees C. Waterborne Diseases ©6/1/2018 326 (866) 557-1746 Sample Preparation Mark each plate with sample type, dilution, date, and any other information before sample application. Thoroughly mix all samples by rapidly making about 25 complete up-and-down movements. Using a sterile bent glass rod, distribute the sample over the surface of the medium by rotating the dish by hand on a turntable. Counting and Recording After incubation period, promptly count all colonies on the plates. The aim of diluting samples is to produce a plate having 30 to 300 colonies, which plates meet these criteria.

The diagnosis and differential diagnosis of oral white lesions should be made on the basis of the medical history isoptin 120mg without prescription, clinical features purchase 40mg isoptin with amex, and laboratory tests cheap isoptin 40mg with visa. O Leukoplakia O Materia alba of the gingiva O Hairy leukoplakia O Fordyce’s granules O Lichen planus O Leukoedema O Lichenoid reactions O White sponge nevus O Linea alba O Dyskeratosis congenita O Nicotinic stomatitis O Pachyonychia congenita O Uremic stomatitis O Focal palmoplantar and oral O Cinnamon contact stomatitis mucosa hyperkeratosis syn- O Chemical burn drome O Candidiasis O Papilloma O Chronic biting O Verrucous carcinoma O Geographic tongue O Squamous-cell carcinoma O Hairy tongue O Skin and mucosal grafts O Furred tongue O Epithelial peeling Laskaris, Pocket Atlas of Oral Diseases © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license 2 White Lesions Leukoplakia Definition Leukoplakia is a clinical term, and the lesion is defined as a white patch or plaque, firmly attached to the oral mucosa, that cannot be classified as any other disease entity. Tobacco, alcohol, chronic local friction, and Candida albicans are important predisposing factors. Speckled and verrucous leukoplakia have a greater risk for malignant transformation than the homogeneous form. The average percentage of malignant transformation for leukoplakia varies between 4% and 6%. The buccal mucosa, tongue, floor of the mouth, gingiva, and lower lip are the most commonly affected sites. Differential diagnosis Lichen planus, cinnamon contact stomatitis, candidiasis, hairy leukoplakia, lichen planus reactions, chronic biting, tobacco pouch keratosis, leukoedema, chemical burn, uremic stomatitis, skin graft, some genodermatoses and discoid lupus erythematosus. Treatment Elimination or discontinuation of predisposing factors, sys- temic retinoid compounds. Rarely, it can also appear in immunosuppressed patients after organ transplan- tation. Clinical features Hairy leukoplakia presents as a white asymptomatic, often elevated and unremovable patch. The lesion is almost always found bilaterally on the lateral margins of the tongue, and may spread to the dorsumand the ventral surface (Fig. Characteristically, the surface of the lesion is corrugated with a vertical orientation. Differential diagnosis Chronic biting, lichen planus, frictional kerato- sis, cinnamon contact stomatitis, uremic stomatitis, candidiasis. Treatment Not required; however, in some cases aciclovir or valaci- clovir can be used with success. Lichen Planus Definition Lichen planus is a relatively common chronic inflammatory disease of the oral mucosa and skin. Etiology Although the cause is not well known, T cell-mediated auto- immune phenomena are involved in the pathogenesis of lichen planus. Clinical features White papules that usually coalesce, forming a net- work of lines (Wickman’s striae), are the characteristic oral lesions of the disease. Six forms of the disease are recognized in the oral mucosa, classified according to frequency: the common (reticular, erosive, Figs. Middle-aged individuals are more com- Laskaris, Pocket Atlas of Oral Diseases © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license 6 White Lesions monly affected (the ratio of women to men ratio is 3 : 2). The skin lesions characteristically appear as polygonal purple, pruritic papules, usually affecting the flexor surfaces of the extremities. The prognosis of lichen planus is usually good, and malignant transformation (particularly of the erosive form) remains controversial. Direct immunofluorescence can also be used, although the features are not specific. Differential diagnosis Discoid lupus erythematosus, candidiasis, graft-versus-host disease, geographic tongue, leukoplakia, erythropla- kia, cicatricial pemphigoid, pemphigus, bullous pemphigoid. Usage subject to terms and conditions of license 8 White Lesions Lichenoid Reactions Definition Lichenoid or lichen planus reactions are a heterogeneous group of lesions of the oral mucosa that show clinical and histopatho- logical similarities to lichen planus, but have a different course. Etiology Hypersensitivity to dental restorative materials, amalgam, composite resins and dental plaque accumulation are the most common causative factors. Clinical features Clinically, they appear as white and/or erythematous lesions, usually associated with peripheral delicate white striae (Fig. Characteristically, the lesions are strictly confined to the mucosa directly in contact with the restorative materials, and do not migrate to other sites. Differential diagnosis Lichen planus, fixed drug eruption, discoid lu- pus erythematosus, cicatricial pemphigoid, cinnamon contact stomatitis. Treatment Replacement of the restorative material, polishing and smoothing, and good oral hygiene are recommended. Usage subject to terms and conditions of license 10 White Lesions Linea Alba Definition Linea alba is a relatively common alteration of the buccal mucosa. Clinical features It presents as an asymptomatic, bilateral, linear elevation with a slightly whitish color at the level of the occlusal line of the teeth (Fig. Nicotinic Stomatitis Definition Nicotinic stomatitis, or smoker’s palate, is a common tobac- co-related type of keratosis that occurs exclusively on the hard palate, and is classically associated with heavy pipe and cigar smoking. Etiology The elevated temperature, rather than the tobacco chemicals, is responsible for this lesion. Clinical features Clinically, the palatal mucosa initially responds to the high temperature with redness. Later, it becomes wrinkled and takes on a diffusely grayish-white color, with numerous micronodules with char- acteristic punctate red centers, which represent the inflamed and dilated orifices of the minor salivary gland ducts (Fig. The lesions are not premalignant, in contrast to the “reverse smoker’s palate” lesion, which is associated with reverse smoking. Differential diagnosis Reverse smoker’s palate, leukoplakia, discoid lupus erythematosus, candidiasis, lichen planus. Usage subject to terms and conditions of license 12 White Lesions Uremic Stomatitis Definition Uremic stomatitis is a rare disorder that may occur in patients with acute or chronic renal failure. Etiology Increased concentration of urea and its products in the blood and saliva. The degradation of oral urea by the enzyme urease forms free ammonia, which may damage the oral mucosa.