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Identifying the site and type of pain order wellbutrin 300 mg online, its duration buy wellbutrin 300 mg fast delivery, and the time of its occurrence (its circadian course) is also of great importance. Where referred pain occurs in the subacromial bursa and pain from a ruptured rotator cuff is referred to the proximal upper arm or felt diffusely in the deltoid, the acromioclavicular symptoms will be located directly over the joint. Pain at night is typical of rotator cuff injuries and of advanced impingement syndromes such as calcific tendinitis. Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. This means that shoulder disorders must be distinguished from neurovascular disorders such as distal compression neuropathies, thoracic outlet syndrome, cervical rib syndrome, cervical spine disorders, and cardiopulmonary disease. Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Orientation Tests Quick Test of Combined Motion Procedure: A quick test of mobility in the shoulder is to ask the patient to place hand behind his or her head and touch the contralateral scapula. In a second movement the patient places the hand behind his or her back, reaching upward from the buttocks to touch the inferior margin of the scapula. Assessment: Mobility on one side that is restricted in comparison with the contralateral side is a sign that a shoulder disorder exists. Assessment: The examiner notes any crepitation in the glenohumeral joint, snapping phenomena (such as dislocations of the long head of the biceps tendon), or restricted motion. The most important bony pressure points, such as the greater and lesser tubercles of the humerus, coracoid process, and sternoclavicular and acromioclavicular joints, are assessed for tenderness to palpation. Joint stability is also assessed, and pain in the tendons of the rotator cuff is evaluated by palpation. The active and passive ranges of motion are determined, as are the region of occurrence and specific localization of symptoms. Restricted motion in every direction indicates the presence of a “frozen shoulder. A chronic tear or advanced impingement syndrome will exhibit the universally restricted motion of a frozen shoulder. Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. The “palm sign” is typical of glenohumeral and subacromial pain; the patient places the palm of the normal contralateral hand directly under the acromion. The “palm sign” is typical of pain in the acromioclavicular joint; in this case, the patient places the finger of the normal contralateral hand directly on the affected acromioclavicular joint. Communicating structures include the subscapular and subcoracoid bursae, and the subdeltoid bursa with its subacromial extension. Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Procedure: The examiner palpates the anterolateral subacromial re- gion with his or her index and middle fingers. This also allows palpation of the superior portions of the rotator cuff and its insertions into the greater tubercle of the humerus. Assessment: Localized tenderness to palpation in the subacromial space suggests irritation of the subacromial bursa but can also be a sign of a rotator cuff disorder. Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. In abduction, the deltoid glides over the margin of the sub- acromial bursa, reducing the pain. Rotator Cuff (Impingement Symptoms) Pain and varying degrees of functional impairment are typically the dominant features in the clinical picture of a rotator cuff lesion. In the phase of acute pain, it will usually be dif• cult to obtain suf• cient information from the examination to determine whether the shoulder is due to calcification, tendinitis, subscapularis syndrome, or a rotator cuff tear. It is even more dif• cult to distinguish a rotator cuff tear from disorders caused by degenerative tendon changes without rupture.

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At one time wellbutrin 300mg on-line, magnolia root was used to treat rheumatism cheap wellbutrin 300 mg visa, and was thought to be superior to quinine in General use treating chills and fever. Russ- ian herbalists use an oil extracted from the flowers and In Chinese herbalism, magnolia bark, hou po, is as- young leaves to treat hair loss and as an antiseptic on skin sociated with the stomach, lungs, spleen, and large intes- wounds. It is used to treat menstrual cramps, abdominal flower is a minor remedy for asthma and fainting. Injections of magnolia bark extract are Little recent scientific research has been done on said to cause muscle relaxation. It is also used in formu- magnolia in the West; however, Asian researchers have las to treat coughing and asthma. As of 2002, honokiol has attracted interest for its ders thought to move upward in the body. In addition, it is being studied for its Research suggests that compounds found in magno- ability to induce apoptosis, or cell self-destruction, in lia bark may have mild antibacterial and antifungal prop- lung cancer cells. In Japan, honokiol is considered a 1274 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 useful anxiolytic; herbal preparations containing honoki- ol are prescribed as mild tranquilizers. Preparations Anxiolytic—A medication or preparation given as Magnolia bark is most commonly used in the fol- a tranquilizer. Magnolia is thought to contain certain chemicals that cause • Agastache: for treatment of stomach flu and gastroin- the apoptosis of cancer cells. Honokiol—A compound derived from magnolia • Apricot seed and linum: for treatment of chronic con- that is used in some Japanese herbal preparations stipation and hemorrhoids. Honokiol may also be use- • Bupleurum, inula and cyperus: for treatment of stress- ful in treating lung cancer. All these formulas can be made into teas or are com- mercially available as pills or capsules. In addition, allergic re- actions to the pollen from magnolia trees are not unusual. Frey, PhD Interactions In Chinese herbalism, both magnolia bark and flow- Maharishi Ayurveda see Ayurvedic ers are often used in conjunction with other herbs with medicine no reported interactions. There are no formal studies of its interactions with Western pharmaceuticals; however, Mai men dong see Ophiopogon there are anecdotal reports of harmful interactions be- tween magnolia bark and prescription weight-loss med- ications. In addition, magnolia should not be taken to- gether with any medications given to lower blood pres- sure, as it increases their effects. Maitake Description Resources BOOKS Maitake, Grifola frondosa, is a mushroom found Chevallier, Andrew. It is also called “hen-in-the- searchers attribute this latter result to the X and ES frac- woods” and can reach the size of a head of lettuce. More recent studies of the use of cause maitake comes from the polypores group, it pro- MD-fraction in treating cancer patients have also found duces a bunch of leaf-like clumps that are intertwined. This culture is used to make what is called a that started the tumor growth and nail them for destruc- spawn, which is then inoculated into production logs tion. During the next 30 days, cells and prevents them from occurring elsewhere in the the spawn settles in and binds to the log. In addition to its antitumor effects, maitake extract are placed in temperature- and humidity-controlled appears to increase cellular immunity to cancer. Cancer research on apoptosis is one of the main They are then moved to a mushroom fruiting house. This process of programmed cell death is entire procedure requires a period of 10–14 weeks. Two other ic) and fraction ES (anti-hypertensive)components of components of maitake, named fraction X and fraction maitake, conducted studies based on the hypothesis that ES, were discovered by Harry Preuss, a medicine and such chronic diseases of aging as diabetes, hyperten- pathology professor at Georgetown University Medical sion and obesity are connected partly to glucose/insulin Center in Washington, DC. From his 1998 study, Preuss concluded that maitake could positively affect the glucose/insulin bal- General use ance and prevent these age-related diseases. A study done at Georgetown University in 2002 found that an ex- Although the Chinese and Japanese have used tract of maitake does indeed improve glucose/insulin maitake in cooking and healing for many centuries, it is metabolism in insulin-resistant mice. Maitake is known as an adaptogen and tonic, and were fed either cholesterol or dried powder containing as such it aids healthy people to keep their levels of 20% maitake mushroom. Results showed that maitake blood sugar, blood pressure, cholesterol, and weight altered the metabolism of fatty acids by stopping fatty normal. The beta glucan in maitake is a cell-surface car- acid from increasing in the liver and fatty acid levels bohydrate.

In addi- and lengthening of the vocal cords buy wellbutrin 300mg online, and a significant tion to the effects on male reproductive function discount 300mg wellbutrin otc, an- (30%) increase in the rate of long bone growth. The degree of virilization clude the growth of male-pattern facial, pubic, and body and timing of puberty also affect peak bone density and hair, the lower vocal pitch resulting from a thickening risk of osteoporosis in males. The protein anabolic actions of androgens on bone and skeletal muscle are responsible for the larger stature of males than females. They also have several of Androgens other actions, not necessarily associated with maleness, Virilizing effects such as lymphoid tissue regression during puberty. Gonadotropin regulation Spermatogenesis Sexual dysfunction CLINICAL USES Sexual restoration and development Protein anabolic effects The primary therapeutic use of androgens is as replace- Increased bone density ment therapy in testicular deficiency (Table 63. Although re- 63 Androgens, Antiandrogens, and Anabolic Steroids 729 placement therapy is the primary use of androgen ad- of puberty. The eunuchoid phenotype is caused by ministration, these hormones also are used and abused absent or deficient androgenic induction of the undif- for their protein anabolic effects. Causes of this con- Hypogonadism dition include deficient testicular steroidogenesis (both congenital and acquired), target organ androgen insen- Testicular failure may occur before puberty and present sitivity syndromes (receptor defects, 5 -reductase defi- as delayed puberty and the eunuchoid phenotype, or af- ciency), deficient pituitary LH and FSH secretion, or ter puberty, with the development of infertility, impo- deficient hypothalamic GnRH production. Androgen tence, or decreased libido in otherwise fully virilized replacement therapy is effective only when the end or- males. The source of hypogonadism can be testicular, as gans are sensitive to androgens, so certain forms of occurs in primary hypogonadism, or it may result from pseudohermaphroditism are unresponsive to androgen abnormalities of the hypothalamic–pituitary axis, as in replacement. The compounds most effective in bringing about masculinization are the long-acting enanthate, cypionate, Prepuberal Hypogonadism or propionate esters of testosterone; these preparations Prepuberal hypogonadism is often unsuspected until a require intramuscular injection. Recently effective cuta- delay in male sexual development is noticed at the time neous forms of androgens have become available and may be equally effective. Owing to inconsistent drug ab- sorption, oral androgen preparations do not result in full sexual development in prepuberal hypogonado- TABLE 63. Primarily for Androgen Replacement Postpuberal Hypogonadism Agent (trade name) Postpuberal hypogonadism is also classified as either primary hypogonadism or secondary hypogonadism. Testosterone (Oreton, Neo-Hombreol F,Testoderm, Primary hypogonadism occurs after puberty as the re- Androderm) Testosterone propionate (Neo-Hombreol, Oreton Propionate, sult of surgical castration or testicular destruction (e. Secondary hypogonadism Testosterone cypionate (DEPO-Testosterone, others) is usually associated with hypopituitarism from destruc- Methyltestosterone (Metandren, Neo-Hombreol [M], others) tion or infiltration of the hypothalamus or pituitary by Fluoxymesterone (Halotestin) infarction, tumoral replacement, or surgical removal. Because of the virilizing side effects of restores secondary male sexual characteristics, such as danazol, causing acne and hirsutism, its use in en- libido and potency. Danazol is also approved for use in fi- Aging and Impotence brocystic breast disease and hereditary angioneurotic edema. Aging in men is associated with decreased testicular function that results in reduced testicular steroidogene- Female Hypogonadism sis, decreased free plasma testosterone levels, decreased 17-ketosteroid excretion, and increased gonadotropin Female hypogonadism, especially prepuberal, may be levels. Androgens are nec- cated as a cause of reduced libido, muscle mass, muscle essary for normal pubic hair induction and long bone strength, and bone density in elderly men. In prepuberal females with hy- these observations are so variable that a causal rela- popituitarism in whom all other hormonal deficiencies tionship between lowered androgen levels has not been (estrogen, progesterone, thyroid, adrenal, and growth firmly established. Androgen replacement in elderly men hormone) have been corrected, normal sexual develop- has not been demonstrated to be beneficial unless there is ment and long bone growth are not complete without true androgen deficiency. Estrogen administra- the indiscriminate use of androgens in this age group tion during adolescence is necessary for the develop- because of the high incidence of prostate neoplasms ment of the breast, the gynecoid pelvis, and other fe- (benign and malignant). However, maximal long bone placement doses has proved to be moderately success- growth and development of axillary and pubic hair will ful in increasing libido and sexual performance in men not occur without small amounts of androgen replace- who have true testicular failure. The use of methyltestosterone (Android) and di- ethylstilbestrol in combination has been demonstrated to be very effective in inducing complete secondary sex- Anemia ual development in these females. Finally, low doses of Androgens stimulate erythrocytosis and are effective in androgens have been used to facilitate impaired libido the treatment of certain anemias that are secondary to in postmenopausal women when combined with estro- endocrine hypofunction or myeloid hypoplasia. However recom- Use of Androgens as Protein binant erythropoietin has replaced the androgens as a Anabolic Agents more effective treatment of most forms of anemia. Anabolic activities of testosterone, such as increases in amino acid incorporation into protein and in RNA Therapeutic Use of Androgens in Women polymerase activity, have been demonstrated in skeletal Because of the antagonistic action of androgens in muscle. Apart from the direct anabolic effects in specific many estrogen-sensitive tissues, it would seem logical tissue, androgens antagonize the protein catabolic ac- that androgens might be effective therapeutic agents in tion of glucocorticoids. The androgen compounds with clinical situations of estrogen excess or in the presence the greatest ratio of protein anabolic effects to virilizing of estrogen-dependent neoplasms.

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