By A. Jens. Ramapo College of New Jersey. 2017.

Others who reject the major scares may find themselves in the grip of the panic over mobile phones or microwaves buy rizatriptan 10mg visa. Everybody is now more careful about what they eat or drink generic 10mg rizatriptan with mastercard, more reluctant to take medication, more aware of the need to take precautions against pathogenic forces, of whose existence they were unaware only a few years ago. Whatever their individual proclivities and prejudices, nobody is immune from the consequences of more than a decade of health scares. Doctors overwhelmed by an influx of patients in the grip of the latest health scare usually blame ‘the media’ for inflaming anxieties with ‘sensational’ headlines and ‘scaremongering’ television documenta- 28 HEALTH SCARES AND MORAL PANICS ries. Politicians complain of public complacency if people appear not to follow government health warnings and of over-reaction if they panic and, for example, suddenly refuse to buy British beef. Surveying the damage wrought on British agriculture—and the balance of trade—a week after his parliamentary statement on the supposed BSE-nvCJD link, health minister Stephen Dorrell declared in exasperation in a Radio Four interview that ‘it’s not the cows that are mad, it’s the public’ (quoted in Lang 1998). But the mad cow panic did not begin on the farms or in the butchers’ shops or supermarkets. It began among the scientists, spread to the politicians and was amplified in their interactions with the media, which transmitted it to the public. Nobody was better placed to dampen down the panic than Dorrell, yet his statement served only to exacerbate the anxieties that devastated farmers in Britain and beyond. The history of the major scares confirms that they did not originate in spontaneous outbreaks of public anxiety. They each started among doctors and scientists who themselves became alarmed, either at the emergence of a new disease (Aids, nvCJD), or the recognition of a new risk factor (front sleeping, MMR, the Pill). In the absence of any effective treatment for any of these conditions, doctors sought to raise public awareness of them, in the belief that this was the only means of prevention. The scares took off when doctors’ own anxieties led them to turn to their contacts with government and the media to generate wider publicity around the focus of their concerns. A number of factors have encouraged medical and scientific experts to project their anxieties into the public realm. One is the wider crisis of medical confidence in tackling the ‘modern epidemics’ of coronary heart disease and cancer, now that the threat of infectious diseases has receded. In the 1970s and 1980s, the recognition that effective treatments for these conditions remained elusive led to a swing towards health promotion in the cause of prevention, the subject of the next two chapters.

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These fractures are often associated with intra-abdominal or retroperitoneal injuries 10mg rizatriptan fast delivery. A haematoma in the posterior mediastinum is often seen around the thoracic fracture site cheap 10mg rizatriptan fast delivery, particularly in the anteroposterior view of the spine and sometimes on the chest radiograph requested in the primary survey. If there is any suspicion that these appearances might be due to traumatic aortic dissection, an arch aortogram will be required. Fractures in the thoracic and lumbar spine are often complex and inadequately shown on plain films. If the neurological lesion is complete the patient will have paralysed intercostal muscles and will have to In tetraplegia: rely on diaphragmatic respiration. Partial paralysis of the Intercostal paralysis diaphragm may also be present, either from the outset or after Partial phrenic nerve palsy—immediate 24–48 hours if ascending post-traumatic cord oedema —delayed Impaired ability to expectorate develops. In patients with injuries of the thoracic spine, Ventilation-perfusion mismatch respiratory impairment often results from associated rib fractures, haemopneumothorax, or pulmonary contusion; there In paraplegia: may also be a varying degree of intercostal paralysis depending Variable intercostal paralysis according to level of injury on the neurological level of the lesion. Associated chest injuries Sputum retention occurs readily during the first few days —rib fractures —pulmonary contusion after injury, particularly in patients with high lesions and in —haemopneumothorax those with associated chest injury. The inability to produce an effective cough impairs the clearing of secretions and commonly leads to atelectasis. The loss of lung compliance contributes to difficulty in breathing and leads to a rapid exhaustion of the inspiratory muscles. Abnormal distribution of gases and blood (ventilation-perfusion mismatch) also occurs in the lungs of tetraplegic patients, producing further respiratory impairment. Regular chest physiotherapy with assisted coughing and breathing exercises is vital to prevent atelectasis and pulmonary infection. Respiratory function should be monitored by measuring the oxygen saturation, vital capacity, and arterial blood gases. Bi-level support is preferable to continuous positive airway pressure (CPAP) and may avoid resorting to full ventilation.

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He became qualified as a senior surgeon purchase 10 mg rizatriptan fast delivery, medullary nail and improved the efficiency of and in 1942 he was elevated to the rank of the fixation discount rizatriptan 10mg with visa. In 1946, he took The callus problem, the healing of fractures, charge of the surgical division of Kreis Hospital, pseudarthrosis, the infected fracture, the malu- Schleswig-Hesterberg. From 1957 until his statu- nited fracture—were all subjects with which he tory retirement in 1965, he was medical director intensely concerned himself. After establishing closed medullary nailing to the treatment of a center for nailing in Spain in 1966, he became pseudarthrosis signified another trail-blazing a visiting physician at St. Through a stab wound, widen- Flensburg, where he continued to work until his ing of the medullary canal and the introduction of death. He was the recipient of numerous intensifier fluoroscope with remote viewing on a awards, including the Danis prize of the Interna- television screen during the 1950s made closed tional Society of Surgeons, the gold medal of the nailing considerably easier. University of Santa Maria, Brazil, and the In his Hamburg period, Küntscher made two Paracelsus medal and honorary citizen of El Paso, more important contributions to bone surgery. He was also an honorary member of 12 developed the distractor, which made it possible German and foreign scientific societies and a cor- to do closed nailing of malaligned pseudarthroses responding member of numerous specialty groups and old fractures. After many years of Society in 1940, he attracted unusual attention effort, Küntscher could now do a closed osteot- with his report, “Medullary Nailing of Fractures,” omy with the medullary osteotome. This pioneer- which has been regarded as an important mile- ing achievement gave a new impetus to closed stone in the operative treatment of fractures. During the Hamburg period Küntscher that time, the name of Küntscher was associated produced an abundance of scientific papers, with a specific surgical technique. It disap- pointed him that his operative methods were regarded sceptically at first. Now he spoke at numerous conventions at home and abroad, drawing large audiences with his extemporaneous lectures, which were as entertaining as they were informative.

Accompanying signs may give clues as to localization order 10 mg rizatriptan with visa, the main possibilities being hemisphere discount 10mg rizatriptan amex, brainstem, or cervical cord. Hemisphere lesions may also cause hemisensory impairment, hemi- - 150 - Hemiplegia Cruciata H anopia, aphasia, agnosia or apraxia; headache, and incomplete unilat- eral ptosis, may sometimes feature. Spatial neglect, with or without anosognosia, may also occur, particularly with right-sided lesions pro- ducing a left hemiparesis. Pure motor hemiparesis may be seen with lesions of the internal capsule, corona radiata, and basal pons (lacu- nar/small deep infarct), in which case the face and arm are affected more than the leg; such facio-brachial predominance may also be seen with cortico-subcortical lesions laterally placed on the contralateral hemisphere. Crural predominance suggests a contralateral paracentral cortical lesion or one of the lacunar syndromes. Brainstem lesions may produce diplopia, ophthalmoplegia, nys- tagmus, ataxia, and crossed facial sensory loss or weakness in addition to hemiparesis (“alternating hemiplegia”). Hemiparesis is most usually a consequence of a vascular event (cerebral infarction). Tumor may cause a progressive hemiparesis (although meningiomas may produce transient “stroke-like” events). Transient hemiparesis may be observed as an ictal phenomenon (Todd’s paresis), or in familial hemiplegic migraine which is associated with mutations in a voltage-gated Ca2+ ion channel gene. Cross References Agnosia; Anosognosia; Aphasia; Apraxia; Babinski’s sign (1); “False- localizing signs”; Hemianopia; Hemiplegia; Neglect; Ptosis; Upper motor neurone (UMN) syndrome; Weakness Hemiparkinsonism Hemiparkinsonism describes the finding of parkinsonian signs restricted to one side of the body, most usually akinesia, in which case the term hemiakinesia may be used. Idiopathic Parkinson’s disease may present with exclusively or predominantly unilateral features (indeed, lack of asymmetry at onset may argue against this diagnosis) but persistent hemiparkinsonism, particularly if unresponsive to ade- quate doses of levodopa, should alert the clinician to other possible diagnoses, including corticobasal degeneration or structural lesions. Cross References Hemiakinesia; Parkinsonism Hemiplegia Hemiplegia is a complete weakness affecting one side of the body, i. Cross References Hemiparesis; Weakness Hemiplegia Cruciata Cervicomedullary junction lesions where the pyramidal tract decus- sates may result in paresis of the contralateral upper extremity and - 151 - H Hennebert’s Sign ipsilateral lower extremity.

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