Sunday, October 10, 2010

Acupuncture Therapy for Neurological Diseases: A Neurobiological View, 2010

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Written in modern scientific language, "Acupuncture Therapy for Neurological Diseases:A Neurobiological View" discusses current research, applying multiple neuroscience approaches, on the effect of acupuncture on neurological diseases and the underlying mechanisms. Apart from basic principles of acupuncture, topics include acupuncture analgesia, acupuncture-drug balanced anesthesia, acute and chronic body pain, stroke, cardiac diseases, hypertension, hypotension, epilepsy, neuroimmuno suppression, female infertility, menopausal & perimenopausal syndrome, smoking, depression, and drug addiction. Each chapter is written by experts in the field. This unique book provides a broad perspective on the principles of acupuncture for acupuncture researchers and neuroscientists. It summarizes clinical applications of various acupoints and optimal conditions in the treatment of neurological diseases. For a medical student, this book is a modern course in ancient Traditional Chinese Medicine, especially acupuncture.

  • Hardcover: 400 pages
  • Publisher: Springer; 1st Edition. edition (August 11, 2010)
  • Language: English
  • ISBN-10: 3642108555
  • ISBN-13: 978-3642108556
  • Product Dimensions: 9.4 x 6.4 x 1.2 inches

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Neurology Emergencies, 2011

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Neurology Emergencies represents this teamwork in that each chapter is co-written by authors representing both the emergency medicine and neurology perspectives. To further ensure a balanced presentation that is useful to medical students and to physicians from both specialties, one editor is an emergency physician and the other is a neurologist. We have tried to create a book that will be as useful to physicians seeing patients in the emergency department as to those caring for patients on the medical or neurological wards and intensive care units.

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Saturday, October 9, 2010

Clinical Neurophysiology (Contemporary Neurology), 3rd Edition, 2009

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Clinical Neurophysiology, Third Edition will continue the tradition of the previous two volumes by providing a didactic, yet accessible, presentation of electrophysiology in three sections that is of use to both the clinician and the researcher. The first section describes the analysis of electrophysiological waveforms. Section two describes the various methods and techniques of electrophysiological testing. The third section, although short in appearance, has recommendations of symptom complexes and disease entities using electroencephalography, evoked potentials, and nerve conduction studies.

Hardcover: 928 pages
  • Publisher: Oxford University Press, USA; 3 edition (May 22, 2009)
  • Language: English
  • ISBN-10: 019538511X
  • ISBN-13: 978-0195385113
  • Product Dimensions: 10 x 7.3 x 1.6 inches

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Handbook of EEG Interpretation, 2007

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EEG interpretation is a critical skill for most practicing neurologists, as well as for an increasing number of specialists in other practice settings. Handbook of EEG Interpretation, the first illustrated, portable handbook to discuss all aspects of clinical neurophysiology, is an essential means of quick reference for anyone involved in EEG interpretation. Handbook of EEG Interpretation provides practical information on reading EEGs by juxtaposing actual EEGs with bullet points of critical information, making it an essential neurophysiology reference for use during bedside, OR, ER, and ICU EEG interpretation. At once more concise, illustrative, and portable than other texts on EEG, Handbook of EEG Interpretation fits in a labcoat pocket, providing immediate information for anyone involved in EEG interpretation. It is a useful tool for all residents, fellows, and clinicians in neurology as well as many internists, psychiatrists, neurosurgeons, anesthesiologists, ICU staff, ER staff, EEG technologists, and nurses. The book's seven main sections cover normal, abnormal, and epileptiform EEG patterns, as well as seizures, patterns of special significance (e.g., stupor and coma), polysomnography, and neurophysiologic intraoperative monitoring.

  • Paperback: 300 pages
  • Publisher: Demos Medical Publishing; 1 edition (July 1, 2007)
  • Language: English
  • ISBN-10: 1933864117
  • ISBN-13: 978-1933864112
  • Product Dimensions: 6.9 x 4.5 x 0.6 inches

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Atlas of EEG in Critical Care, 2010

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  • Atlas of EEG in Critical Care is a comprehensive and accessible introduction to the uses of EEG monitoring in the critical care setting. It includes basic EEG patterns seen in encephalopathy, both specific and nonspecific, nonconvulsive seizures, periodic EEG patterns, and controversial patterns on the ictal–interictal continuum. Confusing artefacts, including ones that mimic seizures, are shown and explained. The new standardized nomenclature for these patterns is included.
After the major section on EEG patterns from both a basic and advanced viewpoint, there is an extensive section on prolonged continuous digital EEG monitoring, including data reduction, screening, and trending techniques such as compressed spectral array. These techniques can aid efficient recognition of seizures, ischemia, and other neurologic events, and can help visualize long-term trends.
  • Explains principles of technique and interpretation of recordings
  • Discusses methods of data management, and ‘trending’ central to long-term monitoring
  • Demonstrates applications in multi-modal monitoring, correlating with new techniques such as microdialysis
  • Features superb illustrations of commonly observed neurologic events, including seizures, hemorrhagic stroke and ischemia
  • Illustrates commonly observed artifacts and ‘problem’ readings
  • Includes new nomenclature for EEG findings in the critically ill
Atlas of EEG in Critical Care is an essential tool for practitioners, fellows and residents in critical care medicine, neurology, epilepsy, and clinical neurophysiology.

  • Hardcover: 344 pages
  • Publisher: Wiley; Ill edition (March 9, 2010)
  • Language: English
  • ISBN-10: 0470987863
  • ISBN-13: 978-0470987865
  • Product Dimensions: 10.7 x 8.8 x 0.9 inches

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Friday, August 6, 2010

Clinical Neurotoxicology: Syndromes, Substances, Environments

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Clinical Neurotoxicology offers accurate, relevant, and comprehensive coverage of a field that has grown tremendously in the last 20 years. You'll get a current symptomatic approach to treating disorders caused by neurotoxic agents, environmental factors-such as heavy metals and pesticides-and more. Apply discussions of cellular and molecular processes and pathology to clinical neurology. Leading authorities and up-and-coming clinical neurotoxicologists present their expertise on wide-ranging, global subjects and debate controversies in the specialty, including Gulf War Syndrome. And, Expert Consult functionality allows you to access the full text of the book online, from any Internet connection.
* Provides a complete listing of neurotoxic agents-from manufactured to environmental-so you get comprehensive, clinical coverage.
* Covers how toxins manifest themselves according to age and co-morbidity so that you can address the needs of all your patients.
* Offers broad and in-depth coverage of toxins from all over the world through contributions by leading authorities and up-and-coming clinical neurotoxicologists.
* Features discussion of controversial and unusual topics such as Gulf War Syndrome, Parkinson's Disease, motor neuron disease, as well as other issues that are still in question.
* Includes access to, a companion website where you can quickly search the complete contents of the book.

Hardcover: 720 pages
Publisher: Saunders; Har/Psc edition (June 18, 2009)
Language: English
ISBN-10: 0323052606
ISBN-13: 978-0323052603
Product Dimensions: 11.1 x 8.7 x 1.3 inches

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Management Strategies in Antithrombotic Therapy

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Intravascular thrombus formation remains one of the most significant problems in cardiovascular medicine. It underlies the clinical presentation of acute coronary syndromes, including unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction.
More and more individuals are stricken with an acute MI and undergo a percutaneous coronary intervention (PCI). Several reasons apply, including an increasingly aged population, the growing burden of chronic risk factors such as diabetes, obesity, sedentary behaviour, and improvements in early recognition and intervention. Thrombus formation also results in substantial morbidity and mortality. Despite significant advances in prevention and treatment of venous thromboembolism, pulmonary embolism remains a common preventable cause of hospital deaths. Implementing the most appropriate, and safe, anticoagulation therapy across the spectrum of cardiovascular disease in the presence of a wide range of other risk factors remains a challenge.
Written by leading authorities in the field, Management Strategies in Antithrombotic Therapy offers a comprehensive review of antithrombotic therapy, including the latest therapies, risk factors and evidence-based strategy. The book acquaints readers with the data behind the commonly used antithrombotic agents and assists them in formulating a sound, evidence-based therapeutic strategy appropriate for each patient.
This book is an invaluable resource for all postgraduate students and specialist physicians in cardiovascular medicine, cardiac and vascular surgery, and critical care.

Hardcover: 366 pages
Publisher: Wiley-Interscience; 1 edition (January 9, 2008)
Language: English
ISBN-10: 0470319380
ISBN-13: 978-0470319383
Product Dimensions: 9.8 x 6.7 x 1 inches

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Fibrinolytic and Antithrombotic Therapy: Theory, Practice, and Management

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Thrombotic disorders of the circulatory system represent the leading cause of morbidity, motality, and health care expenditure in the United States. Fibrinolytic and Antithrombotic Therapy provides a practical, evidence-based approach to the management of thrombotic disorders for all clinicians involved in the care of patients with these disorders. It provides not only vital conceptual information on fibrinolytic and antithrombotic therapy, but also the means to apply it to everyday decision making and patient care. Focusing on managment guidelines and critical pathways, the text stresses practicality and usability. It will be a valuable resource for the wide range of clinicians involved in the care of patients with these disorders, including cardiologists, emergency physicians, primary care physicians, hematologists, neurologists, intensivists, pharmacists, and nurse practitioners.
The Second Edition of Fibrinolytic and Antithrombotic Therapy, even more concise and clinically relevant than the First, provides vital, evidence-based information on management of patients with arterial and venous thrombotic disorders. Since the First Edition, the text has been expanded to cover the evolving topics of atherothrombosis, thrombocardiology, hematologic/thrombophilic conditions, and vascular medicine. It includes up-to-date guidelines for antithrombotic and fibrinolytic therapy, and offers concise summaries of current "standards of care." Chapters are dedicated to discussions of patient-specific therapeutics and to the importance of genomics, proteomics, and metabolomics in defining genotype-phenotype relationships, while throughout the book coagulation, inflammation, and vascular medicine are newly examined as elements in an intricatley-linked triad of biochemical and cellular based phenomenology.

Paperback: 424 pages
Publisher: Oxford University Press, USA; 2 edition (March 23, 2006)
Language: English
ISBN-10: 0195155645
ISBN-13: 978-0195155648
Product Dimensions: 8.2 x 5.5 x 0.9 inches

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Neuroanatomy: An Atlas of Structures, Sections, and Systems

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The Sixth Edition of Dr. Haines’s best-selling neuroanatomy atlas features a stronger clinical emphasis, with significantly expanded clinical information and correlations. More than 110 new images-including MRI, CT, MR angiography, color line drawings, and brain specimens-highlight anatomical-clinical correlations.
Internal spinal cord and brainstem morphology are presented in a new format that shows images in both anatomical and clinical orientations, correlating this anatomy exactly with how the brain and its functional systems are viewed in the clinical setting. A new chapter contains over 235 USMLE-style questions, with explained answers.

Paperback: 319 pages
Publisher: Lippincott Williams & Wilkins; Sixth Edition edition (October 1, 2003)
Language: English
ISBN-10: 0781746779
ISBN-13: 978-0781746779
Product Dimensions: 11.8 x 9 x 0.6 inches

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Thursday, August 5, 2010

Atlas of the Diabetic Foot

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Foot ulcers occur in approximately 15% of the patients with diabetes mellitus in their lifetime, with a major impact on their quality of life. Many hospital admissions related to diabetes are due to foot ulcers, which can result in prolonged hospital stay and increased morbidity and mortality. The majority of lower limb amputations are performed in patients with diabetes every year (80,000 at least in the USA). Most of the diabetes-related foot problems can be prevented or their severity reduced by early detection and treatment. This book contributes to improved foot care through raised awareness of prevention, clinical manifestations, diagnosis and management among healthcare professionals.
This comprehensive atlas, now in a second edition, provides:
* 520 colour photographs, graphs, tables and imaging studies
* Educational examples taken from genuine case reports
* A reference guide for identifying patients at risk for foot problems
* Illustration of common problems such as neuropathic and neuroischaemic ulcers, ischaemia and infection
* Introduction to new technologies and bioengineered materials used for the treatment of foot ulcers
This book will be of interest to diabetologists, endocrinologists, podiatrists, specialist nurses, general practitioners, surgeons and clinical researchers.

Hardcover: 260 pages
Publisher: Wiley-Blackwell; 2 edition (May 10, 2010)
Language: English
ISBN-10: 1405191791
ISBN-13: 978-1405191791
Product Dimensions: 9.8 x 7.3 x 0.8 inches

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Neurology and Clinical Neuroscience

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This brand-new text provides you with an easy-to-use, comprehensive reference that features a clinical perspective balanced with relevant basic science. Inside, you'll find discussions of the latest research and how it has led to a greater understanding of the cause of disease, as well as burgeoning tests and the latest therapeutic agents available. From Alzheimer's disease to vestibular system disorders, you'll find the practical guidance you need to diagnose effectively and provide an appropriate therapeutic approach for each individual case. Plus, a templated, four-color design offers you easy access to pertinent information
Integrates basic science with clinical neurology to help you better understand neurologic diseases and provide the most accurate diagnosis and best treatment plan for each patient.
Discusses the latest research results and offers new information on treatment options. Features the expertise of international authorities, providing a worldwide perspective.

Hardcover: 1664 pages
Publisher: Mosby (December 18, 2006)
Language: English
ISBN-10: 0323033547
ISBN-13: 978-0323033541
Product Dimensions: 11.2 x 8.7 x 2.5 inches

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Headache (Cambridge Pocket Clinicians)

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Headache is the most common presenting symptom in neurology and constitutes more than one-third of primary care consultations. Organized according to the presenting features of the headache (acute, episodic and chronic), this handbook provides diagnostic and treatment information for both common and uncommon causes of headache. Making maximum use of lists, bullet points, summary boxes and illustrations, it allows the reader fast access to essential information where it is needed most. Each topic is dealt with succinctly, using up-to-date knowledge and experience of the authors, all of whom are headache experts from leading clinical centers in the USA and Canada. Providing comprehensive and detailed coverage to satisfy the needs of the busy neurologist, residents in neurology, neurosurgery, psychiatry and other fields of internal medicine, this book will also be a valuable guide to practising clinicians who do not deal with headache on a regular basis.

Mass Market Paperback: 256 pages
Publisher: Cambridge University Press; 1 edition (April 30, 2010)
Language: English
ISBN-10: 0521720575
ISBN-13: 978-0521720571
Product Dimensions: 6.8 x 4.2 x 0.8 inches

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Atlas of Sleep Medicine

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This comprehensive atlas of tracings of polysomnographic studies covers the technical aspects of conducting studies, and includes the features of the various adult and pediatric sleep disorders. Comprehensive and contemporary atlas. Discusses the significance of findings and their correlation with the clinical presentation of the patient. Authoritative and well-organized.

Hardcover: 376 pages
Publisher: Butterworth-Heinemann; 1 edition (June 1, 2005)
Language: English
ISBN-10: 0750673982
ISBN-13: 978-0750673983
Product Dimensions: 11 x 8.7 x 0.9 inches

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Diagnostic Neuroradiology

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In this monograph, the authors summarize their findings in complex neuroimaging work (cranio-, spondylo-, myelo- and angiography as well as CT and MR imaging of the brain and spine) during their longstanding experience at the N. Burdenko Neurosurgical Institute in Moscow. The book begins with a review of modern neuroimaging techniques: CT and MR angiography, perfusion and diffusion imaging, tractography, spectroscopy and functional MR imaging.
The problems and various other aspects of diagnosis of intra- and extra-axial brain tumors (more than 30,000 verified cases) as well as of cerebrovascular, infectious, demyelinating, degenerative and traumatic brain and spine lesions are discussed. The volume is well illustrated with angiographic, CT and MR images of complex diagnostic studies. The numerous images represent a "visual text," which can be used as an atlas by practical clinicians.
This book is a comprehensive reference manual for neurologists, neurotraumatologists and radiologists. It may also be of interest to technicians, medical physicists, students and other specialists interested in neurovisualization and diagnostic imaging.

Hardcover: 1288 pages
Publisher: Springer; 1 edition (February 13, 2009)
Language: English
ISBN-10: 3540756523
ISBN-13: 978-3540756521
Product Dimensions: 11.6 x 9.1 x 2.4 inches

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Neurology Board Review: An Illustrated Study Guide

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Preparing the reader for the written portion of the Neurology Board examination and the Residency In-Service Training Examination (RITE) of the American Academy of Neurology, this reference provides a comprehensive review of the most critical topics in neurology.  With the abundance of neuropathology and neuroimaging figures and neuroanatomy and neurophysiology illustrations, readers will not need to refer to multiple sources for a comprehensive review to prepare for the Neurology Boards and in-service examination.

Hardcover: 1024 pages
Publisher: Informa Healthcare; 1 edition (April 11, 2007)
Language: English
ISBN-10: 0849337917
ISBN-13: 978-0849337918
Product Dimensions: 10.9 x 8.4 x 1.8 inches

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Physiology and Pathology of chloride transporters and channels in the nervous system: From molecules to diseases

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The importance of chloride ions in cell physiology has not been fully recognized until recently, in spite of the fact that chloride (Cl-), together with bicarbonate, is the most abundant free anion in animal cells, and performs or determines fundamental biological functions in all tissues. For many years it was thought that Cl- was distributed in thermodynamic equilibrium across the plasma membrane of most cells. Research carried out during the last couple of decades has led to a dramatic change in this simplistic view. We now know that most animal cells, neurons included, exhibit a non-equilibrium distribution of Cl- across their plasma membranes. Over the last 10 to 15 years, with the growth of molecular biology and the advent of new optical methods, an enormous amount of exciting new information has become available on the molecular structure and function of Cl- channels and carriers. In nerve cells, Cl- channels and carriers play key functional roles in GABA- and glycine-mediated synaptic inhibition, neuronal growth and development, extracellular potassium scavenging, sensory-transduction, neurotransmitter uptake and cell volume control. Disruption of Cl- homeostasis in neurons underlies pathological conditions such as epilepsy, deafness, imbalance, brain edema and ischemia, pain and neurogenic inflammation. This book is about how chloride ions are regulated and how they cross the plasma membrane of neurons. It spans from molecular structure and function of carriers and channels involved in Cl- transport to their role in various diseases.
* The first comprehensive book on the structure, molecular biology, cell physiology, and role in diseases of chloride transporters / channels in the nervous system in almost 20 years
* Chloride is the most abundant free anion in animal cells. THis book summarizes and integrates for the first time the important research of the past two decades that has shown that Cl- channels and carriers play key functional roles in GABA- and glycine-mediated synaptic inhibition, neuronal growth and development, extracellular potassium scavenging, sensory-transduction, neurotransmitter uptake and cell volume control.
* The first book that systematically discusses the result of disruption of Cl- homeostasis in neurons which underlies pathological conditions such as epilepsy, deafness, imbalance, brain edema and ischemia, pain and neurogenic inflammation.
* Spanning topics from molecular structure and function of carriers and channels involved in Cl- transport to their role in various diseases.
* Involves all of the leading researchers in the field.
* Includes an extensive introductory section that covers basic thermodynamic and kinetics aspects of Cl- transport, as well as current methods for studying Cl- regulation, spanning from fluorescent dyes in single cells to knock-out models to make the book available for a growing population of graduate students and postdocs entering the field.

Hardcover: 500 pages
Publisher: Academic Press; 1 edition (September 11, 2009)
Language: English
ISBN-10: 0123743737
ISBN-13: 978-0123743732
Product Dimensions: 11.2 x 8.7 x 1.6 inches

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Neurocritical Care: A Guide to Practical Management (Competency-Based Critical Care)

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Traumatic brain injury is the leading cause of death in young people in the UK and USA. The vast majority of these patients will be initially managed outside the teaching hospital environment and many will remain there for the duration of their treatment. As clinicians, what happens during the first hours and days after injury can have a huge influence on the patient’s chance of survival and also their quality of life after the injury.
Results of a recent national survey have highlighted 2 main areas of major concern. Firstly, there are far too few specialist neurosurgical beds in out tertiary referral centers, which means that District General Hospital Intensive Care Units are frequently having to manage very seriously brain injured patients. Secondly, many clinicians do not know when they should be speaking to their Regional Neurosurgical Centre, do not fully understand how they should be managing these patients, do not know how to interpret the relevant physiological and radiological data, and have difficulty identifying when to escalate treatment and when the situation has become futile.
Lives could therefore be saved and outcomes improved with the introduction of common treatment pathways and better defined lines of communication between referring hospitals and specialist centers.

Paperback: 177 pages
Publisher: Springer; 1st Edition. edition (February 18, 2010)
Language: English
ISBN-10: 1848820690
ISBN-13: 978-1848820692
Product Dimensions: 9.9 x 6.8 x 0.4 inches

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Acute Neuronal Injury: The Role of Excitotoxic Programmed Cell Death Mechanisms

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This book is the result of a convergence of scientific information regarding mechanisms that produce acute nerve cell death in the brain. Although seemingly disparate, stroke, brain and spinal cord trauma, coma from a low serum glucose concentration (hypoglycemia), and prolonged epileptic seizures have in common the inciting factor of excitotoxicity, the activation of a specific subtype of glutamate receptor by an elevated extracellular glutamate concentration that results in an excessive influx of calcium into nerve cells. The high calcium concentration in nerve cells activates several enzymes that are responsible for degradation of cytoplasmic proteins and cleavage of nuclear DNA, resulting in nerve cell death. The high calcium concentration also interferes with mitochondrial respiration, with the resultant production of free radicals that damage cellular membranes and nuclear DNA. Understanding the biochemical pathways that produce nerve cell death is the first step toward devising an effective neuroprotective strategy, the ultimate goal.
Acute Neuronal Injury will be useful to neuroscientists and general cell biologists interested in cell death. The book will also be helpful to clinically oriented neuroscientists, including neurologists, neurosurgeons and psychiatrists.

Hardcover: 306 pages
Publisher: Springer; 1st Edition. edition (November 18, 2009)
Language: English
ISBN-10: 038773225X
ISBN-13: 978-0387732251
Product Dimensions: 9.2 x 6.2 x 1 inches

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Cerebellar Disorders: A Practical Approach to Diagnosis and Management

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During the last three decades, many laboratories worldwide have dedicated their research activities to understanding the roles of the cerebellum in motor control, cognitive processes and the biology of mental processes, behavioral symptoms and emotion. These advances have been associated with discoveries of new clinical disorders, in particular in the field of genetic ataxias, and the growing number of diseases presents a source of difficulty for clinicians during daily practice. This practical guide summarizes and evaluates current knowledge in the field of cerebellar disorders. Encompassing details of both common and uncommon cerebellar ataxias, including vascular, immune, neoplastic, infectious, traumatic, toxic and inherited disorders, this book will assist clinicians in the diagnosis and management of the full spectrum of cerebellar ataxias encountered in daily practice. Essential reading for clinicians, including general practitioners, neurologists, pediatricians, radiologists, psychiatrists and neuropsychologists, this will also prove a valuable tool for students, trainees and researchers.
This practical guide summarizes and evaluates current knowledge in the field of cerebellar disorders. Encompassing details of both common and uncommon cerebellar ataxias, including vascular, immune, neoplastic, infectious, traumatic, toxic and inherited disorders, this book will assist clinicians in the diagnosis and management of the full spectrum of cerebellar ataxias.

Hardcover: 312 pages
Publisher: Cambridge University Press; 1 edition (April 30, 2010)
Language: English
ISBN-10: 0521878136
ISBN-13: 978-0521878135
Product Dimensions: 9.8 x 7.4 x 0.9 inches

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The Interventional Radiology volume of the landmark reference Abrams' Angiography has now been expanded and thoroughly revised to reflect dynamic advances in interventional radiology. More than 60 contributors representing a "Who's Who" of the specialty provide comprehensive, step-by-step coverage of all contemporary vascular and nonvascular interventional procedures. Major sections discuss today's equipment and describe interventions for specific disorders of each organ system, as well as for trauma, pediatric diseases, abscess drainage, and miscellaneous disorders. Fifteen new chapters cover cutting-edge innovations, including stent-grafts, radiofrequency ablation, CT angiography, MR angiography, uterine fibroid embolization, and vertebroplasty. More than 1,100 illustrations complement the text.

Hardcover: 1344 pages.
Publisher: Lippincott Williams & Wilkins; Second Edition (September 1, 2005).
Language: English.
ISBN-10: 0781740894.
ISBN-13: 978-0781740890.
Product Dimensions: 11 x 8.8 x 2.1 inches

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Thursday, May 6, 2010

How to download video from youtube...

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Now we rather difficult to download any videos from youtube. So I want to share you how to download it. Maybe some of you have knew it.

You can follow the instructions below :
1. Open the url:
2. Copy the url of the video from youtube
3. Paste the video's url to
4. Choose and click "Download" button. You can choose and download video in mp4 or flv format.
5. Done.

Now you can download and watch your videos easily. Good luck and enjoy...

Friday, April 9, 2010

Neurologic Manifestation of Systemic Lupus Erythematosus

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Systemic lupus erythematosus is a rare autoimmune disease, affecting 15–124 per 100.000 individuals worldwide. The disease is most common in women of child-bearing age and its prevalence decreases with increasing age. Elderly-onset lupus, which is generally defined as lupus first occurring in patients aged 50–65 years, accounts for 10–20% of patients with the disease and is 5-fold more common in women than in men. Changes in cellular immunity and menopause may contribute to the development of lupus in older individuals (1).

Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with diverse clinical manifestations in all organ systems of the body, and a variable course and prognosis. It is characterized by the production of antibodies to components of the cell nucleus. Involvement of the nervous system is one of the most profound manifestations of the disease, which encompasses a wide variety of neurologic (N) and psychiatric (P) manifestations. Since the first report of stupor and coma in SLE in 1875, a variety of neuropsychiatric syndromes have been reported in SLE patients, with approximately two-thirds of subjects with SLE presenting neuropsychiatric (NP) manifestations. To date, NP lupus is the most poorly understood subset of the disease. The pathogenic mechanisms involved are obscure, although proposed mechanisms include vascular occlusion due to vasculopathy, vasculitis, leukoaggregation or thrombosis, and antibody-mediated neuronal cell injury or dysfunction. Moreover, therapies are empirical, and the course and prognosis for individual patients who present with an NP event is unclear (2).

Neurologic and psychiatric manifestations of SLE have been most commonly termed as central nervous system (CNS) lupus, although several other terms have also been applied, such as CNS vasculitis, lupus cerebritis, neurolupus and neuropsychiatric lupus. The term CNS lupus is inappropriate because the peripheral nervous system (PNS) may also be involved (although CNS manifestations predominate), ‘neuro’ does not include psychiatric manifestations, and ‘vasculitis’ and ‘cerebritis’ imply inflammatory processes which are not always present. The preferred term is neuropsychiatric SLE (NPSLE), since this encompasses the range of possible manifestations. Neuropsychiatric SLE includes the neurologic syndromes of the central, peripheral and autonomic nervous systems, and the psychiatric syndromes observed in patients with SLE in which other causes have been excluded (2).

There are a wide variety of neurologic (N) and psychiatric (P) manifestations of systemic lupus erythematosus (SLE) which extend beyond those identified in the current American College of Rheumatology (ACR) classification criteria for SLE (2,3).

In 1999, the ACR research committee produced a standard nomenclature and set of case definitions for NP-SLE. Using a consensus approach and drawing on a pool of experts from a variety of subspecialties including rheumatology, neurology, immunology, psychiatry and neuropsychology, NP syndromes (Table 1) were defined and diagnostic criteria developed (2,3).

The 19 NP syndromes can be divided into three clinical categories: (i) diffuse psychiatric/neuropsychological syndromes (anxiety disorder, acute confusional state, cognitive disorder, mood disorder and psychosis); (ii) neurologic syndromes of the CNS (cerebrovascular disease, demyelinating syndrome, headache, aseptic meningitis, chorea, seizures and myelopathy); and (iii) neurologic syndromes of the PNS (acute inflammatory demyelinating polyradiculoneuropathy, mononeuropathy, autonomic disorder, plexopathy and polyneuropathy) according to the anatomic location of pathology and clinical manifestation (2).

The most common four of the 19 NP syndromes in each of the five SLE cohorts are summarized in Table 3. Most of the other NP syndromes were infrequent, with a prevalence of less than 1% in the majority of cases (3).

It may help to differentiate between severe and mild manifestations and between thrombotic and non-thrombotic CNS disease, although to make a clear-cut differentiation may be challenging. In this context, a better approach in the management is represented by (i) the recognition of the APS (a common thrombotic disease) and its treatment with anticoagulants, (ii) a more conservative use of steroids, especially in patients with mild manifestations and (iii) the use of pulse cyclophosphamide in diffuse/non-thrombotic CNS lupus. Current therapeutic approach for CNS disease in SLE is summarised in Table 1 (4).

Refferences :
  1. Adis Data Information BV. Early detection and individualized treatment of elderly-onset systemic lupus erythematosus optimizes symptom control. Drugs Ther Perspect 2008; Vol. 24, No. 6.
  2. Sang-Cheol BAE. The ACR classification of neuropsychiatric systemic lupus erythematosus: how this helps in diagnosis and treatment. APLAR Journal of Rheumatology 2003; 6: 188–191.
  3. Hanly JG. ACR classification criteria for systemic lupus erythematosus: limitations and revisions to neuropsychiatric variables. Lupus 2004; 13: 861–864. 
  4. Sanna G, Bertolaccini ML, Khamashta MA. Neuropsychiatric Involvement in Systemic Lupus Erythematosus: Current Therapeutic Approach. Current Pharmaceutical Design 2008; 14: 1261-1269.

Saturday, March 13, 2010

Unusual Neurological Complication Of Typhoid Fever

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A 36-year-old male with typhoid fever presented with conduction aphasia and parietal lobe dysfunction due to an infarct in the left posterior parieto-temporal cortex documented by CT Scan. This case highlights an unusual neurological complication of typhoid fever hitherto not reported in the literature.

Typhoid fever caused by Salmonella group of organisms has a high prevalence in tropical countries of Asia and Africa. Classically described clinical manifestations are rarely encountered due to early diagnosis and institution of antibiotic therapy. Of all the complications described in typhoid fever, the neuropsychiatric manifestations are the most varied and fascinating for the medical world. Here we present a case of typhoid fever developing cortical infarction with aphasia and parietal lobe dysfunction.

Case Report
A 36-year-old male was admitted to the hospital with 20 days history of fever and headache. He was receiving treatment before admission to our hospital as typhoid fever based on positive Widal test (initial titre 1:80 later 1:320) with ciprofloxacin and gentamycin. On the day of admission, there was history of sudden onset of giddiness with altered sensorium for one hour. Following this, the patient became responsive but was unable to communicate freely due to reduced word output for which he was brought to the hospital.
Clinical examination showed an anxious, febrile (39.6° C) patient with mild splenomegaly. The patient was conscious, well oriented, with well-preserved comprehension for spoken words, but had severely impaired naming and repetition. No focal motor deficit was present. All primary modalities of sensations were intact. However, tactile localization and two-point discrimination were impaired on right half of the body. Parietal lobe dysfunction was documented by presence of dyscalculia, ideational apraxia with inattention to tactile and auditory stimulation. Right to left disorientation and finger anomia were also present. Reading and writing could not be tested in detail, as the patient was not literate, and could write only his name. No visual field defect was documented.
Haemoglobin concentration was 15.3g/dL, white blood cell count was 6900cells/mm3, platelet count was 2,18,000/mm3and ESR was 20mm in the first hour. Biochemical parameters were normal. Chest X-ray was normal. Mantoux test and serology for HIV were negative. Malaria and urinary tract infections were ruled out.
A diagnosis of typhoid fever was considered in view of Widal test being strongly positive (1:640 titer after admission for both somatic and flagellar antigen). A rising titer was also documented. Blood cultures were sterile, probably due to prior antibiotic therapy.
CT scan of the brain revealed a hypo-dense lesion involving the left posterior parieto-temporal cortex suggestive of an early infarct (Figure 1). Lumbar puncture showed normal opening pressure and CSF analysis revealed no abnormality.

Figure 1: Plain CT scan study of the brain showing a hypo-dense lesion involving the left posterior parieto-temporal cortex suggestive of an early infarct.

The patient received ceftriaxone and gentamycin following which he became afebrile. He was discharged with aspirin 325 mg per day. Neurological assessment at follow-up 15days later showed markedly improved parietal lobe functions with persistence of language deficit. 6 months after discharge from the hospital, patient was asymptomatic and speech was normal.

Neurological complications in typhoid fever are not uncommon and range from 5 to 35 % in various studies. 1 Of these typhoid encephalopathy is the most common (9.6 to 57%) followed by meningismus (5 to 17%). 1,2 convulsions (1.7 to 40%), spasticity (3.1%), Focal neurological deficit (0.5%) and Meningitis (0.2%) are frequently described. 1,2,3 Other rare complications like Parkinson’s syndrome, Motor-neuron disease, Transient amnesia, Symmetrical sensory-motor neuropathy, schizophreniform psychosis and cerebellar involvement are also described. Aphasia as a complication of typhoid fever is described in 2 to 7.4% in various studies. 2 Case-reports documenting this rare complication have also been published. 1,4,5,6 However, focal parietal lobe involvement has not been documented in literature (Medline search).
Most of the neurological complications described were seen during the course of illness, at height of fever or during defervescence. Some occurred during convalescence like neuropathy, amnesia and psychosis. Others like motor neuron disease, scholastic deterioration occurred well after recovery. 1,3 In our patient, the neurological deficit occurred during the course of the illness after one week of fever.
The mechanisms responsible for the neurological manifestations of typhoid fever have been variously described. Possible mechanisms implicated are hyperpyrexia (>43°C), fluid and electrolyte disturbances, typhoid neurotoxin, vasculitis with peri-vascular cuffing, autoimmune mechanism, pressure effect on blood vessels resulting in cerebral infarction and acute disseminated encephalomyelitis. 1,3,7 CSF analysis in most of these cases revealed no abnormality except for an elevated opening pressure. CT scan wherever done has failed to document any lesion. Typhoid neurotoxin causing damage in the speech area has been put forth as the most likely explanation for aphasia. 3 In our case, the patient had sudden onset of decreased word output with documented parieto-temporal lobe infarct on CT scan most probably pointing to arteritis as a cause for his neurological deficits.
Since our patient had well preserved comprehension and fluency, but severely impaired repetition and naming, we made a diagnosis of conduction aphasia, probably due to posterior parieto-temporal infarct as seen on the CT scan. Common causes of lesion in this region include embolic stroke, neoplasms or trauma. So far no cases of enteric fever with conduction aphasia and parietal lobe dysfunction have been reported. Most of the earlier reported cases were of motor aphasia. 4,5,6
The prognosis of neurological deficits in enteric fever is usually good. In most of the cases the recovery is slow and complete, but in some cases the deficit may persist for long. 1,3 Our patient showed gradual improvement in his parietal lobe functions such as sensory and auditory inattention but nominal aphasia and impaired repetition were persisting even after he became afebrile after treatment with antibiotics.

1. Haque A; Neurological Manifestations of enteric fever. In: Chopra JS, Sawhney IMS, Ed. Neurology in Tropics, 1999. BI Churchill Livingstone, India. 506-512 (s)
2. Bogale Worku: Typhoid fever in an Ethiopian Children's Hospital, 1984-1995. Ethiop J Health Dev 2000; 14(3): 311-313 (s)
3. Osuntokon, et al; Neuro-psychiatric manifestations of typhoid fever in 959 patients. Arch Neurol 1972 July: 27: 07-13 (s)
4. Ozen H, Cemeroglu P, et al: Unusual complications of typhoid fever.Turk J of Paediatr 1993 Apr-Jun; 35(2): 141-4 (s)
5. Bansal AS, Venkatesh S, et al: Acute aphasia complicating typhoid fever in an adult.J Trop Med Hyg 1995 Dec; 98(6): 392-4 (s)
6. Singh S, Gupta A, et al: Wenkebach phenomenon and motor aphasia in enteric fever. Indian J Paediatr 1993 Jan-Feb: 60(1): 147-9 (s)
7. Ramachandran S, Wickemesinghe HR, Perera NV: Acute disseminated encephalomyelitis in typhoid fever.Br Med J 1975; 1: 494 (s)

Citation: S. Vidyasagar, S. Nalloor, U. Shashikiran & M. Prabhu : Unusual Neurological Complication Of Typhoid Fever . The Internet Journal of Infectious Diseases. 2005 Volume 4 Number 1.

Another source about typhoid fever :
  1. The diagnosis, treatment and prevention of typhoid fever.
  2. Typhoid Fever (Enteric Fever).
  3. Neurological Manifestations of Enteric Fever.

Recommended daily intake of vitamins and minerals

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Recommended daily intake of vitamins and minerals

Humans need a certain daily intake of food supplements.
This page summarizes recommended daily intakes by various health experts and agencies in order to provide an overview of recommended daily allowances of all vitamins and minerals.

The above-stated values are not meant for diagnosis, these are mainly reference values for informational purposes.
Most of these values are based on a 2000 calorie intake for people of 4 or more years of age. This reference is applied because it approximates the caloric requirements for postmenopausal women. This group has the highest risk for excessive intake of calories and fat.
Values on labels are stated Daily Reference values (DRV) of Recommended Daily Intake (RDI). The RDI is a renewed value referring to the old Recommended Dietary Allowance (RDA). All values in this table are new RDI values.
Maximum values are based on Food and Drug Administration (FDA) values, the World Health Organization (WHO), BBC Health values, the European Union Directive (based on FDA values) and values from various other governmental and private agencies in the USA and the UK.
Values from the World Health Organization (WHO) may be somewhat lower than those of the FDA for various vitamins and minerals. Examples of differences (WHO values to FDA values): Mg: -60 mg, Vitamin B6: -0,5 mg, Vitamin B12: -4 µg, vitamin C: -15 mg, Vitamin K: -35 mg, folate: -220 µg.
Elements that have a recommended daily intake within µg range are sometimes referred to as trace elements (e.g. copper, chromium, selenium).

Click here if you need complete information about recommended daily intake of vitamins and minerals.

Wednesday, February 24, 2010

It's Our Neuro for Health

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