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Fusion of the Five Elements” teaches how to transmute emotions generic 20 mg cialis jelly free shipping impotence 10, heal dam- aged organs and gain greater balance and insight into oneself cheap 20mg cialis jelly erectile dysfunction cream 16. Tai Chi Chi Kung, Pa Kua Chi Kung and Palm, Hsing I Chi Kung, Death Touch Dan Mu, and Five Finger Kung Fu, build internal power, im- prove body alignment, and enable one to more quickly master the longer forms of Tai Chi Chuan, Pa Kua Palm, and Hsing I Chuan. At the same time it is deeply rooted in an ancient tradition of spiritual self-mastery that, step by step, leads the practitioner to experiencing the full mystery of the Tao. By Michael Winn who is general editor of the Taoist Esoteric Yoga Encyclopedia. March 31,1983 New York City - 22 - Chapter I Part I: Practical Steps to Awaken your own Healing Energy - 23 - Awaken the “Chi” Life Energy Chapter I Awaken the “Chi” Life Energy Meditation, properly speaking, is the stilling of the mind. Most of the meditation techniques taught today still the mind using one of two basic approaches. The first is the Zen approach of “silent sitting”, facing a blank wall until the mind becomes blank. You sit until the moment of pure awareness arrives, even if it takes twenty years. The second is the Mantra approach, in which the mind is rhythmi- cally lulled to sleep with sounds or images. After thousands of rep- etitions the body begins to vibrate at a higher frequency, and the meditator becomes aware of the higher energies operating beyond the sensory process functions of our daily mind. It does not depend on total absence of the flux of thought. Instead, this system stresses the circulation of energy called “chi” along certain pathways inside the body. These pathways help direct the “chi” — also known as prana, sperm or ovarian power, the warm current, or kundalini power — to successively higher power centers (chakras) of the body. The secret of circulating this “chi” has been transmitted for thou- sands of years in China, where it brought extraordinary improve- ments in health and life. But what is this “chi”, and where does it come from? It begins in human life with the pierc- ing of an egg by a sperm cell. From this original fusion an enor- mously complex new human being develops. The main channels of “chi” energy flow in the body were discov- ered by sages meditating upon the human fetus inside the womb. They observed the baby grows up around its mother’s navel point, and that through the navel the fetus absorbs nutrients and expels waste. The fetus literally “breathes” through the umbilical cord from the mother into its own navel down to the perineum and up to the head and down from the tongue to the navel again. The navel point is thus said by Taoists to be the starting point for the flow of the - 24 - Chapter I primordial life energy, or “chi”, and remains the point of strongest energy storage and circulation in the adult. In this sense this esoteric Taoist medita- tion is a rebirth process, a return to one’s original, primordial self. What happened after birth that caused us to lose that original, per- fect equilibrium that was so nurturing and permitted such healthy growth? After a baby enters the world, his/her energy slowly “settles out” into hot and cold parts of the body. In the fetus this “yin” and “yang” energy was perfectly balanced in a kind of “lukewarm” mixture. But by the time a baby has grown to adulthood the hot or “yang” energy has gradually risen to the upper part of the body containing the vital organs such as the heart, liver, lungs and brain. The cold or “yin” energy has tended to settle in the legs, genitals, kidneys and lower abdomen. The result is gen- eral fatigue, weakness, and poor health. A young person usually has sufficient energy to keep the routes less obstructed so that the power still flows. The organs are thus nourished, and there is little sickness. But if we do not live healthily and practice to keep the energy routes open, they will gradually close and cause emotional imbalances, premature sickness and old age. The perfect energy circulation we enjoyed as babies was not aired by the daily stress of living. Simply by re-establishing that same strong flow of lukewarm chi — mixed yin and yang energy — our vital organs will begin to glow with radiant health.
Sweat secre- tion test with the iodine-starch method (Minor test) purchase 20mg cialis jelly amex erectile dysfunction va disability rating. Foto docu- mentation has to be performed when perspiration begins Fig buy cheap cialis jelly 20 mg on line erectile dysfunction due to medication. The right side shows the position of the patient and examiner during the EMG 23 Most often the RR intervals and the sympathetic skin response are used in clinical practice. Tests of sudomotor function, like the quantitative sudomotor axon reflex test (QSART), or the thermoregulatory sweat test (Fig. AAEM Quality Assurance Committee (2001) Literature review of the usefulness of repeti- References tive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert Eaton myasthenic syndrome. Muscle Nerve 24: 1239–1247 American Association of Electrodiagnostic Medicine (2001) AAEM: glossary of terms in electrodiagnostic medicine. Muscle Nerve 24 [Suppl 10]: S1–S 49 Marx JJ, Thoemke F, Fitzek S, et al (2001) Topodiagnostic value of blink reflex R 1 changes. Muscle Nerve 24: 1327–1331 Meier PM, Berde CB, DiCanzio J, et al (2001) Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection threshholds in healthy children and adolescents. Muscle Nerve 24: 1339–1345 Pullman SL, Goodin DS, Marquinez AI, et al (2000) Clinical utility of surface EMG: report of therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 55: 171–177 Oh S, Melo AC, Lee DK, et al (2001) Large-fiber neuropathy in distal sensory neuropathy with normal routine nerve conduction. Neurology 56: 1570–1572 Weber M, Eisen A (2002) Magnetic stimulation of the central and peripheral nervous system. Muscle Nerve 25: 160–175 – Laboratory and muscle enzymes Laboratory tests, – CSF studies biochemistry, and – Autoantibodies immunology – Laboratory tests are an essential part of investigations of neuromuscular diseases. Abnormal liver or renal function, endocrine function, blood glu- cose, and electrolyte abnormalities may be important clues for dysfunction of the neuromuscular system. Laboratory tests are needed to confirm the diagnosis. Autoimmune disease (in particular rheumatoid arthritis (RA) or collagen vascular disease, association with hepatitis B antigen, and clues for hypersensitivity angiitis) can be identified by laboratory tests. Elevated sedimentation rate (ESR), nuclear antigens, antinuclear antibody test (ANA), rheumatoid factor (RF), antineutrophil cytoplasmic antibodies (ANCA), and cryoglobulins can be assayed along with serum and urine electrophoresis, immunoelectrophoresis, and HIV testing. The final diagno- sis of vasculitis is finally confirmed by nerve (and muscle) biopsy. Neuromuscular diseases are associated with polyarteritis nodosa, Churg- Strauss syndrome, Wegener’s granulomatosis, hypersensitivity angiitis, and, rarely, isolated vasculitis of the peripheral nervous system. One important laboratory test is the measurement of creatine kinase (CK). This single, reliable test is usually associated with myopathies, rather than neuro- genic disorders. However, transient CK elevation is also observed after exercise, muscle trauma, surgery, seizures and acute psychosis. Asymptomatic CK eleva- tions occur more often in people of African descent with large muscle mass. The syndrome of idiopathic hyperCKemia is a persistent CK elevation without a definable neuromuscular disease. Reference Al-Jaberi MM, Katirji B (2002) Serum muscle enzymes in neuromuscular disease. In: Katirji B, Kaminski HJ, Preston DC, Ruff RL, Shapiro B (eds) Neuromuscular disorders. Butter- worth Heinemann, Boston Oxford, p 39 CSF studies The CSF is often studied in polyneuropathies, particularly in acute and chronic polyradiculoneuropathies. Often, inflammatory or cellular responses can be ruled out, and the elevated protein levels remain the only significant finding. Radiculitis and CSF findings Infection Cell count Cell type Clinical Other tests manifestation Borreliosis, Up to Lymphocytic, Cranial nerve: VII Antibody Lyme disease 200/µl lymphomonocytic, Meningoradicular detection many activated syndrome by ELISA, lymphocytes Immuno- blotting, PCR Herpes zoster 300/µl Lymphocytic Monoradicular Serology (also myotomal) lesions HIV Seroconversion 8/µl Polymorpho- AIDP, CIDP Serology nuclear cells CMV-Radiculitis 8/µl Mixed cell Cauda equina- population syndrome Syphillis Early: Lymphomonocytic Painful Specific 25–2000/µl cell count polyneuropathy test IgG>> Late: may Tabes dorsalis be normal Brucellosis 15–700/µl Lymphocytic, CN: VII, cells granulomatous lumbar meningitis radiculopathies polyradiculo- pathies West Nile Pleocytosis Lymphocytic AIDP-like fever Protein cell distribution polyneuropathy elevation FSME 60–2000/µl Lymphocytes: Radiculitis, Antibody (“Central 20–60% Myelitis, testing European lymphocytes and Poliomyelitis-like, Tick Ence- 40–80% PMN CN phalitis“) PCR Polymerase chain reaction; AIDP acute inflammatory demyelinating polyneuropathy; CIPD chronic inflammatory demyelinating polyneuropathy; CMV cytomegalovirus; PMN polymorphonuclear cells; CN cranial nerves. Several serologic and immunologic tests of CSF are available. Table 3 gives an overview of expected CSF findings in radiculitis. Autoantibodies have been described in several disease entities, like polyneuro- Immunologic studies pathies, disorders of the neuromuscular junction, paraneoplastic disease and muscle disease. The antibodies can be detected by immunofluorescence meth- ods, enzyme linked immunosorbent assays (ELISA), western blotting, radioim- munoassays, thin layer chromatography, and immunofixation electrophoresis. In the most frequently occuring conditions, like acute and chronic polyradicu- Autoantibodies and loneuropathy (AIDP, CIDP), no constant autoantibody pattern is found. There is immune a high frequency of anti-GM1 antibodies in multifocal motor neuropathy with polyneuropathies conduction block (80%). The antimyelin associated glycoprotein (MAG) neur- opathy is a typical syndrome with MAG positivity in 50–70%.
A radiograph and growth measurements are gen synthesis at the levels of the ovary or the adrenal gland cialis jelly 20mg on line erectile dysfunction over the counter medication. Hormonal anti-androgenic treatment for acne must be continued for a sufficient period of time generic cialis jelly 20mg amex erectile dysfunction nervous, at least 12 months and frequently longer. Mucocutaneous adverse events of women who want to become pregnant due to the risk for isotretinoin (% values) sexual organ malformation in a developing fetus. Cheilitis 75–95 A most effective compound is cyproterone acetate, Dermatitis facialis 30–50 which belongs to the group of hydroxy-progresterones and Xerosis 30–50 blocks the binding of androgens to their receptors. There Dry mucosa 20–50 is current evidence that cyproterone acetate exhibits a Conjunctivitis 30 Epistaxis 25 dual activity by also inhibiting the synthesis of adrenal Itching 25 androgens because it inhibits the conversion of dehydro- Epidermal atrophy 15–25 epiandrosterone to androstenedione by 3ß-hydroxyste- Skin fragility 15–20 roid dehydrogenase/¢5–4-isomerase, which mainly occurs Desquamation 10–20 in the adrenal gland, and in the skin, in the sebaceous Hair loss 10–20 Retinoid dermatitis 5 gland. Cyproterone acetate is incorporated in a marketed hormonal contraceptive at a dose of 2 mg in combination with 35 Ìg ethinyl estradiol to avoid menstrual cycle prob- lems [62–65] (fig. The preparation can be used for both contraception and treatment of acne with or without signs Table 8. Indications for optimal use of hormonal therapy in women of hyperandrogenism, even when serum androgen levels Acne accompanied by mild or moderate hirsutism are normal. It has been shown to decrease serum gonado- Inadequate response to other acne treatments tropin, testosterone and androstenedione, with control of Acne that began or worsened in adulthood seborrhea and acne after three months treatment. In Premenstrual flares of acne women with abnormal androgen metabolism additional Excessive facial oilness Inflammatory acne limited to the ‘beard area’ cyproterone acetate 10–20 mg/day, and in some cases up to 50 mg/day can be administered orally during the first Table 9. Adverse events of systemic anti-acne drugs Agent Adverse event Isotretinoin teratogenicity, skin and mucosal dryness, irritation, bone changes, increase of the blood values for neutral lipids (cholesterol, triglycerides) Hormonal contraceptives edemas, thrombosis, increased appetite, weight gain, breast tenderness, decreased libido Spironolactone breast tenderness, menstrual irregularities, increased potassium blood levels 44 Dermatology 2003;206:37–53 Zouboulis/Piquero-Martin Fig. Acne nodulocystica in a 20-year-old female patient before (left) and after a 6-month treatment with ethinyl estradiol 35 Ìg/day – cyproterone acetate 2 mg/day (right). Acne tarda with increased serum dihydroepiandrosterone in a 31-year-old fe- male patient before (left) and after a 2- month treatment with prednisolone 5 mg/ day (right). Most oral contraceptives contain two agents, estrogen injection of 100–300 mg cyproterone acetate can be (generally ethinyl estradiol) and a progestin. In their early applied at the beginning of the cycle. Circulating free testosterone Systemic Acne Treatment Dermatology 2003;206:37–53 45 levels are reduced by the increased SHBG levels, leading androgens, they also suppress the production of estrogens, to a decrease in sebum production. Oral contraceptives thereby eliminating the function of the ovary. Thus, the inhibit the ovarian production of androgens by suppress- patient could develop menopausal symptoms and suffer ing ovulation. This, in turn, decreases serum androgen from hypoestrogenism. They have variable acceptance levels and reduces sebum production. On the other hand, due to the development of headaches as well as the occur- the progestins administered belong to the families of rence of bone loss, due to the reduction in estrogen. They estranes and gonanes with a variety of drugs in each class. Some progestins can cross react with the androgen recep- tor or, like the progestins norgestrel and levonorgestrel, Severe Inflammatory Acne and Acne fulminans reduce SHBG increasing free testosterone, thus leading to Systemic corticosteroids can become necessary in acne increased androgenic effects and aggravating acne, hir- fulminans to suppress the excessive immunological reac- sutism, or androgenic alopecia [67, 68]. They can also tion, in severe inflammatory forms of acne, and in cause changes in lipid metabolism and can increase serum order to prevent or treat a severe flare of the disease in the glucose, leading to glucose intolerance, as well as possibly first 4 weeks of isotretinoin treatment. It is preferable to interfering with the beneficial effect of estrogen on the administer the corticosteroids for 3–4 weeks before ad- SHBG. Hormonal contraceptives are associated with ede- ministration of isotretinoin but a combination of iso- ma, thrombosis, increased appetite, weight gain, breast tretinoin 0. Spironolactone may in- Acne tarda duce dose-dependent breast tenderness, menstrual irregu- Systemic corticosteroids inhibit adrenal androgen lib- larities and increased potassium blood levels. This variant of acne tarda is characterized by of 250–500 mg/day (optimum 2! The agent becomes active through first-pass terone induces inflammation. They are used at low metabolism to 2-hydroxyflutamide. Also, it may accelerate con- version of active androgens to inactive metabolites. He- patic function laboratory tests should be done periodically New Developments and Future Trends. Among nonhormonal anti-androgens, ketoconazole After decades of stagnation, research on systemic acne (cytochrome P-450 inhibitor and steroidogenesis enzyme treatment has expanded markedly in the last several blocker) in a dose of 1200 mg/day and cimetidine (H2- years. The results of numerous studies have greatly in- receptor antagonist) 5! New developments occurred including the low-dose nafarelin or leuprolide, have been used to interrupt andro- long-term isotretinoin regimen, new isotretinoin formula- gen production by the adrenals and ovaries by blocking tions, understanding of isotretinoin’s anti-sebotropic ac- FSH and LH liberation by the pituitary gland. These tion, new antibiotics, and combination treatments to drugs are efficacious in acne and hirsutism, and are avail- reduce toxicity and bacterial resistance, and new oral con- able as injectable drugs or nasal spray [25, 67].
An in-depth resolution of 80 mm of the skin and a slice thickness of 0 purchase 20mg cialis jelly mastercard impotence 36. STATISTICS Data were analyzed with SPSS software (SPSS generic cialis jelly 20 mg mastercard impotence kegel, Chicago, Illinois, U. All results were expressed as mean Æ standard deviation. Water resonance as well as eight different lipid resonances are clearly resolved. The volume of interest is intentionally selected within a fat lobule to avoid water-rich structures such as ﬁbrous septae. Women with cellulite characteristically have thicker skin on the upper dorsal thigh com- pared to normal women (p ¼ 0. ADIPOSE THICKNESS Table 2 shows the thickness values of the adipose layers measured by MR imaging on both sites. Women with cellulite have thickened adipose layers compared to normal women (p < 0. Furthermore, the increase is much greater in the deep adipose layer than in the superﬁcial layer in women with cellulite (Fig. Table 1 Mean Values (ÆSD) of Skin Layer Thickness Measured by US Imaging on the Hip and Thigh According to Presence of Cellulite Skin thickness (mm) Hip Thigh Women with cellulite 1. CELLULITE CHARACTERIZATION BY US AND MRI & 109 Table 2 Mean Values (ÆSD) of Adipose Layer Thickness Measured by MR Imaging on the Hip and Thigh According to Presence of Cellulite Adipose thickness (mm) Hip Thigh Women with cellulite 53. MR imaging shows that women with cellulite have a much greater increase in the thickness of the deep inner adipose layer compared to women without cellulite. Two experts scored the images with an index deﬁned on the heights of adipose inden- tations and number of indentations on a four-level scale. No statistical difference could be established between experts, whereas the index of irregularity was signiﬁcantly higher in women with cellulite (p < 0. The second step is aimed at describing the 3-D architecture of the ﬁbrous septae within the adipose tissue. After image processing of the series of MR images (Fig. Deep adipose indentations into the dermis are a characteristic marker of cellulite. Camper’s fascia is clearly seen as a thin plane structure more or less parallel to the skin surface. Other septae were detected as pillar-like structures. The percentage of ﬁbrous septae was calculated in three directions: perpendicular, parallel to the skin surface, and tilted at about 45 (Fig. On the upper dorsal thigh, women with cellulite have higher percentages of perpen- dicular septae (p < 0. Table 3 Mean Values (ÆSD) of the Degree of Indentations of Adipose Tissue Within the Dermis on the Hip and Thigh According to Presence of Cellulite Irregularity index Hip Thigh Women with cellulite 3. CELLULITE CHARACTERIZATION BY US AND MRI & 111 Figure 6 Visualization of the 3-D architecture of ﬁbrous septae in subcutaneous adipose tissue after image segmentation of 3-D MR images: (A) woman with cellulite; (B) woman without cellulite. Figure 7 Structured patterns of the ﬁbrous septae network according to presence of cellulite. Quantitative ﬁndings give more evidence about the heterogeneity in the directions of the septae, and highly suggest that modeling the 3-D architecture of ﬁbrous septae as a perpendicular pattern in women with cellulite would be an over simpliﬁcation. LIPID COMPONENTS AND WATER FRACTION IN ADIPOSE TISSUE Saturated and unsaturated lipid components as well as the water fraction measured in pro- ton spectra are listed in Table 4. Moreover, biochemical quantiﬁcation can be obtained by MR spectroscopy. High-frequency 3-D US is a very efﬁcient method for skin imaging. Our results con- ﬁrmed an increase in skin thickness as well as the presence of deep indentations of adipose tissue into the skin in women with cellulite (6,7). MR imaging assessed an increase of adipose tissue in women with cellulite on both the analyzed sites. At high spatial resolutions, Camper’s fascia, as formerly demonstrated by histology (14), was clearly detected in vivo, so that the superﬁcial and deep adipose layers could be measured independently. A thicker deep adipose layer appears as a notable marker of cellulite. After image processing of 3-D MR images, Camper’s fascia appeared as a thin plane structure ‘‘parallel’’ to the skin surface, and vertical septae as pillar-like structures in contradiction with straight planes proposed in diagrams by Nurnberger, although ﬁne details of the ﬁbrous network, which is typically 30 to 70 mm in thickness (unpublished personal histological pictures), remain undetected; our ﬁndings, however, allow quantiﬁcation of the main directions of this ﬁbrous network. In women with cellu- lite, we found a higher percentage of septae perpendicular to the skin surface and a smaller percentage parallel to the surface. In some aspects, our results are in agreement with those of Nurnberger, but this present work gives more evidence about the heterogeneity in the directions of the septae. These ﬁndings highly suggest that modeling the 3-D architecture of the ﬁbrous septae network as a perpendicular pattern in women, whereas as crisscross in men, would be an over simpliﬁcation. CELLULITE CHARACTERIZATION BY US AND MRI & 113 Concerning the changes in the physiology of the adipose tissue in the presence of cellulite, it is still a matter of controversy.
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