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Additionally order 10mg sinequan fast delivery anxiety guru, the termination of all Some Additional Commercially Available Modes breaths is determined by a reduction in inspiratory of Ventilation effort that is reflected in a decrease in flow below a preset percentage of peak flow purchase 25 mg sinequan fast delivery anxiety symptoms electric shock sensation feelings. The amount of pressure can be adjusted sets the duration of inspiration (and thus the Vt to achieve comfortable breathing quality 10 mg sinequan anxiety cures, with acceptable varies) by varying the Ti (time cycled) or by setting Vt and respiratory rate (frequency order sinequan 25mg overnight delivery anxiety questionnaire for adults, or f ). There is a paucity sure devices have incorporated more sophisticated of outcomes studies that demonstrate improved alarm systems to circumvent this problem. Some of the recognized forms of patient— resent a small percentage of patients with acute ventilator asynchrony include ineffective trigger- respiratory failure at those centers, and blinding ing, double triggering, auto triggering, and flow subjects and investigators to the intervention is asynchrony. Graphic display of flow and pressure over time demonstrates two conventional breaths followed by an ineffective trigger in which patient inspiratory effort (arrows) does not trigger a breath. Double-triggering is along the bronchovascular bundles toward the identified by the presence of two positive pressure hila of the lung, rupturing into mediastinum, and breaths separated by a very brief expiratory phase then through the thoracic inlet to produce sub- (less than one half of the preceding Ti; Fig 3). Eventually, air ruptures the patient’s ventilatory demand is high, and the into the pleural space, producing a pneumotho- set ventilator time is too brief, leading to a decrease rax. It is important to recognize lesser forms of in airway pressure early in exhalation that triggers barotrauma, such as subcutaneous emphysema an immediate second positive pressure breath. Volutrauma The development of serious hyperinflation Atelectrauma can be subtle and can be recognized by wheezing Biotrauma Multiple organ dysfunction exhalation persisting up to the next positive pres- Ventilator-associated pneumonia sure breath, respiratory efforts (chest movement) Tracheomalacia without ventilator triggering, characteristic find- Trauma and dysfunction of vocal cords Trauma to lip, teeth, oral cavity, nose, pharynx ings of ineffective trigger on ventilator graphics, Unplanned extubation hyperinflation on chest radiograph, or a decrease in Endotracheal tube malposition the Vt if the patient is receiving positive-pressure Bronchial intubation ventilation in a pressure-targeted mode. One can temporarily occlude the exhalation port by pressing a button on most modern ventilators, creating a no-flow state that allows equilibration and hemodynamic compromise. Hyperinflation of the pressure in the ventilator tubing (where the can overdistend alveoli, increasing the likelihood pressure is sensed) with the pressure deep within of rupture as well as compressing the alveolar cap- the lung. This exhalation is decrease in intrathoracic pressure of sufficient often followed by rapid and dramatic improve- magnitude to be sensed by the ventilator. More definitive extreme, hypotension can progress to frank shock treatment includes bronchodilators, sedation to and even to cardiopulmonary arrest, typically reduce spontaneous respirations, and ventilator with pulseless electrical activity. Mechanisms adjustment to increase expiratory time (reduce include reduced venous return, plus a component respiratory rate, lower Vt, and perhaps increase of altered right and left heart chamber filling, and inspiratory flow rate). The magnitude of inspiratory deflation of alveoli produces damage and inflam- effort by the patient can be measured by the use mation, or so-called atelectrauma. The subsequent of an esophageal balloon that displays changes in mechanical damage to lung tissue activates inflam- pleural pressure during these efforts. These deleterious application of low Vts, ie, 6 mL/kg of predicted effects are thought to be the worst when there is body weight in humans, is associated with reduced local inhomogeneity of ventilation. Lung- management include providing sufficient sedation protective strategies and permissive hypercapnia (and possibly neuromuscular blockade) to control supersede goals of normalization of gas exchange. Follow-up of patients who were A strategy for providing full ventilatory sup- allowed to remain hypercapnic showed no long- port that will provide adequate ventilation and term deleterious effects. Evidence for use rioration is more complex than with conventional of recruitment maneuvers is less compelling, with ventilation, as is ventilator adjustment. Historically, measures of respiratory muscle plate for many weaning protocols (specific criteria) strength, endurance, and gas exchange such as neg- and structured approaches (daily performance by ative inspiratory force, vital capacity, minute venti- respiratory therapists and nurses). It is worth noting, however, that frequency and consistency of measurements and strict adherence to overly conservative criteria can actions, are multidisciplinary and team based, actually delay weaning and/or extubation. The concepts and criteria are based on Chest Physicians, American Association for Respi- the pathophysiology of respiratory failure and also ratory Care, and Society of Critical Care Medicine recognize the importance of nonpulmonary organ published evidence-based guidelines for weaning dysfunction in readiness to proceed. However, vasopressors, pH some protocol criteria may inadvertently delay extu- Mental status Use of continuous sedative bation if the criteria are too restrictive. In fact, oxy- Secretion clearance Cough strength, sputum volume/ suction frequency genation criteria (Pao2/Fio2 180 mm Hg) was the Airway patency Cuff-leak test most common weaning criterion never passed in Miscellaneous Condition improving? However, (3) hemodynamic stability (no active myocardial some patients, particularly smaller individuals and ischemia or clinically significant hypotension); and those with parenchymal lung disease, may have a (4) capability to initiate an inspiratory effort. As noted recommendations serve as a solid basis for current previously, investigators have demonstrated that recommendations; however, newer data allow us to incorporating f/Vt 105 as a screening criterion readdress these and other parameters. Some of the parameters and criteria that can and observed for deterioration in vital signs or ven- affect this process are listed in Table 6, and several tilatory failure. The author’s recom- without ventilatory support, often using oxygen mendations for specific components and caveats delivered directly via the tracheostomy tube, and related to these parameters are listed in Table 7. Effect of Ischemic heart disease Infection and sepsis nitric oxide on oxygenation and mortality in acute Malnutrition lung injury: systematic review and meta-analysis. Intravenous injec- Randomized, unblinded, controlled trial of 304 patients failed tion of methylprednisolone reduces the incidence of to show improvement in 10-day or 6-month mortality. Extubation mechanically ventilated patients in intensive care (Awak- outcome following a spontaneous breathing trial with ening and Breathing Controlled trial): a randomised automatic tube compensation versus continuous positive controlled trial. Effects of and meta-analysis of studies of the timing of tracheos- inhaled nitric oxide in patients with acute respiratory tomy in adult patients undergoing artificial ventilation. High-frequency Med 2006; 173:276–280 oscillatory ventilation for acute respiratory distress syn- Treatment of patients who were found to have adrenal insuf- drome in adults: a randomized, controlled trial. Am J ficiency with hydrocortisone resulted in significantly shorter Respir Crit Care Med 2002; 166:801–808 duration of weaning and improved weaning success. Effect on the American Thoracic Society, The European Society of duration of mechanical ventilation of identifying Intensive Care Medicine, and The Societé de Réanima- patients capable of breathing spontaneously. Crit Care Med 2004; 32:1289–1293 and high positive end-expiratory pressure for acute lung We do not follow low Vt ventilation recommendations and injury and acute respiratory distress syndrome: a ran- here’s why. Spon- intensive care unit organizational factors associated with taneous breathing during ventilatory support improves low tidal volume ventilation in acute lung injury. A prospective study of indexes pre- response to pressure support ventilation delivered before dicting the outcome of trials of weaning from mechanical and after extubation in patients not capable of totally ventilation. Quantitatively, IgG4 is the smallest subclass of IgG and accounts for only 3 to 6% of total IgG in Rare (orphan) disease is defined as a disease or normal serum. Intrathoracic manifestations of IgG4-related sclerosing disease may include focal parenchymal IgG4-Related Sclerosing Disease lesions (eg, inflammatory pseudotumor, plasma-cell granuloma); interstitial infiltrates (organizing pneu- In 2001, Hamano et al1a reported the findings monia, nonspecific interstitial pneumonia patterns); of high serum IgG4 concentrations and dense mediastinal/hilar lymphadenopathy; and medias- lymphoplasmacytic infiltrates containing IgG4- tinal fibrosis. Subsequently, similar IgG4-related round-shaped ground-glass opacities, bilateral lesions were identified in other organs such as the interstitial infiltrates consisting of reticular and bile duct, salivary gland, lacrimal gland, liver, ground-glass opacities, and thickening of bron- kidney, retroperitoneum (retroperitoneal fibrosis), chovascular bundles and interlobular septa. Inspiratory crackles are level was initially reported to be increased in nearly heard in 20 to 50% of patients; digital clubbing is all patients with autoimmune pancreatitis,1a the uncommon. Approxi- without previous amyloidosis may present to pul- mately 85% of patients show improvement after monologists for an evaluation of respiratory symp- lung lavage. The diagnosis of pulmonary amyloidosis is Pulmonary Amyloidosis achieved by obtaining biopsy material that reveals the characteristic apple-green birefringence with Amyloidosis is a heterogeneous group of polarized microscopy after staining with Congo acquired or inherited diseases characterized by red. Lung include oncocytic hybrid tumor, chromophobe renal- nodules are diagnosed by needle aspiration biopsy cell carcinoma, clear-cell carcinoma, and papillary or surgical resection. The progno- pulmonary manifestations (cystic lung disease and sis is poor for patients with primary systemic pneumothorax) in the absence of skin or kidney amyloidosis who have pulmonary involvement. Pulmonary Langer- (hamartoma of the hair follicle), trichodiscomas, hans-cell histiocytosis encountered in adults is and skin tags, along with a propensity for renal usually a smoking-related interstitial lung disease tumors. Mem- transplant recipients, administration of macrolides, branous and terminal bronchioles are purely air- eg, azithromycin, 250 mg three times per week, has demonstrated some beneficial effects.

The subgroup analysis re- He was found to have an abnormal left middle fnger with a bra- vealed that the current weight of the prematurity group was lighter chymesophalangia type 2A buy sinequan 10mg amex anxiety symptoms sleep. Furthermore cheap sinequan 10 mg otc anxiety symptoms getting worse, there was no difference in severity of de- which is twice the life expectancy of his time discount sinequan 10 mg mastercard anxiety 30002. With his multiple abnormalities cheap 25mg sinequan anxiety 8 weeks postpartum, he was prob- lighter than the term children group. However, there is no major dif- ably unable to hunt effectively, yet he was obviously given a better ference in the later body weight, body mass index, and the severity role to play and able to lead a long life of a respected person, being of developmental delay. This indicate that the nutritional status of buried with full honours of his time. Something present society with 994 all its sophistication could think about and learn from. Thus, it seems important to characterize these atti- Introduction/Background: Hearing impairment is a common prob- tudes among different categories of medical and paramedical staff. Material and Methods: The study was conducted in the ma- concentration throughout a hearing test. Results: 340 health professionals were included in the by paediatric rehabilitation specialist from Paediatric Rehabilitation study, 12. The average age of loss: 1) Otoscopic Examination; 2) Tympanometry; 3) Behavioral the participants was 29. They had Assessment such as Pure Tone Audiometry and Visual Reinforce- an average of 5. This score was not the demographic parameters such tory Brainstem Response or Auditory Steady State Response test as age, sex, family status or years of experience. After the hearing assessment was done on these patients, we identifed 995 20% of them had hearing loss. Shazura1 This data supports the fact that children with certain congenital or 1National Orthopaedic Centre of Excellence in Research and genetic disorders, as well as children with a history of birth compli- Learning, Faculty of Medicine, University of Malaya, Kuala Lum- cations, are especially prone to hearing loss. His eleven thousand year old skeleton, the oldest complete 1Cheras Rehabilitation Hospital, Rehabilitation Medicine Depart- to be found in South East Asia tells an interesting story. However, we found a negative Malaysia, Family Health Development Division, Putrajaya, Ma- correlation between insuffcient external tibial torsion and fat foot. A total of 19,931 adults aged 1 18 years and above were interviewed by trained enumerators using Arogi Rehabilitation Center, Rehabilitation, Larissa, Greece, 2University Hospital of Larissa, Obstrectics, Larissa, Greece, 3Aro- locally validated Washington Group Questionnaire (short version). The balance between satisfaction and fatigue is higher in rural compared to urban areas. All participants were surveyed by using the Professional ing in rural as compared to urban areas. Assurances were given to workers concerning confdentiality of complete diffculty in walking in rural as compared to urban ar- and anonymity. Awareness of these factors may 1 2 1 2 help nurses to prevent or offset the development of this condition. It is characterized by a decrease of the plantar concavity indeed collapse of the foot, often associated with other morphostatic de- 1000 formations. The analysis of multiple regression shows a signifcantly 2max rial and Methods: Ten healthy young male volunteers participated elevated correlation among the fat foot and excessive internal rota- in the study. The 5-day exercise protocol was repeated after disorders of lower limbs is a subject evoked by several authors. Health Care Sciences, Ghent, Belgium Introduction/Background: The consequences of the Ehlers-Danlos 1001 Syndrome affect many aspect of daily life. It contains 37 items on 4 Satisfaction scales “Cognition”, “Self”, “Daily Life and Autonomy”, “Relationships”, 1003 and 2 Bothered scales “Emotions” and “Physical Problems. Results: The research shows: (1) there is signifcant difference between hearing impaired children and age-matched normal children in conversational un- derstanding (p=0. Conclusion: The meaning of this study study, I surveyed the questionnaire about “cooking” and “meals” to were explored and forming the conversational understanding test- the students of the occupational therapist training course. We asked ing material for 4–6 years old children; summarized the test of them “How much are you interested in the items instead below? Mishra1 60% students liked cooking, there was little experience of cooking, 1Swami Vivekanand National Institute of Rehabilitation Training and approximately 30% of the student did not have an opportunity and Research, Physiotherapy, Cuttack, India, 2Swami Vivekanand to cook at all in a week. There was no difference in all items regard- National Institute of Rehabilitation Training and Research, Occu- less of sex. Conclusion: Occupational therapists were demanded pational Therapy, Cuttack, India, 3Swami Vivekanand National In- the knowledge about cooking, health and the nourishment. We must stitute of Rehabilitation Training and Research, Physical Medicine introduce the education about the meal to the students of the occu- and Rehabilitation, Cuttack, India pational therapist training course. The social part of 1 2 3 3 the biopsychosocial model investigates how different social fac- O. Results: At 16 weeks, mon among diabetic patients and often end up with amputation patient was able to walk faster and reported an increased ability which leads to poor QoL. The objective of this study was to evalu- to sit continuously, climb stairs and undergo her routine activities ate the QoL of patients with diabetic foot problems and its correla- for a full day without increase in pain. Material and Methods: This was fed with the outcome of the treatment, her interaction with public a cross-sectional study, conducted at the tertiary hospital, Malaysia sphere continue to pose problem in her attempts to reintegrate in to from Dec 2011 until May 2012. Mann-Whitney U test, Kruskal Wallis test and Spear- efforts of rehabilitation may not bear any success at the level of man correlation were used to analyze the variables. It is one of the special skills for the occupational therapist in terms of the physical functioning. Physicians must thus encour- to support disabled persons or elderly persons by instructing their age all patients with diabetic foot problems to undergo a regular daily activities including cooking. Therefore, occupational thera- medical follow up and well-structured rehabilitation program to pists are demanded some techniques about cooking, the knowledge improve diabetic foot care knowledge and practice so as to improve of health and nourishments, and the interests in “meals”. Neuroma formation in the stump Hyogo College of Medicine- Graduate School of Medicine, Re- 2 was assessed one year after surgery. This assessment was done by habilitation, Nishinomiya, Japan, Hyogo College of Medicine 3 measuring the diameter of sciatic nerve ending using sonogram. Sasayama Medical Center, Rehabilitation, Sasayama, Japan, Ko- Sciatic nerve diameter was measured bilaterally at the same level, nan Women’s University, Physical Therapy- Faculty of Nursing and the value of the normal limb was taken as control. Results: and Rehabilitation, Kobe, Japan, 4Konan Hospital, Rehabilitation, Out of 45 patients who underwent tying of sciatic nerve, only 10 Kobe, Japan, 5Konan Women’s University, Visiting Researcher, patients developed thickening of the cut end of sciatic nerve in Kobe, Japan, 6Hyogo College of Medicine, General Medicine and comparison to opposite limb. On the other hand, 45 patients in Community Health Science, Sasayama, Japan, 7Hyogo College of whom the cut end was left open, 35 patients developed neuroma Medicine, Rehabilitation Medicine, Nishinomiya, Japan formation. Conclusion: Rich microvascularity of sciatic nerve results in the formation of Introduction/Background: Although chronic obstructive pulmo- haematoma beneath the cut end, if it is left open. All the subjects 1009 were studied in two standing postures: erect and with arm bracing.

Turkey There was buy sinequan 25mg line anxiety symptoms of going crazy, likewise purchase 25mg sinequan with amex symptoms anxiety 4 year old, a decrease in abrasion ratings (improvement) for both experimental and control groups but were not signifcant discount sinequan 75 mg with visa anxiety symptoms in your head. Conclusion: Intake of collagen hydrolysate com- mon order sinequan 75 mg line anxiety 300mg, idiopathic entity characterized by diffuse fascial infammation bined with standard of care can signifcantly increase femoral articu- of extremities, peripheral eosinophilia and elevated acute phase reac- lar cartilage thickness in more areas compared to control. On physical examination, abduction and fexion was decreased 1Faculty of Medicine Siriraj Hospital, Rehabilitation Medicine, minimally on the left shoulder. The passive range of motion of the Bangkok, Thailand left elbow was 110 degrees in fexion and –40 degrees in extension. Additionally, left Introduction/Background: Pes planus or fatfoot is the common foot 3–5. Search for an adjunct manage- ment has lead to studies on the potential benefts of nutraceuticals F. This study aims to determine the ef- Aranez2 fect of collagen hydrolysate as an adjunct treatment for patients 1Cebu City, Philippines, 2Southwestern university, College of Reha- with knee osteoarthritis based on pain scale and articular cartilage bilitative Sciences, Cebu City, Philippines thickness, clarity and abrasion using musculoskeletal ultrasound. Material and Methods: Patients from the University of Santo Tomas Introduction/Background: Public utility driving is one of the most Hospital and the Marikina Senior Citizen Association (n=110) were exhausting and physically demanding jobs of public transporta- randomized to either experimental (collagen hydrolysate + standard tion. A number of exercises and modalities sound (articular cartilage thickness at medial, lateral, central femo- have been applied in order to improve the extensibility of tight ral area; clarity; abrasion) at baseline and after 6 months. There was signifcant increase ing techniques in increasing muscle hamstring extensibility in the in all thickness measures of the experimental group except in the improvement of functional performance among public utility ve- lateral right knee. Material and Methods: This experimental study in- group but only in the lateral and medial femoral areas. Tripod sign test was used in determining the presence or absence of tightness in the hamstring muscle. They Sousse, Tunisia underwent 10 sessions of stretching techniques within 2 weeks for 5 minutes per session. The hold-relax acterized by radiological skeletal abnormalities of spine similar to agonist contraction includes passive stretch of the extended leg to the Spondyloepiphyseal Dysplasia Tarda, and clinical manifesta- a point of mild discomfort for 10 seconds. Material and Methods: We present the hamstrings was then performed for 5–10 seconds. He had barrel shaped chest, a second passive stretch for 30 seconds was done to increase the short trunk and pectus carinatum, kyphosis and exaggerated lumber fnal stretch. Radiologic examination revealed fattening and irregulari- the start and every after one week of therapy. The signifcant dif- ties of femoral head with short and broad neck of femur, decreased ference before and after therapeutic maneuver were analyzed using gap between vertebral bodies and platyspondyly. Results: complaints were: articular deformity; limited range of motion, gait Both techniques have comparable effect on the extensibility of tight disorders and pain. However, hold-relax agonist tech- terior femoral osteotomy defection; tenotomy of gracilis, adductor nique after 2 weeks showed better improvement. Conclusion: Hold longus and femoral rectus was performed to retrieve the extension relax and hold-relax agonist contraction stretching as an interven- and abduction of both hips. Conclusion: The results after surgery tion for tight hamstring muscles can signifcantly improve func- and rehabilitation were marked by a minimal gain in range of mo- tional performance and extensibility of hamstring muscles. Material and Methods: This is a descriptive study, involving mobilization with orthosis for three weeks post-surgery is commonly 12 patients with camptocormia. However, this immobilization pe- antikyphotic orthesis combined with an adapted training program. We aimed to compare early mobilization Thyroid function and vit D measure were explored. Results: The average age of Material and Methods: Thirty-fve patients (7 female [20%], 28 male patients was 63 years with a sex ratio of 33%. Most of our patients (91%) have benefted from after immobilization for three weeks with orhosis was applied to the prescription of two types of orthesis: “ bivalve with sternal support patients in group 2 (n: 14). Wrist, metacarpophalangeal, and inter- (6 cases), monohull with front closure (5 cases). In addition, pain with visual pain scale; sensation with Semmes 18 months (4–64 months). Respiratory and urinary toler- eral, palmar and pinch gripping with a pinchmeter; functionality with ances were judged good and digestive and skin tolerances adequate Duruoz hand index were performed before starting a rehabilitation (gastroesophageal refux (1 case) scar at the 5th rib (1 case)). Conclusion: The success of the orthesis seems compro- groups after rehabilitation programme. Patients in group 1 had better mised by the failure to obtain a satisfactory straight position and/or results in range of motion, grip strength and functional status when an ankle fexion, associated signifcant pathology, lack of motiva- compared to patients in group 2. A rehabilitation program based on “a postural correction with bilization protocol is more effective than late mobilization in terms stretching the psoas muscle and strengthening spinal muscles” even with range of motion, grip strength and functional status in patients with orthesis seems necessary to guarantee a satisfactory result. Khachnaoui1 1 Monastir University, Department of Physical Medicine and Func- 1Sahloul Hospital, Department of Physical Therapy and Rehabili- tional Rehabilitation, Monastir, Tunisia J Rehabil Med Suppl 55 Poster Abstracts 119 Introduction/Background: Punctures and leaks of the musculo- Suppl): e351S–418S. Results: Fourteen ultra- 1 sound guided acts were performed in our institution for a period of Hospital Sultan Ismail, Rehabilitation Medicine, Johor Bahru, 12 months. The average age of patients was 41 years (23–55 years) Malaysia with a female predominance (42. The articulations most infl- Introduction/Background: Current literature lacks evidence for the trated were the wrist and the hand (57. For the lower magnitudes greater than 40–45 degrees may require surgical inter- limbs the indications were: talocrural osteoarthritis (14. Material and Methods: A total of 22 patients with scoli- ucts used were cortivazol (14. Conclusion: The infltration of tial baseline postural data were obtained from a set of radiographs, an- Musculoskeletal ultrasound guided in musculoskeletal pathology is teroposterior and lateral. Initial baseline postural data were obtained a quick gesture, easy to perform and well tolerated. It should also be fabricated by a skilled orthotist as comfort is the main contributing factor for compliance. Introduction/Background: A 69-year-old female presented with com- plaints of bilateral knee pain. The patient endorsed chronic left knee pain with recent onset of right knee pain after stepping off a bus. D-dimer levels may be underutilized in Introduction/Background: The goal of this study was to determine outpatient rehabilitation as normal elevations can be seen in other the long term effects of progesterone versus corticosteroid local in- medical conditions including post-operative or post-injury patients2. But functional ety conditions/diseases are still less for applying with that exercise. Thus, and electrophysiologically but functional outcome is higher in pro- this study aimed to examine the factors associated with the effect of gesterone group comparing with corticosteroid group. She was found to have a midline abdominal guide the practice were also an important element of the interven- incision from prior surgery and a hard mass was palpated extending tion.

Biol Chem generic 25mg sinequan visa anxiety 411, 378(1997) generic sinequan 10 mg overnight delivery anxiety xiphoid process, 951–961; Willuhn G sinequan 75 mg on-line anxiety symptoms physical, Leven 16 W: Qualität von Arnikazubereitungen cheap sinequan 25mg line anxiety symptoms 97. The herb was shown to reduce cho- 32 lesterol levels in rats (luteolin inhibits cholesterol synthesis), as well as to 33 increase choleresis and reduce symptoms of dyspepsia, compared with 34 controls, in randomized double-blind studies with healthy human volun- 35 teers. In a small trial (n = 44), artichoke extract reduced total cholesterol in 36 volunteers with baseline values above 220 mg/dL, compared with controls. Atherosclerosis 129 (1997), 147; Fintelmann V: 9 Antidyspeptische und lipidsenkende Wirkung von Artischockenblätterex- 10 trakt. Toxicol Appl Pharmacol, 144(1997), 279–286; Wasielewski 14 S: Artischockenblätterextrakt: Prävention der Arteriosklerose. The herb consists of the dried pri- 20 mary roots (tap roots), secondary roots, and hair roots of four- to seven- 21 year-old Panax ginseng C. Stress models demonstrated that Asian ginseng increased the ani- 28 mals’ ability to cope with psychological and physical pressure. In addition, 29 ginseng increases, shortens the recovery phase, and enhances coordination 30 and memory in humans. If only larger root pieces and whole roots are available, 42 the patient should crush or cut the roots into coarse pieces before use; pre- 43 crushed roots may also be available. For a usual 5 : 1 extract, the dose would be 45 about 1 g, equivalent to 2 “0” caps or usually 2 tablets/day. Standardized 46 extract (5–10% ginsenosides, typically 200 mg per unit); 1–2 capsules or 47 tablets twice daily. Treatment should be 48 continued for 3 months followed by a break, after which treatment can be 49 re-initiated. Use of teas from whole roots chopped or ground at home 7 are acceptable; other use should be restricted to standardized preparations. Deutsche Apotheker Ztg 135 (1995), 2136–2138; 13 Pfister-Hotz G: Phytotherapie in der Geriatrie. Ex- 40 pressed orange oil also contains lipophilic flavonoids and furanocoumarins. They stimulate phagocytosis and have hemolytic, cyto- 28 toxic, antiviral, anticholinergic, and local anesthetic effects. The constituent 29 solasodine has a cortisone-like effect in individuals with rheumatic poly- 30 arthritis and Bekhterev’s arthritis, and it has a desensitizing effect. Toxic effects are not to be expected when doses less than approximately 43 25 g per day are used. Unstandard- 9 ized liquid and standardized powdered extracts in capsules and tablets are 10 widely available. The phytoestrogens in the rhizome ofAc- 16 taea racemosa bind to the estrogen receptors, and have selective estrogen 17 receptor modulator properties. In one double-blind placebo-controlled 18 clinical study, black cohosh extract was shown to improve the symptoms 19 of menopause, especially hot flushes. Maturitas 25 (1995), 149–153; Gruenwald J: Standardized Black 45 Cohosh (Cimicifuga) Extract Clinical Monograph. Quarterly Review of Nat- 46 ural Medicine 4 (1998), 117–125; Jarry H et al: Treatment of Menopausal 47 Symptoms with Extracts of Cimicifuga Racemosa, In vivo and in vitro Evi- 48 dence for Estrogenic Activity. Darmstadt, 1995, S 99–112; Liske E: 50 Plant Summaries—B Therapeutic Efficacy and Safety of Cimicifuga racemosa for Gynecologic 1 Disorders. Hence, the herb softens the stools and increases the 15 volume of the bowel contents. Pregnant or nursing mothers 19 should not use buckthorn fruit unless directed by a physician. Alternatively, place the herb in cold water, boil for 2 24 to 3 minutes, then strain immediately. Long-term use can result in the loss of electrolytes, par- 31 ticularly potassium ions, thereby leading to problems such as hyper- 32 aldosteronism and decreased bowel motility. Arrhythmias, nephropathies, 33 edemas, and accelerated bone degeneration are rare side effects. Consumption 34 of large quantities of buckthorn fruit can lead to diarrhea with vomiting and 35 kidney irritation. Deutsche Apotheker Ztg 136 (1996), 2353–2354; Anon: Anwen- 48 dungseinschränkungen für Anthranoid-haltige Abführmittel angeordnet. The herb consists of the dried, 6 coarsely chopped (and usually peeled) rhizome of Acorus calamus (L. In animal studies, the herb 13 demonstrated spasmolytic and sedative effects, reduced spontaneous 14 stomach activity, and lowered the ulcer index (reduced the production of 15 gastric juices and acids). Calamus also has stomachic action due to the pres- 16 ence of bitter principles and the spasmolytic effect of its essential oil. In Germany, no official risk-to- 40 benefit assessment of calamus root has yet been published in any monograph. Natural R(+) 7 camphor is obtained by steam distilling the wood of the camphor tree, 8 the product of which is then purified by sublimation. The herb consists of the essential oil 49 distilled from the ripe seedlike fruit of Carum carvi L. Caraway seeds should be crushed immediately prior to use to prevent 41 unnecessary loss of the highly volatile essential oil. Its hot and 49 spicy fruit is best known as a spice, but is also used in medicine. The herb consists of the ripe, dried 3 fruit (without calyx) of Capsicum annuum L. Topical application of the herb initially induces erythema accom- 8 panied by sensations of pain and heat, followed by a phase of insensitivity 9 (reversible or irreversible deactivation of afferent fibers). The antinocicep- 10 tor and antiphlogistic effects of the herb can persist for several hours to sev- 11 eral weeks. Deutsche Apo- 36 theker Ztg 137 (1997), 1027–1028; Anon: Phytotherapie: Pflanzliche 37 Antirheumatika—was bringen sie? Deutsche Apotheker Ztg 136 (1996), 38 4012–4015; Kreymeier J: Rheumatherapie mit Phytopharmaka. When collecting cham- 45 omile, it is important to remember that the receptacle of true (German) cham- 46 omile is hollow and conical. Only distil- 32 lates and alcohol preparations of the herb contain therapeutically effective 33 concentrations of the essential oil. Deutsche Apotheker Ztg 136 (1996), 1821–1834; Mil- 39 ler T, Wittstock U, Lindequist U, Teuscher E: Effects of some components of 40 the essential oil of chamomile, Chamomilla recutita, on Histamine release 41 from mast cells. It suppresses the release of prolactin and reduces the 5 symptoms of premenstrual syndrome.