The authors were encouraged with the above results; however, a longer follow-up and greater numbers of patients are required before transection of hippocampus is confirmed to be efficacious and sparing of verbal memory function. All had continuous spike and wave in slow-wave sleep from a unilateral perisylvian source, and all had been mute for at least 2 years. Nine of these children had achieved complete recovery of language and were not requiring any speech therapy (77). The frequency of seizures and behavioral disorders were significantly improved in all; however, improvement in language function was not dramatic. This might be related to the duration of the epileptic abnormality prior to surgery (78). In reports by Patel and the Devinsky groups, a moderate improvement in language, social and behavioral function with a significant improvement in seizure frequency was reported (79). In four patients, the targeted seizures were eliminated but the progression of the disease continued. Consequently, patients are expected to experience transient dysfunction of transected cortex, with ensuing neurological deficits lasting for 2 to 3 weeks. We have reported previously a neurological complication rate of 15% with 7% suffering a permanent deficit. These included foot drop in 2%, language deficit in 2%, and a parietal sensory loss in 1%. Both procedures offer therapeutic options in patients previously rejected for more traditional resective surgery. The efficacy of corpus callosotomy has now been demonstrated in multiple centers around the world. Additional experimental and clinical studies are needed before this surgical procedure is fully integrated into the therapeutic armamentarium at all major epilepsy centers. Much of the success of both procedures depends on the proper selection of patients and the experience of the neurologic and neurosurgical teams. A learning curve should be expected whenever these procedures are newly implemented at a center. Surgical division of commissural pathways in the corpus callosum: relation to spread of an epileptic attack. The generalized convulsive seizures induced by daily electrical stimulation of the amygdala in split brain cats. The role of the corpus callosum in bilateral interhemispheric synchrony of spike and wave discharge in feline generalized penicillin epilepsy. Role of the corpus callosum in photosensitive seizures of epileptic baboon Papio papio. Effect of anterior two-thirds callosal bisection upon bisymmetrical and bisynchronous generalized convulsions kindled from amygdala in epileptic baboon, Papio papio. Prediction of seizure outcome after corpus callosotomy in patients ten years or older. Presurgical evaluation for epileptic surgery in the era of longterm monitoring for epilepsy. Magnetic resonance imaging, electroencephalogram and selected neuropsychological testing in staged corpus callosotomy. Anterior callosotomy in the treatment of medically intractable epilepsies: a study of 43 patients with a mean follow-up of 39 months. Anterior callosotomy for intractable epilepsy: outcome in a series of twenty patients. Corpus callosotomy: a palliative therapeutic technique may help identify respectable epileptogenic foci. Paper presented at the Second Dartmouth International Conference on Epilepsy and the Corpus Callosum; August 12, 1991; Hanover, New Hampshire. Corpus callosotomy for intractable epilepsy: seizure outcome and prognostic factors. Predictive factors of callosotomy in drug-resistant epileptic patients with a long follow-up.
Ultimately, all of the dural venous sinuses will empty into the internal jugular vein. Injuries to the head can cause bleeding into the brain (hemorrhages, clots, hematomas). It is a highly conceptual topic, and full understanding of these concepts is essential to success on the Step 1 exam. Causes an increase in sodium reabsorption, increase in potassium secretion, and increase in hydrogen secretion. It is located strategically in a location that allows it to maximally regulate these functions (located between the vascular pole of the renal corpuscle and the distal convoluted tubule). Free Water Clearance Filtration Fraction the filtration fraction represents the proportion of fluid that reaches the kidney which passes to the renal tubules. Angiotensin 2 binds to receptors in the intraglomerular mesangial cells, stimulating the release of aldosterone from the zona glomerulosa of the adrenal cortex. Cl- and K+ are transported into the lumen, which is necessary for secretion of acid. H+ pumped out of the cell and into the lumen in exchange for K+ through a proton pump. The following illustration puts all of the above information into play, significantly simplifying your understanding of the whole process. Intracellular enzymes separate T3 and T4 from the protein Free T3 and T4 enter the circulation *T3 provides negative feedback to the anterior pituitary. Isovolumetric Contraction this is the point between the closure of the mitral valve and the opening of the aortic valve. Systolic Ejection the heart squeezes and blood is ejected through the aortic valve. This phase can be considered the phase between the time the aortic valve opens and closes. Isovolumetric Relaxation this is the period of time between the closure of the aortic valve and the opening of the mitral valve. Rapid filling phase After the opening of the mitral valve, blood pools rapidly into the left ventricle. This rate does not create a ventricular rate of 100 because the sympathetic and parasympathetic fibers have the ability to control how much gets through. This results in a slow conduction velocity that helps to prolong transmission from the atria to the ventricles. Acutely, cardiac output will increase due to stroke volume increases, whereas chronically cardiac output is a result of an increase in heart rate. Preload is increased when there is an increase in blood volume, sympathetic stimulation, and even exercise. Vasodilators will decrease the afterload, this includes most commonly drugs like hydralazine. This law explains that synchronization of cardiac output and venous return occurs without needing external factors to come into play. The classic presentation is the "sawtooth" pattern, which occurs as a result of identical back-to- back depolarizations. Calcium is released and binds to troponin C, which leads to the conformational change (moving tropomyosin out of the myosin-binding groove on actin filament) 3.
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Gamma knife surgery in mesial temporal lobe epilepsy: a prospective multicenter study. A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy: seizure response, adverse events, and verbal memory. Failure of gamma knife radiosurgery for mesial temporal lobe epilepsy: report of five cases. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Clinical characteristics in focal cortical dysplasia: a retrospective evaluation in a series of 120 patients. Normal magnetic resonance imaging and medial temporal lobe epilepsy: the clinical syndrome of paradoxical temporal lobe epilepsy. Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. Frequency and characteristics of dual pathology in patients with lesional epilepsy. Selective amygdalohippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Magnetic resonance imagingbased volume studies in temporal lobe epilepsy: pathological correlations. Long-term seizures and quality of life after epilepsy surgery compared with matched controls. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence. Long term follow-up of the first 70 operated adults in the Goteborg Epilepsy Surgery Series with respect to 94. While the majority arise in the temporal lobe, extratemporal foci are common particularly in childhood. The neocortical epilepsies are a diverse group with a broad spectrum of pathology, which present significant challenges to localizing the epileptogenic focus. The presurgical evaluation focuses on accurate and precise localization of the epileptogenic zone so that complete resection can be achieved. The compilation of clinical, electrographic, and neuroimaging data are directed toward this goal. Surgical procedures vary according to the location and extent of the epileptogenic zone and its proximity to eloquent cortex. Epilepsy surgery should be advocated early in the course of medically intractable seizures (2). Early surgical management will prevent long-term disability, social maladjustment, and impaired quality of life. Timely surgical referral in childhood is particularly important to improve cognitive development and promote neuronal plasticity. For example, semiology helps distinguish frontal versus mesial temporal seizure origin. Motor symptomatology at seizure onset suggests frontal lobe involvement whereas oroalimentary automatisms and psychic symptoms indicate mesial temporal activation (5). Late motor symptoms in temporal lobe cases suggest secondary rather than primary activation of the frontal lobe. The history provides important antecedent factors related to prenatal, perinatal, or postnatal etiologies. The family history will identify genetic syndromes that are not surgically amenable. Assessment of developmental status is important in pediatric patients as catastrophic epilepsies associated with developmental stagnation or regression mandate more urgent surgical referral. Neurologic deficits on examination such as hemiparesis or visual field defects raise suspicion of contralateral seizure origin. Localizing Clinical Semiology Frontal lobe epilepsy accounts for up to 30% of epilepsy surgeries, second only to temporal lobectomies (6,7). Frontal lobe seizures are typically brief, may occur in clusters, and manifest a nocturnal predisposition (8).
This legislation aims to provide better portability (transfer) of employer-sponsored insurance from one job to another. By preventing job lock-the need to remain in the same position or with the same employer for fear of losing health care coverage-the act was designed to afford American workers greater career mobility and the freedom to pursue job opportunities. They also hoped it would provide a measure of protection from genetics-based discrimination. The law prohibits group health plans from denying new coverage based on past or present poor health and guarantees that employees can retain their health care coverage even after they leave their jobs. New employers can still require a routine waiting period (usually no more than three months) before paying for health benefits, but the new employee who applies for insurance coverage can be continuously covered during the waiting period. It neither limits the collection of genetic information by insurers nor prohibits insurers from requiring an individual to take a genetic test. The act does not limit the disclosure of genetic information by insurers, and it does not apply to individual health insurers unless they are covered by the portability provision. Most genetic counseling is informative and nondirective-it is intended to offer enough information to allow families or individuals to determine the best courses of action for themselves but avoids making testing recommendations. Patients undergoing tests to improve their care and treatment have different pretest counseling needs from those choosing susceptibility or predictive testing. In such instances genetic counselors do offer testing recommendations, particularly when a test offers an opportunity to prevent disease. As tests for genetic risk factors increasingly become routine in clinical medical practice, they are likely to be offered without formal pretest counseling. Genetic counselors urge physicians, nurses, and other health care professionals not to discount or rush through the process of obtaining informed consent to conduct a genetic test. They caution that potential psychological, social, and family implications should be acknowledged and addressed in advance of testing, including the potential for discrimination on the basis of genetic-risk status and the possibility that the predictive value of genetic information may be overestimated. The potentially life-changing consequences of genetic testing suggest that all health care professionals involved in the process should not only adhere to thoughtful informed consent procedures for genetic testing but also offer or make available genetic counseling when patients and families receive the results of testing. We are walking hopefully in the scientific foothills of a gigantic mountain range. Their article ushered in a new age of discovery in genetics and laid the foundation for the sequencing of the human genome. Today, genome is widely understood to be the entire complement of genetic material in the cell of an organism. In each organism these bases are arranged in a specific order, or sequence, and this order constitutes the genetic code of the organism. In 2001 a first draft sequence of the entire human genome was completed and made available to the public for study and research. Holley, Khorana, and Nirenberg were awarded the 1968 Nobel Prize in Physiology or Medicine. Visualization of length of labeled restriction fragments that have been seperated by molecular weight using gel electrophoresis 20kb Molecular weight 15kb 10kb 5kb 1kb B C D Normal-length restriction fragment on both chromosomes (example A) and on one chromosome of a pair (examples B, C, D) Abnormal-length restriction fragments indicating the presence of a mutation on one chromosome of each pair Gel electrophoresis "Southern Blot," in GeneTests Data Base: GeneReviews Illustrated Glossary, National Institutes of Health, U. National Library of Medicine, National Human Genome Research Institute. Using these new genetic techniques, several genes for serious human disorders were identified during the 1980s. That same year a gene for neurofibromatosis type I was found on the long arm of chromosome 88 the Human Genome Project 17. Neurofibromatoses are a group of genetic disorders that cause tumors to grow along various types of nerves and can affect the development of nonnervous tissues such as bones and skin. The disorder may also result in developmental abnormalities such as learning disabilities. Department of Agriculture, Beltsville Agricultural Research Center, July 2003, bldg6. The gene for cystic fibrosis was discovered in 1989, and it was determined that three missing nucleic acid bases occurred in the altered gene of 70% of patients with cystic fibrosis. The mutations associated with Duchenne muscular dystrophy were identified in 1987.
We wish such combination drugs offered two key components: guaranteed efficacy of both ingredient drugs, and more affordable pricing. We have always embraced the value of a therapeutic monocular trial in the care of patients for whom we contemplate therapeutic intervention. If a prostaglandin has a therapeutic effect on the first eye, then it almost certainly will have a therapeutic effect on the second eye, and the magnitude of this response will be similar in both eyes. This finding argues against the requirement of additional clinic visits to assess the response of treatment in the second eye. The monocular trial of therapy is effective in accurately predicting the response of an untreated eye to monotherapy with a prostaglandin analogue at all daytime points measured. There is no requirement for patients to be seen at the same time of day after treatment has commenced. The effect in the first eye predicts both the likelihood and magnitude of an effect in the second eye at all time points during office hours, and negates the requirement for an additional visit to check the therapeutic effect when commencing therapy in the second eye. Our take: this is in keeping with our 70-plus combined years of glaucoma patient care, and we commonly embrace the monocular therapeutic trial in most of our patients most of the time. Validity of the monocular trial of intraocular pressure-lowering at different time points in patients starting topical glaucoma medication. As medical practitioners of the eye, it seems appropriate that we should be the first-line providers for the majority of glaucoma patients. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions December 2008. The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand. Thus, accurate evaluation of glaucomatous structural damage is indispensable for appropriate diagnosis of glaucoma. Spectraldomain optical coherence tomography in manifest glaucoma: its additive role in structural diagnosis. Consult this superb article for a thorough discussion of this largely idiopathic condition. Topical timolol in the treatment of monocular oscillopsia secondary to superior oblique myokymia: A review. Most eye doctors are familiar with rebound tonometry, known by the brand name Icare tonometer. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The one-year crossover rates were high in the randomized cohort (approximately 40% in each direction) but moderate in the observational cohort (17% crossover to surgery and 3% crossover to nonsurgical care). The intention-to-treat analysis for the randomized cohort showed no statistically significant effects for the primary outcomes. The as-treated analysis for both cohorts combined showed a significant advantage for surgery at 3 months that increased at 1 year and diminished only slightly at 2 years. Two year study of laminectomy with or without fusion versus non-surgical care for degenerative spondylolisthesis with spinal stenosis. A combination randomized and observational study with substantial cross-over and inconsistent conservative care. Cohort had neurogenic claudication or radicular leg pain with associated neurologic signs for at least 12 weeks and degenerative spondylolithesis on lateral radiographs with patient in standing position. Adjusted cohort analysis ("as-treated") showed improved pain and function in patients treated surgically compared to those treated without surgery. Of all patients receiving surgery, the intraoperative complication rate was 13%, postop complication rate was 13%, and rate of repeat surgery within one year was 6%. In the nonrandomized as-treated comparisons of symptomatic patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically. Surgical compared with nonoperative treatment for lumbar 2/B degenerative spondylolisthesis.
Syndromes
Parametrial invasion is indicated by disruption of the low-signal-intensity cervical stromal ring, with nodular or irregular tumor extending into the parametrium (59). Segmental disruption of the cervical stroma is highly indicative of parametrial invasion; however, additional features, such as a spiculated tumor-parametrium interface, soft-tissue extension into the parametrium, and encasement of the periuterine vessels, improve confidence in diagnosing parametrial invasion (58). Conversely, parametrial invasion may be confidently excluded, with specificity as high as 99%, if the low-signal-intensity cervical stromal rim is thicker than 3 mm, a finding known as the "hypointense rim" sign (62). In large tumors, parametrial invasion may be overestimated on T2-weighted images due to the presence of stromal edema, which is caused by compression of the tumor or inflammation (58). Its accuracy varies according to the size of the tumor, with 96% accuracy in small tumors and 70% accuracy in large tumors (71). Postbiopsy hemorrhage may cause peristromal stranding, another pitfall of assessing parametrial invasion (58,62). Rectal invasion usually follows the path of the uterosacral ligaments because the peritoneal reflection of the pouch of Douglas acts as a barrier for direct invasion from the posterior fornix and into the rectum (62). On T2-weighted images, rectal invasion is indicated by segmental disruption of the low-signal-intensity muscularis layer by the hyperintense tumor. Bullous edema within the bladder causes high-signal-intensity thickening along the superficial internal surface of the bladder, a finding that may mimic tumor involvement (63). In patients with endometrial and cervical cancer, the presence of lymph node metastases confers a poor prognosis and adversely affects survival (80,81). Therefore, identification of involved pelvic and paraaortic lymph nodes alters the therapeutic approach. As our knowledge Lymph Node Evaluation and understanding of tumor biology improve, staging systems must also improve in order to identify significant prognostic factors, which will inform treatment decisions. Ultimately, it provides high-quality data, including response to treatment, survival, and mortality. Thus, it is important that radiologists familiarize themselves with the revised staging classification of endometrial and cervical carcinoma and understand their relevance to disease management. The multidisciplinary tumor conference in gynecologic oncology: does it alter management Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Results and complications of operative staging in cervical cancer: experience of the Gynecologic Oncology Group. The staging of cervical cancer: inevitable discrepancies between clinical staging and pathologic findings. Cervical carcinoma: efficacy of thin-section oblique axial T2weighted images for evaluating parametrial invasion. Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting advanced stage disease in patients with endometrial carcinoma. Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results. Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Diffusionweighted single-shot echo-planar imaging with parallel technique in assessment of endometrial cancer. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3. Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma. Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. The performance of magnetic resonance imaging in early cervical carcinoma: a longterm experience. Pelvic lymphadenectomy for cervical cancer: extraperitoneal versus laparoscopic approach. Radical vaginal hysterectomy with extraperitoneal pelvic lymphadenectomy in cervical cancer. Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review.
See Pituitary-hypothalamic disorders I Imaging studies in acromegaly and gigantism. Thyroid Liver Bone Oesophagus Lung Stomach Foregut Pancreas Midgut Large Intestine Large Intestine Small Intestine Hindgut Rectum InterScience Institute. The questions you will encounter will require recognition and understanding of structures, and the ability to understand and identify their clinical significance. Sensory Deficit Loss of sensation in the thumb, lateral aspect of the palm, and the first 2. The radial nerve innervates the Brachioradialis, Extensors of the wrist/fingers, Supinator, and the Triceps. Compression and/or injury to the radial nerve causes the classic "wrist drop", due to the inability to extend the wrist. With time, weakness of the hand will produce the "claw hand", where the small finger and the ring finger contract and form a "claw". This is late sequelae of ulnar nerve injury, and is a sign of a severely injured ulnar nerve. This occurs most commonly with shoulder dystocia during childbirth, but is also seen from direct blows to the shoulder. The most commonly affected nerves are the axillary nerve, the musculocutaneous nerve, and the suprascapular nerve. This causes a loss of sensation in the arm and atrophy of the deltoid, the biceps, and the brachialis muscles, resulting in a characteristic hanging of the arm to the side with medial rotation. The classic findings: - - - Abductor paralysis (hanging limb to the side) Paralysis of lateral rotators (medial rotation) Loss of biceps action (forearm pronation) the presence of a brisk reflex in the arm often means there is a good prognosis. It is a branch of the Vagus Nerve, and supplies all intrinsic muscles of the larynx except the cricothyroid. Damage to recurrent laryngeal nerve = Hoarseness the right recurrent laryngeal nerve wraps around the right subclavian artery, while the left recurrent laryngeal nerve wraps around the arch of the aorta and the ligamentum arteriosum. The left lung contains, instead of a middle lobe, space that is occupied by the heart (cardiac notch). The most common site of foreign body aspiration is the right lung, because the angle of the right mainstem bronchus is less acute than the left mainstem bronchus. The celiac artery supplies the liver, stomach, spleen, superior half of the duodenum, the abdominal esophagus, and the pancreas (all structures of the foregut). The superior mesenteric artery supplies structures arising from the midgut, while the inferior mesenteric artery supplies structures arising from the hindgut. Due to this innervation, pain and/or pressure to the diaphragm can cause referred pain to the shoulder. There are a few extremely important structures that perforate the diaphragm at the level of T8, T10, and T12. Many abdominal pathologies occur as a result of stasis and/or obstruction of the biliary tree. Retroperitoneal structures can often refer pain to the back, thus knowledge of this anatomy is essential. Protrusion through the deep inguinal ring is lateral to the inferior epigastric vessels.
Taylor type 2 lesions are associated with focal thickening of cortex and blurring of the gray-white junction. Type 2b frequently shows increased signal intensity extending from the cortex to the ventricular surface. Tubers are classically multiple and bilateral but partial seizures are often attributable to a single epileptogenic tuber (83,84). Tumors Brain tumors account for 15% to 30% of patients undergoing epilepsy surgery for neocortical epilepsy (17,88). Approximately 50% of patients with supratentorial tumors will have seizures, though not all are medically intractable. Seizures are often the first presentation of lowgrade tumors and their presence is a favorable tumor prognosticator. These tumors may have intrinsic epileptogenic activity because of their neuronal components. Gangliogliomas are composed of both neoplastic neural and neoplastic glial cells situated most frequently in the temporal lobe (91). These lesions occur frequently in younger patients and most are located in the temporal or frontal lobe (93,94). Low-grade glial tumors account for a substantial proportion of tumor-related epilepsies and most often occur in the Chapter 83: Focal and Multilobar Resection 941 temporal lobe (96). These include low-grade gliomas, pilocytic asytrocytomas, pleiomorphic xanthoastrocytomas, and oligodendrogliomas. Inflammatory Lesions Infectious Though much less common in North America, neurocysticercosis is a major cause of seizures in Latin America, Asia, and Africa (108). Focal seizures occur in 70% of symptomatic patients and are a rare cause of intractable epilepsy due to calcifications or remote epileptogenesis (108,109). Postinfectious encephalitis is associated with multifocal abnormalities that may preclude focal resection. Prior Cerebral Injury (Trauma/Infarct/ Previous Cortical Resection) Cranial injuries are frequently subdivided into penetrating or missile injuries and nonpenetrating head injuries. Approximately 50% to 75% of cortical contusions involve the frontal and temporal lobes, particularly the lateral convexity and basal frontal cortex (97). These lesions of the superficial gray matter are associated with acute hemorrhage. More severe trauma produces encephalomalacia with bilateral asymmetric frontal lesions. The frontal pole and orbitofrontal regions are particularly vulnerable to closed head trauma and post-traumatic epilepsy (98). Pathologic changes in posttraumatic epilepsy vary with the type of injury and vary significantly between affected regions (99,100). Encephalomalacia is nonspecific and results from perinatal insults, head injury, or previous surgical resections. Noninfectious Rasmussen encephalitis is a chronic encephalopathy of unknown, though suspected autoimmune etiology resulting in progressive atrophy and inflammatory changes in one cerebral hemisphere. It is characterized by progressive hemiparesis, hemianopia, and intractable focal seizures (110). Seizures often include epilepsia partialis continua, and hemispherectomy remains the only known effective treatment (111). Because these lesions consist of malformed blood vessels, they lack functioning neuronal tissue and their epileptogenic potential arises from hemorrhage, gliosis, and encephalomalacia in surrounding brain tissue. Cavernous angiomas are clusters of fragile sinusoidal enlarged vessels which lack mature vessel walls and, therefore, are prone to repeated hemorrhages. These lesions account for 10% to 20% of intracranial vascular abnormalities with 30% to 40% resulting in seizures (102). Their epileptogenic potential likely reflects pathologic changes in the surrounding tissue from chronic microhemorrhages (104,105), and there is experimental support for epileptogenicity of hemosiderin-induced damage (106). Resection of cavernous angiomas should include the hemosiderin-stained rim (107) as the vascular malformation itself is not epileptogenic. Venous angiomas rarely cause epilepsy but may be discovered incidentally on neuroimaging.
Many patients present with atypical symptoms and establishing a diagnosis may be challenging. The importance of screening and treatment for depression in this population, however, should be emphasized. The myth that all antidepressants significantly lower seizure threshold and should be avoided must be dispelled. Anxiety disorders also occur more commonly in patients with seizures than in the general population. Common phobias in patients with epilepsy include agoraphobia, social phobia, and a fear of having seizures. Anxiety disorders can be a source of significant distress, and proper treatment is essential. Psychotic symptoms generally occur during the interictal state with features similar to that of schizophrenia. In contrast to schizophrenia, however, patients with epilepsy and psychosis often lack negative symptoms and deterioration of personality. As an increased frequency of postictal psychotic episodes may evolve to chronic interictal psychosis, immediate treatment is indicated. Atypical antipsychotics and psychiatric consultation are the cornerstones of management. Finally, clinicians should note the frequent presence of comorbid personality disorders in this patient population. Aggression may also be evident in patients with seizures, and should be recognized as a treatable disorder. The relationship of neuropsychological functioning to quality of life in epilepsy. Differential impact of mood and anxiety disorders on the quality of life and perception of adverse events to antiepileptic drugs in patients with epilepsy. Depression and anxiety in epilepsy: the association with demographic and seizure-related variables. The interictal dysphoric disorder: recognition, pathogenesis, and treatment of the major psychiatric disorder of epilepsy. Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders. Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy. Psychiatric aspects of temporal lobe epilepsy before and after anterior temporal lobectomy. Psychiatric outcome of temporal lobectomy for epilepsy: incidence and treatment of psychiatric complications. Depression in intractable partial epilepsy varies by laterality of focus and surgery. Depression in epilepsy: ignoring clinical expression of neuronal network dysfunction Co-morbid psychiatric disorder in chronic epilepsy: recognition and etiology of depression. Antidepressant drugs and seizure susceptibility: from in vitro data to clinical practice. Refractory epilepsy: an evaluation of psychological methods in outpatient management. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy. A prospective study of anxiety with respect to seizure outcome after epilepsy surgery. Lifetime history of panic attacks and epilepsy: an association from a general population survey. Association of temporal lobe epilepsy and obsessive-compulsive disorder in a patient successfully treated with right temporal lobectomy. Response of obsessive compulsive disorder to carbamazepine in two patients with comorbid epilepsy.
The Ability to Control Human Reproduction Will Lead to Treating Children Like Products," in Reproductive Genetics Testing: What America Thinks, Genetics and Public Policy Center at the Johns Hopkins University, 2004. Caplan concludes that the decision to forgo germline engineering does not make ethical sense. He laments: [S]ome genetic diseases are so miserable and awful that at least some genetic interventions with the germline seem justifiable. It is at best cruel to argue that some people must bear the burden of genetic disease in order to allow benefits to accrue to the group or species. At best, genetic diversity is an argument for creating a gamete bank to preserve diversity. It is hard to see why an unborn child has any obligation to preserve the genetic diversity of the species at the price of grave harm or certain death. Caplan cites examples of genetic engineering in the United States such as the Repository for Germinal Choice in California, also known as the ``Nobel Prize sperm bank,' which solicits and stores sperm from men selected for their scientific, athletic, or entrepreneurial acumen. The banked sperm is available for use by women of high intelligence for the express purpose of creating genetically superior children. Caplan observes that there have been relatively few critics of this practice, whereas the mere suggestion of the possibility of directly modifying the genetic blueprint of gametes (sperm and eggs) has generated fiery debate in professional and lay communities. He contends that the history of eugenically driven social policy is reason enough to question and even protest the 150 Ethical Issues and Public Opinion Caplan fears that choosing to refrain from efforts to modify the germline will result in lives sacrificed-that is, important benefits will be delayed or lost for people with disorders that might be effectively treated with germline engineering. Caplan recommends responding to justifiable concerns about the dangers and potential for abuse of new knowledge generated by the genome with frank, objective assessments of the appropriate goals of this application of biotechnology. Caplan continues to exhort discussion of safeguards to prevent abuses of new knowledge and technologies. In a September 2, 2006, presentation, Biobanking, Genomics, & Genetic Engineering: Where Are We Headed, and What Genetics and Genetic Engineering Rules Should Take Us There In addition to re-examining the question, ``Should society limit how far we push genetic manipulation He opined that biobanks offer tremendous potential benefits for selected patients, including those receiving organ transplants, but questioned whether there are controls in place to effectively prevent black market sales of human organs and other misuse of biobank tissues and confidential donor information. Although many sources were used to construct the historical overview and highlights contained in this book, James D. Ricki Lewis and Bernard Possidente offer more recent history in A Short History of Genetics and Genetic Engineering (2003. Ethical issues arising from genetic research and engineering are analyzed in Our Posthuman Future: Consequences of the Biotechnology Revolution (2002) by Francis Fukuyama, Playing God The journals Nature and Science have reported every significant finding and development in genetics, and articles dating from 1953 from both publications are Genetics and Genetic Engineering cited in this text, as are articles from Scientific American, Nature Biotechnology, NewScientist. Research describing genetic testing, disorders, and genetic predisposition to disease is reported in professional medical journals. Studies cited in this book were published in the Archives of Disease in Childhood, Archives of Internal Medicine, British Medical Journal, Genetics in Medicine, Hospitals and Health Networks, Journal of Allergy and Clinical Immunology, Journal of the American Medical Association, New England Journal of Medicine, and Seminars in Respiratory and Critical Care Medicine. Ethical and psychological issues and the contributions of genetics to personality and behavior are examined in articles published in the American Journal of Bioethics, Archives of General Psychiatry, British Journal of Psychiatry, European Psychologist, Health Affairs, Journal of the American Academy of Child and Adolescent Psychiatry, Journal of Consulting and Clinical Psychology, Journal of Educational Psychology, Journal of Personality and Social Psychology, and Psychological Review. Department of Energy, describes the ambitious goals and accomplishments of the Human Genome Project since its inception in 1990. The Environmental Genome Project was launched by the National Institute of Environmental Health Sciences. The National Institutes of Health provides definitions, epidemiological data, and research findings about a comprehensive range of genetic tests and genetic disorders. Public opinion data from the following organizations was also very helpful: Cogent Research Syndicated 155 Genomics Attitudes and Trends Survey and the Gallup Organization. Additionally, many colleges, universities, medical centers, professional associations, and foundations dedicated to research, education, and advocacy about genetic disorders and diseases provided up-to-date information included in this edition. If more than one table or figure appears on a particular page, the exact item number for the table or figure being referenced is provided.
References:
