n. 1. (in anatomy) the layer of connective tissue that envelops structures such as nerves, arteries, tendons, and muscles. 2. a *condom.
Causes The cause of these dilatations on the tendon-sheaths is either some irregular growth of the SYNOVIAL MEMBRANE which lines them and secretes the ?uid that lubricates their movements, or the forcing-out of a small pouch of this membrane through the sheath in consequence of a strain. In either case a bag-like swelling forms, whose connection with the synovial sheath becomes cut o?, so that synovial ?uid collects in it and distends it more and more.
Symptoms A soft, elastic, movable swelling forms, most often on the back of the wrist. It is usually small and gives no problems. Sometimes weakness and discomfort may develop. A ganglion which forms in connection with the ?exor tendons in front of the wrist sometimes attains a large size, and extends down to form another swelling in the palm of the hand.
Treatment Sudden pressure with the thumbs may often burst a ganglion and disperse its contents beneath the skin. If this fails, surgical excision is necessary but, as the ganglion may disappear spontaneously, there should be no rush to remove it unless it is causing inconvenience or pain.... ganglion
Large axons are covered by a sheath of insulating myelin which is interrupted at intervals by nodes of Lanvier, where other axons branch out. An axon may be more than a metre long. It ends by branching into several ?laments called telodendria, and these are in contact with muscle or gland membranes and other nerves (see NERVE).... axon
The female condom might be suitable for contraception when a woman misses a day or two of her contraceptive pill; if there is DYSPAREUNIA; when the perineum needs protection, for example, after childbirth; or in cases of latex allergy to traditional condoms. Used properly with spermicide, it provides an e?ective barrier both to infections and to spermatozoa. Failure may result if the penis goes alongside the condom, if it gets pushed up into the vagina, or if it falls out. (See CONTRACEPTION.)... condom
Tendon injuries are one of the hazards of sports (see SPORTS MEDICINE). They usually result from indirect violence, or overuse, rather than direct violence.
Rupture usually results from the sudden application of an unbalanced load. Thus, complete rupture of the Achilles tendon is common in taking an awkward step backwards playing squash. There is sudden pain; the victim is often under the impression that he or she has received a blow. This is accompanied by loss of function, and a gap may be felt in the tendon.
Partial Rupture is also accompanied by pain, but there is no breach of continuity or complete loss of function. Treatment of a complete rupture usually means surgical repair followed by immobilisation of the tendon in plaster of Paris for six weeks. Partial rupture usually responds to physiotherapy and immobilisation, but healing is slow.... tendon
As described by the French physician, Charcot, over 100 years ago, it is not infectious. Symptom-free periods may extend for months, even years, though relapses may be triggered by emotional crises, physical injury, the contraceptive pill, influenza and other infections.
While the cause is unknown, some studies have revealed a link between the disorder and the distemper virus in dogs. Others have linked the disease with mercury toxicity from amalgam dental fillings shown to generate electromotive forces which propel ionised mercury particles into the body from teeth. A further link is persistent infective sinusitis.
MS is high in families that eat excessive meat fat, butter and dairy products but with too little vegetable fat (corn, Soya, sunflower oil, etc). Linoleic acid levels in the blood of MS patients are abnormally low, especially during relapse. (Schwartz JH, Bennett B. Int Arch Allergy Appl Immunol 45; 899-904, 1973) Evening Primrose oil is claimed to make up the deficiency. Ethnic peoples with a diet wholly of fish (Eskimos) seldom develop this disease.
While cure is not possible, herbal medicine may in some cases arrest deterioration. Treatment of severe nerve conditions should be supervised by neurologists and practitioners whose training prepares them to recognise serious illness and to integrate herbal and supplementary intervention safely into the treatment plan.
Nerve sheaths require calcium; herbs to increase its levels: Oats, Lobelia, Horsetail.
Evening Primrose oil makes good a deficiency of linoleic acid (Vitamin F) for efficient function of the brain.
Alternatives:– Tablets/capsules. Black Cohosh, Cramp bark, Prickly Ash, Skullcap, Ginseng.
Formula. Ginkgo 2; Prickly Ash 1; Black Cohosh; Ginger quarter. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.
Formula, for pain. Lobelia 1; Ladyslipper 1; Ginger quarter. Dose: Liquid Extracts: 30-60 drops. Tinctures: one 5ml teaspoon. Powders: 250-500mg.
Rue tea. Traditional remedy for MS.
Evening Primrose: 4 × 500mg capsules, daily.
Aromatherapy. Spinal massage. 10 drops oils of Rosemary and Lavender in egg-cup Almond oil (or other vegetable oil).
Purslane herb. A rich source of non-fish EPA – suitable for a vegetarian approach.
Diet. A diet rich in essential fatty acids appears to arrest deterioration. (MS Unit, Central Middlesex Hospital, London)
High protein, low fat with oily fish. Lecithin. Sugar-free. Gluten-free (see Gluten diet). Cholesterol- free (avoid milk and dairy products). Grape juice. Dandelion coffee. One tablespoon Cod Liver oil daily. Red beet. Vegetable oils (safflower, sunflower, etc). Avoid coffee and caffeine stimulants.
Vitamins. Dismutase enzymes (see entry). B-complex, B3, B6. Vitamin C, 500-1000mg. Vitamin E, 200iu. Daily. Some authorities advise maximum dosage of Vitamin B12.
Minerals. Dolomite. Manganese. Zinc.
Information. Multiple Sclerosis Society, 25 Effie Road, London SW6 1EE, UK. Send SAE. ... multiple sclerosis
Forming the ball of the thumb and that of the little ?nger, and ?lling up the gaps between the metacarpal bones, are other muscles, which act to separate and bring together the ?ngers, and to bend them at their ?rst joints (knuckles).... hand
Causes There is a major immunogenetic predisposition to rheumatoid arthritis in people carrying the HLA-DR4 antigen (see HLA SYSTEM). Other minor immunogenetic factors have also been implicated. In addition, there is a degree of familial clustering which suggests other unidenti?ed genetic factors. Genetic factors cannot alone explain aetiology, and environmental and chance factors must be important, but these have yet to be identi?ed.
Epidemiology Rheumatoid arthritis more commonly occurs in women from the age of 30 onwards, the sex ratio being approximately 4:1. Typical rheumatoid arthritis may occur in adolescence, but in childhood chronic SYNOVITIS usually takes one of a number of di?erent patterns, classi?ed under juvenile chronic arthritis.
Pathology The primary lesion is an in?ammation of the synovial membrane of joints. The synovial ?uid becomes diluted with in?ammatory exudate: if this persists for months it leads to progressive destruction of articular CARTILAGE and BONE. Cartilage is replaced by in?ammatory tissue known as pannus; a similar tissue invades bone to form erosions. Synovitis also affects tendon sheaths, and may lead to adhesion ?brosis or attrition and rupture of tendons. Subcutaneous and other bursae may be involved. Necrobiotic nodules also occur at sites outside synovium, including the subcutaneous tissues, the lungs, the pericardium and the pleura.
Clinical features Rheumatoid arthritis varies from the very mild to the severely disabling. Many mild cases probably go undiagnosed. At least 50 per cent of patients continue to lead a reasonably normal life; around 25 per cent are signi?cantly disabled in terms of work and leisure activities; and a minority become markedly disabled and are limited in their independence. There is often an early acute phase, followed by substantial remission, but in other patients gradual step-wise deterioration may occur, with progressive involvement of an increasing number of joints.
The diagnosis of rheumatoid arthritis is largely based on clinical symptoms and signs. Approximately 70 per cent of patients have rheumatoid factor ANTIBODIES in the SERUM but, because of the large number of false positives and false negatives, this test has very little value in clinical practice. It may be a useful pointer to a worse prognosis in early cases if the level is high. X-RAYS may help in diagnosing early cases and are particularly helpful when considering surgery or possible complications such as pathological fracture. Patients commonly develop ANAEMIA, which may be partly due to gastrointestinal blood loss from antiin?ammatory drug treatment (see below).
Treatment involves physical, pharmacological, and surgical measures, together with psychological and social support tailored to the individual patient’s needs. Regular activity should be maintained. Resting of certain joints such as the wrist with splints may be helpful at night or to assist prolonged manual activities. Sound footwear is important. Early use of antirheumatic drugs reduces long-term disability. Drug treatment includes simple ANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and slow-acting drugs including GOLD SALTS (in the form of SODIUM AUROTHIOMALATE), PENICILLAMINE, SULFASALAZINE, METHOTREXATE and AZATHIOPRINE.
The non-steroidal agents are largely e?ective in reducing pain and early-morning sti?ness, and have no e?ect on the chronic in?ammatory process. It is important, especially in the elderly, to explain to patients the adverse effects of NSAIDs, the dosage of which can be cut by prescribing paracetamol at the same time. Combinations of anti-rheumatic drugs seem better than single agents. The slow-acting drugs take approximately three months to act but have a more global e?ect on chronic in?ammation, with a greater reduction in swelling and an associated fall in erythrocyte sedimentation rate (ESR) and rise in the level of HAEMOGLOBIN. Local CORTICOSTEROIDS are useful, given into individual joints. Systemic corticosteroids carry serious problems if continued long term, but may be useful under special circumstances. Much research is currently going on into the use of tumour necrosis factor antagonists such as INFLIXIMAB and etanercept, but their precise role remains uncertain.... rheumatoid arthritis
The arterial system begins at the left ventricle of the heart with the AORTA, which gives o? branches that subdivide into smaller and smaller vessels. The ?nal divisions, called arterioles, are microscopic and end in a network of capillaries which perforate the tissues like the pores of a sponge and bathe them in blood that is collected and brought back to the heart by veins. (See CIRCULATORY SYSTEM OF THE BLOOD.)
The chief arteries after the aorta and its branches are:
(1) the common carotid, running up each side of the neck and dividing into the internal carotid to the brain, and external carotid to the neck and face;
(2) the subclavian to each arm, continued by the axillary in the armpit, and the brachial along the inner side of the arm, dividing at the elbow into the radial and the ulnar,
which unite across the palm of the hand in arches that give branches to the ?ngers;
(3) the two common iliacs, in which the aorta ends, each of which divides into the internal iliac to the organs in the pelvis, and the external iliac to the lower limb, continued by the femoral in the thigh, and the popliteal behind the knee, dividing into the anterior and posterior tibial arteries to the front and back of the leg. The latter passes behind the inner ankle to the sole of the foot, where it forms arches similar to those in the hand, and supplies the foot and toes by plantar branches.
Structure The arteries are highly elastic, dilating at each heartbeat as blood is driven into them, and forcing it on by their resiliency (see PULSE). Every artery has three coats: (a) the outer or adventitia, consisting of ordinary strong ?brous tissue; (b) the middle or media, consisting of muscular ?bres supported by elastic ?bres, which in some of the larger arteries form distinct membranes; and (c) the inner or intima, consisting of a layer of yellow elastic tissue on whose inner surface rests a layer of smooth plate-like endothelial cells, over which ?ows the blood. In the larger arteries the muscle of the middle coat is largely replaced by elastic ?bres, which render the artery still more expansile and elastic. When an artery is cut across, the muscular coat instantly shrinks, drawing the cut end within the ?brous sheath that surrounds the artery, and bunching it up, so that a very small hole is left to be closed by blood-clot. (See HAEMORRHAGE.)... arteries
Barrier methods These involve a physical barrier which prevents sperm (see SPERMATOZOON) from reaching the cervix (see CERVIX UTERI). Barrier methods reduce the risk of spreading sexually transmitted diseases, and the sheath is the best protection against HIV infection (see AIDS/HIV) for sexually active people. The e?ciency of barrier methods is improved if they are used in conjunction with a spermicidal foam or jelly, but care is needed to ensure that the preparation chosen does not damage the rubber barrier or cause an allergic reaction in the users. CONDOM OR SHEATH This is the most commonly used barrier contraceptive. It consists of a rubber sheath which is placed over the erect penis before intromission and removed after ejaculation. The failure rate, if properly used, is about 4 per cent. DIAPHRAGM OR CAP A rubber dome that is inserted into the vagina before intercourse and ?ts snugly over the cervix. It should be used with an appropriate spermicide and is removed six hours after intercourse. A woman must be measured to ensure that she is supplied with the correct size of diaphragm, and the ?t should be checked annually or after more than about 7 lbs. change in weight. The failure rate, if properly used, is about 2 per cent.
Non-barrier methods These do not provide a physical barrier between sperm and cervix and so do not protect against sexually transmitted diseases, including HIV. COITUS INTERRUPTUS This involves the man’s withdrawing his penis from the vagina before ejaculation. Because some sperm may leak before full ejaculation, the method is not very reliable. SAFE PERIOD This involves avoiding intercourse around the time when the woman ovulates and is at risk of pregnancy. The safe times can be predicted using temperature charts to identify the rise in temperature before ovulation, or by careful assessment of the quality of the cervical mucus. This method works best if the woman has regular menstrual cycles. If used carefully it can be very e?ective but requires a highly disciplined couple to succeed. It is approved by the Catholic church.
SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.
These are supposed to prevent pregnancy by killing sperm before they reach the cervix, but they are unreliable and should be used only in conjunction with a barrier method.
INTRAUTERINE CONTRACEPTIVE DEVICE (COIL) This is a small metal or plastic shape, placed inside the uterus, which prevents pregnancy by disrupting implantation. Some people regard it as a form of abortion, so it is not acceptable to all religious groups. There is a risk of pelvic infection and eventual infertility in women who have used coils, and in many countries their use has declined substantially. Coils must be inserted by a specially trained health worker, but once in place they permit intercourse at any time with no prior planning. Increased pain and bleeding may be caused during menstruation. If severe, such symptoms may indicate that the coil is incorrectly sited, and that its position should be checked. HORMONAL METHODS Steroid hormones have dominated contraceptive developments during the past 40 years, with more than 200 million women worldwide taking or having taken ‘the pill’. In the past 20 years, new developments have included modifying existing methods and devising more e?ective ways of delivering the drugs, such as implants and hormone-releasing devices in the uterus. Established hormonal contraception includes the combined oestrogen and progesterone and progesterone-only contraceptive pills, as well as longer-acting depot preparations. They modify the woman’s hormonal environment and prevent pregnancy by disrupting various stages of the menstrual cycle, especially ovulation. The combined oestrogen and progesterone pills are very e?ective and are the most popular form of contraception. Biphasic and triphasic pills contain di?erent quantities of oestrogen and progesterone taken in two or three phases of the menstrual cycle. A wide range of preparations is available and the British National Formulary contains details of the commonly used varieties.
The main side-e?ect is an increased risk of cardiovascular disease. The lowest possible dose of oestrogen should be used, and many preparations are phasic, with the dose of oestrogen varying with the time of the cycle. The progesterone-only, or ‘mini’, pill does not contain any oestrogen and must be taken at the same time every day. It is not as e?ective as the combined pill, but failure rates of less than 1-per-100 woman years can be achieved. It has few serious side-effects, but may cause menstrual irregularities. It is suitable for use by mothers who are breast feeding.
Depot preparations include intramuscular injections, subcutaneous implants, and intravaginal rings. They are useful in cases where the woman cannot be relied on to take a pill regularly but needs e?ective contraception. Their main side-e?ect is their prolonged action, which means that users cannot suddenly decide that they would like to become pregnant. Skin patches containing a contraceptive that is absorbed through the skin have recently been launched.
HORMONAL CONTRACEPTION FOR MEN There is a growing demand by men worldwide for hormonal contraception. Development of a ‘male pill’, however, has been slow because of the potentially dangerous side-effects of using high doses of TESTOSTERONE (the male hormone) to suppress spermatogenesis. Progress in research to develop a suitable ANDROGEN-based combination product is promising, including the possibility of long-term STEROID implants. STERILISATION See also STERILISATION – Reproductive sterilisation. The operation is easier and safer to perform on men than on women. Although sterilisation can sometimes be reversed, this cannot be guaranteed and couples should be counselled in advance that the method is irreversible. There is a small but definite failure rate with sterilisation, and this should also be made clear before the operation is performed. POSTCOITAL CONTRACEPTION Also known as emergency contraception or the ‘morning after pill’, postcoital contraception can be e?ected by two di?erent hormonal methods. Levonorgesterol (a synthetic hormone similar to the natural female sex hormone PROGESTERONE) can be used alone, with one pill being taken within 72 hours of unprotected intercourse, but preferably as soon as possible, and a second one 12 hours after the ?rst. Alternatively, a combined preparation comprising ETHINYLESTRADIOL and levonorgesterol can be taken, also within 72 hours of unprotected intercourse. The single constituent pill has fewer side-effects than the combined version. Neither version should be taken by women with severe liver disease or acute PORPHYRIAS, but the ethinylestradiol/levonorgesterol combination is unsuitable for women with a history of THROMBOSIS.
In the UK the law allows women over the age of 16 to buy the morning-after pill ‘over the counter’ from a registered pharmacist.... contraception
– the corpus callosum. Other clefts or ?ssures (sulci) make deep impressions, dividing the cerebrum into lobes. The lobes of the cerebrum are the frontal lobe in the forehead region, the parietal lobe on the side and upper part of the brain, the occipital lobe to the back, and the temporal lobe lying just above the region of the ear. The outer 3 mm of the cerebrum is called the cortex, which consists of grey matter with the nerve cells arranged in six layers. This region is concerned with conscious thought, sensation and movement, operating in a similar manner to the more primitive areas of the brain except that incoming information is subject to much greater analysis.
Numbers of shallower infoldings of the surface, called furrows or sulci, separate raised areas called convolutions or gyri. In the deeper part, the white matter consists of nerve ?bres connecting di?erent parts of the surface and passing down to the lower parts of the brain. Among the white matter lie several rounded masses of grey matter, the lentiform and caudate nuclei. In the centre of each cerebral hemisphere is an irregular cavity, the lateral ventricle, each of which communicates with that on the other side and behind with the third ventricle through a small opening, the inter-ventricular foramen, or foramen of Monro.
BASAL NUCLEI Two large masses of grey matter embedded in the base of the cerebral hemispheres in humans, but forming the chief part of the brain in many animals. Between these masses lies the third ventricle, from which the infundibulum, a funnel-shaped process, projects downwards into the pituitary body, and above lies the PINEAL GLAND. This region includes the important HYPOTHALAMUS.
MID-BRAIN or mesencephalon: a stalk about 20 mm long connecting the cerebrum with the hind-brain. Down its centre lies a tube, the cerebral aqueduct, or aqueduct of Sylvius, connecting the third and fourth ventricles. Above this aqueduct lie the corpora quadrigemina, and beneath it are the crura cerebri, strong bands of white matter in which important nerve ?bres pass downwards from the cerebrum. The pineal gland is sited on the upper part of the midbrain.
PONS A mass of nerve ?bres, some of which run crosswise and others are the continuation of the crura cerebri downwards.
CEREBELLUM This lies towards the back, underneath the occipital lobes of the cerebrum.
MEDULLA OBLONGATA The lowest part of the brain, in structure resembling the spinal cord, with white matter on the surface and grey matter in its interior. This is continuous through the large opening in the skull, the foramen magnum, with the spinal cord. Between the medulla, pons, and cerebellum lies the fourth ventricle of the brain.
Structure The grey matter consists mainly of billions of neurones (see NEURON(E)) in which all the activities of the brain begin. These cells vary considerably in size and shape in di?erent parts of the brain, though all give o? a number of processes, some of which form nerve ?bres. The cells in the cortex of the cerebral hemispheres, for example, are very numerous, being set in layers ?ve or six deep. In shape these cells are pyramidal, giving o? processes from the apex, from the centre of the base, and from various projections elsewhere on the cell. The grey matter is everywhere penetrated by a rich supply of blood vessels, and the nerve cells and blood vessels are supported in a ?ne network of ?bres known as neuroglia.
The white matter consists of nerve ?bres, each of which is attached, at one end, to a cell in the grey matter, while at the other end it splits up into a tree-like structure around another cell in another part of the grey matter in the brain or spinal cord. The ?bres have insulating sheaths of a fatty material which, in the mass, gives the white matter its colour; they convey messages from one part of the brain to the other (association ?bres), or, grouped into bundles, leave the brain as nerves, or pass down into the spinal cord where they end near, and exert a control upon, cells from which in turn spring the nerves to the body.
Both grey and white matter are bound together by a network of cells called GLIA which make up 60 per cent of the brain’s weight. These have traditionally been seen as simple structures whose main function was to glue the constituents of the brain together. Recent research, however, suggests that glia are vital for growing synapses between the neurons as they trigger these cells to communicate with each other. So they probably participate in the task of laying down memories, for which synapses are an essential key. The research points to the likelihood that glial cells are as complex as neurons, functioning biochemically in a similar way. Glial cells also absorb potassium pumped out by active neurons and prevent levels of GLUTAMATE – the most common chemical messenger in the brain – from becoming too high.
The general arrangement of ?bres can be best understood by describing the course of a motor nerve-?bre. Arising in a cell on the surface in front of the central sulcus, such a ?bre passes inwards towards the centre of the cerebral hemisphere, the collected mass of ?bres as they lie between the lentiform nucleus and optic thalamus being known as the internal capsule. Hence the ?bre passes down through the crus cerebri, giving o? various small connecting ?bres as it passes downwards. After passing through the pons it reaches the medulla, and at this point crosses to the opposite side (decussation of the pyramids). Entering the spinal cord, it passes downwards to end ?nally in a series of branches (arborisation) which meet and touch (synapse) similar branches from one or more of the cells in the grey matter of the cord (see SPINAL CORD).
BLOOD VESSELS Four vessels carry blood to the brain: two internal carotid arteries in front, and two vertebral arteries behind. These communicate to form a circle (circle of Willis) inside the skull, so that if one is blocked, the others, by dilating, take its place. The chief branch of the internal carotid artery on each side is the middle cerebral, and this gives o? a small but very important branch which pierces the base of the brain and supplies the region of the internal capsule with blood. The chief importance of this vessel lies in the fact that the blood in it is under especially high pressure, owing to its close connection with the carotid artery, so that haemorrhage from it is liable to occur and thus give rise to stroke. Two veins, the internal cerebral veins, bring the blood away from the interior of the brain, but most of the small veins come to the surface and open into large venous sinuses, which run in grooves in the skull, and ?nally pass their blood into the internal jugular vein that accompanies the carotid artery on each side of the neck.
MEMBRANES The brain is separated from the skull by three membranes: the dura mater, a thick ?brous membrane; the arachnoid mater, a more delicate structure; and the pia mater, adhering to the surface of the brain and containing the blood vessels which nourish it. Between each pair is a space containing ?uid on which the brain ?oats as on a water-bed. The ?uid beneath the arachnoid membrane mixes with that inside the ventricles through a small opening in the fourth ventricle, called the median aperture, or foramen of Magendie.
These ?uid arrangements have a great in?uence in preserving the brain from injury.... divisions
Bleeding into or around the brain is a major concern following serious head injuries, or in newborn infants following a di?cult labour. Haemorrhage is classi?ed as arterial – the most serious type, in which the blood is bright red and appears in spurts (in severe cases the patient may bleed to death within a few minutes); venous – less serious (unless from torn varicose veins) and easily checked, in which the blood is dark and wells up gradually into the wound; and capillary, in which the blood slowly oozes out of the surface of the wound and soon stops spontaneously. Haemorrhage is also classi?ed as primary, reactionary, and secondary (see WOUNDS). Severe haemorrhage causes SHOCK and ANAEMIA, and blood TRANSFUSION is often required.
When a small artery is cut across, the bleeding stops in consequence of changes in the wall of the artery on the one hand, and in the constitution of the blood on the other. Every artery is surrounded by a ?brous sheath, and when cut, the vessel retracts some little distance within this sheath and a blood clot forms, blocking the open end (see COAGULATION). When a major blood vessel is torn, such spontaneous closure may be impossible and surgery is required to stop the bleeding.
Three main principles are applicable in the control of a severe external haemorrhage: (a) direct pressure on the bleeding point or points;
(b) elevation of the wounded part; (c) pressure on the main artery of supply to the part.
Control of internal haemorrhage is more dif?cult than that of external bleeding. First-aid measures should be taken while professional help is sought. The patient should be laid down with legs raised, and he or she should be reassured and kept warm. The mouth may be kept moist but no ?uids should be given. (See APPENDIX 1: BASIC FIRST AID.)... haemorrhage
Betony, Damiana, Oats, St John’s Wort, Skullcap, Vervain.
Combination. Tea: Equal parts, Skullcap, Betony, Vervain. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. Half-1 cup freely. ... nerve tonics
It also offers some protection against sexually transmitted infections.... condom, female
All movable joints involve four structures: the bones whose junction forms the joint; a layer of cartilage covering the ends of these, making them smooth; a ?brous sheath, the capsule, thickened at various points into bands or ligaments, which hold the bones together; and, ?nally, the synovial membrane, which lines the capsule and produces a synovial ?uid, lubricating the movements of the joint. In addition, the bones are kept in position at the joints by the various muscles passing over them and by atmospheric pressure. Where the ends of the bones do not quite correspond, a subsidiary disc of ?bro-cartilage may help to adapt the ends of the bones more perfectly to each other. Larger cavities may be ?lled by movable pads of fat under the synovial membrane, giving additional protection to the joint.
Varieties After this main division of joints into those which are ?xed and those movable, the movable joints may be further subdivided. In gliding joints, such as the wrist and ankle, the bones have ?at surfaces capable of only a limited amount of movement. In hinge joints, such as the elbow and knee, movement takes place around one axis. Ball-and-socket joints, exempli?ed by the shoulder and hip, allow free movement in any direction. Subsidiary varieties are named according to the shape of the bones which enter the joint.... joints
The synovium also forms a sheath for certain tendons of the hands and feet.
The membrane secretes synovial fluid, which lubricates the joint or tendon.
The synovium can become inflamed; in a joint this is known as synovitis, in a tendon sheath it is known as tenosynovitis.... synovium
Form and position Each lung is a sponge-like cone, pink in children and grey in adults. Its apex projects into the neck, with the base resting on the DIAPHRAGM. Each lung is enveloped by a closed cavity, the pleural cavity, consisting of two layers of pleural membrane separated by a thin layer of ?uid. In healthy states this allows expansion and retraction as breathing occurs.
Heart/lung connections The HEART lies in contact with the two lungs, so that changes in lung volume inevitably affect the pumping action of the heart. Furthermore, both lungs are connected by blood vessels to the heart. The pulmonary artery passes from the right ventricle and divides into two branches, one of which runs straight outwards to each lung, entering its substance along with the bronchial tube at the hilum or root of the lung. From this point also emerge the pulmonary veins, which carry the blood oxygenated in the lungs back to the left atrium.
Fine structure of lungs Each main bronchial tube, entering the lung at the root, divides into branches. These subdivide again and again, to be distributed all through the substance of the lung until the ?nest tubes, known as respiratory bronchioles, have a width of only 0·25 mm (1/100 inch). All these tubes consist of a mucous membrane surrounded by a ?brous sheath. The surface of the mucous membrane comprises columnar cells provided with cilia (hair-like structures) which sweep mucus and unwanted matter such as bacteria to the exterior.
The smallest divisions of the bronchial tubes, or bronchioles, divide into a number of tortuous tubes known as alveolar ducts terminating eventually in minute sacs, known as alveoli, of which there are around 300 million.
The branches of the pulmonary artery accompany the bronchial tubes to the furthest recesses of the lung, dividing like the latter into ?ner and ?ner branches, and ending in a dense network of capillaries. The air in the air-vesicles is separated therefore from the blood only by two delicate membranes: the wall of the air-vesicle, and the capillary wall, through which exchange of gases (oxygen and carbon dioxide) readily takes place. The essential oxygenated blood from the capillaries is collected by the pulmonary veins, which also accompany the bronchi to the root of the lung.
The lungs also contain an important system of lymph vessels, which start in spaces situated between the air-vesicles and eventually leave the lung along with the blood vessels, and are connected with a chain of bronchial glands lying near the end of the TRACHEA.... lungs
Nerves vary in size from the large pencil-sized sciatic nerve in the back of the thigh muscles to the single, hair-sized ?bres distributed to the skin. A nerve, such as the sciatic, possesses a strong, outer ?brous sheath, called the epineurium, within which lie bundles of nerve-?bres, divided from one another by partitions of ?brous tissue, in which run blood vessels that nourish the nerve. Each of these bundles is surrounded by its own sheath, known as the perineurium, and within the bundle ?ne partitions of ?brous tissue, known as endoneurium, divide up the bundle into groups of ?bres. The ?nest subdivisions of the nerves are the ?bres, and these are of two kinds: medullated and non-medullated ?bres. (See NEURON(E) and NERVOUS SYSTEM for more details on structure and functions of neurons and nerves.)... nerve
Causes In cases of localised neuritis, the ?brous sheath of the nerve is usually at fault, the actual nerve-?bres being only secondarily affected. This condition may be due to in?ammation spreading into the nerve from surrounding tissues; to cold; or to long-continued irritation by pressure on the nerve. The symptoms produced vary according to the function of the nerve, in the case of sensory nerves being usually neuralgic pain (see NEURALGIA), and in the case of motor nerves some degree of paralysis in the muscles to which the nerves pass.
In polyneuritis, usually due to some general or constitutional cause, the nerve-?bres themselves in the small nerves degenerate and break down. The condition is protracted because, for recovery to occur, the growth of new nerve-?bres from the healthy part of the nerve has to take place. The cause of polyneuritis may be infection by a virus – for example, HERPES ZOSTER – or a bacterium, as in LEPROSY. Neuritis may also be the result of agents such as alcohol, lead or products from industrial or agricultural activities. ORGANOPHOSPHORUS insecticides are believed by some to be a factor in neuritis and other neurological conditions.... neuritis
Cause Although this is one of the most common diseases of the central nervous system in Europe – there are around 50,000 affected individuals in Britain alone – the cause is still not known. The disease comes on in young people (onset being rare after the age of 40), apparently without previous illness. The ratio of women-to-men victims is 3:2. It is more common in ?rst and second children than in those later in birth order, and in small rather than big families. There may be a hereditary factor for MS, which could be an autoimmune disorder: the body’s defence system attacks the myelin in the central nervous system as if it were a ‘foreign’ tissue.
Symptoms These depend greatly upon the part of the brain and cord affected by the sclerotic patches. Temporary paralysis of a limb, or of an eye muscle, causing double vision, and tremors upon exertion, ?rst in the affected parts, and later in all parts of the body, are early symptoms. Sti?ness of the lower limbs causing the toes to catch on small irregularities in the ground and trip the person in walking, is often an annoying symptom and one of the ?rst to be noticed. Great activity is shown in the re?ex movements obtained by striking the tendons and by stroking the soles of the feet. The latter re?ex shows a characteristic sign (Babinski sign) in which the great toe bends upwards and the other toes spread apart as the sole is stroked, instead of the toes collectively bending downwards as in the normal person. Tremor of the eye movements (nystagmus) is usually found. Trembling handwriting, interference with the functions of the bladder, giddiness, and a peculiar ‘staccato’ or ‘scanning’ speech are common symptoms at a later stage. Numbness and tingling in the extremities occur commonly, particularly in the early stages of the disease. As the disease progresses, the paralyses, which were transitory at ?rst, now become con?rmed, often with great rigidity in the limbs. In many patients the disease progresses very slowly.
People with multiple sclerosis, and their relatives, can obtain help and guidance from the Multiple Sclerosis Society. Another helpful organisation is the Multiple Sclerosis Resources Centre. Those with sexual or marital problems arising out of the illness can obtain information from SPOD (Association to Aid the Sexual and Personal Relationships of People with a Disability). (See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)
Treatment is di?cult, because the most that can be done is to lead a life as free from strain as possible, to check the progress of the disease. The use of INTERFERON beta seems to slow the progress of MS and this drug is licensed for use in the UK for patients with relapsing, remitting MS over two years, provided they can walk unaided – a controversial restriction on this (expensive) treatment. CORTICOSTEROIDS may be of help to some patients.
The NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) ruled in 2001 that the use of the drugs interferon beta and glatiramer acetate for patients with multiple sclerosis was not cost-e?ective but recommended that the Department of Health, the National Assembly for Wales and the drug manufacturers should consider ways of making the drugs available in a cost-e?ective way. Subsequently the government said that it would consider funding a ‘risk-sharing’ scheme in which supply of drugs to patients would be funded only if treatment trials in individuals with MS showed that they were e?ective.
The Department of Health has asked NICE to assess two CANNABIS derivatives as possible treatments for multiple sclerosis and the relief of post-operative pain. Trials of an under-thetongue spray and a tablet could, if successsful, lead to the two drugs being available around 2005.
It is important to keep the nerves and muscles functioning, and therefore the patient should remain at work as long as he or she is capable of doing it, and in any case should exercise regularly.... multiple sclerosis (ms)
Structure of muscle Skeletal or voluntary muscle forms the bulk of the body’s musculature and contains more than 600 such muscles. They are classi?ed according to their methods of action. A ?exor muscle closes a joint, an extensor opens it; an abductor moves a body part outwards, an adductor moves it in; a depressor lowers a body part and an elevator raises it; while a constrictor (sphincter) muscle surrounds an ori?ce, closing and opening it. Each muscle is enclosed in a sheath of ?brous tissue, known as fascia or epimysium, and, from this, partitions of ?brous tissue, known as perimysium, run into the substance of the muscle, dividing it up into small bundles. Each of these bundles consists in turn of a collection of ?bres, which form the units of the muscle. Each ?bre is about 50 micrometres in thickness and ranges in length from a few millimetres to 300 millimetres. If the ?bre is cut across and examined under a high-powered microscope, it is seen to be further divided into ?brils. Each ?bre is enclosed in an elastic sheath of its own, which allows it to lengthen and shorten, and is known as the sarcolemma. Within the sarcolemma lie numerous nuclei belonging to the muscle ?bre, which was originally developed from a simple cell. To the sarcolemma, at either end, is attached a minute bundle of connective-tissue ?bres which unites the muscle ?bre to its neighbours, or to one of the connective-tissue partitions in the muscle, and by means of these connections the ?bre affects muscle contraction. Between the muscle ?bres, and enveloped in a sheath of connective tissue, lie here and there special structures known as muscle-spindles. Each of these contains thin muscle ?bres, numerous nuclei, and the endings of sensory nerves. (See TOUCH.) The heart muscle comprises short ?bres which communicate with their neighbours via short branches and have no sarcolemma.
Plain or unstriped muscle is found in the following positions: the inner and middle coats of the STOMACH and INTESTINE; the ureters (see URETER) and URINARY BLADDER; the TRACHEA and bronchial tubes; the ducts of glands; the GALL-BLADDER; the UTERUS and FALLOPIAN TUBES; the middle coat of the blood and lymph vessels; the iris and ciliary muscle of the EYE; the dartos muscle of the SCROTUM; and in association with the various glands and hairs in the SKIN. The ?bres are very much smaller than those of striped muscle, although they vary greatly in size. Each has one or more oval nuclei and a delicate sheath of sarcolemma enveloping it. The ?bres are grouped in bundles, much as are the striped ?bres, but they adhere to one another by cement material, not by the tendon bundles found in voluntary muscle.
Development of muscle All the muscles of the developing individual arise from the central layer (mesoderm) of the EMBRYO, each ?bre taking origin from a single cell. Later on in life, muscles have the power both of increasing in size – as the result of use, for example, in athletes – and also of healing, after parts of them have been destroyed by injury. An example of the great extent to which unstriped muscle can develop to meet the demands made on it is the uterus, whose muscular wall develops so much during pregnancy that the organ increases from the weight of 30–40 g (1–1••• oz.) to a weight of around 1 kg (2 lb.), decreasing again to its former small size in the course of a month after childbirth.
Physiology of contraction A muscle is an elaborate chemico-physical system for producing heat and mechanical work. The total energy liberated by a contracting muscle can be exactly measured. From 25–30 per cent of the total energy expended is used in mechanical work. The heat of contracting muscle makes an important contribution to the maintenance of the heat of the body. (See also MYOGLOBIN.)
The energy of muscular contraction is derived from a complicated series of chemical reactions. Complex substances are broken down and built up again, supplying each other with energy for this purpose. The ?rst reaction is the breakdown of adenyl-pyrophosphate into phosphoric acid and adenylic acid (derived from nucleic acid); this supplies the immediate energy for contraction. Next phosphocreatine breaks down into creatine and phosphoric acid, giving energy for the resynthesis of adenyl-pyrophosphate. Creatine is a normal nitrogenous constituent of muscle. Then glycogen through the intermediary stage of sugar bound to phosphate breaks down into lactic acid to supply energy for the resynthesis of phosphocreatine. Finally part of the lactic acid is oxidised to supply energy for building up the rest of the lactic acid into glycogen again. If there is not enough oxygen, lactic acid accumulates and fatigue results.
All of the chemical changes are mediated by the action of several enzymes (see ENZYME).
Involuntary muscle has several peculiarities of contraction. In the heart, rhythmicality is an important feature – one beat appearing to be, in a sense, the cause of the next beat. Tonus is a character of all muscle, but particularly of unstriped muscle in some localities, as in the walls of arteries.
Fatigue occurs when a muscle is made to act for some time and is due to the accumulation of waste products, especially sarcolactic acid (see LACTIC ACID). These substances affect the end-plates of the nerve controlling the muscle, and so prevent destructive overaction of the muscle. As they are rapidly swept away by the blood, the muscle, after a rest (and particularly if the rest is accompanied by massage or by gentle contractions to quicken the circulation) recovers rapidly from the fatigue. Muscular activity over the whole body causes prolonged fatigue which is remedied by rest to allow for metabolic balance to be re-established.... muscle
Sensory These carry signals to the central nervous system (CNS) – the BRAIN and SPINAL CORD – from sensory receptors. These receptors respond to di?erent stimuli such as touch, pain, temperature, smells, sounds and light.
Motor These carry signals from the CNS to activate muscles or glands.
Interneurons These provide the interconnecting ‘electrical network’ within the CNS.
Structure Each neurone comprises a cell body, several branches called dendrites, and a single ?lamentous ?bre called an AXON. Axons may be anything from a few millimetres to a metre long; at their end are several branches acting as terminals through which electrochemical signals are sent to target cells, such as those of muscles, glands or the dendrites of another axon.
Axons of several neurones are grouped
together to form nerve tracts within the brain or spinal cord or nerve-?bres outside the CNS. Each nerve is surrounded by a sheath and contains bundles of ?bres. Some ?bres are medullated, having a sheath of MYELIN which acts as insulation, preventing nerve impulses from spreading beyond the ?bre conveying them.
The cellular part of the neurones makes up the grey matter of the brain and spinal cord – the former containing 600 million neurones. The dendrites meet with similar outgrowths from other neurones to form synapses. White matter is the term used for that part of the system composed of nerve ?bres.
Functions of nerves The greater part of the bodily activity originates in the nerve cells (see NERVE). Impulses are sent down the nerves which act simply as transmitters. The impulse causes sudden chemical changes in the muscles as the latter contract (see MUSCLE). The impulses from a sensory ending in the skin pass along a nerve-?bre to affect nerve cells in the spinal cord and brain, where they are perceived as a sensation. An impulse travels at a rate of about 30 metres (100 feet) per second. (See NERVOUS IMPULSE.)
The anterior roots of spinal nerves consist of motor ?bres leading to muscles, the posterior roots of sensory ?bres coming from the skin. The terms, EFFERENT and AFFERENT, are applied to these roots, because, in addition to motor ?bres, ?bres controlling blood vessels and secretory glands leave the cord in the anterior roots. The posterior roots contain, in addition to sensory ?bres, the nerve-?bres that transmit impulses from muscles, joints and other organs, which among other neurological functions provide the individual with his or her
proprioceptive faculties – the ability to know how various parts of the body are positioned.
The connection between the sensory and motor systems of nerves is important. The simplest form of nerve action is that known as automatic action. In this, a part of the nervous system, controlling, for example, the lungs, makes rhythmic discharges to maintain the regular action of the respiratory muscles. This controlling mechanism may be modi?ed by occasional sensory impressions and chemical changes from various sources.
Re?ex action This is an automatic or involuntary activity, prompted by fairly simple neurological circuits, without the subject’s consciousness necessarily being involved. Thus a painful pinprick will result in a re?ex withdrawal of the affected ?nger before the brain has time to send a ‘voluntary’ instruction to the muscles involved.
Voluntary Actions are more complicated than re?ex ones. The same mechanism is involved, but the brain initially exerts an inhibitory or blocking e?ect which prevents immediate re?ex action. Then the impulse, passing up to the cerebral hemispheres, stimulates cellular activity, the complexity of these processes depending upon the intellectual processes involved. Finally, the inhibition is removed and an impulse passes down to motor cells in the spinal cord, and a muscle or set of muscles is activated by the motor nerves. (Recent advances in magnetic resonance imaging (MRI) techniques have provided very clear images of nerve tracts in the brain which should lead to greater understanding of how the brain functions.) (See BRAIN; NERVOUS SYSTEM; SPINAL CORD.)... neuron(e)
Habitat: The Himalayas, from Kashmir to Kumaon up to an altitude of 4,000 m.
English: Common Reed.Folk: Dila, Dambu (Punjab).Action: Rhizomes and roots—diuretic, emmenagogue, diaphoretic, hypoglycaemic, antiemetic.
The rhizomes are rich in carbohydrates; contain nitrogenous substances 5.2, fat 0.9, N-free extr. 50.8, crude fibre 32.0, sucrose 5.1, reducing sugars 1.1, and ash (rich in silica) 5.8%; as- paragine 0.1% is also present. Leaves possess a high ascorbic acid content (200 mg/100 g).Nodes and sheaths yield 6.6% and the underground parts over 13% of furfural.The root of common Reed is prescribed in Chinese traditional medicine as an antipyretic against influenza and fevers. Presence of polyols, betaines and free poline has been reported in the methanolic extract. The extract is reported to show bactericidal activity. The root gave a polysaccha- ride which contains sugars, arabinose, xylose and glucose in a molar ratio of 10:19:94; some ofthe fractions showed immunological activity.... phragmites communisThe SYNOVITIS usually starts acutely and is frequently asymmetrical, with the knees and ankles most commonly affected. Often there are in?ammatory lesions of tendon sheaths and entheses (bone and muscle functions) such as plantar fasciitis (see FASCIITIS). The severity and duration of the acute episode are extremely variable. Individuals with the histocompatibility antigen HLA B27 are particularly prone to severe attacks.... reactive arthritis
Those in the row nearest the hand are the trapezium, trapezoid, capitate and hamate. These latter articulate with the metacarpal bones in the hand and are closely bound to one another by short, strong ligaments; and the wrist-joint is the union of the composite mass thus formed with the RADIUS and ULNA in the forearm. The wrist and the radius and ulna are united by strong outer and inner lateral ligaments, and by weaker ligaments before and behind, whilst the powerful tendons passing to the hand and ?ngers strengthen the wrist.
The joint can move in all directions, and its shape and many ligaments mean that it rarely dislocates – although stretching or tearing of some of these ligaments is a common accident, constituting a sprain. (See JOINTS, DISEASES OF.) In?ammation of the tendon-sheaths may occur as a result of injury or repetitive movement (see UPPER LIMB DISORDERS). A fairly common condition is the presence of a GANGLION, in which an elastic swelling full of ?uid develops on the back or front of the wrist in connection with the sheaths of the tendons. (See also HAND.)... wrist
Essential fatty acids have an important role in the function of the nervous system, being closely related to the fatty (myelin) sheath and cell membranes. Disturbance in their metabolism may result in nerve disorder. Thus, vegetable oils of Soya, corn, safflower and sunflower should replace animal fats and dairy products.
Symptoms. Numb, prickling, tickling sensation on the skin, paralysis, incoordination, physical weakness and visual complaints.
Treatment. Indeterminate diagnosis.
Tablets/capsules. Prickly Ash, Black Cohosh, Ginseng, Ginkgo.
Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Black Cohosh, Prickly Ash, Ginseng. Doses. Powders: two 00 capsules or one-third teaspoon, (500mg). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water, honey or fruit juice.
Evening Primrose oil capsules or tablets: two 500mg thrice daily.
Aromatherapy. Rosemary spinal rub: 6 drops Oil Rosemary in 2 teaspoons Almond oil.
Diet. High protein, low fat, oily fish or 2 teaspoons Cod Liver oil daily. Gluten-free diet. Cholesterol- free – avoid milk, meat fat and dairy products. Avoid coffee and other caffeine stimulants. Dandelion coffee.
Supplements. B-complex, B3, B6, B12, C, E. Dolomite, Manganese, Zinc. ... demyelinating diseases
Symptoms: muscle weakness. A hand may drop objects. Legs too weak for walking. Asks himself: “Will I ever walk again?” Pain is similar to banging a ‘funnybone’ – but never lets up.
Treatment. Good nursing and family support. Agents that recoat the nerves. A warm bath helps relieve pains.
Alternatives:– Tea: mix equal parts: Skullcap, Oats, Catmint. 1 heaped teaspoon to each cup boiling water; infuse 5 minutes. Dose: half-1 cup, freely.
Tablets, tinctures or extracts: Cramp bark, Valerian, Mistletoe. Ginseng.
Vitamins. B1, B2, B6, B12, B-complex. Pantothenic acid.
Minerals. Magnesium. Dolomite. Zinc. ... guillain-barre syndrome (gbs)
If weak pelvic muscles are causing stress incontinence, pelvic floor exercises may help. Sometimes, surgery may be needed to tighten the pelvic muscles or correct a prolapse. Anticholinergic drugs may be used to relax the bladder muscle if irritable bladder is the cause.
If normal bladder function cannot be restored, incontinence pants can be worn; men can wear a penile sheath leading into a tube connected to a urine bag. Some people can avoid incontinence by self-catheterization (see catheterization, urinary). Permanent catheterization is necessary in some cases.... incontinence, urinary
The nervous system contains billions of neurons, of which there are 3 main types: sensory neurons, which carry signals from sense receptors into the central nervous system (CNS); motor neurons, which carry signals from the CNS to muscles or glands; and interneurons, which form all the complex electrical circuitry within the CNS itself.
When a neuron transmits (“fires”) an electrical impulse, a chemical called a neurotransmitter is released from the axon terminals at synapses (junctions with other neurons). This neurotransmitter may make a muscle cell contract, cause an endocrine gland to release a hormone, or affect an adjacent neuron.
Different stimuli excite different types of neurons to fire. Sensory neurons, for example, may be excited by physical stimuli, such as cold or pressure. The activity of most neurons is controlled by the effects of neurotransmitters released from adjacent neurons. Certain neurotransmitters generate a sudden change in the balance of electrical potential inside and outside the cell (an “action potential”), which occurs at one point on the cell’s membrane and flows at high speed along it. Others stabilize neuronal membranes, preventing an action potential. Thus, the firing pattern of a neuron depends on the balance of excitatory and inhibitory influences acting on it.
If the cell body of a neuron is damaged or degenerates, the cell dies and is never replaced. A baby starts life with the maximum number of neurons, which decreases continuously thereafter.... neuron
Some cases of neuropathy have no obvious cause. Among specific causes are diabetes mellitus, dietary deficiencies, excessive alcohol consumption, and metabolic upsets such as uraemia.
Nerves may become acutely inflamed after a viral infection, and neuropathies may also result from autoimmune disorders, such as rheumatoid arthritis. Neuropathies may occur secondarily to cancerous tumours, or with lymphomas and leukaemias. There is also a group of inherited neuropathies, the most common being peroneal muscular atrophy.
The symptoms of neuropathy depend on whether it affects mainly sensory nerve fibres or mainly motor nerve fibres. Damage to sensory nerve fibres may cause numbness, tingling, sensations of cold, and pain. Damage to motor fibres may cause muscle weakness and muscle wasting. Damage to autonomic nerves may lead to blurred vision, impaired or absent sweating, faintness, and disturbance of gastric, intestinal, bladder, and sexual functioning.
To determine the extent of the damage, nerve conduction studies are carried out together with EMG tests, which record the electrical activity in muscles.
Diagnostic tests such as blood tests, MRI scans, and nerve or muscle biopsy may also be required.
When possible, treatment is aimed at the underlying cause.
If the cell bodies of the damaged nerve cells have not been destroyed, full recovery from neuropathy is possible.... neuropathy
The penis consists mainly of 3 cylindrical bodies of erectile tissue (spongy tissue full of blood vessels) that run along its length.
Two of these bodies, the corpora cavernosa, lie side by side along the upper part of the penis.
The 3rd body, the corpus spongiosum, lies centrally beneath them and expands at the end to form the glans.
Through the centre of the corpus spongiosum runs the urethra, a narrow tube that carries urine and semen out of the body through an opening at the tip of the glans.
Around the erectile tissue is a sheath consisting of fibrous connective tissue enclosed by skin.
Over the glans, the skin forms a fold called the foreskin.... penis
tennis elbow Pain and tenderness on the outside of the elbow and in the back of the forearm. Commonly called epicondylitis, it is caused by inflammation of the tendon that attaches the muscles that straighten the fingers and wrist to the humerus. Treatment consists of resting the arm, applying ice-packs, and taking analgesic drugs or nonsteroidal antiinflammatory drugs (NSAIDs). Ultrasound treatment, injection of a corticosteroid drug, or surgery are sometimes needed. tenosynovitis Inflammation of the lining of the sheath that surrounds a tendon. The usual cause is excessive friction caused by repetitive movements; bacterial infection is a rare cause. The hands and wrists are most often affected. Symptoms include pain, tenderness, and swelling over the tendon. Treatment is with nonsteroidal anti-inflammatory drugs (NSAIDs) or a local injection of a corticosteroid drug. However, if infection is the cause, antibiotic drugs are prescribed. A splint to immobilize the joint, or surgery, may also be needed. tenovaginitis Inflammation or thickening of the fibrous wall of the sheath that surrounds a tendon.... tenesmus
FAMILY: Zingiberaceae
SYNONYMS: Elettaria cardomomum var. cardomomum, cardamom, cardamomi, cardamum, mysore cardamom.
GENERAL DESCRIPTION: A perennial, reed-like herb up to 4 metres high, with long, silky blade-shaped leaves. Its long sheathing stems bear small yellowish flowers with purple tips, followed by oblong red-brown seeds.
DISTRIBUTION: Native to tropical Asia, especially southern India; cultivated extensively in India, Sri Lanka, Laos, Guatemala and El Salvador. The oil is produced principally in India, Europe, Sri Lanka and Guatemala.
OTHER SPECIES: There are numerous related species found in the east, used as local spices and for medicinal purposes, such as round or Siam cardamon (Amomum cardamomum) found in India and China. An oil is also produced from wild cardamon (E. cardamomum var. major).
HERBAL/FOLK TRADITION: Used extensively as a domestic spice, especially in India, Europe, Latin America and Middle Eastern countries. It has been used in traditional Chinese and Indian medicine for over 3000 years, especially for pulmonary disease, fever, digestive and urinary complaints. Hippocrates recommended it for sciatica, coughs, abdominal pains, spasms, nervous disorders, retention of urine and also for bites of venomous creatures. Current in the British Herbal Pharmacopoeia as a specific for flatulent dyspepsia.
ACTIONS: Antiseptic, antispasmodic, aphrodisiac, carminative, cephalic, digestive, diuretic, sialogogue, stimulant, stomachic, tonic (nerve).
EXTRACTION: Essential oil by steam, distillation from the dried ripe fruit (seeds). An oleoresin is also produced in small quantities.
CHARACTERISTICS: A colourless to pale yellow liquid with a sweet-spicy, warming fragrance and a woody-balsamic undertone. It blends well with rose, olibanum, orange, bergamot, cinnamon, cloves, caraway, ylang ylang, labdanum, cedarwood, neroli and oriental bases in general.
PRINCIPAL CONSTITUENTS: Terpinyl acetate and cineol (each may be present at up to 50 per cent), limonene, sabinene, linalol, linalyl acetate, pinene, zingiberene, among others.
SAFETY DATA: Non-toxic, non-irritant, non-sensitizing.
AROMATHERAPY/HOME: USE
Digestive System: Anorexia, colic, cramp, dyspepsia, flatulence, griping pains, halitosis heartburn, indigestion, vomiting.
Nervous System: Mental fatigue, nervous strain.
OTHER USES: Employed in some carminative, stomachic and laxative preparations; also in the form of compound cardamon spirit to flavour pharmaceuticals. Extensively used as a fragrance component in soaps, cosmetics and perfumes, especially oriental types. Important flavour ingredient, particularly in curry and spice products.... cardamon
FAMILY: Zingiberaceae
SYNONYMS: Z. montanum, Z. cassumunar ‘Roxburgh’, Z. purpureum ‘Roscoe’, cassumunar ginger.
GENERAL DESCRIPTION: The root of this tropical perennial plant is tuberous, with long fleshy fibres and jointed appendages, much like ginger but slightly larger. The fresh rhizome, which is yellow inside, has a cool, green, camphoraceous, spicy-warm scent. The stem is made of green leaf sheathes which are grass-like with brownish-purple pointed shoots bearing pale yellow flowers.
DISTRIBUTION: Native to Thailand, Indonesia and India: it is now commonly found throughout Asia. Since plai is an important medicinal plant in Thailand, there are many regions where plai is cultivated and there are now at least three native varieties or sub-species found in Thailand.
OTHER SPECIES: There are several sub-species (and essential oil chemotypes) of plai depending on the location of the plant from which it has been extracted. Essential oil produced from rhizomes grown in the north-west region is the most typical from Thailand and contains almost as much terpinen-4-ol as tea tree oil. Terpinen-4-ol has been well researched, and is to known to activate white blood cells: it also has significant antibacterial, antiviral and antifungal properties. Oil produced from the central region contains more sabinene. Zingiber cassumunar is a close relative of ginger and galangal, both of which are used to produce essential oils.
HERBAL/FOLK TRADITION: Zingiber cassumunar is widely used in folklore remedies as a single plant or as component of herbal recipes in Thailand and many Asian countries for the treatments of conditions, such as inflammation, sprains and strains, rheumatism and muscular pain. Although it is derived from the same plant family as ginger (Zingiber officinale), it does not possess the classic warming effect common to ginger. Instead, plai has a cooling action on inflamed areas, making it an excellent choice for treating injuries, post-operative pain and all types of muscular and joint pain such as torn muscles and ligaments as well as conditions such as arthritis and rheumatism. For this reason, plai has long been regarded by Thai massage therapists as one of the most essential oils to have at their disposal. Although generally diluted with a carrier oil, it can be applied directly to the skin when treating areas of severe pain or inflammation that are close to the surface of the skin. It is reported to ease pain for up to 16–20 hours – it is even used by Thai boxers for pain relief!
Used in skin care, the oil exhibits good antioxidant properties and is used in Thai culture to treat stretch marks and scars; also to heal wounds. Plai herbal compound is used traditionally in the form of a poultice and decoction for the treatment of a range of digestive disorders including colic, constipation, diarrhoea, flatulence, nausea heartburn. Zingiber cassumunar is also a traditional Thai remedy for respiratory conditions, including asthma, catarrh, colds and coughs, fever and influenza.
ACTIONS: Analgesic, antioxidant, antibacterial, antimicrobial, antihistamine, antineuralgic, antifungal, anti-inflammatory, antiseptic, antispasmodic, antitoxic, antiviral, carminative, digestive, diuretic, febrifugal, laxative, rubefacient, rejuvenating, stimulant, tonic, vermifuge.
EXTRACTION: Steam distilled from the fresh rhizome (roots) of the Plai plant (Zingiber cassumunar).
CHARACTERISTICS: The oil is a pale amber colour with a fresh, herbaceous, spicy-green scent and a resinous, slightly floral undertone. It will blends well with black pepper, bergamot, ginger, grapefruit, lemongrass, lime, jasmine, lavender, neroli, petitgrain, rosemary, sandalwood and tea tree.
PRINCIPAL CONSTITUENTS: The main active chemical constituents of the oil are terpinen-4-ol (up to 49 per cent) sabinene (up to 45 per cent), DMPBD (up to per cent), g-terpinene and a-terpinene – depending on the source of the oil.
SAFETY DATA: Non-toxic, non-irritating and non-sensitizing. Best to check for any possible sensitization due to variants in chemo-types available.
AROMATHERAPY/HOME: USE
Skin care: Acne, cuts, stretch marks, scars, wounds.
Circulation muscles and joints: All types of aches and pains caused by inflammation, including arthritis and rheumatism, cramp, gout, joint problems, muscle spasm, sprains and strains, torn muscles and ligaments as well as post-operative pain.
Digestive system: Cramps, colic, constipation, diarrhea, flatulence, indigestion, heartburn.
Respiratory system: Asthma, catarrh, chronic colds, bronchitis, congestion, fever, flu, sinusitis.
Genito-urinary system: Menstrual cramps.
Immune system: Stimulates the immune system and boosts vitality.
Nervous system: Anxiety, nervous tension, stress.
OTHER USES: The fresh rhizome or powdered root is much used in traditional Thai cuisine. The oil is used in the pharmaceutical industry, for example, in mosquito repellant formulations.... plai
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