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Despite the fact that out of 131 prisoners allergy medicine not working generic beconase aq 200mdi with mastercard, 46 complained of torture or ill-treatment allergy medicine ac purchase beconase aq in united states online, the Greek government used selected excerpts from the confidential Red Cross report to announce publicly that the Red Cross had found no evidence of torture allergy ultratab order beconase aq line. The Red Cross complained about publishing it in this way and the whole report was released allergy shots long term effects buy beconase aq with a visa. The official texts included here are excerpts of letters from the State Department to members of the Congress who made inquiries at the request of their constituents. The answers of the Greek Government to charges of torture were exceedingly crudely phrased and created an unfavourable impression on public opinion abroad. Thc State Department answcrs are drafted for a more sophisticated audience and the language of the letters is the guarded language of the lawyer seeking to protect his client. The first inquiries produccd what was to be the basic position taken by the State Department from April 1967 to July 1968: Our tentative conclusion is that there have unfortunately been instances of mistreatment of prisoners in individual cases. Our impression is that these instances occurred particularly with the rounding up, the detention and trial of members of the Patriotic Front, which is regarded by Greek officials and public opinion generally as a Cornmunist-dominated group. During that period, which had its highpoint in the summer and fall of 1967, a series of home-made bombs were exploded in public places in Athens resulting in the death of an innocent bystander, and the police seem to have resorted in a number of cases to excessive means in order to uncover the responsible persons. Since the dispersal of the Patriotic Front, reports of mistreatment of prisoners have declined. Members of the Patriotic Front, a left wing organisation including persons from varying political persuasions, had been arrested and rounded up during August, September and October. On 30 November 1967 a bomb exploded on the roof of the Ministry of Justice and a passer-by, Katerina Milona, was killed by a section of falling pipe. This was the only fatal bombing incident in 1967 and 1968 and it occurred after the Patriotic Front had been arrested, tortured, tried and imprisoned. In the middle of February some prisoners were taken from jail and brought to the laid-up warship Elli at the Scaramang Naval Base for interrogation. The government alleged a plot against the navy by 115 intellectuals and navy enlisted men. Those in Athcns who worried about these matters knew of what was going on and tried to alert public opinion abroad. It was known soon after that one prisoner, Naval Petty Officer Constantinos Paleologos, had died undcr torture, and the details regarding the others became known when some of the victims were returned to prison at the beginning of March. One of these victims, Gerassimos Notaras, described his tortures to the Amnesty delegate and confirmed the reports that the Elli had been used for torture. As of this moment, it does not appear to us that the charges that the Elli is being used as a place of torture arc valid inasmuch as the Elli is located close to the shore, a sizeable crcw is maintained on the ship, many naval crews are stationed nearby and, in these circumstances, the comings and goings of guards and prisoners would be difficult to conceal. Torture reports increased, coming from Athens, Salonika, Crete, and outside Athens at the Dionysos military camp. On 3 July, Gerassimos Notaras stood before a military court and denounced his torturers saying that his confession was false and had been extracted after long periods of Legal remedies 92 Amnesty International report on torture torture, the last sessions on board the Elli. The court did not contest his statement and thc prosecution confirmed that was prisoners had been held on thc Elli, only torture considered judicially irrelevant. But Notaras had set a precedent, for it was the first time a victim of torture publicly denounced his torturers. This was later to become a commonplace of every political trial, but at the time it was a blow to the regime that they could no longer keep the victims quiet. Our Embassy in Athens has replied to our recent inquiry about renewed stories of torturers in Greece. It has no new information of significance and points out that claims of torture continue to be spotlighted by the international press and particularly by those papers which actively oppose the present Greek Government as a policy line. To the best of our knowledge here and that of our Embassy, many of these charges are false or gross distortions by political enemies of the regime. The treatment of prisoners generally by the Greek Government is a topic which the State Department and our Embassy in Athens have pursued diligently. The Greek Government has been made very much aware of the adverse image which such charges create of it. We believe that they have made an effort, particularly since January 1968, to curb any excesses by investigators. We will continue to do all that we can to establish thc truth of these charges and to take advantage of every opportunity to press for continued fair treatment of prisoners. In Europe the struggle for public opinion on the issue of whether or not the regime had deliberately been using torture could be considered a draw at this point. The regime turned out strong denials accompanied by authoritative sounding sources like the Red Cross and British Parliamentarians.

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The duodenum extends from the pylorus to the ligament of Treitz in a sharp curve that almost completes a circle allergy symptoms of colon cancer cheap beconase aq online amex. It is so named because it is about equal in length to the breadth of 12 fingers allergy testing levels buy beconase aq 200mdi cheap, or about 25 cm allergy testing on cats cheap beconase aq 200mdi on line. The stomach and duodenum are closely related in function allergy testing health partners trusted beconase aq 200mdi, and in the pathogenesis and manifestation of disease. The fundus refers to the superior portion of the stomach that lies above an imaginary horizontal plane that passes through the esophagogastric junction. The lesser curve refers to the medial shorter border of the stomach, whereas the opposite surface is the greater curve. The angularis is along the lesser curve of the stomach where the body and antrum meet, and is accentuated during peristalsis (Figure 2). A, Normal anatomy of the stomach and duodenum; B-D, corresponding endoscopic images. The duodenum extends from the pylorus to the ligament of Treitz in a circle-like curve and is divided into four portions. The superior portion is approximately 5 cm in length, beginning at the pylorus, and passes beneath the liver to the neck of the gallbladder. The descending or second part of the duodenum takes a sharp curve and goes down along the right margin of the head of the pancreas. The common bile duct and the pancreatic duct enter the medial aspect of this portion of the duodenum at the major papilla either separately or together. The duodenum turns medially, becoming the horizontal portion, and passes across the spinal column, inclining upward for 5­8 cm. The ascending portion begins at the left of the spinal column, ascending left of the aorta for 2­3 cm, and ends at the ligament of Treitz, where the intestine angles forward and downward to become the jejunum. Excessive gastric acid secretion is only one factor in the pathogenesis of peptic ulcer disease. The integrity of the upper gastrointestinal tract is dependent upon the balance between "hostile" factors such as gastric acid, H. Injury to gastric and duodenal mucosa develops when deleterious effects of gastric acid overwhelm the defensive properties of the mucosa. Inhibition of endogenous prostaglandin synthesis leads to a decrease in epithelial mucus, bicarbonate secretion, mucosal blood flow, epithelial proliferation, and mucosal resistance to injury. The concept of gastroduodenal mucosal injury has evolved from the notion of topical injury to concepts that involve multiple mechanisms. By diminishing the hydrophobicity of gastric mucus, endogenous gastric acid and pepsin may injure surface epithelium. The precursor of prostaglandins, arachidonic acid, is catalyzed by the two cyclo-oxygenase isoenzymes, cyclo-oxygenase-1 and cyclo-oxygenase-2. The gene for cyclo-oxygenase-1, the housekeeping enzyme, maintains the homeostasis of organs. Gastrinoma (Zollinger-Ellison Syndrome) the classic triad of Zollinger-Ellison syndrome involves peptic ulcers in unusual locations. Another 20% of patients have it in the duodenum and others have it in the stomach, peripancreatic lymph nodes, liver, ovary, or small-bowel mesentery. Because gastrin is trophic to the gastric mucosa, endoscopy or x-ray may demonstrate hypertrophy of the gastric rugae. Patients may also experience diarrhea (including steatorrhea from acid inactivation of lipase) and gastroesophageal reflux. Intravenous calcium infusion in normal volunteers induces gastric acid hypersecretion. Additionally, calcium has been demonstrated in vivo and in vitro to stimulate gastrin release directly from gastrinomas. The lifetime prevalence of developing ulcer disease in first-degree relatives of ulcer patients is about three times greater than the general population. Approximately 20­50% of duodenal ulcer patients report a positive family history; gastric ulcer patients also report clusters of family members who are likewise affected. Smoking the literature reveals a strong positive correlation between cigarette smoking and the incidence of ulcer disease, mortality, complications, recurrences and delay in healing rates. Cigarette smoking may increase susceptibility, diminish the gastric mucosal defensive factors, or may provide a more favorable milieu for H.

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Axial head rotation increases facet joint capsular ligament strains in automotive rear impact allergy symptoms migraine buy beconase aq 200mdi lowest price. Non-operative treatment of cervical radiculopathy: a three part article from the approach of a physiatrist allergy shots wiki buy beconase aq 200mdi on line, chiropractor allergy bedding order beconase aq visa, and physical therapist allergy with cough cheap beconase aq online amex. The efficacy of dextrose Prolotherapy for temporomandibular joint hypermobility: a preliminary perspective, randomized, double-blind, placebocontrolled clinical trial. Three disorders that frequently cause temporomandibular joint pain: internal derangement, temporal tendonitis, and Ernest syndrome. Ernest syndrome as a consequence of stylomandibular -ligament injury: a report of 68 patients. Temporal headaches and associated symptoms relating to the styloid process and its attachments. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Back, neck, and shoulder pain in Finnish adolescents: national cross section surveys. Shoulder disorders in general practice: incidence, patient characteristics and management. Prolotherapy: a noninvasive approach to lesions of the glenoid labrum; a non-contArolled questionnaire based study. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes. Treatment of a medial collateral ligament sprain using prolotherapy: a case study. Early osteoarthritis in young sportsmen with severe anterolateral instability of the knee. Recent developments in the understanding of Osgood-Schlatter disease: a literature review. The effects of Prolotherapy with hypertonic dextrose versus Prolozone (intraarticular ozone) in patients with knee osteoarthritis. Chondrogenic effect of intraarticular hypertonic-dextrose (Prolotherapy) in severe knee osteoarthritis. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. The effect of partial meniscectomy on the long-term prognosis of knees with localized, severe chondral damage. The meniscus: review of basic principles with application to surgery and rehabilitation. Transmission of the load in the knee joint with special reference to the role of the menisci. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg-length inequality. The role of the iliotibial band and fascia lata as a factor in the causation of lowback disabilities and sciatica. Pseudo-radiculopathy in subacute trochanteric bursitis of the subgluteus maximus bursa. The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review. Pathogenetic mechanisms of prosttraumatic osteoarthritis: opportunities for every intervention. Subject-specific analysis of joint contact mechanics: application to the study of osteoarthritis and surgical planning. Radiographic prevalence of femoroacetabular impingement in a young population with hip complaints is high. Femoroacetabular impingement syndrome: an underrecognized cause of hip pain and premature osteoarthritis? A retrospective study on Hackett-Hemwall dextrose Prolotherapy for chronic hip pain at an outpatient charity clinic in rural Illinois. Regenerative injection of elite athletes with career-altering chronic groin pain who fail conservative treatment: a consecutive case series. Efficacy of dextrose Prolotherapy in elite male kicking-sport athletes with chronic groin pain. Evaluation and treatment of chronic intractable rectal pain-a frustrating endeavor.

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Abnormalities of gastric or duodenal motility have not been consistently documented with this syndrome allergy forecast kvue order beconase aq on line amex. Endocrine and Metabolic Disorders Gastroparesis and intestinal pseudo-obstruction reportedly complicate hypothyroidism allergy medicine reduce swelling order cheap beconase aq on line, as well as hypoparathyroidism and hyperparathyroidism allergy testing price order beconase aq american express. Patients with gallbladder disorders allergy symptoms clogged ears order beconase aq 200mdi fast delivery, post-cholecystectomy patients, and those with cirrhosis and portal hypertension have also been known to experience delayed gastric emptying. Gastric stasis is also associated with ethanol (alcohol), smoking, and marijuana use. Pregnancy and chronic renal failure with or without dialysis have inconsistently been associated with gastric motor slowing. Abdominal pain is of a varied nature, and may be described as burning, cramping, or diffuse. The physical exam may reveal varying degrees of abdominal distention and/or tenderness; guarding, however, is absent. The rest of the exam should be directed to identifying signs of underlying diseases/disorders. Laboratory Testing There are no sensitive or specific laboratory tests currently available to aid in the diagnosis of gastric stasis disorders. There are, however, tests available that aid diagnosis of underlying systemic illnesses. Gastric stasis may be suggested by the finding of retained food residue (in extreme cases bezoars) after an overnight fast and subsequent endoscopy Figure 8. Patient positioning and room setup for endoscopy Radiology An oral barium contrast x-ray is an alternative to endoscopic evaluation. This will detect delays in liquid phase emptying from the stomach (or small bowel). Gastric Emptying Scintigraphy Gastric Emptying Scintigraphy is the most widely used test to confirm gastric stasis (Figure 9). The requirements of the test are as follows: the patient meal should be of solid consistency, and adequate caloric content (at least 200 kcal), to induce powerful gastric contractions the radiotracer should be effectively bound to the substrate (meal), and resistant to a wide pH range (1-7. Insofar as the 2-hour test is highly sensitive and specific (both 90%) for evaluation of dumping (>47% emptied vs. Although liquid emptying is rarely delayed, it may be assessed (usually in a research setting) through a double tracer study, which generally requires more frequent scans-on the order of one every 15 minutes. In the absence of mechanical obstruction, an abnormal scintigraphic study usually confirms the diagnosis of gastroparesis. Gastroduodenal Manometry Gastroduodenal Manometry involves peroral insertion of a catheter, for a six-hour time period, in order to measure antro-duodeno-jejunal pressures (Figure 10). The first few hours of observation are reserved for fasting-state pressure recordings. Later, pressure recordings are monitored after the patient has eaten a solid meal- which facilitates testing on the effects of different prokinetic agents. Manometry is useful in distinguishing between myopathic (amyloid, scleroderma) and neuropathic processes (diabetes, idiopathic autonomic neuropathy, amyloid neuropathy). Whereas the former are associated with low amplitude complexes, the contractions in the latter are typically of normal amplitude and abnormal organization. Manometry should only be considered in cases in which standard therapeutic measures have failed, for those for whom surgery and/or jejunostomy are being considered, and for those with unexplained nausea. Other Tests Ultrasonography Ultrasonography, which records gastric volume after liquid meal ingestion, is an increasingly common means of evaluating gastroparesis. Solid meals, however, cannot be evaluated through ultrasonography due to their echogenicity. Breath Tests Breath tests after 13C-octanoate or 13C-acetate ingestion are useful in assessing gastric emptying in patients in whom radioactive tracer administration is contraindicated, such as children or pregnant women. This test, however, is only applicable to those patients with normal absorptive function. Although cutaneous gastric electrical recordings were successfully obtained as far back as 1921, it is only in recent years that this method has begun to attract interest as a means of evaluating gastric motor dysfunction.

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A mean of 86% of patients reported overall sustained improvement allergy medicine chlorpheniramine order 200mdi beconase aq with visa, while 33% reported complete functional recovery allergy forecast for chicago generic beconase aq 200mdi mastercard. The good news is a dysfunction in the posterior that Prolotherapy to the cervical spine resolves the underlying cause of these syndromes allergy treatment elderly generic beconase aq 200mdi with mastercard, mainly cervical cervical sympathetic nervous instability and many of the symptoms above allergy medicine inhaler purchase beconase aq with visa, over time. The posterior cervical sympathetic syndrome became known as Barrй-Lieou syndrome and cervicocranial syndrome. The posterior cervical sympathetic nervous system is a group of nerves located near the vertebrae in the neck. Other symptoms may include dysesthesias of the hands and forearms (painful pins-and-needles sensation), corneal sensitivity, dental pain, lacrimation (tearing of the eyes), blurred vision, facial numbness, shoulder pain, swelling of one side of the face, nausea, vomiting, and localized cyanosis of the face (bluish color). A reasonable question to ask is: How can one disorder cause all of these problems? The answer lies in understanding the function of the sympathetic nervous system, which is part of the autonomic nervous system. It keeps your heart pumping, your blood flowing through your blood vessels, your lungs breathing, and a myriad of other activities that occur in your body all the time, every day of your life. The blood vessels shift blood away from the intestines into the muscles, enabling you to run or fight the offender. The posterior-cervical sympathetic nervous system signals the sympathetic part of the autonomic nervous system that controls the head, neck, and face area. In cervicocranial syndrome, the posterior cervical sympathetic system is underactive because the vertebrae in the neck are pinching the sympathetic nerves. Vertebrae pushing on the primary symptom cervical sympathetic is a headache, since ganglion headaches are caused by dilation of blood vessels, as in cervicocranial Figure 5-5: Anterior cervical instability. Symptoms can include dysphagia, tongue Another symptom of numbness, blurred vision, tinnitus, vertigo, dizziness, neck pain, and cervicocranial syndrome migraine headaches. A decrease in sympathetic output to the inner ear will cause an accumulation of fluid in the inner ear. When fluid accumulates in the inner ear, as is often the case with an upper respiratory infection, the ear feels full and the body feels off balance. When Prolotherapy is performed on the head and neck, the posterior sympathetic nervous system begins to function correctly. Often, immediately after Prolotherapy injections to the posterior head and neck areas, patients with cervicocranial syndrome who have had sinus trouble for years experience clear breathing, which they have not had in years. People using decongestants for years for "chronic allergies" and "chronic sinus infections" are often immediately helped by Prolotherapy injections into the head and neck region. The other symptoms, such as blurred vision, severe fatigue, dysesthesias (pins-andneedles sensation down the arm), low blood pressure, and low heart rate, are easily understood by a decrease in the output of the sympathetic system of the head, neck, and face areas. Weakness of the neck ligaments commonly occurs because most people spend a good portion of their days looking down at phones and hunched over while working. Their work may consist of typing on a computer or being constantly tethered to their mobile devices for many hours per day, as well as the huge surge in computer gaming. The ligament laxity causes an even more head-forward position, as the ligaments can no longer keep the cervical vertebrae in their proper posterior alignment. The paracervical muscles (the neck muscles) tighten to stabilize the joints and head. Figure 5-6: Forward head posture from hours of computer work and texting resulting in cervical ligament laxity. Creep, which is a term signifying the slow stretching of ligaments, most commonly occurs by a forward head posture from computer work or looking at a smart phone. Once the ligaments weaken, the muscles contract to give support but this causes chronic neck pain and headaches. Eventually, the muscles can no longer stabilize the vertebrae and the ligaments are stretched even more. Massage therapy, physical therapy, chiropractic/osteopathic manipulation, and pain medicines all help to temporarily relieve the pain. Prolotherapy addresses the root cause of neck pain, ligament laxity, and is consequently effective at eliminating the problem.

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