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Eur Spine J 2:197–202 Spine 13:785–791 ment of the cervical spine: more than 29 cheap cytotec 100mcg mastercard medications janumet. J Neurosurg (Spine) suoka T 200 mcg cytotec mastercard symptoms 10dpo, Miyamoto S, Yonenobu K cervical spine surgery. In: Shark HH, 96:180–189 (2001) Subtotal corpectomy versus et al (eds) The cervical spine, 2nd edn. Kawai S, Sunago K, Doi K, Saika m, laminoplasty for multilevel cervical Lippincott, Philadelphia, pp 831–837 Taguchi T (1988) Cervical lamino- spondylotic myelopathy: a long-term 5. Spine 13:1245– 26:1443–1447 ing ceramic laminas for cervical mye- 50 30. Matsuzaki H, Hoshino M, Kiuchi T, problem of clinical instability in the 6. Herkowitz HN (1988) A comparison Toriyama S (1989) Dome-like expan- human spine. Clinical biomechanics of of anterior cervical fusion, cervical sive laminoplasty for the second cervi- the spine, 2nd edn. Spine 14:1198–1203 delphia, pp 302–326 plasty for the surgical management of 18. Yasuoka S, Peterson HA, Maccarty CS multiple level spondylotic radiculopa- laminectomy. J Neurosurg 57: Maruyama T, Wakano K (1981) Oper- (1987) Spinal deformity and instability 441 ative results and postoperative progres- after multilevel cervical laminectomy. Yonenobu K, Fuji T, Ono K, Okada K, sion of ossification among patients Spine 12:6–11 Yamamoto T, Harada N (1985) Choice with ossification of cervical posterior 20. Miyazaki K, Kirita Y (1986) Extensive of surgical treatment for multisegmen- longitudinal ligament. Spine 6:354–364 simultaneous multisegment laminec- tal cervical spondylotic myelopathy. Hirabayashi K, Watanabe K, Wakano tomy for myelopathy due to the ossifi- Spine 10:710–716 K, Suzuki N, Satomi K, Ishii Y (1983) cation of the posterior longitudinal lig- 33. Yonenobu K, Okada K, Fuji T, Fuji- Expansive open-door laminoplasty for ament in the cervical lesion. Spine 11: wara K, Yamashita K, Ono K (1986) cervical spinal stenotic myelopathy. Miyazaki K, Hirohuji E, Ono S, et al following surgical treatment of cervical 9. Hirabayashi K (1994) Expansive open (1994) Extensive simultaneous multi- myelopathy. An atlas of decompression with posterolateral fu- Asano M, Ono K (1991) Neurological surgical procedures. J Jpn Spine Res Soc 5:167 complications of surgery for cervical delphia, pp 233–250 22. Hoshi K, Kurokawa T, Nakamura K, T, Itoh J (1992) Spinous process-split- 1277–1281 Hoshino Y, Saita K, Miyoshi K (1996) ting laminoplasty using hydroxyapatite 35. Yonenobu K, Hosono N, Iwasaki M, Expansive cervical laminoplasties – spinous process spacer. Spine 17:S41– Asano M, Ono K (1992) Laminoplasty observations on comparative changes 43 versus subtotal corpectomy. Oyama M, Hattori S, Moriwaki N ative study of results in multisegmental longitudinal laminal divisions using (1973) A new method of posterior de- cervical spondylotic myelopathy. Robinson RA, Smith GW (1955) An- Taketomi E, Ueyama K (2001) Inter- (1996) Neck and shoulder pain after terolateral cervical disc removal and and intra-observer reliability of the laminoplasty: a noticeable complica- interbody fusion of the cervical spine. Spine 21:1969–1973 Johns Hopkins Med J 96:223–224 Scoring System for evaluation of cervi- 12. Spine 26: Shichikawa K, Shimomura Y (1985) ment of cervical spondylotic myelopa- 1890–1894 Operations for cervical spondylotic thy. Itoh T, Tsuji H (1985) Technical im- Kaneda K, Fujiya M (2003) Local provements and results of laminoplasty kyphosis reduces surgical outcomes of for compressive myelopathy in the cer- expansive open-door laminoplasty for vical spine. Spine 28:1258–62 REVIEW Max Aebi Spinal metastasis in the elderly Abstract Bony metastases are a fre- columbar spine a posterior decom- quent problem in elderly patients af- pression and posterolateral vertebral fected by cancer, and those with bony body resection through a posterior metastases involve the spine in ap- approach only, with a concomitant prox. The most frequent spinal reconstruction and stabilization, has metastases (60%) are from breast, shown to work sufficiently well. The chance the middle and lower cervical spine that an elderly patient (60–79 years the anterior approach with anterior old) is affected by bony metastases is decompression and anterior column four times higher in men and three reconstruction is most effective and times higher in women than a mid- has a low morbidity, whereas the oc- dle-aged patient (40–59 years old). The outcome should be long the survival of this particular determined by the survival time in an patient group, the spinal metastases ambulatory, independent status, where may become a mechanical issue, thus pain is controlled, and the patient is requesting surgical treatment. Surgical manage- ent classification systems have been ment shows the greatest improve- proposed to rationalize surgical indi- ment in pain reduction, but also in cations, some concentrating solely other domains of quality of life. Since most of the modalities for spinal metastases in- surgical options are of palliative cluding surgery are not available and character, it is more important to base are ethically difficult to achieve, the decision on an overall clinical each case remains an interdiscipli- classification including the different nary, shared decision making process treatment modalities – irradiation, for what is considered best for a pa- chemotherapy, steroids, bisphospho- tient or elderly patient. However, nates, and surgery – to make a shared whenever surgery is an option, it M.

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Journal of Physiology logical conditions generic 100mcg cytotec free shipping medications quizlet, including an enquiry into the aetiology (London) cheap 100 mcg cytotec symptoms of high blood pressure, 432, 445–58. Journal of Physiology (London), 318, reflexes as a tool to investigate the organization of spinal 501–10. Acom- lower limb motoneurons in man: spinal and supraspinal parisonofperipheralandrubrospinalsynapticinputtoslow contributions. Cutaneous nerve stimulation and motoneuronal iology (London), 207, 709–32. Long latency¨ flexor carpi radialis H-reflex following tactile stimulation responses in human thenar muscles mediated by fast of the index fingertip. Experimental Brain Research, 120, conducting muscle and cutaneous afferents. Electrophys- relations between long-latency reflexes in hand muscles, iologic analysis of the motor system after stroke: the flexor somatosensory evoked potentials and transcranial stimu- reflex. Phasic control of reflexes from the dorsum of the paw extremity of hemiparetic subjects. Journal of Neurology, tral pathways responsible for depolarization of primary Neurosurgery and Psychiatry, 26, 39–50. CentralEMG eral flexor nor a withdrawal pattern of nociceptive reflexes and tests of motor control. Neuroscience Research, 37, Electroencephalography and Clinical Neurophysiology, 90, 79–82. Habituation dependent changes in cutaneous reflexes recorded from of cutaneomuscular reflexes recorded from the first dorsal various muscles controlling finger movement in man. Phase-dependentmodulationofcutaneousreflexes organizationofinterneuronestransmittingeffectsfromthe of tibialis anterior muscle during hopping. Journal control of synaptic actions evoked by volleys in the flexion of Physiology (London), 333, 405–19. BrainResearch,505, following ipsilateral mechanical loading of the sole of the 167–70. An electromyo- responses of afferent fibres from the glabrous skin of the graphic study of the nociceptive reflexes of the lower hand during voluntary finger movements in man. Journal of Physiology (London), 115, rosurgery and Psychiatry, 73, 360–62. Spinal reflex mechanisms withspecialreferencetosomeconditionswheretheexten- concerned with skeletal muscle. The maturation of cutaneous nections made by muscle afferents in the spinal cord. Journal of Phys- In Symposium of the XXIth International Physiological iology (London), 335, 643–54. The significance of segmental spinal mechanisms in The effect of DOPA on the spinal cord. In Symposium 4th International Biophysics ization of pathways transmitting excitatory action to alpha Congress, Moscow 1972,pp. Control of Posture and Movement, Progress in Brain References 449 Research,vol. Afferentfeedbackinthecontrol dle afferents and the FRA: a new hypothesis. Evidencesuggest- strong synaptic coupling between single tactile afferents ing a transcortical pathway from cutaneous foot afferents and spinal motoneurones. Mechan- cutaneous stimulation, as studied in normal and spastic ismsunderlyingspinalmotorneuronexcitabilityduringthe man. In NewDevelopments in Electromyography and Clin- cutaneous silent period in humans. Long-latency spinal reflex Electroencephalography and Clinical Neurophysiology, 52, in man after flexor reflex afferent stimulation. In Clinical Neurophysiology of Spasticity, soleus H reflex in patients with a complete spinal cord ed. Amsterdam: lesion: evidence for presynaptic inhibition of Ia transmis- Elsevier. Inhibitory effects on flexor reflexes in patients with a Cutaneomuscular (flexor) reflex organization in normal completespinalcordsection. Flexion-reflex of the limb, crossed extension-reflex, ment of a supraspinal loop. Flexibility of lower limb reflex receptive fields elicited by electrical stimulation of the foot responses to painful cutaneous stimulation in standing sole. Cutaneousreflexresponsesrecordedinchildrenwith neous stimulation during voluntary muscle contraction in various neurological disorders. Jour- reflexes in chronic spinal cord injury triggered by imposed nal of Physiology (London), 542, 559–66. Journal of Neurophysiology, 90, Dynamic control of location-specific information in tactile 3232–41. Nociceptive flexion reflexes as a tool for pain research tromyography and Clinical Neurophysiology,vol.

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Knowing Yourself To understand who and what you are is a special quest of the Taoist order cytotec 100mcg line treatment solutions. This speaks to the Seeing Clearly principle discount 100mcg cytotec overnight delivery medications made from animals, in that you need to know yourself in order to func- tion in the most natural fashion possible. It is not their place to do so, nor does it advance their own spiritual quest. They remain apart from material things, rec- ognizing their needs and distinguishing them from their wants. Thinking Independently Taoists are known for being independent thinkers, not followers of the crowd. I often use the term Wolf or Sheep—do you move and think with the common crowd, or do you stand apart? They place no limits on com- passion or love, but engage fully in understanding and spiritually recognizing all other beliefs. Faith In Life It is all too easy to become pessimistic, the more we experience the bad parts of life. They do not fear change, understanding that it is a natural function of living, and welcome the opportunity to experience and learn new things every day. Right Here, Right Now Taoists are not paralyzed by a fear of the unknown of the future, nor are they caught looking backward longingly into the past. They realize that right here, right now is all we have to work with, so we should make it the best present moment that we can. They know that our time here is short and that going through life mad and sad at everything is a waste of life. They joyously participate in the suffering, as well as the happiness of life. In fact, it helps us deal with adversity and allows us a greater world view. The greatest goal of a Taoist may very well be to become one with Nature, to feel the rhythms, ebbs, and flows of life in an intuitive fashion. Nonresistance Taoism advocates seeking the path of least resistance in life. This is intimately re- lated to the act of nonstriving and being a natural person. Using Taoism in Everyday Life So how does all of this philosophy apply to you, dear reader? In practicing Taoism, you become a better person, both for yourself and for your loved ones. You shed the petty grievances and character flaws and learn to be more compassionate, loving, caring, and gener- ally fun to be around. For the past 2,000 years, traditional Western thinking has been dominated by a dualistic, either-or approach: either something is good, or it is bad; desirable or undesirable; someone is an ally or an enemy. We perceive experiences to be either positive or negative and we expend much energy in trying to eradicate that which we consider to be negative. From a Taoist point of view, this is like trying to erase the negative current from electricity because it is not positive. Taking these differences for the way things really are leads to arguing, fighting, and even killing—all because of this and that. We dislike parts of ourselves and struggle to change, not trusting that our own inner nature will of its own accord move towards a harmoni- ous balance. Indeed, we be- come an agent of change ourselves, rather than resisting it while desperately cling- ing to one experience or perception or the other. Bad luck becomes good luck and crisis contains the opportunity for growth. We can choose to cooperate with this complement of opposites by not denying, suppressing, or struggling against unwanted discomfort or pain, but rather by accepting all facets of our existence, good and bad, as the natural flow of the Tao. By following the path of acceptance and responsiveness to change we can be- come, in the words of the Taoist philosopher Chuang Tzu, true women and men of Tao. This unceasing flow of change manifests itself as a natural order governed by unalterable, yet perceivable laws. Strangely enough, it is the constancy of these governing principles (like the rising and setting of the sun and moon and the changing of the seasons) that allows people to recognize and utilize them in their own process of transformation. From the Taoist viewpoint this represents the ultimate stage of human existence. The writings of the legendary Taoist sages Lao Tzu and Chuang Tzu furnish us with specific principles as a guide to attaining this state of oneness.

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Computer screens If you cannot write a sentence without going back and fiddling with it buy generic cytotec 100mcg line treatment locator, turn off your monitor (see free writing) order cytotec 100mcg overnight delivery treatment alternatives. Many people who come on my courses say they want to learn how to write more concisely. Yet these tend to be the ones who argue loudest in favour of long and flowery words and phrases. Conference abstracts Those with ambitions to travel and to advance their knowledge and careers need to master the art of the conference abstract. Unlike the abstracts published alongside a scientific paper, they stand alone, to be published in the conference abstract book. If you are lucky, they will earn you an invitation to produce a poster, or present a paper. Approach conference abstracts as you would any other writing task (see process of writing). In particular research carefully what the organizers want: this means looking carefully through all the advance material you can get hold of. Look also at the topics dealt with in the past; try to find something that will develop these ideas and discussions. You clearly cannot cover everything and everyone, so these reports are neither a précis nor a set of minutes. Avoid also using the shape of a scientific article (see IMRAD structure). Prefer the feature article structure: from all the informa- tion you will have collected, formulate a message and then choose to put in only the information that will support and elaborate that message. Make sure you get detailed informa- tion from whoever asks you to write the report (see commis- sioning). These could provide detail and colour to lift your report out of the mundane. As with all types of writing, start with the basics: construct a 12 word message from the conference, then go through the usual stages (see process of writing). Conflict of interest Many travel articles are followed by a brief statement stating whether their tickets have been paid for, and if so by whom. Similarly, many papers in scientific journals make it clear if the work has been supported by the pharmaceutical company whose product is being tested. The point is that readers have the right to assume that the views expressed in an article are honestly held, and are not being expressed for other reasons, such as an expenses-paid trip to Monte Carlo. If publications are not trusted, they lose their usefulness (see Pravda effect). If there is any reason for anyone to suppose that bias could take place, then it must be declared. Confusing pairs Some words are troublesome because they sound the same as other words (see homophones); others give trouble because they are confused with other words that sound different – but not too different. Here is a sample: • affect and effect: (1) to influence, and (2) to accomplish, • alleviate and elevate: (1) to lessen, and (2) to raise or increase, 28 CONFUSING PAIRS • continual and continuous: (1) very often, and (2) unbroken, • flaunt and flout: (1) to display ostentatiously, and (2) to display contempt for (the law etc. Controversy Editors realize that there is nothing better for readership than a good row. Copy-editors People used by book publishers (mainly) to put text into house style, correct grammar and spelling, and to point out infelicities (such as, in this case, my failure in the first draft to give copy-editors an entry of their own). Copyright This establishes the creator of a piece of original work and protects authors against others stealing the idea or making money out of copying it, often badly. First, you must seek permission if you want to use substantial pieces of text, charts or tables from another article. Most publishers ask authors to assign the copyright to them, so this task is fairly straightforward. Then there is the question of how authors, particularly those working on their own, can ensure that they, and not their publisher, will make the money their brilliance deserves. This has always been difficult, and the new freedoms of the World Wide Web will make it more so. I suspect that this is one of those areas where the amount of effort (and loss of goodwill) is usually outweighed by the actual amount of money involved. The simple answer is that, if your idea is 29 THE A–Z OF MEDICAL WRITING that good, then you should immediately get yourself an agent, who can carry out these unpopular arguments on your behalf. In fact they are usually changes, and not corrections (see balanced feedback). Corrections Publishing anything is a complicated business, and mistakes are inevitable (see law of late literals). Editors clearly have a duty to their readers to correct information that has been proved to be wrong. Covering letter Presentation is an important part of the battle to impress an editor, and the covering letter offers an excellent opportunity to make a good impression from the start.

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