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The same invitation accompanies this edition erectile dysfunction at 65 order generic kamagra gold online, which in its turn should undergo development and modification erectile dysfunction inventory of treatment satisfaction questionnaire generic 100 mg kamagra gold visa. This in fact has been the experience and chronology of such widely ix accepted classifications as those pertaining to heart disease erectile dysfunction protocol program purchase 100mg kamagra gold fast delivery, hypertension erectile dysfunction treatment videos buy kamagra gold 100mg online, diabetes, toxemia of pregnancy, psychiatric disorders, and a host of others. This will require that they be incorporated in the spoken and written transfer of information, particularly scientific papers, books, etc. The need arises because specialists from different disciplines all require a framework within which to group the conditions that they are treating. This framework should enable them to order their own data, identify different diseases or syndromes, and compare their experience and observations with those of others. Studies of epidemiology, etiology, prognosis, and treatment all depend upon the ability to classify clinical events in an agreed pattern. The delivery of medical services is also facilitated if both the type and number of conditions and patients to be treated can be established in a systematic fashion. In some centers, payment by insurance companies for medical care of the insured creates a demand for a classification system. In regard to chronic pain, it is important to establish such a system of classification that goes beyond what is available in the general international systems such as the International Classification of Diseases. Specialist workers in various fields usually require a more detailed structure for classification than is provided by the overall system. The Ad Hoc Committee on Headache of the American Medical Association developed such an extensive system for one set of pain syndromes (Friedman et al. The first is that we should be able to identify all the chronic pain syndromes we encounter. The second is that we should have as good a description of x each as can be obtained, at least with respect to the pain. It would be expecting too much and also would probably be unnecessary to hope for a complete textbook description. Accordingly, a classification system for pain syndromes has been attempted which, without being a textbook, will provide standard descriptions of all the relevant pain syndromes and a means toward codifying them. The present descriptions and coding systems have been developed in the light of the above considerations. They should allow the standardization of observations by different workers and the exchange of information. In the first edition it was remarked that when articles began to appear that used them as a point of reference, they would have achieved their first aim, and that if other articles emerged that revised or criticized them, they would be achieving their second aim, which was to stimulate a continuing effort at updating and improvement. In the spirit of the quotation at the head of this introduction, the work will still not be complete and it will not be interrupted. It is indeed correct that classifications should be true, at least so far as we know, but complete consistency is beyond the hopes of any medical system of classification. In an ideal system of classification, the categories should be mutually exclusive and completely exhaustive in regard to the data to be incorporated. No classification in medicine has achieved such aims, nor can it be expected to do so (Merskey 1983). Classification in medicine is a pragmatic affair, and we may consider briefly how classifications can be devised. Classifications may be natural if they reflect or presume to reflect an order of nature. The simplest type of classification into animate or inanimate objects is a natural one. An extreme example of an artificial classification is provided by a telephone directory (Galbraith and Wilson 1966). The sequence of letters of the alphabet is used as the criterion for classification. That sequence bears little or no relation to the contents that it arranges, namely the people, their addresses, and their telephone numbers. By contrast, a phylogenetic classification by evolutionary relationships is a very superior form of classification.
Definition Dysmenorrhea erectile dysfunction treatment gurgaon purchase kamagra gold pills in toronto, or painful menstruation erectile dysfunction protocol jason discount 100mg kamagra gold otc, refers to episodes of pelvic pain whose duration is limited to the period of menstrual blood flow erectile dysfunction kidney stones order discount kamagra gold online, or which start one or erectile dysfunction doctors long island cheap kamagra gold, at the earliest, two days before and stop one or, at the latest, two days after the blood flow. System Female internal genital organs; either the uterus or both adnexa or one adnexum. Site the pain is localized either in the whole lower abdomen nearly always symmetrically or in an iliac fossa. It sometimes radiates into the anterior and superior aspect of one or both thighs. Main Features There are two varieties of dysmenorrhea; primary or essential and secondary or symptomatic. If the pain has a lower abdominal location, which is usually symmetrical, and if no structural anomaly is found on clinical examination, the dysmenorrhea is termed primary. Prevalence: between 5 and 10% of all girls in their late teens and early 20s suffer from severe, mostly primary, dysmenorrhea during the first hours of their periods. Age of Onset: primary dysmenorrhea mostly starts a few months after menarche and lasts for several years. Pain Quality: the pain is generally colicky; in about one-fourth of all cases the pain is continuous. Third degree or incapacitating dysmenorrhea has an intensity that compels the patient to stay in bed. Duration: in most cases the pain starts a few hours or half a day before the beginning of the blood flow, and usually lasts less than one day. Associated Features With third degree primary dysmenorrhea there may be nausea, vomiting and/or diarrhea. Usual Course Primary dysmenorrhea may disappear spontaneously after a few years, but it mostly disappears in 8 cases out of 10 after the birth of the first baby. Social and Physical Disability Third degree dysmenorrhea is the cause of periodic absence from work or school in many teenagers and young women. Pathophysiology Primary dysmenorrhea is found at the end of an ovulatory cycle; it has also been reported in women taking oral contraceptives. In some patients uterine contractions during dysmenorrheic episodes show well-coordinated contractions with extremely high intrauterine pressures, in others "dysrhythmic" contractions with high or low pressures, and in others an elevated intrauterine pressure between contractions. Several authors have found elevated prostaglandin concentrations in endometrium and menstrual fluid of patients with primary dysmenorrhea. Although the exact mechanism of primary dysmenorrhea is unknown, it is probable that in most cases the pain is due to hypertony of the uterine isthmus, i. This is combined with an increased production (or perhaps increased retention) of prostaglandins, which leads to increased, or dysrhythmic, myometrial contractions, sensitization of nerve terminals to prostaglandins, and ischemia of the uterine wall. In severe cases the pain can be prevented by cyclic estroprogestogens, or the pain may, when it appears, be alleviated by prostaglandin inhibitors. Differential Diagnosis From conditions causing secondary dysmenorrhea, namely endometriosis, etc. Primary dysmenorrhea is characterized by the absence of any structural abnormality of the internal female genital organs. Recent observations have shown that in about 10% of cases with a negative clinical examination, laparoscopic visualization of the internal genitalia may detect endometriotic lesions, so that the diagnosis of primary dysmenorrhea is not as simple as previously thought. Site the pain may be located in one or in both iliac fossae or over the whole lower abdomen. Main Features Prevalence: the frequency with which endometriosis is found depends on the circumstances in which it is sought. It was found in 15 and 20% of two different series of laparoscopies, but, on the other hand, it was found in 50% of a large series of laparotomies. Because many endometriotic lesions remain symptomless, the true incidence is difficult to determine. The ectopic foci are located either in the pouch of Douglas or on the ovaries or on the posterior leaf of the broad ligament and, less frequently, on the wall of rectum or sigmoid colon; rather seldom they infiltrate the bladder wall or the wall of the ureter. Age of Onset: It used to be thought that endometriosis usually develops in the late twenties or in the thirties, but since more laparoscopies have been performed on younger patients it has been found rather frequently in teenagers, especially those complaining of secondary dysmenorrhea and/or infertility. Symptoms: In some 30 to 40% of patients with endometriosis there are no complaints except perhaps infertility.
It should be emphasized that in this variant the pain episode is selflimited and rather shortlasting erectile dysfunction incidence age generic kamagra gold 100 mg with mastercard. Success in treatment may erectile dysfunction weed discount kamagra gold 100 mg without a prescription, therefore impotence for males buy cheap kamagra gold 100 mg, be confounded with the natural course of the disease condom causes erectile dysfunction order 100 mg kamagra gold overnight delivery. Carotidynia (V-4) Definition Continuous dull aching pain, sometimes throbbing, near the upper portion of the carotid arteries and adjoining cranial regions, with features of migrainous exacerbation. Site Pain in the neck, frequently radiating to the face and head (temporal/mastoid area), usually on one side. Main Features Prevalence: occurrence unknown, depends somewhat upon the criteria used, probably rather rare. Time Pattern: protracted course; dull, continuous neck pain with superimposed separate attacks of hours duration. There is, however, a tendency for the pain episodes to recur after a symptom-free interval. Intensity: moderate, not very severe; apparently less severe than migraine headache. The carotid artery may on palpation appear enlarged, pulsating, and tender, and externally applied pressure against the common carotid artery may reproduce the pain in the neck and face. Regional mus- Mixed Headache (V-5) Mixed headache in most cases probably refers either to migraine with interparoxysmal headache or to chronic tension headache, as described above. The headache should accordingly be categorized, whenever possible, as either migraine or chronic tension headache. X7b Cluster Headache (V-6) Definition Unilateral, excruciatingly severe attacks of pain, principally in the ocular, frontal, and temporal areas, recurring in separate bouts with daily, or almost daily, attacks for weeks to months, usually with ipsilateral lacrimation, conjunctival injection, photophobia, and nasal stuffiness and/or rhinorrhea. Site Ocular, frontal, temporal areas: considerably less frequent in infraorbital area, ipsilateral upper teeth, back of the head, entire hemicranium, neck, or shoulder. The maximum pain is usually in ocular, retro-ocular, or pe- Page 80 riocular areas. The side may, however, change (in approximately 15% of the patients), even within a given cluster period. Patients characteristically pace the floor, bang their heads against the walls, etc. Usually, 1-3 attacks, lasting from half an hour to 2 hours each, occur per 24 hours in the cluster period. Associated Symptoms and Signs Usually there is no nausea, but some may occur, probably with the more severe attacks or at the peak of attacks. Ipsilateral miosis or ptosis associated with some attacks; occasionally they persist after attacks and sometimes permanently. Ipsilateral conjunctival injection, lacrimation, stuffiness of the nose, and/or rhinorrhea occur in most patients. Dysesthesia upon touching scalp hairs in the area of the ophthalmic division of the Vth cranial nerve and photophobia occur in most patients. A reduction in heart rate and irregular heart activity are features in some patients, especially during severe attacks. Relief From ergot preparations, oxygen, corticosteroids, lithium, verapamil, methysergide, etc. Serotonin 1D receptor agonists, like sumatriptan, have a convincing, benefi- cial effect. Usual Course Attacks, less than 1 to 3 per day, appearing in bouts of 412 weeks duration. Essential Features Excruciatingly severe attacks of unilateral headache, appearing in bouts, lasting less than 1 year. Differential Diagnosis Sinusitis, chronic paroxysmal hemicrania, chronic cluster headache, cluster-tic syndrome, and migraine. Cervicogenic headache and tic douloureux ought not to present differential diagnostic problems. X8a Note: Although cluster headache is grouped with migraine and similar disturbances, it is doubtful if vascular disturbances are the primary source of these events, and the second code digit refers to alternative possibilities for the origin of the pain. Site Ocular, frontal, and temporal areas; occasionally the infraorbital, aural, mastoid, occipital, and nuchal areas. Pain may also be felt in the ipsilateral part of the neck, arm, and upper part of the chest.
If the patient survives erectile dysfunction by age buy cheap kamagra gold 100mg online, their disabilities from a hemorrhagic stroke are typically prolonged erectile dysfunction pills australia 100mg kamagra gold fast delivery. The average age for hemorrhagic strokes is lower than that for ischemic strokes erectile dysfunction treatment wikipedia 100mg kamagra gold with visa, but they are less common erectile dysfunction gif kamagra gold 100mg low price, accounting for approximately twelve percent of all strokes. Hemorrhagic strokes can occur within the brain itself (intracerebral hemorrhage), or in the subarachnoid space, which is in the meningeal layers between the brain and the skull (subarachnoid hemorrhage). Figure 41 Illustration of intracerebral hemorrhagic stroke Intracerebral hemorrhages occur when a diseased blood vessel within the brain ruptures, allowing blood to leak inside the brain. The sudden increase in pressure within the brain can cause damage to the brain cells surrounding the blood, as well as leading to unconsciousness or death. Intracerebral hemorrhages are most often found in the basal ganglia, cerebellum, brain stem, or cortex. The most common cause of an intracerebral hemorrhage is hypertension, especially if it is uncontrolled. Less common causes include trauma, infections, tumors, blood clotting deficiencies, and abnormalities in blood vessels (arteriovenous malformations). Figure 42 Intracerebral hemorrhage Subarachnoid hemorrhages occur when a blood vessel just outside the brain ruptures, causing bleeding in the area between the brain and the meningeal layers, particularly the subarachnoid space. The sudden buildup of pressure outside the brain may also cause rapid loss of consciousness or death. Subarachnoid hemorrhages due to injury are often seen in the elderly who have fallen and hit their head. In younger people, motor vehicle crashes are the most common injury leading to a subarachnoid hemorrhage. Important risk factors for subarachnoid hemorrhage include heavy alcohol use, cigarette smoking, hypertension, and possibly oral contraceptive use. A positive family or past personal history of subarachnoid hemorrhage also increases risk. Cerebral aneurysms are abnormalities of the arteries, often found at the base of the brain. Eighty to eight five percent of these lesions are in the anterior cerebral circulation (internal carotid artery and its branches), with the remainder located in the posterior circulation (vertebral arteries and its branches). Multiple cerebral aneurysms are found in approximately twenty five percent of cases. Small areas of rounded or irregular swellings in the arteries can cause the vessel walls to become weak and prone to rupture, leading to a hemorrhagic stroke. Ruptured intracranial aneurysms account for approximately eighty percent of non-trauma subarachnoid hemorrhages. Death can occur if the intracranial pressure is high enough to cause irreversible structural damage or halt cerebral perfusion. The prevalence of aneurysms is two hundred times higher than the annual incidence of subarachnoid hemorrhage, leading to the conclusion that most aneurysms do not rupture. Treatment of the ruptured aneurysm is recommended as soon as tolerable by the patient, with the goal of obliterating the aneurysm within one to three days after the hemorrhage. Microsurgical aneurysm clipping and endovascular coil embolization are two very popular treatments. In microsurgical clipping, the neurosurgeon opens the dura, identifies the parent vessel and the ruptured aneurysm, and clips the aneurysm to exclude it from circulation. Endovascular coiling uses a micro-catheter threaded through a guide catheter to the origin of the ruptured aneurysm. Once inside the aneurysm, platinum coils are inserted into the sac until the aneurysm is densely packed. Coil therapy requires serial monitoring of patients and follow-up cerebrovascular imaging to detect the occasional risk of coil compaction or aneurysm recanalization. Initial treatment yields approximately seventy percent of patients experiencing ninety five to one hundred percent occlusion of the aneurysm. However, twenty five to thirty percent of patients do not have complete obliteration of their aneurysms, and recanalization can occur. The decision to proceed with open surgical clipping or endovascular treatment of an intracranial aneurysm after subarachnoid hemorrhage depends on both aneurysm-specific factors (location, size, morphology, and presence of thrombus), and patient-specific factors (age, density of the subarachnoid hemorrhage, patient preference, and other medical comorbidities).
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