In some patients uterine contractions during dysmenorrheic episodes show well-coordinated contractions with extremely high intrauterine pressures depression test beck order wellbutrin 300mg mastercard, in others "dysrhythmic" contractions with high or low pressures mood disorder association vancouver generic wellbutrin 300 mg with visa, and in others an elevated intrauterine pressure between contractions depression symptoms quiz generic wellbutrin 300 mg on-line. Several authors have found elevated prostaglandin concentrations in endometrium and menstrual fluid of patients with primary dysmenorrhea anxiety relaxation techniques buy wellbutrin 300mg. 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. The main symptom of endometriosis is pain; it may manifest itself as dysmenorrhea, as premenstrual pain with menstrual exacerbation, or as chronic pain. Lesions located in the pouch of Douglas may provoke firm adhesions between the anterior wall of the rectum and the posterior vaginal wall; this location may cause pain on defecation during menstruation. Foci located in the pouch of Douglas or a fixed uterine retroversion due to endometriotic adhesions frequently cause deep dyspareunia. Endometriotic foci that penetrate into or through the bladder wall may cause painful micturition with or without hematuria during menstruation. Signs On pelvic examination a fixed painful retroversion may be found, or tender, enlarged, adherent adnexa on one or both sides. Small, tender nodular lesions, which are frequently palpated either in a sacro-uterine ligament or on the posterior surface of the uterus, are almost pathognomonic of endometriosis. Usual Course the ectopic foci remain receptive in a variable degree to the ovarian steroids, and they will undergo the same histological changes as the "eutopic" endometrium. The ectopic tissue may grow on the surface of the peritoneum or it may become buried in a fibrous capsule. The encapsulated lesions are those most likely to become painful, whereas the superficial ones are usually painless. The pain may start as secondary dysmenorrhea; it may later become premenstrual as well as menstrual, or may become continuous. Subocclusion or occlusion of the small or the large intestine is possible but infrequent. Rupture of an endometriotic cyst located in an ovary may cause an acute abdominal emergency due to irritation of the peritoneum by the old blood flowing from the ruptured cyst. Tiny fragments of menstrual endometrium may be carried away by lymphatics and, more rarely, by veins of the endometrium. Diagnostic Criteria the history and the findings on clinical examination will frequently lead to the diagnosis. When any doubt remains, a therapeutic trial with cyclic estroprogestogens will alleviate the pain in 8 of 10 cases. Laparoscopic inspection of the pelvic cavity has been used rather frequently in recent years to verify the diagnosis and to evaluate the extent of the lesions. Acute pain episodes in the right iliac fossa due to endometriosis may be mistaken for appendicitis. Recurrent episodes of lower abdominal pain, tenderness, and a slight fever may erroneously be taken for recurrent pelvic inflammatory disease. It will vary depending on age of the patient, stage of the disease, and the main presenting problem-pain or infertility or both. Hormonal treatment consists of cyclic estroprogestogens or in the continuous daily administration of oral progestogens, for example, Lynestrenol or norethisterone acetate. During recent years excellent results have been obtained by the continuous oral administration of Danazol, a strong antigo- Page 168 nadotropin and mild androgenic drug. Surgical treatment will, depending on the indication and the stage of the disease, consist of conservative surgery preferably by microsurgical techniques, or semiradical or radical surgery, i. In these circumstances treatment with broad spectrum antibiotics and local heat is indicated. If the pain and the parametrial tenderness persist, another cause of the pain should be looked for by laparoscopy. Main Features Prevalence: genital tuberculosis has become quite uncommon in most developed countries thanks to the gradual disappearance of pulmonary tuberculosis. It remains a problem in many less developed countries where pulmonary tuberculosis is still widely prevalent. Symptoms: the most frequent symptoms are sterility, pelvic pain, poor general condition, and menstrual disturbances. Genital tuberculosis presents under two forms, either the silent or the active form. In the silent forms there are no particular symptoms; there is no pain and no fever. In the active or advanced forms there are general symptoms and signs of the tuberculous process, meno- or metrorrhagias, sometimes amenorrhea. Signs On pelvic examination a fixed retroversion with palpable tubo-ovarian masses may be found. Spontaneous pain and dysmenorrhea may be explained by a pyo- or hydrosalpinx or by a tuberculous pelvioperitonitis. It may, on the other hand, evolve towards a pyosalpinx or an ovarian abscess or to a tuberculous pelvioperitonitis or a general peritonitis. Diagnostic Criteria In advanced cases general symptoms and signs of the tuberculous process, abdominal pain or discomfort, signs of a pelvic infection, together with a positive tuberculin test and bacteriological evidence of tuberculosis constitute the basis of the diagnosis. Prevalence: Because histological proof of the diagnosis is usually missing, the prevalence is unknown, but the condition is seen infrequently. It may be found soon after a delivery, especially if the cervix has been torn and infected. Symptoms: the patient complains of lower abdominal pain with or without low backache, and deep dyspareunia. The pain may occur during the premenstrual period and disappear during menstruation, or it may be continuous, with premenstrual exacerbation. Signs A more or less severely torn cervix is found and either an acute or a chronic cervicitis. Pathology Posterior parametritis on chronic cervicitis is believed to be due to extension of a cervical infection along the lymphatics of the parametrium. Diagnostic Criteria and Treatment Diagnosis of cervicitis depends on finding agglutinated leukocytes in the cervical mucus during the periovulatory period. The presence of an infected cervical canal and of a tender posterior parametrium and the absence of a history and of clinical findings suggestive of endometriosis make the diagnosis of posterior parametritis plau- Page 169 phase. Silent cases are usually diagnosed by the presence of tubercular lesions in an endometrial biopsy taken during the evaluation of infertility cases. Treatment Treatment is essentially medical by means of a combined drug regimen with Rifamycin, isoniazid, and ethambutol. Surgery will be resorted to only if pelvic masses persist or increase under medical treatment, if endometrial lesions persist, and if pain or other pelvic symptoms are not alleviated by drug therapy.
Syndromes
Lynch syndrome (HNPCC)
Diabetes
Fatigue and stress
Vomiting
Reduce the amount of salt you consume (typically less than 1500 milligrams per day) if you are retaining fluid.
Intracranial pressure (ICP) monitoring
Is it getting worse?
Published studies to date have included at most small minorities of individuals who received a second implant as an adolescent anxiety supplements discount wellbutrin 300 mg. Applicability (Generalizability to Real-World Practice): this issue was not considered in evaluating the quality of the evidence since setting and specific population characteristics were not prespecified depression symptoms pdf order wellbutrin 300 mg otc. However depression motivation generic 300 mg wellbutrin overnight delivery, generalizability has implications for how relevant the evidence is to the population served by the Washington State Health Care Authority depression definition earth science order wellbutrin 300 mg free shipping. According to one group of investigators, children receiving bilateral implants typically come from families with more education and greater motivation to try new technologies (Peters et al. There was no evidence pertaining to bilateral implantation in children who have significant disabilities in addition to hearing loss, such as visual impairment, and many of the selected studies specifically excluded patients with structural abnormalities. In summary, the available evidence pertains most directly to children who have prelingual deafness, who had good success with their initial implant, who will be able to follow through with auditory and language training, who have no significant disabilities other than hearing loss, who receive their second implant before adolescence, and who have no structural abnormalities that might interfere with the success of the implantation. Precise estimates of risk were not possible from the evidence available for this report, but major complications, including the need for explanation and reimplantation, may be as high as 10% or more over the long term. The evidence does not allow conclusions about differential effectiveness or differential safety according to patient, device, or provider factors. Applicability (Generalizability to Real-World Practice): Two studies specifically excluded patients lacking the cognitive ability to participate in testing or to complete questionnaires, and presumably, such patients were not enrolled in the other studies. Studies did not report whether any of the participants had physical comorbidities or disabilities, such as blindness. Gaps in the Evidence Optimal age at which to offer a second implant, and whether age at the time of the previous implant makes a difference. On the other hand, the comparative studies conducted in children generally found that localization performance was no better than chance with monaural hearing children but substantially greater than chance with binaural hearing. Biology of Hearing Hearing depends on a series of mechanical and neural processes. The outer ear consists of the external part of the ear, known as the pinna or auricle, and the ear canal, or external auditory meatus. The middle ear consists of the eardrum, or tympanic membrane, and an air-filled chamber containing a chain of three tiny bones, or ossicles, including the hammer (malleus), anvil (incus), and stirrup (stapes), which are successively connected from the eardrum to the oval window at the entrance to the inner ear. The inner ear, or labyrinth, contains the cochlea, which provides the essential organs of hearing, and the vestibule, which provides the organs of balance. Sound waves captured by the pinna of the outer ear travel through the ear canal and produce vibrations on the eardrum. These vibrations are mechanically amplified and transmitted by the ossicles in the middle ear to the oval window of the inner ear, causing the fluid and cilia of the cochlea to vibrate. Different hair cells respond to different sound frequencies and convert them to nerve impulses, which are transmitted along fibers of the auditory nerve to the auditory cortex of the brain, where they are interpreted as auditory sensations, or sound (Ruben, 2006). Conductive hearing loss is caused by disease affecting the external or, more commonly, middle ear and is characterized by the inability of the ear to conduct sound waves to the cochlea (inner ear). Hearing loss is often characterized as having occurred prelingually, with age 3 years serving as a common proxy for speech development, or postlingually (Bond et al. Consequences of Hearing Loss Hearing loss may cause serious linguistic, cognitive, emotional, educational, social, and employment problems. A substantial proportion of adults with hearing loss who are > 60 years of age experiences tinnitus. A high proportion of deaf individuals, especially those > 60 years of age, have additional types of physical disability (Bond et al. The additional cost of a second implant, and uncertainty about the added benefit versus added risks, have prevented bilateral implantation from becoming routine. Dual-ear stimulation allows left-right discrimination of sound location and makes it possible for the hearer to benefit from phenomena known as the head shadow effect, binaural summation, and binaural squelch (see Box 1 for a definition of these binaural effects). Bilateral implantation has the theoretical potential to achieve these effects for the user. Additionally, a second implant provides more electrodes that can compensate for asymmetric spiral ganglion cell loss, as well as a back-up in case of device malfunction. Nittrouer and colleagues suggest that unilateral implantation in children with bilateral hearing loss leaves children in a condition comparable to unilateral hearing loss. Elements of the Bilateral (Binaural) Advantage in Normal Hearing Individuals Head Shadow Effect: Refers to the noise barrier created by the head and shoulder so that each ear is shielded from competing background noise on the contralateral side of the head. If the hearer has the choice of using either ear, the one that will benefit from the shadow effect can be used preferentially in listening. Measured separately for each ear by auditory and speech perception tests that involve a signal from straight ahead and noise delivered to one ear. Quantitatively, it is the difference in test scores between the ear that is ipsilateral to the noise and the ear that is contralateral to the noise, or the reverse. Bilateral (Binaural) Summation: Refers to the additive effects of identical sounds processed by two ears and aids in diotic listening, i. This calculation controls for binaural summation but cannot control for the possibility that performance is better under the bilateral testing condition simply because that condition matches the everyday experience the patient has become accustomed to since the second implant. Bilateral (Binaural) Squelch: Refers to effect of interaural differences in the timing, level, and frequency of received sounds, which allows better discrimination between the speech or other signal of interest and background noise. Like the head shadow effect, it aids dichotic listening, and is reflected in comparisons of bilateral versus unilateral hearing with tests that involve a signal from straight ahead and noise delivered to the one ear. It is quantified by the difference between test scores associated with both cochlear implant devices activated and scores associated with activation of the device contralateral to the noise alone. It was originally thought that there was an advantage in saving one ear for future more sophisticated devices through sequential implantation although reimplantation is a possibility (Bond et al. On the other hand, some experts believe that simultaneous implantation, or sequential implantation with little delay between the procedures, is potentially more advantageous in that it may prevent a lack of coordination between the two devices that could diminish binaural cues and avoids timing differences in auditory brainstem activity that can develop during the time between implants (Smulders et al. The review did not analyze whether these factors were also associated with the benefit of bilateral versus unilateral implantation. Evoked potential studies have suggested that the plasticity of the human auditory system generally starts to diminish a few years after birth, which has implications for the optimal age of both initial implantation and a second implant (Asp et al. The additional disabilities included developmental delay, cerebral palsy, visual impairment, autism, and attention deficit disorder. It is also important to note that the sound intensity results of audiological assessments are on a relative scale, with 0 corresponding to the very faintest sound that is humanly audible rather than to an absolute absence of sound (Bauman, 2003). Communication abilities are assessed, which may require the involvement of speech and language specialists in prelingual children. Medical evaluation is necessary to assure fitness for surgery and to identify comorbidities that could interfere with success. Outcome Measures A wide variety of speech perception tests (also called speech recognition or speech discrimination tests), speech comprehension tests, and speech production tests are available for administration in an audiology laboratory or other clinical setting. Speech perception and sound localization tests might be considered strictly surrogate measures of hearing-related function. Tests of speech comprehension and speech production, while based on evaluation in a clinical setting by an audiologist or speech pathologist, are designed to more closely mirror real-life situations. Questionnaires for measuring actual self-reported or parent-reported hearing-related function in reallife situations are available. Cochlear Implants Final Evidence Report Page 33 Health Technology Assessment See Appendix I for descriptions of the tests and questionnaires used in evidence selected for this report. The external receiver (part 1) captures sounds in the environment as analog signals and transmits these signals by a direct wire connection to the battery-powered external speech processor (part 2), which converts the analog signals to digital signals and transmits them to the implanted receiver/stimulator (part 3) usually by radiofrequency waves. The implanted receiver/stimulator consists of a magnet, a telemetry coil, and a hermetically sealed electronics package; this particulardevice modifies the receiving electrical signals according to complex coding strategies before sending them to individual cochlear electrode channels (part 4), which, in turn, stimulate the auditory nerve. The purpose of the coding strategy software is to provide neural stimulation in patterns that are meaningful to the central auditory system. The key development of the last two decades has been the improvement of soundcoding strategies. The original implants used single-channel electrodes, but currently marketed devices use multichannel electrodes. Although current implants might include up to 22 electrodes, users typically can perceive no more than 10 unique channels because of various factors that limit the spatial specificity of the electrical stimulation. In other words, the number of discrete spiral ganglion cell populations that can be selectively stimulated is limited (Carlson et al. It involves creation of an incision behind the superior portion of the ear and a postauricular skin flap, removal of the bone and other tissue associated with the mastoid, creation of a well in the postauricular skull in which to place the receiver/stimulator portion of the implant, and a cochleostomy for placement of the electrodes (Copeland and Pillsbury, 2004). The external speech processor and the internal receiver/stimulator unit must be programmed for each individual patient to maximize auditory benefit and minimize discomfort from sound that is too loud. Implants can store multiple individualized programs, or maps, for different listening situations.
Laboratory Findings Noncontact measurement of skin temperature indicates a side-to-side asymmetry of greater than 1 depression definition economic buy 300 mg wellbutrin overnight delivery. Because of the unstable nature of the temperature changes in this disorder terminal depression definition wellbutrin 300 mg free shipping, measurements at different times are recommended vapor pressure depression definition chemistry purchase wellbutrin 300mg free shipping. Testing of sudomotor function both at rest and evoked indicates side-to-side asymmetry mood disorder nos symptoms diagnosis purchase 300mg wellbutrin overnight delivery. The bone uptake phase with three-phase bone scan reveals a characteristic pattern of periarticular uptake. Social and Physical Impairment Inability to perform activities of daily living and occupational and recreational activities. The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve. Main Features the onset usually occurs immediately after partial nerve injury but may be delayed for months. The nerves most commonly involved are the median, the sciatic, the tibial, and the ulnar. Spontaneous pain occurs which is described as constant and burning, and is exacerbated by light touch, stress, temperature change or movement of the involved limb, visual and auditory stimuli. Such reactions commonly meet the criteria for allodynia, hyperalgesia, and hyperpathia. In some patients it is difficult to show the altered sensibility with standard clinical tests. The threshold for tactile, vibration, and kinesthetic sensibility may be increased or normal. Usual Course In some cases improvement occurs with time, but in most patients the pain persists. Anticonvulsant drugs help in some instances, especially carbamazepine and particularly for paroxysmal elements of the pain. Social and Physical Disabilities this pain is a great physical and psychological burden to most patients. Allodynia in response to external stimuli and movements may hamper rehabilitation and prevent activities, thus making the patient physically handicapped. Pathology Cerebrovascular lesions (infarcts, hemorrhages), multiple sclerosis, and spinal cord injuries are the most common causes. Central pain is also common in syringomyelia, syringobulbia, and spinal vascular malformation, and may occur after operations like cordotomy. Increasing evidence indicates that central pain only occurs in patients who have lesions affecting the spino-thalamocortical pathways, which are important for temperature and pain sensibility. The lesion can be located at any level along the neuraxis, from the dorsal horn of the spinal cord to the cerebral cortex. Diagnostic Criteria Regional pain attributable to a lesion or disease in the central nervous system and accompanied by abnormal sensibility for temperature and pain, most often hyperpathia. Differential Diagnosis Nociceptive, peripheral neurogenic, and psychiatric causes of pain should be excluded as far as possible. Central Pain (1-6) Definition Regional pain caused by a primary lesion or dysfunction in the central nervous system, usually associated with abnormal sensibility to temperature and to noxious stimulation. Site the regional distribution of the pain correlates neuroanatomically with the location of the lesion in the brain and spinal cord. It may include all or most of one side, all parts of the body caudal to a level (like the lower half of the body), or both extremities on one side. The onset may be instantaneous but usually occurs after a delay of weeks or months, rarely a few years, and the pain increases gradually. Pain Quality: many different qualities of pain occur, the most common being burning, aching, pricking, and lancinating. The pain is usually spontaneous and continuous, and exacerbated or evoked by somatic stimuli such as light touch, heat, cold, or movement. Some patients have no pain at rest but suffer from evoked pain, paresthesias, and dysesthesias. Associated Symptoms and Signs There may be various neurological symptoms and signs such as monoparesis, hemiparesis, or paraparesis, together with somatosensory abnormalities in the affected areas. Increased threshold for at least one modality is most common, and this is frequently accompanied by dysesthetic or painful reactions Page 44 Code If three or more major sites are involved, code first digit as 9: 903. X8c Unknown If only one or two sites are involved, code first digit according to specific site or sites; for example, for head or face, code 003. Social and Physical Disability the disease may be present for 15 to 20 years, progressing slowly, but still compatible with an active, selfsupporting life. After 15 or 20 years the problems of pain, weakness, and general infirmity usually result in increasing invalidism, eventually leading to total dependency. Pathology A tubular cavitation develops slowly in the spinal cord, extending over many segments. Cavities may be bilateral and asymmetric and may communicate with an enlarged central canal. Associated findings may be ectopic cerebellar tonsils, hydrocephalus, cerebellar hypoplasia, and astrocytoma or ependymoma of the spinal cord. Essential Features Pain in the relevant distribution of slowly progressing muscle weakness and wasting and impairment of sensation to pinprick and temperature, while other sensory modalities remain intact. Differential Diagnosis Other conditions which have to be considered are: (1) amyotrophic lateral sclerosis, (2) multiple sclerosis, (3) tumor of the spinal cord, (4) skeletal anomalies of the cervical spine, (5) platybasia, and (6) cervical spondylosis. X0 Face Arm Leg Syndrome of Syringomyelia (1-7) Definition Aching or burning pain usually in a limb, commonly with muscle wasting due to tubular cavitation gradually developing in the spinal cord. Site Pain in shoulder, arm, chest, or leg, rarely in the face, occasionally bilateral. Main Features Pain is usually unilateral and continuous in an area that corresponds to the site of cavitation of spinal cord or brainstem, most frequently in the shoulder-girdle and arm. It may be a periodic diffuse dull ache but sometimes, and particularly when the pain is situated in forearm and hand, may have an intense burning quality. The pain may be severe and referred to deep structures in the limb, not responding to rest or minor sedation. Signs There is commonly muscle wasting beginning in small muscles of the hand and ascending to the forearm and shoulder-girdle with fasciculation and an early loss of tendon reflexes. Characteristically, pain and temperature sensations are impaired but other sensations are intact. The area of sensory impairment typically has a shawl distribution over the front and back of the upper thorax. Usual Course the disease usually begins in the second or third decade and slowly progresses. Polymyalgia Rheumatica (1-8) Definition Diffuse aching, and usually stiffness, in neck, hip girdle, or shoulder girdle, usually associated with a markedly raised sedimentation rate, sometimes associated with giant cell vasculitis, and promptly responsive to steroids. Deep muscular aching pain usually begins in the neck, shoulder girdle, and upper arms, but may only involve the pelvis and proximal parts of the thighs. Associated Symptoms Malaise, fatigue, depression, low grade fever, weight loss, and giant cell arteritis. Laboratory Findings Anemia of chronic disease, raised sedimentation rate (usually greater than 50 mm/hour Westergren). Essential Features Diffuse pain with malaise, elevated sedimentation rate, response to steroids. The diagnosis is to be made if three or more of the above criteria are present, or if one of the above criteria and pathologic evidence of giant cell arteritis is present. Definition Diffuse musculoskeletal aching and pain with multiple predictable tender points. Main Features Primary fibromyalgia, without important associated disease, is uncommon compared to concomitant fibromyalgia. Concomitant fibromyalgia occurs with any other musculoskeletal condition, where it may act to intensify the pain of the associated condition. Although pain in the trunk and proximal girdle is aching, distal limb pain is often perceived as associated with swelling, numbness, or stiff feeling. Day-to-day fluctuation in pain intensity and shifting from one area to another are characteristic, although the pain is usually continuous. Stiffness is present in 80% and is perceived as an increased resistance to joint movement, particularly toward the end of the range of movement. Both pain and stiffness are maximal within the broad sclerotomic and myotomic areas of reference of the lower segments of the cervical and lumbar spine. Fatigue is present in 80%, and is often severe enough to interfere with daily activities.
The levels of biological responses are extraordinarily low (down to the nanowatt and picowatt power density level) great depression test answer key generic 300mg wellbutrin visa. New studies address fertility and reproduction depression hair loss buy wellbutrin 300mg online, fetal and neonatal effects bipolar depression children buy wellbutrin 300mg lowest price, cognitive and behavioral problems in children and neurological damage depression exhaustion generic 300 mg wellbutrin with amex. There are many studies reporting effects of cell phone radiation (even on standbymode), wireless laptop exposure, cell phone use by mothers resulting in altered fetal brain development in the offspring, and more evidence that the blood-brain barrier and memory are at risk from cell phone use. Increased depth of evidence in many threads is presented in this report by well-regarded scientists and researchers from around the world. The exposure levels causing effects are documented to be much lower than in the past. The epidemiological evidence is now showing risks for a variety of adverse health outcomes. All this should be taken seriously by governments, and translated quickly into more protective safety standards, and in the interim, into strong preventative actions, warnings and substitution of safer technologies and redesigned devices. Bioeffects are clearly established and occur at very low levels of exposure to electromagnetic fields and radiofrequency radiation. Bioeffects can occur in the first few minutes at levels associated with cell and cordless phone use. Many of these bioeffects can reasonably be expected to result in adverse health effects if the exposures are prolonged or chronic. Essential body processes can eventually be disabled by incessant external stresses (from systemwide electrophysiological interference) and lead to pervasive impairment of metabolic and reproductive functions. This is the kind of exposure from power lines, battery switching in cell phone devices, laptop computers and appliances. It should be a strong warning to governments to reconsider their safety standards, particularly in light of the billions of people at potential health risk from new wireless technologies. The World Health Organization International Agency for Research on Cancer has classified wireless radiofrequency as a Possible Human Carcinogen (May, 2011). It could also have found a Group 3 designation was a good interim choice (Insufficient Evidence). These studies since 2006 give critical support to the argument that current safety standards are grossly inadequate. They cannot be protecting public health if they do not prevent harm to a variety of types of human cells, human sperm and the developing fetus in-utero. These are all effects reported today due to cell phone radiation exposures that are both legal and common in daily home, business and school environments. This is only a snapshot of the evidence presented in the BioInitiative 2014 updated report. Many of these bioeffects are associated with disruption of normal biological functioning in the genes, and in the physiology of the nervous and cardiac systems of the body (brain, blood-brain barrier, heart, vascular system). Pregnant mice exposed to cell phone radiation give birth to baby mice with attention disorders, hyperactivity and impaired memory function, similar to effects seen in human babies as reported by Divan et al (2008). Chronic exposures that trigger stress responses (stress proteins) regardless of their environmental cause are mal-adaptive if they go on too long. Fetal Effects and Fetal Development Studies: Effects on the developing fetus from in-utero exposure to cell phone radiation have been observed in both human and animal studies since 2006. Divan et al (2008) found that children born of mothers who used cell phones during pregnancy develop more behavioral problems by the time they have reached school age than children whose mothers did not use cell phones during pregnancy. The July 2008 issue of Epidemiology reports that children whose mothers used cell phones during pregnancy had 25% more emotional problems, 35% more hyperactivity, 49% more conduct problems and 34% more peer problems (Divan et al, 2008). Exposed mice had a dose-dependent impaired glutamatergic synaptic transmission onto Layer V pyramidal neurons of the prefrontal cortex. The authors conclude the behavioral changes were the result of altered neuronal developmental programming in utero. Offspring mice were hyperactive and had impaired memory function and behavior problems, much like the human children in Divan et al (2008). A new study from Greece reports altered development of the cranial bones of the mouse fetus from low intensity (0. Other studies conclude that usage of cell phones, exposure to cell phone radiation, or storage of a mobile phone close to the testes of human males affect sperm counts, motility, viability and structure (Aitken et al, 2004; Agarwal et al, 2007; Erogul et al. There are fewer animal studies that have studied effects of cell phone radiation on female fertility parameters. Agarwal et al (2009) evaluated the effect of cell phone radiation during talk mode on human sperm samples. The authors found "radiofrequency electromagnetic waves emitted from cell phones may lead to oxidative stress in human semen. We speculate that keeping the cell phone in a trouser pocket in talk mode may negatively affect spermatozoa and impair male fertility. The authors found statistically significant damage to the mitochondrial genome of epididymal spermatozoa (p<0. Avendado says "(T)o our knowledge, this is the first study to evaluate the direct impact of a laptop use on human spermatozoa. We speculate that keeping a laptop connected wirelessly to the internet on the lap near the testes may result in decreased male fertility. There is a veritable flood of new studies reporting sperm damage in humans and animals, leading to substantial concerns for fertility, reproduction and health of the offspring (unrepaired de novo mutations in sperm). Exposure levels are similar to those resulting from wearing a cell phone on the belt, or in the pants pocket, or using a wireless laptop computer on the lap. The damage was greater to stem cells (derived from adipose tissue in humans) than in fibroblasts. Stem cells did not repair over time - and the damage was done within one hour of microwave exposure. Therefore, "stem cells like blood cells and fibroblasts are always subjected to exposure from mobile phones. Kundi and Hutter (2009) reviewed human effects in fourteen (14) mobile phone base station studies and reported "(F)rom available evidence it is impossible to delineate a threshold below which no effect occurs, however, given the fact that studies reporting low exposure were invariably negative it is suggested that power densities around 0. In the beginning months, adrenaline levels first increased in a dose-dependent fashion according to exposure level (p < 0. Both the average as well as the median adrenaline values increased after the activation of the transmitter and decreased again after one year with exposure levels >0. Chronically ill subjects and children showed especially strong responses; except for some "outliers," no effect was observed in healthy adults (Buchner and Eger, 2012). For dopamine, inverse effects to those for adrenaline and noradrenaline were observed. The median dopamine levels decreased from 199 to 115 g/g creatinine between January and July 2004. The fact that the dopamine levels of the study subjects decreased during this period is highly significant (p<0. Thereafter, the median increased again: In January 2005, it was at 131 g/g creatinine, in July of 2005. Thomas et al (2008) reported an increase in adult complaints of headaches and concentration difficulties with short-term cell phone use at 0. Public safety standards are 1,000 10,000 or more times higher than levels now commonly reported in mobile phone base station studies to cause bioeffects. In multiple trials with the fields either on or not on, the subject experienced and reported temporal pain, feeling of usease, skipped heartbeats, muscle twitches and/or strong headache when the pulsed field (100 ms, duration at 10 Hz) was on, but no or mild symptoms when it was off. The authors conclude that electromagnetic hypersensitivity is a neurological syndrome, and statistically reliable somatic reactions could be provoked in this patient by exposure to 60-Hz electric fields at 300 volts per meter (V/m). Johansson et al (2010) studied symptoms, personality traits and stress in people with mobile phone-related symptoms and electromagnetic hypersensitivity. Johansson (2007, 2009) provide an extensive overview of the relevant literature on electrohypersensitivity. The need for new, biologically-based public exposure standards is recommended in both publications, in order to address electrohypersensitivity. Landgrebe et al (2007) reported that their study of electrosensitive patients showed participants had a reduced intracortical facilitation as compared to two control groups. The team of Sandstrom, Hansson Mild and Lyskov produced numerous papers between 1994 and 2003 involving people who are electrosensitive (Lyskov et al, 1995; Lyskov et al, 1998; Sandstrom et al, 1994; Sandstrom et al, 1995; Sandstrom et al, 1997; Sandstrom et al, 2003). Sandstrom et al (2003) presented evidence that heart rate variability is impaired in people with electrical hypersensitivity and showed a dysbalance of the autonomic nervous system.
Buy discount wellbutrin 300 mg on-line. Mild Cognitive Impairment - Ten Years Later.
References
Nickel JC, Siemens DR, Nickel KR, et al: The patient with chronic epididymitis: characterization of an enigmatic syndrome, J Urol 167:1701n1704, 2002.
Fry CH, Sui GP, Kanai AJ, et al: The function of suburothelial myofibroblasts in the bladder, Neurourol Urodyn 26(6 Suppl):914n919, 2007.
Huang E, Teh BS, Strother DR, et al. Intensity-modulated radiation therapy for pediatric medulloblastoma: early report on the reduction of ototoxicity. Int J Radiat Oncol Biol Phys 2002;52(3):599-605.
Snow N, Lucas AE. Bronchoscopy in the critically ill surgical patient. Am Surg. 1984;50:441-445.
Lu A, Tang Y, Ran R, et al. Brain genomics of intracerebral hemorrhage. J Cereb Blood Flow Metab 2006;26:230-52.
Urbanek K, Torella D, Sheikh F, et al. Myocardial regeneration by activation of multipotent cardiac stem cells in ischemic heart failure. Proc Natl Acad Sci USA 2005;102:8692-8697.
Altunbasak S, Demirtas M, Tunali N, et al: Primary rhabdomyosarcoma of the heart presenting with increased intracranial pressure. Pediatr Cardiol 1996; 17:260-264.
