By V. Rune. Benedictine College.

Lipids begin to accu- levels in the blood mulate in the arterial wall buy discount rhinocort 100 mcg, followed by aggregation of platelets ◗ Take in adequate amounts of vitamin E 100 mcg rhinocort amex, vitamin C discount 100 mcg rhinocort mastercard, folic and macrophages generic rhinocort 100 mcg otc, and the formation of plaque generic rhinocort 100 mcg fast delivery. The arterial acid, and calcium; each has been shown to have beneficial wall soon bulges into the lumen and obstructs blood flow. Ar- effects on the heart teries in the heart, brain, kidneys, and the extremities seem to ◗ Consider adding vitamins B6 and B12 to your diet; both are be especially vulnerable to this process. To help slow this de- ◗ Find ways to reduce stress generative process, you should: 324 CHAPTER FIFTEEN apparent arterial damage, and atherosclerosis may be present without causing hypertension, the two are often Cerebral artery found together in elderly people. The severe pain of Aneurysm angina pectoris may follow the lack of oxygen and the myocardial damage associated with sclerosis of the ves- sels that supply the heart. Posterior communicating ◗ An increase in the amount of urine with the appearance artery of albumin. Albumin is a normal plasma protein usually found in the urine only if there is kidney damage. Other symptoms referable to the kidneys may be caused by renal artery damage. If the dead tissue is invaded by bacteria, the result is gangrene (GANG-grene). The arterial damage that is caused by diabetes, for example, often leads to Figure 15-16 A cerebral aneurysm in the circle of Willis. Philadelphia: Lippincott Williams & Wilkins, Treatment for Arterial Degeneration Balloon 2004. Stents, small tubes inserted to keep vessels open, also amount of blood will cause no problem for a healthy discussed in relation to the heart, are used for other vessels adult, but loss of one liter or more of blood is life-threat- as well. An additional treatment approach is endarterec- ening. The first step to control bleeding is the application tomy (end-ar-ter-EK-to-me), removal of the thickened, of direct pressure to the wound using a clean cloth. Common sites for this pro- sisting person should wear gloves to protect from blood- cedure are the carotid artery or vertebral artery leading to borne diseases. A bleeding extremity should be elevated the brain and the common iliac or femoral arteries leading above the level of the heart. Surgeons can remove a blockage by di- bleeding, application of pressure where a local artery can rect incision of a vessel. More commonly, they use a cut- be pressed against a bone slows the bleeding. The most ting tool inserted with a catheter through the vessel open- important of these “pressure points” are the following: ing to remove plaque. One can feel the pulse of the facial artery in the ness in that part of the vessel (Fig. The aorta and depression about 1 inch anterior to the angle of the vessels in the brain are common aneurysm sites. Whatever the cause, the aneurysm side of the skull just anterior to the ear to stop hemor- may continue to grow in size. As it swells, it may cause rhage on the side of the face and around the ear some derangement of other structures, in which case def- ◗ The common carotid artery in the neck, which may be inite symptoms are present. If undiagnosed, the walls of pressed back against the spinal column for bleeding in the weakened area eventually yield to the pressure, and the neck and the head. Avoid prolonged compression, the aneurysm bursts like a balloon, usually causing death. Surgical replacement of the damaged segment with a syn- ◗ The subclavian artery, which may be pressed against thetic graft may be lifesaving. Capillary oozing usually is stopped by the nor- pressed to avoid serious hemorrhage of the lower ex- mal process of clot formation. BLOOD VESSELS AND BLOOD CIRCULATION 325 It is important not to leave the pressure on too long, supporting the circulation and improving the output of as this may cause damage to tissues supplied by arteries the heart. Oxygen is frequently administered to improve past the pressure point. Checkpoint 15-20 With regard to the circulation, what is meant Shock by shock? In terms of the circulating blood, it refers to a life-threatening condition in Thrombosis which there is inadequate blood flow to the body tissues. A wide range of conditions that reduce effective circulation Formation of a blood clot in a vessel is thrombosis (throm- can cause shock. A blood clot in a vein, termed deep venous throm- ever, a widely used classification is based on causative fac- bosis (DVT), most commonly develops in the deep veins of tors, the most important of which include the following: the calf muscle, although it may appear elsewhere.

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In such cases buy 100 mcg rhinocort free shipping, an operation to remove the eyeball 100mcg rhinocort for sale, Macular degeneration is another leading cause of a procedure called enucleation (e-nu-kle-A-shun) buy rhinocort 100 mcg without prescription, is per- blindness generic rhinocort 100mcg amex. This name refers to the macula lutea generic 100 mcg rhinocort with amex, the yel- formed. It is important to prevent infection in cases of injury Changes in this area distort the center of the visual field. Even a tiny scratch can become so seriously in- In one form of macular degeneration, material accumu- fected that blindness may result. Injuries by pieces of lates on the retina, causing gradual loss of vision. In an- glass and other sharp objects are a frequent cause of eye other form, abnormal blood vessels grow under the damage. The incidence of accidents involving the eye has retina, causing it to detach. Laser surgery may stop the been greatly reduced by the use of protective goggles. Factors con- tributing to macular degeneration are smoking, exposure Cataract A cataract is an opacity (cloudiness) of the to sunlight, and a high cholesterol diet. Some forms are lens or the outer covering of the lens. Box 11-1, Eye Surgery: A causes a gradual loss of visual acuity (sharpness). An un- Glimpse of the Cutting Edge, provides information on treated cataract leads to complete loss of vision. Although the cause of cataracts is not known, age is ◗ The Ear a factor, as is excess exposure to ultraviolet rays. Diseases such as diabetes, as well as certain medications, are The ear is the sense organ for both hearing and equilib- known to accelerate the development of cataracts. It is divided into three main sections: 232 ✦ CHAPTER ELEVEN Box 11-1 Hot Topics Eye Surgery: A Glimpse of the Cutting EdgeEye Surgery: A Glimpse of the Cutting Edge ataracts, glaucoma, and refractive errors are the most ◗ Laser trabeculoplasty to treat glaucoma. This procedure Ccommon eye disorders affecting Americans. In the past, uses a laser to help drain fluid from the eye and lower in- cataract and glaucoma treatments concentrated on managing traocular pressure. The laser is aimed at drainage canals lo- the diseases. Refractive errors were corrected using eye glasses cated between the cornea and iris and makes several burns and, more recently, contact lenses. Today, laser and microsur- that are believed to open the canals and allow fluid to drain gical techniques can remove cataracts, reduce glaucoma, and better. The procedure is typically painless and takes only a allow people with refractive errors to put their eyeglasses and few minutes. These cutting-edge procedures include: ◗ Phacoemulsification to remove cataracts. During this surgi- ◗ Laser in situ keratomileusis (LASIK) to correct refractive er- cal procedure, a very small incision (approximately 3mm rors. During this procedure, a laser reshapes the cornea to long) is made through the sclera near the outer edge of the allow light to refract directly on the retina, rather than in cornea. An ultrasonic probe is inserted through this opening front of or behind it. A microkeratome (surgical knife) is and into the center of the lens. The probe uses sound waves used to cut a flap in the outer layer of the cornea. A com- to emulsify the central core of the lens, which is then suc- puter-controlled laser sculpts the middle layer of the cornea tioned out. Then, an artificial lens is permanently implanted and then the flap is replaced. The procedure is typically painless al- minutes and patients recover their vision quickly and usu- though the patient may feel some discomfort for 1 to 2 days ally with little postoperative pain.

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Risk can only buy rhinocort 100 mcg lowest price, therefore discount rhinocort 100 mcg fast delivery, be identified in a prospective or cohort study purchase rhinocort 100 mcg with amex. By identifying the population before the event buy rhinocort 100 mcg without a prescription, it is less likely that we will introduce bias cheap 100 mcg rhinocort with mastercard. The disadvantage of this method is that it takes time, the study population must be closely observed and, inevitably, it costs considerably more than a case control study. The highest quality method is usually the randomised controlled trial. Using this method there is a much better chance of minimising confounding factors that could influence the results. This method can sometimes be difficult to apply in sports medicine research: athletes seeking treatment may not be prepared to join a control group if they feel it could possibly delay their recovery. It is also difficult to blind subjects to many interventions. It still remains the method of choice where it may be used. The CONSORT12 guidelines are an accepted method of reporting a randomised controlled trial and should be found in any research reporting such a trial. Reading the paper The standard format for a research paper is that of the introduction, methods, results and discussion, often described using the acronym IMRAD and most journals use some variation on this basic formula. The British Journal of Sports Medicine and the Clinical Journal of Sport Medicine both use a structured abstract while other journals such as Medicine and Science in Sports and Exercise continue to use a narrative abstract. The abstract contains the key information and the structured abstract has the advantage of ensuring that most of the important information required for interpretation is available to the reader. Introduction The first component of any research paper is the introduction. It allows the reader to understand the general context and the relevant research in the field. The introduction is, of course, the authors’ interpretation of the background but the introduction should describe relevant work leading to this particular study and set it in the appropriate context. Sackett13 believes there is no alternative for clinical readers, even if only reading in browsing or surveillance mode. Many readers gloss over the methods, focusing on the discussion and conclusions. The authors should outline exactly how the work was done in sufficient detail that a reader could replicate the work if they so wished. One should be able to identify a number of key components of any study as a measure of quality. In studies which are intended to be representative of a particular group, the key word is sampling. Many sport medicine studies are descriptive studies of a particular group. Often it is a sample of athletes in a particular team or sport who have been selected or selected themselves because of an attribute or talent. Clearly this sample will not be representative of the entire population. In cross sectional studies, it is also critically important that sampling be representative. The key to avoiding bias in sampling is randomisation. The sample frame, or the entire population from which the sample is drawn, should be explicit and the method of sampling appropriate, using standard mathematical methods, random number tables or computer generated random numbers. Sporting populations are by definition, different from the rest of the population through their interest and participation in sport. If we draw a sample from a particular sporting group, then we may only generalise the finding of that study to groups of people who have similar patterns of behaviour. A sample of top athletes, for example, is probably not representative of the general population in smoking, alcohol and dietary habits.

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