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Understanding Parkinson’s
THIS FACT SHEET explains what Parkinson’s is, who develops it and what we know about its cause. It describes diagnosis, symptoms, effects of the condition over time, treatments and therapies. What is Parkinson’s?
dementia. More than 80,000 people in Australia Parkinson’s is a neurological condition that are living with it and about 4000 new cases are affects the control of body movements. People diagnosed each year. Parkinson’s affects men and with Parkinson’s experience trembling, rigidity, women and is more prevalent in people aged slowness of movement and changes in posture. The between 50 and 75 years. Approximately 10% of condition is neither fatal nor contagious, but it is those diagnosed are 40 years and younger. degenerative, which means the symptoms become worse over time.
Parkinson’s is highly individual and complex in
What Causes Parkinson’s?
nature and diagnosis is based on clinical assessment and patient history. It also appears similar to a Parkinson’s. We do know that there is a loss of number of other neurological conditions. Many nerve cells (neurones) in the substantia nigra (a patients therefore undergo a range of blood tests pigmented area in the base of the brain), which is and scans (MRI and CT) to eliminate the possibility part of the basal ganglia (the area that controls and (See Fact Sheet 3: Tests and Technology). Neurones produce a chemical called dopamine that There is no defi nitive test to prove a person has enables nerve impulses (messengers to and from Parkinson’s but a good indication of correct the brain) to move between one nerve cell and the diagnosis is if they respond well to levodopa therapy next. With fewer neurones in the substantia nigra, there is less dopamine, which interferes with the Accepting a diagnosis of Parkinson’s can be diffi cult transmission of messages within the basal ganglia. for the person diagnosed and their family. It needs As a result, some parts of the brain which control to be addressed sensitively to allow people time and body movement become overactive, while other space to come to terms with the condition. Do seek further information and advice as you need it. Just The fi rst signs of Parkinson’s are usually noticed dopamine-producing neurones are lost. Why these Symptoms
cells die remains a mystery to researchers.
Each person with Parkinson’s has a different pattern of symptoms that varies enormously both Who Develops Parkinson’s?
throughout the day and over time. It is important to keep a diary that notes any changes in symptoms for degenerative neurological condition after BRAINLINK - A PRACTICAL GUIDE FOR FAMILIES OF PEOPLE WITH NEUROLOGICAL CONDITIONS OR AQUIRED BRAIN INJURY
Many people notice that stress, anxiety and fatigue softer and more diffi cult to understand. Slow, greatly increase the severity of their symptoms. stiff and uncoordinated mouth movements affect Fluctuation of symptoms can also occur as the Loss of animation: Parkinson’s can cloak a
Tremor: Tremor usually begins in a fi nger or
person’s personality and emotional responses. hand, although sometimes the legs, lips and head Communication through facial expression can also shake. The tremor is slow and mostly present become restricted and the voice may become fl at, when limbs are resting. It decreases when the with less expression, which might be mistaken for person uses the limb and it disappears during lack of interest or perhaps, dementia.
sleep. About 70% of people with Parkinson’s will Cognitive problems: Some people have diffi culty
with short-term memory and with organising a Rigidity: This is the resistance you feel when you
move the limb of a person with Parkinson’s. If the resistance feels stiff and jerky, it is known as “cog- Treatments
wheel rigidity”. If it is smooth and consistent, it is The main treatments are individual management “lead-pipe rigidity”. It may affect some limbs more through medication or surgery.
than others and can affect the muscles of the face and neck (often present as cramping). People with Medication: A person with Parkinson’s requires
Parkinson’s sometimes experience “freezing” or a highly specifi c drug regime that suits his or her the inability to start certain movements.
particular needs. This often involves a ‘cocktail’ of different drugs. Responses to the drugs vary Slowness: Parkinson’s causes movements to
with the passage of time, the progression of the become slow and restricted (bradykinesia). condition, the dosage of the drug and the length of Spontaneous movements, such as swinging the arms while walking, facial expressions and gestures, become diffi cult. Bradykinesia usually begins As a result, the drug combination must be reviewed with fi ne movements, such as doing up buttons and modifi ed. For some people, that means or writing. Some people begin to shuffl e as they periodic stays in hospital of two to four weeks to walk, taking smaller steps and leaning forward monitor the effects of the drugs and to work out with hunched shoulders, which can lead to poor the most effective new regime. It also means having regular appointments with a specialist.
Depression: People with Parkinson’s are more
vulnerable to depression due to the chemical changes happening in their brains. Some people fi nd the challenges of Parkinson’s too much, which can also lead to depression. It is important to determine the cause of depression and to get Dopaminergic: These drugs restore levels of
Speech and swallowing difficulties: About half
dopamine in the brain. Levodopa is the most effective of those with Parkinson’s develop some diffi culty treatment for reversing the symptoms. It is absorbed with their speech or swallowing as the condition into the brain and converted into dopamine. Some progresses. Speech may become soft or slurred common therapies are levodopa with carbidopa and speed control becomes diffi cult - the person (brand name: Sinemet or Kinson) and levodopa with may start to talk at normal speed but get faster and BRAINLINK - A PRACTICAL GUIDE FOR FAMILIES OF PEOPLE WITH NEUROLOGICAL CONDITIONS OR AQUIRED BRAIN INJURY
Levodopa treatment has some long-term side monoamine oxidase B (MAO B). Research for effects - dystonias (twisting postures) and a drug that would inhibit MAO B exclusively, thereby allowing a lower dose of levodopa to be more effective, led to the development of a drug Dyskinesia may affect the face, tongue, upper called selegeline (brand name: Eldepryl).
body, arms and legs. The movements are jerky, sudden contractions followed by stretching and Anticholinergics: In a healthy brain, there is a
writhing motions. Newer drugs can be used to balance between dopamine and acetylcholine. extend the benefi ts of levodopa to prevent this.
In a brain affected by Parkinson’s, acetylcholine is more active due to the loss of dopamine. There may be a tendency for the benefi ts of each Anticholinergics can help maintain and balance dose of levodopa to wear off before the next one is due. Many factors, such as stress and diet, affect how long a dose of levodopa lasts.
Anticholinergics available include: benzhexol
(brand name: Artane), biperiden (brand name:
COMT Inhibitors: These agents are taken at
Akineton), procyclidine (brand name: Kemadrin) the same time as levodopa. The addition of a and benztropine (brand name: Cogentin). They COMT inhibitor provides a longer and smoother are typically used to control tremor that cannot be availability of levodopa to the brain. Entacapone Side effects can include dryness of mouth, blurring of vision, nausea, palpitations and Dopamine agonist: Rather than replacing
diffi culty urinating or incontinence (loss of dopamine as levodopa does, these drugs copy control over bladder or bowel movements).
the action of natural dopamine. They are taken Other: Amantadine (brand name: Symmetrel)
in conjunction with levodopa to reduce the has been around for a while, but in recent years it amount of levodopa being taken and to reduce the has been used as an effective treatment for drug- induced dyskinesias. It can produce similar side Three drugs available are: bromocriptine (brand
name: Parlodel), cabergoline (brand name: Surgery: Surgery does not cure Parkinson’s
Cabaser) and pergolide (brand name: Permax). but it provides another option if medication These are taken orally and each tablet works longer becomes less effective. About 5% of all patients are candidates. It can be used to treat specifi c Dopamine agonist drugs have side effects, symptoms and to reduce dyskinesias. The two main particularly in the elderly. They can create procedures are called stereotaxic surgery and deep confusion, hallucinations and the lowering of brain stimulation. Surgery involves considerable risks however, and must be discussed carefully with A fourth dopamine agonist is available by injection - apomorphine. This a very potent, “rescue” Managing Parkinson’s
drug that works within 5 to 10 minutes and gives While there is no cure for Parkinson’s, there are relief of symptoms for about an hour. It may also plenty of ways to reduce some symptoms and the be used for people whose fl uctuating symptoms condition can be managed well with a combination cannot be controlled by oral medications.
of therapies, regular activity and a healthy diet. It is possible to achieve quality of life, independence, MAO Inhibitors: These are used in conjunction
confi dence and mobility. The sooner you begin with levodopa to reduce symptoms. Dopamine working on these areas after diagnosis, the better. is broken down in the brain by an enzyme called BRAINLINK - A PRACTICAL GUIDE FOR FAMILIES OF PEOPLE WITH NEUROLOGICAL CONDITIONS OR AQUIRED BRAIN INJURY
Rehabilitation: Once established, an alert
extremely helpful methods of stress management. rehabilitation team can step in to prevent (See Fact Sheet 5: Assessing Alternative Therapies). problems before they occur and can assist carers in caring for the person at home for as long Parkinson’s Victoria Inc.
As the condition progresses, some people may require intensive “top-up” bursts of therapy in a rehabilitation centre. Others may need long-term day or outpatient therapy, perhaps on a weekly basis. A combination of the two may be needed. Physiotherapy: Physiotherapy improves
coordination, balance and movement. Parkinson’s Disclaimer: This fact sheet is part of a series of information products about brain injury affects a person’s ability to perform many produced by brain injury organisations with significant assistance from the Department of small movements that were once automatic. A Human Services, Victoria. The authors do not accept responsibility for actions taken, or not taken, as a result of any interpretation of the contents of this publication. physiotherapist can help you re-learn how to consciously make these movements. Good mobility also depends on your will to keep as active and fi t as possible. Speech pathologist: A speech therapist may help
with swallowing diffi culties or improving your
ability to speak loudly and clearly, for example.
Dietician: A dietician can devise a nutrition program that deals directly with any complications or defi cits that may be caused by drug treatments or the ongoing effects of Parkinson’s. Occupational therapy: Occupational therapists
can assess potential safety issues around the
home that may arise due to tremor or memory
diffi culties, for example. An occupational therapist
can also demonstrate how to break tasks up into
small, manageable steps.
Self-help programs
There are also more than 100 Parkinson’s support
groups around Australia, with more than 40 in
Victoria. These are terrifi c places to meet other
people and talk through any diffi culties. Contact the
Parkinson’s Association in your state for details.
Developing a good exercise regime is invaluable and can help to reduce rigidity. Tai Chi has proven to be fantastic for many people with balancing problems. Relaxation and meditation are BRAINLINK - A PRACTICAL GUIDE FOR FAMILIES OF PEOPLE WITH NEUROLOGICAL CONDITIONS OR AQUIRED BRAIN INJURY

Source: http://www.abistafftraining.info/PDF/Brainlink/FS_Parkinsons.pdf

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