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Physiotherapy may restore misplaced movement or sensation; speech remedy could assist language disturbances. Strongyloidiasis is contracted in affected areas by walking barefoot on soil contaminated with faeces. Most larvae are passed within the faeces, but some enter the pores and skin around the anus to start a model new cycle. Occasionally, an contaminated individual with decreased immunity dies of problems, corresponding to septicaemia or meningitis. A radioactive variety, strontium ninety, is produced during nuclear reactions and could also be current in nuclear fallout. Strontium 90 accumulates in bone, the place the radiation it emits may trigger leukaemia and/or bone tumours. Other forms of radioactive strontium have been used to diagnose and treat bone tumours. Its main use is as an ingredient in some rodent poisons; most cases of strychnine poisoning occur in youngsters who by accident eat such poisons. Symptoms start quickly after ingestion and embrace restlessness, stiffness of the face and neck, increased sensitivity of listening to, style, and smell, and photosensitivity, adopted by alternating episodes of seizures and floppiness. The victim is given intravenous injections of a tranquillizer or a barbiturate, with a muscle-relaxant drug if needed. Characteristically, a large purple birthmark (port wine stain) extends over one side of the face, including the eye. Malformation of cerebral blood vessels may cause weak spot on one side of the body, progressive mental handicap, and epilepsy. It is more frequent in males, twins, and lefthanded individuals, and may happen with tics or tremors. An attack could trigger loss of consciousness, sometimes preceded by a sudden violent headache. If the individual stays acutely aware, symptoms such as photophobia, nausea, drowsiness, and stiffness 530 of the neck may develop. Even unconscious patients may recuperate, but additional attacks are frequent and often deadly. Treatment includes life-support procedures and management of blood stress to prevent recurrence. About half of these folks affected survive, some recover utterly, others have residual disability similar to paralysis. The cause is narrowing of the arteries that carry blood to the arms, usually due to atherosclerosis. The trapped blood slowly types a large clot within the cranium that presses on mind tissue. The signs, which are probably to fluctuate, could embody headache, confusion, drowsiness, and one-sided weak point or paralysis. The interval between the harm and the start of symptoms varies from days to months. This entails drilling burr holes in the cranium (see craniotomy), so that the blood may be drained out and damaged blood vessels repaired. If treatment is carried out at an early enough stage, the particular person usually makes a full recovery. Drugs taken sublingually, either as tablets or spray, are rapidly absorbed into the bloodstream by way of the lining of the mouth. For example, nitrate tablets are given sublingually to present rapid aid of an angina attack. A subluxated tooth can often be manipulated back into position, and is then immobilized (see splinting, 531 stay in partial contact. Problems may come up due to opposed results or from the habit-forming potential of the substance. Possible threat factors embody: laying the baby face-down to sleep; overheating; parental smoking after the birth; prematurity and low start weight; and poor socioeconomic background. Treatment includes elevation of the affected hand or foot, mild exercise, and heat remedy. It is often the outcomes of a psychiatric illness, similar to severe despair or schizophrenia.

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From the twentieth week progress alm ost ceases and the uterus expands by distension, the stretching of the m uscle bres being due to the m echanical effect of the growing fetus. With distension the wall of the uterus becom es thinner and the shape cylindrical. The uterine blood vessels also undergo hypertrophy and becom e increasingly coiled within the rst half of pregnancy, but no further growth happens after this, and the additional size required to m atch the persevering with uterine distension is obtained by uncoiling the vessels. The uterus is derived from the two M�llerian ducts and the myom etrium is m ade up of a skinny external, largely longitudinal, layer; a thin inside, largely circular layer; and a thick, intricately interlaced m iddle layer, which com prises two spiral system s of interdigitating m uscles derived from the two M�llerian ducts. The proportion of m uscle to connective tissue is best within the fundal space and dim inishes because the lower segm ent of the uterus and cervix is approached, the lower half of the cervix having no m ore than 10% of m uscle tissue. The effect of the uterine distension is to stretch each interdigitating spiral system s and to increase the angle of 20 Weeks 23 Weeks Weight (g) 3200 2800 2400 2000 o Thickness of uterine wall (cm) 27 Weeks 1600 W f fe t 1. This change in the cervix is due to oestradiol, which increases the hygroscopic properties of the cervical connective tissue and loosens the acid m ucopolysaccharides (glycosam inoglycans) of the collagen-binding ground substance. Prostaglandins act on the collagen bres, particularly within the last weeks of pregnancy. At the sam e tim e, collagenase is launched from leucocytes, which additionally helps in breaking down collagen. The cervix becom es softer and m ore simply dilatable � the so-called ripening of the cervix. The plasm a volum e increases to ll the extra intravascular space created by the placenta and the blood vessels. Because the increase within the pink cell m ass is proportionately less than the increase in the plasm a volum e, the focus of the erythrocytes within the blood falls, with a discount in the haem oglobin concentration. Although the haem oglobin focus falls to about one hundred twenty g/L on the 32nd week, a larger total haem oglobin is current than when not pregnant. Concurrently the num ber of white blood cells increases (to about 10,500/m L), as does the blood platelet rely. The decrease uterine segm ent is that a part of the lower uterus and higher cervix lying between the line of attachm ent of the peritoneum of the uterovesical pouch superiorly and the histological inside os inferiorly. It is that a half of the uterus the place the proportion of m uscle dim inishes, this m uscle being replaced more and more by connective tissue (m ainly collagen bres), which kind s 90% of the cervical tissues. Because of this the lower 36 Chapter 5 Physiological and anatom ical adjustments in being pregnant T in a position 5. Ox ord: Blackwell; 1971) particularly in late being pregnant due to the obstruction to venous return attributable to the upper strain of the venous blood returning from the uterus and the m echanical strain of the uterus on the vena cava. This m ay lead to varicosities within the leg veins (and sometimes the vulval veins) of susceptible wom en. Most of the elevated output is as a end result of of an elevated stroke volum e, however the heart price increases by about 15%. The increased cardiac output is balanced by a decrease within the peripheral resistance. For these reasons, blood pressure falls in early being pregnant rising back to prepregnancy levels by the third trim ester. Renal blood and plasm a ow increase to four hundred m L/m in above nonpregnant ranges by the 16th week of being pregnant, and rem ain at this high level to term. This will increase the capability of the renal pelvis and ureters from 12 m L to 75 m L and will increase the prospect of urinary stasis. The m uscles of the interior urethral sphincter relax and this, together with the pressure of the uterus on the bladder, m ay trigger som e diploma of incontinence. The glom erular ltration price increases by 60% in early pregnancy and rem ains on the new degree until the final four weeks of being pregnant, when it falls. As tubular reabsorption is unaltered, the clearance of m any solutes is increased. The elevated glom erular ltration rate, along with the natriuretic effect of progesterone, would cause an increased lack of sodium have been it not for elevated manufacturing of renal renin and, in consequence, angiotensin.

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The caecum and colon are subsequent palpated, the hand pressing down gently as the patient breathes out. This examination ination, which could be perform ed fairly rapidly, ought to embrace inspection of the head and neck, palpation of the supraclavicular areas for enlarged lym ph nodes, auscultation of the heart and lungs, and determ ination of the pulse rate and blood stress. The gynaecological portion of the examination ination ought to include: � A breast examination ination � An abdom inal examination ination � An inspection of the external genitalia � A pelvic examination ination, by speculum, after which digitally as a bim anual vaginoabdom inal exam ination � A rectal examination ination in sure instances. Pe lvic e xaminatio n the pelvic exam ination should follow the abdom inal exam ination and may by no means be om itted unless the patient is a virgin. The external genitalia are rst inspected beneath an excellent mild with the affected person in the dorsal position, the hips exed and kidnapped, and knees exed. The affected person m ust have voided just before the exam ination (unless she is com plaining of stress incontinence). If urinary infection is suspected, a m idstream specim en of urine m ay be obtained at this tim. During the inspection, the contour of the breasts, the scale and form of the areolae and the situation of the nipples are examined. If the doctor intends to take a cervical sm ear to examination ine the exfoliated cells, or a vaginal and cervical swab for m icrobiological examination ination, no lubricant apart from water should be used on the speculum. If the affected person has a prolapse, the diploma of the vaginal wall or uterine descent can finest be assessed if a Sim s speculum is used, with the affected person within the left lateral position. Digital exam ination follows, one or two ngers of the gloved hand being introduced. After the labia m inora have been separated with the left hand to expose the vestibule, the ngers are introduced, passing upwards and backwards to palpate the cervix. The left hand sim ultaneously palpates the pelvis through the abdom inal wall, so that the uterus and ovaries m ay be palpated. As the intravaginal ngers push the cervix backwards, the abdom inally located hand is positioned just under the um bilicus and the ngers attain. Care should be taken to keep away from making use of painful stress on the urethra by inserting the speculum initially obliquely. The inform ation obtained by bim anual exam ination consists of: � By palpation of the uterus. The norm al uterus is positioned both anteriorly or posteriorly and is about 9 cm long. The ideas of the vaginally located ngers are positioned in each lateral fornix in turn after which pushed backwards and upwards as far as attainable without causing pain. The abdom inally situated ngers sim ultaneously press backwards about 5 cm m edial and parallel to the superior iliac backbone. Note that the bladder is empty, the affected person having voided just before the examination. A rectal examination ination is a useful adjunct to a vaginal examination ination when both the outer elements of the broad ligam ents or the uterosacral ligam ents require to be palpated. On event, a rectovaginal examination ination, with the index nger in the vagina and the m iddle nger within the rectum, m ay help to determ ine if a lesion is in the bowel or between the rectum and the vagina. For examination ple, if the wom an com plains of a vaginal discharge, swabs ought to be taken to determ ine the cause (see p. Medical practitioners have a crucial function in encouraging sexually lively wom en to have a screening test for cervical abnorm alities (see Chapter 37). Ultrasound is especially helpful in establishing patency of the Fallopian tubes and in de ning cystic, benign and m alignant tum ours of the interior genital organs. The exam ination m ay be m ade transabdom inally via a full bladder, or transvaginally when the bladder is em pty. Endom etrial biopsy has a job within the investigation of infertility and in helping to attain a analysis in cases of postm enopausal bleeding. The colposcope is positioned in entrance of the vagina and its focal length is adjusted to exam ine the suspect a half of the decrease genital tract (see p. The wom an visits the doctor to con rm that she is pregnant and both to seek antenatal care from the physician or to be referred to an obstetrician or to a hospital clinic. The inform ation consists of m ore than that described for gynaecological examination ination. The historical past of earlier pregnancies must be detailed and include inform ation about: � Spontaneous m iscarriages and induced abortions � Com plications during being pregnant � the gestation interval at supply � the m ethod of delivery (spontaneous vaginal start, forceps, ventouse delivery, caesarean section) � Com plications in the puerperium � Birthweight of the baby, neonatal com plications and long-term outcom e � Maternal physical and m ental health during and after each being pregnant � Breastfeeding historical past.

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Types of ophthalmitis embody ophthalmia neonatorum and sympathetic ophthalmitis: a O uncommon condition by which a penetrating harm to one eye is adopted by extreme uveitis that may cause blindness in the different eye. Sympathetic ophthalmitis can be treated with corticosteroid medicine, but elimination of the injured eye is typically necessary to save the sight of the other. Ophthalmology covers assessment of vision, prescription of glasses or contact lenses, and surgery for eye disorders, corresponding to cataracts and glaucoma. The ophthalmoscope is used first to direct a beam of light into the attention after which to look at the light-sensitive retina; the retinal blood vessels; the pinnacle of the optic nerve; and the jelly-like vitreous humour. Opioids, also is aware of as narcotic drugs, could additionally be abused for his or her euphoric results; abuse might trigger tolerance (the need for larger amounts of a drug to get the identical effect), and bodily and psychological drug dependence. Many fungal infections, similar to candidiasis, and a few viral infections, similar to herpes simplex, are opportunistic infections. Typically, a toddler exhibits hostile, argumentative behaviour that features loss of mood, defiance of guidelines, and swearing. To some extent such behaviour is widespread in adolescence, but when law-breaking or violence happen the situation is deemed to be pathological. Optic atrophy might happen with out prior indicators of nerve illness, similar to irritation. The optic disc is also called the blind spot due to its lack of lightsensitive cells. An ophthalmic optician, or optometrist, additionally examines the eyes to check for myopia, presbyopia, hypermetropia, or astigmatism. People with suspected eye disorders are referred to a specialist called an ophthalmologist. The 2 optic nerves every include about 1 million nerve fibres that transmit impulses from the retina to the brain. The optic nerves converge behind the eyes, the place fibres from the inside halves of the retina cross over. Nerve fibres from the proper halves of both retinas go to right side of the occipital lobes within the brain; those from the left halves go to the left aspect. The latter is caused by strain on the nerve from illness in the orbit or a mind tumour. Vision normally improves inside 6 weeks, but some optic nerve fibres might be broken. Most cases are thought to be because of demyelination of the optic nerve fibres in multiple sclerosis. The situation may also outcome from inflammation or an infection of tissues around the optic nerve. Corticosteroid medication may help to restore vision, however seem to have little effect on longterm end result. Oestrogen tablets include ethinylestradiol; progestogens embody levonorgestrel and norethisterone. When used correctly, the variety of pregnancies amongst girls using oral contraceptives for one 12 months is less than 1 per cent. Actual failure charges could additionally be 4 instances higher, significantly for the minipill, which has to be taken at precisely the same time each day. The minipill works mainly by making the mucus lining of the cervix too thick to be penetrated by sperm. Oestrogen-containing drugs supply safety against uterine and ovarian most cancers, ovarian cysts, endometriosis, and irondeficiency anaemia. They also tend to make menstrual periods regular, lighter, and comparatively pain-free. Possible unwanted facet effects embody nausea, weight acquire, 417 melancholy, swollen breasts, lowered intercourse drive, elevated appetite, leg and belly cramps, complications, and dizziness. These pills may aggravate coronary heart illness or cause hypertension, gallstones, jaundice, and, very not often, liver most cancers. All oral contraceptives can cause bleeding between durations, especially the minipill. Other possible opposed effects of the minipill embody irregular intervals, ectopic being pregnant, and ovarian cysts. There may be a slightly increased long-term risk of breast most cancers for girls taking the combined tablet. The minipill or a lowoestrogen tablet could additionally be used by ladies who ought to keep away from oestrogens.

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Menstruation and menstrual disorders Severe impact on quality of life + no want to conceive + regular uterus +/- small fibroids (<3 cm diameter). Common: persistent vaginal discharge, postembolization syndrome � ache, nausea, vomiting and fever (not involving hospitalization). Less frequent: need for extra surgery, premature ovarian failure, notably in girls over 45 years of age, and haematoma. Rare: haemorrhage, non-target embolization causing tissue necrosis, infection causing septicaemia. Less common: adhesions (which may lead to ache and/or impaired fertility), want for added surgery, perforation, recurrence of fibroids and infection. Rare: haemorrhage Less frequent: adhesions (which might result in ache and/or impaired fertility), want for added surgery, recurrence of fibroids and an infection. Continued Fibroids (>3 cm diameter) + severe influence on high quality of life Hysterectomy. Ovaries can also be removed (oophorectomy) Yes Discuss influence on sexual feelings, fertility, bladder function and psychology. Offer genetic grief counselling Discuss impact on sexual emotions, fertility, bladder function and psychology. With oophorectomy at time of hysterectomy: Common: menopausal-like symptoms Not first line solely for heavy menstrual bleeding. Consider when: � different remedies have failed, are contraindicated or declined � need for amenorrhoea � totally knowledgeable girl requests it � no desire to retain uterus and fertility Hysterectomy. Provided that the probe is in the cavity of the uterus, this can be a very protected procedure as the temperature rises as the endometrium is treated and the probe moved to another area. Success charges There is little variation in success rates between the totally different methods. Overall, approximately 30% of girls shall be amenorrhoeic and an extra 45�50% could have significantly decreased loss, giving a satisfaction price of approximately 75% (Magos et al 1991, Scottish Hysteroscopy Audit Group 1995, Cooper et al 1999). Some women additionally experience relief from symptoms of dysmenorrhoea and premenstrual pressure. Complications essentially the most important problems are those of uterine perforation and fluid absorption. Fluid absorption is uncommon since surgeons have become conscious of the chance and stop the operation if absorption turns into extreme. Infection may happen and most surgeons give prophylactic antibiotics routinely. Comparison of endometrial resection with hysterectomy Endometrial resection was developed as an alternative selection to hysterectomy. There have been numerous randomized comparisons between endometrial ablation and hysterectomy which show that satisfaction with both procedures is excessive (Pinion et al 1994). In addition, the operation may be carried out on a day-case basis and restoration time is short, making it an affordable different to hysterectomy. Its use in dysmenorrhoea is equivocal since it appears to make girls worse in roughly 12% of cases, which can be because of the formation of haematometra. Hydrothermal ablation (fluid-filled thermal endometrial ablation) Hydrothermal ablation is a process by which hightemperature water is used to destroy the lining of the uterus. It is used to treat irregular uterine bleeding even when there are small submucous fibroids. Novasure the NovaSure system is protected and efficient for the remedy of women with irregular uterine bleeding. This minimally invasive process controls heavy bleeding through the use of vitality to remove the liner of the uterus. The common therapy time is roughly ninety s, and the process solely needs to be carried out as soon as to lighten or cease menses. Without the side-effects of hormones or the risks of hysterectomy, NovaSure has a quick recovery time. Most women experience no ache after the process and may return to work the subsequent day.

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Whilst acceptable to establish gestation, pelvic examination for this function alone has generally been outdated by ultrasound, as the former is felt to be much less correct and rarely detects ectopic pregnancy or missed miscarriage. Whether the service chooses to screen for genital tract infection, notably chlamydia, or simply to deal with everyone with prophylactic antibiotics will depend on the background incidence of infection within the local inhabitants, however one or other is crucial. Women who refuse screening should be handled as excessive risk in the course of the abortion procedure. Cervical screening should be supplied in accordance with nationwide screening policies. Blood ought to be collected for measurement of haemoglobin concentration, and the blood group must be determined. Mortality and morbidity related to the process Abortion improve with the gestation of the being pregnant on the time of termination. The threat of major complications doubles when termination is carried out at 15 weeks of gestation compared with 8 weeks. Early-first-trimester abortion (9 weeks) Surgical Vacuum aspiration has been the method of choice for early surgical termination of pregnancy in industrialized countries for over 20 years. Dilatation and curettage requires extra cervical dilatation and is related to a considerably greater complication fee, together with uterine harm, and the next incidence of retained products of conception and antagonistic future reproductive consequence (Henshaw and Templeton 1993). Vacuum aspiration could be carried out underneath either local paracervical block or general anaesthesia. Some proof suggests that using common anaesthesia will increase the chance of the process. Preoperative therapy with a cervical priming agent has been proven to cut back the risk of haemorrhage and genital tract trauma associated with vacuum aspiration. Prostaglandins, bougies and mifepristone are all efficient, but prostaglandins (gemeprost 1 mg vaginally or misoprostol 400 �g vaginally, each 3 h before surgery) probably achieve their effect more quickly. Pretreatment of the cervix provides to the price of the process and could also be troublesome to organize when abortion is performed as a day case. As cervical trauma is more frequent in women underneath the age of 17 years and uterine perforation is associated with growing parity and increasing gestation, efforts to prepare cervical ripening ought to be concentrated on younger women (aged <18 years), extremely parous girls and those presenting at a gestation of greater than 10 weeks. A curette of up to 10 mm internal diameter is handed by way of the cervix, and the contents of the uterus are aspirated using negative strain created by a pump. It is advisable to use the smallest diameter curette which is enough for the gestation; most gynaecologists use an eight mm curette at 8 weeks, 10 mm at 10 weeks, and so forth. For this purpose, medical strategies or a rigorous protocol for early surgical abortion are beneficial. The mortality from vacuum aspiration in the first trimester is lower than roughly one in a hundred,000; significantly lower than the maternal mortality from continuing being pregnant. Mifepristone is a synthetic steroid which blocks the motion of progesterone by binding to its receptor. When mifepristone is used alone, complete abortion solely occurs in approximately 60% of pregnancies. The fee of full abortion rises to over 95% if a prostaglandin is given 36�48 h after the administration of mifepristone. The antiprogesterone itself stimulates some uterine contractility, but mainly works by significantly enhancing the sensitivity of the myometrium to the tocolytic effect of prostaglandins. Offered the selection of method, approximately 30% of women in Scotland favor medical abortion. Women usually select the medical technique as a outcome of it avoids an anaesthetic in most cases, and because they really feel extra in control of the situation. The incidence of great issues might be similar to that related to surgical abortion, but as a end result of 95% of ladies want neither anaesthesia nor instrumentation of the uterus, giant randomized trials may ultimately present medical abortion to be safer. Not all girls are suitable for medical abortion; the contraindications are proven in Box 29. The fetus is usually passed inside four h of prostaglandin administration, and this is accompanied by bleeding and pain. The bleeding is usually described as being like a very heavy period, though hardly ever (<1%) there could additionally be very heavy bleeding requiring resuscitation.

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A frequent example of referred pain is the pain down the left arm brought on by a myocardial infarction. In the simplest reflex, a sensory nerve cell reacts to a stimulus, corresponding to heat or pressure, and sends a sign along its nerve fibre to the central nervous system. There, another nerve cell becomes stimulated and causes a muscle to contract or a gland to increase its secretory exercise. The passage of the nerve sign 483 from authentic sensation to last action is called a reflex arc. Inborn reflexes embrace people who management basic physique functions, corresponding to contraction of the bladder after it has filled beyond a sure point, and are managed by the autonomic nervous system. Conditioned reflexes are acquired through expertise in a course of referred to as conditioning. Several easy reflexes, such as the knee-jerk, are examined in a bodily examination. The examination of significant reflexes managed by the brainstem is the basis for diagnosing mind demise. Primitive reflexes are believed to characterize actions that had been important in earlier phases of human evolution. They include the grasp reflex when one thing is positioned within the hand and the rooting reflex, which permits a child to find the nipple. These reflexes are examined after start to give a sign of the situation of the nervous system. A common kind of reflux is regurgitation of acid fluid from the abdomen (see acid reflux). In medicine, the term is used to describe the return of swallowed meals or drink from the abdomen into the oesophagus and mouth. Drug and alcohol rehabilitation centres help individuals through withdrawal and provide psychological support. The amount of fluid essential depends on age, weight, and the diploma of dehydration. Mild dehydration can often be handled with oral solutions, which can be found as effervescent pill or powder to be made up at house. The tooth needs to be reimplanted soon after the accident and is maintained with a splint (see splinting, dental) while it heals. The syndrome is brought on by an immune response and often develops only in individuals with a genetic predisposition. The arthritis often affects 1 or 2 joints (usually the knee and/or ankle) and is usually related to fever and malaise. Analgesic medicine and nonsteroidal antiinflammatory medication relieve symptoms however might need to be taken for a long interval. Rejection commonly refers to the nonacceptance of tissue grafts or organ transplants. To keep away from rejection, donor tissues are intently matched to the recipient (see tissue-typing). Immunosuppressant drugs, corticosteroid drugs, and ciclosporin are given to organ transplant recipients to suppress rejection. Relapsing fever is transmitted to people by ticks or lice and is characterized by high fever. The signs persist for 3�6 days, culminating in a disaster with a risk of collapse and dying. The spirochaetes could be seen in a blood smear, and they are often eliminated with antibiotic drugs. The couple attends common sessions together in which the counsellor promotes communication and attempts to assist resolve differences between the companions. Relationship counselling is basically based on the ideas and strategies of behaviour remedy.

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Delazar, 27 years: Exercise regimens can be very useful within the administration of established osteoporosis, and represent a component of falls prevention programmes. Only 50% of brachial plexus palsies truly comply with shoulder dystocia and som e 5% occur in association with a caesarean delivery, which im plies that no less than som e have an antepartum aetiology.

Marlo, 30 years: Myocardial infarction sometimes ends in symmetrical gangrene of the extremities. In the lengthy term (days) extra dietary calories are saved as fat (ask any middle-aged pathologist).

Tempeck, 65 years: Disturbances occurring in the course of the m enstrual cycle are discussed in Chapters 28 and 29. With rapid remedy, individuals could survive doses that may in any other case have been deadly.

Umul, 45 years: In the 2nd, there are noncancerous tumours that are inclined to become cancerous or are associated with the development of cancerous tumours elsewhere. In adults, nightmares may be a facet effect of sure drugs, together with beta-blocker medicine and benzodiazepine medication.

References

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• Ronaghi M, Shokralla S, Gharizadeh B. Pyrosequencing for discovery and analysis of DNA sequence variations. Pharmacogenomics 2007;8(10):1437-1441.
• Singh SN, Fletcher RD, Fisher SG, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. N Engl J Med 1995;333:77.
• Herbet M, Feige JJ, Thomas M: Insights into the role of genetic alterations in adrenocortical tumorigenesis, Mol Cell Endocrinol 300(1n2):169n174, 2009.
• Schweinhardt P, Kuchinad A, Pukall CF, Bushnell MC. Increased gray matter density in young women with chronic vulvar pain. Pain. 2008;140(3):411-419.
• Shah PP, Szaflarski JP, Allendorfer J, et al. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation. Front Hum Neurosci 2013;7:888.