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An example of how the 2 sets of arm muscles move to prostate cancer blog order flomax 0.4mg without a prescription pull the bone mens health challenge purchase flomax 0.2mg with visa, on one side and then the other mens health xp purchase flomax 0.4 mg, depending on how the arm is intended to androgen hormone replacement generic 0.4 mg flomax otc move. The musculature involved is highly complex, allowing for a huge range of facial expressions. Others are joined to tendons or to dense, sheet-like clusters of fibrous connective tissue called aponeuroses. Many of these muscles have their other end inserted into deeper layers of the skin. These are followed by lines around the brow and mouth, in front of the ears, between the eyebrows, on the chin and bridge of the nose. Facial expressions Facial expressions are among our most important methods of non-verbal communication. The facial musculature enables many subtle nuances of appearance that convey an enormous variety of emotions. In addition to the mouth, other regions of the face are involved to add shades of meaning. Muscular System Pathologies: Common Disorders and Conditions Muscles allow us to move, but sometimes the wear and tear that comes from moving our bodies can lead to disorders of the muscular system. The carpal tunnel is the passageway in the wrist where the median nerve and flexor tendons pass through a narrow opening. Carpal tunnel syndrome, which is also called median nerve compression, occurs when the tendons become inflamed, causing compression of the median nerve. Carpal tunnel syndrome can occur for a variety of reasons including hereditary predisposition, repetitive movements, diabetes, or thyroid disorders. The carpal tunnel is between the carpal ligament (flexor retinaculum), which restrains and aligns the tendons that move the hand and fingers, and the carpal bones of the wrist. Tendons in their sheaths slide through this passageway, adjacent to the median nerve. If you do a lot of typing or other repetitive motions over a long period of time, you can get Carpal Tunnel Syndrome in one or both wrists. This condition often occurs near joints that perform frequent repetitive motion, such as the shoulder, elbow, hip, and knee. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. The cases described are by no means exhaustive but aims to give the reader an insight into what may be encountered and further diagnoses to consider. Background Imaging of peripheral nerves in patients with symptoms of entrapment neuropathies or polyneuropathy is frequently supplemented with ultrasound after nerve conduction studies. Numerous pathologies producing irritation or entrapment of peripheral nerves may be diagnosed at ultrasound assessment. Neuropathies can be divided into those that result from a structural abnormality in the region of the nerve and those due to an intrinsic abnormality of the nerve, such as a nerve sheath tumour. An appreciation of the usual imaging appearances of peripheral nerves and pathologies occurring along their course is essential. We describe ultrasound techniques such as dynamic assessment of peripheral nerves and imaging features of common pathologies of the extremities that may be identified. Peripheral nerves are hypoechoic structures which are ovoid and multifasicular in transverse section. Median nerve and pathologies at the hand and wrist the median nerve originates from the medial and lateral cords of the brachial plexus (C6, C8 and T1) and passes alongside the brachial artery through the arm. At the forearm, it can be identified between the flexor digitorum superficialis and profundus muscles. It has a purely motor anterior interosseous branch and sensory palmar cutaneous branch, Page 2 of 29 1 both of which arise proximal to the nerve entering the carpal tunnel. The median nerve is identified at the carpal tunnel at the palmar crease using the landmarks of the scaphoid tubercle and pisiform Fig. The nerve is scanned in the transverse plane distally to the level of the trapezium tubercle and hook of hamate, and then assessed in in the longitudinal plane. Women are affected more than men and it may be bilateral in up to 50% of patients. Any pathology that decreases the size of the carpal tunnel or increases the size of the median nerve may lead to carpal tunnel syndrome. The most common median nerve anomaly is that of a bifid median nerve which occurs 3 in 2. This appearance is often noted in patients who present with carpal tunnel syndrome. The measurement of the cross-sectional area of the median nerve is not applicable in cases where there is a bifid median nerve. The presence of a bifid median nerve is often associated with a persistent median artery of the forearm, which is often identified between the two nerve bundles Fig. It has been identified in 26% of asymptomatic volunteers but may be a risk factor for the development of carpal tunnel syndrome. Reporting of this finding is crucial when assessing the median nerve on ultrasound as it may be injured during a carpal tunnel release if the operating surgeon is unaware of the finding. Page 3 of 29 Other abnormalities of the median nerve may include the presence of a fibrolipomatous hamartoma Fig. These are benign tumours of the nerve sheath that occur due to proliferation of adipose tissue. Patients with demyelinating neuropathies (such as chronic inflammatory demyelinating polyneuropathy, Charcot-Marie-Tooth neuropathy or progressive inflammatory neuropathy) will have marked enlargement and hypoechogenicity of peripheral nerves on ultrasound Fig. The space within the carpal tunnel may be reduced by the presence of a ganglion cyst. These are benign, avascular, cystic masses that often occur in the wrist and hand. Ultrasound is not only useful in the assessment of these masses, but may also be utilized to guide aspiration of these masses if clinically indicated. Patients with inflammatory arthropathy often develop proliferative joint disease and synovitis which may be demonstrated on ultrasound Fig. There is synovial thickening, increasing degrees of vascularity and possibly a joint effusion or erosions demonstrated. They are the second most common tumour of the hand after ganglion cysts 6 with a predilection for the flexor surfaces. Ulnar nerve and pathologies at the elbow the ulna nerve originates from the medial cord of the brachial plexus (C8 and T1) and passes medial to the brachial artery through the arm. It enters the posterior compartment Page 4 of 29 of the arm by piercing the medial intramuscular septum to lie posterior to the medial epicondyle in the cubital tunnel. Compression of the ulna nerve at the elbow is the second most common entrapment 1 neuropathy in the body 21-25 cases per 100,000 Fig. Physical labour and recurrent dislocation of the ulna nerve are through to be risk factors for the development of this condition. Snapping, or dislocation, of the ulna nerve often co-insides with dislocation of the medial head of triceps. Compression of the ulna nerve at the elbow may be due to the presence of an accessory muscle Fig. Trauma to the ulna nerve, perhaps following an olecranon fracture or previous surgical intervention, may result in the development of an ulna nerve neuroma Fig. This is identified as a hypoechoic bulb-like distention of a segment of the nerve following an injury to the nerve, or end-bulb distension of a previously severed or 7 amputated nerve. A differential diagnosis for pain over the medial aspect of the elbow is medial epicondylitis, or golfers elbow. This is identified on ultrasound by areas of hypoechogenicity of the common flexor tendon origin. Similarly pain over the lateral aspect of the elbow may be due to lateral epicondylitis, or tennis elbow, which involves the common extensor tendon origin. Calcification in the tendon, bony irregularity of the insertion of the tendon and increased vascularity may be demonstrated Fig. Often these diagnoses are made clinically but 8 ultrasound confirmation is often useful if the diagnosis is in doubt. Lipomas are commonly identified mass lesions that may cause peripheral nerve compression.

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Thus prostate cancer 8 scale buy generic flomax on-line, an estimated 3 to mens health issues buy flomax 0.4 mg on line 4 million physical examinations must be performed annually prostate cancer complications order genuine flomax line, with the demand increasing every year prostate 72 buy discount flomax 0.2mg online. Commercial driver medical fitness for duty records must include all Federal physical qualification requirements found on the Medical Examination Report form. Truck and bus companies may also have additional medical requirements, such as a minimum lifting capability. Stat Regulations States regulate intrastate commerce and commercial drivers who are not subject to Federal regulations. They are required, at a minimum, to adopt Federal physical qualification requirements and may even have additional, different, or more stringent requirements. Medical examiners are responsible for knowing the driver regulations for the State or States in which they practice. As a medical examiner, you should be knowledgeable regarding the physical qualification requirements of the driver specified in Subpart E Physical qualifications and examinations. You may also, at any time, certify the driver for less than 2 years when examination indicates more frequent monitoring is required to ensure medical fitness for duty. The Average Driver the driver population exhibits characteristics similar to the general population, including an aging work force. Aging means a higher risk exists for chronic diseases, fixed deficits, gradual or sudden incapacitation, and the likelihood of comorbidity. All of these can interfere with the ability to drive safely, thus endangering the safety and health of the driver and the public. The Job of Commercial Driving Stress Factors Associated with Commercial Driving Many factors contribute to making commercial driving a stressful occupation. A long relay route requires driving 9 to 11 hours, followed by at least a 10-hour, off-duty period. With a straight through haul or cross-country route, the driver may spend a month on the road, dispatched from one load to the next. The driver usually sleeps in the truck and returns home for only 4 or 5 days before leaving for another extended period on the road. In team operation, drivers share the driving by alternating 5-hour driving periods with 5-hour rest periods. Long hours and extended time away from family and friends may result in a lack of social support. The driver may encounter adverse road, weather, and traffic conditions that cause unavoidable delays. Transporting hazardous materials, including explosives, flammables, and toxics, increases the risk of injury and property damage extending beyond the accident site. Stay alert when driving this demands sustained mental alertness and physical endurance that is not compromised by fatigue or sudden, incapacitating symptoms. Required cognitive skills include problem solving, communication, judgment, and appropriate behavior in both normal and emergency situations. Driving requires the ability to judge the maximum speed at which vehicle control can be maintained under changing traffic, road, and weather conditions. Use side mirrors Mirrors on both sides of the vehicle are used to monitor traffic that can move into the blind spot of the driver. The act of steering can be simulated by offering resistance, while having the driver imitate the motion pattern necessary to turn a 24-inch steering wheel. Use of these components requires adequate reach, prehension, and touch sensation in hands and fingers. This requires the driver to repeatedly perform reciprocal movements of both legs coordinated with right arm and hand movements. Physical demands include grip strength, upper body strength, range of motion, balance, and flexibility. Vision and hearing are used to identify and interpret changes in vehicle performance. When a fatal crash involves at least one large truck, regardless of the cause, the occupants of passenger vehicles are more likely to sustain serious injury or die than the occupants of the large truck. The answer is found in basic physics: injury severity equals relative velocity change. The crash of a vehicle having twice the mass with a lighter vehicle equals a six-fold risk of death Page 21 of 260 to persons in the lighter vehicle. In addition to the grievous toll in human life and survivor suffering, the economic cost of these crashes is exceedingly high. As a medical examiner, your fundamental obligation is to establish whether a driver has a disease, disorder, or injury resulting in a higher than acceptable likelihood for gradual or sudden incapacitation or sudden death, thus endangering public safety. As a medical examiner, any time you answer yes to this question, you should not certify the driver as medically fit for duty. Public Safety Consider Safety Implications As you conduct the physical examination to determine if the driver is medically fit to perform the job of commercial driving, you must consider. Physical condition o Symptoms Does a benign underlying condition with an excellent prognosis have symptoms that interfere with the ability to drive. Is the onset of incapacitating symptoms so gradual that the driver is unaware of diminished capabilities, thus adversely impacting safe driving? Nonetheless, you have a responsibility to educate and refer the driver for Page 24 of 260 further evaluation if you suspect an undiagnosed or worsening medical problem. Medical Examination Report Form Overview As a medical examiner, you must perform the driver physical examination and record the findings in accordance with the instructions on the Medical Examination Report form. The purpose of this overview is to familiarize you with the sections and data elements on the Medical Examination Report form, including, but not limited to. You are encouraged to have a copy of the Medical Examination Report form for reference as you review the remaining topics. As a medical examiner, you are responsible for determining medical fitness for duty and driver certification status. Health History the Driver completes and signs section 2, and the Medical Examiner reviews and adds comments: Figure 5 Medical Examination Report Form: Health History Health History Driver Instructions the driver is instructed to indicate either an affirmative or negative history for each statement in the health history by checking either the "Yes" or "No" box. The driver is also instructed to provide additional information for "Yes" responses, including. Health History Driver Signature Verify that the Driver signs Medical Examination Report Form: Figure 6 Medical Examination Report Form: Driver Signature Page 27 of 260 By signing the Medical Examination Report form, the driver. Regulations You must review and discuss with the driver any "Yes" answers For each "Yes" answer. As needed, you should also educate the driver regarding drug interactions with other prescription and nonprescription drugs and alcohol. Page 28 of 260 Health History (Column 1) Overview In addition to the guidance provided in the section above, directions specific to each category in Column 1 for each "Yes" answer are listed below. Feel free to ask other questions to help you gather sufficient information to make your qualification/disqualification decision. Any illness or injury in the last 5 years A driver must report any condition for which he/she is currently under treatment. The driver is also asked to report any illness/injury he/she has sustained within the last 5 years, whether or not currently under treatment. Seizures, epilepsy Ask questions to ascertain whether the driver has a diagnosis of epilepsy (two or more unprovoked seizures), or whether the driver has had one seizure. Gather information regarding type of seizure, duration, frequency of seizure activity, and date of last seizure. Eye disorders or impaired vision (except corrective lenses) Ask about changes in vision, diagnosis of eye disorder, and diagnoses commonly associated with secondary eye changes that interfere with driving. Complaints of glare or near-crashes are driver responses that may be the first warning signs of an eye disorder that interferes with safe driving. Ear disorders, loss of hearing or balance Ask about changes in hearing, ringing in the ears, difficulties with balance, or dizziness. Loss of balance while performing nondriving tasks can lead to serious injury of the driver. Obtain heart surgery information, including such pertinent operative reports as copies of the original cardiac catheterization report, Page 29 of 260 stress tests, worksheets, and original tracings, as needed, to adequately assess medical fitness for duty. High blood pressure Ask about the history, diagnosis, and treatment of hypertension. In addition, talk with the driver about his/her response to prescribed medications. The likelihood increases, however, when there is target organ damage, particularly cerebral vascular disease.

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The use of prostaglandin analogues Multiple publications [1 prostate oncology 12524 order flomax online now,3 prostate cancer 2 causes buy generic flomax 0.2 mg line,10 man healthy weight buy 0.2 mg flomax fast delivery,18] report using the same criteria have not been widely reported prostate on ultrasound order cheapest flomax and flomax, possibly to avoid their proinfammatory for diagnosis of phacomorphic angle-closure. Phacormorphic angle-closure caused range until cataract extraction can be performed, there are 3 options. All of these treatments are temporizing and an anterior chamber depth less than 2 mm [19]. A relatively small number of cases report combining A vital part of the exam is gonioscopy to confrm a closed angle. If phacoemulsifcation with glaucoma procedures (trabectulectomy [27] the corneal edema is severe, this may not be possible in the involved eye. Adding operative procedures to these eyes increases the is acute angle-closure glaucoma, gonioscopy of the fellow eye should be done to ensure that it is not occludable. The angle in the fellow eye risk of complications such as prolonged uveitis in 3 of 9 patients treated may also be narrow, as 60% of 49 patients with phacomorphic angle with combined cataract extraction and aqueous shunts [8]. In that closure had a moderately narrow angle with a maximum angle width study the fnal visual acuity was worse in the combined cases than in of 20 degrees in the fellow eye [10]. Argon Laser Peripheral Iridoplasty has been suggested as a way to avoid the systemic side efects that come with oral or intravenous In examining the cataract, it is important to evaluate for zonular medicine, such as metabolic acidosis with acetazolamide or congestive laxity since it is associated with both main causes of the intumescent heart failure with hyperosmotics [5]. Despite the fact that only two of ten eyes showed any open angle syndrome was present in 50% of cases in a small case series [4]. However, even though this decreases the chance of forces the phacoemulsifcation tip closer to the corneal endothelium. Although this deepened the chamber and facilitated successful phacoemulsifcation, the The role of pupillary block in the pathophysiology of phacomorphic sclerotomy carries its own risks of retinal dialysis, tear or detachment, angle-closure is not completely understood. It is important to note that necessitating a comprehensive retinal exam at post-op visits. One possible To achieve a continuous curvilinear capsulorrhexis, it will likely be reason to do a laser iridotomy even though cataract extraction is necessary to improve visualization on the capsule by using a dye such as already planned is the report of a patient who had an acute attack trypan blue which will also be of use throughout the case by keeping the successfully aborted with topical medication only to sustain a second edge of the capsulorrhexis in constant view. Another aid that has been angle-closure attack precipitated by the preoperative dilating drops [4]. A laser iridotomy will not of the capsule may necessitate redirecting the capsulorrhexis around relieve angle-closure in advanced cases where the lens is large enough the plaque or using scissors to cut through it [37]. Since hydrated to directly push the peripheral iris into the trabecular meshwork [4]. The free cortex can be removed with a small syringe narrow that the laser will damage the corneal endothelium [5]. To Surgical technique reduce the intralenticular pressure to keep the tractional forces on the capsulorrhexis fat, a 30 gauge needle can be used to directly withdraw Cataract extraction of the intumescent lens necessitates cortex from the lens [36]. Excess viscoelastic will raise the intraocular preparation due to the increased risk of complications. Specifc risks pressure even further, and if liquifed cortex escapes and mixes with include higher positive pressure, risk of expulsive hemorrhage, and viscoelastic it will stay near the capsulotomy site, obscuring the view association with zonular dialysis [18]. This can be used in combination with a cohesive 74 patients by Ramakrishanan et al. Viscoadaptive group, although the average astigmatism was marginally higher with agents may be utilized instead. Employing a stop and chop method will with phacoemulsifcation), and no other serious complications were thin the nucleus and ofer an improved chance of successful chopping. During chopping, using a longer tip by a can-opener or continuous curvilinear capsulorrhexis [33]. Another technique lens can be extracted with various techniques including aggressive called cratering involves deep sculpting of the entire central core of the irrigation or prolapse with hooks (such as a sinskey hook) or a loop, as nucleus (leaving behind only a small posterior cushion), afer which pressure is exerted on the posterior lip of the wound. Afer insertion of the remaining nuclear rim can be split apart with cracking or chopping a single-piece lens, manual aspiration of any free cortical matter is done [41]. Other helpful For phacoemulsifcation, the shallow chamber complicates techniques include using a second instrument to physically break the numerous steps. Tere may be iridocorneal apposition which can dense strands connecting nuclear fragments during aspiration [6]. S1-006 Page 4 of 6 Tere is an increased risk of posterior capsule tear with mature phacomorphic angle-closure are fnal visual acuity and how many of lenses because the large, dense cataract physically stretches the capsule, these patients will go on to develop chronic glaucoma from peripheral which can lead to a thinning and slacking. Reports detailed visual acuity in various subsets, but in order to give Finally, there is ofen no remaining epinucleus which normally acts as an overview, reports with similar groupings are averaged in Table 2. This can be prevented Tere are case reports of patients who presented with hand motion by injecting some viscoelastic underneath the lens as soon as some red vision achieving a fnal visual acuity of 20/20 [4]. In a study of 74 refex is visible afer removal of the frst part of the cataract, ofering patients, visual acuity of 20/40 or better was achieved in 68% [18]. A a cushion between the posterior capsules whilst raising the nucleus retrospective study followed 82 cases of phacomorphic angle-closure closer to the phacoemulsifcation tip [6]. On average, 19 months afer cataract On the day following surgery, common exam fndings include extraction, the visual acuity had improved from light perception severe iritis in up to 84% of patients [10], infammatory fbrin to 20/250. Yet in the largest series of cases, only 40% of 298 cases precipitates (48%) and severe corneal edema (24%) [18]. Hyphema has been reported in 3% [18], comorbidities such as macular degeneration, in this elderly population 8% [10] which resolved by postoperative week one. Corneal Prognosis endothelial cell loss following an attack was reported to be 15% [12]. The visual prognosis in most cases will be defned by the fnal visual Since the attack of angle-closure is due to the swollen lens, if there acuity following removal of the dense, large cataract. As expected, cataract extraction following phacomorphic patients came for a second visit afer surgery. Presenting visual acuity angle-closure deepens the angle: 3 years following cataract extraction, is also a poor indicator of fnal acuity: out of 18 patients who presented the mean Shafer grade of 100 eyes was 3 [1]. A review of the literature reveals only a few reports investigating The duration of symptoms prior to surgery (used as a surrogate for the occurrence of chronic glaucoma. In the retrospective study of 100 patients, the mean found a small but signifcant correlation (r2=0. While 81% of these patients required no the onset of pain and cataract extraction was a strong risk factor for glaucoma treatment following cataract extraction, 15% needed poor fnal visual acuity (odds ratio 3. Tere were 10 patients with an attack lasting 21 days or from visual felds in the afected eye, where the mean deviation was 5. This corroborates the data Best Corrected Final Visual Acuity Mean Percent of Patients suggesting that an attack lasting longer than 5 days is a signifcant risk 20/20-20/50 50 factor for worse outcomes, in terms of both glaucoma status and fnal 20/60-20/200 24 visual acuity. Sowka J, Girgis N (2010) Bilateral phacomorphic angle-closure glaucoma in a Although phacomorphic angle-closure itself should not recur afer highly myopic patient secondary to isolated spherophakia. Optometry 81: 432 removing the cataract, aphakic pupillary block has been reported 436. The fellow cataract should be aggressively monitored so that it and angle-closure glaucoma: recognition and treatment of atypical presentation can be removed before it can become intumescent. Conclusion (2010) Visual prognosis, intraocular pressure control and complications in phacomorphic glaucoma following manual small incision cataract surgery. Phacomorphic angle-closure usually occurs in elderly patients with Indian J Ophthalmol 58: 303-306. Arch medication, a laser iridotomy, or a laser iridoplasty if the view allows Ophthalmol 111: 914-918. Final visual outcome varies in the literature but 80 phacoemulsifcation for management of phacomorphic glaucoma. Optometry 77: treatment once the lens is removed but still require regular follow-up. J Phacoemulsifcation versus manual small-incision cataract surgery for white Cataract Refract Surg 25: 167-173. This article was originally published in a special issue, Cataract handled by Editor(s). Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. It sets out background information regarding the epidemiology of eye disease and injury in Australia, in addition to describing the current service provision and policy context, thereby providing a basis for the development of the National Framework. As a background paper, Eye Health in Australia is by necessity intended to be broader in scope than the Framework, which has as its primary focus the promotion of eye health and the prevention of avoidable blindness.

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Anoxic cells (cells with insufficient oxygen) tend to prostate cancer 65 cheap flomax 0.2 mg free shipping be inactive prostate cancer walk order flomax online pills, such as the cells located in the interior of a tumor prostate cancer location purchase generic flomax. As the tumor is exposed to mens health lists cheap flomax 0.4 mg with mastercard radiation, the outer layer of rapidly dividing cells is destroyed, causing it to shrink in size. If the tumor is given a massive dose to destroy it completely, the patient might die as well. Instead, the tumor is given a small dose each day, which gives the healthy tissue a chance to recover from any damage while gradually shrinking the highly sensitive tumor. Another cell system that is composed of rapidly dividing cells with a good blood supply and lots of oxygen is the developing embryo. Therefore, the sensitivity of the developing embryo to radiation exposure is similar to that of the tumor, however, the consequences are dramatically different. As noted previously, the most sensitive organs are the blood forming organs and the gastrointestinal system. The biological effects on the whole body from exposure to radiation will depend upon several factors. For example, a person, already susceptible to infection, who receives a large dose of radiation may be affected by the radiation more than a healthy person. The first category consists of exposure to high doses of radiation over short periods of time producing acute or short term effects. The second category represents exposure to low doses of radiation over an extended period of time producing chronic or long term effects. Low doses spread out over long periods of time don?t cause an immediate problem to any body organ. The effects of low doses of radiation occur at the level of the cell, and the results may not be observed for many years. Some examples of deaths which have occurred as a result of occupational (worker related) accidents are: Inadvertent criticality (too much fissionable material in the right shape at the wrong time) Irradiator (accidental exposure to sterilization sources, which can be more than 10 million curies) Chernobyl (plant workers) An example of a nonoccupational accident occurred in 1987 in Goiania, Brazil. An abandoned medical therapy source (cesium) was found and cut open by people who did not know what it was. This resulted in the deaths of several members of the public and the spread of radioactive contamination over a large area. A recent inadvertent criticality event occurred in a fuel processing plant in Japan. If a group of people is exposed to a whole body penetrating radiation dose, the above effects might be observed. In the above table, the threshold values are the doses at which the effect is first observed in the most sensitive of the individuals exposed. It is sometimes difficult to understand why some people die while others survive after being exposed to the same radiation dose. The main reasons are the health of the individuals at the time of the exposure and their ability to combat the incidental effects of radiation exposure, such as the increased susceptibility to infections. Effects on the skin include erythema (reddening like sunburn), dry desquamation (peeling), and moist desquamation (blistering). Skin effects are more likely to occur with exposure to low energy gamma, X-ray, or beta radiation. Hair loss, also called epilation, is similar to skin effects and can occur after acute doses of about 500 rad. To produce permanent sterility, a dose in excess of 400 rad is required to the reproductive organs. Cataracts (a clouding of the lens of the eye) appear to have a threshold of about 200 rad. Neutrons are especially effective in producing cataracts, because the eye has a high water content, which is particularly effective in stopping neutrons. The initial signs and symptoms of the acute radiation syndrome are nausea, vomiting, fatigue, and loss of appetite. Below about 150 rad, these symptoms, which are no different from those produced by a common viral infection, may be the only outward indication of radiation exposure. As the dose increases above 150 rad, one of the three radiation syndromes begins to manifest itself, depending upon the level of the dose. At about 300 500 rad, up to one half of the people exposed will die within 60 days without intensive medical attention. At the lower end of the dose range, isolation, antibiotics, and transfusions may provide the bone marrow time to generate new blood cells and full recovery is possible. At the upper end of the dose range, a bone marrow transplant may be required to produce new blood cells. A few days later, things get very bad, very quickly since the gastrointestinal system is destroyed. At doses above 5,000 rad, the central nervous system (brain and muscles) can no longer control the body functions, including breathing blood circulation. As noted, there is nothing that can be done if the dose is high enough to destroy the gastrointestinal or central nervous system. High doses of radiation affect many cells, which can result in tissue/organ damage, which ultimately yields one of the Acute Radiation Syndromes. Even normally radio-resistant cells, such as those in the brain, cannot withstand the cell killing capability of very high radiation doses. Citizen Exposure Source Average Annual Effective Dose Equivalent (millirems) Natural: Radon 200 Other 100 Occupational 0. However, the dose to a portion of the lungs is estimated to be 16,000 millirems/year. The average radiation dose received by the United States population is given in the table above. Radiation workers are far more likely to receive low doses of radiation spread out over a long period of time rather than an acuate dose as discussed previously. The principal effect of low doses of radiation (below about 10 rad) received over extended periods of time is non-lethal mutations, with the greatest concern being the induction of cancer. These are: Genetic the effect is suffered by the offspring of the individual exposed. Since cancer is the primary result, it is sometimes called the Carcinogenic Effect. In-Utero Some mistakenly consider this to be a genetic consequence of radiation exposure, because the effect, suffered by a developing embryo/fetus, is seen after birth. However, this is actually a special case of the somatic effect, since the embryo/fetus is the one exposed to the radiation. Mutations of these reproductive cells are passed to the offspring of the individual exposed. There are also many chemical agents as well as biological agents (such as viruses) that cause mutations. One very important fact to remember is that radiation increases the spontaneous mutation rate, but does not produce any new mutations. Therefore, despite all of the hideous creatures supposedly produced by radiation in the science fiction literature and cinema, no such transformations have been observed in humans. One possible reason why genetic effects from low dose exposures have not been observed in human studies is that mutations in the reproductive cells may produce such significant changes in the fertilized egg that the result is a nonviable organism which is spontaneously resorbed or aborted during the earliest stages of fertilization. This is particularly important since it is believed that risk is directly proportional to dose, without any threshold. Radiation is an example of a physical carcinogenic, while cigarettes are an example of a chemical cancer causing agent. Many studies have been completed which directly link the induction of cancer and exposure to radiation. There are many chemical agents (such as thalidomide) and many biological agents (such as the viruses which cause German measles) that can also produce malformations while the baby is still in the embryonic or fetal stage of development. The effects from in-utero exposure can be considered a subset of the general category of somatic effects. The malformation produced do not indicate a genetic effect since it is the embryo that is exposed, not the reproductive cells of the parents.

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