Avoid Cold: A Brief Look at Tibetan Medical Practice and Ideals Compared to Modern Allopathic Medical Treatment Through a Study and Analysis of the Essential Tremor

For hundreds of years, western science understood the material world as a set of individual objects assembled into an impossibly large and complex machine. This mechanistic ideology, dubbed reductionism, finds its roots in the mathematical theories of Newton, the philosophy of Descartes, and the methodological approaches proposed by Francis Bacon. The culmination of these ideologies lead to the belief that all complex systems could be understood and ultimately mastered by reducing them to their basic elements. Some texts, including Fritjof Capra\u27s The Turning Point argue that once classical physicists established this type of thought, the other sciences, including medicine, simply followed suit and came to accept the attitude as law. Today, the modern western, or allopathic, medical system continues to deal with diseases and treatments according to what\u27s become known as the doctrine of single causation. As it implies, this ideology leads western doctors to seek a\out and isolate specific causes for an ailment. Treatment, then, revolves around the elimination of that problem from the complex system which incorporates it. Consequentially, despite a quick and precise cessation of the ailment, the overall function of the system may be affected. These side effects can range from acceptable (drowsiness, sensitivity etc.) to debilitating and even fatal. The East However, on the other side of the planet, some cultures took an entirely different approach in understanding the nature of the world. In large part due to powerful Buddhist influences, the Tibetan people came to appreciate the complex systems of our planet as a whole. These seemingly utterly interwoven relationships were valued for their function, not the material sub-strata of which they were composed , but the synergy they created. The Tibetan people possessed a solid understanding of the intricate relationships they observed in the natural world and were sensitive to the effects brought on by changes in that world (including changes in time of day, temperature, season, etc.). So it comes as no surprise that Tibetan medicine developed a view of the human body, with its intricate anatomical, philosophical, and intellectual functions, as a microcosm of the natural relationships all around them. Tibetans understood disease as an imbalance within the functioning body and thus healing is effected by restoring the lost equilibrium and not by symptomatic treatment of a particular organ. Furthermore, Tibetan doctors are much more concerned with using symptoms and an understanding of these functions in order to identify the primary cause, or root, of a disease, going beyond the problem to find its much more subtle origins. Their texts state that symptoms are caused by a sort of ‘chain reaction\u27 of events within the body emanating from the primary cause. As a result, diagnosis may require proper environmental setting and timing, while therapies can take significant time and patience as treating the entire system requires much more subtle and sensitive methods than we see in the west. So Why Tremors? While the theories governing these two modern medical systems evolved from vastly different foundations, it is in practice that conflicts become most apparent. Through studying and comparing the alternate methods used to define and treat the disease, we can better comprehend each tradition as a whole (thereby using both reductionist and holistic perspectives). Yet to obtain such a thorough understanding, we must study an appropriate disease; one which exemplifies the inherent conflicts between the two ideologies, while concurrently shedding light on the strengths and weaknesses of each approach to treatment. The essential tremor provides us just that. While tremors have afflicted mankind for thousands of years (ancient texts from both cultures acknowledge the ailment), it\u27s only within the last century that western medicine has begun to truly understand and effectively treat the disease. This current curiosity leaves many researchers more open to recognizing and investigating alternative theories. Additionally, current treatments used by each tradition couldn’t be more typical. Western methods involve invasive surgeries and/or harsh pharmaceuticals which promise rapid results, although sometimes accompanied by serious side effects. Meanwhile, Tibetan methods are slow, holistic, and organic, but can take months to years to gradually show results. Perhaps most significant is the fact that allopathic medicine offers no actual cure for tremors, only treatments which may alleviate symptoms, while Tibetan physicians claim they can ultimately offer a complete cure. Thus, the essential tremor provides us with the perfect lens through which we can analyze these complex traditions

Sarcoidosis of the hypothalamus and pituitary stalk

We report a rare case of sarcoidosis of the hypothalamic and suprasellar region, with clinical course and the magnetic resonance imaging follow-up

Exploring the benefits of magnetic resonance imaging reporting by radiographers: A UK perspective

Background: The United Kingdom (UK) National Health Service (NHS) Imaging and Radiodiagnostic activity 2013/14 report estimate the year on year increase of Magnetic Resonance Imaging (MRI) examinations to be 12.3%, with the designated workforce of radiologists disproportionate to the increase in demand of imaging reporting. Objective: To review the economics, risk and feasibility of MRI reporting by radiographers. Design: A PICO (the four major components of a clinical or research question: patient (population), intervention, comparison, and outcome) framework using example patient demand from audit data of non-complex MRI examination attendance (n=3,525) over 12 months. Reviewing costs, potential outcome risks (diagnostic thresholds), and feasibility (workforce capacity) of both interventions. Conclusions: The benefits of introducing a skills mix reporting service model to the benefit of service delivery in the UK has shown a potential £145,230 - £60,524 per annum cost saving using a generic acute workload model. Research into recorded discrepancy/error audit data for potential detrimental risk to patient outcomes identified a paucity of evidence, and recommends further research is needed

MRI classification of interspinous ligament degeneration of the lumbar spine: intraobserver and interobserver reliability and the frequency of disagreement

Posterior spinal ligament pathology is becoming increasingly recognized as a significant cause of low back pain. Despite the growing clinical importance of interspinous ligament degeneration in low back pain patients, formal reliability studies for the magnetic resonance imaging (MRI) evaluation of interspinous ligaments have not been performed. We proposed an MRI classification system for interspinous ligament degeneration and conducted a comprehensive reliability and reproducibility assessment. Fifty patients who had low back pain with or without leg discomfort (26 males and 24 females) with a mean age of 48.8 years (range 23–85 years) were studied. The classification for lumbar interspinous ligament degeneration was developed on the basis of the literature using mid-sagittal T1- and T2-weighted images. Three spine surgeons independently graded a total of 200 interspinous ligament levels. Intraobserver and interobserver reliability were assessed by kappa statistics. The frequency of disagreement was also identified. The intraobserver agreement was excellent in all readers (kappa range 0.840–0.901). The interobserver agreement was lower as expected, and was substantial to excellent (kappa range 0.726–0.818). Overall complete agreement was obtained in 87.8% of all interspinous ligament levels. A difference of 1, 2, and 3 grades occurred in 8.1, 3.0, and 1.1% of readings, respectively. This proposed MRI classification of interspinous ligament degeneration was simple, reliable, and reproducible. Its use as a standardized nomenclature in clinical and radiographic research may be recommended

Design, data management, and population baseline characteristics of the PERFORM magnetic resonance imaging project

Quantitative information from magnetic resonance imaging (MRI) may substantiate clinical findings and provide additional insight into the mechanism of clinical interventions in therapeutic stroke trials. The PERFORM study is exploring the efficacy of terutroban versus aspirin for secondary prevention in patients with a history of ischemic stroke. We report on the design of an exploratory longitudinal MRI follow-up study that was performed in a subgroup of the PERFORM trial. An international multi-centre longitudinal follow-up MRI study was designed for different MR systems employing safety and efficacy readouts: new T2 lesions, new DWI lesions, whole brain volume change, hippocampal volume change, changes in tissue microstructure as depicted by mean diffusivity and fractional anisotropy, vessel patency on MR angiography, and the presence of and development of new microbleeds. A total of 1,056 patients (men and women ≥55 years) were included. The data analysis included 3D reformation, image registration of different contrasts, tissue segmentation, and automated lesion detection. This large international multi-centre study demonstrates how new MRI readouts can be used to provide key information on the evolution of cerebral tissue lesions and within the macrovasculature after atherothrombotic stroke in a large sample of patients

Preliminary clinical trial of gadodiamide injection: A new nonionic gadolinium contrast agent for MR imaging

The safety and efficacy of a newly developed intravenous formulation of the nonionic contrast agent gadolinium diethylenetriaminepentaacetic acid- bis (methylamide), formulated as gadodia-mide injection, was investigated. In 30 patients who underwent spin-echo magnetic resonance (MR) imaging before and after contrast agent enhancement, the enhanced images had characteristics judged similar to those of images enhanced by means of available gadolinium compounds. In 15 patients, contrast agent administration was of major diagnostic help, either revealing lesions not apparent without enhancement or providing important lesion characterization. In 12 patients, the lack of abnormal enhancement patterns was important in excluding the presence of disease. In three patients, the contrast agent did not provide information additional to that obtained with the unenhanced T1- and T2-weighted images. No clinically significant changes were observed in vital signs, neurologic status, or laboratory results. The authors conclude that, in this limited series, gadodiamide injection proved to be a safe and useful MR imaging contrast agent for evaluation of the central nervous system and surrounding structures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38569/1/1880010107_ftp.pd

Imaging of the Ischemic Penumbra in Acute Stroke

One of the main reasons for the soaring interest in acute ischemic stroke among radiologists is the advent of new magnetic resonance techniques such as diffusion-weighted imaging. This new modality has prompted us to seek a better understanding of the pathophysiologic mechanisms of cerebral ischemia/infarction. The ischemic penumbra is an important concept and tissue region because this is the target of various recanalization treatments during the acute phase of stroke. In this context, it is high time for a thorough review of the concept, especially from the imaging point of view

Small Vessel Ischemic Disease of the Brain and Brain Metastases in Lung Cancer Patients

Brain metastases occur commonly in patients with lung cancer. Small vessel ischemic disease is frequently found when imaging the brain to detect metastases. We aimed to determine if the presence of small vessel ischemic disease (SVID) of the brain is protective against the development of brain metastases in lung cancer patients.A retrospective cohort of 523 patients with biopsy confirmed lung cancer who had received magnetic resonance imaging of the brain as part of their standard initial staging evaluation was reviewed. Information collected included demographics, comorbidities, details of the lung cancer, and the presence of SVID of the brain. A portion of the cohort had the degree of SVID graded. The primary outcome measure was the portion of study subjects with and without SVID of the brain who had evidence of brain metastases at the time of initial staging of their lung cancer.109 patients (20.8%) had evidence of brain metastases at presentation and 345 (66.0%) had evidence of SVID. 13.9% of those with SVID and 34.3% of those without SVID presented with brain metastases (p<0.0001). In a model including age, diabetes mellitus, hypertension, hyperlipidemia, and tobacco use, SVID of the brain was found to be the only protective factor against the development of brain metastases, with an OR of 0.31 (0.20, 0.48; p<0.001). The grade of SVID was higher in those without brain metastases.These findings suggest that vascular changes in the brain are protective against the development of brain metastases in lung cancer patients