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Although genetic and environmental factors operating before or around the time of birth have been demonstrated to be relevant to the aetiology of the major psychoses, a seasonal variation in the rates of admission of such patients has long been recognised. Few studies have compared first and readmissions. This study examined for seasonal variation of admission in the major psychoses, and compared diagnostic categories by admission status. Patients admitted to Irish psychiatric inpatient facilities between 1989 and 1994 with an ICD-9/10 diagnosis of schizophrenia or affective disorder were identified from the National Psychiatric Inpatient Reporting System (NPIRS). The data were analysed using a hierarchical log linear model, the chi-square test, a Kolmogorov-Smirnov (KS) type statistic, and the method of Walter and Elwood. The hierarchical log linear model demonstrated significant interactions between the month of admission and admission order (change in scaled deviance 28.77, df = 11, P < 0.003). Both first admissions with mania, and readmissions with bipolar affective disorder exhibited significant seasonality. In contrast, only first admissions with schizophrenia showed significant seasonal effects. Although first admissions with mania and readmissions with bipolar disorder both show seasonality, seasonal influences appear to be more relevant to onset of schizophrenia than subsequent relapse.
Mitochondrial disorders are a highly diverse group of conditions that can affect almost every major system in the human body, often mimicking common disorders. This clinical variety often results in prolonged and often dangerous, diagnostic delays. This textbook provides a practical framework, to enable rapid identification, investigation, and treatment of mitochondrial disorders across the spectrum of clinical practice. Clinically relevant and comprehensive, this textbook employs a system- and case-based approach for practitioners of all levels. It focuses on major phenotypic features, syndromes and management relevant for clinical practice, within a broad overview of the field. This interactive book supports readers with knowledge distilled from over 20 internationally recognized, mitochondrial experts.
Morphological study of the podia of the suspension feeding Amphiura filiformis and the deposit feeding Amphiura chiajei revealed sensory–secretory complexes in the podial epidermis, consisting of four cells, two secretory and two sensory. Large mucus cells were found in association, but not exclusively, with the sensory–secretory complexes. In A. filiformis, mucus cells stained positively for both acid and neutral mucopolysaccharides, while, in A. chiajei, these cells stained only for acid mucopolysaccharides. The surfaces of the arm podia in A. chiajei were relatively smooth, while the arm podia of A. filiformis bear papillae. The sensory–secretory complexes open through numerous paired pores, with each pair having an intervening cilium. Pores were restricted to the podial tip in A. chiajei, while in A. filiformis they are concentrated on the podial tip and on the papillae. Amphiura chiajei shows very little differentiation of the podia along the length of the arm. In A. filiformis, the distal podia have papillae throughout their entire length, with pores being found on the head region and the papillar tips. Here, the papillae are oriented in such a way (i.e. facing inward towards the ventral arm plate) as to increase the area of the filtering surface of the podium, serviced by the sticky secretions from the sensory–secretory complexes. The proximal podia are relatively simple in structure and are thought to function more in the transportation of mucus wrapped particles to the mouth rather than in their capture. The difference in structure of the podia and chemical composition of podial secretory cells are taken to reflect the difference in feeding styles of the two species.
Keratosis obturans is characterized by the accumulation of desquamated keratinous material in the bony portion of the external auditory canal. Classically, it is reported to present with severe otalgia, conductive hearing loss and global widening of the external auditory canal. Extensive erosion of the bony meatus, with exposure of the facial nerve, has been previously reported, but no case of facial nerve palsy has as yet been published. We report the first published case, to our knowledge, of a unilateral facial nerve palsy secondary to neglected keratosis obturans.