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No vascular damage was detected buy 20 mg zocor fast delivery, and the results of both free vascularized fibular graftings were excellent at the latest follow-up discount 5 mg zocor with mastercard. They reported no significant relationship could be detected between etiology and clinical results. In the present study, the results were excellent or good for 68% of hips. There was a significant relationship between etiology and clinical results. The clinical results of steroid-induced osteonecrosis were poorest among the etiologies. On radiographic evaluation, radiographic progression was observed in 73% of hips in the study by Urbaniak et al. Radiographic progression was observed in 43% of hips in the present study. Significant relation- ships were detected between radiographic results and stage or type. Magnussen reported that articular cartilage that appears macroscopically normal remained mechanically functional even in patients with large osteonecrotic lesions or a late radiographic stage of the disease. However, the present study indicated that most hips with stage 3B progressed during the follow-up period. The present study indicated that patients with larger lesions, preoperative collapse, and a history of high-dose steroids had poor results. Conclusion The current results show that vascularized fibular grafting is a good procedure for the precollapse stages and a valuable alternative for patients with stage 3A. Dorr LD, Luckett M, Conaty JP (1990) Total hip arthroplasties in patients younger than 45 years: a nine- to ten-year follow-up study. Barrack RL, Mulroy RD Jr, Harris WH (1992) Improved cementing technique and femoral component loosening in young patients with hip arthroplasties: a 12-year radiographic review. Kobayashi S, Eftekhar NS, Terayama K, et al (1997) Comparative study of total hip arthroplasty between younger and older patients. Bozic KJ, Zurakowski D, Thornhill T (1999) Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head.

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It has also been observed in some patients with frontotemporal demen- tia; the finding is cross-cultural order zocor 5 mg with visa, having been described in Christians purchase 10 mg zocor mastercard, Moslems, and Sikhs. In the context of refractory epilepsy, it has been associated with reduced volume of the right hippocampus, but not right amygdala. Advances in Neurology 1991; 55: 411-421 Wuerfel J, Krishnamoorthy ES, Brown RJ et al. Religiosity is associ- ated with hippocampal but not amygdala volumes in patients with refractory epilepsy. Journal of Neurology, Neurosurgery and Psychiatry 2004; 75: 640-642 Cross References Hypergraphia; Hyposexuality Hypersexuality Hypersexuality is a pathological increase in sexual drive and activity. Recognized causes include bilateral temporal lobe damage, as in the Klüver-Bucy syndrome, septal damage, hypothalamic disease (rare) with or without subjective increase in libido, and drug-treatment in Parkinson’s disease. Sexual disinhibition may be a feature of frontal lobe syndromes, particularly of the orbitofrontal cortex. Cross References Disinhibition; Frontal lobe syndromes; Klüver-bucy syndrome - 162 - Hyperthermia H Hypersomnolence Hypersomnolence is characterized by excessive daytime sleepiness, with a tendency to fall asleep at inappropriate times and places, for example during meals, telephone conversations, at the wheel of a car. Causes of hypersomnolence include: Narcolepsy or the narcoleptic syndrome: may be accompanied by other features such as sleep paralysis, hypnagogic hallucina- tions, cataplexy Midbrain lesions Idiopathic CNS hypersomnia Kleine-Levin syndrome Nocturnal hypoventilation, due to: Obstructive sleep apnea-hypopnea syndrome (OSAHS; Pickwickian syndrome) Chest wall anomalies Neuromuscular and myopathic disorders affecting the respiratory muscles, especially the diaphragm, for example: Motor neurone disease Myotonic dystrophy Metabolic myopathies, for example, acid maltase deficiency Mitochondrial disorders Drugs: benzodiazepines, ergot-derivative dopamine agonists Post-stroke sleep-related disorders. Nocturnal hypoventilation as a consequence of obstructed breathing, often manifest as snoring, causes arterial oxygen desaturation as a con- sequence of hypopnea/apnea which may lead to disturbed sleep, repeated arousals associated with tachycardia and hypertension. Clinical signs may include a bounding hyperdynamic circulation and sometimes papilledema, as well as features of any underlying neuro- muscular disease. OSAHS may present in the neurology clinics with loss of consciousness (sleep secondary to hypersomnolence), stroke, morning headaches, and cognitive impairment (slowing). Investigations may reveal a raised hematocrit and early morning hypoxia.

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