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The information in this brochure describes the benefts as well as possible pitfalls laser refractive surgery offers to symptoms 6dpiui order diltiazem online now those considering these procedures medicine 852 purchase diltiazem 180 mg overnight delivery. Refractive error prevents light rays from being brought to medications narcolepsy discount diltiazem 180mg otc a single focus on the retina resulting in reduced visual acuity medicine 2355 order diltiazem cheap online. To see clearly medicine keeper generic diltiazem 180mg amex, refractive errors are most often corrected with ophthalmic lenses (glasses medications used to treat depression diltiazem 180mg for sale, contact lenses). The three principal types of refractive conditions are myopia, hyperopia, and astigmatism. Another ophthalmic condition that also results in blurred near vision is called presbyopia. Presbyopia is a progressive loss of accommodation (decreased ability to focus at near distance due to physiological changes in the eyes crystalline lens) that normally occurs around 40 years of age. Myopia (nearsightedness, distant objects appear fuzzy) is a condition in which light rays are focused in front of the retina. Hyperopia (farsightedness, near objects appear fuzzy) is a condition in which light rays are focused behind the retina. Young hyperopes (< 40 years), who can compensate for their farsightedness with their ability to accommodate, are often not counted in this number and some studies incorrectly include presbyopes, who also require plus power lenses to see clearly. Astigmatism is a condition often caused from an irregular curvature of the cornea. Astigmatism can cause blurred vision at any distance and may occur in addition to myopic or hyperopic conditions. The laser photoablates (vaporizes) the corneal tissue to a predetermined depth and diameter. The corneal fap is folded aside and the excimer laser is used to reshape the underlying corneal stroma. An eye care specialist should thoroughly evaluate your current ocular health and correction requirements to determine whether you are a suitable candidate for refractive surgery. Even successful procedures may leave many patients with a small amount of residual refractive error that requires an ophthalmic device (eyeglasses or contact lenses) to obtain 20/20 visual acuity. Surgical Complications: 4 Decentered or detached corneal fap 4 Decentered ablation zone 4 Button-hole fap (fap cut too thin resulting in a hole) 4 Perforation of the eye Operation of an aircraft is a visually demanding activity performed in an environment that is not always user friendly. This becomes particularly evident if the choice of vision correction is ill-suited for the task. Contact sports should be avoided for a minimum of 2 weeks, and many eye surgeons recommend wearing safety eyewear while playing sports. Even after the patients vision has stabilized and healing appears complete, the corneal fap may not be completely re adhered. There have been reports of corneal fap displacement due to trauma up to 38 months after the procedure. After surgery, patients are cautioned to not wear eye makeup or use lotions and creams around their eyes for a minimum of 2 weeks and to discard all previously used makeup to reduce the risk of infection. Additionally, ablation of the underlying stromal tissue results in less corneal haze and the tendency for the cornea to revert back to the original refractive condition during the healing process (refractive regression), which improves predictability. Most patients do not require long-term, postoperative steroid use, decreasing the possibility of steroid-induced complications (cataract, glaucoma). As with any invasive procedure, there are surgical risks, and the recovery process often varies with each individual. For most, vision stabilizes within 3 months to near-predicted results, and residual night glare usually diminishes within 6 months. Ablation zones have an area of transition between treated and untreated corneal tissue. As the pupil dilates and becomes larger than the ablation zone, light (car headlights, streetlights, and traffc signals lights) entering through these transition areas becomes distorted, resulting in aberrations perceived as glare. Patients that develop postoperative haze during the healing process have complained of glare (halos and starbursts). Furthermore, it has been reported that exposure to ultraviolet radiation or bright sunlight may result in refractive regression and late-onset corneal haze. For those with larger amounts of refractive correction, the predictability of the resulting refractive correction is less exact. This can lead to under-correction (requiring an additional laser enhancement procedure and/or corrective lenses) or over-correction of the refractive error. In the case of overcorrection, premature presbyopia and the need for reading glasses can result. The procedure is intended to eliminate the need for a patient to wear corrective lenses for near and distant vision. Anisometropia (difference in correction between the eyes) induced by monovision may result in decreased binocular vision, contrast sensitivity, and stereo acuity. Patients who report blurred vision, diffculty with night driving, and other visual tasks in low-light conditions typically do not adapt to monovision and may require an enhancement on their non-dominant eye so that both eyes are fully corrected for distant vision. If the airman is successful, the lens requirement is removed from their medical certifcate. However, no two people share the same eye irregularities or have similar refractive needs. A laser beam is sent through the eye to the retina and is refected back through the pupil, measuring the irregularities of the light wave (wavefront) as it emerges from the eye. Measuring the corneas imperfections or aberrations in this way allows the refractive surgeon to develop a personalized treatment plan for the patients unique vision needs. Correcting the patients specifc imperfections can result in sharper vision, better contrast sensitivity, and reduces problems associated with higher-order aberrations after surgery, such as haloes and blurred images. Other Advances in Refractive Surgery the eyes optical system creates a limit as to how wide and deep the laser ablation should be, i. The development of new lasers allows the creation of a wider ablation zone while removing the least amount of tissue. Studies have shown that this reduces problems with night vision and other side effects associated with laser refractive surgery. Laser technology that provides variable optical zone sizes and beam shapes with scanning capabilities allows the eye surgeon greater fexibility in developing a more personalized laser vision procedure. A spot laser may be adjusted so minimal spherical aberrations are produced and a larger optical zone is created. Additionally, there was an overall improvement in nighttime visual function and night driving, which is achieved by preserving the optical zone size and better shaping of the ablation profle. While this method has worked well over the years, the performance of these devices can be unpredictable and is the source of a majority of surgical complications. These diffculties result in irregularities in thickness between the central and peripheral areas of the fap that can induce postoperative astigmatism. The laser keratome beam passes into the cornea at a predetermined depth, producing a precise cut that is reportedly more accurate than the microkeratome. Corneal faps made with the laser keratome appear to adhere more tightly to the corneal bed at the end of the procedure, which may eliminate problems with long-term fap displacement. A reported disadvantage to this new technology is that surgical time is increased, leaving the stroma exposed several minutes longer, which has led to reported complaints of photophobia and eye irritation for up to two days after surgery. These reports can be submitted directly to the Aerospace Medical Certifcation Division when released from care, or to their Aviation Medical Examiner during their next fight physical. As with any invasive procedure, there are many variables that can infuence the fnal outcome. You should understand all risks as well as the benefts before electing to have a procedure performed that could compromise your visual performance in the cockpit. However, pobres ao redor do mundo com os mesmos achados clinicos descritos ha seculos. Ophthalmic estao associados com os habitos da sociedade moderna e tem causado preocupacao. As the eyes and their adnexa e seus anexos sao orgaos muito sensiveis a deficiencia e excesso de vitamina A, mani are particularly sensitive to vitamin A deficiency and excess, ocular disturbances festacoes oculares podem ser indicadores precoces do desequilibrio de vitamina A. The present review describes the revisao traz as manifestacoes clinicas de hipovitaminose A enfatizando os chamados clinical manifestations of hypovitaminosis A with an emphasis on so-called modern disturbios dieteticos modernos e formas de abordagem multidisciplinar. The present review evidencias sobre a relacao entre a terapia com acido retinoico e doenca do olho seco. The causes of defciencies Night blindness, xerophthalmia, Bitots spot, keratitis, and kera in the micronutrient vitamin A, the biochemical vitamin A pathway, tomalacia are well-known clinical manifestations of hypovitaminosis food sources of retinol (vitamin A) and its metabolites, and the phy A(1). However, this condition is classically related to food deprivation siological roles of vitamin A have only begun to be understood since associated with malabsorption syndrome resulting from poverty the 20th century(5-9) (Figure 1; Table 1). Interestingly, one of the most complete and objective des the present review aims to inform health professionals of the criptions of the clinical manifestations of hypovitaminosis A was modern presentations, causes, associated systemic diseases, and risk published decades before the specifc underlying cause was known factors of hypovitaminosis A. The utility of retinoic acid application by the Brazilian ophthalmologist, Manoel da Gama Lobo, in 1865(10). Gama Lobo reported four cases of children, all descendants of Herein, we present the clinical presentation of hypovitaminosis A slaves, with ocular disease who subsequently developed lung and and discuss strategies for the investigation and treatment of the digestive disorders before ultimately dying. In this report, the disea causes and consequences of hypovitaminosis A and side efects of se was termed Ophthalmia Braziliana, and the clinical progression the use of retinoic acid (a form of vitamin A) in dermatological and was comprehensively detailed. Accepted for publication: October 20, 2015 Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of 1 Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeca e Pescoco, Faculdade de interest to disclose. Department of Ophthalmology, Otorhinolaryngology 2 Departamento de Patologia e Medicina Legal, Faculdade de Medicina de Ribeirao Preto, Universidade and Head & Neck Surgery, School of Medicine at Ribeirao Preto, University of Sao Paulo. At the end of his report, ses individuals to retarded growth, infertility, congenital malforma Dr. Gama Lobo called the attention of legislators to the need for tions, infections, and early mortality(18,20). The issue of vitamin A def laws aimed at preventing the sequence of problems he outlined. His ciency in these populations, distributed in more than 45 countries, paper was published in Portuguese and in German but is relatively has been the target of international preventive programs of vitamin unknown to the majority of the medical community, although it is A supplementation and periodic evaluation(16,18,19). Individuals sufering from food deprivation and malabsorption Recent epidemiologic data from Brazil in a study population of are often infected with intestinal parasite diseases, such as Ascaris 3,499 children aged between 6 and 59 months and 5,698 women lumbricoides and Ancilostomides, Giardia lamblia, which may aggra aged between 15 and 49 years revealed that hypovitaminosis A is vate the infammatory background and the signs and symptoms of present in all fve regions of Brazil with a prevalence of 17. The highest Other well-known causes of vitamin A defciency can be grouped prevalence was found to be in urban areas and the northeastern and into conditions associated with malabsorption syndrome. However, the majority of these patients will develop low food intake, intestinal parasitosis, malabsorption syndromes, and xerophthalmia (the specifc term for hypovitaminosis A-related dry diets containing low amounts of vitamin A (Figure 2). The most vulnerable individuals are chil chronic alcoholism, liver and pancreas autoimmunity, Crohns disease, dren and pregnant women. The prevalence of hypovitaminosis A can and ulcerative colitis, among other diseases afecting the digestive reach 50% in children under 6 years of age in certain areas(18). The fourth group of conditions that classically cause hypovitami nosis A is those that may initially lead to malabsorption syndrome but later progresses to impaired hepatic storage of vitamin A. Biliary cir rhosis, chronic hepatitis, and chronic cirrhosis caused by toxic agents, viruses, and other causes may lead to hypovitaminosis A and should be screened for and treated by parenteral vitamin A supplementation according to body mass index and level of vitamin A defciency(31). Despite their varying prevalence, such conditions should be carefully considered by ophthalmologists during routine clinical practice. Modern causes of hypovitaminosis A that may also lead to xe rophthalmia and other eye diseases and cause blindness are shown in (Figure 2 and Table 2) and comprising voluntary ingestion of low Figure 1. Metabolic steps underlying vitamin A defciency from the dietary level to tar vitamin A diets or restrictive diets. Restrictive diets resulting from dietary behaviors may lead to Exclusively vegetarian diets particularly put children and pregnant a status of hypovitaminosis A and the consequences mentioned woman at increased risk of hypovitaminosis A as the conversion of above. Diets adopted in conjunction with drugs to reduce appetite, beta carotenes present in vegetables to retinol is limited during di diets with monotonous ingredients, and diets with limited sources of gestion and the availability of vitamin A for absorption and hepatic animal ingredients containing retinol and beta carotene (meat and storage is <20% of dietary vitamin A content(1). The so-called cafeteria diet or competitive food, based on re freshing sodas and industrialized food, is predominantly composed of carbohydrates and lipids of vegetal source and provides insuf cient amounts of dietary vitamin A. Accordingly, such diets could be con sidered causes of hypovitaminosis A and associated ocular problems in patients with excessive habits related to these diets(36). The second group of causes of hypovitaminosis A includes the psychiatric eating disorders, anorexia, and bulimia nervosa, recogni zed as major, growing health problems with severe clinical compli cations, and high mortality. The complexity of such conditions must be recognized in the context of early signs of xerophthalmia and should be managed in parallel with psychiatric specialists(37,38). Bariatric techniques for the treatment of obesity include jejunoi leal bypass and stomach reduction to induce weight loss by malab sorbtive and restrictive mechanisms(39-41). Patients require vitamin su pplementation following these procedures; however, a recent study in Brazil demonstrated that even before bariatric surgery a relative amount of patients already have hypovitaminosis A, and that this pre valence increases 30 and 180 days after the procedure(42). In patients with no compliance for a period of weeks or months, ophthalmolo gists may evaluate the initial manifestations of hypovitaminosis A. Major causes of hypovitaminosis A and diagnosis guidelines Major causes of defciency of vitamin A Description Primary defciency Low dietary intake of vitamin A Food source: liver beef, damascus, spinach, cabbage, milk, carrot, and butter Diagnosis: food intake history, liver function, and vitamin A serum levels Restrictive and monotonous diets Restricted intake of sources of vitamin A and consumption of the same group of food for many months Eating disorders: psychiatric, cafeteria diet, and vegetarian Diagnosis: food intake history. Blood vitamin A levels Malabsorption syndrome Reduction in uptake and mucosa transport of digested nutrients to the blood stream Diagnosis: diarrhea, steatorrhea, weight loss, anemia, hyperkeratosis, and acrodermatitis. Stool analysis (fat, parasites) Bariatric surgery Surgery to treat obesity and associated diseases is divided into restrictive, disabsorptive, and mixed techniques and often mimics malabsorption syndrome Diagnosis: surgical history, use of vitamin supplements, bowel habits. Stool analysis (fat) Short bowel syndrome Mesenteric vascular disease typically caused by congenital obstruction, thrombosis, and other diseases requiring bowel resection Diagnosis: diarrhea, fatigue. Stool analysis (fat) Liver failure Loss of liver digestive and storage functions due to alcohol toxicity, virus infection, or other causes. Stool analysis (fat) Chronic pancreatitis Loss of pancreas exocrine function afecting digestion. Malabsorption mechanisms and signs may be present Diagnosis: blood levels of pancreas enzymes and vitamin A. Stool analysis (fat) Cystic fbrosis Inherited disease afecting chloride channels leading to exocrine gland dysfunction. Malabsorption mechanisms and signs may be present Diagnosis: low weight gain in infancy, progressive malnutrition, chronic cough with hypersecretion, chronic sinusitis, biliary cirrhosis, diabetes, respiratory infections and infertility.

Bedwetting is a common occurrence for young children medications not to take before surgery order diltiazem 60 mg otc, especially before age five treatment ringworm buy diltiazem us, and is not really considered a problem unless it continues page age six or seven medications routes order diltiazem 180 mg fast delivery. Some issues to medicine 94 diltiazem 60 mg free shipping explore with your students might be: what are the appropriate steps for toilet training a child and how early should this start More of a problem medicine used to induce labor order 60 mg diltiazem mastercard, particularly emotionally cold medications order diltiazem online from canada, is encopresis, or defecating at inappropriate times in inappropriate places. Explore the following with your students: how does encopresis differ in severity from enuresis Chapter 15: Disorders of Childhood and Adolescence 265 Based on what the students have learned from the text and by using other resources, have them develop a community plan to educate parents and children about the elimination disorders. Behaviors that are considered disorders in childhood change with the age of the child and the norms of the wider culture. Distribute the handout for this demonstration and ask students to rate each short description on a five-point scale, with l indicating no indication of a problem and 5 being a strong indication of a problem. Remind students that in each case a 10-year-old child is engaging in the behavior today. Have them turn in their handouts; before the next class period, tabulate and average their ratings for the 10-year old and the 14-year-old. Display the averages on the board and ask if students are surprised by any of the ratings. Compare and contrast this attitude with the opinions of those who gave mostly 4s and 5s. Also ask students whether the same behaviors would have been seen as problematic if they themselves had engaged in them as 10 and 14-year-olds. This exercise illustrates how diverse our standards may be and how expectations of normative development influence definitions of abnormality. If your students represent a diverse set of cultures (international students, rural versus urban, white versus people of color), ask if social expectations influenced their ratings. Finally, you will get a rousing discussion of differences in the behaviors parents allow from first-born and last-born children. Birth order is yet another factor that muddies the waters when childhood behavior is rated as problematic or not. Many students have strong opinions about how parents should interact with their children in order to foster self-esteem and open communication. Divide the class into small groups or engage in a round table discussion of the following themes: a. What methods did your parents use in rearing you that you are going to use in raising your own children What child-rearing methods will you use as a parent that your parents failed to use How much is the person you are today the direct result of the way your parents communicated with you It is a good idea to interject questions about how research can evaluate assertions of the right method. Although the text did not include a section on learning disorders (there is a limit to how much can be included in any textbook! It is possible for some students to be able to take the un-timed version of the tests by producing documentation of a diagnosis of a learning disability. If the student cannot compete for admission on the same basis as everyone else, how can he or she compete in the classroom without enormous amounts of assistance Ask the students to discuss these issues keeping in mind that they may have a learning-disabled classmate in the group with them. Ask your students in the groups to discuss the difference between the laws related to special education in the public schools and the Americans with Disabilities Act, which affects higher education. For each of the following descriptions, imagine that the child involved is 10 years old and lives in your hometown. Rate each behavior from 1 to 5, with 1 indicating no behavior problem and 5 indicating a definite problem. The child sometimes goes into stores in the mall and 1 2 3 4 5 shoplifts shirts, jewelry, or other items. The child spends the summertime sitting alone in his 1 2 3 4 5 or her room reading books rather than playing outside or interacting with other children. The child is so nervous before taking a test in school 1 2 3 4 5 that he or she gets only three hours of sleep the night before and throws up after breakfast. During a party thrown by adults, the child sneaks 1 2 3 4 5 three or four drinks of beer. Whenever the childs parents want to go out for the 1 2 3 4 5 evening, the child begs the parents to stay. Afraid of being embarrassed by the teacher, the child 1 2 3 4 5 fakes being ill in order to stay home from school. Whenever a parent asks the child to help with 1 2 3 4 5 household chores, the child screams and refuses. Social-cognitive mechanisms in the development of conduct disorder and depression. Chapter 14, Attention-Deficit Hyperactivity Disorder: All Wound Up and Out of Control. This classic film shows the self-destructive behavior of psychotic children and how contingent punishment can suppress it. The step-by-step operant conditioning methods developed by Ivar Lovaas to increase attending behavior and vocalization and to teach the functional use of speech are illustrated. The case study of a 9-year-old autistic boy who progresses in language use and social interaction through the efforts of his parents, doctor, and teachers. Interviews with parents illustrate the doubts, confusion, and guilt of parents who wonder how their child could have such desperate problems. This video follows the process of a therapy group of adolescent girls at a summer residential camp for disturbed children. The focus is on three girls with problems ranging from cerebral palsy to depression following years of sexual abuse. It shows how an intensive group experience helps change behavior and self-perception. This film illustrates procedures that can help autistic children develop greater awareness of other people and open the door for greater communication. This film shows how genetic diseases are passed on to future generations and discusses genetic counseling and the moral questions this counseling raises. This award-winning documentary film illustrates behavioral techniques used in helping a year old develop self-control skills. This film unflinchingly examines the self-destructive behavior of severely retarded individuals and treatment programs to protect them from themselves. Chapter 15: Disorders of Childhood and Adolescence 269 cooperative efforts of the staff and the therapist are viewed as the primary treatment mode. Silence of the Heart is an excellent, moving movie (now on video) starring a young Charlie Sheen and Chad Lowe dealing with issues of suicide and its effects on family and friends; delves into copycat suicides. More than 5 million Americans have eating disorders, characterized by physically and/or psychologically harmful eating patterns 3. Subtypes: a) Restricting type loses weight through dieting or exercising; b) Binge-eating/purging type loses weight through self-induced vomiting, laxatives, or diuretics. Physical complications: cardiac arrhythmias, low blood pressure, lethargy, and irreversible osteoporosis 4. Associated characteristics: obsessive-compulsive behaviors and certain personality characteristics 5. Course and outcome a) Approximately 44 to 50 percent of individuals treated for anorexia recover completely b) Mortality rate primarily from cardiac arrest or suicide ranges from 5 to 20 percent C. Bulimia nervosa: recurrent episodes of binge eating high caloric foods at least twice a week for three months, during which the person loses control over eating. Differs from binge-eating/purging anorexia: for anorexia, weight is under minimally expected levels 2. Subtypes a) Purging type: individual regularly vomits or uses laxatives, diuretics, or enemas b) Nonpurging type: excessive exercise or fasting are used to compensate for binges. Prevalence rate is 3 percent of women in the United States; few males exhibit the disorder. Physical complications: erosion of tooth enamel, dehydration, swollen parotid glands, and lowered potassium, which can weaken the heart and cause arrhythmia and cardiac arrest 5. Chapter 16: Eating Disorders and Sleep Disorders 271 a) Comorbid mood disorders are common b) Characteristics of borderline personality. Course and outcome a) Onset generally later than for anorexia (late adolescence or early adulthood) b) Follow-up studies tend to find almost 70 to 75 percent remission D. Prevalence a) One and one-half times more likely for females than males b) Range estimated at from 0. Associated characteristics: comorbid features include major depression, obsessive compulsive personality disorder, and avoidant personality disorder. Course and outcome a) Onset typically late adolescence or early adulthood b) Most individuals make a full recovery even without treatment, but weight is likely to remain high E. Determined by social, gender, psychological, familial, cultural, and biological factors. Societal influences: social desirability of thinness in women in western culture C. Family influences: a) Family interactions characterized by parental control, emotional enmeshment, and conflicts and tensions not openly expressed b) Maternal over-protectiveness, parental rejection c) these findings problematic: case studies, and may be reaction to eating problem, not its cause 2. Peers or family members criticize weight, encourage dieting, glorify ultra-slim models 3. Peer relationships can serve as buffer to eating disorders or produce pressure to lose weight D. African Americans ignore white media messages equating thinness with beauty, more likely than white American women to be satisfied with their body shape and to feel that beauty stems from personality not thinness 4. Anorexics are often described as perfectionistic, obedient, good students, excellent athletes, and model children; emphasis on weight allows them to have control over an aspect of their lives. Prevention programs in schools: aimed at reducing the incidence of eating disorders and disordered eating patterns. Focus on weight gain (by feeding tube, contingent reinforcement for weight gain, or both 2. Cognitive-behavioral and family therapy sessions common after weight gain, but relapse and continued obsession with weight are common. Initially assessed for conditions that may have resulted from purging, including cardiac and gastrointestinal problems. Treatment: psychotherapy, cognitive-behavioral treatment, and antidepressant medications 3. Treatments for anorexia and bulimia involve interdisciplinary teams that include physicians and psychotherapists D. Can involve primary insomnia, primary hypersomnia, narcolepsy or breathe related disorders 3. Circadian rhythm sleep disorder is a pattern of sleep disruption caused by the disruption of the biological sleep-wake cycle B. Etiology of parasomnias such as nightmare disorder, sleep terror and sleepwalking disorders is unknown. Psychological techniques such as relaxation or stimulus control and change in habits D. They tend to resolve in adolescence or early adulthood Copyright Houghton Mifflin Company. Consider the physical complications that can arise from anorexia nervosa and why it is difficult to overcome. Delineate other characteristics and mental disorders that are associated with anorexia nervosa. Discuss the characteristics of bulimia nervosa, as well as its physical complications, associated features, and course and outcome. Describe the risk factors for and etiology of eating disorders and evaluate the degree to which society creates eating disorders. Compare the attitudes toward weight of European American and African American females. Compare the treatments for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Discuss the characteristics, etiology, and treatment of primary sleep disorders (pp. A major irony of anorexia nervosa and bulimia nervosa are that they occur in times and places of relative affluence (consider the "vomitoria" of ancient Rome where wealthy Romans would go to purge after binging on lavish feasts). Such a pattern would logically suggest that these eating disorders are socially and culturally influenced. A team of investigators at the Howard Hughes Medical Institute and the University of Texas Southwestern Medical Center isolated the hormones, which they call orexin A and orexin B (orexis means "appetite" in Greek). Anorexia and bulimia are difficult disorders to deal with, even for professionals; typically waiting it out is not an option, while insisting that the person get help is likely to result in withdrawal. You may want to encourage the person to contact you when there is the need to talk to someone. However, there is a lot to gain by the process and a lot to lose if the choice is made to continue the existing behaviors. Chapter 18 discusses legal and ethical issues involved in providing therapy to persons who do not want to accept treatment.

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Maurice liked to medicine 2016 order diltiazem paypal pass himself off as Baron Zero medications ranitidine buy diltiazem 180 mg without prescription, probable counterpart of the dreadful Baron Samedi of Haitian Voodooand consequently a relative of Herve Telemarques Baron Cimetiere (1962) treatment borderline personality disorder purchase generic diltiazem. Audoin also adds in his article on Baron Zero that this Baron Samedi is the Saturnine Ankou of Antillean rituals: we shall revisit these rituals later in chapter 10 symptoms concussion cheap 60 mg diltiazem amex. It so happens that in Fourres posthumous novel treatment 4 sore throat order diltiazem 60 mg, Tete-de-Negre medications going generic in 2016 cheap 60 mg diltiazem visa, the Angevin author writes, The Baron Zero! A death omen (un intersigne) of our Death perhaps, audaciously marrying in one sentence the Celtic imaginal realm to the more colorful one of the Caribbean. The Breton cook from La Nuit du Rose-Hotel by this same author also lives in a silent world of death omens, with the familiar procession of their dead. His death, like my fathers (which occurred some years later) coin cided with a heavy snowfall. It is also from this angle of the malefic premonition that I believe we should view Gracqs scene of the Gaelic cross, on which Albert carved Heides name beneath a veil of shadow that suddenly appeared in the cemetery in the Castle of Argol, which Breton regarded as a surrealist reading of the Grail myth. This is an article about the eye enucleation suffered by Victor Brauner in 1938, which he had so often anticipated in his paintings and drawings. The doctor rejected the hypothesis of chance and demonstrated, through the painters work and life, *122 the strange necessity of the accident. Dont mutilated shapes set magical forces in motion, creating a psychic environment in which the accident would be the inevitable result An adventure like this can only inspire in the mind of the person who experienced it, an absolute mistrust toward all the rational systems that seek to explain its mechanism. This vision was also illustrated by Jules Perahin with his Before the Storm and Richard Oelze with Erwartung (Waiting), which was analyzed by Wieland Schmied this way: The time to 62 come reveals itself. There is the marvelous young woman who at this very minute, beneath the shadow of her lashes, is walking around the great ruined chalk boxes of South America, one of whose glances would call into question the very meaning of belligerence. Behar views this as a prediction of Bretons meeting with Elisa (Bretons third wife). He wrote, No one can rid me of the idea that this phrase is just as premonitory for him as the famous Night of the Sunflower that heralded his meeting Jacqueline Lamba. And I cannot prevent myself from seeing the silhouette of Elisa standing out here. It is of course obvious that these things are easy to decipher after the fact, but how can you understand the phrase of Artaud, sent to Jean Paulhan at the beginning of June 1937, as anything but a premonition Shortly before his fateful trip to Ireland, Artaud, whose sensitivity in this domain is easily imagined, wrote, In a little while I will be dead or in such a situation that I will no longer need a name. There are only presages, Claude Tarnaud writes in De (Le Bout du Monde) (From [the End of the World]). In the Passive Vampire, the Romanian Gherasim Luca shows evidence of a similar faculty when he writes: *123 I finished my work at one in the morning and I placed the objects on the mantel. Slipping into bed, I was scared to fall asleep because I had the premonition there would be an earthquake during the night. I was awoken at four in the morning by a terrible earthquake, the walls cracked, the wardrobes were tossed to the center of the room, books fell all over, objects and glasses broke noisily. While the earthquake lasted, I kept shouting that I had foreseen it, and this gift of clairvoyance that I discovered for the first time increased my terror. It is impossible to read these magnificent lines by Desnos in Poems to the Mysterious Woman, at the junction of love and premonition, without intense emotion: I have so often dreamed of you, walked, spoken, slept with your phantom that perhaps I can be nothing any longer than a phantom among phantoms. With his text Before the Curtain, included in La Cle des champs (Free Rein), Breton, citing in a footnote several evidential examples for the benefit of skeptics, goes so far as to venture an amazing suggestion: Now it may be that surrealism, by opening certain doors that rationalism had boarded up for good, had enabled us to make here and there an incursion into the future, on condition that we should not be aware at the time that it was the future we were entering, that we should become aware of this and be able to make it evident only a posteriori. Again, in Le Pont suspendu, which recounts a strange phenomenon of premonition connected to a 63 small painting offered to him by Luis Fernandez, Breton echoes the already dated works of the Irishman John William Dunne (18751949), an aeronautical engineer by training and the author of the 64 book An Experiment with Time, which had a curious theory of consciousness that claims to supply an original explanation for the phenomena of premonition and makes possible a new kind of dream analysis by means of the notion of serial time, which is based on the fact that variable time can only be conceived as an element of a series. His research also left a mark on Raymond Queneaus novels the Bark Tree (1933) and the Blue Flowers (1965). It is true, as Vera Linhartova writes, that poetry, according to Sima, is a premonition of the world in becoming (but this observation undoubtedly applies to other creators as well as other forms of creation), once the poetic imagination, by accepting the rift between the known world and other possible worlds, stands surety for their reintegration into world one. The bulk of these phenomenaprovoked or notinvolved relationships between the living and the dead. The large place held in surrealist writings by ghosts, haunted castles, mediums, seers, and the idea of 65 automatic writing reflects a similar climate. And did not Breton himself write in 1923, in Earthlight, Veiled premonitions are descending the stairs of the buildings. Knowledge of nature should permit the removal of the cherubim guarding the 3 garden where the tree of life grows: this is the true revolt. I should like to linger for a moment on the significance of the encounter of the surrealists with Rene Alleau, which an eyewitness, Jean-Louis Bedouin, despite some reservations, emphasized in his book Vingt Ans de surrealisme: 19391959: That the author of Aspects of Traditional Alchemy, Fulcanellis disciple and Eugene Canseliets friend, by his own admission, went off to win the Golden Fleece after having known surrealism, confirms in noteworthy fashion the analogical purpose Breton discusses of surrealist and alchemical explorations. The fact his path intersected again years later with the path the surrealists had taken shows that the different paths taken by Alleau and his fellow seekers, and by Breton and the poets sharing the same concerns, encircled the same axis like the two serpents on a caduceus. From either end of their dual evolution, the two paths never merged, although at certain points they crossed and juxtaposed each other. On a side note, Alleau, when he took part in group activities, vigorously attacked Jung and his Psychology and Alchemy (as in the third issue of Medium in 1954), particularly rejecting the idea that the symbols of the adepts and the teachings of the masters as well as the illuminations of Art and the flames of Nature can emerge from the collective unconscious, as the Swiss native defined it. In any event (and setting aside any kind of transcendence), it is obvious that sixteenth-century alchemy (its golden age) was consistently represented as a science aiming to recreate and perfect by art what had been created and left 4 imperfect by nature, with a demiurgic side aiming at correcting the work of God while retaining a technical [aspect] of spiritual realization so adroitly demonstrated by Guenon. I n the Mirror of Magic, Seligmann supplies details that are particularly revealing about the surrealists interest in alchemy; incidentally, they bring to mind Rimbauds verse about the hand with the pen being equal to the hand on the plow. His imagination being ceaselessly directed toward the marvelous, the hermetic philosopher no doubt took great pleasure in his studies. It is because it is based on the imagination as much as it is on manual dexterity (italics added). Robert Amadous view from his book Occident, Orient: parcours dune tradition (West and East: the Journey of a Tradition) is well worth noting: Alchemy is based on the permanent correlation 5 between the material phenomenon and what takes place on the spiritual level. The paradise of theology and that of Greek philosophy, the monsters of the East, the mythical figures of Hellas, all come together under the sign of Hermes. This regeneration appears to be, in the Christian context of Western alchemy, a response to the doctrine of original sin, but is clearly fundamentally different (as is easily 7 verified) as it is nonreligious in its essence. Hester Albach confirms this, at least for Nadja, as indicated by Philippe Noble in the foreword of her book about Leona Delcourt. Never has any alchemy manual communicated anything but clues, a trail through myths, symbols, analogies in the language of the birds, or narrative structures deliberately offering an erroneous chronology. This is true of Nadja, where it is explicitly stated that the story has no preordained order. They tend to make certain descriptions superfluous, just like the enigmatic engravings illustrating alchemical works. It is up to the reader to interpret them, which he will do in accordance with his degree of initiation. One perceives a sparkling, magnetic thread streaking across these medals, which is comparable in its glory to that which the alchemists of other ages attributed to nostoc (from the Greek tokos and noos), that terrestrial alga, which is supposed to evaporate in the rays of the sun and to which they gave a variety of names (as they did to the Emerald of the Adepts), for example, cuckoo-spit, star-jelly, witches butter, spring-froth. There is nothing surprising about this if one remembers that nostoc means literally giving birth to, generating the spirit, which is perfectly applicable to the Gallic coinage. Philippe Sollers, describing his first meeting with Breton in the June 5, 2008, issue ofLe Nouvel Observateur, says: What did he speak of on that day with his impeccable diction Jacques Van Lennep has also stressed this kinship between the thought of the adepts and that of the primary theoretician of surrealism. Andre Bretons writings reveal more than mere allusions to the hermetic art and one concludes from reading them that the approaches of surrealism are not at all foreign to alchemical concerns. In short, Breton appears particularly sensitized to alchemy, and this is in no way some game of a scholar tempted by occultism but reveals his crucial interest in a gnosis that contains the 9 spirit of surrealism in ferment (italics added). Jacques Van Lennep also suggests the poet no doubt remembered that the Great Work for Eliphas Levi was nothing other than the conquest of the central point wherein dwells the balancing force. The philosophers stone is nothing more or less than that which was to enable mans imagination to take a stunning revenge on all things, which brings us once again, after centuries of the minds domestication and insane resignation, to the attempt to liberate once and for all the imagination by the long, immense, reasoned 10 derangement of the senses and all the rest. One may well wonder how the obtaining of more than a few bits of gold could have interested him, when it had been, above all, a matter of building up a spiritual fortune. This brings to mind Seligmann, who said, More than one initiate preferred the path of perfection to perfection itself. Is the admirable fourteenth century any less great as regards human hope (and, of course, human despair) because a man of Flamels genius received from a mysterious power this manuscript, which already existed, of Abraham the Jews book, or because the secrets of Hermes had not been completely lost I do not believe so for one minute, and I think that Flamels efforts, with all their appearance of concrete success, lose nothing by having thus been helped and anticipated (italics added). Again in LArt magique, Breton deplores the irreparable loss of the paintings drawn under the guidance of Nicolas Flamel at the Charnel House of the Innocents, paintings of which theBook of Abraham the Jew only give us a vulgarly executed souvenir. Around this same time of Matherss writing (at the end of the 1920s), Michel Leiris appears to have shared with Andre Masson a love. Here next to works of low magic like the Petit Albert, the great occultists like Paracelsus, as well as Ramon Llulls Ars Brevis and Leonardo Da Vincis Treatise on Painting, could be 12 found. Neither Semiramis nor the Queen of Sheba built this temple, but, it is said, that carved into its stones are the principal secrets of Nicolas Flamel, more enigmatic 13 than even those of Paracelsus. Some time later, 1968 to be exact, in the catalog for the Princip Slasti (Pleasure Principle) exhibition, Philippe Audoin, who like Breton claimed to be merely an amateur when it came to alchemy, enlisted Dame Pernelles husband (Flamel) under the surrealist banner to embody the symbolic link between the banks of the Seine and those of the Vltava. He writes in La Fontaine de Fortune (The Fountain of Happiness): this is the effect of a certain optical hindsight: the staircase Marcel Duchamps Nude descended becomes that of the Tour Saint-Jacques; an endlessly spiraling wingnut and armor-piercing vehicle of what the modern spirit can most aggressively offer when it comes to drillings in the dawn of timeand casting, toward an inverted coronation of the one that signs, in the clouds, the tetramorphic chiasmus, the increased form of Nicolas Flamels Awaited Bride. We know that when Flamel was said to have died, the adepts of the Sublime Science had already found a haven beneath the great heretical porch of Notre Dame. Later, all those who appealed to the whim of Emperor Rudolph knew the figures that the Parisian writer had drawn on the Charnel House of the Innocents. Alchemical gold was struck secretly in Prague and Paris, as if at the two stable poles of an intransitive universe, which underlays the official world of tottering courts and religious 14 massacres. As similar as these poles may be, in Prague the Golden Street of the Alchemists overlooks Stag Moat, where, Gustav Meyrink tells us inThe Angel of the Western Window, bears fed on the flesh of these same adepts and initiates. Nicolas Flamel, the ruril [native] de Pontoise (the famous name is eventually uttered and repeated), lived in the Chatelet quarter near the church of Saint-Jacques-de-la-Boucherie (which is now destroyed). All that survives of the church at the geometrical center of the labyrinth of the capital is that temple dedicated to hermeticism; according to Elie-Charles Flamand that is known as the Tour Saint-Jacques. This quarter thus gives Paris a bit of an air of an alchemical city, like Prague certainly, but also Bourges. All three are built over an inextricable lacing of caves and underground passages, which is confirmed by these lines by Joris-Karl Huysmans in his Gilles de Rais: La Magie en Poitou, which was published confidentially in 1899: *126 During this era, the hermetic center in France was Paris, where alchemists gathered beneath the vaults of Notre Dame and studied the hieroglyphs of the Charnel House of the Innocents and the portal of Saint-Jacques-de-la-Boucherie, on which Nicolas Flamel had written in kabbalistic emblems the preparation of the famous stone. Its especially true that my mind has often prowled around that tower, for me very powerfully charged with occult significance, either because it shares in the doubly-veiled life (one because it disappeared, leaving behind it this great trophy, and again because it embodied, as nothing else, the sagacity of the hermeticists) of the Church Saint-Jacques de la Boucherie, or because it is endowed with legends about Flamel returning to Paris after his death. These returns were notably detailed in the Second Surrealist Manifesto, when Breton admits accepting that someone named Paul Lucas was able to encounter Flamel in Brusa at the beginning of the seventeenth century, that this same Flamel, accompanied by his wife and one son, was seen at the Paris Opera in 1761, and that he made a brief appearance in Paris during the month of May 1819, at which time he was purported to have rented a store at 22 rue de Clery. Let me reiterate, these legends were part of the spirit of the time inasmuch as Apollinaires friend 15 Leo Larguier, cited in Le Flaneur des deux rives (The Idler of the Two Banks), also refers to them in 1936 at the end of his novel Le Faiseur dor, Nicolas Flamel (The Gold Maker, Nicolas 16 Flamel). Describing the affinities between Herold and Breton and their meeting at the foot of the Saint Jacques Tower in his article Jacques Herold et le surrealisme, Jean-Paul Clebert mentions the following anecdote concerning one of the alleged returns of the alchemistunless it was Gerard de Nerval. We know that Breton, in an aperture grafted on Arcane 17, recounted the strange adventure of the painter Halphern to whom a black man appeared, another phantom of Nicolas Flamel. Condensing his story as much as possible to give it more weight, Breton did not mention that Herold had climbed to the top of the tower and introduced himself to the head of the weather bureau there. This bureaucrat of the magnetic fields, a total realist and advocate of scientific method, did not believe in spirits and yet he reported to the painter that one day when he was sitting at his desk filing papers, he suddenly saw a man before him dressed in black with a black hat, silently standing there without moving. In the time it took to call his secretary to ask the reason for the presence of this individual in this private place not open to the public, the man in 17 black had disappeared, with no clue to how he left. This Chatelet quarter was placed under the sign of Saint James, brother to Saint John, who was the patron saint of doctors and alchemists. Saint James was believed, according to the Golden Legend, to have in Spain gotten the best of Trismegistusthe initiated initiatingwhose occult knowledge he consequently had to manage. Part of that fascination was due to the fact that this was where Gerard de Nerval had lived and hanged himself with what he claimed to be the Queen of Shebas garter, as reported by Theophile Gautier. Perhaps, Leiris claims inAurora, because of two semiphantomatic creatures each bore half of this name: Aurelia and Pandora. And the echo answers with the voice of Jean-Pierre Duprey: Now the night is a clear door, which he crosses through like Dante or 18 Orpheus. Nadia Choucha notes: the male and female elements in the Large Glass attempt to achieve union and thus a sense of wholeness. The androgyne is a symbol of the undifferentiated consciousness sought by the alchemists, when all opposites are reconciled. Finally it is worth quoting two alchemical parables from the seventeenth century, which Duchamp must have used as a starting point for his work. These passages are to be found in Albert 20 Poissons Theorie et symboles des alchimistes. Diana [the virgin goddess] no longer wears her garment, So that marriage becomes more desirable. From two noble suitors, both fencers, the Bride receives delicious water So that she can bathe her own body, For her groom. That which is above, that is the volatile, or to put it another way, the black and obscure female, she who is about to seize control [of the alchemical work] for several months. The first (below) is called sulfur, or instead heat and dryness, and the second (above) is called quicksilver, or 21 frigidity and humidity. I n Heliogabalus or the Crowned Anarchist, Artaud associates this black feminine with Proserpine, the woman incarnated in hell and who never gets much out of it. Andre Salmon, who dubbed him the prince-alchemist, revealed, says Marijo Ariens-Volker, that in 1912 the true title of *127 Les Demoiselles dAvignon was Le B. Anne Tronches article Une morphologie totemique de linvisible reminds us that Wifredo Lam had a magnificent knowledge of alchemical heraldry and had put together a particularly important library in Havana of scholarly books tracing its history and successive interpretations, which was ultimately scattered when his studio was ransacked. She adds, Finding symbols that stimulated his imagination in the grimoires of the Adepts, he put them to work to the benefit of his 24 pictorial space.

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