By N. Altus. Lincoln University, San Francisco California.

People’s body images can suffer buy 400 mg indinavir amex, making them shy or embarrassed about physical closeness cheap indinavir 400mg amex. My mate, Gerry, and I have been living together for thirty-three years, which is a long time, half my life. I’m taking a shower, and I need help, but I’ll say to Gerry, “Don’t look! They recounted numerous, less physically demanding activities, and their heartfelt desire to contribute. But one man ruefully ac- knowledged, “There’s some things I can’t do on my own. Expressing thanks for every helpful act—day in and day out—reinforces people’s sense of dependence and potential inequity in relationships. Without the proper contrition, however, they may feel selfish or afraid that their partner will abandon them. Some people make self-sacrifices, not asking for something they re- ally want or need. Jeanette Spencer’s husband, Bertram, led lengthy hikes in the surrounding hills, leaving Jeanette alone. I feel that I shouldn’t ask him to do too much, taking me out to places, because he has so much else to do. Spencer rarely left her home except for doctor’s appointments, although her three grown sons lived nearby. Dynamics often differ depending on whether the husband or the wife has the mobility problem, especially among older couples. Husbands more than wives will hire outside help to perform tasks vacated by the disabled spouse, so husbands typically “experience less role strain” (Olkin 1999, 119). Some husbands, in particular, learn as much as possible about their wife’s disease to help devise mechanical solutions. He got all this information about MS and made himself as well-versed as he could.

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Lumboperitoneal Shunt Lumboperitoneal shunting involves the placement of a silicone tube from the lumbar subarachnoid space to the peritoneal cavity cheap indinavir 400mg online. These have long been used by neurosur- geons for PPTC indinavir 400 mg without prescription, though not always successfully. This approach leads to a rapid resolution of the PPTC, but the tubes can obstruct, become infected, and are 242 Repka associated with the development of a Chiari malformation. Failure to drain is com- mon and blockage leads to a rapid increase in pressure, which can cause catastrophic damage to the optic nerve. Ongoing ophthalmologic observation is recommended especially when there is a recurrence of symptoms. Optic Nerve Sheath Fenestration This treatment has been reported in many adults for the relief of pseudotumor cere- bri, but has only been performed in a small number of children. An incision in the dural sheath of optic nerve is made from an orbital approach under general anesthe- sia. Fenestration has been shown to relieve papilledema of the operated nerve and sometimes even the contralateral nerve. If the contralateral eye does not show evidence of improvement, a second procedure will be needed for this eye. PROGNOSIS Most children with PPTC have a self-limited course, resolving once the causative problem has been corrected. However, the clinician should be vigilant for older chil- dren and teens, who may have more chronic elevation of intracranial pressure or lack an obvious association. Permanent damage to the optic nerves is found in about one- fourth of affected pediatric patients. There does not seem to be any age difference in the occurrence of this unfavorable outcome. SUMMARY Pediatric pseudotumor cerebri is an uncommon neurologic disease of childhood. Obesity is less common in the childhood form of the disease and there is often an asso- ciated condition. Management requires collaboration of neurology, ophthalmology, and pediatrics in evaluating and monitoring the patients.