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????????? Frostbite is due to exposure to cold, especially if accompanied by wind or high altitudes is also encountered in the elderly or the vagrant during cold spells. Pathologically, there is damage to the vessel walls, which is followed by transudation and edema. The sufferer notices severe burning pain in the affected part after which it assumes a waxy appearance and is painless. Blistering and then gangrene follows.
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Treatment: Frostbitten parts must be warmed very gradually. Any temperature higher than that of the body will be detrimental. Many frostbitten limbs have been either stewed or roasted in ignorance and gangrene thereby encouraged. The part should be wrapped in cotton wool and kept at rest. Friction e.g. Rubbing with snow, may damage the already devitalized tissues. Warm drinks and clothing are provided and analgesics are required to relieve the pain, which heralds the return of circulation. Paravertebral injection of the sympathetic chain may be helpful in relieving associated vasospasm. Amputation should be conservative. Hyperbaric oxygen is effective.
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????????? In the motor neurone disease and to a lesser extent in other types of neurogenic weakness, fasciculation’s may occur. These are spontaneous contractions of groups of muscle fibers, probably representing enlarged, re-innervated motor units, or parts of such motor units. Fasciculation’s vary in distribution and frequency and may also occur in fatigued normal subjects. They mostly originate from abnormal generator sites in the peripheral nervous system, although some have their origin more proximally. In chronic neurogenic weakness action fasciculation may be noted. This occurs during initial contraction of a muscle; the muscle is seen to undergo rhythmic fasciculation-like contraction as motor units are recruited into the muscular effort.
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????????? Flatulence is the term used to describe symptoms due to air in the stomach or intestine. It is associated with belching, abdominal distension and passage of flatus per rectum. This is often due to excessive swallowing of air (aerophagia). It is rarely associated with organic disease of the gastrointestinal tract but usually represents a functional disturbance. Flatulence also occurs in conditions like irritable bowel syndrome, lactose intolerance etc., Treatment is by reassurance if any specific cause is found out it should be treated.
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