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Encyclopedia > Abd-ar-rahman I
Abd-ar-rahman I
Abd-ar-rahman I (756-788) was the founder of the branch of the family which ruled for nearly three centuries in Muslim Spain. When the Umayyads were overthrown in the East by the Abbasids he was a young man of about twenty years of age. together with his brother Yahya, he took refuge with Bedouin tribes in the desert. The Abbasids hunted their enemies down without mercy. Their soldiers overtook the brothers; Yahya was slain, and Abd-ar-rahman saved himself by fleeing first to Syria and thence to northern Africa, the common refuge of all who endeavoured to get beyond the reach of the Abbasids.
In the general confusion of the caliphate produced by the change of dynasty, Africa had fallen into the hands of local rulers, formerly amirs or lieutenants of the Umayyad caliphs, but now aiming at independence. After a time Abd-ar-rahman found that his life was threatened, and he fled farther west, taking refuge among the Berber tribes of Mauritania. In the midst of all his perils, which read like stories from the Arabian Nights, Abd-ar-rahman had been encouraged by reliance on a prophecy of his great-uncle Maslama that he would restore the fortune of the family. He was followed in all his wanderings by a few faithful clients of the Umayyads. In 755 he was in hiding near Ceuta, and thence he sent an agent over to Spain to ask for the support of other clients of the family, descendants of the conquerors of Spain, who were numerous in the province of Elvira, the modern Granada. The country was in a state of confusion under the weak rule of the amir Yusef, a mere puppet in the hands of a faction, and was torn by tribal dissensions among the Arabs and by race conflicts between the Arabs and Berbers. It offered Abd-ar-rahman the opportunity he had falled to find in Africa. On the invitation of his partisans he landed at Almunecar[?], to the east of Malaga, in September 755. For a time he was compelled to submit to be guided by his supporters, who were aware of the risks of their venture. Yusef opened negotiations, and offered to give Abd-ar-rahman one of his daughters in marriage and a grant of land. This was far less than the prince meant to obtain, but he would probably have been forced to accept the offer for want of a better if the insolence of one of Yusef's messengers, a Spanish renegade, had not outraged a chief partisan of the Umayyad cause. He taunted this gentleman, Obeidullah by name, with being unable to write good Arabic. Under this provocation Obeidullah drew the sword. In the course of 756 a campaign was fought in the valley of the Guadalquivir, which ended, on May 16, in the defeat of Yusef outside Cordova. Abdar-rahman's army was so ill provided that he mounted almost the only good war-horse in it; he had no banner, and one was improvised by unwinding a green turban[?] and binding it round the head of a spear. The turban and the spear became the banner of the Spanish Umayyads.
The long reign of Abd-arrahman I was spent in a struggle to reduce his anarchical Arab and Berber subjects to order. They had never meant to give themselves a master, and they chafed under his hand, which grew continually heavier. The details of these conflicts belong to the general history of Spain. It is, however, part of the personal history of Abd-ar-rahman that when in 763 he was compelled to fight at the very gate of his capital with rebels acting on behalf of the Abbasids, and had won a signal victory, he cut off the heads of the leaders, filled them with salt and camphor[?] and sent them as a defiance to the eastern caliph. His last years were spent amid a succession of palace conspiracies, repressed with cruelty. Abd-ar-rahman grew embittered and ferocious. He was a fine example of an oriental founder of a dynasty, and did his work so well that the Umayyads lasted in Spain for two centuries and a half.
From an old 1911 Encyclopedia
... State of Christiania - a partially self-governing neighborhood in the city of Copenhagen. This is a disambiguation page; that is, one that just points to other pages ...


The Concord Insider named Burning Ridge the Feb 5th 2019 Book of the Week. Check it out along with this terrific review!
We're so excited that BURNING RIDGE made this Best Books of 2018 list on Kings River Life! If you like mysteries, here's a list you might want to check out!
Read this terrific review of BURNING RIDGE in King's River Life.
Fresh Fiction has posted an excerpt of BURNING RIDGE.
Go here to read the entire review.
Thanks to San Francisco Review of Books for this terrific review of KILLING TRAIL!
"…absolutely riveting start to end." ~Fab Book Reviews. Read the complete review of Burning Ridge.


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Armed Forces Day (Romania)
Blessed Carlo Gnocchi
Blessed Thaddeus McCarthy
Crysanthus and Daria (Western Christianity)
Crispin and Crispinian
The Six Welsh Martyrs and companions (in Wales)
Gaudentius of Brescia
Minias of Florence
Mar Nestorius
The Hallowing of Nestorius
Earliest day on which Nevada Day can fall, while October 31 is the latest; celebrated on last Friday in October. (Nevada)
Earliest day on which October Holiday can fall, while October 31 is the latest; observed on last Monday in October. (Ireland)
Earliest day on which Teacher's Day (Australia) can fall, while October 31 is the latest; celebrated on last Friday in October. (Australia)
Constitution Day (Lithuania)
Customs Officer's Day (Russia)
Day of the Basque Country (Basque Country)
Retrocession Day (Taiwan)
Sovereignty Day (Slovenia)
Thanksgiving Day (Grenada)
National Greasy Food Day
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Chucky, The Notorious Killer Doll Day
International Artist Day
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National Punk for a Day Day
World Pasta Day
World Pizza Makers Day
Discovery of Kiska Island
On October 25, [1741] we had very clear weather and sunshine, but even so it hailed at various times in the afternoon. We were surprised in the morning to discover a large tall island at 51° to the north of us.Georg Wilhelm Steller, Journal of a Voyage with Bering, 1741-1742, trans. by M. Engle and O. W. Frost (Stanford: Stanford University Press, 1988): 119.
Thus wrote the naturalist-physician, Georg Wilhelm Steller, about the discovery of Kiska Island in the Aleutian Islands chain of present-day Alaska. Steller's journal was kept according to the Old Style (Julian) calendar, which was replaced by the Gregorian calendar in 1752, so his October 25 is November 5 by twenty-first-century reckoning. His entries provide a detailed firsthand account of the final voyage of the navigator and explorer Captain-Commander Vitus Jonassen Bering.
Nome City Water Front [from Anchorage in Bering Sea],
Bering was born in 1681 in Horsens, Denmark, but served with the Russian fleet for thirty-eight years. Under Tsar Peter the Great, Bering led an expedition from 1725-30 to explore northeastern Siberia and purportedly to determine if Russia and North America were connected by a land bridge.
Goldi Village on the Amur, North of Khabarovsk; Dog Tied in Foreground,
Siberia,
Around the World in the 1890s: Photographs from the World's Transportation Commission, 1894-1896
Having learned that North America and Russia were not connected, Bering undertook a second exploration, lasting from 1733-43. The Great Northern Expedition sought to secure a Russian foothold on the North American continent. In June 1741, Bering set sail on the St. Peter, with fellow navigator Aleksei Chirikov commanding the St. Paul. The two soon were separated by a storm at sea. Chirikov searched futilely for Bering, but headed home after losing two scouting parties of his own men.
After a futile search for the St. Paul, Bering's men made the first European discovery of the northwest coast of America on July 16, sighting coastal mountains on the northern Gulf of Alaska coast which he named the St. Elias Mountains. By mid-September, Bering had set a return course when, ill with scurvy, he became too weak to command his ships. He and his men took refuge on an uninhabited island. Survivors of Bering's ship finally came ashore in November on land they believed Kamchatka; their journals reveal an extraordinary tale. Bering died in December, but the survivors took advantage of the abundant sea life and natural resources and returned to health by eating whale blubber, and the meat of sea otters and "sea cows,"—the latter having seaweed-nourished meat.
St. Michael's Cathedral [detail],
Novoarkhangelsk
[Sitka, Alaska],
In the Beginning Was the Word: The Russian Church and Native Alaskan Cultures
Fur-trading possibilities soon hastened the settlement of Alaska and the Aleutians. The Russian-American Company, led by Grigorii Shelekov and encouraged by Tsarina Catherine the Great, established a Russian outpost on Kodiak Island in 1784. The Russian Orthodox Church founded its first Orthodox mission in North America in 1794.
The online exhibition In the Beginning Was the Word: The Russian Church and Native Alaskan Cultures examines the Russian state and the Russian Orthodox Church in Russian America from 1794 to about 1915. It explores issues of commerce, the relationship of the Russian Orthodox Church to native Alaskans, and the preservation of the Aleut, Eskimo, and Tlingit languages.
Broadway, View Down Street,
Skaguay, Alaska.
American Landscape and Architectural Design, 1850-1920: a Study Collection from the Harvard Graduate School of Design
Native customs remained strong in Alaska after U.S. Secretary of State William H. Seward purchased this territory from Russia in 1867. However, in 1948, the Cold War halted centuries of native travel back and forth across the Bering Strait. Only after the Reagan-Gorbachev Moscow summit in 1988 did the "Friendship Flights" from Nome to Provideniya allow Alaska natives once again to share their mutual culture. At this time, other economic, scientific, and cultural exchanges also recommenced.
Explore Meeting of Frontiers, a bilingual, multimedia English-Russian digital library that tells the story of the meeting of the Russian-American frontier in Alaska and the Pacific Northwest. Search on the term Bering to see many items related to the captain-commander's voyages, for example, the 1732 Journal of Captain-Commandor Vitus Bering's Voyage to Kamchatka, the Journal of Captain-Commandor Vitus Bering and Lieutenant Sven Waxell written aboard the St. Peter from May 24, 1741 to September 7, 1742, or Georg Wilhelm Steller's Reise von Kamtschatka nach Amerika mit dem Commandeur-Capitån Bering.
View the online exhibition The Empire That Was Russia: The Prokudin-Gorskii Photographic Record Recreated. Prokudin-Gorskii photographed architecture, ethnic diversity, and people at work on the eve of WWI and the coming revolution.
One of the principal features at the 1901 Pan-American Exposition in Buffalo, New York was the "Alaskan or Esquimaux Village." Search on the term eskimo or esquimaux in Last Days of a President: Films of McKinley and the World's Pan-American Exposition, 1901 to find reenacted scenes of life in the north, such as the Esquimaux Game of Snap-the-Whip.
To see images of Russian Orthodox churches, native people, and native villages, view the Harriman Alaska Expedition album in the collection The Evolution of the Conservation Movement.
Search on the term Alaska in the following collections for more related images and stories:
American Life Histories: Manuscripts from the Federal Writers' Project, 1936-1940
Built in America: Historic American Buildings Survey/Historic American Engineering Record, 1933-Present
Explore the Smithsonian Institution's Arctic Studies Center dedicated to the study of Arctic peoples, cultures, and environments.
Abigail Smith Adams
A. Adams, From an Original Painting by Gilbert Stuart,
Engraving,
New York: Johnson, Wilson & Co. Publishers, ca. 1830-1860.
By Popular Demand: Portraits of the Presidents and First Ladies, 1789-Present
On October 25, 1764, Abigail Smith married a young lawyer from Braintree (now Quincy), Massachusetts, by the name of John Adams, who would become, some thirty years later, the second president of the United States. Their union launched a vital and long-lived partnership of fifty-four years, which carried the couple from colonial Boston to Philadelphia and the politics of revolution; to Paris and London and the world of international diplomacy; and finally to New York , Philadelphia, and Washington, D.C., where in November, 1800 they became the first presidential couple to occupy the newly built White House in the nation's new capital. Among their five children, John Quincy Adams would also become a U.S. president. For almost two centuries, Abigail Smith Adams remained the only American who was both the wife and the mother of a president, a distinction she now shares with Barbara Bush.
Abigail Adams is perhaps best remembered for her letters, written especially to her husband during long periods of separation, but also to her larger network of family members and friends, such as Mercy Otis Warren and Thomas Jefferson. The daughter of a Congregational minister born in 1744 in Weymouth, Massachusetts, the young Abigail received a sophisticated though largely informal education, fueled by the presence of many books and frequent visitors in her home. John Adams was one such visitor, and their earliest letters document a witty and affectionate courtship spanning several years. In married life, Abigail Adams proved a talented chronicler of significant events, combining a broad knowledge of history and politics with perceptive commentary and a keen eye for detail. Her letters comprise an important account of key events in the United States' early history as a nation.
Adams and her husband corresponded regularly during the course of his many absences from home, first as a circuit judge in Massachusetts and then, most famously, while he attended the Continental Congress in Philadelphia. It was in one of these letters that Abigail Adams' spirited admonition to "remember the Ladies" appears:
I long to hear that you have declared an independency—and by the way in the new Code of Laws which I suppose it will be necessary for you to make I desire you would Remember the Ladies, and be more generous and favourable to them than your ancestors. Do not put such unlimited power into the hands of the Husbands. Remember all Men would be tyrants if they could. If p[a]rticuliar care and attention is not paid to the Laidies we are determined to foment a Rebel[l]ion, and will not hold ourselves bound by any Laws in which we have no voice, or Representation.Abigail Adams to John Adams, March 31, 1776,
Adams Family Papers, Massachusetts Historical Society
Equal Franchise Society Legislative Series; Extract from a Letter from Abigail Adams to her Husband John Adams,
New York City, New York: Equal Franchise Society, ca. 1910.
Miller NAWSA Suffrage Scrapbooks, 1897-1911
The Adams' frequent separations continued into the 1780s, as John Adams accepted several commissions from the U.S. government to Europe, both during the revolution and after it formally ended. Throughout this time, Abigail Adams managed the family farm and finances, and raised the couple's children largely on her own. The Adams sons, as they grew older, traveled with their father to Europe. In 1784 Abigail joined her husband in Paris, bringing along their oldest daughter, Abigail 2d (Nabby). From there the family moved to London where John Adams served in the challenging role of the United States' first minister to the recently defeated Great Britain. On their return to Boston in 1788, the Adams moved into a new, larger home in Quincy, but only a few months later in March 1789, John Adams was selected the first vice president, serving with President George Washington for the next eight years.
Adams Mansion
Photograph 1: West Side
135 Adams Street, Quincy, Norfolk County, Massachusetts,
Charles E. Peterson, photographer, 1954.
During her husband's vice presidency, Abigail Adams drew on her experience abroad to assist First Lady Martha Washington in official entertaining; together they created the new role of primary hostess for the country. Adams also advised her husband in politics, and kept charge of the family's Massachusetts property, traveling home from the temporary capital at Philadelphia during periods of poor health. In Washington, D.C., she continued her entertaining in the unfinished and drafty White House in a barely habitable city. When, in 1800, John Adams lost his bid for re-election in what proved the nation's first contentious presidential election, she happily retired from public life to spend more time with her husband.
Architecture and Interior Design for 20th Century America: Photographs by Samuel Gottscho and William Schleisner, 1935-1955 contains a series of photographs of the Adams' house in what is now Quincy, Massachusetts, including the bedroom where John and John Quincy Adams were born and the younger Adams's commode. To find them, search the collection on Adams. Built in America: Built in America, Historic American Buildings Survey/Historic American Engineering Record, 1933-Present contains architectural surveys of the John Adams birthplace, Abigail Smith Adams birthplace, John Quincy Adams birthplace, and Adams Mansion, now a National Park Service site.
Starting with the 1840 collection prepared by her grandson Charles Francis Adams, a great number of books containing the correspondence of Abigail Adams have been published. To locate these titles go to the Library of Congress Online Catalog, select "Search by Name," then enter the term Adams, Abigail.<%

redpajama_set_name: RedPajamaCommonCrawl


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Q: How to navigate between jsp pages I have a jsp page called home.jsp outside the WEB-INF directory and an other jsp page called service.jsp inside the WEB-INF folder. I need to put this service.jsp page inside the WEB-INF directory so it cannot be accessible if a user attempts to get access to it by typing its URL. So my problem is how can i navigate from home.jsp to service.jsp with click on button in the home.jsp Thank you.

A: You should use forward to access the file under WEB-INF.
There are two methods for you to choose:
1.look like this :
 <!--  /test/test2.jsp  outside WEB-INF -->
<html>
<body>
<form name="testform">
<jsp:forward page = "/WEB-INF/jsp/test/test.jsp" />
</form>
</body>
</html>

2.use struts to forward
<action path="/test" type=" test.TestAction" scope="request">
<forward name="test" path="/WEB-INF/jsp/test/test.jsp"/>
</action>

A: why is it contradictory ? i want my application to access to that file and keep it away from reach by typing a simple URL.
I finally found what i have to do.
I created a servlet let's say serviceServlet.java in which i include this line in the doGet() method:
    this.getServletContext().getRequestDispatcher("/WEB INF/service.jsp").forward(req, resp);

This line will forward my request to the service.jsp file under WEB-INF.
Next step i defined in my web.xml a url pattern to redirect to that servlet when clicking a button say /service like this
    <servlet>
    <servlet-name>serviceServlet</servlet-name>
    <servlet-class>mypackage.CloudUploadserviceServlet</servlet-class>
    </servlet>
    <servlet-mapping>
    <servlet-name>serviceServlet</servlet-name>
    <url-pattern>/service</url-pattern>
    </servlet-mapping>

And ultimately in the home.jsp file i included this line in the onClick method to call the servlet:
   onclick="location.href='/service'"

And it's done :)

redpajama_set_name: RedPajamaStackExchange


Can a College Bound Network Improve College Dropout Rates?
Is an Online Doctorate Program Right For You?
Is It Better Going Away to College, or to Go to College Nearby?
Who Can Pursue a Degree in Business?


text:
Q: Optimizing SQL Server query SELECT TOP 10 dic.item_cd,
              dic.item_knm,
              dic.item_enm
FROM tbus.dt_item_com dic
INNER JOIN tbus.mfProd mfp ON dic.item_cd LIKE mfp.prodId
INNER JOIN tbus.plu_category plc ON mfp.prodType LIKE plc.plc_prodType
WHERE (dic.item_knm LIKE '%%'
  OR (dic.item_enm LIKE '%%')
  AND (dic.item_cd NOT IN
         (SELECT TOP 0 dic.item_cd
          FROM tbus.dt_item_com dic
          INNER JOIN tbus.mfProd mfp ON dic.item_cd LIKE mfp.prodId
          INNER JOIN tbus.plu_category plc ON mfp.prodType LIKE plc.plc_prodType
          WHERE (dic.item_knm LIKE '%%'
                 OR dic.item_enm LIKE '%%')
          ORDER BY dic.item_cd DESC))
ORDER BY dic.item_cd DESC

This is the SQL query I'm trying to optimize.
What this query does is Inner Join three tables by item names (currently it's just '%%'. It's gonna be something like '%apple%' later on'). And, cuz this is for paging, it has NOT IN syntax in there too.
The problem here is there are two duplicated INNER JOIN & WHERE phrases - one in inside of NOT IN and the other in outside.  How can I remove this duplicated codes and make it faster :( ?
(It's based on SQL Server 2000)

A: Let me answer a different question (as per the comments): How to do paging on SQL Server? You normally use the row-Number function:
select * from (
 select *, row_number() over(order by something) r
 from T
) x
where r >= 10 and r < 20

Then, all your problems go away.


If you wear frequent replacement contact lenses you're probably aware that you need a good contact lens solution to accompany them to ensure they're kept clean and disinfected on a regular basis. Lens solutions are also used for storing weekly and monthly soft contact lenses or rigid gas permeable lenses.
At Vision Direct we provide a range of different solutions to cater for everyone's needs including multi-purpose cleaning solutions, hydrogen peroxide system and gas permeable lens solutions. Most of solutions come in handy two or three month packs with essential contact lens cases for storage, and are designed to be used within 2-6 months of opening.
Some of our bestsellers include ReNu MPS Multi-Purpose Solution, Opti-Free Puremoist and Complete RevitaLens. We also sell a great assortment of travel packs designed for regular travellers and holidaymakers who would rather carry a small bottle of solution that meets airport regulations.


Every winter, I sense the need to adjust how I care for my skin. Freezing cold night temperatures give way to cold, shortened days. My wife likes to turn up the heater, as do my workplace and the stores I frequent. I enjoy a hot shower too. But I know that my psoriasis and eczema don't necessarily take well to dry, heated air and long, hot showers.
It could be the stress of the holidays, it might be because my medications have lost their effectiveness, or it could just be winter. Whatever the cause, I'm needing to take extra measures to make sure my skin is well managed and cared for.
When I last visited my dermatologist, Dr. Emanual Maverakis of the University of California, Davis Health System, I wondered what winter skincare tips he and his resident Dr. Tatyana Petukhova might have for those of us living with psoriasis and eczema.
My years of experience have helped me develop ways to manage any inevitable winter flare-ups. Here are my five recommendations with a few of my doctors' thoughts peppered in.
Without a doubt, this tip to moisturize is the one my dermatologists recommended first. Dr. Maverakis noted that using heaters in the winter dries out the skin, so more moisturizing is needed. That's my experience as well.
I took a couple of climatology classes in college. One professor used the analogy of two different-sized buckets to explain relative humidity. If you have a small bucket, and it's 80 percent full of water, then you would say it's quite full. But if you put that same amount of water in a big bucket, it might only be 20 percent full.
Cold air is like the small bucket, and hot air is like the large bucket. When cold air is heated up, as it often is indoors in the winter, the relative humidity drops. Unless water is added back into the air, such as with a humidifier, the dry air will dry out your skin.
I've noticed my skin is like a hygrometer, a device that measures humidity. I can tell when my skin is dry and needs more moisturizer. Plus, dry skin will easily become itchy and irritated. In the winter, it seems to dry out even faster than usual.
When moisturizing, I start with a layer of a lotion with ceramides (mainly for eczema) to add moisture, then lock in the moisture with a thicker, petroleum-based cream. If I am moisturizing after a bath or shower, I moisturize within a couple of minutes of getting out to trap the moisture in my skin. It took me some time experimenting with different moisturizers, and talking with my doctors, before I settled on a regimen that works for me.
Having a humidifier in the living room, bedroom, and the office helps too — especially during those cold and dry times. Dr. Petukhova also recommended using humidifiers, noting the need to "clean them regularly" and use a humidity level "that feels comfortable."
Simply put, hot water dries out your skin, and that's generally not good for psoriasis or eczema. My dermatologists noted this tip as second important after moisturizing. But I confess I like to bathe in hot water in the winter. When it's cold outside, or even cool, doesn't everyone enjoy a hot shower or bath? After seeing Dr. Maverakis, I turned back the temperature of my shower and cut down the time.
I also will take 10- to 15-minute soothing baths. I sprinkle an over-the-counter oatmeal bath packet into the water as the bath is being drawn, then I add some moisturizing oil. When I get out of the tub, I put on extra layers of moisturizer. This system seems to be working well so far, but it's hard to give up the hot water.
Staying healthy is a key strategy for my winter psoriasis care. Because I take immune-suppression drugs for psoriasis (such as cyclosporine), I easily catch viruses or get bacterial infections. The last time I had the flu (influenza A, according to the viral panel test), my skin exploded with psoriasis and eczema. To make matters worse, I couldn't take some of my psoriasis medications since they affected my immune system. It took weeks to get my skin back under control.
This year I'm focusing on prevention. I got my flu shot early. When I feel like I am about to catch a cold, I go to bed early, stay hydrated, and minimize my workload. I wash my hands regularly, especially after I've shaken someone's hand. Prevention has become more and more of my strategy to stay healthy.
Right now, two of my children have colds. At church, I see people sniffling, coughing, and sneezing. I can't completely avoid the illness around me, but awareness of what an infection will do to my skin keeps me vigilant.
I'm one of those people who wishes they didn't need to sleep so they could get more done. I enjoy my work, but it's never-ending and therefore easy to take home. I have tasks around the house, writing projects, family time, and other interests and hobbies I enjoy. With my type-A personality, it's hard to relax and rest. However, if I don't relax my stress builds and shows up on my skin.
One important way for me to find relaxation is through exercise. I often don't feel like moving in the winter, much less getting out to exercise in the cold or windy weather. Of course, when the weather is especially inclement, I can work out indoors on my rowing or elliptical machine. To further motivate me, over Black Friday weekend I bought a fitness tracking watch for the first time. So far so good.
As a geek at heart, I find the new watch gets me going to reach my goals. It also gives me data and stats on my runs, walks, and elliptical machine workouts that show me how well I'm doing.
Ultimately, my hope is that with less stress, better sleep, and a cleared-out mind through relaxation and exercise, my skin will follow in good health.
Each winter brings its challenges. My skin becomes more challenging, and work at church ramps up around the holidays. This year brought an additional crisis: my daughter had a health emergency that led to a two-week hospitalization. I had been doing well with everything else in life, but I began to feel down within a couple days of her hospital admission.
Predictably, my skin followed with increased infections (folliculitis), eczema rashes all over my face, scalp psoriasis flares, and general break-outs. Dr. Maverakis immediately noticed how much worse my skin became during this time. I told him my psoriasis didn't respond as well to my long-standing treatments.
About a week into my daughter's hospital stay, I made the decision to address my feelings in a positive way, such as taking walks, praying and meditating, and sharing my feelings with my wife and friends. I didn't want to burden others, but what happened to my daughter felt so overwhelming. Just acknowledging how I felt gave me strength to keep moving forward.
It took longer than I expected, but my daughter's conditioned improved. A couple of weeks later, my skin began to respond to my treatments again. The skin-emotion connection is still being researched, but it's clear that they are related. If you'd like to read further, you can find my thoughts on psoriasis and depression here.
It often takes experimentation and consultation with medical professionals to find out how to best manage winter psoriasis. I've shared a few of my strategies — which ones work for you?


text:
Class 9 Miscellaneous
49CFR 173.140
Class 9 Explanation
Listing of Class 9 Materials
These pages provide US DOT (U.S. Department of Transportation) definitions for class 9 materials. Title 49 of the United States Code of Federal Regulations (49CFR) also known as the Federal Motor Carriers Safty Regulations (FMCSR) requires the use hazardous materials placards when shipping hazardous materials cargo and dangerous goods in the United States. Canada, Mexico and many other countries have simular regulations that also require the use of these placards.
Clipart CD of Placards Available
CDs containing high-resolution "clipart" versions of each hazmat placard can be purchased from us for $50 U.S. including shipping (via U.S. Mail). For more information and/or to order the CD, please see our placarding CD ordering page.
Miscellaneous Hazardous Materials
A material which presents a hazard during transportation but which does not meet the definition of any other hazard class. This class includes:
Any material which has an anesthetic, noxious or other similar property which could cause extreme annoyance or discomfort to a flight crew member so as to prevent the correct performance of assigned duties; or
Any material that meets the definition in 49CFR 171.8 of this subchapter for an elevated temperature material, a hazardous substance, a hazardous waste, or a marine pollutant.
ERG GUIDE NUMBER: 171
Assignment of packing group.
The packing group of a Class 9 material is as indicated in Column 5 of the 49CFR 172.101 Table.
Last updated: Feb 2007
An online version of the USDOT hazardous materials table from 49CFR 172.101. This table can be sorted by proper shipping name, UN/NA ID and/or by primary hazard class/division.
ERG (Emergency Response Guidebook)
Have you ever wondered what those four digit numbers on the placards on the side of trucks and rail cars mean? Our online 2004ERG will give you your answer. This is an online version of the guidebook produced by the USDOT for first responders during the initial phase of a Dangerous goods/HazMat incident.
This database focuses on the most common chemical compounds used in the home and industry.
While excerpts from the Code of Federal Regulations Title 49 (49CFR) and the "Emergency Response Guidebook" are in the public domain, the image files on these pages, the design of these pages as well as all other materials on this site and graphics files are copyrighted by J.K. Barbalace, inc. Copyrighted material on this site, including graphics files, MAY NOT BE REPRODUCED in any form without the express permission.
Kenneth Barbalace. USDOT HazMat Placards - Class 9 Miscellaneous. EnvironmentalChemistry.com. 1995 - 2020. Accessed on-line: 1/23/2020
https://EnvironmentalChemistry.com/yogi/hazmat/placards/class9.html
echo USDOT HazMat Placards: Class 9 Miscellaneous (EnvironmentalChemistry.com)- Hazardous materials placards are required when shipping hazardous materials in the United States, Canada and Mexico. This page provides US DOT definitions for Class 9 miscellaneous hazards.
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PLEASE, if you like an article we published simply link to it on our website do not republish it.


text:
Marvel Two-In-One (1974-1983)
Man-Thing vs. The Thing! Ben Grimm takes a side trek to Florida after discovering a swampy menace is using a name similar to his own. It's a battle for the 'Thingdom', as the muck monster and Ever Lovin' Blue Eyed Grimm go head-to-head! But when Molecule Man makes an appearance, will these two set aside their differences?
Marvel Two-In-One Epic Collection: Cry Monster
Marvel Two-In-One Masterworks
Thing: Project Pegasus
Thing: The Serpent Crown Affair


text:
Five members of a family gunned down in Sargodha
June 23, 2018 Edit
SARGODHA (92 News) – As many as Five members of a same family were gunned down on Saturday by unidentified persons in Sargodha. As per detailed garner, some unidentified armed men attacked on a house of 50-year-old Muhammad Tafel, residence of a sweet shop owner, and opened indiscriminate firing resulting in the murder of five people and one injured. The victims were identified as Tufail, his wife Majeeda and their three children Kashif, Sammar and Sana while Asif remained safe as he was not at home. The attacker was escaped to fled from the scene after killing five persons. The deceased and the wounded were moved to a hospital while an investigation into the incident has been launched. The incident took place in a village on the outskirts of Sargodha. Taking notice of the incident, DPO directed to the police that the accused should be arrested as soon as possible. Caretaker Punjab chief minister Hasan Askari also took the the notice of this incident and directed IG Punjab to present the report.
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Travel can be a lot of fun. So, plan for the inevitable small setbacks to make your trip that much more enjoyable. The article here shares some helpful information that you can use.
TIP! When you travel in different countries, use ATM machines to withdraw pocket money instead of exchanging your currency with local currency. The exchange rate should be better.
Get educated about foreign food ingredients to prevent unintentional exposure to allergens. If you do have food allergies, it is a good idea to learn some words for food in the native language. This way you can be sure to alert wait staff of your allergies to specific foods and, in the worst case scenario, be able to inform medical professionals of your condition.
When venturing abroad, be cautious when using taxi cabs. You have to be certain that the taxi is real. Any person can throw a "taxi" label on a vehicle, meaning you may have no idea who they are or where you will end up.
When traveling on an airplane, don't rely on the airline for any of your comfort needs, even if it's an international flight. Be sure to bring a blanket, headphones or pillow if you think you'll need them. Perhaps you should bring some snacks if it is allowed.
TIP! After choosing your destination, learn more about the place you have selected. Get yourself a good map and take the time to review key spots.
When you check into a hotel, see if the alarm is set. Whether by a silly prank or accident, many travelers wake up early or late at night due to the alarm by the bed. To be sure you can rest, check that the alarm is either off or set to the time in which you want to wake up.
TIP! Are you traveling to a country that requires vaccinations? Without this certification, you may have a difficult time entering or living a country. If you don't have your certificate, authorities may quarantine you until they can verify you are telling the truth.
When you are traveling by car or plane with toddlers, you should always have interesting things available to occupy their time. Pack some of his favorite games and toys. It is also a good idea to buy a new toy or two to be used on the trip as unfamiliar toys may engage your child for longer time periods.
TIP! The shoes you wear when you go flying should be comfortable, lightweight, and easy to take off and put on. You are required to take them off when going through security checks.
Try to wear comfortable and light shoes when air traveling – shoes that you can slip out of easily. Security checks at airports now require you to remove your shoes. When traveling, comfort is everything. Do not worry about serious foot support; you will be doing a lot more sitting than walking when you travel by air. Flip-flops or slip-on shoes are recommended for air travel.
TIP! Think about packing a pair of cookie sheets if you are going on the road with kids. They can be used to make flat surfaces for playing cards or a surface for coloring books.
Check the dates on when your passport expires. Different countries have different passport regulations. Some countries won't allow you to come to their country if your passport is about to expire. These periods usually range anywhere from a year to three months.
TIP! If you are traveling to foreign countries, know what to do if you lose your passport or encounter an issue. The State Department has contact information on the website for your destination's U.
Cash your traveler's checks before going shopping or eating. Many places abroad do readily take traveler's checks, but it can be a pain to use them as they are. You may discover you get shorted by using them. If so, convert them to local money before shopping.
TIP! Don't forget to check your passports' expiration dates. A lot of countries have certain rules concerning passports.
Sign up with major airlines to receive newsletters and promotions in your inbox. These e-newsletters will give you access to last-minute offers, special discounts and other deals that may not be available to anyone else. E-newsletters can provide you with money-saving discounts that are beneficial to your travel, even though they may also contribute a clogged inbox.
For many, travel is exciting and an integral part of their lives. Like many experiences in life, it can be enhanced by researching carefully and thinking things through. Use this advice when you are traveling to avoid any negative experiences.


text:
Marc Eggers (* 5. Oktober 1986 in Hamburg) ist ein deutsches Model, Laiendarsteller, Webvideoproduzent und Reality-TV-Teilnehmer.

Leben
Eggers wuchs in Hamburg auf und begann mit 12 Jahren Breakdance. Seinen ersten TV-Auftritt hatte er bei Das Supertalent als Teilnehmer im Jahr 2010. Später sah man ihn bei VOX im Jahr 2011 in der Serie Auf und davon – Mein Auslandstagebuch. Von 2014 bis 2015 wirkte er bei Berlin Models – unser Leben, unser Traum auf RTL mit. 2017 war er Teilnehmer der Tanzshow Dance Dance Dance. Zusammen mit seiner Tanzpartnerin Aminata Sanogo erreichte er den 4. Platz.

Vom 16. Juli 2019 (Folge 1655) bis zum 18. Dezember 2019 (Folge 1765) spielte er die Rolle des "Phil Hensing" bei Köln 50667.

Seit 2015 betreibt Eggers einen YouTube-Kanal namens "Thats M.E" mit rund 500.000 Abonnenten und veröffentlicht dort größtenteils humoristische Straßenumfragen. Im Mai 2022 eröffnete er seine Zweitkanal "Ran an die Banane", auf welchem er Comedy-Videos hochlädt.

Fernsehauftritte
 2010: Das Supertalent (Castingshow; RTL)
 2011: Auf und davon – Mein Auslandstagebuch (Fernsehserie; VOX)
 2014–2015: Berlin Models – unser Leben, unser Traum (Fernsehserie; als er selbst; Regie: Axel Hannemann, Miriam Dehne; RTL)
 2017: Dance Dance Dance (Tanzshow; RTL)
 2019: Köln 50667 (Fernsehserie; als Phil Hensing; Regie: Ludger Hoffmann, Michael Speckbrock; RTL II)
 2021: Promi Big Brother – Die Late Night Show (Late-Night-Show, Sat.1)

Weblinks

Einzelnachweise

Model
Deutscher
Geboren 1986
Mann
Webvideoproduzent

redpajama_set_name: RedPajamaWikipedia


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Holger Stromberg (born 15 March 1972), is a German celebrity chef. At the age of 23 in 1994, he gained his first Michelin star whilst head chef at the restaurant Goldschmieding in Castrop-Rauxel, making him Germany's youngest Michelin starred chef. He is owner and chef patron of Restaurant G in Munich, and the chef of the Germany national football team.

Career
Stromberg trained at Zur Linde in Oberboihingen, Germany, moving afterwards to Schwarzer Adler and to Le Crocodile in Strasbourg. He became head chef at Goldschmieding in Castrop-Rauxel, where he was awarded his first Michelin star at the age of 23 in 1994, becoming the youngest chef in Germany to be awarded a star. He moved onto the Mandarin Oriental, Munich where he was head chef at Restaurant Mark's until 2002.

In 2005 he opened his own restaurant, Restaurant G in Munich. During the same year, he also took over his parents' restaurant Gasthaus Stromberg in Waltrop. After the manager of the Germany national football team, Oliver Bierhoff, ate at Restaurant G in early 2007, Stromberg was asked to become the chef for the team. He accepted, and changed the way their pre-game menus were constructed to incorporate local ingredients for away games. Previously they had taken all the food for the team from Germany, but Stromberg changed this so that only the spices or herbs are transported. In constructing his menus he has also taken advice from the team's doctor, as one early creation of poppyseed dumplings could have resulted in the entire team testing positive for banned substances. Stromberg describes his style of cooking as "fancy", saying that he cooks what he wants to cook rather than following a particular trend.

References

Living people
1972 births
German chefs
People from Münster
Head chefs of Michelin starred restaurants


text:
» Rheumatoid Arthritis
The spine anatomical features
Last Updated on Tue, 11 Jun 2019 | Rheumatoid Arthritis
The complex relationships of the components of a typical vertebra may be illustrated by an exploded diagram (shown here after Kapandji). The bony elements comprise the vertebral body (1), composed of cancellous bone covered with an outer shell of cortical bone; the horseshoe-shaped neural arch (2); two articular masses or processes (3) which take part in the facet (interarticular) joints; the transverse processes (4); and the spinous processes (5). When these components are brought together they form a protective covering for the cord (6) and issuing nerve roots (7). The neural arch (2) is divided by the articular processes (3) into pedicles (8) and laminae (9).
Each vertebra articulates with the one above and below by means of the facet joints and the intervertebral discs. Each disc, lying between the hyaline cartilage endplates of adjacent vertebral bodies, is composed of a nucleus pulposus (NP) surrounded by concentric sheets of fibrous tissue (annulus fibrosis) (AF).
Movements between the vertebrae are possible in several planes, and the axes of these movements pass through the approximate centres of the intervertebral discs. At all levels of the spine, flexion (F) and extension (E), and lateral flexion (LF) to both sides are possible. In the thoracic spine, the plane of the facet joints lies in the arc of a circle which has its centre in the nucleus pulposus (CNP); as a result, (axial) rotation (AR) is possible in this part of the spine. In contrast, the orientation of the facet joints (FJ) in the lumbar region is such that rotation is blocked, i.e. virtually no vertebra! rotation occurs in the lumbar spine.
As a result of the elasticity of the annulus the nucleus pulposus is under constant pressure, and may (uncommonly) herniate into a vertebral body anteriorly (A), or centrally (Schmorl's node) (SN). A much more common occurrence is for the annular fibres to tear (as a result of trauma or degenerative changes) so that the nucleus can bulge posteriorly (P) or laterally (L): ('slipped discs' - central or lateral protrusions). A posterior (central) disc protrusion may affect the cord directly (or the cauda equina in the lower lumbar spine); this may lead to bilateral lower limb signs with or without bladder involvement. With lateral protrusions the neurological disturbance usually results from pressure on one or two nerve roots only, so that the effects are more localized and usually predominate on one side. In the neural canals (NC, circled, top right) the space for the segmental nerves is restricted, and in this region symptoms may be caused not only by disc prolapse but by any other pathology compromising the space available (e.g. arthritic facet joint lipping).
back pain_
Back pain is one of the commonest and most troublesome of complaints; its causes are legion and an exact diagnosis is often difficult. The disability with which it is usually associated is often severe and prolonged; therapy is often ineffective, and the anxious, impatient and dissatisfied sufferer often resorts to lines of treatment which are unproven, illogical and irrational. In this difficult area it is not possible to provide a guide to pathology and diagnosis which is simple and at the same time comprehensive and foolproof. Nevertheless, it may be helpful to consider this subject under three headings:
1. Back pain due to clearly defined spinal pathology, such as vertebral infections, tumours, ankylosing spondylitis, polyarthritis, Paget's disease, and primary neurological disease, osteoporotic spinal fractures, senile kyphosis, spondylolisthesis, Scheuermann's disease (spinal osteochondrosis), and osteoarthritis.
2. Back pain associated with nerve root pain, where the commonest causes are intervertebral disc prolapse and compression of nerve roots within the neural canals.
3. Back pain caused by a disturbance of the mechanics of the spine (mechanical back pain), where in the majority of cases it is not possible to discover the exact cause with any degree of accuracy. This is the largest group of conditions causing back pain, and formerly attracted many emotive but valueless names (such as lumbago, low-back strain etc).
In taking a history, examining and investigating a patient suffering from back pain, possible extraspinal causes should be excluded and an attempt should be made to place the patient in one of the three groups described above. Thereafter, and if possible, a more precise diagnosis may be attempted.
Important points in history taking: 1. Note the patient's age and occupation: both may be relevant.
2. Ask about the onset of the pain:
(a) When did the symptoms commence?
(b) Was the onset slow and insidious, rapid, or sudden? The latter is strongly suggestive of mechanical factors.
(c) Was there a history of an injury, such as, for example, a sudden twist or strain, or a sneeze occurring when the patient was in a flexed position? (This is a common history in cases of intervertebral disc prolapse.)
3. Ask about any directly relevant previous history:
(a) Is there a history of a previous similar attack?
(b) Is there a history of any previous trouble with the spine?
4. Ask about the site and nature of the pain:
(a) Where is the pain situated? Is it well localized, or is it diffuse?
(b) Is the pain always present, or does it disappear at times? The latter is suggestive of a mechanical cause.
(c) Are there any factors that aggravate or alleviate the pain? Note that with mechanical back pain bending or sudden movement may make the pain worse, whereas lying flat, particularly on a hard surface, or applying local heat, or even sitting, may relieve the pain. In the case of backache associated with spinal pathology - particularly in the case of tumour, infections or inflammatory disease - the patient may be unable to find a position of rest; constant night pain (as distinct from short-lived pain when turning in bed) is a feature.
5. Ask about radiation of the pain:
(a) Does the pain radiate into the legs?
(b) If so, exactly how far down does the pain go, and what area is involved? (Note that the commonly affected roots of the sciatic nerve (L4, L5, SI) supply areas of sensation below the knee.)
(d) Is there paraesthesia?
Note that pain radiating into the legs is not necessarily due to nerve root involvement: it seems that irritation of facet joints, ligaments and muscles may produce dull, aching pain in the buttocks and backs of the thighs. In contrast, pain arising from nerve roots is usually sharp and knife-like, and in addition, in the case of the commonly affected L5 and S1 roots, it often extends below the knee to the ankle or foot. In the common situation where there is involvement of one, or at the most two, nerve roots, the whole limb cannot be affected; instead, the area of sensory disturbance should correspond with the relevant dermatome(s); and it should be noted whether paraesthesia occurs within the same restricted territory.
6. Ask about motor involvement:
(a) Has the patient noted any weakness in the lower limbs, or any muscle wasting or fibrillation?
(b) Has there been any disturbance of gait or balance, any tendency to giving-way of the legs, any sign of drop foot?
7. Make enquiries in the following areas:
(a) Has there been any malaise, fever, or involvement of other joints?
(b) Has there been any weight loss?
(c) Has the patient had any large bowel or other gastrointestinal problem?
(d) Have there been any genitourinary symptoms, especially retention or incontinence?
(e) Has the patient had any respiratory difficulty?
(f) Has the patient any symptoms suggestive of a major neurological disturbance?
A positive answer to any of these questions will generally necessitate appropriate further investigation. The possibility of an invasive primary tumour or metastatic lesion must always be kept in mind, and examination of the abdomen, rectum, and common sites of primary tumour is wise if there is any likelihood of malignancy.
The spine should then be examined clinically; if the symptoms have remained unchanged over a 2-week period, radiological examination and estimation of the sedimentation rate should be carried out. At this stage any well defined spinal pathology should be detected (such as spondylolisthesis, ankylosing spondylitis, osteitis of the spine etc.). If conditions such as these have been eliminated, the question as to whether the symptoms are due to a prolapsed intervertebral disc should be considered. The history, clinical findings, and plain radiographs of the spine should be in harmony before it is reasonable to make this diagnosis. By the process of elimination, if a diagnosis has not yet been made the patient is likely to be suffering from mechanical back pain: but note that both the history and findings should be in accord with this. If not, caution must be exercised, close surveillance should be maintained, and further investigation may be indicated.
scoliosis_
Scoliosis is primarily a lateral curvature of the spine, but there is often a degree of associated kyphosis. Mathematical analysis of the curves has revealed several distinct patterns, which are dependent on the relative contributions of these two deformities.
In the management of any case, the first and most important decision to make is whether there is any deformity of the vertebrae (structural scoliosis). If the vertebrae are normal (non-structural scoliosis) the deformity is usually due to one of the following conditions: it may be compensatory, resulting from tilting of the pelvis from real or apparent shortening of one leg. It may be sciatic and due to unilateral protective muscle spasm, especially that accompanying a prolapsed intervertebral disc. Postural scoliosis occurs most commonly in adolescent girls and generally resolves spontaneously.
In structural scoliosis there is alteration in vertebral shape and mobility, and the deformity cannot be corrected by alteration of posture. A careful history and examination is required in an attempt to find a cause and give a prognosis, the two factors on which treatment depends. Structural scoliosis may be congenital, the deformity being due, for example, to a hemivertebra (only half of a single vertebra is fully formed), fused vertebrae, or absent or fused ribs.
In paralytic scoliosis the deformity is secondary to loss of the supportive action of the trunk and spinal muscles, nearly always as a sequel to anterior poliomyelitis.
Neuropathic scoliosis is seen as a complication of neurofibromatosis, cerebral palsy, spina bifida, syringomyelia, Friedreich's ataxia and neuropathic conditions. Primary disorders of the supportive musculature of the spine are responsible for myopathic scoliosis (e.g. in muscular dystrophy, arthrogryphosis). Metabolic scoliosis is uncommon, but occurs in cystine storage disease, Marfan's syndrome and rickets.
Idiopathic scoliosis is the commonest and by far the most important of the structural scolioses, and its cause remains obscure. Several vertebrae at one or, less commonly, two distinct levels are affected (primary cur\'e). In the area of the primary curve there is loss of mobility (the fixed curve) and rotational deformity of the vertebrae (the spinous processes rotate into the concavity, and the bodies that carry the ribs in the thoracic region rotate into the convexity). Above and below the fixed primary curves, secondary curves which are mobile develop in an effort to maintain the normal position of the head and pelvis. The spinal deformity is accompanied by shortening of the trunk (which may be assessed by using anthropometric tables of normal values) and there is often impairment of respiratory and cardiac function. In severe cases this may lead to invalidism. Cor pulmonale may feature in cases where the primary curve exceeds 80°.
Once scoliosis has appeared in the growing child the natural tendency is to deterioration. The prognosis of a given case is dependent on the age of onset, the level of the spine affected, the size and number of the primary curves, and the type of structural scoliosis (e.g. idiopathic or congenital). Deterioration may stop when skeletal maturity is reached, but sometimes continues as a result of disc degeneration and vertebral subluxation: 17° deterioration in 70° thoracic curves, and 20° deterioration in 30° lumbar curves have been recorded. Generally speaking, the higher the level of the spine involved in the primary curve, and the younger the patient, the worse the prognosis. There is the notable exception that in some cases occurring in infancy there is spontaneous recovery, which is as remarkable as its mysterious onset. Favourable factors are left-sided curves occurring in the first year of life in males where there is a rib-vertebral angle of less than 20°. Life expectancy may be reduced in congenital and paralytic scolioses, but not in idiopathic scoliosis.
In all cases of structural scoliosis appropriate investigation, radiographic measurement of the curves and careful observation is essential. Note in particular:
1. Syringomyelia is present in 25% of cases of juvenile idiopathic scoliosis. As decompression may lead to improvement, and failure to decompress before attempted surgical correction or stabilization may lead to neurological complications, an MRI scan is mandatory in all cases of juvenile idiopathic scoliosis.
2. Scoliosis is not normally a painful condition at onset. When there is pain (especially night pain relieved by aspirin) the commonest cause in the adolescent is an osteoid osteoma of a pedicle.
Treatment may be advised in the face of a poor prognosis, evidence of rapid deterioration, or for cosmetic purposes. (Curves are not usually considered for correction unless they are in excess of 25-30°.) The methods available are highly specialized, as is the decision regarding their use and timing. Deterioration in a curve may be controlled by use of the Milwaukee brace (a device incorporating moulded supports for the chin, occiput and pelvis, interconnected by vertical metal struts). This support is employed in older children approaching skeletal maturity who have just acceptable curves, or it may be used in the young child until an age suitable for spinal fusion (10 or over) is reached. Other patterns of support are available, although none has been shown to have statistical superiority (and some doubts have been recently cast on their overall effectiveness). Fusion of the entire primary curve is aimed at preventing further deterioration and at allowing braces to be discarded. Prior to fusion it is necessary to correct the primary deformity as much as is possible. Often a hinged plaster spica (Risser jacket) or the surgical insertion of internal apparatus (e.g. Harrington instrumentation) is employed.
kyphosis _
Kyphosis is the term used to describe an increased convexity of the thoracic spine. This is usually obvious when the patient is viewed from the side. (Diminution of the lumbar concave curve is referred to as loss of lumbar lordosis or flattening of the lumbar curvature; in extreme cases there is reversed lordosis, or posterior convexity of the lumbar curve.)
Kyphosis generally affects a major part of the thoracic spine (i.e. several vertebrae are affected), and the increased curvature is then said to be regular. In angular kyphosis, which must be carefully distinguished, there is an abrupt alteration in the thoracic curvature which is usually accompanied by undue prominence of a spinous process (gibbus).
Where mobility is normal in the kyphotic spine, the deformity is most frequently postural in origin; this is often seen (as is postural scoliosis) in adolescent girls. In some cases the deformity is secondary to an increased lumbar lordosis (which in turn may be due to abnormal forward tilting of the pelvis, and sometimes to flexion contracture of the hips or congenital dislocation of the hips). Less commonly, kyphosis may result from muscle weakness secondary to anterior poliomyelitis or muscular dystrophy.
When the thoracic curvature is not mobile but fixed, the most frequent causes are senile kyphosis, Scheuermann's disease (spinal osteochondrosis), ankylosing spondylitis and Paget's disease. When there is an angular kyphosis the most common causes are tuberculous or other infections of the spine, fracture (traumatic or pathological, e.g. secondary to osteoporosis), or tumours. In adults the commonest tumour is the metastatic deposit, and in children the eosinophilic granuloma.
scheuermann's disease (spinal osteochondrosis)
This condition (whose exact aetiology is unknown, although there is a strong familial tendency), results in a growth disturbance of the thoracic vertebral bodies which in lateral radiographs of the spine are seen to be narrower anteriorly than posteriorly (anterior wedging). There may be associated back pain. The diagnostic protocol for the condition specifies that no fewer than three adjacent vertebrae should have at least 5° of anterior wedging. The epiphyses of the vertebral bodies are often irregular and may be disturbed by herniations of the nucleus pulposus. Nuclear herniation may occur between the epiphyses and bodies anteriorly, or into the centre of the bodies (Schmorl's nodes). Mobility is impaired, thoracic kyphosis is regular and often quite marked, and there is a compensatory increase in lumbar lordosis. Secondary osteoarthritic changes may supervene in the thoracic and lumbar spine.
The normal upper limit of the convexity of the thoracic spine (as measured by the Cobb method) is reckoned to be 45°, and cases of Scheuermann's disease in adolescence with curves of 50° or less should be observed. Where the curve is in excess of this, a Milwaukee brace, worn continuously for not less than 12-18 months (and afterwards till skeletal maturity) may be advised in an attempt to prevent deterioration. (Some question the efficacy of this method of spinal bracing.) If the curve cannot be controlled and reaches 75°, correction by surgical instrumentation should be considered. In the adult with uncontrollable pain and a curve in excess of 60°, surgical fusion may be performed.
calves disease____
Back pain in children may be accompanied by gross flattening of a single vertebral body. Symptoms usually resolve spontaneously. In many cases the pathology is due to an eosinophilic granuloma.
ankylosing spondylitis____
In this disease there is progressive ossification of the joints of the spine: its aetiology is unknown but there is a hereditary tendency, with the overall risks of children of an affected parent developing the condition being 1 in 6. The incidence is greatest in males during the third and fourth decades. Unlike rheumatoid arthritis, to which it is often related, it is comparatively rare in women.
The joints between T12 and LI are often first affected, but the rest of the thoracic and lumbar spine is rapidly involved. The costovertebral joints are usually affected, leading to a reduction in chest expansion and vital capacity. Pulmonary tuberculosis, or pulmonary infections with Aspergillus are sometimes found as a complication. Stiffness of the back and pain are the presenting symptoms in the majority of cases, but on occasion involvement of the knees or hips may first attract attention. There may be pain at the insertions of the Achilles tendons or the plantar fascia (enthesopathy).
The disease is progressive, and although it sometimes arrests spontaneously at an early stage it usually leads to complete ankylosis of the spine, with characteristic changes in the radiographs (bambooing of the spine). Progressive flexion of the spine may be severe, so that forward vision becomes impossible as the head is flexed on to the chest. The sacroiliac joints are almost invariably involved at an early stage, and there may be fusion of the manubriosternal joint. There may be a history of iritis or its sequelae. The sedimentation rate is high (40-120 mm/h), rheumatoid factor is not present, and estimations of HLA-B27 are usually positive. There is often associated anaemia, muscle wasting and weight loss.
The progress of ankylosing spondylitis may be controlled by antiinflammatory drugs, and sometimes deep X-ray therapy (in spite of the risks of aplastic anaemia) is used. Where deformity of the spine is gross, spinal osteotomy is occasionally undertaken to give the patient a tolerably erect posture. Replacement arthroplasty of the hips or knees is often carried out, even if these joints have progressed to fusion.
diffuse idiopathic skeletal hyperostosis (dish)
This comparatively benign condition, also known as Forestier's disease, is sometimes mistaken for ankylosing spondylitis. It is characterized and diagnosed by the presence of flowing calcification and ossification along the anterolateral borders of at least four contiguous vertebral bodies. The disc spaces are, however, preserved (unlike in ankylosing spondylitis), without loss of height or other degenerative changes, and the sacroiliac and the facet joints do not ankylose. Most cases are asymptomatic, or have mild or moderate restriction of movements in the parts of the spine affected. No treatment is effective.
senile kyphosis _
In true senile kyphosis the ageing patient becomes progressively stooped and shorter in stature through degenerative thinning of the intervertebral discs. Pain may occur if there is associated osteoarthritis.
In elderly women the kyphosis may be aggravated by senile osteoporosis or osteomalacia, which lead to anterior vertebral wedging and often pathological fractures. There is usually radiographic evidence of decalcification, the serum chemistry may be disturbed, and pain is a feature if there are recent vertebral body fractures.
Treatment is directed towards controlling the underlying osteoporosis or osteomalacia. Thoracic spinal supports are not particularly effective and cannot be tolerated by the elderly, but often a simple lumbar corset is helpful in relieving pain arising from the secondary increase in lumbar lordosis.
paget's disease_
Paget's disease of the spine is comparatively uncommon, and although the diagnosis is made on the radiographic findings, it may be suggested clinically by other stigmata of the disease. Paget's disease may lead to disturbance of cord function, which may often be successfully treated with bisphosphonates (e.g. etidronate and pamidronate).
tuberculosis of the spine_
Bone and joint tuberculosis is uncommon in Britain, but the incidence is increasing. The factors responsible include the increase in numbers of immunosuppressed individuals, the development of drug-resistant strains of Mycobacterium tuberculosis, and an ageing population. HIV is the leading risk factor for the reactivation of latent tuberculous infections. The World Health Organization reckons that a third of the global population is infected with the organism, and that it is the commonest cause of death and disability on a worldwide basis. About a fifth of newly diagnosed cases are extrapulmonary, and the spine is involved in 50% of cases of bone and joint tuberculosis.
The onset of spinal tuberculosis is often slow, with aching pain in the back and stiffness of the spine. There may be fever and weight loss. Radiographs taken in the earliest stages of the disease show narrowing of a single disc space; later, as the anterior portions of the vertebral bodies become progressively involved, they collapse, leading to anterior and sometimes lateral wedging of the spine. This may produce angular kyphotic or scoliotic deformities. The local abscess may expand and track distally.
The spinal cord may be compromised extrinsically or intrinsically, and weakness of the limbs or paraplegia may ensue. Extrinsic causes include caseous abscesses, granulation tissue and fluid, sequestered bone or disc material, and spinal angulation leading to kinking of the cord over an internal gibbus. Intrinsic causes include the spread of tuberculous inflammation through the cord and meninges.
Initial investigation should include radiographs of the chest, culture of urine and any sputum, Mantoux testing, brucellosis complement fixation testing and, in the case of the lumbar spine at least, an IVP (renal spread being not uncommon). CT and MRI scans of the spine are also invaluable in demonstrating the extent of bone and soft tissue involvement.
The clinical and radiological features of tuberculosis of the spine are mimicked in the early stages by other infections (especially those due to Staphylococcus aureus), and the only certain method of establishing the diagnosis in the majority of cases seen at this stage is by obtaining specimens for histological and bacteriological examination. CT-guided needle aspiration biopsy may be employed if this facility is available. Again, as the abscess is small at first and the early removal of necrotic bone and pus is generally of value from the point of view of accelerating healing, many surgeons combine these procedures. In the later stages, where there is gross bone destruction, minimal new bone formation and the formation of large abscesses, the diagnosis is seldom in doubt.
The aim of treatment is to overcome the infection, eliminate abscesses and sequestra, and promote sound fusion in the affected spinal segment to prevent any recrudescence. The mainstay of treatment is the use of the antituberculous drugs, although the emergence of resistant strains is causing problems. Sensitivity testing is advisable, and drugs should not be used in isolation. Drug therapy for periods up to 2 years was formerly advised, but it has been shown that regimens employing a combination of rifampicin and isoniazid for 6 months only seem equally effective. This is of particular importance where compliance is low. It has been noted that the addition of streptomycin to the drug regimen, bed rest, or a plaster cast do not seem to affect the outcome.
Conservative treatment alone leads to a comparatively low fusion rate, and in about 70% of adult cases there is a deterioration in the kyphosis. In those parts of the world where resources are good, there is at present a trend to early surgical intervention to achieve or accelerate the healing process and assist fusion by early drainage of abscesses and bone grafting. Where paraplegia is due to intrinsic causes, it may resolve following antituberculous therapy, but in many cases the causes are extrinsic, and surgery is indicated to decompress the cord. An MRI scan may give valuable assistance in selecting cases and delineating the scope of the surgery required. If adequately dealt with in the early stages (i.e. within 6-9 months of the onset of paraplegia) complete cure is often achieved. In paraplegia of late onset, where the cord is often acutely angled over an internal gibbus, surgical intervention should always be carried out, but the prognosis here is less good.
pyogenic osteitis of the spine__
Pyogenic osteitis of the spine is relatively uncommon. In the early stages of the disease differentiation from tuberculosis of the spine is often extremely difficult, so that the diagnosis may not be clearly established unless material is provided for bacteriological examination. Specimens may be obtained by needle biopsy with the use of an image intensifier, or by exploration. At a later stage (and many cases may delay in their presentation) exuberant new bone formation in the region of the lesion may favour this diagnosis. The presenting features are of pain and stiffness in the back, often insidious in onset, but sometimes occurring quite rapidly. Nearly all cases resolve with prolonged treatment with the appropriate antibiotic (the majority are due to a staphylococcal infection, but Salmonella, B. typhosus and other organisms are sometimes causal).
metastatic lesions of the spine_
Metastatic disease of the spine is seen particularly in the elderly and may be complicated by paraplegia. The diagnosis is made on the radiographic findings. Treatment of the uncomplicated lesion is dependent on the nature of the primary tumour; in some cases deep X-ray therapy and supportive measures may help the local lesion and give relief of pain. Where paraplegia is present, decompression should be undertaken unless the case is terminal. Primary tumours of the spine are rare; the common types are mentioned in the Cervical spine section.
spondylolysis, spondylolisthesis _
In the erect position there is a tendency for the body of the fifth lumbar vertebra (carrying the weight of the trunk) to slide forwards on the corresponding surface of the sacrum, as the plane of the L5-S1 disc is not horizontal but slopes downwards anteriorly. This movement is usually prevented by the downward-projecting inferior articular processes of the fifth lumbar vertebra impinging on the corresponding upward-projecting articular processes of the sacrum. This mechanism may fail if there is a fracture or defect in the part of the fifth lumbar vertebra lying immediately anterior to its inferior articular process. A defect in this region, if unaccompanied by any significant forward movement of the vertebral body, is known as spondylolysis. The defect may be unilateral or bilateral. When forward slip occurs, the condition is known as spondylolisthesis. Less commonly, the fourth lumbar vertebra may be involved, the slip occurring between L4 and L5.
Both congenital and developmental factors have been recognized in the causation of the condition. There is a higher incidence in the families of those affected (30-70%, with dominant transmission), in certain Inuit tribes (where it reaches 54%), and among the Japanese. The lowest incidence is in black females (1.1%), and in white males it is 6.1%. Defects are rare at birth and before the age of 5, but the incidence in the population goes on increasing up to the end of the fourth decade. Fractures due to trauma or fatigue are thought to be the most likely cause, and this explains the high incidence amongst gymnasts, weightlifters, labourers, loggers and backpackers. It may be associated with sacral spina bifida and Scheuermann's disease.
Both spondylolysis and spondylolisthesis give rise to low back pain which radiates into the buttocks. In adolescents, the majority of whom are active in sports, resolution of symptoms may be achieved in 80% of cases by the avoidance of sports and the use of a corset support. This may lead to the healing of hairline fractures, or to the spine stabilizing as a result of degenerative changes occurring at the level of the slip. In more severe cases, where there is significant forward slip, local spinal fusion is the treatment of choice. This may be performed with or without reduction of the deformity.
A number of patients may suffer from neurological disturbances in the lower limbs, either initially or as an uncommon complication of a local fusion. In the cauda equina syndrome there is usually low back pain with radiation into the buttocks, spinal stiffness, hamstring spasm, gait abnormalities, and disturbance of bladder and bowel control. This may be due to an associated disc protrusion, or be caused by the cauda equina and roots of the lumbosacral plexus being stretched over the prominent upper edge of the fifth lumbar vertebra or the sacrum. These complications should be dealt with by an immediate decompression procedure.
osteoarthritis (osteoarthrosis) _
Primary osteoarthritis of the spine is extremely common, especially in the elderly, and is often asymptomatic. In the majority of cases there are no obvious causes, apart from those associated with the degenerative processes of age. Sometimes obesity and excessive use of the spine by manual workers may be factors. In secondary osteoarthritis, previous pathology in the spine accelerates normal wear and tear processes.
Occasionally osteoarthritis may be localized to one spinal level, at for example the site of a previous fracture or a prolapsed intervertebral disc. Often, however, many vertebral levels are affected, particularly where there is some alteration in the normal curves of the spine; for example, secondary osteoarthritic changes may occur in the lumbar spine when lumbar lordosis is increased as a sequel to Scheuermann's disease of the thoracic spine.
Osteoarthritis of the spine may be accompanied by disc degeneration, anterior and posterior lipping of the vertebral bodies, narrowing and lipping of the facet joints, and sometimes abutment of the vertebral spines (kissing spines) as a result of disc degeneration bringing the vertebrae nearer together.
When osteoarthritis gives rise to symptoms, these are usually of pain and stiffness in the back; once other conditions have been eliminated, the radiological appearances are diagnostic. Treatment is by weight reduction where applicable, spinal exercises to improve the back musculature, and analgesics. Short-wave diathermy is sometimes helpful. In the commonest area, the lumbar spine, a corset support is a widely used and generally very helpful line of treatment. Only rarely is spinal fusion indicated, but this is sometimes considered in the younger patient suffering from secondary osteoarthritis localized to a single level of the spine.
rheumatoid arthritis__
Rheumatoid arthritis may affect the spine; other peripheral sites are normally involved, so that the diagnosis is not normally difficult. Radiographs of the spine in rheumatoid arthritis generally show widespread osteoporosis, disc space narrowing, narrowing of the facet joints, and often reduction in the height of vertebral bodies. The treatment is that of generalized rheumatoid arthritis; locally, corset supports may give considerable relief of symptoms.
spina bifida_
Spina bifida is a condition in which there is a congenital failure of fusion of the posterior elements of the spine, through which the contents of the spinal canal may herniate. The grosser forms in the newly born child present no difficulty in diagnosis. A number require and are amenable to immediate surgery, which may prevent early death from ascending meningitis and ameliorate the frequently concomitant neurological and hydrocephalic problems. The residual neurological defect may unfortunately be profound, and the selection of cases for surgery is specialized and to some extent controversial.
The older child or adult may present with spina bifida occulta, which is diagnosed by radiological examination, although it may be suspected by the presence of a hairy patch, naevus or fat pad, or dimpling of the skin at the site of the abnormality. Many cases are symptom free. In some the only manifestation may be the presence of pes cavus. In others there may be progressive bladder dysfunction, weakness and incoordination of the legs, or trophic changes in the feet.
spinal stenosis__
A decrease in the sagittal diameter of the spinal canal, perhaps associated with narrowing of the nerve root tunnels, may give rise to symptoms of vague backache and morning stiffness. Occasionally there may be temporary motor paralysis or neurogenic claudication, where there are lower limb pains, cramps and paraesthcsiac related to walking or exercise. There may be weakness or giving-way of the legs. The claudication distance is variable, and pain may be rapidly relieved by forward flexion of the spine or by sitting. The sensory loss is segmental, and impulse symptoms are usually present. (In claudication due to vascular insufficiency the claudication distance is constant, the peripheral pulses are usually absent, and the sensory loss generally of the stocking type.) The average age of presentation is 65. Clinically the straight leg-raising test is hardly ever affected, but motor disturbances and absence of the knee jerk are common.
Spinal stenosis is common in achondroplasia, but is more commonly found as a complication of osteoarthritis of the lumbar spine, spondylolisthesis, Paget's disease, previous fracture or spinal surgery. In others the condition may be suspected on clinical grounds. Analysis of the dimensions of the pedicles and the spinal canal in the plain radiographs may be helpful in establishing the diagnosis, but CT and MRI scans reliably demonstrate the space available within the spinal canal for the neurological structures.
If symptoms are marked and the patient is otherwise fit, gratifying relief is often achieved by a decompression procedure.
the prolapsed intervertebral disc (pip)___
In the commonest pattern of intervertebral disc prolapse, a tear in the annulus allows protrusion of the semiliquid nucleus pulposus. This may be limited by intact fibres at the periphery of the annulus (contained prolapse). In other cases extrusion of the nucleus is usually more extensive and the prolapsed material may be cut off from its source (sequestered disc prolapse).
Lumbar disc prolapses are by far the most common, and the diagnosis is usually made on the clinical evidence alone. Confirmation may be obtained by means of non-invasive procedures such as CT and MRI scans.
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When you hear the word arthritis, images of painful hands and joints comes into play. Few people fully understand arthritis and this guide is dedicated to anyone suffering with this chronic condition and wants relief now.
Spine Healing Therapy
Beat Arthritis Naturally
Getting Powerful Shapely Glutes
Instant Remedies for Arthritis
Guide To Painful Conditions Around The Ankle
Uncovertebral Osteophytes
Simian Posture In Pagets Disease
Dermatome - Rheumatoid Arthritis
The wrist - Rheumatoid Arthritis
Osteoarthritis, Spinal, Spine, Lumbar Spine, Buttocks, Thoracic Spine
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