Dilantin

John Waterston MD, FRACP

• Consultant Neurologist, The Alfred Hospital, Melbourne, Vic
• Honorary Senior Lecturer, Department of Medicine, Monash University

A linear immunofluorescence pattern in the wall of the esophagus Caseating granulomas in hilar lymph nodes Councilman (apoptotic) bodies in the liver Fibrinoid necrosis around dermal blood vessels Numerous eosinophils in a nasal polyp 78 medications during childbirth cheap 100 mg dilantin with amex. A human and an animal Two individuals of different species Two individuals of the same species Two individuals of the same inbred strain Identical twins General Pathology 59 79 treatment abbreviation 100 mg dilantin order free shipping. Histologic examination of the kidney reveals neutrophils within arterioles medications removed by dialysis dilantin 100 mg buy mastercard, glomeruli medications dialyzed out order dilantin 100 mg free shipping, and peritubular capillaries. Donor cytotoxic T lymphocytes that are directed against host antigens Host cytotoxic T lymphocytes that are directed against donor antigens Donor natural killer cells that are directed against host antigens Preformed donor antibodies that are directed against host antigens Preformed host antibodies that are directed against donor antigens 80. A 28-year-old female with arthritis and a bimalar photosensitive, erythematous rash on her face b. A 35-year-old female who presents with dry eyes, a dry mouth, and enlarged salivary glands. A 47-year-old female who presents with periorbital lilac discoloration and erythema on the dorsal portions of her hands 60 Pathology 82. Workup reveals decreased left ventricular filling due to decreased compliance of the left ventricle. When viewed under polarized light, this material displays an apple-green birefringence. It is then injected intraperitoneally by percutaneous, ultrasound-guided injection at 16, 17. Autosomal dominant Autosomal recessive Mitochondrial X-linked dominant X-linked recessive General Pathology 61 85. This mass is resected and histologic examination reveals a tumor composed of cells having elongated, spindle-shaped nuclei. The tumor does not connect to the overlying epithelium and is found only in the wall of the stomach. Adipocytes Endothelial cells Glandular epithelial cells Smooth muscle cells Squamous epithelial cells 87. The pathology report from a biopsy specimen indicates that this mass is an invasive adenocarcinoma. Which one of the listed descriptions best describes the most likely histologic appearance of this tumor? A uniform proliferation of fibrous tissue A disorganized mass of proliferating fibroblasts and blood vessels A disorganized mass of cells forming keratin A uniform proliferation of glandular structures A disorganized mass of cells forming glandular structures 62 Pathology 88. A 35-year-old male presents with the new onset of a "bulge" in his left inguinal area. After performing a physical examination, you diagnose the bulge to be an inguinal hernia. You refer the patient to a surgeon, who repairs the hernia and sends the resected hernia sac to the pathology laboratory along with some adipose tissue, which he calls a "lipoma of the cord. Which one of the following features would have been present had the lesion been a lipoma rather than normal adipose tissue? Anaplasia Fibrous capsule Numerous mitoses Prominent nucleoli Uniform population of cells 89. Which one of the listed numbered sequences best illustrates the postulated sequence of events that precedes the formation of an infiltrating squamous cell carcinoma of the cervix? The lesion is removed surgically, and histologic sections reveal sheets of malignant cells with clear cytoplasm (clear cell carcinoma). Acute-transforming viruses Fungi and parasites Gram-negative bacteria Gram-positive bacteria Slow-transforming viruses 92. Point mutations of the oncogene c-ras can result in the inability of the product of this oncogene to bind with a. A 4-year-old African boy develops a rapidly enlarging mass that involves the right side of his face. Biopsies of this lesion reveal a prominent "starry sky" pattern produced by proliferating small, noncleaved malignant lymphocytes. A 76-year-old male farmer presents with a 2-cm mass on the left side of his forehead.

Each such fiber makes synaptic connection with the ganglion cell symptoms congestive heart failure purchase dilantin 100 mg on line, which continues in a postganglionic treatment kidney disease dilantin 100 mg purchase with mastercard, nonmyelinated C-fiber that then synapses on a smooth-muscle cell medications via peg tube dilantin 100 mg with amex, a gland medications used to treat anxiety cheap 100 mg dilantin free shipping, or another neuron. In the sympathetic system, the ganglia are usually in the paravertebral chain, or within some other specialized ganglia. In the parasympathetic nervous system, the ganglia are buried in the effector organs and therefore have only short postganglionic fibers. The diagnostic approach to neurological disease involves localization of the lesion followed by determination of the nature of the lesion. The disease is localized by examining the individual to ascertain which vertical pathways. Although the disease may be localized, site-specific delivery of the drug is usually not possible. A focal cortical injury may be causing seizures, but the anticonvulsant drug will reach all areas of the brain, not just the focal area. Also, various areas of the brain are highly interconnected; blocking a neurotransmitter receptor may have far-reaching consequences that extend beyond the area of interest. Despite these difficulties, medicinal chemistry of neuroactive substances is a rapidly expanding area. Since the brain controls numerous functions throughout the body, modification of neurotransmitters enables the treatment of many non-neurologic problems such as high blood pressure, cardiac arrhythmias, pulmonary bronchospasm, and irritable bowel syndrome (section 4. However, the autonomic innervation of most organs utilizes both the parasympathetic (mediated by cholinergic neurotransmitters) and sympathetic (mediated by adrenergic neurotransmitters, section 4. Thus, if one system causes an increase in some physiological action, the other will cause a decrease, and vice versa. Acetylcholine is normally an excitatory neurotransmitter, although it can occasionally show an inhibitory action in cardiac muscle. There, hyperpolarization rather than depolarization occurs because only K+ can cross the muscle membrane. Acetyl-coenzyme A (CoA) is ubiquitous; choline is obtained from phosphatidy1choline (lecithin) and free choline. It has been assumed that the neurotransmitter in cholinergic and some other neurons is released through the exocytosis of small transmitter-filled synaptic vesicles. Acetylcholine release is inhibited by one of the most potent toxins, the botulinus toxin produced by the anaerobic bacterium Clostridium botulinum. Historically, botulinum toxin was of interest because of its role in botulism food poisoning. Injections of the toxin into the muscles over the forehead or around the eyes will remove "age creases and skin wrinkles," "restoring the youthful appearance" much prized in our image-conscious society. These compounds are peptides containing from 61 to 74 amino acids, five disulfide bridges, and a high proportion of basic arginine and lysine residues, often in close proximity. Venoms are toxic because they block cholinergic neurotransmission by binding to the receptor. It can be solubilized by nonionic detergents such as Triton X-100, Tween 80, and others, or anionic detergents such as deoxycholate, a bile acid derivative. This receptor solution can then be purified further by polyacrylamide gel electrophoresis, by affinity partitioning, or, most efficiently, by affinity chromatography either on an immobilized quaternary ligand or on Siamese cobra toxin bound to an agarose bead matrix. There are four peptide chains, referred to as (mass ~ 40 kD), (~ 48 kD), (~ 58 kD), and (~ 64 kD), which can be separated by electrophoresis. The receptor of Torpedo californica has an 2 chain composition, giving it a monomeric molecular mass of 250 kD. The other chains are integral parts of the receptor and do not dissociate, even in 8 M urea. The different chains have different amino acid sequences but similar compositions. The and chains are preferentially labeled by a nitrene obtained from pyrene-sulfonylazide, a hydrophobic reagent believed to attach itself to proteins within the core of the membrane (see figure 4.

Approximately half of those with residual deficits were permanently disabled from working treatment wrist tendonitis discount dilantin 100 mg without a prescription, mostly on account of progressive parkinsonian symptoms (von Economo 1929) treatment for strep throat cheap dilantin 100 mg buy online. It was disputed whether some cases might run their course as a psychotic illness alone without somatic symptoms at any stage treatment zenkers diverticulum quality dilantin 100 mg. This could neither be proved nor disproved owing to the lack of specific tests for the disease 911 treatment center discount dilantin 100 mg fast delivery. Other forms presented with acute bulbar palsy, or monosymptomatically with intense chorea, persistent hiccough or neuritis. Abortive types were common in most epidemics, with symptoms capable of arousing suspicion during the epidemic but easily overlooked at other times. Fever might accompany the prodromal phase or persist throughout, while other cases ran their whole course without pyrexia. Many abortive cases developed only the prodrome, while others recovered early after definite symptoms and signs had appeared. Usually, however, the acute disturbances lasted for several weeks, with some months more before ocular palsies, lethargy and sleep disturbances resolved. A protracted convalescence was not uncommon, with repeated relapses and fresh exacerbations. Convalescence also brought prolonged asthenic states, incapacitating depressive illness and a variety of sleep disturbances: insomnia, sleep inversion and narcoleptic phenomena. Paralysis of external ocular movements or of isolated eye muscles was frequently permanent, also pupillary abnormalities, difficulty with accommodation and inability Chronic sequelae the most seriously disabling sequelae consisted of parkinsonian developments, change of personality and mental defect. The incidence of each varied in different epidemics, but a definite relationship emerged with regard to the age at which the acute infection had occurred. Adults tended to develop parkinsonism, children personality disturbances, and infants were left with mental defect. Generalised dementia did not appear to occur when the mature brain had been affected. Parkinsonism sometimes developed gradually out of the acute stage, or could set in unexpectedly after full recovery. In the interval the patient may have shown persistent symptoms such as headache, irritability and sleep disturbance but this was by no means invariable. Indeed as time went by it became apparent that sequelae could develop after many months or years of completely normal health. In contrast, personality change and mental defect were usually evident immediately after the acute infection. Postencephalitic parkinsonism this was the most common sequel and could develop even when parkinsonian symptoms had been absent during the acute phase. Its development was usually insidious, with weakness and slowing of movements or the gradual development of a stiff and unnatural posture. The ensuing picture closely resembled other forms of parkinsonism, with masklike face, stooping posture, festinant gait and excessive salivation. Tremor was less common than in paralysis agitans; the typical pill-rolling tremor was rarely seen, but coarser tremor and violent shaking of the limbs occasionally occurred. Paucity of movement was sometimes a striking sign even in the absence of paresis or marked rigidity. It appeared that in large degree this represented a primary disturbance of willed movement, such that the patient was unable to supply the volitional impulse despite a wish to perform. There might be much difficulty in passing from rest to activity, the patient remaining for minutes on end in a state of trance-like immobility. Or a movement once started might freeze halfway, as 446 Chapter 7 when raising a spoon to the mouth. Later typical rigidity developed, with extrapyramidal increase of tone that was obvious on examination. Characteristically, the akinesis and the rigidity could vary markedly, improving at some stage during the day, or allowing some activities while preventing others that required exactly the same musculature.

The fastigial nucleus projects to the saccadic burst generator of the brainstem via the uncinate fasciculus and controls the amplitude of ipsilateral and contralateral saccades symptoms 37 weeks pregnant effective 100 mg dilantin. If the inputs do not match medicine 319 generic dilantin 100 mg visa, an increase in firing of the inferior olivary nucleus results in an error signal treatment bulging disc dilantin 100 mg discount. The role of the inferior olive may be to provide a timing signal to the cerebellum 5 medications discount dilantin 100 mg buy on-line, and the inferior olive may contribute to detection and correction of errors in motor performance. Neurons of the inferior olivary nucleus project a low-frequency, synchronized oscillatory activity via the 164 Section I. Neuroscience and Neuroanatomy disorders resulting in cerebellar findings or ataxia, see Volume 2, Chapter 26, "Cerebellar Disorders and Ataxias. Patients have mild upper motor neuron weakness but moderate to severe ataxia on the weak side. While most commonly this stroke localizes to the ventral pons, the location is variable and can occur anywhere the corticospinal tract and cortico-pontocerebellar tracts entwine (Figure 18. The cerebellar nuclei regulate the inferior olivary nucleus via 2 competing connections. In addition, they project an indirect, excitatory projection via the red nucleus to the inferior olive. The vestibulocerebellum (flocculus, paraflocculus, and nodulus) is important in the vestibuloocular reflex and smooth pursuit. Cognitive information from diffuse areas of the cortex projects to the lateral cerebellum and returns to the cortex via the ventral dentate. The inferior olive compares intended motor commands to actual motor commands from the cerebral cortex, the brainstem nuclei, and the feedback afferent system. Ataxic hemiparesis is a clinical syndrome resulting from impairment of both the cerebrocerebellar circuit and the corticospinal tract. Where the 2 tracts are close to each other (red ovals), a lesion may result in ataxic hemiparesis. It aids in maintaining the internal environment and responds and adapts to the external environment. The autonomic nervous system consists of peripheral components (sympathetic and parasympathetic nerves) and central components (ventrolateral medulla, nucleus ambiguus, nucleus of the solitary tract, periaqueductal gray, anterior cingulate gyrus, insular cortex, amygdala, and hypothalamus). This chapter briefly reviews the anatomy and functional components of the autonomic nervous system and the anatomical clinical correlations. Clinical autonomic diseases are presented in Volume 2, Chapter 44, "Autonomic Disorders. The effects of the sympathetic nervous system depend on the target organ, but they include increased heart rate and blood pressure, increased sweating response, bronchodilatation and pupillary dilatation, and inhibition of peristalsis. In general, parasympathetic inputs produce the opposite effect of the sympathetic response (Table 19. Neuroscience and Neuroanatomy the efferent components include a preganglionic neuron at the level of either the brainstem (parasympathetic) or the spinal cord (sympathetic or parasympathetic). The axons of this neuron synapse in a peripheral ganglion, and the axons of the postganglionic neurons then innervate a target organ. Preganglionic sympathetic fiber neurons originate in the thoracolumbar region of the spinal cord. The sympathetic preganglionic neurons are located at spinal cord segments T1 through L3. The preganglionic sympathetic axons are small myelinated fibers that reach the paravertebral sympathetic chain; some synapse in paravertebral ganglia at the same level or above or below the level of entry, whereas others pass through the chain to innervate the prevertebral ganglia and the adrenal medulla. The paravertebral ganglia innervate the face, trunk, limbs, and thoracic viscera; the prevertebral ganglia innervate the abdominal and pelvic viscera. Cranial parasympathetic neurons are located in the general visceral efferent column of the midbrain, pons, and medulla. Preganglionic and postganglionic parasympathetic neurons are cholinergic; postganglionic sympathetic neurons (except those innervating sweat glands) are adrenergic. Autonomic Nervous System 167 Acetylcholine is the primary neurotransmitter at preganglionic synapses, whether sympathetic or parasympathetic, and at parasympathetic postganglionic neurons. The adrenal medulla is innervated by a preganglionic sympathetic axon, and the adrenal chromaffin cells produce primarily epinephrine. Parasympathetic postganglionic axons release acetylcholine at muscarinic receptors.

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References

• Santegoets LA, Helmerhorst TJ, van der Meijden WI: A retrospective study of 95 women with a clinical diagnosis of genital lichen planus, J Low Genit Tract Dis 14:323n328, 2010.
• Duarte MI, Corbett CE, Boulos M, Amato Neto V. Ultrastructure of the lung in falciparum malaria. Am J Trop Med Hyg 1985;34(1):31-5.
• Alsop DC, Detre JA. Multisection cerebral blood flow MR imaging with continuous arterial spin labeling. Radiology 1998;208:410-16.
• Huckabay C, Twiss C, Berger A, et al: A urodynamics protocol to optimally assess men with post-prostatectomy incontinence, Neurourol Urodyn 24:622n626, 2005.
• Gewillig M, Boshott DE, Dem J, et al. Stenting the neonatal arterial duct in duct-dependent pulmonary circulation: new techniques, better results. J Am Coll Cardiol. 2004;43:107-12.
• Hirsh J: Rationale for development of low-molecular-weight heparin and their clinical potential in the prevention of postoperative venous thrombosis, Am J Surg 161:512, 1991.