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This illustration is provided for self-evaluation of auditory or vestibu- lar pathway understanding 100mg vantin with amex, for the instructor to expand on aspects of these pathways not covered in the atlas buy 100 mg vantin otc, or both best vantin 200 mg. Optic, Auditory, and Vestibular Systems 231 232 Synopsis of Functional Components, Tracts, Pathways, and Systems Hippocampal Connections 7–32 Selected afferent and efferent connections of the hippocam- to the dentate gyrus, Ammon’s horn, and subiculum; and serotonin- pus (upper) and the mammillary body (lower) with emphasis on the ergic fibers arise from the rostral raphe nuclei. The hippocampus receives input from, and projects Clinical Correlations: Dysfunction associated with damage to to, diencephalic nuclei (especially the mammillary body via the post- the hippocampus is seen in patients with trauma to the temporal lobe, commissural fornix), the septal region, and amygdala. The hippocam- as a sequel to alcoholism, and as a result of neurodegenerative changes pus receives cortical input from the superior and middle frontal gyri, seen in the dementing diseases (such as Alzheimer disease and Pick disease). The mam- (remote memory is unaffected), impaired ability to remember recent millary body is connected with the dorsal and ventral tegmental nuclei, (new) events, and difficulty in turning a new experience (something anterior thalamic nucleus (via the mammillothalamic tract), septal nu- just done or experienced) into a longer-term memory that can be re- clei, and through the mammillotegmental tract, to the tegmental pon- trieved at a later time. Also, memory that depends on visual, tactile, tine and reticulotegmental nuclei. These represent visual Neurotransmitters: Glutamate ( )-containing cells in the agnosia, tactile agnosia, and auditory agnosia, respectively. This type of response is fluent but consists of a string of unrelated, pocampal cells that project to septal nuclei and hypothalamic struc- or even made up, “memories” that never actually occurred or make no tures. This may lead to an incorrect conclusion that the patient is suffer- to cholinergic afferents to the hippocampus that travel in the fornix. In addition to lesions in the hippocampus in these pa- addition, a gamma-aminobutyric acid ( ) septohippocampal projec- tients, the mammillary bodies and dorsomedial nucleus of the thalamus tion originates from the medial septal nucleus. The Korsakoff syndrome (see also the Wernicke- mate containing hippocampal afferent fibers arise from the adjacent en- Korsakoff syndrome) as seen in chronic alcoholics is largely owing to thi- torhinal cortex; the locus ceruleus gives origin to noradrenergic fibers amine deficiency and can be treated with therapeutic doses of this vitamin. Abbreviations AC Anterior commissure LT Lamina terminalis AmHrn Ammon’s horn MB Mammillary body Amy Amygdaloid nucleus (complex) MedFCtx Medial frontal cortex AntNu Anterior nucleus of thalamus MedTh Medial thalamus CC, G Corpus callosum, genu MTegTr Mammillotegmental tract CC,Spl Corpus callosum, splenium MtTr Mammillothalamic tract Cing Cingulum NuAcc Nucleus accumbens CingGy Cingulate gyrus OpCh Optic chiasm CorHip Corticohippocampal fibers Pi Pineal DenGy Dentate gyrus RSplCtx Retrosplenial cortex EnCtx Entorhinal cortex SepNu Septal nuclei For Fornix SMNu Supramammillary nucleus GyRec Gyrus rectus Sub Subiculum Hip Hippocampus TegNu Tegmental nuclei Hyth Hypothalamus VmNu Ventromedial hypothalamic nucleus IC,G Internal capsule, genu Review of Blood Supply to Hip, MB, Hyth, and CingGy STRUCTURES ARTERIES Hip anterior choroidal (see Figure 5–38) MB, Hyth branches of circle of Willis (see Figure 2–21) AntNu thalamoperforating (see Figure 5–38) CingGy branches of anterior cerebral Limbic System 233 Hippocampal Connections CingGy Cing IC,G For CC,G CC,Spl RSplCtx AntNu MedTh For Pi AC SepNu LT GyRec NuAcc VmNu Amy CorHip OpCh MB EnCtx DenGy Hip AmHrn Sub CingGy Cing IC,G For MTTr AntNu For AC MTegTr SepNu TegNu Hyth LT DenGy OpCh AmHrn Hip Sub EnCtx Amy MB 234 Synopsis of Functional Components, Tracts, Pathways, and Systems Amygdaloid Connections 7–33 The origin, course, and distribution of selected afferent and complex. Acetylcholine is present in afferents to the amygdala from the efferent connections of the amygdaloid nuclear complex in sagittal (up- substantia innominata, as well as from the septal area. The amygdala receives input from, Alzheimer disease and the associated dementia, there is a marked loss and projects to, brainstem and forebrain centers via the stria terminalis of acetylcholine-containing neurons in the basal nucleus of the sub- and the ventral amygdalofugal pathway. Corticoamygdaloid and amyg- stantia innominata, in the cortex, and in the hippocampus. The behavioral changes seen These neurons project, via the stria terminalis or the ventral amyg- in individuals with amygdala lesions collectively form the Klüver-Bucy dalofugal path, to the septal nuclei (VIP, NT), the bed nucleus of the syndrome. In humans these changes/deficits are 1) hyperorality; 2) visual, stria terminalis (NT, ENK, SP), the hypothalamus (VIP, SOM, SP), the tactile, and auditory agnosia; 3) placidity; 4) hyperphagia or other dietary nucleus accumbens septi, and the caudate and putamen (NT).

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Vascular resistance is high at the apex be- Transairway pressure is most negative in the condi- cause alveolar pressure exceeds capillary pressure purchase 100mg vantin free shipping. In the supine position buy 100 mg vantin otc, the heart is in most positive in the conditions described in choice D generic vantin 200 mg without prescription. Emphysema is an obstructive disor- less than venous pressure in a healthy individual, we der that leads to highly compliant lungs, while pul- have the situation that Pa Pv PA, or a zone 3. A drop in venous pressure has the stiff lungs with decreased compliance. An increase in airway diameter low- for flow is determined by the arterial-venous pressure ers airway resistance, which has the greatest effect on difference. Total lung capacity, inspiratory ca- gradient for flow in zone 2 is the arterial-alveolar pres- pacity, and tidal volume would not appreciably sure difference. A restrictive lung disease causes a de- crease in FEV1, FVC, FRC, and RV. However, the ra- apex, blood flow and airflow are lower than at the base, tio of FEV1/FVC is likely to be increased. Minute ventilation is equal to expired air per minute, tidal volume times frequency of breath- 8. The regional differences in blood ing, or alveolar ventilation plus dead space ventilation. The ventilation-perfusion ratio is (8 L/min) frequency (10 breaths/min) 0. Fibrosis leads to stiff lungs, resulting ative to blood flow; PO2 is high and PCO2 is low at the in reduced compliance and the need for more work to apex. Stiffer lungs also have greater elastic recoil, so the lungs will deflate easier. The A-aO2 gradient in a healthy per- son is due to both a low V˙ A/Q˙ ratio at the base of the 6. A decrease in capillary blood volume, surface area, cardiac output, and blood Chapter 20 hemoglobin concentration will decrease DL. The pulmonary circulation is a high- lar; that for CO2 is steeper and more linear. The blood flow, low-pressure, low-resistance, and high-compli- carries more CO2 than O2. Pulmonary vascular resistance de- the plasma carries the majority of the CO2 (mainly as creases with an increase in pulmonary arterial pressure. Pulmonary vascular re- tion will decrease the O2 content, but will not affect sistance is increased at low and high lung volumes (see the oxygen saturation or PO2. The pulmonary and the systemic cir- from hemoglobin except a rise in pH. Pressure, resistance, and compli- emia, but it will have little effect on arterial PCO2 be- ance are different.

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These include osteopetrosis vantin 100mg on line, pyknodysostosis purchase 200mg vantin otc, metaphyseal dysplasia (Pyle’s disease) buy discount vantin 100mg online, craniometaphyseal dysplasia, frontometaphyseal dyspla- Fig. Bone sia, osteodysplasty (Melnick-Needles syndrome), pro- densitometry: dual gressive diaphysial dysplasia (Camurati-Engelmann dis- energy X-ray ab- ease), hereditary multiple diaphysial sclerosis (Ribbing’s sorptiometry (DXA). The only condition to be considered in this chapter reference range for is osteopetrosis. Osteoclasts in affected bone are usually devoid of the ruffled borders by which osteoclasts adhere to the bone surface and through which their resorptive activity is expressed. In the presence of doses: 1-6 Sv) and is most often performed by radiogra- continued bone formation, there is generalised osteoscle- phers. The equipment would therefore be appropriately rosis and abnormalities of metaphyseal modeling (Fig. There have been reports of reversal of the osteoscle- spine is currently the “gold standard” for the diagnosis rosis following successful bone-marrow transplantation. Images must be scrutinized for in 1904, and is sometimes referred to as marble bone dis- abnormalities that can result in errors in DXA measure- ease, osteosclerosis fragilis generalisata, or osteopetrosis ments (osteophytes in lumbar spine) and for identifying generalisata. There are two main clinical forms: vertebral fractures and other pathologies on DXA im- 1. The latter is now feasible through improve- ifestations and an autosomal recessive transmission ment in spatial resolution of DXA images (0. Benign osteopetrosis with late manifestations inherit- faster fan beam scanning and, on some scanners, a “C”, ed by autosomal dominant transmission arm so that repositioning in the lateral position is not re- There is also a more rare autosomal recessive (inter- quired; computer-assisted diagnosis is also possible [85, mediate) form that presents during childhood, with the 86]. Bone densitometry is relevant to research and phar- signs and symptoms of the lethal form, but the outcome maceutical trials, and thus provides scientific opportuni- on life expectancy is not known. There are some limi- ly described as osteopetrosis with renal tubular acidosis tations of DXA (size dependency) that do not apply to and cerebral calcification is now recognized as an inborn QCT, which can be applied to axial and peripheral sites. The size dependency of DXA is a particular limitation of Neuronal storage disease with malignant osteopetrosis its use in growing children, in whom QCT has advan- has been described, as has the rare lethal, transient infan- tages. There is increasing interest in examining how tile, and post-infectious form of the disorder. MR imag- ing may assist in monitoring those with severe disease who undergo marrow transplantation, since success will be indicated by expansion of the marrow cavity. There is an intermediate recessive form of the disease which is milder than that seen in infants and distinct from the less severe autosomal dominant disease.

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