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also give rise to a variety of positive sensory visual experiences The simplest of these are called phosphenes, ie, ashes of light and colored spots in the absence of luminous stimuli Mechanical pressure on the normal eyeball may induce them at the retinal level, as every child discovers Or they may occur with disease of the visual system at many different sites As mentioned earlier, elderly patients commonly complain of ashes of light in the peripheral eld of one eye, most evident in the dark (Moore s lightning streaks); these are related to vitreous tags that rest on the retinal equator and may be quite benign or may be residual evidence of retinal detachment In patients with migraine, ischemia (or perhaps activation) of nerve cells in the occipital lobe gives rise to the bright zigzag lines of a forti cation spectrum Stimulation of the cortical terminations of the visual pathways accounts for the simple or unformed visual hallucinations in epilepsy Formed or complex visual hallucinations (of people, animals, landscapes) are observed in a variety of conditions, notably in old age when vision fails (Bonnet syndrome, discussed on page 405), in the withdrawal state following chronic intoxication with alcohol and other sedative-hypnotic drugs (Chaps 42 and 43), in Alzheimer disease, and in infarcts of the occipitoparietal or occipitotemporal regions (release hullucinations) or the diencephalon ( peduncular hallucinosis ) These disorders are discussed in Chap 22 Occasionally, patients in whom a hemianopia is evident only when tested by double simultaneous stimulation ( attention hemianopia ) may displace an image to the nonaffected half of the eld of vision (visual allesthesia), or a visual image may persist for minutes to hours or reappear episodically, after the exciting stimulus has been removed ( palinopsia or paliopsia, mentioned earlier); the latter disorder also occurs in defective but not blind homonymous elds of vision Polyopia, the perception of multiple images when a single stimulus is presented, is said to be associated predominantly with right occipital lesions and can occur with either eye Usually there is one primary and a number of secondary images, and their relationships may be constant or changing Bender and Krieger, who described several such patients, attributed the polyopia to unstable xation When this is monocular, there is either a defect in the lens or more often, hysteria Oscillopsia, or illusory movement of the environment, is a perception caused by nystagmus and occurs mainly with lesions of the labyrinthinevestibular apparatus; it is described with disorders of ocular movement (see page 237) A rare idiopathic myokymia of one superior oblique muscle may produce a monocular oscillopsia (see page 234) The clinical effects and syndromes that result from occipital lobe lesions are discussed further in Chap 22. microsoft excel 2010 barcode generator In-cell Barcode () formula for Excel - dLSoft
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Aug 8, 2011 · IDAutomation Barcode Technology. ... This tutorial explains how to create barocdes in ...Duration: 1:51 Posted: Aug 8, 2011 cannot be stimulated On the other hand, the nerve cell may be disinhibited in the anterior horn of the spinal cord, permitting the discharge of continuous action potentials, as in tetanus and the stiff-man syndrome (page 1279); the nerve ber may fail to conduct impulses (demyelinating neuropathies) or the number of bers may be inadequate to produce a fused and sustained contraction (axonal neuropathies); the neurilemma may not distribute the nerve impulse simultaneously to all parts of the motor unit; ACh may not be released at the presynaptic region of the neuromuscular junction (as occurs in botulism and in the Eaton-Lambert syndrome) or, once released, ACh may not be inactivated by cholinesterase (physostigmine, organophosphates); the receptor zone on the postsynaptic membrane may be destroyed or blocked by antibodies or pharmacologic agents (myasthenia gravis or curariform drugs); and, nally, the metabolic or contractile elements of the muscle may not react or, once contracted, may not relax Similarly, the mechanisms involved in fasciculations, cramps, and muscle spasms may be traced to a number of different loci in the neuromuscular apparatus There may be an unstable polarization of the nerve bers, as in tetany and in dehydration with salt depletion, or unexplained hyperirritability of the motor unit, as in amyotrophic lateral sclerosis The threshold of mechanical activation or electrical reactivation of the sarcolemmal membrane may be reduced, as in myotonia, or impairment of an energy mechanism within the ber may slow the contractile process, as in hypothyroidism; or a de ciency of phosphorylase, which deprives muscle of its carbohydrate energy source, may prevent relaxation, as in the contracture of McArdle disease Lesions of the most peripheral branches of nerves, which allow nerve regeneration, may give rise to continuous activity of motor units This is expressed clinically as a rippling of muscle, or myokymia (see pages 1104 and 1278) In recent years, new technologies have made it possible to isolate each of the proteins and channels involved in neuromuscular transmission and the excitation-contraction-relaxation of muscle bers The amino acid composition of most of these proteins has also been determined This information is being increasingly applied to the analysis of gene products in the normal state and under conditions of disease Pertinent comments and references to this subject are found in the chapters that follow. barcode generator macro excel Barcode Excel Add-In TBarCode Office: Create Barcodes in Excel
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