By S. Kan. Reed College. 2017.

Recovery of normal renal function has been documented in patients requir- ing dialysis who received ACE inhibitors buy 300mg lopid with visa. A 35-year-old woman known to have long-standing scleroderma comes to you complaining of worsening constipation. She has been experiencing constipation for the past several months; recently, her constipa- tion has become associated with abdominal pain and very hard stools. Which of the following is NOT a gastroenterologic complication of scleroderma? Esophageal dysmotility, gastroparesis, and intestinal pseudo-obstruction C. Achalasia Key Concept/Objective: To be aware of the different manifestations of scleroderma in the GI tract 16 BOARD REVIEW Although not completely understood, scleroderma-associated lesions of the GI tract appear to be the result of autonomic nerve dysfunction of the GI tract. In time, this autonomic nerve dysfunction leads to smooth muscle atrophy and eventually irreversible muscle fibrosis of the gut. As a consequence, hypomotility of the esophagus, stomach, and small and large intestine are seen in patients with systemic sclerosis. Esophageal dysmotility is associated with reflux and, eventually, strictures and even changes associated with Barrett esophagus. Involvement of the stomach and small intestine is associated with gastropare- sis and pseudo-obstruction, respectively. The presence of wide-mouth diverticula is pathognomonic of scleroderma. The lower two thirds of the esophagus show an absence of peristaltic waves and incompetence of the lower esophageal sphincter. Achalasia is char- acterized by an increase, not a decrease, in activity of the lower esophageal sphincter. A 34-year-old woman presents to your clinic complaining of weakness of 1 month’s duration and short- ness of breath of 2 weeks’ duration.

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The corpus callosum is the massive commissure of Studies done in these individuals have helped to clar- the forebrain purchase 300mg lopid with mastercard, connecting homologous regions of the two ify the role of the corpus callosum in normal brain func- hemispheres of the cortex across the midline (see also tion. Under laboratory conditions, it has been possible to Figure 16). This dissection shows the white matter of the demonstrate in these individuals how the two hemispheres corpus callosum, followed to the cortex. In the midline, of the brain function independently, after the sectioning the thickened anterior aspect of the corpus callosum is of the corpus callosum. These studies show how each called the genu, and the thickened posterior portion is the hemisphere responds differently to various stimuli, and splenium (neither has been labeled). CEREBRAL HEMISPHERES 10 These association bundles are extremely important in informing different brain regions of ongoing neuronal pro- cessing, allowing for integration of our activities (for WHITE MATTER: LATERAL DISSECTED VIEW example sensory with motor and limbic). One of the major — ASSOCIATION BUNDLES functions of these association bundles in the human brain (PHOTOGRAPH) seems to be bringing information to the frontal lobes, especially to the prefrontal cortex, which acts as the “exec- The dorsolateral aspect of the brain is being viewed in utive director” of brain activity (see Figure 14A). The lateral fissure has One of the most important association bundles, the been opened, with the temporal lobe below; deep within arcuate bundle, connects the two language areas. It con- the lateral fissure is the insula (see Figure 14B and Figure nects Broca’s area anteriorly with Wernicke’s area in the 39). It is possible to dissect various fiber bundles (not easily) using a blunt instrument (e. Some of these, functionally, are the association bundles, fibers that interconnect different parts of the cere- Damage to the arcuate bundle due to a lesion, such as an bral cortex on the same side (classified with Figure 16). Aphasia is a association bundles within the hemispheres. The superior general term for a disruption or disorder of language. In longitudinal fasciculus (fasciculus is another term for a conduction aphasia, the person has normal comprehension bundle of axons) interconnects the posterior parts of the (intact Wernicke’s area) and fluent speech (intact Broca’s hemisphere (e.

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B Pres- ence of tonque atrophy Bulbospinal muscular atrophy (BSMA) purchase 300mg lopid free shipping, or Kennedy’s syndrome, affects the Anatomy lower (alpha) motor neurons found in the brainstem cranial nerve motor nuclei and the anterior horns of the spinal cord. On autopsy, patients with BSMA show mild atrophy of the brainstem and spinal cord. Muscle atrophy is also present, with signs of denervation and reinnervation. The mean onset for BSMA is 30 years (range, 15–60 years). Patients exhibit Symptoms symmetrical weakness that progresses slowly over many years, and typically do not need canes or walkers until they are in their fifties or sixties. Facial, tongue, and proximal weakness are typical at presentation. Dysphagia, dysarthria, and masseter weakness are commonly observed. As BSMA only affects lower motor neurons, there are no upper motor neuron Signs signs. Vibratory sensation may be reduced, and patients often show a mild postural tremor. BSMA is an X-linked recessive disorder, caused by a tri-nucleotide repeat Pathogenesis expansion in the first exon of the androgen receptor gene on chromosome Xq11–12. It is unknown how disruption of the androgen receptor in this way leads to specific loss of lower motor neurons, as there are other mutations in 452 this gene that cause testicular feminization but have no affects on motor neurons. Diagnosis Genetic: Patients with appropriate signs and symptoms are diagnosed by positive genetic testing.