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Cortical blindness due to bilateral (sequential or simultaneous) posterior cerebral artery occlusion may leave a small central eld around the xation point intact, also known as macula sparing. Macula splitting, a homonymous hemianopia which cuts through the verti cal meridian of the macula, occurs with lesions of the optic radiation. Hence, macula sparing and macula splitting have localizing value when assessing homonymous hemianopia. This tetanic posture may develop in acute hypocalcaemia (induced by hyperventilation, for instance) or hypomagnesaemia and reects muscle hyperex citability. Likewise, bilateral neural gic amyotrophy can produce an acute peripheral man-in-a-barrel phenotype. Cross References Flail arm; Quadriparesis, Quadriplegia Marche a Petit Pas Marche a petit pas is a disorder of gait characterized by impairments of balance, gait ignition, and locomotion. Particularly there is shortened stride (literally marche a petit pas) and a variably wide base. This gait disorder is often associated with dementia, frontal release signs, and urinary incontinence, and sometimes with apraxia, parkinsonism, and pyramidal signs. This constellation of clinical signs reects underlying pathology in the frontal lobe and subjacent white matter, most usually of vascular origin, and is often associated with a subcortical vas cular dementia.

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Georg Thieme, Triantafyllou A, Laskaris G: Papillary syringadenoma of the Stuttgart, 1959. Pathology-diagnosis-treatment-facial Triantafyllou A, Sklavounou A, Laskaris G: Benign fibrous surgery. Tumorlike Lesions oral salivary glands: A demographic and histologic study of 426 cases. Clinicopathologic study of 224 new cases relationship of its pathogenesis to its clinical characteristics. Am J Surg Pathol 5:37, sialometaplasia of palatal minor salivary glands: A report on 1981. Immunohistochemical and ultrastructural observa normal human submandibular and parotid salivary glands. Premature infants (poor absorption and ^ requirement of zinc) when weaned off breast milk (which has adequate zinc level) 2. The Hospital Juvenile Hyaline Fibromatosis for Sick Children: Atlas of Pediatrics. Vascular malformations represent errors in vas cular morphogenesis (dysplastic vessels) without true cellular proliferation and without regression. Vascular Tumors Vascular Malformations Infantile and Congenital Capillary Malformation (slow ow): Hemangiomas Port-Wine Stain (Nevus Flammeus) Kaposiform Venous Malformation (slow ow): Hemangioendothelioma Cavernous Hemangioma, Phlebectasia Pyogenic Granuloma Lymphatic Malformation (slow ow): Lymphangioma (Lymphangioma Circumscriptum Cystic Hygroma, Cavernous Lymphangioma) Tufted Angioma Arteriovenous Malformation (fast ow): Cirsoid Aneursm Congenital Combined Malformation (slow or fast ow) Hemangiopericytoma A. Paul Getz) B: Anhidrotic ectodermal dysplasia D: Palmoplantar keratoderma in Vohwinkel syndrome (Courtesy of Dr. Incontinentia pigmenti: a review and update on the molecular basis of pathophysiology. Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence.

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It is usually associated with very strong affect that the person, because of his temperament, has great diffculty in expressing. Jaspers considered that delusion is qualitatively different from normal belief, with a radical transforma tion of the meaning attached to events and incorrigible to an extent quite unlike normal belief. An overvalued idea, on the contrary, is an isolated notion associated with strong affect and abnormal personality and similar in quality to passionate political, religious or ethical conviction. Fish (1967) considered there was frequently a discrepancy between the degree of conviction and the extent to which the belief directed action. But the patient with an overvalued idea invariably acted on it, determinedly and repeatedly; it is almost carried out with the drive of an instinct, like nest building. In many respects, these defnitions attempt to locate overvalued ideas somewhere between normal beliefs and delusions. Overvalued ideas differ from delusions in that they arise comprehensibly from what we know about the person and his situation. They are more like pas sionate political, religious or ethical convictions than normal beliefs. This suggests that there is something about the tenacity of the conviction that distinguishes these overvalued ideas from normal beliefs, yet the degree of conviction and incorrigibility is thought to be less than that of delusions. It is obvious, though, that the degree of conviction is not a safe basis for distinguishing between delusions and over-valued ideas. The psychopathology is not an overvalued idea in all cases of each of these conditions; for instance morbid jealousy may be delusional and hypochon driasis may occur secondary to depressed mood. However, when an overvalued idea is found it is usually associated with abnormal personality. A husband was terrifed that his wife was being unfaithful to him because of her casually firtatious conduct. He checked on her every movement, interrogated her repeatedly, examined her underwear, employed detectives to follow her and misinterpreted any innocent contact she had with other men.

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Such a model could simply add some extra kilos, known as adjustment, to the imputed values, but of course we need to be able to justify our choice in light of what we know about the data. In general, the formulation of nonignorable models should be driven by knowledge about the process that created the missing data. Any such methods need to be explained and justied as part of the statistical analysis. Note that Q is a property of the population, so it does not depend on any design characteristics. Examples of scientic estimands include the population mean, the population (co)variance or correlation, and population factor loadings and regression coecients, as well as these quantities calculated within known strata of the population. Examples of quantities that are not scientic estimands are sample means, standard errors and test statistics. We can only calculate Q if the population data are fully known, but this is almost never the case. The goal of multiple imputation is to nd an estimate Q 36 Flexible Imputation of Missing Data that is unbiased and condence valid (Rubin, 1996). Unbiasedness means that the average Q over all possible samples Y from the population is equal to Q. This estimate is condence valid if the average of U over all possible samples is equal or larger than the variance of Q. A statistical test with a stated nominal rejection rate of 5% should reject the null hypothesis in at most 5% of the cases when in fact the null hypothesis is true. In summary, the goal of multiple imputation is to obtain estimates of the scientic estimand in the population. This estimate should on average be equal to the value of the population parameter. Moreover, the associated condence intervals and hypothesis tests should achieve at least the stated nominal value. The amount of uncertainty in Q about the true population value Q depends on what we know about Y. The possible values of Q given our knowledge of the data Yobs are cap tured by the posterior distribution P(Q|Yobs). In itself, P(Q|Yobs) is often intractable, but it can be decomposed into two parts that are easier to solve as follows: Z P(Q|Yobs) = P(Q|Yobs, Ymis)P(Ymis|Yobs)dYmis (2. P(Q|Yobs, Ymis) is the pos terior distribution of Q in the hypothetically complete data, and P(Ymis|Yobs) is the posterior distribution of the missing data given the observed data.

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