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The term anomic aphasia is reserved for unusual cases in which a naming problem overshadows all other de cits. Anomia may often be seen as a residual de cit following recovery from other types of aphasia. Cross References Aphasia; Circumlocution; Paraphasia Anosmia Anosmia is the inability to perceive smells due to damage to the olfactory path ways (olfactory neuroepithelium, olfactory nerves, rhinencephalon). Rhinological disease (allergic rhinitis, coryza) is by far the most com mon cause; this may also account for the impaired sense of smell in smokers. Head trauma is the most common neurological cause, due to shearing off of the olfactory bres as they pass through the cribriform plate. Recovery is possible in this situation due to the capacity for neuronal and axonal regeneration within the olfactory pathways. Cross References Age-related signs; Ageusia; Cacosmia; Dysgeusia; Mirror movements; Parosmia Anosodiaphoria Babinski (1914) used the term anosodiaphoria to describe a disorder of body schema in which patients verbally acknowledge a clinical problem. La belle indifference describes a similar lack of concern for acknowledged disabilities which are psychogenic. Some authorities would question whether this unaware ness is a true agnosia or rather a defect of higher-level cognitive integration. Anosognosia with hemiplegia most commonly follows right hemisphere injury (parietal and temporal lobes) and may be associated with left hemine glect and left-sided hemianopia; it is also described with right thalamic and basal ganglia lesions. Many patients with posterior aphasia (Wernicke type) are unaware that their output is incomprehensible or jargon, possibly through a fail ure to monitor their own output. The neuropsychological mechanisms of anosognosia are unclear: the hypothesis that it might be accounted for by personal neglect (asomatognosia), which is also more frequently observed after right hemisphere lesions, would seem to have been disproved experimentally by studies using selective hemisphere anaesthesia in which the two may be dissociated, a dissociation which may also be observed clinically.

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Carbon monoxide is a colorless, odorless gas that is produced by natural gas heaters and is found in car exhaust. Finally, carbon tetrachloride can produce liver dam age (with steatosis), while ethylene glycol, commonly used as an antifreeze, is toxic to humans (and cats and dogs) because it causes a metabolic acidosis and acute tubular necrosis in the kidney, as ethylene 184 Pathology glycol is metabolized to calcium oxalate (polarizable crystals), which are deposited in the renal tubules. One hypothesis con cerning the pathogenesis of this abnormality is that a decrease in the amount of total body fat will decrease serum levels of leptin, a substance that is thought to normally stimulate gonadotropin release from the pituitary. Weight-loss induced amenorrhea is also seen with anorexia nervosa, which refers to self-induced starvation, usually in previously healthy young females. Decreased thyroid hormone leads to signs and symptoms of hypothy roidism, which include cold intolerance, bradycardia, constipation, and skin and nail changes. Decreased estrogen can produce osteoporosis, while cardiac arrhythmias may result from hypokalemia and may cause sudden death. Compare anorexia nervosa to bulimia, which refers to binge eating followed by induced vomiting, usually in previously healthy young females. Bulimia is also associated with menstrual irregularities; complications include electrolyte abnormalities (hypokalemia) and aspiration of gastric contents. In contrast, the Sonic Hedgehog gene par ticipates in the anterior-posterior symmetry of initial limb bud development and also in brain development, while the Cdx-1 gene is a murine gene expressed in cells participating in gastrulation. The receptor for the Sonic Hedgehog gene protein is probably the patched receptor. The T stands for toxo plasma, the O for others, the R for rubella, the C for cytomegalovirus, and the H for herpes simplex virus. Once the mater nal antibodies cross the placenta, the fetal red cells are destroyed, leading to a hemolytic anemia. The breakdown of hemoglobin leads to hyperbiliru binemia (jaundice), which is due to severe unconjugated hyperbilirubine mia, as the released heme is not easily conjugated by the immature newborn liver, which is deficient in glucuronyl transferase. In an infant with a poorly developed blood-brain barrier, the bilirubin may bind to the lipids in the brain and produce kernicterus. The severe anemia may result in congestive heart failure, which, together with hypoproteinemia may lead to generalized edema (anasarca), which in its most severe form is called hydrops fetalis. In order for the mother to make antibodies that are directed against fetal erythrocyte antigens, she must lack the erythrocyte antigens that the child has, which were inherited from the father. Therefore, for Rh incompatibil ity, the mother must be Rh negative (d), the child Rh positive (D).

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However, widespread use of Christian Barnard in 1967, cardiac transplantation and drug-delivering stents has made it possible to overcome prolonged assisted circulation is being done in many several long-term complications of coronary stening. Most frequently used is autologous graft of higher incidence of malignancy due to long-term adminis saphenous vein which is reversed (due to valves in the vein) tration of immunosuppressive therapy. One of the main and transplanted, or left internal mammary artery may be problems in cardiac transplant centres is the availability of used being in the operative area of the heart. In a reversed saphenous vein graft, long-term luminal into cardiac myocyte has generated interest in treatment of patency is 50% after 10 years. The airways of the lungs arise from the trachea by its division into right and left main bronchi which continue to divide and subdivide further, eventually terminating into the alveolar sacs (Fig. The right main bronchus is more vertical so that aspirated foreign material tends to pass down to the right lung rather than to the left. The trachea, major bronchi and their branchings possess cartilage, smooth muscle and mucous glands in their walls, while the bronchioles have smooth muscle but lack cartilage as well as the mucous glands. Between the tracheal bifurcation and the smallest bronchi, about 8 divisions take place. The bronchioles so formed further undergo 3 to 4 divisions leading to the terminal bronchioles which are less than 2 mm in diameter. An acinus consists of 3 parts: glands and neuroendocrine cells which are bronchial counter 1. Several (usually 3 to 5 generations) respiratory bronchioles parts of the argentaffin cells of the alimentary tract originate from a terminal bronchiole. Each respiratory bronchiole divides into several alveolar of bronchi and its subdivisions as well as from alveoli. Each alveolar duct opens into many alveolar sacs (alveoli) ciliated epithelium but no mucus cells and hence, unlike the which are blind ends of the respiratory passages. In case of blockage of one side of circulation, the the alveolar walls or alveolar septa are the sites of supply from the other can maintain the vitality of pulmonary exchange between the blood and air and have the following parenchyma. The capillary endothelium lines the anastomotic capillaries intercommunicating lymphatics on the surface which drain in the alveolar walls.

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At the same time in the narrowest at the nasofrontal groove, and then become lower cartilaginous vault, the nostrils flare, increasing wide again at the rhinion. The nasion refers to the nasofrontal suture, where the lower lateral cartilages or alar cartilages are responsi the nasal bones fuse with the frontal process. The rhin ble for the support and configuration of lower third of the ion is where the caudal border of the nasal bones meets nose. They do, however, tightly sandwich the caudal sep Nasion Nasal bones tum, a relationship that is important for tip support. Keystone area the intermediate or middle crura form the Radix bridge between the medial and lateral crura. The Nasal process Rhinion of maxilla point at which the medial crura diverge is most commonly considered the start of the intermediate Upper lateral crura. This bend in the alar cartilage is called the Anterior cartilages point of divergence or the medial genu. Angles greater than this tend to create a Alar cartilages boxy or bifid nasal tip. Posterior the apex of the alar cartilages is called the dome, lat septal eral genu, or tip-defining point. This is the area where angle Caudal the intermediate crura merge with the lateral crura. The lateral crura then extend laterally but do not paral tilages are almost free floating, only loosely connected by lel the entire rim of the nostril. It is the medial crura form the shape of the columella and the soft tissue of the lobules that create the shape of the the nostril medially. The the three major factors in nasal tip support all most posterior portion, called the medial crural foot relate to the alar cartilages. The anterior projection of the Tip radix can dramatically affect the overall length of the nose. A deep radix can create the illusion of a dorsal hump or make a small hump look much larger. Alar facial A shallow nasofrontal angle in the presence of a dorsal groove hump may create too straight a line between forehead Nasolabial angle and dorsum once the hump is removed. First, immediately above the tip, there should be a mild depression called ment to the upper lateral cartilage.

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