By B. Marcus. Northern State University.
In particular discount 20mg crestor fast delivery, their beads exhibit free areas where the axolemma is separated from the surrounding tissue by the basal lamina only order 5mg crestor fast delivery. The axoplasm that underlies the bare areas of axolemma shows a faint fila- mentous substructure and appears more electron-dense (Messlinger 1996). A high concentration of axonal mitochondria may be correlated with energy consumption and hence the activity of the sensory endings (Heppelmann et al. Probably, the sensory beads represent the receptive sites of the sensory endings (Andres and von Düring 1973; Chouchkov 1978; Munger and Halata 1983; Messlinger 1996). However, the neuropeptides, released by the endings, do not have a neurotransmitter function (for a discussion on the noceffector concept, see Kruger 1996). They are most densely arranged in the cornea, dental pulp, skin and mucosa of the head, skin of the fingers, parietal pleura, and peritoneum. The two main types of nociceptors in the skin are Aδ mechanical and C poly- modal nociceptors (Willis and Westlund 2004), although other types of nociceptors have also been described (Davis et al. Within the dermis, the afferent fiber gives off several branches that penetrate the basal lamina and extend into the epidermis. Most large axons lose their myelin sheaths and perineurium before reaching the papillary layer of the dermis, with the exception of the axons innervating Merkel cells, although those also become unmyelinated before penetrating the epidermis (Iggo and Muir 1969; Kruger et al. Cauna (1973) described an elaborate cluster of unmyelinated fibers entering the papillary layer of human hairy skin as a free "penicillate ending". Terminals that penetrate the epidermis for a con- siderable distance (to the stratum granulosum) have been reported in studies, utilizing methylene blue or silver stainings (Woolard 1935). In the beginnings of ultrastructural examination, numerous reports on the electron microscopic image of the skin receptors appeared (Halata 1975; Andres and von Düring 1973; Cauna 1973, 1980; Chouchkov 1978; Kruger et al. Even in recent papers (Kruger 1996; Kruger and Halata 1996; Messlinger 1996; Kruger et al.
Suprasellar and Parasellar Lesions 27 Suprasellar and Parasellar Lesions The most frequent suprasellar masses are: suprasellar extension of pituitary adenoma crestor 10 mg sale, meningioma generic 10mg crestor, craniopharyngioma, hypothalamic/ chiasmatic glioma, and aneurysm. These five entities account for more than three-quarters of all sellar and juxtasellar masses. Neoplastic Lesions The most common suprasellar tumor masses are suprasellar extension of pituitary adenoma and meningioma in adults, and craniopharyn- gioma and hypothalamic/chiasmatic glioma in children (Fig. Pituitary tumor – Pituitary adenoma Autopsy series indicate that asymptomatic microade- nomas account for 14–27% of cases, pars intermedia cysts 13–22%, and occult metastatic lesions 5% of patients with known malignancy. In descending order of frequency, the primary sources of pituitary metastases are:! In women: breast cancer is by far the most com- mon, accounting for over half of all secondary pituitary tumors; followed by lung, stomach, and uterus! In men: the most frequent primary tumors are neo- plasms of the lung, followed by prostate, bladder, stomach, and pancreas. On MRI, microadenomas are generally hypointense in comparison with the normal gland on T1-weighted images, and display a variable intensity on T2- weighted images. Macroadenomas have roughly the same signal charac- teristics as microadenomas, although they have a pro- pensity for hemorrhage and infarction due to their poor blood supply. Cystic areas produce low intensity signals on T1-weighted images and high intensity sig- Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. It can locate deformations of the optic tracks, chiasm, and optic nerves, and can demonstrate invasion of the cavernous sinuses or the surrounding structures by neoplasms. MRI is particularly helpful in outlining blood vessels and ruling out aneurysms – Pituitary carcinoma, or carcinosarcoma – Granular-cell tumor of the pituitary or choristoma Craniopharyngiomas These account for 20% of tumors in adults and 54% in children.
Childbirth Recent research has also shown that urinary problems may occur earlier in life for some women following a difficult or problematic childbirth purchase crestor 10mg overnight delivery. It is not clear how such problems interact with PROBLEMS WITH URINATION AND BOWELS 55 those of MS cheap crestor 20mg with visa. However, many techniques of management indicated in this section can be used, although it would be wise for women who feel their pregnancy and childbirth has affected their bladder control to seek professional help and advice. Bowel function Even for people without MS, constipation is a very common problem, as evidenced by the number of remedies available in chemist shops, but there are some special issues that may make constipation worse, more frequent, more continuous or, indeed, more problematic for people with MS. Until a few years ago problems with bowel function were thought to be relatively minor; however, recent research studies, as well as the views of people with MS, have clearly indicated that these can be a real problem. The most common issue is constipation – that is infrequent, incomplete or difficult bowel movements. There may also difficulties with bowel urgency, where there is a need to pass a stool immediately or urgently, or with bowel incontinence, where control of defaecation is effectively reduced or lost. Constipation Constipation is problematic in MS because it can make other symptoms, such as spasticity and urinary difficulties, worse as well as producing pain or discomfort. Constipation may result from several causes in MS: • Demyelination may reduce the speed with which the movement passes through the bowel; as moisture is drawn from the stool continuously, the lower the speed, the more the movement becomes dry and hard and difficult to pass. When MS becomes more severe, it is much more likely that people with the disease will have difficulty evacuating their bowels, as various 56 MANAGING YOUR MULTIPLE SCLEROSIS body systems linked to this process become less efficient. You may need to undergo detailed medical investigation and get help for this problem. For most people with MS who have constipation, especially in the earlier stages of the disease, the advice is very similar to that for other people with the same problem.
