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Practical Neurology 2003; 3: 292-299 Cross References Confabulation; Dementia Amusia Amusia is a loss of the ability to appreciate music despite normal intel- ligence avana 100mg overnight delivery, memory discount 50mg avana with mastercard, and language function. Subtypes have been - 23 - A Amyotrophy described: receptive or sensory (loss of the ability to appreciate music) and expressive or motor (e. Clearly a premorbid appreciation of music is a sine qua non for the diagnosis (particularly of the former), and most reported cases of amusia have occurred in trained musicians. Others have estimated that amusia affects up to 4% of the population (presumably expressive). Amusia may occur in the context of more widespread cognitive dysfunction, such as aphasia and agnosia. It has been found in associ- ation with pure word deafness, presumably as part of a global auditory agnosia. Isolated amusia has been reported in the context of focal cere- bral atrophy affecting the nondominant temporal lobe. However, func- tional studies have failed to show strong hemispheric specificity for music perception, but suggest a cross-hemispheric distributed neural substrate. An impairment of pitch processing with preserved aware- ness of musical rhythm changes has been described in amusics. Psychological Science 2004; 15: 356-360 Schuppert M, Münte TF, Wieringa BM, Altenmüller E. Receptive amusia: evidence for cross-hemispheric neural networks underlying music processing strategies. Amsterdam: North-Holland Publishing, 1969: 195-206 Cross References Agnosia; Auditory agnosia; Pure word deafness Amyotrophy Amyotrophy is a term used to describe thinning or wasting (atrophy) of musculature with attendant weakness. This may result from involve- ment of: ● Lower motor neurones (in which case fasciculations may also be present): Amyotrophic lateral sclerosis Benign focal amyotrophy/monomelic amyotrophy Disinhibition-dementia-parkinsonism-amyotrophy complex (DDPAC) Amyotrophic Creutzfeldt-Jakob disease (obsolete term) “Asthmatic amyotrophy” (Hopkins’ syndrome) ● Nerve roots: Diabetic amyotrophy (polyradiculopathy, especially L2-L4) ● Plexus: Neuralgic amyotrophy (Parsonage-Turner syndrome) Hence although the term implies neurogenic (as opposed to myogenic) muscle wasting, its use is nonspecific with respect to neuroanatomical substrate. These negative sensory phenomena may occur as one component of total sensory loss (anesthesia) or in iso- lation. Consequences of analgesia include the development of neu- ropathic ulcers, burns, Charcot joints, even painless mutilation or amputation. Congenital syndromes of insensitivity to pain were once regarded as a central pain asymbolia (e.

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H2] species formed during the initial approach stage persists for durations up to 120fs before it fragments 50 mg avana mastercard, during which time the excitation energy carried by the Na* atom is funnelled into the H2 coordinate by repeated multidimensional transfer of population between the colliding partners buy 200 mg avana otc. The collision is said to be ‘sticky’, as the Na* H2 collide, bounce off one another and exchange energy and population over a time scale that is very long compared to the period of H2 vibrations (about 8fs). A cluster is a smallish globule, com- prising up to about 1000 atoms or molecules held together by weak attrac- tive forces, that is supremely well-suited for the study of ultrafast phenomena in which many-body effects dominate the collisional outcome. The most important of these concern the fate of the energy initially depos- ited in the cluster by the laser pulse as a result of intra- and intermolecu- lar energy redistribution, coherence loss of the nascent wavepacket and molecular fragmentation, and how these effects evolve with increasing degrees of freedom. A popular choice for investigation has been the disso- ciation of molecular halogens attached to one or more rare gas atoms. A recent experimental study by the group of Neumark at UC Berkeley, _ USA, on the dissociation of the negatively charged diiodide (I2) ion in the presence of zero, six or 20 argon atoms exemplifies marvellously the way in which the issues listed above can be successfully addressed by femtose- cond spectroscopy. In these experiments, the dissociation of size-selected _ I2·Arn clusters was triggered using 100fs pulses from a Ti:sapphire laser and monitored by a second ultrafast pulse which detaches the excess electron from the negatively charged molecule. Measurements of the kinetic energy distribution of the photoejected electrons, called a photoelectron spec- trum, as a function of pump-probe delay time turn out to be an extremely sensitive probe of the rapidly changing local environment of the detached electron, in that they reveal how the forces between the iodine atoms and between the I2 molecule and its immediate surroundings evolve during the dissociative separation of the halogen atoms. The experiments show that, whereas in the absence of argon atoms the break-up of diiodide to I and I– evolves over a time scale of 250fs, it is effectively stopped and returned to near its starting position when 20 argon atoms form a shell around the dis- sociating molecule; subsequent to the caging process, vibrational cooling _ of the I2 molecule thereby regenerated takes an amazingly long 200ps to complete! Experiments such as these provide an incomparable level of detail on the temporal ordering of elementary processes in a multidimensional col- lisional environment. To understand the dynamical evolution of many- body systems in terms of the changing forces that act on the interacting 16 G. ROBERTS atoms requires sophisticated computer simulations to map out the motions of the individual atoms and to elucidate the structures of the tran- sient molecular configurations that control the flow of energy between atoms and molecules over a femtosecond time scale. For clusters contain- ing, say, a diatomic molecule bound to one or two atoms, with computa- tional facilities available today it is possible to carry out calculations in which the dissociative evolution along every degree of freedom is treated by quantum dynamics theory. The early-time ( 150fs) motions of the complex, which is almost T-shaped, comprise a simultaneous length- ening of the I–Br distance and a slower transfer of vibrational energy from the intramolecular mode to the IBr–Ar coordinate.

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I have seen about fifteen ally larger purchase 100mg avana visa, so that nearly every year cheap avana 200 mg, for many years, cases in which this has happened, and the events were his hat, and the helmet that he wore as a member of a in all of them so similar that one description may Yeomanry Corps needed to be enlarged.... The patients were all women, various in age and habitual posture of the patient were thus made from 40 to 60 or more years, having in common strange and peculiar. In all of them the lowered, so that the neck was very short, and the chin, disease began as an eruption on the nipple and areola. The short narrow intensely red, raw surface, very finely granular, as if chest suddenly widened into a much shorter and broad nearly the whole thickness of the epidermis were abdomen, and the pelvis was wide and low. The arms removed; like the surface of very acute diffuse eczema, appeared unnaturally long, and, though the shoulders or like that of an acute balanitis... But it has happened were very high, the hands hung low down by the thighs that in every case that I have been able to watch, cancer and in front of them. Altogether, the attitude in stand- of the mammary gland has followed within at the most ing looked simian, strangely in contrast with the large two years, and usually within one year.... In January 1876 he tion of cancer has not in any case taken place first in began to complain of pain in his left forearm and elbow the diseased part of the skin. But it grew substance of the mammary gland, beneath or not far worse, and swelling appeared about the upper third of from the diseased skin, and always with a clear inter- the radius and increased rapidly, so that, when I saw val of apparently healthy tissue. After this time however, together with rapid Paget’s Disease of Bone increase of the growth upon the radius, there were gradual failure of strength and emaciation, and on the In 1876, Paget wrote the most famous of all his 24th of March, after two days of distress with pleural papers, “On a form of Chronic Inflammation of effusion on the right side, he died.... Holding then the disease to be an inflammation of bones, I would suggest Bones (Osteitis Deformans),” which was read that, for brief reference and for the present, it may be before the Royal Medical and Chirurgical Society 7 called after its most striking character: Osteitis Defor- of London. Abetter name may be given when more is known description of the disease; detailed postmortem of it. He noted But more than a century later, no more is the evolution of the disease in a patient during the known of the origin of the disease, nor of its cure. The borders of the loose body were of bone occurring as the result of trauma without smoothly rounded off.... These loose bodies are inflammatory reaction; he offered the same expla- sequestra, exfoliated after necrosis of injured portions nation for the presence of certain loose bodies of cartilage, exfoliated without acute inflammation. In 1870, he read a paper before Paget described certain fibromata, in connec- the Clinical Society of London on “A case of tion with aponeuroses, fasciae, and tendons, Necrosis of the Femur, without External Inflam- which recur with shortening intervals after mation.

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