generate barcode in asp.net using c# Diseases of the Pituitary Gland in Microsoft Office

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Diseases of the Pituitary Gland
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Proximal muscle weakness and atrophy have been recorded as late developments in many acromegalic patients Formerly thought to be due to neuropathy, these symptoms in acromegaly have been convincingly shown by Mastaglia and colleagues to be the result of a chronic polymyopathy The serum CK is slightly elevated in some cases, and myopathic potentials are observed in the EMG Biopsy specimens have shown atrophy and reduced numbers of type 2 bers but necrosis of only a few bers Treatment of the pituitary adenoma and correction of the hormonal changes restores strength A mild peripheral neuropathy of sensorimotor type has also been reported in a few patients with acromegaly but is less frequent than carpal tunnel syndrome in this disease
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MYOPATHIES DUE TO DRUGS AND TOXINS
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A vast number of drugs and other chemical agents have been identi ed as myotoxic Curry and colleagues, in 1989, found reports (in the English literature alone) of about 100 drugs that had caused rhabdomyolysis and myoglobinuria, mostly in an idiosyncratic manner The list continues to grow, and additional myotoxic agents can be expected to appear as new drugs are introduced It is not practical to describe all the myotoxins individually; they are, therefore, broadly categorized and their main features listed in Table 51-2 Toxic agents produce myopathic changes in several ways They may act directly on muscle cells, either diffusely or locally, as occurs with intramuscular injections, or the muscle damage can be due to diverse secondary factors electrolyte disturbances (hypokalemia), renal failure, excessive energy requirements of muscle (as occur with drug-induced seizures and malignant hyperthermia), or inadequate delivery of oxygen and nutrients (drug-induced coma with compressive-ischemic injury of muscle) The most important category is that of direct toxic effect on the muscle membrane on the internal apparatus of the cell Several clinical features mark a myopathy as toxic in nature: lack of pre-existing muscular symptoms; predictable delay in onset of symptoms after exposure to a putative toxin; lack of any other cause for the myopathy; and often complete or partial resolution of symptoms after withdrawal of the toxic agent Pathologically, this group of disorders is characterized by nonspeci c myopathic changes, which in most severe degrees take the form of myonecrosis (rhabdomyolysis) and myoglobinuria This necrotizing muscle syndrome is the most frequent and serious myotoxic syndrome and is discussed later, along with its more important causes Necrotizing Polymyopathy (Rhabdomyolysis) with Myoglobinuria In any disease that results in rapid destruction of striated
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Diseases of Parathyroid Glands and Vitamin D De ciency
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A small proportion of patients with parathyroid adenomas complain of weakness and fatigability Vicale described the rst example of this disorder and remarked on the muscular atrophy and weakness and the pain on passive or active movement The tendon re exes were retained A few scattered muscle bers had undergone degeneration Claims for a denervative process are disputed We have not been impressed with either a myopathy or neuropathy in this disease In hypoparathyroidism, muscle cramping is prominent but there are no other neuromuscular manifestations In both hypoparathyroidism and pseudohypoparathyroidism the latter with characteristic skeletal abnormalities and, in some instances, mental slowness the most important muscle abnormality is tetany This is due to low ionized serum calcium, which depolarizes axons more than muscle bers (see pages 1096 and 1276) Osteomalacia, due to vitamin D de ciency and disorders of renal tubular absorption, often includes muscle weakness and pain as common complaints, similar to those in patients with primary hyperparathyroidism and uremia (see Layzer for further comment) More striking than any of the foregoing disturbances, in our view, has been a chronic proximal myopathy in conjunction with hypophosphatemia associated with solitary bone cysts In two of our patients, removal of the cyst restored serum phosphorus levels and cured the generalized muscle weakness Also known is an uncommon syndrome of severe hypophosphatemia and generalized bone pain in association with usually benign mesenchymal tumors
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