how to create barcode in using c# DISORDERS OF THE AUTONOMIC NERVOUS SYSTEM, RESPIRATION, AND SWALLOWING 457 in Microsoft Office


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tures: the frontal lobe cortex, the insular cortex, and the amygdaloid and adjacent nuclei The ventromedial prefrontal and cingulate cortices function as the highest levels of autonomic integration Stimulation of one frontal lobe may evoke changes in temperature and sweating in the contralateral arm and leg; massive lesions here, which usually cause a hemiplegia, may modify the autonomic functions in the direction of either inhibition or facilitation Lesions involving the posterior part of the superior frontal and anterior part of the cingulate gyri (usually bilateral, occasionally unilateral) result in loss of voluntary control of the bladder and bowel (see page 393) Most likely a large contingent of these bers terminates in the hypothalamus, which, in turn, sends bers to the brainstem and spinal cord The descending spinal pathways from the hypothalamus are believed to lie ventromedial to the corticospinal bers The insular cortex receives projections from the NTS, the parabrachial nucleus of the pons, and the lateral hypothalamic nuclei Direct stimulation of the insula produces cardiac arrhythmias and a number of other alterations in visceral function The cingulate and hippocampal gyri and their associated subcortical structures (substantia innominata and the amygdaloid, septal, piriform, habenular, and midbrain tegmental nuclei) have been identi ed as important cerebral autonomic regulatory centers Together they have been called the visceral brain (see Chap 25) Of particular importance in autonomic regulation is the amygdala, the central nucleus of which is a major site of origin of projections to the hypothalamus and brainstem The anatomy and the effects of stimulation and ablation of the amygdala have been discussed in Chap 25, in relation to the neurology of emotion In addition to the aforementioned central relationships, it should be noted that important interactions between the autonomic nervous system and the endocrine glands occur at a peripheral level The best-known example is in the adrenal medulla A similar relationship pertains to the pineal gland, in which norepinephrine (NE) released from postganglionic bers that end on pineal cells stimulates several enzymes involved in the biosynthesis of melatonin Similarly, the juxtaglomerular apparatus of the kidney and the islets of Langerhans of the pancreas may function as neuroendocrine transducers insofar as they convert a neural stimulus (in these cases adrenergic) to an endocrine secretion (renin, glucagon, and insulin, respectively) The numerous autonomic-endocrine interactions are elaborated in the next chapter Finally, there is the essential role that the hypothalamus plays in the initiation and regulation of autonomic activity, both sympathetic and parasympathetic Sympathetic responses are most readily obtained by stimulation of the posterior and lateral regions of the hypothalamus, and parasympathetic responses from the anterior regions The descending sympathetic bers are largely or totally uncrossed, although their pathway or pathways have not been sharply de ned According to Carmel, bers from the caudal hypothalamus at rst run in the prerubral eld, dorsal and slightly rostral to the red nucleus, and then ventral to the ventrolateral thalamic nuclei; then they descend in the lateral tegmentum of the midbrain, pons, and medulla to synapse in the intermediolateral cell column of the spinal cord Consistent with this schema, a case described by Luhan and Pollack demonstrated that a small infarct in the territory of supply of the superior cerebellar artery, just posterior to the medial lemniscus, caused an ipsilateral Horner syndrome In the medulla, the descending sympathetic pathway is located in the posterolateral retro-olivary area, where it is frequently involved in lateral medullary infarctions In the cervical cord, the
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bers run in the posterior angle of the anterior horn (Nathan and Smith) According to the latter authors, some of the bers supplying sudomotor neurons run outside this area but also remain ipsilateral Jansen and colleagues, by the use of viral vectors in rodents, were able to label certain neurons of the hypothalamus and the ventral medulla that stimulated sympathetic activity in both the stellate ganglion and the adrenal gland They hypothesized that this dual control underlies the ght-or- ight response, as described in 25 By contrast, the pathways of descending parasympathetic bers are not known Afferent projections from the spinal cord to the hypothalamus have been demonstrated in animals and provide a potential route by which sensation from somatic and possibly visceral structures may in uence autonomic responses
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