java zxing read barcode from image Figure 3 23 Semithin section reveals a normal nerve fascicle in Objective-C

Printer DataMatrix in Objective-C Figure 3 23 Semithin section reveals a normal nerve fascicle

Figure 3 23 Semithin section reveals a normal nerve fascicle
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SECTION I
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APPROACH TO PATIENTS WITH NEUROMUSCULAR DISEASE
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Figure 3 25 Teased nerve bers A normal teased ber internode is seen (A) as well as a short, demyelinated internode (B) A teased nerve ber segment undergoing Wallerian degeneration with myelin ovoids is appreciated in (C) Redundant folds of myelin lead to formation of tomacula (Latin for sausage) that are best appreciated on teased ber preparations (D) and are commonly seen in hereditary neuropathy with liability to pressure palsies and occasionally in other forms of Charcot Marie Tooth disease
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perineurium of the roots and cranial nerves as these leave the subarachnoid space Myelinated and unmyelinated nerve bers intermingle within each fascicle Further, along the course of the entire nerve, individual nerve bers course in and out of different fascicles In the sural nerve, which is most commonly biopsied, myelinated bers range between 2 and 15 m in diameter and have a bimodal distribution There are approximately twice as many small myelinated axons as there are large myelinated bers Segments of myelinated bers (internodes) are separated by nodes of Ranvier A single Schwann cell supplies the myelin sheath for each internode The thickness of the myelin sheath is directly proportional to the diameter of the axon, and the larger the axon diameter, the longer
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the internodal distance The ratio of the diameter of the axon to the diameter of the entire nerve ber (axon plus its surrounding myelin) is approximately 06 A higherthan-normal diameter ratio implies that the axons are thinly myelinated In contrast, lower G ratios are seen in axonopathies with axonal atrophy or rare conductions with redundant myelin (tomaculous neuropathy) Unmyelinated axons are more numerous than myelinated axons and range in size from 02 to 3 m Anywhere from ve to 20 unmyelinated axons are enveloped by a single Schwann cell; there is no specialized differentiation to form myelin Schwann cells, regardless of their association with myelinated or unmyelinated bers, have pale oval nuclei with an even chromatin distribution and an elongated
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MUSCLE AND NERVE HISTOPATHOLOGY
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bipolar cell body On EM, Schwann cells can be differentiated from broblasts because Schwann cells have a basement membrane Within axons there are various organelles and cytoskeletal structures, including mitochondria, vesicles, smooth endoplasmic reticulum, lysosomes, neuro laments, and microtubules Because protein synthesis occurs in the cell body rather than the axon itself, essential proteins and other substances synthesized in the perikaryon are transported down the axon via axoplasmic ow A retrograde transport system serves as a feedback to the cell body These transport systems are dependent on the microtubules and neuro laments as well as speci c proteins such as dynein and dynactin within the axons At the distal nerve terminal, dense-cored and coated vesicles are found
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REACTIONS TO INJURY
Although disease processes affecting nerves have different pathogenic mechanisms, these lead to two principal reactions to injury: demyelination or axonal degeneration3,21,24 28 Damage to Schwann cells or the myelin sheath itself can lead to demyelination Because these diseases affect individual Schwann cells to varying degrees, the process is characteristically segmental
along the length of the nerve The disintegrating myelin is phagocytosed by Schwann cells and macrophages Schwann cells are also stimulated to remyelinate the denuded axon These newly remyelinated axons are thinner in total diameter and the internodes are shorter than normal features that are best seen with teased nerve preparations However, one can appreciate the thinly myelinated axons on semithin sections and on EM (diameter ratio greater than 06) With sequential episodes of demyelination and remyelination, concentric tiers of Schwann cell processes accumulate around the axons forming the so-called onion bulbs (Fig 3 26) Some disease processes are associated with inclusions within Schwann cells (eg, metachromatic leukodystrophy and certain toxic neuropathies) Other abnormalities in the myelin sheath include tomaculae (redundant folds of myelin characteristic of hereditary neuropathy with liability to pressure palsies) and widened periodicity of compacted myelin (seen in neuropathy associated with myelin-associated antibodies) Primary damage to the axon may either be due to a discrete, localized event (trauma, ischemia, etc) or be due to an underlying abnormality of the neuronal cell body or ganglion (neuronopathy) or its axon (axonopathy) These processes lead to axonal degeneration with secondary disintegration of its myelin sheath
Figure 3 26 Onion bulb formation With recurrent bouts of demyelination and remyelination, concentric layers of Schwann cell processes accumulate around the axons forming onion bulbs Prominent onion bulbs can be seen in chronic in ammatory demyelinating neuropathy as in this case but are more typical of hereditary demyelinating neuropathies (ie, Charcot Marie Tooth disease types 1, 3, and 4) on semithin section (A) and on EM (B)
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