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J Korean Med Sci 11: 158–164 Monteyne P discount combivir 300 without a prescription, Dupuis MJ, Sindic CJ (1994) Neuritis of the serratus anterior muscle associated with Borrelia burgdorferi infection. Rev Neurol (Paris) 150: 75–77 Phillips MF (1986) Familial long thoracic nerve palsy: a manifestation of brachial plexus neuropathy. Neurology 36: 1251–1253 189 Thoracodorsal nerve Genetic testing NCV/EMG Laboratory Imaging Biopsy + Fig. Occasionally this nerve is a branch of the axillary and radial nerves. A motor branch goes to the latissimus dorsi muscle, and may also innervate the teres major muscle. Both muscles are adductors and inward rotators of the scapulohumeral joint and help to bring down the elevated arm (see Fig. Symptoms Few clinical symptoms, weakness compensated in part by pectoralis major and teres major muscles. Signs: Atrophy, and slight winging of the inferior margin of the scapula Motor: Latissimus dorsi: weakness in adduction and medial rotation of shoulder and arm. Neuralgic amyotrophy (rarely) Plexus lesions: injury in association with posterior cord or more proximal brachial plexus lesions. Diagnosis EMG Differential diagnosis Plexus: posterior cord lesions, upper/middle trunk lesions Radicular: C5–C7 lesion Therapy Conservative. Surgical interventions are not necessary because of the minor dysfunction. Due to this fact, this muscle can be used for grafting to the biceps brachii and outward rotators of humeroscapular joint. Prognosis Good 191 Pectoral nerve Patients note painless atrophy. Symptoms Weakness and atrophy of the pectoral muscle. Compensatory hypertrophy of Signs other chest muscles.

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The spinal trigeminal tract • Figure 67A: The upper medullary level typi- and nucleus generic 300 combivir otc, conveying the modalities of pain and tem- cally includes CN VIII (both parts) and its perature from the ipsilateral face and oral structures, is nuclei. The solitary nucleus • Figure 67B: This section through the mid- and tract, which subserve both taste and visceral afferents, medulla includes the nuclei of cranial nerves are likewise found in the medulla. The nerve has two nuclei along its course, the ventral and dorsal cochlear nuclei (see UPPER MEDULLA: Figure 8B). The auditory fibers synapse in these nuclei and then go on to the superior olivary complex in the lower CROSS-SECTION pons region. The crossing fibers are seen in the lowermost pontine region as the trapezoid body (see Figure 37 and This section has the characteristic features of the medul- Figure 40). Both these nuclei lie in the 4 and 6 go through the white matter of the hemispheres, same position as the vestibular nuclei in the pontine sec- funnel via the internal capsule (posterior limb), continue tion, adjacent to the lateral edge of the fourth ventricle. The cortico-spinal tract is nuclei contribute fibers to the MLF (discussed with Figure often called the pyramidal tract because its fibers form the 51B). The solitary nucleus is found at this level, surrounding The medial lemniscus is the most prominent ascend- a tract of the same name. This nucleus is the synaptic ing (sensory) tract throughout the medulla, carrying the station for incoming taste fibers (mainly with CN VII, also modalities of discriminative touch, joint position, and with CN IX), and for visceral afferents entering with CN vibration (see Figure 33 and Figure 40). The tracts are IX and X from the GI tract and other viscera. The solitary located next to the midline, oriented in the anteroposterior nucleus and tract are situated just beside (anterior to) the (ventrodorsal) direction (see Figure 40), just behind the vestibular nuclei. Dorsal to them, also along the mid- formation (see Figure 42A and Figure 42B). The most line, are the paired tracts of the MLF, situated in front of prominent of its nuclei at this level is the gigantocellular the fourth ventricle. The anterolateral tract, conveying pain nucleus (noted for its large neurons), which gives rise to and temperature, lies dorsal to the olive, although it is not the lateral reticulo-spinal tract (see Figure 49B). The other of sufficient size to be clearly identified (see Figure 34 functional aspects of the reticular formation should be and Figure 40). Both the medial lemniscus and the ante- reviewed at this point, including the descending pain sys- rolateral system are carrying fibers from the opposite side tem from the nucleus raphe magnus (discussed with Fig- of the body at this level.

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For example 300 combivir overnight delivery, a deletion of the long arm of chromo- some 5 can be detected in some older patients, especially women, with a macrocytic, refractory anemia (RA). The bone mar- row picture in the RA with 5q– syndrome is characterized by the presence of monolobu- lated and bilobulated micromegakaryocytes. Two thirds of these patients have RA or RA with ringed sideroblasts (RARS), and the remainder have RAEB (RA with excess of blasts). In those patients who have a del(5q) as their sole cytogenetic abnormality, MDS tends to follow a more benign course, although progression to acute myeloid leukemia (AML) may occur. A 62-year-old woman well known to you comes to see you in clinic. Since the last time you saw her, she was admitted to the hospital and diagnosed with acute leukemia. She has been followed by a local hema- tologist and has undergone remission-induction chemotherapy. She is scheduled to begin postinduction consolidation therapy. She explains that she and the specialist are working toward a “complete remis- sion” (CR) and wants to know if that means she will be cured. Which of the following definitions of CR is most accurate? Full recovery of normal peripheral blood counts; blast cells are unde- tectable in the bone marrow B. Full recovery of normal peripheral blood counts; bone marrow cellu- larity with less than 5% residual blast cells C. Full recovery of normal peripheral blood counts; bone marrow cellu- larity with less than 10% residual blast cells D. Full recovery of normal peripheral blood counts; bone marrow cellu- larity with less than 10% residual blast cells for a minimum of 1 year Key Concept/Objective: To understand the concept of CR in leukemia patients The goal of remission-induction chemotherapy is the rapid restoration of normal bone marrow function. The term complete remission is reserved for patients who have full recovery of normal peripheral blood counts and bone marrow cellularity with less than 5% residual blast cells.


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