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Imaging studies are seldom of diagnostic value Mild cerebral atrophy and loss of volume of the basal ganglia are seen in some cases, and cavitary lesions are present in some of the severe anoxic encephalopathies The EEG is rarely helpful unless there are seizures The most frequent pathologic nding in the brain has been a whitish, marble-like appearance of the putamen, thalamus, and border zones of the cerebral cortex These whitish strands represent foci of nerve cell loss and gliosis with condensation of bands of transversing myelinated bers so-called status marmoratus (etat marbre) This lesion does not develop if the insult occurs after infancy, ie, after the myelination glia have completed their developmental cycle Kernicterus This is now a rare cause of extrapyramidal motor disorder in children and adults.

Complete the following activities using problem-solving skills and your knowledge of AutoCAD. 1. Use the PRESSPULL command to model the plate shown in Fig. 45-17. The dimensions are given in the orthographic projections in Fig. 45-18. Use the FILLET command to create a llet where the boss joins the main part of the plate. After you have nished the model, produce an isometric view in the Conceptual visual style. The drawing should look like the one in Fig. 45-17.

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Such cases are the neurologic sequelae of erythroblastosis fetalis secondary to Rh and ABO blood incompatibilities or to a de ciency of the hepatic enzyme glucuronosyltransferase The symptoms of kernicterus appear in the jaundiced neonate on the second or third postnatal day The infant becomes listless, sucks poorly, develops respiratory dif culties as well as opisthotonos (head retraction), and becomes stuporous as jaundice intensi es The serum bilirubin is usually greater than 25 mg/dL In acidotic and hypoxic infants (eg, those with low birth weight and hyaline membrane disease), the kernicteric lesions develop with much lower levels of serum bilirubin The majority of infants with this disease die within the rst week or two of life Many of those who survive are mentally retarded, deaf, hypotonic, totally unable to sit, stand, or walk, and spend their lives in homes for the feebleminded.

If the salts are taken orally, there is rst abdominal pain, vomiting, and diarrhea, followed within a few days by pain and tingling in the toes and ngertips and then rapid weakening of muscles of the limbs, initially the distal ones As the weakness progresses, the tendon re exes diminish Pain sensation is reduced more than tactile, vibratory, and position sense Persistent acral pain with allodynia has been a major feature in three of the ve patients we have examined; in two of our patients there was no weakness, only sensory loss and ataxia All cranial nerves except the rst and eighth may be affected; facial palsies, ophthalmoplegia, nystagmus, optic neuritis with visual impairment, and vocal cord palsies are additional abnormalities, but only in the most severely affected patients The CSF protein rises to more than 100 mg Death may occur in the rst 10 days, due to cardiac arrest.

Using the fact that b is a unit vector, it can be shown that the scalar portion of both b b and b b is zero. Therefore, as expected, the scalar portion of eqn. (D.21) is zero. It can also be shown that the vector portions of these quaternions are equal in magnitude and opposite in sign. Therefore, if we let b b = 0 + w, then b b = 0 w. The vector portion of eqn. (D.21) is z = 2w z. (D.22)

There are exceptional patients, however, obviously less damaged, who are mentally normal or at most only slightly limited These are the ones who develop a variety of persistent neurologic sequelae choreoathetosis, dystonia, and rigidity of the limbs a picture not too different from that of cerebral spastic diplegia with involuntary movements Kernicterus should always be suspected if an extrapyramidal syndrome is accompanied by bilateral deafness and paralysis of upward gaze Later there may be a greenish pigmentation of the dental enamel Neonates who die in the acute postnatal stage of kernicterus show a unique yellow staining (icterus) of nuclear masses (at one time called the Kern nuclei ) in the basal ganglia, brainstem, and cerebellum.

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