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The General Anatomy of a Skeletal Muscle
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episodes of vertigo, diplopia, numbness, impaired vision in one or both visual elds, and dysarthria. These TIA syndromes are described more fully further on. Such attacks last from a few minutes to several hours; in most instances the duration is less than 10 min. Those of several hours duration have a different connotation, since they are usually due to demonstrable embolism. The nal stroke may be preceded by one or two attacks or a hundred or more brief TIAs, and the stroke may follow the onset of the attacks by hours, days, or less frequently by weeks or months. When there are no prodromal ischemic attacks, one must use other criteria to establish the diagnosis of atherosclerotic thrombosis. The thrombotic stroke, whether or not it is preceded by warning attacks, nally develops in one of several ways. Most often there is a single episode but the whole illness evolves over a few hours or less. More characteristic is a stuttering or intermittent progression of neurologic de cits extending over several hours or a day or longer. This is a starkly different pro le from the abrupt onset of a complete stroke syndrome that characterizes the embolic mechanism discussed further on. Again, in thrombosis a partial stroke may occur and even recede temporarily for several hours, after which there is rapid progression to the completed stroke or several eeting episodes may be followed by a longer one and, hours or a day or two later, by a major stroke. Several parts of the body may be affected at once or only one part, such as a limb or one side of the face, the other parts becoming involved serially in step-like fashion until the stroke is fully developed. Sometimes the de cit is episodic; spells of weakness or involuntary movement of a hand or arm or dimness of vision, lasting 5 to 10 min, occur spontaneously or are brought on by standing or walking. Each of the transient attacks and the abrupt episodes of progression reproduces the pro le of the stroke in miniature. The principle of intermittency seems to characterize the thrombotic process from beginning to end. As frequent as the modes of onset outlined above, and most characteristic of atherothrombotic events, is the occurrence of the stroke during sleep; the patient awakens paralyzed, either during the night or in the morning. Unaware of any dif culty, he may arise and fall helplessly to the oor with the rst step. This is the story in fully 60 percent of our patients with thrombotic strokes and in a smaller number with embolic ones as well. Most deceptive of all are the relatively few patients in whom the neurologic disorder has evolved over several days or even longer, in a slow, gradual fashion ( slow stroke ). One s rst impulse is to make a diagnosis of brain tumor, abscess, or subdural hematoma. This error can usually be avoided by a careful analysis of the course of the illness, which will disclose an uneven, saltatory progression; if the clinical data are incomplete, observation for a few days makes the stroke pro le more apparent. Actually there are a few cases and these are usually instances of pure motor hemiplegia in which the evolution of a thrombotic stroke is evenly progressive over a period of days. In addition to these several modes of evolution of atherothrombotic stroke, thrombotic stenosis or occlusion of certain large vessels may lead instead to the generation of embolic fragments (artery-to-artery embolus), thereby precipitating a new stroke in a region distal to the occlusion. This is most likely to occur during the period of clinical uctuation and active thrombus formation. The most common occurrence of artery-to-artery embolism is with carotid artery thrombosis, the embolus passing to branches of the ipsilateral middle or anterior cerebral artery. With atherothrombotic blockage of the vertebral or lower basilar artery, the embolus orig-
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FIGURE I7.3 An illustrotion meon (o)discreie (b)continuous for of the ond dotc
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AutoCAD keeps track of time while you work. With the TIME command, you can review this information. 1. Enter TIME at the keyboard or select the Tools menu in the Menu Bar, and pick Inquiry and Time. The AutoCAD Text Window appears, providing information similar to that shown in Fig. 11-2. Of course, the dates and times will be different. Here s what this information means.
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and infinite patience. All these attributes are needed to cope with a boggling array of auto-related questions and problems. In a typical month, he and one assistant gave out 230 auto prices by phone, replied to letters requesting data or photos from eight states and five foreign countries, and answered requests ranging from the easy (1967 Jaguar wiring diagram) and difficult (everything about the Keeley Motor) to the near-impossible (a query on a 1900 Reber from a Canadian museum). Challenges can range from decoding vehicle identification numbers (VINs) to creating a bibliography on social issues and the automobile during the 1920s. Helverson may have to unearth everything known about the Witt Engine Works one day and research Ford Pinto gas tank explosion litigation the next. He gets calls from lawyers seeking car values for divorce or estate settlements and from forensic investigators needing crash data on specific cars. Naturally, he gets calls from collectors pursuing every imaginable subject and from do-it-yourselfers needing repair information on recent models. Two other curatorial responsibilities are acquisitions and cataloging. Helverson has standing orders for each year s new auto repair manuals and magazine subscriptions and also gets notices of just about all the new auto books published. It s my job to choose those that will be best for the collection while fitting into the library s budget, he says. Helverson tries to let his own personality influence the collection. I have to do this based on what we need, not what I like. Cataloging is a problem-filled area, according to Helverson. We use the Dewey decimal system as far as it will go, but for photographs and a lot of the literature, we have to catalog by vehicle make, model, and year. Now the library is beginning to acquire videotapes and DVDs, which are a new cataloging obstacle to sort out. We have a lot of the collection on microfilm, including shop manuals through 1985, but the whole data thing is getting harder to manage. More manufacturers and auto service companies are supplying information on CD-ROM. And no two automotive
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CLASS REPTILIA: CRAWLERS WITH BACKBONES
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INFECTIONS OF THE NERVOUS SYSTEM AND SARCOIDOSIS
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Employ linear regressionto fit this data with linearized versions of Eqs. (13.28)and (13.29). Aside from estimating the model parameters,assess the validity of the fits with both statistical measuresand graphs. Solution. model Equation(13.28),which is in the format of the saturation-growth-rate (Eq. 8.2D, can be linearizedby inverting it to give (recallEq. 13.27) k, I
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The McGraw Hill Companies, 2010
A Knack for Design
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