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A normal adult requirements of the tissue buy 60mg mestinon free shipping, as reflected by the appear- male’s brain containing approx discount mestinon 60mg visa. This is one of the brain’s oxygen consumption is almost entirely for the reasons why primary post-ischemic recovery may be oxidative metabolism of glucose, which in normal followed by delayed post-ischemic hypoxia and physiological conditions is the almost exclusive secondary metabolic failure [47]. The magnitudes of these vide lactate to the neurons where lactate is further increases are linearly related to the frequency of oxidatively phosphorylated [52]. Overall, 87% of the action potentials in the afferent pathways, and total energy consumed is required by signaling, increases in the projection zones occur regardless of mainly action potential propagation and postsynaptic whether the pathway is excitatory or inhibitory. Cerebral blood flow, oxygen utilization and energy metabolism in the brain are still not under- metabolic rates of glucose in man (approximate values). Chapter 1: Neuropathology and pathophysiology of stroke during and after ischemia of varying degree and Flow thresholds for preservation duration it was possible to construct a discriminant of function and morphological integrity curve representing the worst possible constellation of The different energy requirements for maintenance residual blood flow and duration of ischemia still of membrane function and for propagation of infor- permitting neuronal recovery (Figure 1. These mation (signals) lead to different thresholds of energy results broaden the concept of the ischemic penum- consumption and consequently blood flow required bra: the potential for recovery (or irreversible for preservation of neuronal function and morpho- damage) is determined not only by the level of logical integrity. The range of perfusion between residual flow but also by the duration of the flow those limits – a blood flow level below which neur- disturbance. Each level of decreased flow can, on onal function is impaired and a lower threshold average, be tolerated for a defined period; flow below which irreversible membrane failure and mor- between 17 and 20 ml/100 g/min can be tolerated for phological damage occur – was called the “ischemic prolonged but yet undefined periods. As a rule used penumbra” [55]; it is characterized by the potential in many experimental models, flow rates of 12 ml/100 for functional recovery without morphological g/min lasting for 2–3 hours lead to large infarcts, but damage, provided that local blood flow can be re- individual cells may become necrotic after shorter established at a sufficient level and within a certain periods and at higher levels of residual flow. It is characterized by the potential for disappeared at approximately 18 ml/100 g/min. The functional recovery without morphological large variability of the functional thresholds of damage. This explains the gradual development of Imaging of penumbra neurological deficits, which might additionally be Based on the threshold concept of brain ischemia, related to altered single-cell activity with grouped or the penumbra can be localized on quantitative flow regular discharges at flow levels above the threshold. Under experimental conditions opment of irreversible morphological damage is time- the most reliable way to localize the infarct core is the dependent. A biochemical marker of core plus penum- þ leakage of K out of cell bodies, indicating loss of bra is tissue acidosis or the inhibition of protein membrane function and leading to anoxic depolar- synthesis. The interaction of severity and duration of ische- of gene transcripts that are selectively expressed in mia in the development of irreversible cell damage the penumbra, such as the stress protein hsp70 was studied by simultaneous recordings of cortical or the documentation of the gradual disappearance neuronal activity and local blood flow. Based on of the penumbra with increasing ischemia time [60] 13 recordings from a considerable number of neurons (Figure 1. Biochemical imaging of infarct core and penumbra after experimental middle cerebral artery occlusion. An alternative method is vation of vitality markers, such as flumazenil binding quantitative mapping of the apparent diffusion coef- to central benzodiazepine receptors [61]. In the following, Finally, new developments in non-invasive the most important mediators of infarct progression molecular imaging are of increasing interest for will be discussed. These methods make use of contrast probes that trace gene transcription or of Brain infarcts grow in three phases: intracellular conjugates that reflect the metabolic acute phase, within a few minutes after the onset status and/or bind to stroke markers. The number of ischemia; terminal depolarization of cell of molecules that can be identified by these methods membranes; rapidly expands and greatly facilitates the regional subacute phase, within 4–6 hours; molecular analysis of stroke injury. Progression of ischemic injury With the advent of non-invasive imaging evidence has Peri-infarct spreading depression been provided that brain infarcts grow. This growth is A functional disturbance contributing to the growth not due to the progression of ischemia because the of the infarct core into the penumbra zone is activation of collateral blood supply and spontaneous the generation of peri-infarct spreading depression- thrombolysis tend to improve blood flow over time. These depolarizations are Infarct progression can be differentiated into three initiated at the border of the infarct core and spread phases. During the acute phase tissue injury is the over the entire ipsilateral hemisphere. During spread- direct consequence of the ischemia-induced energy ing depression the metabolic rate of the tissue mark- failure and the resulting terminal depolarization of edly increases in response to the greatly enhanced cell membranes. At flow values below the threshold energy demands of the activated ion-exchange of energy metabolism this injury is established within pumps. In the healthy brain the associated increase a few minutes after the onset of ischemia. During the of glucose and oxygen demands is coupled to a paral- subsequent subacute phase, the infarct core expands lel increase of blood flow but in the peri-infarct into the peri-infarct penumbra until, after 4–6 hours, penumbra this flow response is suppressed or even core and penumbra merge. As a result, a misrelationship arises expansion are peri-infarct spreading depressions and between the increased metabolic workload and the low a multitude of cell biological disturbances, collectively oxygen supply, leading to transient episodes of hypoxia referred to as molecular cell injury. Finally, a delayed and the stepwise increase in lactate during the passage phase of injury evolves which may last for several of each depolarization. During this phase secondary The pathogenic importance of peri-infarct depo- phenomena such as vasogenic edema, inflammation larizations for the progression of ischemic injury is and possibly programmed cell death may contribute supported by the linear relationship between to a further progression of injury. The largest increment of infarct volume occurs Correlation analysis of this relationship suggests that during the subacute phase in which the infarct core during the initial 3 hours of vascular occlusion each expands into the penumbra. Using multiparametric depolarization increases the infarct volume by more imaging techniques for the differentiation between than 20%.

Pathologic changes in the cornea: opacities – infiltration order 60mg mestinon with mastercard, cicatrix purchase 60 mg mestinon visa, degeneration, pathologic vessels: superficial, deep. Inflammatory diseases of the cornea: - superficial, non purulent keratitis - superficial purulent keratitis - deep ( parenchimal ) keratitis - trophic keratitis 4. Pathologic changes in iridocyclitis – changes of the structure of the iris, precipitates, Tyndall effect, posterior synechiae, opacities. Differential diagnosis between iridocyclitis, conjunctivitis, keratitis and acute closure angle glaucoma. Examination of a patient with a cataract in one eye and transparent lens in the other eye by focal illumination, trans illumination and bio microscopy. Demonstration of patients and differential diagnosis between open angle glaucoma and cataract. Optic nerve head edema, optic neuritis, retrobulbar neuritis – ophthalmoscopy, clinical picture, treatment. What do we do when there is a trauma of the eye and the accessory structures of the eye. Demonstration of patients with ocular traumas: blunt trauma, penetrating traumas of the eyeball. First aid in acute closure angle glaucoma, occlusion of the central retinal artery or vein. Note: During practice including the anterior and posterior segment of the eye, patients are demonstrated and practical skills developed, depending on the theme of the practice. Inflamatory diseases of the conjunctiva - objective symptoms and subjective complaints. Deep (stromal) keratitis - in congenital lues, tuberculosis keratitis in sclerosing keratitis. Anomalies in size and curvature of the cornea - keratoconus keratoglobus, megalocornea, mikrocornea. Anterior uveitis / iridocyclitis / - clinical features, complications, differential diagnosis, treatment. Inflamatory diseases of the whole uvea - tubercular, syphilitic, Toxoplasma, sarcoidosis. Retinal changes in vascular diseases - atherosclerosis, hypertension and diabetes mellitus. Eyeglasses - definition of spectacle lenses, magnifying glasses, telescopic spectacles. Emergency in ophthalmology: traumas, acute glaucoma attack, acute occlusion of retinal arteries and veins. Arrange by anatomical principle the structures of the eyeball and its accessory organs ( systemic examination ): - vitreous - anterior chamber - lens - orbit - conjunctiva 308 - ocular fundus - eyelids - cornea - iris - pupil - lachrymal apparatus ІІІ. Function of the cornea: transmits light, participates in accommodation, insures dark chamber, participates in the production of aqueous humor. Function of the lens: participates in accommodation, preserves the form of the eye, insures a dark chamber, transforms the light stimulus into a nerve impulse. Function of the iris: transmits light, refracts light, preserves the form of the eye, regulates the quantity of light entering the eye. Function of the choroids: transmits light, preserves the form of the eye, produces aqueous humor. Function of the retina: participates in accommodation, produces aqueous humor, preserves the form of the eye, regulates the light beam entering the eye, transforms the light stimulus into a nerve impulse. Function of the sclera: transmits light, participates in accommodation, preserves the form of the eye, produces aqueous humor. Write down: - correct perception and projection of light - correct perception of light and lack of perception and projection of light - ІІ. Examination of the anterior segment of the eye: focal illumination, transillumination, direct ophthalmoscopy, indirect ophthalmoscopy, skiascopy. Examination of the posterior segment of the eye: mirror image, focal illumination, transillumination, ophthalmoscopy, skiascopy, tonometry. Methods of examination of the refraction of the eye: biomicroscopy, focal illumination, transillumination, skiascopy. Anatomy of the lachrymal gland: - position - dimensions - openings of the channels - types of secretion 2. Differential diagnosis between conjunctival and cilliary hyperemia: diseases, position, color, blood vessels. Examination of the anterior segment of the eye: focal illumination, transillumination, direct ophthalmoscopy, indirect opthalmoscopy, skiascopy. Examination of the posterior segment of the eye: mirror images, focal illumination, transillumination, ophthalmoscopy, skiascopy, tonometry. Methods of examination of the refraction: biomicroscopy, focal illumination, transillumination, skiascopy.

Requirements for Admission Current Accreditation: 2011-2018 The applicant must have a bachelor degree Applicants must hold a bachelor degree with demonstrating a high level of scholarship order mestinon 60mg line. A portfolio courses will be offered by the School of Medi- of non-scientifc art generic 60mg mestinon overnight delivery, including still life draw- cine. Illustration and communications curricu- lum will be provided by the Department of Art ing and painting (watercolor preferred), fgure as Applied to Medicine. Students may indi- studies, graphic design, and digital media is vidualize their study depending on previous submitted for review. Programs Comparative Pathobiology, Associate Professor before he or she is recommended for degree. Materials and tech- Department of Molecular and Comparative niques used in producing instructive three-dimen- Pathobiology. Students may elect additional sional medical sculpture and rehabilitative facial science courses with approval of the director. Skills laboratory and consult with their preceptor by the frst providing hands-on experience in: quarter of the second year. Camera and lighting techniques, include original investigation with expository reproducing art in color and black and white with illustrations or sculpture (3D modeling, ani- both analogue and digital media. An overview of minimum of two consecutive semesters as the essential hardware, software, and peripheral devices for the production of digital images. Courses are directly related to technical, bio- logical, or medical subject matter. Sketching from the assignments require problem solving and cadaver and application of illustration techniques, individual research topics. Complete under- coordinated with gross anatomy dissection sched- standing of the topic is required. Augmented all media communication utilized by clinicians, by autopsy, specimens, and text references. Technical aspects of digital art production using both vector and raster- trating for experience, when appropriate. Creating digital art- First Year work for print and projection media: two-dimension- The academic calendar for frst year students al color still images. Rendering of scientifc niques for creating 3D models and animations for subject matter with emphasis on form, texture, and distribution as electronic fles and videos. Introduction to niques for creation of dynamic animation optimized reproduction methodology, specifcations for copy, for electronic presentation media. Continu- Instructional design process, project planning and ous tone rendering of medical and biological sub- development. Assignments in a variety of media with indi- al designer, project manager, programmer, illustra- vidually researched topics. Survey of ophthalmological surgical pro- illustration techniques to biological, botanical, and cedures. Original investiga- years of distinguished leadership in medical tion under preceptor and department advisor. Design and management of functional illustra- support in the Department of Art as Applied tion production units. Practice in analyzing prob- lems of the visual artist and formulating practical to Medicine was established in 1973 with a solutions. Trott whose death in 1973 tion to operating room protocol, observation and recording of surgical procedures. Principles and colleagues have been added to this Fund of effective oral and written presentation. Exer- cises include a grant proposal, oral presentations since the death of William P. Professional portfolio and students in the feld of medical illustration exhibition preparation and presentation, includes given in memory of Kathleen Mackay Pow- effective negotiation in a professional environment. Elective Studies The Elinor Widmont Bodian Scholarship Students may select from the following cours- in Medical Art This scholarship fund was es with the approval of the director. Bodian and her and course content to be arranged with the family to provide fnancial assistance to stu- instructor. An introduction to human anatomy This scholarship was established in 1999 in through a series of regional dissections. Details recorded through sketching ciation as a medical illustrator for the Depart- with emphasis on form, surface detail and anatomi- ment of Surgery and faculty member in Art as cal accuracy. Conceptualization of lished in Art as Applied to Medicine in honor scientifc information and application to problem of Chester Reather’s distinguished career as solving assignments. Team- ate at The Johns Hopkins University School based approach to producing teaching visuals of Medicine. This fund is used to reward a using medical imaging science and visualization graduate student with a scholarship for inno- techniques. Students may who could distill complex medical subject arrange independent study with a faculty member matter into clear, effective teaching images.