$10.00 Rocky Mountain Region Presenation
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- Posted on Nov. 05, 2009 at 08:17:01AM
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Preview: ... eralized muscle weakness resulting from immune-mediated destruction of acetylcholine receptors (AChRs) at the neuromuscular junction. Acquired MG is probably the most common neuromuscular disorder we can diagnose in the dog. Recent studies have identified a high relative risk for acquired MG in the Akita, Scottish Terrier, German Shorthaired Pointer, and Chihuahua breeds of dogs, and Abyssinian and Somali cats. Familial MG has also been identified in Newfoundlands and Great Danes. Clinical Presentations Acquired MG may be divided into focal (weakness localized to pharyngeal and esophageal musculature), generalized (generalized weakness and esophageal/pharyngeal weakness), acute fulminating (severe generalized weakness), and paraneoplastic forms. The palpebral reflex may be weak, fatigable, or absent. Neurological evaluation will usually be normal if performed before weakness develops. Tendon reflexes are usually normal but may be fatigable. In acute fulminating MG, dogs exhibit rapid development and progression of generalized appendicular weakness and may present non-ambulatory in lateral recumbency. This form of MG may mimic lower motor neuron diseases such as tick paralysis, botulism, and polyradiculoneuritis. Due to the diversity of clinical presentations, acquired MG should be on the list of differential diagnoses of most lower motor neuron disorders. Diagnosis The "gold standard" for the diagnosis of acquired MG in both dogs and cats is the documentation of antibodies against muscle type nicotinic AChRs by immunoprecipitation radioimmunoassay (test available through the Comparative Neuromuscular Laboratory, University of California, San Diego; Website: http://medicine.ucsd.edu/vet_neuromuscular; Email: XXXXXXXXX@XXXX.XXX). This assay has proven to be both sensitive and specific. While false positive results are extremely rare, approximately 2% of dogs with generalized MG may be "seronegative." An edrophonium chloride challenge (0.1 mg/kg IV) may be used for a presumptive diagnosis. A dramatic increase in muscle strength is a positive response. As false positive and negative results may occur with this test, it should not be used to "make or break" the diagnosis. Although associated with an anesthetic risk in a possibly critical patient, electrophysiological evaluation of a decrement in the muscle action potential following repetitive nerve stimulation has also been used in the diagnosis of MG. Thoracic radiographs should be evaluated for the presence of megaesophagus and a cranial mediastinal mass. An electrocardiogram should also be evaluated if bradycardia is present since 3rd degree heart block has been documented in a subpopulation of canine MG patients. MG has also been associated with other disorders including hypothyroidism, other autoimmune diseases, thymoma, thymic cysts, cholangiocellular carcinoma, and osteogenic sarcoma. Treatment There is considerable controversy over the appropriate therapy for MG. Because of a lack of appropriately controlled and well-designed clinical trials in veterinary medicine, optimum treatments for acquired MG have not been established. After study of virtually thousands of cases of canine MG over a 15-year period, this author makes the following recommendations: Altered feeding procedures including elevation of food and water or placement of a PEG tube for maintenance of hydration, nutrition, and drug delivery if esophageal dilatation is present. Anticholinesterase drugs to prolong the action of acetylcholine at the neuromuscular junction and enhance neuromuscular transmission. The most commonly used drug is pyridostigmine bromide (Mestinon, 1-3 mg/kg administered orally BID or TID). IF AN OPTIMAL RESPONSE TO THE ABOVE THERAPY IS NOT OBTAINED, corticosteroid therapy may be initiated. Im ...
The full tutorial is about 2673 words long .
$20.00 SCI 245 - Final Project Factors and Forces of Geological Features-19 slides+Speakers notes+visual-A+(never sold before)
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- Posted on Nov. 05, 2009 at 08:56:44AM
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Preview: ... Falls
Geology of Appalachian Highlan ...
The full tutorial is about 40 words long plus attachments.
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SCI 245 - Final Project Factors and Forces of Geological Features.pptx (2185K)
$5.00 SCI245 - FINAL PROJECT Factors and Forces of Geological Features ROCKY MOUNTAIN SYSTEM- A++
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Preview: ... gical Features RO ...
The full tutorial is about 14 words long plus attachments.
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FINAL PROJECT - Rocky Mountains.ppt (635K)
$25.00 GLG/101--Rocky Mountain System-Very Detailed Speaker Notes-15 slides-9 Sources-4 Images--Great Work!!!!
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- Posted on Nov 06, 2009 at 11:59:53PM
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Preview: ... etailed Speaker Note ...
The full tutorial is about 10 words long plus attachments.
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Rocky Mountain System.pptx (417K)
