By W. Mine-Boss. Samford University. 2018.

In the latter case cheap tadora 20mg overnight delivery, the lesion is adjacent to the midline and in- gal axons that directly innervate cranial nerve motor nuclei and in volves the abducens nucleus and adjacent PPRF tadora 20mg without a prescription, internuclear fibers those fibers that terminate near (indirect) generic 20mg tadora mastercard, but not in cheap 20 mg tadora with amex, the various mo- from the ipsilateral abducens that are crossing to enter the contralat- tor nuclei buy 20 mg tadora free shipping. The cerebral artery occlusion) or the internal capsule (as in lacunar strokes result is a loss of ipsilateral abduction (lateral rectus) and adduction or occlusion of lenticulostriate branches of M1) give rise to a con- (medial rectus, the “one”) and a contralateral loss of adduction (medial tralateral hemiplegia of the arm and leg (corticospinal fiber involve- rectus, the “half ”); the only remaining horizontal movement is con- ment) coupled with certain cranial nerve signs. Strictly cortical lesions tralateral abduction via the intact abducens motor neurons. Abbreviations AbdNu Abducens nucleus OcNu Oculomotor nucleus AccNu Accessory nucleus (spinal accessory nu. Many of brainstem and spinal cord, and the general distribution of tectospinal reticulospinal fibers influence the activity of lower motor neurons. Tectospinal fibers originate from deeper lay- Clinical Correlations: Isolated lesions of only tectospinal and ers of the superior colliculus, cross in the posterior (dorsal) tegmental reticulospinal fibers are essentially never seen. Tectospinal fibers pro- decussation, and distribute to cervical cord levels. Several regions of ject to upper cervical levels where they influence reflex movement of cerebral cortex (e. Such movements may be diminished or slowed in tum, but the most highly organized corticotectal projections arise from patients with damage to these fibers. Pontoreticulospinal fibers (medial reticulospinal) ulospinal) fibers are excitatory to extensor motor neurons and to neu- tend to be uncrossed, while those from the medulla (bulboreticu- rons innervating axial musculature; some of these fibers may also in- lospinal or lateral reticulospinal) are bilateral but with a pronounced hibit flexor motor neurons. Corticoreticular fibers are bilateral with a (lateral reticulospinal) fibers are primarily inhibitory to extensor mo- slight contralateral preponderance and originate from several cortical tor neurons and to neurons innervating muscles of the neck and back; areas. Neurotransmitters: Corticotectal projections, especially those Reticulospinal (and vestibulospinal) fibers contribute to the spasticity from the visual cortex, utilize glutamate ( ). This substance is also that develops in patients having lesions of corticospinal fibers. Some neurons of the giganto- reticulospinal and vestibulospinal fibers (see Figure 7-13 on page 196) cellular reticular nucleus that send their axons to the spinal cord, as also contribute to the tonic extension of the arms and legs seen in de- reticulospinal projections, contain enkephalin ( ) and substance P cerebrate rigidity when spinal motor neurons are released from de- ( ). Enkephalinergic reticulospinal fibers may be part of the descend- scending cortical control. Abbreviations ALS Anterolateral system PO Principal olivary nucleus ATegDec Anterior tegmental decussation PTegDec Posterior tegmental decussation (rubrospinal fibers) (tectospinal fibers) BP Basilar pons Py Pyramid CC Crus cerebri RB Restiform body CRet Corticoreticular fibers RetNu Reticular nuclei CTec Corticotectal fibers RetSp Reticulospinal tract(s) GigRetNu Gigantocellular reticular nucleus RNu Red nucleus LCSp Lateral corticospinal tract RuSp Rubrospinal tract ML Medial lemniscus SC Superior colliculus MLF Medial longitudinal fasciculus SN Substantia nigra MVNu Medial vestibular nucleus SpVNu Spinal (or inferior) vestibular nucleus OcNu Oculomotor nucleus TecSp Tectospinal tract Review of Blood Supply to SC, Reticular Formation of Pons and Medulla, and TecSp and RetSp Tracts in Cord STRUCTURES ARTERIES SC long circumferential branches (quadrigeminal branch) of posterior cerebral plus some from superior cerebellar and posterior choroidal (see Figure 5–27) Pontine Reticular long circumferential branches of basilar plus branches of superior Formation cerebellar in rostral pons (see Figure 5–21) Medullary Recticular branches of vertebral plus paramedian branches of basilar at Formation medulla-pons junction (see Figure 5–14) TecSp and RetSp branches of central artery (TecSp and Medullary RetSp); Tracts penetrating branches of arterial vasocorona (Pontine RetSp) (see Figures 5–14 and 5–6) Motor Pathways 195 Tectospinal and Reticulospinal Tracts CRet CTec Postition of TecSp and RetSp SC CTec SC PTegDec TecSp ML RNu CRet SN PTegDec (TecSp) CRet CC ATegDec (RuSp) MLF Pontine RetNu: oralis TecSp RetNu of Pons caudalis ML ALS BP InfVNu Pontine RetSp MVNu RB MLF TecSp ALS GigRetNu GigRetNu PO ML Pontine RetSp Py TecSp Medullary RetSp LCSp Medullary RetSp to Laminae VII ALS (VI,VII, IX) TecSp Pontine RetSp to Laminae VI, VII (VIII) to Laminae VIII of cervical levels (VII,IX) 196 Synopsis of Functional Components, Tracts, Pathways, and Systems Rubrospinal and Vestibulospinal Tracts 7–13 The origin, course, and position in representative cross-sec- Clinical Correlations: Isolated injury to rubrospinal and vestibu- tions of brainstem and spinal cord, and the general distribution of lospinal fibers is really not seen in humans. Rubrospinal fibers cross in the an- movements seen in monkeys following experimental rubrospinal le- terior (ventral) tegmental decussation and distribute to all spinal levels sions may be present in humans. However, these deficits are over- although projections to cervical levels clearly predominate. Cells in dor- shadowed by the hemiplegia associated with injury to the adjacent cor- somedial regions of the red nucleus receive input from upper extremity ticospinal fibers. The contralateral tremor seen in patients with the areas of the motor cortex and project to cervical cord, but those in ven- Claude syndrome (a lesion of the medial midbrain) is partially related to trolateral areas of the nucleus receive some fibers from lower extremity damage to the red nucleus as well as to the adjacent cerebellothalamic areas of the motor cortex and may project in sparse numbers to lum- fibers. These patients may also have a paucity of most eye movement bosacral levels. The red nucleus also projects, via the central tegmental on the ipsilateral side and a dilated pupil (mydriasis) due to concurrent tract, to the ipsilateral inferior olivary complex (rubroolivary fibers). Medial and lateral vestibular nuclei give rise to the medial and lateral Medial vestibulospinal fibers primarily inhibit motor neurons inner- vestibulospinal tracts, respectively. The former tract is primarily ipsi- vating extensors and neurons serving muscles of the back and neck. Lat- lateral, projects to upper spinal levels, and is considered a component eral vestibulospinal fibers may inhibit some flexor motor neurons, but of the medial longitudinal fasciculus in the spinal cord. The latter tract they mainly facilitate spinal reflexes via their excitatory influence on spinal is ipsilateral and somatotopically organized; fibers to lumbosacral levels motor neurons innervating extensors. Vestibulospinal and reticulospinal originate from dorsal and caudal regions of the lateral nucleus, while (see Figure 7-12 on page 194) fibers contribute to the spasticity seen in pa- those to cervical levels arise from its rostral and more ventral areas. Some lateral vestibulospinal fibers contain aspartate ( ), rigidity, the descending influences on spinal flexor motor neurons (corti- whereas glycine ( ) is present in a portion of the medial vestibu- cospinal, rubrospinal) is removed; the descending brainstem influence on lospinal projection. There are numerous gamma-aminobutyric acid spinal extensor motor neurons predominates; this is augmented by exci- ( )-containing fibers in the vestibular complex; these represent the tatory spinoreticular input (via ALS) to some of the centers giving rise to endings of cerebellar corticovestibular fibers. Abbreviations ATegDec Anterior tegmental decussation MVessp Medial vestibulospinal tract (rubrospinal fibers) MVNu Medial vestibular nucleus CC Crus cerebri OcNu Oculomotor nucleus CorRu Corticorubral fibers PTegDec Posterior tegmental decussation (tectospinal FacNu Facial nucleus fibers) InfVNu Inferior (or spinal) vestibular nucleus Py Pyramid LCSp Lateral corticospinal tract RNu Red nucleus LRNu Lateral reticular nucleus RuSp Rubrospinal tract LVNu Lateral vestibular nucleus SC Superior colliculus LVesSp Lateral vestibulospinal tract SVNu Superior vestibular nucleus ML Medial lemniscus TecSp Tectospinal tract MLF Medial longitudinal fasciculus VesSp Vestibulospinal tracts Review of Blood Supply to RNu, Vestibular Nuclei, MFL and RuSp, and Vestibulospinal Tracts in Cords STRUCTURES ARTERIES RNu medial branches of posterior cerebral and posterior communicating plus some from short circumferential branches of posterior cerebral (see Figure 5–27) Vestibular Nuclei posterior inferior cerebellar in medulla (see Figure 5–14) and long circumferential branches in pons (see Figure 5–21) MLF long circumferential branches of basilar in pons (see Figure 5–21) and anterior spinal in medulla (see Figure 5–14) MVesSp branches of central artery (see Figures 5–6 and 5–14) LVesSp and RuSp penetrating branches of arterial vasocorona plus terminal branches of central artery (see Figure 5–6) Motor Pathways 197 Rubrospinal and Vestibulospinal Tracts Thigh Leg Foot CorRu Position of RuSp and VesSp PTegDec SC OCNu ML RNu RNu PTegDec (TecSp) RuSp CC SVNu ATegDec (RuSp) LVNu MVNu FacNu MVNu InfVNu MLF RuSp SpVNu LRNu Py ML LVesSp MVesSp in MLF LCSp RuSp RuSp to Laminae LVesSp V-VIII MVesSp to Laminae LVesSp VII and VIII MVesSp LCSp RuSp LVesSp 198 Synopsis of Functional Components, Tracts, Pathways, and Systems 7–14 Blank master drawing for motor pathways. This illustration is provided for self-evaluation of motor pathways understanding, for the instructor to expand on motor pathways not covered in this atlas, or both.

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Small lymphocytes possess a deeply stained order tadora 20 mg visa, coarse so reactive that they actually generate light (biological nucleus that is large in relation to the remainder of the CHAPTER 11 Blood Components buy cheap tadora 20 mg on line, Immunity buy cheap tadora 20mg online, and Hemostasis 199 cell cheap 20mg tadora fast delivery, so that often only a small rim of cytoplasm appears door to the development of a variety of new pharmacolog- around parts of the nucleus buy tadora 20mg cheap. In contrast, a broad band of ical agents that have proved useful in the treatment of can- cytoplasm surrounds the nucleus of large lymphocytes; cer, immune disorders, and other diseases. The morphological homogeneity of lymphocytes ob- Blood Cells Are Born in the Bone Marrow scures their functional heterogeneity. Erythrocytes low, lymphocytes participate in multiple aspects of the im- survive in the circulation for about 120 days, after which mune response. Platelets have an average lifespan of 15 to rescent monoclonal antibodies. The majority of circulating 45 days in the circulation; many, if not most, of these cells lymphocytes are T cells or T lymphocytes (for “thymus- are consumed as they continuously participate in day-to- dependent lymphocytes”). The rate of platelet consumption acceler- types of immune responses that do not depend on anti- ates rapidly during the repair of bleeding caused by trauma. T cells comprise 40 to 60% of the total circulating Leukocytes have a variable lifespan. Neutrophils, Subtypes of T cells have been identified using fluores- constantly guarding body fluids and tissues against infec- cent monoclonal antibodies to specific cell-surface anti- tion, have a circulating half-life of only a few hours. All T cells possess the com- trophils and other blood cells must, therefore, be continu- mon CD3 antigen. CD4 antigen cluster, while suppressor T cells lack CD4 As mentioned earlier, the process of blood cell genera- but possess CD8. Patients with AIDS show decreased cir- tion, hematopoiesis, occurs in healthy adults only in the culating levels of CD4-positive cells. Hematopoietic cells Some 20 to 30% of circulating lymphocytes are B cells, are found in high levels in the liver, spleen, and blood of the which have immunoglobulin or antibody on their surface. Shortly before birth, blood cell produc- B cells are bone marrow-derived lymphocytes; when im- tion gradually begins to shift to the marrow. In newborns, munologically activated, they transform into plasma cells the hematopoietic cell content of the circulating blood is that secrete immunoglobulin. Lymphocytes not character- relatively high; hematopoietic cells are also found in the istic of either T cells or B cells are called null cells. Large num- tire scope of the function of null cells, which comprise only bers of hematopoietic cells can be recovered from aspirates 1 to 5% of circulating lymphocytes, is unknown, but it has of the iliac crest, sternum, pelvic bones, long bones, and been established that null cells are capable of destroying tu- ribs of adults. Within the bones, hematopoietic cells ger- mor cells and virus-infected cells. Cir- While B cells mediate immune responses by releasing culating factors and factors released from capillary en- antibody, T cells often exert their effects by synthesizing dothelial cells, stromal fibroblasts, and mature blood cells and releasing cytokines, hormone-like proteins that act by regulate the generation of immature blood cells from binding specific receptors on their target cells. Recent re- hematopoietic cells and the subsequent differentiation of search has led to the discovery of many cytokines, with ac- newly formed immature cells. Depending on the Cytokines that limit viral replication in cells, known as in- stimulating factors, the progeny of pluripotent stem cells terferons, suppress or potentiate the function of T cells, may be other uncommitted stem cells or stem cells commit- stimulate macrophages, and activate neutrophils. The committed In some cases, cytokines, like other hormones, can exert stem cells include myeloblasts, which form cells of the potent effects when supplied exogenously. For example, myeloid series (neutrophils, basophils, and eosinophils); ery- colony-stimulating factors injected into cancer patients can throblasts; lymphoblasts; and monoblasts (Fig. Promoted by hematopoietins and other cy- sult from the administration of chemotherapeutic drugs or tokines, each of these blast cells differentiates further, a radiation therapy. The technology of molecular biology is process that ultimately results in the formation of mature used to produce cytokines for therapy. This is a dynamic process; the hematopoietic tions of lymphocyte DNA containing the gene that codes cells of the bone marrow are among the most actively repro- for the specified cytokine are isolated and then transfected ducing cells of the body. These cells then produce the cytokine and release it granulocytes from the blood, a condition known as granulo- into their culture supernatant, from which it can be puri- cytopenia, or, when specific to neutrophils, neutropenia, in fied, concentrated, and sterilized for injection. Platelets disappear next—thrombocy- ical diversity and potency of the cytokines has opened the topenia—followed by erythrocytes, a sequence that reflects 200 PART IV BLOOD AND CARDIOVASCULAR PHYSIOLOGY Pluripotent (uncommitted) stem cell CFU-GEMM CFU-GM (phagocytic stem cell) Lymphoid stem cell BFU-E CFU-MEG CFU-M CFU-G CFU-Eo CFU-Bas Pro-B cell Pre-T cell (Erythroid (Platelet (Monocyte (Granulocyte (Eosinophil (Basophil stem cell) stem cell) stem cell) stem cell) stem cell) stem cell) Erythrocyte Megakaryoblast Monoblast Myeloblast Eosinophil Basophil Pre-B cell Subcortical differentiation Myeloblast Myeloblast thymocyte Megakaryocyte Promonocyte Myelocyte Eosinophil Basophil Early B cell Medullary thymocyte Myelocyte Myelocyte Monocyte Mature B cell Blood/lymph node thymocyte Erythrocyte Platelets Macrophage Neutrophil Eosinophil Basophil Plasma Memory Suppressor Helper Cytotoxic cell cell T cell T cell T cell FIGURE 11. All circulating blood cells are megakaryocyte colony-forming unit; CFU-GM, granulocyte- believed to be derived from a common, uncom- macrophage colony-forming unit; BFU-E, erythroid burst forming mitted bone marrow progenitor, the pluripotent stem cell.

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Damage to anterior trigeminothal- amic fibers on the left would produce a corresponding right-sided 42 tadora 20mg mastercard. Answer B: Taste fibers (special visceral afferent buy generic tadora 20 mg on-line, SVA) that deficit on the face buy tadora 20 mg fast delivery. The medial lemniscus conveys vibratory tadora 20mg without prescription, dis- serve the anterior two-thirds of the tongue on the ipsilateral side criminative touch cheap tadora 20 mg online, and proprioceptive sensations. The trigeminal ganglion contains cell bodies that convey general sensation (general somatic affer- 48. Answer B: This patient has a lateral medullary syndrome (also ent, GSA), and the ciliary ganglion contains visceromotor cell commonly called a posterior inferior cerebellar artery, or PICA bodies (general visceral efferent GVE, postganglionic, parasym- syndrome) on the left; this correlates with the left-sided sensory pathetic). The superior ganglion of the glossopharyngeal contains loss on the face and right-sided sensory loss on the body. A lateral cell bodies for taste from the posterior one-third of the tongue, medullary lesion on the right would result in the same deficits, but and the superior ganglion of the vagus nerve contains cell bodies on the opposite sides. The Parinaud, Weber, and Benedikt syn- for taste from the root of the tongue. Answer B: Stimulation of the supraorbital nerve (Vth nerve, af- ferent limb of the supraorbital reflex) results in contraction of the 49. Answer B: Wilson disease (hepatolenticular degeneration) is an orbicularis oculi muscle (VIIth nerve, efferent limb of the supra- inherited error of copper metabolism. Changes in pupil size relate to the third nerve, the decreased; urinary levels are increased; and copper accumulates in pupillary light reflex, and the distribution of postganglionic fibers the liver, lenticular nuclei, and kidneys. Contraction of masticatory treated by reducing the level of dietary copper and administering muscles is seen in the jaw-jerk reflex, and nystagmus usually re- a copper-chelating agent. Maintenance can be achieved by taking sults from cerebellum or brainstem lesions or disease of the zinc, and treatment must be life-long. However, none of these is the causative agent in hepatolenticular degeneration. Answer A: Fibers in the postsynaptic posterior column and in 214–215) the spinocervicothalamic pathways are spared in an anterolateral cordotomy. Answer E: The dilator pupillae muscle of the iris is innervated posterior horn that also contribute to the anterolateral system. It by postganglionic sympathetic fibers whose cell bodies of origin is possible that these pathways remodel to transmit pain and ther- are located in the ipsilateral superior cervical ganglion. Pregan- mal sensations in the absence of the normal anterolateral system glionic sympathetic cell bodies are found in the intermediolateral (ALS) pathway. Preganglionic parasympathetic cell bodies are found Q & A’s: A Sampling of Study and Review Questions with Explained Answers 291 in the Edinger-Westphal nucleus; axons of these cells terminate in terminate in the lateral parts of the ventral posterolateral nu- the ciliary ganglion, which, in turn, innervates the sphincter pupil- cleus and, from there, be relayed to the posterior paracentral lae muscle of the iris. The hypothalamus is the origin of hypothal- gyrus (the lower extremity area of the primary somatomotor amospinal fibers that project to the intermediolateral cell column. Answer E: The deficits described for the man are consistent central gyrus is the somatomotor cortex for the lower extrem- with a tumor on the root of the vestibulocochlear (VIII) nerve; ity. Answer E: Syringomyelia is a cavitation in central areas of the of the VIIIth nerve. Acoustic neuroma is an earlier, and now in- spinal cord that results in damage to fibers conveying pain and correct, designation for this lesion. Meningiomas arise primarily thermal sensation as they cross the midline in the anterior white from the arachnoid layer, ependymomas from the cells lining the commissure. The loss is bilateral since fibers from both sides are ventricular spaces, and a glioblastoma multiforme arises from as- damaged as they cross. Tabes dorsalis presents as posterior column trocytes within the substance of the brain. Answer A: This inherited disease is Friedreich ataxia; it initially PICA syndrome characteristically has alternating sensory losses appears in children in the age range of 8–15 years and has the char- (one side of face, opposite side of body). Huntington disease is inherited, but drome has both sensory (anterolateral system and posterior col- appears in adults; olivopontocerebellar atrophy is an autosomal umn) and motor (corticospinal) deficits. The cause of Parkinson disease is unclear, but it is probably not inher- 58. Answer A: There are basically only two areas where a relatively ited; the Wallenberg syndrome is a brainstem lesion resulting restricted lesion would result in weakness of both lower extrem- from a vascular occlusion. One is in caudal parts of the pyramidal decussation (damage to decussating corticospinal fibers traveling to the lumbosacral 53. Answer B: A tumor in the foramen would damage the motor cord levels), and the other would be a lesion in the falx cerebri root of the trigeminal nerve and the mandibular root (sensory) of (such as a meningioma) damaging the lower extremity areas on the the Vth nerve. In this patient, the jaw deviates to the left and the somatomotor cortex bilaterally.

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Calciphylaxis in man: A syndrome of tissue necrosis and vas- Acta Endocinol 14:214-226 cular calcification in 11 patients with chronic renal failure discount 20mg tadora visa. Ryan EA generic 20 mg tadora otc, Reiss E (1984) Oncogenous osteomalacia: Review Pseudohypoparathyroidism - An example of “Seabright- of the world literature of 42 cases order 20 mg tadora otc. Curr Ther Endocrinol Metab 5:492-495 pseudohypoparathyroidism (PH) and pseudo-pseudohy- 56 buy 20 mg tadora. Steendijk R generic 20mg tadora overnight delivery, Hauspie RC (1992) The pattern of growth and poparathyroidism (PPH). Differentiation from other syn- growth retardation of patients with hypophosphataemic vita- dromes associated with short metacarpals, metatarsals and min D-resistant rickets: longitudinal study. Glorieux FH, Marie PJ, Pettifor JM, Delvin EE (1980) Bone of shortening of the bones of the hands in PHP and PPHP – a response to phosphate salts, ergocalciferol and calcitriol in hy- comparison with brachydactyly E, Turner’s syndrome, and pophosphatemic vitamin D-resistant rickets. Milgram JW Compere CL (1981) Hypophosphatemic vitamin pseudohypoparathyroidism Semin Musculoskel Radiol D refractory osteomalacia with bilateral pseudofractures. O’Malley SP, Adams JE, Davies M, Ramsden RT (1988) The with secondary hyperparathyroidism and osteitis fibrosa. Polisson RP, Martinez S, Khoury M et al (1985) Calcification Feldman D, Glorieux FH, Pike JW (eds). Chapter 60, Vitamin of entheses associated with X-linked hypophosphatemic os- D, Elsevier Academic Press, San Diego, California, pp 967-994 teomalacia. Adams JE, Davies M (1986) Intra-spinal new bone formation Clin North Am 19:582-598 and spinal cord compression in familial hypophosphataemic 37. Glorieux FH, St-Arnaud R (1997) Vitamin D vitamin D resistant osteomalacia. Hardy DC, Murphy WA, Siegal BA et al (1989) X-linked hy- Vitamin D, Academic Press, San Diego, California, pp 755- pophosphatemia in adults: prevalence of skeletal radiographic 764 and scintigraphic features. Econs MJ, Samsa GP, Monger M et al (1994) X-linked hy- dent rickets Type II, resistance of target organs to 1,25-dihy- pophosphatemic rickets: a disease often unknown to affected droxyvitamin D. McCance RA (1947) Osteomalacia with Looser’s nodes Radiol Clin North Am 29:97-118 (Milkman’s syndrome) due to raised resistance to vitamin D 40. Brill PW, Winchester P, Kleinman PK (1998) Differential di- acquired about the age of 15 years. In: Bone growth in health and dis- duced osteomalacia: a surgically curable syndrome, report of ease. Taybi H, Lachman R (1996) Radiology of syndromes, meta- (1961) Hypophosphatasia: a genetic study. Looser E (1920) Uber spatrachitis und osteomalacie Klinishe pophosphatasia: report of severe and mild cases. Arch Intern ront-genologische und pathologischanatomische Untersuch- Med 141:727-731 ungen. Milkman LA (1930) Pseudofractures (hunger osteopathy, late phatasia: a report of two cases. Hain SF, Fogelman I (2002) Nuclear medicine studies inmetabol- position in hypophosphatasia: a reappraisal. Mayo-Smith W, Rosenthal DI (1991) Radiographic appear- fractures: clinical course and radiological findings. McKenna MJ, Kleerekoper M, Ellis BI et al (1987) Atypical Musculoskel Radiol 6(3):197-206 insufficiency fractures confused with Looser zones of osteo- 73. Kanis JA, Gluer C-C (2000) An update on the diagnosis and ment of the activity of Paget’s disease of bone. Diffusion-weight- Technical report 843, World Health Organisation, Geneva, ed MR imaging of bone marrow: differentiation of benign ver- Switzerland, pp 5 sus pathologic compression fractures. Rauch F, Glorieux FH (2004) Osteogenesis imperfecta Lancet Radiology of osteoporosis. Rea JA, Steiger P, Blake GM, Fogelman I (1998) Optimizing Comparison of methods for the visualisation of prevalent ver- data acquisition and analysis of morphometric X-ray absorp- tebral fracture in osteoporosis. Smyth PP, Taylor CJ, Adams JE (1999) Vertebral shape: auto- fracture assessment using a semi-quantitative technique. Mughal M, Ward K Adams J (2004) Assessment of bone sta- Radiographics 16:335-348 tus in children by densitometric and quantitative ultrasound 80. Jergas M (2003) Conventional radiographs and basic quantita- techniques.

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