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lignancy, which is exceedingly rare Tumors less than 1 cm in diameter are referred to as microadenomas and are at rst con ned to the sella As the tumor grows, it rst compresses the pituitary gland; then, as it extends upward and out of the sella, it compresses the optic chiasm; later, with continued growth, it may extend into the cavernous sinus, third ventricle, temporal lobes, or posterior fossa Recognition of an adenoma when it is still con ned to the sella is of considerable practical importance, since total removal of the tumor by transsphenoidal excision or some form of stereotactic radiosurgery is possible at this stage, with prevention of further damage to normal glandular structure and the optic chiasm Penetration of the diaphragm sellae by the tumor and invasion of the surrounding structures make treatment more dif cult Pituitary adenomas come to medical attention because of endocrine or visual abnormalities Headaches are present with nearly half of the macroadenomas but are not clearly part of the syndrome The visual disorder usually proves to be a complete or partial bitemporal hemianopia, which has developed gradually and may not be evident to the patient (see the description of the chiasmatic syndromes on page 206) Early on, the upper parts of the visual elds may be affected predominantly A small number of patients will be almost blind in one eye and have a temporal hemianopia in the other Bitemporal central hemianopic scotomata are a less frequent nding A post xed chiasm may be compressed in such a way that there is an interruption of some of the nasal retinal bers, which, as they decussate, project into the base of the opposite optic nerve (Wilbrand s knee) This results in a central scotoma on one or both sides (junctional syndrome) in addition to the classic temporal eld defect (see Fig 13-2) If the visual disorder is of long standing, the optic nerve heads are atrophic In 5 to 10 percent of cases, the pituitary adenoma extends into the cavernous sinus, causing some combination of ocular motor palsies Other neurologic abnormalities, rare to be sure, are seizures from indentation of the temporal lobe, CSF rhinorrhea, and diabetes insipidus, hypothermia, and somnolence from hypothalamic compression With regard to differential diagnosis, bitemporal hemianopia with a normal sella indicates that the causative lesion is probably a saccular aneurysm of the circle of Willis or a meningioma of the tuberculum sellae The major endocrine syndromes associated with pituitary adenomas are described brie y in the following pages Their functional classi cation can be found in the monograph edited by Kovacs and Asa A detailed discussion of the diagnosis and management of hormone-secreting pituitary adenomas can be found in the reviews of Klibanski and Zervas and of Pappas and colleagues; recommended also is an article that details the neurologic features of pituitary tumors by Anderson and colleagues Also worthy of emphasis is the catastrophic syndrome of pituitary apoplexy discussed further on Amenorrhea-Galactorrhea Syndrome As a rule, this syndrome becomes manifest during the childbearing years The history usually discloses that menarche had occurred at the appropriate age; primary amenorrhea is rare A common history is that the patient took birth control pills, only to nd, when she stopped, that the menstrual cycle did not re-establish itself On examination, there may be no abnormalities other than galactorrhea Serum prolactin concentrations are increased (usually in excess of 100 ng/mL) In general, the longer the duration of amenorrhea and the higher the serum prolactin level, the larger the tumor (prolactinoma) The elevated prolactin levels distinguish this disorder from idiopathic galactorrhea, in which the serum prolactin concentration is normal. libtiff c# To load . tiff file in C# - Stack Overflow
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Windows.Media.Imaging TiffBitmapEncoder - 30 examples found. These are the top rated real world C# (CSharp) examples of System.Windows.Media.Imaging. The threshold for perception of pain, ie, the lowest intensity of a stimulus recognized as pain, is approximately the same in all persons In ammation lowers the threshold for perception of pain by a process called sensitization This process allows ordinarily innocuous stimuli to produce pain in sensitized tissues The pain threshold is, of course, raised by local anesthetics and by certain lesions of the nervous system as well as by centrally acting analgesic drugs Mechanisms other than lowering or raising the pain threshold are important as well Placebos reduce pain in about onethird of the groups of patients in which such effects have been recorded Acupuncture at sites anatomically remote from painful operative elds apparently reduces the pain in some individuals Distraction and suggestion, by turning attention away from the painful part, reduce the awareness of and response to pain Strong emotion (fear or rage) suppresses pain, presumably by activation of the above-described descending adrenergic system The experience of pain appears to be lessened in manic states and enhanced in depression Neurotic patients in general have the same pain threshold as normal subjects, but their reaction may be excessive or abnormal The pain thresholds of frontal lobotomized subjects are also unchanged, but they react to painful stimuli only brie y or casually if at all The degrees of emotional reaction and verbalization also vary with the personality and character of the patient The conscious awareness or perception of pain occurs only when pain impulses reach the thalamocortical level The precise roles of the thalamus and cortical sensory areas in this mental process are not fully understood, however For many years it was taught that the recognition of a noxious stimulus as such is a function of the thalamus and that the parietal cortex is necessary for appreciation of the intensity, localization, and other discriminatory aspects of sensation This traditional separation of sensation (in this instance awareness of pain) and perception (awareness of the nature of the painful stimulus) has been abandoned in favor of the view that sensation, perception, and the various conscious and unconscious responses to a pain stimulus comprise an indivisible process That the cerebral cortex governs the patient s reaction to pain cannot be doubted, however It is also likely that the cortex can sup-. c# free tiff library Best 20 NuGet tiff Packages - NuGet Must Haves Package
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An XActLib assembly: a Library for working with Tiff Images (ie processing incoming Faxes). ... Gnostice Free PDF and Office document viewer for WinForms.
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