This document discusses disorders of the autonomic nervous system. It begins by describing the anatomy and neurotransmitters of the sympathetic and parasympathetic nervous systems. It then discusses various tests used to evaluate autonomic function, including heart rate variation with deep breathing, the Valsalva maneuver, sudomotor function tests, and orthostatic blood pressure recordings. The document concludes by describing specific autonomic disorders like Parkinson's disease, spinal cord lesions, autoimmune autonomic neuropathy, and postural orthostatic tachycardia syndrome.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
This Presentation for all medicos and Basic science students --
Introduction
Forms of chemical signaling
Posterior pituitary gland
Antidiuretic hormone
Action of ADH
Regulation of ADH
Actions of oxytocin
Control of oxytocin secretion
Factors affecting secretion oxytocin
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Anatomic Organization
• Autonomic nervous system consists of
Parasympathetic nervous system
Sympathetic nervous system
• The activity of ANS is regulated by central neurons which
post integration of afferent information adjust the
autonomic outflow according to the need.
3. • The preganglionic neurons of the parasympathetic nervous
system leave CNS in the third, seventh, ninth, and tenth
cranial nerves as well as the second and third sacral nerves.
• The preganglionic neurons of the sympathetic nervous system
exit the spinal cord between the first thoracic and the second
lumbar segments.
• The preganglionic fibres are thinly myelinated
4. • The postganglionic neurons, located in ganglia outside the
CNS, give rise to the postganglionic unmyelinated autonomic
nerves that innervate organs and tissues throughout the
body.
5.
6. • Acetylcholine (ACh) is the preganglionic neurotransmitter for
both divisions of the ANS as well as the postganglionic
neurotransmitter of the parasympathetic neurons
• Norepinephrine (NE) is the neurotransmitter of the
postganglionic sympathetic neurons, except for cholinergic
neurons innervating the eccrine sweat glands.
• Purinergic fibers may play a role in the control of vasomotor
tone and in the regulation of regional blood flow.
7. • Responses to sympathetic and parasympathetic stimulation
are frequently antagonistic reflecting highly coordinated
interactions within the CNS.
8.
9. Autonomic control of BP and HR
• Arterial blood pressure is directly proportional to
both vascular resistance and cardiac output; it is
maintained within a narrow range by the baroreflex
mechanisms
• Vasomotor tone, which determines peripheral
resistance, is controlled by the sympathetic nervous
system through a group of neurons in the
ventrolateral medulla that project to the
intermediolateral column(ILC).
10. • The baroreceptors in the carotid sinus and aortic arch are
sensitive to transient blood pressure changes and
maintain the systemic blood pressure at a relatively
constant level.
• When the blood pressure falls, there is a reduction in the
frequency of impulses from the baroreceptors to the
nucleus tractus solitarius and other brainstem centers.
• The reflex increase in sympathetic activity causes an
increase in the vasomotor tone. The corresponding
decrease in vagal efferent activity to the heart causes an
increase in the heart rate.
11.
12. • Sympathetic nerve fiber activity in muscles increases in
response to
a fall in blood pressure
to changes in posture from the lying to sitting and
standing positions and
to the application of negative pressure to the lower body,
which is thought to unload intra thoracic low-pressure
volume receptors.
13. • The splanchnic vascular bed plays an important part in
the regulation of blood pressure in humans. There is a
marked decrease in mesenteric blood flow
on assuming the upright posture or
on applying negative pressure to the lower body
14. Autonomic Control of Sweat Glands
and Skin Blood Vessels
• The sweat glands
postganglionic sympathetic cholinergic fibers and
vasoactive intestinal peptide (VIP)-containing fibers
• Skin blood vessels
postganglionic sympathetic noradrenergic fibers.
15. • The sudomotor fibers are faster conductors than the
vasomotor fibers.
• Muscle and skin sympathetic activity differ in their responses
to a range of stimuli.
• Skin sympathetic activity, in contrast to muscle sympathetic
activity, is increased by mental stress and emotional stimuli
and cooling, but not significantly by the Valsalva maneuver or
body posture.
16. Classification
I. Diseases affecting central nervous system
A. Progressive autonomic failure (PAF) (idiopathic
orthostatic hypotension)
1. Pure PAF
2. PAF with parkinsonian features(PAF-P)
3. PAF with multiple-system atrophy (Shy-Drager
syndrome)(PAF-MSA)
B. Parkinson’s disease
C. Spinal cord lesions
D. Wernicke’s encephalopathy
18. II.Diseases affecting the peripheral autonomic
nervous system
A. Disorders with no associated peripheral neuropathy
1. Acute and subacute autonomic neuropathy
a. Pandysautonomia
b. Cholinergic dysautonomia
2. Botulism
19. B. Disorders associated with peripheral neuropathy
1. Autonomic dysfunction clinically important
a. Diabetes
b. Amyloidosis
c. Acute inflammatory neuropathy
d. Acute intermittent porphyria
e. Familial dysautonomia (Riley-Day syndrome)
f. Chronic sensory and autonomic neuropathy
20. 2. Autonomic dysfunction usually clinically not important
a. Alcohol-induced neuropathy
b. Toxic neuropathies
c. Malignancy
d. Vitamin B12 deficiency
e. Rheumatoid arthritis
f. Chronic renal failure
g. Systemic lupus eryrhematosus
h. Mixed connective tissue disease
i. Fabry’s disease
j. Chronic inflammatory neuropathy
21. Symptomsof Dysautonomia
• orthostatic hypotension
• syncope
• sleep dysfunction
• altered sweating (hyperhidrosis or hypohidrosis)
• constipation
• upper gastrointestinal symptoms (bloating, nausea, vomiting
of old food)
• impotence or
• bladder disorders (urinary frequency, hesitancy, or
incontinence)
22. Testsfor Dysautonomia
Heart Rate Variation with Deep Breathing
• parasympathetic component (vagus nerve) of cardiovascular
reflexes.
• Influenced by multiple factors
subject’s position (recumbent, sitting or standing)
rate and depth of respiration
age
medications
weight and
degree of hypocapnia
23. • Interpretation of results requires comparison of test data with
results from age-matched controls collected under identical
test conditions.
• For example, the lower limit of normal heart rate variation with
deep breathing in persons <20 years is 15–20 beats/min, but
for persons over age 60 it is 5–8 beats/min.
• Rate variation with deep breathing (respiratory sinus
arrhythmia) is abolished by the muscarinic acetylcholine (ACh)-
receptor antagonist atropine but is unaffected by sympathetic
postganglionic blockade (e.g., propranolol)
24. Valsalva Response
• Assesses integrity of the baroreflex control of heart rate
(parasympathetic) and BP (adrenergic).
• Tested in the supine position.
• The subject exhales against a closed glottis for 15s.
• Autonomic function during the Valsalva maneuver can be
measured using beat-to-beat blood pressure or heart rate
changes.
25. Sudomotor Function
• Sweating is induced by release of Ach from sympathetic
postganglionic fiber.
• The quantitative sudomotor axon reflex test (QSART) is a
measure of regional autonomic function mediated by ACh-
induced sweating.
• A reduced or absent response indicates a lesion of the
postganglionic sudomotor axon. For example, sweating may be
reduced in the feet as a result of distal polyneuropathy (e.g.,
diabetes).
26. • The thermoregulatory sweat test (TST) is a qualitative measure
of regional sweat production in response to an elevation of
body temperature under controlled conditions.
• An indicator powder (alizarin red powder or iodine corn starch)
changes color with sweat production during temperature
elevation. The pattern of color change is a measure of regional
sweat secretion.
27. • A postganglionic lesion is present if both QSART and TST
show absent sweating.
• In a preganglionic lesion, QSART is normal but TST shows
anhidrosis.
28. Orthostatic BP Recordings
• Beat-to-beat BP measurements determined in supine, 70° tilt,
and tilt-back positions.
• The BP change combined with heart rate monitoring is useful
for the evaluation of patients with suspected OH or
unexplained syncope
29. Tilt Table Testing for Syncope
• The great majority of patients with syncope do not have
autonomic failure.
• Tilt table testing can be used to make the diagnosis of
vasovagal syncope with sensitivity, specificity, and
reproducibility.
• A standardized protocol is used that specifies the tilt
apparatus, angle and duration of tilt, and procedure for
provocation of vasodilation (e.g., sublingual or spray
nitroglycerin).
30. Treatment
• Management of autonomic failure is aimed at specific
treatment of the cause and alleviation of symptoms.
• Of particular importance is the removal of drugs or
amelioration of underlying conditions that cause or aggravate
the autonomic symptoms, especially in the elderly.
31.
32. PATIENT EDUCATION
• Only a minority require drug treatment.
• All patients should be taught
the mechanisms of postural normotension
volume status
resistance and capacitance bed
autoregulation
the nature of orthostatic stressors
time of day and
the influence of meals, heat, standing, and exercise
33. Patients should learn to
• Recognize orthostatic symptoms early (especially subtle
cognitive symptoms, weakness, and fatigue) and to modify or
avoid activities that provoke episodes.
• Keep a BP log
• Dietary modification (salt/fluids).
• Learn physical counter maneuvers that reduce standing OH
• Practice postural and resistance training.
34. • SYMPTOMATIC TREATMENT
Non pharmacological:
Adequate intake of salt and fluids to produce a voiding volume
between 1.5 and 2.5 L of urine each 24 h is essential
Elevation of head end while sleeping.
Prolonged recumbency should be avoided when possible.
35. Sitting with legs dangling over the edge of the bed for several
minutes before attempting to stand.
Leg-crossing with maintained contraction of leg muscles for 30
seconds compresses leg veins and increases systemic
resistance.
Compressive garments, such as compression stockings and
abdominal binders, are helpful occasionally but are
uncomfortable.
36. Anemia should be corrected with erythropoietin, administered
subcutaneously at doses of 25–75 U/kg three times per week.
The hematocrit increases after 2–6 weeks.
A weekly maintenance dose is usually necessary.
The increased intravascular volume that accompanies the rise
in hematocrit can exacerbate supine hypertension.
37. Pharmacological treatment
Midodrine
directly acting α 1 -agonist
does not cross the blood-brain barrier
duration of action 2–4 h.
The usual dose is 5–10 mg orally tid
Side effects include pruritus, uncomfortable piloerection, and
supine hypertension especially at higher doses.
38. Pyridostigmine
a parasympathomimetic and a reversible cholinesterase
inhibitor
enhances ganglionic transmission.
improves OH without aggravating supine hypertension
39. Fludrocortisone
enhances renal sodium conservation and increases the
sensitivity of arterioles to NE.
At doses between 0.1 mg/d and 0.3 mg bid orally, it reduces
OH, but it aggravates supine hypertension.
Susceptible patients may develop fluid overload, congestive
heart failure, supine hypertension, or hypokalemia.
40. Specific Syndromes
• Progressive Autonomic Failure
• Idiopathic orthostatic hypotension, or progressive autonomic
failure (PAF), is a primary degenerative disorder of the
central and peripheral autonomic nervous systems.
• The condition may be uncomplicated by other neurological
manifestations (PAF), or may be associated with
• Parkinsonian features (PAF-P)
• or multiple-system atrophy (PAF-MSA)
41. • In PAF there is a loss of cells in the ILC, loss of small
myelinated fibers in the ventral roots, and loss of neurons in
the dorsal vagal nuclei.
• Degeneration of sympathetic ganglia and the appearance of
Lewy bodies with hyaline structures in the sympathetic
ganglion cells.
42. • Clinical features include
postural hypotension (most important)
impairment of the sweating mechanism,
disturbances of heart rate and blood pressure control.
• Management is mostly non pharmacological. Drugs are
used for severe symptoms
43. Parkinson’s Disease
• Autonomic disturbances are common in advanced disease.
• Difficult to distinguish from PAF-P
• Management is symptomatic and that of underlying disease
44. Spinal Cord Lesions
• Spinal cord lesions from any cause may result in focal
autonomic deficits or autonomic hyper reflexia
• Autonomic dysreflexia describes a dramatic increase in blood
pressure in patients with traumatic spinal cord lesions above
the C6 level, often in response to stimulation of the bladder,
skin, or muscles.
45. • Potential complications include intracranial vasospasm or
hemorrhage, cardiac arrhythmia, and death.
• Awareness of the syndrome and monitoring of blood
pressure during procedures in patients with acute or chronic
spinal cord injury is essential.
46. Autoimmune Autonomic Neuropathy(AAN)
• Presents with the subacute development of autonomic
disturbances with
OH
enteric neuropathy (gastroparesis, ileus,
constipation/diarrhea), and
cholinergic failure(loss of sweating, sicca complex, and a tonic
pupil)
47. • Autoantibodies against the ganglionic ACh receptor (A3 AChR)
are present and are now considered to be diagnostic.
• Beneficial response to plasmapheresis or intravenous immune
globulin has been documented
• Symptomatic management of OH, gastroparesis, and sicca
symptoms is essential.
48. Postural Orthostatic Tachycardia Syndrome(POTS)
• Characterized by symptomatic orthostatic intolerance (not OH)
and by either an increase in heart rate to >120 beats/ min or
an increase of 30 beats/min with standing that subsides on
sitting or lying down.
• Syncopal symptoms (lightheadedness, weakness, blurred
vision) combined with symptoms of autonomic overactivity
(palpitations, tremulousness, nausea) are common.
49. • Expansion of fluid volume and postural training are initial
approaches to treatment.
• If these approaches are inadequate, then midodrine,
fludrocortisone, phenobarbital, beta blockers, or clonidine
may be used.
50. Inherited Disorders
• There are five known hereditary sensory and autonomic
neuropathies (HSAN I–V).
• The most important ones are HSAN I and HSAN III (Riley-Day
syndrome; familial dysautonomia).
51. • HSAN I is dominantly inherited and often presents as a distal
small-fiber neuropathy (burning feet syndrome).
• The responsible gene, on chromosome 9q, is designated
SPTLC1 . SPTLC is an important enzyme in the regulation of
ceramide.
52. • HSAN III, an autosomal recessive disorder of infants and
children that occurs among Ashkenazi Jews, is much less
prevalent than HSAN I.
• Decreased tearing, hyperhidrosis, reduced sensitivity to pain,
areflexia, absent fungiform papillae on the tongue, and labile
BP may be present . Episodic abdominal crises and fever are
common.
• The defective gene, named IKBKAP , is also located on the
long arm of chromosome 9.
53. Acute Autonomic Syndromes
• An autonomic storm is an acute state of sustained sympathetic
surge that results in variable combinations of alterations in
blood pressure and heart rate, body temperature, respiration,
and sweating.
• Causes of autonomic storm are
brain and spinal cord injury,
toxins and drugs,
autonomic neuropathy, and
chemodectomas (e.g., pheochromocytoma).