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Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The consultant looking after a 41 year old female outpatient with normal renal function and urine dip comes to ask you for advice. The patient had an ultrasound abdomen for query gallstones due to intermittent epigastric and right upper quadrant pain. The ultrasound confirmed gallstones but the report also mentioned bilateral echogenic renal pyramids with otherwise normal kidneys. A CT urinary tract from an emergency department attendance 1 month previously also demonstrated hyperdense medullary pyramids with no hydronephrosis. A CT urogram confirmed a striated nephrogram.
The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Each glomerular capsule leads into a twisted tubule. The proximal convolution (or proximal convoluted tubule) twists around in the cortex near the corpuscle. The tubule then straightens into the medulla, turns in a U-shaped curve, and climbs back toward the corpuscle. This loop, called the loop of Hemie, consists of a narrow descending limb on the proximal side and wider ascending limb on the distal side. As the tubule approaches its own capsule, it twists again into the distal convolution (or distal convoluted tubule) and then straightens again as it joins the first of a series of collecting tubules. The collecting tubules pass through the cortex into the medullary pyramid, collecting the filtrate of other nephrons along the way and joining with other collecting tubules until they make their final junctions into papillary ducts. The papillary ducts emerge from the apex of the pyramid into a minor calyx.
The kidneys
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Both the kidneys are uniformly and equally reduced in size, sometimes only slightly so, but often to about a third of normal. In those kidneys that are greatly shrunken, the capsule is often firmly adherent and the subcapsular surface uniformly and finely irregular. There is diffuse thinning of the cortex, which accounts largely for the reduction in kidney size, while the medullary pyramids are also, although less markedly, shrunken. The amount of fatty tissue around the renal pelvis is increased. In contrast to chronic pyelonephritis, the calyces and renal pelvis are not distorted.
A Case Report of Bilateral Abducens Palsy in the Setting of Clival Fracture – Recovery Related to Pathophysiological Basis of Injury
Published in Neuro-Ophthalmology, 2021
Stefan Dimou, Lobna Alukaidey, Girish Nair
The course of the abducens nerve from the brainstem to the lateral rectus is long and tortuous, leaving it vulnerable to injury. Emerging from the lower border of the pons, above the medullary pyramid, it travels ventrally through the pontine cistern before turning superiorly to pierce the dura mater along the clivus and courses upwards between the layers of the dura. It then passes through the osteofibrous conduit known as Dorello’s canal at the petrous apex to pass into the cavernous sinus, where it runs adjacent to the cavernous segment of the internal carotid artery before entering the superior orbital fissure (Figure 4). Here it runs through the cone of muscles to enter the ocular surface of the lateral rectus muscle, approximately one-third of the way along.2
The psychometric properties of the toe tap test in people with stroke
Published in Disability and Rehabilitation, 2019
Shamay S. M. Ng, Mimi M. Y. Tse, Eric W. C. Tam, Cynthia Y. Y. Lai
The TTT counts on the unaffected sides were also significantly lower than those of the healthy older adults. Ipsilateral weakness following stroke has long been noted in patients with stroke [39,40]. The motor functions of one limb are controlled by both cerebral hemispheres via the corticospinal tract. Neurophysiological studies with monkeys have shown that approximately 10% of the corticospinal tract fibers are uncrossed and project to the distal extremities in the ventral corticospinal tract [41], although the majority of corticospinal axons cross to the contralateral side at the level of the medullary pyramids in most mammals. Thus, lesions in either cerebral hemisphere could influence motor control and the functioning of both limbs [42].
Chondroitinase ABC for neurological recovery after acute brain injury: systematic review and meta-analyses of preclinical studies
Published in Brain Injury, 2018
Chan Hee Koh, Savva Pronin, Mark Hughes
Two studies (with two comparisons) surgically transected the medullary pyramids. There was a significant motor improvement in rats administered ChABC to the cervical spine (NMD: 28.0%; CI: 15.8–40.3%, no HKSJ adjustment; k = 1; p < 0.0001), and a non-significant trend towards improvement in after brain ChABC administration (NMD: 49.6%; CI: −16.5–115.7%, no HKSJ adjustment; k = 1; p = 0.14).