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It should be noted that in patients with hyperactive tendon re exes, striking the muscle rather than its tendon can elicit a stretch re ex An increment in power with a series of several voluntary contractions in the absence of myotonia is a feature of the inverse myasthenic (Lambert-Eaton) syndrome, which is associated in about 50 percent of cases with small-cell carcinoma of the lung The same increment occurs in botulism In both instances there is an electromyographic (EMG) equivalent a rapid increase in the voltage of a series of action potentials upon appropriate stimulation (pages 1101 and 1259) The effect of cold on muscle contraction may also prove informative; either paresis or myotonia, lasting for a few minutes, may be evoked or enhanced by cold This is most prominent in the paramyotonia of Eulenberg, but it may occur to some degree in all the other myotonic disorders.

Returning to our firefighter analogy, when firefighters are called to a fire, they need to know the location of the fire, the type of fire (house fire, chemical fire, and so on) so they know what equipment to bring, and other pertinent information. The particular location and type of fire may well vary from call to call, but in each case this information is necessary in order for the firefighters to do their job.

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Myotonia and myoedema must also be distinguished from the recruitment and spread of involuntary spasm induced by strong and repeated contractions of limb muscles in patients with mild or localized tetanus, with the stiff-man syndrome (Chap 55), and with dystonias of various types These are not primary muscle phenomena but are neural in origin, due to an abolition of inhibitory mechanisms The repeated contraction of forearm or leg muscles after the application of a tourniquet (exceeding arterial pressure) to the proximal part of a limb will often elicit latent tetany (carpopedal spasms) Its special mode of development in conditions that decrease the concentration of ionized calcium as well as its duration, its enhancement by hyperventilation, and the association of tingling, prickling paresthesias separate tetany from ordinary cramp and also from true physiologic contracture.

position, be very cautious because the overall market may be way ahead of you. If you place a long straddle or strangle position after the event is prepriced into the market, the result is not likely to be favorable for your position. It is not uncommon to see volatility signi cantly decline just after major reports or news, especially if the news is neutral to the market or within analysts expectations for the numbers. In agriculture and energy markets, reports are frequently prepriced based on the expected numbers from analyst estimates, and the only signi cant changes in the market occur when the numbers are on the extreme fringes of the range. Call options are often the most susceptible to prepricing because small investors frequently use outright out-of-the-money call options ahead of market news. Portfolio managers may be buying call options as a hedge on short market positions ahead of reports. This demand will drive up the implied volatility only to have these traders reduce their exposure to time value or delta after the report. Time limits for spreads. There is no method for pricing based on the movement of the underlying on long neutral delta since both sides of the market have potential, but with time value always working against the position, you can decide that, if the underlying price remains within a certain range in a certain period of time, then your probability for success on the long strangle or straddle has been signi cantly reduced. Include a time stop or time limit to the spread before you liquidate or roll ahead to a new contract. De ne spread objectives. The most important risk control on long straddle and strangle positions is to clearly outline why

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In practice, the term contracture is applied (somewhat indiscriminately, as discussed below) to all states of xed muscle shortening Several distinct types can be recognized In true physiologic contracture a group of muscles, after a series of strong contractions,.

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Web Item Parameters for the Chart Web Item (continued)

2. Pick a couple of objects and press ENTER to copy the objects to the Windows Clipboard. 3. Save your work. 4. Create a new drawing from scratch using Imperial units. 5. On the Clipboard panel, pick the Paste button to enter the PASTECLIP command. 6. Move the crosshairs and notice that the objects are attached to it. 7. Pick an insertion point. 8. Exit AutoCAD without saving the current drawing.

8:

Saphenous n. (from femoral n.)

than SIMMs. The technique for installing a DIMM (as shown in Exercise 1-6) is slightly different than for a SIMM.

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