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bruit that may be audible to the patient ( self-audible bruit ) Other neurologic manifestations are phrenic nerve palsy, numbness of the face, a Horner syndrome, cerebellar ataxia, and temporal lobe epilepsy The jugular foramen is eroded (visible in basilar skull lms and CT) and the CSF protein may be elevated Women are affected more than men, and the peak incidence is during middle adult life The tumor grows slowly over a period of many years, sometimes 10 to 20 or more Treatment has consisted of radical mastoidectomy and removal of as much tumor as possible, followed by radiation The combined intracranial and extracranial two-stage operation has resulted in the cure of many cases (Gardner et al) A detailed account of this tumor will be found in the article by Kramer.

Carotid Body Tumor (Paraganglioma) This is a generally benign but potentially malignant tumor originating in a small aggregate of cells of neuroectodermal type The normal carotid body is small (4 mm in greatest diameter and 10 mg in weight) and is located at the bifurcation of the common carotid artery The cells are of uniform size, have an abundant cytoplasm, are rich in substance P, and are sensitive to changes in PO2, PCO2, and pH (ie, they are chemoreceptors, not to be confused with baroreceptors) The tumors that arise from these cells are identical in appearance with tumors of other chemoreceptor organs (paragangliomas) Interestingly, they are 12 times more frequent in individuals living at high altitudes.

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Clinically the usual presentation is of a painless mass at the side of the neck below the angle of the jaw; thus it must be differentiated from the branchial cleft cyst, mixed tumor of the salivary gland, and carcinomas and aneurysms in this region As the tumor grows (at an estimated rate of 20 cm in diameter every 5 years), it may implicate the sympathetic, glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves (syndrome of the retroparotid space; see Chap 47) Hearing loss, tinnitus, and vertigo are present in some cases Tumors of the carotid body have been a source of transient ischemic attacks in 5 to 15 percent of the 600 or more reported cases One of the most interesting presentations has been with sleep apnea, particularly with bilateral tumors (see below); respiratory depression as well as lability of blood pressure are common postoperative problems.

Evaluation of a non surgical muscle stimulating system to elevate soft tissue of the face and neck J Drugs of Dermatol 2006;5(5):446-450..

Malignant transformation occurs in 5 percent of cases A similar paraganglioma of the vagus nerve has been reported; it occurs typically in the jugular or nodose ganglion but may arise anywhere along the course of the nerve These tumors may also undergo malignant transformation, metastasize, or invade the base of the skull A carotid body tumor, separate in nature from the glomus jugulare tumor, has been seen in combination with von Recklinghausen neuro bromatosis Familial cases are known, especially with bilateral carotid body tumors (about 5 percent of these tumors are bilateral) The treatment should be surgical excision with or without prior intravascular embolization; radiation therapy is not advised.

Pituitary Adenomas (See also page 486) Tumors arising in the anterior pituitary are of considerable interest to neurologists because they often cause visual and other symptoms related to involvement of structures bordering upon the sella turcica before an endocrine disorder becomes apparent Pituitary tumors are agelinked; they become increasingly numerous with each decade; by the 80th year, small adenomas are found in more than 20 percent of pituitary glands In some cases, an apparent stimulus to adenoma.

To protect a worksheet, use the protect worksheet command, specify the sheet, and add the parameters for the type of protection you want. The following list explains the parameters; each is optional, but you ll normally want to at least set a password to make the protection effective.

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LM7805 - (+) voltage regulator LM7905 - ( ) voltage regulator 24-VCT transformer 2-amp-center tapped SPST toggle switch On-Off 2-amp fast blow fuse

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