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    It was previously believed that the pathogenesis of the diverticulum was due to abnormally high hypopharyngeal pressures caused by defective coordination of upper esophageal sphincter relaxation during pharyngeal 10 CHAPTER 1  SWALLOWING DIsORdERs ANd DYsPHAGIA Table 1-6.  Comparison of the Oropharynx and the Esophagus OROPHARYNX Striated muscle Direct nicotinic innervation Cholinergic ESOPHAGUS Striated muscle , smooth viagra for cheap muscle Myenteric plexus within longitudinal and circular smooth muscles Cholinergic, nitric oxide, vasoactive intestinal peptide bolus propulsion. Zenker diverticulum is an obstructive rather than a propulsive disease, thus. It is now known that Zenker diverticulum is caused by a constrictive myopathy of the cricopharyngeus (poor sphincter compliance).

    1-1). Increased resistance at the cricopharyngeus and increased intrabolus pressures above this relative obstruction cause muscular stress in the hypopharynx with herniation and diverticulum formation. 14. Are Zenker diverticula the result of an obstructive or a propulsive defect?.

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    At least 30% of patients develop psychiatric dis- Niemann–Pick Disease—Type C Niemann–Pick disease—type C is an autosomal recessive disorder of cholesterol metabolism (lipid storage disease) that presents in infants, children, and adults. And death typically by age 3, the infantile form is viagra for cheap a relentlessly progressive neurodegenerative disease with onset between 2 and 2 months of age. Patients with adult-onset disease may have progressive dystonia, spinocerebellar degeneration, motor neuron disease, which may mimic amyotrophic lateral sclerosis (ALS), and/or psychosis.

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