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ophthalmos (early in the disease, exophthalmos may be absent), lack of ptosis, and the lack of de nitive response to neostigmine Polymyositis and inclusion body myopathy are differentiated from myasthenia by lack of involvement of extraocular muscles, but they may affect oropharyngeal muscles as does myasthenia Finding the signs of these diseases in combination with those of myasthenia indicates a concurrence of two independent autoimmune diseases The neurasthenic or depressed patient who complains of weakness when actually referring to fatigability There is no ptosis, strabismus, or dysphagia, though a neurotic individual may complain of diplopia (usually of momentary duration when drowsy) and also of tightness in the throat (globus hystericus) A number of such patients claim improvement with neostigmine, but objective weakness and reversal thereof is always uncertain.

Conversely, myasthenia is as often mistaken for hysteria or other emotional illness, mainly because the physician is unfamiliar with myasthenia (or with hysteria) and has been overly impressed with the precipitation of the illness by an emotional crisis Fatigability is a feature of all of these conditions, but only in the psychiatric ones does it extend to the sphere of mental endurance Moreover, those with myasthenia do not usually complain of fatigue, meaning of the body and mind, whereas these are frequent complaints in psychiatric conditions A similar problem that has arisen frequently on our services pertains to judging breathlessness due to anxiety or cardiopulmonary disease in a patient with presumed myasthenia Careful appraisal of the breathing pattern and determination of the vital capacity and more accurate spirometric measurements are helpful here Progressive external ophthalmoplegia and other restricted myopathies, including the congenital myasthenic states.

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These may be mistaken for long-established myasthenia gravis It should be emphasized that the extraocular muscles and levator palpebrae may be permanently damaged by myasthenia and cease to respond to neostigmine Another possibility is that restricted ocular myasthenia may not respond to anticholinesterase drugs from the beginning and the diagnosis of myasthenia is erroneously excluded One must then turn to other muscles for clinical and electromyographic and serologic con rmation of the diagnosis Myasthenia with dysarthria and dysphagia, but without ptosis or obvious strabismus These may be mistaken for multiple sclerosis, polymyositis, inclusion body myopathy, stroke, motor neuron disease, or some other neurologic disease Testing with an anticholinesterase inhibitor, single- ber recording, and measurement of antibodies usually clari es the matter The initial manifestations of botulism blurred vision, diplopia, ptosis, strabismus, and ophthalmoparesis may be mistaken for myasthenia gravis of acute onset.

In botulism, however, the pupils are usually large and unreactive, and the eye signs are followed in rapid succession by involvement of bulbar, trunk, and limb muscles Similarly, the oculopharyngeal-brachial and Fisher variants of GBS in their early stages have many of the features of myasthenia, including ptosis that may be partially responsive to anticholinesterase drugs The loss of tendon re exes or the development of ataxia in GBS and detailed electrophysiologic testing distinguishes the two conditions Intoxication with organophosphate insecticides, because of.

To associate geometric symbols with speci c dimensions, you must rst create the dimension using the appropriate dimensioning command. Then you use the TOLERANCE command to add the tolerancing information. 1. Pick the Diameter Dimension button from the toolbar and pick a point anywhere on the hole. 2. Pick a second point to position the dimension as shown in Fig. 30-8 on page 412. Let s change the method of tolerance from Basic to Limits. 3. Select the new dimension, right click, and pick Properties from the shortcut menu.

Figure 5-8

You can also depict the chart areas filled in. Choose Radar | Filled to do so. Depending on the size of the individual data series, the areas may overlap. For the following series of chart types, understanding what types of data show up in specific chart types becomes very important. For this series of chart types, we will be using a different data set. The following illustration is the basis for these charts. As you can see, the data provider has been changed to only one key figure for Material Group (note that in the initial query this is listed as the Product Group information and we have adjusted for reporting purposes to show as Material Group). Area charts Profile area charts Pie charts Polar charts Speedometers

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