Reviews

Erectile Dysfunction Protocol Review

Erectile Dysfunction Protocol Review

30 Minutes Body Review

30 Minutes Body Review

Mindore Free Hair Building Fibers Review

Mindore Free Hair Building Fibers Review

Flat Belly Fix Review

Flat Belly Fix Review

Psoriasis Revolution Review

Psoriasis Revolution Review

Felicitys Gluten Free Cookbook Review

Felicitys Gluten Free Cookbook Review

Natural PCOS Diet Review

Natural PCOS Diet Review

Articles

Interactions Between the Reproductive System and Other Organ Systems

Indicates ways in which this system affects other systems indicates ways in which other systems affect this one At puberty, androgens stimulate development of body hair and apocrine glands and increased sebaceous secretion estrogens stimulate fat deposition and breast development in females pregnancy may cause pigmentation changes and stretch marks Sensory stimulation of skin important to sexual arousal mammary glands nourish infant Androgens and estrogens stimulate adolescent skeletal growth...

Interactions Between the Lymphatic and Immune Systems and Other Organ Systems

Indicates ways in which these systems affect other organ systems indicates ways in which other organ systems affect these systems Lymphatic system drains excess tissue fluid and removes cellular debris and pathogens. Immune system provides defense against pathogens and immune surveillance against cancer. Skin provides mechanical and chemical barriers to pathogens has antigen-presenting cells in epidermis and dermis and is a common site of inflammation Lymphocytes and macrophages arise from bone...

Hyposecretion and Hypersecretion

Inadequate hormone release is called hyposecretion. It can result from tumors or lesions that destroy an endocrine gland or interfere with its ability to receive signals from another gland. For example, a fractured sphenoid bone can sever the hypothalamo-hypophyseal tract and thus prevent the transport of oxytocin and antidi-uretic hormone to the posterior pituitary. The resulting ADH hyposecretion disables the water-conserving capability of the kidneys and leads to diabetes insipidus, a...

Interactions Between the Urinary System and Other Organ Systems

Indicates ways in which this system affects other systems indicates ways in which other systems affect this one The urinary system serves all other systems by eliminating metabolic wastes and maintaining fluid, electrolyte, and acid-base balance Renal control of fluid balance essential for sweat secretion Epidermis is normally a barrier to fluid loss profuse sweating can lead to oliguria skin and kidneys collaborate in calcitriol synthesis Renal control of calcium and phosphate balance and role...

History of Immunology

The metamorphosis of immunology from a curiosity of medicine associated with vaccination to a modern science focused at the center of basic research in molecular medicine is chronicled here. The people and events that led to this development are no less fascinating than the subject itself. A great number of researchers in diverse areas of medicine and science contributed to building the body of knowledge we now possess. It is possible to name only a few here, but we owe a debt to them all. We...

Thick Eyebrows Syndrome

Close-up of face of the same infant as in Figure 3.12. Note the hirsutism, bushy eyebrows, downward slanting palpebral fissures, and micrognathia. Figure 3.14. This infant with Cornelia de Lange's syndrome shows many of the characteristic findings coarse, mop-like hair bushy eyebrows and synophrys confluent, thick eyebrows long curly eyelashes short nose with small anteverted nostrils thin lips with a small midline beak of the upper lip long philtrum and downward curving of the...

Fifth metatarsal head resection

This procedure is well suited for older sedentary individuals, and for patients with osteopenia or osteomyelitis of the metatarsal head, where a transpositional osteotomy is not appropriate. Although transfer lesions callus or ulcer have been reported to occur beneath adjacent Fig. 8.15 The Weil lesser metatarsal shortening osteotomy, a The lesser toe is plantarflexed, and the oblique osteotomy cut begins at the distal dorsal edge of the articular cartilage, b Proximal displacement of the...

Maxie C Maultsby Jr and Rational Behavior Therapy RBT

While still a psychiatric resident, Maxie C. Maultsby, Jr., studied briefly with Joseph Wolpe in 1967 and with Ellis for the following 7 years. At the 1975 Chicago National Conference of Rational Emotive and Behavior Therapists, Maultsby described his unique method of psychotherapy called Rational Behavior Therapy, or RBT. Then RBT was and probably still is the only method of psychotherapy that is based on the well-established facts about the mental activities of normal human brains that make...

How did the eponym Alzheimers disease come into being

In the autumn of 1903, Alois Alzheimer left Frankfurt. Following a short stay in Heidelberg, he moved to Munich to continue his scientific and medical activities at the Royal Psychiatric Clinic under director Emil Kraepelin. After Auguste D. died on April 8, 1906, Alzheimer asked that the record and the brain be sent to Munich. He immediately did a report on the admission formulas used in Munich at this time and wrote a full-page epicrisis. After this he made an entry to the autopsy book of the...

Normal Cecum and Ileocecal Valve

The short segment of the colon between the appendix and the ileocecal valve is the cecum. Cecum. The short segment of the colon between the appendix and the ileocecal valve is the cecum. Fig. 6.30 Cecal pole. One of the tenia leading to the appendiceal orifice from about the 9-o'clock position . Note the distinct vascular pattern of the normal mucosa. Fig. 6.30 Cecal pole. One of the tenia leading to the appendiceal orifice from about the 9-o'clock position . Note the distinct vascular...

Testing Your Comprehension

Suppose a pregnant woman with severe morning sickness has been vomiting steadily for several days. How will her loss of stomach acid affect the pH of her body fluids Explain. 2. Suppose a person with a severe anxiety attack hyperventilates and exhales CO2 faster than his body produces it. Consider the carbonic acid reaction on page 70 and explain what effect this hyperventilation will have on his blood pH. Hint Remember the law of mass action. 3. In one form of nuclear decay, a neutron...

The Scope Of The Problem

Diabetic foot complications are a major global public health problem. Amputation rates vary throughout the world but are always increased in people with diabetes compared to those without diabetes. Amputations are increasing in diabetic patients. Throughout the world, health-care systems, both public and private, have been unsuccessful in managing the overwhelming problems of patients suffering with diabetic foot complications. The results of this failure are shown in the following case...

How Large Is 5 Mm Polyp

D Instruments left to right for polyp retrieval normal polypectomy snare, grasping forceps, four-pronged grasping forceps, dormia basket. e Polyp trap device. The specimen bag is placed in the trap so that suctioned polyp fragments or small polyps remain hanging in the bag. The bag is cut open with scissors to retrieve the polyp fragments. f Polyp retrieval net. The net is placed over the working channel of the instrument and the polyp or polyp pieces are caught in the net. The polyps are...

Venous Sinus Obstruction in Pseudotumor Cerebri Syndrome Cause or Effect

Whether venous sinus obstruction in PTS is cause or effect remains unresolved. The experimental and clinical evidence discussed above indicates that there is potential for primary venous sinus pathology to cause PTS and there is also potential for secondary venous sinus obstruction due to raised intracranial pressure. We discuss below the available evidence and also present a unifying theory based on the establishment of a disordered positive feedback cycle. The discussion will centre on the...

Hair At Lower End Of Spinal Cord In Newborn

A cervical meningocele may be difficult to differentiate from an occipital encephalocele. Further study in this infant showed that this was a cervical meningocele. Figure 3.57. A cervical meningocele may be difficult to differentiate from an occipital encephalocele. Further study in this infant showed that this was a cervical meningocele. Figure 3.58. A midline hair tuft in the lumbosacral area. This infant had a tethered cord on MRI study. Hair tufts, skin tags, sinuses, and...

Vacterl Syndrome Life Expectancy

Anorectal malformations ARM and cloacal anomalies are rare and complex malformations of the lower gastrointestinal and genitourinary tract. They affect approximately 1 3,500-1 5,000 live births 1 . They may occur in isolation or in association with abnormalities of the urogenital, cardiovascular and skeletal systems as well as with the vertebral, anal, cardiac, tracheoesophageal, renal and limb abnormalities VACTERL association. Treatment has traditionally focussed on achieving urinary and...

Diverticulosis and Diverticulitis

Colonic diverticula are fingerlike outpouchings protruding outward from the intestinal lumen. True and pseudodiverticula. A distinction is made between true diverticula and pseudodiverticula. The seldom-occurring true diverticula are present at birth and usually only appear in the right hemicolon. Pseudodiverticula, which occur much more frequently, are acquired. They can be found anywhere in the colon, though they tend to appear in the left hemicolon. True diverticula are characterized by...

The Cambridge and Colorado models

The Cambridge AV Fig. 5.2 is essentially similar to the Colorado or Lane model Lane Manufacturing Co., Denver, Colorado and the CSU model Fig. 5.1. The major features required of an artificial vagina AV . Fig. 5.1. The major features required of an artificial vagina AV . Animal Reproductive Systems, Chiro, California . The Cambridge model is primarily used in the UK and the rest of Europe, whereas the Colorado or Lane model and the CSU AV find greater popularity in the USA. Fig. 5.2. The...

Androgens and Sebum Production

The majority of potent androgens are produced by peripheral target tissues. For example, in postmenopausal women, 100 of active sex steroids are synthesized in peripheral target tissues from inactive steroid precursors while in adult men approximately 50 of androgens are locally made in intracrine target tissues 4 . The major androgens that interact with the androgen receptor are testosterone and dihydrotestosterone. Androgen receptors have been localized to the basal layer of the sebaceous...

Table 45 Causes of thick nails andor subungual hyperkeratosis Frequent

Onychomycosis Figure 4.19 Psoriasis Figures 4.14-4.15 Contact eczema Mineral oils Cement Hair styling products Repeated microtrauma Single major trauma Subungual clavus Less frequent Bowen's disease Lichen planus Figure 4.24 Norwegian scabies Pachyonychia congenita Figures 4.21-4.23 Pityriasis rubra pilaris Figure 4.20 Acrokeratosis paraneoplastica Bazex's syndrome Onychopapilloma of the nail bed Rare Alopecia areata Radiodermatitis Arsenic keratosis SPLINTER HAEMORRHAGES AND HAEMATOMAS The...

Table 43 Causes and associations of onychogryphosis Dermatological

Ichthyosis Psoriasis Onychomycosis Syphilis, pemphigus, variola Local causes Isolated injury to the nail apparatus Repeated minor trauma caused by footwear Foot faults such as hallux valgus Regional causes Associated varicose veins Thrombophlebitis even in the upper limb Aneurysms Elephantiasis Disease involving the peripheral nervous system General causes Old age Vagrancy and senile dementia Disease involving the central nervous system Hyperuricaemia Idiopathic forms Subungual hyperkeratosis...

The Importance of External Anatomy

In the study of human anatomy, it is easy to become so preoccupied with internal structure that we forget the importance of what we can see and feel externally. Yet external anatomy and appearance are major concerns in giving a physical examination and in many aspects of patient care. A knowledge of the body's surface landmarks is essential to one's competence in physical therapy, cardiopul-monary resuscitation, surgery, making X rays and electrocardiograms, giving injections, drawing blood,...

Antibodies to Nucleosomes Chromatin

Antibodies to nucleosomes have had a comeback in the last few years. This has to do with both the clinical utility of these antibodies in the diagnosis of SLE and drug-induced lupus DIL and new evidence suggesting that nucleosomes may be major candidate autoimmunogens in lupus. Since it is generally accepted that anti-nucleosome antibodies cause the LE cell phenomenon, they were actually among the first autoantibodies discovered. Of note, autoantibodies against individual components of...

Incisional biopsy and punch biopsy

It is essential to have a working clinical diagnosis, but wherever there is doubt the pathologists can provide much more precise information regarding the nature and extent of the lesion. For example, a patch of Bowen's disease intraepidermal carcinoma may resemble sclerosing superficial basal cell carcinoma and a biopsy will usually distinguish them. Similarly, what seems to be a dysplastic pigmented naevus clinically may, on the one hand, prove to be benign or, on the other hand, turn out to...

The Placenta Its Membranes and the Umbilical Cord

The human placenta is a highly sophisticated organ of interface between mother and fetus, often referred to as the gate-keeper to the fetus. Careful examination of the placenta, its membranes, and the umbilical cord can prove to be a valuable aid in the diagnosis and treatment of the neonate. Gross examination of the placenta takes five minutes, and more sophisticated examination should be considered when there is poor pregnancy outcome, recognizable malformations or abnormalities, multiple...

Benzalkonium Chloride Is Rentered Inactive In Presence Of

Which one of the following chemicals is NOT suitable as a drug excipient 16. Which of the following chemicals may be included in a drug solution as a chelating agent 17. Which of the following ions may be effectively chelated by EDTA 18. Although most drugs in pharmaceutical dosage forms are expected to decompose following first-order kinetics, an exception are drugs formulated in 19. An early sign of a decomposing epinephrine 20. On exposure to air, aminophylline solutions may develop C a...

Defining the Target Population

Defining the target population for a screening program involves describing the settings and the characteristics of the collection of persons who would be eligible for screening Last 1995 . This should be the first step in planning a population-based screening program because screening programs should be tailored to meet the needs of a defined target population. In practice, however, screening programs are developed and implemented in response to the availability of an effective screening test...

The Tympanic Membrane and its Landmarks

This is the most important structure for the clinician diagnostically, because its appearance, and what can be seen through it, are by and large the only anatomic clues to what goes on inside (Figs. 3.3 and 3.4). The most visible landmark beneath the TM is the manubrium, or handle, of the malleus, the lower portion of this first ossicle. The upper portion of the manubrium has a visible prominence, seen near the top of the TM, called the short process. The...

Chapter One Introduction

ANATOMICAL POSITION AND TERMS OF DIRECTION When studying the human body it is important to place the body in anatomical position. Anatomical position is described as the body facing you, feet placed together and flat on the floor. The head is held erect, arms straight by the side with palms facing forward. All references to the body are made as if the body is in this position so when you describe something as being above something else it is always with respect to the body being in anatomical...

Delayed Closure andor Incomplete Ossification of Sutures and Fontanels

Persistent patency of cranial sutures and fontanels at a time when they are meant to be closed The sutures and fontanels are prominent in the newborn, diminishing in size as ossification of the skull proceeds throughout childhood and early adulthood. The anterior fontanel is wide open at birth and shrinks to fingertip size by the age of 15-18 months. The posterior fontanel is usually closed to palpation by 4 months of life, but occasionally closure is evident at birth. The cranial sutures are...

Axis II Personality Disorders and Mental Retardation

On Axis II are listed Personality Disorders and Mental Retardation. These disorders, by definition, are present for a substantial period of time (i.e., years). Although Axis I disorders may also be present for similar lengths of time, enduring symptoms are fundamentally part of these Axis II disorders. Also listed on Axis II are other traits or prominent features of a person's personality that a clinician deems maladaptive (e.g., frequent use of denial, excessive impulsivity). In addition to...

Colitis Inflammatory Bowel Diseases and Other Forms of Colitis

The following abbreviations are used in this chapter DALM dysplasia-associated lesion or mass DGVS German Society of Digestive and Metabolic Diseases Deutsche Gesellschaft f r Verdauungsund Stoffwechselkrankheiten HGIN high-grade intraepithelial neoplasia IBD Inflammatory Bowel Disease LGIN low-grade intraepithelial neoplasia NSAID nonsteroidal anti-inflammatory drugs PSC primary sclerosing cholangitis UC ulcerative colitis Colitis. The intestinal mucosa has a limited number of possible...

Late Stump Complications and Revision

Following surgery, amputation stumps may prove suitable for provision of satisfactory prostheses, or may not, because of a variety of established conditions. Earlier authors were especially concerned about continued suppuration, failure to heal, sugar-loaf formation with bone protrusion, painful scars and overlong below-knee stumps which prevented efficient use of a kneeling peg-leg. Poor or failed healing necessitated permanent bandaging to protect fragile tissues from further damage and also...

Methods and Techniques for Sacral Nerve Stimulation

The sacrum is normally composed of five modified vertebrae which are fused together. It is a triangular bone mass extending from the inferior vertebral column and containing the sacral and coccygeal nerves. The skin in the sacral region is usually thick, and the subcutaneous tissue varies in thickness according to the habitus of the individual. It tends to be thinner than that found in the adjacent gluteal and lumbar regions. Situated deep below the superficial fascia are two layers of fibrous...

Treacher Collins Syndrome

Close-up of the face of the same infant showing the antimongoloid slant and colobomas of the lower eyelids which typically occur at the junction of the inner two-thirds and outer third of the lower eyelids. Note the absence of eyebrows and eyelashes, the prominent nose and the hypoplasia of the zygomatic bone. Figure 3.193. A less severe case of Treacher-Collins syndrome. Note the unilateral macros-tomia and the abnormal ear. Treacher-Collins syndrome is a familial malformation...

Table 42 Causes and associations of nail shedding

Local inflammation, e.g. acute paronychia Figures 4.7-4.12 Kawasaki's syndrome Fever or systemic upsets Syphilis Bullous dermatoses, e.g. pemphigus Stevens-Johnson syndrome Toxic epidermal necrolysis Lyell's syndrome Figures 4.7-4.9 Drugs Cytotoxics Antibiotics Retinoids Keratosis punctata Local trauma X-irradiation Hypoparathyroidism with amelogenesis imperfecta HYPERTROPHIC NAIL AND SUBUNGUAL HYPERKERATOSIS Ideally, the term 'hypertrophy of the nail plate' should be restricted to conditions...

Inversion Radiography

Wangensteen and Rice 50 first described the use of inversion radiography in 1930 to indicate the distance between the gas bubble within the terminal colon and the perineal skin. Many authors 6, 8, 11, 13, 19, 22, 29, 39, 48 then subsequently related the distance from the skin to the underlying abnormality, although the measurement of the distance alone does not provide the essential information required, which is the relationship of the blind-ending rectum to the levator ani and sphincter...

Rectoperineal Fistulas

Rectoperineal fistula is what traditionally was known as a low defect. The rectum is located within most of the sphincter mechanism. Only the lowest part of the rectum is anteriorly mislocated Fig. 20.2 . Sometimes the fistula does not open into the perineum, but rather follows a subepithelial midline tract, opening somewhere along the midline perineal raphe, scrotum, or even at the base of the penis. The diagnosis is established by perineal inspection. No further investigations are required....

Wet Gangrene Of The Hallux

A 72-year-old male patient with type 2 diabetes diagnosed at the age of 60 years and being treated with insulin, attended the outpatient diabetic foot clinic because of pain in his right hallux. His diabetes control was poor HBA1c 8.7 . He had hypertension and background retinopathy in both eyes. He was an ex-smoker. The patient had Figure 7.28 Wet gangrene of the right hallux and claw toe deformity. Ischemic hair, redness over toes, dystrophic nail changes can also be seen Figure 7.28 Wet...

Sigmoid Colon Infection

D, e Acute ulcerative colitis of uncertain genesis presumed cytomegalovirus infection was ruled out. Colon ulcer with adherent clot d . Visible vessel was seen after irrigation and removal of the clot and was closed with a hemoclip Olympus e . f Mild, acute hemorrhagic colitis in left hemicolon. No pathogen isolated. g, h Acute colitis with hemorrhagic erosions g and submucosal hemorrhages h . No pathogen detected. Acute colitis with massive mucosal edema, isolated hemorrhaging, and small,...

Infant Hemifacial Microsomia

Micrognathia in an infant with Goldenhar's syndrome hemifacial microsomia . In addition, note the preauricular skin tags, unilateral macrostomia, and skin tags due to the extra branchial arch anomalies. Figure 1.158. Micrognathia in an infant with Goldenhar's syndrome hemifacial microsomia . In addition, note the preauricular skin tags, unilateral macrostomia, and skin tags due to the extra branchial arch anomalies. Figure 1.159. A congenital midline cervical cleft is a rare...

Scalling Dermatitis Diabetes

A 50-year-old female with undiagnosed type 2 diabetes, applied Bazooker, a proprietary wart remedy, to a small brown tender papule over her right third metatarsal head. Within a few days she developed a cutaneous erosion which failed to heal for 9 months and became increasingly painful Fig. 2.13a,b . Diabetes was diagnosed by her Fig. 2.13 a Ulcer following application of a proprietary wart remedy which proved to be a squamous cell carcinoma, b Close-up of lesion. Fig. 2.13 a Ulcer following...

Ragged Cuticles And Hangnail

Thickened, hyperkeratotic, irregular ragged cuticles Figure 5.12 are most commonly seen in dermatomyositis Figure 5.13 . Perionychial tissues are constantly subjected to trauma. In nail biters and 'pickers' the cuticles and nail folds may show considerable damage, erosions, haemorrhage and crusting. The ulnar side of the nail fold and cuticle is most vulnerable and there may be small trian-gular tags of skin hangnail, Figure 5.14 and separated spicules of nail, still attached proxi-mally....

Frog Leg Position Infants

A CT scan of an infant with a grade II PVH-IVH. There is blood within the lateral ventricles without ventricular dilatation. Figure 3.105. A CT scan of an infant with a grade III PVH-IVH. There is blood within the dilated lateral ventricles. Figure 3.106. A CT scan of an infant with a grade IV PVH-IVH. Note the blood within the lateral ventricles and extension into the cerebral parenchyma. Figure 3.107. This term infant presented with marked increase in head size fronto-occipital...

Causes Of Aseptic Leukocyturia

Self-medication before urine culture Sample contamination by cleansing solution Vaginal discharge Urinary stone Urinary tract tumor Chronic interstitial nephritis especially due to analgesics Fastidious microorganisms requiring special culture medium Ureaplasma urealyticum, Chlamydia, Candida Leukocyturia. A significant number of leukocytes more than 10,000 per milliliter is also required for the diagnosis of urinary tract infection, as it indicates urothelial inflammation. Abundant...

Imperforate Anal Membrane

Table 8.9 Wingspread Conference classification Table 8.9 Wingspread Conference classification 2. Anal agenesis without fistula 3. Anal agenesis without fistula 1. Anocutaneous perineal fistula 1. Anovestibular perineal fistula, 2. Anocutaneous perineal fistula Persistent cloacal anomaly Rare malformations complex, it allowed ARM to be viewed in a structured fashion. Intermediate was later added to this classification to describe those lesions where the rectum ends below the PC line. In 1964...

Thyroid and Parathyroid Disorders

Congenital hypothyroidism is thyroid hyposecretion present from birth it was formerly called cretinism, now regarded as an insensitive term. Severe or prolonged adult hypothyroidism can cause myxedema MIX-eh-DEE-muh . Both syndromes are described in table 17.8, and both can be treated with oral thyroid hormone. A goiter is any pathological enlargement of the thyroid gland. Endemic goiter fig. 17.25 is due to dietary Figure 17.25 Endemic Goiter. The thyroid gland has hypertrophied as a result of...

Effects of Maternal Medication

During pregnancy, the average fetus is exposed to four physician-prescribed and five self-prescribed drugs. Every drug administered or taken by a pregnant woman presents the mother with both risks and benefits. The risks include the drug's potential as a teratogen or as a cause of toxicity in the fetus. Most human teratogens affect the embryo during a very narrow period of early development as illustrated by the time 24 to 33 days gestation during which the fetus is susceptible to limb...

Hormones Secreted By The Pituitary And Their Target Organs

The adenohypophysis produces and secretes many hormones that have diverse target areas. Growth hormone GH is released by the pituitary and causes growth and division of cells throughout the body. Prolactin is more specific in its function. Prolactin stimulates the mammary glands to become functional in milk production. Follicle stimulating hormone FSH and luteinizing hormone LH are gonadotropins that cause the ovaries and testes to release hormones. Thyroid stimulating hormone TSH causes the...

Organs Of The Male Reproductive System

The testes are enclosed in the scrotal sac which is lined with a smooth muscle layer called the dartos muscle. This muscle contracts when the temperatures drop near the testes, causing them to withdraw closer to the body where it is warmer. Another muscle of the region is the cremaster muscle. It also contracts when it is cold but it is made of skeletal muscle. The epididymis sits on top of the testis like a small cap and is a place where sperm cells mature. The spermatic cord consists of the...

Superficial Circumflex Iliac Artery

The superficial circumflex iliac artery arises from the femoral artery near the origin of the superficial epigastric artery. It pierces the deep fascia of the thigh lateral to the saphenous opening and courses laterally toward the anterior superior iliac spine to supply the superficial fascia and skin. It is considered the smallest branch of the femoral artery that anastomoses with the deep circumflex iliac, lateral femoral circumflex iliac and superior gluteal arteries. The course of this...

Overview Of The Nervous System

The body must react to the external environment and the internal environment and communicate information between regions of the body. This job is primarily the task of the nervous system. Proper response to the external environment is critical for thermal regulation, response to threats, taking advantage of opportunities such as food availability, and a host of other stimuli. Response to the internal environment is important for sensing muscle tension, digestive processes, maintenance of blood...

Body Cavities and Membranes

The body is internally divided into two major body cavities, dorsal and ventral fig. A.7 . The organs within them are called the viscera VISS-er-uh singular, viscus9 . Various membranes line the cavities, cover the viscera, and hold the viscera in place table A.2 . The dorsal body cavity has two subdivisions 1 the cranial CRAY-nee-ul cavity, which is enclosed by the cranium braincase and contains the brain, and 2 the verte bral canal, which is enclosed by the vertebral column backbone and...

Tethered Spinal Cord Images

In this infant with a f9 lipomeningocele with a tethered cord, note the associated skin discoloration with a small skin tag. Figure 3.82. A lipomeningocele with an associated sinus tract is present in this infant. Figure 3.83. Infant with a large dermal sinus tract associated with cord tethering and spinal dysraphism. On MRI there was a tethered cord and spina bifida both above and below the lesion. Figure 3.84. Small finger-like dermal tag extending from the mid-line of the back...

Birth Trauma

Birth trauma refers to those injuries sustained during labor and delivery. Despite skilled and competent obstetric care, some may be unavoidable. Factors predisposing infants to injury include macrosomia, prematurity, cephalopelvic disproportion, dystocia, prolonged labor, and abnormal presentation. In 1988, birth injuries ranked eight as major causes of neonatal mortality and caused 4.6 deaths per 100,000 live births. The clinician who cares for newborn infants must be familiar with the...

Midsagittal Brain To Label

When seen from an inferior view, many different features can be seen on the brain. The frontal lobe is anterior and the temporal lobe and cerebellum are visible as well. The cerebellum has small folds called folia. The medulla oblongata is attached to the spinal cord and the pons is anterior to the medulla oblongata. Anterior to the pons are the mammillary bodies which are responsible for the olfactory smell reflex. The pituitary gland is next to the mammillary bodies. Anterior to the pituitary...

Kennedy Disease Disabilities

Early on, there is decreased recruitment and interference, with decreased motor unit action potential amplitudes. In 2-4 weeks, fibrillations will develop, with possible fasciculations. Over time, reinnervation will lead to polyphasic motor units. Nerve conduction velocities and sensory studies are normal. Imaging Inflammation of the anterior spinal cord may be detected with MRI. Post-polio syndrome The diagnosis of PPS is by exclusion of other conditions and demonstration of progressive...

Muscular Dystrophy and Myasthenia Gravis

Muscular dystrophy14 is a collective term for several hereditary diseases in which the skeletal muscles degenerate, lose strength, and are gradually replaced by adipose and fibrous tissue. This new connective tissue impedes blood circulation, which in turn accelerates muscle degeneration in a fatal spiral of positive feedback. The most common form of the disease is Duchenne15 muscular dystrophy DMD , caused by a sex-linked recessive allele. Like other sex-linked traits see chapter 4 , DMD is...

What is kyphoplasty Would it help my spinal fractures

Spinal (or vertebral) fractures are a major concern for men and women with osteoporosis because they can lead to severe pain and disability (see Question 84). These fractures can also lead to kyphosis (see Figure 13 in Question 83). The spine deteriorates and curves due to fractures in individual vertebrae. Most osteoporotic vertebral fractures are traditionally treated with pain medications and a gradual return to normal activities. Although back braces to prevent twisting and support the...

Musculoskeletal Disorders

Although some congenital musculoskeletal dysplasias are among the most obvious disorders of the neonate, they are also the most unusual. Congenital absence of all or part of a limb, deformities of the feet or hands, and lesions of the neck and trunk are rarely a diagnostic problem. The most common musculoskeletal dysplasias are among the most difficult to diagnose. Congenital hip dislocation may not be diagnosed even after repeated examination by experienced observers. Musculoskeletal...

Cervical Curvature Labeled

We are unique as animals because of our upright posture. The vertical position of the spine is reflected in the increase in size of the vertebra from superior to inferior. The vertebral column is divided into five major regions. There are 7 cervical vertebrae that occur in the neck while the 12 thoracic vertebrae have ribs attached to them. The 5 lumbar vertebrae are found in the lower back and the sacrum consists of 5 fused sacral vertebrae. The coccyx is the terminal portion of the vertebral...

Regional Characteristics of Vertebrae

We are now prepared to consider how vertebrae differ from one region of the vertebral column to another and from the generalized anatomy just described. Knowing these variations will enable you to identify the region of the spine from which an isolated vertebra was taken. More importantly, these modifications in form reflect functional differences among the vertebrae. The cervical vertebrae C1-C7 are the smallest and lightest ones other than the coccygeals. The first two C1 and C2 have unique...

Intracerebellar deep cerebellar nuclei

The brainstem is presented from the anterior perspective, with the cerebellum attached as in Figure 6, Figure 7, Figure 8A, and Figure 8B . This diagram shows the intracerebellar nuclei also called the deep cerebellar nuclei within the cerebellum. There are four pairs of deep cerebellar nuclei the fastigial nucleus, the globose and emboliform nuclei together called the intermediate or interposed nucleus , and the lateral or dentate nucleus. Each belongs to a different functional part of the...

External Examination and Palpation

A careful history must be combined with the external exmination of the lacrimal system that begins with an inspection of the face, external ocular surface, and eyelid structure including the position and contour of the eyelid and eye blink Table 3.4 . Periorbital and facial asymmetry are looked for, as well as the lid malposition, bulges in the medial canthal area, facial nerve palsy, etc. Table 3.4. Watering patients external inspection and palpation Table 3.4. Watering patients external...

Fungal Infection With Multimicrobial Colonization

Superficial ulcers of 10 days' duration on the facing sides of the left first and second toe of a 70-year-old type 2 diabetic lady with diabetic neuropathy, before debridement are shown in Figures 8.8 and 8.9. Note soaking of the skin. An X-ray excluded osteomyelitis. Staphylococcus coagulase-negative, Pseudomonas aerugi-nosa and enterobacteriaceae were recovered after swab cultures in addition to Candida albicans. She was treated successfully with itraconazole for 5 weeks. The patient used a...

Scarring and Tympanosclerosis

A normal TM is often described as pearly in appearance. In fact, it is almost transparent. Scarring, which occurs in the middle fibrous layer, destroys this lucency. Scarring may result from repeated effusions or Fig. 5.3 Peripheral tympanosclerosis with central neomembrane, left ear. Source Sanna M, Russo A, DeDonato G. Color Atlas of Otoscopy. Stuttgart Thieme 1999 Fig. 5.3 Peripheral tympanosclerosis with central neomembrane, left ear. Source Sanna M, Russo A, DeDonato G. Color Atlas of...

How To Tell If You Are Lost

Once you have cut the flexor retinaculum proximal to the wrist, you should palpate the transverse carpal ligament with a hemostat or other similar blunt instrument and feel the grittiness of the transverse fibers. You should also feel the hook of the hamate from inside the carpal canal and then start your transection with the nerve protected. Once you are deep to the superficial fat and the palmar fascia, any further fat that is encountered distally indicates you are already distal to the end...

Onychomycosis and its treatment

Antonella Tosti, Robert Baran, Rodney PR Dawber, Eckart Haneke Candida onychomycosis Further reading Fungi may invade the nails in four different ways, leading to four separate types of onychomycosis with specific clinical features, prognosis and response to treatment. The type of nail invasion depends on the fungus responsible and the host susceptibility. Invasion occurs 1 Via the distal subungual area and the lateral nail groove, leading to distal lateral subungual onychomycosis Figure 8.1 ....

Fetal Qrowth and Assessment of Gestational

The normal term infant has completed a gestation of gt 37 weeks and has a birth weight gt 2500 g. Accurate dating of pregnancy is important in evaluating the abnormally grown infant at birth. There are two different populations of low birthweight infants, those who are 1 born premature in gestation i.e, at lt 37 weeks or 2 small for gestational age SGA . Infants are SGA for one of two reasons 1 a normal intrauterine environment but abnormal development due to fetal factors i.e., chromosomal...

Axis III General Medical Conditions

On Axis III are listed general medical conditions that may be relevant to the disorder s listed on Axes I and II. The presence of Axis III should not be taken to suggest a mind-brain dualism, with Axes I and II representing problems of the mind in the absence of a physiological basis. On the contrary, mental experience is rooted in the function of the brain. Axis III is included in the DSM to encourage a comprehensive evaluation and a consideration of the various ways in which a general medical...

Neuroischemic Ulcers At Various Sites

Neuro-Ischemic Ulcer with Osteomyelitis Neuro-Ischemic Ulcer on the Hallux with Osteomyelitis A 68-year-old obese male patient with type 2 diabetes diagnosed at the age of 46 years visited the outpatient diabetic foot clinic because of two chronic ulcers on his right hallux. He was treated with a combination of sulfonylurea during the day and a mixture of 20 rapid acting-80 intermediate acting insulin before dinner he also had dislipidemia which was being treated with simvastatin. On...

Mechanisms of Tear Drainage

Drainage of tears involves a number of different mechanisms Table 1.3 . Physical factors, such as gravity, respiration, and evaporation, have been suggested. A decisive role is played by capillary attraction, aided by contraction of the lacrimal portion of the orbicularis muscle with blinking, as well as distension of the lacrimal sac by the action of the orbicularis muscle 19 . The mucin diversity of the epithelium of the naso-lacrimal ducts together with TFF peptides that are able to...

The Discovery of Amyloid

Glenner died too young in 1995 due to complications of cardiac amy-loidosis. If he had survived, perhaps he and I would be writing this story together. Instead it will only be my personal recollections of the work we did in 1982-85 that led us to the discovery of the Alzheimer's disease beta protein, Glenner and Wong 1984a now also known as A-beta and beta-A amyloid. My introduction to George Glenner was in 1982, when I interviewed for a job in his new laboratory at the University...

Mechanisms of Ischemic Cell Death

Ischemic stroke compromises blood flow and energy supply to the brain, which triggers at least five fundamental mechanisms that lead to cell death excito-toxicity and ionic imbalance, oxidative nitrative stress, inflammation, apoptosis, and peri-infarct depolarization Fig. 1.1 . These pathophysiological processes evolve in a series of complex spatial and temporal events spread out over hours or even days Major pathways implicated in ischemic cell death excitotoxicity, ionic imbalance, oxidative...

Hepatic Portal Veins Trunk Veins

Most of the blood of the body returns to the heart by capillaries flowing into venules and finally into veins before reaching the heart. In a portal system blood moves from one capillary system to another capillary system before reaching the heart. The hepatic portal system takes blood from the capillary beds of many of the abdominal organs and carries it to the liver where metabolic processing takes place. The hepatic portal vein receives blood from various veins including the splenic vein,...

Estimating the Economic Burden of PCOS

We calculated the health care-related economic burden in PCOS based on the above prevalences of disease (64). We restricted the calculation to the United States only, although we recognize that PCOS is an international disorder. However, we should note that our estimation is highly conservative because we did not include a number of costs for which we did not have accurate and present-day prevalence and monetary estimates (Table 1). We did include the costs of the initial evaluation, detailed...

Fitness Proportionate Selection with Roulette Wheel and Stochastic Universal Sampling

Holland's original GA used fitness-proportionate selection, in which the expected value of an individual i.e., the expected number of times an individual will be selected to reproduce is that individual's fitness divided by the average fitness of the population. The most common method for implementing this is roulette wheel sampling, described in chapter 1 each individual is assigned a slice of a circular roulette wheel, the size of the slice being proportional to the individual's fitness. The...

Krickenbeck Consensus for the Classification Grouping of Surgical Techniques and Scoring for Follow Up of Anorectal

Standards for diagnostic procedures International Classi- International grouping Krickenbeck of surgical proce-fication Krickenbeck dures for follow up Perineal cutaneous fistula Rectourethral fistula Bulbar Prostatic Rectovesical fistula Vestibular fistula Cloaca No fistula Anal stenosis Pouch Colon Rectal atresia stenosis Rectovaginal fistula H type fistula Others Perineal operation Anterior sagittal approach Sacroperinal procedure PSARP Abdominosacroperi-neal pull-through Abdominoperineal...

Functional Areas Of The Cerebrum

The cerebrum can be described not only physically but also in terms of the functional areas. The functions of language are many and have different areas of specialization. The motor speech area Broca's area is typically on the left side of the frontal lobe and it involves the formation of words. Coordination of the tongue and other parts of the vocal apparatus occur here. Wernicke's area is located in the parieto-temporal region and is involved in the syntax of speech. Wernicke's area allows...

Exostoses Spurs Horns

Cartilage-covered osseous excrescences exostoses , ossific spine-like outgrowths spurs , and triangular bony processes horns arising from the surface of a bone In this section three types of bone outgrowth are discussed, which differ from one another in origin, structure, radiographic manifestations, and diagnostic implications. Exostoses, or osteochondromas, are cartilage-capped bony protrusions of the external surface of a bone. They are not true neoplasms, but are rather the manifestations...

Gluteal Asymmetry And Newborn

Palmar adduction cortical thumb in a normal infant. The thumbs are freely mobile but are held adducted and flexed across the palms with the fingers tightly clutched over them. Cortical thumbs are a manifestation of hypertonicity when they are present beyond the first 3 to 4 months. Constant palmar adduction or clasped thumb after this age would alert one to the possibility of central nervous system pathology. Clasped thumbs are held in a flexed and adducted position across the palm...

Difficulties In Stereotactic Breast Biopsies

It is important for the physician to anticipate that some patients and some lesions will be difficult for obtaining biopsy specimens. Certain lesion characteristics, such as low-density nodules, faint or nonclustered microcalcifications, or vague asymmetric densities, may be difficult to visualize with digital imaging despite postprocessing features. The position of certain lesions, such as those that are very superficial, those against the chest wall, or those in the axillary tail of the...

Section Of Uterus And Vagina

The oocyte is ovulated from the ovary and moves into the uterine tube. The uterine tube is fringed by small cylindrical structures called fimbriae. The uterus is a small, flask-shaped organ. The uterus has a domed fundus, a main body, a narrowed isthmus, and an inferior cervix. The uterosacral ligament attaches the uterus to the sacrum. Most of the uterine wall is made of the myometrium which is a thick layer of smooth muscle. The vagina is approximately ten centimeters in length and is lined...

The nature of onion dormancy and changes over time

Within the onion bulb, a succession of internal changes take place, preparing it for regrowth see Section 6.11 . In agreement with Brewster 1987 , Miedema 1994a, b and Miedema and Kamminga 1994 showed with Japanese, Dutch and US culti-vars that dormancy exists in bulbs soon after maturation, followed by rest, during which slow internal preparation for rooting and sprouting takes place, unless temperatures are very low near 0 C or above 25 C. Onion dormancy can be rapidly broken under favourable...

Polyps and Polyposis Syndromes

The term polyp describes a mass of tissue protruding into the lumen of the bowel, without implying pathological relevance. Polyps can be stalked, round, or sessile and can vary in size. They can occur as solitary or multiple polyps. Polypoid lesions are the most common pathological finding of colonoscopy. Polyps can only be classified by histological evaluation. Pathologically and anatomically, polyps of epithelial tissue are distinguished from those of mesodermal tissue and there are also a...

Russell Silver Syndrome

The lower extremities of the infant show the less severe changes in that the femora, tibiae, and fibulae are hypoplastic and the feet are abnormal. Figure 3.173. This infant with Rubenstein-Taybi syndrome presented at term with a birth-weight of 2700 g and a length of 48 cm. Note the prominent forehead, hypertrichosis, downslanting palpebral fissures, epicanthic folds, long eyelashes, hypertelorism, broad nasal bridge, a beaked nose with a nasal septum extending below the alae...

Seborrhoeic dermatitis

Seborrhoeic dermatitis has nothing to do with sebum or any other kind of greasiness. There are two distinct types, adult and infantile. The adult type is more common in men and in those with a tendency to scaling and dandruff in the scalp. There are several commonly affected areas Seborrhoeic dermatitis affects the central part of the face, scalp, ears, and eyebrows. There may be an associated blepharitis, giving some red eyes and also otitis externa. The lesions over the sternum sometimes...

Prominent Occiput Infant

Radiograph of an infant with metatropic dysplasia. This is another form of dwarfism associated with a narrow thorax, thoracic kyphoscoliosis and metaphyseal flaring giving the typical dumb-bell appearance . The proportion of the length of the trunk to the extremities reverses during childhood. At first the trunk is too long and the extremities too short. With increasing kyphoscoliosis the trunk becomes short. Figure 2.61. Radiograph of an infant with metatropic dysplasia. This is...

Infant Umbilical Hernia

The same infant also had an omphalocele. The finding of cleft lip and palate with an omphalocele or large umbilical hernia should alert one to the possibility of the diagnosis of trisomy 13. Figure 4.17. Median cleft syndrome may be associated with chromosomal defects. This infant with tri-somy 13 had cyclops with anophthalmia. There is no proboscis present. There was arhinencephaly and alobar holoprosencephaly on CT scan. Figure 4.17. Median cleft syndrome may be associated with...

Noise Induced Hearing Loss

How much of the hearing loss of aging is due to noise exposure Actually, this is a difficult question that often arises in litigation, when an aging patient is seeking compensation for his hearing loss from years of industrial noise exposure. Quite certainly, the two types of loss coexist in many individuals and one aggravates the other. However, characteristic audio-metric differences are noted in the pure forms. The early loss from noise damage shows up as a dip at 4 KHz most often, with...

Passing the Anal Sphincter

After completing inspection and palpation and, if necessary, administering an analgesic, the actual endoscopic examination can begin. A local anaesthetic lubricating jelly, such as a lubricant containing Lidocain, should be applied liberally. The endoscope tip is then inserted in the rectum and guided digitally without visualization. The examiner should explain to the patient the steps being taken and inform the patient that he may experience the urge to evacuate his bowels. The endoscope tip...

Anovulation Is A Characteristic Feature Of Pcos. It Manifests As Menstrual Disturbance 80 Amenorrhoea Oligoamenorrhea

The features of PCOS may be elicited when obtaining the medical history or upon the physical examination. The ovarian morphological and the biochemical and metabolic features of the disorder are discussed in Chapters 16 and 17. The evaluation of patients with androgen excess, including PCOS, is discussed in Chapter 33. 2.1. Features Elicitable by Medical History In this section, we will outline important information that the medical history will elicit concerning the features of PCOS, including...

Overview Of The Endocrine System

The endocrine system is a collection of glands and organs that secrete hormones. This system is grouped according to the function that the individual organs have. Some of these organs have two roles and are called mixed organs. They secrete hormones and also perform other functions such as digestion or secretion. The pancreas is a good example of this. It secretes hormones an endocrine function that regulate blood sugar levels and also secretes enzymes exocrine secretions that break down...

Coronal View Of The Nasal Conchae Amd Larynx

The nasal cavity is more than a hole behind the nose. Inhaled air swirls around the conchae and is warmed and moistened in the process. Label and color the septal cartilage in a coronal section of the nose. Label and color each of the conchae. The superior nasal concha, middle nasal concha, and the inferior nasal concha should each have a different color. The frontal and ethmoid sinuses can also be seen in this illustration. They give resonance to the voice. Note the location of the hard palate...

Larynx Trachea And Lungs Overview

Two main cartilages of the larynx can be seen from an anterior view. The thyroid cartilage is superior to the cricoid cartilage. Below the larynx is the trachea which divides into the right and left primary bronchi. The right primary bronchus leads to the right lung and the left primary bronchus leads to the left lung. Label the parts of the respiratory system illustrated. Color the two visible cartilages of the larynx different colors and the trachea another color. Color the bronchi in first...

Medical History and Physical Examination in Patients With Possible Androgen Excess

We outline here the basics of the medical history and physical exam in the patient suspected of suffering from androgen excess. The timing and pace of pubertal development and its relation to complaints of unwanted hair growth, hair loss, acne, and or obesity should be established. The onset and progression of these complaints should also be established. Drug or medication use and exposure or use of skin irritants should be elicited. A detailed menstrual history should be obtained, with an...

ABC of arterial and venous disease Varicose veins

Varicose veins are tortuous, twisted, or lengthened veins. Unless the enlargement is severe, size alone does not indicate abnormality because size can vary depending on ambient temperature and, in women, hormonal factors. In addition, normal superficial veins in a thin person may appear large, whereas varicose veins in an obese person may be hidden. Varicose veins can be classified as trunk, reticular, or telangiectasia. Telangiectasia are also referred to as spider veins, star bursts, thread...

Conclusion Of Medicinal Chemistry

The interest in the pharmaceutical industry to develop long-acting -adrenoceptor agonists with improved duration of action over salmeterol and formoterol is intense. The coming years will be pivotal as data for the most promising compounds will become available from clinical studies. There remains a continuing need for quality inhaled medicines for the treatment of asthma and COPD and it is a challenge to the industry to supply improved agents. 1 B. Waldeck, Eur. J. Pharmacol, 2002, 445, 1. 2...

What types of medication are usually prescribed for osteoporosis

If you are told you have osteopenia or are diagnosed with osteoporosis, calcium and Vitamin D supplementation with appropriate exercise may not be enough to decrease bone loss or build bone. You may need a prescription medication. Some medications are only prescribed for women and others are prescribed for both women and men. The North American Menopause Society (NAMS) advises that the following women receive prescription medication as part of their treatment for osteoporosis Postmenopausal...

Newborn Marfan Syndrome

A term newborn with Marfan syndrome who had a birth weight of 3720 g and a length of 54 cm. Note the tall stature with long slim limbs and hypotonia. In Marfan syndrome, limbs are disproportionately long and trunk length is usually normal resulting in a low upper lower segment ratio. Ophthalmologic and cardiovascular pathologies, such as dislocation of the lens and aneurys-mal dilatation of the aorta, are usually noted after the neonatal period. Figure 3.98. A term newborn with...