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By H. Tamkosch. Yale University. 2018.

Fibers of both filled buy apcalis sx 20mg amex, ductule structure called the membranous labyrinth effective 20mg apcalis sx. Sensory Organs © The McGraw−Hill Anatomy purchase 20 mg apcalis sx otc, Sixth Edition Coordination Companies 20 mg apcalis sx for sale, 2001 494 Unit 5 Integration and Coordination Extrafusal fibers Intrafusal fibers: Nuclear chain fibers Skeletal muscle Nuclear bag fiber Peripheral nerve (Motor and sensory neurons) Connective tissue sheath Muscle Sensory neurons spindle Sensory neuron Neurotendinous receptors Motor neurons Tendon Bone Motor end plates (a) (b) FIGURE 15 apcalis sx 20 mg overnight delivery. Also, because of decussation (crossing- over), somatic information from each side of the body is projected Knowledge Check to the postcentral gyrus of the contralateral cerebral hemisphere. List the different types of cutaneous receptors and state All somatic information from the same area of the where they are located. What portion of the brain inter- body projects to the same area of the postcentral gyrus. List the receptors that that receive sensory information from different parts of the body respond to pain and the structures of the brain that (see fig. Such a map is greatly distorted, however, be- are particularly important in the perception of pain cause it shows larger areas of cerebral cortex devoted to sensation sensation. The dis- proportionately large areas of the caricature-like sensory ho- 8. Discuss why it is important for a physician that there is a higher density of sensory receptors in the face and to know the referred pain sites. Using a flow chart, describe the neural pathways leading from cutaneous pain and pressure receptors to the postcen- tral gyrus. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 495 FIGURE 15. Olfac- tion functions closely with gustation (taste) in that the receptors Olfactory receptors are the dendritic endings of the olfactory nerve for both are chemoreceptors, which require dissolved substances (I) that respond to chemical stimuli and transmit the sensation of for stimuli. Olfactory receptor cells are located in the nasal mucosa within the roof of the nasal cavity on both sides of the nasal sep- Objective 8 Describe the sensory pathway for olfaction. Olfactory cells are moistened by the surrounding glandular goblet cells. The cell bodies of the bipolar olfactory Olfactory reception in humans is not highly developed compared cells lie between the supporting columnar cells. Because we do not rely on each olfactory cell contains several dendritic endings, called smell for communicating or for finding food, the olfactory sense olfactory hairs that constitute the sensitive portion of the recep- is probably the least important of our senses. These unmyelinated dendritic endings respond to air- in detecting the presence of an odor rather than its intensity. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 496 Unit 5 Integration and Coordination Olfactory Olfactory bulb nerve fibers Cribriform plate of ethmoid bone Olfactory receptor cells Supporting columnar epithelial cells (b) Nasal cavity Olfactory (a) hairs FIGURE 15. The unmyelinated axons of the olfactory cells Knowledge Check unite to form the olfactory nerves, which traverse the foramina 10. Trace the pathway of an olfactory stimulus from the olfac- and white matter called the olfactory bulbs. The olfactory bulbs tory hairs to the cerebral cortex,where interpretation occurs. Within the olfactory bulb, neurons of the olfactory nerves synapse with dendrites of neu- rons forming the olfactory tract. Sensory impulses are conveyed GUSTATORY SENSE along the olfactory tract and into the olfactory portion of the cerebral cortex,where they are interpreted as odor and cause the Taste receptors are specialized epithelial cells, clustered together perception of smell. Only about 2% of inhaled air comes in contact with the olfac- Objective 10 Identify the cranial nerves and the sensory tory receptors, which are positioned in the nasal mucosa pathways of gustation. Olfactory sensitivity can be increased by forceful sniffing, which draws the air into con- tact with the receptors. Taste Certain chemicals activate the trigeminal nerves (V) as well buds are specialized sensory organs that are most numerous on the as the olfactory nerves (I) and cause reactions. Pepper, for example, surface of the tongue,but they are also present on the soft palate may cause sneezing; onions cause the eyes to water; and smelling and on the walls of the oropharynx. The cylindrical taste bud is salts (ammonium salts) initiate respiratory reflexes and are used to revive unconscious persons. However, because of the caustic nature composed of numerous sensory gustatory cells that are encapsu- of smelling salts and the irreparable damage it may cause to the un- myelinated olfactory hairs, it is seldom used in first aid treatment of an unconscious person. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 497 Vallate papilla Filiform papilla Lingual tonsil Epiglottis Fungiform papilla Palatine tonsil Root of tongue Vallate Taste buds Body papillae of tongue (b) Fungiform papillae Squamous Median epithelium groove of tongue Supporting cell Apex Filiform of tongue (a) papillae Gustatory cell Taste pore Gustatory microvilli Connective tissue (c) FIGURE 15. Each gustatory cell contains Taste buds are found only in the vallate and fungiform papil- a dendritic ending called a gustatory microvillus that projects to lae. The filiform papillae, although the most numerous of the the surface through an opening in the taste bud called the taste human tongue papillae, are not involved in the perception of taste.

J Path Bact Seneterre E purchase apcalis sx 20 mg online, Weissleder R buy 20mg apcalis sx otc, Jaramillo D et al (1991) Bone marrow: 94:275-291 ultrasmall superparamagnetic iron oxide for MR imaging buy discount apcalis sx 20 mg on line. Durie BGM 20 mg apcalis sx fast delivery, Salmon SE (1975) A clinical staging system for mul- Radiology 179:529-533 tiple myeloma buy apcalis sx 20 mg low price. Correlation of measured myeloma cell mass Stäbler A, Baur A, Bartl R, Munker R, Lamerz R, Reiser MF with presenting clinical features, response to treatment, and (1996) Contrast enhancement and quantitative signal analysis survival. Cancer 36:842-854 in MR imaging of multiple myeloma: assessment of focal and Engelhard K, Hollenbach HP, Wohlfart K, von Imhoff E, Fellner diffuse growth patterns in marrow correlated with biopsies and FA (2004) Comparison of whole-body MRI with automatic survival rates. AJR Am J Roentgenol 167:1029-1036 moving table technique and bone scintigraphy for screening Stäbler A, Doma AB, Baur A, Krüger A, Reiser MF (2000) for bone metastases in patients with breast cancer. Eur Radiol Quantitative Assessment of Reactive Bone Marrow Changes in 14:99-105 Infectious Spondylitis. Radiology, Radiology 217:863-868 Frager D, Elkin C, Swerdlow M, Bloch S (1988) Subacute osteo- Stäbler A, Krimmel K, Seiderer M, Gartner C, Fritsch S, Raum W. Skeletal Radiol 17:123-126 W (1992) Kernspintomographische Differenzierung osteo- 82 A. Stäbler porotisch und tumorbedingter Wirbelkörperfrakturen: head: predictive value of MR imaging findings. Radiology Wertigkeit von subtraktiven Gradientenechosequenzen mit 212:527-535 verlängerter Repetitionszeit, STIR Sequenzen und Gd-DTPA. Vande Berg BC, Michaux L, Scheiff JM et al (1996) Sequential Fortschr Röntgenstr 157:215-221 quantitative MR analysis of bone marrow: differences during Stäbler A, Schneider P, Link TM, Schöps P, Springer OS, Dürr HR, treatment of lymphoid versus myeloid leukemia. Radiology Reiser M (1999) Intravertebral vacuum phenomenon following 201:519-523 fractures: CT study on frequency and etiology. J Comput Vanel D, Missenard G, Le Cesne A, Guinebretiere JM (1997) Red Assist Tomogr 23:976-980 marrow recolonization induced by growth factors mimicking Steinborn MM, Heuck AF, Tiling R, Bruegel M, Gauger L, Reiser an increase in tumor volume during preoperative chemothera- MF (1999) Whole-body bone marrow MRI in patients with py: MR study. J Comput Assist Tomogr 21:529-531 metastatic disease to the skeletal system. Radiology Tomogr 23:123-129 168:679-693 Steiner RM, Mitchell DG, Rao VM, Schweitzer ME (1993) Wilson AJ, Murphy WA, Hardy DC, Totty WG (1988) Transient os- Magnetic resonance imaging of diffuse bone marrow disease. Radiol Clin North Am 31:383-409 167(3):757-60 Tunaci M, Tunaci A, Engin G et al (1999) Imaging features of tha- Wismer GL, Rosen BR, Buxton R, Stark DD, Brady TJ (1985) lassemia. Eur Radiol 9:1804-1809 Chemical shift imaging of bone marrow: preliminary experi- Vande Berg BE, Malghem JJ, Labaisse MA, Noel HM, Maldague ence. AJR Am J Roentgenol 145:1031-1037 BE (1993) MR imaging of avascular necrosis and transient Yuh WTC, Zachar CK, Barloon TJ, Sato Y, Sickels WJ, Hawes DR marrow edema of the femoral head. Radiographics 13:501-520 (1989) Vertebral compression fractures: Distinction between Vande Berg BC, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE benign and malignant causes with MR imaging. Radiology (1999) Idiopathic bone marrow edema lesions of the femoral 172:215-218 IDKD 2005 Metabolic and Systemic Bone Diseases* J. Freyschmidt Department of Radiology, Central Hospital, Bremen, Germany Introduction Radiology of hyperparathyroidism Metabolic bone diseases represent a fascinating nosolog- To understand the radiology of HPT, it is important to ic group, caused by inborn as well as acquired distur- know that only osteoblasts have classic receptors for bances of bone metabolism. In contrast, osteoclasts are stimulated by bone metabolism may be involved, resulting in various intercellular messengers (e. Only in later stages of the disease when Hyperparathyroidism the parathormone level has been increased over a longer period trabecular bone resorption may occur. Because Hyperparathyroidism (HPT) is defined as an increased HPT today is usually detected early through increased lev- level of parathormone and parathormone peptides in the els of serum calcium, we observe more patients with more serum. It can be devided into three types: bone and fewer patients with less bone, as in former times. In cause of musculoskeletal complaints but because of all cases the serum calcium level is increased. The an- symptoms of nephrocalcinosis, hypertension, arrhythmia, nual incidence of PHPT is calculated to be 25-28 cases per 100 000. In follow-up laboratory studies, ele- production of active vitamin D in disordered kidneys is vated serum calcium levels are usually found. If the pa- reduced or extinguished, intestinal calcium absorption tient then is referred to the radiologist, the latter must be is disturbed with subsequent hypocalcemia and stimu- aware of the various radiologic symptoms of PHPT. Simultaneously phos- The described pathogenetic mechanisms are congruent phate excretion is reduced with hyperphosphatemia with histopathologic findings in PHPT. This stimulates the parathyroid glands, which the iliac crest is intact. The number of osteoclasts indeed in turn increases the level of circulating parathyroid is increased but their depth of resorption is less than nor- hormone. The number of BMU (bone mineral units) is also in- – Tertiary hyperparathyroidism is the result of long- creased, meaning that the number of osteoblasts is elevat- standing secondary hyperparathyroidism due to chron- ed, producing more osteoid matrix, but without a distur- ic renal failure.

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Concentration buy cheap apcalis sx 20 mg on line, volume generic apcalis sx 20mg line, indicator is usually injected on the venous side of the circu- and amount appear in both equations 6 and 7 proven 20 mg apcalis sx, but time is lation (often into the right ventricle or pulmonary artery but order apcalis sx 20mg overnight delivery, present in the denominator on both sides in equation 7 discount 20mg apcalis sx fast delivery. In most clinical situations, of indicator in the distal arterial blood (C) changes with time. A Swan-Ganz carried by the fastest-moving blood reaches the arterial sam- catheter (a soft, flow-directed catheter with a balloon at the pling point. Concentration rises to a peak as the majority of tip) is placed into a large vein and threaded through the indicator arrives and falls off as the indicator carried by the right atrium and ventricle so that its tip lies in the pul- slower moving blood arrives. The catheter is designed to allow a known arrives, the indicator carried by the blood flowing through amount of ice-cold saline solution to be injected into the the shortest pathways comes around again (recirculation). This To correct for this recirculation, the downslope of the curve solution decreases the temperature of the surrounding is assumed to be semilogarithmic and the arterial value is ex- blood. The magnitude of the decrease in temperature de- trapolated to zero indicator concentration. The average con- pends on the volume of blood that mixes with the solution, centration of indicator can be determined by measuring the which depends on cardiac output. A thermistor on the indicator concentration continuously from its first appear- catheter tip (located downstream in the pulmonary artery) ance (t1) until its disappearance (t2). The cardiac output – tion during that period (C) is determined and cardiac output can be determined using calculations similar to those de- is calculated as: scribed for the indicator dilution method. Another way the principle of mass Note the similarity between this equation and the one balance is used to calculate cardiac output takes advantage for calculating volume in a beaker. On the left is volume per of the continuous entry of oxygen into the blood via the Dye (A), mg Mixer Flow mL/min Withdrawal syringe Sample site Lamp Flow = A = A C (t2-t1) t2 Cdt Photocell t1 Densitometer Beginning of recirculation Average dye concentration Extrapolation t1 t2 0 Time FIGURE 14. The volume (volume/time) and the simple volume measurement in Figure per minute flowing in the tube equals the quantity of indicator 14. The downslope of the dye concentration curve shows the (in this example, a dye) injected divided by the average dye effects of recirculation of the dye (solid line) and the semiloga- – concentration (C) at the sample site, multiplied by the time be- rithmic extrapolation of the downslope (dashed line) used to tween the appearance (t1) and disappearance (t2) of the dye. In a steady state, the oxygen leaving the consumption can all be measured and, therefore, cardiac lungs (per unit time) via the pulmonary veins must equal output can be calculated. The theory behind this method is the oxygen entering the lungs via the (mixed) venous blood sounder than the theory behind the indicator dilution and respiration (in a steady state, the amount of oxygen en- method because it avoids the need for extrapolation. How- tering the blood through respiration is equal to the amount ever, because the cardiac catheterization required to meas- consumed by body metabolism): ure pulmonary artery oxygen content is avoided, the indi- cator dilution method is more popular. The two methods O2 in blood leaving the lungs agree well in a wide variety of circumstances. O2 in blood and air entering the lungs (8) or Imaging Techniques Are Also Used for O2 output via pulmonary veins O2 input via pulmonary Measuring Cardiac Output artery O2 added by respiration (9) A variety of other techniques, many of which employ im- The O2 output via the pulmonary veins is equal to the aging modalities, can be used to measure or estimate car- pulmonary vein O2 content multiplied by the cardiac out- diac output. Because O2 is neither added nor subtracted from the heart to estimate the difference between end-dias- the blood as it passes from the pulmonary veins through the tolic and end-systolic volumes. This difference gives left heart to the systemic arteries, the O2 output via pul- stroke volume and, with heart rate, allows calculation of monary veins is also equal to the arterial O2 content (aO2) cardiac output. Similarly, O2 input via the pulmonary artery is equal to mixed venous blood Radionuclide Techniques. In radionuclide tech- oxygen input to the right heart and is mixed venous blood niques, a radioactive substance (usually technetium-99) O content (v–O ) multiplied by the cardiac output (CO). By substitu- 2 The radiation (gamma rays) emitted by the large pool(s) tion in equation 9, of blood in the cardiac chambers is measured using a spe- – ˙ cially designed gamma camera. The emitted radiation is (CO) (aO2) [(CO) (vO2)] VO2 (10) proportional to the amount of technetium bound to the which rearranges to blood (easily determined by sampling the tagged blood) ˙ – and the volume of blood in the heart. Using computer- CO VO2/(aO2 vO2) (11) ized analysis, the amount of radiation emitted by the left Systemic arterial blood oxygen content, pulmonary ar- (or right) ventricle during various portions of the cardiac terial (mixed venous) blood oxygen content, and oxygen cycle can be determined (Fig. The amount Q Cardiac output O consumption 2 250 mL/min O2 consumption Q A–V 250 mL O2/min Q 0. In diastole (C), white arrows in A show the boot-shaped left ventricle during car- the ventricle is large and the wall is thinned; during systole (D), the diac diastole when it is maximally filled with radionuclide-labeled wall thickens and the ventricular size decreases. In B, much of the apex appears to be missing (white arrows) (cine) computed tomography.

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