Ronald A. Kahn, MD

• Professor
• Department of Anesthesiology
• Mount Sinai Medical Center
• New York, New York

Otolith oto-lith one of the small calcified masses in the maculae of the vestibular apparatus in the inner ear medications without doctors prescription cheap generic finax canada. Ovarian cycle o-vare-an the monthly cycle of follicle development symptoms in children generic 1mg finax otc, ovulation medications going generic in 2016 cheap 1mg finax with mastercard, and corpus luteum formation in an ovary medications prednisone cheap finax 1mg. Oxidation oks i-dashun the process of substances combining with oxygen or the removal of hydrogen symptoms of the flu finax 1 mg otc. Oxygen deficit oks i-jen the volume of oxygen required after exercise to oxidize the lactic acid formed during exercise treatment xanthelasma buy discount finax on line. Pancreas pankre-as gland posterior to the stomach, between the spleen and the duodenum; produces both endocrine and exocrine secretions. Pancreatic juice pankre-atik a secretion of the pancreas containing enzymes for digestion of all food categories. Parasympathetic division parah-simpahthetik a division of the autonomic nervous system; also referred to as the craniosacral division. Parathyroid glands parah-thiroid small endocrine glands located on the posterior aspect of the thyroid gland. Passive immunity short-lived immunity resulting from the introduction of "borrowed antibodies" obtained from an immune animal or human donor; immunological memory is not established. Peduncle pe-dungkul a stalk of fibers, especially that connecting the cerebellum to the pons, midbrain, and medulla oblongata. Pelvis pelvis a basin-shaped structure consisting of the pelvic girdle and the coccyx. Perimysium per i-mise-um the connective tissue enveloping bundles of muscle fibers. Perineum peri-neum that region of the body extending from the anus to the scrotum in males and from the anus to the vulva in females. Perineurium coarse connective tissue wrapping that binds groups of fibers in a nerve, forming fascicles, or fiber bundles. Periosteum pere-oste-um double-layered connective tissue membrane that covers and nourishes the bone. Peripheral resistance the resistance to blood flow offered by the systemic blood vessels; a measure of the amount of friction encountered by blood. Peristalsis per i-stalsis the waves of contraction seen in tubelike organs; propels substances along the tract. Peritoneum per i-to-neum the serous membrane lining the interior of the abdominal cavity and covering the surfaces of the abdominal organs. Nerve impulse a self-propagating wave of depolarization; also called an action potential. Nervous system fast-acting control system that employs nerve impulses to trigger muscle contraction or gland secretion. Neuroglia nu-rogle-ah the nonneuronal tissue of the central nervous system that performs supportive and other functions; also called glia. Neuromuscular junction nuro-musku-lar the region where a motor neuron comes into close contact with a skeletal muscle cell. Neurons nuronz cells of the nervous system specialized to transmit messages throughout the body. Neurotransmitter chemical released by neurons that may, upon binding to receptors of neurons or effector cells, stimulate or inhibit them. Neutralization nutral-i-zashun (1) a chemical reaction that occurs between an acid and a base; (2) blockage of the harmful effects of bacterial exotoxins or viruses by the binding of antibodies to their functional sites. Nucleoli nu-kleo-li small spherical bodies in the cell nucleus; function in ribosome synthesis. Nucleus nukle-us (1) a dense central body in most cells containing the genetic material of the cell; (2) cluster of neuronal cell bodies in the brain or spinal cord. Opposition the action by which the thumb is used to touch the tips of the other fingers on the same hand. Organ a part of the body formed of two or more tissues that performs a specialized function. Organ system a group of organs that work together to perform a vital body function;. Organelles organ-elz specialized structures in a cell that perform specific metabolic functions. Permeability perme-ah-bil i-te that property of membranes that permits passage of molecules and ions. Pharyngotympanic (auditory) tube tube that connects the middle ear and the pharynx; allows pressure to be equalized on both sides of the eardrum; also called the eustachian tube. Pharynx farinks the muscular tube extending from the posterior of the nasal cavities to the esophagus. Photoreceptors foto-re-septorz specialized receptor cells that respond to light energy. Pituitary gland p i-tu i-tar e the neuroendocrine gland located beneath the brain that serves a variety of functions including regulation of the gonads, thyroid, adrenal cortex, water balance, and lactation. Placenta plah-sentah the temporary organ that provides nutrients and oxygen to the developing fetus, carries away wastes, and produces the hormones of pregnancy. Pleura ploorah the serous membrane covering the lungs and lining the thoracic cavity. Polar molecules nonsymmetrical molecules that contain electrically unbalanced atoms. Polycythemia pol e-si-theme-ah presence of an abnormally large number of erythrocytes in the blood. Pons (1) any bridgelike structure or part; (2) the brain area connecting the medulla with the midbrain, providing linkage between upper and lower levels of the central nervous system. Positive feedback feedback that tends to cause a variable to change in the same direction as the initial change; enhances the stimulus. Preganglionic neuron pregang-gle-onik a neuron of the autonomic nervous system having its cell body in the brain or spinal cord and its axon (the preganglionic axon) extending to and terminating in a ganglion. Pressoreceptor preso-re-septor a nerve ending in the wall of the carotid sinus and aortic arch sensitive to vessel stretching. Pressure gradient difference in hydrostatic (fluid) pressure that drives filtration. Primary humoral response the initial response of the humoral arm of the immune system to an antigen; involves clonal selection and establishes immunological memory. Prime mover muscle whose contractions are primarily responsible for a particular movement; agonist. Process (1) a prominence or projection; (2) a series of actions for a specific purpose. Pronation pro-nashun the inward rotation of the forearm causing the radius to cross diagonally over the ulna-palms face posteriorly. Proprioceptor propre-oh-septor a receptor located in a muscle or tendon; concerned with locomotion, posture, and muscle tone. Proton proton subatomic particle that bears a positive charge; located in the atomic nucleus. Proximal proksi-mal toward the attached end of a limb or the origin of a structure. Pulmonary circulation system of blood vessels that carry blood to and from the lungs for gas exchange. Pulmonary edema -demah a leakage of e fluid into the air sacs and tissue of the lungs. Purkinje fibers pur-kinje the modified cardiac muscle fibers of the conduction system of the heart. Pus the fluid product of inflammation composed of white blood cells, the debris of dead cells, and a thin fluid. Pyelonephritis pi -lo-n -fritis an inflame e mation of the kidney pelvis and surrounding kidney tissues. Pyloric region pi-lorik the final portion of the stomach; joins with the duodenum. Radiant energy energy of the electromagnetic spectrum, which includes heat, light, ultraviolet waves, infrared waves, and other forms. Receptor re-septor (1) a peripheral nerve ending specialized for response to particular types of stimuli; (2) molecule that binds specifically with other molecules. Reduction restoring broken bone ends (or a dislocated bone) to its original position. Refractory period re-frakto-re the period of unresponsiveness to threshold stimulation. Regulatory T cell type of T lymphocyte that slows or stops activity of B and T cells once the antigenic threat is ended. Renin renin a substance released by the kidneys that is involved with raising blood pressure. Repolarization restoration of the membrane potential to the initial resting (polarized) state. Respiratory system organ system that carries out gas exchange; includes the nose, pharynx, larynx, trachea, bronchi, and lungs. Serous fluid serus a clear, watery fluid secreted by the cells of a serous membrane. Serous membrane membrane that lines a cavity without an opening to the outside of the body (except for joint cavities, which have a synovial membrane); serosa. Shoulder girdle composite of two bones, scapula and clavicle, that attach the upper limb to the axial skeleton; also called the pectoral girdle. Sinoatrial node sino-atre-al the mass of specialized myocardial cells in the wall of the right atrium; pacemaker of the heart. Skeletal system system of protection and support composed primarily of bone and cartilage. Smooth muscle muscle consisting of spindleshaped, unstriped (nonstriated) muscle cells; involuntary muscle. Somatic nervous system so-matik a division of the peripheral nervous system; also called the voluntary nervous system. Spermatogenesis spermah-to-jen sis e- the process of sperm production in the male; involves meiosis. Squamous skwamus (1) flat, scalelike; (2) pertaining to flat, thin cells that form the free surface of some epithelial tissues. Static equilibrium statik ekw i-libre-um balance concerned with changes in the position of the head. Steroids st roidz a specific group of e chemical substances including certain hormones and cholesterol. Stimulus stimu-lus an excitant or irritant; a change in the environment producing a response. Stressor any stimulus that directly or indirectly causes the hypothalamus to initiate stress-reducing responses, such as the fightor-flight response. Stroke a condition in which brain tissue is deprived of a blood supply, as in blockage of a cerebral blood vessel. Summation sum-mashun the accumulation of effects, especially those of muscular, sensory, or mental stimuli. Supination supi-nashun the outward rotation of the forearm causing palms to face anteriorly. Surfactant sur-faktant a chemical substance coating the pulmonary alveoli walls that reduces surface tension, thus preventing collapse of the alveoli after expiration. Sutures soochurz immovable fibrous joints that connect the bones of the adult skull. Sweat glands the glands that produce a saline solution called sweat; also called sudoriferous glands. Sympathetic division a division of the autonomic nervous system; opposes parasympathetic functions; called the fight-or-flight division. Synapse sinaps the region of communication between neurons, or a neuromuscular junction between a neuron and a muscle cell. Synergists siner-jists muscles cooperating with another muscle or muscle group to produce a desired movement. Synovial fluid s i-nove-al a fluid secreted by the synovial membrane; lubricates joint surfaces and nourishes articular cartilages. Synovial joint freely movable joint exhibiting a joint cavity enclosed by a fibrous capsule lined with synovial membrane. Synthesis reaction chemical reaction in which larger molecules are formed from simpler ones. System a group of organs that function cooperatively to accomplish a common purpose; there are eleven major systems in the human body. Responsiveness the ability to sense changes (stimuli) in the environment and then to react to them; see also irritability.

What condition would the capillary bed be in (a or b) if you were doing push-ups at the gym The common factors are the pooling of blood in the feet and legs and inefficient venous return resulting from inactivity or pressure on the veins medications quotes buy finax on line. In any case medicine you can take while pregnant 1mg finax fast delivery, the overworked valves give way medicine and manicures generic 1 mg finax mastercard, and the veins become twisted and dilated medicine zalim lotion cheap 1 mg finax amex. A serious complication of varicose veins is thrombophlebitis (thrombo-fle-bitis) jnc 8 medications buy finax 1 mg otc, inflammation of a vein that results when a clot forms in a vessel with poor circulation treatment plan for anxiety cheap finax 1mg amex. Because all venous blood must pass through the pulmonary circulation before traveling through the body tissues again, a common consequence of thrombophlebitis is clot detachment and pulmonary embolism, which is a life-threatening condition. True capillaries Terminal arteriole Postcapillary venule (a) Sphincters open; blood flows through true capillaries. It has a large, lopsided lumen, relatively thick tunica externa, and a relatively thin tunica media. How is the structure of capillaries related to their (For answers, see Appendix D. The vascular shunt bypasses the true capillaries when precapillary sphincters controlling blood entry into the true capillaries are constricted. Major Arteries of the Systemic Circulation the aorta is the largest artery of the body, and it is a truly splendid vessel. In adults, the aorta is about the size of a garden hose (with an internal diameter about equal to the diameter of your thumb) where it issues from the left ventricle of the heart. The major branches of the aorta and the organs they serve are listed next in sequence from the heart. In many cases the name of the artery tells you the body region or organs served (renal artery, brachial artery, and coronary artery) or the bone followed (femoral artery and ulnar artery). In the axilla, the subclavian artery becomes the axillary artery and then continues into the arm as the brachial artery, which supplies the arm. At the elbow, the brachial artery splits to form the radial and ulnar arteries, which serve the forearm. Other branches of the thoracic aorta supply the lungs (bronchial arteries), the esophagus (esophageal arteries), and the diaphragm (phrenic arteries). The unpaired superior mesenteric (mesenterik) artery supplies most of the small intestine and the first half of the large intestine, or colon. They are called the ovarian arteries in females (serving the ovaries) and the testicular arteries in males (serving the testes). The inferior mesenteric artery is a small, unpaired artery supplying the second half of the large intestine. Each divides into an internal iliac artery, which supplies the pelvic organs (bladder, rectum, and so on), and an external iliac artery, which enters the thigh, where it becomes the femoral artery. At the knee, the femoral artery becomes the popliteal artery, which then splits into the anterior and posterior tibial arteries, which supply the leg and foot. The anterior tibial artery terminates in the dorsalis pedis artery, which via the arcuate artery supplies the dorsum of the foot. Most deep veins follow the course of the major arteries, and with a few exceptions, the naming of these veins is identical to that of their companion arteries. Major systemic arteries branch off the aorta, whereas the veins converge on the venae cavae, which enter the right atrium of the heart. They unite to form the deep brachial vein, which drains the arm and empties into the axillary vein in the axillary region. The basilic and cephalic veins are joined at the anterior aspect of the elbow by the median cubital vein. The brachiocephalic veins join to form the superior vena cava, which enters the heart. They begin at the dorsal venous arch in the foot and travel up the medial aspect of the leg to empty into the femoral vein in the thigh. The common iliac veins join to form the inferior vena cava, which then ascends superiorly in the abdominal cavity. In what part of the body are the axillary, cephalic, (For answers, see Appendix D. The vessels of the pulmonary circulation are not illustrated, accounting for the incomplete appearance of the circulation from the heart. The internal carotid arteries, branches of the common carotid arteries, run through the neck and enter the skull through the temporal bone. Once inside the cranium, each divides into the anterior and middle cerebral arteries, which supply most of the cerebrum. The paired vertebral arteries pass upward from the subclavian arteries at the base of the neck. Nutrients and toxins picked up from capillaries in the stomach and intestine are transported to the liver for processing. From the liver sinusoids, the blood continues into the hepatic veins and inferior vena cava. The anterior and posterior blood supplies of the brain are united by small communicating arterial branches. The result is a complete circle of connecting blood vessels called either the cerebral arterial circle or the circle of Willis, which surrounds the base of the brain. The cerebral arterial circle protects the brain by providing more than one route for blood to reach brain tissue in case of a clot or impaired blood flow anywhere in the system. When you have just eaten, the hepatic portal blood contains large amounts of nutrients. Because the liver is a key body organ involved in maintaining the proper glucose, fat, and protein concentrations in the blood, this system "takes a detour" to ensure that the liver processes these substances before they enter the systemic circulation. As blood flows slowly through the liver, some of the nutrients are removed to be stored or processed in various ways for later release to the blood. Like the portal circulation that links the hypothalamus of the brain and the anterior pituitary gland (Chapter 9, p. The inferior mesenteric vein, draining the terminal part of the large intestine, drains into the splenic vein, which itself drains the spleen, pancreas, and the left side of the stomach. The splenic vein and superior mesenteric vein (which drains the small intestine and the first part of the colon) join to form the hepatic portal vein. Fetal Circulation Because the lungs and digestive system are not yet functioning in a fetus, all nutrient, excretory, and gas exchanges occur through the placenta. The umbilical arteries carry carbon dioxide and debris-laden blood from the fetus to the placenta. As blood flows superiorly toward the heart of the fetus, most of it bypasses the immature liver through the ductus venosus (duktus ve-nosus) and enters the inferior vena cava, which carries the blood to the right atrium of the heart. Because fetal lungs are nonfunctional and collapsed, two shunts see to it that they are almost entirely bypassed. Some of the blood entering the right atrium is shunted directly into the left atrium through the foramen ovale (fo-ramen o-vale), a flaplike opening in the interatrial septum. Blood that does manage to enter the right ventricle is pumped out the pulmonary trunk, where it meets a second shunt, the ductus arteriosus (ar-tereosus), a short vessel that connects the aorta and the pulmonary trunk. Because the collapsed lungs are a high-pressure area, blood tends to enter the systemic circulation through the ductus arteriosus. The aorta carries blood to the tissues of the fetal body and ultimately back to the placenta through the umbilical arteries. As blood stops flowing through the umbilical vessels, they become obliterated, and the circulatory pattern converts to that of an adult. Superficial temporal artery Facial artery Common carotid artery Brachial artery Did You Get lt Which vessel-the hepatic portal vein, hepatic vein, or hepatic artery-has the highest content of nutrients after a meal Radial artery Femoral artery Popliteal artery Physiology of Circulation 11-13 Define pulse, and name several pulse points. These measurements, along with those of respiratory rate and body temperature, are referred to collectively as vital signs in clinical settings. Arterial Pulse the alternating expansion and recoil of an artery that occurs with each beat of the left ventricle creates a pressure wave-a pulse-that travels through the entire arterial system. Normally the pulse rate (pressure surges per minute) equals the heart rate (beats per minute). You can feel a pulse in any artery lying close to the body surface by compressing the artery against firm tissue; this provides an easy way of counting heart rate. Because these same points are compressed to stop blood flow into distal tissues during significant blood loss or hemorrhage, they are also called pressure points. For example, if you seriously cut your hand, you can stop the bleeding somewhat by compressing the brachial artery. Any system equipped with a pump that forces fluid through a network of closed tubes operates under pressure, and the closer the pump, the higher the pressure. Blood pressure is the pressure the blood exerts against the inner walls of the blood vessels, and it is the force that keeps blood circulating continuously even between heartbeats. Chapter 11: the Cardiovascular System 383 Unless stated otherwise, the term blood pressure is understood to mean the pressure within the large systemic arteries near the heart. Blood Pressure Gradient When the ventricles contract, they force blood into large, thick-walled elastic arteries close to the heart that expand as the blood is pushed into them. As you remember, in the passive process of filtration, substances move from areas of high pressure to areas of low pressure through a filter (Chapter 3, p. Blood flow is driven by these same differences in pressure, but with no filter present. The high pressure in these arteries forces the blood to continuously move into areas where the pressure is lower. Recall that the blood flows into the smaller arteries, then arterioles, capillaries, venules, veins, and finally back to the large venae cavae entering the right atrium of the heart. It flows continuously along a pressure gradient (from high to low pressure) as it makes its circuit day in and day out. Notice that if venous return depended entirely on a high blood pressure throughout the system, blood would probably never be able to complete its circuit back to the heart because of the low pressure in large veins. This is why the valves in the larger veins, the milking activity of the skeletal muscles, and pressure changes in the thorax are so important. The pressure differences between arteries and veins become very clear when these vessels are cut. If a vein is cut, the blood flows evenly from the wound; a lacerated artery produces rapid spurts of blood. Continuous blood flow absolutely depends on the stretchiness of the larger arteries and their ability to recoil and keep exerting pressure on the blood as it flows off into the circulation. However, when the water faucet is suddenly turned off, the flow of water stops just as abruptly. The reason is that the walls of the hose cannot recoil to keep pressure on the water; therefore, the pressure drops and the flow of water stops. Arteriosclerosis is also called "hardening of the arteries" (see "A Closer Look" on pp. Thus, two arterial blood pressure measurements are usually made: systolic (sis-tolik) pressure, the pressure in the arteries at the peak of ventricular contraction, and diastolic (dius-tolik) pressure, the pressure when the ventricles are relaxing. Blood pressures are reported in millimeters of mercury (mm Hg), with the higher systolic pressure written first-120/80 (120 over 80) translates to a systolic pressure of 120 mm Hg and a diastolic pressure of 80 mm Hg. Most often, systemic arterial blood 11 384 Essentials of Human Anatomy and Physiology Blood pressure 120 systolic 70 diastolic (to be measured) Pressure in cuff above 120; no sounds audible 120 mm Hg Rubber cuff inflated with air Pressure in cuff below 120, but above 70 Pressure in cuff below 70; no sounds audible 120 mm Hg 70 mm Hg 70 mm Hg Brachial artery (a) the course of the brachial artery of the arm. Brachial artery closed (b) the blood pressure cuff is wrapped snugly around the arm just above the elbow and inflated until the cuff pressure exceeds the systolic blood pressure. At this point, blood flow into the arm is stopped, and a brachial pulse cannot be felt or heard. Sounds audible in stethoscope (c) the pressure in the cuff is gradually reduced while the examiner listens (auscultates) for sounds in the brachial artery with a stethoscope. The pressure read as the first soft tapping sounds are heard (the first point at which a small amount of blood is spurting through the constricted artery) is recorded as the systolic pressure. We have already considered regulation of cardiac output, so we will concentrate on peripheral resistance here. Peripheral resistance is the amount of friction the blood encounters as it flows through the blood vessels. Many factors increase peripheral resistance, but probably the most important is the constriction, or narrowing, of blood vessels, especially arterioles, as a result of either sympathetic nervous system activity or atherosclerosis. Increased blood volume or increased blood viscosity (thickness) also raises peripheral resistance. Any factor that increases either cardiac output or peripheral resistance causes an almost immediate reflex rise in blood pressure. Many factors can alter blood pressure-age, weight, time of day, exercise, body position, emotional state, and various drugs, to name a few. The parasympathetic division of the autonomic nervous system has little or no effect on blood pressure, but the sympathetic division is important. For example, when we stand up suddenly after lying down, the effect of gravity causes blood to pool in the vessels of the legs and feet, and blood pressure drops. This activates pressoreceptors, also called baroreceptors (baro = pressure), in the large arteries of the neck and chest. They send off warning signals that result in reflexive vasoconstriction, increasing blood pressure back to homeostatic levels. When blood volume suddenly decreases, as in hemorrhage, blood pressure drops, and the heart begins to beat more rapidly as it tries to compensate.

We will consider only three muscles of this group treatment variance order 1mg finax with amex, but there are many others that act to extend and flex the ankle and toe joints 6 mp treatment buy finax online pills. Although it is not very important in walking medications for bipolar purchase genuine finax, it is probably the most important muscle for extending the hip when power is needed medicine reviews order finax without prescription, as when climbing stairs and when jumping treatment brown recluse bite buy cheap finax line. It originates from the sacrum and iliac bones and inserts on the gluteal tuberosity of the femur and into the large tendinous iliotibial tract administering medications 8th edition proven finax 1 mg. Gluteus Medius the gluteus medius runs from the ilium to the femur, beneath the gluteus maximus 212 Essentials of Human Anatomy and Physiology for most of its length. The gluteus medius is a hip abductor and is important in steadying the pelvis during walking. Although it might appear that the large, fleshy gluteus maximus that forms the bulk of the buttock mass would be a better choice, notice that the medial part of each buttock overlies the large sciatic nerve; hence this area must be carefully avoided. The superolateral quadrant then overlies the gluteus medius muscle, which is usually a very safe site for an intramuscular injection. It runs from the iliac bone and lower vertebrae deep inside the pelvis to insert on the lesser trochanter of the femur. It also acts to keep the upper body from falling backward when we are standing erect. However, because gravity does most of the work for them, they tend to become flabby very easily. The adductors have their origin on the pelvis and insert on the proximal aspect of the femur. The group consists of three muscles, the biceps femoris, semimembranosus, and semitendinosus, which originate on the ischial tuberosity and run down the thigh to insert on both sides of the proximal tibia. Their name comes from the fact that butchers use their tendons to hang hams (consisting of thigh and hip muscles) for smoking. Sartorius Compared with other thigh muscles described here, the thin, straplike sartorius (sartore-us) muscle is not too important. It runs obliquely across the thigh from the anterior iliac crest to the medial side of the tibia. Quadriceps Group the quadriceps (kwodr-seps) i group consists of four muscles-the rectus femoris and three vastus muscles-that flesh out the anterior thigh. The third, the vastus intermedius, is obscured by the rectus femoris muscle, which lies over it. The group as a whole acts to extend the knee powerfully, as when kicking a football. Because the rectus femoris crosses two joints, the hip and the knee, it can also help to flex the hip. It arises from the upper tibia and then parallels the anterior crest as it runs to the tarsal bones, where it inserts by a long tendon. Extensor Digitorum Longus Lateral to the tibialis anterior, the extensor digitorum longus muscle arises from the lateral tibial condyle and proximal three-quarters of the fibula and inserts into the phalanges of toes 2 to 5. Fibularis Muscles the three fibularis muscles- longus, brevis, and tertius-are found on the lateral part of the leg. Chapter 6: the Muscular System 213 Fibularis longus Gastrocnemius Fibularis brevis Tibialis anterior Extensor digitorum longus Fibularis tertius Tibia Soleus 6 Soleus Calcaneal (Achilles) tendon Medial malleolus Lateral malleolus (a) (b) Posterior view. Gastrocnemius the gastrocnemius (gastrokneme-us) muscle is a two-bellied muscle that forms the curved calf of the posterior leg. It arises by two heads, one from each side of the distal femur, and inserts through the large calcaneal (Achilles) tendon into the heel of the foot. Because it arises on the tibia and fibula (rather than the femur), it does not affect knee movement, but like the gastrocnemius, it inserts into the calcaneal tendon and is a strong plantar flexor of the foot. Practice art labeling >Study Area>Chapter 6 Chapter 6: the Muscular System 215 Table 6. Although its name indicates that it is a superficial muscle, the flexor digitorum superficialis lies deep to the flexor carpi radialis and is not visible in a superficial view. Which muscle is the antagonist of the biceps brachii when the biceps flexes the elbow This development proceeds in a cephalic/caudal direction, and gross muscular movements precede fine ones. Babies can raise their heads before they can sit up and can sit up before they can walk. Muscular control also proceeds in a proximal/distal direction; that is, babies can perform the gross movements like waving "bye-bye" and pulling objects to themselves before they can use the pincer grasp to pick up a pin. By midadolescence, we have reached the peak level of development of this natural control and can simply accept it or bring it to a fine edge by athletic training. Because of its rich blood supply, skeletal muscle is amazingly resistant to infection throughout life, and given good nutrition, relatively few problems afflict skeletal muscles. We repeat, however, that muscles, like bones, will atrophy, even with normal tone, if they are not used continually. A lifelong program of regular exercise keeps the whole body operating at its best possible level. In the developing embryo, the muscular system is laid down in segments (much like the structural plan of an earthworm), and then each segment is invaded by nerves. The muscles of the thoracic and lumbar regions become very extensive because they must cover and move the bones of the limbs. The muscles and their control by the nervous system develop rather early in pregnancy. The expectant mother is often astonished by the first movements (called the quickening) of the fetus, which usually occur by the 16th week of pregnancy. The exception to this is muscular dystrophy-a group of inherited muscle-destroying diseases that affect specific muscle groups. The muscles enlarge because of fat and connective tissue deposit, but the muscle fibers degenerate and atrophy. Active, normal-appearing children become clumsy and fall frequently as their muscles weaken. The disease progresses from the extremities upward, finally affecting the head and chest muscles. Children with this disease rarely live beyond their early twenties and generally die of respiratory failure. Although the cause of muscular dystrophy has been pinned down-the diseased muscle fibers lack a protein (called dystrophin) Homeostatic Imbalance 6. The disease involves a shortage of acetylcholine receptors at neuromuscular junctions. The blood of many of these patients contains antibodies to acetylcholine receptors, which suggests that myasthenia gravis is an autoimmune disease. Although the receptors may initially be present in normal numbers, they appear to be destroyed as the disease progresses. Whatever the case, the muscle cells are not stimulated properly and get progressively weaker. Death usually occurs as a result of the inability of the respiratory muscles to function (respiratory failure). Chapter 6: the Muscular System 219 tissue decreases; thus the muscles become stringier, or more sinewy. Because the skeletal muscles represent so much of the body mass, body weight begins to decline in the older person as this natural loss in muscle mass occurs. Another result of the loss in muscle mass is a decrease in muscle strength; strength decreases by about 50 percent by the age of 80. Regular exercise can help offset the effects of aging on the muscular system, and frail older people who begin to "pump iron" (use leg and hand weights) can rebuild muscle mass and dramatically increase their strength. What must happen before babies can control their A female patient with myasthenia gravis. How does lifelong exercise affect our skeletal muscles and muscle mass in old age Cardiac muscle cells are striated, branching cells that fit closely together and are arranged in spiral bundles in the heart. As it contracts, it causes movement, maintains posture, stabilizes joints, and generates heat. Skeletal muscle forms the muscles attached to the skeleton, which move the limbs and other body parts. Its cells are long, striated and multinucleate, and they are subject to voluntary control. Connective tissue coverings (endomysium, perimysium, and epimysium) enclose and protect the muscle fibers and increase the strength of skeletal muscles. Smooth muscle cells are uninucleate, spindle-shaped, and arranged in opposing layers in the walls of hollow organs. The multinucleate cylindrical skeletal muscle fibers are packed with unique organelles called myofibrils. The banding pattern (striations) of the myofibrils and the cell as a whole reflects the regular arrangement of thin (actin-containing) and thick (myosin) filaments within the sarcomeres, the contractile units composing the myofibrils. Muscle contractions are isotonic (the muscle shortens, and movement occurs) or isometric (the muscle does not shorten, but its tension increases). It is a result of a staggered series of nerve impulses delivered to different cells within the muscle. If the nerve supply is destroyed, the muscle loses tone, becomes paralyzed, and atrophies. Muscles challenged almost beyond their ability by resistance exercise will increase in size and strength. Muscles subjected to regular aerobic exercise become more efficient and stronger and can work longer without tiring. When the neuron releases a neurotransmitter (acetylcholine), the permeability of the sarcolemma changes, allowing sodium ions to enter the muscle cell. Calcium binds to regulatory proteins on the thin filaments and exposes myosin-binding sites, allowing the myosin heads on the thick filaments to attach. The attached heads pivot, sliding the thin filaments toward the center of the sarcomere, and contraction occurs. The origin is the immovable attachment; the insertion is the movable bony attachment. Body movements include flexion, extension, abduction, adduction, circumduction, rotation, pronation, supination, inversion, eversion, dorsiflexion, plantar flexion, and opposition. On the basis of their general functions in the body, muscles are classified as prime movers, antagonists, synergists, and fixators. Muscles are named according to several criteria, including muscle size, shape, number and location of origins, associated bones, and action of the muscle. Muscles have several fascicle arrangements that influence their force and degree of shortening. Although individual muscle cells contract completely when adequately stimulated, a muscle (which is an organ) responds to stimuli to different degrees, that is, it exhibits graded responses. Most skeletal muscle contractions are tetanic (smooth and sustained) because rapid nerve impulses are reaching the muscle, and the muscle cannot relax completely between contractions. The strength of muscle contraction reflects the relative number of muscle cells contracting (more = stronger). The muscles of facial expression include the frontalis, orbicularis oris and oculi, and zygomaticus. The chewing muscles are the masseter, temporalis, and buccinator (which is also a muscle of facial expression). Your ability to lift that heavy couch would be increased by which type of exercise Muscles of the trunk and neck move the head, shoulder girdle, and trunk and form the abdominal girdle. Anterior neck and trunk muscles include the sternocleidomastoid, pectoralis major, intercostals, rectus abdominis, external and internal obliques, and transversus abdominis. Posterior trunk and neck muscles include the trapezius, latissimus dorsi, and deltoid. Muscles of the upper limb include muscles that cause movement at the shoulder joint, elbow, and hand. Muscles causing movement at the elbow include the brachialis, biceps brachii, brachioradialis, and triceps brachii. They include the iliopsoas, gluteus maximus and medius, adductors, quadriceps and hamstring groups, gastrocnemius, tibialis anterior, fibularis muscles, soleus, and extensor digitorum longus. Without exercise, they atrophy; with extremely vigorous exercise, they hypertrophy. If you compare electron micrographs of a relaxed skeletal muscle fiber and a fully contracted muscle fiber, which would you see only in the relaxed fiber Compare skeletal, smooth, and cardiac muscles in regard to their microscopic anatomy, location and arrangement in body organs, and function in the body. Name these connective tissue Chapter 6: the Muscular System coverings, beginning with the finest and ending with the most coarse. Define neuromuscular junction, motor unit, tetanus, graded response, aerobic respiration, anaerobic glycolysis, muscle fatigue, and neurotransmitter. Describe the events that occur from the time a motor neuron releases acetylcholine at the neuromuscular junction until muscle cell contraction occurs. Name each of these attachment points, and indicate which is movable and which is immovable. If you were alternately contracting and relaxing your masseter muscle, what would you be doing Other than acting to flex the spine and compress the abdominal contents, the abdominal muscles are extremely important in protecting and containing the abdominal viscera. What is it about the arrangement of these muscles that makes them so well suited for their job The hamstring and quadriceps muscle groups are antagonists of each other, and each group is a prime mover in its own right.

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Congenital leptin deficiency is associated with severe early-onset obesity in humans medications ending in zole order finax online from canada. Decreased cerebrospinal-fluid/serum leptin ratio in obesity: a possible mechanism for leptin resistance aquapel glass treatment cheap finax master card. Cerebrospinal fluid leptin levels: relationship to plasma levels and to adiposity in humans medicine gabapentin 300mg capsules buy finax 1mg low cost. Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation medicine lock box discount finax 1mg with visa. Benefits at 1 year of nocturnal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome medicine encyclopedia order generic finax from india. Non-invasive positive pressure ventilation improves lung volumes in the obesity hypoventilation syndrome treatment research institute cheap finax amex. 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Proportional assist ventilation improves exercise capacity in patients with obesity. Die Ergometrie trennt das Schlafapnoesyndrom vom Obesitas-Hypoventilationssyndrom auch unter Therapie mit Positivdruckbeatmung [Ergometry separates sleep apnea syndrome from obesity-hypoventilation after therapy positive pressure ventilation therapy]. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Lung function, hypoxic and hypercapnic ventilatory responses, and respiratory muscle strength in normal subjects taking oral theophylline. Positive airway pressure titration in obesity hypoventilation syndrome: continuous positive airway pressure or bilevel positive airway pressure. Acute and chronic respiratory failure in patients with obesity-hypoventilation syndrome: a new challenge for noninvasive ventilation. In addition, ambulatory strategies or integrated models (with ambulatory and hospital elements) can be used in the diagnostic approach. Specific diagnostic considerations in these patients are reviewed in this chapter, including commentaries regarding the selection of the diagnostic devices or clinical pathways in these groups of patients. These estimated prevalence rates represent substantial increases over the last two decades (relative increases of between 14% and 55% depending on the subgroup). This method has been proven to be accurate with a low failure rate because it includes many channels and because it is attended by technical staff. It also provides accurate assessment of sound measurement and, thereby, assessment of snoring in relation to sleep stage and body position. Other common symptoms are nonrestorative sleep, difficulty initiating or maintaining sleep, fatigue or tiredness, and morning headache. Based on these clinical questionnaires, the clinical prediction models seek to establish a reliable diagnosis avoiding the need to perform objective sleep tests. However, the results have not confirmed the utility of these tools and their potential use is limited to the prioritisation of an objective diagnostic test [16]. Single-channel devices the most widely studied single-channel test is pulse oximetry. Respiratory events are identified indirectly via their impact on the nocturnal saturation curve. The accuracy of pulse oximeters in measuring transient changes in arterial oxygen saturation (SaO2) may be affected by the oximeter time response. The settings required (averaging time and sampling frequency), displays (maximum, mean and minimum SaO2) and heart rate need to be checked for a correct interpretation. This technique can led false negatives, especially in young patients, as well as false positives in patients with comorbidities [7, 17]. Other single-channel devices are based on the log of the air flow, with special interest in the ambulatory setting. The ApneaLink (ResMed) device measures airflow through a nasal cannula connected to a pressure transducer. Although the results using single-channel devices are promising, studies are relatively scarce. Single-channel devices are not recommended for diagnostic purposes and their usefulness may lie in rapid screening to prioritise more complete diagnostic tests [7]. The utility of portable monitors for patients with serious comorbid conditions has not been adequately verified [36]. However, in clinical practice, patients get wired up in the laboratory then go home and set up the device at home, or a technician visits the home and sets up the patient. Importantly, signal drop out is high (estimates approaching 70%) and many patients do not wish to take responsibility for signal quality, so this can greatly affect the results. Some investigators have evaluated integrated models, including in-hospital and ambulatory elements. In addition, these integrated models attempt to address the follow-up of the disease. After 3 months of nursing follow-up subsequent to the home diagnosis, the results were comparable to those obtained in patients followed up by traditional methods. Although the results were very positive, the study did not have a control group, so more research is needed to evaluate this type of intervention [39]. They divided their patients into two groups: home diagnosis and nurse-based ambulatory follow-up versus in-laboratory diagnosis and follow-up. The strategies showed no differences in terms of efficacy and adherence to the treatment, but the former required fewer visits during the follow-up period. The final conclusion was that the nursing strategy is cheaper, without any effect on compliance. In another work, three different alternatives were simultaneously evaluated: one group with home diagnosis and follow-up, another with hospital diagnosis and follow-up, and a third group with home diagnosis and hospital follow-up. The use of nasal prongs connected to a pressure transducer is a noninvasive, sensitive method to detect respiratory events with a good time response that allows the detection of several flow-related phenomena, in addition to apnoea and hypopnoea. The incorporation of nasal prongs in routine, full-night studies is an attainable technical option that provides adequate recordings adding relevant information not scored by thermistors is obtained for flow-related respiratory events, thus increasing diagnostic accuracy. Although part of this association may be explained by co-existing risk factors. Metabolic changes, haemodynamic alterations and systemic inflammation are involved. In addition, the transfer of patients with an acute stroke to sleep units is not desirable. The use of portable monitors allows patients to remain on the stroke units while undergoing a study with more rapid results at less cost. Accepted recommendations in the management of subacute inpatients with stroke include the evaluation of the stroke aetiology (vascular diagnostic tests, cardiac monitoring or imaging tests) and the establishment of prevention efforts related to many recognised cardiovascular factors (hypertension, hyperlipidaemia, diabetes, cigarette smoking, alcohol consumption, atrial fibrillation or extracranial carotid disease). Acute increases in pulmonary artery pressure and alveolar hypoxia have been proposed as possible mechanisms. Ambulatory strategies or integrated models (including hospital and ambulatory elements) are valid alternatives. Clinical prediction models and single-channel devices can be used to prioritise the use of resources. 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