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Answer D: The posterior communicating artery originates lobe due to the disruption of flow through the basal vein (of Rosen- from the cerebral part of the internal carotid artery and courses thal) buy cheap brahmi 60 caps on line treatment 4 pimples. None of the other choices receives venous drainage directly caudally to join the posterior cerebral artery (PCA) generic brahmi 60 caps with visa medications depression. Answer B: The deficits experienced by this man (difficulty swal- Important branches arise from both of these parts of the PCA. All three of these cranial nerves exit the jugular foramen along with 14. Answer E: The drainage pattern of the superior sagittal sinus at the continuity of the sigmoid sinus with the internal jugular vein the confluence of sinuses is variable, including about equal to both ( jugular bulb or bulb of the jugular vein). In this case, the venous transverse sinuses or mainly to the right or to the left. However, thrombosis is at the left jugular bulb and impinging on these three the usual pattern is for the superior sagittal sinus to drain pre- cranial nerve roots. Dural sinus thrombosis of the other choices dominately into the right transverse sinus. Anatomy: A Regional Atlas of the Human Body, 3rd an antiserum against histamine. Histaminergic system in Council of Biology Editions Style Manual Committee. Extensive co-occurrence of substance P and beled spinocervical tract terminations in the lateral cervical nucleus dynorphin in striatal projection neurons: An evolutionarily con- of the cat. Correlative Anatomy of the Atlas of Gross Topography in Serial Sections. New York: Oxford University in the monkey: Projections to the thalamus and brain stem nuclei. Correlative Neuroanatomy of Computed Tomography Benarroch EE, Westmoreland BF, Daube JR, Reagan TJ, Sandok BA. Philadelphia: Lea & Febiger, Medical Neuroscience, An Approach to Anatomy, Pathology, and 1984. Atlas of Neuroanatomy with Radiologic Cor- ferent projections as revealed by autoradiography. Structure, Vascularization, and Three-Dimensional Sectional Broman J, Blomqvist A. Spinocervical tract terminals are Federative Committee on Anatomical Terminology. Terminologia enriched in glutamate-like immunoreactivity: An anterograde Anatomica. The GABAergic neurones of the cerebellar nuclei: Projection to the Gasser RF. Manter and Gatz’s Essentials of Clinical Neu- Leah J, Menetrey D, dePommery J. Philadelphia: FA Davis spinal tract cells in the rat: Evidence for parallel processing of as- Company, 2003. The Cranial Nerves: Anatomy Imaging Vascularization, corticospinal neurons of rats. New York: Lehéricy S, Hirsch EC, Cervera-Pierot P, Hersh LB, Bakchine S, Piette Thieme, 2001. Connections of the subthalamic nu- and selectivity of the degeneration of cholinergic neurons in the cleus with ventral striatopallidal parts of the basal ganglia in the rat. Distribution of substance P-like phia: Churchill Livingstone/Elsevier Science, 2002. Spinocervical tract-dorsal column postsynaptic neurons: A Haines DE, May PJ, Dietrichs E. Somatosens Mot Res 1989;6: cerebellar nuclei and hypothalamus in Macaca fascicularis: Cerebello- 445–454. Lufkin R, Flannigan BD, Bentson IR, Wilson GH, Rauschning W, Hamilton WJ, Mossman HW. Magnetic resonance imaging of the brainstem and cra- Williams & Wilkins, 1972.

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They are distinguished by the Elastic Cartilage type and amount of fibers embedded within the matrix buy brahmi 60 caps lowest price treatment ingrown hair. Elastic cartilage is similar to hyaline cartilage except for the pres- ence of abundant elastic fibers that make elastic cartilage very Hyaline Cartilage flexible without compromising its strength (fig quality 60 caps brahmi symptoms pregnancy. This tis- Hyaline cartilage, commonly called “gristle,” has a homogeneous, sue is found in the outer ear, portions of the larynx, and in the bluish-staining matrix in which the collagenous fibers are so fine auditory canal. When viewed through a light microscope, hyaline cartilage has a clear, glassy appearance (fig. Hyaline cartilage is the most abundant cartilage within the Bone Tissue body. It covers the articular surfaces of bones, supports the tubu- lar trachea and bronchi of the respiratory system, reinforces the Bone tissue is the most rigid of all the connective tissues. Unlike nose, and forms the flexible bridge, called costal cartilage, be- cartilage, bone tissue has a rich vascular supply and is the site of considerable metabolic activity. The hardness of bone is largely due to the calcium phosphate (calcium hydroxyapatite) deposited lacuna: L. Histology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 96 Unit 3 Microscopic Structure of the Body Lacuna Intercellular matrix Thyroid Chondrocyte Larynx cartilage (b) (c) Cricoid cartilage Tracheal cartilages Paras (a) FIGURE 4. It occurs in places such as the larynx (a), trachea, portions of the rib cage, and embryonic skeleton. Lacuna Chondrocyte Intercellular matrix Collagenous fibers (b) (c) (a) FIGURE 4. A photomicrograph of the tissue is shown in (b) and a labeled diagram in (c). Histology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 4 Histology 97 Lacuna Chondrocyte Elastic fibers Auricular cartilage (b) (c) Paras (a) FIGURE 4. A photomicrograph of the tissue is shown in (b) and a labeled diagram in (c). In calcium deficiency diseases, such as rickets, the bone tissue becomes pliable and bends under the weight of the body (see fig. Based on porosity, bone tissue is classified as either com- pact or spongy, and most bones have both types (fig. Com- pact (dense) bone tissue constitutes the hard outer portion of a bone, and spongy (cancellous) bone tissue constitutes the porous, highly vascular inner portion. The outer surface of a bone is cov- ered by a connective tissue layer called the periosteum that serves as a site of attachment for ligaments and tendons, provides pro- tection, and gives durable strength to the bone. Spongy bone tis- sue makes the bone lighter and provides a space for red bone marrow, where blood cells are produced. In compact bone tissue, mature bone cells, called osteocytes, are arranged in concentric layers around a central FIGURE 4. Histology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 98 Unit 3 Microscopic Structure of the Body (b) Lamellae Central canal (a) Osteocyte within a lacuna Canaliculi (c) FIGURE 4. An injury to a portion of the body may stimulate tissue repair Each osteocyte occupies a cavity called a lacuna. A minor scrape or cut results in platelet and plasma activity of the exposed blood and each lacuna are numerous minute canals, or canaliculi, which the formation of a scab. The epidermis of the skin regenerates be- traverse the dense matrix of the bone tissue to adjacent lacunae. A severe open wound heals through connective tis- Nutrients diffuse through the canaliculi to reach each osteocyte. In this process, collagenous fibers form from The matrix is deposited in concentric layers called lamellae. Blood (Vascular Tissue) Knowledge Check Blood, or vascular tissue, is a highly specialized fluid connective 9. List the basic types of connective tissue and describe the tissue that plays a vital role in maintaining homeostasis. Which of the previously discussed connective tissues matrix called blood plasma (fig.

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Radiology 213:583-588 Am J Roentgenol 176:97-104 Zanetti M buy brahmi 60 caps visa symptoms of kidney stones, Metzdorf A cheap 60 caps brahmi xerostomia medications side effects, Kundert HP, Zollinger H, Vienne P, Seifert Theodorou DJ, Theodorou SJ, Kakitsubata Y, Lektrakul N, Gold B, Hodler J (2003) Achilles tendons: clinical relevance of neo- GE, Roger B, Resnick D (2000) Plantar fasciitis and fascial vascularization diagnosed with power Doppler US. Radiology rupture: MR imaging findings in 26 patients supplemented 227:556-560 with anatomic data in cadavers. Validation Zeiss J, Fenton P, Ebraheim N, Coombs RJ (1991) Magnetic reso- Studies] Radiographics. Theodorou DJ, Theodorou SJ, Farooki S, Kakitsubata Y, Resnick D Clin Orthop 264-266 (2001) Disorders of the plantar aponeurosis: a spectrum of MR Zeiss J, Fenton P, Ebraheim N, Coombs RJ (1991) Magnetic reso- imaging findings. Am J Roentgenol 176(1):97-104 nance imaging for ineffectual tarsal tunnel surgical treatment. Theumann NH, Pfirrmann CW, Mohana Borges AV, Trudell DJ, Clin Orthop Rel Res (264):264-266 Resnick D (2002) Metatarsophalangeal joint of the great toe: Zeiss J, Fenton P, Ebraheim N, Coombs RJ (1990) Normal mag- normal MR, MR arthrographic, and MR bursographic findings netic resonance anatomy of the tarsal tunnel. J Comput Assist Tomogr 26(5):829-838 10(4):214-218 Umans HR, Elsinger E (2001) The plantar plate of the lesser Zeiss J, Ebraheim N, Rusin J (1990) Magnetic resonance imaging metatarsophalangeal joints: potential for injury and role of MR in the diagnosis of tarsal tunnel syndrome. MRI Clin North Am 9(3):659-669 Imag 14(2):123-126 IDKD 2005 Magnetic Resonance Imaging of Muscle M. Boutin2 1 UCSD Medical Center, San Diego, CA, USA 2 Med-Tel International, Davis, CA, USA Learning Objectives fat. Normal skeletal muscle shows a “striated” and “feathery” appearance, produced by high-signal-inten- At the end of this article, readers should: sity fat interlaced within and between the major mus- • Be able to Identify the normal imaging features of cle bundles. Normal muscle has low signal intensity on skeletal muscle on magnetic resonance (MR) imaging. Accessory muscles are congenital abnormalities in which an anomalous muscle is present. The accessory muscle may be asymptomatic, or it may present as a pal- Normal Muscle pable mass or may affect adjacent structures, particularly The MR appearance of normal skeletal muscle is the if there is nerve compression. The best-known accessory result of an organized admixture of muscle fibers and muscle is the accessory soleus, seen in the pre-Achilles a b Fig. A coronal T1- weighted (a) and T2- weighted fat-suppress- ed (b) image of the right hip demonstrates the appearance of nor- mal muscle. The signal of normal muscle decreases on the T2-weighted image Magnetic Resonance Imaging of Muscle 49 ty infiltration. MR signal alterations are usually seen This middle-aged man pal- pated a mass above his ankle. In A sagittal T1-weighted mag- subacute denervation, the denervated muscle have high netic resonance (MR) image signal intensity on T2-weighted and inversion recovery of the ankle shows an anom- sequences. Typically, the size of the muscle remains nor- alous low-lying soleus mus- mal or is slightly diminished due to concomitant atrophy cle anterior to the Achilles tendon and filling the pre- (Fig. In chronic denervation, the muscle edema re- Achilles fat pad solves, and the involved muscles undergo volume loss fat pad (Fig. Other common accessory muscles include the peroneus quartus muscle, behind the fibula, the accessory abductor digiti minimi, in the wrist, and the anomalous lumbrical muscle, seen in carpal tunnel. Congenital Muscular Disorders There are numerous forms of muscular dystrophy, with Duchenne and Becker muscular dystrophy being the most common. These typically present with progressive proximal muscle weakness in childhood or adoles- cence. The congenital myopathies all involve multiple muscle groups, typically in a symmetrical fashion. In the acute phase of muscle damage, symmetrical mild hyperintensity of the muscles can be seen (Fig. An axial fat-suppressed pro- ton-density (PD)-weighted image of the proximal calf shows a gan- sues remain normal. More advanced disease typically glion adjacent to the proximal tibiofibular joint. Due to compres- shows pseudohypertrophy of lower extremity muscles, sion on the peroneal nerve, denervation changes are apparent in the particularly the calf musculature, due to excessive fat- tibialis anterior muscle Fig. An axial STIR MR image of the thighs shows symmetrical hyperintensity of the quadriceps muscles 50 M. The presence of fatty change implies an Pyomyositis irreversible lesion. Clinical history and the distribution of the muscle abnormalities, which correspond to a specific Deep cellulitis can be associated with septic fasciitis or nerve distribution, allow accurate diagnosis of muscle pyomyositis, an infiltrative deep infection of muscle. Pyomyositis used to be seen most frequently in children and in patients from the tropics.

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Insulin-like growth factor II Relaxin Glycoprotein Family The Simplest Hormones buy 60caps brahmi visa medications high blood pressure, in Terms of Structure purchase 60 caps brahmi mastercard treatment 2nd degree burn, Luteinizing hormone (LH) Consist of One or Two Modified Amino Acids Follicle-stimulating hormone (FSH) Thyroid-stimulating hormone (TSH) Hormones derived from one or two amino acids are small Human chorionic gonadotropin (hCG) in size and often hydrophilic. These hormones are formed Growth Hormone Family by conversion from a commonly occurring amino acid; ep- Growth hormone (GH) inephrine and thyroxine, for example, are derived from ty- Prolactin (PRL) rosine. Each of these hormones is synthesized by a particu- Human placental lactogen (hPL) lar sequence of enzymes that are primarily localized in the Secretin Family endocrine gland involved in its production. The synthesis Secretin Vasoactive intestinal peptide (VIP) of amino acid-derived hormones can, therefore, be influ- Glucagon enced in a relatively specific fashion by a variety of envi- Gastric inhibitory peptide (GIP) ronmental or pharmacological agents. The steps involved CHAPTER 31 Endocrine Control Mechanisms 571 ture in these families resulted from the evolution of a single Androgens, such as testosterone, are primarily produced ancestral hormone into each of the separate and distinct in the testes, but physiologically significant amounts can be hormones. In many cases, there is also considerable homol- synthesized by the adrenal cortex as well. Progestins, such as progesterone, are involved in maintenance of preg- Steroid Hormones Are Derived From Cholesterol nancy and are produced by the ovaries and placenta. Steroids are lipid-soluble, hydrophobic molecules synthe- The calciferols, such as 1,25-dihydroxycholecalciferol, sized from cholesterol. They can be classified into six cate- are involved in the regulation of calcium homeostasis. An ex- dihydroxycholecalciferol is the hormonally active form of ample of each category is shown in Figure 31. Gluco- Polypeptide and Protein Hormones Are corticoids generally produce effects that are catabolic in Synthesized in Advance of Need and nature. Aldosterone, a primary example of a mineralocorti- Stored in Secretory Vesicles coid, is produced in cells of the outermost portion of the adrenal cortex. Aldosterone is primarily involved in regu- Steroid hormones are synthesized and secreted on demand, lating sodium and potassium balance by the kidneys and is but polypeptide hormones are typically stored prior to se- the principal mineralocorticoid in the body. Steroid hormone synthesis and secretion are dis- Cortisol (Aldehyde) (Hemiacetal) (a glucocorticoid) Aldosterone (a mineralocorticoid) Testosterone Estradiol (an androgen) (an estrogen) Progesterone (a progestin) 1,25 (OH)2 Cholecalciferol (a calciferol) FIGURE 31. Like other proteins In some disease states, large amounts of intact precursor destined for secretion, polypeptide hormones are synthe- molecules are found in the circulation. This situation may sized with a pre- or signal peptide at their amino terminal end be the result of endocrine cell hyperactivity or even un- that directs the growing peptide chain into the cisternae of controlled production of hormone precursor by nonen- the rough ER. Although precursors usually have rela- synthesized as part of an even larger precursor or prepro- tively low biological activity, if they are secreted in hormone. The prepeptide is cleaved off upon entry of the sufficiently high amounts, they may still produce biological preprohormone into the rough ER, to form the prohor- effects. As the prohormone is processed through the Golgi nized sign of neoplasia. In many cases, preprohormones may contain the se- gene may be expressed in different tissues, tissue-specific quences for several different biologically active molecules. In contrast, in other cells of the gastrointestinal (POMC) actually contains the sequences for several bio- (GI) tract in which proglucagon is also produced, the mole- logically active signal molecules. Propressophysin serves as cule is cleaved at three different positions such that gli- the precursor for the nonapeptide hormone arginine vaso- centin, glucagon-like peptide-1 (GLP-1), and glucagon-like pressin (AVP). The precursor for TRH contains five repeats peptide-2 (GLP-2) are produced (Fig. In general, two basic amino acid residues, either lys-arg Intracellular Movement of Secretory Vesicles and Exocy- or arg-arg, demarcate the point(s) at which the prohor- tosis. Upon insertion of the preprohormone into the cis- mone will be cleaved into its biologically active compo- ternae of the ER, the prepeptide or signal peptide is rapidly nents. Presumably, these two basic amino acids serve as cleaved from the amino terminal end of the molecule. The specific recognition sites for the trypsin-like endopepti- resulting prohormone is translocated to the Golgi appara- dases thought to be responsible for cleavage of the prohor- mones. Although somewhat rare, there are documented cases of inherited diseases in which a point mutation in- Proglucagon volving an amino acid residue at the cleavage site results in an inability to convert the prohormone into active hor- N-peptide Glucagon IP-1 GLP-1 IP-2 GLP-2 mone, resulting in a state of hormone deficiency. Partially Pancreatic Gastrointestinal alpha cells tract ACTH Glicentin γ-MSH α-MSH CLIP γ-LPH β-Endorphin Proopiomelanocortin N-peptide N-peptide Glucagon IP-1 (POMC) Glucagon GLP-1 AVP Neurophysin IP-2 Propressophysin IP-1 GLP-1 IP-2 GLP-2 GLP-2 FIGURE 31. In alpha cells of the pancreas (left), the major bioactive product formed from proglucagon is glucagon it- FIGURE 31. It is not currently known whether the other peptides are tive sizes of individual peptides are only ap- processed to produce biologically active molecules. MSH melanocyte-stimulating hormone; CLIP cells (right), proglucagon is cleaved to produce the four peptides corticotropin-like intermediate lobe peptide; LPH shown.

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