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With the fingers flat discount 800mg cialis black, move gently over every part of A woman should examine her breasts monthly discount 800 mg cialis black with amex. Use the right hand to examine the left breast generic 800 mg cialis black amex, not yet reached menopause discount cialis black 800mg amex, the ideal time for a BSE is 1 week and the left hand for the right breast. Palpate for any lump, after her period ends because the breasts are less likely to be hard knot, or thickening. A woman no longer menstruat- or lumpy (fibrocystic tissue), the locations of these lumps ing should just pick any day of the month and do a BSE on that should be noted and checked each month for changes in same day on a monthly basis. To examine the right breast, volved in this procedure are the following: put a pillow or folded towel under the right shoulder. Inspect the breasts with the right hand behind the head—this distributes the breast the arms at the sides. With the fingers of the Look for any changes in the contour of each breast—a left hand held flat, press gently in small circular motions swelling, dimpling of skin or changes in the nipple. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 746 Unit 7 Reproduction and Development (a) (b) (c) (d) (e) (f) FIGURE 21. This is usually accompanied tissue in the lower curve of each breast is normal. Also examine the armpit carefully for enlarged lymph Problems Involving the Ovaries nodes. The Pap smear permits a microscopic examination and filled with a serous albuminous fluid. Samples of cells are ob- growths often can be palpated during a gynecological examina- tained by gently scraping the surface of the cervix with a spe- tion and may require surgical removal if they exceed about 4 cm cially designed wooden spatula. They are generally removed as a precaution because Pap smears for the early detection of cervical cancer. Ovarian tumors, which occur most often in women over Developmental Problems the age of 60,can grow to be massive. Ovarian tumors as heavy of the Female Reproductive System as 5 kg (14 lb) are not uncommon,and some weighing as much as 110 kg (300 lb) have been reported. Some ovarian tumors Many of the developmental problems of the female reproductive produce estrogen and thus cause feminization in elderly women, system also occur in the reproductive system of the male and including the resumption of menstrual periods. Hermaphroditism and ir- women with ovarian tumors varies depending on the type of regularities of the sex chromosomes, for example, are develop- tumor,whether or not it is malignant,and if it is,the stage of mental conditions that cause a person to develop both male and the cancer. Two frequent problems involving the uterine tubes are Other developmental abnormalities of the female repro- salpingitis and ectopic pregnancies. Salpingitis (sal-pin-gi-tis) is ductive system may occur during the formation of the uterus and an inflammation of one or both uterine tubes. Papanicolaou, American anatomist and physician, Ectopic pregnancy results from implantation of the blasto- 1883–1962 cyst in a location other than the body or fundus of the uterus. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 21 Female Reproductive System 747 implanted blastocyst causes what is commonly called a tubal Nonmalignant Malignant pregnancy. One danger of a tubal pregnancy is the enlargement, rupture, and subsequent hemorrhage of the uterine tube where implantation has occurred. Ectopic tubal Tubal Infertility, or the inability to conceive, is a clinical prob- pregnancy carcinoma lem that may involve the male or female reproductive system. Submucous Endometrial On the basis of number of people who seek help for this problem, leiomyoma (fibroid) carcinoma it is estimated that 10% to 15% of couples have impaired fertil- Endometrial polyp ity. Generally, when a male is infertile, it is because of inade- quate sperm counts. Female infertility is frequently caused by an Endometrial hyperplasia obstruction of the uterine tubes or abnormal ovulation. Atrophic endometrium Cervical Cervicitis carcinoma Problems Involving the Uterus Cervical polyp Abnormal menstruations are among the most common disorders of the female reproductive system. Abnormal menstruations Atrophic vaginitis may be directly related to problems of the reproductive organs Vaginal carcinoma and pituitary gland or associated with emotional and psycholog- ical stress. Amenorrhea (a-men'o˘-re-a˘) is the absence of menstruation and may be categorized as normal, primary, or secondary.

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His teeth were (a) the obturator foramen anatomy of these appendages generic cialis black 800mg amex, taking into worn on the left side from chewing a (b) the acetabulum account their functional roles generic 800 mg cialis black with visa. Define bipedal locomotion and discuss the “certain peculiarities of the right little (d) the greater sciatic notch adaptations of the pelvic girdle and lower finger suggest that he may have played (e) the linea aspera extremities that allow for this type of the harpsichord buy cialis black 800mg lowest price, piano purchase cialis black 800 mg, or a stringed movement. Explain how the female pelvis is adapted bones can serve as a storehouse of line would involve to the needs of pregnancy and childbirth. Explain the significance of the limb buds, technology, what other types of (b) the femur. What is meant by a congenital skeletal adaptation of the hand or adaptation of pelvis malformation? Speculate as to why a single bone is (b) is narrower at the pelvic outlet. What are the differences between thigh, whereas the antebrachium and leg (d) has a shallower symphysis pubis. Clubfoot is a congenital foot deformity that Give some examples of traumatic 4. Compare the tibia and fibula with respect is clinically referred to as fractures. Why is it important that the fracture be of the tibia or a compound fracture of the (c) pes planus. Contrast the structure of the pectoral and Smithsonian Institution, died in 1829 at pelvic girdles. Articulations © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Articulations 8 Classification of Joints 197 Fibrous Joints 197 Cartilaginous Joints 199 Synovial Joints 200 Developmental Exposition: The Synovial Joints 206 Movements at Synovial Joints 207 Specific Joints of the Body 214 CLINICAL CONSIDERATIONS 224 Clinical Case Study Answer 229 Important Clinical Terminology 230 Chapter Summary 230 Review Activities 231 Clinical Case Study A 20-year-old college football player sustained injury to his right knee during the opening game of the season. Because of rapid swelling and intense pain, he was taken to the emergency room of the local hospital. When the attending physician asked him to describe how the injury oc- curred, the athlete responded, “I was carrying the ball on an end run left on third down and two. As I planted my right foot just before I was going to make my cut, I was hit in the knee from the side. I felt my knee give way, and then I felt a stabbing pain on the inside of my knee. The doctor determined that valgus stress (an inward bowing stress on the knee) caused the medial aspect of the joint to “open. Which cartilaginous structure is frequently injured in association with the previously men- tioned structure? What are some other stabilizing structures within the knee that are frequently injured in sports? Hint: An impact to one side of the knee generally results in greater trauma to the other side. FIGURE: In spite of being well suited for Carefully read the sections in this chapter on the tibiofemoral (knee) joint and trauma to body support, walking, and running, the knee joints. Articulations © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 8 Articulations 197 3. These joints are distinguished bones of the skeleton are classified as fibrous joints, cartilaginous by fluid-filled joint cavities. Fibrous joints firmly bind skeletal ele- A functional classification of joints is based on the degree of ments together with fibrous connective tissue. Using this type of classifi- firmly unite skeletal elements with cartilage. Synovial joints are cation, the three kinds of articulations are as follows: freely movable joints; they are enclosed by joint capsules that contain synovial fluid. Objective 2 Compare and contrast the three principal kinds In accordance with the structural classification of the joints pre- of joints that are classified on the basis of structure. It is not the bones themselves that allow movement, Knowledge Check but rather the unions between the bones, called articulations or joints. List the three categories of structural articulations and The structure of a joint determines the direction range speculate as to which would be most supportive and which of movement it permits. The coordinated activity of the joints permits the sinuous, elegant movements of a gymnast or ballet dancer, just as it permits all of the com- FIBROUS JOINTS monplace actions associated with walking, eating, writing, As the name suggests, the articulating bones in fibrous joints are and speaking. Fibrous joints range Arthrology is the science concerned with the study of joints.

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This pathway is lateral to buy 800 mg cialis black fast delivery, but runs with order 800 mg cialis black amex, a more medial DA pathway effective 800 mg cialis black, predominantly from A10 generic 800mg cialis black visa, which innervates the nucleus accumbens and olfactory tubercle (mesolimbic pathway) as well as parts of the cortex (mesocortical system) such as the prefrontal and perirhinal cortex. The DA innervation to the anterior cingulate cortex also comes from A10 but with some axons from A9. There is in fact no clear divide between A9 and A10 and some overlap of their pathways. The DA mesolimbic tract and the noradrenergic bundles come together in the medial forebrain bundle before entering the cortex. Webster &2001 John Wiley & Sons Ltd 138 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION Figure 7. AMYG, amygdala; CN, caudate nucleus; MFB, medial forebrain bundle; NcA, nucleus accumbers; OT, olfactory tubercle; PUT, putamen; SN, substantia nigra. For full details see text and Moore and Bloom (1978) and Lindvall and Bjorkland (1978) A further totally separate DA pathway arises from A12 in the arcuate nucleus and forms the tuberoinfundibular tract in the median eminence to the pituitary gland for controlling prolactin release. This is partly achieved by DA being released into capillaries of the hypothalamic±hypophyseal portal system and then inhibiting the prolactin releasing cells (lactotrophs) of the anterior pituitary. While the nigrostriatal pathways are ipsilateral some crossing occurs in fibres from the ventral tegmental A10 nucleus. Further details can be obtained from Moore and Bloom (1978) and Lindvall and Bjorkland (1978). The nuclei provide distinct loci for activating the dopamine systems for electrophysiological, release and behavioural studies and for their destruction by electrolytic lesion or injection of the toxin 6-hydroxydopamine (6-OHDA). The concentration of DA in different brain areas of the rat is in keeping with the distribution of its pathways. It is concentrated in the striatum (10 mg/g), nucleus accumbens (5 mg/g) and olfactory tubercle (6 mg/g) but in the cortex there is much less (0. Cells in the substantia nigra in humans and primates differ from those in other species in containing granules of the lipoprotein pigment called neuromelanin. The melanin granules are free in the cytoplasm and give the SN a distinctive dark colour. Cells in this nucleus can also have hyaline inclusion bodies, the Lewy bodies, which are not common normally but appear to increase dramatically in patients with Parkinsonism. Certainly they will require considerable biochemical back-up to maintain function in all their terminals. NEUROCHEMISTRY The biochemical pathways in the synthesis and metabolism of dopamine are shown in Fig. Although both phenylalanine and tyrosine are found in the brain it is tyrosine which is the starting point for NA and DA synthesis. It appears to be transported into the brain after synthesis from phenylalanine (phenylalanine hydroxylase) in the liver rather than from phenylalanine found in the brain. Despite the fact that the concentration of tyrosine in the brain is high (561075 M) very little body tyrosine (1%) is used for the synthesis of DA and NA. This is the rate-limiting step (K 561076 M) in DA synthesis, it requires molecular O and m 2 Fe2‡ as well as tetrahydropterine (BH-4) cofactor and is substrate-specific. It can be inhibited by a-methyl-p-tyrosine, which depletes the brain of both DA and NA and it is particularly important for the maintenance of DA synthesis. Since the levels of tyrosine are above the Km for tyrosine hydroxylase the enzyme is normally saturated and so it is not possible to increase DA levels by giving tyrosine. Dopa decarboxylase By contrast, the cytoplasmic decarboxylation of dopa to dopamine by the enzyme dopa decarboxylase is about 100 times more rapid (K :461074 M) than its synthesis and m indeed it is difficult to detect endogenous dopa in the CNS. This enzyme, which requires pyridoxal phosphate (vitamin B6) as co-factor, can decarboxylate other amino acids (e. Controls of synthesis It is possible to deplete the brain of both DA and NA by inhibiting tyrosine hydroxylase but while NA may be reduced independently by inhibiting dopamine b- hydroxylase, the enzyme that converts DA to NA, there is no way of specifically losing DA other than by destruction of its neurons (see below). In contrast, it is easier to augment DA than NA by giving the precursor dopa because of its rapid conversion to DA and the limit imposed on its further synthesis to NA by the restriction of dopamine b-hydroxylase to the vesicles of NA terminals.

Barriers to returning to or main- The social effects of HIV infection are as taining employment are numerous and varied as the symptoms associated with require motivation and commitment to the condition discount 800mg cialis black with mastercard. HIV infection is a disease overcome (Maticka-Tyndale order 800mg cialis black, Adam discount cialis black 800mg with amex, & that many fear and perceive as shrouded Cohen 800mg cialis black amex, 2002). Many social implications of Many psychosocial, financial, medical, HIV infection are related to this fear and and legal factors affect individuals’ abili- misunderstanding. Others avoid indi- or not they should continue to work viduals with HIV infection because they (Nixon & Renwick, 2003). Contextual fac- fear contagion and are not aware of the tors, such as disability and health insur- actual modes of transmission. Such soci- ance or drug plans, often influence etal concepts can result in ostracism and individuals’ decision (Ferrier & Lavis, discrimination against individuals with 2003). The components of a complete most serious impediments to successful blood count include the following: functioning in the workplace are the fear, • Red blood cell count: measurement of discrimination, and prejudice that they the total number of red blood cells in encounter. Many individuals who are HIV a cubic millimeter of blood positive encounter discrimination at work, • White blood cell count: measurement of and as a result they may withdraw from the total number of white blood cells the workplace altogether (Hunt, Jaques, in a cubic millimeter of blood Niles, & Wiezalis, 2003). Individuals with • Differential: measurement of the pro- HIV frequently fear that they will lose portion of each type of white blood their jobs as a result of their diagnosis, re- cell (i. Because infection can ma is normal) have such serious consequences for indi- viduals with HIV infection, they should Other types of blood tests used to meas- also avoid job situations in which they are ure specific components of blood are as likely to be exposed to infection. As the follows: HIV infection progresses and individuals • Reticulocyte count: assessment of bone experience increasing fatigue, they may marrow function by measuring its need to undertake less strenuous work or production of immature red blood arrange for shorter work schedules or cells (reticulocytes) more frequent rest periods. In the later • Platelet count: measurement of the stages of the disease, mental changes may number of platelets in a cubic mil- affect an individual’s capacity to function limeter of blood in the work setting. A complete blood count is a test Bleeding Time Test used to evaluate a number of different com- ponents in the blood. Sometimes these A bleeding time test measures the length various components are also measured of time it takes for bleeding to stop after Diagnostic Procedures for Conditions Affecting the Blood or Immune System 251 a small puncture wound. The test deter- specific part of the clotting mechanism mines how quickly a platelet clot forms. The bone marrow is then examined A prothrombin time test measures the microscopically for various abnormalities length of time that a blood sample takes in the number, size, and shape of the pre- to clot when certain chemicals are added cursors of red blood cells, white blood to it in the laboratory. Pro- ond test is negative, the test result is con- longation of clotting time indicates that sidered negative. If the result of the individuals may be prone to abnormal second test is positive, the Western blot bleeding. If the test indicates that clotting test is usually performed as a confirmato- time is reduced, there may be blood hy- ry test. If the result of the Western blot test percoagulability, which could contribute is positive, it is highly suggestive that the to the formation of blood clots. HIV antibody is present and that the indi- vidual has been exposed to HIV. Partial Thromboplastin Time (PTT) Test Hemoglobin Electrophoresis A partial thromboplastin time test is used to evaluate a special part of the clotting Hemoglobin electrophoresis is a blood mechanism not evaluated by prothrom- test by which a definitive diagnosis of bin time. As with the prothrombin time sickle cell disease or sickle cell trait can be test, certain chemicals are added to a made. Prolongation of time in which it takes a clot to form is indicative of a Sickle cell prep is a blood test used in sick- bleeding disorder, such as that found in le cell screening. Prolongation of clot formation presence of abnormal hemoglobin but can- may also be found with the use of the not distinguish between sickle cell disease anticoagulant heparin, which affects a and sickle cell trait. Bone marrow transplants are ment is directed toward symptoms and/or used when the immune system is severe- the underlying cause. If a blood disorder ly deficient or when certain types of can- is caused by a toxic substance, the first line cers exist (see Chapter 16).

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