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Skelet Radiol purchase kamagra polo 100 mg without prescription impotence essential oils, whole skeleton and affect children from the age of 2 18:415-426 years generic 100mg kamagra polo amex erectile dysfunction frustration. Wishart J, Horowitz M, Need A, Nordin BE (1990) 40 years, and skeletal involvement is either monostotic or Relationship between forearm and vertebral mineral density in asymmetrically polyostotic. On radionuclide scanning, postmenopausal women with primary hyperparathyroidism. Arch Intern Med 150:1329-1331 there is a generalized increase in uptake, giving a “super 24. Silverberg SJ, Gartenberg F, Jacobs TP et al (1995) Increased scan”, due to excessive osteoblastic activity, with absence bone density after parathyroidectomy in primary hyper- of evidence of renal uptake. Semin Dial 15(4)277- roidism: analysis of 52 cases, including report of new case. Gipstein RM, Coburn JW, Adams JA et al (1976) 28) Salvesen HA, Boe J (1953) Idiopathic hypoparathyroidism. Calciphylaxis in man: A syndrome of tissue necrosis and vas- Acta Endocinol 14:214-226 cular calcification in 11 patients with chronic renal failure. Ryan EA, Reiss E (1984) Oncogenous osteomalacia: Review Pseudohypoparathyroidism - An example of “Seabright- of the world literature of 42 cases. Curr Ther Endocrinol Metab 5:492-495 pseudohypoparathyroidism (PH) and pseudo-pseudohy- 56. Steendijk R, Hauspie RC (1992) The pattern of growth and poparathyroidism (PPH). Differentiation from other syn- growth retardation of patients with hypophosphataemic vita- dromes associated with short metacarpals, metatarsals and min D-resistant rickets: longitudinal study. Glorieux FH, Marie PJ, Pettifor JM, Delvin EE (1980) Bone of shortening of the bones of the hands in PHP and PPHP – a response to phosphate salts, ergocalciferol and calcitriol in hy- comparison with brachydactyly E, Turner’s syndrome, and pophosphatemic vitamin D-resistant rickets. Milgram JW Compere CL (1981) Hypophosphatemic vitamin pseudohypoparathyroidism Semin Musculoskel Radiol D refractory osteomalacia with bilateral pseudofractures. O’Malley SP, Adams JE, Davies M, Ramsden RT (1988) The with secondary hyperparathyroidism and osteitis fibrosa. Polisson RP, Martinez S, Khoury M et al (1985) Calcification Feldman D, Glorieux FH, Pike JW (eds). Chapter 60, Vitamin of entheses associated with X-linked hypophosphatemic os- D, Elsevier Academic Press, San Diego, California, pp 967-994 teomalacia. Adams JE, Davies M (1986) Intra-spinal new bone formation Clin North Am 19:582-598 and spinal cord compression in familial hypophosphataemic 37. Glorieux FH, St-Arnaud R (1997) Vitamin D vitamin D resistant osteomalacia. Hardy DC, Murphy WA, Siegal BA et al (1989) X-linked hy- Vitamin D, Academic Press, San Diego, California, pp 755- pophosphatemia in adults: prevalence of skeletal radiographic 764 and scintigraphic features. Econs MJ, Samsa GP, Monger M et al (1994) X-linked hy- dent rickets Type II, resistance of target organs to 1,25-dihy- pophosphatemic rickets: a disease often unknown to affected droxyvitamin D. McCance RA (1947) Osteomalacia with Looser’s nodes Radiol Clin North Am 29:97-118 (Milkman’s syndrome) due to raised resistance to vitamin D 40. Brill PW, Winchester P, Kleinman PK (1998) Differential di- acquired about the age of 15 years. In: Bone growth in health and dis- duced osteomalacia: a surgically curable syndrome, report of ease.

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The right ovarian vein empties into the inferior vena cava discount 100mg kamagra polo erectile dysfunction causes weed, Objective 4 Describe the position of the ovaries and the whereas the left ovarian vein drains into the left renal vein buy generic kamagra polo 100 mg on-line erectile dysfunction fun facts. Objective 5 Describe the structural changes in the ovaries that lead to and follow ovulation. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 21 Female Reproductive System 729 Ampulla Uterine tube of uterine Suspensory Ovarian ligament tube ligament of Body of uterus ovary Mesovarium Fundus of uterus Ovary Infundibulum of uterine tube Round Fimbriae ligament Egg cell Broad Follicle Endometrium ligament of uterus Myometrium Perimetrium Fornix of vagina Cervix of uterus Vagina Waldrop FIGURE 21. The ovaries have both sympathetic and parasympathetic a newborn girl contain about 2 million oocytes, this number de- innervation from the ovarian plexus. Innervation to the ovaries, clines to 300,000 to 400,000 by the time she enters puberty. On however, is only to the vascular networks and not to the follicu- average, 400 oocytes are ovulated during a woman’s reproductive lar substance within the stroma. Follicle Formation Normal, healthy ovaries usually cannot be palpated either by Primary oocytes that are not stimulated to complete the first vaginal or abdominal examination. If the ovaries become meiotic division are contained within tiny follicles called pri- swollen or displaced, however, they are palpable through the vagina. There are many types of nonmalignant tumors of the ovaries, most of mordial follicles. In response to stimulation by gonadotropic which cause swelling and some localized tenderness. The ovaries at- hormones, some of these oocytes and follicles get larger, and the rophy during menopause, and ovarian enlargement in post- follicular cells divide to produce the follicular epithelium that menopausal women is usually cause for concern. At The germ cells that migrate into the ovaries during early embry- this point, they are called secondary follicles (fig. The mound is called the cumulus oogonia stops at this point and never resumes. Under stimulation of follicle-stimulating of the first meiotic division, and therefore the primary oocytes are still diploid (have 46 chromosomes). Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 730 Unit 7 Reproduction and Development Primary follicles Vesicle Secondary follicle (a) Granulosa cells Antrum Corona radiata Secondary oocyte Zona pellucida Cumulus oophorus Theca interna (b) FIGURE 21. In- By about the tenth to the fourteenth day following day 1 of a terestingly, the follicular cells produce estrogen from its precursor menstrual period, usually just one follicle has matured fully to be- testosterone, which is supplied by a layer of cells immediately come a vesicular ovarian (graafian) follicle (fig. This does not form two complete cells, that it forms a bulge on the surface of the ovary. Under proper however, because only one cell—the secondary oocyte—gets al- hormonal stimulation (a sudden burst of luteinizing hormone most all of the cytoplasm. The other cell formed at this time be- from the anterior pituitary, triggered by a peak level of estrogen), comes a small polar body (fig. The secondary oocyte enters the second meiotic and extrude its secondary oocyte into the peritoneal cavity near division, but meiosis is arrested at metaphase II and is never the opening of the uterine tube in the process of ovulation (ov-yu˘- completed unless fertilization occurs. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 21 Female Reproductive System 731 (a) (b) FIGURE 21. Ovarian cortex Tunica albuginea Ovarian medulla Primordial Maturing follicles follicle Broad ligament FIGURE 21. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 732 Unit 7 Reproduction and Development Fimbriae of uterine tube Knowledge Check 4. Describe the position of the ovaries relative to the uterine tubes and describe the position and functions of the broad Oocyte ligament and mesovarium. Compare the structure of a primordial follicle, primary fol- licle, secondary follicle, and vesicular ovarian follicle. Define ovulation and describe the changes that occur in the ovary following ovulation in a nonfertile cycle. Describe oogenesis and explain why only one mature ovum is produced by this process.

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The male and female reproductive systems complement The organs of the male reproductive system are shown in each other in their common purpose of producing offspring order kamagra polo 100 mg amex impotence lower back pain. The female not only produces her own gametes cate whether they are primary or secondary sex organs order kamagra polo 100 mg on line erectile dysfunction doctors in pa. With respect to the other body systems, discuss the latent male, but her reproductive organs are specialized to provide sites (delayed) development of the reproductive system. Male Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 20 Male Reproductive System 699 Ureter Ampulla of ductus deferens Ampulla of ductus deferens Ejaculatory duct of ductus deferens Testis (sectioned to show testicular lobules) FIGURE 20. Male Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 700 Unit 7 Reproduction and Development their position relative to the pelvic region of the body. Organ(s) Function(s) The external appearance of the scrotum varies at different times in the same individual as a result of the contraction and re- Testes laxation of the scrotal muscles. Both the dartos and the cremaster involuntarily contract Ductus deferentia Store spermatozoa; convey spermatozoa to the in response to low temperatures to move the testes closer to the ejaculatory ducts heat of the body in the pelvic region. The cremaster muscle is a Ejaculatory ducts Receive spermatozoa and additives to produce continuation of the internal abdominal oblique muscle of the ab- seminal fluid dominal wall, which is derived as the testes descend into the Seminal vesicles Secrete alkaline fluid containing nutrients and prostaglandins; helps neutralize the acidic scrotum. Because it is a skeletal muscle, it can be contracted vol- environment of the vagina untarily as well. When the scrotal muscles are contracted, the Prostate Secretes acidic fluid that enhances motility of scrotum appears tightly wrinkled as the testes are pulled closer to spermatozoa the warmth of the body wall. High temperatures cause the dartos Bulbourethral glands Secrete fluid that lubricates the urethra and end and cremaster muscles to relax and the testes to be suspended of the penis lower in the relaxed scrotum. The temperature of the testes is Scrotum Encloses and protects the testes; helps maintain maintained at about 35° C (95° F), or about 3. This temperature is optimal for the production and stor- body; copulatory organ age of spermatozoa. Although uncommon, male infertility may result from an exces- sively high temperature of the testes over an extended period of time. Frequent hot baths or saunas may destroy sperm cells to the extent that the sperm count will be too low to enable fertilization. PERINEUM AND SCROTUM The scrotum is subdivided into two longitudinal compart- The perineum is the specific portion of the pelvic region that con- ments by a fibrous scrotal septum (fig. The scrotum, a pouch that supports the testes, is divided into two internal com- the scrotal septum is to compartmentalize each testis so that in- partments by a connective tissue septum. In addition, the left testis is generally suspended lower in the scrotum than the Objective 4 Describe the location of the perineum and right so that the two are not as likely to be compressed forcefully distinguish between the urogenital and anal triangles. The site of the scrotal septum is apparent on the sur- face of the scrotum along a median longitudinal ridge called the Objective 5 Discuss the structure and function of the scrotum. The perineal raphe extends forward to the undersurface of the penis and backward to the anal opening (see fig. The arteries that serve the scrotum are the internal pu- tween the symphysis pubis and the coccyx (fig. It is the dendal branch of the internal iliac artery, the external pudendal muscular region of the outlet of the pelvis (see fig. The branch of the femoral artery, and the cremasteric branch of the perineum is divided into a urogenital triangle in front and an anal inferior epigastric artery. In the male perineum, the penis and scrotum are similar to that of the arteries. The scrotal nerves are primarily attached at the anterior portion of the urogenital triangle and the sensory; they include the pudendal nerves, ilioinguinal nerves, anus is located within the posterior portion of the anal triangle. Male Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 20 Male Reproductive System 701 FIGURE 20. It is divided into urogenital and anal triangles, indicated in red and purple respectively.

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This un- 14 CHAPTER 1 PSYCHOSOCIAL AND FUNCTIONAL ASPECTS OF CHRONIC ILLNESS AND DISABILITY predictability can be frustrating for affect- stigmatization and marginality (Livneh & ed individuals as well as for those around Wilson purchase kamagra polo 100 mg otc bisoprolol causes erectile dysfunction, 2003) purchase kamagra polo 100 mg visa erectile dysfunction from alcohol. There may be reluctance to plan for diabetes or cardiac conditions, have no out- the future at all, so that inability to pre- ward signs that alert casual observers to an dict the future becomes more disabling individual’s condition. The term invisible than the actual physical consequences of disability refers to these latter conditions. In other instances, Because there are no outward physical given the unpredictability of their condi- signs or other cues to indicate limitations tion, individuals may elect to follow a dif- associated with chronic illness or disabil- ferent life course than they would have ity, others have no basis on which to alter otherwise chosen. Decisions not to have their expectations of the individual’s children, to cut down on the number of functional capacity. Although this lack of hours spent in the work environment, or reaction can be positive (in the sense that to suddenly relocate to a different part of it prevents others from acting out of prej- the country may be misinterpreted by udice or stereotypes), it can also be negative those unaware of the individual’s condi- in the sense that it can enable individu- tion or its associated unpredictability. For als to deny or avoid acceptance of their those conditions in which symptoms or condition and its associated implications. Criticisms of such ness of the observer’s association with the decisions may be particularly distressing individual. Although casual acquaintances to individuals who do not wish to disclose may not notice limitations, those more close- or share intimate details of their condition ly involved with the individual in day-to- with the casual observer. However, some conditions under nor- dition may also cause those closest to the mal circumstances may offer no visible individual to withdraw emotional interac- signs or cues, no matter how close anoth- tions or support in an attempt to protect er person is with the affected individual. The unapparent aspect of the limitation Thus uncertainty poses particular chal- in invisible disability may be a unique ele- lenges for individuals and their families ment related to individuals’ adjustment and and can be a source of stress. Without present, rather than dwelling on events environmental feedback to create a tangi- that may or may not occur, can help to ble reality of the condition, individuals with reduce stress and anxiety and enhance the invisible disability may postpone adapta- quality of life. Some chronic illnesses or disabilities SEXUALITY have associated physical changes that can be objectively assessed by others or have Human sexuality is more than genital functional limitations that necessitate the acts or sexual function. The visibility of a person’s sense of self (Hordern & Currow, condition has often been associated with 2003). It is an ever changing, lived expe- Family Adaptation to Chronic Illness and Disability 15 rience, affecting the way individuals view whom they feel strong psychological themselves and their body (Hordern, bonds. Sexuality encompasses the whole for different people and is not always person and is reflected in all that individ- based on blood or law. It is an important part of protection, socialization, physical care, identity, self-image, and self-concept. Each individual with- Each person is a sexual being with a need in the family structure plays some role for intimacy, physical contact, and love. Family reactions to The expression of sexual urges is one chronic illness and disability may be sim- form of sexuality. Chronic illness or dis- ilar to those experienced by the individ- ability can affect sexual expression be- ual and may include shock, denial, anger, cause of physical limitations, depression, guilt, anxiety, and depression. Families lack of energy, pain, alterations in self- must make adaptations, adjustments, and image, or the reactions of others. In some role changes both as a unit and as individ- conditions, the main barrier to sexual ual family members. The way in which expression may be problems with self-con- families react and adapt to chronic illness cept and body-image; in other condi- and disability affects an individual’s sub- tions, physical changes may present phys- sequent adjustment. Whether families ical barriers that affect sexual function foster independence or dependence, show directly. In When a family member is no longer some instances, it may be necessary to able to perform certain functions, families help individuals overcome their own mis- may react in various ways. There may be perceptions and fears in order to establish a strong desire to be a “normal” family a means for sexual expression. Family members with prior ex- instances, individuals may need assistance pectations for the individual’s future or to overcome barriers or to learn methods “what he or she might have been” may of sexual expression different from those experience anger, resentment, or disap- used previously.

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In of strength generic kamagra polo 100mg amex erectile dysfunction treatment success rate, which will eventually reach near-normal levels some cases kamagra polo 100 mg sale erectile dysfunction and marijuana, there is complete disruption of the muscle if reinjury is avoided. Some muscle tissue is permanently (avulsion), although usually separation is not complete. Most recovered muscles will have a some- ness, weakness, delayed swelling, and “bunching up” in what increased susceptibility to injury for an extended pe- extreme cases. Several predisposing factors may cause a muscle strain Precautions for avoiding strain injury include adequate injury, including relative weakness of a given muscle, result- physical conditioning and practiced expertise at the task at ing from a lack of training early in a sports season, and fa- hand. Preexercise stretching and warm-up may be of some tigue, which leads to increased injury late in an athletic value in preventing strain injury, although the experimen- event. In general, factors that make a muscle less able to con- tal evidence is equivocal. Among muscle fibers, the relative fast-twitch fibers on the basis of their contraction speed importance of each pathway and the presence or absence of (see Table 9. The differences in rates of contraction associated supporting organelles and structures vary. These (shortening velocity or force development) arise from dif- variations form the basis for the classification of skeletal ferences in actomyosin ATPase activity (i. Mitochondria are abundant in usually contains a mixture of fiber types, but in most mus- these fibers because they contain the enzymes involved in cles a particular type predominates. White which dyes for specific enzymatic reactions are used to muscle fibers, which contain little myoglobin, are fast- identify individual fibers in a muscle cross section. They contain significant amounts of stored glycogen, Red Muscle Fibers and Aerobic Metabolism. The color which can be broken down rapidly to provide a quick differences of skeletal muscles arise from differences in the source of energy. Although they contract rapidly and pow- amount of myoglobin they contain. Similar to the related erfully, their endurance is limited by their ability to sustain red blood cell protein hemoglobin, myoglobin can bind, an oxygen deficit (i. They require a period of recovery (and a supply of that depend heavily on aerobic metabolism for their ATP oxygen) after heavy use. White muscle fibers have fewer CHAPTER 9 Skeletal Muscle and Smooth Muscle 165 TABLE 9. There are indica- tigue resistance, chemical measurements of fatigued skele- tions that enzymes of the glycolytic pathway may be tal muscle specimens have shown that the ATP content, closely associated with the thin filament array. In well-moti- vated subjects, CNS factors do not appear to play an im- Red and White Fibers and Muscle Function. The relative portant role in fatigue, and transmission at the neuromus- proportions of red and white muscle fibers fit muscles for cular junction has such a large safety factor that impaired different uses in the body. Muscles containing primarily transmission also does not contribute to fatigue. Muscles containing a preponderance of muscle at a rate far above that necessary for a fused tetanus fast-twitch red fibers support faster and more powerful con- quickly produces high-frequency stimulation fatigue; re- tractions. They also typically contain varying numbers of covery from this condition is rapid (a few tens of seconds). Muscles containing primarily fast-twitch white fibers to less Ca release from the SR. Under most in vivo cir- are suited for rapid, short, powerful contractions.


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