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It has the capacity to continue to increase excretion until blood pressure is returned to a level set by the body for mean arterial pressure discount innopran xl 80mg blood pressure chart low bp. It is believed to be the mechanism whereby the kidney sets the long-term mean arterial pressure set point in the body generic innopran xl 80 mg without prescription blood pressure below 60, around which all cardiovascular reflexes operate pressure–volume curve curve generated by measuring the amount of pleural pressure required to inflate the lungs to a given volume cheap innopran xl 80mg with visa arrhythmia prevalence. The slope of the pressure–volume curve provides a measure of lung compliance presynaptic facilitation effects of chemical mediators or drugs to increase the release of neurotransmitter at a synapse presynaptic inhibition receptors on axons suppress the release of neurotransmitters at neural synapses and neuroeffector junctions presynaptic inhibitory receptors receptors on axons that suppress the release of neurotransmitters at neural synapses and neuroeffector junctions presynaptic terminal the axonal nerve ending from which neurotransmitters are released prevertebral sympathetic ganglia sympathetic ganglia (celiac, aorticorenal, and superior and inferior mesenteric) lying in front of the vertebral column, as distinguished from the ganglia of the sympathetic trunk (paravertebral ganglia); these ganglia occur mostly around the origin of the major branches of the abdominal aorta, and all are in the abdominopelvic cavity; the neurons comprising the ganglia send postsynaptic sympathetic fibers to the gut primary active transport mechanism see active transport primary axons (type Ia) largest myelinated afferent axons from the muscle spindle primary follicular stage ovarian follicle consisting of one layer of cuboidal granulosa cells and a basement membrane surrounding the oocyte primary lymphoid organs see lymphoid organs primary motor cortex (M1) region of the cerebral cortex that fits all four parameters of a cortical motor area and is located just anterior to the central sulcus primary oocyte oocyte in first meiotic arrest primary peristaltic wave peristaltic propulsion in the esophagus initiated by swallowing primary somatosensory cortex (S1) region of the cerebral cortex that receives tactile input and is located just posterior to the central sulcus primary spermatocyte spermatocyte that divides into two secondary spermatocytes prime mover contracting muscle that contributes most to a movement primordial follicle ovarian follicle consisting of a primary oocyte surrounded by a layer of pregranulosa cells progesterone major natural progestogen, promoting the secretory function of the uterus progesterone block maintenance of uterine quiescence throughout gestation by progesterone to prevent premature delivery progestin or progestogen substance that promotes secretory function of the uterus programmed cell death death of a cell mediated by signaling pathways invoked in the cell in response to unhealthy growth conditions (e. The term fibrosis means scaring, and interstitial means the condition occurs in the area of the lung between alveoli. It is the scarring of the tissue between the alveoli that interferes with a patient’s ability to breathe. The major functions are to reduce surface tension at the alveolar air–liquid interface and to maintain alveolar stability at low lung volumes. It opens into the pulmonary artery during systole but closes during diastole pulse pressure difference in systolic and diastolic arterial pressure. It is the change in pressure associated with each cardiac cycle and is a function of arterial compliance and stroke volume purinergic neuron enteric neurons that use a purine nucleotide (e. These glands contain mucous cells that secrete mucus and bicarbonate ions, which protect the stomach from the acid in the stomach lumen. The pyloric glands are located in a larger area adjacent to the duodenum and contain cells similar to mucous neck cells. The endogenous pyrogens may also come directly from tissue necrosis pyrosis burning sensation in the chest usually associated with gastroesophageal reflux; also called heartburn or acid indigestion pyruvate carboxylase enzyme of the ligase class that catalyzes the irreversible carboxylation of pyruvate to form oxaloacetate pyruvate dehydrogenase allosteric enzyme that transforms pyruvate into acetyl-CoA, which is then used in the citric acid cycle pyruvate kinase enzyme that catalyzes the transfer of a phosphoryl group from phosphoenolpyruvate to adenosine diphosphate, yielding a pyruvate molecule pyruvic acid end product of the glycolytic pathway P wave initial, small positive deflection on the electrocardiogram resulting from depolarization of the atria Q10 phenomenon in which the rate of a biological process increases when the temperature is increased by 10°C; this value is obtained using the following formula: Q10 = rate at (T + 10°C)/rate at T, where T = starting temperature; for biological systems, the Q10 value is generally between 1. It involves mixing known quantities of radioactive antigen (frequently labeled with γ-radioactive isotopes of iodine attached to tyrosine) with antibody to that antigen and then adding unlabeled or “cold” antigen and measuring the amount of labeled antigen displaced radioreceptor assay important modification of the radioimmunoassay that uses specific hormone receptors rather than antibodies as the hormone-binding reagent. It is the last phase of systole reduced ventricular filling filling phase of the cardiac cycle in which the rate of ventricular filling begins to diminish. It is the last phase of diastole 5α-reductase steroidogenic enzyme that converts testosterone to dihydrotestosterone reentry tachycardia type of ventricular tachycardia caused by continual recycling of conducted action potentials through an abnormal pathway in the heart referred pain pain from deep structures perceived as arising from a surface area remote from its actual origin; the area where the pain is appreciated is innervated by the same spinal segment(s) as the deep structure; also known as reflective pain reflection coefficient measure of the relative permeability of a particular membrane to a particular solute; calculated as the ratio of observed osmotic pressure to that calculated from van’t Hoff law; also equal to 1 minus the ratio of the effective pore areas available to solute and to solvent reflex neuronal event occurring beyond volition; in neurophysiology, it is a relatively simple behavioral response of an effector produced by influx of sensory afferent impulses to a neural center and its reflection as efferent impulses back to the periphery to the effector (e. Retinyl ester is incorporated in chylomicrons and taken up by the liver retrograde direction of movement of material from the tip of an axon toward the cell body of the neuron retrograde amnesia loss of memory laid down prior to a certain point in time retrograde transport transport of cellular components from the nerve process to the soma retropulsion movement of luminal contents in the oral direction reversal potential voltage across the endplate membrane determined by the Na+ and K+ concentrations inside and out reverse T3 (rT3) reverse triiodothyronine; a substance generated by inner-ring deiodination of thyroxine reward system circuit in the brain involved in pleasurable sensation comprising projections from neurons in the midbrain ventral tegmental area to the nucleus accumbens in the cerebrum and other limbic structures Reynolds number (Re) calculated unit used to predict when turbulence will occur in a fluid flow stream. It is a disabling and painful inflammatory condition, which can lead to substantial loss of mobility as a result of pain and joint destruction rhodopsin pigment of the retina that is responsible for both the formation of the photoreceptor cells and the first events in the perception of light; also known as visual purple rhythmicity property of all heart cells by which they can generate their own action potentials in a repetitive, uniform, or rhythmic manner. It naturally occurs in the nodal tissue of the healthy heart and is responsible for setting the intrinsic heart rate but can be manifested in ectopic foci and thus cause cardiac arrhythmias rib cage 12 pairs of ribs that are hinged to the vertebral column rickets disorder of normal bone ossification manifested by distorted bone movements during muscular action. Rickets is caused by vitamin D deficiency right atrium upper chamber of the right heart. It receives the entire venous blood supply returning from all the systemic organs. It empties into the right ventricle through the tricuspid valve right bundle-branch block condition in which transmission of action potentials is blocked in the right branch of the bundle of His right ventricle lower chamber of the right heart that receives blood from the right atrium through the tricuspid valve and pumps blood across the pulmonic valve into the pulmonary artery right ventricular hypertrophy abnormally increased muscle mass in the right ventricle. It occurs in response to any factor that chronically increases wall stress on the right ventricle, such as pulmonary hypertension or a stenotic pulmonic valve right-to-left shunt anatomical shunt in which blood goes directly from the pulmonary artery to the pulmonary vein and bypasses the alveoli. It can generate its own action potentials in a repetitive manner and is responsible for setting the intrinsic heart rate. It is the first area of the heart to display electrical activity during the cardiac cycle saccades rapid sideways movements of the eyeballs that change the direction of vision safety factor at the myoneural junction, the amount by which the released transmitter substance exceeds that necessary for effective transmission salivary glands heterogeneous group of exocrine glands that produces saliva; innervated by both the parasympathetic and sympathetic divisions of the autonomic nervous system. Parasympathetic stimulation of the salivary glands results in increased salivary secretion. The parotid, submandibular (submaxillary), and sublingual glands are the major salivary glands. These intermediary molecules are generated in large quantities, and this amplifies the signaling initiated by the first messenger. It usually arises from blockage at the level of the atrioventricular node and results in an irregular heart rate secretagogue substance stimulating secretion secretin hormone secreted by the duodenal and jejunal mucosa when exposed to acid chyme that stimulates pancreatic secretion rich in bicarbonate ions.

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There is an association with von cally removed if the anaesthetic risks are acceptable 40 mg innopran xl visa hypertension signs and symptoms treatment. Conservative treatment Neuroblastoma This is a malignant tumour aris- If a phaeochromocytoma is deemed inoperable order innopran xl with a visa arrhythmia laying down, ing from sympathetic ganglia purchase innopran xl on line heart attack 2014. It usually occurs in then lifelong treatment with both alpha- and beta- infants and young children. Phaeochromocytoma This rare tumour is a paragangli- oma or functionally active tumour of the sympathetic Surgical excision nervous system, secreting catecholamines. Schwannomas can be enucleated Shortness of breath 321 preventing extremes of hypertension and hypoten- sion. Both alpha- and beta-blockade is required together with an expert anaesthetic technique and blood volume control. Results The long-term results for the surgical management of benign tumours are excellent. There is a small risk of recurrence, particularly in von Recklinghausen’s disease. Five-year survival following malignant schwannoma resection is less good –50 per cent. In addition, the muscle weakness associated with myasthenia gravis can extend to the bulbar muscles and result in swallowing difficulties (see later). Malignant tumours of the mediastinum may directly invade the oesophagus and occa- sionally cause a fistula (e. Visualization of the more anterior mediastinal structures Endoscopy suggests a posterior mediastinal mass. Stridor a more extensive dissection and resection of the may also be evident in severe airway obstruction. Once the mass is removed The peri-operative medical management of the trachea may collapse during expiration and the phaeochromocytoma is of utmost importance in patient experience acute dyspnoea. Management Treatment of the mass (with surgery, chemotherapy or radiotherapy, depending on the histological diag- nosis) often dramatically relieves the symptoms. Rigid bronchoscopy allows visualization of the airways and permits endobronchial therapies such as tumour debulking (Fig 14. It is a thin-walled, low-pressure conduit and suscep- tible to external compression. Causes of compres- sion are lung cancer in the right upper lobe (usually of the small cell variety), right hilar tumours and metastatic mediastinal lymphadenopathy. Lung flow- The symptoms of patients with lymphomas or germ volume loops may show characteristic flattening cell tumours with a good prognosis improve with Pectus excavatum and pectus carinatum 323 Table 14. Also evident is the The aetiology of pectus excavatum (depressed ster- underlying cause (a right hilar lung cancer) and a raised num or ‘funnel chest’) and pectus carinatum (pro- right hemidiaphragm secondary to invasion of the phrenic truding sternum or ‘pigeon chest’) is not known but nerve both are thought to be caused by abnormal growth patterns of the costal cartilages. They may not become apparent until the adoles- Radiotherapy to the affected site can often pro- cent growth spurts begin. Management Chemotherapy may produce dramatic results in Neither needs to be treated. The usual indication diseases such as small cell lung cancer, lymphoma for surgical treatment is cosmesis. The above treatment modalities are sometimes Surgical correction complemented by intravenous stents to produce In the Ravitch procedure the sternum and costal a rapid relief of symptoms. The sternum is then manipulated into Surgical management is usually limited to a cosmetically acceptable position (which may obtaining tissue for diagnosis. The bar is then rotated and The causes of chest wall deformities are listed in fixed to the chest wall laterally to push the sternum Table 14. This technique was first developed for 324 The thoracic cage, lungs and heart children but can be used for less malleable adult Table 14.

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Kidneys In the early stages cheap 80 mg innopran xl amex hypertension obesity, decreased renal perfusion causes activation of the renin-angiotensin-aldosterone system whereas in the later stages trusted 40 mg innopran xl arteria 3d medieval village, continued reduced renal perfusion may precipitate prerenal azotemia buy innopran xl in india prehypertension wiki. The features seen as a result of the inability of the right heart to pump blood in different organs include: Liver There is presence of congestive hepatomegaly. Only 3%Q of patients with group A streptococcal pharyngitis develop acute rheumatic fever. Major manifestations: J Joint involvement (Polyarthritis) O N - Nodules (Subcutaneous) E - Erythema marginatum S - Sydenham’s chorea Criteria - Carditis 2. Two major or one major and two minor manifestations plus any of the evidence of preceding group A streptococcal infection is required for diagnosis of primary episode of rheumatic fever. The pericarditis is associated with fbrinous/serofbrinous exudate and is called as ‘bread and butter’ pericarditis. The most common valve to be affected is the mitral valve and least commonly affected is pulmonary valve. Pancarditis is a characteristic In acute rheumatic heart disease, the most common valvular lesion is mitral regurgitation and manifestation of the cardiac in chronic rheumatic heart disease, it is mitral stenosis. The arthritis involves one joint after the other (migratory) and subsides spontaneously without any residual deformability in the joints (non-erosive arthritis). Clinically, this is the most commonly seen manifestation and the joint pain shows dramatic response to salicylates like aspirin. Subcutaneous nodules These are painless subcutaneous lesions found on the extensor surface of the elbows, shin and the occiput. Erythema marginatum The plump macrophages There is presence of red macular rash more easily appreciated in fair skinned individuals sparing the called Anitschkow cells are face and without residual scarring. Sydenham’s chorea It is a late manifestation of the disease characterized by presence of involuntary, purposeless movements associated with emotional lability of the patient. Microscopically, the characteristic feature of rheumatic heart disease is Aschoff’s body. These distinctive cells have abundant cytoplasm and central round-to-ovoid nuclei in which the chromatin is disposed in a central, slender, wavy ribbon (hence, they are also called as “caterpillar cells”). The involvement Most commonly affected of the endocardium results in fbrinoid necrosis within the cusps or along the tendinous valve is mitral valve and the cords which also have small vegetations called verrucae present along the lines of closure. The least commonly affected is presence of mitral regurgitation also induces irregular thickening in the left atrial wall called pulmonary valve. The valves show leafet thickening, commissural fusion and shortening, and thickening and fusion of the tendinous cords. Mitral stenosis may also lead to atrial fbrillation and thromboembolic phenomenon in these patients. It can be • Acute • Subacute Acute endocarditis Subacute endocarditis • Necrotizing, ulcerative, invasive valvular • Insidious infection following a protracted course infection on a previously normal valve. Organism in the infective endocarditis Predisposing condition Staphylococcus aureus a. The aortic valve is the most MoRpHoLogy commonly affected valve in The friable, bulky destructive vegetations containing fbrin, bacteria and infammatory cells prosthetic valve endocarditis. The aortic valve and the mitral valve are most commonly infected whereas the right side of heart is affected in intravenous drug abusers. When the vegetations erode into myocardium, they can form an abscess called Ring abscess.

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The cerebellum also plays a criti- ing the afferent vestibular synapses (Highstein and Hol- cal role in coordination and the ability to adapt to vestib- stein 2006) generic 80mg innopran xl otc heart attack 85 blockage. Finally purchase innopran xl now arterial neck pain, while their exact function remains a near the utricle buy 40 mg innopran xl fast delivery blood pressure of 160/100, thus utriculo- or ampullopedal flow subject of ongoing investigation, both cortical and auto- causes an increase in firing, while flow in the opposite nomic pathways are believed to play a role in various vis- direction (ampullo- or utriculofugal) is inhibitory. Con- ceral responses to vertigo, such as nausea, as well as the versely, the opposite is true in the posterior and superior conscious sense of motion. Here the kinocilium is located near the canal side, and deflection of the cupula away from the utricle leads to an excitatory response, whereas deflection toward (utric- The Peripheral Vestibular System ulo- or ampullopedal) is inhibitory. As most head move- The peripheral vestibular system is composed of three ment exists in multiple planes, typically all three canals semicircular canals-the horizontal (or lateral), the poste- are stimulated simultaneously. Using the bilateral planar- rior (or inferior), and the anterior (or superior)-and two paired canals mentioned previously, complex integration otolithic organs-the utricle and saccule (Figure 22–1). Each acceleration are detected by the otolithic organs, the utri- canal is paired with the canal in the opposite ear that lies cle and saccule. In each, the neuroepithe- within each fluid-filled bony framework is the membra- lium is found in a specialized region called the macula, nous labyrinth or the vestibular end-organ. Overlying the mac- fluid of bony labyrinth, has an electrolyte composition ulae is the otoconial membrane, a gel-like matrix similar to similar to extracellular fluid with a greater ratio of sodium the cupula, into which the kino- and stereocilia of the hair to potassium. Embedded in the otoconial membrane are rate from the perilymph and enclosed within the mem- deposits of calcium carbonate called otoliths. Gravita- branous labyrinth, contains a greater concentration of tional and linear acceleration cause movement of these potassium relative to sodium. Ultimately, the vestibular crystals, leading to deflection of the hair cell stereocilia. As in the ampullae of the semicircular canals, Each semicircular canal contains an eccentric dilated movement of the kinocilium with respect to the stereocilia or ampullated end, in which the vestibular sensory recep- allows modulation of neural firing. These ampullae are sepa- polarization in the macula is complex and centered rated from the rest of the canal by a perpendicular septum, around an irregular line called the striola. As in the semi- the cristae ampularis, containing neuroepithelium, blood circular canals, the integration of inhibitory and excitatory vessels, and connective tissue. Vestibular hair cells sit signals in neural firing allows translation of gravitational within the crista, and their cilia protrude into the endo- or linear movement into mechanical stimuli and, ulti- lymphic space topped by a gelatinous mass called the cu- mately, electrical impulses. This leads to release of neurotransmitters and of cranial nerve eight, the vestibulocochlear nerve. Specif- depolarization of the afferent nerve fibers that innervate ically, impulses from the neuroepithelium of the lateral the hair cells. Each hair cell has approximately 70 short and anterior canals, as well as the macula of the utricle and stereocilia and one longer kinocilium that project into the part of the saccule, are carried along the superior vestibu- gelatinous cupula. It is the laterally located kinocilium lar nerve, while information from posterior canal and re- that is the primary determinant of the direction of polar- maining saccular macula are transmitted by the inferior ization. At rest, there is a high baseline firing rate for the ves- Inferior and superior nerve fibers transmit afferent vestib- tibular nerve in each canal. Head movement, leading to ular input from the periphery to four vestibular nuclei in deflection of the kinocilium, causes modulation of this the pontomedullary junction. Deflection of the kinocilium toward that the initial integration and distribution sensory affer- the stereocilia causes an increase in neurotransmitter re- ent input occurs. Focused view of the dilated, or ampullated, end of a semicircular canal showing the cristae ampullaris, neuroepithelium (including the hair cells), and the cupula. Fluid motion, generated by head rotation, generates forces across the cupula that bend the stereocilia of the hair cells, resulting in release of neurotransmitter into the vestibular synapse. Each hair cell has approximately 70 short stereocilia and one longer kinocil- ium that project into the gelatinous cupula.

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