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By W. Ugo. Niagara University. 2018.

With increased amounts of smooth endoplasmic reticulum cheap toradol 10mg mastercard, cells can handle an increased concentration through mechanical vibration purchase toradol 10mg. Ribosomes Cytoplasm and Organelles Ribosomes (ri′bo˘-somz) may occur as free particles suspended Cytoplasm refers to the material located within the cell mem- within the cytoplasm order 10 mg toradol, or they may be attached to the membra- brane but outside the nucleus cheap toradol 10 mg otc. The material within the nucleus is nous wall of the rough endoplasmic reticulum buy discount toradol 10mg line. They synthesize protein molecules that may be When observed through an electron microscope (fig. Some of distinct cellular components called organelles can be seen in the the proteins synthesized by ribosomes are secreted by the cell to highly structured cytoplasm. Cytology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 58 Unit 3 Microscopic Structure of the Body Golgi Complex The Golgi (gol′je) complex (Golgi apparatus) consists of several tiny membranous sacs located near the nucleus (fig. The Golgi complex is involved in the synthesis of carbohy- drates and cellular secretions. As large carbohydrate molecules are synthesized, they combine with proteins to form compounds called glycoproteins that accumulate in the channels of the Golgi complex. When a critical volume is reached, the vesicles break off from the complex and are carried to the cell membrane and released as a secretion (fig. Once the vesicle has fused with the cell membrane, it ruptures to release its contents, thus com- pleting the process known as exocytosis. Pancreatic cells, for example, produce diges- tive enzymes that are packaged in the Golgi complex and se- Nucleus creted as droplets that flow into the pancreatic duct and are transported to the gastrointestinal (GI) tract. Tubule Mitochondria Mitochondria (mi″to˘-kon′dre-a˘) are double-membraned saclike Membrane organelles. They are found in all cells in the body, with the ex- ception of mature red blood cells. The outer mitochondrial mem- Ribosome brane is smooth, whereas the inner membrane is arranged in intricate folds called cristae (kris′te) (fig. They can migrate through the cytoplasm and can reproduce themselves by budding (b) or cleavage. They are often called the “powerhouses” of cells be- cause of their role in producing metabolic energy. Enzymes con- nected to the cristae control the chemical reactions that form Nucleus ATP. Metabolically active cells, such as muscle cells, liver cells, and kidney cells, have a large number of mitochondria because of their high energy requirements. The darker color of some cuts of meat (a chicken thigh, for ex- ample, as compared to a breast) is due to larger amounts of myoglobin, a pigmented compound in muscle tissue that acts to store oxygen. Both mitochondria and myoglobin are important for the high level of metabolic activity in red muscle tissue. Because mitochondria are contained within ova (egg cells) but not within the heads of sperm cells, all of the mitochon- dria in a fertilized egg are derived from the mother. As cells divide during the developmental process, the mitochondria likewise repli- (c) cate themselves; thus, all of the mitochondria in a fetus are geneti- cally identical to those in the original ovum. The rough en- A rare cause of blindness—Leber’s hereditary optic neuropathy— doplasmic reticulum (b) has ribosomes attached to its surface, and perhaps some genetically based neuromuscular disorders, are whereas the smooth endoplasmic reticulum (c) lacks ribosomes. Golgi complex: from Camillo Golgi, Italian histologist, 1843–1926 mitochondrion: Gk. Cytology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 3 Cytology 59 Proteins Secretory Nucleus storage granule (a) Secretion Golgi complex Rough Ribosomes endoplasmic reticulum Cisternae Cytoplasm Lysosome Cell membrane (b) FIGURE 3. Notice the formation of vesicles at the ends of some of the flattened sacs. Mitochondrial diseases may soon be treatable with mitochon- closed within lysosomes are capable of breaking down protein dria replacement. The treatment will require extraction of the and carbohydrate molecules. White blood cells contain large cytoplasm and its organelles from an afflicted egg and replacing it with healthy material from another woman’s donar egg. A potential numbers of lysosomes and are said to be phagocytic, meaning that ethical problem to this procedure is that some scientists regard mito- they will ingest, kill, and digest bacteria through the enzymatic chondrial DNA as part of the human genome. Lysosomes The normal atrophy, or decrease in size, of the uterus following the birth of a baby is due to lysosomal digestive activity.

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If blood in the pelvis caused adhesions best 10 mg toradol, the ovulating female would have adherence of her ovaries to contiguous tissues generic toradol 10mg visa. An abdominal film should be obtained following emergency abdomi- nal surgery and in all instances of a reported incorrect sponge count buy generic toradol 10 mg. Recently cheap toradol 10mg with visa, many gynecological issues leading to litigation have reflected advances in technology generic 10mg toradol mastercard. Foremost among these is the use of the laparoscope for diagnostic and/or therapeutic surgical procedures. For example, pelvic pain is seldom significantly lessened with the lysis of adhesions unless the adhesions are associated with a subacute inflam- matory process. Indeed, adhesions are best left alone unless lysis is Chapter 11 / Obstetrics and Gynecology 149 required to access diseased organs, because after surgery, the lysed adhesions simply reform. An increase in the number of lysis procedures increases the risk of organ injury including bowel and also increases the risk of subsequent bowel obstruction. If not specifically covered by the informed con- sent, then adhesions should be left alone. The prudent practitioner will not hesitate to convert to an open procedure when adhesions limit exposure. Injury to the bowel may be secondary to a needle puncture or sharp or thermal dissection. When recognized at the time of surgery, the gynecologist should be able to effect a satisfactory repair. The patient with bowel injury not recognized at the time of sur- gery typically presents to the emergency department 36–48 hours following discharge with complaints of fever, nausea, vomiting, and abdominal pain. The gynecologist must not rely on the emergency department or office staff to determine the patient’s status and most likely diagnosis. The patient should be evaluated by the responsible gynecologist to ensure that early, aggressive management of sepsis is undertaken, thus forestalling septic shock with its high rates of morbidity and mortality. Patient selection for hysterectomy should be very carefully done with focus on the patient’s health and age. There are many alternatives to hysterectomy, which must be covered in the informed consent pro- cess. It may be negligent to do a hysterectomy in a high-risk patient when an endometrial ablation procedure would have sufficed. Again, prophylactic antibiotics for hysterectomy are the standard of care. Injury of contiguous organs may occur and not be reflective of negligent care. However, failure to recognize the importance of certain postoperative signs and/or symptoms may constitute negligence. Blad- der and bowel injury should be recognized at the time of the gyneco- logic procedure and appropriate repair should be undertaken. Wound infection and dehiscence risk is minimized by avoiding the use of a nonisotonic cleansing solution and by the use of a transverse incision. Drains should not be sewn in place to avoid a nidus for abscess for- mation. Anesthesia approaches are significantly influenced by the physiol- ogy of pregnancy and fetal pharmacokinetics. In general, inhalation agents used with general anesthesia do not pose risk for the fetus as long as the ambient O2 is maintained at normal levels. Failed intubation is more common in pregnant patients particularly in late pregnancy, with short stature and with the generalized edema of preeclampsia (18). Regional anesthesia is the preferred labor and delivery analgesia approach unless contraindicated because of maternal conditions. It is important to maintain adequate maternal cardiac output and thus uteroplacental perfusion to optimize gas exchange by the fetus. American Academy of Pediatrics, American College of Obstetricians and Gyne- cologists. Prevention of Perinatal Group B Streptococcal Disease—Revised Guidelines from CDC. Brachial plexus palsy associated with cesarean section: An in utero injury?

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This mechanism is especially important because buy generic toradol 10mg online, although the eardrum is sus- pended in air purchase 10 mg toradol overnight delivery, the oval window seals off a fluid-filled cham- ber order 10 mg toradol mastercard. Transmission of sound from air to liquid is inefficient; if Pinna sound waves were to strike the oval window directly 10mg toradol mastercard, 99 buy generic toradol 10mg line. Al- though it varies with frequency, the ossicular chain has a Outer ear Middle Inner ear ear lever ratio of about 1. The brane is coupled to the smaller area of the oval window (ap- structures of the middle and inner ear are en- proximately a 17:1 ratio). These conditions result in a pres- cased in the temporal bone of the skull. Although the efficiency depends on the fre- slightly emphasize frequencies in the range of 1,500 to quency, approximately 60% of the sound energy that 7,000 Hz and aids in the localization of sources of sound. Wax-secreting glands line the canal, and its inner end is sealed by the tympanic membrane or eardrum, Approximate Stapedius axis of Superior muscle a thin, oval, slightly conical, flexible membrane that is an- rotation ligament chored around its edges to a ring of bone. An incoming Temporal bone pressure wave traveling down the external auditory canal causes the eardrum to vibrate back and forth in step with Scala vestibuli the compressions and rarefactions of the sound wave. Oval window Lateral The overall acoustic effect of the outer ear structures is to ligament produce an amplification of 10 to 15 dB in the frequency range broadly centered around 3,000 Hz. The next portion of the auditory sys- Basilar tem is an air-filled cavity (volume about 2 mL) in the mas- Incus membrane toid region of the temporal bone. The tube Eardrum opens briefly during swallowing, allowing equalization of Tensor tympani Round the pressures on either side of the eardrum. During rapid muscle window external pressure changes (such as in an elevator ride or during takeoff or descent in an airplane), the unequal Eustachian tube Scali forces displace the eardrum; such physical deformation tympani may cause discomfort or pain and, by restricting the mo- tion of the tympanic membrane, may impair hearing. Outer Middle Inner Blockages of the eustachian tube or fluid accumulation in ear ear ear the middle ear (as a result of an infection) can also lead to difficulties with hearing. Vibrations from the eardrum are transmitted by the lever system Bridging the gap between the tympanic membrane and formed by the ossicular chain to the oval window of the scala the inner ear is a chain of three very small bones, the ossi- vestibuli. The malleus (hammer) is attached to the pensory system for the ossicles, are not shown. The combination eardrum in such a way that the back-and-forth movement of the four suspensory ligaments produces a virtual pivot point of the eardrum causes a rocking movement of the malleus. The stapedius and tensor tympani muscles third bone, the stapes (stirrup). This last bone, through its modify the lever function of the ossicular chain. CHAPTER 4 Sensory Physiology 79 Sound transmission through the middle ear is also af- The process of sound transmission can bypass the ossic- fected by the action of two small muscles that attach to the ular chain entirely. If a vibrating object, such as a tuning ossicular chain and help hold the bones in position and fork, is placed against a bone of the skull (typically the mas- modify their function (see Fig. The tensor tympani toid), the vibrations are transmitted mechanically to the muscle inserts on the malleus (near the center of the fluid of the inner ear, where the normal processes act to eardrum), passes diagonally through the middle ear cavity, complete the hearing process. Bone conduction is used as a and enters the tensor canal, in which it is anchored. Con- means of diagnosing hearing disorders that may arise be- traction of this muscle limits the vibration amplitude of the cause of lesions in the ossicular chain. The actual process of sound transduction contraction changes the axis of oscillation of the ossicular takes place in the inner ear, where the sensory receptors chain and causes dissipation of excess movement before it and their neural connections are located. These muscles are activated by a between its structure and function is a close and complex reflex (simultaneously in both ears) in response to moder- one. The following discussion includes the most significant ate and loud sounds; they act to reduce the transmission of aspects of this relationship. The auditory structures are located msec to operate (depending on the loudness of the stimu- in the cochlea (Fig. Left: Lower right: An enlargement of a cross section of the organ of An overview of the membranous labyrinth of Corti, showing the relationships among the hair cells and the the cochlea. Hearing: Physiological Acoustics, Neural Coding, and Psy- structures involved in the final processes of auditory sensation. The hair cells of the inner and the outer with the vestibule it contains a total fluid volume of 0. Both sets are supported and It is partitioned longitudinally into three divisions (canals) anchored to the basilar membrane by Deiters’ cells and ex- called the scala vestibuli (into which the oval window tend upward into the scala media toward the tectorial mem- opens), the scala tympani (sealed off from the middle ear brane. Extensions of the outer hair cells actually touch the by the round window), and the scala media (in which the tectorial membrane, while those of the inner hair cells ap- sensory cells are located).

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Of course safe toradol 10 mg, these states are not constant:our sleep can be deep or light and discount toradol 10mg visa, even when we are awake buy toradol 10mg online, our attention and vigilance fluctuate generic toradol 10 mg on line, as the reading of these pages will no doubt demonstrate generic toradol 10 mg free shipping. Also, the fact that we sleep does not mean that our neurotransmitters are inactive:this would imply that sleep is a totally passive state, whereas all the evidence suggests that it is an actively induced process, subject to refined physiological control. In order to explain the physiological characteristics of the sleep±waking cycle, as well as how this might be controlled by different neurotransmitters and modified by drugs, we need to know which areas and pathways in the brain are vital to the induction and maintenance of this rhythmic behaviour. Essentially, these brain systems can be resolved into two interacting networks. One is responsible for the basic circadian rhythm and ensures that our sleeping and waking periods normally occur at regular intervals. A second system fine-tunes this process and ultimately determines our precise functional status on the sleep±waking continuum. THE NEURAL BASIS OF CIRCADIAN RHYTHMS It is most probable that sleep and waking stem from an inherent cycle of neuronal activity that can be influenced dramatically by changes in sensory stimulation. This is demonstrable not only in humans and laboratory animals, but also in invertebrates. Thus, while we cannot be sure that other animals sleep in the same way that we do, they do show a circadian cycle of motor activity. In some (nocturnal) species, such as the rat, this activity is actually highest during darkness. Even aplysia, the sea hare, has such a rhythm but this is more like that of humans in being maximally active during daylight (diurnal). These rhythms seem to be innately programmed although they can be adjusted. Interestingly, when humans are in a time-free environment, the change in the rhythm of Neurotransmitters, Drugs and Brain Function. Webster &2001 John Wiley & Sons Ltd 478 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION body temperature does not follow the change in the sleep±waking cycle. Generally, it becomes shorter (to as little as 20 h), rather than longer, which suggests that these cycles are regulated in different ways. Entrainment has also been shown in aplysia which, after exposure to a normal dark±light cycle, retains a cyclic pattern of activity for a number of days even if subjected to continuous light. These genes have been studied most extensively in insects but they have also been found in humans. Their protein products enter the cell nucleus and regulate their own transcription. This feedback process is linked to exposure to light and so it is not surprising that visual inputs are important for maintenance of circadian rhythms. However, it is not the reception of specific visual information, transmitted in the optic nerve to the lateral geniculate nucleus (LGN) and visual cortex (i. The fibres conveying this sensation arise in the retina but diverge from the optic nerve and travel in the retinohypothalamic tract (RHT) to innervate the suprachiasmatic nucleus (SCN), a small nucleus which is found in the anterior hypothalamus above the optic chiasma (Fig. A deficit in information carried in this pathway could help to explain why the blind often suffer from disrupted sleep patterns. Another prominent input to the SCN comes from the intergeniculate leaflet (in the lateral geniculate nucleus (LGN) complex) via the geniculohypothalamic tract (GHT) and, whereas the retinohypothalamic pathway seems to be essential for light-entrainment of the circadian rhythm, the LGN seems to be influenced by rhythmic variations in non-photic inputs such as changes in motor activity. Of course, the LGN is obviously influenced too by visual inputs and, together with the GHT projection to the SCN, can be regarded as an indirect retino- hypothalamic pathway which appears to be inhibitory on SCN neurons. A neuronal input to the SCN from 5-HT neurons in the median Raphe nucleus is another possible route for setting the circadian clock (entrainment) by non-photic stimuli (Fig. Destruction of the SCN, the target of all these pathways, abolishes the synchronised circadian rhythms in locomotor and autonomic function which clearly points to this nucleus as a crucial centre for the control of cyclic function. However, there seems to be some topographical organisation of the neurons in the SCN in respect of their function and the transmitters they release. Whereas those in the dorsomedial zone of this nucleus (or nuclei, since it is paired) contain arginine vasopressin (AVP) or angiotensin II and GABA, neurons in the ventrolateral zone contain vasoactive intestinal peptide (VIP), gastrin-releasing peptide (GRP) and GABA. It is these latter neurons which form the core of the nucleus and show rhythmic pacemaker function. In fact, when maintained in culture, they even display a metabolic rhythm which has the same phase as that of SCN neurons in vivo.

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