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J. Khabir, M.A., M.D.

Clinical Director, Oregon Health & Science University School of Medicine

Botulinum toxin blocks secretion of acetylcholine from somatic motor neurons prostate keep healthy proscar 5 mg order overnight delivery, so skeletal muscles cannot contract mens health 30 day six pack plan cheap 5 mg proscar, which is flaccid paralysis prostate cancer 70 proscar 5 mg buy line. Sensor (sensory receptor), input signal (sensory afferent neuron), integrating center (central nervous system), output signal (autonomic or somatic motor neuron), targets (muscles, glands, some adipose tissue). Upon hyperpolarization, the membrane potential becomes more negative and moves farther from threshold. When you pick up a weight, alpha and gamma neurons, spindle afferents, and Golgi tendon organ afferents are all active. A crossed extensor reflex is a postural reflex initiated by withdrawal from a painful stimulus; the extensor muscles contract, but the corresponding flexors are inhibited. The bottom tube has the greater flow because it has the larger pressure gradient (50 mm Hg versus 40 mm Hg for the top tube). Tube C has the highest flow because it has the largest radius of the four tubes (less resistance) and the shorter length (less resistance). If the canals are identical in size and therefore in cross-sectional area A, the canal with the higher velocity of flow v has the higher flow rate Q. Connective tissue is not excitable and is therefore unable to conduct action potentials. It is possible to conclude that myocardial cells require extracellular Ca2+ for contraction but skeletal muscle cells do not. If all Ca2+ channels in the muscle cell membrane are blocked, there will be no contraction. If only some are blocked, the force of contraction will be smaller than the force created with all channels open. Na+ influx causes neuronal depolarization, and K+ efflux causes neuronal repolarization. The refractory period represents the time required for the Na+ channel gates to reset (activation gate closes, inactivation gate opens). If cardiac Na+ channels are completely blocked with lidocaine, the cell will not depolarize and therefore will not contract. The Ca2+ channels in autorhythmic cells are not the same as those in contractile cells. The Ca2+ channels in contractile cells are slower and do not open until the membrane has depolarized fully. If tetrodotoxin is applied, nothing will happen because there are no voltage-gated Na+ channels in the cell. Cutting the vagus nerve increased heart rate, so parasympathetic fibers in the nerve must slow heart rate. It also slows down the speed at which those action potentials are conducted, allowing atrial contraction to end before ventricular contraction begins. The fastest pacemaker sets the heart rate, so the heart rate increases to 120 beats/min. Atrial pressure increases because pressure on the mitral valve pushes the valve back into the atrium, decreasing atrial volume. Atrial pressure decreases during the initial part of ventricular systole as the atrium relaxes. Atrial pressure begins to decrease at point D, when the mitral valve opens and blood flows down into the ventricles. Ventricular pressure shoots up when the ventricles contract on a fixed volume of blood. After 10 beats, the pulmonary circulation will have gained 10 mL of blood and the systemic circulation will have lost 10 mL. Phase 2 (the plateau) of the contractile cell action potential has no equivalent in the autorhythmic cell action potential. The heart rate is either 75 beats/min or 80 beats/min, depending on how you calculate it. If you use the data from one R peak to the next, the time interval between the two peaks is 0. There are 4 beats in the 3 sec after the first R wave, so 4 beats/3 sec * 60 sec/min = 80 bpm.

Diseases

• Feigenbaum Bergeron syndrome
• Optic atrophy, idiopathic, autosomal recessive
• Rickettsialpox
• Stoll Geraudel Chauvin syndrome
• Leiner disease
• Balantidiasis
• Epstein barr virus mononucleosis
• Chromosome 17, trisomy 17p11 2
• Tosti Misciali Barbareschi syndrome

The vas deferens is lined by pseudostratified columnar epithelium with stereocilia/stereovilli prostate cancer 5k harrisburg pa proscar 5 mg buy discount. The smooth muscle cell layer consists of a middle circular layer surrounded by inner and outer longitudinal layers prostate zones ultrasound order 5 mg proscar otc. Additional components of the spermatic cord include the cremaster muscle prostate cancer vs bph 5 mg proscar cheap otc, arteries (spermatic, cremasteric, and vas deferens arteries), veins of the pampiniform plexus (important for spermatic artery-pampiniform plexus heat transfer to maintain testicular temperature 2oC to 3oC below body temperature for normal spermatogenesis), and nerves. The vas deferens ends in a dilated ampulla receiving the duct of the seminal vesicle to form the ejaculatory duct passing through the prostate gland. The accessory glands of the male reproductive system are the seminal vesicles, the prostate gland, and the bulbourethral glands of Cowper. Each seminal vesicle has three components: (1) An external connective tissue capsule. Under the influence of androgens, the seminal vesicle epithelium contributes 70% to 85% of an alkaline fluid to the human ejaculate. Periurethral nodular hyperplasia produces: (1) Difficulty in urination and urinary obstruction caused by partial or complete compression of the prostatic urethra by the nodular growth. Cancer of the prostate is the result of the malignant transformation of the prostate glands of the peripheral zone. The male urethra has a length of 20 c m and consists of three segments: (1) the prostatic urethra, whose lumen receives fluid transported by the ejaculatory ducts and products from the prostatic glands. The epithelium of the prostatic urethra is transitional (urothelium) with regional variations. Smooth muscle and striated muscle sphincters are present in the membranous urethra. The female urethra is shorter (4 cm long) and is lined by transitional epithelium, also with regional variations. The penis consists of three cylindrical structures of erectile tissue: a pair of corpora cavernosa and a single corpus spongiosum. The erectile tissue contains vascular spaces, called sinusoids, supplied by arterial blood and drained by venous channels. During erection, arterial blood fills the sinusoids, which compress the adjacent venous channels preventing draining. Nitric oxide, produced by branches of the dorsal nerve, spreads across gap junctions between smooth muscle cells surrounding the sinusoids. Follicle Development and the Menstrual Cycle the menstrual cycle represents the reproductive status of a female. There are two coexisting events during the menstrual cycle: the ovarian cycle and the uterine cycle. During the ovarian cycle, several ovarian follicles, each housing a primary oocyte, undergo a growing process (folliculogenesis) in preparation for ovulation into the oviducts or fallopian tubes. During the concurrent uterine cycle, the endometrium, the lining of the uterus, is preparing for embryo implantation. If fertilization of the ovulated egg does not take place, the endometrium is shed, menstruation occurs and a new menstrual cycle starts. This chapter is focused on structural and functional aspects of the ovarian and uterine cycle, including specific hormonal disorders and pathologic conditions of the uterine cervix. The female reproductive system consists of the ovaries, the ducts (oviduct, uterus, and vagina), and the external genitalia (labia majora, labia minora, and clitoris). Knowledge of the developmental sequence from the indifferent stage to the fully developed stage is helpful in understanding the structural anomalies that can be clinically observed. The molecular aspects of the development of the ovary, female genital ducts, and external genitalia are summarized in the next sections. Development of the ovary grating primordial germinal cells derived from the yolk sac. Primary oocytes are arrested after completion of crossing over (exchange of genetic information between nonsister chromatids of homologous chromosomes). Meiotic prophase arrest continues until puberty, when one or more ovarian follicles are recruited to initiate their development. Development of the female genital ducts the differentiation of a testis or an ovary from the indifferent gonad is a complex developmental process involving various genes and hormones. Wnt4 is a major player in the ovarian-determination pathway and sexual differentiation.

Pathology: Lymphadenitis and lymphomas Lymph nodes constitute a defense site against lymphborne microorganisms (bacteria prostate exam meme purchase proscar 5 mg without prescription, viruses prostate cancer joint pain buy cheap proscar 5 mg line, parasites) entering the node through afferent lymphatic vessels mens health 5k training 5 mg proscar cheap fast delivery. In Chapter 12, Cardiovascular System, we indicate that the interstitial fluid, representing plasma filtrate, is transported into blind sacs corresponding to lymphatic capillaries. This interstitial fluid, entering the lymphatic capillaries as lymph, flows into collecting lymphatic vessels becoming afferents to regional lymph nodes (see Box 10-G). Lymph nodes are linked in series by the lymphatic vessels in such a way that the efferent lymphatic vessel of a lymph node becomes the afferent lymphatic vessel of a downstream lymph node in the chain. Soluble and particulate antigens drained with the interstitial fluid, as well as antigen-bearing dendritic cells in the skin (Langerhans cells; see Chapter 11, Integumentary System), enter the lymphatic vessels and are transported to lymph nodes. Soluble and particulate antigens are detected in the percolating lymph by resident macrophages and dendritic cells strategically located along the subcapsular and paratrabecular sinuses. When the immune reaction is acute in response to locally drained bacteria (for example, infections of the teeth or tonsils), local lymph nodes enlarge and become painful because of the distention of the capsule by cellular proliferation and edema. Philadelphia, Mosby, 2000 Electron microscopy image from Damjanov I, Linder J: Pathology: A Color Atlas. Development of the thymus Third pharyngeal pouch 2 Capsule Medulla Trabecula 3 Thymic epithelial cell common precursor (keratins 5 and 18) 1 2 1 Foxn1 Thymocyte (T cell precursor) Thymic cortical epithelial cell (keratin 18) Thymic medullary epithelial cell (keratin 5) Aire Cortex Blood vessel 2 A capsule forms from the neural crest mesenchyme. Capsule-derived trabeculae extending into the future corticomedullary region of the thymus divide the thymus into incomplete lobules. By 14 weeks, thymocyte precursors arrive from bone marrow through blood vessels, after interconnected thymic epithelial cells form a three-dimensional network and macrophages are present. Parathyroid gland tissue, developing from the same pouch, migrates with the thymus and becomes the inferior parathyroid glands. A common precursor (keratins 5 and 18) gives rise to thymic cortical (keratin 18) and medullary (keratin 5) epithelial cells. Thymic epithelial cells express two essential transcription factors: Foxn1 (for forkedhead box N1), and aire (for autoimmune regulator). Aire promotes the expression of a portfolio of tissue-specific cell proteins by thymic medullary epithelial cells, which normally do not express these proteins. They are clinically characterized by nontender enlargement of localized or generalized lymph nodes (nodal disease). Another group in the lymphoma category includes the plasma cell tumors, consisting of plasma cells, the terminally differentiated B cells. Plasma cell tumors (multiple myeloma) originate in bone marrow and cause bone destruction with pain due to fractures (see Box 10-E). Thymus Development of the thymus A brief review of the development of the thymus facilitates an understanding of the structure and function of this lymphoid organ. After puberty, the thymus begins to involute and the production of T cells in the adult decreases. The progenies of T cells become established, and immunity is maintained without the need to produce new T cells. A significant difference from the lymph node and the spleen is that the stroma of the thymus consists of thymic epithelial cells organized in a dispersed network to allow for intimate contact with developing thymocytes, the T cell precursors arriving from bone marrow. In contrast to the thymus, the stroma of the lymph node and the spleen contains reticular cells and reticular fibers but not epithelial cells. There are two important aspects during the development of the thymus with relevance to tolerance for self-antigens and autoimmune diseases: 1. The transcription factor Foxn1 (for forkhead box N1) regulates the differentiation of cortical and medullary thymic cells, which starts before the arrival of thymocyte precursors from bone marrow. Differentiation includes the expression of cytokeratins and establishment of desmosome intercellular linkages. In contrast to the stratified squamous epithelium of the epidermis, thymic epithelial cells form an open network that enables a close contact with thymocytes. In an analogous fashion to thymic epithelial cells, Foxn1 regulates the differentiation of epidermal keratinocytes (see Chapter 11, Integumentary System). The transcription factor aire (for autoimmune regulator) enables the expression of tissue-specific self-proteins by thymic medullary epithelial cells. The expression of these proteins permits the elimination of T cells that recognize specific tissue antigens (autoreactive T cells).