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Sometimes opening of the Circular muscle skull and drainage of cerebrospinal fluid or hemorrhaged 5A 3V Submucosa blood discount effexor xr 75 mg with mastercard, if any buy effexor xr 37.5 mg, may be necessary. Hemorrhaged blood is par- 2V ticularly a problem because clotted blood contains dena- 1V 3A 4A tured hemoglobin that destroys nitric oxide. This in turn leads to inappropriate vasoconstriction of the arterioles in MV 2A the area of the hemorrhage. This response—called Cushing’s re- flex—raises the arterial blood pressure, often dramatically. While blood flow may improve, microvascular pres- sures are elevated, which worsens cerebral edema. The intestinal vasculature is unusual because three very different tissues—the muscle layers, submucosa, and mucosal layer—are served by branches from a common vasculature lo- SMALL INTESTINE CIRCULATION cated in the submucosa. Most of the intestinal vascular resistance is regulated by small arteries and arterioles preceding the separate The small intestine completes the digestion of food and then muscle and submucosal and mucosal vasculatures. MA, muscular absorbs the nutrients to sustain the remainder of the body. At arteriole; 1A to 5A, successive branches of the arterioles; 1V to rest, the intestine receives about 20% of the cardiac output 4V, successive branches of the venules; MV, muscular venule. Quantification of the architectural of these numbers nearly double after a large meal. Unless the changes observed in intestinal arterioles from diabetic rats. Blood flows of 70 to 100 mL/min high blood flow both at rest and during food absorption, per 100 g in this specialized tissue are probable and much the capillary blood pressure is usually 13 to 18 mm Hg higher than the average blood flow for the total intestinal and seldom higher than 20 mm Hg during food absorp- wall (see Table 17. Therefore, plasma colloid osmotic pressure is ing blood flow in the heart and brain. The interstitial space of the villi is mildly hy- sorption, the plasma protein reflection coefficient for the perosmotic ( 400 mOsm/kg H2O) at rest as a result of NaCl.
If the eye is too requires a careful assessment of the irregularities and a prescrip- short effexor xr 37.5 mg low cost, as in hyperopia (c) effexor xr 75mg overnight delivery, the focus is behind the retina. In astigmatism (d), light refraction is uneven As an alternative to a concave lens, a surgical procedure because of an abnormal shape of the cornea or lens. In this technique, 8 to 16 microscopic slashes, like the spokes of a wheel, are made in the cornea from Cataracts the center to the edge. The ocular pressure inside the eyeball A cataract is a clouding of the lens that leads to a gradual blur- bulges the weakened cornea and flattens its center, changing the ring of vision and the eventual loss of sight. It is caused by injury, poisons, infections, tened by vaporizing microscopic slivers from its surface. Recent evidence indicates that even exces- sive UV light may cause cataracts. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 532 Unit 5 Integration and Coordination a tiny intraocular lens that either clips to the iris or is secured into A normal, healthy person who has overindulged in alcoholic the vacant lens capsule. Special contact lenses or thick lenses for beverages may experience diplopia. Infections and Diseases of the Eye Retinal Damage Retinal detachment is a separation of the nervous or visual layer Infections of the retina from the underlying pigment epithelium. It gener- Infections and inflammation can occur in any of the accessory ally begins as a minute tear in the retina that gradually extends structures of the eye or in structures within or on the eyeball it- as vitreous fluid accumulates between the layers. The causes of infections are usually microorganisms, me- ment may result from hemorrhage, a tumor, degeneration, or chanical irritation, or sensitivity to particular substances. A detached retina may be Conjunctivitis (inflammation of the conjunctiva) may re- repaired by using laser beams, cryoprobes, or intense heat to de- sult from sensitivity to light, allergens, or an infection caused by stroy the tissue beneath the tear and rejoin the layers. Bacterial conjunctivitis is commonly called Bright sunlight or reflection from snow may be damaging “pinkeye.
Am J Roentgenol 169:1655-1661 Eustace S buy effexor xr 150mg low price, Tello R buy 150mg effexor xr with amex, DeCarvalho V et al (1998) Whole-body MR imaging versus isotope bone scanning for metastases. Am J Suggested Reading Roentgenol 171:519-520 Normal Bone Marrow Multiple Myeloma Vogler JB, Murphy WA (1988) Bone marrow imaging. Radiology Libshitz HI, Malthouse SR, Cunningham D, MacVicar AD, 168:679-693 Husband JE (1992) Multiple myeloma: appearance at MR Kricun ME (1985) Red-yellow marrow conversion: its effect on the imaging. Skeletal Radiol 14:10-19 Lecouvet FE, Vande Berg BC, Michaux L, Malghem J, Maldague Vande Berg BC, Malghem J, Lecouvet FE, Maldague BE (1998) B, Jamart J, Ferrant A Michaux JL (1998) Stage III multiple Magnetic resonance imaging of the normal bone marrow. Radiology 209:653-660 Ricci C, Cova M, Kang YS, Yang A, Rahmouni A, Scott WW Jr, Moulopoulos LA, Dimopoulos MA, Alexanian R, Leeds NE, Zerhouni EA (1990) Normal age-related patterns of cellular Libshitz HI (1994) Multiple myeloma: MR patterns of re- and fatty bone marrow distribution in the axial skeleton: MR sponse to treatment. Radiology 193:441-446 imaging study Radiology 177:83-88 Moulopoulos LA, Dimopoulos MA, Weber D, Fuller L, Libshitz Baur A, Stabler A, Bartl R, Lamerz R, Scheidler J, Reiser MF HI, Alexanian R (1993) Magnetic resonance imaging in the (1997) MRI gadolinium enhancement of bone marrow: age-re- staging of solitary plasmacytoma of bone. J Clin Oncol lated changes in normals and in diffuse neoplastic infiltration. Radiology sis in MR imaging of multiple myeloma: assessment of fo- 183:47-51 cal and diffuse growth patterns in marrow correlated with Moore SG, Bisset GS, 3d, Siegel MJ, Donaldson JS (1991) Pediatric biopsies and survival rates. Radiology 179:345-360 1036 Hajek PC, Baker LL, Goobar JE, Sartoris DJ, Hesselink JR, Vande Berg BC, Lecouvet FE, Michaux L et al (1996) Stage I mul- Haghighi P, Resnick D (1987) Focal fat deposition in axial tiple myeloma: value of MR imaging of the bone marrow in bone marrow: MR characteristics. Radiology 201:243-246 Abnormal Bone Marrow Lymphoma Steiner RM, Mitchell DG, Rao VM, Murphy S, Rifkin MD, Burk Parker BR, Marglin S, Castellino RA (1980) Skeletal manifesta- DL Jr. Magn Reson Q 6:17-34 Hoane BR, Shields AF, Porter BA Shulman HM (1991) Steiner RM, Mitchell DG, Rao VM, Schweitzer ME (1993) Detection of lymphomatous bone marrow involvement with Magnetic resonance imaging of diffuse bone marrow disease. Blood 78:728- Radiol Clin North Am 31:383-409 738 Vande Berg BC, Malghem J, Lecouvet FE Maldague BE (1998) Rodriguez M (1998) Computed tomography, magnetic resonance Classification and detection of bone marrow lesions with mag- imaging and positron emission tomography in non-Hodgkin’s netic resonance imaging. Stäbler Department of Radiology, Orthopaedic Clinic München Harlaching, München, Germany Introduction Bone marrow imaging is part of various muskuloskeletal diagnosic tasks including detection and staging of diseases originating in the bone marrow like multiple myeloma, lymphoma, leukaemia and myeloproliferative disorders, imaging of secondary bone marrow involvement (metasta- sis) in malignant diseases and reactive bone marrow changes due to stress or trauma of bones and joints. Non- neoplastic reasons for changes of bone marrow cellularity are marrow reconversion, which can be caused by various diseases including haemolytic anemias, chronic infection, smoking, and menstruation. These reactive changes must be differentiated from diffuse malignant bone marrow in- filtration.