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It is found in all systems of the body; in the walls of the viscera cholesterol levels history cheap generic zocor canada, including most of the gastrointestinal cholesterol levels on low carb diet zocor 5mg sale, respiratory cholesterol test questions order zocor no prescription, urinary and reproductive tracts; in the tunica media of blood vessels; in the dermis (as the arrector pili muscles); in the intrinsic muscles of the eye; and in the dartos muscular layer of the scrotum. In some places, smooth muscle fasciculi are associated with Cardiac Muscle It is possible to classify muscles based on their general shape and the predominant orientation of their fibres relative to the direction of pull. Muscles with fibres that are largely parallel to the line of pull vary in form from flat, short and quadrilateral. In such muscles, individual fibres may run for the entire length of the muscle or over shorter segments when there are transverse, tendinous intersections at intervals. In a fusiform muscle, the fibres may be close to parallel in the belly but converge to a tendon at one or both ends. In some muscles, the fibres pass obliquely between deep and superficial aponeuroses, in a type of unipennate form. In other sites, muscle fibres start from the walls of osteofascial compartments and converge obliquely on a central tendon in circumpennate fashion. Many muscles display more than one of these major types of arrangement and show regional variations that correspond to contrasting and, in some cases, independent actions. The names given to individual muscles are usually descriptive, based on their shape, size, number of heads or bellies, position, depth, attachments or actions. These terms are often used in combination-for example, flexor digitorum longus (long flexor of the digits) and latissimus dorsi (broadest muscle of the back). The names given to individual muscles or muscle groups are often oversimplified, and terms denoting action emphasize only one of a number of usual actions. A given muscle may play different roles in different movements, and these roles may change if the movements are assisted or opposed by gravity. The functional roles implied by names should therefore be interpreted with caution. Muscle Nomenclature Smooth Muscle the cellular units of skeletal muscle are the muscle fibres. Their staining characteristics are dominated by the contractile apparatus, which constitutes much of the cytoplasm or sarcoplasm. The contractile proteins are organized into cylindrical myofibrils that are too tightly packed to be visible by routine light microscopy. Of greater significance are transverse striations, which are the result of alignment across the fibre of repeating elements, the sarcomeres, within neighbouring myofibrils. These cross-striations are usually evident in sections stained conventionally, but they may be demonstrated more effectively using special stains. The darker bands are birefringent, rotating the plane of polarized light strongly, and are known as anisotropic or A-bands; the lighter bands rotate the plane of polarized light to a negligible degree and are known as isotropic or I-bands. The structures responsible for this appearance are described more readily at the ultrastructural level. The multiple nuclei are oval and are located at the periphery of the fibres, under the plasma membrane or sarcolemma. They occupy a thin, transparent rim of sarcoplasm between the myofibrils and the sarcolemma and are seen most clearly in transverse sections. Other nuclei belonging to vascular endothelial cells, Schwann cells, fibroblasts, and so forth may be present in the spaces between the fibres, where blood vessels and nerve fibres travel through layers of fine connective tissue, the endomysium. Nuclei of satellite cells lie between the sarcolemma and the surrounding basal lamina. Note the numerous peripherally placed nuclei in these extremely elongated, unbranched syncytial cells and the faint transverse striations in their cytoplasm. The central fibre is sectioned in part through its periphery, close to the sarcolemma, so several nuclei appear to be lying centrally. Cross-striations reflect the sarcomeric organization of actin and myosin within the myofibrils and the alignment of myofibrils in register within the cytoplasm. Actin is the next most abundant contractile protein (20% of the total myofibrillar protein).

The only identified afferent fibres to the medial habenular nucleus come from the septofimbrial nucleus cholesterol test san antonio cheap 40 mg zocor with amex. The medial habenular nucleus sends efferent fibres to the interpeduncular nucleus of the midbrain cholesterol lowering diet and lifestyle discount zocor uk. The lateral habenular nucleus sends fibres to the raphe nuclei and the adjacent reticular formation of the midbrain high cholesterol foods healthy purchase zocor 5 mg fast delivery, to the pars compacta of the substantia nigra and the ventral tegmental area and to the hypothalamus and basal forebrain. The main habenular outflow reaches the interpeduncular nucleus, mediodorsal thalamic nucleus, mesencephalic tectum and reticular formation, the largest component constituting the habenulo-interpeduncular tract to the interpeduncular nucleus. The latter provides relays to the midbrain reticular formation, from which tectotegmentospinal tracts and dorsal longitudinal fasciculi connect with autonomic preganglionic neurones controlling salivation and gastric and intestinal secretory activity and motility and with motor nuclei for mastication and deglutition. The stria medullaris crosses the superomedial thalamic aspect, skirts medial to the habenular trigone and sends many fibres into the ipsilateral habenula. Other fibres cross in the anterior pineal lamina and decussate, as the habenular commissure, to reach the contralateral habenula. Some fibres are really commissural and interconnect the amygdaloid complexes and hippocampal cortices. Serotonin-containing fibres from the ventral ascending tegmental serotoninergic bundle, which join the habenulo-interpeduncular tract to reach the nuclei, may control neurones of the habenulopineal tract and thus influence innervation of pinealocytes. Similarly, habenular nuclear afferents from the dorsal ascending the tegmental noradrenergic bundle may influence pinealocytes. Although the human habenula is relatively small, it is a focus of integration of diverse olfactory, visceral and somatic afferent paths. Lesions that include this area of the medial diencephalon indicate that it plays a role in the regulation of visceral and neuroendocrine functions. Ablation of the habenula causes extensive changes in metabolism and in endocrine and thermal regulation. The posterior commissure, which is of unknown constitution in humans, is a small fasciculus that decussates in the posterior pineal lamina. Among these are the interstitial nuclei of the posterior commissure, the nucleus of Darkshevich in the periaqueductal grey matter, and the interstitial nucleus of Cajal near the upper end of the oculomotor complex, closely linked with the medial longitudinal fasciculus. Fibres from all these nuclei and the fasciculus cross in the posterior commissure. It also contains fibres from thalamic and pretectal nuclei and the superior colliculi, together with fibres that connect the tectal and habenular nuclei. Posterior Commissure Pineal Gland tela choroidea of the third ventricle and the contained cerebral veins. It is enveloped by the lower layer of the tela, which is reflected from the gland to the tectum. Its base, directed anteriorly, is attached by a peduncle, which divides into inferior and superior laminae that are separated by the pineal recess of the third ventricle and contain the posterior and habenular commissures, respectively. Aberrant commissural fibres may invade the gland but do not terminate near parenchymal cells. They divide the gland into lobules and carry blood vessels and fine unmyelinated sympathetic axons. The pineal arteries are branches of the medial posterior choroidal arteries, which are branches of the posterior cerebral artery. Within the gland, branches of the arteries supply fenestrated capillaries whose endothelial cells rest on a tenuous and sometimes incomplete basal lamina. The capillaries drain into numerous pineal veins, which open into the internal cerebral veins or the great cerebral vein. Postganglionic adrenergic sympathetic axons (derived from the superior cervical ganglion) enter the dorsolateral aspect of the gland from the region of the tentorium cerebelli as the nervus conarii, which may be single or paired. The pineal gland contains cords and clusters of pinealocytes, associated with astrocyte-like neuroglia. They contain multiple synaptic ribbons, randomly distributed between adjacent cells, and are coupled by gap junctions. Two or more processes extend from each cell body and end in bulbous expansions near capillaries or, less frequently, on ependymal cells of the pineal recess. These terminal expansions contain rough endoplasmic reticulum, mitochondria and dense-core vesicles that store melatonin. Melatonin and its precursor serotonin are synthesized from tryptophan by the pinealocytes and secreted into the surrounding network of fenestrated capillaries. It modifies the activity of the adenohypophysis, neurohypophysis, endocrine pancreas, parathyroids, adrenal cortex, adrenal medulla and gonads.

This channel is located between the squamous epithelial cells and communicates with the oral cavity low cholesterol foods for breakfast buy zocor 5mg lowest price. The tongue and oral floor derive their blood supply from the lingual and sublingual arteries cholesterol in eggs without yolk purchase zocor 5mg online, which branch from the external carotid artery cholesterol medication harmful cheap 10mg zocor amex. Homonymous accompanying veins provide for drainage via the facial vein to the internal jugular vein. Lymphatic drainage is handled by the ipsilateral and contralateral submandibular and submental lymph nodes, which drain to the lymph nodes at the junction of the facial and internal jugular veins (upper jugular lymph nodes, see. The potential for contralateral lymphogenous spread should always be considered in patients with malignant tumors. Developmentally, the tongue is derived from structures of the first through fourth branchial arches (see 16. The terminal sulcus receives its sensory supply from the lingual nerve, which branches from the third division of the trigeminal nerve. Sensation to the tongue base region is supplied by the glossopharyngeal and superior laryngeal nerves (from cranial nerve X). Physiology Importance for Food Intake the lips are the gateway to the digestive tract, sealing the oral cavity during chewing and swallowing to prevent the spillage of food. Within the oral cavity itself, the tongue has major functional importance as a "multifunction organ" with both motor and sensory properties. The complex motor functions of the tongue, like its other functions, can be traced to a specialized developmental history, which accounts for the sophisticated nerve supply derived from various cranial nerves (see p. The extrinsic muscles are attached to the mandible and to the hyoid bone or styloid process, project into the body of the tongue, and greatly affect the position and movements of the tongue. Reportedly the fibers then travel via the dorsal trigeminothalamic tract, some crossed but most uncrossed, to the thalamus. The cortical taste areas themselves are located in the lateral part of the postcentral gyrus and in the adjacent insular cortex. All gustatory fibers converge centrally in the area of the ipsilateral solitary tract, which ends at the solitary tract nucleus in the medulla oblongata; there the signal is relayed to the second neuron. The tongue muscles as a whole are distinguished both by their extreme mobility and their considerable strength. The molars have the greatest importance in chewing, because they are located closest to the insertion of the masticatory muscles themselves. The precise mechanism that triggers a taste sensation or transmits a gustatory signal at the molecular level remains unknown. Various theories have been advanced ranging from taste mediation by receptor proteins to taste activation through electrostatic interactions. Importance in Phonation and Articulation the musculature of the lips has an essential role in phonation, while "lingual articulation" controls the production of vowels, certain consonants, and palatal sounds through changes in the shape and position of the tongue. Finally, the oral cavity joins with the pharynx, nose, and paranasal sinuses (see 1. The sensory experience of "taste" is a much more complex phenomenon, however, and results from a combination of olfactory, thermal, mechanical, and sensory impressions. Inspection of the lips and oral cavity is an essential part of every otolaryngologic examination. Some problems that cannot be adequately investigated by clinical examination alone. Glossopharyngeal nerve palsy, in which the uvula and palatal arches deviate toward the healthy side ("backdrop sign,". This is done by watching the soft palate while the patient says "ah" several times. Taste Testing Abnormalities of taste are classified as hypogeusia (diminished sense of taste), hypergeusia (increased sensitivity of taste), or ageusia (absence of the sense of taste).

A little more posteriorly cholesterol eggs per day zocor 10 mg amex, the central lateral nucleus appears dorsally in the lamina as the latter splits to enclose the lateral dorsal nucleus cholesterol test measures zocor 10mg line. More posteriorly cholesterol medication pravachol order zocor 20mg on-line, at the level of the ventral posterior nucleus, the lamina splits to enclose the ovoid centromedian nucleus. Thus, the central lateral nucleus projects mainly to parietal and temporal association areas, the paracentral nucleus to the occipitotemporal and prefrontal cortex and the central medial nucleus to the orbitofrontal and prefrontal cortex and to the cortex on the medial surface. Many cells throughout the anterior nuclei have branched axons, which pass to both the cortex and the striatum. The posterior intralaminar nuclei receive a major input from the internal segment of the globus pallidus. Additional afferents come from the pars reticulata of the substantia nigra, the deep cerebellar nuclei, the pedunculopontine nucleus of the midbrain and possibly the spinothalamic tract. The central lateral nucleus receives afferents from the spinothalamic tract, and all component nuclei receive fibres from the brain stem reticular formation, the superior colliculus and several pretectal nuclei. Afferents to all intralaminar nuclei from the brain stem reticular formation include a prominent cholinergic pathway. They appear to mediate cortical activation from the brain stem reticular formation and play a part in sensorimotor integration. Damage to the intralaminar nuclei may contribute to thalamic neglect-that is, the unilateral neglect of stimuli originating from the contralateral body or extrapersonal space. The latter has been targeted in humans for the neurosurgical control of pain and epilepsy. Bilateral injury to the posterior intralaminar nuclei leads to akinetic mutism, with apathy and loss of motivation. A second syndrome associated with damage involving the intralaminar nuclei is that of unilateral motor neglect, in which there is contralateral paucity of spontaneous movement and motor activity. Cells within these regions respond to visual, somatic or auditory stimuli with a latency, suggesting that these properties arise from activation by thalamocortical axon collaterals. The projections into the main thalamic nuclei broadly, but not entirely, reciprocate the thalamoreticular connections. The reticular nucleus is believed to function in gating information relayed through the thalamus. In this chapter, the midline group of nuclei includes those medial thalamic structures ventral to the central medial nucleus-that is, the rhomboid and reuniens nuclei, together with the parataenial nuclei more dorsolaterally. The midline nuclei receive subcortical afferent fibres from the hypothalamus, the periaqueductal grey matter of the midbrain, the spinothalamic tract and the medullary and pontine reticular formations. They are the major thalamic target of ascending noradrenergic and serotoninergic axons from the locus coeruleus and raphe nuclei, respectively, and they also receive a cholinergic input from the midbrain. Efferents from the midline nuclei pass to the hippocampal formation, the amygdala and the nucleus accumbens. Additional thalamocortical axons reach the cingulate and possibly the orbitofrontal cortex. The dual cortical and basal nuclear relationship of these nuclei has often led to their being considered part of the intralaminar system. The relationships of the midline nuclei clearly identify them as part of the limbic system. There is some evidence that they may play a role in memory and arousal and, pathologically, may be important in the regulation of seizure activity. The reticular nucleus is a curved lamella of large, deeply staining fusiform cells that wraps around the lateral margin of the thalamus, separated from it by the external medullary lamina. Anteriorly, it curves around the rostral pole of the thalamus to lie between it and the prethalamic nuclei, notably the bed nucleus of the stria terminalis. The nucleus is so named because it is crisscrossed by bundles of fibres that, as they pass between the thalamus and cortex, produce a reticular appearance. The nucleus is thought to receive collateral branches of corticothalamic, thalamocortical and probably thalamostriatal and pallidothalamic fibres as they traverse it. It receives an additional, probably cholinergic, afferent pathway from the nucleus cuneiformis of the midbrain.

Retrograde pyelogram shows complete obstruction of the pelvic ureter as a result of a complication from cesarean section cholesterol esterase definition buy generic zocor 5mg online. Recent finding and new technologies in nephrolitiasis: a review of the recent literature cholesterol belongs to which class of molecules buy zocor 5mg with amex. Note the stones within the ureterocele lowering cholesterol foods diet purchase on line zocor, which were better seen on the scout radiograph. Note that the lower pole calices of the left kidney are displaced downward by the hydronephrotic upper pole collecting system. Magnetic resonance urography in evaluation of duplicated renal collecting systems. Cysts of the lower male genitourinary tract: embryologic and anatomic considerations and differential diagnosis. Note right-sided hydronephrosis due to obstruction at the right ureterovesical junction. The lesion was resected during cystoscopy, and pathology showed low-grade urothelial carcinoma. The patient had longstanding urinary obstruction in the setting of benign prostatic hypertrophy. This colovesical fistula was due to rectal cancer that had been treated with low anterior resection and radiation therapy. The foreign body eroded into the bladder and lead to chronic urinary tract infections. This unusually advanced and locally invasive prostate cancer indents and invades the bladder. The lesion was surgically resected and pathology showed adenocarcinoma arising in a urachal remnant. The patient underwent partial cystectomy, and pathology was consistent with urachal adenocarcinoma. The lesion was resected during cystoscopy and was confirmed to be an inverted papilloma. At surgery, the mass was vascular and extremely firm and was consistent with an inflammatory pseudotumor. The ureterocele is filled with contrast-opacified urine on this excretory phase image. The patient had a ureterocele in this area earlier during the procedure, which everted to outside of bladder upon further distention. Note the thick-walled bladder due to bladder outlet obstruction as well as the carcinoma that arose in a left-sided diverticulum. The bladder wall is thick due to a bladder outlet obstruction in this 80-year-old man. Establishment of the novel cystoscopic classification for bladder trabeculation of neurogenic bladder. Anomalies of the distal ureter, bladder, and urethra in children: Embryologic, radiologic, and pathologic features. The catheter bulb is spherical and usually has water density fluid and a gas bubble within it. The patient had prior low anterior resection and radiation therapy for rectal cancer. Emphysematous infections of the abdomen and pelvis: a pictorial review Radiographics. This is a common cause of chronic bladder outlet obstruction in elderly male patients. Tuberculous cystitis may be indistinguishable from other forms of bacterial cystitis. Urogenital tuberculosis: update and review of 8961 cases from the world literature. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. Filling of these small submucosal mucus-secreting glands is highly associated with an infectious process. This is the area of the urogenital diaphragm, which is the most common site of injury in blunt pelvic trauma.

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