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Identify the tendons or vessels that can be (a) cleft lip/philtrum and posterior borders of the axilla? Which nerves pass (c) pierced ear/earlobe (b) biceps brachii/triceps brachii through this region? The conjunctiva can be palpated as they pulsate in the (a) covers the entire eyeball buy cheap cialis 20mg line erectile dysfunction exercise video. Varicose veins occur when which of the following become(s) excessively enlarged? Which of the following could not be (a) saphenous veins (b) tibial veins 9 purchase 20mg cialis visa erectile dysfunction pills buy. Describe the locations of the following palpated within the cervix of the neck? Comment on the clinical (c) the trachea (e) all of the above importance of each of these regions. Palpation of an arterial pulse in the neck each of the following could be observed or is best accomplished at 1. List four surface features of the cranium palpated: (a) the distal tendinous (a) the carotid triangle. Identify the four regions of the face and and small saphenous veins; (d) the (d) the submandibular triangle. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 342 Unit 4 Support and Movement Critical-Thinking Questions 2. A Saturday afternoon athlete crashed to the intensive care physician when possible complication of using the while mountain biking without a helmet. He sustained deep cuts across the front of neck is required for the rapid 3. It is often necessary in the critical care his knee, across the back of his elbow, administration of fluids and medications. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 Nervous Tissue and the Central Nervous System 11 Organization and Functions of the Nervous System 344 Developmental Exposition: The Brain 346 Neurons and Neuroglia 348 Transmission of Impulses 357 General Features of the Brain 358 Cerebrum 363 Diencephalon 372 Mesencephalon 373 Metencephalon 374 Myelencephalon 376 Meninges 378 Ventricles and Cerebrospinal Fluid 381 Spinal Cord 384 Developmental Exposition: The Spinal Cord 390 CLINICAL CONSIDERATIONS 391 Clinical Case Study Answer 396 Chapter Summary 397 Review Activities 398 Clinical Case Study A 56-year-old woman visited her family doctor for evaluation of a headache that had persisted for nearly a month. Upon questioning the patient, the doctor learned that her left arm, as she put it, “was a bit unwieldy, hard to control, and weak. He also found weakness, al- though less significant, of the left lower extremity. Sensation in the limbs seemed to be normal, although mild rigidity and hyperactive reflexes were present. Expressing concern, the doctor told the patient that she needed a CT scan of her head, and explained that there could be a problem within the brain, possibly a tumor or other lesion. After explaining the patient’s case, the doctor remarked parenthetically that he believed he knew where the problem was located. Why did the doctor suggest to the patient that there might be a problem within her brain when the symptoms were weakness of the extremities, and then just on one side of her body? Explain the muscle weakness in terms of neuronal path- ways from the brain to the periphery. FIGURE: Improvements in radiographic imaging have greatly enhanced the Hints: Remember the controlling and integrating function of the brain. Carefully study the in- visualization of anatomical structures, and are formation and accompanying figures concerning the structures and functions of the brain and indispensable aids to diagnostic medicine. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 344 Unit 5 Integration and Coordination with the endocrine system, regulates the functions of the other ORGANIZATION AND FUNCTIONS body systems. The brain, however, does much more than that— OF THE NERVOUS SYSTEM and its potential is perhaps greatly underestimated. It is incompre- hensible that one’s personality, thoughts, and aspirations result The central nervous system and the peripheral nervous system from the functioning of a body organ. Plato referred to the brain are structural components of the nervous system, whereas the as “the divinest part of us. Together have devised the technology for launching rockets into space, they orient the body, coordinate body activities, permit the assimi- curing diseases, mapping the human genome, and splitting atoms.

The by altering the air pressure in the ear canal test is useful in evaluating inner ear fluid and measuring the response of the ear- disorders such as Meniere’s syndrome buy discount cialis 2.5mg line erectile dysfunction treatment new delhi. Auditory Brain Stem Response As sound energy strikes the eardrum purchase 5 mg cialis vasculogenic erectile dysfunction causes, some (ABR) Testing is transmitted to the middle and inner ear, but some is reflected back into the ear The ABR records electrical activity gen- canal. If the tympanic membrane is stiff, erated as sound travels from the auditory much of the sound energy is reflected back nerve through the auditory brain stem into the external ear canal. The individual reclines with pedance, the more sound energy is admit- electrodes placed on the mastoid or on the ted to the middle and inner ear. A stimulus is then presented increased level of resistance is diagnostic through earphones, and electroencephalo- of middle ear pathology. The results are gram activity is evaluated and the audito- plotted on a graph called a tympanogram. The ABR The ear’s response is plotted on the verti- is useful in ruling out auditory diseases cal dimension of the graph, and air pres- such as diseases of the cochlea; degener- sures are plotted on the horizontal ative or demyelinating diseases of the dimension. Acoustic immittance testing auditory system, such as multiple sclero- may also be used to measure the acoustic sis; or tumors of the auditory system. It should occur in both ears in response to a loud Otoacoustic emissions are measured sound, even if only one ear is stimulated. Otoacoustic emis- diagnosing conditions or problems that sions testing allows one to measure hear- involve the cochlea or auditory nervous ing in infants, young children, and difficult- system. The technology ed structures) provides medical evaluation has enhanced the ability to detect hearing and treatment of hearing loss. The audiologist reviews hearing test results and consults with indi- Individuals who experience vertigo viduals about their listening needs before (dizziness) or who have problems with recommending which style or type of balance are frequently tested for inner ear hearing aid would be most beneficial. These tests are per- speech production difficulties because of formed either by an audiologist or physi- lack of auditory feedback. In one test of vestibular nerve guage pathologists often work with individ- function, the caloric test, either cold or hot uals to help them with particular aspects water is introduced into the external audi- of speech, language, or both in order to tory canal. The introduction of dividuals with special problems in commun- the water into the ear creates a reflex ication. Such training may be included in response of the eye called nystagmus hearing aid orientation and/or special pro- (involuntary horizontal eye movement). Eye Surgical Procedures movement may be monitored visually or Surgical procedures may be performed with electronystagmography, a procedure in to eliminate pathological conditions and which electrodes are placed near the eye to restore or improve hearing. Myringotomy TREATMENT OF HEARING LOSS When the middle ear is infected, as in AND DEAFNESS otitis media, or when there is a fluid build- up in the middle ear, surgical intervention Both medical and nonmedical interven- may be necessary to drain pus or fluid, tions may be used in the treatment of thus relieving pressure and preventing hearing loss. Medical interventions may in- rupture of the eardrum (tympanic mem- volve surgery or medications, and nonmed- brane). A myringotomy is a procedure in ical interventions may include use of hearing which an incision is made into the aids or other assistive listening devices and eardrum for this purpose. Treatment in cedure is performed under controlled most cases involves a variety of profession- conditions, it seldom leaves enough scar als. An otolaryngologist (a physician who tissue to have a negative effect on hearing. Myringoplasty is a specific type of not remove fluid that has invaded the tympanoplasty in which the damaged mastoid air cell system, however, and addi- eardrum is repaired. Other types of tym- tional intervention may be necessary if the panoplasty may be performed for the sur- mastoid system is to be rendered dry. A gical repair or reconstruction of the ossicles common procedure performed during of the middle ear. Repairing or recon- myringotomy is placing ventilation- or pres- structing the conductive mechanisms of sure-equalizing tubes in the tympanic mem- the middle ear may improve or restore the brane. The pressure-equalizing tubes act as conductive component of individuals’ an artificial eustachian tube, equalizing hearing. Abnormal eustachian tube function is the most common cause Stapedectomy of middle ear problems. The ventilation tubes usually extrude on their own with- The most common surgical treatment in 3 to 18 months with few complications. The surgery due to middle ear disease is usually com- reestablishes a more normal sound path- pletely eliminated. Since the advent of antibiotics for treat- ment of mastoiditis, mastoidectomy is per- Devices and Aids for Hearing Loss formed less frequently. Mastoidectomy is a surgical procedure for removal of infect- Cochlear Implant ed mastoid air cells, which are located in the mastoid process.

In some cases buy cialis 2.5mg free shipping erectile dysfunction cure, smooth muscle makes rapid to 500 times greater than that in skeletal muscle cheap cialis 5 mg erectile dysfunction treatment methods, is vital to phasic contractions, followed by complete relaxation. Economy, as other cases, smooth muscle can maintain a low level of ac- used here, means the amount of metabolic energy input tive tension for long periods without cyclic contraction and compared to the tension produced. In smooth muscle, relaxation; a long-maintained contraction is called tonus there is a direct relationship between isometric tension and (rather than tetanus) or a tonic contraction. The economy is related to the ba- of smooth muscle activated by hormonal, pharmacological, sic cycling rate of the crossbridges: Early in a contraction or metabolic factors, whereas phasic activity is more closely (while tension is being developed and the crossbridges are associated with stimulation by neural activity. The force-veloc- Compared with skeletal muscle, the crossbridge cycle in ity curve for smooth muscle reflects the differences in smooth muscle is hundreds of times slower, and much more crossbridge functions described previously. Although time is spent with the crossbridges in the attached phase of smooth muscle contains one-third to one-fifth as much the cycle. Because the cells are so small produce as much force per unit of cross-sectional area as and numerous, smooth muscle tissue contains a large cell does skeletal muscle. Maintenance of the proper ionic concen- muscle on the force axis would be similar, while the maxi- trations inside the cells requires the activity of the mem- mum (and intermediate) velocity values are very different brane-based ion pumps for sodium/potassium and calcium, (Fig. A and B, Typical peak forces may be similar, the maximum shortening velocity of length-tension curves from skeletal and smooth muscle. Note smooth muscle is typically 100 times lower than that of skeletal the greater range of operating lengths for smooth muscle and muscle. C, CHAPTER 9 Skeletal Muscle and Smooth Muscle 173 force-velocity curves, each corresponding to a different Elastic material Elastic material level of myosin light-chain phosphorylation. Other mechanical properties of smooth muscle are also 5 related to its physiological roles. While its underlying cel- 4 Viscoelastic Viscoelastic lular basis is uncertain, smooth muscle has a length-tension 3 material material curve somewhat similar to that of skeletal muscle, although 2 there are some significant differences (Fig. At lengths 1 at which the maximal isometric force is developed, many 0 smooth muscles bear a substantial passive force. This is 0 5 10 0 5 mostly a result of the network of connective tissue that sup- Time Time ports the smooth muscle cells and resists overextension; in some cases, it may be partly a result of residual interaction between actin and attached but noncycling myosin cross- 5 Slow stretch Rapid stretch bridges. Compared to skeletal and cardiac muscle, smooth muscle can function over a significantly greater range of lengths. It is not constrained by skeletal attachments, and it makes up several organs that vary greatly in volume during 0 the course of their normal functioning. The shape of the 0 5 10 0 5 length-tension curve can also vary with time and the degree Time Time of distension. The behavior of a viscoelastic highly distended by its contents, the peak of the active material (e. The increase in force (or pressure) is propor- organ’s contents, it can reach lengths at which it can no tional to the rate of extension, and at the end of the stretch, the longer exert active force. After a period of recovery at this force decays exponentially to a steady level. A purely elastic ma- shorter length, the muscle can again exert sufficient force terial (dashed line) maintains its force without stress relaxation. These re- versible changes in the length-tension relationship are, at is a result of the tonic contractile activity present in most least in part, the result of stress relaxation, which character- smooth muscles under normal physiological conditions. When a Other processes that are not yet well understood may viscoelastic material is stretched to a new length, it responds also account for some of the length-dependent behavior of initially with a significant increase in force; this is an elastic smooth muscle. In some smooth muscles, mechanical be- response, and it is followed by a decline in force that is ini- havior in the later stages of a contraction depends strongly tially rapid and then continuously slows until a new steady on the length at which the contraction began. If a viscoelastic material is subjected to a called plasticity (not to be confused with nonrecoverable constant force, it will elongate slowly until it reaches a new deformation), appears to arise from molecular rearrange- length. This phenomenon, the complement of stress relax- ments within the contractile protein array and may form the ation, is called creep. In smooth muscle organs, the abundant basis for both long- and short-term mechanical adaptation. The viscoelastic properties of smooth muscle allow it to Modes of Relaxation. Relaxation is a complex process in function well as a reservoir for fluids or other materials; if smooth muscle. The central cause of relaxation is a reduc- an organ is filled slowly, stress relaxation allows the inter- tion in the internal (cytoplasmic) calcium concentration, a nal pressure to adjust gradually, so that it rises much less process that is itself the result of several mechanisms. This trical repolarization of the plasma membrane leads to a de- process is illustrated in Figure 9.

Finding a NT malfunction is obviously a long way from providing an effective treatment 5 mg cialis with mastercard erectile dysfunction l-arginine, let alone a cure order cialis 5 mg without a prescription erectile dysfunction natural remedy. That is more likely to come from attempts to reduce neuronal degeneration (see Selkoe 1999). REFERENCES AND FURTHER READING Abe, K, Takeyama, C and Yoshimura, K (1998) Effect of S-8510, a novel benzodiazepine inverse agonist, on basal forebrain lesion-induced dysfunction in rats. Auld, DS, Kar, S and Quiron, R (1998) b-amyloid peptides as direct cholinergic neuro- modulations: a missing link? Bliss, TVPand Loma, T (1973) Long-lasting potentiation of synaptic transmission in the dentate area of the anaesthetised rabbit following stimulation of the perforant path. Bowen, DM, Smith, CB, White, Pand Davison, AN (1976) Neurotransmitter-related enzymes and indices of hypoxia in senile dementia and other abiotrophies. McGough, JL, Introlni-Collison, IB and Castellano, C (1993) Involvement of opioid peptides in learning and memory. Morris, RGM (1984) Development of a water-maze procedure for studying spatial learning in the rat. Neve, RL and Robakis, NK (1998) Amyloid disease: a re-examination of the amyloid hypothesis. Nitta, A, Fukuta, T, Hasegawa, T and Nabeshima, T (1997) Continuous infusion of b-amyloid proteins into cerebral ventricle induces learning impairment and neuronal and morphological degeneration. Perry, EK, Tomlinson, BE, Blessed, G, Bergmann, K, Gibson, PH and Perry, RH (1978) Correlation of cholinergic abnormalities with senile plaques and mental test scores in senile dementia. Tohgi, H, Abe, T, Kimura, M, Saheki, M and Takahashi, S (1996) Cerebrospinal fluid acetylcholine and choline in vascular dementia of Binswanger and multiple small infarct types as compared with Alzheimer-type dementia. Wischik, CM and Crowther, RA (1986) Subunit structure of the Alzheimer tangle. Yamada, K, Tanaka, T, Mamiya, T, Shiotani, T, Kameyama, T and Nabeshima, T (1999) Improvement by nefiracetam of b-amyloid Ð (1-42) Ð induced learning and memory impair- ments in rats. Yavich, L, Sirvio, J, Haapalinna, A, Puumala, T, Koivisto, E, Heinonen, E and Reikkinen, PJ (1996) The systemic administration of tacrine or selegiline facilitate spatial learning in aged Fisher 344 rats. Edited by Roy Webster Copyright & 2001 John Wiley & Sons Ltd ISBN:Hardback 0-471-97819-1 Paperback 0-471-98586-4 Electronic 0-470-84657-7 19 nxiety S. STANFORD INTRODUCTION Emotional states that would now be classified as anxiety were recognised as long ago as the classical Greek period but have undergone many phases of medical classification since then. The extent to which they share a common neurobiological basis is far from clear but it is evident that different anxiety disorders do not all respond to the same drug treatments. In fact, it is antidepressant drugs, especially the selective serotonin reuptake inhibitors (SSRIs), that are turning out to be the most effective treatments for some anxiety disorders and their use has undoubtedly been encouraged by fears that prolonged treatment with benzodiazepines might induce a dependence syndrome. The beneficial effects of antidepressants in anxiety are often interpreted as support for a neurobiological link between anxiety and depression. Also, because anxiety often progresses to depression and because these disorders can co-exist in the same patients, it has even been suggested that they might be different manifestations of a single problem (Tyrer 1989). However, whereas anxiety drives people to seek medical help, the response to stress is a normal physiological event. A distinctive feature of anxiety, therefore, is that it can be regarded as an inappropriate stress response that is chronic or intermittent, for which the stimulus is either not obvious (as in GAD) or irrational (as in the phobias), or provokes a prolonged emotional disturbance (as in post-traumatic stress disorder). The first is to establish experimental models of anxiety in animals and humans in order to discover its neuro- biological basis. The second is to investigate the actions of anti-anxiety drugs in the brain in the hope that this will give some clues to the cause(s) of anxiety. Webster &2001 John Wiley & Sons Ltd 396 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION Table 19. Agoraphobia: Fear of places or situations from which escape is difficult Ð can occur with or without a history of panic disorder Social phobia: Fear of social or performance situations Specific phobia: Fear of a specific object or situation ANXIETY STATES Panic disorder (with or without agoraphobia): Recurrent unexpected panic attacks Generalised anxiety disorder: At least 6 months of persistent and excessive anxiety and worry Obsessive compulsive disorder: Obsessions (which cause anxiety) and or compulsions (which serve to neutralise anxiety) Post-traumatic stress disorder (PTSD): Re-experiencing of traumatic event outside normal human experience with increased arousal and avoidance of stimuli associated with the trauma Acute stress disorder: Symptoms similar to PTSD but occur within 1 month of the traumatic event Anxiety disorder due to a general medical condition: e. Disorders of thyroid function, cardiovascular system, respiratory system, head injury, etc. Caffeine, cocaine, alcohol Anxiety disorder not otherwise specified: Prominent symptoms of anxiety that do not fit any of the above categories SYMPTOMS AND SIGNS OF ANXIETY (Modified from Nutt 1990) Mood: Apprehension, worry, difficulty in concentration, irritability, insomnia Cognitions: Fear of (for example): death, ineffectiveness, failure, humiliation, mental illness Somatic: Cardiovascular (tachycardia, palpitations), sweating, respiration, GIT, muscle tension, tremor, muscle aches or soreness, nausea, exaggerated startle reflex, increased urinary frequency Behaviour: Hypervigilance, nail-biting, scratching ANIMAL MODELS OF ANXIETY All preclinical animal models of anxiety involve exposing animals (usually rats or mice) to environmental stimuli that disrupt their normal pattern of behaviour (Table 19. Obviously, it can never be confirmed that animals are actually experiencing the equi- valent of human anxiety and so the validity of all preclinical models rests largely on confirming that the change in behaviour is prevented by drugs that have established anti-anxiety effects in humans. The signal can either warn that behaviour which is reinforced by reward will also be punished (e. In the following sections, specific behavioural models used to study anxiety and the effects of anti- anxiety drugs are described.