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Similarly administering medications 8th edition procyclidine 5 mg for sale, cochlea just converts the sound waves into electrical impulses of same frequency symptoms 5 days before missed period purchase procyclidine 5 mg visa. Impulses are transmitted by auditory nerve fibers to cerebral cortex treatment arthritis order procyclidine 5 mg free shipping, where perception and analysis of sound occur medicine video best purchase procyclidine. It is believed that, the nerve fibers can transmit maximum of 1,000 impulses per second. Thus, the telephone theory fails to explain the transmission of sound waves with frequency above 1,000 cycles per second. According to this theory, the impulses of sound waves with frequency above 1,000 cycles per second are transmitted by different groups of nerve fibers. Resonance Theory of Helmholtz Resonance theory was the first theory of hearing to emerge in 1863. Helmholtz named these basilar fibers resonators and compared them with the resonators of piano. Similarly, when the sound with a particular frequency is applied, the basilar fibers in a particular portion of basilar membrane are stimulated. Resonance theory was not accepted because the individual resonators could not be identified in cochlea. Gradually, this theory was modified into another theory called the place theory, which is more widely accepted. Place Theory According to this theory, nerve fibers from different portions (places) of organ of Corti on basilar membrane give response to sounds of different frequency. Accordingly, corresponding nerve fiber from organ of Corti gives information to the brain regarding the portion of organ of Corti that is stimulated. Frequency of sound audible to human ear lies between 20 and 20,000 Hz or cycles/second. The range of greatest sensitivity lies between 2,000 and 3,000 Hz (cycles/second). According to the first group, the analysis of sound frequency is the function of cerebral cortex and the cochlea merely transmits the sound. According to the second group of theories, the frequency analysis is done by cochlea, which later sends the information to cerebral cortex. Telephone Theory of Rutherford Telephone theory was postulated by Rutherford in 1880. According to this Chapter 174 t Mechanism of Hearing 1021 Experimental evidences supporting place theory i. If a person is exposed to a loud noise of a particular frequency for a long period, he becomes deaf for that frequency. In experimental animals, destruction of a portion of organ of Corti occurs by exposing the animal to loud noise of a particular frequency iii. In human high-tone deafness, there is degeneration of organ of Corti near the base of cochlea or degeneration of nerve supplying the cochlea near the base iv. During exposure to high-frequency sound, cochlear microphonic potentials show greater voltage in hair cells near base of the cochlea. Also, during the exposure to low-frequency sound, cochlear microphonic potentials show greater voltage in hair cells near apex of the cochlea. Traveling Wave Theory From place theory, emerged yet another theory called the traveling wave theory. Development, generation, movement and disappearance of traveling wave are already described earlier in this chapter. When loudness of sound increases, it produces large vibrations, which spread over longer area of basilar membrane. This activates large number of hair cells and recruits more number of auditory nerve fibers. It is important for survival and it helps to protect us from moving objects such as vehicles. Cerebral cortex and medial geniculate body are responsible for localization of sound.

Surgical procedures to enhance blood flow may be considered in early-stage disease but are of controversial efficacy; joint replacement may be necessary in late-stage disease for pain unresponsive to other measures medications blood donation effective 5mg procyclidine. Tendinitis May involve virtually any tendon but frequently affects tendons of the rotator cuff around shoulder symptoms breast cancer purchase 5 mg procyclidine amex, especially the supraspinatus symptoms bipolar purchase procyclidine from india. Pain is dull and aching but becomes acute and sharp when tendon is squeezed below acromion symptoms of cheap 5 mg procyclidine with amex. The rotator cuff tendons or biceps tendon may rupture acutely, frequently requiring surgical repair. Calcific Tendinitis Results from deposition of calcium salts in tendon, usually supraspinatus. Adhesive Capsulitis ("Frozen Shoulder") Results from conditions that enforce prolonged immobility of shoulder joint. Shoulder is painful and tender to palpation, and both active and passive range of motion is restricted. The initial inflammatory response is an influx of T helper cells and an accumulation of activated monocytes. Sarcoid manifests clinically in organs where it affects function or where it is readily observed. Features include: hilar adenopathy, alveolitis, interstitial pneumonitis; airways may be involved and cause obstruction to airflow; pleural disease and hemoptysis are uncommon. In patients with mild symptoms, no therapy may be needed unless specified manifestations are noted. Sarcoidosis As sarcoidosis may remit spontaneously, treatment is largely based upon the level of symptoms and extent of organ involvement (Figs. Other immunomodulatory agents have been used in refractory or severe cases or when prednisone cannot be tapered. Overall, 50% of pts with sarcoid have some permanent organ dysfunction; death directly due to disease occurs in 5% of cases usually related to lung, cardiac, neurologic, or liver involvement. Respiratory tract abnormalities cause most of the morbidity and mortality related to sarcoid. Clinical manifestations depend on anatomic distribution and intensity of amyloid protein deposition and range from local deposition with little significance to involvement of virtually any organ system with severe pathophysiologic consequences. Amyloid diseases are defined by the biochemical nature of the protein in the fibril deposits and are classified according to whether they are systemic or localized, acquired or inherited, and by their clinical patterns. Congo red staining of abdominal fat will demonstrate amyloid deposits in >80% of patients with systemic amyloid. Only 50% are eligible for such aggressive treatment and peritransplant mortality is higher than for other hematologic diseases because of impaired organ function. In patients who are not candidates for hematopoietic cell transplant, cyclic melphalan and glucocorticoids can decrease the plasma cell burden, but produces remission in only a few percent of patients with a minimal improvement in survival (median 2 years). Pituitary hormones are secreted in a pulsatile manner, reflecting intermittent stimulation by specific hypothalamic-releasing factors. Each of these pituitary hormones elicits specific responses in peripheral target glands. The hormonal products of these peripheral glands, in turn, exert feedback control at the level of the hypothalamus and pituitary to modulate pituitary function. Disorders of the pituitary include neoplasms that lead to mass effects and clinical syndromes due to excess or deficiency of one or more pituitary hormones. Tumors secreting prolactin are most common and have a greater prevalence in women than in men. Clinical Features Symptoms from mass effects include headache; visual loss through compression of the optic chiasm superiorly (classically a bitemporal hemianopsia); and diplopia, ptosis, ophthalmoplegia, and decreased facial sensation from cranial nerve compression laterally. Pituitary stalk compression from the tumor may also result in mild hyperprolactinemia. Symptoms of hypopituitarism or hormonal excess may be present as well (see below). Pituitary apoplexy is an endocrine emergency that typically presents with features that include severe headache, bilateral visual changes, ophthalmoplegia, and, in severe cases, cardiovascular collapse and loss of consciousness. Patients with no evident visual loss or impaired consciousness can usually be observed and managed conservatively with high-dose glucocorticoids; surgical decompression should be considered when these features are present.

Metformin tends to decrease body weight in pts with obesity and type 2 diabetes mellitus medicine 751 m cheap procyclidine 5 mg amex. Examples of operative interventions used for surgical manipulation of the gastrointestinal tract medications with gluten discount procyclidine 5 mg with mastercard. Procedures with a malabsorptive component require lifelong supplementation of micronutrients (iron treatment zone guiseley order procyclidine 5mg with visa, folate medicine vs engineering buy procyclidine with amex, calcium, vitamins B12 and D) and are associated with a risk of islet cell hyperplasia and hypoglycemia. These criteria should be confirmed by repeat testing on a different day, unless unequivocal hyperglycemia is present. Screening with a fasting plasma glucose level is recommended every 3 years for individuals over the age of 45, as well as for younger individuals who are overweight (body mass index 25 kg/m2) and have one or more additional risk factors (Table 182-1). The metabolic syndrome, the insulin resistance syndrome, and syndrome X are terms used to describe a commonly found constellation of metabolic derangements that includes insulin resistance (with or without diabetes), hypertension, dyslipidemia, central or visceral obesity, and endothelial dysfunction and is associated with accelerated cardiovascular disease (Chap. Special attention should be given on physical exam to retinal exam, orthostatic bp, foot exam (including vibratory sensation and monofilament testing), peripheral pulses, and insulin injection sites. Intensive therapy reduces long-term complications but is associated with more frequent and more severe hypoglycemic episodes. Combinations of insulin preparations with different times of onset and duration of action should be used (Table 182-2). Preferred regimens include injection of glargine at bedtime with preprandial lispro, glulisine, or insulin aspart or continuous subcutaneous insulin using an infusion device. The classes of oral glucose-lowering agents and dosing regimens are listed in Table 182-3. Combinations of two oral agents may be used with additive effects, with stepwise addition of bedtime insulin or a third oral agent if adequate control is not achieved. Individuals who require >1 U/kg per day of long-acting insulin should be considered for combination therapy with an insulinsensitizing agent such as metformin or a thiazolidinedione. A routine urinalysis may be performed as an initial screen for diabetic nephropathy. If it is positive for protein, quantification of protein on a 24-h urine collection should be performed. Short-acting insulin alone is insufficient to prevent the onset of diabetic ketoacidosis. Inadequate production of sperm can occur in isolation or in the presence of androgen deficiency, which impairs spermatogenesis secondarily. Testicular failure can occur as a part of a polyglandular autoimmune failure syndrome in which multiple primary endocrine deficiencies coexist. Testosterone synthesis may be blocked by ketoconazole, and testosterone action may be diminished by competition at the androgen receptor by spironolactone and cimetidine. Secondary hypogonadism is diagnosed when levels of both testosterone and gonadotropins are low (hypogonadotropic hypogonadism). Destruction of the pituitary gland by tumors, infection, trauma, or metastatic disease causes hypogonadism in conjunction with disturbances in the production of other pituitary hormones (see Chap. Clinical Features the history should focus on developmental stages such as puberty and growth spurts, as well as androgen-dependent events such as early morning erections, frequency and intensity of sexual thoughts, and frequency of masturbation or intercourse. The physical examination should focus on secondary sex characteristics such as hair growth in the face, axilla, chest, and pubic regions; gynecomastia; testicular volume; prostate; and height and body proportions. Eunuchoidal proportions are defined as an arm span >2 cm greater than height and suggest that androgen deficiency occurred prior to epiphyseal fusion. The presence of varicocele should be sought by palpation of the testicular veins with the patient standing.

Summary the obvious function of hemopoietic tissues is to provide blood with continuous replacement of cells treatment yeast infection women buy procyclidine 5mg low price. Separation of the replicating cells from their end products in the blood and sequestering them in specific hemopoietic tissues allows the establishment of environments best suited to each tissue symptoms 3 dpo purchase procyclidine 5 mg with amex. It ensures that replicating cells are not unduly influenced by the activities of other organs and tissues treatment naive definition procyclidine 5 mg generic, as would occur if replication occurred within the bloodstream treatment 2015 procyclidine 5mg mastercard. It also provides the blood with small cells that can more easily circulate through fine capillary beds. Subdivision of hemopoietic tissue into lymphatic and bone marrow components allows separate conditioning of cells (such as T-lymphocytes) without, at the same time, exposing the remainder of the hemopoietic cells to the same conditioning factors. Within bone marrow, yellow marrow fills in spaces unoccupied by active marrow, but being very labile, this fatty marrow can quickly be replaced by hemopoietic marrow when demands for blood become insistent. The sinusoids of the marrow provide sites where newly formed blood cells can gain access to the circulation. Additional maturation of cells occurs within the sinusoids and the cells held here serve as a reserve that can be mobilized as needed. The purposeful movements of the body and the maintenance of posture are the result of contractions of muscles attached to the skeleton. Muscular contraction also is responsible for beating of the heart, breathing, constriction of blood vessels, movements of the intestines, emptying of the bladder, and other vital processes. The unit of structure of muscle tissue is the muscle cell, which, because of its elongated shape, also is called a fiber. Functionally, the shape of the cell is important, because a greater unidimensional contraction can be achieved by an elongated cell than by a globular cell of the same volume. Some muscle cells show a regular pattern of alternating light and dark bands that extend across the width of the fiber and these have been called striated muscles. This is the type of muscle associated with the skeleton and heart and thus forms skeletal and cardiac muscle. Smooth muscle cells lack cross-striations, occur in the walls of viscera, and often are referred to as visceral muscle. Functionally, muscle is either voluntary (under control of the will) or involuntary (not controlled by the will). Striated skeletal muscle is voluntary; smooth muscle is involuntary; and cardiac muscle is involuntary striated muscle. It permits a wide range of voluntary activities from the intricate and fine movements involved in writing to the rapid, powerful forces associated with jumping or throwing a ball. The power that can be generated by skeletal muscle is illustrated by the speed attained by a thrown ball which, at the moment it leaves the fingertips, may reach speeds of over 90 mph. Glycogen is synthesized from glucose using glycogen synthase during hyperglycemia (following a highcarbohydrate meal) and an increase in the insulin to glucagon ratio. The enzyme, glucose-6-phosphatase, is absent in skeletal muscle and therefore glycogen is not degraded to free glucose. Thus, glucose remains in the phosphorylated form and cannot leave the muscle cell. This provides a metabolic advantage for this cell type in that glucose does not have to be phosphorylated and is available to provide energy directly by glycolysis. Fascicles vary in size with different muscles and in general are small in muscles associated with fine movements and large in muscles that perform actions demanding greater power. The entire muscle is surrounded by a connective tissue sheath called the epimysium. Skeletal Muscle Skeletal muscle is the most abundant tissue in the body and forms those structures generally referred 89 Septa pass from the deep surface of the epimysium to invest each fascicle as the perimysium; delicate extensions of the perimysium wrap each fiber as the endomysium. Although given different names according to its association with different structural units of muscle, the connective tissue is continuous from one part to another. It consists of collagenous, reticular, and elastic fibers and contains several cell types including fibroblasts, macrophages, and fat cells. The endomysium is especially delicate and consists mainly of reticular fibers and thin collagen fibers; it carries blood capillaries and small nerve branches. The connective tissue not only binds the muscle units together but also acts as a harness and aids in integrating and transmitting the force of their contractions.

The outer part of the phospholipid molecule is called the head portion and the inner portion is called the tail portion symptoms 0f parkinsons disease buy procyclidine 5mg low price. Head portion is the polar end and it is soluble in water and has strong affinity for water (hydrophilic) symptoms 11dpo procyclidine 5 mg with amex. Two layers of phospholipids are arranged in such a way that the hydrophobic tail portions meet in the center of the membrane daughter medicine discount procyclidine 5 mg overnight delivery. Cholesterol Cholesterol molecules are arranged in between the phospholipid molecules treatment quadriceps pain 5mg procyclidine sale. Protective function: Cell membrane protects the cytoplasm and the organelles present in the cytoplasm 2. Selective permeability: Cell membrane acts as a semipermeable membrane, which allows only some substances to pass through it and acts as a barrier for other substances 3. Absorptive function: Nutrients are absorbed into the cell through the cell membrane 4. Excretory function: Metabolites and other waste products from the cell are excreted out through the cell membrane 5. Exchange of gases: Oxygen enters the cell from the blood and carbon dioxide leaves the cell and enters the blood through the cell membrane 6. Maintenance of shape and size of the cell: Cell membrane is responsible for the maintenance of shape and size of the cell. Peripheral proteins Peripheral proteins or peripheral membrane proteins are the proteins which are partially embedded in the outer and inner surfaces of the cell membrane and do not penetrate the cell membrane. Peripheral proteins are loosely bound with integral proteins or lipid layer of cell membrane. Channel proteins help in the diffusion of watersoluble substances like glucose and electrolytes 3. Carrier or transport proteins help in the transport of substances across the cell membrane by means of active or passive transport 4. Pump: Some carrier proteins act as pumps, by which ions are transported actively across the cell membrane 5. Receptor proteins serve as the receptor sites for hormones and neurotransmitters 6. Enzymes: Some of the protein molecules form the enzymes and control chemical (metabolic) reactions within the cell membrane 7. Antigens: Some proteins act as antigens and induce the process of antibody formation 8. Cell adhesion molecules or the integral proteins are responsible for attachment of cells to their neighbors or to basal lamina. Carbohydrates of the Cell Membrane Some of the carbohydrate molecules present in cell membrane are attached to proteins and form glycoproteins (proteoglycans). Carbohydrate molecules form a thin and loose covering over the entire surface of the cell membrane called glycocalyx. Carbohydrate molecules are negatively charged and do not permit the negatively charged substances to move in and out of the cell 2. It contains a clear liquid portion called cytosol and various particles of different shape and size. Ectoplasm: Peripheral part of cytoplasm, situated just beneath the cell membrane 2. Endoplasm: Inner part of cytoplasm, interposed between the ectoplasm and the nucleus. Some organelles are bound by limiting membrane and others do not have limiting membrane (Box 1. It is covered by a limiting membrane which is formed by proteins and bilayered lipids. Endoplasmic reticulum Golgi apparatus Lysosome Peroxisome Centrosome and centrioles Secretory vesicles Mitochondria Nucleus Organelles without limiting membrane 1. Cytoskeleton 7 between nucleus and cell membrane by connecting the cell membrane with the nuclear membrane. Types of Endoplasmic Reticulum Endoplasmic reticulum is of two types, namely rough endoplasmic reticulum and smooth endoplasmic reticulum.

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