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However generic altace 5 mg mastercard, when present in joints altace 2.5mg otc, the typical pre- sus nonseptic inflamed joint: MRI characteristics buy altace 5 mg cheap. Skeletal Radiol 28:616-620 sentation is that of monoarticular arthritis order altace 5mg amex. Lancet 351:197-202 tive changes are similar to those of other granulomatous 12. Rheum Dis Clin of North Am 24:275-86 histologically viewing the organism on a biopsy speci- 13. MRI may be useful in selected cases to define the Clin North Am 123:239-259 14. Von Essen R, Savolainen HA (1989) Bacterial infection fol- extent of infection. Babcock HM, Matava MJ, Fraser V (2002) Postarthroscopy Conclusions surgical site infections: review of the literature. Resnik CS, Sawyer RW, Tisnado J (1987) Septic arthritis of the The careful selection of imaging tests, taking into ac- hip: a rare complication of angiography. Can Assoc Radiol J count the clinical presentation, physical appearance and 4:299-301 the results of appropriate lab tests, can lead to prompt 17. Tehranzadeh J, Ter-Organesyan RR, Steinbach LS (2004) recognition of the infection and institution of therapy. In Musculoskeletal disorders associated with HIV infection and selected cases, advanced imaging techniques can be cost- AIDS: Part I: Infectious musculoskeletal conditions. Lazzarini L, Mader JT, Calhoun JH (2004) Osteomyelitis in Radiology of skeletal tuberculosis. Santiago Restrepo C, Gimenez CR, McCarthy K (2003) as multifocal lytic cortical lesions in the femur. Skeletal Radiol Imaging of osteomyelitis and musculoskeletal soft tissue in- 33:244-247 fections: current concepts. Hugosson C, Nyman RS, Brismar J, Lrsson SG, Lindahl S, 109 Lundstedt C (1996) Imaging of tuberculosis. Karchevsky M, Schweitzer ME, Morrison WB, Parellada JA Schepper AM (2003) Imaging features of musculoskeletal tu- (2004) MRI findings of septic arthritis and associated os- berculosis. Horger M, Eschmann SM, Pfannenberg C, Storek D, Magnetic resonance imaging in coccidioidal arthritis. Skeletal Dammann F, Vonthein R, Claussen CD, Bares R (2003) The Radiol 25:661-665 IDKD 2005 Peripheral Arthritis L. Resnik2 1 Department of Radiology, University of Arizona Health Sciences Center, AZ, USA 2 Depatment of Diagnostic Radiology, University of Maryland Medical System, MD, USA Introduction radiographic characteristics at each individual joint, the distribution of joint involvement, and the presence or ab- Radiographs are used in peripheral arthritis to confirm sence of other ancillary radiographic findings. The radiographic findings may be either process is limited to one joint (monoarticular) or involves consistent or inconsistent with the clinical diagnosis. Each joint disease has a inconsistent, alternative diagnosis should be made on the characteristic distribution of joint involvement (Fig. This pattern is based on the or asymmetrically (involvement of a joint on one side Fig. Sites and distribution of com- mon arthritides of the hand (A) and foot (B). The more common sites are encircled with thick lines and the less common sites with thin lines. Note the periosteal reaction or new-bone forma- tion classically identified in Reiter’s disease. Note also the potential for “sausage digit” dis- tribution in psoria- sis. When joints are encircled in isola- tion, the distribution is random and may be isolated to any joint 144 L. Resnik without simultaneous involvement of the corresponding The distribution of joint involvement is characteris- joint on the opposite side).

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The anatomy professor by Mondino de’ Luzzi discount altace 2.5mg otc, also of the University of Bologna altace 2.5mg overnight delivery, in 1316 order 2.5mg altace fast delivery. The dissections were performed by hired First published in 1487 generic altace 10mg fast delivery, it was more a dissection guide than a assistants. One of them, the ostensor, pointed to the internal struc- study of gross anatomy, and in spite of its numerous Galenic er- tures with a wand as the professor lectured. Because of the rapid putrefaction of an unembalmed corpse, the anatomy textbooks of the early Renaissance were orga- Leonardo nized so that the more perishable portions of the body were consid- ered first. Dissections began with the abdominal cavity, then the The great Renaissance Italian Leonardo da Vinci (1452–1519) is chest, followed by the head, and finally the appendages. He displayed genius as a painter, sculptor, ar- With the increased interest in anatomy during the Renais- chitect, musician, and anatomist—although his anatomical sance, obtaining cadavers for dissection became a serious prob- drawings were not published until the end of the nineteenth cen- lem. As a young man, Leonardo regularly participated in cadaver finally an official decree was issued that permitted the bodies of dissections and intended to publish a textbook on anatomy with executed criminals to be used as specimens. When Corpses were embalmed to prevent deterioration, but this Leonardo died, his notes and sketches were lost and were not dis- was not especially effective, and the stench from cadavers was apparently a persistent problem. The advancement of anatomy from a thronelike chair at some distance from the immediate area would have been accelerated by many years if Leonardo’s note- (fig. The phrase, “I wouldn’t touch that with a 10-foot pole” books had been available to the world at the time of his death. He was The major advancements in anatomy that occurred during intent on accuracy, and his sketches are incredibly detailed the Renaissance were in large part due to the artistic and scien- (fig. He experimentally determined the structure of com- tific abilities of Leonardo da Vinci and Andreas Vesalius. He made wax ing in the fifteenth and sixteenth centuries, each produced casts of the ventricles of the brain to study its structure. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 14 Unit 1 Historical Perspective FIGURE 1. Vesalius The contribution of Andreas Vesalius (1514–64) to the science of human anatomy and to modern medicine is immeasurable. He re- ceived his early medical training at the University of Paris and completed his studies at the University of Padua in Italy, where he began teaching surgery and anatomy immediately after gradu- ation. At Padua, Vesalius participated in human dissections and initiated the use of live models to determine surface landmarks for internal structures (fig. By the time he was 28 years old, he had already completed the mas- terpiece of his life, De Humani Corporis Fabrica, in which the vari- ous body systems and individual organs are beautifully illustrated and described (fig. His book was especially important in that it boldly challenged hundreds of Galen’s teachings. Vesalius wrote of his surprise upon finding numerous anatomical errors in FIGURE 1. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 1 History of Anatomy 15 FIGURE 1. Tulp, a famous Rembrandt painting completed in 1632, depicts one of the public anatomies that were popular during this period. Nicholas Tulp was a famous Dutch anatomist who described the congenital defect in the spinal column known as spinal bifida aperta. Two of the most important contributions were the explana- name Vesanus (madman). Vesalius became so unnerved by the tion of blood flow and the development of the microscope. Harvey Although Vesalius was the greatest anatomist of his epoch, In 1628, the English physician William Harvey (1578–1657) others made significant contributions and to an extent paved published his pioneering work On the Motion of the Heart and the way for Vesalius. Not only did this brilliant research establish supplied with corpses by the friar of a local monastery. Mondino de’ Luzzi and the surgeon Jacopo Berengario of Carpi also corrected proof of the continuous circulation of blood within contained many of Galen’s errors.

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The middle piece contains spiral sheaths of mi- with this disorder have an accessory X chromosome caused tochondria that supply energy for sperm metabolism and lo- by meiotic nondisjunction altace 2.5 mg lowest price. The tail is composed of a 9 2 arrangement of XXY order altace 10 mg visa, but there are other chromosomal mosaics altace 5mg with amex. Testicular microtubules altace 2.5mg discount, which is typical of cilia and flagella, and is sur- volume is reduced more than 75% and ejaculates contain rounded by a fibrous sheath that provides some rigidity. Spermatogonic cell differentia- tail propels the sperm by a twisting motion, involving inter- tion beyond the primary spermatocyte stage is rare. The Formation of a Mature Spermatozoon Requires Extensive Cell Remodeling Testosterone Is Essential for Sperm Production and Maturation Spermatids are small, round, and nondistinctive cells. Dur- ing the second half of the spermatogenic cycle they un- Spermatogenesis requires high intratesticular levels of dergo considerable restructuring to form mature spermato- testosterone, secreted from the LH-stimulated Leydig cells. Notable changes include alterations in the nucleus, the The testosterone diffuses across the basement membrane of formation of a tail, and a massive loss of cytoplasm. The nu- the seminiferous tubule, crosses the blood-testis barrier, cleus becomes eccentric and decreases in size, and the and complexes with ABP. Sertoli cells some-like structure unique to spermatozoa, buds from the also contain FSH receptors. However, recent studies using Golgi apparatus, flattens, and covers most of the nucleus. The absolute requirement for FSH in sperm nine peripheral doublet microtubules surrounding a central production remains unknown. This becomes the axoneme or that testosterone may be sufficient for spermatogenesis. Throughout this reshaping The actions of FSH and testosterone at each point of process, the cytoplasmic content is redistributed and dis- sperm cell production are unknown. During spermiation, most of the remaining cyto- sis, spermatogenesis appears to depend on the availability plasm is shed in the form of residual bodies. In human males, FSH is thought The reasons for this lengthy and metabolically costly to be required for the initiation of spermatogenesis before process become apparent when the unique functions of puberty. Unlike other cells, the spermato- achieved, LH alone (through stimulation of testosterone zoon serves no apparent purpose in the organism. Its only production) or testosterone alone is sufficient to maintain function is to reach, recognize, and fertilize an egg; spermatogenesis. CHAPTER 37 The Male Reproductive System 659 TESTICULAR STEROIDOGENESIS hydrogenase), which substitutes the keto group in posi- tion 17 with a hydroxyl group. Unlike all the preceding Following spermatogenesis, the second primary function of enzymatic reactions, this is a reversible step but tends to the testes is steroidogenesis. Although estrogens are only minor products of testicu- Testosterone is then converted to dihydrotesterone lar steroidogenesis, they are normally found in low con- (DHT), the most biologically active androgen, and to centrations in men. Androgens (C19) are converted to es- estradiol, the most biologically estrogen. Aromatization involves the removal of Testosterone Production Requires Two the methyl group in position 19 and the rearrangement of Intracellular Compartments and Several Enzymes ring A into an unsaturated aromatic ring. The products of aromatization of testosterone and androstenedione are Steroid hormones are produced from cholesterol by the ad- estradiol and estrone, respectively (see Fig. Cholesterol, a testis, the Sertoli cell is the main site of aromatization, 27-carbon (C27) steroid, can be obtained from the diet or which is stimulated by FSH; however, aromatization may synthesized within the body from acetate. Each organ uses also occur in peripheral tissues that lack FSH receptors a similar steroid biosynthetic pathway, but the relative (e. The major steroid produced by the testis is Primarily Mediated by cAMP testosterone, but other androgens, such as androstenediol, androstenedione, and dehydroepiandrosterone (DHEA), as The action of LH on Leydig cells is mediated through spe- well as a small amount of estradiol, are also produced. A Leydig cell Cholesterol from low-density lipoprotein (LDL) and has about 15,000 LH receptors, and occupancy of less than high-density lipoprotein (HDL) is released in the Leydig 5% of these is sufficient for maximal steroidogenesis.

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