By F. Kadok. Missouri Tech.

Synergists—steady body parts and assist prime mover B buy bupron sr 150 mg without prescription anxiety 4th herefords. Levers and body mechanics—muscles function with skele- II order bupron sr 150 mg on line mood disorder nos in dsm 5. Generation of heat c Force—muscle contraction Building Understanding Fill in the blanks. Bones are covered by a connective tissue membrane 2. Matching Match each numbered item with the most closely related lettered item. For more information, please visit online support service featuring access to live e-struc- the text’s companion website at http://connection. To demo this service, please visit the website listed memmler, or contact your local LWW representative. To demo the online Resource CD, which includes a test generator, image course, please visit the website listed above. This is my opportunity to thank those who have helped with revisions for the 10th edition of Memmler’s The Human Body in Health and Disease. My editor, John Goucher, has guided this project through from start to finish and showed great skills in putting out fires. Senior Development Editor Dana Knighten kept her eye on the big picture as well as the tiniest details—and every- thing in between. Jason Taylor gave advice on the entire manuscript and also wrote the spe- cial interest boxes and chapter summary questions. Kerry Hull’s contribution as a reviewer landed her the job of writing all of the ancillary materials, assisted by Ancillary Editor Molly Ward. Elizabeth Connolly and Jennifer Clements kept the art program on track, managing all of the electronic art files. My thanks to all the many reviewers, listed separately, who made such valuable and detailed comments on the text. Their insights and advice truly guided every aspect of this new edition. Enormous thanks to Craig Durant and Dragonfly Media Group for their brilliant work on the art program. They understood our needs, often better than we did, and rendered art aston- ishing in its clarity, instructional value, and beauty of design. And as always, thanks to my husband Matthew, currently an instructor in anatomy and physiology, for his advice on and contributions to the text. Tissues, Glands, and Membranes 000 Unit II Disease and the First Line of Defense 000 5. The Skin in Health and Disease 000 Unit III Movement and Support 000 7. The Muscular System 000 Unit IV Coordination and Control 000 9. The Nervous System: The Spinal Cord and Spinal Nerves 000 10. The Nervous System: The Brain and Cranial Nerves 000 11. The Endocrine System: Glands and Hormones 000 Unit V Circulation and Body Defense 000 13. Body Defenses, Immunity, and Vaccines 000 Unit VI Energy: Supply and Use 000 18. The Urinary System 000 Unit VII Perpetuation of Life 000 23. Heredity and Hereditary Diseases 000 Glossary 000 Glossary of Word Parts 000 Appendices 000 Index 000 xix Contents Unit I Movement That Requires Cellular Energy How Osmosis Affects Cells THE BODY AS A WHOLE 000 Cell Aging 000 1 rganization of the Human Body 000 Cells and Cancer 000 Studies of the Human Body 000 Cancer Risk Factors 000 Levels of Organization 000 Body Systems 000 4 T issues, Glands, and Membranes 000 Metabolism and Its Regulation 000 Tissue Classification 000 Homeostasis 000 Epithelial Tissue 000 The Effects of Aging 000 Structure of Epithelial Tissue 000 Directions in the Body 000 Special Functions of Epithelial Tissue 000 Directional Terms 000 Glands 000 Planes of Division 000 Connective Tissue 000 Body Cavities 000 Soft Connective Tissue 000 Dorsal Cavity 000 Fibrous Connective Tissue 000 Ventral Cavity 000 Hard Connective Tissue 000 The Metric System 000 Muscle Tissue 000 Units of Length 000 Nervous Tissue 000 Units of Weight 000 The Neuron 000 Units of Volume 000 Neuroglia 000 Temperature 000 Membranes 000 Epithelial Membranes 000 2 Chemistry, Matter, and Life 000 Connective Tissue Membranes 000 Elements 000 Membranes and Disease 000 Atoms 000 Benign and Malignant Tumors 000 Molecules and Compounds 000 Benign Tumors 000 The Importance of Water 000 Malignant Tumors 000 Symptoms of Cancer 000 Mixtures: Solutions and Suspensions Diagnosis of Cancer 000 Chemical Bonds 000 Tissues and Aging 000 Ionic Bonds 000 Covalent Bonds 000 Compounds: Acids, Bases and Salts 000 The pH Scale 000 Buffers 000 Unit II Isotopes and Radioactivity 000 Use of Radioactive Isotopes 000 DISEASE AND THE FIRST LINE OF DEFENSE 000 Chemistry of Living Matter 000 Organic Compounds 000 5 Disease and Disease-Producing Organisms 000 Categories of Disease 000 Predisposing Causes of Disease 000 3 ells and Their Functions 000 The Study of Disease 000 The Role of Cells 000 Disease Terminology 000 Microscopes 000 Treatment and Prevention of Disease 000 Cell Structure 000 Complementary and Alternative Medicine 000 Plasma Membrane 000 Prevention of Disease 000 The Nucleus 000 Infectious Disease 000 The Cytoplasm 000 Modes of Transmission 000 Surface Organelles 000 Microbiology- The Study of Microorganisms 000 Cellular Diversity 000 Normal Flora 000 Protein Synthesis 000 Bacteria 000 Nucleic acids- DNA and RNA Viruses 000 Cell Division 000 Fungi 000 Stages of Mitosis 000 Protozoa 000 Movement of Substances Across the Plasma Parasitic Worms 000 Membrane 000 Roundworms 000 Movement That Does Not Require Cellular Energy 000 Flatworms 000 xxi xxii CONTENTS Microbial Control 000 Tumors 000 Microbes and Public Health 000 Infection 000 Aseptic Methods 000 Structural Disorders 000 Infection Control Techniques 000 Fractures 000 Antimicrobial Agents 000 Skeletal Changes in the Aging 000 Laboratory Identification of Pathogens 000 The Joints 000 Bacterial Isolations and Tests 000 More About Synovial Joints 000 Staining Techniques 000 Disorders of Joints 000 Other Methods of Identification 000 8 The Muscular System 000 6 The Skin in Health and Disease 000 Types of Muscle 000 Structure of the Skin 000 Smooth Muscle 000 Epidermis 000 Cardiac Muscle 000 Dermis 000 Skeletal Muscle 000 Subcutaneous Layer 000 The Muscular System 000 Accessory Structures of the Skin 000 Structure of a Muscle 000 Sebaceous (Oil) Glands 000 Muscle Cells in Action 000 Sudoriferous (Sweat) Glands 000 Energy Sources 000 Hair 000 Effects of Exercise 000 Nails 000 Types of Muscle Contractions 000 Functions of the Skin 000 The Mechanics of Muscle Movement 000 Protection Against Infection 000 Muscles Work Together 000 Protection Against Dehydration 000 Levers and Body Mechanics 000 Regulation of Body Temperature 000 Skeletal Muscle Groups 000 Collection of Sensory Information 000 Muscles of the Head 000 Other Activities of the Skin 000 Muscles of the Neck 000 Observation of the Skin 000 Muscles of the Upper Extremities 000 Color 000 Muscles of the Trunk 000 Lesions 000 Muscles of the Lower Extremities 000 Burns 000 Effects of Aging on Muscles 000 Tissue Repair 000 Muscular Disorders 000 Effects of Aging on the Integumentary System 000 Diseases of Muscles 000 Care of the Skin 000 Disorders of Associated Structures 000 Skin Disorders 000 Dermatitis 000 Psoriasis 000 Cancer 000 Unit IV Acne and Other Skin Infections 000 Alopecia (Baldness) 000 COORDINATION AND CONTROL 000 Allergy and Other Immune Disorders 000 9 The Nervous System: The Spinal Cord and Pressure Ulcers 000 Spinal Nerves 000 Role of the Nervous System 000 Structural Divisions 000 Functional Divisions 000 Unit III Neurons and Their Functions 000 Structure of a Neuron 000 MOVEMENT AND SUPPORT 000 Types of Neurons 000 7 The Skeleton: Bones and Joints 000 Nerves and Tracts 000 Bones 000 Neuroglia 000 Bone Structure 000 The Nervous System at Work 000 Bone Growth and Repair 000 The Nerve Impulse 000 Bone Markings 000 The Synapse 000 Bones of the Axial Skeleton 000 The Spinal Cord 000 Framework of the Skull 000 Structure of the Spinal Cord 000 Framework of the Trunk 000 The Reflex Arc 000 Bones of the Appendicular Skeleton 000 Medical Procedures Involving the Spinal Cord 000 The Upper Division of the Appendicular Skeleton 000 Diseases and Other Disorders of the Spinal Cord 000 The Lower Division of the Appendicular Skeleton 000 The Spinal Nerves 000 Disorders of Bone 000 Branches of the Spinal Nerves 000 Metabolic Disorders 000 Disorders of the Spinal Nerves 000 CONTENTS xxiii The Autonomic Nervous System (ANS) 000 12 The Endocrine System: Glands and Divisions of the Autonomic Nervous System 000 Hormones 000 Functions of the Autonomic Nervous System 000 Hormones 000 Hormone Chemistry 000 10 The Nervous System: The Brain and Cranial Hormone Regulation 000 The Endocrine Glands and Their Hormones 000 Nerves 000 The Pituitary 000 The Brain 000 The Thyroid Gland 000 Protective Structures of the Brain and Spinal Cord 000 The Parathyroid Glands 000 Cerebrospinal Fluid 000 The Adrenal Glands 000 The Cerebral Hemispheres 000 The Pancreas and Its Hormones 000 Functions of the Cerebral Cortex 000 The Sex Glands 000 Communication Areas 000 The Thymus Gland 000 Memory and the Learning Process 000 The Pineal Gland 000 The Diencephalon 000 Other Hormone-Producing Tissues 000 The Limbic System 000 Prostaglandins 000 The Brain Stem 000 Hormones and Treatment 000 The Midbrain 000 Hormones and Stress 000 The Pons 000 Aging and the Endocrine System 000 The Medulla Oblongata 000 The Cerebellum 000 Brain Studies 000 The Electroencephalograph 000 Unit V Disorders of the Brain and Associated Structures 000 Hydrocephalus 000 CIRCULATION AND BODY DEFENSE 000 Stroke and Other Brain Disorders 000 13 The Blood 000 Injury 000 Functions of the Blood 000 Degenerative Diseases 000 Transportation 000 Cranial Nerves 000 Regulation 000 Names and Functions of the Cranial Nerves 000 Protection 000 Disorders Involving the Cranial Nerves 000 Blood Constituents 000 Aging of the Nervous System 000 Blood Plasma 000 The Formed Elements 000 Hemostasis 000 11 The Sensory System 000 Blood Clotting 000 The Senses 000 Blood Types 000 Sensory Receptors 000 The ABO Blood Type Group 000 Special and General Senses 000 The Rh Factor 000 The Eye and Vision 000 Uses of Blood and Blood Components 000 Coats of the Eyeball 000 Whole Blood Transfusions 000 Pathway of Light Rays and Refraction 000 Use of Blood Components 000 Function of the Retina 000 Blood Disorders 000 Muscles of the Eye 000 Anemia 000 Nerve Supply to the Eye 000 Leukemia 000 Errors of Refraction and other Eye Disorders 000 Clotting Disorders 000 The Ear 000 Blood Studies 000 The Outer Ear 000 The Hematocrit 000 The Middle Ear and Ossicles 000 Hemoglobin Tests 000 The Inner Ear 000 Blood Cell Counts 000 Otitis and Other Disorders of the Ear 000 The Blood Slide (Smear) 000 Other Special Sense Organs 000 Blood Chemistry Tests 000 Sense of Taste 000 Coagulation Studies 000 Sense of Smell 000 Bone Marrow Biopsy 000 The General Senses 000 Sense of Touch 000 14 The Heart and Heart Disease 000 Sense of Pressure 000 Circulation and the Heart 000 Sense of Temperature 000 Location of the heart 000 Sense of Position 000 Structure of the Heart 000 Sense of Pain 000 The Pericardium 000 Sensory Adaptation 000 Special Features of the Myocardium 000 xxiv CONTENTS Divisions of the Heart 000 The Reticuloendothelial System 000 Blood Supply to the Myocardium 000 Disorders of the Lymphatic System and Lymphoid Function of the Heart 000 Tissue 000 Cardiac Output 000 Lymphedema 000 The Heart’s Conduction System 000 Lymphadenopathy 000 Control of the Heart Rate 000 Splenomegaly 000 Heart Sounds 000 Lymphoma 000 Heart Disease 000 Classifications of Heart Disease 000 17 Body Defenses, Immunity, and Vaccines 000 Congenital Heart Disease 000 Why Do Infections Occur? All are interdependent and work together as one tem are as follows (Fig. The nervous system serves as the chief coordinat- and spinal cord. Conditions both within and ◗ The peripheral (per-IF-er-al) nervous system (PNS) is outside the body are constantly changing.

Various combi- nations of fatty acids may be present buy bupron sr 150mg with visa depression symptoms in seniors. The fatty TG acid at carbon 2 of the glycerol is usually unsaturated cheap bupron sr 150 mg on line depression no motivation. The head group is the group Adipose attached to the phosphate on position 3 of the glycerol moiety. The TG of VLDL, produced in the liver, is group is choline, but ethanolamine, serine, digested by lipoprotein lipase (LPL) present on the lining cells of the capillaries in adipose inositol, or phosphatidylglycerol also may be and skeletal muscle tissue. Fatty acids are released and either oxidized or stored in tissues as present. Glycerol is used by the liver and other tissues that contain glycerol kinase. FA = fatty charged, and the head group may carry a posi- acid (or fatty acyl group). The inositol may be phosphorylated and, thus, Fatty acids, produced in cells or obtained from the diet, are used by various negatively charged. In the liver, triacylglycerols are produced from fatty acyl CoA and glycerol 3- phosphate. Phosphatidic acid serves as an intermediate in this pathway. The tria- cylglycerols are not stored in the liver but rather packaged with apoproteins and other lipids in very-low-density lipoprotein (VLDL) and secreted into the blood (see Fig. In the capillaries of various tissues (particularly adipose tissue, muscle, and the lactating mammary gland), lipoprotein lipase (LPL) digests the triacylglyc- erols of VLDL, forming fatty acids and glycerol (Fig. The glycerol travels to the liver and other tissues where it is used. Some of the fatty acids are oxidized by muscle and other tissues. After a meal, however, most of the fatty acids are con- verted to triacylglycerols in adipose cells, where they are stored. These fatty acids are released during fasting and serve as the predominant fuel for the body. Glycerophospholipids are also synthesized from fatty acyl CoA, which forms esters with glycerol 3-phosphate, producing phosphatidic acid. Various head groups H H are added to carbon 3 of the glycerol 3-phosphate moiety of phosphatidic acid, gen- erating amphipathic compounds such as phosphatidylcholine, phosphatidylinositol, O C C Hydrocarbon tail and cardiolipin (Fig. In the formation of plasmalogens and platelet-activat- O ing factor (PAF), a long-chain fatty alcohol forms an ether with carbon 1, replac- O C Fatty acid ing the fatty acyl ester (Fig. Cleavage of phospholipids is catalyzed by phos- O pholipases found in cell membranes, lysosomes, and pancreatic juice. O P O Head group Sphingolipids, which are prevalent in membranes and the myelin sheath of the central nervous system, are built on serine rather than glycerol. In the synthesis of O– sphingolipids, serine and palmityl CoA condense, forming a compound that is Fig. Reduction of this compound, followed by addition of a Carbon 1 of glycerol is joined to a long-chain second fatty acid in amide linkage, produces ceramide. Carbohydrate groups fatty alcohol by an ether linkage. The fatty attach to ceramide, forming glycolipids such as the cerebrosides, globosides, and alcohol group has a double bond between car- gangliosides (Fig. The addition of phosphocholine to ceramide produces bons 1 and 2. These sphingolipids are degraded by lysosomal enzymes. By the time of discharge, he had gained back 8 of the 22 lb he had lost and weighed 133 lb. Veere developed a craving for “sweet foods” O such as the candy he bought and shared with his new friend. After 6 months of this H N C Fatty acid high-carbohydrate courtship, Percy had gained another 22 lb and now weighed 155 lb, just 8 lb more than he weighed when his depression began.

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Radiographs showed severe varus posi- tion with a parallel talus and calcaneus (Figure C11 cheap bupron sr 150mg on line bipolar depression warning signs. Because of the fixed deformity order bupron sr 150 mg without prescription anxiety 30924, he had a closing wedge and lateral displacement osteotomy of the calcaneus (Fig- ure C11. After rehabilitation, his foot position in stance was neutral (Figure C11. However, the main complaint is usually skin breakdown from footrests while individuals are in the wheelchair. If surgical correction is de- sired, a choice has to be made between a triple arthrodesis and a talectomy. If there is some mobility in the foot that allows substantial correction under anesthesia, a triple arthrodesis can be performed with a tenotomy of the tib- ialis posterior at the level of the medial malleolus. Most of the severe de- formities are very stiff, and a talectomy is a simpler procedure that allows excellent correction. All these deformities that we treated have occurred in nonambulatory children in whom the symptomatic problem was skin break- down over the feet as they grew to adult size. Along with the talectomy, all the muscles are tenotomized, including the tendon Achilles, tibialis anterior, tibialis posterior, and peroneus brevis and longus. Both talectomy and triple arthrodesis provide stable long-term correction of the deformity in this group of individuals with limited demands on the feet. Outcome of Treatment There are no published data to evaluate the outcome of orthotic management of varus foot deformities. It is doubtful that there is a significant effect on the foot with the use of orthotics; however, the orthotics do allow children to be more stable and comfortable. Also, the use of orthotics allows children to grow and age so predicting the final development of the deformity is more clearly defined. The outcome of evaluating children with EMG, then applying an algo- rithm similar to that presented, reportedly yields good results in all cases. Reporting good results has been the trend in most other publica- tions96–98 that reported the results of tibialis posterior tendon surgery. Only in one study99 was an overcorrection rate of 15% reported with tibialis pos- terior tendon surgery. The outcome of these studies leads one to conclude that overcorrection from split transfer of the tibialis posterior is exceedingly rare; however, this is not the case (Case 11. In our review with an 8-year follow-up, we found a high rate of overcorrection in individuals with diple- gia and quadriplegia. Children with ambulatory diplegia had a 52% failure rate with 66% of those failing due to valgus overcorrection. Equinovarus due to quadriplegia had a failure rate of 66%, with 40% of those failing due to valgus overcorrection. Even children with hemiplegia can have over- correction, but it is much less likely as we found only 2 overcorrections of 39 feet. The endemic problem in this literature is that there is no objective way to evaluate these feet, and it is a well-known fact that mild to moderate planovalgus is better tolerated than mild to moderate varus. Therefore, these investigators probably tend to overlook valgus overcorrection because the children and caretakers are happier with valgus than with varus. However, over the long term, there is a tendency for these feet to fall into progressively worse valgus, some of which was probably caused by the tendon surgery and some of which was due to the natural history, with the tendon surgery just causing it to occur earlier. The optimistic outcome reports published in the literature of tibialis posterior tendon surgery for spastic equinovarus prob- ably reflect the outcome for children with hemiplegia only. Outcome reports of lengthening the tibialis posterior tendon as promoted by Ruda and Frost suggested an excellent outcome. One evaluated with the major parental concern being her walk- year after surgery, her gait was much improved except she ing up on her toes and in-toeing. Based on a full evalua- was already developing worsening valgus deformity in tion, she was believed to have significant anteversion of the left foot. This was treated with rigid in-shoe supra- the femurs, stiff knees in swing phase due to rectus spas- malleolar orthotics, which she tolerated well. Her gait and ticity, hamstring contracture limiting knee extension in foot deformity stabilized and seemed to improve slightly stance, equinovarus feet due to gastrocnemius contrac- by the 3-year follow-up; however, when she had signifi- ture, and spastic tibialis posterior. Based on this, she had cant weight gain with onset of puberty, she developed bilateral femoral derotation osteotomies, rectus transfer painful callosities and bunions that made orthotic wear to the sartorius, distal hamstring lengthening, gastrocne- difficult (Figures C11.

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Multiple spectrins can bind to each actin filament cheap bupron sr 150mg without prescription treatment of bipolar depression an update, resulting in a branched mem- brane cytoskeleton generic 150 mg bupron sr visa depression thesaurus. The spectrin cytoskeleton is connected to the membrane lipid bilayer by ankyrin, which interacts with -spectrin and the integral membrane protein, band 3. When the red blood cell is subjected to mechanical stress, the spectrin network rearranges. Some spectrin molecules become uncoiled and extended; others CHAPTER44 / THE BIOCHEMISTRY OF THE ERYTHROCYTE AND OTHER BLOOD CELLS 815 M V Bridge cleaved M N M 2+ N Fe N P V N P M Heme O2 heme CO, Fe2+ oxygenase A M V M M M V O N N N N H H H Biliverdin IXα NADPH biliverdin reductase NADP+ M V M M M V O N N N N H H H B H Fig. Bilirubin IXα Wright-stained cells, displaying the pale stain- ing in the center. A methylene bridge in heme is cleaved, releasing present in the preparation. Scanning electron micrograph, showing the biconcave disc structure of the become compressed, thereby changing the shape of the cell, but not its surface cells. These photographs were obtained, with permission, However, membrane lipids can be freely exchanged with circulating lipoprotein from Ross et al, Histology, A Text and Atlas lipids. The glutathione system protects the proteins and lipids from oxidative with Cell and Molecular Biology, 4th Ed. AGENTS THAT AFFECT OXYGEN BINDING The major agents that affect oxygen binding to hemoglobin are shown in Figure 44. Defects in erythrocyte cytoskeletal proteins lead to hemolytic anemia. As the membrane is lost, the red intermediate 1,3-bisphosphoglycerate, as indicated in Figure 44. As these cells become more energy required for the conformational changes that facilitate the binding of oxy- spherical, they are more likely to lyse in gen. Thus, 2,3-BPG lowers the affinity of hemoglobin for oxygen. Therefore, oxy- response to mechanical stresses in the circu- gen is less readily bound (i. Agents that affect oxygen binding trin, is linked to the plasma membrane either through interactions with ankyrin and band 3, by hemoglobin. Binding of hydrogen ions, 2,3 or with actin, band 4. Other proteins in this complex, but not shown, are bisphosphoglycerate, and carbon dioxide to tropomyosin and adducin. A view from inside the cell, looking up at the cytoskeleton. Proton Binding (Bohr effect) The binding of protons by hemoglobin lowers its affinity for oxygen (Fig. The pH of the Tissues Lungs 100 blood decreases as it enters the tissues (and the proton concentration rises) because the CO2 produced by metabolism is converted to carbonic acid by the reaction cat- 80 alyzed by carbonic anhydrase in red blood cells. Oxygen binds to hemoglobin, causing a Hb release of protons, which combine with bicarbonate to form carbonic acid. This 40 decrease of protons causes the pH of the blood to rise. Carbonic anhydrase cleaves the carbonic acid to H2O and CO2, and the CO2 is exhaled. Thus, in tissues in which 20 the pH of the blood is low because of the CO2 produced by metabolism, oxygen is released from hemoglobin. In the lungs, where the pH of the blood is higher because O CO2 is being exhaled, oxygen binds to hemoglobin. Effect of pH on oxygen saturation Although most of the CO2 produced by metabolism in the tissues is carried to the curves. As the pH decreases, the affinity of lungs as bicarbonate, some of the CO2 is covalently bound to hemoglobin hemoglobin for oxygen decreases, producing (Fig. In the tissues, CO2 forms carbamate adducts with the N-terminal the Bohr effect. In the CHAPTER44 / THE BIOCHEMISTRY OF THE ERYTHROCYTE AND OTHER BLOOD CELLS 817 A + Hb NH3 + CO2 RBC Hemoglobin Tissues CO2 H2O carbonic anhydrase H CO – + + 2 3 Hb N COO H H – Carbamate of hemoglobin HCO3 + Fig.

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