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One can easily appreciate that abnormal leakage of K vascular system (e 30g acticin overnight delivery. A variety of factors influence the distribution of K be- tween cells and ECF (Fig purchase 30g acticin with mastercard. If this enzyme is inhibited—as a result of in- adequate tissue oxygen supply or digitalis overdose, for ex- Potassium (K ) is the most abundant ion in the ICF com- ample—hyperkalemia may result. It has many important effects in the body, and its 2) A decrease in ECF pH (an increase in ECF [H ]) tends plasma concentration is closely regulated. When a mineral acid such as HCl is added to the ECF, a fall in blood pH of 0. When an organic acid (which can penetrate plasma membranes) is Acid-Base Balance, and Metabolism added, the rise in plasma K for a given fall in blood pH is As the major osmotically active solute in cells, the amount considerably less. The fact that blood pH influences plasma of cellular K is the major determinant of the amount of [K ] is sometimes used in the emergency treatment of hy- water in (and, therefore, the volume of) the ICF compart- perkalemia; intravenous infusion of a NaHCO3 solution ment, in the same way that extracellular Na is a major de- (which makes the blood more alkaline) will cause H to terminant of ECF volume. When cells lose K (and accom- move out of cells and K , in exchange, to move into cells. This effect appears to be a result of stim- 418 PART VI RENAL PHYSIOLOGY AND BODY FLUIDS Shift K+ to Shift K+ + Ingested K outside of cells into cells 100 mEq/day Body cell Input ECF pH, ECF pH, digitalis, K+ insulin, O2 lack, epinephrine Bone, dense ATP hyperosmolality, connective tissue, hemolysis, cartilage K+ ADP + Pi Extracellular Intracellular infection, 300 mEq fluid K+ + + fluid K ischemia, Na 60 mEq 3,300 mEq trauma Transcellular fluid K+ K+ H+ + HCO - CO + H O 40 mEq 3 2 2 H+ K+ Output + Urinary K K+ in feces excretion 10 mEq/day FIGURE 24. In- sulin (administered with glucose) is also used in the emer- gency treatment of hyperkalemia. In chronic renal failure, hyperkalemia usually does shrink and raises intracellular [K ], which then favors out- not develop until GFR falls below 15 to 20 mL/min because ward diffusion of K into the ECF. The major cause of renal K wasting is iatro- pseudohyperkalemia, results if blood has been mishandled genic, an unwanted side effect of diuretic drug therapy. In un- The plasma [K ] is sometimes taken as an approximate controlled diabetes mellitus, K loss is increased because of guide to total body K stores. For example, if a condition the osmotic diuresis caused by glucosuria and an elevated is known to produce an excessive loss of K (such as taking rate of fluid flow in the cortical collecting ducts. Several a diuretic drug), a decrease in plasma [K ] of 1 mEq/L may rare inherited defects in tubular transport, including Bart- correspond to a loss of 200 to 300 mEq K.

Advanced stages of gonorrhea in females may infect the uterus and the uter- ine tubes discount acticin 30g without a prescription. A pregnant woman with gonorrhea who is not treated may transmit the bacteria to the eyes of her newborn during its passage through the birth canal buy generic acticin 30g, possibly causing blindness. Syphilis is less common than gonorrhea but is the more serious of the two diseases. During the primary stage of syphilis, a lesion called a chancre develops at the point where contact was made with a similar sore on an infected person. The chancre per- sists for 10 days to 3 months before the disease enters the sec- ondary stage, which is characterized by lesions or a skin rash (fig. This stage lasts from 2 weeks to 6 months, and the symptoms disappear of their own accord. The tertiary stage of untreated syphilis may occur 10 to 20 years FIGURE 20. This stage is characterized by de- generative changes in various systems of the body that may lead to blindness, insanity, and death. Acquired immune deficiency syndrome (AIDS) is a viral disease that is transmitted primarily through intimate sexual con- tact and through drug abuse (by sharing contaminated syringe needles). Additional information about this fatal disease, for which there is no known cure, is presented in table 20. Male Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 722 Unit 7 Reproduction and Development Disorders of the Prostate It, too, is common in males over 60 and accounts for about 25,000 deaths annually. The metastases of this cancer to the The prostate is subject to several disorders, many of which are spinal column and brain are generally what kills the patient. The four most frequent prostatic prob- vanced prostatic carcinoma is treated by removal of the prostate lems are acute prostatitis, chronic prostatitis, benign prostatic hyper- and frequently by removal of the testes, or orchiectomy trophy, and carcinoma of the prostate. An orchiectomy eliminates testosterone secre- Acute prostatitis is common in sexually active young men tion, which inhibits the growth of prostate cancer cells. The symptoms of acute prostatitis are a swollen and tender prostate, painful urination, and in extreme conditions, pus dripping from Disorders of the Testes and Scrotum the penis.

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The driver Information gained from these tests may of the other car was only slightly injured; be used for diagnosis acticin 30g online, monitoring of however purchase acticin 30g with amex, Mr. When admitted to the trauma unit, tion to assessing cognitive processes, most his Glasgow Coma Scale was recorded as neuropsychological tests also assess per- 9. While at the rehabil- tial abilities, and emotional and personal- itation center, he worked on learning how ity consequences of brain damage or to walk, talk, and regain physical strength dysfunction. Residuals from his head Examples of commonly used neuropsy- injury include mild dysarthria. In addi- chological tests are the Wechsler Intelli- tion, he has developed a seizure disorder, gence Scales, the Wechsler Memory Scales, having experienced several grand mal the Halstead-Reitan Neuropsychological seizures for which he is currently receiv- Test Battery, and the Luria Nebraska ing medication, which appears to control Neuropsychological Battery. PSYCHOSOCIAL ISSUES IN NERVOUS Questions SYSTEM CONDITIONS INVOLVING THE BRAIN 1. What other potential residual effects might you expect resulting from Mr. What specific accommodations would tion and rehabilitation, he returned home, you expect Mr. What psychosocial issues might you at work, was taken to the emergency consider in Mr. Physical Medicine and Rehabilitation; A comparison of acute and postdischarge predic- State of the Art Reviews, 6, 1–19. Rehabilitation Counseling Bulletin, spective: Review of results of a community-based 47(2), 112–120, 122. New York: Demos mild traumatic brain injury: A review of current Publications. Mild traumatic brain injury traumatic brain injury: Coma, the vegetative state, in persons with multiple trauma: The problem of and the minimally responsive state. A psychodynam- Rehabilitation treatment of sexuality issues due to ic model of behavior after acute central nervous acquired brain injury. Driving considerations following mild traumatic brain after brain injury. Sexuality issues NIH Consensus Development Panel on among survivors of traumatic brain injuries.

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Basset RW cheap 30g acticin with amex, Cofield RH (1983) Acute tears of the rotator cuff: the The most commonly affected muscles are those innervat- timing of surgical repair buy acticin 30g with visa. Clin Orthop 175:18-24 ed by the suprascapular nerve, including the supra- and Beltran J, Bencardino J, Mellado J, Rosenberg ZS, Irish RD (1997) infraspinatus. The deltoid muscle can also be compro- MR arthrography of the shoulder: Variations and pitfalls. Later in the Radiographics 17:1403-1412 Beltran J, Rosenberg ZS, Chandanani VP, Cuomo F, Beltran S, course of the disease, there may be muscle atrophy, man- Rokito A (1997) Glenohumeral instability: evaluation with ifested by decreased muscle bulk. Radiographics 3:657-673 Blacksin MF, Ghelman B, Freiberger RH, Salvati E (1990) Inflammatory and Other Miscellaneous Lesions Synovial chondromatosis of the hip: evaluation with air com- puted arthrotomography. Clin Imaging 14:315-318 Bureau NJ, Dussault RG, Keats TE (1996) Imaging of bursae The manifestations of idiopathic synovial osteochondro- around the shoulder joint. Skeletal Radiol 25:513-517 matosis on MRI depend on the degree of calcification or Burkhead WZ Jr (1990) The biceps tendon. WB Saunders, Philadelphia, tion is present, it may simulate a joint effusion, with low p 791 Campeau NG, Lewis BD (1998) Ultrasound appearance of syn- SI on T1-weighted images and high SI on T2-weighted ovial osteochondromatosis of the shoulder. However, high-resolution MRI may be able to 73:1079-1081 demonstrate a signal that is more inhomogeneous than Cervilla V, Schweitzer ME, Ho C, Motta A, Kerr R, Resnick D fluid. If calcifications are present, these will manifest (1991) Medial dislocation of the biceps brachii tendon: ap- themselves as multiple small foci of decreased SI on both pearance at MR imaging. Radiology 180(2):523-526 Chung C, Coley BD, Martin LC (1998) Rice bodies in juvenile T1- and T2-weighted pulse sequences, surrounded by rheumatoid arthritis. Am J Roentgenol 170:698-700 high SI haloes on T2-weighted images, which represent Chung CB, Dwek JR, Feng S, Resnick D (2001) MR arthrography of the cartilaginous coverage. The presence of low-SI mate- the glenohumeral joint: a tailored approach. Recht Crotty JM, Monu JU, Pope TL Jr (1996) Synovial osteochondro- yapatite crystals, active collagenase, and neutral protease with matosis. Arthritis Rheum Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF (1997) 24:464-473 Traumatic tears of the subscapularis tendon.