By S. Kasim. LeMoyne-Owen College.

These devices do not permit knee rotation and are subject to failure (loosening) in pa- Bone In-growth and Porous Coating tients whose activity level is high order panadol 500mg mastercard. Porous coating panadol 500mg amex, while significantly adding to the cost of Patellofemoral: Either as part of a total knee replacement, joint replacement, may significantly improve implant when a polyethylene “button” is cemented into the articu- longevity. Beads of a similar alloy are sintered onto the lar surface of the patella, or as a specific patellofemoral metallic components, permitting bony in-growth to occur joint replacement when the major knee compartments are without the need for intervening cement. Clearly, this requires stability to allow in-growth to occur, with implications for the postoperative period. Normal Appearances Anticipated normal plain-film appearances include re- sorption of medial femoral cortex at the calcar femoris Hip Replacements (98%), reduced bone density where it is unloaded, the ab- sence of a thin lucent rim around the implant, although The following features on plain film suggest an ideal po- such a lucency with a sclerotic margin is common (79%) sition for a total hip replacement. A lucent line of more than 2 mm implies unacceptable tion angle should be about 40±10° on an AP view. It is also normal to see endosteal sclerosis at the Acetabular anteversion should measure 0–30° on a true tip of a prosthesis (36%), localized periosteal new bone lateral view. The femoral component should be coaxial and cortical thickening, representing altered stress loading with the femoral shaft. Acetabular screws, if used, should (12%) and a degree of prosthetic subsidence (7%). The lucent line has Complications of Joint Replacement a sclerotic margin and develops during the first 2 years after insertion. A metal- joints, including pain and other symptoms, for which no bone lucency may be present immediately after surgery cause may be found. In addition, not all abnormal joint replace- quential radiographs for cemented devices whereas slight ments are associated with symptoms.

It is covered by the dura mater and is supported by the sella turcica of the sphenoid bone buy panadol 500 mg low cost. The cerebral arterial circle surrounds the highly vascular pituitary gland purchase panadol 500 mg with amex, providing it with a FIGURE 14. The adenohypophysis consists of two parts in adults: (1) the pars distalis (anterior pituitary) is the bulbar portion, and (2) the hypothalamus continues to secrete the releasing factor until a given pars tuberalis is the thin extension in contact with the in- level of hormones is present in the body fluids and is detected by fundibulum (fig. A pars intermedia, a strip of tissue be- the hypothalamus through a negative feedback mechanism. During fetal development, its cells mingle with those of the anterior Knowledge Check lobe, and in adults they no longer constitute a separate structure. What are some of the ways in which endocrine and ex- The neurohypophysis is the neural part of the pituitary ocrine glands differ structurally? How are the nervous and endocrine systems functionally which is in contact with the adenohypophysis, and the funnel- related? Also list the organs that serve other body functions, in addition to secreting hormones. Using diagrams, describe the mechanism of steroid hor- mone action and the mechanism of protein hormone ac- tion within cells. List the three kinds of hormones, give examples of each, into the nasal cavity) and describe their chemical compositions. Endocrine System © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 14 Endocrine System 461 Anterior Third ventricle cerebral artery Optic chiasma Cerebral cortex Hypothalamus Optic nerve Oculomotor nerve Pituitary stalk Trochlear nerve Posterior Anterior lobe lobe of of pituitary pituitary gland gland Sphenoidal Basilar artery sinus Sphenoid Sella turcica bone Waldrop (a) FIGURE 14. Endocrine System © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 462 Unit 5 Integration and Coordination Chromophobes Chromophils GH is regulated by growth hormone–releasing hormone (GH–RH) and growth hormone–inhibiting hormone (GH–IH), or somatostatin, from the hypothalamus. The precise mechanism of GH is not understood, but it seems to promote the movement of amino acids through cell membranes and the utilization of these substances in pro- tein synthesis. Pathological hyposecretion of GH during adolescence limits body growth, causing a type of dwarfism. In both of these conditions, body proportions are greatly distorted (see fig. In this condition, the soft tissues rapidly proliferate and certain body features, such as the hands, feet, nose, jaw, and tongue, become greatly distorted (see fig.

Combined effects of the autoimmune response cause the demyelination buy discount panadol 500mg line, axonal damage panadol 500mg mastercard, and scarring seen in patients with MS 2. How many exacerbations, with neurologic symptoms referable to lesions in the white matter of the CNS, must a patient experience before a definite diagnosis of MS can be made? On onset, MS follows a relapsing-remitting pattern in approximately what percentage of patients? Continuing care needs of a patient with relapsing-remitting MS do not include: a. Ensuring adequate access to medications and adaptive equipment 113 114 NURSING PRACTICE IN MULTIPLE SCLEROSIS: A CORE CURRICULUM b. Sustaining care for patients with advanced MS may include all except which of the following? Recommending installation of adaptive hand controls on the patient’s automobile d. Agents that may help reduce symptoms of fatigue include all of the following except: a. Interferons and glatiramer acetate should be started early in the disease because they do all of the following except: a. Which of the following complications should a nurse caring for a patient with advanced MS be alert to? As part of continuing care for patients with relapsing-remitting MS who have experienced a relapse, the nurse will need to do all of the following except: a. Emphasize the importance of continuing treatment CHAPTER 22: CERTIFICATION STUDY QUESTIONS 115 b. Help the patient to establish realistic expectations of the drug therapy 12. Which of the following statements about the role of MS nurses is not correct? Cost containment pressures brought about a dramatic and ongoing expansion in the role of the nurse b. The MS nurse provides primary, acute, specialized, and reha- bilitative care for patients with multiple sclerosis d.

Specialized serous mem- with saliva (mastication); initiates digestion of branes support the GI tract and provide a structure through which carbohydrates; forms and swallows soft mass of nerves and vessels pass generic panadol 500mg online. The wall of the GI tract is composed of chewed food called bolus (deglutition) four tunics buy panadol 500mg low cost. Pharynx Receives bolus from oral cavity; autonomically continues deglutition of bolus to esophagus Objective 4 Describe the arrangement of the serous Esophagus Transports bolus to stomach by peristalsis; lower membranes within the abdominal cavity. These organs are supported and covered by down chyme; absorbs nutrients; transports wastes serous membranes that line the cavities of the trunk and cover through peristalsis to large intestine; prohibits the organs within these cavities. Serous membranes are com- backflow of intestinal wastes from large intestine posed of simple squamous epithelium, portions of which are rein- Large intestine Receives undigested wastes from small intestine; absorbs forced with connective tissue. Serous membranes secrete a water and electrolytes; forms, stores, and expels feces when activated by a defecation reflex lubricating serous fluid that continuously moistens the associ- ated organs. The parietal portion of the serous membrane lines the body wall, and a visceral portion covers the internal organs. As de- scribed in the previous chapter, the serous membranes associated with the lungs are called pleurae (see fig. The serous It usually takes about 24 to 48 hours for food to travel the membranes of the abdominal cavity are called peritoneal mem- length of the GI tract. Along the posterior abdominal cavity, the pari- specific functions in preparing food for utilization (table 18. The mesentery so many people are malnourished that eating patterns have supports the GI tract, at the same time allowing the small intes- become a critical public health concern. Grossly overweight people are at greater risk for cardiovas- ture for the passage of intestinal nerves and vessels. People with good nutritional habits are better able to withstand mesocolon is a specific portion of the mesentery that supports trauma, are less likely to get sick, and are usually less seriously ill the large intestine (fig. The peritoneal covering continues around the intestinal viscera as the visceral peritoneum. The peritoneal cavity is the Knowledge Check space between the parietal and visceral portions of the peri- toneum.

Bristow safe 500 mg panadol, LJ buy panadol 500mg overnight delivery, Kramer, MS, Kulagowski, J, Patel, S, Ragan, CI and Seabrook, GR (1997) Schizophrenia and L745,870, a novel dopamine D4 receptor antagonist. Busatto, GF and Kerwin, RW (1997) Perspectives on the role of serotonergic mechanisms in the pharmacology of schizophrenia. Chiodi, LA and Bunney, BS (1983) Typical and atypical neuroleptics: differential effects of chronic administration on the activity of A9 and A10 midbrain dopamine neurones. Dalley, JW and Webster, RA (1993) Dopamine-like effects of clozapine on spontaneously active neurons in the rat prefrontal cortex. Farde, L (1996) The advantage of using positron emission tomography in drug research. Farde, L, Wiesel, FA, Nordstrom, AL and Sedvall, G (1989) D1 and D2 dopamine receptor occupancy during treatment with conventional and atypical neuroleptics. Geyer, MA, Swerdlow, NR, Mansbach, RS and Braff, DL (1990) Startle response models of sensorimotor gating and habituation deficits in schizophrenia. Grace, AA, Bunney, BS, Moore, H and Todd, CL (1997) Dopamine-cell depolarization block as a model for the therapeutic actions of antipsychotic drugs. Ishimaru, M, Kurumaji, A and Toru, M (1994) Increases in strychnine-insensitive glycine binding sites in cerebral cortex of chronic schizophrenics: evidence for glutamate hypothesis. Kerwin, R (1992) A history of frontal and temporal lobe aspects of the neuropharmacology of schizophrenia. Knoble, MB and Weinberger, DR (1997) Dopamine, the prefrontal cortex and schizophrenia. Lidow, MS, Williams, GV and Goldman-Rakic, PS (1998) The cerebral cortex: a case for a common site of action of antipsychotics.