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Recall that extracellular pathogens are eliminated by antibodies produced by B cells erectile dysfunction and diabetes ppt discount cialis black 800 mg visa. Lymphocytes erectile dysfunction 70 year olds generic 800mg cialis black fast delivery, like all other hematopoietic cells erectile dysfunction treatment in unani buy cialis black with mastercard, are derived from a common pluripotential bone marrow stem cell. These stem cells give rise to myeloid cell precursor and the stem cell committed to lymphocytic lineages. Three lymphoid cell lineages lead to mature T and B cells (plasma cells) or natural killer cell formation. In humoral immunity, B lymphocytes secrete antibodies that primarily target extracellular microbes. In cellmediated immunity, T lymphocytes either activate macrophages to destroy phagocytosed microbes or kill infected cells. Fetal-maternal hemorrhage refers to the passage of fetal blood into the maternal circulation and is most often due to a breach in the integrity of the placental circulation. Allergens cross-link to allergen-specific IgE antibodies that are already located on the mast cell membranes (also basophils) from the first exposure to the allergen. Cross-linking of allergens to IgE antibodies results in an early phase reaction or immediate hypersensitivity that is characterized by mast cell/basophil release of preformed mediators (released within minutes after re-exposure of allergen). It is due to a backup of venous blood from decreased drainage into veins in the nasal mucosa. The nasal crease across the lower third of the nose (arrow) results from chronic upward rubbing of the nose with the hand (allergic salute). The schematic shows an incompatible blood transfusion where a patient who is blood group A with anti-B antibodies (IgG or IgM) inadvertently receives blood group B blood. The anti-B antibodies attach to the transfused B cells forming antigen-antibody complexes. These complexes then bind to Fc receptors on macrophages, where they are phagocytosed and destroyed. A, Binding of the antibody to the antigen on the surface of the cell activates complement, resulting in cell destruction. B, An antibody-dependent, cellular, cytotoxic reaction involves effector killer cells, which destroy the target cell coated with the antibody. Cross-linking FcR1 on eosinophils by IgE bound to helminth antigens may also induce eosinophil degranulation, releasing enzymes toxic to the parasites. IgE binds to Fc receptors on mast cells, and subsequent exposure to the allergen leads to crosslinking of subjacent IgE antibodies, causing activation of the mast cells and the release of preformed mediators. Not shown in the schematic is the late phase reaction, in which the mast cells synthesize and release prostaglandins, leukotrienes, and plateletactivating factor, which prolong the inflammatory response. Antigen-antibody immunocomplexes formed in blood deposit in tissue and activate complement, which attracts neutrophils that release enzymes and free radicals that damage the tissue. Localized formation of antigen-antibody complexes results in complement activation and leukocytic inflammation. Deposits of fibrin formed from its soluble precursor protein fibrinogen are prominent, accounting for the term fibrinoid necrosis, used to describe such lesions. The tissue lesions are caused by activated complement and leukocytes attracted to the site of antigen-antibody complex deposition.

Posterior 1/3 of posterior limb carries sensory fibers (including audio-visual pathways) acupuncture protocol erectile dysfunction generic 800mg cialis black with mastercard. Retrolenticular portion is caudal to the lentiform nucleus and carries the optic radiation (geniculo-calcarine tract) from the lateral geniculate body to the occipital visual cortex (calcarine fissure) erectile dysfunction treatment austin tx cialis black 800mg on line. Sublentiform portion is beneath the lentiform nucleus and carries the auditory pathway from the medial geniculate nucleus to the primary auditory cortex (superior temporal gyrus) guaranteed erectile dysfunction treatment cialis black 800mg generic. Pyramidal tract (corticospinal and corticonuclear tracts) constitutes a significant proportion of the internal capsule, carrying information from the upper motor neurones (in cerebral cortex) to the lower motor neurons (in brainstem and spinal cord) to modulate the skeletal muscle activity in the body. These fibers undergo decussation and end in the motor nuclei of the cranial nerves of the opposite side. Sensory fibres are carried by trigeminal system from the head region and fibres pass through the genu of internal capsule. Lateral and medial striate arteries from the middle and anterior cerebral arteries supply major part of internal capsule. Which of the following parts of the internal capsule are associated with acoustic radiation: a. Diencephalon Diencephalon is the part of the prosencephalon (forebrain), which includes thalamus and the related thalami. The ventricle of thalamus is the third ventricle, which lies in the midline between the two thalami. Thalamus Thalamus is a division of the diencephalon and is a relay and integration centre for the sensory and motor signals to the cerebral cortex. The two thalami form the lateral wall of the third ventricle and are interconnected by a flattened gray band (interthalamic adhesion), which passes through the ventricle. Thalamus has third order neurones, which in turn project on to the parietal sensory cortex (1,2,3). Spinothalamic tract-spinal lemniscal system (pain, temperature) and dorsal column- medial lemniscal system (tactile discrimination, vibration etc. Connections Thalamus receives input from all sensory systems except the olfactory system.

Definition: Deposition of calcium pyrophosphate dihydrate in cartilage and less commonly in tendons erectile dysfunction herbs purchase 800 mg cialis black visa, ligaments erectile dysfunction treatment australia buy cialis black 800mg free shipping, and synovial tissue 2 erectile dysfunction lab tests generic 800mg cialis black with mastercard. Radiograph of the knee shows linear calcification in the lateral meniscus, representing calcium pyrophosphate deposition in the articular cartilage (arrow). Diseases that have overlapping clinical features and evidence of a common etiology (1) Ankylosing spondylitis (2) Reactive arthritis (a) Reiter syndrome is associated with Chlamydia trachomatis urethritis. Definition: Seronegative spondyloarthropathy that initially targets the sacroiliac joint in young men; presents with bilateral sacroiliitis and morning stiffness b. Clinical findings in ankylosing spondylitis (1) Begins as bilateral (symmetric) sacroiliitis (pain and tenderness); eventually involves the vertebral column (Link 24-55) (a) Fusion of the vertebrae (bamboo spine) causes forward curvature of the spine (kyphosis;. Definition: Reactive type of seronegative spondyloarthropathy associated with urethritis, arthritis, conjunctivitis, and balanitis (inflammation of glans penis) b. Clinical findings in Reiter syndrome (1) Classic triad is arthritis, conjunctivitis, and a history of urethritis. Bone formation at the junction of the Achilles tendinitis with the plantar fascia is a confirmatory radiologic sign of Achilles tendinitis. Note the erosions and sclerosis (black arrows) along the iliac sides of the sacroiliac joints. Lateral radiograph of the lumbar spine demonstrating anterior squaring of the vertebrae (black arrows). Note swelling of the left Achilles tendon insertion into the bone (called enthesitis) and milder swilling of the right Achilles tendon insertion. C, New bone formation at the junction of the Achilles tendon with the plantar fascia in a patient with Reiter syndrome. D, Sterile conjunctivitis (note redness of the conjunctiva) in a patient with Reiter syndrome. Psoriatic arthritis typically involves the small joints of the hands, especially the distal interphalangeal joints (solid white arrows), leading to telescoping of one phalanx into another (pencil-in-cup deformity). Rash on the distal shaft and glans penis appears as vesicles, shallow ulcerations, or both. Clinical and radiographic findings in psoriatic arthritis (1) Patterns of joint involvement in psoriatic arthritis include peripheral joint disease. This is one of the infrequent but distinctive cutaneous findings associated with this syndrome. Nails also have onycholysis (separation of the nail from the nail bed) and an "oil drop" sign (yellow-orange discoloration of the nail; see. Definition: Inflammatory spondyloarthropathy associated with inflammatory bowel disease. Clinical findings in enteropathic arthritis (1) Association with ulcerative colitis or Crohn disease in 10% to 20% (2) Bacteria associations include Shigella spp. Definition: Painful infection of a joint; may occur via the bloodstream or direct inoculation. Viral arthritis: causes (1) Direct synovial invasion or via an immune reaction (2) Parvovirus B19 (a) Usually involves the hands (b) Adult infections can occur without rash (see Chapter 25) or fever. Definition: Multisystem inflammatory disease caused by Borrelia burgdorferi, a spirochete that is transmitted by the bite of an Ixodes tick (Link 24-68 A) b.

Cubital Fossa Cubital fossa is a triangular space on the anterior aspect of the elbow that is bounded by the brachioradialis muscle laterally erectile dysfunction drugs generic names order cialis black mastercard, pronator teres muscle medially erectile dysfunction medication free samples purchase discount cialis black on line, and superiorly by an imaginary horizontal line connecting the two epicondyles of the humerus impotence at age 30 800mg cialis black with mastercard. The contents (in medial to lateral order) are the median nerve, brachial artery, biceps tendon and radial nerve. From medial to lateral, the basilic, median cubital and cephalic veins lie in the superficial fascia (at the roof). Fascial roof is strengthened by the bicipital aponeurosis on which runs the antecubital vein draining cephalic vein into the basilic vein. The contents of the cubital fossa are compromised specifically the median nerve and brachial artery. The muscles are replaced by fibrous tissue, which contracts, producing the flexion deformity. Brachial artery is medial to biceps tendon Mammary Gland Breast It lies in the superficial fascia of the anterior chest wall overlying the pectoralis major and serratus anterior muscles. Extends over the second to sixth ribs and from the sternum to the midaxillary line, nipple lies at the level of the fourth intercostal space. It lies in the superficial fascia, supported by the suspensory ligaments (of Cooper), strong fibrous attachments, that run from the dermis of the skin to the deep layer of the superficial fascia (pectoral fascia) running through the breast. Upper Limb It is separated from the deep fascia covering the underlying muscles by retromammary space (allows movement of breast over the pectoralis major muscle). It has the axillary tail, a small part of the mammary gland that extends superolaterally through the deep fascia to enter the axilla. There are 15 to 20 lobes of glandular tissue, which are separated by fibrous septa that radiate from the nipple. Each lobe opens by a lactiferous duct onto the tip of the nipple, which enlarges to form a lactiferous sinus (stores milk). During surgery radial incisions should be put to avoid damaging the lactiferous ducts. Additional venous drainage from the breast is to the internal thoracic vein via medial mammary veins, anterior intercostal veins, and posterior intercostal veins (drain into the azygos system). Metastasis of breast carcinoma to the brain may occur by the following route: Cancer cells enter an intercostal vein external vertebral venous plexuses internal vertebral venous plexus cranial dural sinuses. Nerve supply: Anterior and lateral cutaneous branches of the second to the sixth intercostal nerves. Lymphatics Lymph Drainage from the Lateral Quadrant Majority of the lymph (>75%) drains as follows: Axillary nodes (humeral, subscapular, pectoral, central, and apical) infraclavicular and supraclavicular nodes right subclavian lymph trunk (for the right breast) or left subclavian lymph trunk (for the left breast). Remaining (25%) of lymph drainage occurs via the interpectoral, deltopectoral, supraclavicular, and inferior deep cervical nodes.

Contains left anterior descending coronary artery Atrioventricular groove (coronary sulcus) separates atria from ventricles erectile dysfunction due to diabetic neuropathy 800mg cialis black free shipping. Right coronary artery lodges in right part of coronary sulcus and left coronary artery gives circumflex branch in left part of coronary sulcus impotence curse order cialis black 800mg mastercard. Left anterior descending coronary artery runs in the anterior interventricular groove erectile dysfunction drugs in nigeria cheap 800 mg cialis black fast delivery. Heart Chambers Right atrium has an anterior rough-walled portion (atrium proper and the auricle) lined with pectinate muscles and a posteriorly situated smooth-walled (sinus venarum) into which the two venae cavae open. Sulcus terminalis is a groove on the external surface of the right atrium (embryologic junction of the sinus venosus and primitive atrium) corresponding to crista terminalis on internal surface. Pectinate muscles are the prominent ridges of atrial myocardium located in the interior of both auricles and the right atrium. The interior of minimi) auricle presents reticular sponge-like network of the muscular ridges 608 Thorax Right atrium is larger but thinner than the left atrium. Right auricle is the conical muscular pouch of the upper anterior portion of the right atrium, it covers the proximal part of the right coronary artery. Fossa ovalis is an oval-shaped depression in the interatrial septum and represents the site of the foramen ovale, through which blood runs from the right atrium to the left atrium in fetal circulation. It has an upper rounded (horseshoe-shaped) margin known as limbus fossa ovalis. Four valveless pulmonary veins from lungs (oxygenated blood) open into the left atrium. Right ventricle is largely evident anteriorly and contributes to the major portion of the sternocostal surface of the heart. Trabeculae carneae are irregular anastomosing muscular ridges, which form the trabeculated part of the ventricles (inflow tract) and develop embryologically from the primitive ventricle. Supraventricular crest (a C-shaped internal muscular ridge), marks the junction between the trabeculated part and smooth part of the right ventricle. Papillary muscles are cone-shaped muscles enveloped by endocardium, extend from the anterior and posterior ventricular walls and the septum, and their apices are attached to the chordae tendineae. These contract to tighten the chordae tendineae, preventing the cusps of the tricuspid valve from being everted into the atrium, preventing regurgitation of ventricular blood into the right atrium. Chordae tendineae extend from one papillary muscle to more than one cusp of the tricuspid valve. It is called the moderator band for its ability to prevent overdistention of the ventricle and carries the right limb (Purkinje fibers) of the atrioventricular bundle from the septum to the sternocostal wall of the ventricle. Table 29: Differences of inflowing and outflowing parts of the right ventricle Inflowing lower part It develops from primitive ventricle It is large in size and lies below the supraventricular crest Outflowing upper part It develops from bulbus cordis It is small in size and lies above the supraventricular crest It is rough due to presence of the muscular ridges-the trabeculae It is smooth and forms upper 1 inch conical part of the right ventricular carneae. It forms most of the right ventricular chamber chamber-the infundibulum, which gives rise to pulmonary trunk Left ventricle is mainly evident at the posterior view of the heart, its apex is directed downward, forward, and towards the left. Crista terminalis divides right atrium into smooth posterior part and rough anterior part. Superior vena cava Inferior vena cava opening is guarded by eustachian valve (rudimentary), coronary sinus by Thebesian valve and atrioventricular opening by tricuspid valve. Aortic sinus bulging into right atrium Torus aorticus (aortic mound) is the prominent region of the right atrial septum, which marks the projection of the noncoronary aortic sinus into the right atrial wall. Because the esophagus is so close to the upper chambers of the heart, clear images of those heart structures and valves can be obtained. Valves Heart valves are situated around the fibrous rings of the cardiac skeleton and are lined with endocardium. They incorporate leaflets or cusps, which close together to seal and prevent backflow.

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