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WA Rocca generic bupron sr 150mg visa, JH Bower cheap bupron sr 150mg without prescription, SK McDonnell cheap 150 mg bupron sr mastercard, BJ Peterson, DM Maraganore. Time trends in the incidence of parkinsonism in Olmsted County, Minnesota. M Baldereschi, A De Carlo, WA Rocca, P Vanni, S Maggi, E Perissinotto, F Grigoletto, L. Parkinson’s disease and parkinsonism in a longitudinal study. R Mayeux, K Marder, LJ Cote, N Hemenegildo, H Mejia, MX Tang, R Lantigua, D Wilder, B Gurland, A Hauser. The frequency of idiopathic Parkinson’s disease by age, ethnic group, and sex in northern Manhattan, 1988–1993. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. GW Ross, LR White, H Petrovitch, DG Davis, J Hardman, J Nelson, W Markesbery, DM Morens, A Grandinetti. Lack of association of midlife smoking or coffee consumption with presence of Lewy bodies in the locus ceruleus or substantia nigra at autopsy. A Elbaz, JH Bower, DM Maraganore, SK McDonnell, BJ Peterson, JE Ahlskog, DJ Schaid, WA Rocca. Risk tables for parkinsonism and Parkinson’s disease. In: A Bicentenary Volume of Papers Dealing with Parkinson’s Disease. M Critchley, WH McMenemey, FMR Walshe, JG Greenfield, eds. Historical review: abnormal movements associated with epidemic encephalitis lethargica. A neurological syndrome associated with orthostatic hypotension. Progressive supranuclear palsy: a heterogeneous degeneration involving the brain stem, ganglia and cerebellum with vertical gaze and pseudobulbar palsy, nuchal dystonia and dementia. An early photographic case of probable supranuclear palsy. The clinical and pathologic hallmarks of progressive supranuclear palsy. IG McKeith, EK Perry, RH Perry, for the Consortium on Dementia with Lewy Bodies. Report of the second dementia with Lewy body international workshop. AR Merdes, LA Hansen, G Ho, D Galasko, CR Hofstetter, LJ Thal, J Corey- Bloom. Proceeding of 126th Annual Meeting of the American Neurological Association 2001; 30(abstr). RK Mosewich, AH Rajput, A Shuaib, B Rozdilsky, L Ang. Pulmonary embolism: an under-recognized yet frequent cause of death in parkinsonism. Causes of death in a community-based study of Parkinson’s disease. DD Webster Critical analysis of disability in Parkinson’s disease. Death rates from Parkinson’s disease in Norway reflect increased survival. RJ Uitti, JE Ahlskog, DM Maraganore, MD Muenter, EJ Atkinson, RH Cha, PC O’Brien. Levodopa therapy and survival in idiopathic Parkinson’s disease: Olmsted County project.

Neurologic Control of the Musculoskeletal System 139 tective response to falling purchase bupron sr 150mg line, they should be wearing protective helmets and have supervision when walking 150mg bupron sr with amex. There are some children who cannot learn this protective response buy generic bupron sr 150 mg on line, and they will have a tendency to fall like a cut tree; this is especially dangerous if the individual has a tendency to fall backward, which places them at high risk of head injury. These children will have to be kept in wheelchairs except when they are under the direct supervision of an- other individual. The second area of treatment focus for children with ataxia should be directed at exercises that stimulate balancing. These exercises in- clude single-leg stance activities, walking a narrow board, roller skating, and other activities that stimulate the balancing system. These exercises have to be carefully structured to the individual child’s abilities, with the goal of maximizing each child’s ability safely and effectively. Walking effectively as an adult requires an individual to be able to alter gait, speed, and especially to slow down speed to reserve energy as she tires. This may mean using an assistive device, such as forearm crutches. For safety and social propriety, it is important that an individual can stop walking and stand in one place. Children who cannot learn to stop and stand in one place will have to switch to the use of an assistive device, usually forearm crutches, in middle childhood or adolescence. This step may seem like a regression to parents; however, it is moving the child forward to a more stable gait pat- tern that is socially acceptable and functional into adulthood. It is appro- priate for 3-year-old children to run and then fall when they get to where they are going and want to stop; however, this method in a 13-year-old would be both unsafe for the child and socially unacceptable. Finding the appropriate device requires some trial and error. There are rare children who can use single-point canes. Three- or four-point canes are a poor choice because they slow the child too much and are generally very inefficient. Either forearm crutches or a walker are typically the best assistive devices for an individual child. Some children’s ataxia is so severe that it requires the use of a wheel- chair for safe and functional mobility. Surgery for the Child with Ataxia The sensory perception and processing of balance cannot be altered in any predictable known way with surgery; however, the mechanical stability can be altered. Mechanical stability means that children have a stable base of support upon which to stand. Children with severe equinus at the ankle, such that they can only stand on their toes, will be unstable even if their balance is otherwise normal. Other examples of mechanical instability are severe planovalgus or equinovarus feet, severe fixed scoliosis, or severe contractures of the hip and knee. In general, the spine, hip, and knee contractures need to be very severe before they substantially affect balance. Fixed ankle equinus is the most common situation that is seen in early and middle childhood. Many of these children walk very well on their toes when they are moving with sufficient speed; however, they have no stable ability to stand in one place; this means that the children have to hold onto a wall, keep moving around in a circle, or fall to the floor when they want to stop. When these same children are made more stable by lengthening the gastrocnemius mus- cle to allow their feet to become plantigrade, their walking velocity slows, but they can now stop and stand in one place. This trade-off of stability and stance versus the speed of walking needs to be explained to parents to avoid their disappointment in the slower walking. This kind of fast toe walking is not a reasonable long-term option for older children for the safety reasons already explained.

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A saw seldom needs to be used for adolescent bunions or spastic bunions in the same way it is used for adult bunions (Figure S5 buy bupron sr 150mg on line. If the joint surface looks good and the child is a functional ambulator buy discount bupron sr 150mg line, attempts at a realignment procedure are preferred cheap bupron sr 150mg with visa. An incision is made on the medial side between the first and second toes, carried down through the subcutaneous tissue, and the tendons of the adductor hallucis and the flexor hallucis brevis are identified where they insert into the sesamoid and the capsule. A knife is utilized and these tendons are resected sharply off their in- sertion. The medial capsule of the first metatarsal phalangeal joint is opened, and the sesamoid is visualized (Figure S5. If the radiograph demonstrates a significant metatarsus primus varus, usually greater than 10°, an osteotomy of the metatarsal is re- quired (Figure S5. If the radiograph demonstrates significant valgus of the proximal pha- lanx, a proximal phalangeal osteotomy is required (Figure S5. The first metatarsal osteotomy is performed by making a separate dorsal incision just lateral to the extensor hallucis longus tendon and carried down to the subcutaneous tissue. Subperiosteal dissec- tion is undertaken of the medial half of the first metatarsal, avoiding the epiphysis if the epiphysis is opened. Retractors are placed on the medial and lateral side of the first meta- tarsal, and a proximally directed dome osteotomy is performed at 1016 Surgical Techniques Figure S5. This osteotomy should be directly vertical to the longitudinal axis of the foot and therefore will be oblique from dor- sal proximal to plantar distal in the metatarsal. The metatarsus primus varus is corrected by pressure on the lateral border of the proximal first metatarsal and medial pressure on the 5. The osteotomy is fixed with an intrafragmentary screw going from dorsal to plantar, or it can be fixed with cross K- wires (Figures S5. If the proximal phalanx is in valgus, an osteotomy is made at the distal middle third section of the proximal phalanx using a small os- cillating saw. A medial-based wedge is removed, leaving the lateral cortex intact. Then, a fracture of the lateral cortex is produced with correction of the valgus deformity, and the osteotomy is stabilized with a K-wire (Figure S5. There is overlapping of the plantar medial joint capsule to align the sesamoids under the distal end of the first metatarsal (Figure S5. The first metatarsal joint is now aligned to neutral, and the distal- based flap is sutured back to the metatarsal to maintain this correc- tion (Figure S5. All the wounds are closed and a soft dressing is applied, with a bulky dressing between the first and second metatarsal. Usually, a short-leg cast is applied because this procedure almost al- ways is performed in combination with hindfoot correction. A small wrap is placed around the great toe to hold it in correct alignment. Immobilization is required for 4 to 6 weeks until the osteotomies have healed. Postoperative orthotic use usually is not indicated. If the articular surface has severe degenerative changes, or if the child is a nonambulator, a metatarsal phalangeal joint fusion is indicated. Cartilage should be removed utilizing an oscillating saw and resect- ing only the distal half of the articular surface of the first metatarsal. This cartilage should be transected in a plane that will be vertical with the foot, usually with a 15° to 20° dorsal angulation to the longitudinal axis of the metatarsal. This distal phalanx then has its cartilage and surface resected par- allel to the distal phalanx. The two flat surfaces now will meet with the toe being in approximately 15° to 20° of dorsiflexion rel- ative to the longitudinal axis of the metatarsal. Additional dorsi- flexion at the first metatarsal phalangeal joint is indicated if there is any weight bearing on the proximal phalanx with the foot in neutral position.

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My thanks to all the many reviewers purchase bupron sr 150mg with visa, listed separately generic bupron sr 150mg overnight delivery, who made such valuable and detailed comments on the text discount bupron sr 150mg visa. 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. The nervous made up of all the nerves outside the CNS. It includes system must detect and respond to these changes all the cranial nerves that carry impulses to and from (known as stimuli) so that the body can adapt itself to the brain and all the spinal nerves that carry messages new conditions. The nervous system has been com- to and from the spinal cord. Functional Divisions Although all parts of the nervous system work in co- ordination, portions may be grouped together on the Functionally, the nervous system is divided according to basis of either structure or function. Any tissue or organ that carries out a command from the nerv- ous system is called an effector, all of Posterior view which are muscles or glands. The somatic nervous system is controlled voluntarily (by conscious Brain Cranial nerves will), and all its effectors are skeletal Central muscles (described in Chapter 8). The nervous system involuntary division of the nervous sys- Spinal tem is called the autonomic nervous cord system (ANS), making reference to its automatic activity. It is also called the visceral nervous system because it Peripheral nervous controls smooth muscle, cardiac mus- system cle, and glands, much of which make up the soft body organs, the viscera. The ANS is further subdivided into a sympathetic nervous system and a parasympathetic nervous system based on organization and how each affects specific organs. The ANS is de- Spinal nerves scribed later in this chapter.

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