By E. Knut. Stanford University.
On day 9 or 10 of the cycle generic 200 mg pyridium with mastercard gastritis diet ãîãëå, the vascu- wall facilitates the rupture of the follicle purchase pyridium 200mg mastercard gastritis diet suggestions. The extrusion of the larity of the dominant follicle is twice that of the other antral oocyte-cumulus complex is aided by smooth muscle con- follicles, permitting a more efficient delivery of cholesterol traction. At the time of rupture, the oocyte-cumulus complex to theca cells and better exposure to circulating go- and follicular fluid are ejected from the follicle. At this time, the main source of circulating The LH surge triggers the resumption of the first meiosis. Since estradiol is the pri- Up to this point, the primary oocyte has been protected by mary regulator of LH and FSH secretion by positive and neg- unknown factors within the follicle from premature cell divi- ative feedback, the dominant follicle ultimately determines sion. Within a couple of hours after the initiation of circulating estradiol, and it causes multiple changes in the of the LH surge, the production of progesterone, androgens, dominant follicle, which occur within a relatively short time. Progesterone, acting These include the resumption of meiosis in the oocyte (as al- through the progesterone receptor on granulosa cells, pro- ready discussed); granulosa cell differentiation and transfor- motes ovulation by releasing mediators that increase the dis- mation into luteal cells; the activation of proteolytic en- tensibility of the follicular wall and enhance the activity of zymes that degrade the follicle wall and surrounding tissues; proteolytic enzymes. As LH levels reach their peak, plasma increased production of prostaglandins, histamine, and other estradiol levels plunge because of down-regulation by LH of local factors that cause localized hyperemia; and an increase FSH receptors on granulosa cells and the inhibition of gran- in progesterone secretion. Eventually, LH receptors on luteinizing onset of the LH surge, this coordinated series of biochemical granulosa cells escape the down-regulation, and proges- and morphological events culminates in follicular rupture terone production increases. The midcycle FSH surge is not essential for ovulation because an injection of either LH or human chori- onic gonadotropin (hCG) before the endogenous go- FORMATION OF THE CORPUS LUTEUM FROM nadotropin surge can induce normal ovulation. However, THE POSTOVULATORY FOLLICLE only follicles that have been adequately primed with FSH will ovulate because they contain sufficient numbers of LH In response to the LH and FSH surges and after ovulation, receptors for ovulation and subsequent luteinization. The granulosa cells begin to cease their proliferation cycle regulator), and a transcription factor called C/EBP and begin to undergo hypertrophy and produce proges- (CCAAT/enhancer binding protein). The ruptured follicle which these proteins interact to regulate follicular rupture are develops a rich blood supply and forms a solid structure largely unknown. However, mice with specific disruption of called the corpus luteum (yellow body). The mature corpus genes for any of these proteins fail to ovulate, and these pro- luteum develops as the result of numerous biochemical and teins are likely to have a functional role in human ovulation. The granulosa cells and theca cells in the corpus lu- surge are the release of vasodilatory substances, such as his- teum are called granulosa-lutein cells and theca-lutein tamine, bradykinin, and prostaglandins, which mediate in- cells, respectively. The highly vascu- Continued stimulation by LH is needed to ensure mor- larized dominant follicle becomes hyperemic and edematous phological integrity (healthy luteal cells) and functionality and swells to a size of at least 20 to 25 mm in diameter. If pregnancy does not occur, the 676 PART X REPRODUCTIVE PHYSIOLOGY corpus luteum regresses, a process called luteolysis or luteal LH; therefore, LH is referred to as a luteotropic hormone. Luteolysis occurs as a result of apoptosis and Lack of LH can lead to luteal insufficiency (see Clinical Fo- necrosis of the luteal cells. Luteal regression is thought to be induced corpus luteum is a transient endocrine structure formed from by locally produced luteolytic agents that inhibit LH action. It serves as the main source of cir- Several ovarian hormones, such as estrogen, oxytocin, culating steroids during the luteal (postovulatory) phase of prostaglandins, and GnRH, have been proposed, but their the cycle and is essential for maintaining pregnancy during role as luteolysins is controversial. The corpus luteum is res- the first trimester (see Case Study) as well as maintaining cued from degeneration in the late luteal phase by the action menstrual cycles of normal length. Af- mone that is produced by the embryonic trophoblast during ter acquiring a high concentration of LH receptors, granu- the implantation phase (see Chapter 39). This hormone losa cells respond to the LH surge by undergoing morpho- binds the LH receptor and increases cAMP and proges- logical and biochemical transformation. Unlike the nonvascular granulosa cells in the THE MENSTRUAL CYCLE follicle, luteal cells have a rich blood supply. Invasion by capillaries starts immediately after the LH surge and is facil- Under normal conditions, ovulation occurs at timed inter- itated by the dissolution of the basement membrane be- vals. Sexual intercourse may occur at any time during the cy- tween theca and granulosa cells. Peak vascularization is cle, but fertilization occurs only during the postovulatory reached 7 to 8 days after ovulation. Once pregnancy occurs, ovulation ceases, and after Differentiated theca and stroma cells, as well as granulosa parturition, lactation also inhibits ovulation. The first men- cells, are incorporated into the corpus luteum, and all three strual cycle occurs in adolescence, usually around age 12.
Sensitive electrodes placed on the The development of the CT scanner pyridium 200 mg generic gastritis muscle pain, or computerized scalp record particular EEG patterns being emitted from evoked axial tomographic scanner purchase 200mg pyridium otc chronic gastritis symptoms stress, has revolutionized the diagnosis of cerebral activity. The CT scanner projects a sharply focused, de- patients to predict seizures and to determine proper drug therapy, tailed tomogram, or cross section, of a patientâs brain onto a tele- and also to monitor comatose patients. The versatile CT scanner allows quick and The fact that the nervous system is extremely sensitive to accurate diagnoses of tumors, aneurysms, blood clots, and hemor- various drugs is fortunate; at the same time, this sensitivity has rhage. The CT scanner may also be used to detect certain types potential for disaster. Drug abuse is a major clinical concern be- of birth defects, brain damage, scar tissue, and evidence of old or cause of the addictive and devastating effect that certain drugs recent strokes. Much has been written on drug A machine with even greater potential than the CT scan- abuse, and it is beyond the scope of this text to elaborate on the ner is the DSR, or dynamic spatial reconstructor. A positive aspect of drugs is their administration CT scanner, the DSR is computerized to transform radiographs in medicine to temporarily interrupt the passage or perception of into composite video images. Injecting an anesthetic drug near a nerve, as in dimensional view is obtained, and the image is produced much dentistry, desensitizes a specific area and causes a nerve faster than with the CT scanner. Nerve blocks of a limited extent occur if an appendage is cross-sectional images in 5 seconds, whereas the CT scanner can cooled or if a nerve is compressed for a period of time. Nervous Tissue and the Â© The McGrawâHill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 392 Unit 5 Integration and Coordination discovery of pharmacological drugs, physicians would frequently German measles, and excessive irradiation of the fetus are all cool an affected appendage with ice or snow before performing commonly associated with mental retardation. A local anesthetic causes a nerve block by desensi- tizing a specific area. Injuries Although the brain and spinal cord seem to be well protected within a bony encasement, they are sensitive organs, highly sus- Developmental Problems ceptible to injury. Congenital malformations of the CNS are common and fre- Certain symptomatic terms are used when determining quently involve overlying bone, muscle, and connective tissue. Headaches are the most com- The more severe abnormalities make life impossible, and the mon ailment of the CNS. Most headaches are due to dilated less severe malformations frequently result in functional disabil- blood vessels within the meninges of the brain. Neurological malformations usually have a genetic basis, generally symptomatic of brain disorders; rather, they tend to be but they also may result from environmental factors such as associated with physiological stress, eyestrain, or fatigue. Some tent and intense headaches may indicate a more serious problem, of these malformations were briefly described in the previous such as a brain tumor. It is not known why only 5%â10% of the tebral elements and may or may not involve the spinal cord. This defect usually involves few vertebrae, is not tend to trigger migraines. It may Spina bifida cystica, a severe type of spina bifida, is a saclike pro- occur when a person rapidly arises from a reclined position, re- trusion of skin and underlying meninges that may contain por- ceives a blow to the head, or experiences an intense psycho- tions of the spinal cord and nerve roots. It is most common in logic stimulus, such as viewing a cadaver for the first time. The Fainting is of more concern when it is symptomatic of a partic- position and extent of the defect determines the degree of neuro- ular disease. A concussion usually results in cephaly occurs once per thousand births and makes sustained a brief period of unconsciousness, followed by mild delirium in extrauterine life impossible. This congenital defect apparently re- which the patient is in a state of confusion. Amnesia is a more sults from the failure of the neural folds at the cranial portion of intense disorientation in which the patient suffers varying de- the neural plate to fuse and form the prosencephalon. Microcephaly is an uncommon condition in which brain de- A person who survives a severe head injury may be co- velopment is not completed. If enough neurological tissue is pres- matose for a short or an extended period of time. A coma is a state ent, the infant will survive but will be severely mentally retarded. This condition occurs approximately reticular activating system is likely to result in irreversible coma. It is characterized by protrusion of Although a head injury is the most common cause of coma, chem- the brain and meninges through a cranial fissure, usually in the ical imbalances associated with certain diseases (e.
If individuals tak- um should have regular blood tests to Psychosocial and Vocational Issues in Psychiatric Disability 197 measure levels of the medication in the PSYCHOSOCIAL AND VOCATIONAL blood and must be monitored by a physi- ISSUES IN PSYCHIATRIC DISABILITY cian on a regular basis purchase pyridium 200 mg online gastritis journal pdf. Psychological Issues Antianxiety Medications Individuals with psychiatric disability Formerly called minor tranquilizers 200mg pyridium fast delivery gastritis diet 2 weeks, anti- experience a wide range of symptoms that anxiety medications are generally used for affect psychological and cognitive func- mental disorders in which anxiety is the tion, and their needs are multifaceted and predominant symptom. Al- tions are commonly classiï¬ed as benzodi- though the beneï¬ts of medication in the azepines (e. Antianxiety medications are symptoms, deï¬cits, and impairments as a used mainly for time-limited, short-term result of their condition, and many are treatment of anxiety. These medications subject to periodic relapses with recur- should not be regarded as the mainstay or rence of symptoms. Because many sure or to cope with the normal stresses antianxiety agents also have the risk of of everyday life. They may have limited abuse or physical dependence, their use problem-solving ability or ï¬nd it difï¬cult should be carefully monitored. Some can include drowsiness and sedation or individuals may become passive, apathet- motor difï¬culty. Symptoms experienced vary with the Before psychopharmacologic prepara- condition, causing varying degrees of im- tions were readily available, electroconvul- pairment. Although fear and anger are nor- sive therapy (shock therapy) was a major mal emotional responses, these responses mode of treating some types of mental ill- may be acutely disproportionate to the ness. Its use has diminished with the stimuli in some psychiatric disabilities. Some individuals manifest their when the long-term administration of condition through patterns of behavior medication is contraindicated (Fink, rather than in emotional manifestations. Although electroconvulsive thera- Others experience subjective distress, such py does not cure mental disorders, it can as an inner sense of weakness, jealousy, or bring about a remission of symptoms. It anxiety, although function in most of may be used in conjunction with psy- their life is minimally disturbed. For example, the use of MAO in- can affect individualsâ ability to function hibitors in the treatment of depression in an unstructured environment. Other of memory and perception can severely medications have side effects, such as limit independent function. Individuals drowsiness and sedation, that also affect may fail to carry out age-appropriate role daily function. Indi- Symptoms of the psychiatric disability viduals with a depressive disorder may lose may cause psychic stress and anxiety, fur- interest in sexual activity, whereas individ- ther compounding the disabling compo- uals with a bipolar depression may have ex- nent of the condition. The side effects of anguish over their impoverished life can some medications can alter sexual function be devastating. In addition, subjective manifesta- impaired function and the impact of their tions of lowered self-esteem and self-con- condition both on others and on their ï¬dence may make it more difï¬cult for future may cause considerable pain and individuals to form intimate relationships. In some instances, individu- als with psychiatric disability may be re- Social Issues luctant to seek appropriate help because of their fear of the stigma associated with The impact of a psychiatric disability on psychiatric conditions that require profes- social function also depends on the nature sional help. Individuals who experi- als may not be aware of their symptoms ence mania as a part of their disability may and the effect of their symptoms on func- enjoy the euphoria and feel that it con- tion, which also hinders them from using tributes to their social well-being. Even though attitudes of society have become more accepting of individuals Lifestyle Issues with mental illness, family members may continue to be resistant to recognizing the The degree to which psychiatric disabil- problem and pursuing appropriate treat- ity affects individualsâ lifestyle depends to ment (Hall & Purdy, 2000). If, however, a great extent on the nature of the condi- individuals manifest bizarre, abusive, or tion. Some psychiatric disabilities so severe- socially offensive behavior, family members ly impair individualsâ ability to carry on the or others within a social group may avoid activities of daily living that constant the individual altogether, leaving him or supervision or hospitalization is necessary. In other instances, individuals are able to Other psychiatric disabilities may lead carry on these activities, but in an altered to social withdrawal. These stresses may be rearrange their schedules so that they can caused by their objective problems in deal- attend therapy sessions. Some medications ing with the individuals and their condi- used in the treatment of psychiatric dis- tion, as well as by more subjective psycho- ability may require special lifestyle consid- logical distress (Hall & Purdy, 2000). Psychosocial and Vocational Issues in Psychiatric Disability 199 Psychiatric disabilities, especially those psychiatric disability (Tschopp, Bishop, & in which individuals need close supervi- Mulvihill, 2001).
If the trunk muscles are affected order pyridium 200 mg line gastritis diet ãóãúë, a muscle imbalance may Individuals in the initial stages of polio result discount pyridium 200mg overnight delivery chronic gastritis from stress, lead to scoliosis (lateral curvature are acutely ill. Initial symptoms are usu- of the spine), which can interfere with ally nonspeciï¬c, such as gastrointestinal breathing as well as the functioning of or upper respiratory symptoms accompa- internal organs. Symptoms later progress to After the initial acute episode of polio- headache, stiff neck, and muscle pains. The degree of residual disability group of muscles are affected; in others, is dependent on the extent of the perma- paralysis is widespread and may include nent damage to nerves that has occurred. Extremity involvement is often asymmetrical, so that one extremi- Manifestations of Post-Polio Syndrome ty may have major paralysis while the opposite limb has only slight weakness or Poliomyelitis itself is not a progressive may not be affected at all. Consequently, many individu- cles are paralyzed, functions of sensation, als who contracted the disease 30 or more bowel and bladder control, and sexual years ago adapted to residual paralysis, response are left intact. Despite in- myelitis began to seek medical advice creasing decline, however, individuals will because of new symptoms that ranged not return to the level of disability they from mildly to severely debilitating. At experienced when polio was in its acute ï¬rst they were not taken seriously. With appropriate exercise, strength were classiï¬ed as having âemotional dis- and function can be improved and dete- turbances,â or symptoms were merely rioration slowed, if not halted. Spinal tap or fecal sample can ety of symptoms in individuals who had be used to conï¬rm the diagnosis. The recovered from poliomyelitis many years diagnosis of post-polio syndrome is, at earlier. Symptoms of post-polio generalized fatigue syndrome may be difï¬cult to distinguish â¢ new muscle weakness in muscles not from other degenerative disorders of mus- previously affected cles and joints, such as osteoarthritis or â¢ muscle pain (myalgia) and/or joint osteoporosis. General medical evaluation, pain routine laboratory tests, electromyographic â¢ respiratory difï¬culty studies (graphic record of the contraction The cause of post-polio syndrome is un- of a muscle as the result of electrical stim- known (Burk & Agre, 2000). It appears ulation), and nerve conduction studies may that most of the motor neurons original- help to identify and exclude other dis- ly damaged in the initial bout of polio are eases. Magnetic resonance imaging may be involved in post-polio syndrome and used to exclude other conditions of the that most individuals who had polio are spine that could cause similar symptoms at risk to develop the syndrome. Those No speciï¬c treatment is available to who had been able to walk without assis- alter the course of post-polio syndrome. Those who had used muscle weakness, fatigue, and pain should Conditions Affecting the Spinal Cord 93 ï¬rst have a thorough physical exam- reduction may be recommended to ination by a physician to rule out other reduce fatigue and stress on muscles and potential causes of symptoms. For those whose respiratory mus- is largely directed toward managing cles were also affected by the initial infec- symptoms and helping individuals main- tion, weight control can also help to tain functional status and independence prevent respiratory difï¬culty. Good health practices, including proper nutrition and adequate Psychosocial Issues in rest, are important. Post-Polio Syndrome Generalized fatigue is treated with lifestyle changes consisting of energy Since poliomyelitis is not a progressive conservation measures. Physical activities disease, many individuals believed their should be paced to prevent excessive recovery to be permanent and adapted fatigue. Individuals may require frequent and adjusted to the functional limitations rest periods throughout the day. Using and residual effects associated with the additional assistive devices, such as a condition, going on to lead full and pro- wheelchair rather than crutches, may ductive lives. Exercises unexpected symptoms associated with that are tolerable and that do not con- post-polio syndrome threaten their func- tribute to more weakness and fatigue may tion and independence and can be psy- be prescribed. Individuals frustrating for the individual, who again are instructed to exercise for short inter- must adjust and adapt to continuing func- vals, to rest between bouts of exercise, and tional limitations, the potential use of to exercise only every other day to pre- new assistive devices, and an alteration in vent excessive muscle fatigue. After regaining function previ- Individuals with respiratory difï¬culty ously through much physical and emo- may require noninvasive positive-pressure tional effort, being forced to deal again ventilation at night. Because individuals with disability symptoms that are much with post-polio syndrome are more sus- like the initial symptoms can be discour- ceptible to infectious diseases, pneumonia aging. Individuals may reject new assis- and inï¬uenza vaccines are usually recom- tive devices because they symbolize the mended. Changes in Vocational Issues in Post-Polio Syndrome orthotics or in the mode of ambulation may be required. Moving from braces or Many individuals with poliomyelitis have crutches to a wheelchair can also reduce achieved gainful employment and lived stress on joints. Although its cause re- number of alterations necessary in the mains unknown, evidence suggests that work setting. In some instances, depending both genetic and environmental factors on performance requirements, the individ- may play a role (Janson, Leone, & Freese, ual may be unable to perform all of the 2002; Nussbaum & Ellis, 2003).