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In patients with this condition cialis professional 20mg overnight delivery erectile dysfunction ginseng, angioplasty or coro- improves circulation to the heart and decreases the work that the nary artery bypass surgery may be performed (fig purchase cialis professional 40mg free shipping erectile dysfunction radiation treatment. Myocardial ischemia is associated with increased concen- Myocardial cells are adapted to respire aerobically and can- trations of blood lactic acid produced by anaerobic respiration of not respire anaerobically for more than a few minutes. This condition often causes substernal pain, chemia and anaerobic respiration continue for more than a few Van De Graaff: Human VI. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 595 FIGURE 16. Lumen of vessel minutes, necrosis (cellular death) may occur in the areas most de- prived of oxygen. A sudden, irreversible injury of this kind is called a myocardial infarction, or MI. Myocardial ischemia may be detected by characteristic (a) changes in the ECG (fig. The diagnosis of myocardial in- farction is aided by examining the blood concentration of vari- ous enzymes that are released from the damaged cells. Vascular Disorders Atherosclerotic plaques Hypertension, or high blood pressure, is the most common type of vascular disorder. In hypertension, the resting systolic blood pressure exceeds 140 mmHg and the diastolic exceeds 90 mmHg. An estimated 22 million adult Americans are afflicted by hyper- tension. About 15% of the cases are the result of other body problems, such as kidney diseases, adrenal hypersecretion, or ar- teriosclerosis, and are diagnosed as secondary hypertension. Pri- mary hypertension is more common and cannot be attributed to any particular body dysfunction. If hypertension is not controlled by diet, exercise, or drugs that reduce the blood pressure, it can damage various vital body organs, such as the heart or kidneys. An embolism, or embolus, is a de- tached thrombus that travels through the bloodstream and lodges The causes of atherosclerosis are not well understood, but so as to obstruct or occlude a blood vessel. An embolism lodged the disease seems to be associated with improper diet, smoking, in a coronary artery is called a coronary embolism; in a vessel of hypertension, obesity, lack of exercise, and heredity. Aneurysms are caused by weakening of the tunicas and may rup- arteriosclerosis: Gk. In prolonged lymphadenitis, an abscess usually forms in the nodal tissue. If an infection is not contained by localized lymph nodes, lymphangitis may ensue. In this condition, red streaks can be seen through the skin extending proximally from the infected area. The term lymphoma is used to describe primary malignan- cies within lymphoid tissues. Lymphomas are generally classified as Hodgkin’s disease lymphomas or non-Hodgkin’s lym- phomas. Hodgkin’s disease manifests itself as swollen lymph Saccular aneurysm Fusiform aneurysm nodes in the neck and then progresses to involve the spleen, (a) liver, and bone marrow. Non-Hodgkin’s lymphomas include an array of specific and more obscure lymphatic cancers. The lymphatic system is also frequently infected by metas- tasizing carcinomas. Fragmented cells from the original tumor may enter the lymphatic ducts with the lymph and travel to the lymph nodes, where they may cause secondary cancerous growths. The surgical treat- ment involves the removal of the infected nodes, along with some of the healthy nodes downstream to ensure that the cancer is eliminated. Trauma to the Circulatory System Hemorrhage and shock are two clinical considerations that di- rectly involve the circulatory system. Knowledge of how to treat a victim experiencing these conditions is of paramount impor- tance in administering first aid. Techniques to control bleeding and to administer first aid to victims experiencing shock are pre- sented in the next two sections.

Therapeutic withdrawal from a sedative purchase cialis professional 40 mg visa thyroid causes erectile dysfunction, like the therapeutic withdrawal from Sedatives alcohol cheap cialis professional 20mg otc erectile dysfunction insurance coverage, usually involves the administra- tion of a cross-tolerant drug to suppress Sedation implies calmness and tranquil- withdrawal symptoms with gradual taper- ity. The drug being with- pharmacologic action they produce, drawn determines the length of time namely, depression of the central nervous required for tapering. Examples of sedative drugs are 7 to 10 days is sufficient for detoxification. Many symptoms of withdrawal are flulike, Opioids although they may include anxiety, irri- tability, and restlessness. Because opioids (narcotic drugs such as Opiate substitution drugs are sometimes morphine, meperidine [Demerol], pro- used in treatment of opiate addiction and poxyphene [Darvon], oxycodone [Perco- may be used for either detoxification or dan], and codeine) are frequently maintenance. Methadone and another prescribed for pain, addiction can occur opiate-substitute, levomethadyl acetate, through regular prescription use. In oth- may be used to reduce the use of illicit opi- er instances, these medications are ates and the high-risk behaviors associat- obtained illegally. O’Connor, 2000), as well as to provide In addition to producing pain relief, medical assistance with withdrawal of opi- narcotics produce euphoria, sedation, and ates. At first, individu- drug dosage is gradually tapered during als may take illegal narcotics primarily for the withdrawal period. Repeated admin- may be enrolled in a maintenance program istration rapidly produces tolerance and in which they do not undergo detoxifica- intense physical dependence. Eventually, tion but rather receive maintenance dos- as the dosage and/or frequency of drug es of an opiate substitute along with administration increases, individuals need counseling. The goal of such programs is to continue to take the drug regularly to first to help individuals return to a social- avoid symptoms of physical withdrawal. Drugs that are injected increase individuals’ risk of Stimulants contracting HIV infection or hepatitis C if needles are shared. Adding adulterants to Acting directly on the central nervous substances or using nonsterile techniques system, stimulants create an increased state of injection may also produce medical of arousal and concentration and speed up complications. Individuals may (inflammation of tissues), thrombophle- take stimulants for such effects as in- bitis (inflammation of a vein with associ- creased alertness and increased sense of ated clot formation), septicemia (presence well-being, increased confidence, reduc- of toxins in the blood), and bacterial tion of fatigue, or decrease in appetite. They can be taken Withdrawal symptoms vary in severity orally, topically, intravenously, or by inhala- and duration, depending on the particu- tion. In addition to central nervous system 216 CHAPTER 7 CONDITIONS RELATED TO SUBSTANCE USE effects, stimulants have generalized sys- lasts only a matter of minutes, however, temic effects, including an increase in heart and is often followed by irritability, rest- rate, an increase in blood pressure, a rise in lessness, and depression. The aftereffects body temperature, and the constriction of of crack can be so intense that individuals peripheral blood vessels (Sarnyai, Shaham, continue to smoke it, despite obvious & Heinrichs, 2001). It Aside from its psychological, social, and may be taken orally, used intranasally vocational consequences, cocaine use can (snorted), smoked, or injected intraven- have serious medical consequences. The technique of free-basing basing or smoking crack can lead to pul- cocaine, which gained popularity in the monary complications. Chronic use of 1980s, involves heating a flammable sol- intranasal cocaine may cause ulceration or vent such as petroleum or ether, and then perforation of the nasal septum. The process intoxication can produce neurologic effects, “frees” cocaine hydrochloride from its such as confusion, anxiety, hyperexcitabil- salts and adulterants, converting it to a ity, agitation, and violence. The effects are the result of acute cocaine toxi- free-base cocaine can be inhaled or city, which is dose related, in which indi- smoked, usually with a water pipe, for viduals can experience stroke or seizures, direct absorption through the alveoli in severe hyperthermia (increased body the lungs. The technique rapidly delivers temperature), arrhythmia (irregular heart- high concentrations of cocaine to the beat), myocardial infarction (heart brain and results in blood levels as high attack), and, in some instances, sudden as those for self-injection. Cocaine psychosis, another side The free-basing technique can cause effect of cocaine use, is manifested by additional disability caused by the burns paranoia, panic, hallucinations, insomnia, from fires started during the free-basing and picking at the skin. The level of tolerance for cocaine episode can last from 24 to 36 hours. Dependence is produced profit on its sale, may cause additional very rapidly. Its concentrated form and its route result from the nature of the substance of administration make its potency many used to cut the cocaine or from the dosage times greater than that of cocaine alone. Adulterants such as talc or corn- The euphoric effect produced by crack starch can cause complications ranging Use Disorders Involving Other Substances 217 from inflammation to embolus (undis- psychoactive responses to the drug depend solved matter in the blood).

Frequently generic cialis professional 20mg erectile dysfunction drugs in australia, they are teased and rejected by classmates generic cialis professional 20 mg line erectile dysfunction drugs new, which causes psychological stress. At least 5% of children in the United States can be classified as obese. Obesity in adults is a major health problem considering that one of five adults is at least 30% over his or her ideal, healthy weight. A controlled diet and regular ex- ercise are fundamental in correcting obesity. The height of the cranial vault Adolescence (distance between planes A and B) is shown to be the same in both the infant and adult skulls. Growth of the skull occurs almost exclu- Adolescence is the period of growth and development between sively within the bones of the facial region. Adolescence is frequently said to end seventh year, and then the deciduous teeth are shed approxi- at 20 years of age, but it is not clearly delineated and varies with mately in the same sequence as they were acquired. Deciduous the developmental, physical, emotional, mental, or cultural cri- teeth are replaced at a rate of about four per year over the next teria that define an adult. If, for example, the 8-year-olds who were refers to the continuum of physical changes during puberty, par- among the tallest and heaviest 10% of their age group were to ticularly in regard to body hair. Although puberty is under hor- stop growing for a year while their classmates grew normally, monal control, a complex interaction of other factors, including they would still be taller than half their contemporaries and nutrition and socioeconomic forces, has a decisive influence on heavier than three-quarters of them. Thus, for both sexes there is During childhood, the average child becomes thinner and wide individual variation. The average 10-year- old, for example, can throw a ball twice as far as the average 6- year-old. Visceral organs, particularly the heart and lungs, develop tremendously during this period, enabling a child to run adolescence: L. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance Chapter 22 Developmental Anatomy, Postnatal Growth, and Inheritance 779 TABLE 22. Pubic hair usually begins to appear shortly after the morphic characteristics—traits that distinguish the sexes—are breast buds become apparent, but in about one-third of all girls, apparent. The average adult male, for example, has a deeper sparse pubic hair appears before the breast buds. Axillary hair ap- voice and more body hair and is taller than the average adult fe- pears a year or two after pubic hair. During puberty, the vaginal secretions Puberty actually begins before it is physically expressed. Sexual changes are usually thought of as the only features of first indication of puberty in boys is growth of the testes and the puberty, but major skeletomuscular changes take place as well. During late childhood, the body proportions of the sexes are sim- This is followed by growth of the penis, which continues for ilar, males being slightly taller. Under the influence of hormones, about 2 years, and the appearance of axillary hair. Vocal changes females experience a growth spurt in early adolescence that pre- generally begin during early puberty but are not completed until cedes that of males by nearly 2 years. Facial hair and chest hair (which may or may not be are temporarily taller. Once puberty begins in males, the heights present) first appear toward the end of puberty. The mean age at of both sexes equalize, and at the culmination of puberty, males which semen can be ejaculated is 13. By the time growth is completed at the end of adolescence, 16 years of age. Other dimorphic differences involving skeletal structures include a broadening of the pelvic girdle in females. The muscles Adulthood of males become more massive and stronger than those of fe- Adulthood is the final stage of human physical change. Females acquire a thicker subcutaneous layer of the skin period of life beyond adolescence. An adult has reached maxi- during adolescence, which gives them more rounded contours.