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Because it does not have a bony framework like that of the thorax the surface anatomy is not as well defined generic 40mg prednisone free shipping allergy shots vs zyrtec. Bony land- marks of both the thorax and pelvis are used when referring to ab- dominal structures (fig discount prednisone 20mg free shipping penicillin allergy symptoms joint pain. The right costal margin of the rib cage is located over the liver and gallbladder on the right side, and the left costal margin is positioned over the stomach and spleen on the left. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 313 8 1 1 9 2 2 10 3 11 4a 6 4b 12 5 6 3 7 7 4 5 8 9 1 Deltoid m. The linea alba separates the paired, straplike gions or four quadrants in order to describe the location of inter- rectus abdominis muscles, which can be seen when a person flexes nal organs and to clinically identify the sites of various pains or the abdomen (as when doing sit-ups). Clinically, the linea alba is a favored site for abdominal surgery because an incision made along this line severs no muscles Although the position of the umbilicus is relatively consistent in all and few vessels or nerves. For example, there may be an has been said that only a zipper would provide a more convenient opening to the outside, called a fistula, or herniation of some of the ab- entry to the abdominal cavity. Acquired umbilical hernias may develop in children who have a weak abdominal wall in this area, or they may develop in The lateral margin of the rectus abdominis muscle can be pregnant women because of the extra pressure exerted at this time. The external abdominal oblique nal cavity in a procedure called laparotomy. Laparotomy is frequently done to examine or perform surgery on the internal female reproduc- muscle is the superficial layer of the muscular abdominal wall. A depressed umbilicus on an obese person is difficult to The iliac crest is subcutaneous and can be palpated along its en- keep clean, and so various types of infections may occur there. The highest point of the crest lies opposite the body of the fourth lumbar vertebra, an important level in spinal anes- Internal Anatomy thesia. Another important landmark is McBurney’s point, lo- cated about one-third of the distance from the right anterior superior iliac spine on a line between that spine and the umbili- Thorax cus (fig. McBurney’s point: from Charles McBurney, American surgeon, 1845–1914 laparotomy: Gk. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 314 Unit 4 Support and Movement Trachea Common carotid a. Aortic arch Superior vena cava Left lung Right lung Ascending portion of aorta Pericardium (cut) Cusp of tricuspid valve Left ventricle Apex of heart Diaphragm Falciform ligament Left lobe of liver Right lobe of liver FIGURE 10. Aortic arch Left bronchus Thoracic portion of aorta Esophagus Phrenic n. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 315 4 1 5 1 5 6 6 2 7 7 8 8 3 9 10 2 9 4 11 10 3 11 12 1 External occipital 7 Sternocleidomastoid m. The rib cage is formed by the sternum, the costal cartilages, and nerves. Because of the domed shape of the diaphragm,some the ribs attached to the thoracic vertebrae. It protects the lungs, of the abdominal viscera are protected by the rib cage. It also affords a site of attach- abdominal region is shown in photographs of cadavers in ment for the muscles of the thorax, upper extremities, back, and figures 10. The principal organs of the respiratory and circula- tory systems are located within the thorax, and the esophagus of the digestive system passes through the thorax. Because the vis- Knowledge Check cera of the thoracic cavity are vital organs, the thorax is of im- 12. Why are the linea alba, costal margins, linea semilunaris, testines,the liver and gallbladder,the kidneys and adrenal and McBurney’s point important landmarks? Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 316 Unit 4 Support and Movement Trapezius m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 317 1 2 6 3 4 7 8 5 9 1 Rectus abdominis m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 318 Unit 4 Support and Movement Diaphragm Liver Transverse colon Superior mesenteric a. Although the inguinal ligament can- not be seen, an oblique groove overlying the ligament is an ap- The surface features of the pelvic region are important primarily to parent surface feature. The Objective 12 Describe the location of the perineum and list surface features of this region are further discussed in chapters 20 the organs of the pelvic and perineal regions. The surface anatomy of the perineum of a female be- comes particularly important during parturition.

By contrast proven prednisone 10mg allergy medicine rx, high doses of dopamine agonists increase arousal and cortical desyn- chronisation quality prednisone 5 mg allergy medicine stronger than zyrtec, possibly by activating postsynaptic D2-receptors. Indeed, local infusion of dopamine into the nucleus accumbens increases waking, an effect blocked by the D2-receptor antagonist, haloperidol. Such an action is consistent with the general improvement in sleep (especially sleep continuity) in patients treated with neuroleptics, such as haloperidol and clozapine, which share D2-receptor antagonism as a common target. However, the various changes seen in the different phases of the EEG seem to depend on the actual compound tested. Early experiments SLEEP AND WAKING 491 suggested that an increase in 5-HT transmission actually helps to induce sleep (see Jouvet 1974). Thus pCPA, which blocks the synthesis of 5-HT, causes insomnia in cats and reduces SWS; this insomnia is reversed by giving the 5-HT precursor, 5-hydroxytryptophan (5-HTP), which bypasses the pCPA block. Also, a lesion of the dorsal Raphe nucleus (DRN) produces insomnia, the degree of which is proportional to the loss of 5-HT neurons and the decrease of 5-HT turnover in their projection areas. Despite such lesions, sleep patterns return to normal after some days and, if they are made in new-born rats, sleep patterns normalise after a few weeks, suggesting that they are not solely dependent on 5-HT. In contrast to this evidence that 5-HT activity decreases arousal, antidepressants are generally thought to increase serotonergic transmission while the central depressant, reserpine, reduces it, although it must be remembered that both these treatments affect central noradrenergic transmission as well. Nevertheless, direct stimulation of Raphe neurons, or systemic administration of a 5-HT precursor, actually increases waking. This suggests that 5-HT has either an excitatory influence on behaviour and/or an inhibitory effect on sleep. This view is supported by electrophysiological recordings of the activity (firing frequency) of neurons in the cat DRN. Insofar as it can be certain that it is serotonergic neurons that are being monitored in this nucleus, these studies have shown that, during quiet waking, their activity is about 2±3 spikes/s, but that this rate decreases progressively and becomes less regular as sleep progresses to SWS. In fact, these neurons become virtually totally quiescent during REM sleep and this reduction in activity is probably effected by GABAergic inputs to the DRN. Assigning a particular role for changes in 5-HT transmission in sleep is confounded by the existence of 5-HT neurons in several distinct Raphe nuclei (Fig. These project to different regions of the brain but the differences in their functional influences are, as yet, poorly understood. Most studies have in fact investigated the DRN, which innervates forebrain areas, but it does seem that other serotonergic nuclei in the medulla show a similar pattern of responses. Moreover, unlike DRN neurons, those in the NRO and NRP continue to fire, albeit at a reduced frequency, during REM sleep. The implications of these differences in the regulation of the sleep cycle are unclear. However, environmental stimuli that provoke behavioural orientation induce a marked phasic increase in serotonergic neuronal activity (see Chapter 9) suggesting that they do have some role in the response to stimuli requiring attention. A link between 5-HT release and increased waking is supported by evidence from in vivo microdialysis of cats and rats. This has confirmed that the extracellular concen- tration of 5-HT in all brain regions studied to date is lower during both SWS and REM sleep than in the awake state (see Portas, Bjorvatn and Ursin 2000). Interestingly, if behaviour is maintained at a constant level, the activity of 5-HT neurons does not show circadian variation although 5-HT turnover in the brain areas to which they project 492 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION Figure 22. Neurons that release 5-HT are clustered in two groups of nuclei in the pons and upper brainstem. The reasons for this apparent dissociation between firing rate and transmitter release are not clear but it does suggest that neuronal firing rate is not necessarily a reliable indicator of transmitter release in the terminal field. In so doing, they are responsible for gating motor output and coordinating this with homeostatic and sensory function (Jacobs and Azmitia 1992; Jacobs and Fornal 1999). This would be consistent with evidence that, like the noradrenergic system, increases in the firing rate of neurons in the DRN precede an increase in arousal. The frequency of discharge would code the state of arousal and prime target cells for forthcoming changes in the response to sensory inputs. Apart from the problem of trying to associate the effects of 5-HT with specific nuclei, there is also no clear picture of which 5-HT receptors mediate any of these changes in sleep and waking. This is not least because of the large number of receptor subtypes, the limited receptor selectivity of most test drugs, species differences in the response, as well as time- and dose-related differences in the response to any given agent. Nevertheless, it is evident that activation of many different receptor subtypes affect the sleep±waking cycle. For instance, recent evidence suggests that activation of 5-HT1A, 5-HT1B, 5-HT2A/C and 5-HT7 receptors in the SCN all affect circadian rhythms.

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A blow to the head or certain drugs and dis- smooth muscles of arteriole walls cheap 20mg prednisone otc allergy testing for dogs, causing them to con- eases may damage the RAS generic 10mg prednisone allergy medicine while pregnant second trimester, causing unconsciousness. The respiratory center of the medulla oblongata controls the rate and depth of breathing and functions in conjunction with the respiratory nuclei of the Knowledge Check pons (see fig. Describe the major reflex centers of the medulla oblongata Other nuclei of the medulla oblongata function as centers that regulate autonomic functions. Explain the statement that the RAS is the brain’s “chief be initiated voluntarily, but once they progress to a certain point watchguard. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 378 Unit 5 Integration and Coordination Skin of scalp Dura mater: Periosteal layer Galea aponeurotica Meningeal layer Skull Arachnoid Arachnoid villi Subarachnoid space Pia mater Cerebral cortex Dural sinus Falx cerebri FIGURE 11. The inner meningeal layer, which is thinner, follows the general contour of the brain. The spinal As mentioned previously in the discussion of the brain’s gen- dura mater is not double layered. It is similar to the meningeal eral features, the entire delicate CNS is protected by a bony layer of the cranial dura mater. In certain regions, however, by three membranous connective tissue coverings called the the layers separate, enclosing dural sinuses (see fig. Individually, from the out- collect venous blood and drain it to the internal jugular veins side in, they are known as the dura mater, the arachnoid, and of the neck. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 Chapter 11 Nervous Tissue and the Central Nervous System 379 Epidural space Dura mater Arachnoid Spinal cord Subarachnoid space Pia mater Spinal nerve Body of vertebra Waldrop FIGURE 11. The epidural space in the lower lumbar region is of clinical importance as a site for an epidural block that may be administered to facilitate childbirth. The subarachnoid space, located between the mater forms distinct septa to partition major structures on the arachnoid mater and the deepest meninx, the pia mater, con- surface of the brain and anchor the brain to the inside of the cra- tains cerebrospinal fluid. These septa were identified earlier and are reviewed in tained by weblike strands that connect the arachnoid and pia table 11. The epidural space is highly vascular and tions of the brain and the irregular contours of the spinal cord, is contains loose fibrous and adipose connective tissues that form a composed of modified loose connective tissue. The pia mater is specialized over the roofs of the ventricles, where it contributes to the for- Arachnoid mation of the choroid plexuses along with the arachnoid. This delicate, netlike membrane spreads over the mentum denticulatum, which attaches the spinal cord to the CNS but generally does not extend into the sulci or fissures of dura mater (fig. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 380 Unit 5 Integration and Coordination TABLE 11. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 Chapter 11 Nervous Tissue and the Central Nervous System 381 Cerebrospinal fluid (CSF) is a clear, lymphlike fluid that forms a protective cushion around and within the CNS. CSF circulates through the various ventri- cles of the brain, the central canal of the spinal cord, and the sub- arachnoid space around the entire CNS. The cerebrospinal fluid returns to the circulatory system by draining through the walls of the arachnoid villi, which are venous capillaries. Ventricles of the Brain The ventricles of the brain are connected to one another and to the central canal of the spinal cord (figs. Each of the two lateral ventricles (first and second ventricles) is lo- cated in one of the hemispheres of the cerebrum, inferior to the corpus callosum. The third ventricle is located in the dien- cephalon, between the thalami. Each lateral ventricle is con- nected to the third ventricle by a narrow, oval opening called the interventricular foramen (foramen of Monro). The fourth ventricle is located in the brain stem between the pons and cere- bellum. The mesencephalic aqueduct (cerebral aqueduct) passes through the midbrain to link the third and fourth ventricles. The fourth ventricle also communicates posteriorly with the central canal of the spinal cord. Cerebrospinal fluid exits from the fourth ventricle into the subarachnoid space (fig. Internal hydrocephalus (hi'dro-sef'a˘-lus) is a condition in which cerebrospinal fluid builds up within the ventricles of the Meningitis, an inflammation of the meninges, is usually caused brain (fig.

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In addition discount prednisone 20mg allergy treatment gold coast, amphetamine increases cytoplasmic DA by weakly reducing its uptake into vesicles effective prednisone 40mg allergy on eyelid. As a reasonably lipophilic compound amphetamine can enter the vesicles where being a weak base it takes up H‡ ions. This makes the vesicle interior less acidic and the reduction in pH gradient across the vesicle membrane appears to inhibit DA uptake into the vesicle. In addition, amphetamine is an inhibitor of MAO but it preferentially attacks the A form so its effect is greater on the breakdown of NA than of DA. Most of the motor effects of amphetamine, especially stereotypy, are due to the release of DA as are its psychotic effects such as hallucinations. Its ability to mimic the action of DA in reward and reinforcement behaviour may contribute to its abuse potential (see Chapter 22) but its arousal (stimulant) properties also involve NA release. CENTRAL FUNCTIONS It is perhaps easier to identify some of the central functions of DA than that of the other monoamines because not only does it have distinctive central pathways associated with particular brain areas, but it has few peripheral actions. Thus DA must be involved in the initiation of vomiting, the secretion of prolactin and control of motor and behavioural activity. Its role in emesis and as the prolactin release inhibitory factor have been adequately covered above. It is also known that an imbalance of DA function on the two sides of the rat brain, either by stimulation or lesion of one SN, causes off-line or rotational movement (Ungerstadt and Arbuthnott 1970). This is best shown some days after 6-OHDA lesion of one substantia nigra and its nigrostriatal pathway when systemic apomorphine (DA agonist) causes animals to turn away from the lesioned side (contraversive), presumably Figure 7. Amphetamine, an indirectly acting amine, releases DA and so can only act on the right side. Since the animal moves away from the dominating active side it induces ipsilateral rotation (i. By contrast, the development of postsynaptic supersensitivity to DA on the lesioned side ensures that apomorphine, a directly acting agonist, is actually more active on that side and so the animal turns away from it (contralateral rotation) 156 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION because the denervated striatum has become supersensitive and therefore more responsive than the control side to the DA agonist. Conversely, the indirectly acting amine amphetamine promotes movement towards the lesioned side (ipsiversive) because it can only release DA in the intact striatum (Fig. Thus animals move away from the side with the most responsive and active striatum. It appears that stereotypy is due to activation of the nigrostriatal pathway as it is absent after lesion of the substantia nigra and follows apomorphine and amphetamine injection into the striatum, whereas locomotor responses to amphetamine are reduced by lesions to A10 and can be induced by its injection into the nucleus accumbens. Another indication of the importance of DA in motor control is the observation that in humans its precursor levodopa, and DA agonists like bromocriptine, not only overcome the akinesia of Parkinsonism but in excess will actually cause involuntary movements, or dyskinesia (Chapter 14). Thus DA seems to sit on a knife edge in the control of motor function (Fig. PSYCHOSES The main use clinically of DA antagonists is in the treatment of schizophrenia (Chapter 17) and the control of mania. Since psychotic symptoms are also a side-effect of levodopa therapy in Parkinsonism and as amphetamine causes hallucinations and schizophrenic-like symptoms in humans, presumably by releasing DA, it appears that DA also has an important part to play in the control and induction of psychotic symptoms. It is possible that the role of DA in psychosis is mediated primarily through the mesolimbic and mesocortical pathways and its control of motor function through the striatum, and there is evidence that the neurons from which these pathways arise have different characteristics. Although there is some overlap between the various DA nuclei in respect of the location of the cell bodies of the neurons that give rise to the different DA pathways, neurons can be identified by antidromic activation of their terminal axons in the appropriate projection areas. Recordings from neurons so identified show that they have differing firing patterns. Those cells innervating the prefrontal cortex fire at a much higher rate (9. Unlike the NA neurons they are also remarkably little affected by the state of the animal, i. The cells in A10 which form the mesocortical pathway are also less easily inhibited by DA agonists suggesting that they probably have fewer autoreceptors. Unfortunately it seems that the DA postsynaptic receptor is the same at both sites so it has been difficult to divorce the antischizophrenic from the extrapyramidal-inducing activity of DA antagonists (see Chapter 16). REWARD AND REINFORCEMENT We expect reward to be pleasurable and it is assessed in animals by their willingness to seek and approach something, such as a lever linked to either food dispensing or brain DOPAMINE 157 Figure 7. The latter may be controlled by neuroleptic drugs (DA antagonists) but they can swing the balance in DA activity sufficiently to produce akinesia (Parkinsonism). DA agonists (and levodopa) may overcome akinesia but can induce DA overactivity and dyskinesia (peak dose effect) (see Chapter 15) stimulation. Reinforcement is the manner in which one event (stimulus) strengthens the likelihood of its repetition, i.

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