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The knowledge these people had was of the basic discount 20mg nolvadex with amex women's health center of lebanon pa, practical type—a knowledge neces- sary for survival quality nolvadex 10mg menopause vs perimenopause. Sculpted from a single block of white, flawless Carrara marble, a˘-na′shun), the drilling of a hole in the skull, or removal of a por- this masterpiece captures the physical nature of the human body in tion of a cranial bone, seems to have been practiced by several an expression of art. Trepanation was probably used as a ritualistic procedure to release evil spirits, or on some patients, perhaps, to relieve cranial pressure resulting from a head wound. It is likely that a type of practical comparative anatomy is the oldest Trepanated skulls have been found repeatedly in archaeological science. Judging from the partial reossification in some of anatomical structures and how they function. Our prehistoric an- these skulls, apparently a fair proportion of the patients survived. Through the trial and through information derived from cave drawings, artifacts, and error of hunting, they discovered the “vital organs” of an animal, fossils that contain paleopathological information. Paleopathol- which, if penetrated with an object, would cause death (fig. The butchering of an animal following the kill provided many valuable anatomy lessons for prehistoric people. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 4 Unit 1 Historical Perspective death in prehistoric humans. A person’s approximate age can be determined from skeletal remains, as can the occurrence of cer- tain injuries and diseases, including nutritional deficiencies. Diets and dental conditions, for example, are indicated by fossilized teeth. What cannot be determined, however, is the extent of anatomical information and knowledge that may have been transmitted orally up until the time humans invented symbols to record their thoughts, experiences, and history. Why would it be important to know the anatomy of the skull and brain before performing a surgery such as trepanation? What types of data might a paleopathologist be interested in obtaining from an Egyptian mummy? Amazingly, more than a few patients sur- vived this ordeal, as evidenced by ossification around the bony Human anatomy is a dynamic and growing science with a long, edges of the wound. It continues to provide the foundation for med- ical, biochemical, developmental, cytogenetic, and biomechanical research. Objective 6 Discuss some of the key historical events in the science of human anatomy. Objective 7 List the historical periods in which cadavers were used to study human anatomy. Cadaver Dissections Influences Embalming Religion and philosopy Religion and superstition Galen Vesalius Events and Pharaohs Homer Hippocrates Realism Plague epidemic in art Microscope personalities Cell theory Antiquity Egyptian Greece Alexandria Rome “Dark Ages” Civilization Renaissance Baroque Human dissection performed Acceptance of human dissection 30 25 20 15 10 5 0 5 10 15 20 Centuries BC AD FIGURE 1. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 1 History of Anatomy 5 TABLE 1. Described the anatomy of wounds in the Iliad Hippocrates Ancient Greece About 460–377 B. Father of medicine; inspired the Hippocratic oath Aristotle Ancient Greece 384–322 B. Founder of comparative anatomy; profoundly influenced Western scientific thinking Herophilus Alexandria About 325 B. Conducted remarkable research on aspects of the nervous system Erasistratus Alexandria About 300 B. Sometimes called father of physiology; attempted to apply physical laws to the study of human function Celsus Roman 30 B. A few of the individuals who made significant contribu- Objective 9 Discuss one way of keeping informed about tions to the field are listed in table 1. Some of their developments in anatomical research and comment on the contributions were in the form of books (table 1. The scientific period begins with recorded anatomical observa- tions made in early Mesopotamia on clay tablets in cuneiform script over 3,000 years ago and continues to the present day. Ob- Mesopotamia and Egypt viously, all of the past contributions to the science of anatomy cannot be mentioned; however, certain individuals and cultures Mesopotamia was the name given to the long, narrow wedge of had a tremendous impact and will be briefly commented on in land between the Tigris and Euphrates rivers, which is now a large this section. Archaeological excavations and ancient records show that this area was settled prior to 4000 B. Onthe basis of recorded information about the culture of the people, cuneiform: L.

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Barnes buy 10mg nolvadex free shipping breast cancer 900 position, NM and Sharp generic nolvadex 20 mg menopause vaginal discharge, T (1999) A review of central 5-HT receptors and their function. Beckett, S and Marsden, CA (1997) The effect of central and systemic injection of the 5-HT1A receptor agonist 8-OHDPAT and the 5-HT1A receptor antagonist WAY100635 on peri- aquaductal grey-induced defence behaviour. Bremner, JD, Krystal, JH, Southwick, SM and Charney, DS (1996) Noradrenergic mechanisms in stress and anxiety. Cao, BJ and Rodgers, RJ (1997) Influence of 5-HT1A receptor antagonism on plus-maze behaviour in mice. Chaouloff, F (1993) Physiopharmacological interactions between stress hormones and central serotonergic systems. In Biological Psychiatry (Eds Bittar, EE and Bittar, N), JAI Press, Stanford, CT, pp. Chiu, TH, Dryden, DM and Rosenberg, HC (1982) Kinetics of [3H]-labelled flunitrazepam binding to membrane-bound benzodiazepine receptors. Costa, E and Guidotti, A (1991) Diazepam binding inhibitor (DBI): a peptide with multiple biological actions. Coupland, N, Glue, P and Nutt, DJ (1992) Challenge tests: assessment of the noradrenergic and GABA systems in depression and anxiety disorders. Dalley, JW, Mason, K and Stanford, SC (1996) Increased levels of extracellular noradrenaline in the frontal cortex of rats exposed to naturalistic environmental stimuli: modulation by acute systemic administration of diazepam or buspirone. Deakin, JFW, Graeff, FG and Guimaraes, FS (1992) 5-HT receptor subtypes and the modulation of aversion. In Central Serotonin Receptors and Psychotropic Drugs (Eds Marsden, CA and Heal, DJ), Blackwell Scientific Publications, Oxford, pp. De Robertis, E, Pena, C, Paladini, AC and Medina, JH (1988) New developments on the search for endogenous ligand(s) of central benzodiazepine receptors. Doble, A and Martin, IL (1996) The GABAA/Benzodiazepine Receptor as a Target for Psychoactive Drugs, RG Landes Co. Done, CJ and Sharp, T (1994) Biochemical evidence for the regulation of central noradrenergic activity by 5-HT1A and 5-HT2 receptors: Microdialysis studies in the awake and anaesthetised rat. Do Rego, JL, Mensah-Nyagan, AG, Feuilloley, M, Ferrara, P, Pelletier, G and Vaudry, H (1998) The endozepine triakontatetraneuropeptide diazepam-binding inhibitor [17±50] stimulates neurosteroid biosynthesis in the frog hypothalamus. Dorow, R, Horowski, R, Paschelke, G, Amin, M and Braestrup, C (1983) Severe anxiety induced by FG7142, a b-carboline ligand for benzodiazepine receptors. Dourish, CT, Hutson, PH and Curzon, G (1986) Putative anxiolytics 8-OHDPAT buspirone and TVXQ 7821 are agonists at 5-HT1A autoreceptors in the raphe nuclei. Duggan, MJ and Stephenson, FA (1988) Benzodiazepine binding site heterogeneity in the purified GABAA receptor. Eison, AS, Eison, MS, Stanley, M and Riblet, LA (1986) Serotonergic mechanisms in the behavioural effects of buspirone and gepirone. File, SE (1997) Anxiolytic action of a neurokinin1 receptor antagonist in the social interaction test. File, SE and Hyde, JR (1979) A test of anxiety that distinguishes between the actions of benzodiazepines and those of other minor tranquilisers and of stimulants. Fontana, DJ, McMiller, LV and Commissaris, RL (1999) Depletion of brain norepinephrine: differential influence on anxiolytic treatment effects. Geller, I, Kulak, JT and Seifter, J (1962) The effects of chlordiazepoxide and chlorpromazine on a punished discrimination. Gobert, A, Rivet, JM, Cistarelli, L, Melon, C and Millan, MJ (1997) Alpha2-adrenergic receptor blockade markedly potentiates duloxetine- and fluoxetine-induced increases in noradrenaline, dopamine and serotonin levels in the frontal cortex of freely moving rats. Graeff, FG, Guimaraes, FS, De Andrade, TGC and Deakin, JFW (1996) Role of 5-HT in stress, anxiety and depression. Gray, JA (1987) The Psychology of Fear and Stress, 2nd edition, Cambridge University Press, Cambridge. Han, QP and Dryhurst, G (1996) Influence of glutathione on the oxidation of 1-methyl-6- hydroxy-1,2,3,4-tetrahydro-beta-carboline; chemistry of potential relevance to the addictive and neurodegenerative consequences of ethanol use. Handley, SL (1995) 5-Hydroxytryptamine pathways in anxiety and its treatment. In Neurotherapeutics, Emerging Strategies (Eds Pullan, LM and Patel, J), Humana Press Inc.

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Clin Radiol Evaluation of chemotherapy response in pediatric bone sarco- 50:384-390 mas by [F-18]-flourodeoxy-d-glucose positron emission to- 42 order nolvadex 20mg with visa womens health of mansfield. Luc UCL generic nolvadex 20 mg without a prescription menstruation leg cramps, Brussels, Belgium The objectives of this chapter are three-fold. Second, a logical analysis of MR imaging (MRI) placed by yellow marrow in the peripheral skeleton. Finally, the Meanwhile, the proportion of fat cells within the axial opportunity to analyze MR images of patients with bone red marrow progressively increases. By the age of 25, metastases, multiple myeloma or lymphoma, with em- red and yellow marrow have reached their final adult phasis on lesion detection, will be provided. This fundamental process explains the distribution of most Normal Adult Bone Marrow: Distribution, marrow lesions in the body. Composition and MR Appearance Yellow marrow contains almost exclusively adipocytes Normal Variants in MR Appearance of Bone (Table 1) which accounts for its high signal intensity on Marrow T1-weighted SE and T2-weighted FSE images (Table 2). Hematopoietic cells and adipocytes are present in red Important variations in red-marrow signal intensity and marrow and cause intermediate signal intensity of red heterogeneity at MRI are encountered. Yellow marrow High signal intensity areas on T1-weighted SE images also differs from red marrow in vasculature and in distri- in axial marrow reflect focal fatty involution, and are ir- bution within the body (Table 1). Anatomy of red and yellow marrow Yellow marrow Red marrow Chemical composition 80% lipids, 15% water 40% lipids, 40% water Cellular composition Fat cells Hematopoietic and fat cells Vasculature Few capillaries Permeable sinusoids Distribution Appendicular skeleton Axial skeleton Table 2. Magnetic resonance imaging (MRI) characteristics of red and yellow marrow MRI Red marrow Yellow marrow T1-weighted Intermediate High T2-weighted SE Intermediate Intermediate/high STIR, T2-fat saturated Moderately high Low Gradient-echo Low Intermediate Contrast enhancement Moderate enhancement No enhancement Imaging of Bone Marrow Disorders 69 a b Hematopoietic marrow hyperplasia frequently occurs in middle-aged women. It is defined by the presence of hypercellular marrow in axial marrow and the expansion of red marrow in the appendicular skeleton. It can be id- iopathic or associated with heavy smoking habit, long distance running and obesity. It is most generally inci- dentally discovered on routine knee MR examination, as it shows low to intermediate signal intensity in the distal femoral metaphyses on T1-weighted images in patients older than 25 years. The marrow signal intensity should remain consistent with that of red marrow on other se- quences and the adjacent epiphysis should contain fatty marrow. Significant marrow heterogeneity can be en- countered in axial skeleton of patients with red-marrow hyperplasia. In other words, the T1-weighted SE sequence ter detection of lesion on T1- than on T2-weighted images). The with its exquisite sensitivity to the presence of fat en- low-signal-intensity areas on the fat-saturated images (white ar- ables assessment of the fat/non-fat marrow balance in rows) with high signal intensity on T1-weighted images correspond the medullary cavity. It must be emphasized that the to areas of fatty marrow and lack clinical significance decrease in the amount of marrow fat that can be de- tected at MRI completely lacks specificity, and the clinical value of MRI resides in its sensitivity for le- shows high signal intensity on both T1- and T2-weighted sion detection and not in its specificity. They can be confused with weighted sequences detect changes in water content relevant marrow lesions if T2-weighted images only are that are not systematically altered in marrow lesions. The T1-weighted SE images are mandatory to Therefore, the T1-weighted sequence represents the demonstrate the presence of fat, which confirms the be- cornerstone in marrow imaging. T2- it must be kept in mind that a strictly normal appear- and fat-saturated intermediate-weighted FSE images as ance of the bone marrow on T1- and T2-weighted MR well as enhanced T1-weighted SE images may help to images does not exclude clinically significant alter- differentiate this normal variant from lesions (Table 3). Suggested guidelines that can be used cautiously to differentiate benign heterogeneities of normal red marrow from marrow lesions Benign heterogeneity Marrow lesion T2-weighted images Low/intermediate signal intensity High signal intensity STIR, fat-saturated, T2-weighted images Low/intermediate signal intensity High signal intensity Contrast-enhanced images No/discrete enhancement Enhancement Distribution in bone Near cortical bone Any area Distribution in body Symmetrical Variable Margins Generally fuzzy Generally sharp Centre on T1-weighted images High signal intensity Low signal intensity Bone scintigraphy No change Altered uptake CT image Normal trabecular bone Altered trabeculae Follow-up No change Increase in size and number 70 B. Elementary lesions patterns at MRI T1-weighted signal intensity Fat amount Clinical significance Depletion High Increased None Infiltration Moderately low Moderately reduced Reactional lesion Replacement Low Markedly reduced Primary lesion Signal void Black Absent Lack of protons Marrow Depletion Differentiating focal marrow “replacement” from “in- filtration” is important because marrow infiltration is fre- Red-marrow depletion is a pattern characterized on T1- quently a reaction to changes in an adjacent lesion. Focal red-marrow depletion: quiescent or healed le- sions, Paget disease, and vertebral hemangioma. Diffuse red marrow depletion: steroids, chemotherapy, For lesion detection, the T1-weighted SE sequence is fre- aplastic anaemia. Fat-sat- Marrow Infiltration urated T2- or intermediate-weighted images and STIR are also efficient in lesion detection and will also show high Marrow infiltration is a pattern characterized by a subtle to signal intensity on a background of low to intermediate moderate decrease in marrow signal intensity on T1- signal intensity. Margins are generally indistinct, with including in young women and children, these sequences a gradual zone of transition toward normal bone marrow. T2-weighted gradi- with some possible residual adipocytes in the lesion. The ent-echo images are generally not used for lesion detec- term bone marrow “edema” is frequently used to charac- tion except in the work-up of patients with multiple terize marrow infiltration because of its high signal inten- myeloma (purely lytic lesions) (Fig. Contrast-en- sity on T2-weighted SE images, consistent with an increase hanced T1-weighted images can be used to differentiate in the free water content.

This can be seen in neonates under stress cheap 10mg nolvadex women's health issues in malaysia, vicinity of the physis are left behind nolvadex 20mg line women's health center clinton, falsely appearing and in children with leukemia or methotrexate osteopa- to migrate towards the diaphysis (Fig. The navicular is the last tarsal bone to os- tions are prone to repeated minor avulsive injury. There are normally two ossification centers, but cortex becomes irregular, particularly in the posterior multiple irregular, dense centers can develop, and fuse 150 D. Aseptic necrosis of the navicular Scintigraphy (Kohler’s disease) affects older children, and is associ- ated with pain. Tc-99m diphosphonate uptake is high in long bone phy- ses and in physeal equivalents of the flat bones [16, 17]. MR Imaging This physiologic uptake decreases gradually with age but may persist even after the physes have fused radiograph- Age-related transformations of cartilage to bone, and of ically. Skeletal structures that have not yet ossified have hematopoietic to fatty marrow, strongly influence the no Tc-99m diphosphonate uptake. Epiphyseal cartilage has intermediate signal life does not mean ischemia, and decreased activity in the intensity on T1-weighted images and low signal inten- tarsal navicular below the ages of 2 years in girls and 4 sity on T2-weighted and STIR images. The physis is of high signal intensi- Imaging Strategies ty on most pulse sequences (Fig. With physeal clo- sure, the cartilage loses signal intensity and ultimately In pediatric musculoskeletal imaging, the first imaging disappears. Because of its high water content, normal haps the use of ultrasonography during the first six month hematopoietic marrow is of low signal intensity on of life for evaluation of developmental dysplasia of the T1-weighted images, intermediate signal intensity on hip, where radiographs are of little value. Different imag- conventional T2-weighted and STIR images, and high ing modalities have different strengths, and, for the most signal intensity on fast spin-echo T2-weighted and part, their information is complementary rather than STIR images. It is important to know the relative strengths hematopoietic to fatty marrow begins in the epiphyses and indications of each modality in the evaluation of pe- and diaphysis, and then advances into metaphyses. Unlike meniscal tears, which are usually multiplanar and three-dimensional (3D) reconstructions vertical in children, intrameniscal nutrient ves- are considered (Fig. In the context of trauma, CT is sels are horizontal, central, originate from the capsu- optimal for detection of subtle fractures (e. In slipped capital femoral epiphysis, CT demonstrates the physeal irregularity, the degree of inferior and posterior displace- ment of the femoral head, and the retroversion of the con- tralateral femur. In acetabular fractures, 3D reconstruc- tions demonstrate the relationships between fragments better. In infants with hip dislocation who have under- gone reduction and placement of the hips in an abduction spica cast, CT can be used to assess the position of the femoral heads. If a low mAs technique is used, the total ovarian dose can be as low as 112 mrad (1. Two-year-old In adolescents and young adults with undetected hip dys- girl with an abscess plasia, CT with 3D reconstructions demonstrates the con- in the soft tissues of figuration and containment of the femoral head, acetabu- the thigh. Sagittal post-gadolinium lar architecture, and narrowing of the joint space. In the T1-weighted image spine, vertebral abnormalities and fusions between verte- shows enhancement brae or ribs are easily demonstrated with CT. Frontal and posterior oblique 3D surface renderings of the spine of a 3-month-old girl with a severe defect of the bony thorax. The study was performed using a multi-detector CT, without need for sedation. Multiple tarsal ing treatment for developmental dysplasia of the hip coalitions may occur in up to 20% of cases and not (DDH) [31, 32]. Although accuracy for Calvé-Perthes disease, and with femoral ischemia of detecting tarsal coalitions is comparable for CT and MR other etiologies, MR imaging will demonstrate marrow imaging, CT allows easier evaluation of both feet, edema and lack of gadolinium enhancement of the and it is less expensive, and more readily available. MR imaging can also images demonstrate a complete osseous fusion if the depict associated physeal and metaphyseal abnormali- coalition is bony, or irregularity of the articular surfaces of ties and the extent of marrow involvement [36, 37]. In more advanced disease, MR imaging shows the con- tainment of the femoral head and the congruity of the MR Imaging articular surfaces. MR imaging is crucial for evaluating spinal os- MR imaging is the modality of choice for assessing spinal teomyelitis, by depicting epidural abscess and extension abnormalities.

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