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The anterior group of muscles viagra sublingual 100 mg with amex erectile dysfunction medicine in dubai, referred Objective 16 Discuss the clinical importance of the buttock buy cheap viagra sublingual 100 mg on line erectile dysfunction medication new, to as the quadriceps femoris, extends the knee joint when it is femoral triangle, popliteal fossa, ankle, and arches of the foot. The medial muscles are the adductors, and when contracted they draw the thigh medially. The “ham- strings” are positioned on the posterior aspect of the thigh Surface Anatomy (see fig. The tendinous Buttock attachments of the hamstrings can be palpated along the poste- rior aspect of the knee joint when it is flexed. The hamstrings or The superior borders of the buttocks, or gluteal region, are formed their attachments are often injured in athletic competition. It can be seen as a the natal cleft (gluteal cleft) extends vertically to separate the depression inferior to the location of the inguinal ligament on buttocks into two prominences, each formed by pads of fat and the anteromedial surface in the upper part of the thigh (see by the massive gluteal muscles. The major vessels of the lower extremity, as well as pated in the lower portion of each buttock. Hernias are frequent in the ischial tuberosities support the weight of the body. More important; the femoral triangle serves as an arte- standing, these processes are covered by the gluteal muscles. The inferior border of The greater trochanter of the femur can be palpated on the the gluteus maximus muscle forms the fold of the buttock. At the knee, the lateral and medial condyles of the femur and tibia can be buttock: O. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 327 importance in setting fractures of the leg is knowing that the top Femoral triangle of the medial malleolus lies about 1. The heel is not part of the leg; rather, it is the posterior part of the calcaneus. It warrants mention with the leg, how- Adductor group ever, because of its functional relationship to it. The tendo of muscles calcaneus (tendon of Achilles) is the strong, cordlike tendon Rectus femoris m. The muscles forming the belly of the calf are the gastrocnemius and soleus. The superficial veins of the leg can be observed on many individuals (see fig. The great saphenous vein can be seen subcutaneously along the medial aspect of the leg. The less con- spicuous small saphenous vein drains the lateral surface of the Vastus medialis m. If these veins become excessively enlarged, they are called varicose veins. Shinsplints, proba- Patella bly the result of a stress fracture or periosteum damage of the tibia, is a common condition in runners. A fracture of one or both Lateral epicondyle malleoli is caused by a severe twisting of the ankle region. Skiing of femur fractures are generally caused by strong torsion forces on the body Medial epicondyle of the tibia or fibula. The structural features and surface anatomy of the foot are in- dicative of these functions. The longitudinal arch of the foot, lo- cated on the medial portion of the plantar surface (see figs. The head of the first metatarsal bone forms the medial ball of the foot, just proximal to the hallux (great toe). The feet and toes are adapted to endure tremendous com- pression forces during locomotion. Although appropriate cated within the patellar tendon, anterior to the knee joint.

The bioactivity of FSH (and LH) purchase viagra sublingual 100mg mastercard erectile dysfunction how can a woman help, indicative of the lack of ovarian func- testosterone is reduced by SHBG because testosterone tion buy viagra sublingual 100 mg line erectile dysfunction caused by lack of sleep. Menses starts at age 12, not age 50, and its onset cannot bind to its receptor when bound by SHBG. Excessive SHBG increases the circulating half-life of testosterone corpora lutea would likely indicate multiple ovulations by slowing the clearance and metabolism of testos- or a failure of luteal regression. SHBG does not alter the secretion of inhibin or fication is an indicator of estrogen secretion, which androgen-binding protein. The androgen diffuses to fect on the hypothalamus, increasing the basal body Sertoli cells, which contain aromatase, the enzyme temperature for a few days after ovulation. Women that converts androgens to estrogens under the influ- who, because of ovulatory problems, are having trou- ence of FSH. Therefore, Leydig cells, Sertoli cells, LH, ble getting pregnant are sometimes asked to record and FSH are required. Follistatin binds activin and their daily oral temperatures and look for the increase would reduce FSH secretion, an essential component in basal body temperature, indicating an increase in for estradiol production. Activin would increase the secretion of terone induces a secretory type of endometrium, FSH, which is a necessary component for estradiol, but whereas estrogens induce a proliferative type. Similarly, Ley- the luteal phase, when progesterone is increasing, dig cells would need LH to stimulate the production of graafian follicles are not present. FSH decreases when the influence of FSH, are needed to aromatize andro- progesterone is rising. Androgens and estrogens are known gens under the influence of LH, whereas granulosa to stimulate the closure of the epiphyses at puberty. Theca interna cells do Because eunuchs are castrated, they have no testicular contain cholesterol side-chain cleavage enzyme, source of androgen and estrogen, and the closure of which converts cholesterol to pregnenolone. In eunuchs, long bones con- theca cells do not express aromatase, they cannot con- tinue to grow, resulting in a tall stature. The theca interna has a have a positive effect in maintaining bone; however, rich blood supply. Choice B is incorrect, although eunuchs itary portal system leads to a lack of dopamine and may have elevated circulating LH (as a result of the GnRH reaching the pituitary. The absence of testes delays the closure of tion, the lack of GnRH will lead to reduced secretion the epiphyses, and androgen levels are low in eunuchs of LH and FSH, reduced ovarian function, and even- because of the lack of testes. PRL will have no effect on the ovary or inhibit ovarian follicle development. Disrup- Chapter 38 tion of the hypothalamic-pituitary axis will lead to re- duced follicular development, lack of ovulation, and 1. Although crease, but FSH will not increase because there is no LH may stimulate aromatase in granulosa cells, granu- GnRH reaching the pituitary from the disrupted axis. Estradiol synthe- Excessive ovarian androgen usually occurs in the pres- sis in the graafian follicle is unrelated to progesterone ence of excessive LH secretion or an androgen tumor synthesis in the corpus luteum and does not increase in the ovary. Inhibin is produced by granulosa cells between FSH and progesterone in regulating estradiol and inhibits the secretion of FSH. Granulosa cells do not have the en- can have local ovarian effects, it has profound in- APPENDIX A Answers to Review Questions 735 hibitory effects on FSH secretion. Inhibin has two reaction and pronuclei formation occur after the sperm forms, A and B; the subunits are the same, whereas has entered the ovum. Inhibin binds activin and space after penetration; there is no evidence that this decreases FSH secretion. Estrogen induces the formation of a assists in movement of the sperm through the mass of stringy vaginal secretion that is called spinnbarkeit, granulosa cells for the sperm to get to the surface of the observed in the late follicular phase. However, the cumulus cells do not as- dometrium is under the influence of progesterone; sist in actual penetration of the zona. The production of hCG by tro- Spinnbarkeit is not produced in response to proges- phoblast cells stimulates the corpus luteum to continue terone, androgen, or prolactin. Although The oocyte must have entered a second meiotic divi- PRL levels increase throughout pregnancy, PRL is not sion to reduce the chromosome number of the oocyte responsible for maintenance of the corpus luteum of to a haploid state (n) so that it may fuse with the sperm pregnancy.

Until this occurrence generic viagra sublingual 100 mg otc pills to help erectile dysfunction, however viagra sublingual 100 mg sale erectile dysfunction vegan, disruption of the growth plate can adversely affect growth of the bone. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 Developmental Exposition Initially, the developing limbs are directed caudally, but The Appendicular Skeleton later there is a lateral rotation in the upper extremity and a me- dial rotation in the lower extremity. As a result, the elbows are directed backward and the knees directed forward. EXPLANATION Digital rays that will form the hands and feet are apparent The development of the upper and lower extremities is initiated by the fifth week, and the individual digits separate by the end of toward the end of the fourth week with the appearance of four the sixth week. The superior pair are the arm buds, whose development precedes that of the infe- A large number of limb deformities occurred in children born between 1957 and 1962. Each limb bud consists of a tive thalidomide was used by large numbers of pregnant women mass of undifferentiated mesoderm partially covered with a layer to relieve “morning sickness. The malformations ranged from As the limb buds elongate, migrating mesenchymal tissues micromelia (short limbs) to amelia (absence of limbs). Primary ossifica- tion centers soon form in each bone, and the hyaline cartilage tissue is gradually replaced by bony tissue in the process of endo- micromelia: Gk. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 Chapter 7 Skeletal System: The Appendicular Skeleton 193 CLINICAL PRACTICUM 7. On examination, you note a markedly deformed forearm with an open wound. You note that the patient has mildly weakened strength in the hand, normal sensation, as well as normal capil- lary refill and normal radial pulse. Why is it important to evaluate neuromuscular and vascular function in the hand in this case? At the current appointment, she complains of a new pain in her right hip. This pain began approxi- mately one month before and has been slowly progressing. On physical exam, you find nothing remarkable with the exception that the patient is now walking with a no- ticeable limp. A conventional radiograph (left) and a CT scan (right) of the hip are shown here. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 194 Unit 4 Support and Movement Chapter Summary Pectoral Girdle and Upper Extremity notch, and the radial notch. Anteriorly, each (b) Proximally, distinguishing features of (a) Proximally, distinguishing features of clavicle articulates with the sternum at the radius include the head and neck the femur include the head, fovea the sternoclavicular joint. Distally, they include the acromial and sternal process and ulnar notch. The hand contains 27 bones including epicondyles, the lateral and medial costal tuberosity. The thumb lacks a middle The linea aspera is a roughened ridge include the spine, acromion, and phalanx. The pelvic girdle is formed by two ossa borders; and superior, inferior, and the os coxae and distally with the coxae, united anteriorly at the symphysis lateral angles. Each os coxae consists of an ilium, lateral condyles, intercondylar anatomical neck, and an ischium, and pubis. Distally, they features of the os coxae include an Distally, they include the medial include medial and lateral obturator foramen and an acetabulum, the malleolus and fibular notch. The epicondyles, coronoid and olecranon latter of which is the socket for anterior crest is a sharp ridge fossae, a capitulum, and a trochlea. The antebrachium contains the ulna include the body, ramus, ischial 7 tarsal bones, 5 metatarsal bones, (medially) and the radius (laterally). The great toe lacks a (a) Proximally, distinguishing features of (c) Distinguishing features of the pubis middle phalanx. The clavicle articulates with (d) the clavicle arranged in two transverse rows of (a) the scapula and the humerus. The proximal process of the ulna is (b) All of the carpal bones are considered (c) the manubrium and the scapula. Skeletal System: The © The McGraw−Hill Anatomy, Sixth Edition Appendicular Skeleton Companies, 2001 Chapter 7 Skeletal System: The Appendicular Skeleton 195 (d) The trapezium, trapezoid, capitate, 2. Explain why the clavicle is more frequently been buried in Italy, it was reinterred in and hamate articulate with the fractured than the scapula.

The left sixth arch forms the proximal portion of the left pulmonary artery cheap 100mg viagra sublingual overnight delivery erectile dysfunction viagra not working, and the distal portion of this arch per- sists as an embryonic shunt between the pulmonary trunk and the aorta called the ductus arteriosus cheap viagra sublingual 100 mg without a prescription erectile dysfunction treatment supplements. DEVELOPMENT OF THE MAJOR ARTERIES The derivatives of the aortic arches are summarized in table 16. The formation of the major arteries occurs simultaneously with Although the embryonic vessels that develop from the the development of the heart. The most complex and fascinating truncus arteriosus are called aortic arches, they should vascular formation is the development of the aortic arches asso- not be confused with the adult aortic arch; that is, ciated with the pharyngeal pouches and branchial arches in the the major systemic artery leaving the heart. These aortic arches arise from the trun- fourth arch participates in the formation of the adult aortic arch. Although six pairs of aortic arches develop, they An examination of the persisting aortic arches in the adults are not all present at the same time, and none of them persists in of different classes of vertebrates reveals interesting evolutionary entirety through fetal development. Fish have six aortic arches persisting in the gill re- The transformation of the sixaortic arches into the basic gion. Reptiles have only one pair, a branch to the left and one to adult arterial arrangement occurs between the sixth and eighth the right. All birds have a single right aortic arch, and all mammals have a single left aortic arch. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 (a) (b) 1 Dorsal aorta 2 Aortic arches 3 1 Disappearing 4 aortic arches 2 6 Aortic sac 3 4 Truncus Truncus arteriosus arteriosus 6 Dorsal aorta Pulmonary Heart artery Intersegmental artery (gives rise to Internal carotid vertebral artery) artery (dorsal aorta) Internal carotid Internal carotid artery (c) artery (d) External carotid External carotid artery artery External carotid artery 3 3 Vertebral artery Vertebral artery 4 4 Subclavian Subclavian artery Subclavian artery artery Ductus arteriosus Vertebral artery Brachiocelphalic trunk Pulmonary Pulmonary arteries artery Pulmonary artery Descending Pulmonary aorta Descending aorta trunk Waldrop EXHIBIT III Formation of the aortic arch and major arteries of the thoracic region. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 592 Unit 6 Maintenance of the Body the atria (fig. Ventricular Fibrillation Sinus bradycardia Fibrillation is caused by a continuous recycling of electrical waves through the myocardium. Because the myocardium enters a refractory period simultaneously at all regions, this recycling is normally prevented. If some cells emerge from their refractory periods before others, however, electrical waves can be continu- ously regenerated and conducted. The recycling of electrical Sinus tachycardia waves along continuously changing pathways produces uncoordi- (a) nated contraction and an impotent pumping action. Fibrillation can sometimes be stopped by a strong electric shock delivered to the chest—a procedure called electrical defib- rillation. The electric shock depolarizes all the myocardial cells at the same time, causing them to enter a refractory state. The conduction of random recirculating impulses thus stops, and the Ventricular tachycardia SA node can begin to stimulate contraction in a normal fashion. Although this does not correct the initial problem that caused the abnormal electrical patterns, it can keep a person alive long enough to take other corrective measures. Ventricular fibrillation Blood Disorders (b) Because blood is the functional component of the circulatory sys- tem, and because the circulatory system works in such close asso- FIGURE 16. Peripheral arterial pul- be abnormally slow (bradycardia—46 beats per minute in this exam- sations, usually obtained at the radial artery, provide information ple) or fast (tachycardia—136 beats per minute in this example). Capillary filling, following blanching, is an in- Ventricular tachycardia is produced by an ectopic pacemaker in the dicator of peripheral arterial circulation and is generally tested at ventricles. This is done by firmly pressing the thumbnail fibrillation, also shown in (b). If the pinkish color returns quickly to the whitened (blanched) area, circulation is considered normal. Lack Both bradycardia and tachycardia can occur normally of peripheral coloration indicates vascular insufficiency. Endurance-trained athletes, for example, com- Certain cardiovascular and blood abnormalities are ex- monly have a slower heart rate than the general population. Activation of the sympathetic division of the ANS during skin because of a deficiency of erythrocytes or hemoglobin. An ab- an excessive accumulation of interstitial (tissue) fluid, causing a normal tachycardia occurs if the heart rate increases when a per- swelling of a portion of the body.