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The effusion can planning surgery by demonstration of anatomic variants 25mg coreg otc, be demonstrated between the hyperechoic linings of the such as a bifid median nerve or the presence of median iliofemoral ligament and the femoral neck (transient syn- artery purchase coreg 25mg overnight delivery, and by detection of expansible masses that cannot ovitis cheap 6.25mg coreg fast delivery, septic arthritis buy coreg 6.25mg lowest price, rheumatoid arthritis, osteoarthritis, be successfully treated by endoscopy. Longitudinal (a) and trans- verse (b) US images obtain- ed over the pal- Fig. Longitudinal (a) and transverse mar aspect of (b) color Doppler images obtained over the dorsal aspect of the the third finger. US shows the Sonograms pannus as a hypoechoic area containing multiple flow signals show the gan- (white arrowheads). An erosion (empty arrowheads) can be noted glion (asterisk) as an anechoic mass with sharp borders located on the dorsal aspect of the capitate. P1 Proximal phalanx Musculoskeletal Sonography 163 In loosening of a hip prosthesis, the capsule to bone distance which is normally less than 3. US can detect different hypoechoic bursae around the hip: the trochanteric bursa, the ischiogluteal bursa, and the iliopsoas bursa, of which the latest may communicate with the joint. The cause is most often mechanical, less frequent inflammatory, and rarely infectious or tu- moral. The complete spectrum of changes associated with tendinosis may occur at the insertion of the gluteus medius and minimus tendons. The diagnosis of hamstring or adductor insertion ten- donitis requires a comparison of the thickness and echo texture of the involved structures (Fig. US can demonstrate the extraarticular origin of a painful snapping hip by a dynamic evaluation of the il- iopsoas, gluteal and tensor fascia lata tendons. Hyperechoic crystal deposition (arrow) proximal in the rectus Different types of hernias in the groin region can also femoris tendon surrounded by edema be differentiated and diagnosed by US. In sports injuries, US detects hematoma and disconti- nuity in tendon or muscle tears of the hamstrings, adduc- tor, and rectus femoris muscles, or, apophyseal avulsions in patients 14-25 years of age. In chronic or repetitive lesions, muscular fibrosis and Knee Sonography calcifications are found. The US evaluation of hip dysplasia allows evaluation Ultrasound can detect small effusions of various of the cartilage components of the femoral head and ac- echogenicity (depending on the etiology), loose bodies, etabulum in multiple planes, both at rest and with move- and synovial proliferations (Fig. In tendinosis of the proximal patellar tendon (jumper’s knee), the spectrum of focal hypoechoic tendon enlarge- ment (areas of fibromyxoid degeneration), fissures, par- tial tears, focal hypervascularization, and calcifications can be monitored by US, and can easily be differentiated from peritendonitis or bursitis [46, 47]. Microavulsions of cartilage in Osgood-Schlatter or Sinding Larson Johansson disease are seen as hyperehoic calcified foci accompanied by hypoechoic focal tendon thickening and, occasionally, mild bursal effusion. US differentiates quadriceps tendon lesions from in- juries to the distal quadriceps muscle bellies. In iliotibial band friction syndrome, hypoechoic thick- ening and fluid collection in the soft tissues between the lateral femoral condyle and the ilotibial tract should be looked for in a comparative study completed by a dy- namic evaluation. Different types of bursitis, chronic, metabolic, infec- tious, and hemorrhagic, generally have a distinct clinical and sonographic presentation. Right and left compara- ovial- (bursa, joint space) or peritendinous tissue can be de- tive study of the hamstring’s insertion in a transverse plane at the ischial tuberosity. The right hamstring’s insertion appears marked- tected and monitored by power Doppler. When a hemor- ly thickened compared to the left rhagic prepatellar bursitis is detected, a rupture of the 164 S. The broad (15 mm) trilaminar medial collateral liga- ment and the cordlike lateral collateral ligament will be interrupted and surrounded by a hematoma when torn, or will show a hypoechoic focal thickening at the site of rup- ture. A torn posterior cruciale liga- ment appears hypoechoic and diffusely thickened; the an- terior cruciale ligament is evaluated by a comparatively posterior approach to the intercondylar region in a trans- verse plane and appears markedly swollen when torn. Anechoic fluid in a Baker’s cyst with hyperechoic thickened synovial Nerve-sheath ganglia of the peroneal nerve may arise wall (chronic synovitis). The cyst lies superficial to the medial gas- either in the nerve sheath or from the proximal tibiofibu- trocnemius muscle and has a rounded inferior border (no rupture) lar joint and appear as spindle-shaped cysts. A ruptured Baker’s cyst mimics a deep thrombophlebitis, and is char- In tendinosis, a focal or diffuse tendon enlargement and acterized by a pointed (not a rounded) inferior border, ac- a hypoechoic appearance is noted; calcifications are a companied by subcutaneous edema and fluid surrounding sign of chronic disease. Chronic traumatic bursitis ciated with pain, while tendon inhomogeneity is correlat- presents as hyperechoic thickened walls and a variable ed with an unfavorable outcome. Hyperechoic foci embedded in a hy- In tenosynovitis, an abnormal amount of fluid is noted poechoic inflammatory substance is a typical presenta- in the tendon sheath (but: less than 3 mm of fluid can be tion of bursitis in chronic gout at the extensor site of the seen at the dependent portions of the peroneal tendons, knees and elbows.
During division purchase 25mg coreg mastercard, the sequence of bases along the sides Structure of RNA and RNA Synthesis of the DNA molecule serves as a template that determines the sequence along each new strand cheap coreg 12.5mg without a prescription. In the process of protein synthesis coreg 25 mg overnight delivery, DNA produces a messenger molecule of RNA of complementary structure to transport the James Watson and Francis Crick order coreg 6.25mg visa, who devised the double- helix model, first described their vision of DNA in 1953, in the genetic information. The closing sentence of their brief arti- nucleotides joined together by sugar-phosphate bonds. Cytology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 3 Cytology 67 T A G C RNA C G G T DNA C C G C G C G G G G G C A G C A T U A C T G C G G A G U G T C C C G C G G C G FIGURE 3. Four types of RNA are produced within the nucleus, each with a FIGURE 3. Notice that different composition and function: only one of the two DNA strands is used to form a single-stranded 1. Messenger RNA (mRNA), which contains the code for rectly through its regulation of RNA and protein synthesis. Transfer RNA (tRNA), which transfers amino acids and strand of DNA that is several thousand nucleotide pairs long. In which is needed for decoding the genetic message con- order for the genetic code to be translated for the synthesis of tained in mRNA; and specific proteins, the DNA code must first be transcribed into an 4. During RNA synthesis, the enzyme RNA polymerase breaks The DNA that codes for rRNA synthesis is located in the nucle- the weak hydrogen bonds between paired DNA bases. Pre-mRNA and tRNA synthesis is controlled by DNA lo- not occur throughout the length of DNA, but only in the re- cated elsewhere in the nucleus. Double-stranded DNA, therefore, Genetic Transcription—RNA Synthesis separates in these regions so that the freed bases can pair with During cell division, the chromosomes are inactive packages of the complementary RNA nucleotide bases that are freely avail- DNA. The genes do not become active until the chromosomes able in the nucleus. Cytology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 68 Unit 3 Microscopic Structure of the Body T G G A G G T T C G T C G A C T C A C G G C C A G C DNA G T double G A C C G G helix C DNA coding strand T A C C C G A G G T A G C C G C G T C G T A U G G G C U C C A U C G G C G C A G C A Messenger RNA Codon 1 Codon 2 Codon 3 Codon 4 Codon 5 Codon 6 Codon 7 Methionine Glycine Serine Isoleucine Glycine Alanine Alanine Protein FIGURE 3. The association of mRNA with ribosomes is needed for pairing: guanine bonds with cytosine (and vice versa), and ade- genetic translation—the production of specific proteins according nine bonds with uracil (because uracil in RNA is equivalent to to the code contained in the mRNA base sequences. In RNA synthesis, only one of the two freed strands of DNA serves as a guide (see fig. Once an RNA Functions of Codons and Anticodons molecule has been produced, it detaches from the DNA strand on which it was formed. This process can continue indefinitely, Each mRNA molecule contains several hundred or more nu- producing many thousands of RNA copies of the DNA strand cleotides, arranged in the sequence determined by complemen- being transcribed. When the gene is no longer to be transcribed, tary base pairing with DNA during genetic transcription (RNA the separated DNA strands can recoil into their helical form. Every three bases, or base triplet, is a “code word”— In the case of pre-mRNA, the finished molecule is altered called a codon—for a specific amino acid. Within the pre-mRNA are noncoding regions their amino acid “translation” are shown in figure 3. The introns are removed through the action of mRNA move through the ribosome, the sequence of codons is enzymes, and the coding regions are then spliced together so that translated into a sequence of specific amino acids within a grow- they can direct the synthesis of a specific protein. Translation of the codons is accomplished by transfer RNA (tRNA) and particular enzymes. The anticodon consists of three nucleotides Protein Synthesis that are complementary to a specific codon in MRNA. Enzymes Once produced, mRNA leaves the nucleus and enters the cyto- in the cell cytoplasm join specific amino acids to the ends of plasm, where it attaches to ribosomes. The mRNA passes through tRNA, so that a tRNA with a given anticodon is always bonded a number of ribosomes to form a polyribosome, or polysome for to one specific amino acid. Cytology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 3 Cytology 69 Codons Anticodons mRNA C Next amino acid Ala U A 9 C G tRNA 5 8 C G I A U Codons 7 H 4 U A tRNA 6 C G G G 5 F Gly Next amino acid 4 E 3 Iso D Gly 2 C Ser Iso 1 B A Amino acids Gly in growing Ser polypeptide chain Met Gly Met Ribosome FIGURE 3. The three-letter abbreviations for the amino acids in the growing polypep- tide chain stand for the amino acids indicated in figure 3. Each syn- tide chain lengthens as new amino acids are added to its growing thetase must not only recognize its specific amino acid, it must tip (fig.
Only a small por- The eighth cranial nerve is an afferent tion reaches directly into the cerebellum via nerve consisting of two components coreg 6.25 mg low price, the the inferior cerebellar peduncle (restiform cochlear root for the organ of hearing and the body) buy 12.5mg coreg overnight delivery. The vestibular nuclei lie in the floor of the Cochlear Root (A) rhomboid fossa below the lateral recess: the superior nucleus (Bechterew’s nucleus) The nerve fibers originate from the bipolar (B14) order coreg 6.25mg on-line, the medial nucleus (Schwalbe’s nu- neurons of the spiral ganglion (A1) buy 12.5 mg coreg with visa, a band of cleus) (B15), the lateral nucleus (Deiters’ cells following the spiral course of the nucleus) (B16), and the inferior nucleus cochlea. The primary vestibular fibers termi- cells terminate at the hair cells of Corti’s nate mostly in the medial nucleus. Second- organ; the central processes form small ary fibers run from the vestibular nuclei to bundles that organize into the foraminous the cerebellum and into the spinal cord (ves- spiral tract (A2) and combine in the floor of tibulospinal tract) (B18). The The function of the vestibular apparatus plays latter extends, together with the vestibular an important role for balance and upright root (B) inside a common connective-tissue posture. Thetractstothecerebellumandthe sheath, through the internal acoustic meatus spinal cord serve this purpose. At the entrance of the bulospinal tract has an effect on muscular eighth cranial nerve into the medulla ob- tension in various parts of the body. The ves- longata at the cerebellopontine angle, the tibular apparatus controls especially move- cochlear component lies dorsally and the ments of the head and fixation of vision vestibular component ventrally. The cochlear fibers terminate in the ante- rior cochlear nucleus (A4) and in the pos- terior cochlear nucleus (A5). From the anterior nucleus, the fibers cross over to the opposite side (trapezoid body) (A6) (p. The fibers originating from the posterior cochlear nucleus cross partly as medullary striae (posterior acoustic striae) just below the rhomboid fossa; they ascend in the lateral lemniscus as well. Vestibular Root (B) The nerve fibers originate from bipolar neu- rons of the vestibularganglion (B9) which lies in the internal acoustic meatus. The periph- eral processes of these cells terminate at the sensory epithelia of the semicircular ducts (B10),thesaccule(B11),andtheutricle(B12) (p. Their central processes unite to form the vestibular root (B13) and terminate, after bifurcation into the ascending and de- Kahle, Color Atlas of Human Anatomy, Vol. Eighth Cranial Nerve 121 A Vestibulocochlear nerve, nuclear region, 5 and entrance of the cochlear root 4 8 6 7 3 5 2 4 1 B Vestibulocochlear nerve, nuclear region, and entrance of the vesti- bular root 14 16 15 13 14 10 16 15 9 17 18 12 11 Kahle, Color Atlas of Human Anatomy, Vol. The stapedius nerve The seventh cranial nerve supplies motor supplies the stapedius muscle in the middle fibers to the muscles of facial expression; in ear. The chorda tympani (BC14) branches off a nerve bundle emerging separately from above the stylomastoid foramen, runs the brain stem, called the intermediate beneath the mucosa through the tympanic nerve, it carries taste fibers and viscero- cavity (p. It contains taste fibers large, multipolar neurons in the nucleus of for the anterior two-thirds of the tongue (D) the facial nerve (AB2). They arch around and preganglionic fibers for the subman- the abducens nucleus (AB3) (internal genu of dibular and sublingual glands as well as the facial nerve) and emerge on the lateral various lingual glands. The cells of the Before it enters the parotid gland, the facial preganglionic secretory fibers (AB4) form the nerve gives off the posterior auricular nerve superior salivatory nucleus (AB5). The (E17) as well as branches to the posterior taste fibers (AB6) originate from the pseudo- belly of the digastric muscle (CE18) and to unipolar cells in the geniculateganglion (BC7) the stylohyoid muscle (C19). The parotid and terminate in the cranial section of the plexus gives off the temporal branches (E20), solitary nucleus (AB8). The visceroefferent the zygomatic branches (E21), the buccal and taste fibers do not arch around the ab- branches (E22), the marginal mandibular ducens nucleus but join the ascending limb branch (E23), and the cervical branch (E24) of the nerve and emerge as intermediate for the platysma (see vol. The branches nerve (B9) between the facial nerve and the provide innervation to all the muscles of fa- vestibulocochlear nerve. Both parts of the nerve pass through the Ramifications of the cervical branch lying inner auditory canal, the internal acoustic beneath the platysma form the superficial meatus (petrous part of temporal bone, in- cervical ansa by anastomosing with ternal acoustic pore, see vol. The small branches of the nerve in the petrous bone (external departing from the ansa are mixed sen- genu of the facial nerve) lies the geniculate sorimotor nerves. The canal continues above tions of temporal branches, buccal the tympanic cavity (p. The nerve ramifies into terminal branches (parotidplexus) (E11) in the parotid Clinical Note: Injury to the nerve results in atony of all muscles of the affected half of the gland. The mouth region drops, and the eye can no The greater petrosal nerve (BC12), the longer close (F). There is increased sensitivity to stapedius nerve (BC13), and the chorda sound, hyperacusis (p. Seventh Cranial Nerve 123 7 12 25 8 13 3 5 15 6 2 4 14 1 10 18 16 19 A Nuclear region of the facial nerve C Facial nerve, course within 2 3 the petrous bone 7 1 4 6 5 8 12 9 13 10 14 D Tongue area supplied B Exit of the facial nerve by taste fibers 20 21 17 22 11 23 18 24 E Muscles innervated F Paralysis of the by the facial nerve left facial nerve Kahle, Color Atlas of Human Anatomy, Vol.
Fraser-Hill MA discount coreg 6.25 mg mastercard, Renfrew DL generic 12.5mg coreg free shipping, Hilsenrath PE (1992) Classification of Tumors of Bone: Introduction discount 6.25mg coreg with visa. CDM coreg 6.25mg otc, Unni KK, Mertens F (eds) World Health Organization Cost-effectiveness. Stoker DJ, Cobb JP, Pringle JAS (1991) Needle biopsy of mus- soft tissue and bone. IARC, Lyon, pp 226-232 culoskeletal lesions: A review of 208 procedures. Greene FL, Page DL, Fleming I D et al (2002) AJCC staging Joint Surg (Br) 73:498-500 manual, 6th edn. Jelinek JS, Murphey MD, Welker JA et al (2002) Diagnosis of ing in the evaluation of the solitary tumor of bone. Curr Opin primary bone tumors with image-guided percutaneous biopsy: Radiol (CORA) 2:697-702 Experience with 110 tumors. Anderson MW, Temple HT, Dussault RG, Kaplan PA (1999) mor-like lesion of bone. Top Magn Reson Imaging 1:17-29 Compartmental anatomy: relevance to staging and biopsy of 11. Sundaram M, Maguire MH (1988) Computed tomography or musculoskeletal tumors. Am J Roentgenol 173:1663-1671 magnetic resonance for evaluating the solitary tumor or tumor- 32. Mankin HJ, Lange TA, Spainer SS (1982) The hazards of biop- like lesion of bone? Skeletal Radiol 17:393-401 sy in patients with malignant primary bone and soft tissue tu- 12. J Bone Joint Surg Am 64:1121-1127 fluorodeoxyglucose positron emission tomography in the 33. Mankin HJ, Mankin CJ, Simon MA (1996) The hazards of management of soft-tissue sarcomas. Lucas JD, O’Doherty MJ, Cronin BF et al (1999) Prospective Mankin HJ (1995) Osteoid osteoma: percutaneous radio-fre- evaluation of soft tissue masses and sarcomas using fluo- quency ablation. Erickson JK, Rosenthal DI, Zaleske DJ, Gebhardt MC, Cates 86:550-556 JM (2001) Primary treatment of chondroblastoma with percu- 14. Tse N, Hoh C, Hawkins R, Phelps M, Glaspy J (1994) Positron taneous radio-frequency heat ablation: report of three cases. Franzius C, Daldrup-Link HE, Sciuk J et al (2001) FDG-PET CL (2001) Treatment of epithelioid hemangioendothelioma of for detection of pulmonary metastases from malignant prima- bone using a novel combined approach. Fletcher BD, Wall JE, Hanna SL (1993) Effect of hematopoi- 12:479-486 etic growth factors on MR images of bone marrow in children 16. Franzius C, Sciuk J, Daldrup-Link H E, Jurgens H, Schober O undergoing chemotherapy. Ryan SP, Weinberger E, White KS et al (1995) MR imaging of neoplasms: Static and dynamic Gd-DTPA-enhanced MR imag- bone marrow in children with osteosarcoma: Effect of granulo- ing. Silberzweig JE, Haller JO, Miller S (1992) Ifosfamide: A new after chemotherapy: evaluation with contrast material-en- cause of rickets. Franzius C, Sciuk J, Brinkschmidt C et al (2000) Evaluation of Monitoring the effect of chemotherapy in Ewing’s sarcoma of chemotherapy response in primary bone tumors with F18 FDG bone with MR imaging. Skel Radiol 23:493-500 positron emission tomography compared with histologically 41. Holscher HC, Bloem JL, Van der Woude HJ et al (1995) Can assessed tumor necrosis. Clin Nucl Med 25:874-881 MRI predict the histopathological response in patients with os- 45. Hawkins D S, Rajendran J G, Conrad E U et al (2002) teosarcoma after the first cycle of chemotherapy?