Condet

Morgan Erika Grams, M.D., M.H.S., Ph.D.

• Associate Professor of Medicine

https://www.hopkinsmedicine.org/profiles/results/directory/profile/8656422/morgan-grams

This type of smooth muscle is found in the wall of the vas deferens erectile dysfunction protocol free cheap 100mg kamagra soft, iris of eye erectile dysfunction nervous kamagra soft 100mg on-line, erector pili erectile dysfunction overweight buy 100 mg kamagra soft otc, and some arteries erectile dysfunction drug approved to treat bph symptoms order kamagra soft 100mg on line. Organization Smooth muscle cells may be present as isolated units or small bundles in ordinary connective tissue, as in intestinal villi, the tunica dartos of the scrotum, and the capsule and trabeculae of the spleen. In any one sheet of muscle, the fibers tend to be oriented in the same direction but are offset so that the thick portions of the cells lie adjacent to the tapering ends of neighboring cells. Thus, in transverse sections, the outlines of the cells vary in diameter according to where along their lengths the cells were cut. Nuclei are few and present only in the largest profiles, which represent sections through the expanded, central areas of the cells. A thin connective tissue consisting of fine collagenous, reticular, and elastic fibers extends between the smooth muscle cells and becomes continuous with a more dense connective tissue that binds the muscle cells into bundles or sheets. The latter connective tissue contains more abundant fibroblasts, collagenous and elastic fibers, and a network of blood vessels and nerves. The traction produced by contracting smooth muscle cells is transmitted to the reticuloelastic sheath about the cells and then to the denser connective tissue, permitting a uniform contraction throughout the muscle sheet. The reticular and elastic fibers of the reticuloelastic sheath are products of the smooth muscle cells. Histogenesis Skeletal muscle arises from mesenchyme in various parts of the embryo. Muscles of the limbs and trunk develop from myotomal mesenchyme; those of the head and neck arise in the mesenchyme of the branchial arches. Initially the precursor muscle cells are rounded, noncontractile cells with single centrally placed nuclei. As the cells develop, they elongate and begin to synthesize myofilaments, creatinine kinase, and acetylcholine receptors, thus becoming identifiable as myoblasts. The spindle-shaped myoblasts contain numerous ribosomes, prominent Golgi complexes, and rather short mitochondria, as well as a few myofilaments. Bulk synthesis of contractile proteins occurs in the myotubule, and organization of sarcomeres with recognizable A and I bands and Z lines takes place. Clusters of myofibrils appear, aggregate, increase in length and thicken, and soon show banding. Fusion of Z bodies to which actin filaments are joined results in the appearance of Z lines, aligned with the T-tubule system and units of the sarcoplasmic reticulum. New generations of myoblasts continue to develop and either form new myotubules or fuse to the ends of older myotubules to form fibers that contain 50 to 100 nuclei. It is likely that new myotubules continue to form until their number equals that of the cells of a given mature muscle. By the thirteenth week, the nuclei begin to move from the center of the tube to the periphery, and the cell becomes known as a myofiber. However, development of the cell is not synchronous along its length, and the same structure may show features of a myotubule and a myofiber. The most mature regions are those in the middle of the cell, where fusion of myoblasts first occurred. Thus, for a time the middle of the cell might show peripheral nuclei, while at the ends, central nuclei are present as fusion of myoblasts continues. As the myotubule develops, the number of mitochondria increases and the cristae increase in number and are more tightly packed. There is no evidence that the number of cells increases postnatally, but the cells do increase in length by the addition of new sarcomeres at the ends. Increase in girth is due to an increase in the number of myofibrils and the amount of sarcoplasm. Rather, satellite cells associated with the mature fibers proliferate and fuse to form new skeletal muscle cells. The forming fibers differentiate in a similar way as observed during normal development.

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Additionally new erectile dysfunction drugs 2012 buy cheap kamagra soft 100mg on line, the saliency of the material to be recalled influence encoding and retrieval erectile dysfunction essential oils 100mg kamagra soft mastercard. For example erectile dysfunction kya hota hai cheap kamagra soft 100 mg fast delivery, material which is learned in one physical environment is recalled much better in the same environment or a highly similar environment lipo 6 impotence discount kamagra soft 100mg fast delivery. This phenomenon is appreciated when examining the discrepancy when recalling high school events while at your old high school. The graph below demonstrates the stages of memory and processes by which information is transferred from one stage to another and notes some of the factors which impact consolidation of information into long-term memories. Sensory Storage Attention ShortTerm Memory Processing no attention Rehearsal Elaboration Emotionally charged Incidentalintentional Statedependence effects Encoding Long-term Memory forgetting no processing forgetting. These memory types are referred to as Declarative (or Explicit) memory and Non-declarative (or Implicit) memory. This type of memory is also termed Explicit memory, and the two terms (declarative and explicit are often used interchangeably). Declarative (or explicit) memory is divided into Episodic memory and Semantic memory (Squire and Zola 1996). This is the memory for what you did yesterday, where you went on your first date, or your first car. Episodic memory is the active recall of the learning event, while semantic memory recall is retrieval of a fact, and does not require one to recall the autobiographical event when the material was learned. Semantic memory is unable to determine a particular place and time the information was learned. The unique aspects of this remembered material is the conscious effort involved in the learning 184 J. This is the conscious material that can be recalled which is unique to the experiences of the individual. Declarative memory is the type of memory which we most commonly refer to when discussing memory in a clinical setting. And it is episodic memory which is of particular emphasis in neuropsychological assessments. Nondeclarative (Implicit) Memory Nondeclarative memory refers to memory for skills and procedures which are learned and recalled. Evidence for such a memory system is found by the efficiency and skill gains which accumulate for even complex activities. The origins of the learning process are often lost such as learning to speak or riding a bicycle, but the transfer of learning must occur for such behaviors to be demonstrated and recalled. Nondeclarative memory includes a number of acquired motor skills, but also includes a great number of very complex behaviors such as playing a musical instrument or driving a car. The adaptation of humans to perform repetitive skills with precision and very little conscious processing is astounding. The next section provides an overview of common terms used to describe memory problems followed by a brief review of neuroanatomical correlates of memory. Classically, amnesia describes the loss of memory while other neuropsychological functions remain intact. The individual exhibits a profound inability to learn new material, in which declarative memory functions are largely lost. Anterograde Amnesia Anterograde amnesia describes the inability to encode new material since the event onset or injury. With pure anterograde amnesia, the individual is able to recall previous events, up to very close to the time of the event leading to anterograde amnesia (see below for common causes of anterograde amnesia). The most common is an inability to recall immediate previous information from before the event. Retrograde amnesia is frequently temporally graded, such that memories immediately before the event leading to amnesia are markedly poor while memories farther removed from the event (moving increasingly early in recent experience) may be better recalled. Typical Patterns of Memory Loss A typical pattern for amnesia is for anterograde to predominate while retrograde amnesia is temporally graded by hours, days, weeks, months, or rarely years. Anterograde amnesia may be temporally limited, that is recovery of normal memory functions after a period of hours, days, weeks, or rarely months to years. Alternatively, some conditions can result in a permanent amnestic syndrome involving anterograde amnesia and usually some retrograde amnesia.

Language function can be divided into two broad neuroanatomical zone best erectile dysfunction vacuum pump cheap 100 mg kamagra soft, an anterior expressive language zone and posterior receptive language zone erectile dysfunction treatment fruits purchase 100 mg kamagra soft mastercard. The illustration includes areas of the cortex not traditionally considered to be involved in language erectile dysfunction doctor memphis discount kamagra soft 100 mg fast delivery. The production of speech includes the corticobulbar tracts and cranial nerves involving the motor/sensory function of the mouth erectile dysfunction pills supplements buy kamagra soft 100mg otc, tongue, and larynx as well as control of the diaphragm in order to produce speech. Large lesions in the left hemisphere frequently produce both verbal expressive and auditory receptive language deficits such that reading and writing are also impaired. Prosodic functions are similarly represented as Expressive and Receptive language functions in the left hemisphere, with expressive prosody functions being associated with right anterior (frontal) areas and receptive prosody being associated with right posterior (temporoparietal) regions. Individuals with expressive aprosody are often viewed by others as dull, emotionless, and lacking compassion and empathy. When asked directly, they are often able to verbalize the presence of emotional states that they are not able to display adequately in their verbal tone and inflection. They often miss verbal cues that would communicate the emotional states of others. This in turn leads to a decrease in appropriate emotional responsiveness and a generally literal interpretation of what is verbally said with little appreciation for the way it was verbalized or the context in which it occurred. These basic functions are prerequisite skills to the assessment of both higher and more difficulty aspects of language (phonemic or semantic fluency) and verbal reasoning. The appendix demonstrates items which assess a progression of receptive language skills from simple to complex. Each item should be passed easily by intact individuals, but additional items of similar complexity can be administered to assess degree and consistency of deficit in the assessed area of functioning. Expressive Language and Expressive Aprosodies Expressive language should be assessed both verbally and in writing. Similarly, expressive language should be assessed in both simple and gradually more complex functions. Assessment should include both responses to simple questions and responses to more unstructured, open-ended questions. Again, emphasis should be taken to note any paraphasic errors of either phonemic or semantic type as well as any articulation or oral motor deficits. Schoenberg 7 Language Problems and Assessment: the Aphasic Patient 167 Recovery of Language Function It is important to note that lesions that result in language deficits acutely may resolve substantially over the course of the first few weeks to months post-injury. Thus, assessment must consider the time since injury carefully as a critical factor in expected future functional language deficits and treatment programming (see also Chap. Often, individuals having acquired broad language deficits (receptive and expressive speech is impaired) will exhibit recovery, but less recovery of language function than individuals with less disrupted language functions. A patient with pronounced acute expressive deficits may present in the neuropsychology clinic months later with subtle deficits of reduced phrase length, dysnomia, and dysgraphia. Conversely, patients with moderate to severe receptive language deficits may recover concrete receptive language skills, with only subtle residual deficits. Recovery may be so complete that deficits remain only in complex receptive language and are only detectible with detailed, in-depth testing of language skills. Unfortunately, patients with global deficits acutely often do not have good functional language outcomes and remain profoundly impaired. We turn now to descriptions of various language problems one might encounter in the clinic setting. For the sake of description, subtle impairments which may be present are not reviewed, and the following is limited to description of language problems that may be readily identified by a detailed bedside evaluation of language functions. Schoenberg Language Problems: A Behavioral Guide Below, we provide a symptomatic description of various common language problems followed by a possible diagnostic or syndromic explanation for the observed language deficits. Further details of the identified aphasia syndrome and associated neurological and neuropsychological deficits can be found in Chap. Nonfluent Speech Problems: Speech Is Generally Nonfluent the patient is unable to speak or speech is halting or limited to a few words and/or may be of shorter phrase length in less severe cases.

Diseases

• Karsch Neugebauer syndrome
• Mental retardation spasticity ectrodactyly
• Hepatitis C
• Pancreatic beta cell agenesis with neonatal diabetes mellitus
• Say Barber Miller syndrome
• Schindler disease
• Hereditary carnitine deficiency

After a short lag erectile dysfunction pills at gnc cheap kamagra soft 100mg amex, small lymphocytes leave the nodes erectile dysfunction drug types discount kamagra soft 100 mg without prescription, infiltrate the affected region erectile dysfunction jokes 100mg kamagra soft, and destroy the antigen erectile dysfunction drugs and alcohol 100 mg kamagra soft otc. Committed T-cells also are disseminated throughout the body as memory cells and form part of the recirculating pool of small lymphocytes. Since an associated humoral response also develops, newly formed germinal centers appear in the cortex. Normal humans have no significant splenic reservoir of erythrocytes (only 30 to 40 ml), as in some species, but there are indications that even this small volume can be mobilized. About onethird of the platelets in the body are sequestered in the spleen, where they form a reserve available on demand. The spleen serves as a filter for blood, removing particulate matter that is taken up by macrophages in the marginal zone, splenic cords, and sheathed 146 capillaries. The sinusoidal endothelium and the reticular cells of the reticular net have no special phagocytic powers and contribute little to the clearing of foreign materials from the blood. The spleen also functions as the graveyard for worn out red cells and platelets and possibly for granular leukocytes as well. As the blood filters through the splenic cords, it comes under constant scrutiny and monitoring by macrophages. Viable cells are allowed to pass through the spleen, but damaged, aged, or infected cells are retained and phagocytosed. As the cell ages, changes in the surface may permit antigenic reaction with opsonizing antibodies that enhance phagocytosis. The sinusoidal wall is a barrier to the re-entrance of cells into the circulation, since the cells must insinuate themselves through the narrow slits between sinusoidal endothelial cells. Normal cells are pliant and able to squeeze through the interendothelial clefts, but cells such as spherocytes or sickled red cells are unable to pass through the sinusoidal barrier. As red cells age, their membranes become more permeable to water, and the relatively slow passage through the red pulp may allow the cells to imbibe fluid, swell, and become too rigid to pass into the sinusoids. Red cells that have been excluded are phagocytosed, and the cells appear to be taken up intact without prior lysis or break down. Components of the red cells that can be reused in production of new blood cells are recovered by the spleen; it is especially efficient in conserving iron freed from hemoglobin and returning it to accessible stores. Red cells that contain rigid inclusions (malarial parasites or the iron-containing granules of siderocytes, for example) but that are otherwise normal are not destroyed, but the inclusions are removed at the wall of the sinusoid. The flexible part of the erythrocyte passes through the sinusoidal wall, but the rigid inclusion is held back by the narrow intercellular clefts and is stripped from the cell. The rigid portion remains in the splenic pulp and is phagocytosed; the rest of the cell enters the lumen of the sinusoid. The spleen has great importance in the immune system, mounting a large scale production of antibody against blood-borne antigens. However, antigen introduced by other routes also evokes a response in the spleen, since an antigen soon finds its way into the bloodstream. The reactions in the spleen are the same as those occurring in lymph nodes and include primary and secondary responses. In the primary response, clusters of antibody-forming cells first appear in the periarterial lymphatic sheaths, then increase in number and concentrate at the edge of the sheath. Immature and mature plasma cells appear, and germinal centers develop in the splenic nodules. Ultimately, plasma cells become numerous in the marginal zone between white and red pulp and in the red pulp cords, either by direct emigration from the white pulp or indirectly via the circulation. During a secondary response, germinal center activity dominates, occurs almost immediately, and is of large scale. The spleen has important hemopoietic functions in all vertebrates and in lower forms is the primary blood-forming organ, producing all types of blood cells. The spleen produces red cells, platelets, and granulocytes only during embryonic life, but production of lymphoid cells continues throughout life. In some conditions (leukemia and some anemias) the red pulp contains islets of hemopoietic tissue, even in the adult.

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References

• Hosoya T, Adachi M, Yamaguchi K, et al. Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 1999;30(5):1083-90.
• Cullen MH, Billingham LJ, Gaunt CH, Steven NM. Rational selection of patients for antibacterial prophylaxis after chemotherapy. J Clin Oncol 2007;25:4821-28.
• Toole JF, Parrish ML. Nitrofurantoin polyneuropathy. Neurology. 1973;23:554-559.
• Rehemtulla A, Hamilton CA, Chinnaiyan AM, et al. Ultraviolet radiation- induced apoptosis is mediated by activation of CD-95 (Fas/APO-1). J Biol Chem 1997;272(41):25783-25786.