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Amniotic fluid Placenta Syringe Endoscope (guided withdraws to exact location by Left cerebral blood pulsed sound waves) hemisphere Orbit of eye Left hand Uterine wall Thorax FIGURE 22 order diflucan 150mg with amex fungus roots. Placenta Fiber optics Needle punctures fetal vein on placenta FIGURE 22 diflucan 150mg generic anti fungal nappy rash cream. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance Chapter 22 Developmental Anatomy, Postnatal Growth, and Inheritance 789 Fetal monitor Amplifier Cardiotachometer Fetal heart rate Uterine Amplifier activity Pressure transducer FIGURE 22. The extent of stress to the fetus from uterine contractions tal problems have been discussed in previous chapters, in con- can be determined through FHR-UC monitoring (fig. If the baby’s health and vitality are presumed to be in danger be- cause of a difficult delivery, the physician may decide to perform a cesarean section. Clinical Case Study Answer Two amnions and one chorion in all but very unusual cases prove the Congenital Defects twins to be monozygotic. Thus, when considering genetic disorders such as cleft palate, Major developmental problems called congenital malformations one would expect a high degree of concordance (both twins of a occur in approximately 2% of all newborn infants. Many such defects how- caused by genetic inheritance, mutation (genetic change), or en- ever can be present in only one twin—a consequence of nongenetic fac- tors, such as intrauterine environment. About 15% of neonatal deaths are attrib- inadequate blood supply to only one twin, resulting in a defect in that uted to congenital malformations. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance 790 Unit 7 Reproduction and Development CLINICAL PRACTICUM 22. On (arrow) seen to the left of the urinary physical exam, you note a mass in her left bladder (B)? It is secretion because of a defect in the iodine hereditary leukomelanopathy (loo'ko-mel'a˘- accompanied by brain and nerve damage and transport mechanism. People with this condition are pseudohypertrophic muscular dystrophy A inability to metabolize galactose, a generally susceptible to infections and early sex-linked recessive disorder characterized by component of milk sugar. It usually begins disorder have cataracts, damaged livers, and Huntington’s chorea An autosomal dominant during childhood and causes death in mental retardation. A latent disorder characterized by progressive atrophy in the blood and tissue resulting from an expression of this disorder allows the mutant of the retina and eventual blindness. It has a disproportionately high from an abnormal metabolism of porphyrins. Huntington’s chorea: from George Huntington, American physician, 1850–1916 Marfan’s syndrome: from Antoine Bernard-Jean Marfan, French physician 1858–1942 Van De Graaff: Human VII. Developmental © The McGraw−Hill Anatomy, Sixth Edition Development Anatomy, Postnatal Companies, 2001 Growth, and Inheritance Chapter 22 Developmental Anatomy, Postnatal Growth, and Inheritance 791 Chapter Summary Fertilization (pp. Upon fertilization of a secondary oocyte umbilical cord, and the extraembryonic centers appear, the genitalia are formed, by a spermatozoon in the uterine tube, membranes. These events make it possible and the digestive, urinary, respiratory, and meiotic development is completed and a for morphogenesis to continue. Morphogenesis is the sequential the amnion, yolk sac, allantois, and are formed and the fetal heartbeat can be formation of body structures during the chorion. During the 17-to-20-week period, prenatal period lasts 38 weeks and is surrounding the embryo. It contains quickening can be felt by the mother, and divided into a preembryonic, an amniotic fluid that cushions and vernix caseosa and lanugo cover the skin embryonic, and a fetal period. A capacitated spermatozoon digests its (b) The yolk sac produces blood for the 5. During the 21-to-25-week period, way through the zona pellucida and embryo. Cleavage of the zygote is initiated within and embryonic tissue, has a transport role 7. At 38 weeks, the fetus is full-term; the 30 hours and continues until a morula in providing for the metabolic needs of normal gestation is 266 days. A hollow, fluid-filled space forms within the morula, at which point it is called a polypeptide hormones. Implantation begins between the fifth and can cross the placenta to the fetus. The umbilical cord, containing two pituitary, and prostaglandins, produced in secretion of enzymes that digest a portion umbilical arteries and one umbilical vein, the uterus. Labor is divided into dilation, expulsion, (a) During implantation, the trophoblast tissues on the underside of the embryo. From the third to the eighth week, the gonadotropin (hCG), which prevents structure of all the body organs, except Periods of Postnatal Growth the breakdown of the endometrium the genitalia, becomes apparent.

Addictive Behavior purchase diflucan 50 mg on-line fungus hair scalp home remedies, 10 order diflucan 150 mg visa fungus on tongue, Alcoholism, Clinical and Experimental Research, 22, 319–323. Substance and shadow: Women England Journal of Medicine, 349(10), 975–986. Office-based treatment of of methamphetamine with implications for prevention, opiate addiction with a sublingual-tablet formu- treatment, and research. New Mental Health Services Administration and Center England Journal of Medicine, 349(10), 949–958. Caffeine consumption and disability: Clinical The role of corticotrophin-releasing factor in drug issues in rehabilitation. New England Journal of Behavioral Health Services and Research, Journal of Medicine, 343(18), 1332–1333. Drug abuse and mental illness: Screening instruments for alcohol and other drug Progress in understanding comorbidity. Journal of Mental Health Counseling, Journal of Psychiatry, 158(8), 1181–1183. C HAPTER 8 Conditions of the Blood and Immune System NORMAL STRUCTURE AND contained within the blood are red blood FUNCTION cells (erythrocytes), white blood cells (leu- kocytes), and platelets (thrombocytes). Blood is a combination of different More than 99 percent of the cells in blood types of cells and liquid that circulates are red blood cells. The The number of circulating white blood quantity of blood in the adult body cells under normal circumstances is min- remains constant under normal condi- imal. Blood cells are produced in the bone stimuli are present, white blood cells pro- marrow, as well as in lymphoid tissue and liferate so that there are large numbers of organs. The number of platelets circulating in Blood has many important functions: the blood normally does not change. If there should be a decrease in the number • It carries oxygen and nutrients to the of platelets, however, the condition is body tissues. It contains no blood cells but is sues to the organs of excretion, such essential for carrying blood cells and nutri- as the lungs and the kidneys. Approximately three-fifths of the total • It promotes clotting to minimize blood volume is plasma. Normal Structure and Function of Several different types of cells make up Red Blood Cells the blood. Approximately two-fifths of the total blood volume is composed of cells Erythrocytes (red blood cells) carry oxy- that are formed by a process called hemo- gen to the tissues. They are normally 231 232 CHAPTER 8 CONDITIONS OF THE BLOOD AND IMMUNE SYSTEM disk shaped, with a thin center and thick- Normal Structure and Function of er edges. Their flexible shape allows them White Blood Cells and Immunity to fit through blood vessels of differing sizes. Hemoglobin is the red-pigmented The immune system is a complex organ- protein contained within the erythrocytes ization of specialized cells and organs that and is the specific part of the red blood cell distinguishes between self and nonself, that carries oxygen. Although the body is exposed to Special cells in the bone marrow pro- a number of microorganisms each day, the duce erythrocytes. Several vitamins, such immune system helps it fight off bacteria, as vitamin B12 and folic acid (which is part viruses, and other microbes. Although of the vitamin B complex), are necessary constantly bombarded by microorganisms for the formation of erythrocytes. They are or trauma that can result in infection, dis- obtained from the diet. Iron, which is also ease, or injury, the body has specific de- obtained from the diet, is important for fenses to protect it against such invasions. Excess The immune system has traditionally amounts of iron and vitamin B12 are been divided into innate and adaptive com- stored in the liver. Although most erythrocytes are body’s first line of defense against foreign released into the blood, some are taken up material is called nonspecific or innate im- by the spleen to be stored for emergency munity. This type of immunity includes the use when the red blood cell count drops protection provided by the skin, which significantly below normal levels, such as acts as a barrier to organisms, and by the during hemorrhage.

Babyn PS discount diflucan 50 mg with amex antifungal cream otc, Kim HK buy 50mg diflucan overnight delivery fungus gnats harmful humans, Gahunia HK, Lemaire C, Salter RB, Fornasier V, Pritzker KP (1998) MRI of the cartilaginous epi- Inflamed synovium is thickened and hypervascular and physis of the femoral head in the piglet hip ischemic damage. Gadolinium-enhanced imaging is thus DeNanassy J, Pritzker KP (1996) High-resolution magnetic needed to depict the extent and distribution of abnormal resonance imaging of normal porcine cartilage epiphyseal synovium, especially if quantification for serial assess- maturation. J Magn Reson Imaging 6:172-179 ment of disease severity and treatment response is re- 3. Magn Reson Imaging Clin N Am 6:473-495 The synovial intima lacks a tight junction or base- 4. Barnewolt CE, Chung T (1998) Techniques, coils, pulse se- ment membrane and thus allows rapid diffusion of quences and contrast enhancement in pediatric musculoskele- gadolinium compounds into the joint fluid. Therefore, tal MR imaging, Magn Reson Imaging Clin N Am 6:441-453 static imaging must be undertaken immediately after 5. Barnewolt CE, Shapiro F, Jaramillo D (1997) Normal Gadolinium-enhanced MR images of the developing appen- gadolinium administration, or dynamic techniques must dicular skeleton: part I Cartilaginous epiphysis and physis. Contrast-enhanced, fat-suppressed T1- J Roentgenol 169:183-189 weighted 3D gradient echo techniques are most effec- 6. Dwek JR, Shapiro F, Laor T, Barnewolt CR, Jaramillo D tive, allowing an optimal differentiation from adjacent (1997) Normal Gadolinium-enhanced MR images of the de- fat pads. Am J Roentgenol 169:191-196 Synovial inflammation can be quantified and moni- 7. Erlemann R, Reiser MF, Peters PE et al (1989) tored as time-activity curves of enhancement or volume Musculoskeletal neoplasms: static and dynamic Gd-DTPA-en- of enhancing pannus by processing the imaging data. Radiology 171:767-773 Contrast Enhancement of the Growing Skeleton: Rationale and Optimization in Pediatric MRI 179 8. Herve-Somma CM, Sebag GH, Prieur AM, Bonnerot V, Pediatric spinal bone marrow: assessment of normal age-relat- Lallemand DP (1992) Juvenile rheumatoid arthritis of the ed change MRI appearance. Jaramillo D, Shapiro F (1998) Musculoskeletal trauma in chil- Bensahel H, Hassan M (1997) Dynamic Gadolinium-enhanced dren. Magn Reson Imaging Clin N Am 6:521-536 subtraction MR imaging a simple technique in the early diag- 10. Jaramillo D, Shapiro F (1998) Growth cartilage: normal ap- nosis of Legg-Calve-Perthes disease: preliminary results. Jaramillo D, Villegas-Medina O, Laor T, Shapiro F, Millis MB the musculoskeletal system. Radiol Clin North Am 35:213-237 (1998) Gadolinium-enhanced MR imaging of pediatric pa- 19. Verstraete KL, Dierick A, De Deene Y et al (1994) Firstpass tients after reduction dysplastic hips: assessment of femoral images of musculoskeletal lesions: a new and useful diagnos- head position, factors impeding and femoral head ischemia, tic application of dynamic contrast-enhanced MRI. Verstraete KL, Van der Woude HJ, Hogendoorn PR et al (1996) with juvenile chronic arthritis. Eur J Radiol 33:85-93 Dynamic contrast-enhanced MR imaging of musculoskeletal 13. Lamer S, Dorgeret S, Khairouni S, Brillet PY, Bacheville E, tumors: basic principles and clinical applications. J Magn Bloch J, Penneçot GF, Hassan M, Sebag G (2002) Femoral Reson Imaging 6:311-321 head vascularisation in Legg-Calvé-Perthes disease: compari- 21. Magn Imaging Clin N son of dynamic gadolinium-enhanced subtraction MRI with Am 6:627-631 bone scintigraphy. Polisson RP, Schoenberg OI, Fischman A et al (1995) Use of ue and significance of bone scintigraphy in LCP. J Pediatr magnetic resonance imaging and positron emission tomogra- Orthop 17:230-239 phy in the assessement of synovial volume and glucose me- 23. Arthritis Rheum In: Maddison PJ, Isenberg DA, Woo P, Glass DN (eds) Oxford 38:819 textbook of rheumatology, third edition. Sebag GH, Pinzuti V, Argyropoulou M, Elmaleh M (1997) Press, New York, pp 534-52 Doppler ultrasonography in the study of the vascularization of 24.

Histology © The McGraw−Hill Anatomy purchase 200 mg diflucan fast delivery fungus gnats facts, Sixth Edition of the Body Companies 150 mg diflucan fungus za mdomoni, 2001 82 Unit 3 Microscopic Structure of the Body Lumen of renal tubule Basement membrane Nucleus (c) FIGURE 4. Liver Stomach Gallbladder Large intestine Small intestine (b) (b) Lumen of small intestine Nucleus Creek Basement (a) membrane Goblet cell Cilia (c) FIGURE 4. Histology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 4 Histology 83 Body of uterus Uterine tube Uterine cavity Paras (b) Ovary Lumen of uterine tube Cilia (a) Vagina Cell membrane Nucleus Basement membrane (c) FIGURE 4. Specialized unicellular glands called goblet cells are scattered The tissue appears to be stratified because the nuclei of the cells through this tissue at most locations. Numerous goblet cells and a cili- bricative and protective mucus along the free surfaces of the ated exposed surface are characteristic of this epithelium. Simple columnar epithelium is found lining the inside walls found lining the inside walls of the trachea and the bronchial of the stomach and intestine. In the digestive system, it forms a tubes; hence, it is frequently called respiratory epithelium. Its func- highly absorptive surface and also secretes certain digestive tion is to remove foreign dust and bacteria entrapped in mucus chemicals. Within the stomach, simple columnar epithelium has from the lower respiratory system. Coughing and sneezing, or simply “clearing the throat,” are protective reflex mechanisms for clearing the respiratory pas- Simple Ciliated Columnar Epithelium sages of obstruction or of inhaled particles that have been trapped in the mucus along the ciliated lining. The material that is coughed up Simple ciliated columnar epithelium is characterized by the pres- consists of the mucus-entrapped particles. Cilia produce wavelike movements that transport materials through tubes or passage- Stratified Epithelia ways. This type of epithelium occurs in the female uterine tubes Stratified epithelia have two or more layers of cells. Stratified epithelia have a primarily evidence indicates that sperm introduced into the female protective function that is enhanced by rapid cell divisions. They vagina during sexual intercourse may be moved along the return cur- rents, or eddies, generated by ciliary movement. This greatly en- are classified according to the shape of the surface layer of cells, hances the likelihood of fertilization. Pseudostratified Ciliated Columnar Epithelium Stratified Squamous Epithelium As the name implies, this type of epithelium has a layered ap- pearance (strata = layers). Actually, it is not multilayered (pseudo Stratified squamous epithelium is composed of a variable number = false), because each cell is in contact with the basement mem- of cell layers that are flattest at the surface (fig. Histology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 84 Unit 3 Microscopic Structure of the Body Larynx Trachea Bronchiole Lung Secondary bronchi (b) (b) Cilia Goblet cell Bronchus Nucleus (a) Basement membrane Connective tissue (c) FIGURE 4. Uterine tube Ovary Uterus Urinary bladder Cervix Urethra Rectum Vagina Anus (b) (a) Stratified squamous epithelium (c) FIGURE 4. In the moistened areas, such as in the vagina (a), it is nonkeratinized, whereas in the epidermis of the skin it is keratinized. Histology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 4 Histology 85 Parotid gland Nuclei Lumen of parotid duct Basement (b) membrane (c) Parotid duct (a) FIGURE 4. Stratified Cuboidal Epithelium As the newly produced cells grow in size, they are pushed toward Stratified cuboidal epithelium usually consists of only two or the surface, where they replace the cells that are sloughed off. This type of epithelium is Movement of the epithelial cells away from the supportive base- confined to the linings of the large ducts of sweat glands, salivary ment membrane is accompanied by the production of keratin (ker′a˘- glands, and the pancreas, where its stratification probably pro- tin) (described below), progressive dehydration, and flattening. There are two types of stratified squamous epithelial tis- sues: keratinized and nonkeratinized. Keratinized stratified squamous epithelium contains ker- atin, a protein that strengthens the tissue. Keratin makes Transitional epithelium is similar to nonkeratinized stratified the epidermis (outer layer) of the skin somewhat waterproof squamous epithelium except that the surface cells of the former and protects it from bacterial invasion. The outer layers of are large and round rather than flat, and some may have two nu- the skin are dead, but glandular secretions keep them soft clei (fig. Nonkeratinized stratified squamous epithelium lines the permit distension (stretching) of the urinary bladder as it fills oral cavity and pharynx, nasal cavity, vagina, and anal with urine. This type of epithelium, called mucosa (myoo-ko′sa˘), being rounded when the urinary bladder is empty to being some- is well adapted to withstand moderate abrasion but not what flattened as it distends with urine. The cells on the exposed surface are alive and are A summary of membranous epithelial tissue is presented in always moistened. Stratified squamous epithelium is the first line of defense against the entryof living organisms into the body.