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The influence of prosthetic stem stiffness and of a calcar collar on stresses in the proximal end of the femur with a cemented femoral component generic tadapox 80mg otc erectile dysfunction caused by diabetes. Effects of material properties of femoral hip components on bone remodeling purchase 80mg tadapox otc erectile dysfunction and pregnancy. Effects of fit and bonding characteristics of femoral stems on adaptive bone remodeling. The effect of hip stem material modulus on surface strain in human femora. Fluid pressure causes bone resorption in a rabbit model of prosthetic loosening. Schmalzried T P, Kwong L M, Jasty M, Sedlacek R C, Haire T C, O’Connor D O, Bragdon C R, Kabo J M, Malcolm A J, Harris W H. The mechanism of loosening of cemented acetabular components in total hip arthroplasty. Albrektsson T, Branemark˚ P-I, Hansson H-A, Lindstrom¨ J. Re- quirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Introduction to osseointegration, in Tissue Integrated Prosthesis. Branemark˚ P-I, Zarb GA, Albrektsson T, eds: Quintessence: Berlin, 1985: 11–76. Branemark P-I, Hansson B-O, Adell R, Breine U, Lindstrom J, HallenO˚ ¨ ´ ,O¨ hman A. Osseointegrated implants in the treatment of the edentulous jaw. Adell R, Eriksson B, Lekholm U, Branemark P-I, Jemt T. A long-term follow-up study of osseointe-˚ grated implants in the treatment of totally edentulous jaws. Albrektsson T, Dahl E, Enbom L, Engevall S, Engquist B, Eriksson R A, Feldmann G, Freiberg N, Glantz P-I, Kjellman P, KJristersson L, Kvint S, Kondell P-A, Palmquist J,¨ ˚ Werndahl L, Astrand˚ Osseointegration Principles in Orthopedics 237 P. A Swedish multicenter study of 8139 consecutively inserted Nobel- pharma implants. Albrektsson T, Branemark P-I, Jacobsson M, Tjellstrom A. Present clinical applications of osseointe-˚ ¨ grated percutaneous implants. Eight years’ experience with titanium implants for craniofacial rehabilitation, in¨ Tissue Integration in Oral and Maxillofacial Construction van Steenberghe D, ed. Amsterdam: Excerpta Medica, Elsevier Science, 1986:182–186. Roos J, Sennerby L, Lekholm U, Hemt T, Grondahl K, Albrektsson T. A qualitative and quantitative¨ method for evaluating implant success: a 5-year retrospective analyisis of the Branemark˚ implant. Carlsson L V, Rostlund¨ T, Albrektsson B, Albrektsson T, Branemark˚ P-I. On tissue reactions to metal implants, PhD Thesis, Goteborg¨ Universitet, Sweden, 1991. On the bone tissue response to titanium implants, PhD Thesis, University of Gothenburg, Gothenburg, Sweden, 1991. Carlsson L V, Rostlund¨ T, Albrektsson B, Albrektsson T. Cylindrical implant–bone interface studied in rabbits.

Cells Tissues nosis (“jumper’s knee”): A neuroimmunohistochemical Organs 1999 purchase tadapox 80 mg with mastercard what do erectile dysfunction pills look like; 165: 30–39 tadapox 80mg with amex erectile dysfunction statin drugs. Neuroanatomical Bases for Anterior Knee Pain in the Young Patient: “Neural Model” 53 57. Hypoxia reg- pain in the young patient: What causes the pain? Sanchis-Alfonso, V, E Roselló-Sastre, F Revert, et al. Histologic retinacular changes associated with ischemia 65. Hypothesis relevant to defec- in painful patellofemoral malalignment. Orthopedics (in tive position sense in a damaged knee. Distribution of substance-P nerve fibers in the knee Otolaryngol Head Neck Surg 1995; 113: 569–581. Vascular endothelial Knee Surg Sports Traumatol Arthrosc 1999; 7: 177–183. Nature 1992; 359: Innervation of the human knee joint by substance-P 843–845. Diagnostic Electron Microscopy for Pathologists-in- Cytokines, nerve growth factor and inflammatory Training. New York-Tokyo: Igaku-Shoin Medical hyperalgesia: The contribution of tumour necrosis fac- Publishers Committee, 1995. Localization of vascular endothelial growth factor in 63. Neural reflex arcs synovial membrane mast cells: Examination with and muscle control of knee stability and motion. Atienza-Vicente, Carlos Puig-Abbs, and Mario Comín-Clavijo Introduction ing the undoubted relation between sport activ- The mechanical theory has received more atten- ities and the articular overuse concept. Overuse tion than the neural hypothesis in orthopedic bib- is defined in general terms as a repetitive micro- liography. Additional factors in the genesis of traumatism, as is very frequently seen in the the overuse syndromes include using the wrong practice of sports. Indeed, 49% of the patients in techniques, training inadequately (including our surgical series suffered an indirect trauma- overtraining), and not employing the right tism during sport activities before the onset of equipment. Out of these, jumping is the main Sport is an important agent in the pathogene- culprit in the origin of chronic lesions of the sis of the anterior knee pain syndrome and in knee. Furthermore, jumping is one of the prin- the functional patellar instability as seen by the cipal causes of the patellar tendinopathy fact that 73% of our operated patients (unpub- (“jumper’s knee”), which is the typical example lished data) used to play energetic sports (vol- of overuse knee lesion, and in 49% of our cases leyball, basketball, handball, football, rhythmic it was linked to a symptomatic PFM (unpub- gymnastics, or hockey) of level I (4–7 days a lished data). The reaction forces generated week of practice) or level II (1–3 days a week of when jumping from the standing position, practice) before the symptoms started. In addi- transmitted through the musculoskeletal system tion to this, the degree of pain was related to the from feet to head, can be up to four times the patient’s level of activity. It is worth remember- weight of the player, and up to nine times when 55 56 Etiopathogenic Bases and Therapeutic Implications the jump follows a previous run. Footwear can contribute to reducing the reac- For instance, a player of the NBA is supposed to tion force after impact in three fundamental jump at least 70 times per match. On the other increase heel fat shock-absorbing role and a hand, during running the impact forces against strong heel stiffener to prevent hyperprona- the ground reach 2 to 3 times the body weight. These sportive movements are lar skeletal system by limiting ankle mobility, inevitable and form part of the sport itself, but as opposed to the shoe-type footwear). Overlooking these norms in sport footwear will increase the impact stresses when jumping and Importance of Footwear, Ground running and therefore it will produce an over- Surface, and Personal Technique load of the knee and will favor the development in the Origin and Prevention of overload chronic lesions. Having the ankle supported (boot-type footwear) diminishes the of the Lesions efficiency when running and swivelling, very The human body has some natural systems of frequent gestures in handball, and so this type of shock absorption to protect itself from the effect footwear is not advised for this sport. This would favor the mobility of out by Gross and Nelson,21 the series of articular the midtarsal joint (natural shock-absorbing movements on landing from a vertical jump system). The knee and other hand, lack of this adherence can, as well, the hip have a first-rate role in the process of be the cause of lesions.

Acoustic impedances are most often reported in MRayls tadapox 80mg with visa erectile dysfunction doctor toronto, where 1 MRayl = 106 kg m–2 s–1 discount tadapox 80mg overnight delivery erectile dysfunction drug companies. The velocity of ultrasound in biological tissues varies negligibly over a wide range of frequencies; that is, it is nondispersive. The acoustic impedance of a tissue is constant with changing frequency. For reflection at an interface, the pressure of the reflected wave is determined by the difference in acoustic impedance between the two media at the interface. The larger the difference in acoustic impedance at the interface, the greater the pressure of the wave reflected back toward the transducer. Conversely, if the acoustic impedance of the media on each side of the interface is the same, all of the incident beam is transmitted and none will be reflected. For optimum imaging in acoustic microscopy, the sound pressure after reflection must be maximized, and for this a liquid-solid interface is used. That is, to examine a solid like bone, a liquid couplant is used to propagate sound from the transducer to the bone specimen. To illustrate this, consider sound traveling through water, which has an acoustic impedance of 1. The coefficient of reflection, R, is computed by the formula: Z − R = Z + where Z1 and Z2 are the acoustic impedances of the two interfacial media, water and bone. Expressed as a percentage, the reflected wave will have 68% of the sound pressure of the incident wave. However, this large amplitude is not the amplitude of the wave received by the transducer. As the reflected wave travels through the water on the return path toward the transducer, it is attenuated and suffers a loss in intensity. Moreover, this attenuation increases with increasing frequency. This is a practical limitation of reflection acoustic microscopy which prevents it from being used to study softer materials such as soft biological tissues which have acoustic impedances only slightly higher than water. Attenuation in the second media at the interface is not a concern in this case. Although the transmitted wave traveling through the second media will undergo attenuation, the reflected wave will not be affected. It is evident upon inspection of the reflection coefficient formula that the acoustic impedance of the second material at an interface may be determined if the acoustic impedance of the first material is known and the reflection coefficient measured. The Relationship between Acoustic Impedance and Mechanical Properties Once the acoustic impedance of a material is determined, the relation to the mechanical properties of a material may be assessed. As stated earlier, acoustic impedance is a function of material density and velocity. It will now be shown that the mechanical properties of stiffness, in particular, the bulk modulus, Young’s modulus, and the shear modulus are also functions of the same material density and velocity. When the wave equation which describes the displacement of a harmonic wave is substituted into the general equation of motion of a continuum, a relation is established between the velocity of propagation and stress since, in the equation of motion, the force exerted on a solid is the gradient of the stress. This is the equation for the bulk longitudinal dilatational velocity C, in an infinitely extended medium of bulk modulus k, shear modulus G, and density ρ. In a bar subject to a longitudinal wave, if the wavelength is long compared to the lateral dimensions, the entire cross section is subject to uniform stress and displacement and the velocity of propagation exten- sional longitudinal is the bar wave velocity C, where:** C L and E is Young’s modulus. The distinction in the two velocity equations exists because of the difference in the relative dimensions of the wavelength and the media. In the first case, the propagation of longi- tudinal waves subjects the infinitely extended media to compression and shear, and thus the shear modulus and the bulk modulus are involved. These two velocity equations and the equation of acoustic impedance show that the material moduli and the acoustic parameter Z are dependent on the same physical constants, namely, density and velocity. Therefore, a direct proportionality exists between the acoustic impedance and the mechanical properties of a material. With acoustic microscopy, a measure of the mechanical properties of a material may be determined by invoking their proportionality with acoustic impedance.

The dorsal aspect of the medullary tegmentum is occu- pied by two large nuclei: the nucleus cuneatus (cuneate ADDITIONAL DETAIL nucleus) laterally 80 mg tadapox mastercard buy erectile dysfunction pills online uk, and the nucleus gracilis (gracile The accessory cuneate nucleus is found at this level generic tadapox 80mg without a prescription low libido erectile dysfunction treatment, as nucleus) more medially. These are found on the dorsal well as at the mid-medullary level. This nucleus is a relay aspect of the medulla (see Figure 9B and Figure 40). These for some of the cerebellar afferents from the upper extrem- nuclei are the synaptic stations of the tracts of the same ity (see Figure 55). The fibers then go to the cerebellum name that have ascended the spinal cord in the dorsal via the inferior cerebellar peduncle. The inferior cerebellar column (see Figure 33, Figure 68, and Figure 69). At this level, the © 2006 by Taylor & Francis Group, LLC Neurological Neuroanatomy 197 Gracilis t. Medial lemniscus Cortico-spinal fibers Hypoglossal nerve (CN XII) FIGURE 67C: Brainstem Histology – Lower Medulla © 2006 by Taylor & Francis Group, LLC 198 Atlas of Functional Neutoanatomy FIGURE 68 ASCENDING TRACTS SPINAL CORD: • Dorsal column tracts, consisting at this level CROSS-SECTIONS of both the fasciculus cuneatus and fasciculus gracilis (see Figure 33 and Figure 40): These are the pathways for discriminative touch sen- UPPER ILLUSTRATION: NUCLEI sation, joint position and “vibration” from the This diagram shows all the nuclei of the gray matter of same side of the body, with the lower limb fibers the spinal cord — both sensory and motor (see Figure 4, medially (gracile) and the upper limb pathway Figure 32, and Figure 44). In fact, both sets of body, with the lower limb fibers more lateral pathways are present on both sides. Some salient features and the upper limb fibers medial. This pathway crosses tion, particularly relating to pain afferents. Its role in human motor func- cord following an accident, will usually result in a com- tion is not certain. After a period of about from the pontine and medullary reticular forma- 3–4 weeks, the spinal cord reflexes will return. In a matter tion, respectively (see Figure 49A and Figure of weeks, due to the loss of all the descending influences 49B): These pathways are the additional ones for on the spinal cord, there is an increase in the reflex respon- indirect voluntary control of the proximal joints siveness (hyperreflexia) and a marked increase in tone and for posture, as well as being important for (spasticity), along with the Babinski response (discussed the control of muscle tone. Although rare, this is a useful axial muscles to changes in gravity. This path- lesion for the learner to review the various deficits, sensory way remains ipsilateral. In • Medial longitudinal fasciculus (MLF, see Fig- particular, it helps the learner understand which side of ure 51B): This mixed pathway is involved in the body would be affected because of the various crossing the response of the muscles of the eyes and of of the pathways (sensory and motor) at different levels. It likely descends only to the cervical spinal cord level. FIGURE 68: Spinal Cord — Nuclei and Tracts © 2006 by Taylor & Francis Group, LLC 200 Atlas of Functional Neutoanatomy Various layers of meninges are seen in these cross- FIGURE 69 sections, as well as dorsal and ventral roots in the sub- SPINAL CORD: arachnoid (CSF) space. CROSS-SECTIONAL VIEWS — THORACIC LEVEL — T6 HISTOLOGICAL The thoracic region of the spinal cord presents an altered morphology because of the decrease in the amount of gray The spinal cord was introduced in the orientation section matter. There are fewer muscles and less dense innervation of this atlas (Section A, see Figure 1–Figure 5). The gray matter has, in nization of the nervous tissue in the cord has the gray addition, a lateral horn, which represents the sympathetic matter inside, in a typical “butterfly” or “H-shaped” con- preganglionic neurons. The lateral horn is present from figuration, with the white matter surrounding (see Figure T1 to L2. The functional aspects of the spinal cord were presented in Section B, including the nuclei and connections for the afferent fibers (sensory, see LUMBAR LEVEL — L3 Figure 32), and the efferent circuits with some reflexes This cross-sectional level of the spinal cord has been used (motor, see Figure 44). This cross-section is similar in appearance divided by it into three areas: the dorsal, the lateral, and to the cervical section, because both are innervating the the anterior areas. There is, however, proportionately less white matter as funiculi (singular funiculus). The descending tracts are smaller in each of these three zones, some ascending and some because many of the fibers have terminated at higher lev- descending, which were reviewed (see previous illustra- els. The ascending tracts are smaller because they are tion). There is still a fair CERVICAL LEVEL — C8 amount of gray matter because of the innervation of the pelvic musculature. This is a cross-section of the spinal cord through the This region of the spinal cord, roughly the conus med- cervical enlargement. This level has been used in many ullaris (see Figure 2A), also contains the preganglionic of the illustrations of the various pathways (in Section B). The dorsal horn is The anterior spinal artery, the main blood supply to the likewise large, because of the amount of afferents coming spinal cord, comes from branches from each of the verte- from the skin of the fingers and hand.