By N. Kerth. Freed-Hardeman University.

Longitudinal ultrasound image demonstrating crystal deposition disease of the hip order avodart 0.5mg line. Longitudinal ultrasound image of the hip demonstrating avascular necrosis of the femoral head buy discount avodart 0.5mg on line. Longitudinal sonogram image shows needle tip (arrowhead) in anechoic effusion (asterisk) along anterior aspect of femur (F) purchase 0.5 mg avodart with mastercard. Ultrasound has special utility in the evaluation of patients who have undergone total hip arthroplasty (Figs discount avodart 0.5mg. This modality has clinical utility at the bedside in the evaluation of heterotopic ossification of the hip joint and surrounding tissues in spinal cord-injured patients (Fig. Sonogram of the anterior hip longitudinal to the femoral neck shows the hyperechoic surface of the total hip arthroplasty (arrowheads) with posterior reverberation artifact. The native acetabulum (A) and proximal femur (F) show posterior acoustic shadowing. Sonogram of the anterior hip longitudinal to the femoral neck shows abnormal anechoic fluid (curved arrow), which distends the pseudocapsule. A: Longitudinal ultrasound images of the hip in a patient with heterotopic ossification. The zone phenomenon or “cloudy appearance” (arrowheads) is detected within the muscle compartment overlying the proximal portion of femur (Fe). Arrows indicate the secondary acoustic shadowing that interrupts the white cortical lining of the femur. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Anatomy, special imaging considerations of pelvis, hip, and lower extremity pain syndromes. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. The nerve fibers enter the psoas muscle where they fuse together within the muscle body and then descend laterally between the psoas and iliacus muscles. The femoral nerve provides motor innervation to the iliacus muscle as it descends toward the iliac fossa. The nerve then passes just lateral to the femoral artery, lying on top of the iliacus muscle and beneath the fascia iliaca as it travels beneath the inguinal ligament with the artery, vein, and nerve enclosed in the femoral sheath (Fig. It is at this point that the nerve can be consistently identified with ultrasound scanning and is amenable to ultrasound-guided nerve block. The femoral nerve provides motor innervation to the sartorius, quadriceps femoris, and pectineus muscles and also provides sensory fibers to the knee joint as well as the skin overlying the anterior thigh (Fig. The femoral nerve is subject to the development of neuropathy from a variety of causes including compression, iatrogenic trauma, and metabolic abnormalities, vasculitis, ischemia, and most notably diabetes mellitus. The clinical findings of femoral neuropathy include weakness of the quadriceps femoris and occasionally the iliacus muscle, diminished or absent knee jerk, and sensory loss over the anteromedial aspect of the thigh and medial aspect of lower leg. Spontaneous retroperitoneal hematomas within the psoas-iliacus groove in anticoagulated patients can severely compress the femoral nerve (Fig. The femoral nerve, artery, and vein can also be compressed by tumor, lymphadenopathy, and abscess. The neurovascular bundle is subject to traumatic injury from penetrating injuries, hip fracture, iatrogenic injuries during abdominal, pelvic, groin, and hip surgery as well as during needle-induced trauma during femoral arterial cannulation (Fig. Hematoma in the left iliacus muscle (thin arrows), left psoas muscle was displaced to anteriorly and medially due to hematoma (thick arrows). Conservative treatment of femoral neuropathy following retroperitoneal hemorrhage: a case report and review of literature. Plain radiograph demonstrating a transcervical fracture of the femoral neck resulting in varus deformity and external rotation. Plain radiographs of the hip and pelvis are indicated in all patients who present with femoral neuralgia to rule out occult bony pathology. Based on the patient’s clinical presentation, additional testing may be warranted including a complete blood count, uric acid level, erythrocyte sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging of the lumbar spine and lumbar plexus and retroperitoneum is indicated if herniated disc, tumor, or hematoma is suspected. Ultrasonography and Doppler evaluation of the femoral artery and nerve can help identify thrombus, embolus, occlusion by hematoma, tumor, abscess, foreign bodies, for example, bullet fragments, clot, and arteriosclerotic plaque (Fig. A: Long-axis image demonstrating obstruction to flow at the bifurcation of the right common femoral artery. B: 732 Reconstructed three-dimensional computed tomography angiogram confirming the findings of the ultrasound examination. Clinical sonopathology for the regional anesthesiologist: part 1: vascular and neural. The inguinal crease on the affected side is identified and a linear high-frequency ultrasound transducer is placed in an oblique plane perpendicular with the inguinal ligament. The iliacus muscle is identified with the femoral nerve lying between the muscle and the pulsatile femoral artery (Fig. The femoral vein lies medial to the femoral artery and is easily compressible by pressure from the ultrasound transducer (Fig. Color Doppler can be used to aid in the identification of the femoral artery and vein (Fig. When these anatomic structures are clearly identified on oblique ultrasound scan, each structure is evaluated for abnormality (Fig. Femoral neuropathy can be identified by abnormal echogenicity of the neurofibular pattern and enlargement of the nerve (Fig. The nerve, artery, and vein are then evaluated for the compression by abnormal mass or tumor, and the vasculature is evaluated using both ultrasound and color Doppler for the presence of thrombus, embolus, and plaque (Figs. Oblique placement of the ultrasound transducer placed in a plane perpendicular with the inguinal ligament with the inferior aspect of the transducer lying over the anterior-superior iliac spine and the superior aspect of the transducer pointed directly at the umbilicus. Oblique ultrasound image demonstrating the iliacus muscle, the fascia iliacus, the femoral nerve, artery, and vein. Oblique ultrasound image demonstrating the compressibility of the femoral vein which lies medial to 733 the pulsatile femoral artery. It would be reasonable to conclude that an injection extramuscularly may result in a suboptimal block. Clinical sonopathology for the regional anesthesiologist: part 1: vascular and neural. This patient sustained a dramatic femoral neuropathy after a total hip revision on the left side. The patient was having an ultrasound examination by a radiologist as part of a comprehensive diagnostic evaluation. The dotted line in each image outlines the femoral nerve as seen by the radiologist. The decision where to draw this line may seem arbitrary, but the line was drawn based on the observed presence of a fascicular pattern (internal hypoechoic circles).

However buy avodart 0.5 mg without prescription, advancement anterior or lateral fistulas cheap avodart 0.5mg otc, the prone jackknife position is still flap did not gain wider popularity until much later buy generic avodart 0.5 mg line. The fistula should be characterized by type advantages of the operation became more apparent order 0.5mg avodart amex, endorectal (intersphincteric, transsphincteric, extrasphincteric, or supra- advancement flap became one of the most widely used sphincteric), the amount of muscle involved, and the location surgeries to treat fistula in ano. Careful attention should be paid to the endorectal advancement flap has theoretical advan- identifying any additional tracts, as undrained tracts will tages over other strategies to treat anal fistula. Beginning distal to the inter- the internal opening of the fistula, it interrupts the course of nal opening, a partial-thickness flap is raised incorporating the fistula, thus encouraging healing. The location of the flap on the high- so that the base is at least twice the width of the apex of the pressure side of the fistula maintains the flap in place, rather flap to ensure adequate blood supply to the flap. Dissection than tending toward disruption of the flap by pressure trans- of the flap continues cephalad until the flap reaches easily mitted through the fistula if the flap were to be located on the past the internal opening without excessive tension. Thus, endorectal advance- point many surgeons perform a partial fistulectomy, coring ment flaps have great potential to effect cure in the treatment out the fistula tract beginning at the external opening until of anal fistulas. If a fistulectomy is not performed, the fistula tract should be curetted to remove granulation tissue and debris. While doing this, the sutures should to 3–4 or even 6 days [4–9], but the patient can be discharged be spaced more closely together on the flap than on the rectal the same day in the majority of cases. Pain medication, sitz defect so that the flap is gradually advanced to cover the inter- baths, and bulk laxatives should be prescribed; no restricted nal opening without excessive tension. However, many publications regarding endorectal advance- Results ment flap erroneously illustrate the internal opening above the dentate line with the finished flap extending to the dentate Healing of Fistula line (Fig. The area is then dular fistulas after endorectal advancement flap vary widely inspected for hemostasis; rectal packing is not necessary. Their results, over a median follow-up of 42 months, been found to range widely from a median of 8 weeks to did not differ significantly from those of Mitalas, showing a 9 months [10 – 12]. Some studies show the majority of recur- mean time to recurrence of 5 months and no recurrences rences occurring within the first year [13], or even all recur- after 1 year. Thus, it appears the majority of recurrences will rences occurring within the first 3 months [14 ], while become clinically apparent within the first year, but a small other studies have shown recurrences up to 55 months after minority of patients may experience late recurrence after surgery [7, 15 ]. Studies designed specifically to examine the length of follow-up needed to capture all recurrences demonstrate that the majority of recurrences occur early. However, in this study the long-term transsphincteric cryptoglandular fistulas who had recurrence follow-up was performed by having patients fill out a after an initial rectal advancement flap [18]. The healing questionnaire rather than by an office visit with examination, rate after the second flap was 69 %. Jensen endorectal advancement flap was successful in 90 % of regression analyses after controlling for other factors patients after a maximum of two attempts. However, one study did find a significantly patients undergoing repeat flap had no change in fecal incon- greater proportion of men had primary healing of their fistula tinence scores, suggesting that repeat flap carries a low risk of [30]. The most common complication appears to decreased success rate for full-thickness flaps [23]. In a case series of 189 patients with mucosal study, the recurrence rate was 14 % for non-obese patients flaps by Aguilar et al. However, other studies have found no difference There are also reports of urinary retention [21], including in recurrence with obesity [24, 26 , 28], or even increased a 7. For this reason it is reasonable to ensure patients have found no effect of smoking on flap success [23 , 25 , can void before they are discharged from the recovery 28, 31]. In the Aguilar study [4] there were two cases of rate in other studies [22, 24, 27], which may be plausible due anal stenosis; however, 80 % of these patients also had a to the possibility of decreased blood flow to the rectal mucosa hemorrhoidectomy, so it is unclear whether these compli- as a result of smoking [31]. All of these studies performed cations arose as a result of the advancement flap or the multivariate analyses which demonstrated that smoking was hemorrhoidectomy. It may therefore be prudent to encour- in healing rates with age, increased age is associated with a age patients to quit smoking prior to endorectal advance- higher likelihood of healing. One with other studies showing a trend toward an increased like- confounding factor may be the prevalence of Crohn’s; in the lihood of failure with steroid use [26 , 29]. This may be due Sonoda paper a higher proportion of the younger patients to steroid use serving as a proxy for a greater severity of had Crohn’s disease while the older patients were more Crohn’s disease, which would predispose patients to recur- likely to have cryptoglandular fistulas. In contrast, there is evi- studies demonstrating no effect of age on healing rates dence that biologic immunomodulators may contribute to included significant numbers of patients with Crohn’s dis- the success of endorectal advancement flaps in patients with ease [22, 26]. In a case series of 19 patients with Crohn’s ing at younger ages found in some studies is due to a disease who were treated with preoperative infliximab, eight differential prevalence of Crohn’s among the study patients healed and did not require surgery. Similarly, in a retrospective review of 218 patients affect fistula healing rates [28], including in multiple logistic with Crohn’s undergoing a variety of surgical interventions 14 Endorectal Advancement Flap 101 for anal fistulas, there was improvement or healing in 71. Thus, surprisingly, the majority of those not receiving biologics, although the overall healing studies show no effect of complexity on healing rates. For exam- Success rates were 88% among those with no prior repairs, ple, Sonoda et al. Additional stud- There is some evidence that the activity of Crohn’s disease, ies have found a decreased success rate [7 , 27] or trend not just the presence of Crohn’s, can affect recurrence rate toward this [38] with prior attempts at repair. A success rate of 25 % has been found in the presence other studies have found no difference in the recurrence rate of small bowel Crohn’s, vs. In contrast, though, Crohn’s activity was any relationship to the number of prior attempts at repair not found to affect the healing rate after rectovaginal fistula [23, 24 , 26]. Thus, while patients with a history of multiple repair (done in most cases with a mucosal advancement flap prior attempts at repair should be cautioned about the risk of although a significant minority of patients had other proce- failure, there is evidence that they can expect a success rate dures performed) [26]. Patients with Crohn’s disease should which may not be markedly different than patients who have therefore be counseled that they may experience a higher rate not had prior attempts at repair. Operative Technique Location of the fistula does not appear to affect healing A seton is often placed prior to surgery to allow maturation rates, with anterior, posterior, and lateral fistulas having sim- of the fistula tract prior to endorectal advancement flap. Data are mixed as to whether There is some evidence that this may contribute to a greater different types of fistulas have differential healing rates. A number of studies have compared placed in situations where the surgeon anticipated a lower rectovaginal fistulas to other fistulas, with a higher healing likelihood of healing. The finding of no difference or an rate [6, 35], lower healing rate [5], and no difference [27] all increase in healing in these presumably more difficult fistulas having been found. Seton placement for a min- Data are similarly mixed as to the effect of fistula com- imum of 6 weeks prior to flap should therefore be strongly plexity on healing rates. While the majority of centers administer than more straightforward fistulas [28 , 30]. Fistulas with a a dose of perioperative antibiotics, some centers also con- horseshoe component have been found to have higher [34 ], tinue antibiotics postoperatively for variable durations. Some lower [13], and similar [24] healing rates when compared to centers limit patients to a clear liquid diet for a period of time fistulas without a horseshoe component. The healing rate for and/or place them on constipating medications, while others rectovaginal fistulas was not found to vary by the location of have no particular restrictions. Referral to a tertiary institution may also operative regimen including clear liquid diet, immobiliza- serve as a proxy for fistula complexity, but has not been tion, and antibiotics [39]. In terms of postoperative bowel regimen to promote consti- Gustafsson and Graf did a randomized controlled trial pation, no difference in healing rates has been found between comparing flap alone to flap with a gentamicin-collagen a constipating regimen and no regimen [7, 10].

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The rest of the H and L chain is called constant region buy 0.5 mg avodart, tively removed from the body during their thymic and as this part of antibody is same in all types of anti- bursal development buy generic avodart 0.5mg on line, so that they are not available in post- bodies buy avodart 0.5 mg visa. Functions of Antibodies Different antibodies play different role in immunological Clonal Anergy responses: the self-reactive clone of T and B cells those remain alive IgG: Complement fixation by classical pathway during post-natal life loose the capacity to be activated in Chapter 19: Physiology of Immunity 177 response to self antigens discount avodart 0.5mg on-line. Transplant rejection is due to the activation of cellular activity of their receptors and lymphokine systems to react immunity. The immune system recognizes the transplanted tissue suppression of these cells by body’s self regulating sys- as a foreign organ and initiates a series of immunological tems. Autograft: Transplantation of a tissue from one part antigens and do not react against them. Autografts are is genetically a different organ (fetal graft) and foreign tissue never rejected. Fetal tolerance is due to four mechanisms: the transplantation of tissues from the identical twin. During the formation of placenta, trophoblast cells that separate Isograft is also not rejected. Allograft: This is the transplantation of organs between therefore, loose their immunogenicity. Therefore, antibodies against individuals of the same species, but with different fetal tissue do not develop. Allograft This attachment causes apoptosis of T cells that are supposed to is rejected. Xenograft: This is a transplant from or between dif- causes suppression of T and B cells that react against fetal graft. High level of progesterone during pregnancy is believed to between animal and man. This is a purine antimetabolite that debilitating diseases like renal failure, liver failure, etc. However, the individual on aza- Commonly transplanted organs are skin, kidney, bone and thioprine is susceptible to severe infection because of liver. Glucocorticoid therapy: Glucocorticoids have strong planted organ, which is a foreign tissue to him: immunosuppressive activity. Antilymphocyte globulins: These are monoclonal anti- the year 1990 was awarded to American transplant bodies produced against T lymphocytes. Antibiotics: Antibiotics usually used for the prevention transplantation in the treatment of human disease. Cyclosporine is a fungal extract and tacrolimus is an antibiotic of fungal origin. Monoclonal antibodies: They prevent activation and Immunotherapy is the treatment that aims at induction proliferation of T cells. This is Monoclonal Antibodies especially helpful for the treatment of different malig- nant diseases. There are different types of immunothera- Monoclonal antibodies are antibodies prepared from pies: cellular immunotherapy, cytokine therapy, antibody a single clone of B or plasma cells. They are obtained by fusing a Cellular Immunotherapy B cell with a tumor cell that produces antibodies in large Cells that have anti-tumor activity are injected into the quantity. These activated cells are called as lympokine-activated in a patient suffering from multiple myeloma. The fused cells (hybridoma cells) are separated and Different cytokines (see below) can be used in the treat- every single cell is allowed to form a clone of cells. The single clone of hybridoma cells produce specific Interferons are especially used for the treatment of viral antibody consisting of heavy or light chains of spleen infections or malignancies. Antibody Therapy Uses of Monoclonal Antibody Monoclonal antibodies are extensively used for the treat- Monoclonal antibodies are used in a wide variety clinical ment of malignancies or for preventing transplant rejection. Diagnosis of allergic diseases, hepatitis, sexually trans- Adjuvant is a compound, which is introduced with an anti- mitted diseases, etc. There are two system and the discovery of the principle for production of monoclonal types of allergies: the local allergy and the systemic antibodies”. Examples are swelling of the These reactions are mediated by macrophages that are lips, eczema, hives, urticaria, etc. This causes proliferation of T cells, some of which functions), is called systemic allergy or anaphylaxis. The appropriate example is the skin test for tuber- results in shock, called anaphylactic shock. Scientist contributed Autoimmune Diseases the Nobel Prize for the year 1913 for Physiology or Medicine was awarded to the Staff of Professors Normally, the immune system does not react against self of the Caroline Institute, Charles Richet, Professor proteins. However, in some conditions, immune system of Physiology in the Medical Faculty, Paris, for his fails to neglect self antigens and triggers immune reaction work on anaphylaxis. This may be due to the persistence of T cells or B cells (1850–1935) that are active against self antigens. Especially, failure of the process that removes antibodies against self Hypersensitivity Reactions antigens leads to formation of autoantibodies (Clinical There are four types of hypersensitivity reactions: Box 19. For example, in myasthenia gravis, and slow-releasing substance A from mast cells and antibodies are formed against nicotinic cholinergic basophils. It is an acute medical emer- Antibodies may cross-react: Sometimes autoantibodies may cross­ gency, which requires prompt medical support. Another example is Goodpasture syndrome, in which antibodies formed against alveolar Incompatible blood transfusions, hemolytic diseases of basement membrane cross react against glomerular basement newborn and autoimmune hemolytic anemias are exam- membrane, resulting in pulmonary hemorrhage and glomerulonephritis. They are secreted from activated lymphocytes, cells (pre-T cells) in thymus fail to develop into mature macrophages, endothelial cells, glial cells, etc. Therefore, severe deficiency occurs in the develop- Interleukins ment of both humoral and cellular immunity. They are produced by macrophages, activated T cells, ciency of humoral system of immunity ensues. Thus, both cellular and leucocytes, lymphopoiesis, erythropoiesis, thrombo- humoral immunities fail to develop. Though it increases capillary permeability, it on the surface of helper cells and decreases number of produces hypertension. T cell (T8 cell or cytotoxic T cell) is for cellular immunity, which is mainly targeted against intracellular pathogens like viruses, parasites and fungi, cancer cells, tumor cells, and transplanted tissues. B cell is for humoral immunity mediated by antibodies, which is mainly targeted against extracellular pathogens like bacteria. Type 1 helper cell induces cellular immunity and type 2 helper cell induces humoral immunity. In examinations, ‘Mechanism of cellular immunity’, ‘Mechanism of humoral immunity’, ‘Mechanism of defense by phagocytic and inflammatory cells’ and ‘Development of T and B lymphocytes’ usually come as Long Questions. In addition, classification of immunity, types of antibodies and their functions, and all immunological disorders, may be asked. Describe the structure (cytoskeletal systems and granules) of platelet and correlate the structure with platelet functions.

Oogenesis order 0.5 mg avodart with amex, Corpus luteum discount 0.5mg avodart with mastercard, Graafian follicle generic 0.5 mg avodart with amex, Stages of follicular development discount 0.5mg avodart otc, Regulation of follicular development, may be asked as Short Questions in exam. In Viva, examiner may ask…… How the corpus luteum is formed, What are the functions of corpus luteum, How is the lutenization regulated, What is luteal regression, What is luteal deficiency and what are its features, What is D and C, What are the functions of ovary, What are the stages of oogenesis, How the age of oocyte contributes to the health of children, List the stages of follicular development, How the early tertiary stage is regulated, How is the late tertiary stage regulated, What are the changes that occur in primordial follicular stage, What are the changes that occur in primary follicular stage, What are the changes that occur in secondary follicular stage, What are the changes that occur in tertiary follicular stage. Correlate histological modification at different segments of nephron with their specific functions. Describe the structural and functional organization of different parts of the nephron. Note that the renal corpuscle is located in superficial layers of cortex in cortical nephron and close to corticomedullary junction in juxtamedullary nephron. Also note the size of glomer- ulus which is small in cortical nephron and large in juxtamedul- lary nephron. In cortical nephron, the loop of Henle is small, does not have a thin ascending limb and does not extend into the inner medulla. In juxtamedullary nephron, the loop of Henle is long, has a thin ascending limb and extends deep into the inner medulla. Location of renal corpuscle In the superficial region of cortex In the juxtamedullary region of the cortex 2. Main function Urine formation &excretion of waste products Urine concentration (1816–1892) was an English surgeon, histologist and anatomist. He is best known for his research using microscopes to study various human organs. Abnormality of nephrin molecules allows free filtration of protein molecules resulting in massive proteinuria, the outstanding feature of the disease. When terminal part of thick densa) and extraglomerular mesangial cell (Lacis cell). His important contribution was the discovery of which is discharged into circulation from renal veins, & regulates blood pressure, salt and water homeostasis and is an important therapeutic target. The structural medications of tubular epithelial cells in different parts of the nephrons are primarily meant for their participation in specific functions. The loop of Henle of Juxtamedullary nephron is longer to facilitate its role in urine concentration. Mechanism of counter-current heat exchange between inflow (downward arrow) and outflow (upward arrow) tubes of a furnace. Note, cooler air of inflow tube exchanges heat with hot air of outflow tube, so that the heat is maintained in the inner furnace. Note that the flow is in opposite direction in descending and ascending limbs of loop of Henle (as indicated by arrows inside), and vasa recta (as indicated by arrows outside vasa recta). This close proximity of descending and ascending limbs in a parallel arrangement and the opposite direction of flow in limbs are essential components of a counter-current mechanism to be effec- tively operative. Also, note the direction of flow in collecting duct (as indicated by arrow within the collecting duct). Ability of the kidney to concentrate urine is a critical adaptation of life on land. Countercurrent mechanisms not only operate in medulla of kidney, but also in where the blood vessels lie close to each other and allow exchange of solute, solvent and temperature between them. For example, exchange of heat between the inflowing and outflowing vessels of the feet of penguin helps penguin to maintain its body temperature when it stands on ice for a long. In collecting duct, urea diffuses out of the tubular fluid that aids to increase the interstitial osmolality. This higher interstitial osmolality transfers water from tubular fluid leaving collecting duct and makes the urine concentrated. Note, the tubular fluid and blood in vasa recta entering into medulla becomes gradually hyperosmolal and fluid and blood leaving medulla becomes gradually hypoosmolal. Thus, interstitial osmolality (mosm/kg of water) increases gradually from outer layers to inner layers of medulla reaching about 1200 mosm/kg of water in innermost part. This osmolal gradient transfers water from tubular fluid of collecting duct leaving the medulla that makes urine concentrated. Urea content of tubular fluiddepends mainly on the urea filtered in the glomerular filtering membrane, which depends on the. Low-protein diet impairs the ability of kidney to maximally concentrate urine as this decreases the urea content in the medullary interstitium. The osmotic gradient created in the medullary interstitium reabsorbs water from the tubule & makes urine concentrated. In examination, “Describe the countercurrent mechanism of urine concentration” is usually asked as 2. Explain the role of the loop of Henle as countercurrent multiplier, Explain the role of the vasa recta as countercurrent exchanger, Explain the role of collecting duct in countercurrent mechanism in kidney, may be asked as in exam. Understand the physiological basis of genesis and management of acute and chronic renal failures. Describe the procedure, application, merits and demerits of kidney function tests. Physiologically, kidney function tests are done to assess glomerular filtration and tubular functions. However, ‘Describe the physiological basis and application of kidney function tests’ may come as a long question. Tubular function tests, Glomerular function tests, Clearance tests, Urine analysis, Acute renal failure, Chronic renal failure may be asked as in exam. Describe the features in spinal, decerebrate, midbrain and decorticate preparations. Understand the role of various components of neuraxis in regulation of posture and movement. He proposed the concept of integration of body functions of organism as a whole is the coordinated action of nervous system. He analyzed the stretch reflex, described arrangement of motor fibers in lumbosacral plexus and studied functions of many parts of the brain. Many experimental studies of nervous system are named after him, for example, decerebrate preparation for the study of medullary integration of motor function is known as. The facilitatory reticular area discharges spontaneously; whereas the inhibitory reticular area to discharge effectively requires input from cortex, basal ganglia, and cerebellum. In midcollicular ences reticulospinal activity via its projection to the motor cortex. Therefore, ullary reticular activity, they are classified under inhibitory brain inhibitory output of the medullary reticulospinal tract becomes areas (as indicated by ‘minus’ sign). Output of vestibulospinal tract less inhibitory, whereas facilitatory area continues to discharge is facilitatory. As motor neurons are primarily driven by reticulospinal tract influence, decerebration causes severe rigidity. J J J ƵůŽƐƉŝŶĂů ƚƌĂĐƚ ǀŝĂ ɲ ŵŽƚŽƌ ŶĞƵƌŽŶƐ J J the vestibulospinal tract mainly influences α motor neurons and reticulospinal tract influences J motor neurons in the spinal cord. Section (Ia) are interrupted by deafferentation, the input from muscle spindle of Ia fibers that carry sensation from muscle spindle abolishes to spinal cord is abolished. As J motor neurons control muscle tone influence of reticulospinal tract on muscle that mediates effects via spindle sensitivity, deafferentation removes the influences through mostly through J motor neurons.

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