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Lateral to the body medicine nobel prize 2016 order endep 10 mg with mastercard, we see the superior surface of the lateral part, which is also called the ala. We can again distinguish medial and lateral parts separated by four pairs of posterior sacral foramina. The medial part of the dorsum of the sacrum is formed by the fused laminae of sacral vertebrae. The laminae of the fifth sacral vertebra (sometimes also of the fourth) are deficient leaving an inverted Ushaped or V-shaped gap called the sacral hiatus. The midline is marked by a ridge called the median sacral crest on which four spinous tubercles (representing the spines) can be recognised. Just medial to the dorsal sacral foramina, we see four small tubercles that represent fused articular processes. Lateral to the foramina, we see a prominent lateral sacral crest formed by the fused transverse processes. The lower end of the bone (apex) bears an oval facet for articulation with the coccyx. At the sides of the sacral hiatus, we see two small downward projections called the sacral cornua. When the sacrum is viewed from the side, we see that the pelvic aspect of the bone is concave forwards, while the dorsal aspect is convex backwards. The lateral surface bears a large L-shaped auricular area (or facet) for articulation with the ilium. The area behind the auricular surface is rough and gives attachment to strong ligaments that connect the sacrum to the ilium. This is to be correlated with the fact that the female pelvis is also shorter and broader than the male pelvis. However, for practical purposes the sex of a given sacrum is most easily found out by examining the base. In the female, the transverse diameter of the body is approximately equal to the width of the ala. But in the male, the diameter of the body is distinctly larger than that of the ala. Chapter 24 Bones and Joints of the Abdomen Theattachmentsonthesacrum,anditsossification,aredescribed below along with those of the coccyx. The base or upper end has an oval facet for articulation with the apex of the sacrum. Lateral to the facet, there are two cornua that project upwards and are connected to the cornua of the sacrum by ligaments. The iliacus arises from the anterolateral part of the upper surface of the ala (or lateral part). The medial part of the origin is in the form of three digitations that arise from the areas between the sacral foramina. The coccygeus is inserted into the lateral side of the pelvic aspect of the last piece of the sacrum and to the coccyx. The levator ani is inserted into the sides of the lower two segments of the coccyx. The gluteus maximus arises from the lateral margin of the lowest part of the sacrum, and that of the coccyx. Ligaments of the joints between the fifth lumbar vertebra and the sacrum correspond to those of other intervertebral joints. The area around the auricular surface gives attachment to the ventral, dorsal and interosseus ligaments of the sacroiliac joint. The sacrotuberous ligament is attached to the lower lateral part of the dorsal surface of the sacrum. The sacrospinous ligament is attached to the lower part of the lateral margin of the sacrum and to the adjoining lateral margin of the coccyx. The rectum is in contact with the ventral surface of the 3rd, 4th and 5th pieces of the sacrum. Deep to the peritoneum and rectum, the ventral surface is crossed by the right and left sympathetic trunks, the median sacral vessels, the right and left lateral sacral vessels, and the superior rectal vessels. The ala is covered by the psoas major muscle and is crossed by the lumbosacral trunk. The ventral and dorsal sacral foramina give passage to the corresponding rami of sacral nerves.

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The posterior surface of the lens lies in a depression in the vitreous body called the hyaloid fossa symptoms wisdom teeth endep 50 mg for sale. Changes in the tension on the suspensory ligament, produced by contraction of the ciliary muscle, produce alterations in the convexity of the lens and enable it to focus objects at varying distances from the eye. They end in numerous branches that form a plexus in the choroid and supply it (44. The capillary plexus in the choroid is also responsible for providing nutrition (by diffusion) to the outer part of the retina. They pierce the sclera a short distance to the corresponding side of the lamina cribrosa (44. These arteries then run forward between the sclera and the choroid to reach the region of the ciliary body. Similarly, the lower branches of the two sides anastomose to form the greater arterial circle at the periphery of the iris. This circle is joined by small anterior ciliary arteries that reach the region through the attachments of the rectus muscles to the eyeball. Branches pass radially into the iris from the greater circle, and join each other just round the pupil to form the lesser arterial circle. The veins draining the iris, the ciliary body and the choroid form a dense plexus deep to the sclera. The main blood supply to the retina reaches it through the central artery of the retina. This artery runs forwards through the distal part of the optic nerve to enter the retina through the optic disc. It divides into upper and lower branches, each of which divides into medial (or nasal) and lateral (or temporal)branches. These arteries can be seen in the living subject by looking into the eye through the pupil using an instrument called an ophthalmoscope (44. Blockage of any branch results in death of the part of the retina supplied by it, and to consequent loss of the part of the fieldofvisionconcerned. The blood from the retina is drained by tributaries that correspond to the branches of the central artery, but do not accompany them closely. These tributaries end in two veins superior and inferior that pierce the lamina cribrosa and join each other to form the central vein of the retina. The nerves (other than the optic nerve) that supply the eyeball are the long and short ciliary nerves. The long ciliary nerves are branches of the nasociliary nerve, while the short ciliary nerves arise from the ciliary ganglion. Sympathetic postganglionic fibres meant for the dilator pupillae normally travel through the long ciliary nerves. Other structures in the eye that may be infected are the iris (iritis), the ciliary body (cyclitis), and a combination of both these (iridocyclitis). Corneal ulcers can also be caused by injury or by foreign bodies that enter the eye. Injuries to the cornea can result in corneal opacities that can lead to blindness. The so-called eye transplantations that are advertised so much in the lay press are really corneal transplants. Alterations in the curvature of the cornea can lead to an error of refraction called astigmatism (see below). Vision can be restored by removing the lens, and this is one the most common operations done on the eyeball. Errors of Refraction Defects in the shape of the eyeball, or in refractive media, lead to errors of refraction in which images are not focussed on the retina. In myopia (near sightedness), the image comes into focus in front of the plane of the retina.

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Such spasm can be relieved by appropriate drugs that can symptoms after embryo transfer endep 75 mg purchase with mastercard, therefore, relieve and prevent the occurrence of angina. Complete blockage of a branch of a coronary artery leads to death of the part of the myocardium supplied by that branch (myocardial infarction). In suitable cases, coronary bypass surgery can enable a person with ischaemic heart disease to lead a much more normal life. In aortocoronary bypass, an isolated segment of the long saphenous vein (of the patient) is used as a graft. At one end, it is connected to the ascending aorta, and the other end to a coronary artery beyond the site of obstruction. When more than one vessel is obstructed multiple grafts are used, or multiple anastomoses are made with one graft. The artery itself is mobilized and its distal end anastomosed to a coronary artery (the right or left internal thoracic artery being used as appropriate). In a recent technique called percutaneous transluminal coronary angioplasty, blockage in coronary arteries can be removed through cardiac catherization in suitable cases. A catheter with a miniature balloon is passed along the guide wire into the area of narrowing. A patient with cardiac arrest can be saved if immediate resuscitative measures are taken. Mouth to mouth breathing, and external cardiac massage are relatively simple procedures that can be learnt even by a lay person and they can save the life of a person in cardiac arrest if used immediately. In some cases in whom closed chest cardiac massage does not succeed in restarting the heart an open cardiac massage can be done by opening the thorax. In the years that have passed cardiac transplants have been done with success in many centres in the world. The procedure is attempted only on persons who are likely to die in the absence of an implant (because of advanced disease that cannot be treated by other means). The main problem of all transplantation surgery is that tissues of the body tend to reject any tissues that are foreign to it. The risks of rejection can be minimised by careful matching of the donor and recipient and by the use of immunosuppressive drugs. From the point of view of the student of anatomy, it is easy to understand the complexity of this kind of procedure. These include the aorta, the pulmonary trunk, the superior and inferior venae cavae, and the four pulmonary veins. The pulmonary trunk arises from the right ventricle, the junction between the two being guarded by the pulmonary valve. The trunk runs upwards and backwards and ends by dividing into the right and left pulmonary arteries (21. The lower end of the trunk lies opposite the sternal end of the left third costal cartilage. The lower part of the trunk lies in front of, and to the left of, the ascending aorta; and higher up on its left side (21. The upper branch supplies the upper lobe of the lung and the lower branch supplies the lower lobe. Each of these branches subdivides to accompany the branches of the corresponding bronchi. Anterior to it, there are the ascending aorta, the superior vena cava and the upper right pulmonary vein. Here, it divides into two main branches that are distributed to the two lobes of the left lung. Superiorly, it is connected to the arch of the aorta by the ligamentum arteriosum (21. The heart distributes blood to the entire body through an elaborate arterial tree.

Syndromes

• Neck x-ray
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The median nerve descends into the forearm through the interval between the superficialanddeepheads medications zocor buy endep with a visa. As the ulnar artery descends, it passes deep to the deep head of the pronator teres. In the lateral part of the fossa we see the radial nerve and some of its branches. The radial nerve enters the region by passing forwards in the interval between the brachialis (medially) and the brachioradialis (laterally). Here it gives branches to both these muscles, and also to the extensor carpi radialis longus. The deep branch enters the substance of the supinator muscle (and while within the muscle) winds round the radius to reach the back of the forearm. Medial head from posterior surface of humerus below the radial groove, and from intermuscular septa. Olecranon process of ulna (posterior part of superior surface) Radialnerve(C6,7,8) 1. Long head helps in bringing back the abducted or extended arm to the side of the body the ridge from which the lateral head arises corresponds to the upper part of the lateral border of the bone. Insertion Nerve supply Action Note 98 Notes about the Triceps Part 1 Upper Extremity 1. The long head descends passing anterior to the teres minor, but posterior to the teres major. Just above the origin of the medial head, the posterior aspect of the humerus bears the radial groove. In the upper part of the arm it lies behind the upper part of the brachial artery. It leaves the front of the arm by passing backwards (between the long and medial heads of the triceps). This nerve enters the back of the arm through the interval between the long head of the triceps and the humerus. Finally, it passes through an aperture in the lateral intermuscular septum to reach the cubital fossa. Here it descends between the brachialis (medially) and the brachioradialis and the extensor carpi radialis longus (laterally). Branches arising from the radial nerve near its upper end (while the nerve is medial to the humerus) supply the long and medial heads of the triceps. The branch to the medial head descends along the medial side of the humerusclosetotheulnarnerve(5. In the radial groove the nerve gives another branch to the medial head of the triceps, and also supplies the lateral head. Branches arising from the radial nerve after it has pierced the lateral intermuscular septum. The posterior cutaneous nerve of the arm is given off by the radial nerve while the latter is in the axilla. The posterior cutaneous nerve of the forearm also arises from the radial nerve while the latter lies in the radial groove. It supplies an extensive area of skin on the back of the arm and on the back of the forearm (5. Further details of the course of the radial nerve in the forearm and hand will be considered in Chapter 6. The relationship of the flexor carpi radialis tendon to the flexor retinaculum is illustrated in 6. The lateral border of the pronator teres forms the medial boundary of the cubital fossa. The muscle ends in a tendon that passes anterior to the wrist in its lateral part. Here the tendon passes through a tunnel, bounded laterally by a groove in the trapezium, and medially by two slips of the flexor retinaculum that are attached to the margins of the groove. The radial artery lies just lateral to the tendon of this muscle (between it and the brachioradialis). Weak flexor of elbow supracondylar ridge and (b) medial at about its middle epicondyle 2.

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