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By P. Arokkh. Olivet College.

Locations of meniscal tear purchase 150mg bupropion with amex depression symptoms veterans, capsu- ed in trabecular bone generic bupropion 150 mg without a prescription kessler depression test, there is no contusion. By understanding plain radiographs may be difficult or impossible to visu- traumatic patterns, the identification of one abnormality alize on MR images. Poor visualization reflects both the may lead to a directed search for subtle abnormalities in- absence of marrow fat within the distracted fragment as volving anatomically or functionally related structures, well as the absence of sentinel bone-marrow edema sur- thus improving diagnostic confidence. Larger avulsed fragments con- tain trabecular bone and marrow fat, which have high signal intensity on T1-weighted images and are conspic- References uous against the surrounding lower signal intensity of 1. Lee JH, Weissman BN, Nikpoor N et al (1989) Lipohe- soft-tissue edema and hemorrhage. If the avulsed frag- marthrosis of the knee: a review of recent experiences. Gray SD, Kaplan PA, Dussault RG et al (1997) Acute knee On MR images, the likelihood of identifying small trauma: how many plain film views are necessary for the ini- tial examination? Skeletal Radiol 26:298-302 avulsed cortical fragments is improved by inspecting the 3. Rosenberg TD, Paulos LE, Parker RD et al (1988) The forty- usual locations of avulsion based on the suspected mech- five-degree posteroanterior flexion weight-bearing radiograph anism of injury. J Bone Joint Surg [Am] 70:1479-1483 avulsion in the knee: the medial femoral condyle at the 4. Jones AC, Ledingham J, McAlindon T et al (1993) attachment of the medial collateral ligament; the inter- Radiographic assessment of patellofemoral osteoarthritis. Ann Rheum Dis 52:655-658 condylar eminence at attachments of both cruciate liga- 5. Smith SL, Wastie ML, Forster I (2001) Radionuclide bone ments; the anterior part of the intercondylar eminence at scintigraphy in the detection of significant complications after attachment of the anterior cruciate ligament; the posteri- total knee joint replacement. Pelosi E, Baiocco C, Pennone M et al (2004) 99mTc-HMPAO- or part of the intercondylar eminence at the attachment leukocyte scintigraphy in patients with symptomatic total hip of the posterior cruciate ligament; the lateral tibial rim at or knee arthroplasty: improved diagnostic accuracy by means the attachment of the lateral capsule (Segond fracture); of semiquantitative evaluation. J Nucl Med 45:438-444 fibular head at attachment of the fibular collateral liga- 7. Khan KM, Bonar F, Desmond PM et al (1996) Patellar tendi- nosis (jumper’s knee) : findings at histopathologic examina- naculum. Victorian Institute of Sport Tendon In the knee, the avulsion fracture fragments that are Study Group. Radiology 200:821-827 most difficult to identify involve the lateral tibial rim and 9. These locations should be inspected when- detection of Baker’s cysts: comparison with MR imaging. Am ever there is evidence for distraction injury involving the J Roentgoenol 176:373-380 10. Wicky S, Blaser PF, Blanc CH et al (2000) Comparison be- lateral compartment of the knee, or impaction injury in- tween standard radiography and spiral CT with 3D recon- volving the medial compartment. Evidence of later- struction in the evaluation, classification and management of al distraction injury includes sprain of the fibular collat- tibial plateau fractures. Eur Radiol 10:1227-1232 eral ligament and strain of the iliotibial band or popliteus 11. Anteromedial kissing contusions are closely as- tector CT in skeletal trauma. Semin Musculoskelet Radiol 8:147-156 sociated with posterolateral avulsion injury. Mutschler C, Vande Berg BC, Lecouvet FE et al (2003) traction fracture is suspected based on MRI findings, it is Postoperative meniscus: assessment at dual-detector row spiral reasonable to recommend plain radiography to exclude CT arthrography of the knee. Vande Berg BC, Lecouvet FE, Poilvache P et al (2002) Assessment of knee cartilage in cadavers with dual-detector spiral CT arthrography and MR imaging. Brossmann J, Preidler KW, Daenen B et al (1996) Imaging of osseous and cartilaginous intraarticular bodies in the knee: Multiple traumatic, degenerative, inflammatory, infec- comparison of MR imaging and MR arthrography with CT and CT arthrography in cadavers. Radiology 200:509-517 tious, and neoplastic conditions occur in and around the 15. Radiographs, ultrasound, CT, MR, and the postoperative meniscus of the knee: a study comparing arthrography each play a role in the imaging evaluation conventional arthrography, conventional MR imaging, MR of these conditions. Imaging is important not only to de- arthrography with iodinated contrast material, and MR tect or exclude disease, but also to stage, guide therapy, arthrography with gadolinium-based contrast material.

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The vinar buy bupropion 150mg visa anxiety 24, medial purchase bupropion 150mg on-line depression yoga, and lateral geniculate nuclei, the basilar pons, and middle cere- terminal vein is also called the superior thalamostriate vein. The two MRI images (both inversion recovery) are at the of the cerebellum see Figures 2-31 to 2-33 on pp. Coronal Brain Slice—MRI Correlation 71 Body of corpus callosum (BCorCl) Crus of fornix (CrF) Fimbria of fornix (FFor) Body of lateral ventricle (BLatVen) Pulvinar (Pul) Body of caudate nucleus (BCaNu) Retrolenticular limb of internal capsule Stria terminalis and Fimbria of hippocampus terminal vein Pineal Hippocampal Tail caudate nucleus formation (Hip) Inferior horn of lateral ventricle (IHLatVen) Superior colliculus (SC) Cerebral aqueduct (CA) Periaqueductal gray (Pag) Flocculus Medulla (Med) Middle cerebellar peduncle (MCP) FFor Splenium BCorCl of corpus callosum BLatVen Pul BLatVen SC SC IHLatVen Hip Hip CA Pag Pag MCP Med MCP Pyramid 4-8 The rostral surface of a coronal section of brain through the pul- tures identified in the brain slice. The terminal vein is also called the vinar nucleus, the superior colliculus, the middle cerebellar peduncle, and the superior thalamostriate vein. For details of the cerebellum see Figures rostral portion of the medulla oblongata. The two MRI images (both are inversion re- nium of corpus callosum, the inferior colliculus, the middle cerebellar pe- covery) are at the same plane and show many of the structures identi- duncle in the base of the cerebellum, and the rostral portion of the fied in the brain slice. Internal Morphology of the Brain in Slices and MRI Brain Slices in the Axial Plane with MRI Orientation to Axial MRIs: When looking at an axial MRI using MRI (or CT) in the diagnosis of the neurologically impaired image, you are viewing the image as if standing at the patient’s patient. So, when looking at the slice, the observer’s ages, the observer’s right is the left side of the brain in the MRI right is the left side of the brain slice. It is absolutely essential to relates exactly with the orientation of the brain as seen in the ac- have a clear understanding of this right-versus-left concept when companying axial MRIs. The plane of the section just touches the upper identified in the brain slice. The terminal vein is also called the superior portion of the body of caudate nucleus. Axial Brain Slice—MRI Correlation 75 Cingulate gyrus Anterior cerebral arteries Genu of corpus calllosum Head of caudate nucleus (HCaNu) Anterior horn of lateral ventricle (AHLatVen) Stria terminalis and terminal vein Body of fornix Anterior nucleus of Anterior tubercle thalamus Corona radiata (CorRad) Ventral anterior nucleus of thalamus Lateral thalamic nuclei Tail of caudate nucleus Dorsomedial nucleus of thalamus Lateral ventricle (LatVen) Tail of caudate nucleus Crus of fornix Splenium of corpus callosum Caudate AHLatVen nucleus LatVen HCaNu Putamen CorRad Internal capsule Septum pellucidum Dorsal thalamus Atrium of lateral ventricle 4-11 Ventral surface of an axial section of brain through the splenium sion recovery—left; T2-weighted—right) are at a comparable plane of corpus callosum and the head of the caudate nucleus. This plane includes and show some of the structures identified in the brain slice. The two MRI images (inver- minal vein is also called the superior thalamostriate vein. The arrowheads in the brain slice the corpus callosum, head of caudate nucleus, centromedian nucleus, and dor- and in the MRIs are pointing to the mammillothalamic tract. The two MRI images (inversion recovery— minal vein is also called the superior thalamostriate vein. MGNu thalamic nuclei Tap Pul Hip Dorsomedial nucleus SC ALatVen Crus of fornix PHLatVen OpRad SpCorCl 4-13 Ventral surface of an axial section of brain through the anterior can be discerned on the right side of the brain. The MRI images (both commissure, column of fornix, medial and lateral geniculate nuclei, and supe- T2-weighted) are at approximately the same plane and show many of rior colliculus. The medial and lateral segments of the globus pallidus are vis- the structures identified in the brain slice. The lateral and medial segments of the globus pallidus 78 Internal Morphology of the Brain in Slices and MRI Hypothalamus (HyTh) Anterior cerebral arteries (ACA) Head of Lamina terminalis caudate nucleus Third ventricle (ThrVen) Nucleus accumbens Optic tract (OpTr) Anterior perforated substance Uncus Crus cerebri (CC) Amygdaloid nuclear complex Inferior horn of lateral ventricle (IHLatVen) Mammillary body (MB) Interpeduncular Hippocampal fossa (IPF) formation Lateral geniculate Substantia nucleus nigra (SN) Tail of caudate nucleus Decussation of superior Hippocampal formation (Hip) cerebellar peduncle Choroid plexus in inferior horn Inferior colliculus (IC) Periaqueductal gray Cerebellum (Cbl) Cerebral Aqueduct (CA) ACA OpTr ThrVen HyTh ThrVen Un MB CC SN IPF IHLatVen Hip CA IC Posterior cerebral artery Posterior horn lateral ventricle Cbl 4-14 Ventral surface of an axial section of brain through the hypo- planes and show many of the structures identified in the brain slice. The three MRI images (inverted inversion For details of the cerebellum see Figures 2-31 to 2-33 on pp. Axial Brain Slice—MRI Correlation 81 Basilar artery Basilar pons Anterior median fissure (AMF) Pyramid (Py) Preolivary sulcus (PreOIS) Olivary eminence (OlEm) Vestibulocochlear nerve Vagus and glossopharyngeal nerves Retroolivary sulcus (Postolivary sulcus) (PoOIS) Restiform body (RB) Medial lemniscus Tonsil of cerebellum (TCbl) Hemisphere of posterior lobe Fourth ventricle (ForVen) of cerebellum (HCbl) Vermis of posterior lobe of cerebellum (VCbl) AMF Py PreOlS OlEm PoOlS RB TCbl TCbl ForVen HCbl VCbl OlEm Lesion-Lateral medullary syndrome RB ForVen 4-17 Ventral surface of an axial section of brain through portions of show many of the structures identified in the brain slice. Note the lateral the medulla oblongata, just caudal to the pons–medulla junction and the medullary lesion (lower), also known as the posterior inferior artery posterior lobe of the cerebellum. The three MRI images (T1-weighted— syndrome or the lateral medullary syndrome (of Wallenberg). For de- upper left and right; T2-weighted—lower) are at the same plane and tails of the cerebellum see Figures 2-31 to 2-33 on pp. CHAPTER 5 Internal Morphology of the Spinal Cord and Brain in Stained Sections Basic concepts that are essential when one is initially learning how and the lateral corticospinal tract (grey). In the brainstem, these to diagnose the neurologically impaired patient include 1) an un- spinal tracts are joined by the spinal trigeminal tract and ventral derstanding of cranial nerve nuclei and 2) how these structures re- trigeminothalamic fibers (both are light green). The importance of these relationships is clearly color-coded on one side only, to emphasize 1) laterality of function seen in the combinations of deficits that generally characterize le- and dysfunction, 2) points at which fibers in these tracts may de- sions at different levels of the neuraxis. First, deficits of only the cussate, and 3) the relationship of these tracts to cranial nerves.

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Therefore effective 150 mg bupropion mood disorder xyy, estrogens have the most abundant and is 12 and 80 times more potent than a positive effect on bone maintenance discount bupropion 150mg free shipping depression motivation, and later in life, ex- estrone and estriol, respectively. Much of estrone is derived ogenous estrogens oppose the osteoporosis often associ- from peripheral conversion of either androstenedione or ated with menopause. During pregnancy, large quantities As mentioned earlier, the first menstruation is called of estriol are produced from dehydroepiandrosterone sul- menarche and occurs around age 12. The first ovulation fate after 16 -hydroxylation by the fetoplacental unit (see does not occur until 6 to 9 months after menarche be- Chapter 39). Most estrogens are bound to either albumin cause the hypothalamic-pituitary axis is not fully respon- ( 60%) with a low affinity or to sex hormone-binding sive to the feedback effects of estrogen. Estrogens are bertal period, the development of breasts, under the metabolized in the liver through oxidation or conversion to influence of estrogen, is known as thelarche. The metabolites are then ex- the appearance of axillary and pubic hair occurs, a devel- creted in the urine. The adrenals begin to produce significant through 1,25-dihydroxyvitamin D3. HRT is not an uncommon treatment to improve sponsible in part for pubarche. Estrogen therapy is contraindicated in cases of existing reproductive tract carcinomas or hyper- tension and other cardiovascular disease. The prevailing MENOPAUSE opinion is that the benefit of treating postmenopausal Menopause is the time after which the final menses occurs. Generally, menstrual cycles and bleed- ing become irregular, and the cycles become shorter from the lack of follicular development (shortened follicular INFERTILITY phases). The ovaries atrophy and are characterized by the presence of few, if any, healthy follicles. One of five women in the United States will be affected by The decline in ovarian function is associated with a de- infertility. A thorough understanding of female endocrinol- crease in estrogen secretion and a concomitant increase in ogy, anatomy, and physiology are critical to gaining in- LH and FSH, which is characteristic of menopausal women sights into solving this major health problem. Environmental factors, disor- LH stimulates ovarian stroma cells to continue producing ders of the central nervous system, hypothalamic disease, androstenedione. Estrone, derived almost entirely from the pituitary disorders, and ovarian abnormalities can interfere peripheral conversion of adrenal and ovarian androstene- with follicular development and/or ovulation. Be- ovulation occurs, structural, pathological, and/or endocrine cause the ratio of estrogens to androgens decreases, some problems associated with the oviduct and/or uterus can pre- women exhibit hirsutism, which results from androgen ex- vent fertilization, impede the transport or implantation of cess. The lack of estrogen causes atrophic changes in the the embryo, and, ultimately, interfere with the establish- breasts and reproductive tract, accompanied by vaginal ment or maintenance of pregnancy. Similar changes in the urinary tract may give rise to urinary distur- Amenorrhea Is Caused by Endocrine Disruption bances. Menstrual cycle disorders can be divided into two cate- Hot flashes, as a result of the loss of vasomotor tone, os- gories: amenorrhea, the absence of menstruation, and teoporosis, and an increased risk of cardiovascular disease are oligomenorrhea, infrequent or irregular menstruation. Hot flashes are associated with episodic in- mary amenorrhea is a condition in which menstruation has creases in upper body and skin temperature, peripheral va- never occurred. They occur concurrently with LH called gonadal dysgenesis, a congenital abnormality caused pulses but are not caused by the gonadotropins because they by a nondisjunction of one of the X chromosomes, resulting are evident in hypophysectomized women. Because the two X chro- sisting of episodes of sudden warmth and sweating, reflect mosomes are necessary for normal ovarian development, temporary disturbances in the hypothalamic thermoregula- women with this condition have rudimentary gonads and do tory centers, which are somehow linked to the GnRH pulse not have a normal puberty. Estrogen an- Other abnormalities include short stature, a webbed neck, a tagonizes the effects of PTH on bone but enhances its ef- coarctation of the aorta, and renal disorders. Another congenital form of primary amenorrhea is hy- Estrogen also promotes the intestinal absorption of calcium pogonadotropism with anosmia, similar to Kallmann’s syn- TABLE 38. Patients do not progress ies reveal that exogenous TRH increases the secretion of through normal puberty and have low and nonpulsatile LH PRL. However, they can have normal stature, press ovulation is not entirely clear. The disorder is caused by a that PRL may inhibit GnRH release, reduce LH secretion in failure of olfactory lobe development and GnRH defi- response to GnRH stimulation, and act directly at the level ciency. Primary amenorrhea can also be caused by a con- of the ovary by inhibiting the action of LH and FSH on fol- genital malformation of reproductive tract structures origi- licle development. Secondary amenorrhea is the cessation of menstrua- Anorexia nervosa, a severe behavioral disorder associated tion for longer than 6 months.

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