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Acetylcholine - synthesis: cholin+acetylCo A (acetyltransferase) - inactivation: acetylcholinesterase: cholin+acetate Cholin the uptake for the resynthesis Ach very short effect duration Receptors for Ach - nicotinic (N) receptors - in the synapses between the pre- and postganglionic neurons buy levonorgestrel 0.18 mg low cost birth control for 7 months, in the neuromuscular junction - muscarinic (M) receptors: postggl discount levonorgestrel 0.18mg birth control pills best. Autonomic tone and excitability Tone there are discharges in autonomic nerves at rest reflex: (stimulation of baro- generic 0.18 mg levonorgestrel otc birth control pills 10 mcg estrogen, chemoreceptors) central (hypothalamus) 58 sympathetic (e generic 0.18 mg levonorgestrel free shipping birth control pills less periods. Cardiovascular system the variability of cardiovascular parameters short-term generic 0.18 mg levonorgestrel with amex birth control kellymom, long-term Ewing battery of cardiovascular tests deep breathing orthostatic test Valsalva manoeuvre hand-grip test other cardiovascular tests oculocardiac test, diving reflex, mental and physical load. Psychosomatic relationships cerebral cortex the influence on the respiratory, cardiovascular, immune, autonomic and other systems relationships - cortex - organs organs - cortex efferent influences of the cerebral cortex: 1. Visual pathways: Collaterals of optic tract: Hypothalamus (circadian rhythm) Pretectal nuclei (accomodation, pupillary light reflex) Superior colliculus (eye movements) Field of vision: -visual area seen at given moment - monocular, binocular - blind spot (15 deg. Floaters (muscae volitantes) -slowly drifting transparent blobs of varying size and shape -particularly noticeable when lying on the ground looking up at the sky -caused by imperfections in the fluid of the eye 2. Scheerer`s phenomenon = blue field phenomenon -noticeable when viewed against a field of pure blue light - tiny bright dots moving rapidly along squiggly lines in the visual field -caused by leucocytes moving in the capillaries in front of retina 3. External ear the pinna (helps to direct sounds), the external auditory meatus, auditory Canal transmits sound waves to the tympanic membrane 2. Middle ear separated from extrenal ear by tympanic membrane (called eardrum), chain of ossicles the malleus, the incus, and the stapes. Eustachian tube connects middle ear to the pharynx and equilizes pressure differences between external and mid. Inner ear bony and membraneous labyrinth (cochlea and vestibular apparartus), receptors for two sensory functions. Cochlea spiral-shaped organ, divided by basal and Reissneri membranes to three parts scala tympani and scala vestibuli by perilymph (helicotrema), between scala media by endolymph). On basal membrane organ og Corti with receptors hair cells Adequate stimulus for auditory receptors sound - sound is produced by waves of compression and decompression transmitted in air (or other media such as water), propagation in the air 335 m/s - sound composed of many unrelated frequencies - noise - frequency (nm. The vibrations are transferred by the ossicular system through the oval window on the structures of inner ear (by the vawe movement of perilymph) - stimulation of the organ of Corti causes action potencials in nerve fibres function of mm. Axons penetrate the base of the skull through openings in the cribriform plate of the ethmoid bone as olfactory nerve filaments (fila olfactoria) to olfactory bulb. Stimulation of the olfactory cells - olfactory receptors telereceptors - they response to the odorant substance (gas) in inhaled air dissolved in the mucus 66 - chemical interaction with the membrane of the cilia + - they evoke receptor (generator) potencial by changing permeability of membrane for Na - fast adaptation - in humans ability to distinguish between 2 4000 different odors - the olfactory cells the highest degree of chemical discrimination Intensity of the stimulus depends on concentration of the odor substance (the number of stimulated receptors and the number of moleculs reaching the cell) Quality of perception depends on concentration: at low c. Function of the muscle spindle Receptors - active at rest stretching of the muscle activation of the anulospiral endings higher frequency of the impulses facilitation of the alfa motoneurons of the its own muscle. Pavlov) - originated during development = mechanisms for assurance of ability to survive and live classification: - apetitive - protective - orientation - sexual Innate mechanisms: 1. Drive: - processes which represent an immediate response to fundamental necessities of the body - they force the human to fill the needs - after filling the needs - antidrive 3. Storing of encoded information biochemical, biophysical and electrophysiological processes 3. Each receptor is highly specific for a single hormone Principal mechanisms: 1) Confirmational changes of the receptor alter the membrane permeability to ions. Properties of the hormone effects: 1) Target effect hormone acts on target cells organ (estrogen uterus, mammary gland etc. It lies in the sella turrica at the base of brain and is connected with hypothalamus by the pituitary (hypophyseal) stalk.
Hypothyroidism is the clinical condition resulting from low levels of circulating thyroid hormones order levonorgestrel 0.18mg on line birth control xulane side effects. The term myxoedema refers to the deposition of muco- Atrial brillation polysaccharide beneath the skin cheap 0.18mg levonorgestrel with mastercard birth control pills blood clots, producing a non- order levonorgestrel 0.18mg overnight delivery birth control pills yasmin. Atrial brillation responds poorly to digoxin and pitting swelling of the subcutaneous tissues trusted levonorgestrel 0.18 mg birth control pills 3 month cycle. Anticoagulation is also required as the risk of em- $10 : 1) discount 0.18mg levonorgestrel mastercard birth control for women doctors, reecting the high proportion of cases due to bolisation is relatively high. This is a rare but potentially life-threatening disorder, Aetiology which requires urgent treatment targeted at various steps in the thyroid hormone synthesis/action ThecausesofhypothyroidismareshowninTable16. Block peripheral manifestations of excess thyroid be asymptomatic or manifest mild hypothyroid hormones: propranolol (initially 0. Pregnancy untreated maternal hypothyroidism is Verapamil can be used in those with a history of associatedwithhigherratesofmiscarriage,stillbirth asthma. Hashimotos thyroiditis typically associated with agoitre:atrophicthyroiditiswhentheglandatrophieswithoutproducing a goitre) Previous treatment for thyrotoxicosis (e. Anaemia (microcytic if menorrhagia, macrocytic if gestive of a central (hypothalamic/pituitary) dis- co-existent pernicious anaemia, or normocytic). Standard treatment is with levo-thyroxine (L-T4), s disease developing/relapsing in the post-partum typically beginning with a dose of 50mcg/day. Myxoedema coma: treatment includes ventilatory tures and the pituitary gland sits within a bony seat, and circulatory support, correction of hypothermia the sella turcica (Fig. The optic chiasm lies just and hypoglycaemia, glucocorticoid replacement above the pituitary fossa, and on either side are the until normal adrenal reserve is demonstrated, treat- cavernous sinuses (venous lakes) through which the ment of precipitating event and thyroid hormone intracavernous carotid artery passes. The third, replacement (L-T4 or L-T3 dose and regimen fourth, upper division of the fth and sixth cranial should be decided in conjunction with an nerves lie within the lateral and inferior aspects of the endocrinologist). Thyroiditis Thesphenoidsinus,whichisbelowthepituitaryfossa, Acute thyroiditis is the route through which the pituitary gland is ap- proached during transsphenoidal surgery (Fig. Although relatively uncommon, acute thyroiditis Thehypothalamusandpituitaryworkinconcertto may follow an upper respiratory tract or other regulate a number of different endocrine systems infection. Hypothalamic releasing fac- swellingand tenderness of theglandand sometimes tors (e. Occasionally prednisolone 30mg/day is necessary, the inhibitory hormones somatostatin and dopamine but this can usually be tailed off rapidly. The term hypopituitarism denotes an insufciency of Knowledge of the anatomy and physiology of the one or more of the anterior or posterior pituitary hypothalamus and pituitary helps to understand the hormones. With pituitary tumours, the usual se- different presentations of patients with sellar and quence in which pituitary hormone function is lost parasellar lesions. In contrast, vasopressin and oxytocin are transported along axonal projections fromthehypothalamustotheposteriorpituitaryandstoredinvesiclespriortorelease. Negativefeedbackatthelevel of the pituitary and hypothalamus is mediated via hormones secreted by target organs (shown in italics). In the majority of cases patients present with features of one or more of hormone Destruction/compression of the normal pituitary tis- hypersecretion, hormonehyposecretion or local mass sue or reduction in the blood supply (including effects, as outlined above. Aside from a small number of genetic cases, the factors underlying pitutary adenoma for- Prolactinomas are the most commonly encountered mation remain poorly understood. Clinical presentation Hyperprolactinaemia per se is associated with This is variable and depends on not only the aetiology reduced libido in both sexes and galactorrhoea in but also the extent of endocrine dysfunction and the females. In contrast, lesions Posterior pituitary dysfunction, and in particular originating in the suprasellar region (e. Third, fourth and sixth cranial lowing pituitary surgery (when it is often transient), nerve palsies are relatively rare even with lateral but can also be seen with inltrative disorders (e.
The most pro- try generic 0.18 mg levonorgestrel amex birth control 5 hours late, are ideally placed to motivate sedentary depressed indi- nounced psychological mechanisms are increased feelings of viduals to become active and to stimulate physical activity as mastery or self-efficacy levonorgestrel 0.18 mg free shipping birth control pills 4 times a year, distraction purchase levonorgestrel 0.18 mg visa birth control for women in the 1920s, a reduction in negative health promotion strategy levonorgestrel 0.18mg with visa birth control junel fe. There is growing evidence that exercise has a bene- health effective levonorgestrel 0.18 mg birth control for women gyn, and psychosomatic complaints. Posi- patients motivation and to optimize effects of exercise ther- tive effects of regular aerobic and resistance training on cog- apy following recommendations for physical therapists are nition have been observed in studies among subjects with helpful [44-45]. The positive effects on cognition occur generally and even more so for those Anticipate the barriers for participation by an acquain- processes requiring greater executive control (i. For mild to moderate de- pression the effect of exercise may be comparable to antide- Avoid between-patient comparisons. Therefore, the effectiveness of exercise inter-  American Psychiatric Association: diagnostic and statistical manual ventions for depression also needs to be evaluated in terms of mental disorders. Depression and coronary heart disease: association Psychiatrists, general practitioners and physical therapists and implications for treatment. Cleve Clin J Med 2008; 75 (Suppl) are increasingly confronted with patients with depression. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. The epidemiology, pathophysiology, and management of psychosocial dation for health-related physical fitness. Due to the benefits risk factors in cardiac practice: the emerging field of behavioural of physical activity on depression and its co-morbid physical cardiology. Physical therapists, with a specialised education in psychia- Exercise and Depression The Open Complementary Medicine Journal, 2009, Volume 1 83  Zoeller R. Prospective study of physical activity and de- depression, and risk of cardiovascular mortality. The effect of exercise on clinical depression pression as a risk factor for the onset of type 2 diabetes mellitus. Peripheral insulin-like growth factor-I produces antide-  Ilias I, Alesci S, Gold P, Chrousos G. Depression and osteoporosis pressant-like behaviour and contributes to the effect of exercise. Role of physical activity in the prevention of osteopo-  Dishman R, Berthoud H, Booth F, et al. Aerobic exercise effects on cognitive and ity guidelines advisory committee report 2008. Physical inactivity: the biggest public health problem of adults: is there a role for resistance training programmes? Association between physical activity and mental key roles of growth factor cascades and inflammation. Physical durance exercise improves executive functions in depressed pa- activity and depression: evidence from the Alamada County study. Physical activity and personal changes in physical self-concept, global self-esteem, depression characteristics associated with depression and suicide in American and anxiety following two different psychomotor therapy programs college men. Received: March 17, 2009 Revised: May 20, 2009 Accepted: June 03, 2009 Knapen et al. Many patients suffering from depression commit suicide never having had access to psychiatric care or proper treatment. Therefore, the role of the primary care physician, not only that of the psychiatrist, is critical in preventing such patients from committing suicide.
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