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Radiation causes a type of cell trauma that is cumulative in Atrophy can occur in the cells of any organ and may be classified effect order 250 mcg seroflo amex. When X rays are administered for therapeutic purposes as disuse atrophy buy seroflo 250mcg with mastercard, disease atrophy purchase seroflo 250mcg with visa, or aging (senile) atrophy cheap 250 mcg seroflo visa. Immature or mi- involves the change of highly specialized cells into more general- totically active cells are highly sensitive 250mcg seroflo sale, whereas cells that are ized buy discount seroflo 250mcg, protective cells. For example, excessive exposure to inhaled no longer growing, such as neurons and muscle cells, are not as smoke causes the specialized ciliated columnar epithelial cells vulnerable to radiation injury. Viruses usually invade and destroy cells as they reproduce them- selves. Bacteria, on the other hand, do not usually invade cells Trauma to Cells but will frequently poison cells with their toxic metabolic wastes. As adaptable as cells are to environmental changes, they are sub- ject to damage from aging and disease. If a trauma causes exten- Medical Genetics sive cellular death, the condition may become life threatening. Medical genetics is a branch of medicine concerned with dis- A person dies when a vital organ can no longer perform its meta- eases that have a genetic origin. Genetic diseases are a diverse group of disorders, including mal- formed blood cells (sickle-cell anemia), defective blood clotting (hemophilia), and mental retardation (Down syndrome). Cytology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 3 Cytology 73 cells are called mutations (myoo-ta′shunz). Mutations either occur naturally or are environmentally induced through chemi- cals or radiation. About 12% of all congenital malformations are caused by muta- tions and probably come about through an interaction of genetic and environmental factors. Many of these problems can be pre- Normal cells dicted by knowing the genetic pedigree of prospective parents (with hairlike cilia) and prevented through genetic counseling. Teratology (ter-a˘- tol′o˘-je) is the science concerned with developmental defects and the diagnosis, treatment, and prevention of malformations. Genetic problems are occasionally caused by having too few or too many chromosomes. The absence of an entire chro- mosome is termed monosomy (mon′o-som″me). People with Turner’s syndrome have only one X chromosome and have a better chance of survival than those who are missing one of the other chromosomes. Tri- Cancer cells somy (tri′ so-me), a genetic condition in which an extra chromo- some is present, occurs more frequently than monosomy. In an attempt to better understand medical genetics, the Human Genome Project was launched by Congress in 1988 with the ambitious goal of completely mapping the human genome. Scientists are currently on the verge of determining the exact se- quences of bases with which the 3 billion base pairs are arranged to form the 50,000 to 100,000 genes in the haploid human genome of a sperm cell or ovum. The various types of cancers are classified on the basis of the Cancer tissue in which they develop. Lymphoma, for example, is a cancer of lymphoid tissue; osteogenic cancer is a type of bone cancer; Cancer refers to a complex group of diseases characterized by un- myeloma is cancer of the bone marrow; and sarcoma is a general controlled cell replication. The rapid proliferation of cells results term for any cancer arising from cells of connective tissue. How- frequently called tumors, are classified as benign or malignant ever, initiating factors, or carcinogens (kar-sin′o˘-jenz), such as based on their cytological and histological features. Benign neo- viruses, chemicals, or irradiation, may provoke cancer to de- plasms usually grow slowly and are confined to a particular area.

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Radiology 213:583-588 Am J Roentgenol 176:97-104 Zanetti M cheap 250 mcg seroflo amex, Metzdorf A purchase seroflo 250mcg with mastercard, Kundert HP discount seroflo 250mcg mastercard, Zollinger H purchase seroflo 250 mcg with mastercard, Vienne P cheap 250 mcg seroflo with visa, Seifert Theodorou DJ discount 250mcg seroflo with visa, Theodorou SJ, Kakitsubata Y, Lektrakul N, Gold B, Hodler J (2003) Achilles tendons: clinical relevance of neo- GE, Roger B, Resnick D (2000) Plantar fasciitis and fascial vascularization diagnosed with power Doppler US. Radiology rupture: MR imaging findings in 26 patients supplemented 227:556-560 with anatomic data in cadavers. Validation Zeiss J, Fenton P, Ebraheim N, Coombs RJ (1991) Magnetic reso- Studies] Radiographics. Theodorou DJ, Theodorou SJ, Farooki S, Kakitsubata Y, Resnick D Clin Orthop 264-266 (2001) Disorders of the plantar aponeurosis: a spectrum of MR Zeiss J, Fenton P, Ebraheim N, Coombs RJ (1991) Magnetic reso- imaging findings. Am J Roentgenol 176(1):97-104 nance imaging for ineffectual tarsal tunnel surgical treatment. Theumann NH, Pfirrmann CW, Mohana Borges AV, Trudell DJ, Clin Orthop Rel Res (264):264-266 Resnick D (2002) Metatarsophalangeal joint of the great toe: Zeiss J, Fenton P, Ebraheim N, Coombs RJ (1990) Normal mag- normal MR, MR arthrographic, and MR bursographic findings netic resonance anatomy of the tarsal tunnel. J Comput Assist Tomogr 26(5):829-838 10(4):214-218 Umans HR, Elsinger E (2001) The plantar plate of the lesser Zeiss J, Ebraheim N, Rusin J (1990) Magnetic resonance imaging metatarsophalangeal joints: potential for injury and role of MR in the diagnosis of tarsal tunnel syndrome. MRI Clin North Am 9(3):659-669 Imag 14(2):123-126 IDKD 2005 Magnetic Resonance Imaging of Muscle M. Boutin2 1 UCSD Medical Center, San Diego, CA, USA 2 Med-Tel International, Davis, CA, USA Learning Objectives fat. Normal skeletal muscle shows a “striated” and “feathery” appearance, produced by high-signal-inten- At the end of this article, readers should: sity fat interlaced within and between the major mus- • Be able to Identify the normal imaging features of cle bundles. Normal muscle has low signal intensity on skeletal muscle on magnetic resonance (MR) imaging. Accessory muscles are congenital abnormalities in which an anomalous muscle is present. The accessory muscle may be asymptomatic, or it may present as a pal- Normal Muscle pable mass or may affect adjacent structures, particularly The MR appearance of normal skeletal muscle is the if there is nerve compression. The best-known accessory result of an organized admixture of muscle fibers and muscle is the accessory soleus, seen in the pre-Achilles a b Fig. A coronal T1- weighted (a) and T2- weighted fat-suppress- ed (b) image of the right hip demonstrates the appearance of nor- mal muscle. The signal of normal muscle decreases on the T2-weighted image Magnetic Resonance Imaging of Muscle 49 ty infiltration. MR signal alterations are usually seen This middle-aged man pal- pated a mass above his ankle. In A sagittal T1-weighted mag- subacute denervation, the denervated muscle have high netic resonance (MR) image signal intensity on T2-weighted and inversion recovery of the ankle shows an anom- sequences. Typically, the size of the muscle remains nor- alous low-lying soleus mus- mal or is slightly diminished due to concomitant atrophy cle anterior to the Achilles tendon and filling the pre- (Fig. In chronic denervation, the muscle edema re- Achilles fat pad solves, and the involved muscles undergo volume loss fat pad (Fig. Other common accessory muscles include the peroneus quartus muscle, behind the fibula, the accessory abductor digiti minimi, in the wrist, and the anomalous lumbrical muscle, seen in carpal tunnel. Congenital Muscular Disorders There are numerous forms of muscular dystrophy, with Duchenne and Becker muscular dystrophy being the most common. These typically present with progressive proximal muscle weakness in childhood or adoles- cence. The congenital myopathies all involve multiple muscle groups, typically in a symmetrical fashion. In the acute phase of muscle damage, symmetrical mild hyperintensity of the muscles can be seen (Fig. An axial fat-suppressed pro- ton-density (PD)-weighted image of the proximal calf shows a gan- sues remain normal. More advanced disease typically glion adjacent to the proximal tibiofibular joint. Due to compres- shows pseudohypertrophy of lower extremity muscles, sion on the peroneal nerve, denervation changes are apparent in the particularly the calf musculature, due to excessive fat- tibialis anterior muscle Fig. An axial STIR MR image of the thighs shows symmetrical hyperintensity of the quadriceps muscles 50 M.

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In these cases generic seroflo 250 mcg with amex, treatment require regular transfusions to survive involves fluid replacement to decrease the (Olivieri seroflo 250 mcg low price, 1999) quality seroflo 250mcg. In addition to transfusion therapy cheap seroflo 250 mcg free shipping, iron Agranulocytosis is the marked reduc- chelation therapy is often necessary to tion in the level of a specific type of leuko- prevent iron overload (Rodgers seroflo 250mcg sale, 2000) purchase 250mcg seroflo otc, cyte. This reduction in leukocytes is called and in some instances bone marrow leukopenia. A common cause of agranu- transplantation may be indicated locytosis is toxic reaction to certain medica- (Giardini, 1997). Because the platelet may also result from exposure to certain count is normal in hemophilia, bleeding chemicals or to ionizing radiation. However, the deficien- in fighting infection, a reduction in the cy in clotting factors does pose the dan- number of these cells increases individu- ger of bleeding into the internal organs, als’ susceptibility to infection. Treatment is directed toward ease, but they can inherit the trait and pass removing the toxic agent responsible and it to their sons. None of the sons of a man with hemophilia will have hemophil- Purpura is a condition characterized by ia; however, all of his daughters will be hemorrhage of small blood vessels into carriers. Small amounts of blood leak into There are several different types of various tissues of the body. It can be hemophilia, which are differentiated by caused by an allergic response or a defi- the specific clotting factor that is deficient. In this type of hemophilia, a protein in clotting Leukemia Factor VIII is deficient. The next most com- mon type is hemophilia B, also called The leukemias are caused by the cancer- Christmas disease, in which clotting Factor ous production of lymph cells or white IX is defective. They are discussed in greater philia is von Willebrand’s disease, in which detail in Chapter 16. Hemophilia The severity of hemophilia varies along a continuum from a tendency toward slow, Hemophilia is an inherited, potentially prolonged, persistent bleeding to a ten- disabling condition associated with high dency toward severe hemorrhage, and it financial costs (Beeton, 2002). Several is categorized as mild, moderate, or severe inherited blood disorders make up the depending on the level of clotting factor condition known as hemophilia, a chron- present. Individuals with mild hemophilia ic bleeding disorder in which there is a will probably experience abnormal bleed- deficiency in or absence of one of the clot- ing only after major injuries or minor sur- ting factors (Bolton-Maggs & Pasi, 2003). Individ- Individuals with hemophilia have a bleed- uals with moderate hemophilia may have ing tendency. Although they do not ini- prolonged bleeding after major trauma or tially bleed faster, the normal clotting surgery. Individuals with severe disease may 238 CHAPTER 8 CONDITIONS OF THE BLOOD AND IMMUNE SYSTEM bleed spontaneously and have hemor- episodes when they do occur. Because of the higher concentra- ankles are affected most frequently, al- tions of clotting factors, plasma concen- though elbows may become involved lat- trates are given more frequently than is er. Clotting factors are usually result from damage to the joint structure replaced through intravenous infusion and from atrophy (wasting) of surround- (infusing substance directly into a vein). Bleeding into the muscle, if The amount, type, and duration of the severe, may exert pressure on nerves and infusion depend on the individual’s clot- cause a temporary sensory loss. If the hem- ting deficiency and the size and severity orrhage damages muscle tissue, fibrous tis- of the bleeding problem. Treatment may sue may form, causing varying degrees of be instituted prior to surgery to prevent functional loss. Early treatment of bleeding helps to pre- Treatment for Hemophilia vent complications. Consequently, learn- ing to administer clotting factor concen- Hemophilia is not curable and requires trates at home is beneficial. To do so, how- treatment for bleeding problems through- ever, individuals must be able to calculate out the individual’s life. With proper care the appropriate dose and mix and admin- and treatment, however, individuals with ister the concentrate intravenously. Home hemophilia can manage their chronic dis- therapy is appropriate for mild bleeding ease, and their life expectancy approach- but is not sufficient when major bleeding es normal (Teitel et al.

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