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These are the transverse cervical and the Trapezius muscle Brachial plexus Suprascapular arery External jugular Anterior scalene muscle 3rd part of subclavian artery 1026 Fig buy 20mg cialis jelly otc erectile dysfunction after vasectomy. They are both branches the base of the posterior triangle buy cialis jelly without a prescription impotence 40 years, the external jugular discount cialis jelly american express herbal erectile dysfunction pills uk, and buy zithromax australia, of the thyrocervical trunk purchase fluticasone overnight delivery, which arises from the frst part possibly buy provera canada, the suprascapular and transverse cervical veins of the subclavian artery. It ends by joining with the internal Afer branching from the thyrocervical trunk, the jugular vein to form the brachiocephalic vein near the ster­ transverse cervical artery passes laterally and slightly noclavicular joint. In the posterior triangle it is anterior to, posteriorly across the base of the posterior triangle anterior and slightly lower than, the subclavian artery and passes to the anterior scalene muscle and the brachial plexus. Reaching the deep surface of the trapezius muscle, it Transverse cervical and suprascapular veins travel with divides into superfcial and deep branches: each of the similarly named arteries. These veins become tributaries to either the external jugular vein or the initial • The superfcial branch continues on the deep surface part of the subclavian vein. Passing either deep to or Veins through and innervating the sternocleidomastoid muscle, Veins accompany all the arteries described previously. As it crosses triangle, still in an obliquely downward direction, within Lesser occipital nerve Great auricular nerve Supraclavicular nerves 1027 Fig. Head and Neck the investing layer of cervical fascia as this fascia crosses Muscular branches between the sternocleidomastoid and trapezius muscles. A major branch is the of the trapezius muscle, it continues on the deep surface of phrenic nerve, which supplies the diaphragm with both the trapezius and innervates it. It arises from the accessory nerve as it crosses the posterior triangle the anterior rami of cervical nerves C3 to C5. The cervical plexus also contributes to the formation of the superior and inferior roots of the ansa cervicalis The cutaneous branches are visible in the posterior tri­ (Fig. This loop of nerves receives contributions angle emerging from beneath the posterior border of the from the anterior rami of the cervical nerves C1 to C3 and sternocleidomastoid muscle (Fig. Lesser occipital nerve Superior root of ansa cericalis Transverse cervical nerve nerve Inferior root of ansa cervicalis Fig. As the roots emerge from between the posterior border of the sternocleidomastoid muscle these muscles, they form the next component of the bra­ (Figs. The trunks cross the base of the posterior triangle • The great auricular nerve consists of branches from (see Fig. Several branches of the brachial plexus cervical nerves C2 and C3, emerges from the posterior may be visible in the posterior triangle (see Fig. These include the: across the muscle to the base of the ear, supplying the skin of the parotid region, the ear, and the mastoid area. The right subclavian artery begins posterior to the It contains structures passing between the neck, sternoclavicular joint as one of two terminal branches thorax, and upper limb. Thisconsists of an upward projection of the pleural cavity in the root of the neck and posterior to the anterior cavity, on both sides, and includes the cervical part of the scalene muscle. Continuing laterally across rib I, it becomes parietal pleura (cupula), and the apical part of the superior the axillary artery as it crosses its lateral border.

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Diseases

  • Hypokalemic alkalosis with hypercalcinuria
  • Idiopathic edema
  • Deal Barratt Dillon syndrome
  • Craniometaphyseal dysplasia recessive type
  • Lymphoma, gastric non Hodgkins type
  • Glutaricaciduria I
  • LyP (lymphomatoid papulosis)
  • Herpes virus antenatal infection
  • Pulmonary valves agenesis

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Semimembranosus muscle Biceps femoris muscle Posterior cutaneous (short head) nerve of thigh Femoral vein Adductor hiatus Popliteal Tibial nerve fossa Popliteal vein Plantaris Popliteal artery Common fibular nerve Popliteus muscle Small saphenous vein Posterior cutaneous Small saphenousvein nerve of thigh A B c 616 Fig buy cialis jelly paypal do erectile dysfunction pumps work. Regional anatomy • Thigh • The margins of the smaller lower part of the space are begins as the femoral artery passes posteriorly through the formed medially by the medial head of the gastrocne­ adductor hiatus in the adductor magnus muscle cheap 20mg cialis jelly otc erectile dysfunction shake cure. It descends obliquely through the fossa knee joint and adjacent surfaces of the femur and tibia cheap 20mg cialis jelly free shipping erectile dysfunction pills herbal, with the tibial nerve and enters the posterior compart­ and purchase cheap top avana line, more inferiorly discount silvitra 120mg free shipping, by the popliteus muscle levitra super active 40 mg on-line. The popliteal artery is the deepest of the neurovascular structures in the popliteal fossa and is therefore difcult to palpate; however, a pulse can usually be detected by deep Contents palpation near the midline. The major contents of the popliteal fossa are the popliteal In the popliteal fossa, the popliteal artery gives rise to artery, the popliteal vein, and the tibial and common fbular branches, which supply adjacent muscles, and to a series nerves (Fig. Tibial and common fbular nerves The popliteal vein is superfcial to and travels with the The tibial and common fbular nerves originate proximal popliteal artery. It exits the popliteal fossa superiorly to to the popliteal fossa as the two major branches of the become the femoral vein by passing through the adductor sciatic nerve. The most important structure • The tibial nerve descends vertically through the popli­ in the superfcial fascia is the small saphenous vein. This teal fossa and exits deep to the margin of the plantaris vessel ascends vertically in the superfcial fascia on the muscle to enter the posterior compartment of the leg. It ascends to the back of the knee where femoris tendon over the lower lateral margin of the pop­ it penetrates deep fascia, which forms the roof of the pop­ liteal fossa, and continues to the lateral side of the leg liteal fossa, and joins with the popliteal vein. The leg is that part of the lowerlimbbetween the knee joint The tibia is the weight-bearing bone of the leg and is and ankle joint (Fig. Above, it takes part in the formation of the knee joint and below it forms the • Proximally, most major structures pass between the medial malleolus and most of the bony surface for articula­ thigh and leg through or in relation to the popliteal fossa tion of the leg with the foot at the ankle joint. The leg is divided into anterior (extensor), posterior • Distally, structures pass between the leg and foot mainly (flexor), and lateral (fbular) compartments by: through the tarsal tunnel on the posteromedial side of the ankle, the exceptions being the anterior tibial artery • an interosseous membrane, which links adjacent and the ends of the deep and superfcial fbular nerves, borders of the tibia and fbula along most of their length; which enter the foot anterior to the ankle. It articulates superiorly with the inferior aspect of the lateral condyle of the proximal tibia, Muscles inthe anterior compartment ofthe leg dorsiflex but does not take part in formation of the knee joint. Muscles in distal end of the fbula is frmly anchored to the tibia by a the posterior compartment plantarflex the ankle, flex the toes, and invert the foot. Bones Interosseous membrane Shaft and distal end of tibia posterior Theshaf of the tibia is triangular in cross section and has intermuscular anterior, interosseous, and medial borders and medial, septa lateral, and posterior surfaces (Fig. In addition, a vertical line descends down the upper of leg part of the posterior surface from the midpoint of the soleal line. The distal end of the tibia is shaped like a rectangular box with a bony protuberance on the medial side (the Fig. The interosseous border of the fbula riorly and medially onto the posterior surface of the medial faces and is attached to the interosseous border of the tibia malleolus. Shaft and distal end of fbula The posterior surface is marked by a vertical crest The fbula is not involved in weight-bearing. The fbular (medial crest), which divides the posterior surface into shaft is therefore much narrower than the shaft of the two parts each attached to a different deep flexor muscle.

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Diseases

  • Paraphilia
  • Gangliosidosis (Type2)(GM2)
  • Charcot Marie Tooth disease, intermediate form
  • Eisenmenger syndrome
  • Leigh syndrome, French Canadian type
  • Neonatal hemochromatosis
  • Willems De vries syndrome
  • Roy Maroteaux Kremp syndrome

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The new semisynthetic or wholly drugs is hindered by the common evolutionary legacy synthetic drugs had improved pharmacokinetic prop- humans share with all living organisms; success requires erties buy cialis jelly with mastercard erectile dysfunction 40 year old man, greater stability order cialis jelly mastercard erectile dysfunction remedies natural, and extended spectrums of exploitation of metabolic or structural differences be- action order cialis jelly once a day impotence treatment devices. The emergence of microbial antibiotic drug resist- The more closely related the undesirable cells are to ance was speeded by the indiscriminate use of antibi- normal human cells purchase cheap sildalis, the more difficult the task of find- otics in humans and livestock order 100 mg kamagra chewable fast delivery. For example buy red viagra paypal, it is easier to cure concentrations of antibiotic in meat or milk may have malaria than cancer. Since viruses commandeer human provided a path whereby human pathogens could cells to provide the necessary structural and metabolic eventually evolve high-level antibiotic drug resistance. Inappropriate use of antibiotics is very common, Humans were not the first to exploit the selective and it accelerates the development of resistance in toxicity of chemicals. The concentration of the drug In the laboratory the strain of pathogen, the number of in a patient’s body as a function of time is determined infecting organisms, the culture medium, the antibiotic by the dose administered and the drug’s pharmacoki- concentration, and the duration of antibiotic exposure netics in that patient. Aluminum, calcium, man disease is complex, as it depends on a complex and magnesium ions in antacids or dairy products form patient–drug–pathogen interaction. This interaction has insoluble chelates with all tetracyclines and inhibit their six components: absorption. Food inhibits tetracycline absorption but • Pharmacokinetics: What the patient does to the enhances doxycycline absorption; food delays but does drug. For example, a patient with renal failure not diminish metronidazole absorption; fatty food en- will have diminished renal clearance of gen- hances griseofulvin absorption. The chemical structure of a drug determines which • Pharmacodynamics: What the drug does to the enzymes metabolize it; a drug that fails to cross the cell patient. For example, erythromycin stimulates membrane because of its polarity or size will be unme- gut motilin receptors and may induce nausea. Systemic use of drugs • Immunity: What the patient does to the that are poorly absorbed or are destroyed by the gas- pathogen. Of course, if the goal is to attack pathogens in disease in spite of receiving a course of postex- the gastrointestinal tract, then poor gastrointestinal ab- posure prophylactic antituberculosis chemo- sorption may be an advantage. For cludes both nonspecific complement-mediated example, imipenem is hydrolyzed by renal dipeptidase opsonization and specific antibody- and cell- to a metabolite that is inactive against bacteria but is mediated immunity. The intrahepatocellular concentration of chloroquine is • Resistance: What the pathogen does to the drug. For example, some strains of Pseudomonas Macrolides and fluoroquinolones are also selectively aeruginosa produce a plasmid-mediated adeny- partitioned into cells, which accounts in part for their ef- lase that inactivates gentamicin by chemically ficacy against mycoplasma and chlamydia, both intra- altering its structure. For example, acyclovir triphosphate, free level and decreases the compound’s glomerular fil- the phosphorylated derivative of acyclovir, tration. As mentioned earlier, pharmacokinetics is not solely the property of a drug but instead is the consequence of interactions between the drug and the physiology of the Pharmacokinetics patient.