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By M. Kulak. Utah Valley State College. 2018.

Synovial sheath – – third 37 – horizontal section 210 f – of short head of biceps brachii muscle 387 – premolar 37 buy aceon 2mg amex heart attack definition, 50 f – jugular 172 f – of stapedius muscle 126 purchase aceon 8 mg free shipping hypertension blood pressure, 128 – upper 22, 41 f, 44 f, 50 ff – lumbar 332 – of superior oblique muscle 135 f, 140 Trabecula(-ae) – lumbosacral 471 – of supraspinatus muscle 378 – carneae 259 – lymph vessels 17 – of temporalis muscle 60 f, 80, 82 – septomarginal 258 – median section 4, 233 – of tensor veli palatini muscle 126 Trachea 154, 243, 255, 274 ff, 285 – – in neonate 233 – of tibialis anterior muscle 458, 461, 493, 495, Tract(s) 477 – midsagittal section 322, 354 498 f – cerebellorubral 103 – neuro-vascular segments 187 – of tibialis posterior muscle 460 f – iliotibial 448, 452 f, 455, 480, 495 – parasagittal section 325 – of triceps brachii muscle 409 – – surface anatomy 476 f – pulmonary 245, 252 ff, 260 ff, 266, 269, 271 Tenon’s space 132 – olfactory 65 f, 69, 74 f, 98 f, 103, 107, 114 f, – – of fetus 288 Tentorium cerebelli 67, 75, 87 ff, 97, 121 146 – – relation to bronchial tree 275 Testis 3, 218, 330, 336 f, 339, 341, 343, 351, 479 – – lateral root 99 – reference lines 217 – Head’s area 205 – – medial root 99 – regions 217 – longitudinal section 343 – olivocochlear 131 – sagittal section 5 Thalamus 90 f, 99, 103 ff, 107, 113, 116, 120 – optic 66, 71, 107, 137 f – skeleto-motoric segments 187 Thenar muscles 390 f, 395, 423 – pyramidal 109, 116 – skeleton 221 – axial section 431 – – course 111 – subclavian 184, 332 Thigh – – lateral 103 – sympathetic 18, 67, 146, 162, 164 f, 168, 185, – anterior region 478 ff – of Rasmussen 131 266, 279 ff, 327, 333, 334 f, 471 f – arteries 480 f – spiral, foraminous 123 – – cervical part 174 – axial section 496 Tractus solitarius 116 – – Ramus communicans 280 f 530 Index Page numbers in bold indicate main discussions. Trunk – sacral 433 Uvula 62, 86 f, 144, 147, 163, 165 – thyrocervical 162, 168 ff, 177, 271, 396, 404 – tibial 440 f, 458 f – of bladder 338 – vagal 335 – ulnar 374 – of vermis 102 – – anterior 327 Tubules, seminiferous, convoluted 343 – – posterior 327 Tunica Tube – albuginea – auditory 120, 122 ff, 126 f, 143 – – of corpora cavernosa 339 V – – bony part 27 – – of corpus spongiosum 339 – – opening 145, 147 – – of testis 341 Vagina 322 f, 355, 356, 358, 360 – – pharyngeal opening 86, 144, 246 – vaginalis Vallecula of epiglottis 149 – uterine 354 ff, 359 f, 366 f – – parietal layer 341, 343 Valve(s) – – position 323 – – testis 218, 343 – aortic 253, 255 f, 258 f, 261, 284 Tuber – – visceral layer 341, 343 – atrioventricular – calcanei 451 ––left255 f, 258 f – cinereum 99 – – right 255 f, 258 ff, 287 – frontal 35 – bicuspid 255 f, 258 f – parietal 29, 35 U – of heart 255 ff – of vermis 102 – – position 255, 260 Tuber-trochanter line 482 Ulna 7, 10, 368, 374, 376 f, 379 ff, 425 – ileocecal 310 Tubercle – anterior surface 375 – – horizontal section 320 – anterior – axial section 419, 431 – of inferior vena cava 288 – – of atlas 191 – of newborn 9 – mitral 255 f, 258 f – – of transverse process 191 – posterior surface 374 – pulmonary 255 f, 259 f, 271, 286, 325 – articular 21, 27 f, 50, 54 Umbilicus 3, 187, 209 – tricuspid 255 f, 258 ff, 287 – conoid 369 Uncus Vasa recta of renal medulla 329 – corniculate 160 – hippocampi 99 Vein(s) 16, 468 – cuneiform 160 – of parahippocampal gyrus 106 – alveolar – dorsal, of atlas 223 Urachus 289, 339, 354, 361 – – inferior 83 – genial 36, 52 Ureter 3, 210, 296, 300, 326 ff, 330 ff, 336 ff, – anastomotic – greater, of humerus 372 f, 430 359 – – inferior 92 – infraglenoid 370 ff – abdominal part 326 f, 330, 336 – – superior 89 – intercondylar – Head’s area 205 – angular 170 – – lateral, of tibia 440 – pelvic part 330, 336 – arcuate 329, 468 – – medial, of tibia 448 – position 323 – axillary 170, 186, 196, 214, 252, 264, 398, – – posterior, of tibia 440 Urethra 411 – jugular 25, 27, 39 – female 354 f – azygos 244, 246, 276, 279 f, 332 – lesser, of humerus 373, 430 – male 336 ff – basilic 398, 402, 410, 419 – olfactory 99 – membranous part 336 ff, 342, 344 – brachial 398, 415 – pharyngeal 25, 27, 33, 164 – prostatic part 336 ff, 344 f – – surface anatomy 402 – posterior – spongy 337 ff – brachiocephalic 155, 170, 177, 244, 252, 255, – – of atlas 191, 200 Urinary bladder 265, 267, 271, 274, 396, 398 – – of transverse process 191 – base 367 – – of fetus 288 f – pubic 433, 435 – of the female 354 f, 357 ff, 361 – cardiac – of rib 191 f, 197 – of the fetus 289 – – great 258, 262 – supraglenoid 370 f – frontal section 293 – – middle 262 – thyroid – Head’s area 205 – – minimal 262 – – inferior 159 – horizontal section 324 – – small 262, 270 – – superior 159 – of the male 336 ff – cephalic 170 f, 207, 209, 211, 265, 290, 398, Tuberculum sellae 38 – midsagittal section 322 406, 416 Tuberosity – mucous membrane 338 f – – accessory 401 f – calcaneal 443, 450, 457, 463, 491 – position 323 – – on forearm 398, 401 f, 419 – deltoid 373 Urinary organs, position 323 f – – surface anatomy 402 – of distal phalanx 376 f Urinary system 330 f – cerebral 92 – – of great toe 442 Urogenital system – – great 90, 145 – of fifth metatarsal bone 443 – female 354 ff – – inferior 89, 92 – ischial 188, 344, 433, 436 f, 455 f, 472, 482 – male 336 ff – – internal 86 – masseteric 52 Uterus 354 ff, 358, 359 f, 366 f – – middle, superficial 92 – maxillary 39 ff, 46 – position 323 – – superior 89, 92 – radial 374 f, 379 Utricle, prostatic 338 – of Cockett 468 f Index 531 Page numbers in bold indicate main discussions. Lymph vessels – – nerves 214 ff – coronal section 425 – retinal 134 – – posterior 316 ff Vestibular apparatus 122 ff, 129 – – – veins 279 Vestibule – – transverse section 213 – of larynx 149 – – vessels 214 ff – of lesser sac 324 – thoracic 206 ff Z – nasal 53, 144 f – – anterior 187, 206 ff – oral 50, 53, 83, 150 – – – arteries 208 Zona orbicularis 444 f . The color-coded reference guide on the first page will help you find what you need. The aspects of each pathogen are covered systematically, using the following order wherever practicable: & Classification & Pathogenesis and Clinical Picture & Localization & Diagnosis & Morphology and Culturing & Therapy & Developmental Cycle & Epidemiology and Prophylaxis & A summary at the beginning of a chapter or section provides a quick over- view of what the main text covers. Students can use the summaries to obtain a quick recapitulation of the main points. Additional information In-depth expositions and supplementary knowledge are framed in boxes inter- spersed throughout the main body of text. The headings outline the topic covered, enabling the reader to decide whether the specific material is needed at the present time. Emeritus Professor of Medical Microbiology Institute of Medical Microbiology University of Zurich Zurich, Switzerland Kurt A. Emeritus Professor of Virology Institute of Medical Microbiology University of Basle Basle, Switzerland Johannes Eckert, D. Emeritus Professor of Parasitology Institute of Parasitology University of Zurich Zurich, Switzerland Rolf M. Professor Institute of Experimental Immunology Department of Pathology Zurich, Switzerland 177 illustrations 97 tables Thieme Stuttgart Á New York Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license Library of Congress Cataloging-in- Important note: Medicine is an ever-chan- Publication Data ging science undergoing continual develop- Medizinische Mikrobiologie. Nevertheless, this does not involve, imply, 1st German edition 1969 or express any guarantee or responsibilityon 2nd German edition 1971 the part of the publishers in respect to any 3rd German edition 1974 dosage instructions and forms of applica- 4th German edition 1978 tions stated in the book. Every user is re- 5th German edition 1982 quested to examine carefully the manufac- 6th German edition 1986 turers’ leaflets accompanying each drug and 7th German edition 1989 to check, if necessary in consultation with a 8th German edition 1993 physician or specialist, whether the dosage 9th German edition 1998 schedules mentioned therein or the contra- 1st Greek edition 1995 indications stated by the manufacturers dif- fer from the statements made in the present 1st Italian edition 1996 book. Such examination is particularly im- 1st Japanese edition 1980 portant with drugs that are either rarely 1st Spanish edition 1974 used or have been newly released on the 2nd Spanish edition 1982 market. Every dosage schedule or every 1st Turkish edition 2001 form of application used is entirely at the user’s own risk and responsibility. The This book is an authorized and updated authors and publishers request every user translation of the 10th German edition to report to the publishers any discrepancies published and copyrighted 2001 or inaccuracies noticed. Title of the German edition: registered designs referred to in this book Medizinische Mikrobiologie are in fact registered trademarks or proprie- tary names even though specific reference to ª 2005 Georg Thieme Verlag, this fact is not always made in the text. Ru¨digerstraße 14, 70469 Stuttgart, Therefore, the appearance of a name without Germany designation as proprietary is not to be con- http://www. Any use, ex- Cover design: Cyclus, Stuttgart ploitation, or commercialization outside the Typesetting by Mitterweger & Partner narrow limits set by copyright legislation, GmbH, 68723 Plankstadt without the publisher’s consent, is illegal Printed in Germany by Appl, Wemding and liable to prosecution. Usage subject to terms and conditions of license V Preface Medical Microbiology comprises and integrates the fields of immunology, bacteriology, virology, mycology, and parasitology, each of which has seen considerable independent development in the past few decades. The com- mon bond between them is the focus on the causes of infectious diseases and on the reactions of the host to the pathogens. The objective of this textbook of medical microbiology is to instill a broad- based knowledge of the etiologic organisms causing disease and the patho- genetic mechanisms leading to clinically manifest infections into its users. This knowledge is a necessary prerequisite for the diagnosis, therapy, and prevention of infectious diseases. Beyond this academic purpose, its use- fulness extends to all medical professions and most particularly to physicians working in both clinical and private practice settings. This book makes the vast and complex field of medical microbiology more accessible by the use of four-color graphics and numerous illustrations with detailed explanatory legends. Most chapters begin with a concise summary, and in-depth and supplementary knowledge are provided in boxes separating them from the main body of text. This textbook has doubtless benefited from the extensive academic teaching and the profound research experience of its authors, all of whom are recognized authorities in their fields. The authors would like to thank all colleagues whose contributions and advice have been a great help and who were so generous with illustration material.

Named after Aphrodite buy 4mg aceon with mastercard coenzyme q10 high blood pressure medication, the Greek goddess of sexual love and beauty cheap aceon 2 mg visa blood pressure chart meaning, there is a long list of purported aphrodisiacs, including anchovies, oysters, adrenaline, licorice, chocolate, and Spanish fly. According to the Food and Drug Administration, the re- puted sexual effects of aphrodisiacs are based in folklore, not fact. In 1989, the agency declared that there is no scientific proof that any over-the-counter aphrodisiacs work to treat sexual dysfunction. Lifestyle Suggestions • Exercise: Aerobic activities such as walking and cycling can reduce stress, improve mood, increase energy, and improve circulation (improved blood supply to the pelvic area may help to improve sexual sensation and satisfaction). Aromatherapy oils known to inspire romance include rose, clary sage, sandalwood, and jasmine. Top Recommended Supplements Arginine: An amino acid that is involved in many body processes including hormone secre- tion and the production of nitrous oxide (substance that relaxes blood vessels). Several studies have found it helpful for improving sexual desire and function in both men and women. It is often combined with other products such as yohimbe, ginkgo biloba and dami- ana. Muira puama: Also known as potency wood, clinical studies have found it beneficial for enhancing libido and other aspects of sexual function in both men and women. Researchers at the Institute of Sexology in Paris studied the effects of a product con- taining muira puama and ginkgo biloba in 202 women with low sex drive. Various aspects of their sex life were rated before and after one month of treatment. Significant improvements occurred in the frequency of sexual desires, sexual intercourse, sexual fantasies, satisfaction with sex life, intensity of sexual desires, excitement of fantasies, ability to reach orgasm, and intensity of orgasm. Reported compliance and tolerability were good (Advances in Therapy, 2000: 17(5): 255–262). One double-blind, placebo-controlled study looked at the effects of a combination therapy of arginine, ginseng, ginkgo, damiana, multivitamins, and minerals (ArginMax) in 77 women with poor sexual function. Improvements were seen in libido, orgasm, vaginal lubrication, and clitoral sensation (Journal of Sex and Marital Therapy, 2001: 27; 541–549). Another double-blind placebo-controlled study using the same product formulation was conducted in 108 women with low sexual desire. After four weeks, both pre- and post-menopausal women who took the ArginMax noted a significant improvement in sexual desire. Supplements for erectile dysfunction are listed under that condition in this book. Supplements of arginine, ginkgo biloba and muira puama may help improve several aspects of sexual interest and function. It most commonly affects your skin, joints, kidneys, blood cells, heart, and lungs. The un- L derlying cause of lupus is not known, but researchers believe that it results from a combination of factors, including genetics, environment (sunlight), and hormones. The word “lupus” comes from the Latin word for “wolf” because doctors once thought the classic lupus rash resembled a wolf’s face. It appears across the cheeks and bridge of the nose and is actually more of a butterfly-shaped rash. Drug-induced lupus: Results from the long-term use of certain prescription drugs, such as the antipsychotic chlorpromazine, high blood pressure medications (hydralazine), the tuberculosis drug isoniazid, and the heart medication procainamide. Symptoms (joint pain, swelling, fever, and fatigue) usually disappear after the drug is stopped. This form causes inflammation and pain throughout the body, affecting the joints, muscles, and skin. In recent decades, early diagnosis and treatment have greatly improved the life expectancy and quality of life for those with lupus. Proper medical care and lifestyle strategies can help to manage the symptoms and put the disease into remission.

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Wood (1998) provides an extensive literature review on dilemmas of endotracheal suction buy 2mg aceon amex hypertension kidney failure. Reviewing literature for developing departmental guidelines aceon 4 mg with amex blood pressure chart software, McKelvie (1998) gives a reliable overview. Identify those effects that you have observed in your own clinical practice and those from the literature. Lighter sedation ■ enables patients to remain semiconscious, thus reducing psychoses while promoting autonomy ■ reduces hypotensive and cardioinhibitory effects caused by most sedatives Light sedation is a narrow margin between over- and under-sedation. The focus is therefore a nursing one rather than pharmacological, although some widely used sedatives are described. Neuromuscular blockade, once a common adjunct of sedation therapy, is also mentioned. Shelly (1998) stresses that comfort (in its widest sense) can be achieved through sedation. Sedation is now usually only necessary for ventilation if patients have: ■ tachypnoea, which will cause exhaustion ■ discomfort from artificial ventilation (usually from oral endotracheal tubes; also for brief procedures such as cardioversion and bronchoscopy). There are some specific pathologies, such as intracranial hypertension, where sedation is therapeutic. Some authors suggest that potential line displacement justifies sedation (Shelly 1994). Amnesia prevents recall of often horrific procedures, but inability to recall experiences, however horrific, may cause greater psychological trauma (Perrins et al. Prolonged benzodiazepine use causes receptor growth and down-regulation (tolerance), necessitating higher doses (Eddleston et al. Endorphins (endogenous opiates) contribute to sedative effects of critical illness. Midazolam is largely hepatically metabolised and renally excreted, so failure of these organs may cause accumulation of active metabolites (especially with older people, who usually have reduced renal clearance); causing unpredictable increases in half-life with critical illness (Bion & Oh 1997). Being relatively cheap, midazolam is still used by many units for prolonged sedation. Flumazenil’s effect is far shorter than benzodiazepines (half-life under one hour (Armstrong et al. Opiates Most opiates have sedative effects; as analgesia is usually necessary, this ‘side effect’ can be beneficial, provided it is remembered when assessing sedation. Opiates may become Sedation 51 the most important part of sedative regimes (Bion & Oh 1997). Morphine remains one of the most powerful opiates, but newer drugs, such as fentanyl, achieve rapid sedation with strong respiratory depression (which facilitates ventilation). Propofol Propofol’s lipid emulsion facilitates transfer across the blood-brain barrier, achieving rapid sedation. Inactivity of metabolites (Sherry 1997) and rapid redistribution into fatty tissue (Eddleston et al. Widely used for short- term sedation, Propofol is relatively expensive and so some units restrict use to circumstances where sedation is planned to last less than one day. Propofol depresses cerebral metabolism, thus reducing both cerebral oxygen consumption and intracranial pressure (Viney 1996). A number of disadvantages have been reported with propofol: ■ bradycardia from resetting of carotid receptors (Sherry 1997) ■ hypotension from resetting of baroreceptors, sympathetic inhibition and increased venous capacitance (Robinson et al. Use of any drug or equipment beyond a manufacturer’s licence places the onus of legal liability on the users (see Chapter 45). Since propofol does not have any analgesic effect, concurrent analgesia should be given. Intensive care nursing 52 Bolus sedation The introduction of shorter-acting sedatives together with the improvement of infusion pump technology has largely replaced the use of bolus sedation with continuous infusions. Like analgesia, bolus sedation can cause fluctuations between under- and over- sedation (Shelly 1998). Where sedative effects are prolonged, constant infusion can result in over-sedation (Shelly 1998).

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They suggested that: s a health behaviour was a behaviour aimed to prevent disease (e buy aceon 2 mg with mastercard blood pressure monitor watch. Health behaviours were further defined by Matarazzo (1984) in terms of either: s health impairing habits discount 8 mg aceon overnight delivery hypertension risks, which he called ‘behavioural pathogens’ (e. In short, Matarazzo distinguished between those behaviours that have a negative effect (the behavioural pathogens, such as smoking, eating foods high in fat, drinking large amounts of alcohol) and those behaviours that may have a positive effect (the behavioural immunogens, such as tooth brushing, wearing seat belts, seeking health information, having regular check-ups, sleeping an adequate number of hours per night). Generally health behaviours are regarded as behaviours that are related to the health status of the individual. Over the past century health behaviours have played an increasingly important role in health and illness. McKeown’s thesis The decline of infectious diseases In his book The Role of Medicine, Thomas McKeown (1979) examined the impact of medicine on health since the seventeenth century. In particular, he evaluated the widely held assumptions about medicine’s achievements and the role of medicine in reducing the prevalence and incidence of infectious illnesses, such as tuberculosis, pneumonia, measles, influenza, diphtheria, smallpox and whooping cough. He showed, however, that the reduction in such illnesses was already underway before the development of the relevant medical interventions. McKeown therefore claimed that the decline in infectious diseases seen throughout the past three centuries is best understood not in terms of medical intervention, but in terms of social and environmental factors. He argued that: The influences which led to [the] predominance [of infectious diseases] from the time of the first agricultural revolution 10,000 years ago were insufficient food, environmental hazards and excessive numbers and the measures which led to their decline from the time of the modern Agricultural and Industrial revolutions were predictably improved nutrition, better hygiene and contraception. To support this thesis, McKeown examined the main causes of death in affluent societies and observed that most dominant illnesses, such as lung cancer, coronary heart disease, cirrhosis of the liver, are caused by behaviours. Behaviour and mortality It has been suggested that 50 per cent of mortality from the ten leading causes of death is due to behaviour. For example, Doll and Peto (1981) reported estimates of the role of different factors as causes for all cancer deaths. They estimated that tobacco consumption accounts for 30 per cent of all cancer deaths, alcohol – 3 per cent, diet – 35 per cent, and reproductive and sexual behaviour – 7 per cent. Accordingly, approximately 75 per cent of all deaths due to cancer are related to behaviour. It has been calculated that 90 per cent of all lung cancer mortality is attributable to cigarette smoking, which is also linked to other ill- nesses such as cancers of the bladder, pancreas, mouth, larynx and oesophagus and coronary heart disease. The impact of smoking on mortality was shown by McKeown when he examined changes in life expectancies in males from 1838 to 1970. The relationship between mortality and behaviour is also illustrated by bowel cancer, which accounts for 11 per cent of all cancer deaths in men and 14 per cent in women. Research suggests that bowel cancer is linked to behaviours such as a diet high in total fat, high in meat and low in fibre. However, in Georgia, among the Abkhazians, 400 out of every 100,000 live to be over 100, and the oldest recorded Abkhazian is 170 (although this is obviously problematic in terms of the validity of any written records in the early 1800s). Weg (1983) examined the longevity of the Abkhazians and suggested that their longevity relative to that in other countries was due to a combination of biological, lifestyle and social factors including: s genetics; s maintaining vigorous work roles and habits; s a diet low in saturated fat and meat and high in fruit and vegetables; s no alcohol or nicotine; s high levels of social support; s low reported stress levels. Analysis of this group of people suggests that health behaviours may be related to longevity and are therefore worthy of study. However, such cross-sectional studies are problematic to interpret, particularly in terms of the direction of causality: Does the lifestyle of the Abkhazians cause their longevity or is it a product of it? Longevity: The work of Belloc and Breslow Belloc and Breslow (1972), Belloc (1973) and Breslow and Enstrom (1980) examined the relationship between mortality rates and behaviour among 7000 people. They concluded from this correlational analysis that seven behaviours were related to health status. These behaviours were: 1 sleeping 7–8 hours a day; 2 having breakfast every day; 3 not smoking; 4 rarely eating between meals; 5 being near or at prescribed weight; 6 having moderate or no use of alcohol; 7 taking regular exercise. The sample was followed up over five-and-a-half and ten years in a prospective study and the authors reported that these seven behaviours were related to mortality. In addition, they suggested for people aged over 75 who carried out all of these health behaviours, health was comparable to those aged 35–44 who followed less than three. Health behaviours seem to be important in predicting mortality and the longevity of individuals.

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