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Special- Inferior lacrimal ized sebaceous glands called tarsal glands are embedded in the punctum tarsal plates along the exposed inner surfaces of the eyelids buy 160mg malegra fxt plus free shipping erectile dysfunction walmart. The Lacrimal caruncle ducts of the tarsal glands open onto the edges of the eyelids order 160 mg malegra fxt plus with amex top rated erectile dysfunction pills, and Lacrimal sac their oily secretions help keep the eyelids from sticking to each Middle concha other. Modified sweat glands called ciliary glands are also lo- cated within the eyelids, along with additional sebaceous glands Nasolacrimal duct at the bases of the hair follicles of the eyelashes. An infection of Inferior meatus these sebaceous glands is referred to as a sty (also spelled stye). It con- sists of stratified squamous epithelium that varies in thickness in Nasal septum different regions. The palpebral conjunctiva is thick and adheres to the tarsal plates of the eyelids. Where the conjunctiva reflects onto the anterior surface of the eyeball, it is known as the bulbar FIGURE 15. This portion is transparent and especially thin through which the lacrimal fluid drains into the nasal cavity. Because the conjunctiva is continu- moistens and cleanses the conjunctiva that lines the interior surface of ous from the eyelids to the anterior surface of the eyeball, a space the eyelids and covers the exposed anterior surface of the eyeball. The conjunctival sac protects the eyeball by preventing In people of Asian descent, a fold of skin of the upper eye- foreign objects from passing beyond the confines of the sac. The lid, called the epicanthic fold, may normally cover part of the me- conjunctiva heals rapidly if scratched. An epicanthic fold may also be present in some infants with Down syndrome. Each eyelid supports a row of eyelashes that protects the eye from airborne particles. The shaft of each eyelash is sur- rounded by a root hair plexus that makes the hair sensitive tarsal: Gk. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 502 Unit 5 Integration and Coordination Trochlea Superior oblique muscle Levator palpebrae superioris muscle (cut) Medial rectus muscle Superior rectus muscle Creek Lateral rectus muscle (cut) Inferior rectus muscle Optic nerve Inferior oblique muscle FIGURE 15. Each extrinsic ocular muscle originates from the gland, which is about the size and shape of an almond, is located bony orbit and inserts by a tendinous attachment to the in the superolateral portion of the orbit. Four recti muscles (singular, loacinar gland that secretes lacrimal fluid through several excre- rectus) maneuver the eyeball in the direction indicated by tory lacrimal ductules into the conjunctival sac of the upper their names (superior, inferior, lateral, and medial), and eyelid. With each blink of the eyelids, lacrimal fluid is spread two oblique muscles (superior and inferior) rotate the eye- over the surface of the eye—much like windshield wipers spread ball on its axis (see also fig. From here, the lacrimal fluid drains through the supe- taching to the eyeball. Lacrimal fluid is a lubricating mucus secretion that con- The motor units of the extrinsic ocular muscles are the tains a bactericidal substance called lysozyme. Normally, about 1 milliliter of serves about 10 muscle fibers, resulting in precise movements. If irritating substances, such as particles of sand or chemicals while relaxing antagonistic muscles. Innervation of the other skeletal the eye by diluting and washing away the irritating substance. Humans are the only animals known to weep in response to emotional stress. While crying, the volume of lacrimal secre- tion is so great that the tears may spill over the edges of the eyelids and the nasal cavity fill with fluid. The crying response is an effective means of communicating one’s emotions and results from stimulation of the lacrimal glands by parasympathetic motor neurons of the fa- cial nerves. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 Chapter 15 Sensory Organs 503 (a) (b) (c) (d) (e) (f) (g) (h) (i) FIGURE 15. Sensory Organs © The McGraw−Hill Anatomy, Sixth Edition Coordination Companies, 2001 504 Unit 5 Integration and Coordination A physical examination may include an eye movement test.

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This cortical area corre- projects to MI via the red nucleus and ventrolateral thala- sponds to Brodmann’s area 4 in the precentral gyrus buy malegra fxt plus 160 mg mastercard erectile dysfunction over 75. Other afferent projections come from the nonspecific is structured in six well-defined layers (I to VI) buy malegra fxt plus 160mg amex erectile dysfunction pills non prescription, with layer I nuclei of the thalamus, the contralateral motor cortex, and being closest to the pial surface. Thalamic afferent fibers terminate in two lay- between the precentral (motor) and postcentral (so- ers; those that carry somatosensory information end in matosensory) gyri and many connections to the visual cor- layer IV, and those from nonspecific nuclei end in layer I. Because of their connections with the so- Cerebellar afferents terminate in layer IV. Efferent axons matosensory cortex, the cortical motor neurons can also arise in layers V and VI to descend as the corticospinal respond to sensory stimulation. Body areas are represented in an orderly manner, as vating a particular muscle may respond to cutaneous stim- somatotopic maps, in the motor and sensory cortical areas uli originating in the area of skin that moves when that (Fig 5. Those parts of the body that perform fine muscle is active, and they may respond to proprioceptive movements, such as the digits and the facial muscles, are stimulation from the muscle to which they are related. Through these connections, the motor Low-level electrical stimulation of MI produces twitch- cortex can control the flow of somatosensory information like contraction of a few muscles or, less commonly, a sin- to motor control centers. Slightly stronger stimuli also produce responses The close coupling of sensory and motor functions may in adjacent muscles. Movements elicited from area 4 have play a role in two cortically controlled reflexes that were the lowest stimulation thresholds and are the most discrete originally described in experimental animals as being im- of any movements elicited by stimulation. Stimulation of portant for maintaining normal body support during loco- MI limb areas produces contralateral movement, while cra- motion—the placing and hopping reactions. Contact of any part of the animal’s to immediate paralysis of the muscles controlled by that foot with the edge of a table provokes immediate place- area. In humans, some function may return weeks to ment of the foot on the table surface. The hopping reaction months later, but the movements lack the fine degree mus- is demonstrated by holding an animal so that it stands on cle control of the normal state. If the body is moved forward, backward, or to the in the arm area of MI, the use of the hand recovers, but the side, the leg hops in the direction of the movement so that capacity for discrete finger movements does not. Lesions of the contralateral precen- tral or postcentral gyrus abolish placing. Hopping is abol- ished by a contralateral lesion of the precentral gyrus. The MII corti- MII cinguli cal area is located on the medial surface of the hemispheres, above the cingulate sulcus, and rostral to the leg area of the primary motor cortex (see Fig. This cortical region Longitudinal within Brodmann’s area 6 has no clear cytoarchitectural fissure boundaries; that is, the shapes and sizes of cells and their MI processes are not obviously compartmentalized, as in the layers of MI. Electrical stimulation of MII produces movements, but a greater strength of stimulating current is required than for MI. Central sulcus The movements produced by stimulation are also qualita- tively different from MI; they last longer, the postures elicited may remain after the stimulation is over, and the movements are less discrete. MII is re- ciprocally connected with MI, and receives input from other motor cortical areas. Experimental lesions in MI eliminate the Sylvian ability of MII stimulation to produce movements. Primary thought to be active in bimanual tasks, in learning and motor cortex (MI) and supplementary motor preparing for the execution of skilled movements, and in cortex (MII) areas in the monkey brain. The mechanisms that underlie 102 PART II NEUROPHYSIOLOGY the more complex aspects of movement, such as thinking Primary motor about and performing skilled movements and using com- cortex (area 4) plex sensory information to guide movement, remain in- completely understood. The primary somatosensory cortex (Brod- mann’s areas 1, 2, and 3) lies on the postcentral gyrus (see Fig. Electrical stimula- tion here can produce movement, but thresholds are 2 to 3 times higher than in MI. The somatosensory cortex is re- ciprocally interconnected with MI in a somatotopic pat- tern—for example, arm areas of sensory cortex project to arm areas of motor cortex. Efferent fibers from areas 1, 2, Internal and 3 travel in the corticospinal tract and terminate in the capsule dorsal horn areas of the spinal cord. The superior parietal lobe (Brodmann’s areas 5 and 7) also has important motor functions. In addition to con- tributing fibers to the corticospinal tract, it is well con- nected to the motor areas in the frontal lobe.

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The tendo of muscles calcaneus (tendon of Achilles) is the strong malegra fxt plus 160 mg without prescription latest news erectile dysfunction treatment, cordlike tendon Rectus femoris m buy 160 mg malegra fxt plus fast delivery erectile dysfunction after radical prostatectomy treatment options. The muscles forming the belly of the calf are the gastrocnemius and soleus. The superficial veins of the leg can be observed on many individuals (see fig. The great saphenous vein can be seen subcutaneously along the medial aspect of the leg. The less con- spicuous small saphenous vein drains the lateral surface of the Vastus medialis m. If these veins become excessively enlarged, they are called varicose veins. Shinsplints, proba- Patella bly the result of a stress fracture or periosteum damage of the tibia, is a common condition in runners. A fracture of one or both Lateral epicondyle malleoli is caused by a severe twisting of the ankle region. Skiing of femur fractures are generally caused by strong torsion forces on the body Medial epicondyle of the tibia or fibula. The structural features and surface anatomy of the foot are in- dicative of these functions. The longitudinal arch of the foot, lo- cated on the medial portion of the plantar surface (see figs. The head of the first metatarsal bone forms the medial ball of the foot, just proximal to the hallux (great toe). The feet and toes are adapted to endure tremendous com- pression forces during locomotion. Although appropriate cated within the patellar tendon, anterior to the knee joint. This tension at the metatarsophalangeal joint with flexion at the proximal area becomes clinically important in elderly people who suffer interphalangeal joint. A corn is a cone-shaped horny mass of thick- ened skin resulting from recurrent pressure on the skin over a bony degenerative conditions. Most often it occurs on the outside of the little toe or the common, as are popliteal abscesses resulting from infected lymph upper surfaces of the other toes. The small saphenous vein as it traverses the popliteal and are kept soft by moisture. The fifth metatarsal bone forms much of the lateral bor- der of the plantar surface of the foot. The tendons of the ex- Leg tensor digitorum longus muscle can be seen along the superior Portions of the tibia and fibula, the bones of the leg, can be ob- surface of the foot, especially if the toes are elevated. The medial surface and anterior border tions of the dorsal pedal artery can be palpated on the supe- (commonly called “shin”) of the tibia are subcutaneous and are rior surface of the foot between the first and second palpable throughout their length. The individual phalanges of the toes, the malleolus of the tibia and the lateral malleolus of the fibula are joints between these bones, and the toenails are obvious sur- easy to observe as prominent eminences (fig. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 328 Unit 4 Support and Movement Tensor fasciae Adductor magnus m. Popliteal fossa Lateral epicondyle of femur Medial epicondyle of femur Medial head of gastrocnemius m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 329 Medial head of Lateral head of gastrocnemius m. Medial malleolus Lateral malleolus Calcaneus Calcaneus Extensor digitorum Abductor hallucis m. Lateral malleolus of fibula Medial malleolus of tibia Tendo calcaneus Site for palpation Medial malleolus of dorsal pedal a. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 330 Unit 4 Support and Movement (a) (b) (c) FIGURE 10. Iliac crest Gluteus medius muscle Gluteus minimus muscle Greater trochanter Sacrum of femur Piriformis muscle Sacrotuberous ligament Superior gemellus muscle Coccyx Obturator internus muscle Gluteus maximus Inferior gemellus muscle muscle Quadratus femoris Anus muscle Biceps femoris muscle Semitendinosus muscle FIGURE 10. Internal Anatomy CLINICAL CONSIDERATIONS The internal anatomy of the buttock and lower extremity in- clude the structures of the hip, thigh, knee, leg, and foot. The Head and Neck Regions principal structures of these regions are shown in the cadaver dis- sections in figures 10. The highly specialized head and neck regions are extremely vul- nerable to trauma and disease.

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