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This is true whether an atom fills its outer shell by sharing viagra super active 50 mg cheap injections for erectile dysfunction that truly work, gaining generic viagra super active 100mg visa erectile dysfunction kamagra, or losing electrons. Being such large molecules, proteins need to be built from complex molecules to begin with. Don’t forget that the Krebs cycle, during which pyruvate is broken down, occurs in the mitochondrion. Recall that during aero- bic exercise, you’re trying to circulate oxygen to your muscles. The other answers are incorrect because glycolysis takes place in the cytoplasm, and anaerobic respiration isn’t one of the three cellular respiration processes. Just as you can’t power a lamp with a lump of coal, cells can’t use glucose directly. Chapter 2 The Cell: Life’s Basic Building Block In This Chapter Breaking through the cell membrane Aiming for the nucleus Sorting through what’s inside the cell Putting together proteins made to order Following the cell cycle ytology, from the Greek word cyto, which means “cell,” is the study of cells. Every living Cthing has cells, but not all living things have the same kinds of cells. Eukaryotes like humans (and all other organisms besides bacteria and viruses) have eukaryotic cells, each of which has a defined nucleus that controls and directs the cell’s activities, and cytosol, fluid material found in the gel-like cytoplasm that fills most of the cell. Plant cells have fibrous cell walls; animal cells do not, making do instead with a semipermeable cell mem- brane, which sometimes is called a plasma membrane or the plasmalemma. Because human cells don’t have cell walls, they look like gel-filled sacs with nuclei and tiny parts called organelles nestled inside when viewed through an electron microscope. In this chapter, we help you sort out what makes up a cell, what all those tiny parts do, and how cells act as protein-manufacturing plants to support life’s activities. Gaining Admission: The Cell Membrane Think of it as a gatekeeper, guardian, or border guard. Despite being only 6 to 10 nanometers thick and visible only through an electron microscope, the cell membrane keeps the cell’s cytoplasm in place and lets only select materials enter and depart the cell as needed. This semipermeability, or selective permeability, is a result of a double layer (bilayer) of phospho- lipid molecules interspersed with protein molecules. The outer surface of each layer is made up of tightly packed hydrophilic (or water-loving) polar heads. Inside, between the two layers, you find hydrophobic (or water-fearing) nonpolar tails consisting of fatty acid chains. Cholesterol molecules between the phosphate layers give the otherwise elastic membrane stability and make it less permeable to water-soluble substances. Both cytoplasm and the matrix, the material in which cells lie, are primarily water. The polar heads electrostatically attract polarized water molecules while the nonpolar tails lie between the layers, shielded from water and creating a dry middle layer. The membrane’s interior is made up of oily fatty acid molecules that are electrostatically symmetric, or nonpolarized. Lipid-soluble molecules can pass through this layer, but water-soluble molecules such as amino acids, sugars, and proteins cannot. Because phospholipids have both polar and nonpolar regions, they’re also called amphipathic molecules. Part I: Building Blocks of the Body 24 The cell membrane is designed to hold the cell together and to isolate it as a distinct functional unit of protoplasm. Although it can spontaneously repair minor tears, severe damage to the membrane will cause the cell to disintegrate. It allows movement across its barrier by diffusion, osmosis, or active transport as follows: D i f f u s i o n : This is a spontaneous spreading, or migration, of molecules or other particles from an area of higher concentration to an area of lower concentration until equilibrium occurs. When equilibrium is reached, diffusion continues, but the flow is equal in both directions. Diffusion is a natural phenomenon that behaves in much the same way as Brownian motion; both phenomena are based on the fact that all molecules possess kinetic energy. They move randomly at high speeds, colliding with one another, changing directions, and moving away from areas of greatest concentration to areas of lower concentration. The rate of movement depends on the size and temperature of the molecule; the smaller and warmer the molecule is, the faster it moves. Diffusion is one form of passive transport that doesn’t require the expenditure of cellular energy. A molecule can diffuse passively through the cell membrane if it’s lipid-soluble, uncharged, and very small, or if it can be assisted by a carrier molecule. The unassisted diffusion of very small or lipid-soluble particles is called simple diffusion. The cell membrane allows nonpolar molecules (those that don’t readily bond with water) to flow from an area where they’re highly concentrated to an area where they’re less concentrated. Embedded with the hydrophilic heads in the outer layer are protein molecules called channel proteins that create diffusion-friendly openings for the molecules to diffuse through. O s m o s i s : This form of passive transport is similar to diffusion and involves a sol- vent moving through a selectively permeable or semipermeable membrane from an area of higher concentration to an area of lower concentration. The solvent is the liquid in which a substance is dissolved; water is called the universal solvent because more materials dissolve in it than in any other liquid. Typically, a cell contains a roughly 1 percent saline solu- tion — in other words, 1 percent salt (solute) and 99 percent water (solvent). Water is a polar molecule that will not pass through the lipid bilayer; however, it is small enough to move through the pores of most cell membranes. Osmosis occurs when there’s a difference in molecular concentration of water on the two sides of the membrane. The membrane allows the solvent (water) to move through but keeps out the particles dissolved in the water. Transport by osmosis is affected by the concentration of solute (the number of particles) in the water. Osmolarity is the term used to describe the concentration of solute par- ticles per liter. Eventually, the pressure within the cell becomes equal to, and is bal- anced by, the osmotic pressure outside. An example is 100 percent distilled water, which has less solute than what’s inside the cell. Therefore, if a human cell is placed in a hypo- tonic solution, molecules diffuse down the concentration gradient until the cell’s membrane bursts. Chapter 2: The Cell: Life’s Basic Building Block 25 •Ahypertonic solution has more solute and lower water potential than inside the cell. So the membrane of a human cell placed in 10 percent saline solu- tion (10 percent salt and 90 percent water) would let water flow out of the cell (from higher concentration inside to lower concentration outside), therefore shrinking it. Embedded with the hydrophilic heads in the outer layer of the membrane are protein mole- cules able to detect and move compounds through the membrane. The carrier molecules combine with the transport molecules — most importantly amino acids and ions — to pump them against their concentration gradients. Active transport lets cells obtain nutrients that can’t pass through the mem- brane by other means. In addition, there are secondary active transport processes that are similar to diffusion but instead use imbalances in electrostatic forces to move molecules across the membrane.

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Intensive care nursing 364 Gross vasodilation causes hypotension and ischaemia and further release of mediators from ischaemic endothelium buy generic viagra super active online erectile dysfunction causes smoking, often progressing to multisystem dysfunction buy 50 mg viagra super active fast delivery impotence 20s. Gut ischaemia facilitates translocation of bacteria, and so prophylactic antibiotics are usually prescribed (Johnson 1998). Serum amylase levels usually increase up to tenfold (Reece-Smith 1997) within 6 hours, but may return to normal within 48 hours (Santamaria 1997). Chronic underlying pancreatic disease (from alcoholism) may prevent a rise in serum amylase (Johnson 1998) so that normal levels can not preclude diagnosis. Acute pancreatitis can progress to fulminant stages, most texts identifying these as acute oedematous or toxic pancreatitis, and necrotizing or fulminant pancreatitis. Tissue damage causes release of vasoactive mediators (see above), triggering massive extravasation of plasma, hypovolaemic shock and gross oedema. Disruption of vessels in and around the pancreas causes systemic release of enzymes and toxic chemicals, resulting in inflammation, haemorrhage and fat necrosis. The problems may not be apparent until patients relapse some weeks following apparent recovery from acute pancreatitis. Most pseudocysts resolve spontaneously (Venables 1991), but until resolution, surrounding tissues can be compressed and fistulae into surrounding tissue can develop, causing haemorrhage (especially hepatic or splenic) or infection (especially with bowel fistulae). Pseudocysts unresolved after six weeks should be drained percutaneously, under endoscopy, or removed surgically (Venables 1991). Pancreatitis 365 Symptoms Oedema and distension of the pancreatic capsule, biliary tree obstruction or chemical peritoneal burning (phospholipidase A) cause severe acute abdominal pain (Krumberger 1995), requiring opiate analgesia. Use of morphine is controversial; theoretically, morphine constricts the sphincter of Oddi, accentuating pain, but Krumberger (1995) suggests morphine has minimal effects on the sphincter of Oddi. Pethidine may avoid this problem (Reece-Smith 1997; Johnson 1998), although Santamaria (1997) suggests both drugs cause constriction, but that pancreatic secretions through the sphincter will be minimal so that differences are largely theoretical. Mitchell and MacFie (1991) similarly support the use of either pethidine or morphine. Thoracic epidural analgesia may also be useful (Johnson 1998), provided that clotting is not impaired. Epidural blockade can cause further vasodilation (Johnson 1998), and so blood volume should be monitored and replaced as appropriate. Increased capillary permeability from vasoactive mediators causes massive and rapid intra-abdominal fluid shifts, hypovolaemia and gross oedema. Possible skin discoloration includes Turner’s sign (bluish-purple discoloration of flanks, from retroperitoneal haemorrhage); this occurs in about 1 per cent of cases, indicating probable mortality (Gunning 1997). Pancreatitis causes electrolyte imbalances: ■ hyperglycaemia (from impaired insulin secretion, increased glucagon release, circulating antagonists such as catecholamines, and glucose in parenterai feeds); blood sugars should be closely monitored; sliding scales of insulin may be prescribed ■ hypocalcaemia is usually caused by hypoproteinaemia (Santamaria 1997) ■ hypomagnesaemia is common, especially with alcohol-related pancreatitis (Santamaria 1997) Multisystem complications Pancreatitis compromises most major systems. Gross ascites causes physical splinting of both lung bases, precipitating respiratory failure, the main cause of deaths (Krumberger 1995). Atelectasis and pleural effusions may occur, especially in the left lung (Gunning 1997). Cardiovascular instability is caused by Intensive care nursing 366 ■ continuing massive fluid shifts ■ myocardial depressant factor (pancreatic hormone released in response to pancreatic ischaemia) ■ pericardial effusions ■ electrolyte imbalances. Autodigestion of arteries near the pancreas (especially splenic arteries) by pancreatic juices can cause aneurysms (Chalmers 1991). The cardiovascular system should be closely monitored, with supports to maintain homeostasis. Direct damage to the gastrointestinal system can cause ■ peptic ulceration ■ gastritis ■ bowel infarction ■ paralytic ileus ■ translocation of gut bacteria. Hypermetabolism increases energy expenditure, necessitating additional nutritional support. If possible, feeding should be enterai (Johnson 1998), but paralytic ileus and/or duodenal damage may prevent enterai feeding, although jejunal feeds (which unlike gastric feeds do not stimulate pancreatic secretions (Santamaria 1997)) may be possible; parenteral nutrition may be necessary, but will expose patients to potential infection, hyperglycaemia and other complications. Severe systemic hypotension often causes acute tubular necrosis; in these circumstances, haemofiltration will be needed. Dialysis does not remove vasoactive mediators effectively (Gunning 1997), but plasmapheresis appears promising. Most studies have proved disappointing (Johnson 1998), with the result that antiprotease treatment has largely been abandoned. Leucocyte by-products cause most damage, and so possible treatments (needing further evaluation) include (Neoptolemos 1992): Pancreatitis 367 ■ antioxidants ■ tumour necrosis factor antagonists ■ leukotriene antagonists ■ plasminogen activation factor antagonists Lexipafant appears promising, but antioxidant therapy remains untested (Johnson 1998) and trials of antibodies for tumour necrosis factor-alpha have proved detrimental, so that this treatment is not now recommended. The current treatment is largely support systems, with pain control being a particularly important nursing role. Further reading Pathophysiology is well described by Reece-Smith (1997), although Johnson’s (1998) article draws on more recent material. Krumberger (1995), Gunning (1997), Santamaria (1997)) usually provide useful overviews. Prior to this Gita was attending a large family wedding where she experienced worsening of left-sided epigastric pain. She had experienced this pain intermittently over two days The pain radiated towards her back and was accompanied by nausea and Intensive care nursing 368 vomiting. Other abnormal results from admission assessment included: Vital signs Blood serum Temperature 38. Consider the type, route and amount of nutritional support suitable for her increased metabolic demands, impaired digestion and carbohydrate metabolism, control of blood sugars. What advice and information can you give to Gita to enhance her short-term recovery and longer-term health? Consider: infection risks, metabolic disturbances from pancreatic insult, advice on diet/medications/activities, etc. Impaired voluntary nervous function may be frustrating for patients, but autonomic nervous system dysfunction may prove life-threatening. The problems are similar in all three conditions: muscle weakness (including respiratory), underlying hypotension and bradycardia with potentially excessive inappropriate episodes of hypertension and tachycardia. Nursing patients with these conditions can be labour intensive and stressful; they need care and support with many activities of living, while minimising complications significantly improves recovery and survival. Management of all three conditions centres on ■ attempts to remove underlying causes ■ prevention of complications ■ system support. While there is some research evidence, practice varies between units; some approaches described below are anecdotal rather than evidence-based. While the literature is consistent on incidence, it is inconsistent about possible gender, age, racial and seasonal prevalence. Immune system dysfunction results in T-lymphocyte migration to peripheral nerves causing inflammation oedema (Ross 1993) and myelin destruction (Desforges 1992), creating lesions (especially in spinal nerves and near dorsal root ganglia) (Waldock 1995) and the progressive destruction of the nodes of Ranvier. This, in turn, causes ascending motor and sensory paralysis, resulting in diffuse muscle weakness. Prolonged artificial ventilation is often needed, and many units favour early tracheostomy.

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Substance purchase viagra super active 100 mg online erectile dysfunction when cheating, perforated – auricular cheap viagra super active 100 mg fast delivery erectile dysfunction pump cost, of sacrum 191, 433 – – of foot 501 – posterior 103, 137 – bare – – of hand 390 Substantia nigra 65, 99, 103, 116 – – of ascending colon 318 – of hand 14 Sulcus – – of descending colon 318 – of tendon – calcarine 99, 103, 137 – costal 369 – – of extensor hallucis longus muscle 493 – – communication with parieto-occipital sulcus – diaphragmatic – – of flexor pollicis longus muscle 390 f 99 – – of liver 298 – – of tibialis anterior muscle 493 – carotid 30, 38 – – of lung 249 Systole 260 – central 89 f, 94, 100 f – gluteal, of ilium 437 – – of insula 72 – lunate, of acetabulum 433, 436, 445 – chiasmatic 25, 30 – malleolar, lateral, of talus 443 – cingulate 99 – patellar, of femur 439, 441, 447 T – circular, of insula 109 – pelvic, of sacrum 433 – coronary 252, 257 f, 260 ff – popliteal, of femur 439, 441 Taenia – of corpus callosum 99 – symphysial, of pubis 433, 438 – coli 306 – frontal, superior 100 Surface anatomy 204 f, 401 f, 476 f – free, of colon 307 f, 310, 318 – infra-orbital 132 Sustentaculum tali 443, 450 f Tail – intertubercular 373, 378 Suture – of caudate nucleus 115 – interventricular 268 – coronal 20 ff, 29, 35 – of epididymis 343 f – – anterior 252, 255, 257, 260, 262 – ethmoidolacrimal 20 – of pancreas 297, 300, 316 – – posterior 252, 257, 262 – frontal 22 f, 35 Talus 443, 449 ff – lateral 89, 100 – frontomaxillary 23 – articular surface – – ascending ramus, anterior 100 f – frontonasal 22 – – calcaneal – – horizontal ramus, anterior 100 f – frontosphenoid 21 – – – anterior 449 – – posterior ramus 101 – intermaxillary 22 – – – middle 449 – lunate 100 – internasal 22 f –––posterior 449 – malleolar, of tibia 440 – lacrimomaxillary 20 – – navicular 449 – median, of tongue 149 – lambdoid 20 f, 29, 35 – of newborn 9 – mylohyoid 52 – nasomaxillary 20 ff, 23 Tectum 94, 108, 114 – occipital, transverse 92 – of newborn 35 Telencephalon 91 – olfactory 66 – occipitomastoid 20 f, 29 Tendon 393, 415, 499 – orbital, of frontal lobe 66 – palatine – of abductor pollicis longus muscle 388, 390, – parieto-occipital 99 – – median 33, 45 392, 394, 401, 427 – postcentral 100 f – – transverse 45 – annular, common 135, 141 – precentral 99 f, 101 – palatomaxillary 33 – of biceps femoris muscle 455 f, 484 – temporal, inferior 66 – parietomastoid 20 – – surface anatomy 476 f – terminalis – sagittal 29, 35 – calcaneal 449, 457 ff, 489, 491 ff – – cordis 256, 260 f – sphenofrontal 20, 23 – – surface anatomy 476 – – of tongue 149 – sphenosquamosal 21 – central Supination 368 f, 391 – sphenozygomatic 23 – – of diaphragm 278, 283, 298, 329 Surface – squamomastoid 125 – – of perineum 353, 361 – articular – squamous 20 f – of deep flexor muscles 458 – – calcaneal – zygomaticomaxillary 22 f – of extensor carpi radialis brevis muscle 392 ff – – – anterior, of talus 449 Symmetry, bilateral 1 – of extensor carpi radialis longus muscle 392 ff – – – middle, of talus 449 Symphysis, pubic 7, 188 f, 293, 354, 356, 432, – of extensor carpi ulnaris muscle 392, 424 –––posterior, of talus 449 435 f – of extensor digiti minimi muscle 392 – – inferior, of tibia 440 – midsagittal section 322 – of extensor digitorum brevis muscle of foot 493 – – malleolar, of fibula 440 Synchondrosis, spheno-occipital 27, 38 – of extensor digitorum longus muscle of foot – – navicular, of talus 449 Syndesmosis, tibiofibular 443, 495 459, 462, 491, 498 f – – of navicular bone 449 Synovial fluid 12 – of extensor digitorum muscle of hand 392 ff, – – of patella 441, 448 Synovial sheath 401, 424 – – proximal, of tibia 447 – common – of extensor hallucis longus muscle 458 f, 491, – – superior – – of extensor digitorum longus muscle 493 493, 498 f –––ofaxis200 – – of flexor tendons of hand 390 f – of extensor indicis muscle 392, 394, 401 –––oftibia440 – digital – of extensor muscles of hand 381 – – talar – – of flexor tendons of hand 390 f – of extensor pollicis brevis muscle 388, 392, – – – anterior, of calcaneus 449 – – of foot 501 394, 427 – – – middle, of calcaneus 449 – of extensor tendons of hand 392 – of extensor pollicis longus muscle 392, 394, –––posterior, of calcaneus 449 – of flexor tendons 424 Index 529 Page numbers in bold indicate main discussions. Synovial sheath – – third 37 – horizontal section 210 f – of short head of biceps brachii muscle 387 – premolar 37, 50 f – jugular 172 f – of stapedius muscle 126, 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. The authors are also grateful to the specialists at Thieme Verlag and to the graphic design staff for their cooperation. Usage subject to terms and conditions of license Kayser, Medical Microbiology © 2005 Thieme All rights reserved. I Basic Principles of M edical icrobiologie and Im unology Macrophage hunting bacteria Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Kayser & Infectious diseases are caused by subcellular infectious entities (prions, viruses), prokaryotic bacteria, eukaryotic fungi and protozoans, metazoan an- imals, such as parasitic worms (helminths), and some arthropods. Definitive proof that one of these factors is the cause of a given infection is demon- strated by fulfillment of the three Henle-Koch postulates. For technical rea- sons, a number of infections cannot fulfill the postulates in their strictest sense as formulated by R. In the medical teachings of Hippocrates, the cause of infections occurring fre- quently in a certain locality or during a certain period (epidemics) was sought in “changes” in the air according to the theory of miasmas. This concept, still reflected in terms such as “swamp fever” or “malaria,” was the predominant academic opinion until the end of the 19th century, despite the fact that the Dutch cloth merchant A. At the time, general acceptance of the notion of “spontaneous generation”—creation of life from dead organic material—stood in the way of implicating the bacteria found in the corpses of infection victims as the cause of the deadly diseases. It was not until Pas- teur disproved the doctrine of spontaneous generation in the second half of the 19th century that a new way of thinking became possible. By the end of that century, microorganisms had been identified as the causal agents in many familiar diseases by applying the Henle-Koch postulates formulated by R. The History of Infectious Diseases 3 The Henle–Koch Postulates 1 The postulates can be freely formulated as follows: & The microorganism must be found under conditions corresponding to the pathological changes and clinical course of the disease in question. However, the fact that these conditions are not met does not necessarily exclude a contribution to disease etiology by a pathogen found in context. In particular, many infections caused by subcellular entities do not fulfill the postulates in their classic form. The Present The frequency and deadliness of infectious diseases throughout thousands of years of human history have kept them at the focus of medical science. The development of effective preventive and therapeutic measures in recent dec- ades has diminished, and sometimes eliminated entirely, the grim epidemics of smallpox, plague, spotted fever, diphtheria, and other such contagions. As a result of these developments, the attention of medical researchers was diverted to other fields: it seemed we had tamed the infectious diseases. Previously unknown pathogens causing new diseases are being found and familiar organisms have demonstrated an ability to evolve new forms and reassert themselves.

Alligood (1995) applied the theory to within the Framework orthopedic nursing with adults buy discount viagra super active 25 mg line best erectile dysfunction pump. In contrast cheap viagra super active 25mg otc chewing tobacco causes erectile dysfunction, Advocacy Bramlett, Gueldner, 1990 Benedict and Frey (1995) examined the use of the and Sowell theory within the delivery of emergency care. Autonomy Glenn* 1989 The midrange Theory of Goal Attainment Coping King 1983 (King, 1981) is also used when nurses wish to ex- Empathy Alligood, Evans, and 1995 plore a particular concept within a theoretical con- Wilt text. Temple and Fawdry (1992) examined caregiver Health King 1990 role strain while perceptual congruency between Health (social system) Sieloff 1995 nurses and clients was explored by Froman (1995). Health (systems) Winker 1995 Nurses also use the Theory of Goal Attainment Power Hawkes 1991 (King, 1981) to examine concepts related to the Quality of life King 1993 theory. This application was demonstrated by Social support Frey 1989 Kameoka (1995) as she analyzed nurse-patient in- Space Rooke 1995 teractions in Japan. Transaction Binder* 1992 Finally, the theory has been applied in nonclini- cal nursing situations. Messmer (1995) used the *Indicates thesis or dissertation theory in implementing theory-based nursing practice. In summary, Table 16–3 system (Sieloff, 1995b), health of systems (Winker, chronicles applications of King’s midrange Theory 1995), and space (Rooke, 1995b). Within the nursing profession, the nursing pro- cess has consistently been used as the basis for Theory of Goal Attainment nursing practice. Although many published the Interacting Systems Framework, she developed applications have broad reference to the nursing the midrange Theory of Goal Attainment (1981) process, several deserve special recognition. Other explicit examples of integration with This midrange theory has found great application the nursing process are those by Woods (1994), and to nursing practice, since the theory focuses on Frey and Norris (1997). Additionally, Frey and concepts relevant to all nursing situations—the at- Norris also drew parallels between the processes of tainment of client goals. These Attainment, (3) exploring a particular concept re- languages include the Nursing Diagnoses, Nursing lated to the Theory of Goal Attainment, and (4) Interventions, and Nursing Outcomes. Although application of the theory in nonclinical nursing these languages were developed after many of the situations. The focus was to develop the concepts (revised to group 1996* of judgment and action as core concepts in the power) 1995 personal system. Other concepts in the theory in- Families, children, Frey 1995 cluded communication, perception, and decision and chronic illness 1993 making. Family health Wicks 1995 In relation to the interpersonal system, several Family health Doornbos 1995 middle-range theories have been developed regard- (families with young chronic ing families. Doornbos (2000) addressed family mentally ill health in terms of families with young chronically individuals) mentally ill individuals. Frey (1995) developed a Perceptual awareness Brooks and 1997 middle-range theory regarding families, children, Thomas and chronic illness; and Wicks (1995) delineated a Satisfaction, client Killeen* 1996 middle-range theory regarding the broader concept of family health. In relation to social systems, *Indicates thesis or dissertation or research in progress Sieloff (1995a) developed the Theory of Depart- mental Power to assist in explaining the power of groups within organizations. Table 16–5 further works, nursing frameworks such as King’s Inter- lists middle-range theories developed within King’s acting Systems Framework (1981) can still find ap- framework (1981). And, it is this type of application that further demonstrates the frame- Instrument Development work’s utility across time. Instrument development in nursing is needed in (1995) implemented nursing diagnoses within the order to measure relevant nursing concepts. Table 16–4 provides a However, instruments developed for a research listing of applications of King’s work in relation to study rarely undergo the rigor of research the nursing process and to nursing languages. King (1988a) developed the Health Development of middle-range theories is a natural Goal Attainment instrument, designed to detail the extension of a conceptual framework. Middle- level of attainment of health goals by individual range theories, clearly developed from within a clients. The Family Needs Assessment Tool was de- conceptual framework, accomplish two goals: (1) veloped by Rawlins, Rawlins, and Horner (1990). Such theories can be directly applied to nursing sit- Table 16–6 provides a listing of instruments devel- uations, whereas a conceptual framework is usually oped in relation to King’s work. Additional evidence of the scope and usefulness of In addition to the midrange Theory of Goal King’s framework and theory is its use with clients Attainment (King, 1981), several other midrange across the life span. Several applications have tar- theories have been developed from within King’s geted high-risk infants (Frey & Norris, 1997; Norris Interacting Systems framework. Hanna (1993) investigated the effect of systems (the nursing staff and hospital environ- nurse-client interactions on oral-contraceptive ad- ment). Interestingly, these theory is their utility in encompassing complex set- studies considered personal systems (infants), in- tings and situations. Kenny (1990) also studied the 1988), and renal procedures (Hanucharurnkui role of the elderly in their care. Gender-specific work in- ied the “impact of information on the health be- cluded Sharts-Hopko’s (1995) use of concepts haviors of older adults” (p. Clearly, focus of care (client system) and/or focus of health these applications, and others, show how the problem (phenomenon of concern). The focus of complexity of King’s framework and midrange the- care, or interest, can be an individual (personal sys- ory increases its usefulness for nursing (refer to tem) or group (interpersonal or social system). Thus, application of King’s work, across client sys- tems, would be divided into the three systems iden- Client Systems tified within King’s Interacting Systems Framework A major strength of King’s work is that it can (1981): personal (the individual), interpersonal be used with virtually all client populations. Frey addition, applications proposed the Theory of and Norris (1997) used both the Interacting Sys- Goal Attainment as the practice model for case tems Framework and Theory of Goal Attain- management (Hampton, 1994; Tritsch, 1996). The earliest 1995a) and revised into a Theory of Group Power applications involved the use of the framework and within Organizations (2003). Educational settings, theory to guide continuing education (Brown & also considered as social systems, have also been Lee, 1980) and nursing curricula (Daubenmire, the focus of application of King’s work (Bello, 1989; Gulitz & King, 1988). Table 16–9 sum- marizes applications related to clients’ phenomena Phenomena of Concern to Clients of concern; the table also groups these applications, Within King’s work, it is critically important for the primarily identified by disease or medical diagno- nurse to focus on, and address, the phenomenon of sis, as illness management. Without this emphasis on the Health is one area that certainly binds clients client’s perspective, mutual goal-setting cannot and nurses. Hence, a client’s phenomena of concern was end point, or outcome, of nursing care and selected as neutral terminology that clearly demon- something to which clients aspire. In addition, Frey applications, tends to support the goal of improved (1996) expanded her research to include risky health directly and/or indirectly, as the result of the behaviors. Health status is explic- As stated previously, diseases or diagnoses are itly the outcome of concern in practice applica- often identified as the focus for the application of tions by Smith (1988). For example, Kohler (1988) conducted research with patients with broncho- focused on increased morale and satisfaction, and pneumonia, while patients with end-stage renal DeHowitt (1992) studied well-being. In Health promotion has also been an emphasis for addition, clients with chronic inflammatory bowel the application of King’s ideas. The experience of parenting was studied by concerns have also been the focus of work, using Norris and Hoyer (1993), and health behaviors King’s conceptualizations (Murray & Baier, 1996; were Hanna’s (1995) focus of study. Clients’ concerns ranged from King (1981) stated that individuals act to main- psychotic symptoms (Kemppainen, 1990) to fami- tain their own health. Although not explicitly lies experiencing chronic mental illness (Doornbos, stated, the converse is probably true as well: 2002) to clients in short-term group psychotherapy Individuals often do things that are not good for (Laben, Sneed, & Seidel, 1995).