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The thalamus then can either excite the cortex (as a result of the direct pathway) or fail to excite the cortex (as a result of the indirect pathway) discount nimotop 30mg on-line. The switch between the two pathways is the substantia nigra pars compacta quality 30 mg nimotop, which projects to the striatum and releases the neurotransmitter dopamine discount nimotop 30mg with visa. When the substantia nigra pars compacta is firing, it signals to the basal nuclei that the body is in an active state, and movement will be more likely. When the substantia nigra pars compacta is silent, the body is in a passive state, and movement is inhibited. To illustrate this situation, while a student is sitting listening to a lecture, the substantia nigra pars compacta would be silent and the student less likely to get up and walk around. Likewise, while the professor is lecturing, and walking around at the front of the classroom, the professor’s substantia nigra pars compacta would be active, in keeping with his or her activity level. As shown in this video, the direct pathway is the shorter pathway through the system that results in increased activity in the cerebral cortex and increased motor activity. As shown in this video, the indirect pathway is the longer pathway through the system that results in decreased activity in the cerebral cortex, and therefore less motor activity. The indirect pathway has an extra couple of connections in it, including disinhibition of the subthalamic nucleus. The Myth of Left Brain/Right Brain There is a persistent myth that people are “right-brained” or “left-brained,” which is an oversimplification of an important concept about the cerebral hemispheres. There is some lateralization of function, in which the left side of the brain is devoted to language function and the right side is devoted to spatial and nonverbal reasoning. Whereas these functions are predominantly associated with those sides of the brain, there is no monopoly by either side on these functions. A drastic way to deal with a rare and devastating neurological condition (intractable epilepsy) is to separate the two hemispheres of the brain. After sectioning the corpus callosum, a split-brained patient will have trouble producing verbal responses on the basis of sensory information processed on the right side of the cerebrum, leading to the idea that the left side is responsible for language function. However, there are well-documented cases of language functions lost from damage to the right side of the brain. The deficits seen in damage to the left side of the brain are classified as aphasia, a loss of speech function; damage on the right side can affect the use of language. Right-side damage can result in a loss of ability to understand figurative aspects of speech, such as jokes, irony, or metaphors. Nonverbal aspects of speech can be affected by damage to the right side, such as facial expression or body language, and right-side damage can lead to a “flat affect” in speech, or a loss of emotional expression in speech—sounding like a robot when talking. The Diencephalon The diencephalon is the one region of the adult brain that retains its name from embryologic development. The single exception is the system associated with olfaction, or the sense of smell, which connects directly with the cerebrum. In the earliest vertebrate species, the cerebrum was not much more than olfactory bulbs that received peripheral information about the chemical environment (to call it smell in these organisms is imprecise because they lived in the ocean). There are other structures, such as the epithalamus, which contains the pineal gland, or the subthalamus, which includes the subthalamic nucleus that is part of the basal nuclei. All sensory information, except for the sense of smell, passes through the thalamus before processing by the cortex. Axons from the peripheral sensory organs, or intermediate nuclei, synapse in the thalamus, and thalamic neurons project directly to the cerebrum. For example, the portion of the thalamus that receives visual information will influence what visual stimuli are important, or what receives attention. The primary output of the basal nuclei is to the thalamus, which relays that output to the cerebral cortex. The cortex also sends information to the thalamus that will then influence the effects of the basal nuclei. Hypothalamus Inferior and slightly anterior to the thalamus is the hypothalamus, the other major region of the diencephalon. The hypothalamus is the executive region in charge of the autonomic nervous system and the endocrine system through its regulation of the anterior pituitary gland.

Renin is an enzyme nimotop 30mg amex, although because of its importance in the renin-angiotensin-aldosterone pathway purchase 30 mg nimotop overnight delivery, some sources identify it as a hormone nimotop 30 mg with visa. Specialized cells in the kidneys found in the juxtaglomerular apparatus respond to decreased blood flow by secreting renin into the blood. Renin converts the plasma protein angiotensinogen, which is produced by the liver, into its active form—angiotensin I. In addition to renin, the kidneys produce erythropoietin, which stimulates the production of red blood cells, further increasing blood volume. Erythrocytes are the major formed element of the blood and may 918 Chapter 20 | The Cardiovascular System: Blood Vessels and Circulation contribute 40 percent or more to blood volume, a significant factor of viscosity, resistance, pressure, and flow. Autoregulation of Perfusion As the name would suggest, autoregulation mechanisms require neither specialized nervous stimulation nor endocrine control. Rather, these are local, self-regulatory mechanisms that allow each region of tissue to adjust its blood flow—and thus its perfusion. Chemical Signals Involved in Autoregulation Chemical signals work at the level of the precapillary sphincters to trigger either constriction or relaxation. As you know, opening a precapillary sphincter allows blood to flow into that particular capillary, whereas constricting a precapillary sphincter temporarily shuts off blood flow to that region. The factors involved in regulating the precapillary sphincters include the following: • Opening of the sphincter is triggered in response to decreased oxygen concentrations; increased carbon dioxide concentrations; increasing levels of lactic acid or other byproducts of cellular metabolism; increasing concentrations of potassium ions or hydrogen ions (falling pH); inflammatory chemicals such as histamines; and increased body temperature. Again, these factors alter tissue perfusion via their effects on the precapillary sphincter mechanism, which regulates blood flow to capillaries. Since the amount of blood is limited, not all capillaries can fill at once, so blood flow is allocated based upon the needs and metabolic state of the tissues as reflected in these parameters. Bear in mind, however, that dilation and constriction of the arterioles feeding the capillary beds is the primary control mechanism. The Myogenic Response The myogenic response is a reaction to the stretching of the smooth muscle in the walls of arterioles as changes in blood flow occur through the vessel. This may be viewed as a largely protective function against dramatic fluctuations in blood pressure and blood flow to maintain homeostasis. If perfusion of an organ is too low (ischemia), the tissue will experience low levels of oxygen (hypoxia). The myogenic response is a localized process that serves to stabilize blood flow in the capillary network that follows that arteriole. In response, it relaxes, allowing the vessel to dilate and thereby increase the movement of blood into the tissue. When blood flow is too high, the smooth muscle will contract in response to the increased stretch, prompting vasoconstriction that reduces blood flow. For a healthy young adult, cardiac output (heart rate × stroke volume) increases in the nonathlete from approximately 5. Along with this increase in cardiac output, blood pressure increases from 120/80 at rest to 200/90 at maximum values. The average weight of the heart for the nonathlete is about 300 g, whereas in an athlete it will increase to 500 g. This increase in size generally makes the heart stronger and more efficient at pumping blood, increasing both stroke volume and cardiac output. Tissue perfusion also increases as the body transitions from a resting state to light exercise and eventually to heavy exercise 920 Chapter 20 | The Cardiovascular System: Blood Vessels and Circulation (see Figure 20. These changes result in selective vasodilation in the skeletal muscles, heart, lungs, liver, and integument. Simultaneously, vasoconstriction occurs in the vessels leading to the kidneys and most of the digestive and reproductive organs. The flow of blood to the brain remains largely unchanged whether at rest or exercising, since the vessels in the brain largely do not respond to regulatory stimuli, in most cases, because they lack the appropriate receptors. As vasodilation occurs in selected vessels, resistance drops and more blood rushes into the organs they supply.

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No es en general una gangrena por isquemia order 30mg nimotop amex, por lo tanto los pulsos pueden estar presentes buy generic nimotop 30 mg online. Se caracteriza por pérdida de la arquitectura del pie con edema discount 30mg nimotop overnight delivery, eritema, esfacelos, secreción purulenta y evidente fetidez. Constituye una urgencia clínica, pues existe gran descompensación metabólica y a su vez es una urgencia quirúrgica. Pie diabético séptico: gangrena diabética 84 Tratamiento preventivo del pie diabético 1. El ejercicio diario de una marcha razonable favorece la circulación de las piernas. Si por alguna razón está limitado a una silla o la cama, entonces mover las extremidades tanto como pueda, flexionarlas, estirarlas. El aceite de coco, la manteca de cerdo, los chicharrones y los embutidos, en general son muy agresivos contra las arterias. Comer pescados azules que son ricos en ácidos grasos omega 3, protectores arteriales. Acudir de inmediato al médico de familia ante cualquier lesión por mínima que parezca. No aplicar ningún tratamiento por su cuenta: Prohibir cualquier intento de acciones por su cuenta. No utilizar cuchillas de afeitar, limas metálicas o productos químicos en callos o lesiones. La atención a las uñas, callos, deformidades, grietas y otras, deberá ser por una mano calificada y experta. No exponerse innecesariamente a traumas, por ejemplo: no caminar descalzos, ni siquiera en el interior de la casa, pues puede haber en el piso, pequeños vidrios, tachuelas, agujas, espinas, etc. Cargar objetos pesados, criar animales en el patio, trabajar en el jardín, son acciones que exponen los pies (y las manos) a golpes, rozaduras y arañazos. La parte anterior debe ser ancha para que no presione los dedos y la posterior no debe rozar con la inserción del tendón de Aquiles. La rozadura repetida y que no siente debido a la neuropatía, es causa frecuente de lesiones, con preferencia en el primer dedo o dedo grueso y también en el pequeño o quinto. Además, sus delgadas suelas son atravesadas con facilidad por puntillas, clavos, tachuelas, alambres y espinas. A esta hora del día, el pie se encuentra microscópicamente hinchado, momento propicio para comprar zapatos. Revisar cuidadosamente con las manos el interior de los zapatos antes de calzarse, en busca de puntillas, piedras, hilos gruesos de costuras y otros cuerpos extraños, que no sentiría con los pies afectados por la neuropatía. Cuando regrese a casa y se descalce, entonces revisar los pies en busca de pequeñas ampollas, heridas, rasguños, callos, inflamaciones, cambios de coloración, pinchazos y otras lesiones aparentemente sin importancia. Si tiene afectada la visión o no puede inclinarse adecuadamente para observar sus pies, debe auxiliarse de un espejo o mejor pedir ayuda a un familiar. Romper los elásticos si le aprietan, no utilizar ligas, cambiar las medias diariamente y no utilizar zapatos sin llevar medias. Solamente lo podrá hacer un personal calificado, después de reconocer si tiene las pulsaciones arteriales. Seque completamente entre los dedos de los pies a través de una gentil presión con la toalla. Usar talcos fungicidas, de óxido de zinc o contra los hongos como el micocilén y otros. También pueden utilizarse pinceladas, pero no utilizar cremas entre los dedos, pues reblandecen y lesionan la piel. Utilizar crema de lanolina o almendras, con la piel limpia y aplicarla gentilmente con sus dos manos, dando suaves masajes desde abajo hacia arriba, es decir, desde los dedos hacia los tobillos. Puede producirse una grave y peligrosa quemadura si se utilizan botellas o bolsas de agua caliente, almohadillas eléctricas o se sumergen los pies en agua caliente, al no sentir adecuadamente el intenso calor.

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