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Panhypopituitarism: In this condition erectile dysfunction drugs available over the counter order 50mg silagra amex, there is reduction in the secretion of all the hormones of anterior pituitary gland erectile dysfunction female doctor silagra 50mg cheap. This type of dwarfism is associated with other symptoms due to the deficiency of other anterior pituitary hormones erectile dysfunction treatment massage 100 mg silagra fast delivery. The maximum height of anterior pituitary dwarf at the adult age is only about 3 feet ii impotence psychological buy generic silagra 50mg on line. Pituitary dwarfs do not show any deformity and their mental activity is normal with no mental retardation iv. However, during panhypopituitarism, the dwarfs do not obtain puberty due to the deficiency of gonadotropic hormones. Psychogenic dwarfism Dwarfism occurs if the child is exposed to extreme emotional deprivation or stress. This type of dwarfism is called psychogenic dwarfism, psychosocial dwarfism or stress dwarfism. Dwarfism in dystrophia adiposogenitalis Dystrophia adiposogenitalis or Frцhlich syndrome is a pituitary disorder (see below). Dwarfism in panhypopituitarism Panhypopituitarism is the pituitary disorder due to reduction in secretion of all anterior pituitary hormones. Acromicria Acromicria is a rare disease in adults characterized by the atrophy of the extremities of the body. Panhypopituitarism: In this condition, there is a reduction in secretion of all the hormones of anterior pituitary gland. Acromicria is associated with other symptoms due to the deficiency of other anterior pituitary hormones. Atrophy and thinning of extremities of the body, (hands and feet) are the major symptoms in acromicria ii. The senile decay is mainly due to deficiency of hormones from target glands of anterior pituitary, i. So there is continuous loss of sodium, resulting in persistent plasma hypotonicity. Signs and symptoms Loss of appetite Weight loss Nausea and vomiting Headache Muscle weakness, spasm and cramps Fatigue Restlessness and irritability. Lesion (injury) or degeneration of supraoptic and paraventricular nuclei of hypothalamus ii. Polyuria: Excretion of large quantity of dilute urine, with increased frequency of voiding is called polyuria. It stimulates the thirst center in hypothalamus, resulting in intake of large quantity of water. Dehydration: In some cases, the thirst center in the hypothalamus is also affected by the lesion. Water intake decreases in these patients and loss of water through urine is not compensated. Causes Dystrophia adiposogenitalis is due to hypoactivity of both anterior pituitary and posterior pituitary. Common cause of this disease is the tumor in pituitary gland and hypothalamic regions, concerned with food intake and gonadal development. Other causes are injury or atrophy of pituitary gland and genetic inability of hypothalamus to secrete luteinizing hormone-releasing hormone. Due to the abnormal stimulation of feeding center, the person overeats and consequently becomes obese. Obesity is accompanied by sexual infantilism (failure to develop secondary sexual characters) or eunuchism. The structure and the function of the thyroid gland change in different stages of the sexual cycle in females. Its function increases slightly during pregnancy and lactation and decreases during menopause. These follicles are lined with cuboidal epithelial cells, which are called the follicular cells. Follicular cavity is filled with a colloidal substance known as thyroglobulin, which is secreted by the follicular cells.

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Schwann cells also synthesize nerve growth factors why alcohol causes erectile dysfunction buy silagra 50mg free shipping, which attract the fibrils form proximal segment erectile dysfunction uk generic 50 mg silagra with visa. In the nerve cell body diabetes-induced erectile dysfunction epidemiology pathophysiology and management silagra 100mg sale, first the Nissl granules appear followed by Golgi apparatus 9 erectile dysfunction treatment by ayurveda order 50mg silagra otc. Though anatomical regeneration occurs in the nerve, functional recovery occurs after a long period. It starts as early as 4th day after injury, but becomes more effective only after 30 days and is completed in about 80 days. Neuroglial cells are non-excitable and do not transmit nerve impulse (action potential). When compared to the number of neurons, the number of glial cells is 10 to 15 times greater. Neuroglial cells play an important role in the reaction of nerve during infection. This type of astrocytes play an important role in the formation of blood-brain barrier by sending processes to the blood vessels of brain, particularly the capillaries, forming tight junction with capillary membrane. Protoplasmic Astrocytes Protoplasmic astrocytes are present mainly in gray matter. Twist around the nerve cells and form the supporting network in brain and spinal cord ii. Form the blood-brain barrier and thereby regulate the entry of substances from blood into brain tissues (Chapter 163) iii. These cells are derived from monocytes and enter the tissues of nervous system from blood. Engulf and destroy the microorganisms and cellular debris by means of phagocytosis i. When stimu lated, receptors produce a series of impulses, which are transmitted through the afferent nerves. So, receptors are often defined as the biological transducers, which convert (transducer) various forms of energy (stimuli) in the environment into action potentials in nerve fiber. Cutaneous Receptors or Mechanoreceptors Receptors situated in the skin are called the cutaneous receptors. Cutaneous receptors are also called mech anoreceptors because of their response to mechanical stimuli such as touch, pressure and pain. Chemoreceptors Receptors, which give response to chemical stimuli, are called the chemoreceptors. Telereceptors Telereceptors are the receptors that give response to stimuli arising away from the body. Proprioceptors Proprioceptors are the receptors, which give response to change in the position of different parts of the body. In addition, each type of sensation depends upon the part of the brain in which its fibers terminate. This phenomenon is called WeberFechner law, which states that intensity of response (sensation) of a receptor is directly proportional to logarithmic increase in the intensity of stimulus. Derivation of Weber-Fechner Law WeberFechner law is derived as follows: R = k log S Where, R = Intensity of response (sensation) k = Constant S = Intensity of stimulus 4. Series of events occur to carry out this function such as the development of receptor potential in the receptor cell and development of action potential in the sensory nerve. For example, the chemoreceptor con verts chemical energy into action potential in the sensory nerve fiber. Touch receptor converts mechanical energy into action potential in the sensory nerve fiber. Receptor potential is short lived and hence, it is called transient receptor potential. The change in shape of the corpuscle leads to the deformation of center core fiber of the corpuscle. Receptor potential leads to development of local circuit which spreads up to first node within the capsule. Receptor potential is nonpropagated; it is con fined within the receptor itself ii.

It also occurs because of lesion in Edinger-Westphal nucleus erectile dysfunction pills at cvs silagra 50mg generic, diabetes and alcoholic neuropathy erectile dysfunction japan silagra 50 mg generic. It is also called BernardHorner syndrome prostate cancer erectile dysfunction statistics silagra 50 mg low cost, Claude Bernard-Horner syndrome or oculosympathetic palsy erectile dysfunction use it or lose it cheap 100 mg silagra with amex. Discrimination and appreciation of colors depend upon the ability of receptors in retina. Wavelength is the distance between two identical points in the wave of light energy. Accordingly, red has got the maximum wavelength of about 8,000 Е and the violet has got the minimum wavelength of about 3,000 Е. Refraction of spectral colors by the 1000 Section 11 t Special Senses prism also depends on wavelengths. Purkinje Phenomenon Purkinje phenomenon is the shift of brightest part of spectrum, when the intensity of illumination is changed. When white light is passed through a prism, it splits into spectral colors from red to violet and if the colors are viewed at high illumination, the brightest part of the spectrum is the yellow, i. But when the light intensity is reduced to that of twilight, the color of the spectrum fades. According to Purkinje, this effect is due to the maximal stimulation of cones by yellow and the maximal stimulation of rods by green. Examples of complementary colors are red and greenish blue; orange and cyan blue; yellow and indigo blue; violet and greenish yellow; purple and green. Different color sensations are produced by the stimulation of various combinations of these three types of cones. For sensation of white light, all the three types of cones are stimulated equally. The sensitive filaments of nerves give response selectively to one or other of the three primary colors. He studied the action potentials in ganglionic cells, which are stimulated by light and obtained some sensitivity curves. Sensitivity curves were recorded by using different wavelengths of light both in light-adapted and dark-adapted eyes. On the basis of these sensitivity curves, Granit classified the ganglionic cells into two groups namely, dominators and modulators. Dominators for cones, which respond in lightadapted eye and a broad sensitivity curve is produced with the maximum response around the wavelengths 55 Е ii. Dominators for rods, which respond in darkadapted eye and in the sensitivity curve the maximum response is given at the wavelengths of 500 Е. Modulators of blue, which are stimulated by light with wavelengths of 450 to 470 Е ii. Modulators of green, which are stimulated by light with wavelengths of 520 to 540 Е iii. If green light falls on retina, modulators of green are stimulated and other two are less affected. Each one possesses its own photosensitive Chapter 170 t Color Vision 1001 (rods) and light-adapted (cones) eyes. All the seven receptors are divided into three units: First Unit First unit is a tricolor unit consisting of receptors for orange, green and blue. Second Unit Second unit is a dicolor unit with receptors for yellow and blue colors. Each substance produces the sensation of a particular color by its breakdown or resynthesis. Its breakdown causes sensation of white and resynthesis causes sensation of black. Its breakdown causes sensation of yellow and resynthesis causes sensation of blue. This theory explains the successive contrast and afterimages, but not the simultaneous sensation of antagonistic colors. When black is placed against white or white against black, these two colors set one another off, i. Maximum effect of simultaneous contrast is obtained when the complementary colors are paired. Reason for simultaneous contrast is that, the stimulation of an area of retina by one color modifies the response in the surrounding or neighboring areas.

Further goals of treatment are preservation of mobility and function erectile dysfunction vasectomy order 50mg silagra visa, maintenance of skeletal integrity erectile dysfunction pills list safe 100 mg silagra, and preservation of quality of life erectile dysfunction drugs australia purchase 100 mg silagra otc. The global response to radiotherapy of bone metastasis in reducing pain is about 80% erectile dysfunction treatments herbal silagra 100 mg on-line. About 3 out of 10 people (30%) will have no pain within a month of radiotherapy treatment. For at least another 4 out of 10 (40%) people, the treatment reduces the pain by half. About 6 to 12 weeks after treatment, the bone repairs itself and becomes stronger. Local palliative efficiency can be expressed as the time to pain progression, the rate of pathological fractures, and the requirement of local retreatment. Depending on the reported time periods for evaluation and how the results were assessed, the documented duration of pain relief is more than 6 months in at least 50% of patients, and the first increase in pain score can be expected after 1 year in 40% of patients. The reported incidence of pathological fractures following palliative radiotherapy of bone metastases is low, varying between 1% and 10%. Recalcification of osteolytic bone metastases after 6 months, defined as a rise of density in the region of interest of more than 20%, was found in 25­58% of patients. Studies show that hemibody or wide-field irradiation gives nearly all patients some pain relief. It can relieve pain completely in up to half of the people treated and can help to stop new painful areas developing. The clinical trials included patients with painful bone metastases of any primary sites, mainly in the prostate, breast, and lung. The radiation doses of the most common schedules are single fractionation treatments with 8 Gy, shorter duration treatments with four times 5 Gy or five times 4 Gy, or more protracted regimens such as 10 times 3 Gy or 20 times 2 Gy. Fractions with single doses of 4 Gy and 5 Gy are applied three to four times a week, 3 and 2 Gy fractions most often five times a week, up to the total doses of 30 Gy and 40 Gy. The degree and duration of pain relief do not depend on the fractionation schedules applied. No significant differences in terms of pain relief and analgesic use were found with single fractions, shorter duration treatments, or more protracted regimens. However, the retreatment rate and pathological fracture rates are higher after single-fraction radiotherapy because a relevant recalcification of osteolytic bone metastases following irradiation is related to more protracted schedules. A second course of palliative radiotherapy of the affected bone is possible and helpful if the first course does not work well or if the pain is initially relieved, but increases again some weeks or months later. The decision for retreatment has to take into account any sensitive structures in the irradiated volume, for example the spinal cord or kidneys. Irrespective of the fractionation schedule chosen, the incidence of grade 2 or greater acute and late toxicity is low, with a rate of approximately 10­15% (acute) and 4% (late), respectively. Pronounced tiredness and listless are the most common general side effects, but recovery occurs within a few weeks after treatment. Most specific side effects of external palliative radiotherapy depend on the location of treatment. While radiotherapy of the bones of the extremities might affect the skin locally with a light reversible erythema, a predominance of gastrointestinal adverse effects such as emesis and diarrhea What fractionation schedules are applied for pain control? Conflicting opinions on low-dose, short-course radiotherapy versus prolonged or higher-dose schedules led to many scientific publications and randomized trials Cytoreductive Radiation Therapy may be noted if the bowels or the stomach are involved. Supportive treatment with antiemetics or antidiarrheal agents might be indicated symptomatically. The side effects tend to come on gradually through the treatment course and may last for a week or two after the treatment has finished. The time and effort in terms of travel and accommodation for the radiotherapy treatment, the costs, the technical complexity of the radiotherapy must be balanced against the benefit. More protracted schedules should be used in palliative situations with a life expectancy of more than 6 months as the rates of retreatment and pathological fractures are reduced. What about radiotherapy for locally advanced tumors and metastases in soft tissues and organs? As in the case of pain due to bone metastases, radiotherapy is effective in tumor-related pain due to visceral recurrences and metastases. Besides all direct tumorassociated pain from locally extended and nerve-infiltrating situations, indications include pelvic pain due to recurrent non-operable rectal cancer or cancer of the cervix. In this palliative situations, marked pain relief may be achieved with only minor shrinkage of the pelvic mass.

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