By D. Alima. Fordham University.
The ribs arise on or between thoracic vertebrae and are connected to the sternum by cartilaginous extensions order glycomet 500 mg with visa. The joints of the axial skeleton are heavily reinforced by an array of lig- aments glycomet 500mg cheap, and as a result they permit only limited movement. The appendicular skeleton consists of the bones of the upper and lower limbs and the supporting elements (girdles) that connect them to the trunk (see Fig. Each arm articulates with the trunk at the shoulder (the pec- toral girdle), and the lower extremities are attached to the trunk at the pelvic girdle. There are 126 bones in the appendicular skeleton, and ap- proximately 300 muscles act on them to cause movement or to sustain a certain pause. The shoulder girdle consists of the S-shaped clavicle (collarbone) and a broad, flat scapula (the shoulder blade). The clavicle joins at one end to the sternum and at the other end meets the scapulae. The only di- rect connection between the shoulder girdle and the axial skeleton is the 1. Skeletal muscles support and po- sition the scapula, which has no direct bony or ligamentous connections to the rib cage. Once the shoulder joint is in position, muscles that origi- nate on the pectoral girdle help to move the upper extremity. The bone of the upper arm, the humerus, articulates with the scapula on the proximal end. At its distal end, it articulates with the bones of the forearm, the radius and ulna. The ra- dius and the ulna are connected through their entire length by a flexible interosseus membrane. The wrist is composed of eight carpal bones that are arranged in two rows, proximal and distal carpals. In the hand, five metacarpals articu- late with the distal carpals of the wrist and support the palm. The pelvis is a composite structure that is composed of the hip bone (coxae) of the appendicular skeleton and the sacrum and coccyx, the last two el- ements of the vertebral column.
Age and coronary heart disease The majority of patients presenting with CHD are aged 50 years and older buy discount glycomet 500 mg line. For the exercise prescriber generic 500mg glycomet, this poses a challenge to accommodate these other conditions while ensuring that the patient can exercise safely and without aggravating other pathologies. The following section considers changes associated with ageing and co- pathologies often associated with the older patient and the CHD process. Where appropriate adaptations of the FITT principles for each are considered for the ageing process, hypertension, hypotension, obesity, diabetes, peripheral vascular disease, osteoarthritis and rheumatoid arthritis, and osteoporosis. Ageing processes As many individuals in the cardiac rehabilitation population are 50+ years of age, it is important that the exercise prescriber takes into account the 120 Exercise Leadership in Cardiac Rehabilitation 80 70 60 50 40 MALE 30 FEMALE 20 10 0 <35yrs 35- 45- 55- 65- 75yrs+ 44yrs 54yrs 64yrs 74yrs Figure 4. Cardiovascular Function There is loss of VO2max by about 1% per year between the ages of 25 and 75 years (Shvartz and Reibold, 1990). This loss of functional capacity is not inevitable and appears to be closely related to reduced activity levels. The elas- ticity of the major blood vessels declines with age, resulting in an increase in both systolic and diastolic blood pressure. This increases peripheral resistance and in turn increases afterload (see Chapter 3), which can result in ventricu- lar hypertrophy. This is thought to be due to a decrease in myocardial sensitivity to catecholamines and the effect of prolonged diastolic ﬁlling (ACSM, 2001). The predictive age-adjusted HR formula (see Chapter 3) does take this into consideration. Some care is required in using this formula, due to the limitation of over- or under-prescription. Many older adults will increase their rate of breathing, rather than depth, to increase ven- tilation. This may result in additional work for the respiratory muscles, and many will describe symptoms of breathing discomfort during exercise. Exercise Prescription 121 Bone Women begin to lose bone at age 30, and will lose about 20% by the age of 65 and 30% by the age of 80.
Imaging Findings of Chronic Sinusitis Sinus CT may show mucosal thickening in various degrees generic glycomet 500 mg free shipping, from minimal mucosal thickening to severe opaciﬁcation of the paranasal sinuses purchase 500 mg glycomet with mastercard. Fre- quently, for various reasons, sinus CT shows no or only minimal mucosal abnormality. Those patients with persistent chronic sinusitis symptoms have taken antiinﬂammatory medication as well as nasal spray; thus the degree of mucosal inﬂammation is usually subtle. Some ear, nose, and throat (ENT) surgeons schedule CT scan 4 to 6 weeks after antibiotic treat- ment, in order to see ﬁne bone detail, which is often obscured by mucosal disease. Alternatively, those patients may have some other disease mimic- king chronic sinusitis. At the other extreme, sinus CT may show severe opaciﬁcation of all paranasal sinuses. Occasionally, bone thickening or scle- rosis of the affected sinus is seen, suggestive of chronic periosteal inﬂam- mation. Polypoid soft tissue masses seen within the nasal cavity along with complete sinus opaciﬁcation is suggestive of sinonasal polyposis (Fig. Chronic sinusitis is occasionally caused by fungi, such as aspergillosis or mucormycosis. There are three distinct categories of sinus fungal infec- tion, allergic fungal sinusitis, invasive fungal sinusitis, and fungal ball (also called sinus mycetoma). Chronic inspissated secretion may appear in a high attenuation central region separated from the sinus wall on noncontrast CT (Fig. Acute inva- sive fungal sinusitis presents with a rapid clinical deterioration and has very poor prognosis. Imaging studies often show inﬁltrative soft tissue abnormalities with gross bone destruction.
Bone degradation products are then transported within vesicles across the cell and emptied out to the extracellular space generic 500mg glycomet with amex. This process buy glycomet 500 mg, called resorption, is fundamental to the regulation of calcium and phosphate concentration in body fluids. In the human body, regard- less of age, osteoblasts are adding to the bone matrix at the same time os- 12 1. The balance between the activities of these two cell types is important: if too much salt is removed, bones become weaker. Approximately one-fifth of the adult skeleton is demolished and then rebuilt or replaced in a year. The turnover rates vary from bone to bone, possibly depend- ing on the function of the bone. For example, the spongy ends of long bones of human limbs remodel at a much higher rate than the shaft of a long bone. The bone growth and remodeling appear to be tightly regulated in the human body by hormones and steroids. Electrical fields are known to stimulate bone repair and stimulate the self-repair of bone fractures. Heavily stressed bones become thicker and stronger, whereas bones not subjected to ordinary stresses become thin and brittle. The long bones of the average infant lengthen by 50% during the first year after birth. The bone growth stops around 30 years of age, and between 35 and 40 the osteoblast activity begins to decline gradually while osteoclast ac- tivity continues at previous levels. Nevertheless, among all the mature tissues and organs of adult body, only one has the ability to remake it- self and that is bone. When broken, bone reconstructs itself by triggering biological processes reminiscent of those that occur in the embryo.