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Psoriasis: A condition where the skin cells build up and form scales and itchy, dry patches. 

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Psoriasis: A condition where the skin cells build up and form scales and itchy, dry patches. 

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53-year-old man who had a history of psoriasis fro more that 20 years. 

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53-year-old man who had a history of psoriasis fro more that 20 years. 

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The 53 year old man had gone to a dermatology clinic hoping to manage the psoriasis that keeps reappearing.

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He had previously been treated insufficiently by using topical calcipotriene and betamethasone. 

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He had previously been treated insufficiently by using topical calcipotriene and betamethasone. 

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The systematic treatment was discontinued due to side effects it had caused. 3 weeks before this presentation the man had undergone a ECG. Which, was followed 2 weeks later by new appearances of lesions where the electrodes were placed during the ECG.

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The examination also revealed highly defined erythematous plaques of different sizes with silvery scale on the trunk arms and legs and the scalp.

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The examination also revealed highly defined erythematous plaques of different sizes with silvery scale on the trunk arms and legs and the scalp.

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In a patient with psoriasis stimuli like drugs, infection, local irritation, and pychological stress can trigger relapses of the chronic inflammatory disease.

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The Koebner phenomenon, aka isomorphic response: characterized by the appearance of new psoriatic lesions after mechanical irritation

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The Koebner phenomenon, aka isomorphic response: characterized by the appearance of new psoriatic lesions after mechanical irritation

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The patient was then treated with adalimumab, that then led to a quick response of healing all or the majority of his psoriatic.

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Vertebral Column: contains about 33 bones called vertebrae. There are 5 different regions of the vertebral column. 

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Vertebral Column: contains about 33 bones called vertebrae. There are 5 different regions of the vertebral column. 

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The 5 regions are listed below in order from top to bottom:
1. Cervical
2. Thoracic
3. Lumbar
4. Sacrum
5. Coccyx

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The cervical spine includes 7 vertebrae, the smallest and uppermost part of the spine. They support the skull, help the spine move, and protect the spinal cord.

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The thoracic includes 12 vertebrae in the mid back. The main function of the thoracic section of the spine is to hold the rib cage and protect the heart and lungs. The range of motion in this section is limited

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The lumbar includes 5 vertebrae in the lower back. The main function of the lumbar is to bear the weight of the body. Vertebrae are larger in size in the lumbar spine to absorb stress from lifting and carrying heavy objects.

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The sacrum spine includes 5 vertebrae that are fused together and the main function is to connect the spine to the hip bones.

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The coccyx includes 4 fused vertebrae and is used as an attachment point for tendons, ligaments and muscles. It is also used as an insertion point of some of the muscle on the pelvic floor. Another function of the coccyx is to support and stabilize a person while they are in a sitting position.

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Overview

The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine. Yet, any of these structures affected by strain, injury, or disease can cause pain.

Spinal curves

When viewed from the side, an adult spine has a natural S-shaped curve. The neck (cervical) and low back (lumbar) regions have a slight concave curve, and the thoracic and sacral regions have a gentle convex curve (Fig. 1). The curves work like a coiled spring to absorb shock, maintain balance, and allow range of motion throughout the spinal column.

The abdominal and back muscles maintain the spine's natural curves. Good posture involves training your body to stand, walk, sit, and lie so that the least amount of strain is placed on the spine during movement or weight-bearing activities (see Posture). Excess body weight, weak muscles, and other forces can pull at the spine's alignment:

An abnormal curve of the lumbar spine is lordosis, also called sway back.

An abnormal curve of the thoracic spine is kyphosis, also called hunchback.

An abnormal curve from side-to-side is called scoliosis.

Muscles

The two main muscle groups that affect the spine are extensors and flexors. The extensor muscles enable us to stand up and lift objects. The extensors are attached to the back of the spine. The flexor muscles are in the front and include the abdominal muscles. These muscles enable us to flex, or bend forward, and are important in lifting and controlling the arch in the lower back.

The back muscles stabilize your spine. Something as common as poor muscle tone or a large belly can pull your entire body out of alignment. Misalignment puts incredible strain on the spine (see Exercise for a Healthy Back).

Vertebrae

Vertebrae are the 33 individual bones that interlock with each other to form the spinal column. The vertebrae are numbered and divided into regions: cervical, thoracic, lumbar, sacrum, and coccyx (Fig. 2). Only the top 24 bones are moveable; the vertebrae of the sacrum and coccyx are fused. The vertebrae in each region have unique features that help them perform their main functions.

Cervical (neck) - the main function of the cervical spine is to support the weight of the head (about 10 pounds). The seven cervical vertebrae are numbered C1 to C7. The neck has the greatest range of motion because of two specialized vertebrae that connect to the skull. The first vertebra (C1) is the ring-shaped atlas that connects directly to the skull. This joint allows for the nodding or "yes" motion of the head. The second vertebra (C2) is the peg-shaped axis, which has a projection called the odontoid, that the atlas pivots around. This joint allows for the side-to-side or "no" motion of the head.

Thoracic (mid back) - the main function of the thoracic spine is to hold the rib cage and protect the heart and lungs. The twelve thoracic vertebrae are numbered T1 to T12. The range of motion in the thoracic spine is limited.

Lumbar (low back) - the main function of the lumbar spine is to bear the weight of the body. The five lumbar vertebrae are numbered L1 to L5. These vertebrae are much larger in size to absorb the stress of lifting and carrying heavy objects.

Sacrum - the main function of the sacrum is to connect the spine to the hip bones (iliac). There are five sacral vertebrae, which are fused together. Together with the iliac bones, they form a ring called the pelvic girdle.

Coccyx region - the four fused bones of the coccyx or tailbone provide attachment for ligaments and muscles of the pelvic floor.

While vertebrae have unique regional features, every vertebra has three functional parts (Fig. 3):

a drum-shaped body designed to bear weight and withstand compression (purple)

an arch-shaped bone that protects the spinal cord (green)

star-shaped processes designed as outriggers for muscle attachment (tan)

Intervertebral discs

Each vertebra in your spine is separated and cushioned by an intervertebral disc, which keeps the bones from rubbing together. Discs are designed like a radial car tire. The outer ring, called the annulus, has crisscrossing fibrous bands, much like a tire tread. These bands attach between the bodies of each vertebra. Inside the disc is a gel-filled center called the nucleus, much like a tire tube (Fig. 4).

Discs function like coiled springs. The crisscrossing fibers of the annulus pull the vertebral bones together against the elastic resistance of the gel-filled nucleus. The nucleus acts like a ball bearing when you move, allowing the vertebral bodies to roll over the incompressible gel. The gel-filled nucleus contains mostly fluid. This fluid is absorbed during the night as you lie down and is pushed out during the day as you move upright.

With age, our discs increasingly lose the ability to reabsorb fluid and become brittle and flatter; this is why we get shorter as we grow older. Also diseases, such as osteoarthritis and osteoporosis, cause bone spurs (osteophytes) to grow. Injury and strain can cause discs to bulge or herniate, a condition in which the nucleus is pushed out through the annulus to compress the nerve roots causing back pain.

In rare cases, this leads to a weakening of the erection and a small amount of generic Cialis will help relieve the symptom, but the problem will still remain in the vertebra.

Vertebral arch & spinal canal

On the back of each vertebra are bony projections that form the vertebral arch. The arch is made of two supporting pedicles and two laminae (Fig. 5). The hollow spinal canal contains the spinal cord, fat, ligaments, and blood vessels. Under each pedicle, a pair of spinal nerves exits the spinal cord and pass through the intervertebral foramen to branch out to your body.

Surgeons often remove the lamina of the vertebral arch (laminectomy) to access the spinal cord and nerves to treat stenosis, tumors, or herniated discs.

Seven processes arise from the vertebral arch: the spinous process, two transverse processes, two superior facets, and two inferior facets.

Facet joints

The facet joints of the spine allow back motion. Each vertebra has four facet joints, one pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets) (Fig. 6).

Figure 6. The superior and inferior facets connect each vertebra together. There are four facet joints associated with each vertebra.

Ligaments

The ligaments are strong fibrous bands that hold the vertebrae together, stabilize the spine, and protect the discs. The three major ligaments of the spine are the ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL) (Fig. 7). The ALL and PLL are continuous bands that run from the top to the bottom of the spinal column along the vertebral bodies. They prevent excessive movement of the vertebral bones. The ligamentum flavum attaches between the lamina of each vertebra.

Figure 7. The ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL) allow the flexion and extension of the spine while keeping the bones aligned.

Spinal cord

The spinal cord is about 18 inches long and is the thickness of your thumb. It runs from the brainstem to the 1st lumbar vertebra protected within the spinal canal. At the end of the spinal cord, the cord fibers separate into the cauda equina and continue down through the spinal canal to your tailbone before branching off to your legs and feet. The spinal cord serves as an information super-highway, relaying messages between the brain and the body. The brain sends motor messages to the limbs and body through the spinal cord allowing for movement. The limbs and body send sensory messages to the brain through the spinal cord about what we feel and touch. Sometimes the spinal cord can react without sending information to the brain. These special pathways, called spinal reflexes, are designed to immediately protect our body from harm.

Any damage to the spinal cord can result in a loss of sensory and motor function below the level of injury. For example, an injury to the thoracic or lumbar area may cause motor and sensory loss of the legs and trunk (called paraplegia). An injury to the cervical (neck) area may cause sensory and motor loss of the arms and legs (called tetraplegia, formerly known as quadriplegia).

Spinal nerves

Thirty-one pairs of spinal nerves branch off the spinal cord. The spinal nerves act as "telephone lines," carrying messages back and forth between your body and spinal cord to control sensation and movement. Each spinal nerve has two roots (Fig. 8). The ventral (front) root carries motor impulses from the brain and the dorsal (back) root carries sensory impulses to the brain. The ventral and dorsal roots fuse together to form a spinal nerve, which travels down the spinal canal, alongside the cord, until it reaches its exit hole - the intervertebral foramen (Fig. 9). Once the nerve passes through the intervertebral foramen, it branches; each branch has both motor and sensory fibers. The smaller branch (called the posterior primary ramus) turns posteriorly to supply the skin and muscles of the back of the body. The larger branch (called the anterior primary ramus) turns anteriorly to supply the skin and muscles of the front of the body and forms most of the major nerves.

Figure 8. The ventral (motor) and dorsal (sensory) roots join to form the spinal nerve. The spinal cord is covered by three layers of meninges: pia, arachnoid and dura mater.

The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal. The 8 cervical spinal nerves are C1 through C8, the 12 thoracic spinal nerves are T1 through T12, the 5 lumbar spinal nerves are L1 through L5, and the 5 sacral spinal nerves are S1 through S5. There is 1 coccygeal nerve.

Figure 9. The spinal nerves exit the spinal canal through the intervertebral foramen below each pedicle.

The spinal nerves innervate specific areas and form a striped pattern across the body called dermatomes (Fig. 10). Doctors use this pattern to diagnose the location of a spinal problem based on the area of pain or muscle weakness. For example leg pain ( sciatica) usually indicates a problem near the L4-S3 nerves.

Figure 10. A dermatome pattern shows which spinal nerves are responsible for sensory and motor control of specific areas of the body.

Coverings & spaces

The spinal cord is covered with the same three membranes as the brain, called meninges. The inner membrane is the pia mater, which is intimately attached to the cord. The next membrane is the arachnoid mater. The outer membrane is the tough dura mater (Fig. 8). Between these membranes are spaces used in diagnostic and treatment procedures. The space between the pia and arachnoid mater is the wide subarachnoid space, which surrounds the spinal cord and contains cerebrospinal fluid (CSF). This space is most often accessed when performing a lumbar puncture to sample and test CSF or during a myelogram to inject contrast dye. The space between the dura mater and the bone is the epidural space. This space is most often accessed to deliver anesthetic numbing agents, commonly called an epidural, and to inject steroid medication (see Epidural Steroid Injections).

Sources & links

If you have more questions, please contact the Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Links

Spine-health.com
SpineUniverse.com

dorsal: the back or posterior side of the body.

kyphosis: an abnormal forward curvature of the thoracic spine, also called hunchback.

lordosis: an abnormal curvature of the lumbar spine, also called swayback.

paraplegia: paralysis of both legs and lower body below the arms indicating an injury in the thoracic or lumbar spine.

quadraplegia: paralysis of both legs and arms indicating an injury to the cervical spine.

scoliosis: an abnormal side-to-side curvature of the spine.

ventral: the front or anterior side of the body.

updated > 9.2018
reviewed by > Tonya Hines, CMI, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.

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Spine Anatomy, Anatomy of the Human Spine

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The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine.

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What could injuries do to the spine or cause to the body? 

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What could injuries do to the spine or cause to the body? 

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Damage to any part of the spine can be very dangerous, often it causes permanent changes in strength, sensation, and other body functions. Spinal cord injuries can result in one or more of the following symptoms

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-Loss of movement
-Loss or altered sensations, including the ability to feel heat or cold and touch
-Loss of bowel or bladder control
-Exaggerated reflex activities or spasms
-Pain or an intense stinging sensation caused by damage to nerves
- Difficulty breathing, coughing, or clearing secretions from your lungs

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-Extreme back pain or pressure in neck, head or back
-Weakness incoordination or paralysis in any part of the body
-Numbness, tingling or loss of sensations in your hands, fingers, feet or toes
-Loss of bladder or bowel control
-Difficulty with balance or walking
-Impaired breathing after injury
-An oddly positioned or twisted neck or back

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-Car accident - leading cause, almost half injuries per year
-Falls - after age 65 more than 15% are cause by falls per year
-Acts of violence- about 12% result from gunshots and knife wounds
-Sports or recreation injuries- impact sports, diving into shallow water causes about 10% per year
- Alcohol- is a factor is about 1 out of 4 spinal cord injuries
-Diseases - Cancer, arthritis, osteoporosis and inflammation can cause spinal cord injuries

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Spinal cord injury - Symptoms and causes

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Learn what may happen after the spinal cord has been damaged.

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1. Cardiac muscles
2. Smooth muscles
3. Skeletal muscles

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This muscle type is an involuntary and striated muscle that make up the main tissue of the walls of the heart.
Function: to pump blood throughout the body
Examples: Blood vessels

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This muscle type is where contractile fibril are not highly ordered, they occur in the gut and other internal organs and are involuntary.
Function: help women push her baby out when pregnant, in the bladder it helps push out urine. They also determine the flow of blood in the arteries, and move food through the digestive tract.
Example: Blood vessels and intestines

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This muscle type is a muscle that is connected to the skeleton to form parts of the mechanical system to move each limb in the body. These muscles are voluntary.
Function: Support and movement of the body. They are contractions and pull on tendons attached to the bones. If the muscles contract it shortens the muscle moving the limbs.
Examples: Biceps, Triceps, etc

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Muscle Tissue

Muscle is one of four different tissues found in our bodies. The other general tissue types include epithelial tissue, connective tissue, and nervous tissue. Specifically, we have three different types of muscle tissue, including skeletal, cardiac, and smooth. Each type of muscle is unique in terms of its structure and its function. Regardless of the specific type, all muscle serves the same general function, and that is support and movement. In other words, muscles contract, thus causing the body and body parts to move. In this lesson, we will compare and contrast the three different muscle types in terms of their structure and function.

Muscle Histology

Tissues are made of cells, and a muscle cell is referred to as a myocyte or sometimes simply a muscle fiber because some are long and they look like a fiber. Let's first compare muscle tissue based on what you would see under a microscope; that is, its histology.

Both cardiac and skeletal muscle are termed striated muscle, as they have striations that run across their muscle fibers. In contrast, smooth muscle is not striated, and it's, well, smooth. The striations are end-to-end junctions of repeating units that are referred to as sarcomeres. A sarcomere is a functional unit of striated muscle, as it contains all the tools necessary for contraction. In this sense, you can think of a smooth muscle as a giant sarcomere. Skeletal and cardiac muscle, while both striated, can be distinguished based on arrangement of the fibers. While skeletal muscle fibers are long and linear, cardiac muscle fibers are short and branched.

Looking at skeletal muscle with a microscope, we can see the fibers stacked neatly together in a parallel arrangement. Additionally, these fibers are long, and they run the entire length of the muscle organ. I guess this is what my mother expected my room to look like - nice and orderly.

Cardiac muscle, on the other hand, looks more like my kid's room - a complete mess. As the myocytes are branched, they run in different directions as they interconnect with one another. Additionally, cardiac fibers are connected end-to-end with each other with special structures called intercalated discs. The intercalated discs, like the striations separating the sarcomeres, run across the fibers. However, they appear darker on the slide, and they allow for direct communication between the adjacent myocytes.

Smooth muscles have a characteristic spindle shape.

Muscular Contraction

Skeletal muscle tissue is found in our skeletal muscles; for example, the biceps. Cardiac muscle is found in our heart, and smooth muscle is found in our visceral, or hollow, organs - for example, blood vessels and intestines. All muscles contract as a result of interaction between special proteins within the myocytes. Skeletal, cardiac, and smooth muscle cells synthesize the contractile proteins actin and myosin, which are needed for muscular contraction.

When the muscle cell is stimulated, actin and myosin interact in such a way to cause the cell to shorten and, thus, the muscle to contract. Furthermore, all muscles contract in response to intracellular calcium. In striated muscle, calcium binds to a regulatory protein called troponin, which allows actin and myosin to interact with each other. In smooth muscle, calcium binds to the regulatory protein calmodulin, which allows the contractile proteins to interact and, thus, the muscle to contract.

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cardiac & smooth - video & lesson transcript | study.com

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Types of Muscle Tissue: Skeletal, Cardiac & Smooth - Video & Lesson Transcript | Study.com

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Muscle is one of four different tissues found in our bodies. The other general tissue types include epithelial tissue, connective tissue, and nervous tissue. Specifically, we have three different types of muscle tissue, including skeletal, cardiac, and smooth. Each type of muscle is unique in terms of its structure and its function.

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A. My health experience- I have had regular check ups like you are recommend to have with you family doctors. I have had pretty good health throughout my life
B. Like I had a said before I have had a pretty good health throughout my life no major sicknesses that were particularly life threatening. I have had whopping cough in 4th grade, and have had strep throat a few times otherwise just common colds or flus.
C. I have had great experiences with healthcare. My family and I love our family doctor even though we try out best to not have to go see her with any injuries. I have also broken my patella and impact fractured my tibial plateau August 2017 and my health care team was great. They were very on top of thing to try and get me back to full health and back to the things that I love.

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This system consists of the heart, blood vessels, and blood. The 3 main functions are transportation of nutrients, oxygen, and hormones to cells throughout the body and removal of metabolic waste.

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1. The Heart: Organ that pumps blood throughout the body through blood vessels
2. Arteries: The blood vessels that take blood away from the heart
3. Veins: Blood vessels that return blood to the heart
4. Capillaries: Very small vessels that lie between the arteries and veins

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The system delivers nutrients and oxygen to all the cells in the body. The arteries carry blood away from the heart The veins carry the blood back to the heart
When the blood is being taken to the lungs from the heart it is low on oxygen and once it passes the lungs it bring oxygen rich blood back to the heart.

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1. 3D printing
2. Artificial intelligence
3. BCI and BBIs
4. Robotics
5. Electronic diagnoses
6. Patient-physician interaction technologies

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California-based research company organovo that has printed human liver tissue to get tested on certain sections of the liver. Thinking that in the future it will workout well enough to print organs for transplants.

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IBM's Watson is just the first step toward using this technology in medicine. The supercomputer that beat 2 human champions on Jeopardy! is now being used to diagnose and manage lung cancer treatment.

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As Brain-computer interfaces become more advanced, healthcare will incorporate more complex human-computer connections. The uses range from helping pain management to controlling robotic limbs. (Beckers hospital review) Harvard has made the first brain to brain interface. It allowed a human to control another humans movement and a rat's tail.

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They are quickly evolving medical treatment. Ekso Bionics launched the first version of its eksoskeletron enabling paraplegics to stand and walk independently.

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Technology promises to put the burden of care and diagnosis directly in the hands of patients. Making patients to not go to the doctor or hospital. Instead they can use an in home device to make it more accessible where it would send the data to the physicians then they would know if the patient needs to still come in to be seen in person.

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Want to shorten the process by making the first 3 steps to be done by the patient themselves to give the doctor more time directly with the patient.

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1. Chemical
2. Cell
3. Tissue
4. Organs
5. Systems
6. Organisms

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Used to make proteins
Example: Carbon, Proteins, fats, carbs, vitamins

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Molecules form cells
Example: Muscles, Nerves, Blood cells

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A group of similar cells that work together to perform a particular function
Example: Muscle tissues

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2 or more different tissues joined to have a specific function
Example:  Heart, Lungs, Liver

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Several related organs working together
Examples: Digestive system, Nerve system, Skeletal system

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one living organism all parts of the body functioning as one whole

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How has their health been in their lifetime?

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How has their health been in their lifetime?

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Mom: "Had a pretty good heath in lifetime"
Mom: "Had carpal tunnel surgery, and shoulder surgery."
Mom: "Most recent was heart valve surgery"

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Have they had any major medical issues and what was their experience with that?

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Have they had any major medical issues and what was their experience with that?

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Mom: "Major medical history would be finding out his heart valve was not good, his heart was but the valve was not working properly"

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What has been their experience with healthcare?

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What has been their experience with healthcare?

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Mom: "Overall has had good doctors none that he didn't like. He likes one doctor mainly where he actually drive an 1-2 hours for his doctors that he like that most unless in a huge emergency."

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Interview with my mother Pamela Kilian about Her father

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Interview with my mother Pamela Kilian about Her father