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Dimensions and relation- of Periodontology Chicago: The American Academy of ships of the dentogingival junction in humans order mentat ds syrup 100 ml without prescription. Histological determi- of definitions of periodontitis and methods that have been nation of probe tip penetration into gingival sulcus of used to identify this disease order 100 ml mentat ds syrup amex. J Clin Periodontol 2009;36(6): humans using an electronic pressure-sensitive probe buy mentat ds syrup paypal. Periodontol 2000 2007;43: surface characteristics on bacterial colonization and peri- 278–293. The management of inflammation in and incidence of coronary heart disease is significantly periodontal disease. Periodontol immune responses in pregnancy and periodontitis: relation- 2000 2001;25:100–109. Current interpretations of periodontal prob- 737 North Michigan Avenue, Chicago, Illinois. Woelfel, 267 dental hygiene students gingival sulcus is usually deeper interproximally. Similar measured their gingival sulcus depths with a calibrated measurements made on the mesiofacial aspect of mandib- periodontal probe. These measurements indicate that the on posterior teeth than those on anterior teeth. Root canals con- Root (pulp) nect to the pulp chamber through canal orifices on the canals floor of the pulp chamber, and pulp canals open to the out- Accessory canal side of the tooth through openings called apical foramina (singular foramen) most commonly located at or near the root apex (Fig. The shape and number of root canals Apical foramen in any one root have been divided into four major ana- tomic configurations or types (Fig. The pulp cavity of this either two canals or one canal that is spilt into two for part mandibular second molar is made up of a coronal pulp cham- ber with pulp horns and two root (pulp) canals. The four canal types are defined as follows: Type I—one canal extends from the pulp chamber to the apex. The ber and remain separate, exiting the root apically as number of pulp horns found within each cusped tooth two separate apical foramina. An exception is one type of maxillary lateral incisor (called a peg lat- Accessory (or lateral) canals also occur, located eral with an incisal edge that somewhat resembles one most commonly in the apical third of the root (Fig. Refer to Table 8-1 8-3A and B) and, in maxillary and mandibular molars, for a summary of the number of pulp horns related to are common in the furcation area. A scanning electron photomicrograph of an instrumented (cleaned) root canal of a maxillary central incisor. After cleaning the root canal, the tooth was split and mounted for viewing with the scanning electron microscope. This view shows the apex of the tooth at the top of the picture and includes the apical third of the root. Near the bottom of the picture (right wall of canal), an accessory canal can be seen at the arrow. A scanning electron photomi- crograph at a higher power of the accessory canal is observed in A. The adherent “stringy” extensions around the blood vessels are supporting collagen fiber bundles. Dennis Foreman, Department of Oral Biology, College of Dentistry, Ohio State University. Operating the lathe at a fairly best studied by the interesting operation of grind- high speed is less apt to flip the specimen from your ing off one side of an extracted tooth. If you can teeth should always be sterilized as described in the devise an arrangement by which a small stream of introduction of this text and kept moist. Wearing water is run onto the surface of the wheel as the a mask and gloves, you can use a dental lathe tooth is ground, you will eliminate flying tooth dust equipped with a fine-grained abrasive wheel about and the bad odor of hot tooth tissue. Pulp Chamber and Pulp Horns frequently dipping the surface being ground in water of Anterior Teeth or by dripping water onto the wheel with a medicine dropper. Look often at the tooth surface you are When an incisor is cut mesiodistally and viewed from cutting and adjust your applied pressure to attain the facial (or lingual) (similar to the view on dental the plane in which you wish the tooth to be cut. A radiographs), the pulp chambers are broad and may high-speed dental handpiece and bur will greatly appear as three pulp horns. However, the incisal border of the pulp wall (roof of the chamber) As you examine different sides of each kind of tooth, of a young tooth may show the configuration of three notice how the external contours of the pulp cham- mamelons, that is, has developed with three pulp horns: ber are similar to the external morphology of the located mesially, centrally, and distally. On incisors and canines, you can remove that there is an unusual peg lateral incisor that only has either the facial or lingual side from some teeth to one pulp horn. When an anterior tooth is cut labio- On premolars and molars, the removal of either the lingually and viewed from the proximal, the pulp cham- mesial or distal side will expose the outline of the bers taper to a point toward the incisal edge (Fig. Finally, on Recall that all anterior teeth are most likely to have one molars, the removal of the occlusal surface will reveal root. The number of root canals in each type of anterior the openings (orifices) to the root canals on the floor tooth is also most frequently one. Maxillary central inci- of the pulp chamber (as seen later in the diagram in sors, lateral incisors, and canines almost always have Fig. Sectioned teeth showing pulp cavity shapes relative to the external tooth surface. Mesiodistal section of a maxil- lary central incisor showing only two of its three pulp horns. Faciolingual section of a maxillary first premolar with two roots and two obvious pulp horns, one under each cusp. The high pulp horns (only two are visible in this tooth section) and the broad root canal indicate that this is a young tooth. The pulp chamber of this older tooth is partially filled with secondary dentin, and the root canal is narrower than in the tooth shown in A. Thus, two roots (though still uncommon), one facial and one the buccal horns are longer than the lingual horns. Therefore, the premolars that are the two- cusp type most often have two pulp horns (Fig. Pulp Chambers and Pulp Horns in Premolars molars that have a functionless lingual cusp may have When premolars are cut mesiodistally and viewed from only one pulp horn (Fig. Root Canal(s) and Orifices of Premolars the pulp chamber is curved beneath the cusp similarly to the curvature of the occlusal surface. When cut bucco- Maxillary first premolars most often have two roots lingually and viewed from the proximal, the pulp cham- (one buccal and one lingual) and two canals (one in ber often has the general outline of the tooth surface, each root as seen in Fig. Even maxillary first pre- sometimes including a constriction near or apical to the molars with a single root almost always have two canals.

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Contraception should be discussed with females of child-bearing age order mentat ds syrup 100 ml, as pregnancy carries a 30% to 50% mortality risk and is contraindicated generic mentat ds syrup 100 ml line. If flying buy cheap mentat ds syrup 100 ml line, supplemental oxygen should be used if the patient’s preflight saturation is less than 92%. Careful reassessment for safety and efficacy is mandatory, because only half of these patients will prove to be long-term responders and many will need additional vasodilators. Prostacyclin is a potent endogenous vasodilator and an inhibitor of platelet aggregation and also appears to have antiproliferative activity. Treprostinil (Remodulin) is another prostacyclin analog that can be administered by inhalation, orally, or via continuous subcutaneous pump. Copyright © 2009 American College of Cardiology Foundation and the American Heart Association, Inc. Liver injury and teratogenicity are major concerns and require monthly monitoring. Sildenafil (Revatio) has favorable effects on exercise capacity, symptoms, and hemodynamics. Tadalafil (Adcirca) has the same effects, although it also delays the time to clinical worsening. Combination therapy is being routinely employed if treatment goals are not achieved with one compound (“goal- directed therapy”). The rationale is based on attacking different pathologic processes with different agents. It is recommended that surgical evaluation and procedure be performed at high-volume centers. This may help target future research and identify those patients who would benefit from management at a specialized center where a multidisciplinary approach may be provided. Although this raises valid concerns regarding the long-term benefit of many expensive drugs, it is interesting that the overall survival in this patient population is improving. Pulmonary vasodilators have generally been ineffective or harmful in patients with left-sided heart failure. One study, PhosphodiesterasE-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure Study, is currently enrolling participants to study the effect of sildenafil in patients with diastolic heart failure. The natural history of this group shows survival rates of 68%, 48%, and 34% after 1, 3, and 5 years, respectively. There is registry level evidence that prognosis has improved with pulmonary vasodilator therapies. A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc. A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Early detection of pulmonary arterial hypertension in systemic sclerosis: a French nationwide prospective multicenter study. The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. Pulmonary hypertension in heart failure: pathophysiology, pathobiology, and emerging clinical perspectives. Stenosis most commonly occurs at the level of the valve; however, subaortic stenosis and supravalvular stenosis are also well-defined entities. Although initially thought to be the result of normal “wear and tear” of the valve leaflets, there is now ample evidence that suggests that the progression of stenosis is related to an activeprocess of inflammation involving the renin–angiotensin system, lipid accumulation, and resultant calcification. Several inflammatory pathways are implicated, including those that utilize osteopontin, bone morphogenic proteins, and receptor activator of nuclear factor-κB ligand. Recent studies suggest that those with excess lipoprotein (a) are at greater risk of aortic valve calcification and progression to stenosis. The most common abnormality seen in bicuspid valves is fusion of the right and left coronary cusps (79. Concurrent dilation of the thoracic aorta occurs in as many as 50% of patients, while coarctation, aortic dissection, and coronary anomalies are seen in a minority of patients. The mainstay of diagnosis is echocardiography (transthoracic or transesophageal if transthoracic imaging is suboptimal; 92% sensitivity and 96% specificity if adequate images are obtained). The diagnosis is made during systole in the short-axis view and classically the valve opens as an oval rather than as a triangle in normal people. In addition, if the surgery is to be performed by an experienced aortic surgical team and the patient has a low surgical risk, it is reasonable to perform aortic surgery once the aorta is ≥5. Increasingly, the impact of patient size on aorta size is being appreciated and therefore when the maximal ascending/aortic root area in square centimeter divided by patient’s height in meters exceeds 10, this is considered an indication for surgical intervention by some authorities. In more extreme cases, a tunnel-like obstruction may be present, rather than a discrete membrane. It may exist with other left-sided obstruction lesions, such as coarctation or as part of Shone syndrome. Characteristic features of Williams syndrome include hypercalcemia, elfin facies, developmental delay, small stature, and multiple stenoses in the aortic and peripheral arteries. Lipid deposits in severe forms of familial hypercholesterolemia may also cause obstruction above the valve in the ascending aorta. In response to the pressure overload and increased wall stress, the left ventricle undergoes compensatory concentric hypertrophy. Myocardial oxygen is determined by heart rate, contractility, and myocardial wall stress imposed on the left ventricle by progressive pressure overload. The imbalance between myocardial oxygen supply and demand can precipitate ischemia during exertion even in the absence of significant obstructive coronary disease. Although the underlying cause helps predict the age of symptom onset, there is marked individual variability in the length of the latent period and the subsequent rate of progression of disease. Once the valve becomes severely stenotic, as evidenced by a peak Doppler velocity of 4 m/s, the likelihood of development of symptoms or requiring surgical intervention over the following 2 years is very high. Patients with angina have a 50%, 5-year survival rate without surgical intervention. Those with syncope have a 50%, 3-year survival rate without surgical intervention. Patients with heart failure have a mean survival time of <2 years if treated medically. The ensuing hypotension can cause presyncope, syncope, or even cardiovascular collapse and death.

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The two conditions purchase mentat ds syrup with mastercard, though sharing to some extent the same diagnostic “label purchase mentat ds syrup toronto,” are significantly different discount mentat ds syrup 100 ml visa. Rather, they have personality traits, attitudes, and general behavior characterized by perfectionism, moral inflexibility, and difficulties in delegating tasks to others. Probably more than any other class of symptoms, obsessions and compulsions are present in various diagnostic categories and should be considered to a certain extent as transdiagnostic. They may affect persons with a high level of relational and social functioning, as well as patients with a frankly psychotic structure and functioning. Conveying the message that hostile and selfish thoughts are understandable and not inherently dangerous may also be of help. Although nota- bly challenging clinically, some obsessions and compulsions remit when the afflicted person can express the feelings connected with difficult experiences—especially nor- mal disappointment, anger, and grief. As noted above, obses- sions include ruminations and horrific temptations; compulsions include rituals. The subject unsuccessfully resists either one, resulting in unpleasant repetition. Onset is generally in adolescence or early adulthood and tends to be earlier in males and in those with a tic disorder. Depression is not uncom- mon, with suicidal ideation and plans related to the sense of being unable to deal with symptoms in everyday life. When insight is largely absent and close to delusional think- ing, a person is likely to project aggression into others, thereby feeling actively isolated by others or in danger from them. When individuals with this disorder are prevented from carrying out their compulsions or rituals, they may become diffusely terrified, irritable, or overtly aggressive. Behind such symptoms, psychoanalytic clinical expe- rience points to a range of unconscious concerns, including potential loss of control (especially with respect to contamination, aggression, and shame). Cognitive Patterns Insight is a critical dimension in assessing individuals with obsessions and compul- sions. Obsessions may be recognized as a mental dysfunction, something that interferes with the common functioning and flow of thinking, and may be experienced as highly ego-dystonic, disturbing, and intrusive. Magical thinking in the absence of insight may seem delusional; patients with intact insight tend to find it absurd and shameful. Compulsive activity is often a remnant of the magical thinking of early childhood, when impulses and actions were incompletely differentiated. Thus, individuals with obsessive–compulsive symptoms may be understood as having convicted themselves unconsciously of thought crimes (hostile, selfish cognitions), which continue to haunt them in the form of obsessive images and ideas, motivating attempts to expiate their guilt through rituals that repre- sent the defenses of reaction formation and undoing. In subjects with contamination obsessions and severe cleaning/washing compulsions, it is quite frequent to see health problems (e. In addition, even though it is not exactly a somatic state but rather a motor disturbance, it should be noted that patients with obsessions and compulsions may present with co-occurring motor tics (approximately 30% over a lifetime, according to recent epidemiology studies). Relationship Patterns Obsessions and compulsions may severely affect quality of life by impairing social and relational functioning. In some severe cases, they intrude into the persons’ lives, lead- ing to social isolation. In general, afflicted individuals tend to remain in relationships if they can control the partner. They may also choose significant others who actively reas- sure them in their symptoms or even become participants in their compulsive rituals. The Subjective Experience of the Therapist The internal experience of a person with an obsession has often been intuited as shaped by a struggle between besieging and besieged parts of the mind. Countertransference may be dominated by themes of “control” as patients try to control their lives and behaviors— efforts often deemed as tragically defeated. Whatever strength is expended in efforts to control inner life by throwing rejected thoughts out the window is sabotaged by their quickly and triumphantly reentering via the front door as uncontrolled compulsions. Clinical Illustration A 33-year-old man comes to a therapist after being fired for delays in completing work assignments. He is very anxious about his future, with pessimism not only about finding another job, but also about the future of his marital relationship: His wife is becoming less and less tolerant of what she calls his “manias. There are too many contaminants outside, and so I take particular care of my hands and clothes. I wash my hands up to 30 times a day, and clean my desk and computer quite often with special products to remove the dust and to kill all the germs. I know that this is time-consuming, but it is necessary to prevent contamination and diseases. Many sufferers spend several hours a day attempting to conceal or cor- rect their perceived flaws, which may be really present though exaggerated in severity. Earlier literature reported gender-based discrepancies about prevalence, which likely arose from inconsistent views among researchers prior to the creation of standardized questionnaires and more clinical assessment. Age at onset is usually adolescence (prompted by the somatic changes of puberty) or early adulthood. Current models include aesthetic sensitivity and the self as an aesthetic object, social pressure to appear “perfect,” and neurobiological predisposition. From a psychoanalytic perspective, pervasive identification with an uncompromising ego ideal underlies these excessive bodily concerns, with severity in direct proportion to ego-ideal demands, which may be persecutory. The criticized part of the body thus represents a hated part of one’s personality. A second psychoanalytic construct is the “body-self”: the body image that devel- ops within the self in the context of the early relationship with the “object of desire,” usually the mother. In some cases, severe depression may occur, and sui- cidal risk becomes a critical issue to be carefully assessed in clinical settings. Mood swings are frequent, as the incomplete or unstable sense of self (largely reduced to the body-self) follows the concerns about being ugly and not acceptable to others. Irrita- bility may occur when the person cannot obtain the reassurances he or she is seeking compulsively or when the aesthetic, medical, or surgical interventions do not have the expected outcome. Insight varies along a continuum with two extremes: Symptoms may be recognized as absurd or exaggerated concerns and behaviors (good insight) or may be psychotically denied, with the insistence that such “real” physical problems call for medical or surgical attention. Severe dam- age to relationships is also common since the affected individuals may be too scared or ashamed by their physical appearance to get involved in close relationships. In some cases, patients’ significant others may be used as “special” source of reassurance. The disorder is diagnosed when there is a pattern of compulsive and excessive acquisition of, and inability or unwillingness to separate from, many and various objects that have no objective value or use (e. When severe, hoarding may so compromise the home living space that it limits activities such as cleaning, moving around, cooking, and even sleeping.

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Plantar fibromatosis is more common in males and can be associated with other forms of fibromatosis such as its palmer equivalent Dupuytren disease and Peyronie disease mentat ds syrup 100 ml fast delivery, which is penile fibromatosis order on line mentat ds syrup. While there are no clear pathophysiologic predictors for the condition purchase mentat ds syrup with amex, plantar fibromatosis may be associated with areas of repeated trauma, epilepsy, alcoholism, hypothyroidism, hypothyroidism, diabetes mellitus, and especially hereditary factors. Treatment is necessary only if the lesion is painful from pressure on surrounding structures. Surgery involves radical resection with large margins of normal-appearing plantar fascia; reoccurrence rate is high. Nodular Fasciitis (Pseudosarcomatous Fasciitis) Nodular fasciitis is a benign, self-limiting, fibroblastic proliferation most commonly seen in the forearm; lower extremity involvement is relatively uncommon. Lesions present as rapidly growing, firm, soft tissue nodules in the subcutaneous tissue. They are far more frequent in organ systems such as the gastrointestinal tract and the female genital system. When found in the soft tissue, leiomyomas are confined to the superficial subcutaneous tissue and skin. Basic types are as follows: Angioleiomyoma Angioleiomyomas are benign leiomyomas arising from vascular smooth muscle. There may be an increase in size and pain at the site of the lesions during physical activity or during temperature changes due to the vascular nature of the lesions. Pilar Leiomyoma (Leiomyoma cutis) A benign smooth muscle tumor arising from the arrector pili muscles that are attached to each hair follicle. Pilar leiomyomas occur only where there is hair and so are not found on the plantar surface of the feet. They present as well-circumscribed, smooth, firm, reddish-brown nodules ranging their size from 2 to 15 mm. They are often tender or painful, and pain may increase in situations when the hairs stand on end, commonly referred to as “goose bumps. When found in the soft tissue, leiomyosarcomas are confined to the superficial subcutaneous tissue and skin and are more common on the dorsum vs. Present as a large painful or tender nodule with possible skin discoloration and ulceration. Treatment is excision with a large margin of clinically normal surrounding tissue; amputation may be necessary along with chemotherapy and irradiation. Myositis Ossificans (Munchmeyer Disease) A benign reactive lesion of striated muscle resulting from trauma. They present as soft (doughy), freely moveable, lobulated masses that usually arise superficially in the subcutaneous tissue. They are the most common benign soft tissue tumor in adults, and usually occur between ages 50 and 60 years. Lipomas can occur anywhere, although neck, shoulder, arms, and trunk are most common, rarely found in the foot. Multiple lipomas are seen in several syndromes, including Gardner syndrome and neurofibromatosis. It usually occurs between ages 20 and 40 years and is benign and presents much the same as lipoma. Liposarcoma Liposarcomas are a slow-growing malignant tumor of adipose tissue seen most commonly between ages 40 and 60 years. Usually arising from deep in the subcutaneous tissue or between the fascial planes of major muscle groups. Liposarcomas may occur almost anywhere but are most commonly seen in the upper thigh, buttocks, or back. Compared with lipomas, liposarcomas tend to be somewhat more firm, less compressible, and less freely moveable and are found deeper in the tissue than benign lipomas. Treatment may include amputation, chemotherapy, and irradiation; check for metastasis. One of the most common soft tissue sarcomas in adults; however, it is still about 100 times less common than a benign lipoma. Angiolipoma Angiolipomas are essentially the same as lipomas but have a vascular component and are painful. Piezogenic Pedal Papule Benign herniation of subcutaneous fat into the dermal connective tissue found frequently on the lateral and medial aspect of the weight-bearing heel. Piezogenic pedal papules usually measure less than 10 mm in diameter and tend to be more common in obese patients due to pressure. When symptomatic, treatment involves heel-cupping orthoses and weight loss programs. Neurofibromas feel “rubbery” on palpation and are more prone to becoming malignant as compared with neurilemmonas. When multiple cutaneous lesions are noted along with café au lait spots, the condition is called von Recklinghausen disease. In von Recklinghausen disease, the skin lesions may produce protuberant, saggy, disfiguring masses. Solitary neurofibromas are usually small, superficial nodules that are asymptomatic. Due to its central location in the peripheral nerve, the entire nerve segment is usually required during excision. Neurilemmomas present as a solitary, painless, fusiform, round, or oval mass that is sharply circumscribed and encapsulated. Tumors develop along the course of digital nerves and tend to favor the flexor surfaces of the extremity. Due to its eccentric location, the nerve of origin is rarely damaged during excision. The cyst is filled with synovial fluid, forming a fluctuant mass that readily transmits light. A pen light placed on the side of the ganglion will cause the whole cyst to glow (transilluminate). Although the skin is freely moveable over the ganglion, the ganglion itself is usually firmly tied to its structure of origin so that it cannot be mobilized over the underlying bones and joints.

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Basset lesion A lesion on the anterior dorsal lateral aspect of the articular cartilage of the talus caused by rubbing from a hypertrophic anterior inferior tibiofibular ligament order genuine mentat ds syrup line. In the majority of patients purchase genuine mentat ds syrup line, there is a preceding condition such as stress best order mentat ds syrup, fatigue, or a common cold. The disorder involves the seventh cranial nerve and the facial muscles it supplies. Blair fusion An ankle fusion salvage procedure used when the talar body is missing or cannot be salvaged. Brodie abscess A foci of bone destruction caused by osteomyelitis filled with pus or connective tissue. Carcinoma A malignant tumor arising from epidermis or visceral organ cells and tends to give rise to metastases. Cheyne–stokes respirations Repeating cycle of gradual increase in depth of breathing followed by gradual decrease in depth of breathing until apnea occurs. Coleman block test Determines whether a rearfoot varus deformity is flexible or rigid. The patient is placed on a wooden block 1 inch thick such that the entire foot is standing on the block except the medial forefoot. In a flexible rearfoot varus, the 1st metatarsal will plantarflex down to the ground and the rearfoot varus will evert into a corrected position. Constitutional symptoms Symptoms which are indicative of disorders of the whole body. Crescent sign The early sign of avascular necrosis, which represents a subchondral fracture through the insertion of the individual trabeculae. Crista A ridge in the plantar articular surface of the 1st metatarsal head that separates the sesamoids. Cyma line A smooth “S” configuration formed by the talonavicular and calcanealcuboid joints seen on a lateral x-ray. With a pronated foot the cyma, line is anteriorly displaced, meaning that the talonavicular joint is anterior to the calcanealcuboid joint and does not follow a nice “S” shape. Cytochrome P450 Cytochrome P450 constitutes a family of enzymes that metabolize a variety of endogenous and exogenous substances in the liver, most notably drugs. The 450 comes from the fact that they maximally absorb light at 450 nm wavelength. The significance of the enzyme comes from the fact that many drugs may be largely dependent on a single form of P450 for their metabolism in the liver. If the enzyme is actively metabolizing a particular drug and another drug is administered that relies on the same for P450 for its metabolism, the drug may reach toxic levels at relatively low doses. Classic facial features include an epicanthal fold, thick lips, large tongue with deep furrows, and a small nose with a broad bridge. Other features may include a broad short neck, clinodactyly of the fifth finger, syndactyly, polydactyly, and a simian line (a single transverse palmer crease). Eburnation The final end product of bone sclerosis and is sometimes used as a term that is synonymous with bone sclerosis. Ehlers–Danlos syndrome Collagen and elastic tissues are abnormal, resulting in thin, easily stretched hyperelastic skin. Ligamentous laxity, resulting in flat feet, genu valgus, congenital hip dislocation, and scoliosis. Endoneurium The interstitial connective tissue in a peripheral nerve, surrounds a single nerve fiber. Enthesitis Inflammation of the entheses, the site where a tendon or ligament attaches to bone. Fibrous dysplasia An abnormal bone growth where normal bone is replaced with fibrous bone tissue. Fistula Abnormal communication between two hollow, epithelialization organs or between a hollow organ and the exterior (skin). Genu varum Bowleg, may be associated with Rickets, abnormal Ca and Ph metabolism, or Blount disease. Gigli saw A bone saw that consists of a flexible roughened wire used to cut through bone. Because of muscle weakness, patients raise themselves to the standing position by crawling up their legs. Hanging heel sign Used in the diagnosis of metatarsus adductus, the deformity persists as viewed plantarly when the foot is lifted by the toes. Hematoma Accumulation of blood within the tissue, which clots to form a solid swelling. The tuber fragment displaces superiorly, relaxing the triceps and decreasing its plantarflexory power. Hoke tonsil The fat plug in the sinus tarsi that is removed during sinus tarsi surgery. Homocystinuria Clinically very similar to Marfan syndrome except that the patients are mentally retarded and excrete large amounts of homocystine in their urine. Hunting response A secondary vasodilation response that occurs after prolonged vasoconstriction due to cold application. Ichthyosis Abnormal cornification of the skin, resulting in dryness, roughness, and scaliness. Results from hypertrophy of the horny layer resulting from excessive production of keratin. Islet of Langerhans A type of tissue found scattered throughout the pancreas, involved in glucose metabolism. Jones compression dressing The Robert Jones dressing is a thick, well-padded dressing. Push up on the plantar surface of the metatarsal head and see if the toe straightens out. Kussmaul respiration Deep, rapid respiratory pattern seen in coma or diabetic ketoacidosis. Kyphosis Excessive primary curvature of the thoracic spine (hunch back), associated with aging, especially in women. Lister’s corn Painful corn that develops in the lateral nail groove of the fifth toe from the varus rotation of the phalanx. Lordosis Excessive secondary curvature of the lumbar spine (sway back), often seen during pregnancy. Maceration A white soggy appearance that the skin takes on after tissue is soaked.