Middleton Position

Because of its peculiar position between the acromioclavicular arch and the humeral head, only the distal part of the supraspinatus tendon can be examined while keeping the patient s arm in neutral position (Fig. 6.29a). To obtain a more complete visualization of this tendon, the patient is asked to extend the arm posteriorly, placing the palmar side of the hand on the superior aspect of the iliac wing with the elbow flexed, directed posteriorly and toward the midline, so that the acromion is moved away from it (Fig. 6.29b). With this maneuver (commonly known as the modified Crass or Middleton position), the tendon is depicted in its full extent, even including visualization ofits myotendinous junction (Crass et al. 1988b Middleton et al. 1992). When the patient assumes this position, the supraspinatus rotates and becomes a more anterior structure (Fig. 6.29b). Some... 

Gilson 300 position programmable Gilson International Box 27 300 W Beltine Middleton Wisconsin 53562 USA... 

The equilibrium position of this reaction is 6 X 10 which is quite unfavorable for the synthesis of acetoacetyl-CoA. However, as will be pointed out below, when it functions in conjunction with the next enzyme in the sequence, synthesis is favored. The turnover number in the forward direction (as written) was found to be 1770 while that of the reverse was 54000. The enzyme from mitochondria has two electrophoretically distinct forms, and the cytoplasmic enzyme could be clearly distinguished from the two mitochondrial proteins by the difference in their isoelectric points. Middleton surveyed many tissues from rat as well as selected tissues from ox and pigeon for both the cytoplasmic and the mitochondrial enzymes. The highest levels of the cytoplasmic enzyme were found in the liver, adrenal, brciin of the neonate, and ileum [14,15]. There was an obvious positive correlation between sterol biosynthetic capacity and the distribution of this enzyme. The mitochondrial enzyme was found predominantly in heart, kidney, and liver. The cytosolic enzyme has also been highly purified from rat liver [16]. 

See Richard of Middleton s presentation of the unitist position in the edition of his De gradu forjmrum published by Zavalloni, Richard de Mediavilla, pp. 42-43,11. 37-49 (for the argument from De animd) and pp. 45-46,11. 85-96 (for the passage from the Metaphysics). 

Note. If the substance is suspected to be an ammonium salt of a nitrogen-containing acid, heat it with sodium hydroxide solution until all ammonia has been driven off. Acidify the solution, evaporate it carefully to drjmess, and apply the Middleton test for nitrogen. A positive result will confirm the presence of nitrogen in the free acid. 

---