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Also identifiable in this micrograph is a dense connective tissue surrounding the muscle prostate 64 purchase confido 60 caps with amex, namely epimysium (E). This higher magnification of a longitudinal section of a muscle reveals two muscle fascicles (F). With few exceptions, the nuclei (N), which tend to run in linear arrays, belong to individual muscle fibers. The inset, taken from a glutaraldehyde-fixed, plastic-embedded specimen, is a much higher magnification of a portion of two muscle fibers. The major bands are readily identifiable at this magnification and degree of specimen preservation. Between A bands is a lightly stained area, the I band, which is bisected by the Z line. Below them are a capillary (C) and a portion of an endothelial cell nucleus (End). At this higher magnification, the endothelial nuclei, as well as the nuclei of the fibroblasts, can be distinguished from the muscle cell nuclei by their smaller size and heterochromatin, giving them a dark stain. The muscle cell nuclei (N) exhibit more euchromatin with a speckling of heterochromatin, thus giving them a lighter staining appearance. For example, if one imagines a cut crossing a number of cells (see dashed line), the close proximity of the muscle cells can mask the boundary between individual cells within a fascicle when observed in the opposite or longitudinal plane. At this magnification, it is difficult to distinguish between occasional fibroblasts that belong to the endomysium from the nuclei of the muscle cells. Myofibrils are best seen at higher magnification in the light microscope in a cross-section of the cell where they appear as dot-like structures. It is the arrangement of the thick and thin filaments that produce density differences that in turn create the cross-striations of the myofibril when viewed in longitudinal section. Careful examination of the A band in the light microscope reveals a light-staining area in the middle of the A band. This is referred to as the H band, which is occupied by thick filaments and is devoid of thin filaments. At the middle of each I band is the thin, dense Z line to which the thin filaments are attached. The filaments, however, maintain a constant length, thus, the contraction is produced by an increase in the overlap between the two filament types. Of the many nuclei that can be observed in this plane of section, only some belong to the muscle fibers. Other nuclei that may be present but are very difficult to identify belong to satellite cells. Although they appear to be markedly different in width, the difference is due mainly to the plane of section through each of the fibers. Because the nuclei of the muscle fibers are located at the periphery of the cell, their location is variable when observed in a longitudinal section.
Syndromes
Some functionally important phagocytic cells are not derived directly from monocytes prostate cancer untreated confido 60 caps order free shipping. For example, microglia are small, stellate cells located primarily along capillaries of the central nervous system that function as phagocytic cells. Also, fibroblasts of the subepithelial sheath of the lamina propria of the intestine and uterine endometrium have been shown to differentiate into cells with morphologic, enzymatic, and functional characteristics of connective tissue macrophages. These cells are able to phagocytose avidly vital dyes such as trypan blue and India ink, which makes them visible and easy to identify in the light microscope. Mast cells can also be activated by the IgE-independent mechanism during complement protein activation. Two types of human mast cells have been identified based on morphologic and biochemical properties. Most mast cells in the connective tissue of the skin, intestinal submucosa, and breast and axillary lymph nodes contain cytoplasmic granules with a lattice-like internal structure. In contrast, mast cells in the lungs and intestinal mucosa have granules with a scroll-like internal structure. Mast cells are especially numerous in the connective tissues of skin and mucous membranes but are not present in the brain and spinal cord. On the basis of its anticoagulant properties, heparin is useful for treatment of thrombosis. Tryptase is selectively concentrated in the secretory granules of human mast cells (but not basophils). It is released by mast cells together with histamine and serves as a marker of mast cell activation. The secretions of eosinophils counteract the effects of the histamine and leukotrienes. Similar to histamine, leukotrienes trigger prolonged constriction of smooth muscle in the pulmonary airways, causing bronchospasm. The bronchoconstrictive effects of leukotrienes develop more slowly and last much longer than the effects of histamine. Bronchospasm caused by leukotrienes can be prevented by leukotriene receptor antagonists (blockers) but not by antihistaminic agents. The leukotriene receptor antagonists are among the most prescribed drugs for the management of asthma; they are used for both treatment and prevention of acute asthma attacks. It increases expression of adhesion molecules in endothelial cells and has antitumor effects.
Tonsils prostate cancer 75 unnecessary operations purchase confido 60 caps with amex, like other aggregations of lymphatic nodules, do not possess afferent lymphatic vessels. Lymph, however, does drain from the tonsillar lymphatic tissue through efferent lymphatic vessels. In other sites, the lymphocytes (Ly) have infiltrated the epithelium to such an extent that the epithelium is difficult to identify. The body of the nodules (N) lies within the mucosa and because of their close proximity, they tend to merge. Beneath the nodules is the submucosa (S) consisting of dense connective tissue, which is continuous with the dense connective tissue beyond the tonsillar tissue. At the higher magnification of this micrograph, the characteristic invasiveness of the lymphocytes into the overlying epithelium is readily evident. Note on the lower left side of the micrograph a clear boundary between the epithelium and the underlying lamina propria. The underlying lamina propria is occupied by numerous lymphocytes; only a few have entered the epithelial compartment. In contrast, the lower right side of the micrograph displays numerous lymphocytes that have invaded the epithelium. More striking is the presence of what appear as isolated islands of epithelial cells (Ep) within the periphery. The thin band of collagen (C) lying at the interface of the epithelium is so disrupted in this area that it appears as small fragments. They serve as filters of the lymph and as the principal site in which T and B lymphocytes undergo antigen-dependent proliferation and differentiation into effector lymphocytes (plasma cells and T cells) and memory B cells and T cells. A low-magnification (14) micrograph of a section through a human lymph node is shown on this page for orientation. The parenchyma of the node is composed of a mass of lymphatic tissue, arranged as a cortex (C) that surrounds a less dense area, the medulla (M). The cortex is interrupted at the hilum of the organ (H), where there is a recognizable concavity. It is at this site that blood vessels enter and leave the lymph node; the efferent lymphatic vessels also leave the node at the hilum. Afferent lymphatic vessels penetrate the capsule at multiple sites to empty into an endothelium-lined space, the cortical or subcapsular sinus.
Agrin (500 kDa) is another important molecule found almost exclusively in the glomerular basement membrane of the kidney prostate cancer under 40 buy confido 60 caps mastercard. It plays a major role in renal filtration as well as in cell-to-extracellular matrix interactions. These proteins are synthesized and secreted by the epithelial cells and other cell types that possess an external lamina. These cross-shaped glycoprotein molecules (140 to 400 kDa) are composed of three polypeptide chains. The 7S domain of the tetramer (called the 7S box) determines the geometry of the tetramer. The primary sequence of these molecules contains information for their self-assembly (other molecules of the basal lamina are incapable of forming sheet-like structures by themselves). Studies using cell lines have shown that the first step in self-assembly of the basal lamina is calciumdependent polymerization of laminin molecules on the basal cell surface domain. These two structures are joined together primarily by entactin/nidogen bridges and are additionally secured by other proteins (perlecan, agrin, fibronectin, etc. Next, four dimers join together at their 7S domains to form tetramers connected by the 7S box. The reticular lamina, as such, belongs to the connective tissue and is not a product of the epithelium. In normal kidney glomeruli, for example, no collagen (reticular) fibers are associated with the basal lamina of the epithelial cells. Several structures are responsible for attachment of the basal lamina to the underlying connective tissue. They either extend from the basal lamina to the structures called anchoring plaques in the connective tissue matrix or loop back to the basal lamina. To produce a basal lamina, each epithelial cell must first synthesize and secrete its molecular components. The calcium-dependent polymerization of laminin molecules that occurs at the basal cell surface initiates basal lamina formation. These two structures are connected by entactin or nidogen bridges and are additionally secured by other proteins. The epithelial cell is located on the outer (abluminal) surface of the endothelial cell. Note that the endothelial cells and epithelial cells are separated by the shared basal lamina and that no collagen fibrils are present.
Many of the epithelial cells in the secretory segment of these glands exhibit an apical bleb-like protrusion that was earlier thought to represent their mode of secretion mens health cover model 2013 trusted confido 60 caps. The secretion is a clear, viscous product that becomes odiferous through the action of resident microbes on the skin surface. In the human, its role is unclear, but it is generally believed that the secretion may act as a sex attractant (pheromone). Apocrine glands are present at birth but do not fully develop and become functional until puberty. In the upper part of this image are two sweat glands (SwG) also surrounded by dense connective tissue. Note the considerable difference in diameter and lumen size of the two types of glands. The epithelium (Ep) of the apocrine sweat gland from the boxed area to the left is simple columnar. At other sites, the cells have been sectioned tangentially and appear as a series of parallel linear profiles (MyC). In this micrograph, the eccrine sweat gland from above is seen at higher magnification. The epithelium of the secretory segment is simple columnar; the duct segment is two cell layers thick, namely, stratified cuboidal. When the tubule wall of the secretory segment is cut in a perpendicular plane, the simple columnar nature of the epithelium (Ep) is evident. Because the tubule is so tortuous, more often the epithelium appears to be multilayered. Under conditions of high ambient temperature, water loss is increased by an increased rate of sweating. This thermoregulatory sweating first occurs on the forehead and scalp, extends to the face and the rest of the body, and occurs last on the palms and soles. Emotional sweating, however, occurs first on the palms and soles and in the axillae. Sweating is under both nervous control through the autonomic nervous system and hormonal control. Sebaceous glands secrete sebum, an oily substance that coats the hair and skin surface. Sebaceous secretion is a holocrine secretion; the entire cell produces, and becomes filled with, the fatty secretory product while it simultaneously undergoes progressive disruption, followed by apoptosis, as the product fills the cell.
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This photomicrograph shows the typical features of a plasma cell as seen in a routine H&E preparation prostate 60 cheap confido 60 caps online. Note clumps of peripheral heterochromatin alternating with clear areas of euchromatin in the nucleus. It is bounded by the basal laminae of various epithelia and by the external laminae of muscle cells and nerve-supporting cells. Classification of connective tissue is primarily based on the composition and organization of its extracellular components and on its functions: embryonic, connective tissue proper, and specialized connective tissue. It contains a loose network of spindle-shaped cells that are suspended in a viscous ground substance containing fine collagen and reticular fibers. Dense connective tissue is further subdivided into dense irregular and dense regular connective tissue. Loose connective tissue is characterized by large number of cells of various types embedded in an abundant gel-like ground substance with loosely arranged fibers. It typically surrounds glands, various tubular organs, blood vessels, and is found beneath the epithelia that cover internal and external body surfaces. Dense irregular connective tissue contains few cells (primary fibroblasts), randomly distributed bundles of collagen fibers, and relatively little ground substance. It provides significant strength and allows organs to resist excessive stretching and distension. Dense regular connective tissue is characterized by densely packed, parallel arrays of collagen fibers with cells (tendinocytes) aligned between the fiber bundles. They are flexible, have a high tensile strength, and are formed from collagen fibrils that exhibit a characteristic 68-nm banding pattern. In the lymphatic and hemopoietic tissues, reticular fibers are produced by specialized reticular cells. Elastic fibers are composed of a central core of elastin associated with a network of fibrillin microfibrils, which are made of fibrillin and emilin. These molecules are composed of long-chain unbranched polysaccharides containing many sulfate and carboxyl groups. They covalently bind to core proteins to form proteoglycans that are responsible for the physical properties of ground substance. By means of special link proteins, proteoglycans indirectly bind to hyaluronan, forming giant macromolecules called proteoglycan aggregates. They also interact with cell-surface receptors such as integrin and laminin receptors. Resident cells include fibroblasts (and myofibroblasts), macrophages, adipocytes, mast cells, and adult stem cells.
A once-a-day dosage is then continued or several weeks prostate cancer psa 01 60 caps confido purchase with visa, to be ollowed by withdrawal menses. One proposed taper stretches dosing to every 6 hours or 4 days, then every 8 hours or 3 days, then every 12 hours or 2 to 14 days. With any o these medication regimens, an intrauterine Foley balloon can be in ated or brisk bleeding. This acts to tamponade the endometrial vessels while the above-listed agents exert their control. Several provocateurs o this change in vascular tone are suggested, especially prostaglandins. Contraindications include an abnormal uterine cavity, untreated breast or reproductive tract cancer, acute liver disease or tumor, and reproductive tract in ection or in ection risks. T nex mic a cid this anti brinolytic drug reversibly blocks lysine binding sites on plasminogen. In addition, it requires administration only during menstruation and has ew minor reported side e ects that are predominantly gastrointestinal and dose-dependent. The recommended dose is two 650-mg tablets orally taken three times daily or a maximum o 5 days during menses. The drug has no e ect on other blood coagulation parameters such as platelet count, P, and P (Wellington, 2003). Associated symptoms may not be appreciated by those with preexisting color blindness. T eir presumed method o action is endometrial atrophy, although diminished prostaglandin synthesis and decreased endometrial brinolysis are other suggested actions (Irvine, 1999). T us, one advantage is that they are Endothe lia l ce lls taken only during menstruation. This binding degrades well tolerated, they o ten are only modfibrin into fibrin degradation products and leads to clot lysis. T us, i greater reductions in blood loss are needed, other agents in this section may prove more bene cial. Endometrial resection or ablation attempts to permanently remove and destroy the uterine lining. Methods are considered rst- or second-generation techniques according to when they were introduced into use and their need or concurrent hysteroscopic guidance. Similarly equivalent ef cacy is seen among the various second-generation options, which are described in Chapter 44 (p. A ter ablation, 70 to 80 percent o women experience signi cantly decreased ow, and 15 to 35 percent o these develop amenorrhea (Sharp, 2006).
Thrombocytopenia (a low blood platelet count) is an important clinical problem in the management of patients with immune-system disorders and cancer prostate yourself order 60 caps confido with amex. It increases the risk of bleeding and in cancer patients often limits the dose of chemotherapeutic agents. The neutrophil progenitor (NoP) undergoes six morphologically identifiable stages in the process of maturation: myeloblast, promyelocyte, myelocyte, metamyelocyte, band (immature) cell, and mature neutrophil. Eosinophils and basophils undergo a morphologic maturation similar to that of neutrophils. The nucleus is no longer present, and the cytoplasm shows the characteristic fimbriated processes that occur just after nuclear extrusion. Myeloblasts are the first recognizable cells that begin the process of granulopoiesis. The myeloblast is the earliest microscopically recognizable neutrophil precursor cell in the bone marrow. The promyelocyte has a large spherical nucleus with azurophilic (primary) granules in the cytoplasm. Azurophilic granules are produced only in promyelocytes; cells in subsequent stages of granulopoiesis do not make azurophilic granules. For this reason, the number of azurophilic granules is reduced with each division of the promyelocyte and its progeny. Recognition of the neutrophil, eosinophil, and basophil lines is possible only in the next stage-the myelocyte- when specific (secondary) and tertiary granules begin to form. The mitotic (proliferative) phase in granulopoiesis lasts about a week and stops at the late myelocyte stage. The postmitotic phase, characterized by cell differentiation-from metamyelocyte to mature granulocyte-also lasts about a week. The time it takes for half of the circulating segmented neutrophils to leave the peripheral blood is about 6 to 8 hours. Neutrophils leave the blood randomly-that is, a given neutrophil may circulate for only a few minutes or as long as 16 hours before entering the perivascular connective tissue (a measured half-life of circulating human neutrophils is only 8 to 12 hours). Neutrophils live for 1 to 2 days in the connective tissue, after which they are destroyed by apoptosis and are subsequently engulfed by macrophages. Also, large numbers of neutrophils are lost by migration into the lumen of the gastrointestinal tract from which they are discharged with the feces. Bone marrow maintains a large reserve of fully functional neutrophils ready to replace or supplement circulating neutrophils at times of increased demand. Specific granules begin to emerge from the convex surface of the Golgi apparatus, whereas azurophilic granules are seen at the concave side. The metamyelocyte is the stage at which neutrophil, eosinophil, and basophil lines can be clearly identified by the presence of numerous specific granules. A few hundred granules are present in the cytoplasm of each metamyelocyte, and the specific granules of each variety outnumber the azurophilic granules.
Last mens health june 2012 buy 60 caps confido with mastercard, cases in which no peritoneal implants are ound, but solely isolated retroperitoneal lesions are noted, implicate lymphatic spread (Moore, 1988). Endometriosis is a common benign disorder de ned as the presence o endometrial glands and stroma outside o the normal location. Implants o endometriosis are most o ten ound on the pelvic peritoneum, but other requent sites include the ovaries and uterosacral ligaments. Endometrial tissue located within the myometrium is termed adenomyosis and discussed in Chapter 9 (p. Women with endometriosis may be asymptomatic, sub ertile, or su er varying degrees o pelvic pain. This is an estrogen-dependent disease and thus lends itsel to hormone-based treatment. However, in those with disease re ractory to medical management, surgery may be required. Moreover, imaging modalities have low sensitivities or small implants (Wall, 2015). The primary method o diagnosis is laparoscopy, with or without biopsy or histologic diagnosis (Dunselman, 2014). Using this standard, the annual incidence o surgically diagnosed endometriosis was 1. In asymptomatic women, the prevalence o endometriosis ranges rom 6 to 11 percent, depending on the population studied and mode o diagnosis (Buck Louis, 2011; Mahmood, 1991). However, because o its link with in ertility and pelvic pain, endometriosis is notably more prevalent in subpopulations o women with these complaints. From Endometriosis Another theory concerns coelomic metaplasia and suggests that the parietal peritoneum is pluripotent and can undergo metaplastic trans ormation to tissue histologically identical to normal endometrium. This process may also underlie cases o endometriosis in those without menstruation, such as premenarchal girls and males treated with estrogen and orchiectomy or prostate cancer (Marsh, 2005; aguchi, 2012). As such, the anterior and posterior cul-de-sacs, other pelvic peritoneum, the ovary, and uterosacral ligaments are requently involved. Additionally, the rectovaginal septum, ureter, and bladder and rarely, pericardium, surgical scars, and pleura may be a ected. One pathologic review revealed that endometriosis has been identi ed on all organs except the spleen (Markham, 1989).
Fully keratinized cells (black layer) are present in the center of the thymic corpuscle man health base mens health base themes confido 60 caps order amex. It is highly impermeable to macromolecules and is considered a major structural component of the barrier within the cortical parenchyma. The underlying basal lamina of endothelial cells and occasional pericytes are also part of the capillary wall. Macrophages residing in the surrounding perivascular connective tissue may phagocytose antigenic molecules that escape from the capillary lumen into the cortical parenchyma. Type I epithelioreticular cells with their occluding junctions provide further protection to the developing T cells. The perivascular connective tissue is enclosed between the basal lamina of the epithelioreticular cells and the endothelial cell basal lamina. These layers provide the necessary protection to the developing immature T cells and separate them from mature immunocompetent lymphocytes circulating in the bloodstream. Cells that pass the positive selection test leave the cortex and enter the medulla. These cells are now ready for the immune response; they leave the thymus from the medulla and enter the blood circulation. Now the cells leave the thymus by passing from the medulla into the blood circulation. Spleen the spleen is about the size of a clenched fist and is the largest lymphatic organ. It is located in the upper left quadrant of the abdominal cavity and has a rich blood supply. In addition to large numbers of lymphocytes, it contains specialized vascular spaces or channels, a meshwork of reticular cells and reticular fibers, and a rich supply of macrophages and dendritic cells. These contents allow the spleen to monitor the blood immunologically, much as the macrophages and dendritic cells of the lymph nodes monitor the lymph. The spleen is enclosed by a dense connective tissue capsule from which trabeculae extend into the parenchyma of the organ. In these species, contraction in the capsule and trabeculae helps discharge stored red blood cells into the systemic circulation. The human spleen normally retains relatively little blood, but it has the capacity for contraction by means of the contractile cells in the capsule and trabeculae. The hilum, located on the medial surface of the spleen, is the site for the passage of the splenic artery and vein, nerves, and lymphatic vessels.
Grubuz, 32 years: The bone-lining cells (endosteal cells) on the surface of the spicule are indicated by the arrows. Boston, Little Brown, 1966 McCann J, Miyamoto S, Boyle C, et al: Healing o nonhymenal genital injuries in prepubertal and adolescent girls: a descriptive study.
Brenton, 34 years: The cells are in contact but lack a free surface, although they have developed from an epithelial surface by invagination. New Engl J Med 328:1581, 1993 Fisher B, Dignam J, Wolmark N, et al: amoxi en in treatment o intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial.
Nerusul, 57 years: Processes of these neurons are included in somatic afferent and visceral afferent nerve fibers. As a result, when a steroid is chosen or treatment, each clinical end point should be considered individually.
Zarkos, 60 years: Primary and secondary ossification centers are separated by the epiphyseal growth plate, providing a source for new cartilage involved in bone growth seen in children and adolescents. The cells are elongated with their long axis parallel to the direction of blood flow.
Jensgar, 35 years: Int J Impot Res 11(Suppl 1):S31, 1999 Bloch M, Rotenberg N, Koren D, et al: Risk actors or early postpartum depressive symptoms. The majority of aged erythrocytes (90%) are phagocytosed by macrophages in the spleen, bone marrow, and liver.
Khabir, 26 years: Puberty may be delayed in girls who begin training be ore menarche (Frisch, 1981). A ected women usually have lower abdominal pain, ever, leukocytosis, and unilateral or bilateral adnexal masses.
Givess, 38 years: It contains a thick layer of longitudinally arranged smooth muscle bundles (seen here in cross-section) separated by collagen and elastic fibers. Although glial cells have long been described as supporting cells of nerve tissue in the purely physical sense, current concepts emphasize the functional interdependence of neuroglial cells and neurons.
Kan, 56 years: An immune response is generated against a specific antigen, which can be a soluble substance. Myolysis describes myoma puncture with tools to permit mono- or bipolar cautery, laser vaporization, or cryotherapy.
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