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They are found mainly in the olfactory epithelium (where smell stimuli are sensed) malegra fxt 140mg visa doctor for erectile dysfunction in hyderabad, and as part of the retina malegra fxt 140 mg lowest price erectile dysfunction medications cost. With the exception of the unipolar sensory ganglion cells, and the two specific bipolar cells mentioned above, all other neurons are multipolar. Anaxonic neurons are very small, and if you look through a microscope at the standard resolution used in histology (approximately 400X to 1000X total magnification), you will not be able to distinguish any process specifically as an axon or a dendrite. Nevertheless, even if they cannot be easily seen, and one specific process is definitively the axon, these neurons have multiple processes and are therefore multipolar. Neurons can also be classified on the basis of where they are found, who found them, what they do, or even what chemicals they use to communicate with each other. Some neurons referred to in this section on the nervous system are named on the basis of those sorts of classifications (Figure 12. Glial Cells Glial cells, or neuroglia or simply glia, are the other type of cell found in nervous tissue. They are considered to be supporting cells, and many functions are directed at helping neurons complete their function for communication. The name glia comes from the Greek word that means “glue,” and was coined by the German pathologist Rudolph Virchow, who wrote in 1856: “This connective substance, which is in the brain, the spinal cord, and the special sense nerves, is a kind of glue (neuroglia) in which the nervous elements are planted. Astrocytes have many processes extending from their main cell body (not axons or dendrites like neurons, just cell extensions). But most everything else cannot, including white blood cells, which are one of the body’s main lines of defense. One oligodendrocyte will provide the myelin for multiple axon segments, either for the same axon or for separate axons. While their origin is not conclusively determined, their function is related to what macrophages do in the rest of the body. When macrophages encounter diseased or damaged cells in the rest of the body, they ingest and digest those cells or the pathogens that cause disease. Ependymal cells line each ventricle, one of four central cavities that are remnants of the hollow center of the neural tube formed during the embryonic development of the brain. The choroid plexus is a specialized structure in the ventricles where ependymal cells come in contact with blood vessels and filter and absorb components of the blood to produce cerebrospinal fluid. These glial cells appear similar to epithelial cells, making a single layer of cells with little intracellular space and tight connections between adjacent cells. Satellite cells are found in sensory and autonomic ganglia, where they surround the cell bodies of neurons. Schwann cells are different than oligodendrocytes, in that a Schwann cell wraps around a portion of only one axon segment and no others. Oligodendrocytes have processes that reach out to multiple axon segments, whereas the entire Schwann cell surrounds just one axon segment. Whereas the manner in which either cell is associated with the axon segment, or segments, that it insulates is different, the means of myelinating an axon segment is mostly the same in the two situations. Myelin is a lipid-rich sheath that surrounds the axon and by doing so creates a myelin sheath that facilitates the transmission of electrical signals along the axon. The appearance of the myelin sheath can be thought of as similar to the pastry wrapped around a hot dog for “pigs in a blanket” or a similar food. The glial cell is wrapped around the axon several times with little to no cytoplasm between the glial cell layers. For oligodendrocytes, the rest of the cell is separate from the myelin sheath as a cell process extends back toward the cell body. For Schwann cells, the outermost layer of the cell membrane contains cytoplasm and the nucleus of the cell as a bulge on one side of the myelin sheath. The inner edge wraps around the axon, creating several layers, and the other edge closes around the outside so that the axon is completely enclosed. The axon contains microtubules and neurofilaments that are bounded by a plasma membrane known as the axolemma. Outside the plasma membrane of the axon is the myelin sheath, which is composed of the tightly wrapped plasma membrane of a Schwann cell. What aspects of the cells in this image react with the stain to make them a deep, dark, black color, such as the multiple layers that are the myelin sheath? Because a micrometer is 1/1000 of a millimeter, this means that the length of a myelin sheath can be 100–1000 times the diameter of the axon. If the myelin sheath were drawn to scale, the neuron would have to be immense—possibly covering an entire wall of the room in which you are sitting.
Hydrocephalus in Children Description: It is a condition that results when normal exit and absorption of cerebral spinal fuid in the ventricles are impaired cheap 140 mg malegra fxt overnight delivery constipation causes erectile dysfunction. Tis leads to progressive accumulation of this fuid in the ventricles of the brain discount 140 mg malegra fxt visa impotence quit smoking, resulting in progressive damage to the developing brain with associated mental retardation and visual impairment. Causes - Congenital abnormality - Intraventricular hemorrhage - Infection - Head trauma - Brain tumor Signs and symptoms - Accelerated head growth - Te baby’s sof spot (anterior fontanelle) is usually full or bulging, or even tense, due to the increased pressure inside the head. Myelomeningocele Defnition: Congenital defect in vertebral arches with cystic dilatation of meninges and structural or functional abnormality of spinal cord or cauda equina. It is broadly classifed into 2 entities: - Open head trauma in which there is a scalp laceration with underlying skull fracture and breached Dura Mater (i. It can also be classifed by severity into mild, moderate and sever head trauma depending on the level of consciousness. Patients with severe maxillofacial injury will also need to be given a tracheostomy. Mannitol should be used with caution in patients with clotting disorders because it afects coagulation, and in congestive heart failure patients it increases intravascular volume before it causes diuresis. Remember steroids (dexamethasone, hydrocortisone) have no place in management of acute head injury. Complications - Post-traumatic seizures - Permanent neurological disability - Post-traumatic hydrocephalus - Post-Concussion Syndrome - Infection e. It is subdivided into acute (< 72hours) Subacute (between 72 hours and 3 weeks) and Chronic ( > 3weeks). Chronic Subdural Hematoma Cause - Minor head injury or fall ofen not remembered by patients or relatives. Epidural Hematoma Defnition: It is the collection of blood between the skull and the Dura Mater caused by a rupture of artery and vein in epidural space, as a result of a fracture of the skull at the moment of the impact in 60-90% of cases. Intracranial Hematoma Defnition: Traumatic intraparancymal hemorrhage is commonly associated with brain contusion. Simple Rib Fracture Defnition: Simple rib fracture is a break in continuity of the rib(s). Flail Chest Defnition: Segmental fracture of rib(s) resulting in paradoxical movement of the chest that may lead to respiratory dysfunction. Pneumothorax Defnition: Collection of air in pleural cavity which can be either simple or under tension resulting in pressure on the mediastinum. Cardiac Tamponade Defnition: Te collection of blood in pericardium causing cardiac dysfunction. Ruptured Diaphragm Defnition: A tear in the diaphragm which allows protrusion of abdominal organs in the chest. Pulmonary Fibrosis and Bronchectasis Defnition: Fibrosis of the lung following bacterial infection and/or lung abscess. Lung Cancer Defnition: Malignant growth of the bronchials or parenchyma of the lung. Mediastinum Masses Defnition: Space occupying lesions that may be solid or cystic located in the mediastinum compartment. Note: For more information refer to relevant textbooks (Short Practice of Surgery by Bailey and Love and Principles of Surgery by Schwartz) 3. Congenital Diaphragmatic Hernias Defnition: Is the herniation of abdominal viscera into the chest cavity through a congenital defect of the diaphragm. Abdominal Injuries Defnition: It is an injury to the abdomen, it may be blunt or penetrating and it may involve damage of abdominal organs. Colon Injury - Immediate surgery - Primary closure and proximal defunctioning colostomy/ ileostomy - Peritoneal lavage - Excision and exteriorization of two ends with re-anastomosis at 3months 4. Rectal Injury - Most ofen penetrating - Can occur with pelvic function Diagnosis - Blood on examination glove - Sigmoidoscopy Management - Primary repair - +/- colostomy - +/- pre-sacral drainage 128 Surgery Clinical Treatment Guidelines 5. Oesophagial Atresia Defnition: Congenital disorder with a blind end to the oesophagus, at frst feed the infant coughs and may become cyanosed.
The treatment of hypertensive emergencies is usually started with furosemide given by parenteral route at dose of 20-40mg malegra fxt 140 mg sale erectile dysfunction wikihow. In addition buy 140 mg malegra fxt overnight delivery erectile dysfunction protocol scam alert, parenteral use of diazoxide, sodium nitroprusside, hydralazine, trimethaphan, labetalol can be indicated. Drug used in heart failure Congestive heart failure occurs when there is an inability of the heart to maintain a cardiac out put sufficient to meet the requirements of the metabolising tissues. Heart failure is usually caused by one of the following: Ischaemic heart disease, Hypertension, Heart muscle disorders, and Valvular heart disease. Drugs with positive inotropic effect:- Drugs with positive inotropic effect increase the force of contraction of the heart muscle. These include: • Cardiac glycosides, 57 • Bipyridine derivatives, • Sympathomimetics, and • Methylxanthines 1. Cardiac glycosides comprise a group of steroid compounds that can increase cardiac out put and alter the electrical functions. This results in an increased intracellular movement of sodium and accumulation of sodium in the cells. As a consequence of the higher intracellular sodium, decreased transmembrane exchange of sodium and calcium will take place leading to an increase in the intracellular calcium that acts on contractile proteins. All cardiac glycosides exhibit similar pharmacodynamic properties but do differ in their pharmacokinetic properties. Therapeutic uses of cardiac glycosides include: • Congestive heart failure • Atrial fibrillation, • Atrial flutter, and • Paroxysmal atrial tachycardia. For the management of arrhythmias or serious toxicity, potassium supplementation, administration of anti-arrhythmic drugs (e. Bipyridine derivatives are used in cases of heart failure resistant to treatment with cardiac glycosides and vasodilators. However, positive chronotropic effect of these agents minimizes the benefit particularly in patients with ischaemic heart disease. The positive inotropic effect of dobutamine is proportionally greater than its effect on heart rate. It is reserved for management of acute failure or failure refractory to other oral agents. Diuretics Diuretics are first – line drugs for treatment of patients with heart failure. In mild failure, a thiazide may be sufficient but are ineffective at low glomerular filtration rates. The reduction in venous pressure causes reduction of edema and its symptoms and reduction of cardiac size which leads to improved efficiency of pump function. The vasodilators are effective in acute heart failure because they provide a reduction in preload (through venous dilation), or reduction in after-load (through arteriolar dilation), or both. Reduction in systemic vascular resistance leads to a considerable rise in cardiac out put. Sodium nitroprusside is a mixed venous and arteriolar dilator used also for acute reduction of blood pressure. These drugs reduce after load by reducing peripheral resistance and also reduce preload by reducing salt and water retention by way of reduction in aldosterone secretion. They are nowadays considered a head of cardiac glycosides in the treatment of chronic heart failure. The following are essential for long-term management of chronic heart failure: Modify cardiovascular risk factor profile, e. When the increase in coronary blood flow is unable to match the increased oxygen demand, angina develops. It has become apparent that spasm of the coronary arteries is important in the production of angina. Organic nitrates: organic nitrates are potent vasodilators and successfully used in therapy of angina pectoris for over 100 years. The effects of nitrates are mediated through the direct relaxant action on smooth muscles. Vasodilating organic nitrates are reduced to organic nitrites, which is then converted to nitric oxide. The action of nitrates begins after 2-3 minutes when chewed or held under tongue and action lasts for 2 hours.
Examples for antigens triggering type I reactions: Inhalation allergens: -Pollen from • grasses: timothy purchase 140mg malegra fxt mastercard erectile dysfunction doctors tucson az, cocksfoot and ryegrass malegra fxt 140mg with mastercard impotence australia, but also crops like rye • herbs: mugwort, ribwort/plantain, ragweed • trees and shrubs: birch, alder, hazel -Fungal spores: Aspergillus, Alternaria, Cladosporum -Animal antigens: epithelia of cats and dogs, parakeet dung, feathers -House dust mite antigen Today, one of the most common causes of "hay fever" or allergic asthma is the antigen Der p 1 from fecal particles from the house dust mite (Dermatophagoides pteronyssinus). A decisive factor for the antigenicity of Der p 1, which functions as a digestive protease, is its enzymatic activity: it cleaves components of tight junctions between respiratory epithelial cells, enabling it to negotiate the epithelial barrier. Food allergens: (*denotes pollen allergy-associated food allergies) -Nuts: peanut (actually, a legume), almond*, hazelnut* -Fruit: kiwi fruit*, apple* -Vegetables: fennel, celery* -Milk: α-lactoglobulin, β-lactoglobulin, casein -Eggs: ovalbumin -Fish: bass, salmon -Seafood Drugs taken orally, like penicillin, can cause type I reactions, too. Food allergy causes symptoms in the gastrointestinal tract like diarrhea, nausea and vomiting, but may also cause problems in other organs: coughing or asthma in the respiratory tract and urticaria (hives) in the skin. If mast cell degranulation is systemic, vasodilatation may cause a dip in blood pressure, fainting or, in the worst case, anaphylactic shock. Lactose intolerance is a shortage of the intestinal enzyme lactase, which cleaves the lactose disaccharide into monosaccharides glucose and galactose. Due to the osmotic effect of uncleaved lactose, as well as by secondary changes in bacterial colonization, affected individuals suffer from diarrhea in response to lactose intake (milk, cheese, chocolate,. It is very common in the tropics, and, due to counter selection, less common in individuals stemming from those northern parts of the world where people relied on animal milk for a large part of daily nutrition (e. Other examples of pseudo-allergies are fructose intolerance (fruit), or scombroid food poisoning, caused by histidine-derived histamine on the surface of insufficiently refrigerated fish. Type I reactions are most frequently caused by inhalation or ingestion, but other routes are possible. Latex particles sometimes cause hives and itching in sensitized persons by direct contact to the skin. The most efficient way for an allergen to cross epithelial barriers obviously is by injection, as seen in type I reactions against injected penicillin and other drugs, and in allergic reactions to insect stings. In treating allergy, especially allergic asthma, the most important component is to identify the allergen and to help the patient to avoid it. If this is not done, the patient may be progressively sensitized to more and more allergens by the following pathophysiological mechanism. In addition to releasing histamine and chemokines, mast cells activated by cross-linked Fcε receptors promote class switch to IgE in nearby B cells, e. The patient, who used to produce IgG antibodies against most antigens, now progressively switches to IgE, meaning he becomes allergic to more and more antigens. A Rhesus-negative mother is immunized with Rhesus antigen during childbirth of her first Rhesus-positive child. Problems arise only if these waste management mechanisms are overburdened, leaving dangerous immune complexes to be deposited in "illegal dumps". As antibodies have at least two binding sites (IgM has more), and most antigens have many antigen-binding domains, higher order complexes may form, depending on relative molar concentrations. In the event of antibody or antigen excess, immune complexes tend to remain small and soluble, while in the zone of approximate equivalence, large three-dimensional lattices tend to form. Along these lines, two subtypes of immune complex diseases are differentiated: In diseases of the Arthus-reaction type, large complexes are formed that activate complement and phagocytes at the site of precipitation, leading to local tissue damage (Maurice Arthus was a French immunologist). Important diseases of this type are the various forms of extrinsic allergic alveolitis (hypersensitivity pneumonitis). If inhalation antigens enter the lungs in very high concentrations, the immune system tends to react by producing 58 IgG, not IgE. In the joints, large complexes form between rheumatoid factor and other IgG antibodies, contributing to inflammation and tissue destruction. They overwhelm the erythrocyte transport system and accumulate at sites of plasma filtration: kidney glomerula, linings of serous cavities, joints, arterioles in general. This is the time required until T cells and macrophages accumulate at the site of immunological controversy. Typical examples are: • Metal ions: -Nickel: from watches, costume jewelry, jeans rivets/buttons, scissors,. Clinically, contact dermatitis develops 48 to 72 hours upon re-exposure to the antigen, with red, indurated, confluent papules that feel dry and somewhat scaly. The protracted elimination of insulin-producing cells in diabetes mellitus type 1 is the result of a cellular autoimmune reaction, too. The β-chain aspartate forms a salt bridge with an arginine from the α-chain that alters the shape of the peptide binding cleft.
