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By: G. Kadok, M.A., M.D., M.P.H.

Program Director, University of North Texas Health Science Center Texas College of Osteopathic Medicine

This results formed in the body are as follows: i) Release of superoxide free radical in Fenton reaction (see in cell injury; it may also cause malignant transformation of cells diabete mellitus symptoms generic glucotrol xl 10mg on-line. Currently diabetes medications japan cheap 10 mg glucotrol xl with visa, oxygenderived free radicals have been known to play an important role in many forms of cell injury: iv) Exogenous sources of free radicals include some environ- i) Ischaemic reperfusion injury ii) Ionising radiation by causing radiolysis of water mental agents such as tobacco and industrial pollutants diabetes medications dpp 4 purchase genuine glucotrol xl on line. Free radicals are formed iv) Chemical carcinogenesis in physiologic as well as pathologic processes diabetes type 1 omega 3 purchase glucotrol xl 10mg otc. Basically, v) Hyperoxia (toxicity due to oxygen therapy) oxygen radicals are unstable and are destroyed spon- vi) Cellular aging taneously. The ix) Destruction of tumour cells net effect of free radical injury in physiologic and disease x) Atherosclerosis. However, if not degraded, then free radicals are highly substances which inactivate the free radicals. These destructive to the cell since they have electron-free residue substances include the following: Vitamins E, A and C (ascorbic acid) and thus bind to all molecules of the cell; this is termed Sulfhydryl-containing compounds. Incoming activated neutrophils utilise oxygen quickly (oxygen burst) and release a lot of oxygen free radicals. Pathogenesis of Chemical Injury Chemicals induce cell injury by one of the two mechanisms: by direct cytotoxicity, or by conversion of chemical into reactive metabolites. Some chemicals combine with components of the cell and produce direct cytotoxicity without requiring metabolic activation. The cytotoxic damage is usually greatest to cells which are involved in the metabolism of such chemicals. Depending upon the severity of cell injury, degree of damage and residual effects on cells and tissues are variable. In general, morphologic changes in various forms of cell injury can be classified as shown in Table 3. However, now it is realised that this term does not provide any information on the nature of underlying changes and thus currently more acceptable terms of retrogressive changes or simply reversible cell injury are applied to non-lethal cell injury. Following morphologic forms of reversible cell injury are included under this heading: 1. Mucoid change Hydropic Change Hydropic change means accumulation of water within the cytoplasm of the cell. Other synonyms used are cloudy swelling (for gross appearance of the affected organ) and vacuolar degeneration (due to cytoplasmic vacuolation). The common causes include poisoning, the greatest damage occurs to cells of the alimentary tract where it is absorbed and kidney where it is excreted. Cyanide kills the cell by poisoning mitochondrial cytochrome oxidase thus blocking oxidative phosphorylation. Other examples of directly cytotoxic chemicals include chemotherapeutic agents used in treatment of cancer, toxic heavy metals such as mercury, lead and iron. This mechanism involves metabolic activation to yield ultimate toxin that interacts with the target cells. The target cells in this group of chemicals may not be the same cell that metabolised the toxin. Other mechanism of cell injury includes direct toxic effect on cell membrane and nucleus. Pathogenesis of Physical Injury Injuries caused by mechanical force are of medicolegal significance. Radiation injury to human by accidental or therapeutic exposure is of importance in treatment of persons with malignant tumours as well as may have carcinogenic influences (Chapter 8). Killing of cells by ionising radiation is the result of direct formation of hydroxyl radicals from radiolysis of water. Nomenclature Retrogressive changes (older term: degenerations) Cell death-necrosis Apoptosis Subcellular alterations Intracellular accumulation of lipid, protein, carbohydrate Gangrene, pathologic calcification Mechanism of Cell Injury 1. After-effects of necrosis acute and subacute cell injury from various etiologic agents such as bacterial toxins, chemicals, poisons, burns, high fever, intravenous administration of hypertonic glucose or saline etc. Cloudy swelling results from impaired regulation of sodium and potassium at the level of cell membrane. This, in turn, leads to rapid flow of water into the cell to maintain iso-osmotic conditions and hence cellular swelling occurs. Hydropic swelling is an entirely reversible change upon removal of the injurious agent. Grossly, the affected organ such as kidney, liver, pancreas, or heart muscle is enlarged due to swelling.

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There would be no further regeneration of endometrium as the basal layer of endometrium as well as the basal and spiral arterioles are destroyed blood glucose experiments cheap glucotrol xl online visa. Procedure: Endometrial resection is done from cornu to cornu (fundus) and all the walls diabetes mellitus type 2 goals cheap 10 mg glucotrol xl free shipping. Myometrium is desiccated through contact coagulation for 30-40 seconds to control bleeding diabetes symptoms eye twitch discount glucotrol xl on line. Hematometro and pyometers-may occur due to infection after hysteroscopic surgery with cervical stenosis diabetes type 1 vs diabetes mellitus purchase glucotrol xl uk. In gynecology as much as 80 percent of operations can be performed endoscopically with the use of either a laparoscope or a hysteroscope. During laparoscopy, the magnification of the object depends upon the distance of the laparoscope from the object. Before any procedure is undertaken, contraindications must be carefully excluded (Table 35. Informed consent should include the permission for open surgery if necessity arises. Hemostasis during laparoscopic surgery can be achieved using electrocoagulation (monopolar/bipolar), laser coagulation, ligatures, sutures(extracorporeal/intra-corporeal), enseal, harmonic scalpel or by stapler and clips. Tissue damage with heat is as follows: 45°C = Tissue death; 70°C = Coagulation; 90°C = Desiccation; 100°C = Vaporization; 200°C = Carbonization (charring). Complications of laparoscopy may be due to the procedure itself or due to anesthesia (see p. The distending media commonly used in hysteroscopy is normal saline or glycine (1. Complications include fluid overload, pulmonary edema, and injury to genital or abdominal organs or electrosurgical injuries (see p. Ability to self renew (undergoing numerous cell divisions) maintaining the undifferentiated state. Totipotent Stem Cells are produced by first few divisions of the fertilized egg cell. Totipotent stem cells (from the morula) can differentiate into embryonic and extraembryonic cell types. These cells can differentiate on tissues derived from any of the three germ layers including fetal tissues (placenta, umbilical cord, amnion, amniotic fluid cells). Multipotent Stem Cells can differentiate into various tissues originating from a single germ layer (mesenchymal cells or hemopoietic stem cells that produce red blood cells, white blood cells, platelets). It is the major concern about the oncogenic potential of pleuripotent stell cells (embryonic stem cells). Multipotent Stem Cells can be obtained from several fetal tissues (following medical termination of pregnancy or at birth). This is aimed to restore and regenerate rhabdomyosphincter muscle content and function. Acellular natural or synthetic biomaterials are used as an implant which becomes incorporated through ingrowth of cells from the adjacent native host cells of the bladder. The biomaterials used are: Small intestinal submucosa and bladder-derived acellular matrix. Reports are available indicating possibility of creating full thickness bladder wall. Biomaterials should have good biocompatibility and appropriate biomechanical and biochemical properties. Mьllerian ducts reconstruction Progenitor cells with ability of self repair (bone marrow stem cells) can be used for uterine malformations. Autologous cells (from vaginal biopsy) can be expanded and functional vagina can be reconstructed for a woman with vaginal agenesis. The purpose is to generate new muscles/tissues which can perform in an integrated manner with the existing tissues to provide mechanical support to the pelvic organs. Hybrid biomaterials (synthetic and naturally-derived polymers) may be fabricated to restore pelvic floor However, till date it is essential to understand its known limitations, putative benefits and the unknown risks. Until there is sufficient evidence on the efficacy of therapy, each case should be considered on an individual basis. Procedure For cervical cells-Projected end of the spatula goes within the external os. For endocervical cells-The cytobrush goes within the cervical canal and is rotated to collect cells [Fig.

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The important role of vitamin D1 diabetes medications list purchase glucotrol xl online now, parathyroid hormone and calcitonin in calcium metabolism has already been discussed on page 248 diabetes xango discount glucotrol xl 10mg on-line. Inorganic material of cartilage is calcium hydroxyapatite similar to that in bone matrix but the organic material of the cartilage is distinct from the bone blood glucose and insulin glucotrol xl 10 mg free shipping. High water content of cartilage matrix is responsible for function of articular cartilage and lubrication metabolic disease 2012 cheap glucotrol xl generic. Proteoglycans are macromolecules having proteins complexed with polysaccharides termed glycosaminoglycans. Cartilage glycosaminoglycans consist of chondroitin sulfate and keratan sulfate, the former being most abundant comprising 55-90% of cartilage matrix varying on the age of the cartilage. Primitive mesenchymal cells which form bone cells form chondroblasts which give rise to chondrocytes. Hyaline cartilage is the basic cartilaginous tissue comprising articular cartilage of joints, cartilage in the growth plates of developing bones, costochondral cartilage, cartilage in the trachea, bronchi and larynx and the nasal cartilage. Hyaline cartilage is the type found in most cartilage-forming 831 tumours and in the fracture callus. It is found in annulus fibrosus of intervertebral disc, menisci, insertions of joint capsules, ligament and tendons. Fibrocartilage may also be found in some cartilage-forming tumours and in the fracture callus. Elastic cartilage is found in the pinna of ears, epiglottis and arytenoid cartilage of the larynx. Diseases of skeletal system include infection (osteomyelitis), disordered growth and development (skeletal dysplasias), metabolic and endocrine derangements, and tumours and tumour-like conditions. A number of systemic infectious diseases may spread to the bone such as enteric fever, actinomycosis, mycetoma (madura foot), syphilis, tuberculosis and brucellosis. However, two of the conditions which produce significant pathologic lesions in the bone, namely pyogenic osteomyelitis and tuberculous osteomyelitis, are described below. Pyogenic Osteomyelitis Suppurative osteomyelitis is usually caused by bacterial infection and rarely by fungi. Pyogenic osteomyelitis by haematogenous route occurs most commonly in the long bones of infants and young children (5-15 years of age), particularly in the developing countries of the world. In the developed world, however, where institution of antibiotics is early and prompt, haematogenous spread of infection to the bone is uncommon. In such cases, instead, direct extension of infection from the adjacent area, frequently involving the jaws and skull, is more common mode of spread. Bacterial osteomyelitis may be a complication at all ages in patients with compound fractures, surgical procedures involving prosthesis or implants, gangrene of a limb in diabetics, debilitation and immunosuppression. Though any etiologic agent may cause osteomyelitis, Staphylococcus aureus is implicated in a vast majority of cases. Less frequently, other organisms such as streptococci, Escherichia coli, Pseudomonas, Klebsiella and anaerobes are involved. There may be transient bacteraemia preceding the development of osteomyelitis so that blood cultures may be positive. Clinically, the child with acute haematogenous osteomyelitis has painful and tender limb. Draining sinus tracts may form which may occasionally be the site for development of squamous carcinoma. A, the process begins as a focus of microabscess in a vascular loop in the marrow which expands to stimulate resorption of adjacent bony trabeculae. Simultaneously, there is beginning of reactive woven bone formation by the periosteum. The formation of viable new reactive bone surrounding the sequestrum is called involucrum. The extension of infection into the joint space, epiphysis and the skin produces a draining sinus. The basic pathologic changes in any stage of osteomyelitis are: suppuration, ischaemic necrosis, healing by fibrosis and bony repair. The infection begins in the metaphyseal end of the marrow cavity which is largely occupied by pus.

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