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About 99% of bile acids secreted into intestine returns to liver through portal circulation arrhythmia recognition buy 4mg cardura amex. So blood pressure 40 year old woman 4mg cardura with amex, it is eliminated through the feces along with other bile that escaped reabsorption blood pressure chart senior citizens cheap 4 mg cardura mastercard. Steroid hormones are synthesized in various tissues using cholesterol as starting material arteria epigastrica superior order cardura on line. Site Most of the reactions of steroid hormone formation occurs in mitochondria and smooth endoplasmic reticulum. Pregnenolone is the common intermediate of all the five classes of steroid hormone biosynthetic pathways. Enzymes involved in steroid hormone formation are dehydrogenases, hydroxylases and lyases. Formation of pregnenolone A mitochondrial cyt P450 dependent cholesterol desmolase converts cholesterol to pregnenolone by cleavage of side chain. Plasma and urinary levels of testosterone, estradiol and progesterone in men and women at different stages are presented in Table 10. Genetic factors Hyper cholesterolemia Lipid Metabolism 255 Plasma cholesterol level is high in atherosclerosis, coronary artery disease, diabetes, xanthomatosis, nephrotic syndrome, hypothyroidism and obstructive jaundice. Cholesterol lowering drugs (Hypocholesterolemic drugs) Since raised cholesterol level is associated with development of coronary artery disease, several drugs are used to lower blood cholesterol level. Lowering of plasma cholesterol level decreases incidence of coronary artery disease. For example, at the age of 40, a decrease in blood cholesterol level from 250 to 200mg% lowers incidence of coronary artery disease by 50%. Hypocholesterolemic drugs lower plasma cholesterol level by affecting cholesterol metabolism at several stages. Nicotinic acid It decreases plasma cholesterol by interfering with the mobilization of free fatty acids. Neomycin It interferes with bile acid re-absorption and absorption of dietary cholesterol. Probucol It also decreases blood cholesterol level by increasing excretion of cholesterol and bile acids. Cholesteramine (Questran) It lowers blood cholesterol level by decreasing re-absorption of bile acids. Clofibrate (Astromid-S) It blocks cholesterol formation in liver and increases excretion of cholesterol and bile acids. Dextro thyroxine (D-thyroxine) It lowers blood cholesterol level by accelerating cholesterol catabolism thereby increasing fecal cholesterol excretion. Plant lectins and gums They lower blood cholesterol level by interfering with absorption of cholesterol and bile acids. Guava Consumption of this tropical fruit for three months bring down plasma cholesterol from 250 mg% to 200 mg%. Hypocholesterolemia Plasma cholesterol level is decreased in hyper thyroidism, liver disease malabsorption syndrome and hemolytic anaemia. Gall stones Since cholesterol solubility is less in bile, an increase in cholesterol amount in bile favours gall stone formation. In this condition, initially cholesterol esters particularly cholesterol oleates of arterial smooth muscle cells deposits in arterial intima. If condition is not controlled continued extracellular deposition of cholesterol esters along with apo B-100 of lipoproteins results in the formation of plaque in the arterial wall. Blood vessel narrowing due to deposition of cholesterolester and apo B-100 is called as atherosclerosis. If clot formation occurs in coronary artery, the blood and O2 supply to cardiac muscle diminishes.

Much of this adaptation is accomplished through alterations in the rates of transcription of specific genes blood pressure is determined by purchase discount cardura. Many different observations have led to the current view of how hormones affect transcription arteria pancreatica magna buy cardura 4mg fast delivery. An essential component is the hormone response element which binds the ligand (m)-bound receptor (R) iglesias heart attack purchase on line cardura. This family blood pressure chart with pulse rate buy 4 mg cardura mastercard, now with more than 50 members, includes the nuclear hormone receptors discussed above, a number of other receptors whose ligands were discovered after the receptors were identified, and many putative or orphan receptors for which a ligand has yet to be discovered. It is possible to sort this large number of receptors into groups in a variety of ways. Another group of orphan receptors that as yet have no known ligand bind as homodimers or monomers to direct repeat sequences. Not surprisingly, this area is a fertile field for investigation of new therapeutic interventions. Receptors with known ligands, such as the steroid hormones, bind as homodimers on inverted repeat half-sites. Another class of receptors for which ligands have not been determined (orphan receptors) bind as homodimers to direct repeats and occasionally as monomers to a single half-site. The number of these coregulator molecules now exceeds 100, not counting species variations and splice variants. These ligands are not hormones in the classic sense, but they do have a similar function in that they activate specific members of the nuclear receptor superfamily. The different names for members within a subfamily often represent species variations or minor splice variants. There is about 35% amino acid identity between members of the different subfamilies. This is particularly interesting in view of the fact that acetylation, phosphorylation, methylation, sumoylation, and ubiquitination-as well as proteolysis and cellular translocation-have been proposed to alter the activity of some of these coregulators and their targets. It appears that certain combinations of coregulators-and thus different combinations of activators and inhibitors-are responsible for specific ligand-induced actions through various receptors. In some cases, complexes consisting of as many as 47 transcription factors have been observed on a single gene. Many hormone responses are accomplished through alterations in the rate of transcription of specific genes. The nuclear receptor superfamily of proteins plays a central role in the regulation of gene transcription. Another large family of coregulator proteins remodel chromatin, modify other transcription factors, and bridge the nuclear receptors to the basal transcription apparatus. The polysaccharides, triacylglycerols, and proteins that make up the bulk of the diet must be hydrolyzed to their constituent monosaccharides, fatty acids, and amino acids, respectively, before absorption and utilization. Minerals and vitamins must be released from the complex matrix of food before they can be absorbed and utilized. Globally, undernutrition is widespread, leading to impaired growth, defective immune systems, and reduced work capacity. By contrast, in developed countries, there is excessive food consumption (especially of fat), leading to obesity, and the development of cardiovascular disease and some forms of cancer. Deficiencies of vitamin A, iron, and iodine pose major health concerns in many countries, and deficiencies of other vitamins and minerals are a major cause of ill health. In developed countries nutrient deficiency is rare, although there are vulnerable sections of the population at risk. Intakes of minerals and vitamins that are adequate to prevent deficiency may be inadequate to promote optimum health and longevity. Excessive secretion of gastric acid, associated with Helicobacter pylori infection, can result in the development of gastric and duodenal ulcers; small changes in the composition of bile can result in crystallization of cholesterol as gallstones; failure of exocrine pancreatic secretion (as in cystic fibrosis) leads to undernutrition and steatorrhea.

The groups of acini are either closely packed in back-to-back arrangement without intervening stroma or are haphazardly distributed pulse blood pressure normal order discount cardura on line. Stroma Normally blood pressure normal limit order 4mg cardura free shipping, fibromuscular sling surrounds the acini arrhythmia fatigue discount 2mg cardura free shipping, whereas malignant acini have little or no stroma between them blood pressure too high purchase cardura 2mg online. Gland pattern Most frequently, the glands in well-differentiated prostatic adenocarcinoma are small or medium-sized, lined by a single layer of cuboidal or low columnar cells. Moderately-differentiated tumours have cribriform or fenestrated glandular appearance. The cells may show varying degree of anaplasia and nuclear atypia but is generally slight. Invasion One of the important diagnostic features of malignancy in prostate is the early and frequent occurrence of invasion of intra-prostatic perineural spaces. Direct spread Direct extension of the tumour occurs into the prostatic capsule and beyond. In late stage, the tumour may extend into the bladder neck, seminal vesicles, trigone and ureteral openings. Haematogenous spread leads most often to characteristic osteoblastic osseous metastases, especially to pelvis, and lumbar spine; other sites of metastases are lungs, kidneys, breast and brain. Two biochemical serum tumour markers employed for diagnosis and monitoring the prognosis of prostatic carcinoma are as under: 1. A reading between 4 and 10 ng/ml (normal 0-4 ng/ml) is highly suspicious (10% risk) but value above 10 is diagnostic of prostatic carcinoma. Treatment of prostatic carcinoma consists of surgery, radiotherapy and hormonal therapy. The hormonal dependence of prostate cancer consists ofdeprivingthetumourcellsofgrowth-promotinginfluenceoftestosterone. This can be achieved by bilateral orchiectomy followed by administration of oestrogen. In an undescended testis the risk of developing a testicular malignancy is increased to average of: A. Yolk sac tumour Granulomatous orchitis is the term used for inflam ation of m testis due to following etiology: A. Locally aggressive tumour Sequential tumorigenesis in seminomatous tumours involves: A. Multiple hits Spermatocytic seminoma differs from classic seminoma in the following respects except: A. Leydig cell tumour the following penile lesions are considered as in situ carcinoma except: A. Immature teratoma Which of the following testicular tumour is most radiosensitive Immature teratoma Classic perivascular structures seen in yolk sac tumours are known as: A. The inner surface of labia majora, labia minora and vestibule are covered by stratified squamous epithelium. M/E Shows the usual appearance of acute suppurative inflammation with neutrophilic infiltration, hyperaemia, oedema and epithelial degeneration. Alternatively, the chronic process evolves from repeated attacks of less severe acute inflammation which may be short of abscess formation and resolves incompletely. M/E Shows variable lining of the cyst varying from the transitional epithelium of the normal duct to a flattened lining because of increased intracystic pressure. The cyst wall may show chronic inflammatory infiltrate and a few mucus-secreting acini. The term is applied to chronic lesions of the vulva characterised clinically by white, plaque-like, pruritic mucosal thickenings and pathologically by disorders of epithelial growth. Clinically, the patient, usually a post-menopausal woman, complains of intense pruritus which may produce excoriation of the affected skin. Eventually, there is progressive shrinkage and atrophy resulting in narrowing of the introitus, clinically referred to as kraurosis vulvae. Lichen sclerosus is not a premalignant lesion and responds favourably to topical treatment with androgens. The stroma consists of loose fibrous and myxomatous connective tissue with some adipose tissue and blood vessels.

These changes in amount of plasma proteins in diseases are visualized by electrophoresis blood pressure chart when to go to the hospital buy 2 mg cardura fast delivery. Several types of electrophoresis are used to know changes in plasma proteins in diseases arrhythmia lying down buy cardura 2 mg on line. They are paper electrophoresis arrhythmia facebook buy cardura 2 mg online, cellulose acetate electrophoresis and agar gel electrophoresis arrhythmia 20 years old cheap cardura 2mg on-line. Some examples of electrophoretic patterns and densitometre scans are given in. In nephorsis albumin and -globulin are decreased but -globulins increased and globulins remained normal. In cirrhosis albumin is less but -globulin is more and other globulins are normal. In rheumatoid arthritis and -globulins are increased and other fractions are normal. In Hodgkins disease albumin and -globulin are decreased but -globulins are increased significantly. Polyacrylamide gel is used as supporting material for separation which also act as molecular seive. After reaching bone marrow through circulation it acts on bone marrow (stem) cells which differentiate and proliferate to mature erythrocytes. Apart from erythropoietin other proteins insulin like growth factor, interleukins etc. Structure of Erythrocyte Membrane Erythrocyte membrane is lipid bilayer consisting of lipids, proteins and carbohydrates. Lipids present in membrane, are phospholipids, glycosphingolipids and cholesterol. About 10 major proteins and more than 100 minor proteins are identified in erythrocyte membrane. Glycophorins, glucose transporter and anion exchange canal are integral membrane proteins. Spectrin, ankyrins, actin and tropomyosin are periph- Biochemistry of Blood 711 eral proteins. The peripheral proteins form cytoskeleton network on cytosolic side of erythrocyte membrane. They interact with integral proteins to regulate shape and flexibility of erythrocyte. Synthesis, degradation, structure, functions and diseases associated with these aspects of hemoglobin are described in chapter-22. Diseases due to defiencies of enzymes of salvage pathways are detailed in chapter-15. Likewise B blood group individuals have B blood group substances on erythrocytes and anti A-antibodies in blood. A B blood group individual erythrocyte contains both A and B groups blood substances and he lacks anti-A, anti-B antibodies in blood. In contract O blood group individual erythrocytes has O group substancses, and lacks A, B groups substances. Fu cose C e ram ide - o ligo sa cch arid e - Galacto se -N -A cetylga la ctose A gro up sub stan ce. Fu cose C e ram ide - o ligo sa cch arid e - Galacto se - Ga la cto se B gro up sub stan ce. The oligosaccharide is a trisaccharide and composed of glucose, galactose and N-acetylgalactose. In A group substance N-acetyl galactose and in B group substance galactose are attached to terminals galactose respectively. The Rh blood group is due to substance known as Rh factor which is an integral membrane protein of erythrocytes. Some individuals (about 9% of whites) lacks this proteins and they are known as Rh negative individuals. Determination of Rh blood groups is important in the case of woman who may become pregnant. If infant is Rh positive and mother is Rh negative abortion due to production of antibodies may occurs.

Products of lymphocytes are called lymphokines blood pressure 220 120 buy cardura online pills, while products of monocytes or macrophages are called monokines blood pressure 8050 buy cardura toronto. Interferon is an antiviral inter heart attack grill menu order cardura once a day, feron blood pressure news order 4mg cardura, while interferon is an immune interferon. In general these class I molecules bind to proteins synthesized within the cell; one example is the cellular production of viral antigens. Macrophages and neutrophils are active phagocytes and have receptors for the Fc portion of IgG and C3b; both of these substances are important opsonins. Ankylosing spondylitis is one type of spondyloarthropathy that lacks the rheumatoid factor found in rheumatoid arthritis. They are classified into four different cat- 128 Pathology egories based on the immune mechanisms involved. Type I hypersensitivity reactions involve IgE (reaginic) antibodies that have been bound to the surface of mast cells and basophils. This IgE then attaches to mast cells and basophils, because these cells have cell surface receptors for the Fc portion of IgE. When these "armed" mast cells or basophils are reexposed to the allergen, the antigen bridges two IgE molecules and causes mast cells to release preformed (primary) mediators. This antigen-to-antibody binding also causes these cells to synthesize secondary mediators. The reactions that occur as a result of the primary mediators of type I hypersensitivity are rapidly occurring, since the mediators have already been made and are present within the granules of mast cells. These substances include biogenic amines, such as histamine, chemotactic factors, enzymes, and proteoglycans. Histamine causes increased vascular permeability, vasodilation, and bronchial smooth muscle contraction. Mast cells also produce new products (secondary mediators) via a series of reactions within the cell membrane that lead to the generation of lipid mediators and cytokines. Membrane receptors bound to IgE activate phospholipase A2, which then cleaves membrane phospholipids into arachidonic acid. These last three leukotrienes are the most potent vasoactive and spasmogenic agents known. Prostaglandin D2, which is produced via the enzyme cyclooxygenase, is abundant in lung mast cells. Local reactions include urticaria (hives), angioedema, allergic rhinitis (hay fever), conjunctivitis, food allergies, and allergic bronchial asthma. Systemic reactions usually follow parenteral administration of antigen, such as with drug reactions (penicillin) or insect stings. Symptoms include vomiting, cramps, diarrhea, itching, wheezing, and shortness of breath, and death may occur within minutes. Complement-mediated cytotoxicity occurs when IgM or IgG binds to a cell surface antigen with complement activation and consequent cell membrane damage or lysis. Blood transfusion reactions and autoimmune hemolytic anemia are examples of this form. Systemic anaphylaxis is a type I hypersensitivity reaction in which mast cells or basophils that are bound to IgE antibodies are reexposed to an allergen, which leads to a release of vasoactive amines that causes edema and broncho- and vasoconstriction. This process is followed by chemotaxis and aggregation of neutrophils, which leads to release of lysosomal enzymes and eventual necrosis of tissue and cells. Interferon activates macrophages (epithelioid cells) and forms granulomas (caseating or non- 130 Pathology caseating). A local area of erythema and induration peaks at about 48 h following intracutaneous injection of tuberculin. Granulomatous inflammation (with epithelioid cells), poison ivy reactions, and contact dermatitis are types of delayed type hypersensitivity. Contact dermatitis is often the result of sensitivity to nickel, which can be found in some watchbands. The latter may also reveal fibrinoid necrosis around blood vessels, while eosinophils in an allergic nasal polyp are an example of a type I hypersensitivity reaction.

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