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Astrocytes provide a framework of support for the neurons and contribute to their nutrition and metabolic activity erectile dysfunction age 22 order genuine fildena line. The processes often expand to form end feet (foot processes) that are aligned along the internal surface of the pia mater and around the walls of blood vessels erectile dysfunction medication list fildena 100 mg without prescription. The largest concentration of end feet occurs beneath the pial surface what food causes erectile dysfunction purchase 150 mg fildena visa, where they surround the brain and spinal cord to form a membrane-like structure called the glia limitans erectile dysfunction after 70 cheap fildena 50mg online. Smaller neuroglial cells with fewer processes and more deeply stained nuclei are oligodendrocytes, of which there are two types. Interfascicular oligodendrocytes occur mainly in the fiber tracts that form the white matter of the brain and spinal cord. Perineuronal satellite oligodendrocytes are restricted to the gray matter and are closely associated with the cell bodies of neurons. Large numbers of microtubules form parallel arrays that run throughout the cytoplasm of the cell body and into its processes. Schwann cells are not present in the central nervous system; oligodendrocytes serve as the myelinforming cells for this region. Myelinated nerve fibers of the central nervous system have nodes of Ranvier, but unlike peripheral myelinated fibers, they do not show incisures. Nodes in the central nervous system are bare, while those of the peripheral nervous system are partly covered by extensions of cytoplasm from adjacent Schwann cells into the paranodal area. The myelin sheath begins just beyond the initial segment of the axon, a few microns from the axon hillock, and ensheathes the rest of the axon to near its end. Each internodal segment of a nerve fiber in the central nervous system is formed by a single cytoplasmic process from a nearby oligodendrocyte, which wraps around the axon. Unlike Schwann cells of the peripheral nervous system, a single oligodendrocyte provides the internodal segments of the myelin sheath for several separate, but adjacent axons. In some regions, as in the optic nerve, a single oligodendrocyte may be responsible for the internodal segments on 40 to 50 axons. Because perineuronal satellite oligodendrocytes lie close to the perikarya of neurons, it has been proposed that oligodendrocytes influence the metabolism and nutrition of neurons. In addition, glia appear to be involved in calcium homeostasis and in the recycling of certain types of neurotransmitters. In the central nervous system, perineuronal satellite and interfascicular oligodendrocytes have the same relationship to perikarya and their axons as that which exists between satellite cells and Schwann cells of peripheral nerve fibers. Schwann cells and satellite cells could be considered as neuroglial elements of the peripheral nervous system. Microglia have extensive ramifying processes, a characteristic phenotype that suggests they may be dendritic antigen-presenting cells. In areas of damage or disease, they are thought to proliferate and become phagocytic and are supplemented by monocytes from the blood that transform into additional macrophages. As material is phagocytosed, the cells enlarge and then are called Gitterzellen, or compound granular corpuscles. Monocytes appear to be the precursors of microglial cells, which thus are part of the mononuclear system of phagocytes with ultimate derivation from the bone marrow. The ependyma lines the central canal of the spinal cord and ventricles of the brain. It consists of a simple epithelium in which the closely packed cells vary from cuboidal to columnar. The luminal surfaces of the cells show large numbers of microvilli and, depending on the location, may show cilia. Adjacent cells are united by desmosomes and zonula adherens; zonula occludens generally are not seen. Hence, cerebrospinal fluid in the central canal and ventricles can pass between ependymal cells to enter the parenchyma of the central nervous system. The bases of ependymal cells have long, threadlike processes that branch, enter the substance of the brain and spinal cord, and may extend to the external surface, where they contribute end feet to the glia limitans. The ependyma forms a secretory epithelium in the ventricles of the brain, where it is in direct contact with a highly vascular region of the pia mater; the tela choroidea. The modified ependyma called choroid epithelial cells and the tela choroidea form the choroid plexus, which produces cerebrospinal fluid.

Squamous cell carcinoma of vagina constitutes less than 2% of all gynaecologic malignancies and is similar in morphology as elsewhere in the female genital tract erectile dysfunction 40 fildena 150mg without prescription. Adenocarcinoma of the vagina is much less frequent than squamous cell carcinoma of the vagina erectile dysfunction treatment london buy discount fildena 50mg on line. Similar tumours may occur in the urinary bladder can erectile dysfunction cause prostate cancer trusted fildena 25 mg, head and neck region (orbit buying erectile dysfunction pills online order fildena 100 mg fast delivery, nasopharynx, middle ear, oral cavity) and biliary tract. G/A the tumour is characterised by bulky and polypoid grape-like mass (botryoides = grape) that fills and projects out of the vagina. Groups of round to fusiform tumour cells are characteristically lying underneath the vaginal epithelium, called cambium layer of tumour cells. The central core of polypoid masses is composed of loose and myxoid stroma with many inflammatory cells. The tumour invades extensively in the pelvis and metastasises to regional lymph nodes and distant sites such as to lungs and liver. Ectocervix (exocervix) or portio vaginalis is the part of the cervix exposed to the vagina and is lined by stratified squamous epithelium, whereas the endocervix is continuous with the endocervical canal and is lined by a single layer of tall columnar mucus-secreting epithelium. The junction of the ectocervix and endocervix-junctional mucosa, consists of gradual transition between squamous and columnar epithelia (squamo-columnar junction) and is clinically and pathologically significant landmark. The most common organisms responsible for chronic cervicitis are the normal mixed vaginal flora that includes streptococci, enterococci. Factors predisposing to chronic cervicitis are sexual intercourse, trauma of childbirth, instrumentation and excess or deficiency of oestrogen. Nabothian (retention) cysts may be grossly visible from the surface as pearly grey vesicles. M/E Chronic cervicitis is characterised by extensive subepithelial inflammatory infiltrate of lymphocytes, plasma cells, large mononuclear cells and a few neutrophils. G/A Cervical polyp is a small (up to 5 cm in size), bright red, fragile growth which is frequently pedunculated but may be sessile. M/E Most cervical polyps are endocervical polyps and are covered with endocervical epithelium which may show squamous metaplasia. The stroma of the polyp is composed of loose and oedematous fibrous tissue with variable degree of inflammatory infiltrate. The condition is caused by progestrin stimulation such as during pregnancy, postpartum period and in women taking oral contraceptives. Depending upon the thickness of squamous epithelium involved by atypical cells, dysplasia is conventionally graded as mild, moderate and severe. Carcinoma in situ is the full-thickness involvement by atypical cells, or in other words carcinoma confined to layers above the basement membrane. The use of Pap smear followed by colposcopy-directed biopsy confirms the diagnosis which has helped greatly in instituting early effective therapy and thus has reduced the incidence of cervical cancer in many developed countries. Epidemiologic studies Based on epidemiology of large population of women with cervical cancer, several risk factors have been identified which include the following 4 most important factors: i) Women having early age of sexual activity. Immunologic studies Circulating tumour specific antigens and antibodies are detected in patients of cervical cancer. The cancerous focus, if present, fails to stain because of lack of glycogen in the surface cells. G/A No specific picture is associated with cellular atypia found in dysplasias or carcinoma in situ except that the changes begin at the squamocolumnar junction or transitional zone. The degree of atypicality in the exfoliated surface epithelial cells can be objectively graded on the basis of 3 principal features: 1. More severe nuclear dyskaryotic changes such as increased hyperchromasia and nuclear membrane folding. With introduction of effective Pap screening programme in developed countries, incidence of invasive cervical cancer has declined greatly. However, still worldwide cervical cancer remains third most common cancer in women, next to breast and lung cancer. Cervical screening recommendations include annual cervical smear in all sexually active women having any risk factors listed above. Descriptive diagnosis is given in abnormal smears that includes: benign cellular changes, reactive cellular changes, and abnormalities of epithelial cells. The incidence of invasive carcinoma of the cervix has shown a declining trend in developed countries in the last half of the century due to increased use of Pap smear technique for early detection and diagnosis but the incidence remains high in developing countries with low living standards.

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The medical laboratory scientist began the laboratory investigation of the transfusion reaction by assembling pre- and post-transfusion specimens and all paperwork and computer printouts men's health erectile dysfunction pills discount 150 mg fildena visa. Perform an antibody screen on the posttransfusion sample Blood bank/Apply knowledge of standard operating procedures/Transfusion reactions/2 anaphylactic and anaphylactoid reactions Donor plasma has reagins (IgE or IgA) that combine with allergens in patient plasma C erectile dysfunction drugs medicare discount fildena online amex. Patient is deficient in IgE and develops IgE antibodies via sensitization from transfusion or pregnancy D erectile dysfunction pills by bayer cheap fildena 50mg with mastercard. Patient is deficient in IgA and develops IgA antibodies via sensitization from transfusion or pregnancy Blood bank/Apply knowledge of fundamental biological principles/Transfusion reactions/1 4 impotence of psychogenic origin fildena 150mg fast delivery. The most time-saving approach would be to check all paperwork before performing any laboratory testing. D Anaphylactic or anaphylactoid reactions are the most severe form of allergic transfusion reaction and are associated with deficient or absent IgA in the patients, allowing them the capability to form antiIgA. These patients must be transfused with washed cellular products where the plasma has been removed. B A transfusion reaction that occurs several days after a transfusion of blood products is probably a delayed immunologic reaction due to an antibody formed against donor antigens. Transfusion-related acute lung injury Blood bank/Apply knowledge of fundamental biological characteristics/Transfusion reactions/1 to an O patient Febrile nonhemolytic transfusion reaction Blood bank/Apply knowledge of fundamental biological characteristics/Transfusion reactions/2 9. During the transfusion, her pulse was 94, and blood pressure rose from 114/59 to 132/64. Delayed hemolytic Blood bank/Correlation of laboratory and clinical data/Transfusion reactions/3 red cells 2 days ago. An antibody screen and panel studies revealed the presence of anti-Jkb (postspecimen). The recipient cells were likely positive for the Jkb antigen Blood bank/Apply knowledge of fundamental biological characteristics/Transfusion reactions/3 evaluation of a transfusion reaction, except: A. B Group A blood given to a group O patient would cause an immediate hemolytic transfusion reaction because a group O patient has anti-A and anti-B antibodies and would destroy A cells. C this is an example of an anamnestic reaction where the patient was most likely exposed to the Jkb antigen at some point in his life, and upon re-exposure to the antigen, the antibody titer rose to detectable levels. A febrile nonhemolytic reaction is highly consistent with both symptoms and posttransfusion test results. A 92-year-old male diagnosed with anemia 147 and episodes of frequent falling was typed as B negative and transfused 1 unit of packed red blood cells, also B negative. Volume overload Blood bank/Correlation of laboratory and clinical data/Transfusion reaction/3 transfused 2 units of packed red blood cells. The technologist attributed the reaction to the Fya antigen being present on the A1 cells. Two units of A-positive packed cells were crossmatched that were Fya negative, and were compatible. D the tachycardia, increased pulse, and volume transfused before a reaction was called are consistent with volume overload. The temperature change did not meet criteria for a febrile reaction, and evidence for a hemolytic reaction is lacking. B this case emphasizes the statistic that not all causes of death are related to transfusion.

Othertimes erectile dysfunction doctors in houston tx buy fildena on line amex,duetoobstructionofthelymphaticsbytumourcells erectile dysfunction mayo clinic generic 100 mg fildena,the lymphflowisdisturbedandtumourcellsspreadagainsttheflowoflymph causing retrograde metastases at unusual sites latest advances in erectile dysfunction treatment fildena 50mg lowest price. The sites where blood-borne metastasis commonly occurs are: the liver erectile dysfunction pumps review buy fildena 150mg with mastercard, lungs, brain, bones, kidney and adrenals. However, a few organs such as the spleen, heart, and skeletal muscle generally do not allow tumour metastasis to grow. Blood in the pulmonary veins carrying cancer cells from the lungs reaches left side of the heart and then into systemic circulation and thus may form secondary masses elsewhere in the body. Aggressive clonal proliferation and angiogenesis Thefirststepin thespreadofcancercellsisthedevelopmentofrapidlyproliferatingcloneof cancercells. Entry of tumour cells into capillary lumen the tumour cells after degrading the basement membrane are ready to migrate into lumen of capillariesorvenules. Thrombus formation the tumour cells protruding in the lumen of the capillaryarenowcoveredwithconstituentsofthecirculatingbloodandform the thrombus. Extravasation of tumour cells Tumour cells in the circulation (capillaries, venules, lymphatics) may mechanically block these vascular channels and attach to vascular endothelium and then extravasate to the extravascularspace. Survival and growth of metastatic deposit the extra asated v malignantcells onlodgement intherightenvironment growfurtherunder theinfluenceofgrowthfactorsproducedbyhosttissues,tumourcellsand bycleavageproductsofmatrixcomponents. Grading is defined as the gross appearance and microscopic degree of differentiation of the tumour, while staging means extent of spread of the tumour within the patient. Gross features like exophytic or fungating appearance are indicative of less malignant Neoplasia 116 Section I General Pathology growth than diffusely infiltrating tumours. However, grading is largely based on 2 important histologic features: the degree of anaplasia, and the rate of growth. In general, most common cancers in the developed and developing countriesareasunder: Developed countries: lung,breast,prostateandcolorectal. About one-third of all cancers worldwide are attributed to 9 modifiable life-style factors: tobacco use, alcohol consumption, obesity, physical inactivity, low fiber diet, unprotected sex, polluted air, indoor household smoke,andcontaminatedinjections. In general, the risk of developing cancer in relatives of a known cancer patient is almost three times higher as compared to control subjects. Theoverall estimates suggest that genetic cancers comprise about 5% of all cancers. Afewexamplesare: i) Cigarette smoking ii) Alcohol abuse iii) Synergistic interaction of alcohol and tobacco iv) Cancerofthecervix v) Penilecancer vi) Betelnutcancer vii) Industrialandenvironmentalsubstances viii)Overweightindi iduals,deficiencyofvitaminAandpeopleconsuming v diet rich in animal fats. Generally, cancers occur in older individuals past 5th decade of life (two-third of all cancers occur above 65 years of age), though there are variations in age incidence in different forms of cancers. Althoughthere aregeographicandracialvariations,cancer of the breast is the commonest cancer in women throughout the world while lung cancer is the commonest cancer in men. Miscellaneous conditions Certaininflammatory(bothinfectiousand non-infectious) and hyperplastic conditions are prone to development of cancer,e. Adenocarcinoma of the vagina is m n seen with increased frequency in adolescent daughters of mothers who had receivedoestrogentherapyduringpregnancy. Othertumours showing a slightly increased frequency in women receiving contra eptive c pillsforlongdurationsarebenigntumoursoftheliver. Monoclonality of tumours There is strong evidence to support that most human cancers arise from a single clone of cells by genetic transformationormutation. Forexample: i) Inacaseofmultiplemyeloma(amalignantdisorderofplasmacells), there is production of a single type of immunoglobulin. Field theory of cancer In an organ developing cancer, in the backdropofnormalcells,limitednumberofcellsonlygrowintocancerafter undergoing sequence of changes under the influence of etiologic agents. Multi-step process of cancer growth and progression Carcinogenesisisagradualmulti-stepprocessinvolvingmanygenerationsofcells. Genetic theory of cancer Cell growth of normal as well as abnormal typesisundergeneticcontrol. Thusthe abnormalities in genetic composition may be from inherited or induced mutations (induced by etiologic carcinogenic agents namely: chemicals, viruses,radiation).