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The thin segment of the loop of Henle (in most cases the simple squamous epithelium of these tubules cannot be distinguished from that of a capillary in the inner zone of the medulla) 3 cheap 60caps mentat with visa. The thick ascending segment of the loop of Henle (cytologically similar in appearance to the distal convoluted tubules with which they are continuous) returns to the glomerulus of origin of the nephron and forms the macula densa (see description above) Try to visualize the spatial relationships of an entire nephron as you examine the cortical labyrinth and rays buy mentat 60caps visa, and consider which components you would expect to find in each region. The renal medulla consists primarily of collecting tubules and larger collecting ducts, thin segments of the loop of Henle, and the thick ascending and descending segments of the loop of Henle. The largest collecting ducts that open on the area cribrosa of the papilla are the papillary ducts (of Bellini). Examine the tubules and glomeruli under higher magnification and identify all the components of the cortical labyrinth. Be sure you understand which cells form the visceral epithelium and the composition of the glomerular filter. Be certain that you understand the blood supply of the renal corpuscle, the convoluted tubules, and the loop of Henle, and the functional significance of these. Under higher magnification examine the characteristic transitional epithelium, and note the dome- shaped or bulging appearance of the surface cells and their more intense staining affinities. Observe the direction of the muscle bundles in the muscularis and locate blood vessels and nerves in the adventitia. The basic structural arrangement of the bladder is similar to that of the ureter, and the structures and layers should be studied as in the previous slide. Study the epithelial lining of the penile urethra and observe that its appearance varies in different regions of the same section. Mucous glands may occur as nests of epithelial cells along the lining epithelium (intra-epithelial glands) or they may occur as more typical urethral glands (of Littre) whose ducts empty into local recesses of the urethral lumen. The erectile tissue and the supporting fibro-muscular network of trabeculae that supports them are considered in the chapters on the male reproductive system. It has three parts, the pars distalis (anterior lobe), pars tuberalis (enveloping the infundibular stalk), and pars intermedia (rudimentary in adults). The neurohypophysis is a neuroectodermal downgrowth from the floor of the diencephalon (part of the central nervous system) and includes the pars nervosa (posterior lobe) and the infundibulum. Identify the pars distalis, neurohypophysis, and remnants of the pars intermedia with the aid of your text. H&E The red or blue staining of the secretory granules is due to the acidophilia or basophilia of the hormone contained in the granules. The pars intermedia, which is not seen clearly on this slide, forms a cap around the neurohypophysis and separates it from the pars distalis. From left to right: neurohypophysis, Rathke’s pouch, pars distalis Review the various hormones secreted by the basophils and acidophils (as defined in the trichrome stains) of the pars distalis. This preparation demonstrates the Herring bodies (large magenta-stained swellings on the neurosecretory axons) in the neural lobe. The neural crest-derived cells of the medulla are innervated by preganglionic fibers of the sympathetic nervous system and secrete catecholamines. You should be able to distinguish 5 zones in the organ: 1) the outer connective tissue capsule, 2) a thin zona glomerulosa just beneath this, 3) the wide zona fasciculata, 4) a thin zona reticularis, 5) the central medulla, within which lies the large central vein. The fibrous capsule is supplied with many small arteries, which pierce it and empty into the enlarged fenestrated capillaries (cortical sinusoids) of the adrenal cortex. The nuclei are round and the cytoplasm may contain a few lipid droplets, which will appear as lipid vacuoles. The cytoplasm appears frothy or spongy because of the many lipid droplets that have been removed during processing of the tissue. The zona reticularis consists of a branching and anastomosing network of polyhedral cells smaller than those of the zona fasciculata. The medulla is composed of cells that are also arranged in the typical fashion of endocrine glands, cords and clumps of cells surrounded by fenestrated medullary sinusoids. The medullary cells do not have lipid vacuoles, but if fixation is not prompt autodigestion vacuoles may appear in the cytoplasm. The tissue surrounding the central vein may not be medullary but instead may be in-growths of cortical tissue. The chromaffin reaction following bichromate fixation results in differential staining of epinephrine and norepinephrine cells, the latter are stained more darkly brown. Parafollicular cells are found interspersed within the follicular epithelium and in clusters between follicles. Cells in these glands secrete parathyroid hormone, which acts to increase calcium resorption from bone and in the renal tubules. Large intensely eosinophilic oxyphil cells may be found interspersed or in nests among the chief cells.

In contrast with endocytosis buy discount mentat 60caps line, exocytosis (taking “out of the cell”) is the process of a cell exporting material using vesicular transport (Figure 3 mentat 60caps with visa. Many cells manufacture substances that must be secreted, like a factory manufacturing a product for export. When the vesicle membrane fuses with the cell membrane, the vesicle releases it contents into the interstitial fluid. Endocrine cells produce and secrete hormones that are sent throughout the body, and certain immune cells produce and secrete large amounts of histamine, a chemical important for immune responses. The membrane of the vesicle fuses with the cell membrane, and the contents are released into the extracellular space. The tiny black granules in this electron micrograph are secretory vesicles filled with enzymes that will be exported from the cells via exocytosis. The genetic disease is most well known for its damage to the lungs, causing breathing difficulties and chronic lung infections, but it also affects the liver, pancreas, and intestines. This characteristic – puzzled researchers for a long time because the Cl ions are actually flowing down their concentration gradient when transported out of cells. Cilia on the epithelial cells move the mucus and its trapped particles up the airways away from the lungs and toward the outside. In order to be effectively moved upward, the – mucus cannot be too viscous; rather it must have a thin, watery consistency. The transport of Cl and the maintenance + of an electronegative environment outside of the cell attract positive ions such as Na to the extracellular space. As a result, through osmosis, water moves from cells and extracellular matrix into the mucus, “thinning” it out. This is how, in a normal respiratory system, the mucus is kept sufficiently watered-down to be propelled out of the respiratory system. The absence of ions in the secreted mucus results in the lack of a normal water concentration gradient. The resulting mucus is thick and sticky, and the ciliated epithelia cannot effectively remove it from the respiratory system. Bacterial infections occur more easily because bacterial cells are not effectively carried away from the lungs. All living cells in multicellular organisms contain an internal cytoplasmic compartment, and a nucleus within the cytoplasm. Cytosol, the jelly-like substance within the cell, provides the fluid medium necessary for biochemical reactions. An organelle (“little organ”) is one of several different types of membrane-enclosed bodies in the cell, each performing a unique function. Just as the various bodily organs work together in harmony to perform all of a human’s functions, the many different cellular organelles work together to keep the cell healthy and performing all of its important functions. Organelles of the Endomembrane System A set of three major organelles together form a system within the cell called the endomembrane system. These organelles work together to perform various cellular jobs, including the task of producing, packaging, and exporting certain cellular products. The organelles of the endomembrane system include the endoplasmic reticulum, Golgi apparatus, and vesicles. The smooth and rough endoplasmic reticula are very different in appearance and function (source: mouse tissue). These products are sorted through the apparatus, and then they are released from the opposite side after being repackaged into new vesicles. If the product is to be exported from the cell, the vesicle migrates to the cell surface and fuses to the cell membrane, and the cargo is secreted (Figure 3. Some of these products are transported to other areas of the cell and some are exported from the cell through exocytosis. Enzymatic proteins are packaged as new lysosomes (or packaged and sent for fusion with existing lysosomes). Lysosomes Some of the protein products packaged by the Golgi include digestive enzymes that are meant to remain inside the cell for use in breaking down certain materials. The enzyme-containing vesicles released by the Golgi may form new lysosomes, or fuse with existing, lysosomes. A lysosome is an organelle that contains enzymes that break down and digest unneeded cellular components, such as a damaged organelle. For example, when certain immune defense cells (white blood cells) phagocytize bacteria, the bacterial cell is transported into a lysosome and digested by the enzymes inside. In the case of damaged or unhealthy cells, lysosomes can be triggered to open up and release their digestive enzymes into the cytoplasm of the cell, killing the cell. This “self-destruct” mechanism is called autolysis, and makes the process of cell death controlled (a mechanism called “apoptosis”).

When peripheral tumors is attached to parietal pleura mentat 60 caps with mastercard, extrapleural resection can be attempted with good success or en bloc resection will be required c discount 60 caps mentat visa. Most important prognostic factor is whether a complete resection can be performed Surgical Treatment of T3 (Proximity to carina) Non-Small Cell Lung Cancer 1. Most important diagnostic procedure is bronchoscopy in order to determine proximity of the tumor to the carina 2. Indication is for bulky tumors in proximity to or involving the carina or tracheobronchial angle v. Number of nodes affected survival, upper paratracheal nodes affected survival with an overall 5 year survival of 20% i. Found that post-operative radiotherapy significantly decreased local recurrence but no affect on survival iii. Chemotherapy and found increased disease free survival in those patients that received chemotherapy a. If left untreated the pain becomes unremitting and spreads medially to the scapula, extends along the ulnar nerve distribution of the arm to involve the elbow, forearm and hand. Other involved structures include the cervical sympathetics (Horner’s syndrome), vagus and phrenic nerves, carotid artery, and the vertebral bodies. Small cell is rare Location All are T3 since they invade the chest wall; classified as T4 when mediastinal and/or cervical invasion has taken place. Posterior—stellate ganglion, posterior ribs, brachial plexus (upward extension), and vertebral bodies (medial extension) Anterior—1st rib, scalene muscle, subclavian vessels, phrenic nerve Resection possible even with brachial plexus, stellate ganglion, rib, transverse process, subclavian artery (adventitia), vertebral body (<25%). It is not effective for tumors that invade the posterior aspects of the ribs and their transverse processes, the stellate ganglion and sympathetic chain, and the vertebral bodies. Pathogenesis · The lung is the first capillary bed draining most primary sites, with tumor cells usually depositing in the periphery · 10-20% of patients with pulmonary metastases have disease confined to the lungs (especially with sarcomas) 2. Patient Selection · There are four criteria which should be met prior to resection of pulmonary metastases: 1. Prognostic Factors · Histologic cell type affects the pattern of metastasis as well as outcome · Tumors with longer doubling time have better survival · The number of metastases, the disease-free interval, and unilateral vs. Operative Technique · Wedge resections should be performed wherever possible to preserve parenchymal tissue · Manual exploration is preferred to thoracoscopic examination to identify all nodules · Bilateral disease may be treated either by staged bilateral thoracotomy or median sternotomy for a single operation 6. Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: Results of a prospective trial. This important article reports five-year survival of 37% for resection of a solitary metastasis and 30% after a second resection for recurrent metastasis. This series of 33 patients shows an increased survival for resection (36% vs 11%) over medical therapy. The authors suggest that resection be considered in patients without evidence of concomitant extrapulmonary disease. Chapters 25 and 28: Superior Sulcus Tumors and Indications for Resection of Pulmonary Metastases. Respiratory Tract Tissue examination Most lesions are peripheral Radiographic features- major diagnostic aid Calcification "Popcorn" type Well defined margins Lobulated Growth (? Epithelial tumors Mesodermal tumors Vascular tumors Bronchial tumors Neurogenic tumors Developmental or unknown origin tumors Inflammatory and other pseudo0tumors 3. Tumors of Epithelial origin Papilloma- 5 sib-classifications Solitary benign papilloma Multiple benign papillomas Combined bronchial mucous gland and surface papillary tumor In situ papillary bronchial carcinomas Bronchiolar papillomas Proximal Squamous, stalk Distal Clara cells One of few lesions that can be managed by bronchoscopic resection Recurrence is high Rare malignant transformation 4. Tumors of Mesodermal Origin Hemangioma Subglottic area of larynx or upper trachea of infants Airway obstuction Dx: Bronchoscopy Other vascular lesions of skin, mucous membranes Tx: Radiation therapy Lymphangioma Upper airway obstruction in infancy Associated with other lesions- cystic hygroma, hemangioma in the neck Tx: surgical excision 6. Hemangiopericytoma Solitary, encapsulated, asymptomatic Originates from pericytes associated with pulmonary capillaries Considered malignant Tx: Surgical resection for cure or radiation therapy for palliation 10. Fibroma Mostly tracheobronchial in origin Most common benign tumor of mesodermal origin in adult and pediatric age group Collagenous/ spindle cells- myxomatous/ adipose elements Tx: Bronchoscopic resection if stalk is present vs conservative pulmonary resection 11. Lipoma Rare, intrabronchial lesion; male predominance Slowly growing, avascular, obstructive, pedunculated Tx: Bronchoscopic removal for small lesions; bronchotomy for larger ones Arise in fat cells Associated with bronchiectasis (chronic obstruction) 13. Granular Cell Tumors (Myoblastoma) Previously thought to originate from myoblasts Originates from Schwann cells or histiocytes Arises from the tongue or skin 6% originate endobronchially Tx: Surgical removal with wide margins Bronchoscopic removal associated with recurrence < 8 mm 16. Developmental or Unknown Origin Hamartomas Most common benign tumor of the lung 8% of coin-shaped lesions 0. Thymoma Ectopic thymus tissue (rare) Intrapulmonary thymoma may be associated with Myasthenia Gravis 21. Pseudolymphoma Discrete localization Unilateral Resembles lymphoid interstitial pneumonitis Rare conversion to malignant lymphoma Tx: Lobectomy/ segmental resection with follow-up 23. Amyloid Deposition may be diffuse of localized Occasionally may be obstructive Tx: Bronchoscopic removal/ resection 25.

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