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This is represented by vari­ tected from mechanical damage by layers ation in the number of x-ray photons in known as the supercoating (Fig order generic prednisone line allergy testing codes. We are unable to make direct use of the infor­ Film Base mation in this form order prednisone 40mg free shipping allergy shots salt lake city, however quality 20mg prednisone allergy shots pain, and must The only function of the flm base is to transfer it to a medium suitable for viewing provide a support for the fragile photo­ by the eye. Three characteristics of involve a magnetic tape or disc, a fuoro­ the base must be considered. The most im­ not produce a visible pattern or absorb too portant material used to "decode" the in­ much light when the radiograph is viewed. In reviewing x-ray flm, we must examine both the film and those factors that infuence the amount of information lost in the transfer process. In must not change during the developing 1960 the first medical radiographic flm us­ process or during the stored life of the flm. Poly­ Figure 10-2 illustrates a radiograph in ester as a film base offers the advantage of which the base has slowly diminished in size improved dimensional stability, even when over a period of 22 years. Notice how stored under conditions of varying humid­ shrinking of the base has thrown the un­ ity, and it is much stronger than acetate. It is no longer possible to make a "fat under conditions of low pressure and high plate of the abdomen," because x-ray plates temperature to form a molten polymer that are not available. The onset of World War is then literally stretched into sheets of ap­ I cut off the supply of photographic glass propriate size and thickness to form flm from Belgium and created a demand for a base. Cellulose nitrate is Triacetate and polyester bases are clear quite fammable, however, and several fres and colorless. In 1933 the frst commer­ were caused by improper handling and cialized blue tint was added to x-ray flm in storage of the flm. Because of this fre haz­ an effort to produce a flm that was "easier" ard a new "safety base" flm was urgently to look at, causing less eyestrain. The slightly thinner polyester base has handling properties approximately equal to those of the thicker acetate. Therefore, a thin layer of adhesive sub­ stance is applied to the base to ensure per­ fect union between base and emulsion. Emulsion The two most important ingredients of a photographic emulsion are gelatin and silver halide. The exact composition of the various emulsions is a closely guarded in­ dustrial secret. Most x-ray flm is made for use with intensifying screens, and has emulsion coated on both sides of the base. Emulsion thickness varies with flm type, Figure 10-2 Wrinkled emulsion resulting *Dacron and Cronex are trademarks of E. A thicker emulsion would not be useful be­ cause of the inability of light to penetrate to the deeper layers. Photographic gelatin for x-ray film is made from bone, mostly cattle bone from India and Argentina. It keeps the silver hal­ ide grains well dispersed and prevents the clumping of grains. Processing (developing and fxing) solutions can penetrate gelatin rapidly without destroying its strength or permanence, and gelatin is available in a reasonably large quantity and uniform quality. The hal­ ide in medical x-ray film is about 90 to 99% silver bromide and about 1 to 10% silver iodide (the presence of Agi produces an emulsion of much higher sensitivity than a pure AgBr emulsion). The silver iodo­ Figure 10-3 The silver iodobromide crystal lattice bromide crystals are precipitated and emulsifed in the gelatin under exacting conditions of concentration and tempera­ ture, as well as the sequence and the rate emulsions. In general, the precipitation and each grain contains an average of reaction involves the addition of silver ni­ 1,000,000 to 10,000,000 silver ions. A point The silver halide in a photographic defect consists of a silver ion that has emulsion is in the form of small crystals moved out of its normal position in the suspended in the gelatin. The crystal is crystal lattice; these interstitial silver ions formed from ions of silver (Ag+), ions of may move in the crystal (Fig. A dis­ bromine (Br-), and ions of iodine (I-) ar­ location is a line imperfection in the crystal, ranged in a cubic lattice (Fig. These and may be thought of as a brick wall that grains, or crystals, in a medical x-ray film contains one row in which the bricks are emulsion are small but still relatively large not the same size as all the other bricks, compared to fne-grain photographic thus causing a strain in the wall structure. The electron gives the sensitivity speck a negative charge, and this attracts the mo­ bile interstitial Ag+ ions in the crystal. Growth of silver atoms at the Figure 10-4 A point defect site of the original sensitivity speck con­ tinues by repeated trapping of electrons, This may be the way in which the iodine followed by their neutralization with inter­ ion strains the crystal. The negative bromine Chemical sensitization of a crystal takes ions that have lost electrons are converted several forms. It is commonly produced by into neutral bromine atoms, which leave adding a sulfur-containing compound, the crystal and are taken up by the gelatin such as allylthiourea, to the emulsion, of the emulsion. Figure 10-5 diagrams the which reacts with silver halide to form sil­ development of a two-atom latent image ver sulfide. It is one or many of these centers in which the sensitivity speck that traps electrons to atomic silver atoms are concentrated. The begin formation of the latent image cen­ presence of atomic silver is a direct result ters. These small clumps of silver can, however, be seen with electron mi­ Metallic silver is black. These clumps of silver atoms are produces the dark areas seen on a devel­ termed latent image centers, and are the oped radiograph. We must explain how ex­ sites at which the developing process will posure of the sensitized silver iodobromide cause visible amounts of metallic silver to grains in the film emulsion to light (from be deposited. The difference between an x-ray intensifying screens), or to the direct emulsion grain that will react with the de­ action of x rays, initiates the formation of veloping solution and thus become a visible atomic silver to form a pattern. The energy silver deposit and a grain that will not be absorbed from a light photon gives an elec­ "developed" is the presence of one or more tron in the bromine ion enough energy to latent image centers in the exposed grain. The electron can move in the crys­ At least two atoms of silver must be present tal for relatively large distances as long as at a latent image center to make a grain it does not encounter a region of impurity developable (i. The more photoelectric absorption or Compton scat­ silver atoms that exist at a latent image cen­ tering, and have rather long ranges in the ter, the greater the probability that the emulsion. Some centers will this way may react with many grains in an contain several hundred silver atoms. The manner in which the energy der the usual conditions, the absorption of of the electrons is imparted to the photo­ one quantum of light by a silver halide graphic emulsion is complex and will not grain will produce one atom of silver and be considered in detail. The sorption of x rays by the emulsion is not energy of one absorbed x-ray photon can caused by electromagnetic radiation itself produce thousands of silver atoms at latent but by electrons emitted when the x-ray image sites in one or several grains. Even photon interacts with the silver halide in this large number of silver atoms is low, the emulsion. Most of the energy of the absorbed veloped film may be used as an indication photon is lost in processes that do not pro­ of how much x-ray exposure (i. Only 3 to 10% of the pho­ Because the sensitivity of the flm varies ton energy is used to produce photolytic greatly with the energy (kVp) of the x rays, silver. The photographic effect of direct however, blackening of a piece of flm does x-ray exposure on an emulsion can be in­ not give an accurate estimation of the ex­ creased by a factor of almost 100 by proper posure to which the flm has been sub­ chemical sensitization of the emulsion.

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Appearance on standing Does not reach full size immediately Reaches full size immediately 6 20 mg prednisone overnight delivery allergy treatment by homeopathy. Complications (obstruction/strangulation) Common as the neck is narrow Not common as neck is wide 10 generic prednisone 20mg overnight delivery allergy symptoms glands swollen. Herniotomy (Ligation and exision of in a hernia sac order prednisone 20 mg without prescription allergy forecast grand prairie tx, Meckel’s diverticulitis in b. Herniotomy and reconstruction of the lef and cecum on right side and sometimes posterior wall of the inguinal canal, Tis is a common method of classifying the on either side by a portion of bladder. The use of this classifcation It mostly occurs in males and most ing or Meshplasty). Persistence of preoperative factors: and anastomosis is performed if gangre- • Presence of chronic cough nous changes occur in the bowel. Inguinal lymphadenitis below inguinal • A direct hernia is repaired but the sper- severe colicky abdominal pain and step ligament. The incidence of recurrence is more with nia – Narrow neck, irreducibility, sudden 5. Saddle bag hernia, pan- Any preexisting cause of recurrence is corrected obstruction with shock and toxemia. Incarcerated hernia-It is an obstructed It is both direct and indirect hernia in the is done by operations like Lichtenstein mesh hernia caused by solid fecal matter in the same patient. One sac lying medial to the inferior operation of giant prosthesis for reinforce- tents of hernia get infamed, e. In this 267 Section 10  Umbilicus, Abdominal Wall, Peritoneum and Herniae operation, prosthetic reinforcement of the Table 42. Surgical balloons are used to infate Strangulation is a type of acute intestinal 4. Bladder is catheterized the extraperitoneal space along the ante- obstruction where blood supply of gut wall 5. A prosthetic mesh is now stapled over venous obstruction, because they are superf- the defect under laparoscopic control. Operation mesh is secured to the posterior rectus Due to venous obstruction there is edema The incision is made as for an inguinal hernia. If this Afer cutting the external oblique aponeuro- nar ligament, the transversus abdominis fuid gets infected by the translocation of bac- sis, the layers covering the sac are dissected aponeurotic arch, and laterally to the lat- teria from the gut, toxicity appears. Following arterial obstruction, the gut sac is highly infected and is carefully mopped The mesh is placed across the back of becomes friable and fabby. Gangrene may the sac is now cut and the intestine is checked beyond the deep inguinal ring and medi- progress to perforation and peritonitis. Finally there is hypovolemia and shock tine of doubtful viability with a warm and A comparison of open vs. If viable, the gut inguinal hernia repair is given in table is returned to the peritoneal cavity if non- 42. Clinical Features viable, resection and anastomosis of the gut is • Tere is history of inguinal hernia which done. Repair of the posterior wall is done by • The onset of strangulation is heralded by a tissue repair as use of synthetic mesh will Definition sudden pain over the site of hernia. It is useful for the bilat- • Women are more afected than men (2:1) eral hernias, multiple hernias and recurrent and right side is more afected than the Treatment hernias. Preoperative resuscitation followed by opera- Tere are two techniques of laparoscopic tion is the treatment of choice and is most hernia repair viz. Prophylactic parenteral antibiotic against is then incised above the hernia and a It extends from the femoral ring above to the bowel organisms. Strangulation-An obese lady may present with the features of intestinal obstruction or strangulation of an unno- Fig. Fascia transversalis – representing ante- Treatment Femoral Ring: Boundary rior femoral sheath. Laterally-Fibrous septum separating the descends vertically courses forward and when Herniotomy and closure of the femoral ring canal from the femoral vein (Silver fascia). Tere are three approaches to the femoral The sac can not pass down into the thigh hernia repair. A funnel-shaped fascial prolongation around at the lower border of the fossa ovalis. Causes The anterior wall of the sheath is formed Femoral hernia is almost always acquired in by the fascia transversalis and the posterior nature. Pregnancy: Repeated pregnancy causes three compartments separated by fbrous increased abdominal pressure which is septae. Wide femoral canal: Tis is due to ral nerve (femoral nerve is outside the narrow insertion of iliopubic tract into Fig. Sex Common in male child Common in females ing and extended above the inguinal ligament 3. Causes Neonatal sepsis Obesity, weak muscles, multiple pregnancy and the sac can be dissected from both above 4. Defect A small defect in the Defect is above or below the umbilicus umbilical scar and below. Symptoms of peptic ulcer-As stated It is the protrusion or herniation of extraperi- above. Pain may also be due to associated toneal fat through a defect in the linea alba peptic ulcer or gallstone disease. Tere is a frm globular swelling, varying from a pea size to 2cm diameter, does not Etiology Fig. The gap in the linea alba cannot in manual laborers between the ages of 30 be felt clearly. For this reason epigastric her- • Most cases are symptomsless but par- and 45yrs ofen precipitated by sudden strain nia is difcult to distinguish from lipoma. Conservative-Most of the hernia close Initially there is protrusion of extraperitoneal overlooked. Reassurance to the parents known as preperitoneal lipoma or false epi- ing peptic ulcer disease. See operative section for details of opera- tion of the hernia-A coin covered In the next stage, as the hernia grows big- tion chapter 96. Operative-Herniorrhaphy is indicated the sac when the patient complains of drag- Comparison of umbilical hernia of infants when the hernia is still present afer ging pain, discomfort or pain afer food, not and paraumbilical hernia of adults (Table 2 years of age. See operative section for details of opera- Umbilical hernia occurs as a complication tion (chapter 96). Clinical Features of umbilical sepsis, which causes weakness of Tere are three clinical types: the umbilical scar. Symptomless-At the initial stage it is symptomless and ofen discovered by the Clinical Features (Syn – Paraumbilical hernia) (Fig. Painful swelling-Localized pain exactly compliant of swelling in the umbilical In adults, hernia does not protrude through at the site of hernia as the fatty content of region, whenever the child cries.

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Specifically buy prednisone american express allergy symptoms 8-10, a birth cohort study in Finland reported affect health and the ability to function in society cheap prednisone 5mg with visa allergy treatment center. According to the committee buy genuine prednisone on line allergy testing jersey ci, evi- likely much higher than suggested by the previous retro- dence of long-term adverse health effects was strongest for spective self-report finding (Silver et al. According to sensory integrity, motor speed and coordination, atten- several studies, an estimated 25%–87% of the jail and tion, processing, and executive functions) was found to be prison population reported having experienced one or insufficient/inadequate based on the published literature 10 Textbook of Traumatic Brain Injury to date. The failure to separate concus- Lange 2003), including university students (Wang et al. Recent analysis of been shown to enhance cognition, counteract age-related the biases inherent in these estimates, including the non- memory decline, delay the onset of neurodegenerative dis- representativeness of study samples, suggests a much eases, and promote recovery after brain injury (van Praag lower estimate of the prevalence of persistent postconcus- 2008). The timing of exercise and degree of exertion are sive symptoms, perhaps as low as <5% (Iverson 2005). Disability was de- sistent postconcussion symptoms when compared with fined broadly and was inferred from self-reports of in- no-treatment baseline measurements (Leddy et al. These disor- They do not include persons treated and released from ders are characterized by severe alteration of the aware- emergency departments or who received no medical care. Service members injured outside of the United States and Coma is a transitory state of unconsciousness in which those treated in military health care facilities within the the eyes remain continuously closed and there is no behav- United States also are not included. This is in part because ioral evidence of an awareness of self or the environment. They do, however, exhibit periods of eye 12 Textbook of Traumatic Brain Injury opening that occur either spontaneously or in response to Economic Cost sensory stimulation, but show no signs of purposeful be- havior. These cost estimates do not ade- in the vegetative state (Multi-Society Task Force 1994) and quately account for the costs of extended rehabilitation, 280,000 in the minimally conscious state (Strauss et al. An estimated 40% of individuals with disorders the value of lost quality of life or productivity losses for of consciousness are children (Strauss et al. Detailed information about per- Costs provide a way to weight the severity of injuries sons in vegetative states and minimally conscious states in different settings. From an incidence viewpoint, falls, struck by/ ature (Multi-Society Task Force 1994), it was reported that against injuries, and injuries in motor vehicle crashes each 52% of adults and 62% of children in a vegetative state accounted for 24%–29% of the cases. Consequently, motor vehicle crashes Among adults, at 1 year postinjury, 28% had severe dis- accounted for almost 40% of the costs and firearms for al- ability, 17% had moderate disability, and 7% had a good most 30%, with falls accounting for 15% and struck by/ recovery according to the Glasgow Outcome Scale. However, because military per- by 15 months posthospital discharge (Selassie et al. Total lifetime comprehensive costs of traumatic brain injury by level of treatment, 2000 (million 2009$) Level of Medical cost Work loss cost Quality of life loss Total cost % of treatment Incidence (millions) (millions) (millions) (millions) total Fatal 40,148 585 53,329 93,345 147,260 66. Total lifetime comprehensive costs of traumatic brain injury by sex and age, 2000 (million 2009$) Age (years) Fatal Hospitalized Nonhospitalized Total All 144,651 57,803 18,729 221,183 0–4 4,394 4,315 3,161 11,869 5–14 6,095 5,733 6,925 18,753 15–24 41,242 14,157 1,381 56,780 25–44 55,721 17,706 4,453 77,881 45–64 26,519 9,068 2,338 37,925 65–74 5,194 2,502 169 7,865 75+ 5,487 4,322 301 10,111 Males 113,147 41,035 11,876 166,057 0–4 2,646 2,577 1,429 6,652 5–14 3,983 4,087 5,284 13,354 15–24 33,297 10,999 774 45,071 25–44 45,303 13,696 3,130 62,129 45–64 21,038 6,460 1,078 28,575 65–74 3,667 1,413 94 5,174 75+ 3,212 1,802 88 5,103 Females 31,504 16,769 6,853 55,126 0–4 1,748 1,738 1,732 5,218 5–14 2,111 1,646 1,642 5,399 15–24 7,945 3,157 607 11,709 25–44 10,418 4,011 1,324 15,752 45–64 5,481 2,608 1,260 9,349 65–74 1,528 1,088 75 2,691 75+ 2,274 2,520 214 5,008 Source. Unit lifetime comprehensive costs of traumatic brain injury by sex and age, 2000 (2009$) Age (years) Fatal Hospitalized Nonhospitalized Total All 3,602,901 371,518 16,322 164,666 0–4 5,050,354 464,758 21,223 74,608 5–14 5,213,794 464,426 24,500 63,318 15–24 5,369,199 515,669 7,030 245,155 25–44 4,766,926 479,288 16,727 247,338 45–64 3,192,815 355,677 18,354 235,314 65–74 1,576,560 204,669 6,850 195,625 75+ 768,604 135,740 2,980 72,163 Males 3,791,387 419,877 22,312 251,662 0–4 5,225,409 479,782 21,144 90,548 5–14 5,392,840 475,878 29,757 71,456 15–24 5,489,843 537,342 8,735 391,255 25–44 4,884,279 505,311 29,110 431,755 45–64 3,232,235 380,111 17,243 332,271 65–74 1,521,141 213,342 8,704 260,980 75+ 740,493 143,305 4,965 147,543 Females 3,057,068 289,831 11,139 80,666 0–4 4,806,583 444,136 21,288 60,933 5–14 4,906,421 438,248 15,619 49,402 15–24 4,916,379 452,140 5,628 100,582 25–44 4,315,974 407,604 8,339 92,128 45–64 3,050,035 306,826 19,425 124,380 65–74 1,727,643 194,403 5,411 132,045 75+ 812,149 130,801 2,559 47,459 Source. Incidence and lifetime medical and work loss costs of traumatic brain injury by mechanism, 2000 (2009$) Medical and Comprehensive work loss cost cost % of (in millions % of (in millions Cause Incidence incidents of 2009$) costs of 2009$) Total 1,343,000 100. Percentage of traumatic brain injury hospitalizations pre- and postwar, by selected external causes, U. Prewar=January 1, 1997, to August 31, 2001; postwar=September 1, 2001, to December 31, 2006. It is year, an increase of approximately 14% compared with the important to note that external cause information was prewar number. First, the majority nisms, such as falls or motor vehicle crashes, than as the of service members who screened positive for a possible sole reported injury (Schneiderman et al. Although self-report elic- nal cause of injury (such as fall, motor vehicle crash) and ited by structured or in-depth interview is considered the context (such as battle or nonbattle related). High-quality prospective ceived comprehensive evaluations, this estimate must be and well-controlled natural history studies are needed. Institute of Medicine: Gulf War and Health, Vol 7: Long-term Con- Accessed August 4, 2009. Clin Neuropsychol 23:1299– ration of rooflessness in entrants to a hostel for homeless 1314, 2009 men. J Head Trauma ical and cognitive injuries, their consequences, and services Rehabil 2009, Dec 29 [Epub ahead of print] to assist recovery. J Head Trauma Rehabil Mild Traumatic Brain Injury in the United States: Steps to 8:48–59, 1993 Prevent a Serious Public Health Problem. American Academy of Neurology: Practice parameter: the man- Available at: http://www. Arch Phys Med Rehabil 76:302– American Psychiatric Association: Diagnostic and Statistical 309, 1995 Manual of Mental Disorders, 4th Edition, Text Revision. Armed Forces Health Surveillance Center: New surveillance case Department of Defense: Traumatic brain injury numbers. Armed Forces Health Surveillance Center: Deriving case counts Department of Veterans Affairs, Department of Defense. Med Surveill Mon liability and validity of the Traumatic Brain Injury Question- Rep 17:21, 2010 naire. Brain Inj 19:85–91, Coma Scale–Extended in symptom prediction following 2005 mild traumatic brain injury. Child Abuse Negl 28:1099–1111, 2004 study of inflicted traumatic brain injury in young children. J Head Trauma Rehabil 5:9– Disease Control and Prevention, National Center for Injury 20, 1990 Prevention and Control, 2010. New York, Ox- related hospital discharges: results from a 14-state surveil- ford University Press, 2006 lance system, 1997. Crit Care Nurs Q 23:52–58, 2001 impact of traumatic brain injury: a brief overview. Operation Enduring Freedom 8: Afghanistan, chartered by Consequences of Traumatic Brain Injury. J Head tent postconcussive symptoms and posttraumatic stress dis- Trauma Rehabil 14:602– 615, 1999 order. J Head Trauma Rehabil 23:123– ing of acute mild traumatic brain injury in adolescents. J Head Geneva, World Health Organization, 1992 Trauma Rehabil 25:1–6, 2010 Wu A, Molteni R, Ying Z, et al: A saturated-fat diet aggravates the Winqvist S, Luukinen H, Jokelainen J, et al: Recurrent traumatic outcome of traumatic brain injury on hippocampal plasticity brain injury is predicted by the index injury occurring under and cognitive function by reducing brain-derived neu- the influence of alcohol. Pathological data have been Impact injuries require the head to make contact with an developed through observations of human autopsies and object, with the forces being transmitted to the brain. These biomechanical findings account for the asso- polypathology of human brain injury; and there are likely ciation between subdural hemorrhage and falls or assaults, to be significant differences in the anatomical basis of in- both being situations in which there is a rapid acceleration jury and cellular responses between species. Inertial forces do not require contact, but rather the brain moves within the cranial cavity. Blast injuries are the clinical, pathological, and cellular/molecular features the least well described and are seen in military or terrorist of this complex process. In 2007 a workshop convened by situations; the shock waves from an explosive device can the National Institute of Neurological Disorders and result in injuries to the brain parenchyma. Mechanisms of traumatic brain injury atomical, describing injuries as focal or diffuse, or patho- physiological, based on primary and secondary injuries.

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All the features discussed above are of reversible cell injury because if the injurious agent is removed at this point buy prednisone 20mg overnight delivery allergy symptoms weather, cell can recover back to its normal state of functioning prednisone 20mg with mastercard allergy shots lexington ky. Pyknosis is nuclear condensation – Calcium infux: Massive infux of Ca2+ results in the formation of large focculent Karyorrhexis is fragmentation mitochondrial densities and activation of enzymes buy prednisone 10 mg without a prescription allergy medicine yellow pill. Inability to reverse mitochondrial dysfunctionQ and development of profound disturbances in the mem- brane function characterize irreversibilityQ. Irreversible cell injury may be necrosis or apoptosis (Programmed cell death) Necrosis Apoptosis • Always pathological • May be physiological or pathological Increased calcium, reactive • Associated with disruption of cellular homeostasis • Important for development, homeostasis oxygen species and oxygen (e. Aschoff is similar to liq- – Seen in or- bodiesQ (in uefactive necro- gans (heart, rheumatic sis and is due liver, kidney heart disease) to secondary etc. So, Apoptosis or programmed cell death can be induced by intrinsic or extrinsic pathway. So, withdrawal or absence of growth factors can result in release of these mediators and initiate the intrinsic pathway. Condensation of nuclear chro- matin is the most characteris- tic feature of apoptosis Mnemonic: Short Story to understand the pathogenesis of apoptosis. This person is fred from work (equivalent to extrinsic pathway through death receptors). Person is not given pay for long time, so that the person himself gives resignation (equivalent to intrinsic pathway, due to absence of growth factors). In latter case, before giving resignation, the person will talk to his colleagues, whether Glucocorticoids induce apop- he should leave or not. Some of them will suggest him to leave (equivalent to pro-apoptotic gene prod- tosis while sex steroids inhibit ucts like bak, bid etc. Some members of this family like bak, bid, bin, bcl-xs (to remember, S for stimulate apoptosis) stimulate apoptosis whereas others like bcl-2, bcl-xL (to remember, L for lower apoptosis) etc inhibit apoptosis. Apoptosis affects only single cells or small group of cells Normal cells have bcl-2 and bcl-xL present in the mitochondrial membrane. They inhibit apoptosis because their protein products prevent the leakage of mitochondrial cyt ‘c’ into Cells are decreased in size due the cytoplasm. When there is absence of growth factors or hormones, bcl-2 and bcl-xL are to destruction of the structural replaced by bax, bin etc. Virus infected cells and Neoplastic cells by obliteration as in cystic fbrosis cytotoxic T cells 3. Estimation of Annexin V (apoptotic cells express phosphatidylserine on the outer layer of tosis. Clinical Signifcance of apoptosis in cancers On agarose gel electrophoresis, ladder patternQ is seen in Mutated cells are cleared normally in the body by apoptosis but in cancers, apoptosis is decreased. Atrophy Hypertrophy Hyperplasia • Reduced size of • Increase in size and • Increase in number of cells in tissues/ an organ or tissue function of cells organ. Metaplasia Dysplasia • Reversible changein which one differentiated • Abnormal multiplication of cells characterized cell type (epithelial or mesenchymal) is by change in size, shape and loss of cellular Epithelial metaplasia: Barret’s replaced by another cell type. Chaperones help in protein folding and transportation across endoplasmic reticulum and golgi apparatus. Chaperones thus can be induced by stress (like heat shock proteins; hsp 70 and hsp 90). However, if misfolding occurs, chaperones facilitate degradation of damaged protein via ubiquitin-proteasome complex. Hyaline change: It is any intracellular or extracellular accumulation that has pink homogenous appearance. Calcifcation: Pathologic calcifcation is the abnormal tissue deposition of calcium and the diaphragm are the usual salts, together with smaller amounts of iron, magnesium, and other mineral salts. On re-establishment of blood fow, there is acteristically seen in cardiac increased recruitment of white blood cells which cause infammation as well as generation of more cells appearing as contraction free radicals. Decreased activity of this enzyme is associated with ageing whereas excessive activity is associated with cancers. Decreased activity of telome- rase is associated with ageing whereas its excessive activity is associated with cancers. This is associated with formation of more free radicals thereby making free radical induced injury as an autocatalytic reaction. This group includes both manganese-superoxide 2 2 2 2 2 2 dismutase, which is localized in mitochondria, and copper-zinc-superoxide. For electron microscopy, the • Frozen section is a rapid way to fx and mount histology sections. It is used in surgical most commonly used fxative is removal of tumors, and allow rapid determination of margin (that the tumor has glutaraldehyde. The frozen tissue is sliced using a microtome, and the frozen slices are mounted on a glass slide and stained the same way as other methods. Which of the following is the characteristic of the following substances from the mitochondria? Apoptosis is associated with all of the following (d) Proptosis features except: (Karnataka 2009) 21. Which fnding on electron microscopy indicates (b) Ischemic necrosis of the brain irreversible cell injury? All of the following are morphological features of (c) Flocculent densities in the mitochondria apoptosis except (Karnataka 2004) (d) Myelin fgures (a) Cell shrinkage (b) Chromatin condensation 23. Which of the following is the hallmark of programmed (a) Cell degeneration cell death? After 5 days (b) Liquefactive necrosis of pain and tenderness at the site of trauma, she noticed (c) Caseous necrosis the presence “lump” which was persistent since the (d) Fat necrosis day of trauma. The amorphous material is an (a) The death receptors induce apoptosis when it example of engaged by fas ligand system (a) Apocrine metaplasia. Inactivation of which of the (b) Programmed cell death following molecules/genes is responsible for the (c) Post traumtic cell death resistance shown in the tumor cells? First cellular change in hypoxia: (Kolkata 2003) (b) Bcl-2 (c) p53 (a) Decreased oxidative phosphorylation in mitochon- (d) Cytochrome P450 dria (b) Cellular swelling 46. Dr Maalu Gupta is carrying out an experiment in which (c) Alteration in cellular membrane permeability a genetic mutation decreased the cell survival of a cell (d) Clumping of nuclear chromatin culture line. These cells have clumping of the nuclear chromatin and reduced size as compared to normal 40. Which of the following is the most likely involved (a) Injury due to hypoxia gene in the above described situation? The physician immediately gave him a nitrate (a) Brain tablet to be kept sublingually following which his chest (b) Breast pain decreased signifcantly. Which of the following best represents the biochemical (d) All change in the myocardial cells of this patient during the transient hypoxia? A patient Fahim presents to the hospital with jaundice, (a) Decreased hydrogen ion concentration right upper quadrant pain and fatigue.

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