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Assistant Professor, Florida Atlantic University Charles E. Schmidt College of Medicine

The other population of cells contains vesicles that are smaller menopause age generic 35 mg fosamax mastercard, more homogeneous menopause sweating cheap fosamax 35 mg with mastercard, and less dense menopause cramps order fosamax paypal. The cortical arterioles form a cortical network of capillaries, which drain into a second capillary network in the medulla. The medullary capillary network is formed primarily by the medullary arterioles and drains into the central medullary vein. Adrenal medulla, zones of the cortex, and features of basic cell types and their secretory products are noted. Exocytosis of the secretory vesicles is triggered by release of acetylcholine from presynaptic sympathetic axons that synapse with each chromaffin cell. Glucocorticoids secreted in the cortex induce the conversion of norepinephrine to epinephrine in chromaffin cells. Epinephrine and norepinephrine account for less than 20% of the contents of the medullary secretory vesicles. Drugs such as reserpine, which cause depletion of catecholamines from the vesicles, may act by inhibiting this transport mechanism. Glucocorticoids produced in the adrenal cortex reach the medulla directly through the continuity of the cortical and medullary sinusoidal capillaries. They induce the enzyme that catalyzes the methylation of norepinephrine to produce epinephrine. The nature of the blood flow correlates with regional differences in distribution of norepinephrine- and epinephrine-containing chromaffin cells. The epinephrine-containing cells are more numerous in areas of the medulla supplied with blood that has passed through the cortical sinusoids and thus contains secreted glucocorticoids. In some species, the norepinephrine-containing cells are more numerous in those regions of the medulla supplied by capillaries derived from the cortical arterioles. The release of catecholamines also causes an increase in blood pressure, dilation of the coronary blood vessels, vasodilation of vessels supplying skeletal muscle, vasoconstriction of vessels conveying blood to the skin and gut, an increase in heart rate and output, and an increase in the rate and depth of breathing. Zonation of the Adrenal Cortex the adrenal cortex is divided into three zones on the basis of the arrangement of its cells. This photomicrograph shows the center of the adrenal gland with a central adrenomedullary vein in the middle. These projections represent longitudinal bundles of smooth muscles of the tunica media. In areas where muscle bundles are absent, cells of the adrenal medulla (lower part of the image) or sometimes adrenal cortex (upper part of the image) are separated from the lumen only by a thin layer of tunica intima. The zona glomerulosa secretes aldosterone, which functions in the control of blood pressure. The sudden release of catecholamines establishes conditions for maximum use of energy and thus maximum physical effort. Aldosterone acts on the principal cells in the distal tubules of the nephron in the kidney, the gastric mucosa, and the salivary and sweat glands to stimulate resorption of sodium at these sites, as well as to stimulate excretion of potassium by the kidney. The final step of aldosterone biosynthesis is facilitated by aldosterone synthase, which is exclusively expressed in cells of the zona glomerulosa. Cells of the zona glomerulosa lack the enzyme 17 -hydrolase and therefore are unable to produce other adrenal steroid hormones, such as cortisol or adrenal androgens. The epinephrine-secreting cells (E) possess vesicles with less intensely staining granules. The juxtaglomerular cells in the kidney release renin in response to a decrease in blood pressure or a low blood sodium level. It includes the connective tissue capsule, the zona glomerulosa, and the zona fasciculata. Continuous with the zona glomerulosa are the straight cords of cells that characterize the zona fasciculata. The red linear stripes represent capillaries that are engorged with red blood cells.

This change in reproductive function is referred to as the menopause or climacterium (commonly called the change of life) menstruation stopped fosamax 70mg visa. Part of the wall of the uterus women's health center templeton purchase generic fosamax online, uterine tube menstrual cycle at age 7 cheap 35 mg fosamax with amex, and vagina has been removed to reveal their internal structure. Note the three distinct layers of the uterine wall: the inner layer, the endometrium lining the uterine cavity; the middle and thickest layer, the myometrium; and the outer layer, the perimetrium, which is the peritoneal covering of the uterus. If implantation does not occur, the endometrium of the uterus degenerates and menstruation follows. Each ovary is attached to the posterior surface of the broad ligament by a peritoneal fold, the mesovarium. The superior (or tubal) pole of the ovary is attached to the pelvic wall by the suspensory ligament of the ovary, which carries the ovarian vessels and nerves. This ligament is a remnant of the gubernaculum, the embryonic fibrous cord that attaches the developing gonad to the floor of the pelvis. Before puberty, the surface of the ovary is smooth, but during reproductive life, it becomes progressively scarred and irregular because of repeated ovulations. In postmenopausal women, the ovaries are about one-fourth the size observed during the reproductive period. The ovaries have two interrelated functions: gametogenesis (the production of gametes) and steroidogenesis (the production of steroids). Two major groups of steroid hormones-estrogens and progestogens-are secreted by the ovaries. Estrogens also act on mammary glands to promote breast development by stimulating ductal and stromal growth and accumulation of adipose tissue. Progestogens prepare the internal sex organs, mainly the uterus, for pregnancy by promoting secretory changes in the endometrium (discussed in the section on cyclic changes in the endometrium). Progestogens also prepare the mammary gland for lactation by promoting lobular proliferation. The cortex or cortical region is found in the peripheral portion of the ovary surrounding the medulla. This drawing shows stages of follicular development from the early primary follicle to the mature (Graafian) follicle. Changes in the follicle after ovulation lead to development of the corpus luteum and eventually the corpus albicans. The surface of the ovary is covered by a single layer of cuboidal and, in some parts, almost squamous cells. This cellular layer, known as the germinal epithelium, is continuous with the mesothelium that covers the mesovarium. The term germinal epithelium is a carryover from the past when it was incorrectly thought to be the site of germ cell formation during embryonic development. It is now known that the primordial germ cells (both male and female) are of extragonadal origin and that they migrate from the embryonic yolk sac into the cortex of the embryonic gonad, where they differentiate and induce differentiation of the ovary. A dense connective tissue layer, the tunica albuginea, lies between the germinal epithelium and the underlying cortex (Plate 92, page 876). Tumors that arise from the epithelial surface of the ovary account for more than 70% of ovarian cancers. The origin of surface epithelial tumors may be related to repeated disruption and repair of the germinal epithelium that occurs during ovulations. The oocytes present at birth remain arrested in development at the first meiotic division (see page 801). The first ovulation generally does not take place for a year or more after menarche. A cyclic pattern of follicular maturation and ovulation is then established that continues in parallel with the menstrual cycle. Normally, only one oocyte reaches full maturity and is released from the ovary during each menstrual cycle. Obviously, the maturation and release of more than one egg at ovulation may lead to multiple zygotes. Most of the estimated 600,000 to 800,000 primary oocytes present at birth do not complete maturation and are gradually lost through atresia, the spontaneous death and subsequent resorption of immature oocytes.

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By virtue of their positive charge womens health consultants ob gyn 35mg fosamax visa, these drugs are absorbed poorly across mucosal surfaces and thus produce fewer side effects than atropine menopause zest cheap fosamax 35mg, especially when given by inhalation women's health center jackson ms purchase 70 mg fosamax. On the basis of this knowledge, antiinflammatory agents, particularly corticosteroids, are now included in the treatment regimens of an ever-increasing proportion of asthmatic patients. Corticosteroids A major breakthrough in asthma therapy was the introduction in the 1970s of aerosol corticosteroids. The success of inhaled steroids has led to a substantial reduction in the use of systemic corticosteroids. Inhaled corticosteroids, along with 2-adrenoceptor agonists, are front-line therapy of chronic asthma. Clinical Uses Ipratropium bromide (Atrovent) is a quaternary amine derivative that is used via inhalation in the treatment of chronic obstructive pulmonary disease and to a lesser extent, asthma. Compared with 2-adrenoceptor agonists, ipratropium is generally at least as effective in chronic obstructive pulmonary disease but less effective in asthma. The novel proteins that are formed may exert a variety of effects on cellular functions. The precise mechanisms whereby the corticosteroids exert their therapeutic benefit in asthma remain unclear, although the benefit is likely to be due to several actions rather than one specific action and is related to their ability to inhibit inflammatory processes. At the molecular level, corticosteroids regulate the transcription of a number of genes, including those for several cytokines. The corticosteroids have an array of actions in several systems that may be relevant to their effectiveness in asthma. These include inhibition of cytokine and mediator release, attenuation of mucus secretion, upregulation of -adrenoceptor numbers, inhibition of IgE synthesis, attenuation of eicosanoid generation, decreased microvascular permeability, and suppression of inflammatory cell influx and inflammatory processes. The effects of the steroids take several hours to days to develop, so they cannot be used for quick relief of acute episodes of bronchospasm. Clinical Uses the corticosteroids are effective in most children and adults with asthma. They are beneficial for the treatment of both acute and chronic aspects of the disease. Inhaled corticosteroids, including triamcinolone acetonide (Azmacort), beclomethasone dipropionate (Beclovent, Vanceril), flunisolide (AeroBid), and fluticasone (Flovent), are indicated for maintenance treatment of asthma as prophylactic therapy. Inhaled corticosteroids are not effective for relief of acute episodes of severe bronchospasm. Systemic corticosteroids, including prednisone and prednisolone, are used for the short-term treatment of asthma exacerbations that do not respond to 2-adrenoceptor agonists and aerosol corticosteroids. Systemic corticosteroids, along with other treatments, are also used to control status asthmaticus. Because of the side effects produced by systemically administered corticosteroids, they should not be used for maintenance therapy unless all other treatment options have been exhausted. A fixed combination of inhaled fluticasone and salmeterol (Advair) is available for maintenance antiinflammatory and bronchodilator treatment of asthma. Side effects are much more prevalent with systemic administration than with inhalant administration. The severity of all of these side effects can be reduced markedly by alternate-day therapy. In contrast to systemically administered corticosteroids, inhaled agents are either poorly absorbed or rapidly metabolized and inactivated and thus have greatly diminished systemic effects relative to oral agents. The most frequent side effects are local; they include oral candidiasis, dysphonia, sore throat and throat irritation, and coughing. Some studies have associated slowing of growth in children with the use of high-dose inhaled corticosteroids, although the results are controversial. Regardless, the purported effect is small and is likely outweighed by the benefit of control of the symptoms of asthma. Care should be taken in transferring patients from systemic to aerosol corticosteroids, as deaths due to adrenal insufficiency have been reported. In addition, allergic conditions, such as rhinitis, conjunctivitis, and eczema, previously controlled by systemic corticosteroids, may be unmasked when asthmatic patients are switched from systemic to inhaled corticosteroids. Caution should be exercised when taking corticosteroids during pregnancy, as glucocorticoids are teratogenic.

Note the ventricular and vocal folds in the middle of the larynx atraso menstrual 07 dias cheap fosamax 35 mg without prescription, approximately at the level of the thyroid cartilage breast cancer 5k topeka ks discount fosamax 35 mg with mastercard. This part of the larynx represents the narrowest portion of the respiratory system and is responsible for producing sound by audible vibration of the vocal folds menopause 10 years after hysterectomy discount fosamax online master card. Posteriorly, where the vestibule ends, the stratified squamous epithelium becomes thinner and undergoes a transition to the pseudostratified epithelium that characterizes the respiratory region. It is lined by the respiratory mucosa that contains a ciliated, pseudostratified columnar epithelium on its surface. The underlying lamina propria is firmly attached to the periosteum and perichondrium of the adjacent bone or cartilage. The medial wall of the respiratory region, the nasal septum, is smooth, but the lateral walls are thrown into folds by the presence of three shelf-like, bony projections called conchae or turbinates. The conchae divide each nasal cavity into separate air chambers and play a dual role. They increase surface area and cause turbulence in airflow to allow more efficient conditioning of inspired air. The ciliated, pseudostratified columnar epithelium of the respiratory mucosa is composed of five cell types: the epithelium of the respiratory region of the nasal cavity is essentially the same as the epithelium lining most of the parts that follow in the conducting system. Because the respiratory epithelium of the trachea is studied and examined in preference to that of the nasal cavity, the above cell types are discussed in the section on the trachea (page 670). The arrangement of the vessels allows the inhaled air to be warmed by blood flowing through the part of the loop closest to the surface. The capillaries that reside near the surface are arranged in rows; the blood flows perpendicular to the airflow, much as one would find in a mechanical heatexchange system. These same vessels may become engorged and leaky during allergic reactions or viral infections such as the common cold. The lamina propria then becomes distended with fluid, resulting in marked swelling of the mucous membrane with consequent restriction of the air passage, making breathing difficult. Their secretions supplement that of the goblet cells in the respiratory epithelium. By increasing surface area, the conchae (turbinates) increase the efficiency with which the inspired air is warmed. The turbinates also increase the efficiency of filtration of inspired air through the process of turbulent precipitation. Particulate matter suspended in the air stream is thrown out of the stream and adheres to the mucus-covered wall of the nasal cavity. Particles trapped in this layer of mucus are transported to the pharynx by means of coordinated sweeping movements of cilia and are then swallowed. The lamina propria of the olfactory mucosa is directly contiguous with the periosteum of the underlying bone (Plate 69, page 688). This connective tissue contains numerous blood and lymphatic vessels, unmyelinated olfactory nerves, myelinated nerves, and olfactory glands. The olfactory epithelium, like the epithelium of the respiratory region, is also pseudostratified, but it contains very different cell types. In living tissue, this mucosa is distinguished by its slight yellowish brown color caused by pigment in the olfactory epithelium and the associated olfactory glands. Supporting or sustentacular cells are columnar cells that are similar to neuroglia cells and provide mechanical and metabolic support to the olfactory receptor cells. Basal cells are stem cells from which new olfactory receptor cells and supporting cells differentiate. This diagram shows the three major cell types located within the olfactory epithelium: the olfactory cell, supporting (sustentacular) cell, and basal cell. The olfactory cell is the receptor cell; it has an apical expansion, the olfactory vesicle, from which long, nonmotile cilia extend.