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When bacterial overgrowth of the small bowel is present erectile dysfunction vacuum pump price discount 60mg cialis extra dosage visa, ingestion of lactulose results in two separate periods during the test in which hydrogen is produced: an earlier period caused by the bacteria in the small intestine and a later one caused by the bacteria in the colon impotence urban dictionary generic 50mg cialis extra dosage. Interfering factors · · Enterogenous steatorrhea Strenuous exercise Smoking may increase blood glucose levels erectile dysfunction water pump purchase discount cialis extra dosage. Patients with diabetes may have glucose levels that exceed 20 mg/dL despite lactase insufficiency. Antibiotics can decrease the bacteria in the intestine and may cause false-negative breath tests and thus should not be taken for 1 month prior to testing. Instruct the patient to avoid strenuous exercise for 8 hours before testing because exercise may factitiously affect the blood glucose level. Inform the patient that smoking is prohibited for approximately 8 hours before testing because smoking can increase the blood glucose level. During · Collect a venous blood sample in a gray-top tube from the fasting patient. Tell the patient that the only discomfort is the venipuncture; however, patients with lactase deficiency may have symptoms of lactose intolerance. Abnormal findings Decreased levels Lactase insufficiency Intestinal malabsorption/maldigestion Small bowel overgrowth of bacteria notes L 578 laparoscopy laparoscopy Type of test Endoscopy Normal findings Normal-appearing abdominal and pelvic organs Test explanation and related physiology Laparoscopy is used to visualize directly the abdominal and pelvic organs when pathology is suspected. It is used to evaluate patients with: · Acute abdominal/pelvic pain · Chronic abdominal/pelvic pain · Suspected advanced cancer · Abdominal mass of uncertain etiology · Unexplained infertility During laparoscopy, the abdominal organs can be visualized by inserting a scope through the abdominal wall and into the peritoneum (Figure 26). A camera is attached to the scope, and the view of the scope is seen on color monitors. This is particularly helpful in diagnosing abdominal and pelvic adhesions, tumors, and cysts affecting any abdominal organ and tubal and uterine causes of infertility. Endometriosis, ectopic pregnancy, a ruptured ovarian cyst, and salpingitis can be detected during an evaluation for pelvic pain. Contraindications · Patients who have had multiple abdominal surgical procedures, because adhesions may have formed · Patients with suspected intraabdominal hemorrhage Potential complications · Perforation of the bowel or bladder · Hemorrhage · Umbilical hernia due to inadequate repair of the hole in the fascia made by the trocar used to insert the laparoscope Interfering factors · Adhesions or extreme obesity may obstruct the field of vision. Instruct the patient to void before going to the operating room because a distended bladder can be easily penetrated. During · After general anesthesia is induced, a catheter and nasogastric tube are inserted to minimize the risk of penetrating a distended stomach or bladder with the initial needle placement. After the abdominal skin is cleansed, a blunt-tipped (Verres) needle is inserted through a small incision in L 580 laparoscopy the periumbilical area and into the peritoneal cavity. Alternatively, a slightly larger incision is placed in the skin, and the abdominal wall is separated under direct vision. The peritoneal cavity is filled with approximately 2 to 3 L of carbon dioxide to separate the abdominal wall from the intraabdominal viscera, enhancing visualization of pelvic and abdominal structures. A laparoscope is inserted through a trocar to examine the abdomen (see Figure 26). After the desired procedure is completed, the laparoscope is removed, and the carbon dioxide is allowed to escape. The incision(s) is closed with a few skin stitches and covered with an adhesive bandage. Most patients will have mild incisional pain later and also may complain of shoulder or subcostal discomfort from pneumoperitoneum. Inform the patient that the carbon dioxide inserted into the peritoneal cavity during the procedure may cause discomfort in the shoulder area or under the ribs. If patients have shoulder or subcostal discomfort from pneumoperitoneum, assure them that this usually lasts only 24 hours. Abnormal findings Abdominal adhesions Ovarian tumor or cyst Endometriosis Ectopic pregnancy Pelvic inflammatory disease Uterine fibroids notes Abscess or infection Cancer Ascites Portal hypertension Other abdominal pathology lead 581 lead Type of test Blood Normal findings <10 mcg/dL Critical values Pediatrics (15 years): 20 mcg/dL Adults (16 years): 70 mcg/dL Test explanation and related physiology Lead poisoning is a preventable condition that results from environmental exposure to lead. This exposure, indicated by elevated blood lead levels, can result in permanent damage of almost all parts of the body. However, its effects are most pronounced on the central nervous system and kidneys, causing symptoms ranging from mild learning disabilities and behavioral problems to encephalopathy. Children less than 6 years of age are the most likely to be exposed and affected by lead. Blood lead levels are the best test for detecting and evaluating recent acute and chronic exposure. Blood lead samples are used to screen for exposure and to monitor the effectiveness of treatment. The diagnosis of legionnaires disease can be made by culturing this organism from suspected infected fluids. Sputum for this test is best obtained by transtracheal aspiration or from bronchial washings. Another method of diagnosis is by directly identifying the organism in a microscopic smear of infected fluid with the use of direct fluorescent antibody methods. A presumptive diagnosis of legionnaires disease can be made in a symptomatic person when a single antibody titer is 1:256 or greater. A fourfold rise in titer to at least 1:128 between the acute-phase (1-week) and the convalescentphase (3-week) titer is diagnostic. L Procedure and patient care · See inside front cover for Routine Blood Testing. Lipase is an enzyme secreted by the pancreas into the duodenum to break down triglycerides into fatty acids. Because lipase was thought to be produced only in the pancreas, elevated serum levels were considered to be specific to pathologic pancreatic conditions. It is now apparent that other conditions can be associated with elevated lipase levels. Intestinal infarction or obstruction also can be associated with lipase elevation. However, the lipase elevations in nonpancreatic diseases are less than three times the upper limit of normal compared with those in pancreatitis, where they are often five to ten times normal values. In acute pancreatitis, elevated lipase levels usually parallel serum amylase levels. The lipase levels usually rise a little later than amylase (24 to 48 hours after the onset of pancreatitis) and remain elevated for 5 to 7 days. Because lipase peaks later and remains elevated longer than serum amylase, it is more useful in the diagnosis of acute pancreatitis later in the course of the disease. Interfering factors Drugs that may cause increased lipase levels include bethanechol, cholinergics, codeine, indomethacin, meperidine, methacholine, and morphine. As part of the lipid profile, these tests are performed to identify persons at risk for developing heart disease and to monitor the response to therapy if abnormalities are found. Lipoproteins are proteins in the blood whose main purpose is to transport cholesterol, triglycerides, and other insoluble fats. Levels of lipoproteins are genetically influenced; however, these levels can be altered by diet, lifestyle, and medications. The function of removing lipids from the endothelium (reverse cholesterol transport) provides a protective effect against heart disease. Levels in excess of 25% to 50% are associated with increased risk of coronary disease.
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Tests to erectile dysfunction pills photos purchase cialis extra dosage 100 mg with mastercard asses Vitamin K status include the prothrombin time-an important test in the investigation and management of jaundiced patients and of those on anticoagulant treatment erectile dysfunction treatment ppt cheap cialis extra dosage 40mg with amex. Some elements are needed at high concentrations erectile dysfunction viagra doesn't work proven cialis extra dosage 200mg, required more than 100mg per day. Sodium and Potassium: They are important in cell, muscle physiology, transmission of messages and other biological processes. Since both are widely distributed, deficiency of the two elements is rarely found. It has a role, along with others, in the neuro muscular excitability Sodium is exchanged with Hydrogen in renal tubules to acidify urine. Sodium and Potassium maintain the degree of hydration of plasma proteins, and there by viscosity of blood. Hypernatremia: It occurs nearly always due to water deficiencies rather than Na2+ excess. It is usually seen in patients with dehydration, on steroid therapy or excess sodium intake. Hyponatremia: It is common in patients who are in diuretics or excessive sweating, kidney disease, diarrhea and congestive heart failure. Other causes are decreased excretion by the kidney, diseases like Anuria, tissue damage or Diabetes Mellitus. Hypokalemia: Low potassium is not due to dietary deficiency but due to conditions like vomiting, diarrhea. Calcium and Phosphate: Major parts (90%) of them are found in the form of crystal lattice in the bone. People, who get enough sunlight, exercise regularly, on high protein diet, require 300400mgs per day. Absorption: It is influenced by · · Acidic pH solubilizes Calcium salts, promote absorption. High protein diet favors absorption Certain plant products, high fiber diet, oxalates interfere with absorption. Clinical conditions: Hyper- calcemia; may be due to hyper parathyroidism, endocrine causes, renal failure and malignancies. Hypoalbuminemia Hypo parathyroidism 184 · Renal disease/ failure Vitamin D deficiency Chronic deficiency leads to loss of bone mass (bone resorption) and osteoporosis, bone fractures Phosphorus: Dietary sources are cheese, milk, nuts. Iron In body it is found in Haemoglobin, Myoglobin, ferritin, hemosiderin, transferrine and enzymes like cytochromes etc. Homeostasis of Iron in blood Causes of iron deficiency: · · · Storage depletion Reduced dietary intake. Malnutrition Hemolysis Children who are on milk diet only are prone to iron deficiency. Chronic bleeding, irregular menstrual cycles Peptic ulcer, piles Hook worm infection Repeated malarial infections. Sources: cereals, legumes, raisins, nuts etc Functions: · Cofactor of enzymes like cytochrome oxidase, dopamine decarboxylase, tyrosinase, Cyt. C oxidase and superoxide dismutase and monoamine oxidases are dependant on copper. Tyrosyl oxidase is important for collagen metabolism · Ceruloplasmin (serum ferroxidase) catalyses Fe++ to Fe+++, a pre requisite for the incorporation of iron into transferrin. Absorption of copper from the intestine is grossly impaired, but treatment with parentral copper has not proved successful. Patient has normal absorption of iron but transport across the serosal aspect of mucosal membrane is defective. Patients are treated with Pencillamine, which binds to tissue copper and mobilizes it. Sources: Widely distributed in vegetables, chlorophyll, cereals, beans, potatoes, cheese and animal tissues. Fluorine It is solely derived from water, tea, and fish Daily intake should not be more than 3mg. Small quantities of it promotes bone development, increases retention of calcium and phosphate, prevent osteoporosis High level of fluoride in bone causes abnormal rise in calcium deposition, increases bone density Flurosis is due to toxicity of fluoride. Excess can be due to high dietary intake, contaminated water or inhalation of fluorine. Iodine Sources: Vegetables, fruits obtained from sea shore, sea fish are rich in iodine. It is absorbed from small intestines and transported as protein complex in plasma. See the details of iodine metabolism, thyroid hormone synthesis from the chapter on hormones. Zinc Sources are liver, milk, fish, dairy products, cereals, legumes, pulses, oil seeds, yeast and spinach etc. Absorption of Zinc from the intestine appear to be controlled in a manner similar to Iron. It is transported bound to a protein (2-macroglobulin and transferrin) It is excreted in urine and feces. The body does not store Zinc to any appreciable extent in any organ, urinary excretion is fairly constant at 10 mol/day. Retenene reductase (zinc enzyme) participates in the regeneration of rhodopsin (visual cycle). Insulin is secreted, stored as a complex of Zinc It is important for wound healing. Deficiency of Zinc: Patients requiring total parentral nutration, pregnancy, lactation, old age and alcoholics have been reported as being associated with increased incidence of Zinc deficiency. It stimulates ribonuclease activity; thereby it affects the synthesis of mononucleotides and nucleic acids. Hepatosplenomegaly 190 · Severe Zinc deficiency can lead to a postular skin rash, loss of body hair, diarrhea and mood change. Deficiency of selenium: · Liver cirrhosis Pancreatic degeneration Myopathy, infertility Failure of growth Toxicity: Selenium toxicity is called Selenosis Toxic dose is 900micro gram/day It is present in metal polishes and anti-rust compounds 191 - the Toxicity symptoms are Hair loss,failing of nails, diarrhea,weight loss and gaslicky odour in breath(due to the presence of dimethyl selenide in expired air). Introduction Hormones are responsible for monitoring changes in the internal and external environment. They direct the body to make necessary adaptations to these environmental changes. Tissue production (paracrine) of hormones is also possible Hormones and Central nervous system interact to shape up development, physiology, behaviour and cognition. The actions and interactions of the endocrine and nervous system control the neurological activities as well as endocrine functions. A messenger secreted by neurons is neurotransmitter while the secretion of endocrine is called hormone. Cellular functions are regulated by hormones, neurotransmitters and growth factors through their interaction with the receptors, located at the cell surface. Part of chapter discusses receptors, signal transduction and second messenger pathways.
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He became Assistant Professor of Oceanography at Johns Hopkins in 1958 and a research Chesapeake Bay Institute in 1960 (a position he still holds) erectile dysfunction protocol diet purchase cialis extra dosage online from canada. He is Past President of the Atlantic Estuarine Research Society and is Chairman of the Panel on Chemical Methods erectile dysfunction treatment australia buy cialis extra dosage 50 mg low price, National Academy of Sciences Committee of Oceanography erectile dysfunction medicine discount 100mg cialis extra dosage mastercard. He has more than 20 publications connected with meascientist at 1967, he surement techniques in natural waters. For the more abundant constituents, analytical precision and accuracy approaching the classical atomic weight measurements is required if improved data are to be obtained. For the moderately abundant constituents and, in particular, for those elements that participate in biological processes, large time and space variations occur and the requirement of large amounts of data favors automated analyses, if precision and accuracy can be retained. For the trace constituents including many of the heavy metals, inaccuracy produced by current techniques and analysts has produced a nearly useless body of data. The chemistry of sea water is described Keywords: Chemical analysis; oceanography; pollution; water analysis. Introduction Oceanography is the study of a very large, naturally occurring object, is arbitrarily defined for intellectual purposes. This may be observed today and we see that the rates of addition and loss of compounds of the mobile elements (high aqueous solubility - little other reactivity) are millionths of ties in 1 percent per year of the existing quanti- the oceans and even for relatively immobile (low aqueous solubilireactivity) elements the fractional ty-high chemical is change in inventory of the order of 0. The solution is well stirred and, therefore, If the rates of the energetically favored reactions were rapid, with half times of decades to perhaps a century, it would be possible to write a con- cise thermodynamic description of the oceans and that would be that. Goldberg  estimates the rate of growth of manganese nodules, which are widely distributed in the surface sediments, at 1 to 100 atomic layers per day (0. The other complicating aspect of the oceanic system is the presence of tions appear to occur only at solid surfaces living organisms. Constituents are assimilated, the biological structure moves tion is in contrast to the water motion and an altered distribution is produced. Swimming is important but sinking from gravitational attrac- the effects of biological activity vary from eledepending on the degree of participation in the biological process. Productivity of the photosynthetic organisms in the oceans is limited by light and the availability of nutrients. As pointed out by Ryther  the situation in the ocean is rather different than on land, which he ilthe major process. For a terrestrial environment with fertile soil one meter thick, the fixed nitrogen content of approximately 0. The structure of the terrestrial photosynthetic organisms leads to conversion of solar energy to an organic yield of 10 g per day or an annual production of several kilograms per meter square and the local supply of nitrogeo is adequate for maximum growth for many years. This productive layer is roughly 100 m thick and the reservoir of fixed nitrogen is 10 g. Complete conversion to organic matter would yield roughly 100 g of dry plant tissue. Self shading as the crop develops reduces the rate of production and the total possible crop is not achieved. Limited areas of the oceanic system have high yield because the producer extracts nutrients from a large volume of water, i. Many of the processes and phenomena studied by soil chemists and in- agronomists are important in the oceans but the temporal and spatial tensities of the processes are quite different. Some Historical Aspects of Oceanography the scientific study of the oceans developed as a part of the disciplines of physics, chemistry and biology, with valid observations beginning in the seventeenth century. Riley  in his historical review, Robert Boyle might be considered the founder of scientific chemi- oceanography in about 1670. Three hundred years later, this wretched characteristic of sea water salts plagues the modern analyst and we are unable to determine the simple property, total dissolved solids, by the obvious operation of quantitatively removing the water. Boyle and Hooke resorted to indirect estimates from measurements of specific gravity with a hydrometer or crude pycnometer as a more precise estimate. The use of indirect methods persists today and conductivity or refractive index measurements are employed to estimate the salinity of sea water samples. During the eighteenth century, the first analyses of the composition of sea water were undertaken by Antoine Lavoisier, using selective precipitation during evaporation and selective extraction of the remaining salts. Analytical properties have been ascribed to one constituent and subsequently shown to be influenced by unsuspected constituents. The development of oceanography as the integrated application of the scientific disciplines to the study of the oceans received major impetus from the planning and work undertaken on the world-wide expedition of H. The care and logic with which Dittmar devised and tested analytical procedures and his realistic appraisal of the probable accuracy and precision of the sample results are a model of quality that modern analysts have difficulty in emulating. Considering the and analytical techniques available to Dittmar, his results are a remarkable achievement. The accuracy of his results as judged by comparison with modern results is better than 1 percent exlimitations of chemical theory cept for the magnesium results that appear to be 2. The methods for each constituent were tested and then adhered that if to rigidly, so the systematic errors might be nearly constant and Dittmar hoped subsequent investigations demonstrated systematic errors, all a simple correction might be appHed to his resulte for the samples from the oceans. In addition, the precision of the measurements to was estimated be of the order of 0. The results for the 77 samples studied by Dittmar established that the major constituents of sea water are present throughout the oceans in nearly constant proportions, but that small variations might be present. This principle of constant proportions has been used as a major feature of oceanographic work. Each of the major constituents may be estimated from any one of the others when the proportionality constants have been determined. Many of the papers on chemical oceanography during the twentieth century have been studies of the proportionalities, usually in the form of the ratio of a constituent to chlorinity (the sum of the halides expressed as chlorine equivalent using 1900 atomic weights - see below). The importance of these results is that all the physical properties, and, in particular, density, may be expected to correlate to chlorinity with high precision. Salinity was estimated by Dittmar as the sum of the individually determined constituents, a laborious procedure. The need for precise relationships between an easily determined quantity and both salinity and density (more accurately, specific gravity) led to the formation of an international commission in 1 899 to investigate and advise on the definition and determination of salinity. The work of the commission was reported by Forch, Knudsen and S0rensen in 1902 . The method was used on nine samples, of which two came from the open ocean and the others came from the North Sea, Baltic Sea and Red Sea. A correlation between measurements of chlorinity and salinity by the S0rensen procedure was found and the best fit equation was dissolved inorganic matter in 1 iodide have been replaced by the equivalent amount of chloride, 8 = 0. As Knudsen points out in the first sentence of the section of the report dealing with salinity, "By salinity one means when no other stipulations are made, the weight of dissolved salt per unit weight of sea water. It is necessary to guess the meaning of salinity in various publications and it appears probable that authors using ordinary dictionaries and without special knowledge of oceanographic nuances would mean total dissolved salts and that authors publishing in oceanographic journals would mean the above peculiar felt the commission that "salinity" could be estimated reliably either specific gravity or chlorinity quantity. During the past two decades, instruments for measuring devised and are commercially available.
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Therefore erectile dysfunction treatment at gnc discount cialis extra dosage 100mg with mastercard, transport of molecules from low to erectile dysfunction solutions purchase cialis extra dosage 40mg without prescription high concentration is possible only when energy is supplied erectile dysfunction treatment doctors in hyderabad cheap 200 mg cialis extra dosage fast delivery. There are two main ways for the transport of water soluble solutes across membranes. Mediated transport Passive Diffusion Transport of solute molecules from high concentration to low concentration across membrane is known as simple diffusion. Active transport Facilitated Diffusion or Facilitated Transport Facilitated diffusion is faster than simple diffusion. Facilitated diffusion by carrier molecule involves conformational change of carrier molecule. In the native conformation the carrier is exposed to high concentration of solute. It exposes solute molecule to low concentration and solute molecules are released into the cell. The empty carrier returns to the native state to transport solute molecules once again. Carrier molecules which are capable of transporting one kind of solute molecule in both directions are called as uniporters, two types of solute molecules in the same direction (symporters) and two types of solute molecules in opposite directions (antiporters) are present in biological membranes. Glucose uptake by erythrocytes, heart, adipose tissue, retina and brain is an example for uniport type of facilitated diffusion. It functions as gated pore for the transport of glucose in the erythrocyte membrane. Binding of glucose to carrier causes pore formation and transport of glucose occurs. Anion channel of erythrocytes is another example for antiport type facilitated diffusion. It moves chloride from outside to inside of erythrocytes simultaneously expelling bicarbonate from inside to outside. Uptake of amino acids by intestinal cells are examples for symport type facilitated transport. The carrier molecule is a symporter and moves sodium ions along with amino acids across membrane. Inositol-1, 4, 5-triphosphate receptor present in membrane of golgi complex and endoplasmic reticulum act as ion channel. It has an N-terminal ligand binding cytosolic domain, a C-terminal channel domain that protrudes into cytosol and central six transmembrane domains. When ligand Inositol-1, 4, 5-triphosphate binds at N-terminus, C-terminal channel domain opens for Ca2+. Binding of acetylcholine to receptor causes opening of channel to selective cations. Sodium valproate an antiepileptic drug work by blocking voltage dependent K+ and Ca2+ channels. The tastantion channel interaction produce depolarization of taste receptor cell by changing ion channel activity. It moves solute molecules from low 132 Medical Biochemistry concentration to high concentration or against concentration gradient. It is integral membrane protein present in intestine, erythrocytes, kidney and brain etc. It is responsible for the maintenance of high intracellular K+ level which is essential for membrane potential of nerve and muscle. K+ present outside binds to modified subunits which causes the release of phosphate. The modified subunits undergo conformational change to native conformation releasing K+ in the cell. It transports the calcium from the cytosol to sarcoplasmic reticulum against concentration gredient. The concentration of calcium in the cytosol is 109M whereas its concentration in sarcoplasmic reticulum is 102 M. When sarcoplasmic reticulum is excited by nerve impulse large amount of Ca2+ is released to facilitate muscle contraction. Coupling of the two systems facilitates glucose uptake against concentration gradient. They are rapidly growing super family of membrane transport proteins identified in prokaryotes and eukaryotes. They are involved in the transport of wide variety of substances like heavy metals, drugs, ions, amino acids, sugars, peptides, steroids, phospholipids, hormones etc. They form pores in membrane through which ions or large molecules can enter into cell. Oxaloacetate is converted to -ketoglutarate by transminase which uses glutamate and oxaloacetate as substrates. In the cytosol -ketoglutartate is converted to oxalo acetate by transaminase which uses aspartate also as substrate. Thus oxaloacetate is regenerated in the cytosol and glutamate formed is transported back to mitochondria by antiporter. Creatine Phosphate Shuttle It transfers high energy phosphate from mitochondria to cytosol. An isoenzyme of creatine kinase present between mitochondrial membrane space is involved in the transfer of phosphates from mitochondria to cytosol. The macro molecules are nutrients, hormones, viruses, bacteria, nucleic acids etc. Lysosomal enzymes hydrolyze macromolecules to simple molecules like amino acids and sugars which diffuses into cytosol where they are used for synthesis etc. Ingestion of viruses and bacteria by macrophages is similar to endocytosis and it is referred as phagocytosis. For example, digestive enzymes of pancreas are stored as vesicles in pancreatic cells. These vesicles fuses with cell membrane in response to stimulus like hormone in this case and releases digestive enzymes precursors into duct. Critical regions for activation gating of the inositol-1, 4, 5-triphosphate receptor. Three-dimensional structure of inositol-1, 4, 5-triphosphate receptor at 24° A resolution. Write shuttle systems involved in the transport of reducing equivalents from cytosol to mitochondria. The two sides of cell membrane are (a) Identical (c) Not identical (a) Lateral motion (c) Horizontal motion 3. Anion channel is present in (a) Erythrocytes (c) Liver (b) Leucocytes (d) Nerve (b) Rich in carbohydrates (d) Rich in cholesterol (b) Transverse motion (d) Parallel motion 2. Digestive process converts minerals and vitamins of food into easily absorbable forms. Diseases like peptic ulcer and duodenal ulcer are due to excessive production of digestive fluids.
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Ammonium oxalate is added to erectile dysfunction exercise video generic cialis extra dosage 100 mg with visa serum to erectile dysfunction causes weight purchase cialis extra dosage with american express precipitate calcium in serum as calcium oxalate erectile dysfunction doctor in los angeles cheap 40 mg cialis extra dosage free shipping. The excess ammonium oxalate is removed by washing precipitate with dilute ammonium hydroxide. A balnk containing only sulphuricacid is also titrated and titre value (B) is obtained. They produce urine from the blood to maintain water, electrolyte, acid-base balance of the body and normal composition of extracellular, intracellular fluids. Acids, bases formed, various metabolic end or waste products, detoxified substances, compounds that are produced in excess and present in blood in excess are eliminated from blood by kidneys. Physical characteristics of normal urine Urine produced by normal healthy individual is known as normal urine. The physical characteristics of normal urine are (a) Volume (b) Color (c) pH (d) Specific gravity (e) Odor (f) Turbidity. Environment, food, exercise, temperature, fluid intake and physiological conditions affects volume of urine output. The color of the urine intensifies on standing due to conversion of colorless compounds to color compounds by atmospheric O2. The pH of urine is influenced by acid, basic, organic as well as Biochemical Technology 755 inorganic ions present in urine. The organic and mineral (inorganic) acids present in urine contributes to titrable acidity of urine. On protein diet urine pH decreases where as urine pH increases on fruit and vegetable diets. Due to secretion of H+ ions into gastric juice urine passed soon after a meal is alkaline. Hence specific gravity of urine passed during night is more than specific gravity of the urine passed during day time. However on standing urine may appear slightly cloudy (turbid) due to mucoproteins and epithelial cells that may enter into urine from linings of urinary tract. Chemical composition of Normal urine Normal urine contains mostly water, nitrogenous organic compounds, non-nitrogenous organic compounds and inorganic salts. Urine also contains very small amounts of amino acids, urobilinogen, vitamins, hormones, enzymes, porphyrins and low molecular weight peptides. It is the only nonprotein nitrogenous substance that is excreted in large amounts in the urine of humans. However excretion of urea in urine is influenced by diet particularly protein diet. Further excretion of urea increases in wasting diseases due to increased protein catabolism. Since urine creatinine is derived from muscle creatinine excretion is more in men and less in women. So if muscle mass is affected in any disease condition then creatine excretion in urine increases. Myasthenia gravis and muscular dystrophy are two diseases where skeletal muscle is badly affected. Meat, meat products and leukemia causes increased excretion of uric acid in urine. Other amino group containing compounds like purines and pyrimidine breakdown also yield ammonia. Amino acids excretion is more in urine in inherited diseases of amino acid metabolism. Amino acid excretion is more in other diseases also like Fanconi syndrome, muscular dystrophy etc. It is detoxified form of indole which is produced in colon by bacteria from tryptophan. Amount of indican in urine is proportional to formation of indole from tryptophan. Putrifaction of intestinal contents by bacteria increases excretion of indoxylsulfate in urine. Benzoates present in plant foods are detoxified as hippuric acid and excreted in urine. Urobilinogen excretion in urine is altered in diseases associated with bilirubin metabolism. However if these and other water soluble vitamins are taken in excess their excretion in urine becomes more. Steroid hormones like male sex hormones, female sex hormones and aldosterone are excreted in urine. Urine contains enzymes like urokinase, pepsin, trypsin, amylase, -glutamyltranspeptidase, angiotensin converting enzymes etc. When concentration of these enzymes in blood is elevated their excretion in urine is more. Non-Nitrogenous organic constituents of normal urine Very small amounts of non nitrogenous organic compounds are found in urine of normal individuals. Usual laboratory tests are unable to detect these small amounts that are present in urine. Some of them are glucose, glucuronides, organic acids like citric acid, oxalic acid, acetoacetic acid, pyruvic acid, lactic acid etc. Biochemical Technology 757 Inorganic constituents of normal urine Anions and cations are the inorganic constituents of normal urine. Chloride excretion in urine is influenced by diet, fluid intake and acidbase status of the individual. In Addisons disease chloride excretion is more but it is less in vomiting and diarrhoea. In rickets, Vit-D deficiency, hypoparathyroidism, pregnancy, kidney disease less phosphate is eliminated in urine but in hyperparathyroidism excretion of phosphate in urine is increased. Anesthetics, cyanides and nitrites also increases urinary sulfate because they are detoxified to sulphur compounds and eliminated through urine. Cations of normal urine Sodium and potassium are the major cations present in urine. Abnormal constituents of urine In pathological conditions physical characteristics of urine like color, volume, pH etc. Likewise excretion of certain compounds which are usually excreted in very small amounts is increased markedly in diseases conditions. Further some compounds which are usually absent in normal urine are excreted in urine in some diseases. Some of the diseases in which excretion of organic and inorganic constituents of urine is altered are mentioned earlier.
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N-Acyl derivatives of neuraminic acid impotence guilt buy cialis extra dosage 100 mg free shipping, eg impotence natural generic cialis extra dosage 60mg otc, N-acetylneuraminic acid (NeuAc; see Figure 1316) erectile dysfunction causes stress buy generic cialis extra dosage 60mg, the predominant sialic acid. Carbohydrate chains are only attached to the amino terminal portion outside the external surface (Chapter 41). Sialic acids are constituents of both glycoproteins and gangliosides (Chapters 14 and 47). Their presence on the outer surface of the plasma membrane (the glycocalyx) has been shown with the use of plant lectins, protein agglutinins that bind with specific glycosyl residues. Glycophorin is a major integral membrane glycoprotein of human erythrocytes and spans the lipid membrane, having free polypeptide portions · Carbohydrates are major constituents of animal food and animal tissues. They include proteoglycans and glycosaminoglycans, associated with structural elements of the tissues; and glycoproteins, proteins containing attached oligosaccharide chains. Lindahl U, Hццk M: Glycosaminoglycans and their binding to biological macromolecules. They are important dietary constituents not only because of their high energy value but also because of the fat-soluble vitamins and the essential fatty acids contained in the fat of natural foods. Nonpolar lipids act as electrical insulators, allowing rapid propagation of depolarization waves along myelinated nerves. Combinations of lipid and protein (lipoproteins) are important cellular constituents, occurring both in the cell membrane and in the mitochondria, and serving also as the means of transporting lipids in the blood. Precursor and derived lipids: these include fatty acids, glycerol, steroids, other alcohols, fatty aldehydes, and ketone bodies (Chapter 22), hydrocarbons, lipid-soluble vitamins, and hormones. Fatty acids that occur in natural fats are usually straight-chain derivatives containing an even number of carbon atoms. The chain may be saturated (containing no double bonds) or unsaturated (containing one or more double bonds). Phospholipids: Lipids containing, in addition to fatty acids and an alcohol, a phosphoric acid residue. They frequently have nitrogencontaining bases and other substituents, eg, in glycerophospholipids the alcohol is glycerol and in sphingophospholipids the alcohol is sphingosine. Glycolipids (glycosphingolipids): Lipids containing a fatty acid, sphingosine, and carbohydrate. Thus, saturated acids end in -anoic, eg, octanoic acid, and unsaturated acids with double bonds end in -enoic, eg, octadecenoic acid (oleic acid). Various conventions use for indicating the number and position of the double bonds (Figure 141); eg, 9 indicates a double bond between carbons 9 and 10 of the fatty acid; 9 indicates a double bond on the ninth carbon counting from the - carbon. Prostaglandins exist in virtually every mammalian tissue, acting as local hormones; they have important physiologic and pharmacologic activities. They are synthesized in vivo by cyclization of the center of the carbon chain of 20-carbon (eicosanoic) polyunsaturated fatty acids (eg, arachidonic acid) to form a cyclopentane ring (Figure 142). A related series of compounds, the thromboxanes, have the cyclopentane ring interrupted with an oxygen atom (oxane ring) (Figure 143). The leukotrienes and lipoxins are a third group of eicosanoid derivatives formed via the lipoxygenase pathway (Figure 144). They are characterized by the presence of three or four conjugated double bonds, respectively. Leukotrienes cause bronchoconstriction as well as being potent proinflammatory agents and play a part in asthma. Common Number of Name C Atoms Acetic 2 Major end product of carbohydrate fermentation by rumen organisms1 An end product of carbohydrate fermentation by rumen organisms1 In certain fats in small amounts (especially butter). An end product of carbohydrate fermentation by rumen organisms1 Spermaceti, cinnamon, palm kernel, coconut oils, laurels, butter Nutmeg, palm kernel, coconut oils, myrtles, butter Common in all animal and plant fats Propionic 3 Butyric Valeric Caproic Lauric Myristic Palmitic Stearic 4 5 6 12 14 16 18 Most Naturally Occurring Unsaturated Fatty Acids Have cis Double Bonds the carbon chains of saturated fatty acids form a zigzag pattern when extended, as at low temperatures. If the acyl chains are on the same side of the bond, it is cis-, as in oleic acid; if on opposite sides, it is trans-, as in elaidic acid, the trans isomer of oleic acid (Fig- 1 Also formed in the cecum of herbivores and to a lesser extent in the colon of humans. Number of C Atoms and Number and Position of Double Bonds Family 16:1;9 18:1;9 18:1;9 18:2;9,12 7 9 9 6 / 113 Common Name Palmitoleic Oleic Elaidic Linoleic Systematic Name Monoenoic acids (one double bond) cis-9-Hexadecenoic cis-9-Octadecenoic trans-9-Octadecenoic Dienoic acids (two double bonds) all-cis-9,12-Octadecadienoic Trienoic acids (three double bonds) Occurrence In nearly all fats. Some plants, eg, oil of evening primrose, borage oil; minor fatty acid in animals. Found in animal fats and in peanut oil; important component of phospholipids in animals. Naturally occurring unsaturated long-chain fatty acids are nearly all of the cis configuration, the molecules being "bent" 120 degrees at the double bond. This has profound significance on molecular packing in membranes and on the positions occupied by fatty acids in more complex molecules such as phospholipids. Mono- and diacylglycerols wherein one or two fatty acids are esterified with glycerol are also found in the tissues. Physical and Physiologic Properties of Fatty Acids Reflect Chain Length and Degree of Unsaturation the melting points of even-numbered-carbon fatty acids increase with chain length and decrease according to unsaturation. A triacylglycerol containing three saturated fatty acids of 12 carbons or more is solid at body temperature, whereas if the fatty acid residues are 18:2, it is liquid to below 0 °C. The membrane lipids, which must be fluid at all environmental temperatures, are Carbons 1 & 3 of Glycerol Are Not Identical To number the carbon atoms of glycerol unambiguously, the -sn- (stereochemical numbering) system is used. It is important to realize that carbons 1 and 3 of glycerol are not identical when viewed in three dimensions (shown as a projection formula in Figure 147). Phosphatidic acid is important as an intermediate in the synthesis of triacylglycerols as well as phosphoglycerols but is not found in any great quantity in tissues. Choline is important in nervous transmission, as acetylcholine, and as a store of labile methyl groups. Dipalmitoyl lecithin is a very effective surfaceactive agent and a major constituent of the surfactant preventing adherence, due to surface tension, of the inner surfaces of the lungs. Its absence from the lungs of premature infants causes respiratory distress syndrome. Phosphatidylethanolamine (cephalin) and phosphatidylserine (found in most tissues) differ from phosphatidylcholine only in that ethanolamine or serine, respectively, replaces choline (Figure 148). The O- shown shaded in phosphatidic acid is substituted by the substituents shown to form in (A) 3-phosphatidylcholine, (B) 3-phosphatidylethanolamine, (C) 3-phosphatidylserine, (D) 3-phosphatidylinositol, and (E) cardiolipin (diphosphatidylglycerol). Plasmalogens Occur in Brain & Muscle these compounds constitute as much as 10% of the phospholipids of brain and muscle. In some instances, choline, serine, or inositol may be substituted for ethanolamine. Sphingomyelins Are Found in the Nervous System Sphingomyelins are found in large quantities in brain and nerve tissue. On hydrolysis, the sphingomyelins yield a fatty acid, phosphoric acid, choline, and a complex amino alcohol, sphingosine (Figure 1411). The combination of sphingosine plus fatty acid is known as ceramide, a structure also found in the glycosphingolipids (see below). They occur particularly in the outer leaflet of the plasma membrane, where they contribute to cell surface carbohydrates. Galactosylceramide is a major glycoO 1 2 3 sphingolipid of brain and other nervous tissue, found in relatively low amounts elsewhere.
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Patients with tumors that have high recurrence scores have a significant chance of recurrence and can experience considerable benefit from chemotherapy problems with erectile dysfunction drugs purchase cheapest cialis extra dosage and cialis extra dosage. Explain the benefits of genomics in helping the physician and the patient make appropriate decisions regarding the use of adjuvant chemotherapy erectile dysfunction 19 year old male buy generic cialis extra dosage 100 mg line. During · the pathologist will send paraffin-embedded tissue to erectile dysfunction stress cheap cialis extra dosage line the centralized laboratory. Test explanation and related physiology the most important predictor of recurrent breast cancer is stage of disease, including lymph node status. Patients with positive lymph node metastasis are more likely to develop recurrence. However, nearly 30% of the patients whose tumors have been completely removed and who have no evidence of lymph node metastasis will also develop recurrence. Conventional predictors such as tumor size, grade, histologic type, and hormone receptors (see p. However, it is important to accurately predict the patients who are destined for recurrence so they can be selected for systemic therapy; patients who will not have a recurrence can be spared the morbidity of a treatment that is not needed. Normally, cells are diploid (one set of paired chromosomes) and have a small number of cells in the S phase of cell division. Because the more aggressive cancer cells divide more rapidly, many cells are in various stages of the mitotic phase. B Cathepsin D this protein catabolic enzyme was found to be absent in resting breast tissue but significantly elevated in malignant tissue. This protein exists on tumor cell membrane and is correlated with worse clinical outcomes. The exact cutoff point between a favorable prognosis and unfavorable prognosis has yet to be standardized. Mutation of the gene causes overexpression and a buildup of mutant proteins on the surface of the cancer cells. Interfering factors · Delay in tissue fixation may cause deterioration of marker proteins and may produce lower values. Preoperative use of some chemotherapy agents may cause decreased levels of some marker proteins. Procedure and patient care Before Inform the patient that an examination for these tumor predictor markers may be performed on their breast cancer tissue. Abnormal findings Unfavorable test results indicating a risk of cancer reoccurrence notes breast ductal lavage 187 breast ductal lavage Type of test Fluid analysis Normal findings No atypical cells in the effluent Possible critical values Cancer cells in the effluent Test explanation and related physiology the theory behind ductal lavage is that by washing out exfoliated cells from a few breast ducts, the risk of breast cancer developing in the near future can be assessed. If atypical cells are obtained, the risk of breast cancer developing in the next decade may be as high as 4 to 10 times normal. Once that risk is identified, the patient may choose to attempt to alter that risk by using chemopreventative medications. Initially, it was hoped that ductal lavage would be able to identify ductal carcinoma of the breast at its earliest stages. Its use has now been limited to women who have been found to be at a statistically higher risk for breast cancer by Gail or Claus breast cancer risk models. These statistical models are based on age at menarche, age at first pregnancy, prior breast surgery, family history, and history of atypical changes in previous breast biopsies. Many women found to be at increased risk would like more data before they decide to take a medication designed to reduce those risks. If these women were found to have atypical cells in the lavage, most would choose to take the medication. There are still no data to confirm that the findings do accurately reflect a true risk for breast cancer. B Contraindications · Patients with prior breast cancer surgery, because their risks are already known to be high Potential complications · Infection 188 breast ductal lavage Procedure and patient care Before Explain the procedure to the patient. Often these women have already received extensive counseling regarding their risk of breast cancer. A tiny catheter is gently placed into the nipple duct, and the duct is lavaged with 1 to 3 mL of saline. The procedure is then repeated for the other ducts that produced fluid with nipple suction. There is minimal to moderate discomfort associated with the nipple suction, duct cannulation, and lavage. Abnormal findings Atypical cells Ductal cancer cells notes breast ultrasonography 189 breast ultrasonography Breast sonogram) (Ultrasound mammography, B Type of test Ultrasound Normal findings No evidence of cyst or tumor Test explanation and related physiology Ultrasound examination of the breast is diagnostically performed to determine if a mammographic abnormality or a palpable lump is a cyst (fluid-filled) or a solid tumor (benign or malignant). It is also used in screening for breast cancer in women whose breasts are dense on mammography. In diagnostic real-time ultrasonography, harmless highfrequency sound waves are emitted and penetrate the breast. The sound waves are reflected back to the sensor and are arranged in a pictorial image by electronic conversion. Ultrasonography of the breast is used to: · Differentiate cystic from solid breast lesions. Ultrasonography is also useful for examination of symptomatic breasts in women in whom the radiation of mammography is potentially harmful. With high-quality diagnostic ultrasonography, the characteristics of an abnormality can be evaluated and a reasonable prediction can be made whether it is malignant. Diagnostic accuracy is improved when breast ultrasonography is combined with mammography (see p. Ultrasound is especially useful in patients with an abnormal mass identified on a mammogram, because the nature (cystic or solid) of the mass can be determined. Ultrasound can be used to locate and accurately direct percutaneous biopsy probes to a nonpalpable breast abnormality for 190 breast ultrasonography biopsy or aspiration. Ultrasound is painless, harmless, and without any radiation effects on the breast tissue. Instruct the patient not to apply any lotions or powders to the breasts on the examination day. During · the patient is placed in the supine position, and the transducer is directly applied to the breast using contact gel to improve sound transmission. After · After the test is completed, the breasts are dried and the conductive paste is removed. Abnormal findings Cyst Hematoma Cancer Fibroadenoma Fibrocystic disease Abscess notes bronchoscopy 191 bronchoscopy Type of test Endoscopy Normal findings Normal larynx, trachea, bronchi, and alveoli Test explanation and related physiology Bronchoscopy permits endoscopic visualization of the larynx, trachea, and bronchi by either a flexible fiberoptic bronchoscope or a rigid bronchoscope. Diagnostic uses of bronchoscopy include: · Direct visualization of the tracheobronchial tree for abnormalities. Also, the collection of bronchial washings (obtained by flushing the airways with saline solution), pulmonary toilet, and the instillation of anesthetic agents can be carried out through these extra lumens. Doublesheathed, plugged-protected brushes also can be passed through this accessory lumen. Needles can be placed through the scope to obtain biopsies from tissue immediately adjacent to the bronchi. Laser therapy to burn out endotracheal lesions can now be performed through the bronchoscope. Laryngoscopy is often performed through a short bronchoscope to allow inspection of the larynx and paralaryngeal structures.
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Pathways involved in the synthesis of the three major classes of adrenal steroids (mineralocorticoids erectile dysfunction 55 years old discount generic cialis extra dosage uk, glucocorticoids erectile dysfunction pills cape town 60mg cialis extra dosage with amex, and androgens) erectile dysfunction ka desi ilaj purchase cialis extra dosage line. Note that the 17-hydroxylase and 17,20-lyase activities are both part of one enzyme, designated P450c17. Testosterone can thus be considered a prohormone, since it is converted into a much more potent compound (dihydrotestosterone) and since most of this conversion occurs outside the testes. Some estradiol is formed from the peripheral aromatization of testosterone, particularly in males. Reduction of androstenedione at the C17 position results in the formation of testosterone, the most potent adrenal androgen. Small amounts of testosterone are produced in the adrenal by this mechanism, but most of this conversion occurs in the testes. Testicular Steroidogenesis Testicular androgens are synthesized in the interstitial tissue by the Leydig cells. The immediate precursor of the gonadal steroids, as for the adrenal steroids, is cholesterol. Once in the proper location, cholesterol is acted upon by the side chain cleavage enzyme P450scc. The conversion of cholesterol to pregnenolone is identical in adrenal, ovary, and testis. This sequence, referred to as the progesterone (or 4) pathway, is shown on the right side of Figure 425. Pregnenolone can also be converted to testosterone by the dehydroepiandrosterone (or 5) pathway, which is illustrated on the left side of Figure 425. These enzyme pairs, both contained in a single protein, are shown in the general reaction sequence in Figure 425. Ovarian Steroidogenesis the estrogens are a family of hormones synthesized in a variety of tissues. In pregnancy, relatively more estriol is produced, and this comes from the placenta. The general pathway and the subcellular localization of the enzymes involved in the early steps of estradiol synthesis are the same as those involved in androgen biosynthesis. The cellular source of the various ovarian steroids has been difficult to unravel, but a transfer of substrates between two cell types is involved. Progesterone, a precursor for all steroid hormones, is produced and secreted by the corpus luteum as an end-product hormone because these cells do not contain the enzymes necessary to convert progesterone to other steroid hormones (Figure 428). In females, adrenal androgens are important Dihydrotestosterone Is Formed From Testosterone in Peripheral Tissues Testosterone is metabolized by two pathways. One involves oxidation at the 17 position, and the other involves reduction of the A ring double bond and the 3-ketone. The pathway on the left side of the figure is called the 5 or dehydroepiandrosterone pathway; the pathway on the right side is called the 4 or progesterone pathway. Dihydrotestosterone is formed from testosterone through action of the enzyme 5-reductase. This reaction is not regulated, and it also occurs with low efficiency in kidney and intestine. Finally, conversion of androstenedione to estrone is the major source of estrogens in postmenopausal women. Aromatase activity is present in adipose cells and also in liver, skin, and other tissues. Increased activity of this enzyme may contribute to the "estrogenization" that characterizes such diseases as cirrhosis of the liver, hyperthyroidism, aging, and obesity. This compound constitutes about 80% of the catecholamines in the medulla, and it is not made in extramedullary tissue. In contrast, most of the norepinephrine present in organs innervated by sympathetic nerves is made in situ (about 80% of the total), and most of the rest is made in other nerve endings and reaches the target sites via the circu- A. Epinephrine and norepinephrine may be produced and stored in different cells in the adrenal medulla and other chromaffin tissues. The conversion of tyrosine to epinephrine requires four sequential steps: (1) ring hydroxylation; (2) decarboxylation; (3) side chain hydroxylation to form norepinephrine; and (4) N-methylation to form epinephrine. The biosynthetic pathway and the enzymes involved are illustrated in Figure 4210. As the rate-limiting enzyme, tyrosine hydroxylase is regulated in a variety of ways. The most important mechanism involves feedback inhibition by the catecholamines, which compete with the enzyme for the pteridine cofactor. Catecholamines cannot cross the blood-brain barrier; hence, in the brain they must be synthesized locally. Tyrosine hydroxylase is found in both soluble and particle-bound forms only in tissues that synthesize catecholamines; it functions as an oxidoreductase, with tetrahydropteridine as a cofactor, to convert L-tyrosine to L-dihydroxyphenylalanine (L-dopa). Compounds that resemble L-dopa, such as -methyldopa, are competitive inhibitors of this reaction. The thyroid hormones T3 and T4 are unique in that iodine (as iodide) is an essential component of both. A complex mechanism has evolved to acquire and retain this crucial element and to convert it into a form suitable for incorporation into organic compounds. At the same time, the thyroid must synthesize thyronine from tyrosine, and this synthesis takes place in thyroglobulin (Figure 4211). Carbohydrate accounts for 810% of the weight of thyroglobulin and iodide for about 0. It contains 115 tyrosine residues, each of which is a potential site of iodination. A follicular cell is shown facing the follicular lumen (top) and the extracellular space (at bottom). Thyroid hormone synthesis occurs in the follicular space through a series of reactions, many of which are peroxidase-mediated. Various acid proteases and peptidases hydrolyze the thyroglobulin into its constituent amino acids, including T4 and T3, which are discharged from the basal portion of the cell (see Figure 4211). A deiodinase removes I- from the inactive monoand diiodothyronine molecules in the thyroid. A peripheral deiodinase in target tissues such as pituitary, kidney, and liver selectively removes I- from the 5 position of T4 to make T3 (see Figure 422), which is a much more active molecule. Several other hormones are synthesized as parts of large precursor molecules, not because of some special structural requirement but rather as a mechanism for controlling the available amount of the active hormone. Iodide Metabolism Involves Several Discrete Steps the thyroid is able to concentrate I- against a strong electrochemical gradient. The thyroid is the only tissue that can oxidize I- to a higher valence state, an obligatory step in I- organification and thyroid hormone biosynthesis.