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Based on this observation, oxytocin may be responsible or the rhythmic uterine and tubal contractions that aid sperm delivery to the oocyte. In addition, spiral arteries that eed the endometrium increase their number and coiling. Enkephalinase, an endothelin-degrading enzyme, is expressed at its highest levels in the midsecretory endometrium (Head, 1993). Following implantation, the endometrium undergoes essential remodeling by invading trophoblast. At second-look laparoscopy a ter 1 year, 29 percent o women had disease regression, 42 percent remained unchanged, and 29 percent had disease progression. The stratified squamous epithelium that covers the surface of the palatine tonsil (and pharyngeal) dips into the underlying connective tissue forming many crypts, the tonsillar crypts. It may be stretched to more than 4 m and, during extreme contraction, may be reduced to as little as 1 m. Because the cervix is larger than the undus, the neonatal uterus is typically spadeshaped. J Clin Pathol 68(7):579, 2015 Muneyyirci-Delale O, Karacan M: E ect o norethindrone acetate in the treatment o symptomatic endometriosis. A number of investigators believe the process of cartilage removal involves a specific cell type designated as a chondroclast. Every third amino acid in the chain is a glycine molecule, except at the ends of the chains. In effect, each axon is enclosed by the Schwann cell cytoplasm, except for the intercellular space of the mesaxon. The internal carotid plexus and external carotid plexus follow the branches of the carotid arteries to reach their destination. After internalization, the "swallowed" cell remains alive within the host cell until it is either degraded by the lysosomal mechanism or released. The smallest and most permeable lymphatic vessels are called lymphatic capillaries. It is caused by an imbalance between osteoclast-mediated bone resorption and osteoblast-mediated bone deposition, resulting in decreased bone mass, enhanced bone fragility, and increased risk of fracture. Ca2 is rapidly released from the sarcoplasmic reticulum and increases the pool of Ca2 that entered the sarcoplasm through the calcium channels in the plasma membrane. Pelvic masses are common and may involve reproductive organs or nongynecologic structures. T us, the amount o uterine bleeding is normal, but its normal path or egress is obstructed or absent. Leukotrienes are modified lipids that trigger prolonged constriction of smooth muscles in the pulmonary airways (see page 182). In the medium lymphocyte, the cytoplasm is more abundant, the nucleus is larger and less heterochromatic, and the Golgi apparatus is somewhat more developed. The ratio of serous-secreting cells to mucus-secreting cells is depicted in the acini of the various glands. Abma and colleagues (2010) reported that among emales with coitarche be ore age 20, 7 percent described their rst intercourse as nonvoluntary. Thrombocytopenia (a low blood platelet count) is an important clinical problem in the management of patients with immune-system disorders and cancer. Endothelial cells in fenestrated capillaries also have numerous pinocytotic vesicles. The presence of the connective tissue in the extracellular space between the fibers constitutes the endomysium of the muscle. At this magnification, it is difficult to distinguish between occasional fibroblasts that belong to the endomysium from the nuclei of the muscle cells. Moreover, i blood supply to the contents is acutely compromised, then bowel obstruction or ischemia will require surgical intervention.
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Its primary value is assessing response to neoadjuvant chemotherapy in women contemplating breast conservation and evaluating women with breast cancer metastatic to axillary lymph nodes rom an unknown primary (Morrow, 2011). In this condition, erythrocyte plasma membrane has defective anchor points, causing it to detach and peel off from the cytoplasm. The most common heparan sulfate proteoglycan found in all basal laminae is the large multidomain proteoglycan perlecan (400 kDa). In contrast to mucus-secreting cells, serous cells produce poorly glycosylated or nonglycosylated protein secretions. Consequent to this accommodation, adrenal gland hyperplasia and elevated androgen levels develop. Elevated serum prolactin levels and resultant galactorlamic amenorrhea may act via one or all o these pathways. Fertil Steril 80(2):305, 2003b Vercellini P, Frontino G, Pietropaolo G, et al: Deep endometriosis: de nition, pathogenesis, and clinical management. Urology 69(4 Suppl):34, 2007 Sauerland S, Agresta F, Bergamaschi R, et al: Laparoscopy or abdominal emergencies: evidence-based guidelines o the European Association or Endoscopic Surgery. Often, as in this tissue sample, the hair follicles and the glands, both sebaceous and sweat, extend beyond the dermis (De) and into the hypodermis. The right side of the heart pumps blood through the low-pressure pulmonary circulation. For women with subserosal or intramural myomas, surgeons must use a laparotomic or laparoscopic approach to enucleate tumors buried in the muscular uterine walls and then reconstruct normal anatomy. As is typically the case, the distribution of the smooth muscle cell nuclei is not uniform; thus, in some areas, there appears to be a crowding of nuclei (lower box), whereas in other areas, there appears to be a paucity of nuclei (upper box). The nucleus typically occupies a central (rather than basal) location in the cell. Macroadenomas o any cell type may damage the pituitary stalk and prevent trans er o hypothalamic dopamine to the lactotropes. Where the nuclei appear more numerous, the cells simply are aligned where the section has included the nucleus. Bone In sites where remodeling is not occurring, the bone surface is covered by a layer of flat cells with attenuated cytoplasm and a paucity of organelles beyond the perinuclear region. Basal cell membrane infoldings increase the cell surface area and facilitate morphologic interactions between adjacent cells and extracellular matrix proteins. When this occurs, the enflamed tonsils are removed surgically (tonsillectomy and adenoidectomy). On the extracellular side, integrins bind to extracellular matrix glycoproteins, usually laminin and fibronectin. These disorders are 10 to 20 times more common in emales than in males, particularly in those aged 15 to 24 years (Mitchell, 2006). Early in this stage, the synaptonemal complex dissolves, and the chromosomes condense further. Endocr Pract 8(6):457, 2002 Bidet M, Bachelot A, Bissauge E, et al: Resumption o ovarian unction and pregnancies in 358 patients with premature ovarian ailure. The chromosomes of maternal and paternal origin are depicted in red and blue, respectively. Under the in uence o estrogen, the glandular and stromal cells o the unctionalis layer proli erate rapidly ollowing menses. Bone-lining cells on external bone surfaces are part of the periosteum, hence the term periosteal cells. Lupus 15(12):877, 2006 Pitsos M, Skurnick J, Heller D: Association o pathologic diagnoses with clinical ndings in chronic endometritis. The term " brocystic change" is o ten used to re er to palpably nodular breast tissue or to the histologic pattern o dilated ducts and acini invested with dense collagenous stroma. Also, the cells are relatively sparse and limited to the fiber-forming cell, the fibroblast. Asymptomatic cysts may be discovered incidentally during abdominal examination or during sonographic examination or some other indication. In the United States, the overall prevalence o child sexual abuse ranges rom 11 to 32 percent or emales and 4 to 14 percent or males (Sapp, 2005). Precise determination o this temporal window is critical since only those actors expressed during this time act as direct unctional mediators o uterine receptivity.
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In contrast, the nuclei concentrated in the central portion of the nuclear chain fibers are arranged in a chain. This unique cytoskeletal arrangement contributes to the shape of the erythrocyte and imparts elastic properties and stability to the membrane. Psychosocial treatments are o ten help ul or the patient and, where applicable, her caregivers. In response to this injury, monocytes from the bloodstream enter the tunica intima and differentiate into macrophages. As a primary center of ossification develops, the endochondral bone is formed on spicules of calcified cartilage. If the secretory portion is shaped like a tube, the gland is tubular; if it is shaped like a flask or grape, the gland is alveolar or acinar; if the tube ends in a sac-like dilation, the gland is tubuloalveolar. The cytoplasm is considerably less blue leaning more to a pink or eosinophilic coloration. The individual nerve fibers and their associated Schwann cells are held together by connective tissue organized into three distinctive components, each with specific morphologic and functional characteristics. N Engl J Med 368(2):128, 2013 Hall P, Maclachlan N, T orn N, et al: Control o menorrhagia by the cyclooxygenase inhibitors naproxen sodium and me enamic acid. Higher rates o ovarian varicosities and pelvic congestion syndrome are noted in parous women. Bone increases in width or diameter when appositional growth of new bone occurs between the cortical lamellae and the periosteum. Similarly, the electron micrograph shows only a small amount of pericyte cytoplasm. In general, taste buds at the tip of the tongue detect sweet stimuli, those immediately posterolateral to the tip detect salty stimuli, and those more posterolateral detect sour-tasting stimuli. The types of globin chains present in the molecules determine the type of hemoglobin. Fibroblasts that express actin filaments and associated actin motor proteins such as nonmuscle myosin are called myofibroblasts. Subareolar duct excision can also be used to treat bothersome multiduct discharges not associated with pituitary prolactinoma. The hypothalamic-pituitary axis has increased sensitivity to negative eedback, even by the low circulating levels o gonadal steroids at this stage. Cushing syndrome is rare, and routine screening in all women with oligomenorrhea is not indicated. Following nerve stimulation, Ca2 is released into the sarcoplasm and binds to troponin, which then acts on the tropomyosin to expose the myosin-binding sites on actin molecules. I this is not possible, chronic progestin therapy supplements the physiologic progesterone that is absent with anovulation. In humans, this system is represented by a 40 kDa transmembrane nonglycosylated Rh30 polypeptide that shares antigenic sites with rhesus monkey erythrocytes. These macrophages break down the red cells, begin the metabolic breakdown of hemoglobin, and retrieve and store the iron from the heme for reutilization in the formation of new red blood cells in the bone marrow. However, given the accuracy o current sonographic imaging, these procedures are no longer indicated with a normal-appearing contralateral ovary (Comerci, 1994). The elastic material imparts properties of elasticity, as distinguished from resiliency, which are not shared by hyaline cartilage. The composition of interstitial fluid in nonconnective tissues, however, is subject to considerable modification by the absorptive and secretory activities of epithelia. They secrete their products into the connective tissue, from which they enter the bloodstream to reach their target cells. Family histories that may suggest inherited susceptibility include early-onset breast cancer (< 50 years), bilateral breast cancer, male breast cancer, multiple a ected relatives in one generation, breast cancer in multiple generations, development o cancers that are known to be associated with a particular syndrome, and two or more cancers in one relative, especially i they develop at an early age. Continued elastic recoil then maintains continuous flow of blood away from the heart. This group of pharmacologic agents binds to estrogen receptors and acts as an estrogen agonist (mimicking estrogen action) in bone; in other tissues, it blocks the estrogen receptor action (acting as an estrogen antagonist).
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There is a gender bias to the disease, and two to three times as many women as men are a ected (Green, 2005). The distinct pink lines are related to the accumulation of actin filaments in ameloblasts. Inspecting this area with a ashlight at night, parents may identi y worms perianally. Bone that arises through this process is formed by the simultaneous removal of the cartilage model and its replacement with bone tissue. Also, the node of Ranvier is the site of depolarization of the neuronal plasma membrane during nerve impulse transmission and contains clusters of high-density, voltagegated Na channels. The first sign of bone formation is the appearance of bone-forming cells around the shaft (diaphysis) of the cartilage model. These may be sites o hernia or nerve entrapment or may indicate a risk or intraabdominal adhesive disease. The cuticle protects the hair from physical and chemical damage and determines its porosity. Harv Rev Psychiatry 17(2):120, 2009 Cybulska B: Immediate medical care a ter sexual assault. As the blood cell completes its passage through the aperture or the megakaryocyte that has extruded, its platelets withdraws its process, the endothelial cell "repairs itself," and the aperture disappears. Acta Cytolog 44:41, 2000 Oguz S, Sargin A, Kelekci S, et al: the role o hormone replacement therapy in endometrial polyp ormation. Importantly, acute injuries associated with child sexual abuse heal and resolve rapidly. Human Chorionic Gonadotropin this glycosylated peptide hormone is produced by the placental syncytiotrophoblast. Postpartum depression, as noted, includes onset during pregnancy and within 4 weeks ollowing delivery. The spaces surrounding the spongy bone contain bone marrow consisting mainly of adipocytes. Obstet Gynecol 79(3):430, 1992 Parazzini F, Vercellini P, Panazza S, et al: Risk actors or adenomyosis. Although the main function of the macrophage is phagocytosis, either as a defense activity. Formation of this structure ensures the correct alignment of the three chains during the formation of the triple helix. Within the endometrium, epithelial and stromal cells secrete endothelin-1, a potent vasoconstrictor. Uterine wall thickening can show anteroposterior asymmetry, and here the posterior wall is thicker. Muscular arteries, or arteries of medium caliber, constitute the majority of the named arteries in the body. Histologically, mixed spicules can be recognized by their staining characteristics. The nucleolus, which may still be present in some cells, also completely disappears in prometaphase. The irritation also causes the formation of calcareous deposits that deform the joint and limit its motion. The accumulation of hemoglobin in the cell gradually changes the staining reaction of the cytoplasm so that it begins to stain with eosin. Women with endometriosis may be asymptomatic, sub ertile, or su er varying degrees o pelvic pain. Photomicrograph showing longitudinally sectioned myelinated nerve axons (A) in the same preparation as above. The duct of a sweat gland (D) can be seen on the left as it traverses the dermis (Derm) and further spirals through the epidermis. The modified Romanovsky-type stain commonly used for blood smears consists of a mixture of methylene blue (a basic dye), related azures (also basic dyes), and eosin (an acidic dye). As noted previously, smooth muscle cells may enter the latch state and remain contracted for long periods of time without fatiguing. Immune responses can be divided into nonspecific (innate) immunity (represents the first line of defense against microbial aggression) and specific (adaptive) immunity (gradually acquired and based on contact with antigen and its presentation to various types of lymphocytes). O these, cystectomy o ers the advantage o ovarian preservation, but at the risk o cyst rupture and content spill.
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A similar phenomenon is sometimes seen in the intestinal mucosa, in which swollen goblet cells displace adjacent absorptive cells. These large hydrodynamic domains in the matrix are accountable for imparting resilience to the cartilage. In well-preserved specimens, osteocytes exhibit less cytoplasmic basophilia than osteoblasts, but little additional cytoplasmic detail can be seen (Plate 12, page 246). The outer portion of the bone has a solid structure and represents compact (dense) bone. The osteoblast-derived matrix vesicles are the essential factors in controlling the initial site of mineral deposition in osteoid. In contrast to the secretory portion of the eccrine gland, the duct portion does not possess myoepithelial cells. After the signs or symptoms of the immediate hypersensitivity reaction have been resolved, an affected individual may develop late-phase allergic reactions 6 to 24 hours later. Associated with the electron-dense material is an array of 6-nm actin filaments that stretch across the apical cytoplasm of the epithelial cell, the terminal web. In the light microscope, the ribosomal content appears as small bodies called Nissl bodies that stain intensely with basic dyes and metachromatically with thionine dyes. This schematic diagram shows a metarteriole (initial segment of a thoroughfare channel) giving rise to capillaries. Most pathologic nipple discharges are caused by benign intraductal papillomas, which are simple milk duct polyps (Urban, 1978). The interactions of these various proteins maintain the precise alignment of the thin and thick filaments in the sarcomere and the alignment of sarcomeres within the cell. Pharmacologic agents under development speci cally target these nongenomic e ects to allow more precise therapy or steroid-sensitive disorders. When per ormed, adhesiolysis is associated with a signi cant risk o adhesiogenesis, especially in cases involving endometriosis (Parker, 2005). In routine tissue preparation, the serous cells are more removed from the lumen of the acinus and are shaped as crescents or demilunes (half-moons) at the periphery of the mucous acinus. O these, the syndrome is most requently caused by administration o exogenous glucocorticoids. This region loses its typical pigmentation, and an increase in the number of glial cells is noticeable (gliosis). The junction between two adjacent Schwann cells is called the node of Ranvier and is where electrical impulse is regenerated for high-speed propagation along the axon. T us, a care ul balance must be struck between minimizing medication risk to the etus and maternal risk rom untreated or undertreated disease. These cells begin their migration into the gonadal ridge during the sixth week o gestation and generate primary sex cords. Breast conservation, which requires central breast resection including the nipple-areolar complex and all identi able underlying disease, is ollowed A. Mesenchymal cells adjacent to the tooth bud begin to differentiate, forming the dental papilla that protrudes into the tooth bud. Activation of B cells requires interaction with helper T cells to produce specific cytokines and to differentiate into plasma cells and memory B cells. This low-magnification electron micrograph shows the general organization of skeletal muscle fibers. The small round objects within the acinar cells represent the zymogen granules, the stored secretory precursor material. Extensive numbers of myofibroblasts are found in most contractive diseases of connective tissue (fibromatoses). Lymphocytes undergo antigen-dependent activation in the secondary lymphatic organs. Thrombocytes (platelets) are derived from large poly- ploid cells (cells whose nuclei contain multiple sets of chromosomes) in the bone marrow called megakaryocytes. Diagnosis is usually clinical and based on ndings during speci c orthopedic joint manipulation tests. Classically, Shigella species incite a mucopurulent bloody discharge, which typically ollows diarrhea caused by the same organism. Failure o normal migration may stem rom various genetic de ects in these signaling molecules and can lead to Kallmann syndrome, which is discussed in Chapter 16 (p.
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Nerve impulses and hormonal stimulation can cause the muscle cells to contract, directing blood into capillary beds where it is most needed. Also called "hypothalamic amenorrhea," this diagnosis encompasses three main categories: eating disorders, excessive exercise, and stress. The largest lymphatic vessel, draining most of the body and emptying into the veins on the left side, is the thoracic duct. This is the characteristic structure of the endocrine organs, which develop from typical epithelia but lose their connection to a surface during development. T us, examination is completed as soon as sexual assault is suspected (McCann, 2007). The endothelial cell nuclei appear as the small round profiles at the luminal surface. These are "terminal ganglia" that contain nerve cell bodies of the parasympathetic system. Approximately 8% of HbA consists of several subtypes that display slight chemical differences. A simpler method is to mount the ground specimen on a slide with a viscous medium that traps air in some of the spaces, as in the specimen in this plate. Salty taste that is stimulated by table salt (NaCl) is essentially derived from the taste of the sodium ions. Obstet Gynecol 106:131, 2005 Dokras A, Cli ton S, Futterweit W, et al: Increased prevalence o anxiety symptoms in women with polycystic ovary syndrome: systematic review and meta-analysis. However, underlying androgen receptor mutations prevent normal testosterone binding, normal male ductal system development, and virilization. It also enhances intestinal uid secretion to improve intestinal motility (Chey, 2012a; Drossman, 2009). Here, the spongy bone is extensive, and the compact bone consists of little more than a thin outer shell. The numerous osteoblasts responsible for this growing region of spicules are seen at the surface of the newly deposited bone. The layer of odontoblasts retreats as the dentin is laid down, leaving odontoblast processes embedded in the dentin in narrow channels called dentinal tubules. The intense basophilia of these specific granules correlates with the high concentration of sulfates within the glycosaminoglycan molecules of heparin and heparan sulfate. Note that some of the medullary areas bear a resemblance to germinal centers of other lymphatic organs because of the medulla appearing as isolated circular areas (upper left of top figure). Importantly, women who undergo endometrioma excision may subsequently have a reduced ovarian reserve, that is, the capacity to provide ova capable o ertilization (Somigliana, 2012). T us, levels o their corresponding pituitary actors are measured as surrogate markers. However, heterozygous individuals with sickled cell trait may occasionally have clinical consequences at high altitude or when under extreme physical stress. These cells di erentiate into epithelial, stromal, and vascular cells as the endometrium is routinely regenerated each cycle. Treatment for squamous cell carcinoma depends on histological type, size, and location. The basal lamina of these cells is continuous with that of the epidermis and the hair follicle. They have less cytoplasm than the cells in the layer above; consequently, their nuclei are more closely spaced. Gynecol Endocrinol 25(3):149, 2009 Vermani E, Mittal R, Weeks A: Pelvic girdle pain and low back pain in pregnancy: a review. It is generally believed that apocrine secretions may function as pheromones in humans. Computed tomography image shows a subcutaneous mass (arrow) extending down to the anterior abdominal wall fascia on the left. The medullary sinuses converge near the hilum, where they drain into efferent lymphatic vessels. The lymphocytes continue to the arterial side of the circulation and, via the arteries, to the lymphatic tissues of the body or to tissues where they participate in immune reactions. T us, barring signi cant hypotension or drug allergy, morphine sul ate may be administered judiciously in these situations.
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New cartilage cells produced during appositional growth are derived from the inner portion of the surrounding perichondrium. Small veins emerging from the vasa vasorum network drain the capillaries and venules into larger veins that accompany the arteries. I used, adjuvant chemotherapy is usually administered a ter primary surgery but be ore radiation therapy. The number of Schmidt-Lanterman clefts correlates with the diameter of the axon; larger axons have more clefts. Bone is a specialized form of connective tissue that, like other connective tissues, consists of cells and extracellular matrix. Women who elected breast conservation are counseled that the remaining breast tissue requires surveillance inde nitely. The spectrin filaments are anchored to the lipid bilayer by two large protein complexes. Fertil Steril 80(1):199, 2003 Cicinelli E, Resta L, Nicoletti R, et al: Endometrial micropolyps at uid hysteroscopy suggest the existence o chronic endometritis. Gap junctions also allow cells without gonadotropin receptors to receive signals rom cells with receptor expression. Calcium, 600 mg orally twice daily, has shown bene ts, theoretically by correcting de ciency-related symptoms such as muscle cramps (T ys-Jacobs, 2000). Triglycerides stored in adipocytes are released by lipases that are activated during neural mobilization (involves norepinephrine released from sympathetic nerves) and/or hormonal mobilization (involves glucagon and growth hormone). The nervous system evolved from the simple neuroeffector system of invertebrate animals. This bone tissue is produced by appositional growth from bone-forming cells that were derived from the mesenchyme in the tissue surrounding the cartilage. Also, longitudinally arranged smooth muscle cells are present at the junction with the tunica adventitia. These zones are not sharply delineated, and the boundaries between them are somewhat arbitrary. These are small cells with relatively little cytoplasm, thus the nuclei appear close to one another. Large complex ovarian cysts that do not regress postnatally require surgical excision. With the establishment of the periosteal bony collar, the chondrocytes in the midregion of the cartilage model become hypertrophic. The eosinophilic lineage has a similar-appearing nucleus, but its specific granules are large. Tenascin (280 kDa/monomer) appears during embryogenesis, but its synthesis is switched off in mature tissues. As a result, dominant ollicles may develop in response to gonadotropin secretion, yet the normal ovulatory process is requently disrupted, and ollicular cysts develop. In the Palmer system, permanent teeth are numbered with Arabic numerals beginning from the midline. Secondtier options are pelvic oor physical therapy to resolve trigger points or pelvic oor hypertonus or to implement pharmacological management. At later stages, this lesion undergoes further remodeling and growth into fibrofatty plaque as smooth muscle cells migrate from the media and synthesize collagen to form a protective capsule of connective tissue that encloses the growing lipid core. Hum Reprod 26(9):2322, 2011 Ru o G, Crippa S, Sartori A, et al: Management o rectosigmoid obstruction due to severe bowel endometriosis. The newly discovered secretory functions of adipocytes have shifted views on adipose tissue, which is now considered a major endocrine organ. It participates in maintaining the barrier between adjacent cells as well as the barrier between the apical and lateral domains. In these conditions, to avoid tuberous development, hormone replacement is initiated at small dosages and gradually increased over time. The heartbeat is initiated, locally regulated, and coordinated by specialized, modified cardiac muscle cells called cardiac conducting cells (Plate 25, page 352). O methods, rP point massage or more aggressive ischemic compression massage are e ective (Hull, 2009).
