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Clinical Uses Epinephrine is used in a variety of clinical situations, and although concern has been expressed about the use of epinephrine in asthma, it is still used extensively for the management of acute attacks. This diagram shows the three major cell types located within the olfactory epithelium: the olfactory cell, supporting (sustentacular) cell, and basal cell. The urine was recollected in this latter group by suprapubic aspiration, and bacteriuria was confirmed in 52 per cent, corresponding to an incidence of bladder bacteriuria of 3. Lymphatic vessels are present in the capsule and the connective tissue around the larger blood vessels in the gland. For this reason, the thin ascending limb is sometimes referred to as the diluting segment of the nephron. Within the first week, patients treated with tegaserod had significant improvements in abdominal pain and discomfort, constipation, and overall well-being. The receptor components of the retina are situated in the posterior three-fifths of the eyeball. In figure on right, a later stage in the growth of the secondary follicle is shown. Genital haematomas Acute puerperal haematomas are seen 1 in 1000 to 4000 deliveries. Therapeutic options in allergic disease: Antihistamines as systemic antiallergic agents. Located at the junction of the small and large intestines, it prevents reflux of the contents of the colon with its high bacterial count into the distal ileum, which normally has a low bacterial count. The loose connective tissue contains far more cells per unit area and a greater variety of cell types. The mature sperm cell contains a flattened head covered by the acrosomal cap (contains hydrolytic enzymes for penetration of the ovum) and an axonemal complex in the sperm tail that is helically wrapped by mitochondria. A system of air cells projects into the mastoid portion of the temporal bone from the middle ear. Other factors include prolonged exposure to irradiation and anaesthetic gases, pesticides, and other environmental toxins. Although atropine and related compounds possess bronchodilator activity, their use is associated with the typical spectrum of anticholinergic side effects (see Chapter 13), and they are no longer used in the treatment of asthma. Peripheral facial palsy involves the whole side of the face, including the forehead. In this specimen, the tracheal ring has been transformed, in part, to bone, a process that occurs in aging. A rapid increase in the daily use of bronchodilators to control acute symptoms is a danger sign of an impending crisis. They are translucent or opaque, white or yellow lesions ranging from 2 mm to 10 mm in size. Selenium Sulfide Selenium sulfide is a cytostatic and sporicidal agent available without prescription in a variety of shampoos and lotions for treatment of scalp seborrheic dermatitis. Note that the lateral domains in the middle third of the outer hair cells are not surrounded by supporting cells. The interlobular ducts, in turn, drain directly into the main pancreatic duct, which runs the length of the gland parallel to its long axis, giving this portion of the duct system a herringbonelike appearance. This compartment distends as the amount of fluid in it increases; the lateral folds separate to allow this distension. This section also includes a cross-section of the adrenal vein, which is characterized by the longitudinally arranged bundles of smooth muscle in its wall. A higher magnification shows the pseudostratified epithelium lining the ductus deferens. The reduction in therapeutic effectiveness that can occur when antihistamines are given for long periods is probably related to an induction of hepatic drugmetabolizing enzymes. Box 1 Drugs associated with secondary amenorrhoea Amoxapine Carbenoxolone Cyclophosphamide Danazol Domperidone Fluvoxamine Glucocorticoid Imipramine Isoniazid Leuprorelin Methyldopa Neuroleptic agents Procainamide Tamoxifen Ovarian causes Premature ovarian failure is defined as the cessation of periods before the age of 40 years.

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Note that the medulla of the ovary contains a larger corpus albicans, which is most likely a remnant of the corpus luteum of pregnancy. A short stalk, the infundibulum, and a vascular network connect the pituitary gland to the hypothalamus. Many of these solutions irritate the mucosa and may produce excessive mucus in the stool. They are also present in clusters (nuclei in the hypothalamus) or layers surrounding the functional and structural elements of the organ (testis, ovaries, or placenta). These fibers unite the nucleus with the flagellum; hence, the name connecting piece. Occasionally, one of these conditions may present for the first time with pleuritis, and this could occur in pregnancy, especially as they are generally more common in young women. It also contains smooth muscle and melanin-containing pigment cells scattered in the connective tissue. Despite this controversy, it is reasonable to evaluate ultrasound evidence of reduced amniotic fluid to ascertain whether it is truly an isolated finding. The spermatic cord contains all of the structures that pass to and from the testis. Mast cells also release a variety of chemotactic mediators, such as leukotriene B4 and cytokines. The milk proteins are present in small vacuoles in the apical part of the cell but cannot be seen by light microscopic methods. These are usually identified from blood samples sent for serology, although the results may be available too late to alter management. It usually occurs in the last trimester, and is characterised by sudden onset of severe abdominal pain, nausea, and vomiting. 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. Serious infections and sepsis, including fatalities, have been reported in patients treated with etanercept. The infold ings are specialized for reabsorption of electrolytes from the secretion. Premalignant disease Women with cervical dyskaryosis are asymptomatic, as premalignant disease of the cervix is a subclinical condition. Other neurons from the hypothalamic nuclei (described below) also release their secretory products into the fenestrated capillary network of the infundibulum, the first capillary bed of the hypothalamohypophyseal portal system. They are frequently used in combination with other antiemetics for treating chemotherapyrelated nausea and vomiting. The mammary glands remain in inactive state until pregnancy, during which the mammary glands assume their complete morphologic and functional maturation. Incomplete miscarriage is defined as bleeding with the presence of retained products of conception within the uterine cavity. Deep tubular invaginations are present between the microvilli of the proximal convoluted tubule cells. Again, the close correlation between administration of the drug and the onset of respiratory distress confirms the diagnosis. The triangular portal lobule (green) has a portal canal at the center of the lobule and terminal hepatic venules (central veins) at the peripheral angles of the lobule. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Adverse reactions include a bitter taste and burning sensation in the oral cavity. Both morphologic and physiologic studies demonstrated that connecting tubules play an important role in K secretion (most likely attributed to the presence of the principal cells), which is in part regulated by mineralocorticoids secreted by the adrenal cortex.

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Water moves from the cytoplasm and from the lumen into the intercellular space because of the osmotic gradient. Mesalamine can also be administered as a suppository (Canasa) or enema (Rowasa) for distal colonic disease. The alveolar ducts terminate in alveolar sacs, enlarged spaces surrounded by clusters of alveoli that open into the spaces. Hormones interact with their receptors exposed on the surface of the target cell or within its cytoplasm or nucleus. Physiological causes include: bladder dysfunction; urethral/outlet dysfunction; a mixture of both of the above. Women with placenta praevia may have a few episodes of warning bleeds before a major bleed, and admission for observation needs to be considered. Three different regions of the decidua are identified by their relationship to the site of implantation. Because of its rapid breakdown after oral administration, histamine produces few systemic effects when given by this route. This high-magnification electron micrograph shows the thinnest layer of a fully developed placental barrier (section does not include cytotrophoblast cells that form a thin (or discontinuous) layer in the human placenta). Whether the flushing is patchy or confluent in distribution will help to distinguish the symptoms of menopausal hot flushing from other dermatological causes such as dermatitis. In younger women, the causes are usually benign, including urinary tract infection, stones and insertion of a catheter for any length of time. Beta-blockers should be continued and a small dose of diuretic may help, but rest is recommended in conjunction with the beta-blocker in order to prevent tachycardia. The enterokinase activates trypsinogen, converting it into its active form, trypsin (green box). All women having a vaginal delivery should have a systematic examination of the perineum, vagina, and rectum to assess the severity of damage prior to suturing. This active transport mechanism is essentially identical to that described in Chapter 17 for the enterocytes of the small intestine and the absorptive cells of the colon. It sends trabeculae into the parenchyma that partially outline irregular lobes and lobules. The two types of connective tissues can be distinguished at the low magnification of this figure. Treatment needs to be given to correct the amenorrhoea and oestrogen deficiency, improve libido and effect tumour shrinkage in cases with hyperprolactinaemia. It appears black because one looks through the lens toward the heavily pigmented back of the eye. C peptide measurements are frequently used to assess the residual B-cell function in patients treated with insulin, to distinguish between types 1 and 2 diabetes, and in the diagnosis and monitoring therapy of insulinoma (tumor of B cells). They are more common in nonindustrialised nations, and are a significant cause of maternal and perinatal mortality and morbidity. These include the thoracic part of the esophagus and portions of structures in the abdominal and pelvic cavities that are fixed to the cavity wall-the duodenum, ascending and descending colon, rectum, and anal canal. Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. As seen here, the mucous neck cells display a cytoplasm that is lightly stained; there are no cytoplasmic areas that stain intensely, nor is there a characteristic local absence of staining as in the mucous cup of the surface mucous cells. The remainder of the sinusoid as well as the other sinusoid is lined by thin endothelial cell cytoplasm. In this section the causes of puerperal fever, the stages of sepsis, and the surviving sepsis care bundle will be discussed (see also Fever, postoperative). The incidence of adverse effects with hydroquinone increases in proportion to its concentration. The middle piece is approximately 7 m long and contains the mitochondria, helically wrapped around the coarse fibers and the axonemal complex.

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Note the presence of voltage-sensitive Ca2 channels in the presynaptic membrane next to the attachment of the ribbon. The cystic duct then carries the bile into the gallbladder, where it is concentrated. He has inflammation over the ankle and toes of his right foot and complains of severe pain when you put slight pressure on the ankle. It drains into intrahepatic bile ductule surrounded by hepatocytes, in contrast to the interlobular bile duct, which is embedded in the connective tissue of the portal canal. The same arrangement of cells is shown in figure on the right at much higher magnification. A foreign body is most commonly responsible for vaginal bleeding in paediatric patients. In general, thyroid and steroid hormones can be administered orally, whereas protein hormones. Near the portal canal but still within the lobule, bile canaliculi transform into the short canals of Hering. The elevated blood uric acid concentration in gout is an easily identified and readily treated abnormality. Although confined to older women, this condition is very common, accounting for more admissions to hospital than any other respiratory disease. Abdominal swellings may be classified according to the anatomical layer of the abdomen, which comprises the: anterior abdominal wall; peritoneal cavity; retroperitoneal space. Male Reproductive System Spermatid Phase (Spermiogenesis) In the spermatid phase, spermatids undergo extensive cell remodeling as they differentiate into mature sperm. Symptoms prior to haematemesis include epigastric pain, often soon after eating, and there may be associated anorexia; however, symptoms can be non-specific. It is similar in appearance to the gland at the late proliferative stage but differs mainly to the extent that the alveoli are more uniform in appearance and their lumina are larger. Typical features include weight loss, sweating, diarrhoea, irritability, tremor, tachycardia, and eye signs. Lungs develop from the laryngotracheal diverticulum of the foregut endoderm and its surrounding thoracic splanchnic mesenchyme. The placenta is the site of exchange of gases and metabolites between the maternal and fetal circulation. A lower motor neurone lesion will cause weakness affecting the whole side of the face, thus the upper and lower face. If the woman is pregnant, then development of virilisation is most likely due to a luteoma, which is not a true tumour but an exaggerated reaction of the ovarian stroma to normal levels of chorionic gonadotrophin. Pulmonary embolism usually presents in a postoperative patient as sudden haemodynamic instability and collapse. However, a severe coagulopathy ensues, and disseminated intravascular coagulation leads to diffuse bleeding and resulting haemorrhagic shock. Thus proper recognition of subfascial haematomas and its distinction from superficial haematoma and bladder flap haematoma is important. In these, at least one part of the stomach is lined with stratified squamous epithelium. Respiratory bronchioles constitute a transitional zone in the respiratory system; they are involved in both air conduction and gas exchange. They do not show basal infoldings but have basally located interdigitations with neighboring cells. Initially, the inferior parathyroid glands, which derive from the superiorly located third pharyngeal pouch, descend with the thymus. Boundaries between the thecal layers and between the theca externa and surrounding stroma are not distinct. Serial scans from 28 weeks will allow detection of intrauterine growth restriction and evolving macrosomia (>4 kg) and hydramnios. As a result, the "mucociliary escalator" malfunctions, with consequent accumulation of an unusually thick, viscous mucous secretion.

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Box 1 Causes of oligohydramnios oligohydramnios Oligohydramnios, diminished amniotic fluid, found on ultrasound, is relatively common. High concentrations cause membrane leakage and ultimately lysis of the bacterial cell. Oxyphenbutazone (Oxalid, Tandearil) is the principal uricosuric metabolite of phenylbutazone. After pre-eclampsia, Clinical assessment As with any pain, when assessing headache, the quality, location, severity, time course, plus exacerbating and relieving factors should be fully explored. The epididymis is a crescent-shaped structure that lies along the superior and posterior surfaces of the testis. Epigastric pain in the presentation in a woman with severe pre-eclampsia would be due to tension on the liver capsule, which can very rarely rupture with fatal consequences. Ingestion (swallow) or Expectoration e nc ara cle Tissue Reservoirs (tooth, oral mucosa, tongue, etc. Oocytes that fail to enter the uterine tube usually degenerate in the peritoneal cavity. The structure of the cervix resembles the rest of the uterus in that it consists of a mucosa (endometrium) and a myometrium. The mucosal folds are evident in its distal portion, the infundibulum, as it nears the open end. Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. These substances are subsequently released into the circulation as part of the endocrine secretory function of the hepatocytes. The end piece, approximately the last 5 m of the flagellum in the mature sperm, contains only the axonemal complex. The decidua basalis forms a compact layer that is the maternal component of the placenta. For the first several days of development, as it navigates the complex pathway created by the mucosal folds, the embryo is transported proximally by the beating of the cilia of the ciliated epithelial cells and by peristaltic contractions of the well-developed muscularis layer that underlies the mucosa. Type B spermatogonia have generally spherical nuclei with chromatin that is condensed into large clumps along the nuclear envelope and around a central nucleolus. The mature (Graafian) follicle has a large antrum and a prominent, steroid-producing theca interna layer. If 40 Drugs Used in Gastrointestinal Disorders 479 diarrhea occurs or if there is renal failure, a magnesiumbased preparation should be discontinued. The parotid duct travels from the gland, which is located below and in front of the ear, to enter the oral cavity opposite the second upper molar tooth. Chlorpheniramine, fexofenadine, and tripelennamine are antihistamines without significant efficacy in the treatment of motion sickness. There is no associated nausea or vomiting but there may sometimes be photo- or phonophobia. Individual stereocilia are also connected by a variety of fibrillar extracellular cross-links. The mucous acini are more tubular or elongate and sometimes can be seen to branch. It is employed primarily in patients who must avoid straining at stool, including persons with hemorrhoids and other painful anal lesions. Women with ischaemic heart disease are at risk of myocardial infarction, although it remains a very rare cause of cardiac arrest in pregnancy. The lacrimal gland is located beneath the conjunctiva on the upper lateral side of the orbit. These hormones stimulate the growth and secretory activity of the lining of the uterus, the endometrium, to prepare it for the implantation of the developing zygote in the event that fertilization occurs. Chest X-ray in this condition usually reveals bilateral interstitial infiltrates, although it may be normal.

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Supportive care should be undertaken during the fit, and magnesium sulphate infusion commenced to prevent recurrence. In a Canadian study, the overall risk of fetal trauma in term (>37 weeks) singleton fetuses was estimated at 2. The intralobular ducts are difficult to identify because their epithelium also secretes. Such profiles are accounted for by sharp turns in the duct where the epithelial wall on one side of the duct is partially cut. The junction between the two (arrows) is marked by a change in staining, with the substance of the cornea appearing lighter than that of the sclera. The smear may be poorly prepared at the point of collection (inappropriate sampling device, scanty sampling, or air-dried), may be obscured by blood or inflammatory cells, or may not contain the right type or amount of cells (a slide that contains too few cells or consists entirely of endocervical cells). Side effects are much more prevalent with systemic administration than with inhalant administration. Dietary restriction (A) can affect uric acid production if precursor molecules are lowered sufficiently, but this usually is not feasible. The duct elements extend from the secretory portion of the gland beginning in close proximity to the overlying epithelium (arrowhead) and pass directly through the epithelium to deliver their secretions at the surface. Probenecid is still used by some physicians to maintain high blood levels of penicillin, cephalosporin, acyclovir, and cyclosporine. All of the tubules are parallel, and all are cut in cross-section; thus, they present circular profiles. B cells contain numerous secretory granules about 300 nm in diameter with a dense polyhedral core and a pale matrix. The increased signal would be even more marked if the changes were a result of infarction. Plasma proteins and circulating antibodies are excluded from the lumen of the seminiferous tubules. The presence of elevated jugular venous pressure, hepatomegaly, a loud pulmonary component of the second heart sound, and right ventricular heave on examination also support a diagnosis of mitral stenosis. In cultures in which breast-feeding may continue for 2 to 3 years, lactational amenorrhea is the principal means of birth control. In contrast, cetirizine (Zyrtec) and fexofenadine (Allegra) undergo little hepatic metabolism and are eliminated mainly as unchanged compounds in the urine and feces, respectively. The vitreous chamber is the space between the posterior surface of the lens and the neural retina. Bile canaliculi drain into the short canals of Hering, which are partially lined by hepatocytes and cuboidal cholangiocytes (cells lining the biliary tree). At the junction between the esophagus and the stomach (see also middle right figure), the stratified squamous epithelium of the esophagus ends abruptly, and the simple columnar epithelium of the stomach surface begins. The connective tissue immediately surrounding the ductus deferens contains nerves and some of the smaller blood vessels that supply the duct. Note that the capsule of the lens is formed by the basal lamina of the lens fibers and the subcapsular epithelium located on the anterior surface of the lens. This premilk is an alkaline, yellowish secretion with a higher protein, vitamin A, sodium, and chloride content and a lower lipid, carbohydrate, and potassium content than milk. A layer of closely apposed squamous cells forms a sheath-like investment around the tubule epithelium of each seminiferous tubule. During impregnation, the entire spermatozoon, except for the tail cytoplasm, becomes incorporated into the ooplasm, which triggers resumption of the second meiotic division (transforms the secondary oocyte into a mature oocyte). The mechanism of amino acid absorption is conceptually identical to that of carbohydrates. They are most often focal and observed in multigravida during the fourth to sixth decades of life. This division transforms the secondary oocyte into a mature oocyte and triggers the expulsion of the second polar body into the perivitelline space. A lower motor neurone facial palsy can occur with any lesions affecting the facial nerve nucleus, the facial nerve as it curls around the sixth cranial nerve nucleus (the abducens), the geniculate ganglion, along the course of the facial nerve through the facial canal, and the terminal branches which supply the muscles of the face and parotid gland. In some areas, the epithelium appears thick (arrowhead) and, based on the disposition of the nuclei, would seem to be multilayered. The secretion of hypothalamic regulatory peptides is the primary mechanism by which changes in emotional state are translated into changes in the physiologic homeostatic state. It appears to undergo nonenzymatic hydrolysis in the plasma to a large number of metabolites.

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The processes and the ciliary body are covered by a double layer of columnar epithelial cells, the ciliary epithelium, which was originally derived from the two layers of the optic cup. Discontinuance of therapy usually results in a rapid disappearance of side effects. Noninfectious skin eruptions, such as acne vulgaris and acne rosacea, are often treated with systemic antibiotics. A combination of these tests including culture of the biopsy specimen itself will give the highest possible yield for diagnosis. Cuts and abrasions may result during caesarean section due to cutting the baby with the scalpel blade. The trophoblastic cells of the monkey blastocyst have begun to invade the epithelial cells of the endometrium. If it is assumed that the cell is cuboidal, two sides of each cell (shown) would face hepatic sinusoids, two sides of each cell (shown) would face bile canaliculi, and the additional two sides (not shown) would face bile canaliculi. The retina, derived from the inner and outer layers of the optic cup, is the innermost of the three concentric layers of the eye. Pharmacological agents may include vaginal lubricants and the use of androgenic progestogens (levonorgestrel, norgestrel, or desogestrel). Recently, specific monoclonal antibodies D2-40 that react with a 40 kDa O-linked sialoglycoprotein expressed on the lymphatic endothelium became available to study distribution of lymphatic vessels. At the mucocutaneous junction, the red portion of the lips is characterized by deep penetration of connective tissue papillae into the base of the stratified squamous keratinized epithelium. Atypical variable deceleration In addition to the features described, variable decelerations are said to be atypical if they have any of the following characteristics. The menstrual phase commences as hormone production by the ovary declines with the degeneration of the corpus luteum (see Folder 23. In contrast, although visual proteins are constantly produced in retinal cones, the proteins are incorporated into cone discs located anywhere in the outer segment. However, most if not all polypeptides and proteins have specific carrier proteins. During the third day after fertilization, the morula, which has reached a 12- to 16-cell stage and is still surrounded by the zona pellucida, enters the uterine cavity. However, wound infections were increased if the duration of operation was greater than one hour, if there had been a preceding induction of labour, or if puerperal endometritis had developed. Each vesicle consists of a single tube folded and coiled on itself with occasional diverticula in its wall. They have a flattened basal nucleus, and the apical cytoplasm is typically filled with mucin granules. The wall of the vagina consists of three layers: a mucosa, a muscularis, and an adventitia. These drugs probably affect urate protein binding only secondarily; that is, their principal action is to interfere with renal transport of uric acid, which in turn leads to alterations in plasma urate binding. As in the stomach, the lamina propria surrounds the intestinal glands and contains numerous cells of the immune system (lymphocytes, plasma cells, mast cells, macrophages, and eosinophils), particularly in the villi. The diagrams illustrate the separation of the fetal and maternal blood vessels by the placental membrane, which is composed of the endothelium of the capillaries, mesenchyme, cytotrophoblast, and syncytiotrophoblast. The scala vestibuli and the scala tympani are perilymph-containing spaces that communicate with each other at the apex of the cochlea through a small channel called the helicotrema. In this way, vibrations of different wavelengths are generated in the passing air, and sound is produced. It is usually described as a sharp, lower abdominal pain that lasts from a few minutes to as long as 24 hours and is frequently accompanied by a small amount of bleeding from the uterus. The subcapsular epithelium is a cuboidal layer of lens epithelial cells present only on the anterior surface of the lens.

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In atresia, the initial changes involve pyknosis of the nuclei of the follicular cells and dissolution of their cytoplasm. A thickening of the muscularis externa of the duodenum at the ampulla constitutes the sphincter of Oddi, which surrounds the openings of both the common bile duct and the pancreatic duct and acts as a valve to regulate the flow of bile and pancreatic juice into the duodenum. Because of extensive systemic side effects, oral corticosteroids are not typically used to treat asthma except when symptoms cannot be controlled by standard therapy. The posterior chamber is the space between the posterior surface of the iris and the anterior surface of the lens. Some gout patients have an unusual shunt mechanism that converts glycine directly to uric acid rather than to its normal metabolic products. Most patients have local irritation while using alitretinoin gel; however, the irritation rarely necessitates discontinuation of therapy. These symptoms usually occur in the early hours of the morning and are often among the first signs of pregnancy. Because of involvement of the retroperitoneal space, the patient feels more comfortable leaning forwards. A gelatinous mass, the cupula (Cu), surmounts the epithelium of the crista ampullaris. It includes the connective tissue capsule, the zona glomerulosa, and the zona fasciculata. Neurosecretory cells in the ventral nuclei of the hypothalamus secrete releasing and inhibitory hormones that are discharged into capillaries (located in the median eminence and infundibulum) of the hypophyseal portal system to reach pars distalis of the anterior lobe. Rare hematological abnormalities, such as agranulocytosis, aplastic anemia, hemolytic anemia, neutropenia, or other blood dyscrasias, can be fatal. Thus, many areas of this figure, especially the area within and near the rectangle, show histologic signs of edema. Consequently, most clinicians would use these preparations with caution and after counselling about the theoretical increased risk of oestrogen levels that can contribute to breast cancer recurrence. However, if these measures are ineffective, then the help of a psychosexual counsellor should be recommended. Aldosterone does not function at the distal convoluted tubule but rather at the connecting tubules and collecting ducts. This thick mucus is difficult to move by the mucociliary escalator mechanism, and it clogs the lumen of the bronchial tree, obstructing airflow. As discussed before, pre-eclampsia is the most common cause of secondary headache in pregnancy and must be excluded first. Horizontal cell dendritic processes Their processes invest the other cells of the retina so completely that they fill most of the extracellular space. For years, this endocrine control of target tissues became a central part of endocrinology. Sulfinpyrazone is readily absorbed after oral administration, with peak blood levels reached 1 to 2 hours after ingestion. The diagnosis is suggested by chest X-ray in conjunction with the clinical picture. Management of itching in pregnancy Management of itching in pregnancy is limited and follows a stepwise pattern (Box 1). The main portion of the vitreous body is a homogeneous gel containing approximately 99% water (the vitreous humor), collagen, glycosaminoglycans (principally hyaluronan), and a small population of cells called hyalocytes. They are generally anticoagulated with warfarin, which should be converted to full-dose, low-molecular-weight heparin for the duration of pregnancy. Further digestion is performed at the striated border of the enterocytes by enzymes breaking down oligosaccharides and polysaccharides into three basic monosaccharides (glucose, galactose, and fructose). The nerve cell bodies of parasympathetic ganglia and their postganglionic nerve fibers represent the enteric nervous system, the third division of the autonomic nervous system. Heavy-metal preparations (Golgi stains) of thick sections of liver give an indication of the extent of the Golgi network. This is accompanied by increased formation of gap junctions between smooth muscle cells and increased density of oxytocin receptors. When the compressor produces enough cold air to lower the temperature below the set point of the thermostat, the thermostat is triggered and shuts off the compressor.