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Rheumatology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Decreased secretion from exocrine glands: dry eyes (positive Schirmer’s test)dry mouth.
Basic medicine: physiology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
There are two main sorts of gland in the body. Exocrine glands, such as the salivary and sweat glands, secrete their juice into a duct, whereas endocrine or ductless glands secrete hormones directly into the bloodstream. Hormones are proteins that act as chemical messengers, travelling in the blood to modulate the activity of a target organ that possesses the relevant hormone receptor. Endocrine tissue is found in many different organs, but it is concentrated in certain glands of which the pituitary is the most important. The pituitary gland is located inside the skull just below the brain and contains two main lobes. The anterior lobe secretes tropic hormones that control the activity of several other glands, including the thyroid, adrenal, breast, ovary and testis; it also secretes growth hormone, which affects the growth of many organs. The posterior pituitary secretes vasopressin and oxytocin, which act on the kidney and uterus, respectively. Pituitary insufficiency therefore has widespread effects. Pituitary secretion is controlled by a feedback system: rising blood levels of hormones secreted by the target organ in response to the pituitary hormone inhibit the secretion of that tropic hormone.
Cystic Fibrosis
Published in Stephen D. Litwin, Genetic Determinants of Pulmonary Disease, 2020
Alexander G. Bearn, Β. Shannon Danes
The pathogenesis of the disease is reasonably clear [3]. The most remarkable disturbance in pathophysiology lies in the behavior of the secretions from the exocrine glands. The mucous secretions are abnormally viscous; they obstruct the bronchi giving rise to pulmonary disease and the pancreatic ducts leading to pancreatic insufficiency. Hepatic cirrhosis, usually of the biliary type, intestinal obstruction caused by inspissated secretions, and other complications may arise. The only reliable biochemical abnormality is the increase in the sodium and chloride content of the sweat [3]. This is present from birth, continues throughout life, and is not related to the severity of the clinical disease [3-5]. The meconium [3,5] and electrolyte-sensitive electrode [4,6] tests used for diagnosis are both considered to be about 85% sensitive and 85-99% specific [7].
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
Sjogren’s syndrome (SS) is a complex autoimmune rheumatic disease characterized by chronic inflammation of the exocrine glands and the presence of autoantibodies against the ribonucleoprotein particles SSA/Ro and SSB/La [1,2]. Primary (p) SS refers to the diagnosis of SS in the absence of additional autoimmune disease [3]. The T cell mediated inflammation targets primary lacrimal and salivary glands [1]. Mononuclear cell infiltration and progressive injury of the exocrine glands are the main pathological features, and sicca syndrome is the clinical hallmark of the disease [3]. However, a wide spectrum of clinical manifestations have been described, varying from mild disease limited to exocrine glands to severe multi-systemic involvement, including but not limited to lungs, skin, kidney, and the nervous system [1,4]
The discovery of the lymphatic system in the seventeenth century. Part V: an ode to the nerves
Published in Acta Chirurgica Belgica, 2019
Raphael Suy, Sarah Thomis, Inge Fourneau
Excretory glands (now known as exocrine glands) were described by Wharton as being composed of very many pieces, connected to each other in a particular manner, and joined together by means of membranes and vessels [6]. These glands, such as the pancreas, the mandibular gland, the breasts in women, and a few others were supposed to ‘take some of the excess fluids of the passing nerves […] to put it down through their own vessels’ [6]. According to Wharton, formation of milk was more complex since milk was considered to be a mixture of chyle and vital fluid; the chyle was not passed directly from the intestines to the breast, but conveyed through the chyle-bearing duct into the left subclavian vein, thence to circulate through the ventricles of the heart to the arteries of the thorax where it was separated from the sanguineous parts of the blood to be stored in the ducts of the breast for feeding the child. However, children needed also ‘the noblest nutritious juice’ for the growth of their spermatic tissues. This specific matter was supplied by means of the thoracic nerves which were, according to Wharton, indeed much larger and more succulent at the time of giving milk [6].
The findings of musculoskeletal ultrasonography on primary Sjögren’s syndrome patients in childhood with articular manifestations and the impact of anti-cyclic citrullinated peptide antibody
Published in Modern Rheumatology, 2019
Kosuke Shabana, Nami Okamoto, Yuko Sugita, Keisuke Shindo, Takuji Murata, Hiroshi Tamai, Kenta Fujiwara
Sjogren’s syndrome is an autoimmune disease presenting not only the exocrine glands disorder but also the systemic organ disorders, and about half of the pSS patients have extra-glandular manifestations. The exocrine glands disorder become apparent after the long course of inflammation and pSS-C patients show sicca symptoms less frequently than adult patients. The joint involvement is one of the most common extra-glandular manifestations among pSS-C patients. Sometimes pSS-C patients develop articular manifestations as their first symptom and it is important to distinguish them from other rheumatic diseases. However, little is known about the image findings of articular lesion and the correlation with autoantibodies in pSS-C patients. This is the first clinical study for the joint involvement of pSS-C patients that was evaluated by using MSUS and the correlation with autoantibodies.