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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.
Pediatric Thyroid Surgery
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Thyroid pathologies for children treat a varied mix of benign and malignant conditions. Functionality of the gland may vary physiologically and pathologically. Surgical problems are often a manifestation of the embryological remnant variations, and therefore thorough anatomical knowledge is a must for due planning, e.g., thyroid cyst or resultant abscess due to infection prone remnants of otherwise uncommon third and fourth branchial arches or thyroglossal duct cyst containing entire thyroid tissue and likewise. Since these are majorly indolent conditions, it is essential to minimize or avoid iatrogenic morbidity. Pediatric thyroid cancers are a distinct entity with a different biological behavior than the adult counterpart. They are much more aggressive with higher chances of nodal and distant metastases. Many of these require adjuvant treatment in view of higher stages. However, prognosis is excellent with more than 95% 10-year survival outcomes in a major series [1].
Regulation of the Pituitary Gland by Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
Diagnosis of potential thyroid dysfunctions starts with a history and physical examination. If dysfunction of the gland is suspected, laboratory tests can help support or rule out thyroid disease. As illustrated in Figure 5.15, a sensitive serum TSH assay can be initially used to indicate which additional diagnostic steps should be undertaken. If an autoimmune disorder of the thyroid such as Grave’s disease is suspected, blood tests, looking for antithyroid autoantibodies, can be obtained. Ultrasound, biopsy and radioiodine scanning and uptake may be used to help with the diagnosis, particularly if a nodule is suspected. Treatment of thyroid disease varies, based on the disorder. Levothyroxine is the mainstay of treatment for hypothyroidism, while hyperthyroidism caused by Graves’ disease can be managed with iodine therapy, antithyroid medication, or surgical removal of the thyroid gland. Thyroid surgery may also be performed to remove a thyroid nodule or to reduce the size of a goiter if it obstructs nearby structures or for cosmetic reasons.
Histotyping and grading of endometriosis and its association with clinico-pathological parameters
Published in Journal of Obstetrics and Gynaecology, 2022
Jyothika Litson, Rini Agnes, Gayatri Ravikumar
The histopathological features studied include the quantity of endometriotic foci, components, phasing of the endometriotic foci, and stromal features.Quantity of endometriotic foci (severity): Assessed on the entire tissue examined and graded based on the extent occupied in low power field (LP) as (i) mild (one LP field), (ii) moderate (2–3 LP fields) and (iii) severe (>3 LP fields).The components in the endometriotic foci: classified as (i) pure glandular (when only glands were present without stroma), (ii) pure stromal (only stroma was present without glands), and (iii) mixed stromal and glandular (both gland and stroma were present). The type of gland seen was also classified as endometrial type (well-differentiated glands), undifferentiated type (when glandular component resembled other mesothelial types), and glandular pattern of mixed differentiation (both endometrial and undifferentiated glands present). The presence and absence of haemorrhage and hemosiderin was recorded.Phasing of the endometriotic foci: inactive, proliferative, or secretory, similar to that of eutopic endometrium. The presence of atypia was noted.Stromal features: Presence of oedema, fibrosis, and inflammation was noted.
Prostatic dystrophic calcification following salvage cryotherapy for prostate cancer – an under-reported entity?
Published in Scandinavian Journal of Urology, 2021
Arnon Lavi, Shiva M. Nair, Daniel Halstuch, Joseph L. Chin
Cryotherapy for prostate cancer, first introduced in the 1960s, is commonly used as an ablative therapy for treatment of prostate cancer either in the primary or salvage settings [1,2]. The main mechanism of action is tissue necrosis first described by Cooper in 1964 [3]. Treatment had been delivered to the entire gland but, more recently, focal therapy to affected regions has become popular. Salvage cryoablation (SCA) of the prostate is an accepted local treatment option for biochemical recurrence (BCR) after radiotherapy [2,4,5]. The long-term oncological outcomes of SCA have been reported with disease-free survival (DFS) of 39% at 10 years [4], and up to 64% if pre-salvage serum prostate specific antigne (PSA) was <5 ng/ml. Notable complications following SCA include incontinence of various degrees (9–83%), urinary retention (3–55%), urethral sloughing (5–40.9%) and rectourethral fistula (0–3.3%) [6]. The complication rates have improved significantly with 3rd generation cryoablation devices.
Incidence and risk factors for radioactive iodine-induced sialadenitis
Published in Acta Oto-Laryngologica, 2020
Alvaro Sánchez Barrueco, Fernando González Galán, Ignacio Alcalá Rueda, Jessica Mireya Santillán Coello, María Pilar Barrio Dorado, José Miguel Villacampa Aubá, Manuel Escanciano Escanciano, Lucía Llanos Jiménez, Ignacio Mahillo Fernández, Carlos Cenjor Español
Nevertheless, there have been reports of several complications of 131I such as transient neck pain and edema, pulmonary, gastrointestinal, and hematopoietic systems dysfunction; gonadal damage, conjunctivitis, alopecia, as well as secondary tumors [2]. Salivary gland disorders are one of the most frequent among the possible side effects of this treatment [2], usually manifesting as swelling of the affected salivary gland. One such disorder, sialadenitis, is characterised by episodic or permanent inflammation of one or more salivary glands with associated pain, usually in submandibular and/or parotid gland. This inflammation can present alongside xerostomia, taste alteration, and salivary gland infection. Sialadenitis associated with 131I treatment is referred to as radioactive iodine-induced sialadenitis (RAIS). Sialadenitis can occur within the first 48 h after radio iodine treatment, or late, up to 3 to 6 months after the therapy has been received.