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Increased intake of dietary fibres is the most appropriate method for prevention of functional constipation breast cancer grade 0 safe aygestin 5mg. As such women's health center birmingham al effective aygestin 5mg, bran is useful for prevention of constipation women's health zumba best aygestin 5mg, but not for treating already constipated subjects pregnancy hemorrhoids trusted 5mg aygestin. It should not be used in patients with gut ulcerations, adhesions, stenosis and when faecal impaction is a possibility. Psyllium (Plantago) and Ispaghula They contain natural colloidal mucilage which forms a gelatinous mass by absorbing water. It emulsifies the colonic contents and increases penetration of water into the faeces. By a detergent action, it can disrupt the mucosal barrier and enhance absorption of many nonabsorbable drugs, e. It is a mild laxative; especially indicated when straining at stools must be avoided. Liquid paraffin It is a viscous liquid; a mixture of petroleum hydrocarbons, that was introduced as a laxative at the turn of 19th century. Disadvantages (a) It is bland but very unpleasant to swallow because of oily consistency. The primary site of action of diphenyl methanes is in the colon where they irritate the mucosa, produce mild inflammation and increase secretion. They irritate intestinal mucosa and thus were thought to primarily stimulate motor activity. Though some of them do directly increase motility by acting on myenteric plexuses, the more important mechanism of action is accumulation of water and electrolytes in the lumen by altering absorptive and secretory activity of the mucosal cell. Larger doses of stimulant purgatives can cause excess purgation resulting in fluid and electrolyte imbalance. Routine and long-term use must be discouraged, because it can produce colonic atony. They can reflexly stimulate gravid uterus, therefore are contraindicated during pregnancy. Diphenylmethanes Phenolphthalein is a litmus-like indicator which is in use as purgative from the beginning of the 20th century. These doses may be ineffective in some individuals, but produce fluid evacuations and cramps in others. Morphological alterations in the colonic mucosa have been observed; the mucosa becomes more leaky. Allergic reactions-skin rashes, fixed drug eruption and Stevens-Johnson syndrome have been reported. It is hydrolysed by colonic bacteria to the active form, which then acts locally to irritate the mucosa and activate myenteric neurones. Anthraquinones these are plant products used in household/ traditional medicine for centuries. These and a number of other plant purgatives contain anthraquinone glycosides, also called emodins. Unabsorbed in the small intestine, they are passed to the colon where bacteria liberate the active anthrol form, which either acts locally or is absorbed into circulation- excreted in bile to act on small intestine. Taken by lactating mothers, the amount secreted in milk is sufficient to cause purgation in the suckling infant. The purgative action and uses of anthraquinones are quite similar to those of diphenylmethanes. Taken at bed time-a single, soft but formed evacuation generally occurs in the morning. The active principle of these drugs acts on the myenteric plexus to increase peristalsis and decrease segmentation.

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Midsagittal longitudinal sections of adrenal glands under the above conditions will reveal either a disproportionately wider cortex relative to the medulla or vice versa women's health clinic chico ca safe 5mg aygestin, resulting in an abnormal cortical:medullary ratio breast cancer volleyball shirts buy 5 mg aygestin. Nodular lesions that distort and enlarge one or both adrenal glands suggest that a neoplasm is present breast cancer uk proven aygestin 5 mg. A single well-demarcated nodular lesion suggests a cortical adenoma whereas widespread incorporation of the entire adrenal gland by a proliferative mass is suggestive of cortical carcinoma women's health center elkhart indiana trusted 5mg aygestin, especially if there is evidence of local invasion into periadrenal connective tissues or into adjacent blood vessels and the kidney. Non-neoplastic lesions of the adrenal cortex induced by xenobiotic chemicals are characterized by changes ranging from acute progressive degeneration to reparative processes such as multifocal hyperplasia. Early degenerative lesions characterized by enlarged cortical cells filled with cytoplasmic vacuoles (often lipid) may result in a diffuse hypertrophy of the cortex. This type of vacuolar degeneration is a reflection of impaired steroidogenesis resulting in an accumulation of steroid precursors. More destructive lesions such as hemorrhage and/or necrosis are associated with an inflammatory response in the cortex. Ultrastructural alterations of adrenal cortical cells associated with chemical injury are quite diverse in nature. The zonae reticularis and fasciculata typically are most severely affected, although eventually the lesions involve the zona glomerulosa. Mitochondrial damage with vacuolization and accompanying changes in the endoplasmic reticulum and autophagocytic responses appear to be among the most common ultrastructural changes observed following chemical injury in the adrenal cortex. The decreased production of aldosterone results in decreased renal tubular reabsorption of sodium and chloride, increased serum potassium due to decreased tubular excretion, and decreased tubular reabsorption of water resulting in lower blood volume and pressure. There is a distinct species sensitivity with dogs > guinea pigs > rabbits > monkeys > rats. Many of the chemicals that cause morphological changes in the adrenal glands also affect cortical function. Chemically induced changes in adrenal function result either from blockage of the action of adrenocorticoids at peripheral sites or by inhibition of synthesis and/or secretion of hormone. In the first mechanism, many antisteroidal compounds (antagonists) act by competing with or binding to steroid hormone-receptor sites; thereby, either reducing the number of available receptor sites or by altering their binding affinity. Cortexolone (11-deoxycortisol) an antiglucocorticoid and spironolactone, an antimineralocorticoid, are two examples of peripherally acting adrenal cortical hormone antagonists. Xenobiotic chemicals affecting adrenal function often do so by altering steroidogenesis and result in histologic and ultrastructural changes in adrenal cortical cells. For example, chemicals causing increased lipid droplets often inhibit the utilization of steroid precursors, including the conversion of cholesterol to pregnenolone. Chemicals that affect the fine structure of mitochondria and smooth endoplasmic reticulum often impair the activity of 11-, 17-, and 21-hydroxylases, respectively, and are associated with lesions primarily in the zonae reticularis and fasciculata. Atrophy of the zona glomerulosa may reflect specific inhibition of aldosterone synthesis or secretion, either directly (e. Chemically induced proliferative lesions of the adrenal cortex are less frequently reported and include hyperplasia, adenoma, and carcinoma. A variety of different chemicals are associated with an increased incidence of adrenal cortical neoplasia. Most of the reported tumors tend to be benign (adenomas) although an occasional tumor may be malignant (carcinomas). The zonae reticularis and fasciculata are more prone to develop tumors following chemical injury whereas the zona glomerulosa is spared unless invaded by an expanding tumor in the adjacent zones of the cortex. The tumorigenic agents of the adrenal cortex have a diverse chemical nature and use. Spontaneous proliferative lesions may be found in all zones of the adrenal cortex but in adult rats are found most frequently in the zona fasciculata. Spontaneous nodular hyperplasia of the adrenal cortex is common in the rabbit, golden hamster, rat, mouse, dog, cat, horse, and baboon. Naturally occurring adrenal cortical tumors are found infrequently in domestic animals, except adult dogs and castrated male goats. However, cortical adenomas and (to a lesser extent) cortical carcinomas have been reported in moderately high incidence in certain strains of laboratory hamsters (e.

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Indeed menstrual 2 days late spotting safe 5mg aygestin, in some instances menstrual extraction generic aygestin 5mg, the immune system has been shown to be compromised (decreased lymphoid cellularity menstrual migraine prevention proven aygestin 5 mg, alterations in lymphocyte subpopulations pregnancy 4 weeks 2 days purchase 5mg aygestin, decreased host resistance, and altered specific immune function responses) in the absence of observed toxicity in other organ systems. These studies coupled with tremendous advances made in immunology and molecular biology have led to a steady and exponential growth in our understanding of immunotoxicology during the past 25 years. Recognition by regulatory agencies that the immune system is an important, as well as sensitive, target organ for chemicaland drug-induced toxicity (as described in greater detail later in this chapter) is another indication of the growth of this subdiscipline of toxicology. With the availability of sensitive, reproducible, and predictive tests, it is now apparent that the inclusion of immunotoxicity testing represents a significant adjunct to routine safety evaluations for therapeutic agents, biological agents, and chemicals now in development. Understanding the impact of toxic responses on the immune system requires an appreciation of its role, which may be stated succinctly as the preservation of integrity. It is a series of delicately balanced, complex, multicellular, and physiological mechanisms that allow an individual to distinguish foreign material (i. Examples of nonself are a variety of opportunistic pathogens, including bacteria and viruses, and transformed cells or tissues (i. The immune system is characterized by a virtually infinite repertoire of specificities, highly specialized effectors, complex regulatory mechanisms, and an ability to travel throughout the body. The great complexity of the mammalian immune system is an indication of the importance, as well as the difficulty, of its role. If the immune system fails to recognize as nonself an infec- tious entity or neoantigens expressed by a newly arisen tumor, then the host is in danger of rapidly succumbing to the unopposed invasion. This aspect of immunocompetence is the reason why the immune system is often made synonymous with "host defense. This aspect of immunocompetence emphasizes the tremendous destructive potential that is associated with the host defense mechanisms of the immune system. The cost to the host of these mistakes, made in either direction, may be quite high. The fact that mistakes can occur in either direction is an indication that immunotoxicology should be considered as a continuum (Fig. At the center of the concept of the continuum is the recognition that immune responses in the normal human population can vary by more than two standard deviations (Luebke et al. Because the cost of mistakes in immunocompetence can be so high, and because of the tremendous diversity involved in the identification of self versus nonself, a complex array of organs, cells, soluble factors, and their interactions has evolved to regulate this system and minimize the frequency of errors in either direction. Due to the potentially profound effects resulting from disruption of the delicately balanced immune system, there is a need to understand the cellular, biochemical, and molecular mechanisms of xenobiotic-induced immune modulation. This chapter provides (1) an overview of basic concepts in immunology (structure, components, and functions), which are important to the understanding of the impact xenobiotics may have on the exposed individual; (2) a summary of selected current methods utilized to assess immune function; and (3) a brief review of current information on the immune modulation (immune suppression, immune enhancement, hypersensitivity, and autoimmunity) induced by a variety of xenobiotics. This chapter is not meant to be an immunology textbook, nor an exhaustive review of the mechanisms Autoimmunity & Hypersensitivity Mortality & Morbidity Immunostimulation Normal range of immune responses Immunosuppression Adverse effects of immunosuppression Adverse effects of immunostimulation Mortality & Morbidity Infections & Cancer Continuum of Immunotoxicology Figure 12-1. For detailed information on immunology, the reader is referred to three texts: the first edited by Paul (5th edition, 2003), Fundamental Immunology, the second edited by Roitt, Brostoff, and Male (10th edition, 2003), Immunology, and the third edited by Janeway, Travers, Walport, and Capra, (6th edition, 2004), Immunobiology, the Immune System in Health and Disease. For a more comprehensive review of immunotoxicology, the reader is referred to two texts: the first edited by Vohr et al. It comprises numerous lymphoid organs (Table 12-1) and numerous different cellular populations with a variety of functions. The bone marrow and thymus are referred to as primary lymphoid organs because they contain the microenvironments capable of supporting the production of mature B- and T cells, respectively. In addition, the bone marrow is the site of origin of the pluripotent stem cell, a self-renewing cell from which all other hematopoietic cells are derived (Figs. During gestation, this cell is found in the embryonic yolk sac and fetal liver; eventually, it migrates to the bone marrow. Within the bone marrow, the cells of the immune system developmentally "commit" to either the lymphoid or myeloid lineages. Cells of the lymphoid lineage make a further commitment to become either Tor B cells. Because of their critical role in initiation and regulation of immune responses, T-cell precursors are programmed to leave the bone marrow and migrate to the thymus, where they undergo "thymic education" for recognition of self and nonself. Mature, naive, or virgin lymphocytes (those T- and B cells that have never undergone antigenic stimulation) are first brought into contact with exogenously derived antigens within the highly organized microenvironment of the spleen and lymph nodes, otherwise known as the secondary lymphoid organs. The spleen serves as a filter for the blood, removing both foreign antigens and any circulating dead cells and cellular debris. The lymph nodes are part of a network of lymphatic veins that filter antigens from the fluid surrounding the tissues of the body.

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However menstrual 9gag generic 5mg aygestin, it does not appear to be obligatory for initiating parturition-delivery occurs even in hypophysectomized animals and humans women's health exercises at home 5 mg aygestin, though labour may be prolonged in its absence breast cancer 6s jordans trusted 5mg aygestin. Milk ejection reflex Suckling induces oxytocin release from pituitary which contracts the myoepithelial cells menstrual zine purchase aygestin 5mg. Neurotransmission Oxytocin appears to function as a peptide neurotransmitter of oxytocinergic neurones in the hypothalamus and brainstem to regulate autonomic outflow. Pregnant uterus and placenta elaborate a specific aminopeptidase called oxytocinase-which can be detected in maternal plasma. Induction of labour Labour needs to be induced in case of postmaturity or prematurely in toxaemia of pregnancy, diabetic mother, erythroblastosis, ruptured membranes or placental insufficiency. Uterine contractions are then closely monitored: the drug is discontinued when they are strong enough. Before deciding to use an oxytocic for strengthening uterine contractions, all the conditions as setout above (for induction of labour) must be fulfilled. Too strong contraction can be catestrophic: use should only be made in selected cases and by experienced people. It acts by forcefully contracting the uterine muscle which compresses the blood vessels passing through its mesh work to arrest haemorrhage from the inner surface exposed by placental separation. Oxytocin is effective only in such cases; an intranasal spray may be given few minutes before suckling. Oxytocin challenge test It is performed to determine uteroplacental adequacy in high risk pregnancies. Desamino-oxytocin It has been developed as a buccal formulation; action is similar to injected oxytocin, but less consistent. Only the amine ergot alkaloid ergometrine (ergonovine) and its derivative methylergometrine are used in obstetrics. At low doses, contractions are phasic with normal relaxation in between, but only moderate increase in dose raises the basal tone, contracture occurs with high doses. Pharmacokinetics In contrast to the amino acid ergot alkaloids, ergometrine and methylergometrine are rapidly and nearly completely absorbed from the oral route. They can decrease milk secretion if higher doses are used for many days postpartum; this is due to inhibition of prolactin release (dopaminergic action). Ergometrine should be avoided in- (i) patients with vascular disease, hypertension, toxaemia. However, routine use in all cases is not justified- only in those expected to bleed more, e. These drugs produce sustained tonic uterine contraction: perforating uterine arteries are compressed by the myometrial meshwork- bleeding stops. However, routine use in all cases is not justified because normal involution is not hastened. Multipara and others in whom slow involution is apprehended, these drugs may be given prophylactically. They have been used to delay or postpone labour, arrest threatened abortion and in dysmenorrhoea. Suppression of premature labour may be needed to allow the foetus to mature, to allow time for initiating glucocorticoid therapy for foetal lung maturation or to transfer the mother in labour to a centre with proper facilities. However, no clearly satisfactory drug is available since none of them has been shown to improve foetal outcome. Measures to delay labour should not be undertaken if membranes have ruptured, antepartum haemorrhage is occurring, in severe toxaemia of pregnancy, intrauterine infection or foetal death.

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