THE ENDOCRINE SYSTEM1. INTRODUCTION1.1 General Endocrinology can be defined as the study ofcommunication between cells by a chemical messenger (Hormone)synthesized by endocrine cells in vivo and directed at specifictarget cells.1.2 Most endocrine cells that synthesise the hormones have alimited capacity to store the hormone. Thus these glands need toturnover several times just to keep pace with daily requirementsfor the hormones. The normal thyroid gland contains two weeksstored supply in the form of thyroglobulin. Nerve endings may haveseveral days supply of norepinophrine.1.3 The rate of different hormone release is periodic in the formof a set rhythm, the cycles varies from minutes to hours or daily(Circadian) loss of this rythm in clinical cases may be an earlyevidence of a disordered state.2. A HORMONEA hormone, being the chemical substance synthesized by agroup of endocrine cells (in ductless glands) and secreteddirectly into the blood stream (since there are no ducts) forquick transport to target organs so as to influence their internalmetabolism.2.1 The important body functions responsive to hormone actionsare:2.1.1 The Milieu Interior (fluid, Electrolytes). The internalenvironment2.1.2 Emergency stress response i.e.metabolic response to injury2.1.3 Reproduction i.e. ova and sperm production, fertilisationand implantation2.1.4 Growth and development of bothi) Normal tissue andii) Neoplastic tissue2.2 The hormones we know are either* Peptides (made of sequence of amino acids)* Steroids (The hormones has a six sided steroid ring and theprecursor is cholesterol) or* amines (are also derived from amino acids)Hormone action starts with the step of binding with a cellmembrane or intracellular specific receptor for the hormone.2.3 There is evidence available that the Endocrine System isintegrated in its activity to achieve biologic goals. The ed by- the activity of the pituitary gland (Fig 30.1a & b). The pituitarygland receives instruction through neural signals (Fig 30.2
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Saturday, July 15, 2017
Sunday, July 9, 2017
Renal Transplantation 5 Longterm follow up
LONG-TERM FOLLOW-UP
Patients
with satisfactory renal
function can usually
be
discharged from hospital 2 to 3 weeks after the
operation.
Regular monitoring on a daily or alternate day basis is
essential
during the first month after position.
A live donor
transplant offers a much greater chance of
success
than a cadaver graft
Excellent
results can be
expected in the
rare cases of
transplantation between identical twins.
However, with a kidney from and HLA identical sibling
the I-year
graft survival in most centres is over 90%
In sibling transplants
without complete HLA
identify and in
parent to child operations; the levels of graft
survival are
lower, but still around 75% at I year.
An increasing awareness of the potentially lethal
effects of
immunosuppression has led to a gradual reduction in the
mortality
and morbidity of transplantation.
Today 2 year
survival in 40-60 years recipients is 61%, 4
years
survival in the same age group is 71%. Survival in 15 to
45 years
stands at 90% at 86% at 2 and 4 years. This has been
achieved by
some supportive dialysis after transplantation when
required.
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Monday, July 3, 2017
Renal Transplantation 4 post operative
POST-OPERATIVE MANAGEMENT
Patients are
usually nursed in isolation for the first 48
hours
after
operation and careful isolation
and barrier nursing
is
essential.
* Kidneys with a
short warm ischaemic time usually
function
immediately
after transplantation
* In this
situation, biochemical estimations are the mainstay of
the diagnosis of
rejection
* The serum creatinine , creatinine clearance and
blood urea
should be
estimated daily
* Of these,
the serum creatnine is the most
reliable index of
rejection
* Confirmatory
clinical signs are often present
These include graft swelling and tenderness:
- A reduction in
urine volume
- Pyrexia
- Unexplained
weight gain or
- A rise in blood
pressure
* Isotope techniques such as gamma camera
sintiscanning, the
uptake of 125I
fibrinogen and the injection of Indium labelled
autologous platelets have all been used to give
arly warning
of rejection
* The urine
may also be tested for
the presence of
cells
fibrin/fibrinogen degradation
products and specific urinary
enzymes such as
N-acetyl glucosaminidase.
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