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Follow-up blood testing reflects that clozapine is still in his system buy discount oxcarbazepine 300mg online osteoporosis treatment, but in a substantially lower blood concentration buy oxcarbazepine uk symptoms hiv. Typically oxcarbazepine 300mg amex medicines 604 billion memory miracle, patients who consume intoxicants are judged as having become volun- tarily intoxicated (103) order 600mg oxcarbazepine amex medications causing hair loss. Laws may be more accommodating to the benefit of the defense if a defendant drank alcohol or took an illicit drug with the expectation of relief, espe- cially if he were suffering from psychotic mental illness, and the existing antipsycho- tic regimen was ineffective (104). Also known as “major tranquilizers,” the traditional antipsychotics assumed forensic significance because of the significant side effects that could appear fairly dramatically with relatively small fluctuations in dose of the medicine. With the revolution of psychopharmacology, and the release and widespread use of atypical antipsychotics, forensic civil implications have changed for these medi- cines. Because there are medicines now available that are not as associated with signif- icant side effects, future civil forensics will relate more directly to the decision to choose traditional vs atypical antipsychotics. As significant as the impairments from schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression are, the impact of those illnesses on employability was worsened by the often-unavoidable side effects of traditional antipsychotics. The effects of akathisia, driving a person to perpetual motion, would interfere with the essential functions of most work. The cognitive effects of other traditional antipsy- chotics also limit even compliant patients with major psychiatric disorders from fulfill- ing the core demands of intellectual dexterity of many positions. The condition, which limits the ability to move quickly and spontaneously, may substan- tially curtail the efficiency with which one can do any task that requires movement. Furthermore, the masklike face of parkinsonism (105) calls attention to an employee as “medicated,” and can further isolate someone who especially needs the support. New Frontiers of Accommodation With the release of clozapine, and later, olanzapine, and seroquel, treatments became available that do not affect movement, do not cause parkinsonism, and do not produce confusion. Employees can now engage in more intellectually competitive pursuits, even while taking atypical antipsychotics (106). The obstacles of traditional antipsychotics have been removed by the next gener- ation. Now, employers can more easily anticipate reversible side effects, and more easily accommodate side effects of interactions such as increased sedation (a side effect of all of the atypical antipsychotics), or dizziness upon rapidly standing (clozapine) (107). Poor compliance with treatment has also had a major impact on accommodating employees with psychotic mental illness. Atypical antipsychotics have been demon- strated to have superior compliance (108), which in turn promotes maintaining a symp- tom-free presentation and adherence to a plan worked out for an employee. At the time of the onset of his illness, he was 6 months removed from law school and had no health insurance. While he remained without manic symptoms, he noticed a subjective sense of great restlessness. After gentle input, a senior partner demanded a drug test, suspecting Mark of being on cocaine or amphetamines. No cocaine was found in Mark’s blood; however, when he demonstrated traces of fluphenazine, and his firm confronted him, Mark disclosed his condition. The employer contacted Mark’s psychiatrist to advise him of the firm’s concerns; the psychiatrist changed Mark’s antipsychotic to olanzapine. Soon afterward, Mark spent noticeably more time at his own desk, without pacing about, and others noted him to be more crea- tive as well. As we become more acquainted with the atypical drugs, previously unrecognized interactions will be discovered. Case reports describe panic attacks arising, for exam- ple, in those treated with high-dose antipsychotics (109). Modifying the regimen and early intervention, in such cases, quickly reverses the side effects without necessarily having to accommodate the condition by changing occupational responsibilities. Unfortunately for some, even those who derive benefit from the atypical antipsy- chotics, residual symptoms of the condition may linger. If these symptoms interfere with the performance of essential functions, then even the most tolerable medicines will not salvage the employee’s job or warrant accommodation by the employer. Should an employee demonstrate a sudden mental or physical deterioration, any neces- sary changes relating to contributing drug interactions can be recommended, with quick response. Such structure also reinforces the need for continued compliance with treat- ment. In the past, physicians confronted liability based on the consequences of traditional anti- psychotic side effects, heightened by interactions. In the future, malpractice suits will originate based upon the physician’s decision to prescribe a traditional antipsychotic instead of an atypical antipsychotic. Atypical anti- psychotics are drugs of choice; therefore, liability may be clear when a patient suffers from the side effects of a traditional antipsychotic when an atypical agent was available and this option was not presented to the patient or otherwise considered. Since psychiatric malpractice originates most commonly after unwanted death, particular attention needs to be directed to medication regimens in cases of sudden death. Postmortem toxicology studies may rule out overdose, but medications may still be respon- sible. Chlorpromazine and thioridazine are two antipsychotics that can cause substantial drops in blood pressure (110). This effect can be more pronounced in patients given tri- cyclic antidepressants and monoamine oxidase inhibitors (110). Significant hypotension has also been described with mesoridazine and clozapine (110). Since so many other medication options are available to treat acute agitation, and psychosis, clinical practice warrants accounting for why these medicines are pre- scribed instead of medicines that do not represent any risk to the circulatory system— particularly in the medically vulnerable or in those at risk for suicide by overdose. Unwanted lethality may rarely arise from the very rare side effect of agranulocy- tosis, or loss of ability to make white blood cells, attributed to clozapine. Again, accounting for this risk is sufficient, especially if clinical choices are more restricted. Sometimes the interactions of med- icines prescribed for nonpsychiatric conditions can affect glucose metabolism, or worsen sexual function, or contribute to weight gain. These problems may lead to the develop- ment of diabetes, divorce, or cardiac problems, respectively. The prescribing physi- cian has a duty to monitor for these difficulties, and to discuss and resolve the problems with his or her patient, regardless of the different possible causes. Interactions with antipsychotics may impact tort liability if a patient’s excessive sedation or confusion results in impaired operation of a motor vehicle or other lethal equipment. Interactions that increase blood levels of clozapine may be responsible for 210 Welner causing seizures (114), which can create a highway catastrophe. In this regard, standard psychiatric practice has reinforced the responsibility for psychiatrists to advise patients of risks associated with operating such items when prescribed antipsychotics. Since trusts and wills often concern individuals with health problems, such deci- sions may be affected by the interactions of prescribed drugs. Cases involving such competencies therefore warrant close scrutiny of medical, prescription, and pharmacy records. Comparison of decisions made, with corresponding dates, yields vital detail about the relevance of drug interactions. As agitation in the medically ill, and in the elderly, is often treated with antipsy- chotics, confusion and sedation may be attributable to the medicine—if not the under- lying condition. Careful consideration of the clinical course will enable the distinction of whether a drug interaction was responsible.
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Roxithromycin had a small but significant effect on the pharma- cokinetics and pharmacodynamics of midazolam (310) buy oxcarbazepine overnight treatment bronchitis. Azithromycin had no effect on the pharmacokinetics and pharmacodynamics of midazolam (290 discount oxcarbazepine american express medicine administration,306; Table 27) purchase oxcarbazepine on line amex symptoms rotator cuff tear. The fluoroquinolone antibiotic ciprofloxacin was found to inhibit the elimina- tion of 5 mg intravenous diazepam in one study (311) discount 300mg oxcarbazepine visa symptoms synonym, with little or no pharmacody- namic effect. In another study, ciprofloxacin had little or no effect on the elimination of 10 mg intraveneous diazepam (312; Table 26). Possibly higher doses of diazepam overcome a weak inhibitory action of ciprofloxacin. Interactions with Antiretroviral Agents The antiretroviral agents, particularly the protease inhibitors and nonnucleoside reverse transcriptase inhibitors, are an emerging group of potent inhibitors, and, in some cases, inducers of drug-metabolizing enzymes (313–315). In vitro, the protease inhib- itors are particularly potent inhibitors of P450 3A4, with 2C9 and 2C19 also inhibited by some (Fig. The relative potency for inhibition of 3A4 is ritonavir > indinavir > saquinavir (316–321; Fig. Saqinavir has variously been found equipotent to nelfinavir (318), less potent than nelfinavir (319,320), and more potent than nelfinavir (321). In a single study on amphenavir, it was found to inhibit 3A4 with a potency simi- lar to indinavir (320). A single study comparing the inhibitory potency of the nonnucle- oside reverse transcriptase inhibitors suggests that their relative ability to inhibit P450 3A4 is delaviridine > efanvirenz >> nevirapine (322). P450s 2C9 and 2C19 are also sus- ceptible to inhibition by delaviridine and efanvirenz (Fig. Much of what is currently know about their ability to induce drug metabolism comes from clinical studies on the combination of two or more of these drugs. From these studies the protease inhibitors, ritonivar, nelfinavir, amprenavir, and the nonnucleoside reverse transcriptase inhibi- tors, efavirenz and nevirapine, have all shown the potential to induce drug metabolism (313,315). Studies on the interactions of antiretroviral agents with benzodiazepines are cur- rently limited (Table 28), but will probably grow based on the clinical significance of these drugs. Ritonavir, after 2 or 3 d of treatment, has been found to inhibit the elimina- tion of triazolam (323) and alprazolam (324). The inhibition of triazolam is quite sig- nificant with major effects on the pharmacokinetics of this benzodiazepine. The effects on alprazolam are also significant, but did not have as great an impact on its pharma- codynamics. In the paper concerning ritonavir and alprazolam (324), the authors cite an abstract that was unavailable for review. The abstracted study apparently tested the inter- action between ritonavir and alprazolam after 10 d of ritonavir treatment and found no significant effect. The data for the non-nucleoside reverse transcriptase inhibitors are from von Moltke et al. Three- or 5-d treatment with saquinavir causes a significant inhibition of the elimination of oral midazolam associated with a significant enhancement of its pharmacokinetics. Saqua- nivar also inhibited the elimination of intravenous midazolam, but to a lesser extent (325; Table 28). The mixed inductive and inhibitory nature of the protease inhibitors and the nonnucleoside reverse transcriptase inhibitors may make it more difficult to predict when drug interactions will occur. Interactions with Grapefruit Juice In a seminal study reported in 1991, Baily et al. P450 3A4 is also the major P450 in the gastrointestinal system (327,328), and the drugs affected by grapefruit juice are 3A4 substrates (329,330). Efforts to determine the components of grapefruit juice responsible for its inhibitory effects therefore cen- tered on P450 3A4 inhibitors. It can make up to 10% of the dry weight of the juice and is responsible for the bitter taste. Additional studies confirmed the ability of these flavonoids to inhibit 3A4 specific activities, including nifedipine oxidation (334), midazolam a-hydroxy- lation (37,335), quinidine 3-hydroxylation (335), 17b-estradiol metabolism (336), and saquinavir metabolism (337). Two clinical studies examined the relative inhibitory action of quercetin vs grapefruit juice on nifedipine pharmacokinetics (338) and narin- gen vs grapefruit juice on felodipine pharmacokinetics (339). Neither flavoniod when administered at doses comparable to those in the grapefruit juice caused any effect on the bioavailability of the drug (338,339). Their inhibitory capacity for 3A4-related substrates was one to two orders of magnitude greater than the flavonoids (Fig. The relative potency of components of grapefruit juice to inhibit P450 3A4 activities. The data for the flavonoids are for nifedipine oxidation and are from Guengerich and Kim (333). With only limited amounts of the furanocoumarins available, there has not yet been a clinical study to indicate they can substitute for grapefruit juice in causing drug inter- actions. Their role in grapefruit juice drug interactions therefore has not yet been established. Grapefruit juice also effects P-glycoprotein-mediated transport, increas- ing the basolateral to apical flux (337,346,347). The relative role the transporter and P450 3A4 have on the bioavailability of a drug may also be important in determining the active component in the effect of grapefruit juice. For benzodiazepines undergoing oxidative metabolism, P450 3A4 appears to be more important. In normal subjects, the effect was modest, and accompanied with no or only minor effects on the pharmacodynamics of the benzodiazepines (348,350–352). This suggests that cirrhotics are more dependent upon intestinal metabolism of midazolam. In a study on other juices, tangerine juice was found to delay the absoprtion of midazolam and slightly delay its pharmacodynamic effects (353; Table 29). Interactions with Miscellaneous Agents Clinical studies concerning potential drug interactions with benzodiazepines have been performed with a number of drugs for which either only a single drug in its class was studied, or there was no explicit connection with an aspect of drug metabolism. It did produce a significant decrease in the pharmacodynamic measures of diazepam (354; Table 30). The effect of chronic theophylline on alprazolam was compared in subjects with chronic obstructive pul- monary disease that were or were not taking theophylline. Caffeine was found to have no effect on the pharmacokinetics of diazepam (356) or alprazolam (203); but caffeine did slightly diminsh the pharmaco- dynamic measures for diazepam (356; Table 30). Chronic disulfiram treatment was found to diminsh the elimination of chlordiazepoxide and diazepam, but not that of oxazepam in normal subjects (Table 30). The clearance and t1/2 of the three benzodiazepines in chronic alcoholics who had received chronic disul- firam treatment were similar to those in the disulfirma-treated normal subjects (358).
It may be prescribed with most happy results with other alteratives in scrofula or syphilis order oxcarbazepine with american express treatment hyperkalemia, or in the eruptions which result from these disorders purchase 600mg oxcarbazepine overnight delivery medicine pills. Younkin is authority for the use of this agent in one-sixth of a grain doses best 150mg oxcarbazepine medicine and manicures, with ten grains of the potassium bitartrate discount oxcarbazepine 300mg visa symptoms 9f diabetes, given every two hours in gonorrheal epididymitis, of which it relieves the pains and abridges the inflammation. Physiological Action—Senega has sustained a reputation in the past, as an antidote to the poison of venomous reptiles. It is an alterative of much power, exercising a marked influence upon both the skin and mucous membranes, notably the latter. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 357 It causes a sensation of acridity in the throat when a moderate dose is swallowed, and may be employed in chronic pharyngitis, as a local stimulant, where the mucous membrane is relaxed and the secretion abundant. Specific Symptomatology—The agent is indicated in typhoid pneumonitis, capillary bronchitis, in aged and debilitated subjects, chronic bronchitis with profuse secretion, in the declining stages of pneumonitis, bronchitis and croup, when the inflammatory condition has passed off, chronic bronchitis with pain and soreness in the chest and asthma. Therapy—The agent is in use in the treatment of dropsy from obstruction and glandular enlargement, also in rheumatism, syphilis, squamous skin diseases and in amenorrhea. Senega has been employed as a stimulating expectorant in chronic bronchitis, in aged and debilitated subjects, where a stimulating medicine is demanded and in the later stages of pneumonia and catarrhal inflammations. In these cases, given in small doses, it improves secretion, removes abnormal deposits and restores the strength. It is an energetic stimulant to the mucous membranes of the air passages: and, when given before the inflammation has subsided, aggravates the cough and does harm. Given in small doses, it also acts as an alterative, and may thus be given in dropsy from obstruction, in syphilis, and in squamous skin diseases. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 358 Therapy—In suppression of the menses from cold, thirty drops in hot water may be drunk every two hours. It may be begun two weeks before the menses should next appear, if one period has passed, and given every four hours in cold water, until a day or two before the expected time, when it can again be given in hot water. More recently, I have used it in conjunction with one or two of the other uterine remedies, carefully selected, in all forms of menstrual suppression, except in feeble and anemic patients, and have, found it efficient and readily controllable. It acts promptly upon the skin and kidneys and seems to be to a certain extent antispasmodic, as in hystero-epilepsy, or epilepsy depending upon suppression of the menses, it relieves the paroxysms and reduces the number of the attacks. Goss recommended it when there was urinary suppression from cold and in retention with lack of power in the bladder. In certain forms of flatulent colic, when the pains are sharp and lancinating, intermittent, and of a severe griping character, it is curative. Physiological Action—Given in large doses polymnia acts as an emeto- cathartic, producing painful evacuations, with severe emesis, and if pushed produces gastro-intestinal inflammation, dizziness, convulsions and even death. Specific Symptomatology—It is indicated in conditions of inactivity of the organs, with passive fullness of the circulation of the parts, or of surrounding tissues which may be of a sodden inelastic character. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 359 Inactive engorgements, or stagnations of the circulation, are general conditions pointing to the use of this agent. Scudder gave as its indications full, flabby, sallow tissues, impaired circulation, glandular enlargement and other impaired functions from lack of tone. Therapy—The older writers of our school lauded this remedy as of much importance in rheumatism. Others spoke of it favorably in the same class of cases in which phytolacca is used. Pruitt used it in the form of an ointment, in inflammation of the mammary glands, and other glandular inflammations, especially if abscesses had formed. The specific influence of the remedy, however, as agreed by all writers, is upon enlargement of the spleen. This gland is influenced in chronic malarial conditions, in scrofulous diseases and in tubercular difficulties. It is upon the malarial form of splenic enlargement that it acts to the best advantage. It should be used freely internally, and externally the hot infusion must be applied. A chronically enlarged inactive engorged liver, with tenderness on pressure, is quickly and satisfactorily cured by it. A womb enlarged from subinvolution or other hypertrophy, yields satisfactorily to its influence. It has been used in mastitis or “caked breast” so-called, to excellent advantage, but its prolonged use may suppress the secretion of milk. It is an active stimulant to the removal of waste in all the conditions mentioned. The removal of chronic inflammatory deposits stimulates the capillary circulation to better action and relieves the aching pain and soreness common to such conditions. It has been praised most highly in the treatment of rheumatism, lumbago, myalgia, and other painful conditions dependent upon the imperfect removal of the products of retrograde metamorphosis. It is a remedy of much value in scrofulous conditions with glandular indurations or abscess. Its external application has relieved many cases of severe spinal irritation, especially if present with the general conditions named above as indicating the use of this agent. Scudder gave the following list of disorders, in which it had a direct Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 360 influence: Chronic enlargement of the spleen, chronic enlargement of the liver, chronic hypertrophy of the cervix uteri, chronic gastritis, chronic metritis with hypertrophy, uterine subinvolution and general glandular enlargement. The remedy, no doubt, stands at the head of spleen remedies, but it is not used as it should be, the younger physicians paying but little attention to it. Felter says, when dyspepsia depends upon a sluggish circulation in the gastric and hepatic arteries, and is attended with full, heavy, burning sensation, in the parts supplied by these arteries, this is our remedy. A common cause of failure in the treatment of chronic diseases is the lack of persistency. The solid extract of polymnia is readily incorporated with any ointment base, and the external use of the agent over enlarged glands is often as important as its internal use. Scudder claimed that it was the best hair tonic in the materia medica, in the proportions of four ounces of the tincture with twelve ounces of bay rum, to be rubbed thoroughly into the scalp. A good combination would be castor oil three parts, glycerine one part, lanolin three parts, extract uvedalia two parts, melted and rubbed together and cooled. The addition of a very small quantity of cantharides improves this in stubborn cases. Specific Symptomatology—The agent is used in anasarca, ascites, urinary obstruction, suppression of urine in children, febrile and inflammatory diseases, uric and phosphatic acid gravel, acute gonorrhea with severe burning pain on passing urine, irritation of the bladder, difficult micturition of pregnancy, and often occurring during parturition. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 361 Therapy-The agent is a hydragogue diuretic and causes a very large evacuation of urine when administered in dropsy, while it promotes the absorption of the fluid at the same time. Though it is not always effective, probably on account of using a spurious article, the genuine has been known to remove forty pounds of urine from a dropsical patient in twenty-four hours. Therapy—The older writers were enthusiastic concerning the tonic and antiperiodic properties of this drug. A recent writer says that he soon learned that a strong infusion of the bark would cure those forms of intermittent fever, of a chronic or irregular character.
Since gap junction channels are large enough to allow passage of small molecules such as amino acids or nucleotides order oxcarbazepine now medicine 44334, it seems reasonable to ask if biochemical communication also takes place discount 300mg oxcarbazepine fast delivery symptoms dehydration. One might imagine oxcarbazepine 300 mg low cost medicine cabinets with mirrors, for example purchase 150 mg oxcarbazepine otc symptoms ringworm, that cell-to- Excitability and Conduction - Richard Tsien, Ph. Such "metabolic cooperation" might be particularly important in cases of localized ischemia. The ease of current flow between cells is detrimental when an area of tissue is injured; however, the permeability of gap junctions is regulated. Damage to a localized region (as in a myocardial infarction) causes electrical spread of depolarization to surrounding areas. Fortunately, heart muscle (unlike skeletal muscle or nerve) can use its ability to regulate gap junctions in order to heal over within a minute or two after injury. Cardiac gap junctions can reversibly decrease their permeability when there are significant and sustained rises in Ca2+ or H+ concentrations or both. These regulatory mechanims provide the cell with a way of controlling the intercellular communication, and possibly conduction velocity and transfer of second messengers. A rise in intracellular Ca2+ can be triggered by cellular injury, a drop in intracellular pH accompanies ischemia. Thus, the damaged or necrotic cells can gallantly uncouple themselves from their healthy neighbors. This is in contrast to certain electrical junctions between nerve cells, where a marked bias is shown in favor of one direction of current flow. Electrical coupling in heart or smooth muscle is even more unlike chemical communication, which is often distinguished experimentally by its completely unidirectional nature. In a chemical synapse, transmitter is released by one cell (pre-synaptic) and acts specifically on another (postsynaptic) cell; the chemical machinery for release or response is usually restricted to only the pre-or postsynaptic cell respectively; thus, transmission must be one-way. The possibility of bi-directional spread of excitation is important clinically, since some types of cardiac arrhythmia are thought to arise from retrograde (wrong-way) conduction. The Figure describes the role of unidirectional block in the phenomenon called reentry. In panel A, an excitation wave traveling down a single bundle of fibers (S) continues down both left (L) and right (R) branches. The depolarization wave enters the connecting branch (C) from both ends and is extinguished when the opposing impulses collide. The antegrade (forward heading) impulse is blocked, but the retrograde impulse is conducted through. This could happen if the electrical mass of C was much greater than that of S (easier for log to ignite twig than twig to ignite log). If the retrograde impulse propagates slowly enough, it will arrive after bundle S has recovered its responsiveness. This retrograde impulse “reenters” S and can cause repetitive and possibly arrhythmogenic firing. More about reentry and how it can be pharmacologically ablated in the next lecture. Conduction of impulse by atrial wall, and more rapid conduction by specialized tracts (anterior, middle, and posterior internodal pathways) conveying excitation to A-V nodes (see figure below). The branches are composed of Purkinje tissue with relatively fast conduction velocity (2-4 m/sec. The branches ramify extensively, and the conducting tissue undergoes a gradual morphological transition into working myocardium. H H D221 Spring 2009 Page 64 VesselType W h ere Internal C h aracteristics Valves Vasa F unction Elastic Vasorum L am ina E lastic Aorta, Yes Thickm ediawith both N o Som etim esConduction;m aintainbloodpressure Artery com m on m uscleand50-60 underhigh pum ping load >1cm elastic lam ella carotid, subclavian M uscular Iliacs, Yes Thickm edia; N o N o D istributiontoorgans;changevessel Artery vertebrals, m orem usclethan diam eterwith sm ooth m uscle 2-10m m according tosym pathetic control coronaries, elastic fibers cerebralArt. Sm allArtery U biquitous Yes,but 1-6m usclelayers N o N o D istributiontotissues;control Arteriole thin inm edia resistancewith sm. This decrease coincides with a reduction in elastic substance and an increase in smooth muscle in the arteries. Connective tissue under the endothelium contains bands of collagen and fibroblasts. These large specialized cardiac muscle cells contain very few myofibrils and function as part of a specialized conduction system that coordinates the contraction of the heart. With high magnification note the relative proportion of blue stained collagen, pink smooth muscle, and unstained elastic tissue. Slide 56 External ear (Elastic stain) Look in the loose connective tissue near the elastic cartilage in this section and you will see a muscular artery and its companion vein. The internal elastic lamina of this small artery is very prominent because of the elastic fiber stain; in some places the external elastic lamina may be seen. Note the striking refractile internal elastic lamina and the pink staining smooth muscle (25 40 layers) of the tunica media (note that the smooth muscle nuclei are twisted into a corkscrew characteristics of contraction). The external elastic lamina (between the media and adventitia) is less pronounced. The connective tissue comprising the adventitia is oriented mostly longitudinally and most of the collagen bundles here (stained blue) are thus cut in cross section. Remember that in blood vessels the components of the adventitia are arranged longitudinally, those of the media are circular, and those of the intima are longitudinal. Venules, with an equally thin wall but a wider diameter, are found in the same area. These will be a bit lower in the dermis (the connective tissue immediately under the epithelium). Slide 23 Mesentery spread (flat mount, H and E) (C&M 150-156 for ultrastructure) This is not a section, but a piece of mesentery mounted under a coverslip. Observe the large, lymph vessel and smaller blood vessels running alongside it and extending into other parts of the mesentery. The lymph vessel contains valves that consist of a pair of pockets arranged on opposite walls. Arterioles have a smaller lumen, endothelium and a smooth muscle media; venules have a wider lumen and a thin endothelial lining. By adjusting the fine focus of your microscope, you can follow the smooth muscle nuclei as they encircle the arteriole. Trace small branches from the arteriole to see them become capillaries, and, if possible, follow them back to a venule. Capillaries are distinguished by a lumen size as small as a single red blood cell. In addition observe several medium-sized thin-walled veins, which are collapsed and hence have an irregular lumen. This is a cross section of a large vein which has been opened up and laid flat before sectioning. Observe the bundles of smooth muscle cells (red) and collagen (blue), which make up the thick adventitia.
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