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Patrlj L glucotrol xl 10mg on line diabetes mellitus type 2 ncbi, Kocman B buy glucotrol xl 10mg signs your diabetes is out of control, Martinac M buy generic glucotrol xl 10 mg on line diabetes in dogs how to treat, Jadrijevic S purchase glucotrol xl 10 mg amex diabetes test baby, Sosa T, Sebecic B, Dis Colon Rectum. Zmora O, Neufeld D, Ziv Y, Tulchinsky H, Scott D, Khaikin M, fistulas; is there any advantage? Treatment of chronic fistula-in-ano using fistula plug and fibrin glue versus conventional treatment in repair commercial fibrin glue. Fibrin glue is effective healing perianal Long-term healing of Crohn’s anal fistulas with fibrin glue injec- fistulas in patients with Crohn’s disease. Haim N, Neufeld D, Ziv Y, Tulchinsky H, Koller M, Khaikin M, complex fistula in ano. Efficacy of anal fistula plug results in the treatment of fistula-in-ano with fibrin glue: a prospec- vs. Fibrin glue as an adjunct to flap repair of anal results of surgery plus fibrin sealant for anal fistula. Meta-analysis of fibrin glue versus surgery for ment for simple and complex anal fistulas. Biologic Fistula Plugs 12 Samuel Eisenstein and Alex Jenny Ky granulation tissue and epithelialization. This is primarily ease or irradiation, in patients with a history of incontinence, because most studies to date have been too small to demon- and anterior fistulae in women [1 , 2]. Historically cutting strate significant results and few prospective studies have setons have been used in treating complex fistulae, however been performed. With time the data will likely improve, their efficacy has recently been called into question with up to however the use of biologic agents in the treatment of anal a 60 % incontinence rate in some studies and significant pain fistulae is still in its infancy. When simple fistulotomy is not sive list of the various agents which have been used for this an option, usually in the setting of a recurrent or complex purpose to date. Numerous biologic agents have been developed over the Injectable Glue last 20 years for use in treating anal fistulae. Since then many other biologic agents have also been employed to this end, primarily in the form of Fibrin glue was the first biologic event described in the treat- plugs composed of either acellular biologic matrices or ment of anal fistula in 1991 [4]. The procedure is noninvasive, only requiring removal of both of these ends and primarily work as a scaffolding to any granulation tissue or epithelialization prior to glue injec- promote tissue ingrowth. Prior to placement of a biologic tion, and therefore has little impact on continence. At the time of the plug placement less promising, however, with cure rates between 40 and or glue injection the tract should be curetted to remove all 54 % [7], with only one recent study, by Maralcan et al. Several recent meta-analyses of the literature have been published and demonstrate no advantage for the use of fibrin glue over S. However, because it is Department of Surgery, Mount Sinai School of Medicine, 5 East 98th St. Short tract length, less than 4 cm, was also shown to complex fistulae which may have failed previous attempts be a risk factor for plug failure in another study where longer at closure. Ineffective clearance of the infectious process, failure Cryolife Bioglue to appropriately de-epithelialize the tract, and failure to optimize the patients’ inherent ability to heal the fistula, such Bioglue is a combination of bovine serum albumin and glu- as diabetic control and smoking cessation, have all been taraldehyde which has been primarily used in achieving implicated in further failures [17]. It’s use has been described in the postoperative considerations have been implicated in improv- treatment of anal fistulae, however, due to a low cure rate of ing closure rates, including cleaning the tract with hydrogen 21 % at 60 months, an unacceptably high rate of acute sepsis peroxide, postoperative antibiotics, avoiding strenuous activ- necessitating repeat drainage, as well as demonstrably toxic ities postoperatively, and the implementation of a clear liquid serum levels of glutaraldehyde, it should not be used for this diet for several days, however none of these has been demon- purpose [10 – 12 ]. With most plugs costing around $1,000 significant expense can be Biologic Fistula Plugs added onto the procedure cost. This study was limited, however, by the als and come in a variety of shapes and sizes. Once the probe has been rently being done on an outpatient basis at most institutions. When hospital stay was controlled for the savings in place with an absorbable suture, usually in figure-of-8 were $825, demonstrating a financial advantage for using fashion to prevent extrusion. It is advised that materials, non-biologic absorbable plugs have been devel- some space be left at the external opening to allow for drain- oped. These are less expensive and have demonstrated simi- age of the tract, and for this reason the plug is not sewn in lar results in preliminary studies as their biologic counterparts, distally. Plugs are an appealing therapeutic option because they do not require ligation of the fistula or division of the sphincters, Xenograft both of which can lead to postoperative decrease in conti- nence. These same their efficacy is mixed with closure rates ranging between 13 materials have been repurposed for use in anal fistulae based and 86 % [13, 14 ]. Plug tions as well as maintain resistance to infection while being extrusion clearly accounts for a significant number of early rapidly absorbed by host tissues after stimulating tissue postoperative failures with a 0–41 % extrusion rate reported ingrowth. Extrusion is thought to be a techni- Xenograft tissues are readily available and less expensive cal failure from plug placement and rates are thought to than allografts. Their primary drawback is that since they are decrease as one masters the learning curve. This has not been demonstrated to be the case with in the intersphincteric space following fistula tract ligation. Initial studies demonstrated a 94 % cure rate at 15 months with minimal postoperative morbidity [26]. Surgisis sheets have also been used as interposition material after rectovagi- Cook Surgisis Plug nal fistula closure with success rates between 66 and 81% at 12 months [27 , 28]. The Cook Surgisis plug was released in 2006 and was the first commercially available fistula plug. The plug is completely type I collagen with a small amount of elastin as well as type degraded by host tissues over a period of 3 months [19, 20]. It is manufactured in two constructs, a porous Initial studies demonstrated an 83 % cure rate at 12 months sheet and milled fibers in saline suspension [29, 30 ]. However, because this comparing Permacol strips sutured into fistula tracts to the plug has been on the market the longest time, it is the plug milled fibers, suspended in fibrin glue, injected into the for which most data is available. At a median of two and a half years the suspension Multiple prospective, blinded studies have been carried group achieved an 80 % cure rate vs. This prospective cal errors led to an unacceptably high extrusion rate which randomized trial demonstrated a significant improvement in led to early plug failures [22]. We observed that over time the efficacy of plug or anal deformity rates between the two groups [32 ]. Also, interestingly, patients who received multiple plugs did significantly worse than those treated with a single plug Allograft (12. Long-term follow-up of that same cohort demonstrated and employed as fistula plugs. Because they are composed of a 51 % closure rate at 24 months indicating that those fistulae a variety of tissue types, including collagens, fibrin, elastin, that stayed closed at 6 months were likely to remain closed and glycosaminoglycans [33 , 34], it was initially thought that over the long term. These grafts all lack any cellular component which could potentially lead Considerations to rejection. The primary drawback associated with allograft use stems Crohn’s Disease from the scarcity of the product due to the manner in which is harvested. Cadaveric tissue is donated by the deceased Managing perineal Crohn’s disease can be very complicated, leading to a much greater cost when compared to easily requiring multiple interventions, and often exhausting the acquired xenograft sources. Few studies have looked specifically at patients with Crohn’s, however, a recent meta-analysis pooled similarly matched patients with and without Crohn’s Ruinuo Human Acellular Dermal Matrix and demonstrated similar fistula closure rates in both groups with usage of the Surgisis plug (54.

Untoward effects due to over dosage are generally attributable to excessive sympathomimetic activity buy glucotrol xl 10 mg amex diabetes insipidus bun. Nausea generic glucotrol xl 10mg without prescription diabetic diet for dogs, vomiting order 10mg glucotrol xl with visa codice 013 diabete, tachycardia discount glucotrol xl 10 mg with amex diabetes injectable medications list, arrhythmias, headache, hypertension, and vasoconstriction may be encountered during an infusion of dopamine, although it is less likely to produce these side effects than epinephrine or isoproterenol. Since the drug has an extremely short half-life in plasma, these effects usually disappear quickly if the infusion is slowed or interrupted. Rarely, gangrene of the fingers or toes has followed the prolonged infusion of the drug. If this is threatened, local infiltration of the region with phentolamine should be instituted. Careful adjustment of dosage also is necessary for the patient who is taking tricyclic antidepressants, as responses may be particularly variable. Dopamine antagonists such as metoclopramide or haloperidol may attenuate response to dopamine. Increases blood supply to the kidneys and possibly also the gastrointestinal tract. There is paucity of pediatric data, however adult data supports the use in low cardiac output states. It resembles dopamine structurally but possesses a bulky aromatic substituent on the amino group. The pharmacological effects of dobutamine are due to direct interactions with α and β adrenergic receptors. Dobutamine possesses two enantiomeric forms present in the racemic mixture that is used clinically. In contrast, (+) dobutamine is a potent α1 adrenergic receptor antagonist, which can block the effects of (-) dobutamine. The (+) isomer is about ten times more potent as β adrenergic receptor agonist than is the (-) isomer but is nearly devoid of α agonist activity. In summary the dobutamine racemate and (-) dobutamine are potent partial α agonists. Clinical Pharmacology the cardiovascular effects of racemic dobutamine represent a composite of the distinct pharmacological properties of the (-) and (+) stereoisomers. Dobutamine has relatively more prominent inotropic than chronotropic effects on the heart compared to isoproterenol. At equivalent inotropic doses, dobutamine enhances automaticity of the sinus node to a lesser extent than does isoproterenol; however, enhancement of atrioventricular and intraventricular conduction is similar for the two drugs. The relative constancy of peripheral resistance presumably reflects counterbalancing of α1 adrenergic receptor mediated vasoconstriction and β2 receptor-mediated vasodilatation. Therapeutic Uses Dobutamine has been used in a variety of conditions associated with poor myocardial function. It is most commonly used in viral myocarditis, cardiomyopathy or myocardial infarct (Kawasaki’s disease). Dobutamine increases cardiac output and stroke volume in such patients, usually without a marked increase in heart rate. It has been found to be of use following corrective or palliative cardiovascular surgery when myocardial dysfunction is suspected or demonstrated. It is of particular use in children undergoing operation for mitral valve disease. In combination with dopamine it has been shown to increase cardiac output, left ventricular stroke volume and blood pressure. Consequently, a loading dose is not required, and steady-state concentrations generally are achieved within 10 minutes of initiation of an infusion. The rate and duration of the infusion are determined by the clinical and hemodynamic responses of the patient. For example, at 5 mcg/kg/min, serum concentrations of the drug range from 25 to 350 ng/mL, a fourteen-fold variation. It is thought that after more than 72 hours of dobutamine usage, tolerance occurs to the effects of the drug. Adverse Effects In some patients, blood pressure and heart rate may increase significantly during administration of dobutamine; this may require reduction of the rate of infusion. Patients with a history of hypertension may be at greater risk of developing an exaggerated pressor response. Since dobutamine facilitates atrioventricular conduction, patients with atrial fibrillation are at risk of marked increases in ventricular response rates. The efficacy of dobutamine over a period of more than a few days is uncertain; there is evidence for the development of tolerance. It is less likely to produce atrial and ventricular arrthymias than other catecholamines but may do so in patients of myocarditis, electrolyte imbalance and high infusion rates. Clinical Pharmacology Epinephrine has widespread metabolic and hemodynamic effects. Particularly prominent are its actions on the heart and on vascular and other smooth muscles. It acts directly on the predominant β1 receptors of the myocardium and of the cells of the pacemaker and conducting tissues. The force of contraction of myocardium is increased by the positive inotropic action and the heart rate increases by positive chronotropic action. The myocardial oxygen consumption increases out of proportion to the increase in force of contraction, decreasing the myocardial efficiency. The increase in systolic pressure is greater than the increase in diastolic pressure, so that the pulse pressure increases. These effects are mediated via different mechanisms, myocardial stimulation and increase in the heart rate through β1 receptors and vasoconstriction in many vascular beds, specially in the pre-capillary vessels of skin mucosa and kidney through α receptors. Small doses of epinephrine promote relaxation of resistance arterioles through stimulation of β2 receptors causing the diastolic blood pressure to fall. At slightly higher rates of infusion, there may be no change or a slight rise in peripheral resistance and diastolic pressure, depending on the dose and the resultant ratio of α to β2 responses in the various vascular beds; compensatory reflexes also may come into play. Pulmonary vascular resistance also increases at higher doses from direct effect of epinephrine and secondary to increased venous return. Vascular Effects the chief vascular action of epinephrine is exerted on smaller vessels and precapillary arterioles. Various vascular beds react differently which results in a substantial re-distribution of blood flow. Blood flow to skeletal muscles is increased in therapeutic doses due to powerful β2 receptor vasodilator action. In usual doses, there is no significant constrictor action on cerebral arterioles. Doses of epinephrine that have little effect on mean arterial pressure consistently increase renal vascular resistance and reduce renal blood flow by as much as 40%. Although direct pulmonary vasoconstriction occurs, redistribution of blood from the systemic to the pulmonary circulation, due to constriction of the more powerful musculature in the systemic great veins, plays an important part in the increase in pulmonary pressure. Very high concentrations of epinephrine may cause pulmonary edema precipitated by elevated pulmonary capillary filtration pressure and possibly by “leaky” capillaries.

Puberty may be delayed in spite of presence of normal gonads discount glucotrol xl 10mg with mastercard diabetes type 1 job restrictions, which is called eunuchoidism in males and Abnormalities of puberty can be broadly classified into primary amenorrhea in girls glucotrol xl 10mg fast delivery diabetes mellitus secondary. In females buy glucotrol xl 10mg on-line diabetes type 1 and 2, ovaries become unresponsive to the puberty and precocious pseudopuberty purchase glucotrol xl 10mg amex diabetes insipidus drugs. The functions of gonads slowly decrease finally resulting in complete cessation of menstrual cycle. Early development of secondary sexual characteristics, may be associated with premature development of Mechanism and Features gonads is known as true precocious puberty. This occurs due Mechanism of Menopause to early pubertal pattern of secretion of gonadotropin the mechanism and purpose of menopause are not clear. The female gonads progressively become unresponsive True precocious puberty occurs due to following to gonadotropins with advancing age. Hypothalamic precocity: Usually occurs due to tumor Ovaries stop secreting progesterone and estrogen in or infection of hypothalamus that causes premature appreciable amount. The uterus and vagina become gametogenesis without increase in gonadotropin atrophic. In males, though there is some decline in reproductive capacity from 5th decade of life, climacteric does not the development of secondary sexual characteristics with- occur. Testicular functions and potency persist till 8th out gametogenesis is called as precocious pseudopuberty. Thus, in males, there is no andropause (male This occurs due to exposure of immature males to abnor- menopause). Features of Menopause Precocious pseudopuberty occurs due to following causes: Hot flushes (sensation of warmth spreading from trunk 1. Adrenal causes: Congenital virilizing adrenal hyper- to the face) occur frequently. Gonadal causes: Leydig cell tumor of testis in male increased, which occurs in episodes of 30–60 minutes. It occurs usually due to panhypopituitarism that Management of Menopause causes failure of maturation of gonads. It needs proper care, counseling and assurance of hormonal supplementation of estrogen is usually the spouse to make her understand and adjust to this helpful. In some cases, hot flushes and psychological symp- gen should be kept in mind while continuing estrogen toms become more problematic. Increased secretion of adrenal androgens (adrenarche) sensitizes hypothalamo-pituitary-gonadal axis for pubertal changes. Reproducibility totally stops at menopause, whereas in males reproducibility continues. Precocious puberty, Stages of puberty in boys and girls, Mechanism of onset of puberty, Mechanism, features and management of menopause may be asked as Short Questions in exam. In Viva, examiner may ask… Define puberty, What is the age of onset of puberty in boys and girls, What are the stages of puberty in boys, What are the stages of puberty in girls, Explain the mechanism of onset of puberty, What is true precocious puberty and what are its causes, What is precocious pseudopuberty and what are its causes, What is delayed puberty, What is menopause, What is the mechanism of menopause, What is the age of menopause, What are the features of menopause, How menopause can be managed. Name the different parts of male reproductive system, and give the functions of each. Name the steps of spermatogenesis and describe the mechanism and regulation of spermatogenesis. Describe the regulation of testicular functions and hypothalamo-pituitary-gonadal axis in males. The primary objective of the male reproductive system is the epididymis from where they pass into the vas deferens to produce healthy sperms capable of fertilizing the ovum. Epididymis and proximal part of vas deferens the main specialty of male reproduction is that the male store sperms. At the time of ejaculation, sperms enter into gametes are produced in millions and after puberty the the urethra in the body of prostate through the ejaculatory process of production is a continuous phenomenon. Scientist contributed the Testes Enrico Sertoli (1842–1910) an Italian physiologist and histologist was a professor of anatomy and physiology In human beings, testes are located in scrotum. During intra- at the Royal School of veterinary medicine in Milan, uterine life, testes are placed in the abdominal cavity beneath and after 1907, he worked only as a professor of phys- the posterior abdominal wall. In Milan, he founded the laboratory of to the inguinal canal during mid-pregnancy. He is remembered for his 1865 months before term, they descend further through the discovery of the eponymous Sertoli cell that provide Enrico Sertoli inguinal canal into the scrotum (Application Box 67. In female, the male reproductive system consists of testes, epididymis, the gonads (ovaries) are well preserved in the abdominal cavity. Scrotum is the sac, which keeps testis at about 2– 3°C below the mation of spermatozoa) and steroidogenesis (synthesis core body temperature and this cooler environment is highly favorable for spermatogenesis. Spermatozoa produced by testes enter Chapter 67: Male Reproductive System 589 Fig. The scrotal temperature is cooler than core body temper- ature for following reasons: 1. Anatomical location: Scrotum forms sacs that are like outpouching from the body, which has less direct transmission of the inner body temperature into it. Pampiniform plexus of the blood vessels: These plex- uses of blood vessels serve as counter-current exchanger between warm arterial blood entering the testes and cooler venous blood leaving the testes (Fig. Role of cremasteric & dartos muscles: Cremaster mus- cle is a small band of skeletal muscle present in the spermatic cord that contracts or relaxes in response to change in environmental temperature. This increases wrinkling Kulkarni, 2016; Jaypee Brothers Medical Publishers (P) Ltd. Each testis is made up of seminif- cles prevent temporary sterility in extreme weathers. Hundreds of tubules are tightly packed to Weight of each testis is about 10–15 grams, length 5 cm from a mass of coiled loops (Fig. Each loop begins and ends in a single duct called tubu- the spermatic arteries that originate directly from the aorta. Seminiferous Tubule Each seminiferous tubule has a basement membrane that separates it from the surrounding Leydig cells, the peritu- bular cells (myoid cells) and the connective tissue. Spermatogonia and Sertoli cells are located in the wall of the tubule just beneath the basement membrane (Fig. There are two principal cell types in seminiferous tubules: somatic cells (Sertoli cells) and germ cells (Fig. Sertoli Cells Sertoli cells are the sustentacular cells in seminiferous tubules, which form the major cell mass in them. Structure of Sertoli cells They are irregularly shaped cells that are extended from the basement membrane into the lumen of seminiferous Fig. Sperms are attached to the apical membrane of (1) and spermatoginia (2) lie in the periphery of the tubules, and sperms in different stages of development in the middle of the tubule (3 to 6). The interstitial cells of Leydig are present between the seminiferous tubules (7). Tubules are arranged in lobules separated by septa formed by extensions of tunica albuginea. Myoid cells are present surrounding the basal lamina of the seminiferous tubules and interstitial cells of Leydig are present in the space between the seminif- erous tubules (Fig. Thus, testis consists of seminiferous tubules and inter- stitium that mainly contains Leydig cells, connective tissues and capillaries, and few myoid cells and fibro- Fig.

Each ring in microtubule usually Cytotoxic drugs act by inhibiting microtubular functions: Many contains 13 subunits (13 protofilaments) (Fig generic glucotrol xl 10 mg free shipping blood glucose is high. For Special characteristics: example 10 mg glucotrol xl free shipping diabetes type 2 unexplained weight loss, anticancer chemotherapeutic agents such as vincristine and vinblastine promote disassembly of microtubules effective 10mg glucotrol xl diabetes diet weekly plan. A unique property of tubulin subunits is their property anticancer drug binds with microtubules and stabilize them against of disaggregating (disassembly) and re-aggregating depolymerization cheap glucotrol xl 10 mg without prescription diabetes high blood pressure. Therefore, microtubules form a dynamic do not undergo dynamic changes necessary for cell cycle completion. Colchicine inhibits polar in nature with assembly predominating end (+ve microtubule assembly. Chapter 4: Cellular Organization and Intercellular Connections 23 Intermediate Filaments Axonemal Dynein: Cilia and flagella contain dynein­ based molecular motors that are axonemal type. Thus, These are filamentous structures made up of various sub­ these dynein molecules are responsible for beating cilia units (Fig. They connect the nuclear membrane to the cell mem­ Actin-based Molecular Motors brane and also membranes of cell organelles. There­ Actin­based molecular motors make movement of mole­ fore, the major function of these filaments is to inte- cules along the actin filaments. They form supple skeletal network for the cell and the head binds with actin and pulls actin by bending the resist rupture of cell from external pressure. In myosin V, the heads of myosin molecules absence of microfilaments, cells easily rupture. Myosin formation in skin is common in humans when these molecules perform various functions like muscle contrac­ filaments are absent or abnormal. Therefore, they are frequently used as All living cells in humans except red blood cells contain cellular markers. For example, cytokeratin is the marker of epithelial cells, whereas vimentin is the marker of fibroblast. Most cells are uninucleated and the nucleus is commonly located at the center of the cell as round, intensely stained structure. Molecular Motors However, there are variations in the size, shape and loca­ Molecular motors help in the movement of various cell tion of the nucleus within the cell, especially in different parts, proteins and organelles within the cell cytoplasm. They have two domains: a bilayer nuclear membrane that surrounds the nucleo­ the domain that attaches with cargo (the cell part to be plasm. In some cells, nuclear mem­ into two categories: Microtubule­based and actin­based. Cytoplasmic Dynein: It functions like that of conven­ tional kinesin that moves cargo toward the negative ter­ Fig. Junctions that tie cells together plays organizing role in these transport mechanism. When cell is not dividing the genetic material is pre­ – Zonula adherens sent in the form of tangled mass called nuclear chromatin b. Cell to basal lamina anchoring junctions and when cell division begins, the tangled mass unwinds – Hemidesmosome and appears as distinct strands known as chromosomes. Junctions that allow transfer of ions and small molecules bound to large quantities of basic proteins (histones). Gap junctions Nucleolus the nucleus contains nucleolus, a patchwork of granules rich 2. There may be multiple nucleoli in a nucleus, espe­ are held together by cell to cell adhesions. In epithelial tissues that line the free surfaces such as skin, and basement membrane of tubular structures Functions of Nucleus and cavities of the body such as alimentary tract, kid­ Nucleus regulates cell functions. The Functionally, intercellular connections or junctions are of cells in tissues are usually held together by the extracel­ two types: junctions that tie cells together and Junctions lular matrix. In connective tissues such as fibroblasts, cartilage and bones, the extracellular matrix is abundant, and Tight Junctions therefore the cells are sparsely distributed within the Tight junctions are commonly found in the epithelium of substance of the matrix. At tight junctions, the outer layer of the cell membrane of neighboring cells fuse with each other that oblite­ rates the intercellular space close to their apical margin. They are made up of ridges, half of which is contrib­ uted by both neighboring cells and each half is bound tightly to each other. Therefore, they practically form the barrier for transport of solutes and solvents from the lumen into the interstitial space and between cells. They contain ion and water channels that make them selectively leaky, though the degree of leakiness varies in different epithelia. The membrane proteins that contribute to formation of junctions are present toward apex of cells and hemidesmosome tight junctions belong to three main families: occludin, toward the base of the cell. In general, they form selective permeability barrier that prevent transport of macromolecules from the luminal fluid into the interstitial space. Thus, macro­ molecules pass only through the epithelial cell as vesi­ cles (vesicular transport). Due to the presence of leaky channels, small size water­ soluble particles are permitted through tight junctions. For exam­ + ple, in the gut, Na ions pass fairly freely, while in the urinary bladder, the passage for sodium is almost nil. Furthermore, the permeability of a substance through tight junctions can be increased, depending on the osmolality gradient across the epithelium. In the brain, tight junctions between endothelial cells of cerebral blood vessels contribute to the effective- ness of blood-brain barrier. In the ciliary bodies, they form blood-aqueous barrier also present in this space. Zonula Adherens Anchoring Junctions Zonula adherens is located below the base of tight junc­ Anchoring junctions are of two types: Cell to cell anchor­ tions (Figs. It is the major site of attachment ing junctions and cell to basal lamina anchoring junctions. Cell to Cell Anchoring Junctions Cell to cell anchoring junctions are desmosome and zonula Cell to Basal Lamina Anchoring Junctions adherens. Cell to basal lamina anchoring junctions are hemidesmo­ Desmosomes some and focal adhesion. Desmosomes are the junctions characterized by focal Hemidesmosomes thickening of two adjacent cell membranes (Fig. In appearance, they look like half of desmosomes, and the thickened area is the presence of dense layer of therefore are called hemidesmosome. Thickened area of two sides is separated by a gap of 25 of cadherins and desmogleins in desmosome, hemides­ nm. The intercellular space between the two membrane Focal adhesions (focal spots) connect cell to the basal thickenings also contains filamentous cell adhesion lamina. Intracellularly, they are associated with actin fila­ materials such as desmogleins and cadherins (Fig. Note, intermediate filaments are attached to thickened area in desmosome, and actin filaments in zonula Figs. Electrical synapses: As the pores of gap junction are larger than ligand­gated or voltage­gated channels, Gap junctions are called nexus between the cells at which passage of substances is easier through them.

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