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According to Blackmann who postulated Law of Limiting factor in 1905 purchase 30mg procardia otc blood vessels growing over cornea, photosynthesis is limited by slowest step of the most limiting factor in the pathway cheap procardia 30mg free shipping coronary heart 7 acupuncture. This means that at a given time discount procardia 30mg coronary heart 5k, only the factor that is most limiting among all will determine the rate of photosynthesis cheap 30 mg procardia mastercard blood vessels neck. Light between the wavelength of 400nm to 700nm is most effective for photosynthesis and this light is called photosynthetically active radiation. Photochemical reactions and dark reactions of photosynthesis respond differently to temperature. Photochemical reactions in the thylakoid remain unharmed by temperature, whereas the enzymatic dark reactions get influenced adversely. Since, nitrogen is a basic constituent of chlorophyll and all enzymes involved in dark reactions, any reduction in nitrogen supply to plants has an adverse effect on photosynthesis. The photosynthetic enzymes also get inactivated resulting in reduced rate of photosynthesis. A few branches of Hydrilla are kept in a beaker containing pond water in which a small amount of sodium bicarbonate is dissolved. The branches are covered with a glass funnel and a test tube full of water is kept inverted over the Test tube stem of the funnel as shown in the figure. The gas Beaker bubbles may be observed from the ends of hydrilla branches kept within the glass funnel. These gas bubbles are collected Water in the test tube by the downward displacement of water. When a burnt splinter is Hydrilla taken near the mouth of the tube, it glows brightly and proves that the gas is oxygen. Ganongs light screen experiment Ganongs light screen experiment demonstrates that light is essential for photosynthesis. When a pot plant is kept for 48 hours in dark room, the leaves become free from starch. Ganongs light screen is a clip like instrument with a tin foil disc having a star shaped opening through which light can enter. The advantage of light screen is to allow free ventilation and at the same time it cuts off light. The light screen is fixed to a leaf of the destarched potted plant as shown in the figure. The Ganongs light screen experiment demonstrates that light is essential for photosynthesis. Mode of nutrition Autotrophic nutrition Most of the green plants are self- dependent, because they synthesize their own food materials by photosynthesis. Epiphytic plants are not parasitic on these trees, but they only make use of the place to grow. Clinging roots fix the epiphytes to the bark of the tree and also absorb the little nutrients found in the debris accumulating on the bark. These roots are usually green and covered by a spongy tissue called velamen which absorbs the moisture in the air as well as rain water. Heterotrophic nutrition Due to lack of chlorophyll or nitrogen defeciency, some plants have to depend on other plants, insects or dead organic matter for their food. Heterotrophic plants are grouped into saprophytic, parasitic and insectivorous plants. Cuscuta Tentacle Parasite Haustorium Host stem Partial parasite Insectivorous plant eg. Parasitic plants Some plants get their nourishments from other living plants or animals. The plants or animals from which the parasites get their nourishments are called hosts. Parasites have some special roots, which penetrate the host plants and absorb food from the phloem and water and minerals from xylem. Therefore, it is totally dependent on the host stem for organic food materials, water and minerals. It twines around the stem of the host and sends haustoria into it to absorb nourishments. The haustoria of these plants have connection only with the xylem of the host to absorb water and mineral salts. Insectivorous plants Though insectivorous plants are capable of manufacturing carbohydrates by photosynthesis, they are not able to synthesize enough proteins due to the deficiency of nitrogen. This fluid shines in sunlight and appears as dew; hence the plant is called sundew plant. The digested food is finally absorbed by the leaves and the tentacles again come in their original straight position. Chemosynthesis Chemosynthesis is a process by which certain organisms synthesize carbohydrates by using energy obtained by the oxidation of inorganic substances. Most of the bacteria obtain their food materials from external sources and they cannot synthesize their food by themselves. Whereas, some bacteria are capable of synthesizing their food either by photosynthesis or chemosynthesis. Organisms which use sunlight energy for synthesis of food materials are called photosynthetic organisms or photoautotrophs. Those organisms which use chemical energy for the synthesis of carbon compounds are called chemosynthetic organisms. There are two groups of chemosynthetic organisms namely, chemosynthetic autotrophs and chemosynthetic heterotrophs. Chemosynthetic autotrophs Examples for chemosynthetic autotrophs are Nitrosomonas, Beggiatoa. The energy liberated during this process is used for the synthesis of carbohydrates. For example, en- ergy is released when glucose is oxidised in the process of respiration. Which of the following wavelengths of light is most effective for photosynthesis a. Explain the test tube and funnel experiment to demonstrate that oxygen is evolved during photosynthesis. Describe the light reactions of photosynthesis (or) Explain cyclic and noncyclic photophosphorylation. Respiration In the previous chapter, you have learnt that light energy is converted into chemical energy and stored in complex organic molecules called carbohydrates glucose and starch. The breaking of C C bonds of such compounds through oxidation releases a considerable amount of energy. This phenomenon of release of energy by oxidation of various organic molecules is known as respiration. The compounds that are oxidised during this process are known as respiratory substrates. During respiration, the whole energy contained in the respiratory substrate is not released all at once. In respiration, oxygen is utilized and carbondioxide, water and energy are released.

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Balsam Poplar Buds (Poplar). Procardia.

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You will have to assess how readily you can resect the tumour: a more experienced surgeon may manage a more extensive resection order procardia 30 mg fast delivery blood vessels expand, but the prognosis may not necessarily be improved thereby purchase 30mg procardia amex cardiovascular system quiz for medical students. If radiotherapy & chemotherapy (usually 5-fluorouracil) is available 30mg procardia otc blood vessels wrap around the world, it may shrink an unresectable tumour and make it resectable cheap 30 mg procardia fast delivery coronary heart pain. It is inoperable if there are palpable masses in the liver, widespread metastatic mesenteric lymphadenopathy, or malignant ascites (or of course metastases elsewhere outside the abdomen. The contents of the large bowel are always loaded with bacteria, so when you have to operate in an emergency for obstruction avoid contaminating the peritoneal cavity, and try to decompress the proximal colon as much as you can. When you anastomose the Solutions: G, right hemicolectomy with an end-to-end ileocolic anastomosis. I, excision ileum to the transverse colon, remember to save as much of tumour of the left colon with protective loop colostomy. J, excision ileum as you can, because its last few centimetres are the of tumour of the left colon with adjacent colostomy. This wont have any effect on the risk of an anastomotic leakage, but will make it less dangerous for (c) If the colon is obstructed: the patient. If the tumour is not resectable (12-16D), (2);If the condition is poor or you are inexperienced, make make a defunctioning right transverse loop colostomy a bypass, as in (b). This might thereby mean missing the (11-13): this is preferable to a sigmoid colostomy which opportunity of a curative resection, however. Perform an end-to-end bring out the proximal bowel as an end-colostomy, anastomosis (12-16M). If not, resect more bowel, but not more confident with bowel anastomoses, you can clean out the mesentery. Try to remove the anastomosis; make sure you test it afterwards by filling the tumour and its lymphatic drainage area to make a pelvis with water and blowing air up the rectum (12. If necessary, If the tumour is in the middle or lower rectum try to get a more experienced colleague to perform a wider (12-16E): resection if that would be possible. Biopsy the tumour through a proctoscope or preferably with a non-absorbable suture for the outer layer. If there are liver metastases or a fixed bring the two cut ends out as a double-barrelled colostomy tumour, think hard before you make a colostomy. The patient may live a few more months, but dying with a colostomy will be miserable, especially if colostomy care If the tumour is in the sigmoid or upper rectum is poor. If the tumour is not resectable, it is better to (12-16E): perform a bypass operation, an ileotransverse or colo-colic anastomosis. You may need to mobilize the proximal If a bypass is impossible, however, a colostomy is better colon to make sure it reaches the distal end without than dying in obstruction. When the operation is over, wash out the (posteriorly) in the middle with 2 separate sutures knotted peritoneal cavity with warm fluid; do not insert drains. If you cannot make a safe anastomosis, bail out and fashion a colostomy and mucous fistula or perform a Hartmanns operation (12. This can only happen if they are all free to rotate as population may be infected by the parasite trypanosoma the result of a rare anomaly of the mesentery. This is more cruzi which are deposited in insect faeces on the skin and common during pregnancy. The abdomen distends and becomes is carried by a bug, triatoma infestans, which lives in tender centrally and in the right lower quadrant. Trypanasoma may also affect the heart and oesophagus giving a picture like achalasia (30. Fix thin capillary blood films in methanol and stain both thin and thick films by Giemsa, immersing the thick films beforehand for 1sec in 05% aq. Advice on hygiene and high fibre diet is all that is needed for early cases; enemas may need saline drip irrigation in addition to soften faecalomas. When you inspect the right lower quadrant, you will find that the caecum is not in its normal If the mesenteric blood supply is compromised, patches or place. Chronic arterial insufficiency can produce long-standing If it is viable, ask your assistant to retract the right side of discomfort (intestinal angina), but there is usually a the abdominal incision. Do not If this is arterial from an embolus, the result is sudden complicate this procedure by fashioning a caecostomy, or ischaemia of the small bowel which rapidly becomes adding an appendicectomy, which may contaminate a necrotic. If the thrombosis is venous, there is infarction of bowel If it is not viable, and you are skilled, perform a right but because of the vascular arches this may be incomplete hemicolectomy (12. This may be drain the abscess: this will usually be enough to relieve the difficult to distinguish from pancreatitis and amylase obstruction. Featureless bowel gives no clue towards the diagnosis initially, but thickened bowel wall with air within the wall If you feel a solid object at the point where the develops later; occasionally you can see air in the distended loops join the collapsed ones, decompress the intrahepatic portal veins! Often you only discover the problem at solid object to another site in the bowel where the mucosa laparotomy. Remove the foreign body and repair If the bowel is suspicious, apply warm packs, and if after the bowel transversely. If it is a gallstone, it has come 5mins the bowel remains suspicious, lavage, close the through a fistula from an inflamed gallbladder. If it is a food bolus that has impacted in the small bowel If there is patchy necrosis, resect affected portions, but especially if there is a gastrojejunostomy (13. If there is an obvious embolus in a mesenteric artery, If you find a tumour in the small bowel causing try to remove it using a Fogarty embolectomy balloon obstruction, look for other such tumours (especially catheter after isolating the artery segment with bulldog purplish Kaposi sarcoma lesions). If there are many inflammatory adhesions between loops of bowel, do not try to resect bowel. You are unlikely to make the diagnosis of rarer causes of If there is atresia of the jejunum in a neonate (33. Here are some guidelines: Check for more areas of atresia distally by injecting saline into the distal bowel. If you find an inflammatory swelling in the caecum If an internal hernia is obstructing the bowel, or colorectum, it may be an amoeboma (14. You may not be able safely, but be careful with a hernia into the recess formed to make a diagnosis without histology, so take a biopsy. If you find the ileum encased in a membrane in a woman, carefully open this cocoon and free the bowel. If inflammation is peritoneal irritation (which could be due to a leaking severe or extensive, or there is evidence of perforation or anastomosis, iatrogenic bowel damage, haemorrhage or spillage (you will be able to smell it! If there is radiation damage to bowel, it will not hold Do not wait too long; if there is no improvement within sutures well. He had obstructive bowel sounds, some colicky pain, and a moderate amount of fluid was coming up the nasogastric tube. The return of normal After a messy operation with much pus, bleeding or bowel sounds is a sign that the bowel is starting to work spillage, expect ileus with absent bowel sounds.

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Cacalia Amara (Carqueja). Procardia.

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Platelet concentrate Platelets are separated from one unit of blood and suspended in a small volume of the original plasma generic 30mg procardia mastercard cardiovascular group pc lawrenceville ga. Cryoprecipitate 0 This is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 c buy 30 mg procardia amex cardiovascular system consists of. Plasma protein fraction Similar to albumin but contains additional protein molecules generic procardia 30mg overnight delivery heart disease recipes. Complications and risks of blood transfusion Hemolytic transfusion reactions Intravascular hemolytic transfusion reactions; are potentially life threatening reactions that can occur by blood transfusion generic 30 mg procardia fast delivery cardiovascular system journey of blood. Pathophysiology During hemolytic transfusion reaction all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure. These reactions also activate the complement system with subsequent release of vasoacative amines causing hypotension. Treatment Stop transfusion immediately Administration of fluids and diuresis with mannitol or frusemide Transfused blood with patients blood sample should be sent for analysis Sodium bicarbonate may prevent precipitation of hemoglobin in the renal tubules Steroids may ameliorate the immunologic consequences. Transfusion reactions from mismatches involving the Rh system or minor antibodies usually induce extravascular hemolysis, since these reactions occur slowly, serious complications do not often develop. Non-hemolytic transfusion reaction Non-hemolytic reaction may occur after transfusions. Allergic reaction: occurs in 2-3% of all transfusion and manifests by urticaria and rashes. Other complications: Complications that can occur with massive transfusion include Citrate toxicity Acidosis Hyperkalemia N. B:- As blood transfusion is accompanied by various complications mentioned above, the decision to transfuse should only be made when it is believed to be life saving. What factors determine the need for blood transfusion in patients with chronic blood loss or chronic anemia? But in addition to this, the patients pre-operative situation should be well evaluated so as to make the patient able to withstand the stress of surgery. Factors which make the patient high risk for surgery should be controlled as much as possible. Also, the patients postoperative course highly depends on the postoperative care given, and anticipation with early diagnosis and management of postoperative complications. General consideration Preoperative evaluation should include a general medical and surgical history, a complete physical examination and laboratory tests. The most important laboratory tests are: Complete blood count Blood typing and Rh-factor determination Urinalysis Chest x-ray Further laboratory tests should be performed only when indicated by the patients medical condition or by the type of surgery to be performed. Patients with heart disease should be considered high-risk surgical candidates and must be fully evaluated. The perioperative monitoring, induction, and maintenance techniques of anesthesia, and post operative care can be tailored to the specific cardiovascular diseases. Pulmonary system The following respiratory tract problems make patients high risk for surgery; Upper airway infections Pulmonary infections Chronic obstructive pulmonary diseases: chronic bronchitis, emphysema, asthma Elective surgery should be postponed if acute upper or lower respiratory tract infection is present. If emergency surgery is necessary in the presence of respiratory tract infection, regional anesthesia should be used if possible and aggressive measures should be taken to avoid postoperative atelectasis or pneumonia. Renal system Renal function should be appraised If there is a history of kidney disease, diabetes mellitus and hypertension If the patient is over 60 years of age If the routine urinalysis reveals proteinuria, casts or red cells It may be necessary to further evaluate renal function by measuring creatinine clearance, blood urea nitrogen and plasma electrolyte determination. Anemia in pre-operative patients is of iron deficiency type caused by inadequate diet, chronic blood loss or chronic disease. Iron deficiency anemia is the only type of anemia in which stained iron deposit cannot be identified in the bone marrow. Megaloblastic, hemolytic and aplastic anemia usually are easily differentiated from iron deficiency anemia on the basis of history and simple laboratory examinations. In emergency or urgent cases, a preoperative blood transfusion preferably with packed red cells may be given. In the patient with thrombocytopenia but normal capillary function, platelet deficiency begins to manifest itself clinically as the count falls below 100,000/ml. Treatment - treat the underlying cause and support with platelet transfusions and clotting factors as necessary. Endocrine system Diabetes mellitus Diabetics with poor control are especially susceptible to post-operative sepsis. Preoperative consultation with an internist may be considered to ensure control of diabetes before, during and after surgery. Insulin dependent diabetics with good control should be given half of their total morning dose as regular insulin on the morning of surgery. This is preceded or immediately followed by 5% dextrose solution intravenously to prevent hypoglycemia. Chronic medical conditions associated with diabetes may also complicate the preoperative period, e. These patients should have an extended cardiac work up and receive metoclopromide as well as a non particulate antacid before surgery. Thyroid disease Elective surgery should be postponed when thyroid function is suspected of being either excessive or inadequate. In Hyperthyroidism, The patient should be rendered euthyroid before surgery if possible. In all cases, treatment should be started with a very low dose of thyroid replacement to avoid sudden and large workload on the myocardium. In addition to the above discussed factors, there are issues which might need special consideration in preoperative patients. The diagnosis of early pregnancy must be considered in the decision to do elective major surgery in reproductive age female. After all this, prior to the operation, it is important to have an empty stomach because full stomach can result in reflux of gastric contents and aspiration pneumonitis. In elective surgery, patients should not eat or drink anything after midnight on the day before surgery. Post-operative care, complications and their Treatment Post-operative care Post-operative care is care given to patients after an operation in order to minimize post operative complications. Early detection and treatment of post operative complications is possible if there is optimal care. Some of the care is given to all post operative patients, while the rest are specific to the type of operation. Patients encouraged to ambulate In the following sessions, we will focus on common postoperative complications. Cardiovascular complications Shock Postoperative efficiency of circulation depends on blood volume, cardiac function, neurovascular tone and adrenal secretions. Shock, or failure of the circulation, may follow: Excessive blood loss Escape of vascular fluid into the extra vascular compartments (third spacing) Marked peripheral vasodilatations Sepsis Adrenocortical failure Pain or emotional stress Airway obstruction Treatment includes Arresting hemorrhage Restore fluid and electrolyte balance Correct cardiac dysfunction Establish adequate ventilation Maintain vital organ function and avert adrenal cortical failure Control pain and relief apprehension Blood transfusion if required. Thrombophlebitis Superficial thrombophlebitis It is usually recognized within the first few days after operation. Clinical features A segment of superficial saphenous vein becomes inflamed manifested by: Redness Localized heat Swelling Tenderness 27 Treatment includes Warm moist packs Elevation of the extremity Analgesics Anticoagulants are rarely indicated when only superficial veins are involved.

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