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Joel Schechter Case Studies 2008

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Joel Schechter Case Studies 2008 Powered By Docstoc
					              CASE #3
          Stomach ulcer

     What is a stomach ulcer?
     An ulcer is a break or disruption in the inner
     lining of the stomach.
     Why does an ulcer hurt?
     We feel pain when nerves are stimulated.

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     Note that the stomach is
     formed into layers
     & each layer has a name
24
 Surfaces of our body are covered by epithelia, both
 inside and outside. Epithelia are one of 4 basic tissues
 of our bodies and epithelia cover body surfaces.

 A second type of basic tissue lies just beneath the
 epithelia. That tissue is connective tissue.
                Free surface

                                       Epithelium


                                       Basal lamina


                                       Connective tissue
                                       nerves (& cells,
                                       blood vessels, etc.)


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            CASE #4
     Lacrimal Gland & Dry Eye
             Disease




39
 What is dry eye disease?
 Who is affected by dry eye disease?
 How does it impact people’s lives?


Dry eye disease is a complex disease that has many
aspects to it. However, simplistically it is a disease in
which the eye surface becomes chronically irritated
(burning, itchy, stinging, etc.).
Women are primarily affected, especially as they age
and are menopausal. The incidence of dry eye in
females exceeds that in males by ~12:1 or 13:1.
Women affected by dry eye often must repeatedly wet
their eye surface with drops all day long.

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 The lacrimal gland is the major source of materials
 in our tears.

 Tears contain:
 Hormones
 Immunoglobulins
 Proteases
 Water
 Lipid
 Glycoproteins
 Growth factors        And all of these components
 Sodium                must be maintained in proper
 Potassium             balance to ensure the proper
                       health & function of the eye
 Glucose
                       surface.
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                      Acinus




        Duct




                               Duct system
                               conducts the
                               fluid produced
                               by the secretory
                               cells out to the
                               ocular surface.
42 Acinus      Duct
 Why do women suffer so much more than men from
 dry eye disease?
 Male sex hormones (androgens) are known to be a
 key factor in maintaining the health of the lacrimal
 gland.


     Androgens
     in blood                                 Maintains LG
     stream                                   function


                                              Does not
                                              maintain
                                              LG function


                 Male   Female   Menopausal
                                 Female

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 Are there other times when androgen levels might be
 low in females? And, if so do the women experience
 dry eye symptoms?


                      Androgen levels are lowered
                      during pregnancy!
                      And there is evidence that
                      pregnant women report
                      increased incidence of dry
                      eye symptoms.
                      Therefore, we asked - what is
                      happening in the lacrimal
                      gland? What is happening to
                      the tear fluid?

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 Tear fluid production decreases during pregnancy.


 Term pregnant NZW rabbit        Term pregnant NZB mouse




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     In non-pregnant rabbits lymphocytes are collected
     around venules & ducts
      Vein & lymphocytes




                                                 Venule
                                                 & duct




                                            Perivenular/
       Acinus       Duct                    periductal
                                            immune
                                            cells

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 Non-Pregnant
 Rabbit




                            PRL &
     PRL, EGF, TGF-,IL-2   IL-2




                                    Term Pregnant Rabbit



 In pregnant animals
 lymphocytes are
 present around the          PRL, EGF, TGF-, IL-2 & IL-2R   PRL & IL-2

 acini!


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     Immunostaining again aids in clarifying the functional
     status of the lacrimal gland.
Non-pregnant, CD-18




                                    Term pregnant, CD-18
              d




                                                           d




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