Dýchací systém

Pohárkové buňky - ekrinní, až skoro holokrinní občas (zůstává jen kousek cytoplazmy) sekrece. Aktivují se až kontaktem s prostředím.

Řasinkové buňky - alternativní reprodukce centriolů, kolem nich se nahromadí fibrogranulárního materiál, z těch se udělají deuterozomy (takové duté koule) a z nich (resp. kolem) pak velké množství řasinek, aby tam pořád něco bylo. Pak se z nich vyvíjí spousta nediferenciovaných bazálních tělísek, která pak dozrávají. Mají dlouhé mikroklky.

Buňky difuzního neurokrinního systému - typická sekreční granula (200-400nm), uniformní vzhled v jedné buňce, protože každá buňka umí tvořit jen jeden typ proteinu tohoto.

 
 

Takové to funky schéma koordinovaného pohybu řasinek.

Řasinky se dotýkají té vrstvy hutného hlenu jen v jednu chvíli, svou špičkou, na které mají štětičky (bristles). Toto je základ samočisticí schopnosti organismu. Když je např. ten hlen moc řídký, tak se nacpe mezi ty řasinky a nejde s ním dobře hýbat - chyba! Tento sekret je hlavně produktem submukózních žlázek.

 
 

Cytoplazmatická protruze s axonémami je, když se škodlivina dostane až k cytoplazmě a ta se rozšíří až po celé výšce řasinek.

 
 

Narušení cilionémie je u malformovaných řasinek, axoném. To je přitom děsně fundamentální věc, co se skoro nikdy nemalformuje. Nově se ale zjistilo, že jsou i u zdravých, asi do 1%. Do 3% to neovlivní samočisticí schopnost.

• Chyba radiálních struktur, dislokace taky
  
• Chyba dyneinových ramének
  
• Chyba tubulů, i dislokace a tak
  

   
   

  Kouření zastavuje pohyb řasinek a narušuje apikální spojovací komplexy.
  

   
   

  Cavum nasi proprium - septum nasi, conchy.
  

  Lamina propria mucosae má velmi vyvinutou síť kapilár. Tím se hodně ohřívá vzduch. Drobné seromucinózní žlázky. Bazálně větší venózní plexy a kolem nich hladké svalové buňky, při zduření uzavírají průchod vzduchu nosem.
  

  Larynx
  

  Plica ventricularis - řídké kolagenní vazivo a žlázky.
  

  Plicae vocales vícevrstevný dlaždicový.
  

  Trachea
  

  Mucosa = lamina epitelialis + epitel + lamina propria mucosae.
  

  Submucosa = submukózní žlázky, hladké svalové buňky v m. trachealis, prstence chrupavek.
  

  Adventicie = tunica adventicia.
  

   
   

  Bronchiální strom, dýchací oddíl (?)
  

  Velký bronchus >9mm
  

  Kulaté chrupavky, hlen seromucinózní žlázky
  

  Malý bronchus <9mm
  

  Nemá prstence chrupavky, jen destičky, méně hlen produkujících elementů, přibývají elastická vlákna a hladké svalové buňky spojující ty chrupavky
  

  Bronchioly <1mm
  

  Velmi poskrovnu pohárkových buněk, nejsou submukozní žlázky, hodně hladké svalové atp.
  

  Bronchioli terminales
  

  Jednovrstevný epitel (hurá, konečně). Hlen už nesecernují elementy. Jsou tam ale Clara buňky.
  

  Clara buňky - se vyklenují do lumenu. Secernují proteiny, ojedinělá densní granula, hodně GER. Apikální část (vyklenuje se do dýchacích cest) obsahuje hodně vyvinuté HER a velké mitochondrie. Je tam kvůli detoxikaci, cytochrom c a oxidace.
  

   
   

  Respirační oddíl
  

  Bronchioli respiratorii
  

  Vyklenují se alveoly. Vymizují sekreční buňky (Clara), pak i řasinkové, na konci jsou jen ploché dlaždicové.
  

  Ductuli alveolares
  

  Stěna je vlastně jenom mezi odstupy jednotlivých alveolů. Hladký svalový sfinkter co umí uzavřít (asi) alveoly pulmonales.
  

  Alveoly
  

  200um, slepé, koncové. Pneumocyty 1. a 2. typu. Epitel + bazální membrána, elastická a retikulární vrstva vláken.
  

  Pneumocyty 1. typu = složité, ploché jádro, vysílají složitý systém laterálních cytoplazmatických výběžků, obsahující pinocytické vezikuly. Tyto výběžky se mohou ztenčovat až na cca 20nm.
  

  Pneumocyty 2. typu = granulární, kubické. Sférické jádro, velký GER, Golgi, mitochondrie, lamelární tělíska. Dělají surfaktant. Často překryty laterálními výběžky prvních pneumocytů.
  

  Pevné spojovací komplexy.
  

  Mezi nimi interalveolární septa, řídké kolaenní vaziva. Tenký × tlustý oddíl.
  

  Tlusté interalveolární septum
  

  Fibroblasty, kolagenní vlákna, speciální kontraktilní buňky těchto sept, alveolární makrofágy (co ale nikdy nebyly v alveolech!). Hafo moc kapilár somatického typu.
  

  Tenké interalveolární septum
  

  Zprostředkovává kapilární-alveolární kontakt. Splývají laminae densae.
  

   
   

  Pleura
  

  Vrstvička mezotelových buněk,
  

Busy little bee

Oy.

I've been busy, can't you tell? The last 6 days were shit, I took 4 tests and overall had a rather hectic time. On the other hand my grandfather bougth me a Yamaha CLP-330, magnificient piece of work. I love it and I'm gonna play it.

Also one reply to my phone-selling adverts emerged amongst the number of scammers from West Africa (they can speak Czech and Slovak now!) offering me 6000CZK (I posted the ad for 6490CZK) and driving over to buy it tomorrow (well, today, he wrote that yesterday). I'm thinking of going through with the deal. I doubt I'd get more for the device anyway.

All is cool on the home front.

Adam

The Undying Lady

The short (45 minutes or so) visit to the local GP was rather interesting, as was the meeting with our designated patient.

She was a 93 years old lady, moved around with just one walking stick in a very agile manner, cared for herself in her appartment, her skin was spotless, she had no problems with her heart, blood pressure, joints, when there's enough light she could read without glasses, her hands didn't tremble one bit (heck, MINE do!)... Just think of any kind of ailment that accompanies old age and she didn't have it. In fact, she didn't have any kind of health problem. She was in a hospital some time ago because she fell down and hit her hip and before that because she fell down on the street breaking her wrist and shoulder. She took 3 pills a day to dilatate the veins in her head as she was afraid of having a stroke and being left paralyzed. Born in 1915 her direct family now accounts for 20 people, 6 grand-grandsons. I liked her and her miraculous health was just stunning.

The local GP visit was only awesome to certain degree, but still quite educational. Four patients came into the office – one valetudinarian, one old lady with recently passed away husband, one aging joker with failed spinal surgery refreshing his driving licence and one lady who had to drink urological tea. I noticed that the doctor did not let any one of them speak at all, asked a question and kept talking...

I don't know if I can elaborate on this matter further, but it was interesting to see the different kinds of patients. They really were quite textbook J

 

Adam

THE Week

Tell you what, these daily regular bus rides to school could be the great opportunity for me to write blog post, sum up my previous day, think of a couple jokes (yes, that's one of them) – oh my God, my Nemesis just got onto the same bus and we saw each other...AAAWKWAAARD.

Anyway, what's so special about this week? We don't run on a proper timetable yet, instead we devote the whole week to practical medicine – basically what GPs do. Not exactly, though, because GPs (much unlike "praktičtí lékaři" or "obvoďáci") need to be quilified to care cradle-to-coffin, whereas their Czech counterparts I mentioned only specialize in adult care.

This block education will consist of a couple lectures (topics like "general practice medicine", "hospice care", "prevention", "geriatrics" etc.), several seminaries ("drugs", "videoconsultations", "blind patients"...) and most importantly a one-hour stage in an office of a random GPs we are allocated and a visit to a patient.

I'm not quite sure what should we be doing on either of the last two mentioned, honestly. Taking notes how does the GP treat patients, care for them, understand how does a daily doctor-to-patient relationship and communication work. The patient visit I consider more interesting, we should probably ask them what's up, what are they being treated for, if they adhere to prescribed medication and dosage, if they like their doctor etc.

So far I've attended the general practice medicine lecture and the blind-orientated seminary. The seminary...it took place in Tyfloservis, the place some of you might be familiar with as it's the drop-off point for the "Bílá pastelka" collection. There were two things I liked about how they introduced us into the problematics. First, when we were just lining up on the stairs so that we can be shown way to some other room we should split into, they blindfolded us and let us cope with just a minimum of help and a music playing in the room we should reach. Sitting down once we all entered was a bit of a problem as well, as when I entered most of the chairs were taken and I had to ask if anyone has a spare around. Some answered "there is one!", luckily some were clever enough to say "here" so I could follow their voice. After a while we could take the blindfolds off... The other thing was when we formed pairs, one was blindfolded again and the other one lead him through the unkown building we were in.

I like both of these experiences surprisingly much. I'm a visual type and as such would be the one to choose "deafness over blindness". But the feeling of being blindfolded, not seeing... It brought me closer to others, to those aroud me, to my surroundings. I was dependant on them, some of them were dependant on me. It was surprisingly elleviating.

Adam

Back on track

The exam period is over, the school's started once again. That means I have to wake up early yet again and ride the bus to school – and because I have nothing to revise for (yet!), I open the laptop and scribble this.

I can't say this was the best holiday ever, no. I only went skiing twice and with utmost dislike – it was cold, windy, snowing and cloudy – you know, winter in its worse aspect. After a couple of rather unpleasant events I have mostly broken up with my girlfriend, which I hope is a step towards the greater good, but so far I'm not so sure and struggle to ee it that way. My parents are, once again, sad, angry and disillusioned by me spending far too much time in front of the computer... Well, everything's the way it usually is, really.

As such I make no promises of keeping this place live and kicking, but then again I have a distinct feeling my school attendance and life in an organized and structured way supports it, so...

Anyway, you guys keep up the good work, I'll post something later today. Probably. I might postpone it a little ;)

On Mercenaries

OK, another post. I've arrived into our second lecture hall and have some 45minutes before the lecture starts. So, instead of using the productively, I'll tell you a little story about my father and myself.

He recently attended an employee evaluation testing that lasted for two days and consisted of various tests analyzing you motivation, efficiency, loyalty, role skills and other relevant variables. At first they had to sort seven colours according to, I don't know, how they appealed to their sences, how they made them feel, how they energized them and whatnot. Then there were over 200 (!), around 250 terms ranging from "work" or "family" to "interstructural networking" or "signal encryption modulation" that had to be allocated three colors ranking from the most suitable to the third most suitable. This was then evaluated (obviously if you had purple as the colour that made you feel the worst and then allocated it to work, you were found disloyal etc) and they were given their position on loyalty/efficiency scale.

The four ranks you could score were "evangelist" for loyal and efficient, "resident" for loyal but inefficient/not motivated, "mercenaries" for not loyal but efficient and finally something I don't even remember the name of that was neither loyal nor efficient.

My father, quite unsurprisingly, was foud to be extremely unmotivated, not loyal at all, but highly efficient. He gets his work done superbly, as long as he is paid enough, then goes home and doesn't give a damn about the company at all.

This is how I tend to feel these days, only related to the college, not work. I want to get it over with, waltz through the exams and get back to doing whatever it is I find enjoyable. I think, though, that this attitude is higly unsuitable for medicine in particular. Many of the people that I see around myself are evangelists, they live the school, and I fear that is the only way one can get through this place.

Most importantly, though, finding myself feeling this scared the shit out of me. Hell, I'm just half a year (well, less, but...) into what I "chose" to do for life and I already find it a neccessity I must bear with, not an interesting domain where I can realize myself. Perhaps this will pass and I will finally take off. Till then, I remain dubious.

Adam

Tuesday Morning

I have yet to discover the biological mechanism behind this, but mornings can be both extremely joyful and extremely depressing time.

Sadly, today was one of the latter, I guess that was mainly because I had to go to school for the first time in like a fortnight or so. Snoozed the alarm twice, then, with an iron will, stumbled out of bed, tumbled into the kitchen, made myself a cup of ambition (tea), prepared a snack box into the school and had a very determined and focused breakfast. Each and every move I made was intended solely to keep me awake and finish the tasks I have to finish before I can leave the house – there was no joy or grace in any of them.

One thing I avoid at all costs when trying to get up is looking out of the window. It's cold, dark and unfriendly outside, the near-twilight being slit through by the occasional solitary street lamp... Not a sight for those weak of heart. And definitely not a sight that would improve the morale of someone who knows he has to leave the appartment in the matter of minutes anyway.

Everything seems pointless in the morning. School, work, hobbies, relationships, life...it all fades into insubstantiallity. All that matters is the bed, the alarm clock and the blanket.

Well, at least I'm warm now, sitting in the bus with my trusty laptop on my, well, lap, tucked in my headphones, hat, coat and sweatshirt. What gets me through the day is the vision of my bed I will be returning to in the evening.

This concludes my first 2009 dated and fairly pointless post. Surprised that I didn't mention the Christmas and New Year's Eve? Yeah, well, just you wait for it. Much like everything else right now it's faded into insubstantiallity ;)

Adam