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However, it is important to note that other forms of programmed cell death have been described and other forms of programmed cell death may yet be discovered Formigli et al. Apoptosis occurs normally during development and aging and as a homeostatic mechanism to maintain cell populations in tissues.
Apoptosis also occurs as a defense mechanism such as in immune reactions or when cells are damaged by disease or noxious agents Norbury and Hickson, Although there are a wide variety of stimuli and conditions, both physiological and pathological, that can trigger apoptosis, not all cells will necessarily die in response to the same stimulus.
Irradiation or drugs used for cancer chemotherapy results in DNA damage in some cells, which can lead to apoptotic death through a pdependent pathway. Some hormones, such as corticosteroids, may lead to apoptotic death in some cells e. Some cells express Fas or TNF receptors that can lead to apoptosis via ligand binding and protein cross-linking.
Other cells have a default death pathway that must be blocked by a survival factor such as a hormone or growth factor. There is also the issue of distinguishing apoptosis from necrosis, two processes that can occur independently, sequentially, as well as simultaneously Hirsch, ; Zeiss, At low doses, a variety of injurious stimuli such as heat, radiation, hypoxia and cytotoxic anticancer drugs can induce apoptosis but these same stimuli can result in necrosis at higher doses.
Morphology of Apoptosis Light and electron microscopy have identified the various morphological changes that occur during apoptosis Hacker, During the early process of apoptosis, cell shrinkage and pyknosis are visible by light microscopy Kerr et al. With cell shrinkage, the cells are smaller in size, the cytoplasm is dense and the organelles are more tightly packed. All three patients were thoroughly investigated, and management was bespoke to the extent of disease and their physiological state at the time of diagnosis.
This ranged from extensive surgical intervention including cystectomy, partial sigmoidectomy, excision of the abdominal wall with reconstruction and ileal conduit formation to palliation. Presentation and diagnosis can be challenging; however, prompt investigation and intervention are essential given the high degree of morbidity and mortality.
Routine check of the SPC site may be indicated in those patients in whom the SPC has been present for more than 5 years. We are sorry, but there is no personal subscription option available for your country. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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