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The myeloid cells up to the myelocyte stage continue to divide and, therefore, comprise mitotic or proliferative pool. On physical examination, there are needle tracks in the left antecubital fossa, miosis, and a loud diastolic heart murmur. Which of the following statements best describes the wound site at the time of suture removal Further history reveals that his usual diet has poor nutritional value and is deficient in vitamin C. Genetic susceptibility and role of Epstein-Barr virus are considered important factors in its etiology (page 225). Histopathology of Leprosy Usually, skin biopsy from the margin of lesions is submitted for diagnosis and for classification of leprosy. Daily and heavy consumption of alcohol is more harmful than moderate social drinking since the liver, where ethanol is metabolised, gets time to heal. Leukocytes leave the vasculature and migrate to the site of bacterial inoculation. Development of cancer in chronic gastric ulcer is a rare occurrence (less than 1%). Formation of calcium soaps imparts the necrosed foci firmer and chalky white appearance. Which of the following insect vectors was most likely responsible for the rapid spread of this disease Fleas Mosquitoes Reduviid bugs Sand flies Ticks 27 A 25-year-old woman has had pelvic pain, fever, and vaginal discharge for 3 weeks. In general, the point of action by anti-oncogenes is also G1 S phase transition and probably act either by inducing the dividing cell from the cell cycle to enter into G0 (resting) phase, or by acting in a way that the cell lies in the post-mitotic pool losing its dividing capability. Histologically, it consists of epithelial follicles similar to those of ameloblastoma, set in a very cellular connective tissue stroma. These include indices such as diameter of the frontal horns in relation to the inner table of the skull (ventricular or Evans index), frontal horn radius, and ventricular angle. Congestion occurs when there is vascular dilation with pooling of blood within an organ. Ascariasis involves the lower gastrointestinal tract, and the worms reside in the lumen. The atria and occipital horns are often disproportionately enlarged ("colpocephaly"), suggesting the presence of callosal and forceps major dysgenesis. Living bacilli may be present even in calcified tuberculous lesions, lymph nodes, lungs, etc. The prostatic lesion is palpated with the pulp of the finger and sampled by puncturing through the fingercot with a long 22 gauge needle introduced through the cannula. Digitated anterior head, body, tail of the hippocampus lie along the floor of the temporal horn of the lateral ventricle. Which of the following underlying diseases is most likely to be associated with these findings Antiphospholipid syndrome Factor V Leiden mutation Hemophilia A Scurvy Sepsis with Escherichia coli Vitamin K deficiency 21 A 23-year-old woman has had altered consciousness and slurred speech for the past 24 hours. Asthmatic patients suffer from episodes of acute exacerbations interspersed with symptomfree periods. The dividing cells are then arrested in metaphase by the addition of colchicine or colcemid, both of which are inhibitory to microtubule formation. B, Mechanism of polymerisation and consequent sickling of red cells containing HbS. Since study of haematopoietic system involves two phases-laboratory haematology and clinical haematology, understanding of broad principles of management of common haematological diseases has been considered desirable part of the discussion on these topics. This occurs by proliferation from margins, migration, multilayering and differentiation of 173 epithelial cells in the same way as in the epidermal cells in healing of skin wounds. After-effects of necrosis acute and subacute cell injury from various etiologic agents such as bacterial toxins, chemicals, poisons, burns, high fever, intravenous administration of hypertonic glucose or saline etc. Carcinogenesis is a gradual multi-step process involving many generations of cells. These grampositive organisms elaborate an exotoxin that circulates and produces myocarditis and neuropathy. Fat necrosis hydrolyses neutral fat present in adipose cells into glycerol and free fatty acids. Passive Hyperaemia (Venous Congestion) the dilatation of veins and capillaries due to impaired venous drainage results in passive hyperaemia or venous congestion, commonly referred to as congestion.

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Additional factors contributing to malnutrition in alcoholics are chronic gastritis and pancreatitis. Differentiation of pulmonary thrombosis from pulmonary thromboembolism is tabulated in Table 5. In this type, the blood-brain barrier is intact and the fluid accumulation is intracellular. The atrium contains the choroid plexus glomus and is formed by the convergence of the body with the temporal and occipital horns. In acute infections, the spleen can enlarge rapidly to 2 to 3 times its normal size causing acute splenic enlargement termed acute splenic tumour. However, tumours and tumour-like lesions which are specific to the ear are described below. Approximately 60% of all single-suture craniosynostosis cases involve premature fusion of the sagittal suture, followed in frequency by those that involve the coronal (22%) and metopic (15%) sutures. This controversy is resolved by classifying all cardiomyopathies into two broad groups: a) primary cardiomyopathy; and b) secondary cardiomyopathy i. However, lymphatics lined by a single begins in the foot and progresses slowly upwards to involve the whole extremity. Rheumatic myocarditis is characterized by minimal myocardial necrosis with foci of granulomatous inflammation (Aschoff bodies). A cavity is formed which is called an abscess and contains purulent exudate or pus and the process of abscess formation is known as suppuration. A minimum of 30% cells positive for sex chromatin is indicative of genetically female composition. Because fat deposits commonly accompany congenital malformations such as callosal dysgenesis (41-23) or tethered spinal cord, imaging studies should be closely scrutinized for the presence of additional abnormalities. The lesions in the lungs are similar in all cases of hypersensitivity pneumonitis. Microscopically, they show intermediate or mixed pattern, characteristic vertical villi and deeper part showing tubular pattern. Microfilaments, intermediate filaments, and microtubules are responsible for maintaining cellular form and movement and are collectively referred to as cytoskeleton. However, a proportion of patients develop clinical symptoms such as low abdominal pain, distension, constipation and sometimes intermittent bleeding. Some inborn errors of metabolism may be treated with enzyme replacement following birth, but this is very expensive. A list of important clinical conditions producing abnormalities in sodium and potassium are given in Table 5. One cause is a cytogenetic abnormality in the developing embryo that occurs just in the trophoblast, and only placenta is affected. Besides above, smokers suffer higher risk of development of a few other cancers and non-neoplastic conditions as illustrated in. Hepatic congestion is not directly related to renal failure, and hepatorenal syndrome has no characteristic gross appearance. How asbestos causes all these lesions is not clearly understood but the following mechanisms have been suggested. Mitochondria are oval structures and are more numerous in metabolically active cells. Pericarditis can produce chest pain, although not in relation to exercise, and it is not relieved by nitroglycerin. Fat emboli are globules of lipid that are most likely to form after traumatic injury, typically to long bones. A forward-biased quadrature set (D166) was chosen for the accurate angular calculation at the beam-line from the core to the collimator output. Nondisjunction during mitosis results in mosaicism, meaning thereby that the individual has two or more types of cell lines derived from the same zygote. Focal ulceration can occur over the varicosities, but extensive gangrene similar to that seen in arterial atherosclerosis does not occur. These are septic emboli carrying organisms that can start growing and produce local arterial destruction wherever they are carried.

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The disease is endemic in several parts of the world, especially in tropical Africa, parts of South and Central America, India and South-East Asia. The varicosities do not affect muscle; however, diminished muscular support for veins to "squeeze" blood out for venous return can predispose to formation of varicose veins. These include the phagocytic leucocytes of blood (polymorphs and monocytes), phagocytes of tissues (mononuclear-phagocyte system) and the immune system as discussed in Chapter 4. Chronic Non-neoplastic (Pre-malignant) Conditions Premalignant lesions are a group of conditions which predispose to the subsequent development of cancer. Aortic coarctation (35%), arterial occlusions (21%), progressive stenoses (18%), and saccular aneurysms (13%) are the most common potentially symptomatic anomalies. Haematologic derangements seen as haemolytic anaemia, or thrombocytopenia (<100,000/l), or leucopenia (>4,000/l). The underlying alterations in biochemical systems of cells for reversible and irreversible cell injury by various agents is complex and varied. T2* sequences may demonstrate multiple "blooming" hypointensities in the cortex and along the pial surface of the hemispheres (33-19) (33-20). Which of the following changes most likely occurs in this virus to increase its virulence What is the most likely mode of transmission by which these children get infected Breast-feeding Inhalation of droplet nuclei Fecal-oral contact Transfer across placenta Sexual abuse 9 A study of nosocomial infections involving urinary catheters is performed. Cheilosis describes the fissuring at the corners of the mouth that accompanies riboflavin (vitamin B2) deficiency. Capillary telangiectasias are distinct from capillary vascular malformations and consist of numerous thin-walled ectatic capillaries interspersed in normal brain parenchyma. Unilateral obstructive hydrocephalus is rare, occurring when only one arm of the foramen of Monro becomes occluded (34-8). Which of the following blood cell types in this medium is the most likely to have bactericidal activity against E. Grossly, the tumours are usually bulky, pale grey-white, firm masses with poorly-defined margins. It is actually covered by a thin membranous roof that bulges into the interhemispheric fissure, displacing the fornices laterally. After the fourth episode 1 month ago, she was unconscious for 6 hours and had weakness in her right arm and difficulty speaking. Fibril Proteins By electron microscopy, it became apparent that major component of all forms of amyloid (about 95%) consists of meshwork of fibril proteins. Nondisjunction during first meiotic division stage will result in two gametes from both the parental chromosomes due to failure to separate while the other two gametes will have no chromosomes (nullisomic). This is the commonest of the familial, genetically-determined diseases of the liver affecting 2-5% of the population. Nonphysiologic increase in pituitary volume-pathologic pituitary enlargement-is much less common and typically occurs in response to end-organ failure. The splenium and most of the body can usually be identified, although the genu and rostrum are often absent. Oligohydramnios with diminished amniotic fluid leads to deformations, not disruptions. Microscopically, the tumour has a thick fibrous capsule from which extend collagenous septa into the tumour dividing it into lobules. Retrospectively we divided the patients into two groups to investigate the prognostic factors. These tumours are found most often in the dermis of the fingers or toes under a nail; other sites are mucosa of the stomach and nasal cavity. However, it may be mentioned here that various stages of the disease may be seen in different vessels and even within the same vessel. This occurs in the following situations: Production of large amounts of lactic acid (lactic acidosis). A brief account of both main branches of cytology is given below while their contrasting features are presented in Table 11. The finding of large ventricles in a large head favors hydrocephalus; seeing large ventricles with a normal to small head is more common with congenital anomalies or volume loss (atrophy). C, When viewed under polarising microscopy the corresponding area shows apple-green birefringence. The new fibroblasts originate from fibrocytes as well as by mitotic division of fibroblasts. Vasoconstrictive type, in which there is widespread and sustained hypoxic vasoconstriction and alveolar hyperventilation leading to pulmonary hypertension.

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Continued destruction of hepatocytes causes collapse of normal lobular hepatic parenchyma followed by fibrosis around necrotic liver cells and proliferated ductules and there is formation of compensatory regenerative nodules. The smears or cell block sections can be further evaluated by immunocytochemical stains by employing panel of antibodies selected on the basis of differential diagnosis made after routine morphologic examination of smears. Findings may be minimal or absent in newborn infants, so serial imaging is necessary in suspected cases. Other causes of macrocephaly and conditions with middle cranial fossa cystlike spaces in infants and children should be considered in the differential diagnosis. The other listed inheritance patterns are not seen with most cases of diabetes mellitus. We close the section with a discussion of two inherited disorders with abnormal copper metabolism, Wilson disease and Menkes disease. Tau-immunoreactive cellular inclusions accumulate within both neurons and glia (in "tufted" or starshaped astrocytes). Colloid cyst is the most common mass found at the foramen of Monro, followed by tuberous sclerosis (subependymal nodules and giant cell astrocytoma). The inferior cerebellar peduncles (also known as the restiform bodies) connect the cerebellum to the medulla and contain spinocerebellar tracts and tracts to the vestibular nuclei. The effective clearance mechanism is interfered in endobronchial obstruction from tumour, foreign body, cystic fibrosis and chronic bronchitis. Because Pap smear screening can detect dysplasias and in situ carcinomas that can be treated before progression to invasive lesions, deaths from cervical carcinoma have steadily decreased since this screening method became widely available in the last half of the 20th century. A Gram stain of the pharyngeal membrane shows numerous small, gram-positive rods within a fibrinopurulent exudate. Lymphadenitis; reticuloendothelial hyperplasia; granulomas with central necrosis and neutrophils. Therefore, we decided the maximum thermal neutron fluence on the surface of the brain should be below 2. Rise in serum gastrin levels by more than 50% of basal value is diagnostic of Zollinger-Ellison syndrome (gastrinoma). Chemotherapeutic agents have carcinogenic potential, particularly alkylating agents such as cyclophosphamide, but leukemias and lymphomas are the usual result. Neutrophils and macrophages on reaching the tissue spaces produce several proteolyitc enzymes-lysozyme, protease, collagenase, elastase, lipase, proteinase, gelatinase, and acid hydrolases. In man, the bone marrow and the thymus are the primary lymphopoietic organs where lymphoid stem cells undergo spontaneous division independent of antigenic stimulation. The Scl-70 autoantibody is indicative of scleroderma, which can produce renal failure. In 15-30% of cases, cognitive decline and behavioral changes are the presenting complaints and can remain the only clinical feature throughout the disease course. On physical examination, he is afebrile, his pulse is 78/min and regular, and there are no murmurs or gallops. These autoantibodies cause damage to human tissues due to crossreactivity between epitopes in the components of bacteria and the host. Their to obstruction to capillary blood flow by sickled red cells diagnosis is made by haemoglobin electrophoresis and upon deoxygenation or dehydration. Based on these mechanisms, the pathogenesis and main features of the two predominant forms of hyperbilirubinaemia are discussed below (Table 21. This is not true of all women, however, and progestins tend to have the opposite effect. Schwannomatosis is a paradigm for a tumor predisposition syndrome caused by the concomitant mutational inactivation of two or more tumor suppressor genes. Congenital infection with which of the following organisms is most likely to produce these findings Her prior pregnancies ended with delivery of normal term infants who are still living. Causes of reversible dementia that can be identified on imaging studies include mass lesions, such as chronic subdural hematoma or neoplasm, vitamin deficiencies (thiamine, B12), endocrinopathy.

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The position for the source plane of the treatment planning code was chosen between the bismuth collimator and the phantom in a place, where the epithermal neutron fluence is most homogeneous in the radial direction [27]. Hyperprolactinemia with stalk effect caused by the infundibular compression may be present. Metals like nickel, lead, cobalt, chromium etc in industrial workers causing lung cancer. Spleen is unfavourable site due to open sinusoidal pattern which does not permit tumour cells to stay there long enough to produce metastasis. H & E staining is routinely used to diagnose microscopically vast majority of surgical specimens. Briefly, it consists of the following: Myelin sheath and axon of the intact distal nerve undergo Wallerian degeneration up to the next node of Ranvier towards the proximal end. Chemically and structurally, membranes of mitochondria are similar to cell membrane. Detailed classifications of benign and malignant tumours pertaining to different tissues and body systems along with morphologic features of specific tumours appear in the specific chapters of Systemic Pathology later. Affected individuals in these families are most likely to have a mutation in a gene encoding a cell surface receptor for which of the following A bone marrow biopsy is obtained and microscopically shows numerous pale phagocytic cells filled with fine vacuoles (secondary lysosomes). In this section, we briefly review the syndrome and summarize the spectrum of imaging findings that-in conjunction with clinical history and neurologic examination-may suggest the diagnosis. Normally B lymphocytes have surface immunoglobulin molecules of both M and G heavy chains. Diabetes mellitus also can lead to this finding, which is most often seen in kidneys. In equivocal biopsies and controversial cases, it is desirable to have internal and external consultations. Toxic liver injury produced by drugs and chemicals may virtually mimic any form of naturallyoccurring liver disease. These methods, therefore, lack sensitivity as well as specificity and can only be employed for the following: Firstly, as an adjunct to the pathologic diagnosis arrived at by other methods and not for primary diagnosis of cancer. Aflatoxins and ergot alkaloids are naturally occurring toxins; the former are found in moldy cereal and are a risk for hepatocellular carcinoma, whereas the latter are found in moldy grains and can induce seizure activity. The various causes of this type of pericarditis are as follows: i) Uraemia ii) Myocardial infarction iii) Rheumatic fever iv) Trauma such as in cardiac surgery v) Acute bacterial infections. Initially, there is infiltration by neutrophils and intense alveolar capillary congestion, but later their place is taken by haemosiderin, phagocytes and granulation tissue. Which of the following long-term complications in her coronary artery is most likely to be prevented by paclitaxel Angiosarcoma Bacillary angiomatosis Cystic medial degeneration Giant cell arteritis Proliferative restenosis Thromboangiitis obliterans 48 A 6-year-old previously healthy child has had increasing size of his neck for the past year. Two classic disorders represent the effects of chronic repeated seizures (mesial temporal sclerosis) and prolonged acute seizure activity (status epilepticus) on the brain. Immunologic mechanisms have been implicated in the pathogenesis of lesions in systemic sclerosis which finally cause activation of fibroblasts. A, Conventional classification, showing correlation of the macroscopic subtypes with the main histological patterns. Chapter 13 Disorders of Platelets, Bleeding Disorders and Basic Transfusion Medicine granules. Dementia with Lewy bodies typically demonstrates generalized, nonfocal hypometabolism. Multiple regions are affected, especially the inferior-frontaloccipital fascicles, corpus callosum, and superior longitudinal fasciculus. Francisella tularensis is very infectious; only 10 to 50 organisms can cause disease. Basophils and mast cells have receptors for IgE and degranulate when cross-linked with antigen. This is a possible mechanism of autoimmunity in the brain and in pancreatic islet cells.

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There is release of inflammatory cytokines and other inflammatory mediators and generation of free radicals. The dorsomedial thalami can also be involved, whereas the globi pallidi are less commonly affected. In the process, some neutrophils die, and the release of their lysosomal enzymes can cause liquefactive necrosis of the tissue. All types of pigmented naevi as well as malignant melanoma can occur in oral cavity. If uncompensated, these mechanisms may lead to impaired cellular metabolism and death. Some industrial carcinogens and cigarette smoking have cocarcinogenic effect, particularly in uranium mines and asbestos workers. In the dose-volume-histogram the normal brain dose includes the normal brain, target and tumour. Which of the following chemical mediators is most important in the pathogenesis of this lesion Bradykinin Complement C5a Interferon- Nitric oxide Prostaglandins 32 One month after an appendectomy, a 25-year-old woman palpates a small nodule beneath the skin at the site of the healed right lower quadrant sutured incision. Often, coexistent changes of atherosclerosis are present altering the histologic appearance. Some patients have scarred ventricular walls with decreased compliance and reduced tolerance for the normal fluctuations in intracranial pressure. Fibroblasts are more likely participants in chronic inflammatory responses and in healing responses, generally appearing more than 1 week after the initial event. If the target could be treated to a minimum dose of 17 Gy-Eq with one field the patient will be placed on the single field group (protocol 4a). The meninges, especially around the craniovertebral junction, are often thickened and appear very hypointense on T2-weighted images (31-60). Carbon dioxide is likely to be cleared via normal lungs, which are still sufficiently perfused by a failing heart. Lymphoid Series the maturation stages in production of lymphocytes are illustrated in. In contrast to nephrotic oedema, nephritic oedema is not due to hypoproteinaemia but is largely due to excessive reabsorption of sodium and 99 water in the renal tubules via renin-angiotensin-aldosterone mechanism. Appendix and terminal ileum, the two most common sites for carcinoids, depict variation in their age and sex incidence and biologic behaviour: Appendiceal carcinoids, occur more frequently in 3rd and 4th decades of life without any sex predilection, are often solitary and behave as locally malignant tumours. In the developed countries, individual vitamin deficiencies are noted more often, particularly in children, adolescent, pregnant and lactating women, and in some due to poverty. The only dietary sources of vitamin B12 are foods of animal protein origin such as kidney, liver, heart, muscle meats, fish, eggs, cheese and milk. Aceruloplasminemia is a disease of middle-aged adults characterized by the clinical triad of diabetes, retinopathy, and neurologic symptoms (primarily dementia, craniofacial dyskinesia, and cerebellar ataxia). Since necrotising arteriolitis occurs in vessels in which there is sudden and great elevation of pressure, the changes are said to result from direct physical injury to the vessel wall. There are no specific biochemical or morphologic changes in common acquired mental diseases due to mental stress, strain, anxiety, overwork and frustration. This is characterised by an orderly and regular hyperplasia of squamous epithelium with hyperkeratosis on the surface. Increased diffusivity in the same tract can be seen as early as 2 weeks following shunting. Clinical manifestations of a particular electrolyte imbalance are related to its pathophysiologic role in that organ or tissue. The activated receptor for ion exchange such (gap 1) phase, S (synthesis) phase, G2 (gap 2) phase, and M as for sodium, potassium and calcium and certain peptide (mitotic) phase. Most common benign tumours, in descending order of frequency, are: leiomyomas, adenomas and vascular tumours (haemangioma, lymphangioma). Coxsackievirus A Mycobacterium kansasii Viridans streptococci Staphylococcus aureus Toxoplasma gondii Trypanosoma cruzi 53 A 17-year-old girl jumps up for a block in the third match of a volleyball tournament and suddenly collapses. A wedge-shaped shrunken area of pale colour is seen with base resting under the capsule, while the margin is congested. The tumour arising from the retina (arrow) shows undifferentiated retinal cells and the typical rosettes.

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Axial scans demonstrate the classic "molar tooth" appearance with foreshortened midbrain, narrow isthmus, deep interpeduncular fossa, and thickened superior cerebellar peduncles surrounding an oblong or diamond-shaped fourth ventricle. A ping pong ball was inserted into the cavity and neutron flux was measured on the surface of the ping pong ball and on the bottom of the cavity. Acute aspirin toxicity can cause metabolic acidosis with respiratory compensation. Which of the following organs is most likely to serve as the reservoir for proliferation of the infectious agent producing this disease It becomes a 1-cm nodule with a central depression, and then ulcerates over the next month. There were 83 patients with glioblastoma, 44 patients with anaplastic astrocytoma and 16 patients with low grade astrocytoma (grade 1 or 2). Iodine deficiency and maternal thyroid disease can also cause hypothyroidism in neonates. These cause ischaemic necrosis of the deprived part (infarct) which may lead to gangrene. The cyst wall is formed by proliferating capillaries, inflammatory cells, and gliosis (proliferating glial cells) in the case of brain and proliferating fibroblasts in the case of abscess cavity. Depending upon the type epithelium transformed, two types of epithelial metaplasia are seen squamous and columnar: 1. He becomes diaphoretic and short of breath, but waits until the end of his 8-hour shift to go to the hospital. A number of risk factors predispose an individual to hepatic drug injury such as preexisting liver disease, aging, female sex and genetic inability to perform a particular biotransformation. These antigens of the bacilli determine the immune reaction of host lymphocytes and macrophages. Microwave fixation may also be used in the laboratory for rapid fixation and processing of routine surgical specimens. Some organs receive blood supply from arteries which do not have significant anastomosis and are thus functional end-arteries. Eating infected meat, typically uncooked pork, can lead to trichinosis; Trichinella encysts in striated muscle to produce fever and myalgias. A subset of patients is found to have more severe congestive heart failure, poor exercise tolerance, and decreased arterial oxygen saturation levels. Other Colorectal Malignant Tumours Aside from colorectal carcinoma, other malignant tumours which are encountered sometimes in the large bowel are leiomyosarcoma (page 737) and malignant lymphoma (page 559). Hypoxic ischemic encephalopathy to include watershed infarction is nonprogressive and associated with positive health history. The follicular centre is a very active zone where lymphocytes from peripheral blood continuously enter and leave, interact with macrophage-histiocytes and endothelial cells and undergo maturation and transformation. Hyperplastic Arteriolosclerosis the hyperplastic or proliferative type of arteriolosclerosis is a characteristic lesion of malignant hypertension; other causes include haemolytic-uraemic syndrome, scleroderma and toxaemia of pregnancy. Viral myocarditis may last for weeks, but not for 1 year, and pain may be present at rest. Microscopically, chronic marginal gingivitis is characterised by heavy chronic inflammatory cell infiltrate, destruction of collagen, and epithelial hyperplasia so as to line the pocket. Selfswallowing of sputum in patients with active pulmonary tuberculosis may cause secondary intestinal tuberculosis, most commonly in the terminal ileum and rarely in the colon. These cells on degranulation also release mediators of inflammation like acid proteases, collagenase, elastase and plasminogen activator. Inherited Metabolic Disorders progressive gait disturbances and delayed psychomotor development. Metaplasia of muscle does not occur, although loss of muscle occurs with aging and ischemia as myofibers are replaced by fibrous tissue. After an observation period of at least 6 months, the dose is increased by 10% for the next cohort if less then three severe side effects related to the treatment occurred. The basic morphologic features of myeloblasts and lymphoblasts are summed up in Table 14. Agyria is defined as a thick cortex with absence of surface gyri ("complete" lissencephaly). Severe intracranial hypotension often has minimal or no abnormal dura-arachnoid thickening and enhancement.

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Iron staining demonstrates siderotic granules in the cytoplasm of normoblasts, increased reticuloendothelial iron but ring sideroblasts are only occasionally seen. Certain environmental factors are known to play a role in the etiology of leukaemias and lymphomas: i) Ionising radiation. Cystic fibrosis Bronchopulmonary dysplasia Pulmonary hypoplasia Sudden infant death syndrome Ventricular septal defect Which of the following is the most likely risk factor for this fetal infection Ingestion of contaminated meat Inhalation of droplet nuclei Injection drug use Mosquito bite Previous blood transfusion Sexual intercourse 22 In a study of lung maturation, the amount of surfactant at different gestational ages is measured. Congenital Malformations of the Skull and Brain 1182 cerebellar vermis (not the tonsils! Marfan syndrome is a risk for aortic dissection starting in a dilated ascending aorta. Squamous cell or epidermoid carcinoma comprises 90% of primary oesophageal cancers. Malignant gastric ulcers are larger, bowl-shaped with elevated and indurated mucosa at the margin. Generally, carcinoma of the supraglottic and subglottic regions tends to be more poorly-differentiated than the glottic tumour. Estimation of haemoglobin, examination of a blood film and evaluation of absolute values are essential preliminary investigations. Bundles of microfilaments are especially prominent close to the plasma membrane and form terminal web. The two bumps along its anterior aspect are the facial colliculi, and (36-9) Coronal graphic shows brachium pontis (middle cerebellar peduncles), vermis, flocculi, and tonsils projecting inferiorly from the biventral lobules. Low value or achlorhydria are observed in: pernicious anaemia (atrophic gastritis); and achlorhydria in the presence of gastric ulcer is highly suggestive of gastric malignancy. Most of the dust-laden macrophages accumulated in the alveoli die leaving the dust, around which fibrous tissue is formed. Capillaritis is most likely to be described with inflammation involving the lungs. The extent of cellular pleomorphism generally correlates with the degree of anaplasia. Toxic exposure to which of the following substances best accounts for these findings Ethylene glycol Kerosene Lead Methanol Sodium hypochlorite Environmental and Nutritional Diseases 115 10 Increasing numbers of children younger than 5 years are observed to exhibit cerebral palsy, deafness, blindness, and mental retardation in a coastal community. Infarction is the process of tissue necrosis resulting from some form of circulatory insufficiency; the localised area of necrosis so developed is called an infarct. In adults, the sources are as follows: Occupational exposure to lead during spray painting, recycling of automobile batteries (lead oxide fumes), mining, and extraction of lead. The inheritance pattern described here is autosomal dominant, typical for inherited defects in structural proteins. A change in the glandular epithelium to squamous epithelium around a prostatic infarct would be an example of metaplasia. These include the following: i) Ectopic hormone production: Different hormonal syndromes are characteristic of different histologic types of lung cancer. Gross and microscopic changes in gastric and duodenal ulcers are similar and quite characteristic. The most commonly involved tissues for primary complex are lungs and hilar lymph nodes. Hepatic failure may result in jaundice, characterized by a yellow color in tissues. If a large, gaping wound is not closed by sutures, it can granulate it and myofibroblastic contraction eventually helps close the wound by second intention. As a result of anaplasia, noticeable morphological and functional alterations in the neoplastic cells are observed. Two months later, an endomyocardial biopsy specimen shows focal myocardial cell death with scattered perivascular lymphocytes and plasma cells. Such cysts can be ventricular outpouchings or separate structures that do not communicate with the ventricular system. The circumscribed nature of this lesion and its long, unchanged course suggest its benign nature. A transbronchial biopsy is performed, and the microscopic findings are shown in the figure. The basal ganglia are affected in Wilson disease and mitochondrial disorders, but the pons is less commonly involved. Serum alkaline phosphatase is produced by many tissues, especially bone, liver, intestine and placenta and is excreted in the bile.

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There is considerable pressure gradient at the two ends of 95 capillary loop-being higher at the arteriolar end (average 32 mmHg) than at the venular end (average 12 mmHg). As the disease progresses, memory deficits increase and are associated with neuropsychiatric changes, difficulties in finding words and spatial cognition, and reduced executive functioning. Chronic Pericarditis Chronic pericarditis is the term used for tuberculous pericarditis and the healed stage of one of the various forms stroma. The perivascular (Virchow-Robin) space is widened and clear halos are seen around the small blood vessels. Aggregates of platelets represent localized thrombosis, an unlikely event in the lungs. Grossly, characteristic vegetations occur most frequently on the mitral and tricuspid valves. Seizures, usually the generalized tonic-clonic type, occur in less than 1% of cases. Which of the following laboratory findings is most likely to be present in this group of subjects Decreased urinary sodium Elevated plasma renin Hypokalemia Increased urinary catecholamines Lack of angiotensin-converting enzyme 7 A 61-year-old woman has smoked two packs of cigarettes per day for the past 40 years. Patients with leukemias may have reversal 22 C the figure shows intensely eosinophilic myocardial fibers with loss of nuclei, all are indicative of coagulative necrosis. Shifting of tissue fluids into the plasma due to lowered capillary hydrostatic pressure (hypotension). The two key approaches are to preserve visual function and reduce long-term headache disability. The cell receptors take part in activation of synthesis and secretion cycle is the phase between two consecutive divisions of various hormones. He is given a thiazide diuretic and his urine output increases and his edema resolves. In a young patient a heritable disorder of connective tissues, such as Marfan syndrome, must be strongly suspected. In the acute stage, there is corneal oedema and infiltration by inflammatory cells, affecting the transparency of the cornea. Immune system: Reduced IgG response to antigens, frequent directly correlated with metabolic rate of the organisms. They are more common in the atrial appendages, especially of the right atrium, and on mitral and aortic valves called vegetations which may be seen in infective endocarditis and non-bacterial thrombotic endocarditis (Chapter 16). The tumour is significant in view of its recognised association with occupational exposure to asbestos (particularly crocidolite) for a number of years, usually 20 to 40 years (page 492). They are enveloped by two layers of membrane-the outer smooth and the inner folded into incomplete septa or sheaf-like ridges called cristae. Predisposing Factors A number of primary (genetic) and secondary (acquired) factors favour thrombosis. These represent only a small number of hypomyelinating disorders that have been described. He undergoes adrenalectomy, and on microscopic examination there is extensive vascularity of the neoplasm. Neuronal degeneration is relatively advanced histopathologically before it becomes apparent clinically. Cut section shows lesions in the mucosa and submucosa but in late stage whole thickness of the gut wall may be affected. A disturbance due to impaired red cell production from various causes may produce anaemia. The pyrogens stimulate prostaglandin synthesis in the hypothalamus to "reset the thermostat," so that fever occurs as a sign of the acute inflammatory response. Children with fetal alcohol syndrome tend to be developmentally impaired throughout childhood, but the physical anomalies tend to become less apparent as the child matures. The substances acting as chemical mediators of inflammation may be released from the cells, the plasma, or damaged tissue itself. Basically, v) Hyperoxia (toxicity due to oxygen therapy) oxygen radicals are unstable and are destroyed spon- vi) Cellular aging taneously.

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Hyperchromatic (less significant), uneven distribution, coarse irregular angulated chromatin clumping, parachromatin clearing (more significant). Precancerous states can be distinguished from invasive carcinoma on the basis of cytomorphological features observed in smears. Endonucleases are generated following caspase activation and lead to nuclear fragmentation. Though cell membranes are composed of lipid, dysfunction or disruption of those membranes does not significantly alter plasma lipid concentrations. A quality control of the facility is performed on the first day of each treatment week, when the resolution of the detector is checked using a 60Co source, and the function and accuracy of the entire system is checked using calibration samples. The apoptotic cells are round to oval shrunken masses of intensely eosinophilic cytoplasm (mummified cell) containing shrunken or almost-normal organelles. Aspergillus flavus, found on moldy peanuts and other foods, produces the potent hepatic carcinogen aflatoxin B1. It arises from the epithelial rests in the gingiva and is lined by keratinising squamous epithelium. However, in general, the following principles apply in pathogenesis of most forms of cell injury by various agents: 1. Lymphangioma may develop most commonly on the tongue producing macroglossia; on the lips producing macrocheilia, and on the cheek. A perforated appendix as occurs in gangrenous appendicitis may cause localised or generalised peritonitis. These include the following: In the external ear-aural (otic) polyps and cerumengland tumours. Now on physical examination, a harsh, waxing and waning, machinery-like murmur is heard on auscultation of the upper chest. The spread occurs by retrograde embolism through intraspinal veins which carry tumour emboli from large thoracic and abdominal veins due to increased pressure in body cavities. Bicoronal and bilambdoid synostoses cause an unusual pattern of bulging temporal bones, towering skull, and shallow orbits (41-22). Free fluid in body cavities: Dpending upon the body cavity in which the fluid accumulates, it is correspondingly known as ascites (if in the peritoneal cavity), hydrothorax or pleural effusion (if in the pleural cavity), and hydropericardium or pericardial effusion (if in the pericardial cavity). In tetralogy of Fallot, the aorta overrides a ventricular septal defect, but is not transposed. The major differential diagnosis of intracranial hypotension is Chiari 1 malformation. Reduced volume in the hypothalamus, basal forebrain, and midbrain may be seen in some severe cases. Hearing: Disability in hearing due to senility is related to consumption by the cell is converted into reactive oxygen otosclerosis. Before describing the mechanism of oedema by sodium and water retention in extravascular compartment, it is essential to recollect the normal regulatory mechanism of sodium and water balance. Transmantle heterotopia or deeply infolded polymicrogyria may be difficult to distinguish from schizencephaly with closed, nearly fused "lips. Healing of Muscle All three types of muscle fibres have limited capacity to regenerate. Which of the following immunologic reactions is most consistent with this appearance Arthus reaction Graft-versus-host disease Delayed-type hypersensitivity Localized anaphylaxis Serum sickness 19 A 24-year-old woman has had increasing malaise; facial skin lesions shown in the figure are exacerbated by sunlight exposure; and arthralgias and myalgias for the past month. Aortic atresia is not compatible with continued survival, as seen in hypoplastic left heart syndrome. Identification of a heterozygous pathogenic variant in one of the causative genes can establish the diagnosis if clinical features are inconclusive. Nitric oxide generated in endothelium leads to vasodilation, whereas nitric oxide produced in macrophages aids in microbial killing. Glaucoma is a group of ocular disorders that have in common increased intraocular pressure.