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  • Elton Yates Professor of Medicine, Pharmacology and Neurology
  • Vanderbilt University
  • Director, Clinical & Translational Research Center, vanderbilt institute for Clinical and Translational Research, Nashville


The eggs are passed in human faeces which the cyst while the cyst wall shows palisade layer of histiocytes cheap 10mg doxepin visa anxiety symptoms after eating. Herpes and cytomegalovirus infections are common intrapartum infections acquired venereally. Toxoplasmosis is a protozoal infection acquired by contact with cat’s faeces or by ingestion of raw uncooked meat. Cytomegalovirus and herpesvirus infection are generally transmitted to foetus by chronic carrier mothers. An infectious mononucleosis-like disease is present in about 10% of mothers whose infants have Toxoplasma infection. Genital herpes infection is present in 20% of mothers whose newborn babies suffer from herpes infection. Rubella infection during acute stage in the first 10 weeks of pregnancy is more harmful to the foetus than at later stage of gestation. Symptoms of cytomegalovirus infection are present in less than 1% of mothers who display antibodies to it. The suffix maturation of cells in normal adults is controlled as a result ‘-oma’ is added to denote benign tumours. Malignant tumours of which some cells proliferate throughout life (labile cells), of epithelial origin are called carcinomas, while malignant some have limited proliferation (stable cells), while others mesenchymal tumours are named sarcomas (sarcos = fleshy) do not replicate (permanent cells). However, some cancers are composed of highly neoplastic cells lose control and regulation of replication and undifferentiated cells and are referred to as undifferentiated form an abnormal mass of tissue. Therefore, satisfactory definition of a neoplasm or tumour Although, this broad generalisation regarding is ‘a mass of tissue formed as a result of abnormal, excessive, nomenclature of tumours usually holds true in majority of uncoordinated, autonomous and purposeless proliferation of cells instances, some examples contrary to this concept are: even after cessation of stimulus for growth which caused it’. The melanoma for carcinoma of the melanocytes, hepatoma for branch of science dealing with the study of neoplasms or carcinoma of the hepatocytes, lymphoma for malignant tumours is called oncology (oncos=tumour, logos=study). Leukaemia is the term used for cancer of localised without causing much difficulty to the host, or blood forming cells. The categories of tumours are examples which defy the common term used for all malignant tumours is cancer. The word ‘cancer’ means crab, thus reflecting combined in the same tumour, it is called a mixed tumour. These tumours occur more frequently in infants and children iv) Collision tumour is the term used for morphologically two (under 5 years of age) and include some examples of tumours different cancers in the same organ which do not mix with in this age group: neuroblastoma, nephroblastoma (Wilms’ each other. Hamartoma is benign tumour which is made combination of both epithelial and mesenchymal tissue of mature but disorganised cells of tissues indigenous to the elements.

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The In any case doxepin 10mg with mastercard venom separation anxiety, the extent of damage produced by any of the area supplied by distal branches of the cerebral arteries above causes depends upon: suffers from the most severe ischaemic damage and may i) rate of reduction of blood flow; develop border zone or watershed infarcts in the junctional ii) type of blood vessel involved; and zones between the territories supplied by major arteries. Microscopically, the nerve cells die and disappear and are replaced by reactive fibrillary gliosis. Grossly, cerebral infarcts variations in the distribution of neuronal damage to the may be anaemic or haemorrhagic. The affected area is soft and swollen and there is blurring of junction between grey and white matter. The histologic firm glial reaction and thickened leptomeninges, forming changes are reactive astrocytosis, a few reactive macrophages and neovascularisation in the wall of the cystic lesion. It is usually the result of fragmentation of occlusive arterial emboli or venous thrombosis. Initially, there is eosinophilic neuronal necrosis and Spontaneous intracerebral haemorrhage occurs mostly in lipid vacuolisation produced by breakdown of myelin. Most hypertensives over middle Simultaneously, the infarcted area is infiltrated by age have microaneurysms in very small cerebral arteries in neutrophils. After the first 2-3 days, there is progressive invasion microaneurysms is believed to be the cause of intracerebral by macrophages and there is astrocytic and vascular haemorrhage. In the following weeks to months, the macrophages the common sites of hypertensive intracerebral haemor clear away the necrotic debris by phagocytosis followed rhage are the region of the basal ganglia (particularly the by reactive astrocytosis, often with little fine fibrosis putamen and the internal capsule), pons and the cerebellar (Fig. Ultimately, after 3-4 months an old cystic infarct is the lesion, hemispheric, brainstem or cerebellar signs will formed which shows a cyst traversed by small blood be present. About 40% of patients die during the first 3-4 vessels and has peripheral fibrillary gliosis. Small cavi days of haemorrhage, mostly from haemorrhage into the tary infarcts are called lacunar infarcts and are commonly ventricles. The survivors tend to have haematoma that found as a complication of systemic hypertension. There are two main types of copically, the haemorrhage consists of dark mass of spontaneous intracranial haemorrhage: clotted blood replacing brain parenchyma. Intracerebral haemorrhage, which is usually of hyper of the lesion are sharply-defined and have a narrow rim tensive origin. Subarachnoid haemorrhage, which is commonly aneu rhages in the Virchow-Robin space in the border zone are rysmal in origin. Ipsilateral ventricles are distorted and In addition to hypertension and rupture of an aneurysm, compressed and may contain blood in their lumina. After a few weeks to months, intracerebral and subarachnoid haemorrhage, haemorrhagic the haematoma undergoes resolution with formation of a diathesis and haemorrhage into tumours. Its margins are yellow-brown and have are the result of rupture in the posterior circulation, vascular haemosiderin-laden macrophages and a reactive zone of malformations and rupture of mycotic aneurysms that occurs fibrillary astrocytosis. In all types of aneurysms, the rupture of thin-walled dilatation occurs in Subarachnoid Haemorrhage association with sudden rise in intravascular pressure but Haemorrhage into the subarachnoid space is most comm chronic hypertension does not appear to be a risk factor in only caused by rupture of an aneurysm, and rarely, rupture their development or rupture. On rupture, they produce severe generalised A general discussion of aneurysms is given on page 405.

Applying the Law of Segregation: Probability fi Punnett square – way of diagramming genetic crosses that uses the laws of probability purchase 10 mg doxepin mastercard anxiety symptoms 8 weeks. Applying the Law of Segregation fi more terminology fi monohybrid cross – cross between individuals that are both heterozygous for the gene that you are following. Applying the Law of Segregation a monohybrid cross results in a 3:1 phenotype ratio and 1:2:1 genotype ratio. Study Tip fi be sure to work some examples on your own; the textbook and website have plenty of genetics problems – note how they are typically presented as word problems and expect that format on your test. Mendel’s Law of Independent Assortment fi dihybrid cross – cross between individuals that are both heterozygous for two different genes that you are following fi when Mendel performed dihybrid crosses he found phenotype ratios of 9:3:3:1 fi note that this follows the product rule: 3:1 x 3:1 = 9:3:3:1. Mendel’s Law of Independent Assortment fi this led to his law of independent assortment: fi segregation of any one pair of alleles is independent of the segregation of other pairs of alleles fi we now know that this is also a consequence of events in meiosis. Mendel’s Law of Independent Assortment fi this is also a consequence of events in meiosis – the independent assortment of homologous chromosomes during Meiosis I. Mendel’s Law of Independent Assortment fi law of independent assortment doesn’t hold perfectly true for all genes (more on genetic linkage that violates this law later). Mendel’s Law of Independent Assortment the hard way fi using the law of independent assortment in genetic problems fi with independent assortment a dihybrid cross is simply two separate monohybrid crosses multiplied fi avoid making tedious and difficult Punnett squares like fi we will work examples in class; be sure to try some on No no no!!! Mendel’s Law of Independent Assortment fi independent segregation of chromosomes during meiosis I leads to independent assortment fi independent assortment can lead to recombination. Mendel’s Law of Independent Assortment fi recombination – any process that leads to combinations of genotypes not seen in the parents fi recombinant gametes – gametes that display a recombinant genotype fi recombinant offspring – offspring whose phenotype reveals that they inherited genes from a recombinant gamete. Genetic linkage – independent assortment does not always occur fi genes that are on the same chromosome may not sort independently; such genes are said to be linked. Genetic linkage – independent assortment does not always occur fi crossing over breaks linkages between genes fi recall crossing over during prophase I between homologous chromosomes; it is the only way to get genetic recombination between genes that are on the same chromosome fi the further apart two genes are, the more likely they are to have crossing over occur between them (thus leading to genetic recombination). Genetic Maps of Chromosomes fi percentage of crossing over or recombination is calculated from 100 x number of recombinant offspring the total number of offspring fi map unit – by convention, one map unit = 1% recombination fi the term cM or centiMorgan is sometimes used for map units, in honor of Thomas Hunt Morgan, the pioneer in gene mapping fi map distances between genes on the same chromosome are measured in map units. Genetic Maps of Chromosomes fi linkage group = all genes on a particular chromosome; tend to be inherited together. Genetic Maps of Chromosomes fi placement of a gene into a position in a linkage group is genetic mapping. Genetic Maps of Chromosomes fi map distances get less meaningful as they get large fi as genes get further apart, the odds of multiple crossing over events between them increase fi when distances approach 50 map units, the genes appear essentially unlinked fi many chromosomes have an overall map length of well over 50 map units fi genetic maps are useful in locating the actual physical location of genes. Methods of studying human inheritance: family pedigree analysis fi pedigree – a chart summarizing phenotypes and/or genotypes within a family over several generations fi pedigree analyses only work well when a single locus is involved in determining a phenotype (so-called Mendelian traits). A Pedigree Analysis of Albinism fi Successive generations marked by Roman numerals fi Individuals in each generation are marked by Arabic numerals fi Is albinism dominantfi

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It occurs in about aortic incompetence results from spread of the syphilitic 80% cases of tertiary syphilis buy doxepin 10mg mastercard anxiety symptoms mayo clinic. The lesions diminish in severity in descending thoracic aorta the features distinguishing syphilitic aortitis from aortic and disappear completely at the level of the diaphragm. The opened vessels show intimal surface studded with pearly changes may accompany syphilitic meningitis. These lesions are separated by Grossly, the cerebral vessels are white, rigid and thick wrinkled normal intima, giving it characteristic tree-bark walled. Cut section of the lesion shows more firm and Microscopically, changes of endarteritis and periarteritis fibrous appearance than the atheromatous plaques. There However, superimposed atherosclerotic lesions may be is atrophy of muscle in the media and replacement by present. Sites Ascending aorta, aortic arch; Progressive increase from the arch to abdominal absent below diaphragm aorta, more often at the bifurcation 2. Macroscopy Pearly-white intimal lesions resembling Yellowish-white intimal plaques with fat in the core; tree-bark without fat in the core; ulceration ulceration and calcification in plaques common and calcification often not found 3. Microscopy Endarteritis and periarteritis of vasa Fibrous cap with deeper core containing foam vasorum, perivascular infiltrate of plasma cells, cholesterol clefts and soft lipid cells and lymphocytes 4. However, some vasculitis, more often affecting arterioles, venules and usual clinical features are fever, malaise, weakness, weight capillaries, and hence also termed as small vessel vasculitis. The from many of patients with vasculitis of immunologic origin condition is believed to result from deposition of immune show the presence of following immunologic features: complexes and tumour-related antigens. While most cases of iii) Healed stage—In this stage, the affected arterial wall is immunologic vasculitis have immune complex deposits in markedly thickened due to dense fibrosis. The internal the vessel wall, there are some cases which do not have such elastic lamina is fragmented or lost. Healed stage may immune deposits and are termed as cases of pauci-immune contain haemosiderin-laden macrophages and organised vasculitis (similar to pauci-immune glomerulonephritis, thrombus. However, it may be mentioned here that various stages of the disease may be seen in different vessels and even Polyarteritis Nodosa within the same vessel. The tissues and organs most commonly involved order of frequency of involvement, are the kidneys, heart, are the skin, mucous membranes, lungs, brain, heart, gastrointestinal tract, kidneys and muscle. Most commonly involved 403 results from immunologic response to an identifiable antigen organs are the lungs, paranasal sinuses, nasopharynx and that may be bacteria. Typical features include pneumonitis with bilateral Hypersensitivity vasculitis includes clinicopathologic entities infiltrates in the lungs (Chapter 17), chronic sinusitis, naso such as serum sickness, Henoch-Schonlein purpura, mixed pharyngeal ulcerations (Chapter 18) and renal disease cryoglobulinaemia, vasculitis associated with malignancy, (Chapter 22).

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Venous drainage is through corresponding vessles into the internal mammary and axillary veins buy generic doxepin 75 mg on-line anxiety symptoms joins bones. Lymphatic drainage this is largely into the axillary glands, with some dranage in to the portal fissure of the liver and mediastinal glands. Nerve supply the function of the breast is largely controlled by hormone activity but the skin is supplied by breanches of the thoracic nerves. There is also some sympathetic nerve supply, especially around the areola and nipple. List different menastrial disorder and responsablitiies of the nurse in their management: 2. List the main femal gentail orgns that are important in the process of reproduction. Mention the main pelvic land mark that are important in obstatrics during proegnancy and labour process. What are the obstratrical importancy of fontanalles and sutures in the process of labour mangment. Fertilization must occur fairly quickly after release of the ovum because it usually occurs in the outer third of a fallopian tube, 36 the ampullar portion. The functional life span of aspermatozoa is about 48 hours / may be as long as 72 hours or longer. Division takes place and the fertilized ovum divides into two cells, and then into four, then eight, and sixteen and soon until a cluster of cells is formed known as the morula. Next, fluid filled the cavity or blastocele appears in the morula which now becomes known as the blastocyst. Around the out side of the blastocyst there is a single layer of cell known as the trophoblast while the remaining cells are clumped together at one end forming the inner cell mass. The trophoblast will form the placenta and chorion, while the inner cell becomes the fetus, umbilical cord and the amnion. The syncitiotrophoblast is composed of nucleated protoplasm which is capable of breaking down tissue as in the process of embedding. The cells differentiate into three layers, each of which will form particular parts of the fetus. The amniotic cavity lies on the side of the ectoderm; the yolk sac lies on the side of the endoderm and provides 39 nourishment for the embryo until the trophoblast is defficiaently developed to take over. Functions of Placenta Respiration As pulmonary exchange of gases does not take place in the uterus the fetus must obtain oxygen and excrete carbon dioxide through the placenta Nutrition Food for the fetus derives from the mother’s diet and has already been broken down into forms by the time reachs the placenta site. The placenta is able to select those substances required by the fetus, even depleting the mother’s own supply in some instances. Storage the placent metabolises glucose and can also stores it in the form of glycogen and reconverts it to glucose as required.

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