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The differentiated bile duct epithelial cells do not produce bile, so, this cancer is rarely bile stained xkcd antibiotics buy tetracycline once a day. Tumors stain positively for cytokeratin 7, 8, and 19 and negatively for cytokeratin 20 infection definition biology buy generic tetracycline 250 mg on-line. Liver Tumor markers Metastasis Spread of the cancer takes place to lungs, vertebrae, adrenals, brain and regional lymph nodes. Which of the following condition is associated with unconjugated hyperbilirubinemia A patient with unconjugated bilirubinemia has increased excretion of urobilinogen in his urine. Which of the following serologic test findings is most likely to be positive in this patient Which of the following is not a function of liver: operative without any interference. A 40 years old woman Hema Thapar presents with (d) Hemolytic anemia generalized pruritus for last 4 months which is not 9. Which one of the following is not a feature of liver relieved by various lotions available in the market. Her reports are as (a) Fibrosis in and around the portal tracts follows: 531 Liver Review of Pathology (b) Thrombosis of the medium and small portal vein Most Recent Questions branches (c) Non specific inflammatory cell infiltrates in the 15. Nutmeg liver is seen in: (c) Chronic venous congestion of liver (a) Right sided heart failure (d) Fatty liver (b) Left sided heart failure 11. Micronodular cirrhosis is seen in all except: (c) Periumbilical (a) Alcoholic cirrhosis (d) Liver (b) Viral hepatitis 12. Thamim carried out the physical examination in which Mr Signature was visibly jaundiced with ascites. The investigations reveled increased prothrombin time and prolonged activated partial thromboplastin time, as well as significantly increased serum ammonia levels. With the known finding of significantly increased serum ammonia, which of the following physical findings may be expected in this patient A 50-year-old chronic alcoholic with jaundice and ascites secondary to known cirrhosis becomes disoriented and confused. A 42-year-old woman Kiran with polycythemia vera develops progressive severe ascites and tender hepatomegaly over a period of several months. Which of the following tests would be most likely to establish the probable diagnosis In a pioneering clinical study at Spartans Institute, patients having infection with infectious hepatitis, (as in hepatitis A, B, C, D, E, F, and G) are being followed for 40 months. Which of the following is the best predictor of development of chronic disease progressing to cirrhosis Sarin conducts a study in hepatitis B patients for which the patients are followed for almost a decade. Hepatitis B virus is not associated with (a) Fulminant hepatitis (b) Chronic active hepatitis (c) Hepatocellular carcinoma (d) Cholangiocarcinoma 28. Piece meal necrosis is pathognomic of (a) Alcoholic Liver disease (b) Chronic active hepatitis (c) Toxic hepatitis (d) Wilson disease 29. Hepatitis E is transmitted by (a) Blood (b) Feco-oral (c) Venereal (d) All of the above 30. A 34-year-old man Bholu presents to his physician with loss of appetite, nausea and vomiting, and fatigue. Laboratory examination confirms the diagnosis of hepatitis B, and the man becomes icteric 2 weeks later. This patient may also be particularly vulnerable to the development of which of the following disorders After passing his physical exam, a young army recruit gives urine and blood samples for further testing. Mallory bodies are composed of: (a) Fat droplets (b) Mitochondria (c) Lysosomal enzymes (d) Intermediate filaments (Karnataka 2009) 46. In Alcoholic liver disease, which of the following pigments is deposited in the hepatocytes Mallory bodies are seen is (a) Viral hepatitis (b) Toxic hepatitis (c) Alcoholic hepatitis (d) All 49. Mallory bodies contain: (b) Multiple myeloma (a) Vimentin (c) Hepatocellular carcinoma (c) Keratin (d) Glioblastoma multiforme 50. A 46-year-old man, Sushil who has a long history of excessive drinking presents with signs of alcoholic hepatitis. Sethi, the radiologist describes her findings to be normal except a mass in the right lobe of the liver. Which of the following most significantly increases the (d) Nodular focal hyperplasia risk of hepatocellular cancer Which of the following is not correct about fibrolamellar variant of hepatocellular carcinoma A young woman Ms Shaano who is otherwise normal goes for an annual examination in a nursing home. Cholangiocarcinoma of liver is caused by (a) Hepatitis B infection (b) Cirrhosis of liver (c) Antitrypsin deficiency (d) Clonorchis sinensis infection 59. A 50-year-old male film actor Sallu Kahn looses weight rapidly for one of his forthcoming films.

In another trial involving heterosexual couples in which one partner was infected, the drug reduced the risk of infections by 75% antibiotics for streptococcus viridans uti order tetracycline now. The American Cancer Society estimates that 355,900 new cases will occur worldwide and 69,740 cases will occur in the United States in 2013 antibiotic resistance threat 500 mg tetracycline overnight delivery. Signs and symptoms include painless swelling of lymph nodes (neck, armpit, or groin), fatigue, pain, unexplained fever, soaking night sweats, itchy skin, coughing, trouble breathing, chest pain, swelling or a feeling of fullness in the abdomen, and unexplained weight loss. Imaging tests, bone marrow biopsy, and a lumbar puncture are used to stage the disease. In these Chapter Two Immunity and Disease L 29 cases, "watch and wait" may be a treatment option. Treatment may include radiation therapy, chemotherapy, anti-inflammatory medication, stem cell transplant, and monoclonal antibody therapy to tag cancer cells for destruction. Prognosis varies and depends on the stage of the cancer, the subtype, patient age, and overall health of the patient. Tom was not vaccinated against the rubella virus and is concerned he may have contracted measles. His physician takes a blood sample and sends it to a lab to measure rubella antibody levels. The results show an elevated level of IgM antibodies to the rubella virus but very few IgG antibodies to the virus. Some people with decreased IgA exhibit recurrent sinus and respiratory infections. Type I hypersensitivities involve IgM or IgG and cause destruction of foreign cells. Thanks to modern medicine, notorious infectious diseases such as tuberculosis are things of the past. Fiction: Population growth, climate and weather change, antibiotic resistance, modern travel, human behavior, and other factors are responsible for the reemergence of many infectious diseases, including tuberculosis. One of the great unsolved mysteries surrounding the 1918 pandemic is why it tended to kill healthy adults. In contrast, the greatest mortality for seasonal influenza occurs among young children, older adults, and those with chronic health conditions. Scientists believe that the return of a virus equivalent in pathogenicity to the virus of 1918 could cause another pandemic. Illness and death from infectious diseases are particularly tragic because they are largely preventable and treatable. The World Health Organization reports that in high-income countries, only one of the top 10 causes of death is an infectious disease; in contrast, among low- and middle-income countries, infectious diseases account for 4 of the 10 leading causes of death. Poverty, lack of access to health care, antibiotic resistance, evolving human migration patterns, new infectious agents, and changing environmental and developmental activities all contribute to the growing impact of infectious diseases. This chapter describes the nature of infectious diseases, surveys the types of microorganisms responsible for infections, explains their transmission, and discusses treatment. Principles of Infectious Disease Infectious diseases are caused by microorganisms known as pathogens. A fitting name, pathogen is derived from Greek words that mean "to cause suffering. Some infectious diseases are not transmitted directly from person to person and are not contagious. For example, rabies can be transmitted by the bite of a rabid raccoon, and cholera is transmitted by drinking fecal-contaminated water. Epidemiology is the study of the transmission, occurrence, distribution, and control of disease.

Acquired idiopathic sideroblastic anemia falls within the diagnostic category of refractory anemia with ring sideroblasts as defined by the French-American-British group and World Health Organization classification antibiotics before surgery purchase tetracycline 250mg otc. Distinguishing between idiopathic myelofibrosis and myelodysplasia is Differential Diagnosis Ring sideroblasts are not limited to acquired sideroblastic anemia; they also occur in other myelodysplastic conditions, such as refractory anemia with excess blasts, in which the blast count is higher than 5% virus protection software generic tetracycline 250 mg on-line. Family surveys are very useful in distinguishing acquired from hereditary forms of sideroblastic anemia, because the latter may present in late adult life. When changes are confined to dyserythropoiesis, the condition has been called pure sideroblastic anemia. Cytogenetic analysis of marrow aspirates provides important information, because a normal karyotype predicts long survival in any type of acquired sideroblastic anemia. A trial of pyridoxine at 100 to 200 mg/day for 3 months is worthwhile in patients who have anemia but who do not display neutropenia or thrombocytopenia. However, few patients with acquired idiopathic sideroblastic anemia respond to this vitamin. If any response is achieved, maintenance therapy with pyridoxine at lower dosage is indicated. Cyclosporin (5 to 6 mg/kg/day) has been reported to benefit the anemia of the closely related myelodysplastic condition of refractory anemia, although the response appeared limited to those with hypoplastic bone marrows. Red blood cells show dimorphic morphology; evidence in the marrow of folate deficiency is present in half of cases. The ring sideroblasts gradually disappear over 4 to 12 days when alcohol is withdrawn202; during this period, there may be a rebound erythroid hyperplasia, reticulocytosis, and thrombocytosis. Folic acid should be given for the associated megaloblastic changes after blood is taken for vitamin B12 and folate assays. First is the severity of the anemia, because repeated transfusions markedly increase iron overload and invariably lead to the organ dysfunction characteristic of secondary hemosiderosis. The second factor is whether neutropenia and thrombocytopenia are associated with the anemia. These cytopenias form the basis of a simple prognostic scoring system in which two or more of the following place the patient in a poor prognostic category: hemoglobin level less than 10 g/dL, neutrophil count less than 2. Conversely, monosomy 7 or a partial loss of the long arm of chromosome 7 as a single defect imparts a high probability of transformation to acute myeloid leukemia. Multiple chromosomal abnormalities and del(20q) are also associated with an increased risk for progression to leukemia; in contrast, trisomy 8 has no adverse prognostic significance. Isoniazid Administration of the antituberculous drug isoniazid occasionally has been associated with development of a sideroblastic anemia after 1 to 10 months of therapy. The anemia is hypochromic and microcytic, with a dimorphic blood smear and ring sideroblasts in the marrow. This complication is thought to occur only in slow acetylators of isoniazid, allowing this drug to react nonenzymatically with pyridoxal and to form a hydrazone that is rapidly excreted in the urine. The anemia can be fully reversed by coadministration of pyridoxine (25 Chapter 36 Heme Biosynthesis and Its Disorders: Porphyrias and Sideroblastic Anemias 471 to 50 mg/day) with isoniazid or by withdrawing isoniazid. This effect is predictable and separate from the rare idiosyncratic side effect of aplastic anemia in approximately 1 of 20,000 exposed persons. Nearly all patients given chloramphenicol (>2 g/day) develop vacuolation of the erythroid precursors and ring sideroblasts. Chloramphenicol inhibits mitochondrial protein synthesis and reduces cytochrome a, a3, and b levels. Other Drugs A reversible acquired sideroblastic anemia has been described with penicillamine therapy and with the use of triethylene tetramine hydrochloride, a copper-chelating agent used in the treatment of Wilson disease. In some reports, patients present with neurologic symptoms such as paresthesias, weakness, or ataxia; and demyelination is seen on the magnetic resonance image of the brain. Serum copper and ceruloplasmin levels are low, whereas serum iron and transferrin saturation levels are normal. Large quantities of ingested zinc interfere with copper absorption and produce the neutropenia and sideroblastic anemia characteristic of copper deficiency. Sideroblastic anemia has also been ascribed to zinc toxicity arising from the ingestion of coins over a period of many years. Zinc must be discontinued for 9 to 12 weeks for full reversal of the anemia and neutropenia.

When added to immunosuppressive therapies, androgens failed to result in any increase in response rates virus kansas city purchase 250 mg tetracycline visa. Androgens continue to be helpful in occasional patients when used as a secondline therapy bacteria articles discount tetracycline master card. Most hematologists have observed patients who appeared to respond or even to develop hormone dependence. Androgen therapy remains popular in developing countries because it is inexpensive, well tolerated, and seemingly effective. Various preparations of androgens in different doses have resulted in similar response rates of 35% to 60% after 6 months of therapy. Useful androgens include nandrolone decanoate, oxymetholone, and danazol; unfortunately, their popularity and abuse by athletes have led to restrictions of their availability and manufacture. Complications occur infrequently, although some are serious and can limit effective therapy, especially in elderly patients. Relapse can manifest as a gradual decline in one blood count, need for transfusion after a period of transfusion independence, or abrupt recurrence of severe pancytopenia. Most relapse responds to retreatment, and there is no clear relationship with worse survival. Before recent improvements in treatment, leukemia was considered an unusual complication, but late-onset clonal disorders do not appear to be the result of the introduction of immunosuppressive therapy. In European and National Institutes of Health trials, the overall rate of clonal evolution is 12% to 15% at about 1 decade. Nevertheless, many patient are treated with pharmacologic high doses of cytokines, often with uncertain justification. Extrapolated survival curves for patients with severe disease are derived from retrospective reviews from the University of Utah of 101 records collected from the late 1940s to early 1970s. The patients received blood transfusions and, later in this period, also received platelets. Almost all were treated with corticosteroids, and one-half were also treated with androgens. Data for patients who did not receive transplants come from a multicenter study of the efficacy of bone marrow transplantation performed in the early 1970s; this control group was treated with androgens. The mpl receptor is expressed by hematopoietic stem cells, and laboratory and clinical data indicate physiologic stimulation of stem cells by thrombopoietin. Some patients with disease refractory to other forms of treatment can also receive prolonged courses of cytokines in the hope of raising the low neutrophil count. Preferably, the use of growth factors over long treatment periods, especially in patients who are not severely neutropenic, should be in the context of a formal study. Physicians and patients should be aware of possibly significant risks associated with such treatment. Clonal evolution, especially monosomy 7, is a poor prognostic factor, and age-adjusted telomere length of leukocytes at diagnosis may predict this serious complication. International Agranulocytosis and Aplastic Anemia Study: Risks of agranulocytosis and aplastic anemia: A first report of their relation to drug use with special reference to analgesics. Kojima S, Matsuyama T, Kato S, et al: Outcome of 154 patients with severe aplastic anemia who received transplants from unrelated donors: the Japan Marrow Donor Program. Tichelli A, Socie G, Marsh J, et al: Outcome of pregnancy and disease course among women with aplastic anemia treated with immunosuppression. In: the drug etiology of agranulocytosis and aplastic anemia, New York, 1991, Oxford University Press. Viollier R, Socie G, Tichelli A, et al: Recent improvement in outcome of unrelated donor transplantation for aplastic anemia. Peffault de Latour R, Purtill D, Ruggeri A, et al: Influence of nucleated cell dose on overall survival of unrelated cord blood transplantation for patients with severe acquired aplastic anemia: A study by Eurocord and the aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation. Scheinberg P, Marte M, Nunez O, et al: Paroxysmal nocturnal hemoglobinuria clones in severe aplastic anemia patients treated with horse antithymocyte globulin plus cyclosporine. Scheinberg P, Nunez O, Weinstein B, et al: Horse versus rabbit antithymocyte globulin in acquired aplastic anemia.

Hu M, Krause D, Greaves M, et al: Multilineage gene expression precedes commitment in the hemopoietic system antibiotics for acne short term cheap tetracycline 250mg on line. Miyamoto T, Iwasaki H, Reizis B, et al: Myeloid or lymphoid promiscuity as a critical step in hematopoietic lineage commitment antibiotic resistant outbreak buy tetracycline 250 mg with amex. Testa N: Structure and regulation of the erythroid system at the level of progenitor cells. Sonoda Y, Ogawa M: Serum-free culture of human hemopoietic progenitors in attenuated culture media. Rich I, Kubanek B: the effect of reduced oxygen tension on colony formation of erythropoietic cells in vitro. Bernstein A, Forrester L, Reith A, et al: the murine W/c-kit and Steel loci and the control of hematopoiesis. Kaushansky K: Thrombopoietin: the primary regulator of platelet production Blood 86:419, 1995. Claessens Y-E, Park S, Dubart-Kupperschmitt A, et al: Rescue of earlystage myelodysplastic syndrome-deriving erythroid precursors by the 27. Papayannopoulou T: Current mechanistic scenarios in hematopoietic stem/progenitor cell mobilization. Fibach E, Manor D, Oppenheim A, et al: Proliferation and maturation of human erythroid progenitors in liquid culture. Migliaccio G, Di Pietro R, di Giacomo V, et al: In vitro mass production of human erythroid cells from the blood of normal donors and of thalassemic patients. Leberbauer C, Boulme F, Unfried G, et al: Different steroids co-regulate long-term expansion versus terminal differentiation in primary human erythroid progenitors. Civin C, Loken M: Cell surface antigens on human marrow cells: Dissection of hematopoietic development using monoclonal antibodies and multiparameter flow cytometry. Broxmeyer H: Relationship of cell-cycle expression of Ia-like antigenic determinants on normal and leukemia human granulocyte-macrophage progenitor cells to regulation in vitro by acidic isoferritins. Papayannopoulou T, Brice M, Farrer D, et al: Insights into the cellular mechanisms of erythropoietin-thrombopoietin synergy. Debili N, Coulombel L, Croisille L, et al: Characterization of a bipotent erythro-megakaryocytic progenitor in human bone marrow. Sawada K, Krantz S, Sawyer S, et al: Quantitation of specific binding of erythropoietin to human erythroid colony-forming cells. Sawada K, Krantz S, Dai C, et al: Purification of human blood burstforming units-erythroid and demonstration of the evolution of erythropoietin receptors. Ponka P: Tissue-specific regulation of iron metabolism and heme synthesis: Distinct control mechanisms in erythroid cells. Akashi K, Traver D, Miyamoto T, et al: A clonogenic common myeloid progenitor that gives rise to all myeloid lineages. Auffray I, Marfatia S, de Jong K, et al: Glycophorin A dimerization and band 3 interaction during erythroid membrane biogenesis: In vivo studies in human glycophorin A transgenic mice. Coulon S, Dussiot M, Grapton D, et al: Polymeric IgA1 controls erythroblast proliferation and accelerates erythropoiesis recovery in anemia. Hiroyama T, Miharada K, Sudo K, et al: Establishment of mouse embryonic stem cell-derived erythroid progenitor cell lines able to produce functional red blood cells. Chaurasia P, Berenzon D, Hoffman R: Chromatin-modifying agents promote the ex vivo production of functional human erythroid progenitor cells. Hiroyama T, Miharada K, Kurita R, et al: Plasticity of cells and ex vivo production of red blood cells. Adolfsson J, Mansson R, Buza-Vidas N, et al: Identification of Flt3+ lympho-myeloid stem cells lacking erythro-megakaryocytic potential: A revised road map for adult blood lineage commitment. Krystal G: A simple microassay for erythropoietin based on 3Hthymidine incorporation into spleen cells from phenylhydrazine treated mice. Bauer A, Tronche F, Wessely O, et al: the glucocorticoid receptor is required for stress erythropoiesis. Varricchio L, Masselli E, Alfani E, et al: the dominant negative beta isoform of the glucocorticoid receptor is uniquely expressed in erythroid cells expanded from polycythemia vera patients. Lazarides E: From genes to structural morphogenesis: the genesis and epigenesis of a red blood cell.